Dr Edward Jenner (1749-1823) is acclaimed to this day as the “father of vaccination”. For most of the 19th century, his vaccine was presented as the sole officially-approved method of stopping smallpox.1
In 1798 Jenner published an account of the research that led to his discovery of vaccination.2 In it he asserted that smallpox stemmed from too close an association between human and animal, or to use scientific parlance, he believed the disease to be zoonotic. While Jenner pinpointed the immediate culprit as the farmyard cow, he claimed that it actually originated in a disease of the domesticated horse. Known colloquially as “the Grease”, the chief symptom of this equine ailment was a “swelling in the heel”, from which oozed contaminated pus. To Jenner’s eyes this pus looked so similar to that produced on the bodies of smallpox victims “that I think it highly probable it may be the source of that disease”.3
Jenner suspected that the disease reached humans as a result of farmhands carrying the pus from horse to cow. If a dairy maid collected milk from an affected cow, she then became infected herself and passed on the disease to everyone else on the farm. However, by then it had mutated into a relatively benign form known as cowpox and its victims usually made a full recovery.
One of his modern-day admirers has written that, during the research period, “Jenner was in a hurry and cut corners”.4 Perhaps that explains why, if zoonotic transference invariably resulted in the milder cowpox he described, Jenner did not explain how the full-blown version of smallpox came to affect its victims as I described in Part 2. In any event, Jenner went public with his theory that inoculating with cowpox matter would confer the same protection against smallpox as the traditional variolation procedure. Before outlining how Jenner tested this hypothesis, I need to provide a little more background.
Although it was regarded as preferable to contracting smallpox naturally, variolation was not risk-free. It was believed that those who went through the procedure could still end up with the full-blown infection, resulting in death or life-changing injuries. It was thought also that a recently-inoculated person could pass the disease on to others. One historian put it like this:
Unless practised under strict quarantine, the operation [i.e. variolation] was as likely to start an epidemic as to stop one.5
But even if variolation did not prove fatal for the subject, the immediate after-effects could be nasty. Dr Richard Mead described a young girl whom he inoculated in 1721 by inserting “into her nostrils a tent wetted with matter taken out of ripe pustules”. The patient recovered but, as Mead related in his memoir, she
suffered much…being, immediately after the poison was received into the nose, miserably tormented with sharp pains in her head, and a fever, which never left her till the eruption of the pustules.6
As I mentioned last time, Edward Jenner was variolated against smallpox as a boy. Although he later wrote of the “happy effects” of the procedure, he could not have been referring to his own experience, which one of his friends later lambasted as “barbarism”. The eight-year-old Jenner underwent the painful treatment while at school. Although he never contracted smallpox, he attributed problems with his long-term health to that experience of variolation.
as a child, he could never enjoy sleep, and was constantly haunted by imaginary noises; and a sensibility too acutely alive to these and sudden jars has ever since subsisted.7
Much later, as a physician practising in rural Gloucestershire, Jenner decided to test his theory about smallpox by experimenting on his gardener’s eight-year-old son, James Phipps. According to Jenner’s account of the experiment, he cut two incisions in the boy’s arm and inserted under the skin “matter…taken from a sore on the hand of a dairymaid” named Sarah Nelmes. Nelmes had become “infected with the Cow Pox” a short time previously as a consequence of her job on a nearby farm.8
After about a week Phipps developed a sore arm and could not eat or sleep. However, he recovered quickly and about six weeks later Jenner inoculated him again, this time with smallpox pus. Jenner gave the boy a third inoculation after a few more months, again with smallpox matter, before concluding that his theory must be correct. As he put it in his published findings:
What renders the Cow-pox virus so extremely singular, is, that the person who has been thus affected is for ever after secure from the infection of the Small Pox; neither exposure to the variolous eflluvia, nor the insertion of the matter into the skin, producing this distemper.9
James Phipps, or “poor Phipps” as Jenner referred to him, never stopped being a guinea pig. By the time he reached adulthood, Phipps had undergone the variolation procedure no less than 20 times - as Jenner observed: “all without effect”.10 What Jenner meant of course was that Phipps never contracted smallpox, despite the many attempts to infect him with the disease. But if Jenner himself was left with lifelong health problems as a result of his one experience of variolation, it is unlikely that Phipps escaped unscathed from his multiple exposures to the same procedure.
Perhaps Jenner’s allusions to the adult Phipps suffering from “tubercles of the lungs” and having been “very ill”, indicate some of the more serious after-effects. Whatever the truth, a few years before he died, Jenner had a cottage built to house Phipps and his young family.11 Was this a gesture of gratitude to a faithful ally in the battle against a dreaded disease, or an attempt to salve a guilty conscience?
It can be difficult to see behind the revered legacy of a man like Edward Jenner who, right up to the present, is singled out for lavish praise.12 However occasionally the sources reveal insights that paint a more complex picture.
When his eldest son was ill, Jenner applied the then-common medical practice of bleeding his young patient to rid his body of whatever ailed him. While most physicians at the time would have done the same, Jenner went one step further by burying the blood he had extracted at the root of a willow tree growing in his garden.13 On display in Jenner’s coach-house was the hide of the farm animal from which Sarah Nelmes contracted her cow pox, which its owner kept apparently as a memento of his first vaccination.14 Then there was the one-room hut that Jenner had built in the grounds of his home. As a visitor later reported, once a week Jenner used this building to administer his vaccine to the local poor.
It is for this reason I have given my little cottage the name of the Temple of Vaccina; and like a faithful priest, added he, smiling, I am always anxious to find it filled with worshippers.15
While this sort of behaviour might seem strange to our eyes, perhaps to an active Freemason such as Jenner these ostensibly ritualistic practices were not that unusual?16
Jenner’s idea of using cowpox rather than smallpox may have led to him being hailed as the “father of vaccination”, but his discovery was not the breakthrough this implies. If the word ‘breakthrough’ is appropriate at all, it should be applied to variolation itself. The fact that people were willing to subject themselves to a procedure that even its advocates regarded as “repulsive” created the opportunity for Jenner to come up with what he proclaimed to be his safer and equally effective alternative.17
If he had tried, Jenner could hardly have picked a better place or time to launch his new discovery than mighty Britain at the turn of the 19th century. He must have realised this because, from the beginning, he seemed certain that his vaccine would be well-received. In 1800, just two years after publication of his findings, Jenner was expressing his ambition that vaccination would spread “throughout every part of the British Empire”.18 Even 20 years earlier, long before he had finished his cowpox experiments, Jenner anticipated that his discovery would lead “to the total extinction of small-pox”.19
As I related in Part 2, Jenner’s prognosis was vindicated when the WHO declared in 1980 that smallpox in its natural state had been eradicated from the planet. Of course it helped enormously that, from the start, Jenner was backed by many influential people. His conclusions about the efficacy of the vaccine were quickly accepted by the British establishment, including the royal family, senior government leaders, and the medical profession.
Prominent among the last mentioned was Dr William Woodville who practised at the Smallpox Hospital in London. In volume 1 of his planned two-part history of variolation he described that procedure as “a modern art in this country… that now rarely fails of success”.20 Yet after he had studied Jenner’s findings a couple of years later, we are told that this champion of variolation turned into “an energetic ambassador for vaccination”, promoting the new method in his subsequent travels around continental Europe.21
In a report published in May 1802, a committee of the British parliament issued its official response to Jenner’s discovery. Its findings were based on testimonies gathered from aristocrats, physicians, clergymen, public officials, indeed anyone from the establishment who had knowledge or experience of the new vaccine procedure. Their feedback was almost entirely favourable and this was reflected in the report’s conclusions:
[Vaccination] may be safely performed at all times of life…in the earliest infancy, as well as during pregnancy, and in old age; and that it tends to eradicate, and, if its use becomes universal, must absolutely extinguish one of the most destructive disorders by which the human race has been visited.22
From the start the political and medical authorities were determined that Jenner’s vaccine should become “universal”. On July 8th 1806, during a debate in the British House of Commons, speaker after speaker extolled the benefits of the vaccine and deplored the public’s hesitancy in adopting Jenner’s discovery.
Judging by the remarks made by one member of parliament who participated in that debate, variolation rather than smallpox was now the enemy.
it is well known that it forms a magazine of the most dreadful evils, and that contagion, with all its baneful effects, usually follows. A reference to the bills of mortality will prove this assertion, and show to demonstration, that the number of deaths have been greatly increased since the first discovery of the small pox inoculation.23
This debate marked a sharp turn in the smallpox story, taking it in a much darker direction.
In Part 5 I will explore how Jenner’s vaccine was promoted, promulgated, and enforced, in a campaign that prefigured many aspects of the official response to covid-19.
The term ‘vaccination’ was derived from the title of Jenner’s book and comes from vacca, the Latin word for cow.
Edward Jenner, An inquiry into the causes and effects of the variolae vaccinae (London, 1798).
Ibid, pp. 1-2.
Gareth Williams, Angel of Death: The story of Smallpox (Basingstoke, 2010), p. 198.
Elizabeth A. Fenn, ‘The Great Smallpox Epidemic’, History Today, 53/8, August 2003 [https://www.historytoday.com/archive/great-smallpox-epidemic], 2 May 2022.
Richard Mead, A discourse on the small pox and measles (London, 1748), pp. 88-9.
Thomas Dudley Fosbroke, ‘Biographical Anecdotes of Edward Jenner, M.D., F.R.S., &c.’, in Berkeley Manuscripts: Abstracts and Extracts of Smyth's Lives of the Berkeleys (London, 1821), pp. 221-2.
Jenner, An inquiry, pp. 32-4.
Ibid, p. 6.
John Baron, The life of Edward Jenner (2 vols, London, 1838), ii. p. 304.
Ibid, pp. 304-5.
In a recent speech, the director-general of the World Health Organisation referred to Jenner’s vaccine: “We all continue to benefit from the incredible gift he gave the world – a gift that has changed the course of history and changed the course of the COVID-19”. (‘WHO Director-General's keynote speech at the Global Pandemic Preparedness Summit’, 8 Mar. 2022 [https://www.who.int/director-general/speeches/detail/who-director-general-s-keynote-speech-at-the-global-pandemic-preparedness-summit], 7 May 2022.)
Baron, Edward Jenner, ii. pp. 296-7.
Ibid, pp. 303-4.
‘The Life of Dr. Jenner’, The Analectic Magazine, Vol. 9, Jan. 1817, p. 57.
“Jenner became a Master Mason in 1802 and was a member of the Gloucestershire Lodge of Faith and Friendship #270. He was involved in the fraternity, serving as Master of his lodge in 1812. The Prince of Wales – the future George IV – was a frequent visitor to this lodge, and he would play an important part in Jenner’s life. Jenner was selected as King George IV’s special physician in 1821.” [https://freemasonscommunity.life/masonic-contributions-to-science-medicine/], 8 May 2022.
‘Inoculation’ (tr. Antoinette Emch-Deriaz) in The Encyclopedia of Diderot & d'Alembert Collaborative Translation Project. [http://hdl.handle.net/2027/spo.did2222.0000.954], 22 Apr. 2022.
Baron, Edward Jenner, i. p. 368.
Ibid, i. p. 128.
William Woodville, The History of the Inoculation of the Small-pox, in Great Britain (London, 1796), p. v.
Williams, Angel of Death, p. 202.
Report from the Committee on Dr. Jenner's Petition respecting his discovery of Vaccine Inoculation, 6 May 1802.
Hansard, HC Deb 2 Jul. 1806, vol. 7, col 884.