“It was probably in early 1803, as Jenner’s fame swelled and more doctors were adopting vaccination, when Bell met a farmer with a curious story. The farmer’s name was Benjamin Jesty, from the Downshay farm in a nearby village. Seeing the growing practice of vaccination, Jesty was eager to tell his story and claimed he deserved rewards just like Jenner. Bell, probably intrigued, recorded Jesty’s account.”

Rod Tanchanco is an internal medicine physician and can be reached on Twitter @rodtmd. He is the author of First Patients: The incredible true stories of pioneer patients.

He shares his story and discusses his KevinMD article, “Farmer Jesty’s bold experiment.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Rod Tanchanco. He is an internal medicine physician. He’s the author of the book First Patients: The Incredible True Stories of Pioneer Patients. There’s an excerpt from that book on KevinMD titled “Farmer Jesty’s bold experiment.” Rod, welcome to the show.

Rod Tanchanco: Hi, Kevin. Thank you very much for having me. I’m glad to be here.

Kevin Pho: We’ll get into your excerpt and book in a little bit, but first off, just share your story and journey to where you are today.

Rod Tanchanco: Sure. Well, as you mentioned, I’m an internist, going on 30 years now this year, and I’ve had pretty much a traditional internal medicine career pathway, going from a group practice and then starting my own private practice for several years after that. Along the way, I got involved in work in clinical trials as a principal investigator. I tried other things in utilization management, and then eventually I went back, and I find myself now in clinical trial work again, as a medical director and medical monitor for early-phase clinical trials.

Also along the way, obviously, I wrote a book, but writing has always been an interest, something I’ve always liked to do. As you know, I have a number of articles on KevinMD, and thanks for posting them throughout the years. That’s a great opportunity there. Then several years ago, I had enough stories, I think, to put together in this book, and I thought it might be interesting. It was definitely interesting for me, and I think it will be interesting for a lot of other people. So that’s where we are.

Kevin Pho: So you said that you’ve been an internist for 30 years now. Tell me, was it difficult for you to transition outside of a clinical role into some of the nonclinical stuff that you do right now?

Rod Tanchanco: No, and I wouldn’t say it was difficult. Some of them just kind of landed in my lap, I guess. When I was in private practice, in solo practice, you get an email or a mail inviting you: “Do you want to try this out?” Just try a physician advisor type of thing on the side. I’m sure a lot of doctors get those. I said, “You know, why not?” It was something maybe to explore, and it’s sort of a rabbit hole you get into, and then I did that full time eventually, also for a number of years.

The clinical trial thing, I was just interested in it again. You get invited to do a phase four trial in your practice, and I said, “Why not? Let’s see what it is about.” I kind of enjoyed it, actually, and the patients enjoyed it. So I got into these other things. My wife tells me I have ADHD; it’s probably true. You get into these other things, and they’re all interesting.

Kevin Pho: So we’re going to explore one of your other interests, which is, of course, your book, titled First Patients: The Incredible True Stories of Pioneer Patients. I know there’s an excerpt on KevinMD titled “Farmer Jesty’s bold experiment.” But before we get into the excerpt, just tell me, how did the book come together, and what made you interested in writing it?

Rod Tanchanco: Well, we have to do our yearly CMEs, right? Several years ago, I was doing just that, reading some updates on pacemakers, pretty much the cardiology subject, and that’s where the pacemaker story came from. It was pretty much a little blurb on the history of the pacemaker, and that story was about the first implantable one in 1958. This woman in Sweden, her husband was dying and having syncope 30 times a day. He had to have CPR several times a day; not fun.

Then she found out that at the hospital where the husband was, Dr. Senning, and a lot of our colleagues know Dr. Senning, the famous cardiovascular surgeon, right, the Senning procedure and all that stuff, was working on early models of pacemakers, and there was also another inventor there. So she begged these two doctors to make a prototype, and that was sort of an interesting story. That’s how the first implantable pacemaker was created, and he saved this patient’s life.

I thought, “Yeah, that’s interesting.” You’re reading through all this technical and jargony stuff without a lot of personal stories like that. I said, “Yeah, you know, let’s write about that,” because I’ve been writing these stories, and then maybe I’d look for other stories that are in the same theme, first patients. What was the story? The backstories are what I was looking for in some of these medical milestones. That’s how I found these other ones, and they’re all very interesting, fascinating, and a lot of them are little-known.

We know the innovations and the discoveries, but sometimes the backstories, as I mentioned, the personal stories behind them, make it a little bit more human, more memorable, and more interesting. So that was the whole premise of writing it.

Kevin Pho: So tell us about one of those stories. You excerpted one on KevinMD, “Farmer Jesty’s bold experiment.” Tell us about that particular story.

Rod Tanchanco: Well, I think it was a bit more timely for our times, obviously, with the pandemic and so forth, and I thought something about vaccination would be interesting. So I looked into that, and this is about smallpox and the first vaccination. In the medical world, we probably all know, or most of us would have heard of, Dr. Edward Jenner, right? Smallpox vaccination and his famous experiments, and his famous story about the milkmaids not being infected with smallpox because they were exposed to cowpox, right? That’s the milkmaids, and that’s his theory.

Now, that was according to his biography, but apparently 20 years before that, this farmer had the same idea. This is Benjamin Jesty, who was not a doctor, not a science guy. He was not a scientist, and he was just really relying on folklore, the stories that they knew in the community, that people who worked with cows, who had cowpox, which is another viral infection that has some similarities to smallpox but is not as severe, seemed to be immune.

So he wanted to protect his family. We’ve never seen smallpox nowadays, right? We don’t see that; it has been eradicated. But as we know, 200 years ago, it was pretty much decimating whole communities and cities and so forth, with whole swaths of the population, the world population, dying from it. It would come and go in communities in England; this is where it happened.

So he said, “Maybe if we get this cowpox, look for some infected cow and get that material, that pus from the teats of the cows, and poke it into my family, that will give them some immunity.” It was based on that sort of heuristic folklore that they knew at the time. No one was doing it, obviously, and he had to do it in secret.

What they were doing back at that time was called variolation, which was taking patients who actually had smallpox, and with the same procedure, they would take the scabs or pus from a smallpox lesion and inject it into patients. So what you’re doing, obviously, is infecting them; it was a very dangerous procedure. But a lot of doctors back then were doing it, and it was a very lucrative practice for a lot of the doctors then, so they weren’t really looking for any change, because why change something that’s not broken? But it was also very dangerous, because you’re spreading smallpox to the community that way, obviously, and people also died from it.

But anyway, this farmer did it without any medical background, and we didn’t really know how it worked, obviously; no one did. But it did save his family. His wife got sick, but she recovered, and the kids, he had two boys back then, never got smallpox.

But the parallel today is that he was kind of ridiculed and ostracized and almost banished from his community. He was a pillar in his community back then. He was a prominent farmer, he had a lot of land, and he was very active in the parish and so forth. So he was kind of a pillar in the community, but after that happened, he was not very popular. He would go to the market, and he would get pelted by the people and so forth, so he kind of had to lay low. That was the story there.

The thinking back then was, why would you introduce any material from a beast into a human being? It was sacrilegious. They really believed that doing that was not only ungodly and that kind of thing but would actually turn people into beasts, into cows. So you would have these articles in the newspapers, drawings of people turning into cows after the vaccination and so forth. That was the kind of treatment that he got; it was more abuse than anything else. So he kind of had to lay low, and 20 years later, Jenner did it again, and he had the same experience.

Even prominent doctors during that time who were very well respected really believed that doing that would turn people into oxen or cows and so forth, and they actually had scientific arguments to try and prove that. They would show drawings of kids with swollen faces and say, “This patient is undergoing transformation into a beast after Jenner.”

Nowadays, obviously, we have anti-vaccination people and pro-vaccination people, so the passions about this, to me, are still there, right? The reasons are more sophisticated. We don’t think people will turn into cows with vaccinations, but just the same, I don’t think it will ever go away. There’s always going to be some resistance to stuff like that. So I thought it was time to see what it was like back then and how it correlates and parallels to today’s situation.

Kevin Pho: Now, how did you go about researching some of these stories, or determining which patients or stories to write about and include in your book?

Rod Tanchanco: Yeah, well, it took some time. Basically, I discovered them as I read on something: “Yeah, this may be included. Yeah, I’ll include it. It’s kind of interesting,” and so forth. So there was really no set criteria for it. The main criteria was, A, did I find it interesting, pretty much, and will other people find it interesting? Is there enough material there?

There’s also another criterion, I should say, on the personal stories behind it, not just the innovations or the discovery, but to actually find some primary source material that looks into the personal histories and so forth, not only of the patients, obviously, but of the doctors also who discovered them. Sometimes the doctors were the patients. I have a few stories on self-experimenters and so forth.

So in the research, you go to whatever sources you can. Obviously, sometimes you have to read a couple of books, look through their sources, dig through those primary sources, and look for it yourself and so forth. So it’s pretty much a long process to go through.

Kevin Pho: As you delved into medical history through all these stories, are there any prominent themes that you’ve uncovered, anything that we as physicians today, or the medical community today, can learn from looking at the past?

Rod Tanchanco: Yeah, absolutely. I think especially for our young colleagues starting out in medicine or in the health care field, or for that matter, finding an area that really interests you, or that you feel will be interesting to you, is probably important to do early on. From the point of view of a lot of these discoverers, what I’ve noticed is they weren’t just showing up to a job every day, you know what I mean? They felt that they had to do something more. They were trying to answer questions that they found important and, most importantly, interesting to them, even though maybe a lot of people around them didn’t think so; they didn’t think it was important. But it was that kind of mindset and attitude and interest that really made these people go the extra mile, pretty much, and not just do the usual job, and then in the process, find stuff and make innovations and so on. So I think that’s an important component of it.

One thing that is also sort of correlated to that, and that I also found interesting and kind of surprising, is that a lot of these innovators, doctors or physicians or scientists who did this, didn’t set out to say, “I’m going to save the world. I’m going to invent something or come up with something that’s going to save humanity,” that kind of thing. They actually said this in interviews: “I wasn’t trying to do that.”

One of the stories is on H. pylori. We know that story very well. For hundreds of years, it was acid. We had a dictum, remember: “No acid, the ulcer.” Then Barry Marshall came along, and Robin Warren, Australian doctors who proved that H. pylori was a cause of most of these ulcers and so forth. He was a medical resident and was just looking for a project to do, and he was saying, “I wasn’t trying to really upend the GI world or find something revolutionary. I was just trying to do a project and maybe get published.” So it was very simple, and then they found out they might be onto something, and then it got a little bit bigger.

It’s the same thing with the penicillin story. I’m not talking about Fleming, who basically just accidentally saw the mold, and the story pretty much ends there. The real discovery was 10 years later with the Oxford group, with Dr. Howard Florey and his team, who actually worked on extracting it and developing the antibiotic. But even he was saying, “We weren’t trying to save humanity. It was just an interesting question,” whether the substance had antibacterial properties. That’s the only question they wanted to find out.

Then it became big because it was not as toxic and it was very effective. During that time, it also happened during World War II, in the 1940s, when there was a little bit more urgency, because now you need antibiotics to save the troops. He ended up traveling to America, because obviously England didn’t have a lot of resources while being bombed. So he came over here, and it was here that the penicillin production actually blew up, from 5.5 milligrams in 1942, or 5.5 grams in 1942, to billions of units, which was very instrumental in treating the troops on D-Day, that kind of thing. But he wasn’t thinking of that. He was just thinking of the scientific question. So that’s an interesting kind of perspective.

Kevin Pho: We’re talking to Rod Tanchanco. He is an internal medicine physician and author of the book First Patients: The Incredible True Stories of Pioneer Patients. Rod, what are some of your take-home messages that you want to leave with the KevinMD audience?

Rod Tanchanco: Yeah, sure. We’ve had, as a human race, pretty much, this three-year experience now with the pandemic, right? I think it’s sometimes good to just look back at some of these stories to give us a little bit of perspective, to remind us of the human inventiveness, resilience, and, most importantly, compassion that happened 200 years ago, is still ongoing now, and will probably keep on going. I think that’s how we make progress and make things better for the next generation.

I just happened to be listening to your other recent podcast. You had that recent one on BioNTech. It was just amazing to me, some of the themes there, that small company making important strides, and it happened with serendipity and things that they weren’t expecting to happen. I mean, the same things are still going on now, so it’s kind of amazing. It’s nice to get a perspective from history and from now, too. So I think that’s what we’ll get from it.

Kevin Pho: Rod, thank you so much for sharing your time and insight, and thanks again for being on the show.

Rod Tanchanco: Thank you very much, Kevin, for having me. Thank you.