Jabs
Richard Horton
- Edward Jenner 1749-1823 by Richard Fisher
Deutsch, 361 pp, £20.00, July 1991, ISBN 0 233 98681 2
Imagine that you are a country doctor with an idea for an experiment. Your only difficulty is finding a suitable person to experiment on. This obstacle faces all would-be investigators in this field: willing human guinea-pigs are hard to come by. But a neighbour of yours owns his own business, and one of his employees – Phipps – has a healthy eight-year-old son called James. You ask this boy’s father if you can experiment on his son. The father agrees. After all, you are a respected figure.
Your experiment goes something like this. A young girl, Sarah Nelmes, is a patient of yours and is known to be infected with the human immunodeficiency virus (HIV). You draw a syringe full of blood from her arm and go back to James Phipps to make two superficial cuts in his skin, which are about half-an-inch long. You dip a needle into the serum of Sarah Nelmes’s blood and gently place the infected fluid into the incisions on the boy’s arm. You wait. Although James is unwell for a few days with a fever, he recovers. You return to Sarah Nelmes and take another blood sample, but this time you inject the blood directly into a vein in the boy’s arm. This experiment, which seems so brutal, and is unethical by modern standards, is the equivalent of Edward Jenner’s first trials of vaccination. In May 1796, he took material from a pustule on the hand of Sarah Nelmes, a dairymaid who had cowpox, and placed that fluid on incisions made in the arm of James Phipps. A later attempt to inoculate Phipps with smallpox failed.
The comparison with HIV not as ludicrous as it may at first appear. American researchers recently suggested the existence of strains of HIV that do not lead to Aids. Blood taken from an individual thought to have been infected with this benign form of HIV for over ten years was injected into 11 HIV-infected patients whose disease had not responded to drug treatment. The American team noted a clinical benefit in four patients. This experiment has been condemned by some as ‘unethical, unscientific, and dangerous’, but is, in essence, identical to Jenner’s. Similar objections have been raised against the work of the French immunologist Daniel Zagury, who developed an Aids vaccine that he gave to uninfected individuals, including himself. Concerns over his work led to a protracted inquiry and to a ban by the French government. Even today, the methods Jenner adopted are able to stimulate ill-tempered debate among members of a normally reticent scientific community.
Born on 17 May 1749, he was the second son of the marriage between the vicar of Berkeley, Gloucestershire, and the daughter of a former vicar of the same parish. Orphaned at the age of five, he attended grammar school and soon became apprentice to a local surgeon. At 21 he moved to London to continue his medical studies as anatomical assistant to John Hunter at St George’s Hospital. Although Jenner returned to his Berkeley medical practice in 1773, Hunter had recognised Jenner’s scientific prowess and encouraged him in his research. ‘Why think – why not try the experiment,’ he wrote in 1775. Hunter’s patronage led to Jenner’s renowned work on the breeding habits of the cuckoo, published in the Philosophical Transactions of the Royal Society in 1788. Jenner observed that the cuckoo is reared in the nest of another bird such as the hedge-sparrow, and that the natural offspring of the cuckoo’s foster parents were frequently ejected. He noted that the cuckoo was responsible for this eviction, and described a depression in the cuckoo’s wing, which he claimed assisted the bird in shouldering his foster brothers out of the nest. On the strength of this work, he was elected as a Fellow of the Royal Society in 1779.
Letters
Vol. 14 No. 21 · 5 November 1992
From Philip Raikes
Richard Horton makes a dramatic comparison between Edward Jenner’s first vaccination in 1796 and deliberate infection with HIV for inoculative purposes, both being seen as highly dangerous leaps in the dark (LRB, 8 October). But to make such a claim for vaccination is problematic, since it conflates vaccination (the use of cowpox serum) with inoculation. According to William McNeill’s study Plagues and People (1977), inoculation against smallpox, with material from human smallpox pustules, was introduced into England from Turkey by Lady Mary Wortley Montagu in 1721, via a pamphlet written by two Greek doctors in Constantinople. ‘In the next year the royal children were successfully immunised’ and ‘the practice became widespread in England in the 1740s’ – a good fifty years before Jenner’s experiment. What the latter was introducing was not an entirely new and dangerous technique, but a safer version of one already widespread in England.
Since the subject of Horton’s article was which of two Englishmen was responsible for the first vaccination, it might have been relevant to mention this earlier form of immunisation against smallpox. It had apparently been widespread as a folk-practice over large parts of the Middle East and North Africa, and along the caravan routes of Central Asia, for some centuries. A version is recorded as having been introduced to China from India ‘at the beginning of the 11th century’. There is even evidence suggesting that inoculation was practised at folk level in parts of Wales before 1721. McNeill asks why, when the practice was so widely known at folk level, it should have taken so long to penetrate Western medical practice, and why this should have occurred when and where it did. He finds a partial answer to the latter question in the fact that Lady Mary Wortley Montagu, who travelled to Constantinople as the wife of the Ambassador to the Porte, had a personal interest in inoculation, as one whose complexion had been disfigured by smallpox. A similar concern about smallpox was agitating royalty at that time: a number of royal heirs had died of it in the previous decades.
While immunisation against smallpox was widely practised in England long before either Jenner or Jesty experimented with cowpox, its rapid spread over the rest of the world in the years after vaccination does pose some interesting questions. To be sure, vaccination is safer than inoculation with smallpox serum, but it does look rather as if enthusiasm for this practice on the part of the medical profession grew in proportion to its being taken over and safely divorced from its folk roots. Is the omission of all mention of these roots in an article by an editor of the Lancet an example of this process?
Philip Raikes
Frederiksberg, Denmark
From William LeFanu
Richard Horton judges Richard Fisher’s new life of Edward Jenner severely, but his treatment of Jenner is even more severe. Derrick Baxby in his masterly book Jenner’s Smallpox Vaccine: The Riddle of Vaccinia Virus and its Origin (1981) surveyed in detail, from the viewpoint of a practising virologist, the work of Jenner’s first critics and the difficulty of determining from written reports what different strains of virus were used. While not uncritical of Jenner, who was too hasty in reacting to criticism and rousing unnecessary controversy, Baxby noticed with mild amusement those critics who supported their possibly justifiable dislike of vaccination by personal abuse of Jenner. Horton approves of vaccination and praises Jenner’s ability as a naturalist and ‘sympathetic physician’ who worked tirelessly to disseminate his findings. He bases his adverse opinion of Jenner’s character on ‘a critical look at the factual evidence available’, but he ignores Jenner’s effort through the last third of his long life to refine his knowledge and where necessary abandon his first hypotheses.
Horton says nothing of Jenner’s work in 1801-04 on Varieties & Modifications and on Variolous Contagion in 1808, whose importance I emphasised in my revised Bibliography (1985). Baxby wrote that ‘in modifying his first conclusions rather awkwardly he brought severe criticism of his honesty – criticism revived several times in the succeeding two centuries.’ In vindicating Jenner’s revisions Baxby found him ‘at his most brilliant and his most evasive’; Pearson and the other London vaccinators believed he was covering his mistakes. To disparage Jenner they brought forward Benjamin Jesty, who deserves his credit as the first known inoculator of cowpox. But Jesty in his country churchyard is a mute inglorious innovator, while Jenner had the vision of the ultimate eradication of smallpox. The unkindest cuts come when Horton accuses Jenner of ‘ruthless ambition’ and ‘manipulating his peers for personal gain’. Hunter teased Jenner for publishing a pamphlet describing an improved medicament instead of selling it privately, and Jenner affirmed that Parliament’s awards merely repaid the expenses of his continuous campaign against smallpox through a vast correspondence and a flow of publications till the end of his life. After his thorough education under John Hunter he could have begun a lucrative career in London, but he chose to be a simple country surgeon.
William LeFanu
Chelmsford, Essex
