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.

Jenner was a sympathetic physician, a scientist who keenly observed the natural world around him, and a man who moved in influential political and social circles. And, of course, he ‘discovered’ vaccination. That his life deserves attention is endorsed by the countless number of studies – 105 secondary sources are listed in the latest account – that already exist. Richard Fisher, a Yale history graduate, is a ‘full-time writer’ who has ‘found time to take an MSc in brain sciences’, and he has turned Jenner’s life into a hagiographic fairy-tale. Until now, his efforts have largely been directed towards a prodigious output of dictionaries. Drugs, mental health, slimming, body chemistry, symptoms and diseases have all come in for his A-to-Z treatment. Perhaps this explains why he has produced such a turgid and unbalanced account of Jenner. ‘Lord Bacon complains of biographical literature of his day. He says that actions both great and small, public and private, sho’d be so blended together as to secure that genuine nature and lively representation, which forms the peculiar excellence and use of biography.’ Fisher quotes these wise words of Jenner’s, but his book ignores them. Church records have been analysed, Gloucestershire villages visited, graveyards picked through, and adulatory opinions of Jenner accepted uncritically. The desire to catalogue assiduously, so important to the compiler of dictionaries, is not an attribute that serves the potential biographer well. Amid all its impressive detail, there is only the one frayed thread to hold the story together: its concern with Jenner as heroic scientist. An alternative view of the life emerges if one takes a more critical look at the factual evidence available. Fisher makes no attempt to analyse how Jenner manoeuvred himself through potentially adverse circumstances to a position of maximum advantage, and reveals himself as a sophist of some excellence in his assessment of a Dorset farmer, Benjamin Jesty.

Two years after the experiments on James Phipps in 1796, Jenner published his classic description of vaccination, An Inquiry into the Causes and Effects of the Variolae Vaccinae, which gave sketchy details of at least ten other cases in support of his main thesis. His decision to publish this work at his own expense followed advice from senior colleagues at the Royal Society who judged his flimsy evidence insufficient to merit publication in Philosophical Transactions. After the Inquiry had appeared, Jenner returned to Gloucestershire. There was little response to it until Henry Cline, another pupil of Hunter’s, repeated Jenner’s experiments and confirmed his result.

The first published comment on the Inquiry came from George Pearson, who verified the efficacy of vaccination from his own collaborative work with William Woodville at the Smallpox Hospital in London. Woodville went on to describe over five hundred individuals who had received vaccination, and his work lent credibility to Jenner’s preliminary observations. Although the initial discovery of vaccination was attributed to Jenner, however, it was Benjamin Jesty who deserves priority as the first known vaccinator.

Benjamin and Elizabeth Jesty lived with their three children in Yetminster, North Dorset. In 1774, it was commonly believed that milkmaids were protected from smallpox because of previous exposure to the cowpox virus. Traditionally, milkmaids were thought to be fair and attractive because of their smooth skins, which had been spared the unsightly pits usually left by the smallpox virus. The Jesty family employed two milkmaids, Ann Notley and Mary Reade, who had both nursed relatives with smallpox and yet had not contracted the disease. The average life expectancy one could hope for in the mid-18th century was little more than forty years and smallpox killed one in three of those it infected. This poor outlook (his wife was already 50) led Benjamin, who was afflicted with cowpox as a young man, to persuade his wife that she and their two sons should be infected with cowpox material as protection. He found a cow with ‘mature’ pox and, with the point of a stocking needle transferred matter from a pustule on the cow to a scratch that he had made on his wife’s arm. He repeated the procedure on the two boys. These inoculations were the first recorded vaccinations.

The rudimentary and unhygienic procedure that Jesty applied was not without its complications. Although his sons had a mild illness and recovered quickly, his wife became very sick. On hearing of Jesty’s ‘bold’ actions, those living in his village reacted angrily. Benjamin was ‘hooted at, reviled and pelted whenever he attended markets in the neighbourhood. He remained however undaunted and never failed from this cause to attend to his duties.’ His wife recovered and lived until she was 84. Although Fisher mentions Jesty’s experiment, he avoids any comment on the likely authenticity of this work that might detract from Jenner’s supposedly central position in the history of vaccination.

Jenner’s experiments were completed 22 years after Jesty’s first vaccination, but because he was both (to quote Fisher) ‘a successful doctor with landed interests which assured his status as a member of the ruling English gentry’ and already recognised as an experimentalist of some distinction, Jenner was in a position to capitalise on this discovery. He deserves credit for recognising the public health importance of his work and he worked tirelessly to disseminate his findings. Both President Thomas Jefferson and Napoleon promoted vaccination vigorously among their respective compatriots. There is no doubt that he was unaware of Benjamin Jesty’s work when he completed his first experiments in 1796. However, Jenner’s subsequent actions expose both his ruthless ambition and his ability to manipulate his peers for financial gain.

After Woodville’s publication of his 510 cases in Reports of a Series of Inoculations for the Variolae Vaccinae or Cowpox in 1799, both Woodville and Pearson in London and Jenner in Gloucestershire worked closely together to secure the place of vaccination in the fight against smallpox. But their partnership was soon to show signs of strain. In an exchange in the Medical and Physical Journal in 1800, Pearson noted that some of his patients experienced a generalised eruption of pustules after cowpox vaccination. Normally this reaction was seen with smallpox; cowpox usually led to pustules only at the site of inoculation. Jenner replied in the same issue that ‘I very much suspect, that where variolous pustules have appeared, variolous matter has occasioned them’, implying that Pearson’s vaccine was contaminated with smallpox, a claim that suggested grave negligence on the part of the London physicians. Moreover, in December 1799 Pearson had set up the ‘Institution for the Inoculation of the Vaccine-Pock’. The patron was the Duke of York, and the director and chief physician Pearson himself. Jenner was offered the position of ‘extra-corresponding physician’, which he judged an insult. He proposed the formation of the Jenner Society and sought a meeting with the Duke of York to persuade him to withdraw his patronage from Pearson’s Institution. Jenner was successful and, together with the support of the Duke of Bedford, Admiral Berkeley and the Lord Mayor of London, he established the Royal Jennerian Society in 1802 to promote vaccination and ‘put an end to smallpox’. Pearson had been trounced both by Jenner and by his aristocratic supporters.

Jenner’s inability to accept criticism eventually led to the collapse of his own Society in 1808. They insisted on examining claims that vaccination might not give lifetime protection against smallpox infection, one of the cornerstones of Jenner’s theory. Despite his initial intransigence, Jenner was forced to admit that vaccine failures could occur. He had also become concerned that his part in the discovery of vaccination might be devalued as the technique was taken up across the country. He persuaded his friends to petition Parliament, on his behalf, for official recognition of his work and for financial reward. A committee was formed in 1802 under the chairmanship of Admiral Berkeley. One can imagine Jenner’s delight at the Admiral’s appointment, for he was now assured of a favourable hearing. The Jenner family had close associations with the Berkeley estate. Edward’s brother, Stephen, was a tutor to the son of the Earl of Berkeley, the Admiral’s brother. The Earl had a reputation for ruining one young woman after another, but his affections finally settled on a 16-year-old domestic servant called Mary Cole. Although he took her for his wife, no marriage followed. The Earl made an unsuccessful attempt to forge an entry in the local church marriage register, but later had to marry her in London. At that point, his wife was four months pregnant and Jenner, who had been a loyal and unquestioning family physician during these times, attended her throughout a difficult pregnancy. The Berkeley family owed Edward Jenner a sizeable debt.

Jenner wrote a defence of his priority, The Origin of the Vaccine Inoculation, which he submitted as evidence to Parliament. He began his statement with the surprisingly forthright comment that ‘my inquiry commenced upwards of 25 years ago.’ This takes the origin of vaccination back, not to 1796 and James Phipps, but to the mid-1770s, exactly the time when Jesty had vaccinated his family. The work of the Dorset farmer came to light in a paper written by Pearson in 1797. Clearly, Jenner felt vulnerable to the accusation that Jesty’s work may have pre-dated his own. Pearson repeated his claims to the House of Commons committee, but vigorous lobbying by Jenner’s supporters led Parliament by a narrow margin (59 votes for,56 against) to award him £10,000.

In 1805, Benjamin Jesty was invited to London to sit for a portrait. He was fêted by Pearson’s Vaccine-Pock Institute and was presented with two gold-mounted lancets and a document attesting to his discovery of vaccination. Jenner sought further money from Parliament in 1806 and, despite the restatement of Jesty’s case for priority, Jenner was awarded a further £20,000 so that he could enjoy ‘a state of ease, affluence and independence for the remainder of his days’.

Jenner refused to accept the claims made by others on behalf of Jesty. He was especially contemptuous of George Pearson and ‘his treatment of me before the committee of the House of Commons, the portrait of the farmer from the Isle of Purbeck with the farmers’s claim to reward as the discoverer [of vaccination] at the foot of it, with a thousand minor tricks’. Nevertheless, Pearson’s claims had been occasioned by the testimonies of four independent witnesses – Mr Dolling, Dr Pulteney, Dr Drewe and Dr Bell – who confirmed Jesty’s work and his priority over Jenner. Jenner’s attempt to personalise the debate about his priority by pointing to previous disagreements with Pearson, which would have cast doubt on Pearson’s motivation, was a blatant attempt to obfuscate the truth. Jenner probably believed that a simple farmer could not have had the intelligence to make the connection between cowpox and protection against smallpox. In an essay published in the Artist in 1807, while he was awaiting Parliament’s decision on his second claim for financial support, Jenner outlined a sevenfold classification of the human intellect. He described The Idiot, a vegetative being; The Dolt, a weak and poor creature; Mediocrity, most of mankind; Mental Perfection; Eccentricity; Insanity; and the Maniac. Jenner believed this essay to be of sufficient merit to have it reprinted in 1820. Fisher comments that this work was ‘a fair summary of the common 18th-century wisdom on mental attributes, elevated slightly by being ordered into classes’. One wonders where Jenner would have placed Jesty in his classification.

To reduce a scientific discovery to the activities of a single person is to misunderstand the process of scientific achievement. If it had not been for country folklore, neither Jesty nor Jenner would have had the idea for their experiments. The work of Cline, Pearson and Woodville corroborated Jenner’s observations and brought them to greater public attention. The ultimate explanation of why the name of Jenner is attached to the discovery of vaccination was stated simply by John Fosbroke in 1829: ‘had he not both fortune, fame and high alliance, his merit would have been crushed or faintly supported’.

In 1967, the World Health Organisation (WHO) stated their wish to eradicate smallpox. The estimated number of cases of smallpox in the world at that time was over ten million. And yet, ten years later, the WHO was able to announce that endemic smallpox had indeed been extinguished. Except for a few careless and embarrassing mistakes in the laboratory, which led to several further deaths including a suicide, the variola virus now exists as a historical curiosity. But it would be premature to write an epitaph for this family of viruses. Vaccinia – a close relation to both smallpox and cowpox – may now offer a bridge between the major public health concern of the 18th century and its 20th-century equivalent, Aids. One method of vaccinating against Aids is to incorporate genetic material from HIV into a safe form of live vaccinia virus. The principles established by Jesty and Jenner, the tools they adopted, and the bitter controversies they were part of, are now echoed in an age when over thirteen million adults are currently infected with HIV and a projected 110 million people might be infected by HIV in the year 2000. If the vaccinia-based Aids vaccine does prove successful in controlling the HIV pandemic, it may be worth remembering the inscription on the tombstone of Benjamin Jesty in Worth Matravus Church in Dorset: ‘an upright honest man particularly noted for having been the first person (known) that introduced the cowpox by inoculation, and who from his great strength of mind, made the experiment’.