January 21, 1799 (a Monday)

James Gillray's caricature in 1802 of Dr. Jenner administering a smallpox vaccination to an unnerved woman. The cows emerging from the bodies of those inoculated point to the fear of the new vaccination, created from cowpox.(Library of Congress).

Until Edward Jenner came along, the only way to prevent smallpox was through a procedure called variolation (from variolae, Latin for “smallpox”) — the deliberate infection of an individual with smallpox. While in Constantinople in 1717, Lady Mary Wortley Montagu, the wife of the British ambassador, had learned about variolation, which had originally been developed in Asia. In 1721, at the urging of Montagu and the Princess of Wales, several prisoners and abandoned children were inoculated by having smallpox scabs from a recent victim inserted under the skin. As expected, they then contracted a mild form of the disease. Several months later, the children and prisoners were deliberately exposed to smallpox. When none contracted the disease, the procedure was deemed safe and members of the royal family were inoculated. The procedure then became fashionable in Europe. Between 1% to 2% of those variolated died as compared to 30% who died when they contracted the disease naturally.

However, variolation was never risk-free. Not only could the patient die from the procedure but the mild form of the disease which the patient contracted could spread, causing an epidemic. Victims of variolation could be found at all levels of society; King George III lost a son to the procedure as did many others. Edward Jenner was himself variolated while at school. He was “prepared” by being starved, purged and bled; then locked up in a stable with other artificially infected boys until the disease had run its course. He suffered particularly badly. It was an experience he would never forget.

Edward Jenner, a rural English doctor, is shown injecting his first patient, James Phipps, in 1796, using fluid obtained from one of the blisters on the hand of dairymaid Sarah Nelmes, standing behind him.

Jenner, an English physician, used folk knowledge to find an alternative to variolation. Recognizing that dairymaids infected with cowpox were immune to smallpox, he deliberately infected James Phipps, an eight year old boy, with cowpox on 14 May 1796 by placing fluid from a victim’s sore into two small incisions on the boy’s arm. A week later, Phipps developed the symptoms of cowpox, including infected sores, chills, head and body aches, and loss of appetite. The child recovered quickly. On 1 July 1796, Jenner variolated Phipps using fluid from smallpox pustules, and he had no reaction. Jenner inoculated the boy several more times in this manner with the same results. After repeating the experiment on other children, including his own son, Jenner concluded that this procedure, later named vaccination (from vacca, Latin for “cow”) by Louis Pasteur, provided immunity to smallpox without the risks of variolation. Jenner rejected the suggestion that he could become personally wealthy from his new smallpox vaccination, and he planned to share it with all of England and the world.

In late 1796, Jenner submitted a paper to be considered for publication in Philosophical Transactions of the Royal Society, England’s premier scientific journal. However, the Council of the Royal Society rejected the article and berated Jenner in scathing terms, characterizing his findings as unbelievable and “in variance with established knowledge”. It advised him that advancing such wild notions would destroy his professional reputation.

In June of 1798, Jenner independently published the findings from all of his research to date, including reports of the cases from his first manuscript and nine other patients he had vaccinated beside Phipps. This seventy-five-page book was titled An Inquiry into the Causes and Effects of the Variolae Vaccinae, a Disease Discovered in Some of the Western Counties of England, Particularly Gloucestershire, and Known by the Name of The Cow Pox. Again, the London medical establishment was extremely negative toward his findings. Some prominent physicians questioned the validity of his findings. Others, who were profiting handsomely from variolation, attacked Jenner for fear of losing their lucrative monopoly on protecting the public from smallpox.

After the publication of his book, Jenner tried for three months to find people who would agree to be vaccinated in order to demonstrate the effectiveness of the procedure. He did not find a single volunteer because of the public attacks on his professional competence. Instead, Jenner pursued his goal of popularizing vaccination indirectly, through London physicians to whom he provided vaccine.

And so, on this date, Dr. William Woodville, a physician at the London Smallpox and Inoculation Hospital in England, first began inoculating the general public with Jenner’s vaccine. The results over the next four months were largely favorable to the new practice but contradicted several of Jenner’s claims, since approximately 60% of patients developed generalized pustular eruptions and were thought to be infectious. Jenner argued that Woodville’s vaccines had become contaminated with smallpox. Woodville ultimately accepted that this was the case. (Cowpox samples often became contaminated with smallpox itself because those handling it worked in smallpox hospitals or carried out variolation.) Nevertheless, despite the calumnies of the skeptics and confusion among its supporters, cowpox inoculation spread remarkably quickly in Britain, in the rest of Europe, and in other parts of the world.

References:

  • Murray Dworetzky, Sheldon Cohen, and David Mullin, “Prometheus in Gloucestershire: Edward Jenner”, The Journal of Allergy and Clinical Immunology Vol. 112, Issue 4, pp. 810-814 (October 2003)
  • John M. Hull, The philanthropic repertory of plans and suggestions for improving the condition of the labouring poor, (Sold by Suter, Cheapside, and by Snow, 1841) p. 72.
  • John Powell (ed.), Great Events from History: The 18th Century, 1701-1800 (Hackensack, NJ: Salem Press Inc., 2006).
  • History of Medicine Division/U.S. National Library of Medicine/National Institutes of Health, “Smallpox: A Great and Terrible Scourge” last updated 9 Dec 2011, accessed 23 Jan 2012.
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