Douglas Lanska
Madison, Wisconsin, United States

Norwegian physician Gerhard Armauer Hansen (1841–1912)¹ is remembered for his discovery in 1873 of Mycobacterium leprae as the causative agent of leprosy. However, Hansen’s legacy also includes unethical behavior for which he was convicted and lost his post at the Leprosy Hospital in Bergen, Norway (although in a legal-political compromise he retained his position as chief medical officer for leprosy in Norway).^2-7

On November 3, 1879, while on rounds at the Bergen Leprosy Hospital, Hansen instructed a thirty-three-year-old woman with leprosy to accompany him to his office, where he inoculated leprous material from another patient under the conjunctiva of her eye with a cataract knife. The patient reported this assault to the hospital pastor, who in turn reported this to authorities. Later, in court proceedings, Hansen acknowledged that he had neither obtained her permission nor told her of his purpose in doing this. He omitted telling her because he “took for granted that [she] would not regard the experiment from his point of view” and because he assumed that he could successfully treat a lepromatous lesion if one developed that might affect her vision. He further justified his actions by noting that she already had leprosy so that he was not exposing her to a “new” disease, even if her existing illness had not involved her eye. He adopted a utilitarian stance (as was frequent among physicians who were caught performing unethical experiments), claiming that the “great scientific and national importance of finding the answer to the question [of the transmissibility of leprosy] forced him to act as he did.” However, sixty-seven years before the Nuremberg Code, the Norwegian court ruled that by trying to intentionally transmit a disease to a patient placed in his care, Hansen had misused his authority.

Norwegian microbiologist and historian Thomas M. Vogelsang (1896–1977) concluded that the legal decision of the Norwegian court showed “that even a celebrated scientist is bound to obey the law of the land, and that it is the court’s duty to protect every citizen also against encroachments from more influential persons,” including overzealous physicians intent on augmenting their professional fame at the expense of their patients.³

Hansen entirely ignored the principles of beneficence and non-maleficence outlined in the Hippocratic Oath (if not referred to as such until the twentieth century). Moreover, the Hippocratic corpus also includes the manuscript now referred to as Epidemics I, in which is found the precept, “As to diseases, make a habit of two things—to help, or at least to do no harm.”⁸ In this instance, Hansen did neither.

If medical history is to have value, we must examine the successes of the past, but also the failures, including failures of medical ethics.

References

1. Fischer H. Dr. Gerhard Hansen – A great discoverer. Hektoen International, Fall 2023. hekint.org/2023/10/19/dr-gerhard-hansen-a-great-discoverer
2. Vogelsang TM. A serious sentence passed against the discoverer of the leprosy bacillus (Gerhard Armauer Hansen), in 1880. Medical History 1963;7(2):182-6.
3. Blom K. Armauer Hansen and human leprosy transmission. Medical ethics and legal rights. Int J Lepr Other Mycobact Dis. 1973;41(2):199-207.
4. Vogelsang ThM. Gerhard Henrik Armauer Hansen 1841-1912. The discoverer of the leprosy bacillus. His life and his work. Int J Lepr Other Mycobact Dis. 1978;46(3-4):257-332.
5. Lock S. Research ethics–a brief historical review to 1965. J Intern Med. 1995;238(6):513-20.
6. Marmor MF. The ophthalmic trials of G. H. A. Hansen. Surv Ophthalmol. 2002;47(3):275-87.
7. Lanska DJ. Armauer Hansen: The controversy surrounding his unethical human-to-human leprosy transmission experiment. World Neurology 2015;30(4):8.
8. Hippocrates [attributed]. Hippocrates, Volume I. Ancient Medicine. Airs, Waters, Places. Epidemics 1 and 3. The Oath. Precepts. Nutriment. Edited and translated by Paul Potter. Loeb Classical Library 147. Cambridge, MA: Harvard University Press, 2022, p. 171.