were--(a) Cowpox produces an eruption extremely like that of
mild smallpox, it is, therefore, probably a form of smallpox
modified by transmission through the cow; (b) And an attack of
cowpox protects from smallpox. To test these things
experimentally some one must first be inoculated with cowpox,
and, having recovered from the vaccinia, that same person must,
secondly, be inoculated with the virus of smallpox or be
exposed to the infection, and, thirdly, this person ought not
to take the disease.
In 1788 Jenner had a careful drawing made of the hand of a
milkmaid suffering from cowpox to demonstrate to Sir Everard
Home how exceedingly similar were vaccinia and variola. Home
agreed it was "interesting and curious," and the subject began
to attract some attention in medical circles.
In November, 1789, Dr. Jenner inoculated his eldest child
Edward, aged 18 months, with some swinepox virus, and as
nothing untoward happened, he inoculated him again with
swinepox on April 7, 1791. The child had a slight illness, very
like vaccinia, from which he rapidly recovered. The moment for
the crucial experiment was not yet; it came in due time, but
Jenner had to wait five years for it, and five years are a long
time to a man who is yearning to perform his crucial
experiment. Happily for suffering humanity, in the early summer
of 1796 the opportunity came; the hour and the man were there
together.
Cowpox had broken out on a farm near Berkeley and a dairy maid
called Sarah Neames contracted the disease. On May 14, 1796,
Dr. Jenner took some fluid from a sore on this woman's hand and
inoculated it by slight scratching into the arm of a healthy
boy eight years old, by name James Phipps. The boy had the
usual "reaction" or attack of vaccinia, a disorder
indistinguishable from the mildest form of smallpox. After an
interval of six weeks, on July 1, Jenner made the most
momentous but justifiable experiment, for he inoculated James
Phipps with smallpox by lymph taken from a sore on a case of
genuine, well-marked, human smallpox, AND THE BOY DID NOT TAKE
THE DISEASE AT ALL. Jenner waited till the nineteenth of the
month, and finding that the boy had still not developed
variola, he could hardly write for joy. "Listen," he wrote to
Gardner, "to the most delightful part of my story. The boy has
since been inoculated for the smallpox which, aS I VERNTURED TO
PREDICT, produced no effect. I shall now pursue my experiments
with redoubled ardor."
Here we are behind the scenes at a great discovery; "as I
ventured to predict"; prediction is part of scientific
theorizing; there is a place for legitimate prediction as there
is for experimentation. All discoverers have made predictions;
Harvey predicted the existence of the capillaries, Halley
predicted the return of his comet, Adams predicted the place of
the planet Neptune, the missing link in the evolutionary series
of the fossil horses had been predicted long before it was
actually found by Professor Marsh. Pasteur predicted that the
sheep inoculated with the weak anthrax virus would be alive in
the anthrax-infected field, while those not so protected would
all be dead. A prediction verified is a conclusion
corroborated, an investigator encouraged.
Early in 1797, through another outbreak of cowpox, Jenner was
able to inoculate three persons with variola, only to find as
before that they were immune from smallpox. He now felt himself
justified in preparing a paper for the Royal Society, the
highest scientific tribunal in England. The council, however,
returned him his paper with the remark that in their opinion
the amount of evidence was not strong enough to warrant its
publication in the Transactions. Jenner was wise enough not to
be discouraged, and so in June, 1798, he published the paper
himself under the title, "Inquiry into the causes and effects
of the Variolae-Vacciniae, a disease discovered in some of the
western counties of England, particularly Gloucestershire, and
known by the name of cowpox." This historic pamphlet, which
ranks with the great classics of medicine, was dedicated to Dr.
O. H. Parry, of Bath. Later on the Royal Society was sagacious
enough to elect the very man whose paper it had previously
refused.
While in London attending to the publication of his pamphlet,
Dr. Jenner called on the great surgeon Mr. Cline, and left some
cowpox virus with him for trial. Cline inoculated a young
tubercular patient with vaccinia and later with smallpox in no
less than three places. In due time this patient did not show a
sign of smallpox. So impressed was Cline with this remarkable
result that he wrote to Jenner thus: "I think the substitution
of cowpox poison for smallpox one of the greatest improvements
that has ever been made in medicine. The more I think on the
subject, the more I am impressed with its importance."
The word "vaccination" was coined by the French, so remarkable
for the aptness of their descriptive terms, and it has ever
since remained with us as a convenient expression for the
inoculation of vaccinia as protecting from variola.[4]
[4] It is certainly not necessary to point out that the
principle of vaccination has been one of wide application in
modern medicine. Our word "vaccine" testifies to this. A
vaccine is a liquid, the result of bacterial growth, injected
into a patient in order to render him immune from that
particular disease which is caused by sufficient infection with
the microorganisms in question, e. g., of typhoid fever or of
plague.
Dr. Jenner's views were now becoming known, and the critics and
the doubters had appeared: St. Thomas has always had a large
following. The most formidable of the early objectors was Dr.
Igenhouz, who had come to London to study inoculation for
variola, and had already inoculated, among other notable
persons, the Archduchess Theresa Elizabeth of Vienna. The
careless vaccinations of Doctors Pearson and Woodville at the
London Smallpox Hospital brought much apparent discredit on
Jenner's work. In all his early work Jenner used lymph obtained
directly from papules on the cow or calf, but Woodville in 1799
showed that excellent results could be got from arm-to-arm
vaccination. As this latter method is a very convenient one,
the technique was widely adopted. We have to remember that we
are speaking of a period about sixty years before Lister gave
to suffering humanity that other great gift, antisepsis: and so
many arms "went wrong," not because of being vaccinated, but
because the scratches were afterwards infected by the
microorganisms of dirt. Jenner knew well the difference between
the reaction of clean vaccination and that of an infected arm,
but a great many medical men of his time did not, and so he was
constantly plagued with reports of vaccinations "going wrong"
when it was septic infection of uncleansed skin that had
occurred. The explanation of these things by letter consumed a
very great deal of his valuable time. By the end of 1799 a
large number of persons had, however, been successfully
vaccinated. As one Pearson proved troublesome by starting an
institution for public vaccination on principles which Jenner
knew to be wrong, and as Jenner found himself virtually
supplanted and misrepresented, he came up to London in 1800 to
vindicate his position. The King, the Queen and the Prince of
Wales, to whom he was presented, materially helped on the cause
by countenancing the practice of vaccination. Lord Berkeley,
his Lord of the Manor, was in this as in all things a kind and
wise patron. In the United States of America vaccination made
rapid progress, having been introduced there under the good
auspices of Dr. Waterhouse, professor of medicine at Cambridge,
Mass. The discovery was announced with true American
informality as "Something curious in the medical line," on
March 12, 1799.
Things went even better on the continent of Europe; deCarro, of
Vienna, inaugurated vaccination with such zeal and
discrimination that it spread to Switzerland, France, Italy and
Spain. From Spain it passed over to Latin America. In Sicily
and Naples, "the blessed vaccine" was received by religious
processions. Sacco, of Milan, commenced vaccinating in 1801,
and in a few years had vaccinated 20,000. In Paris, a Vaccine
Institute was established; and Napoleon ordered all his
soldiers who had not had smallpox to be vaccinated. On Jenner's
application, the Emperor liberated several English prisoners
remarking--"What that man asks is not to be refused." Napoleon
voted 100,000 francs for the propagation of vaccination. Lord
Elgin introduced it into Turkey and Greece. The Empress of
Russia, Catherine II., was one of the greatest supporters of
Jennerian vaccination. She decreed that the first child
vaccinated in Russia should be called "Vaccinoff," should be
conveyed to Petrograd in an imperial coach, educated at the
expense of the state and receive a pension for life. The
Emperor of Austria and the King of Spain released English
prisoners at Jenner's request. There were statues of Jenner
erected abroad, at Boulogne and at Brunn, in Moravia, before
any in England. Thus the European countries showed their
gratitude to the Englishman whose patience, genius and absence
of self-seeking had rid them of the detestable world-plague of
smallpox. Vaccination was made compulsory by law in no less
than five European countries before it was so in the United
Kingdom in 1853. In eight countries vaccination is provided
free at the expense of the government. The clergy of Geneva and
of Holland from their pulpits recommended their people to be
vaccinated. In Germany, Jenner's birthday (May 17) was
celebrated as a holiday. Within six years, Jenner's gift to
humanity had been accepted with that readiness with which the
drowning clutch at straws. The most diverse climes, races,
tongues and religions were united in blessing vaccination and
its discoverer. The North American Indians forwarded to Dr.
Jenner a quaintly worded address full of the deepest gratitude
for what he had saved them from: "We shall not fail," said
these simple people, "to teach our children to speak the name
of Jenner, and to thank the Great Spirit for bestowing upon him
so much wisdom and so much benevolence."
There are two allusions to smallpox in "Don Juan," which was
published in 1819, showing to what an extent Jennerian
teachings were in the air. The first is:
The doctor paid off an old pox
By borrowing a new one from an ox.
(Canto I., stanza 129.)
The second is:
I said the smallpox has gone out of late,
Perhaps it may be followed by the great.
(Stanza 130.)
Before 1812, Jenner had been made an honorary member of nearly
every scientific society in Europe, and had received the
freedom of the cities of London, Edinburgh, Dublin and Glasgow.
The Medical Society of London presented him with a gold medal
struck in his honor; in Berlin in 1812 there was a Jennerian
festival on the anniversary of Phipps's vaccination. Addresses
and diplomas were showered on him, and in 1813 the University
of Oxford conferred on him the degree of M.D. honoris causa. As
he refused point blank to pass the examination in Latin and
Greek required by the Royal College of Physicians of London,
Jenner never obtained admission into that learned body. When
some one recommended him to revise his classics so that he
might become an F.R.C.P. he replied, "I would not do it for a
diadem"; and then, thinking of a far better reward, added: "I
would not do it for John Hunter's museum."
But while the pure in heart were thus receiving the blessing
offered them by the benovelent man of science, the pests of
society, those discontented and jaundiced ones who are always
to be found in the dark recesses of the cave of Adullam, were
not idle. Many of his medical colleagues did indeed sneer, as
some are always apt to do at any new thing however good. To all
these Jenner replied, and a very great deal of his valuable
time was consumed in arguing with them. But the sect of the
anti-vaccinators had arisen, and was to some extent organized.
Caricatures, lampoons, scurrilities, vulgarities and
misrepresentations, the mean, were scattered on all sides.
Nothing was too absurd to be stated or believed--that
vaccinated persons had their faces grow like oxen, that they
coughed like cows, bellowed like bulls and became hairy on the
body. One omniscient objector declared that, "vaccination was
the most degrading relapse of philosophy that had ever
disgraced the civilized world." A Dr. Rowley, evidently
imagining himself honored by a special participation in the
Divine counsels, declared that "smallpox is a visitation from
God, but cowpox is produced by presumptuous man. The former was
what Heaven had ordained, the latter is a daring violation of
our holy religion." It was rather hard to blame Dr. Jenner for
the origin of cowpox. It took much forbearance to endure this
sort of thing; but Jenner's was a first-class mind and he
evidently dealt leniently even with fools. It was not for the
first time in the world's history that a lover of mankind had
been spurned with the words--"He hath a devil and is mad."
Besides enduring all these mental and physical worries, and the
annoyance that the Royal Jennerian Society established in 1802
was so mismanaged that it collapsed in 1808, Jenner had spent a
very large sum of private money on the introduction of
vaccination. He had been, as he himself expressed it, "Vaccine
clerk to the whole world." Parliament, it is true, in 1801,
voted him a sum of 10,000 pounds which was not paid for three
years afterwards and was diminished by 1,000 pounds deducted
for fees, so that it barely recompensed him for his outlays. By
1806, the immensity of the benefit conferred upon his diseased
fellow-creatures having been recognized more perfectly in every
other country than his own, the British Parliament woke up, and
voted him a sum of 20,000 pounds, only one member representing
the anti-vaccinators opposing the grant. Parliament, which had
previously received from the Colleges of Physicians of London,
Edinburgh and Dublin the most favorable reports of the efficacy
of vaccination, decided to reestablish the Royal Jennerian
Institute. A subscription of 7,383 pounds from grateful India
reached Jenner in 1812. In 1814 he was in London for the last
time, when he was presented to the Emperor of Russia, Alexander
I., who told him that he had very nearly subdued smallpox
throughout that vast Empire. Jenner refused a Russian order on
the ground that he was not a man of independent means.
The management of the Institute caused him much concern in his
later years; he disapproved of the personnel and of many of the
details of its working. One of the last worries of his life was
an article in the November number for 1822 of the famous
Edinburgh Review. Although it contained a good deal of praise,
it was not favorable to Jenner, who said of it, "I put it down
at 100,000 deaths at least." I have ascertained that this
article was not written by the celebrated Francis Jeffrey,
although he was editor of the Review until 1829.
Jenner's life, apart from his great discovery and his
developing the practice of vaccination, has not much incident
in it. He was born on May 17, 1749, the son of the Rev. Stephen
Jenner, vicar of Berkeley, Gloucestershire, England, the same
Berkeley in whose castle, Edward II., the vanquished at
Banockburn, was murdered in 1327. Jenner's mother's name was
Head. Edward went to school at Wotton-under-Edge and at
Cirencester, and began to study medicine with a Mr. Ludlow, a
surgeon at Sodbury near Bristol. In his twenty-first year,
Jenner went to London as a pupil of the great John Hunter, in
whose house, he lived two years, during which time he was
entered as a medical student at St. George's Hospital. It is
interesting to know that while still a student he was asked by
Sir Joseph Banks to arrange and catalogue the zoological
specimens brought home by the circumnavigator Captain Cook in
his first voyage of 1771. Jenner devoted considerable attention
to natural history, to geology and to the study of fossils, on
which topics he kept up correspondence with Hunter long after
he left London. In the year 1788 he married a Miss Kingscote,
and settled down to practice in his native place. Mrs. Jenner
died in 1815, after which date Jenner never left Berkeley
again.
Curiously enough, it was not until 1792 that Jenner obtained
the degree of M.D., and it was not from an English university
at all, but from the University of St. Andrews in Scotland.
This university, the smallest although the oldest of the
Scottish universities, has therefore the honor of being the
Alma Mater to the epoch-making Englishman. I have seen the
entry of the name in the list of graduates for the year 1792;
it has evidently been misspelled, for the name is corrected.
The first foreign university to recognize Jenner's eminence was
Gottingen. In 1794 Jenner had an attack of typhus fever. Jenner
never cared for London or a city life, and although in 1808 he
was persuaded to take a house in town, he soon gave it up and
went back to his beautiful Gloucestershire. For many years he
practiced during the season in the pleasant health-resort of
Cheltenham. He loved the country, he studied lovingly the
living things around him there: many are familiar with a piece
of verse he wrote on "The signs of rain."
The year 1810 was a sad one for Jenner: his eldest son died,
and that noticeably depressed his health. In 1823 he presented
a paper to the Royal Society on the migration of birds, a
subject not even yet fully cleared up. On January 26, in the
same year, he was stricken with paralysis on the right side and
died within twenty-four hours. His body was buried in the
chancel of the parish church of Berkeley, where there is a
memorial window placed by public subscription. In person,
Edward Jenner was short and rather heavily built; his
expression of face was pleasant with a touch of sadness. All
reports agree that in dress he was conspicuously neat, looking
more like a gentleman-farmer than a physician, with his blue
coat, yellow buttons, red waistcoat, buff breeches and
top-boots.[5]
[5] He was painted by Sir Thomas Lawrence, by Northcote and by
Vigneron.
There is no disguising the fact that during his lifetime Dr.
Jenner was much more appreciated in foreign countries than in
England. The medico-social club of Alverton, near where he
lived, would not listen to him when he addressed them on
vaccination. The effort to collect enough money from the
medical men of England in order to place a marble statue to
Jenner in the nave of Gloucester Cathedral, was successful only
after a long delay. An attempt to erect a statue in London died
of apathy; but in 1858, 32 years after he died, a statue was
erected in Trafalgar Square. In 1862 it was removed to a quiet
corner of Kensington gardens; and perhaps its surroundings, the
trees, the flowers and the birds he loved are more suitable
than the effigies of those national heroes who served their
country by taking, not by saving life. No, Nelson the hero is
hardly the suitable companion for Jenner the hero.
There is no doubt that Jenner's medical contemporaries, at
least in England, failed to appreciate the magnitude of the
gift their colleague had presented not merely to his own
country, but to the world at large. The discovery had, of
course, been led up to by several different lines of
indication, but this in no way detracts from the genius of
Jenner in drawing his memorable inductions from the few facts
which others had known before his time. The fame of Newton is
no whit diminished because Copernicus, Kepler and Galileo lived
and worked before him, the credit due to Harvey is none the
less because many before his time had worked on the problem of
the heart and vessels, and because some of them, notably
Cesalpinus, came within a very little of the discovery of the
circulation; the achievements of Darwin are not to be belittled
because Lamarck, Malthus or Monboddo had notions in accordance
with the tenor of his great generalization of evolution among
living beings. Certainly Jenner had precursors; but it was his
genius and his genius alone which, putting together the various
fragments of knowledge already possessed, gave us the grand but
simple induction based on his own experiments that vaccinia
prevents from variola. It was too simple and too new to be
appreciated in all its bearings either by the medical men or
the laity of his own day. Its impressiveness is not inherent in
it, as it is in the mathematical demonstration of universal
gravitation, as it is in the atomic theory or in that of the
survival of the fittest through natural selection. The English
country doctor merely said in essence--"let me give you cowpox
and you will not get smallpox." Unless the fact of this
immunity is regarded as possessed by all the nations of the
world for ever more there is nothing particularly impressive in
it; and so it failed to impress his contemporaries. It is only
when we contrast the loathsomeness and danger of smallpox with
the mildness and safety of vaccinia and varioloid that we grasp
the greatness of the work which Jenner did for mankind. The
very simplicity of vaccination detracts from its impressiveness
unless its results are viewed through the vista of the
centuries. We need the proper historical perspective in this as
in all else. Thus viewed, however, the simplicity of the
procedure and the universality of its application are most
imposing. Vaccination does not, indeed, dazzle the scientific
imagination like some of the other generalizations of biology,
but it is one that has been gloriously vindicated by the
subsequent history of the world's hygiene.
Jenner knew himself to be a benefactor of the human race; he
would have been insincere if he had pretended otherwise; he
finished his first paper with these words: "I shall endeavor
still farther to prosecute this enquiry, an enquiry, I trust,
not merely speculative, but of sufficient moment to inspire the
pleasing hope of its becoming essentially useful to mankind";
and on his death-bed he said, "I do not marvel that men are not
grateful to me, but I am surprised that they do not feel
grateful to God for making me a medium of good."
In private life Dr. Jenner was amiable and kind-hearted. Dibden
said of him: "I never knew a man of simpler mind or of warmer
heart." He was particularly kind to the poor. Dr. Matthew
Baillie said of him: "Jenner might have been immensely rich if
he had not published his discovery."
We may in conclusion examine some of the objections to and
criticisms of vaccination. The objections can be classified as
those entertained (a) by medical men and (b) those by the
public generally.
The objections raised by medical men are now a matter of
ancient history. Each generation of medical men has refused at
first to admit any new teaching promulgated in its time;
physiological inertia is not at once overcome. The most
enlightened of Jenner's critics did really believe that he was
drawing too extensive an induction from insufficient data; this
was the position of the Royal Society in 1788; but the
Edinburgh reviewer of 1822 should have known better. The purely
technical criticisms of Jenner's work have by this time been
fully assessed and replied to. It is true that at one time it
was not clear what were the relationships of chickenpox and
smallpox, of vaccinia and variola, of vaccinia and varioloid,
of the various forms of pox in animals--cowpox, swinepox,
horsepox or grease--either inter se or to human smallpox. But I
do not suppose that in this year of grace 1914 there can be
found one properly trained medical man, acquainted with the
history of Jennerian vaccination, familiar with the ravages of
smallpox and with the protective power of vaccinia, who could
be induced, by no matter how large a bribe, to say that he
disapproved of vaccination or that he believed it did not
protect from smallpox. There are cranks in all walks of life,
but the medical crank who is also an anti-vaccinationist is
happily the rarest of them all.