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.

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