Edward Jenner

Born 1749
Died 1823

Related eponyms

Bibliography

English physician, born May 17, 1749, Berkeley, Gloucestershire; died January 26, 1823, Berkeley.

Biography of Edward Jenner

Benefactor of mankind
Wohltäter der Menschheit

How listening to a milkmaid's story can change the world.

Edward Jenner has a place among the immortals in preventive medicine. His invention of vaccination against smallpox was the medical breakthrough which saved most lives before the era of antibiotics. Before him, smallpox was a killer disease, the majority of its victims infants and young children. And, except for the skin lesions, there is nothing small about smallpox. In the twentieth century alone it killed more than 300 million � three times the number of deaths from all the century's wars and battles combined. The last reported case of smallpox occurred in Somalia. There, on October 26, 1977, a youth named Ali Maow Maalin recovered from a rash caused by the disease. He was pronounced the last case of natural smallpox in the world. In 1980, as a result of Jenner's discovery, the World Health Assembly officially declared "the world and its peoples" free from endemic smallpox.

For bibliography, see under Jennerian vaccination.

A country boy
Edward Jenner was the sixth and youngest child of the Reverend Stephen Jenner (1702-1754), Master of Arts from Oxford, rector of Rockhampton and vicar of Berkeley, a small market town in the Severn Valley in Gloucestershire. His mother was a daughter of the Reverend Henry Head, a former vicar of Berkeley. In addition to his church offices, Jenner�s father owned a considerable amount of land in the vicinity of Berkeley. In 1754, when Edward was five years old, both parents died within a few weeks of each other and he came under the guardianship of his elder brother, the Reverend Stephen Jenner, who had succeeded their father as rector of Rockhampton.

Jenner's first schooling was received from the Reverend Mr. Clissold at the nearby village of Wotton-under-Edge. Later he was sent to the grammar school of Dr. Wasbourn in Cirencester. He was then placed in the care of a clergyman in Wooden-under Edge who gave him an introduction to classical knowledge.

Growing up in the depths of the countryside, surrounded by nature and men of the country, Jenner developed a love for nature which he preserved during his life. As a boy he could recognise the cry of every bird and name every plant that grew alongside the Castle brooks and streams. One of his favourite boyhood activities was searching for fossils among the oolite rocks of the countryside.

A surgeon's apprentice
Despite his initial interest in classical studies, Jenner early decided for medicine, and in 1761, 13 years of age, he was apprenticed to Abraham Ludlow, a surgeon of Sodbury, near Bristol. In the ensuing years Jenner received a thorough introduction to medical and surgical practice. It was during this time he heard a dairymaid say "I shall never have smallpox for I have had cowpox. I shall never have an ugly pockmarked face." This belief was part of common lore.

At this time studies at the medical faculty of a university was both expensive and rather theoretical, and thus the best opportunity for further education was at one of the London Hospitals. London then had no university.

At 21 years of age, in 1770, after completing his apprenticeship, Jenner went to London to study anatomy and surgery under John Hunter as �surgical dresser� at St. George�s Hospital. Hunter had just taken over the large house of his brother William in Jermyn Street, and Jenner was one of Hunter�s first boarding pupils. With Hunter, Jenner learned surgical techniques and, more important, use of the scientific method, which his instructor summarized as follows "Why think; why not try the experiment?"

Jenner also served as Hunter�s anatomical assistant and, while with Hunter, arranged the zoological specimens brought back by Joseph Banks from the first voyage of H. M. S. Endeavour under captain James Cook (1728-1779) in 1772. The close friendship between the two lasted until Hunter died of angina pectoris in 1793. Before this Jenner had made observations on angina pectoris, but would not publish these of concern to John Hunter, whom he knew to suffer from the disease.

Jenner declined Cook's offer to take part in the second voyage and, after two years in London, in 1773 returned to Berkely where he lived with his elder brother and built a very successful practice as a village surgeon. He was capable, skillful and popular.

Jenner's medical practice at Berkeley left him enough leisure time for activity in local medical societies. He was a member of the Gloucestershire Medical Society, whis assembled three times a year in Rodborough near Stroud; and the Convivio-Medical Society, meeting in Alveston every wednesday. Of these the first was the more important. Here met old friends, former classmates and student mates like Caleb Hillier Parry (1755-1822), to whom Jenner was later to dedicate his work on cow pox, and Daniel Ludlow, the son of Jenner�s old master.

He played the violin in a music society, and as a natural scientist he made numerous observations, particularly on the nesting habits of the cockoo and migrations of birds. He also wrote verse, a poetry which sometimes has a simple beauty, his best poems being Address to a Robin and The signs of Rain, both showing his love of the countryside.

The naturalist
Hunter continually encouraged Jenner's studies in natural history, for instance, by asking him to obtain patricular specimens and to investigate temperatures of hibernating animals. Hunter incorporated many of Jenner's observations in his own papers, published in the Philosophical Transactions of the Royal Society and in his book Observations on certain Parts of the animal Oeconomy (London, 1786).

Many of Hunter's letters to Jenner have been preserved, but Jenner's letters to Hunter have unfortunately been lost. This letter from Hunter to Jenner, dated September 25, 1778, reveals the closeness of their friendship:

    Dear Jenner,
    I know I was at a loss to account for your silence and I was sorry for the cause. I can easily conceive how you must feel for you have two passions to cope with, viz. that of being disappointed in love, and that of being defeated; but both will wear out, perhaps the first the soonest. I know I was glad when I heard you was married to a woman of fortune; but "let her go, never mind her". I shall employ you with hedgehogs, for I do know how far I might trust mine. I want you to get a hedgehog in the beginning og winter and weigh him; put him in your garden and let him have some leaves, hay or straw to cover himself with, which he will do; then weigh him in the Spring and see what he has lost. Secondly I want you to kill one at the beginning of Winter to see how fat he is, and another in Spring to see what he has lost of his fat. Thirdly, when the weather is very cold, and abouth the month of January, I could wish you would observe their beat . . . . so much at present for hedgehogs. I beg pardon - examine the stomach and intestines.
    Ever yours, J. Hunter.
One flew over the cuckoo's nest
In 1786 Jenner wrote a paper on the breeding habits of the cuckoo and Hunter submitted it to the Royal Society. Jenner had shown that when a cuckoo's egg, laid in the nest of another bird such as the hedge sparrow, was hatched, the eggs or nestlings of the foster parent were thrown out of the nest, apparently by their own parents. Jenner had no explanation for this seemingly unnatural bahaviour. The paper was read before the society on March 29, 1787 and was accepted for publication in the Philosophical Transactions. Then, on June 18, 1787, Jenner discovered that it was the newly hatched cuckoo which ejected from the nest of its own "foster parent" the hedge sparrow's own unhatched eggs and nestling. Accordingly, Jenner withdrew his original paper before publication and revised it. On December 27, 1787 he sent the revised report to Hunter, and it was read before the Royal Society on March 13, 1788.

The speckled death
Smallpox was a leading cause of death in the 18th century, respecting no social class, it left many of the patients who recoverd disfigured. The methods used against it were insufficient at best: mercury, antimon, campher, china, etc.

The only means of combating the disease was the so-called inoculation - intentionally infecting a healthy person with the "matter" taken from a patient sick with a mild attack of smallpox. This practice, which originated in the East, had been introduced into England early in the eighteenth century. A person in good health was inoculated with matter from smallpox pustules and was thus given what was usually a mild case of the disease in order to confer immunity against further smallpox infection. The practice was dangerous, however, since smallpox thus induced could be severe or fatal, and it tended to spread smallpox among the population.

Sutton's method
When Jenner began medical practice at Berkeley, he was frequently asked to inoculate persons against smallpox. Inoculation was evidently not a common practice in the English countryside until about 1768, when it was improved by Robert Sutton of Debenham, Suffolk. Sutton required the patient to rest and maintain a strict diet for two weeks before inoculation. He inoculated by taking, on the point of a lancet, a very small quantity of fluid from an unripe smallpox pustule and introducing it between the outer and inner layers of the skin of the upper arm without drawing blood. He used no bandage to cover the incision.

Jenner began to inoculate against smallpox using Sutton's method, but he soon found some patients to be completely resistant to the disease. On inquiry he found that these patients had previously had cowpox. Jenner, however, familiar with this folklore, concluded that cowpox not only protected against smallpox, but could be transferred from one human being to another as a deliberate mechanism of protection.

As early as 1780 Jenner learned that the eruptions of the teats of infected cows differed. All were called cowpox and all could be communicated to the hands of the milkers, but only one kind created a resistance to smallpox. He called this type "tru cowpox". Jenner subsequently found that even true cowpox conferred immunity against smallpox only when matter was taken from the cowpox pustules before they were too old (as had been the case with Sutton's smallpox fluid). At that period of time, smallpox was at a low ebb in the Vale of Berkeley and it was some time before he could put his theory to the test.

In 1791 one Mary Barge, who had had cowpox many years previously, was inoculated with smallpox. A pale red inflammation appeared at the inoculation site and spread extensively, but it disappeared within a few days. Jenner noted how remarkable it was that the smallpox virus should produce such inflammation more rapidly than it could produce smallpox itself. He also observed that although cowpox gave immunity to smallpox, it did not confer similar immunity to the cowpox itself.

Breakthrough
The story of the great breakthrough is well known. In May 1796 a farm in Jenner's district was struck with cowpox, and Jenner met a young maid, Sarah Nelmes, who had fresh scars of cowpox on her finger. Sarah was described as a Berkeley milk maid but in fact was from an old highly respected local family, and certainly no peasant.

On May 14, 1796 Jenner obtained consent for a risky experiment from the parents of James Phipps, an eight year old boy with no known history of either cowpox or smallpox. Removing pus from Sarah, Jenner deposited it over scratches he had made on the boy's arms. The boy developed cowpox symptoms a week later, then recovered shortly afterward.

On July 1, 1796, Jenner performed a more daring experiment. He inoculated Phipps, this time with pus from a smallpox patient. James did not develop smallpox, even after repeated inoculations. The protection was complete.

Some of Jenner's medical colleagues awaited the results with excitement while others condemned him for the risk he was taking. James Phipps, however, lived to a ripe old age. Sir Walter Farquhar said to Jenner that if he chose to preseve it a secret he might make one hundred thousand pounds by it, but Jenner was determined to give it to the world, and he was as good as his word.

As early as 1881, Louis Pasteur honored Jenner by christening the process "vaccination", for the vaccinia virus of cowpox.

"Lest it should injure his established credit"
After conducting the experiment successfully on thirteen more patients, Jenner at the end of 1796 submitted a report describing this to the Royal Society. However, Sir Joseph Banks, the President of the Royal Society, and Sir Everard Home rejected the manuscript for publication in Philosophical Transactions of this august body. The Council of the Royal Society repulsed Jenner because he was "in variance with established knowledge" and "incredible." Jenner was further warned: "He had better not promulgate such a wild idea "lest it should injure his established credit." The title words of his manuscript were: "An Inquiry into the natural History of a Disease known in Glostershire by the name of the Cow-pox."

One of the first persons he inoculated was his own one-year old son. Jenner was the family physician of the Berkeley's at Berkeley Castle, and their own son was among the first people to be vaccinated.

Jenner was not able to resume his experiments until the spring of 1798 because no new cases of cowpox were recorded in the vicinity. In June 1798 he published at his own expense a small 75-page book based on twenty-three cases in which cowpox had conferred lasting immunity to smallpox: 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. In it Jenner described 10 cases of vaccination and 13 persons who had had cowpox in whom variolation was unsuccessful.

To describe the matter producing cowpox Jenner introduced the term "virus", contending that the cowpox virus had to be acquired from the cow and that it gave permanent protection from smallpox. In Case IV of the Inquiry Jenner also describes a kind of reaction now known as anaphylaxis, an allergic hypersensitivity reaction of the body to a foreign protein or drug.

But, Mr. Pearson . . .
Jenner's publication was not immediately well received, and his work was subjected to fierce criticism. Some physicians were skeptical; others had a financial interest in variolation. He went to London to find volunteers for vaccination, but after three months he had found none.

In London vaccination was made popular by others, in particular the surgeon Henry Cline (1750-1827), whom Jenner had given some of his inoculation matter, and the physicians George Pearson (1751-1828) from St. George's Hospital, and William Woodville (1752-1805), head of the London Smallpox and Inoculation Hospital. Some difficulties arose, of which some were very unpleasant. Pearson, who began vaccinating in 1799 and proved Jenner's findings, attempted to steal the honour from Jenner.

In 1799 Jenner was seriously attacked by William Woodville, who vaccinated about 600 persons in the first 6 months of 1799. Woodville had contaminated the cowpox-matter with smallpox matter, and thus inadvertently inoculated his patients with smallpox when he attempted to vaccinate them, a misfortune which produced serious cases of smallpox and at least one death.

During this early stage of the development of the vaccine, it is probable that mistakes were made. On many occasions, smallpox rashes were confused with cowpox rashes, presumably leading to the use of smallpox material for vaccination. Another possible source of error was the contamination of the pustule fluid with the smallpox virus. This was always a danger because the same lancets were used for variolation and for vaccination.

Vaccinations conquers the world
Jenner's procedure had proved its value, and Jenner became extremely active in promoting vaccination. The method was taken up not only by medical practitioners but also by country gentlemen, clergymen, and schoolmaster. Jenner found that lymph taken from smallpox pustules might be dried in a glass tube or quill and kept for as long as three months without losing its effectiveness. The dried vaccine could thus be sent long distances. Jean de Carro, a Swiss physician living in Vienna, introduced vaccination on the continent of Europe and was instrumental in sending vaccine virus into Italy, Germany, Poland, and Turkey.

In 1801, Lord Elgin, British ambassador at Constantinople (known for having removed the frieses - now called the Elgin Marbles - from Acropolis, and brought them to British Museum in London), sent vaccine received from de Carro overland to Bussora (Basra) on the Persian Gulf, and thence to Bombay. The marquis of Wellesley, governor general of India, actively promoted the distribution of the vaccine and many thousands of people were vaccinated in India during the next few years.

In Massachusetts, Benjamin Waterhouse (1754-1846), professor of the theory and practice of physics at Harvard Medical School, was among the first to be convinced of the value of Jenner's work, and introduced vaccination to America with vaccine received from Jenner. On July 8, 1800, he vaccinated his five year old son, Daniel Oliver Waterhouse, who thus became the first person to be vaccinated in America. After he successfully vaccinated his son and two slaves, they were inoculated with smallpox, with negative results. Jenner also sent vaccine to president Thomas Jefferson, who had 18 members of his family and some of their neighbours at Monticello vaccinated. On this occasion the last Mohican was also vaccinated. He was later immortalized by James Fenimore Cooper's book The Last of the Mohicans (1826) which has been filmed.

Letter from Thomas Jefferson, 3rd president of the United States: 1801-1809:

    SIR, - - I have received a copy of the evidence at large respecting the discovery of the vaccine inoculation which you have been pleased to send me, and for which I return you my thanks. Having been among the early converts, in this part of the globe, to its efficiency, I took an early part in recommending it to my countrymen. I avail myself of this occasion of rendering you a portion of the tribute of gratitude due to you from the whole human family. Medicine has never before produced any single improvement of such utility. Harvey's discovery of the circulation of the blood was a beautiful addition to our knowledge of the animal economy, but on a review of the practice of medicine before and since that epoch, I do not see any great amelioration which has been derived from that discovery. You have erased from the calendar of human afflictions one of its greatest. Yours is the comfortable reflection thatmankind can never forget that you have lived. Future nations will know by history only that the loathsome small-pox has existed and by you has been extirpated.

    Accept my fervent wishes for your health and happiness and assurances of the greatest respect and consideration.

    Monticello, May 14, 1806.


In 1802 the British Parliament voted Jenner a grant of £10.000 in recognition of his discovery and in 1806 an additional grant of £20.000. In 1803 the Royal Jennerian Society was founded at London to promote vaccination of the poor and Jenner took a large party in its affairs; it was superseded in 1808 by a national vaccination program, National Vaccine Establishment.

Although Great Britain and France were at war, in 1804 Napoleon had a medal struck in honor of Jenner�s discovery and in 1805 he made vaccination compulsory in the French army. During the Napoleonic wars Jenner wrote to Napoleon requesting the release of a relative of his, captain Milman. Napoleon said: "Ah, c'est Jenner, je ne peut rien refuser à Jenner".

Despite some errors and occasional chikanery, the process of vaccination spread rapidly and the death rate from smallpox plunged. Complications however, were many. Vaccination seemed simple, but the vast number of persons who practiced it did not necessarily follow the procedure that Jenner had recommended, and deliberate and unconsious innovations often impaired the effectiveness. Pure cowpox vaccine was not always easy to obtain, nor was it easy to preserve or transmit. Furthermore, the biological factors that produce immunity were not yet understood.

Surgeon turned doctor
In 1785 Jenner acquired The Chantry, a comfortable Georigian country house at Berkeley, where he resided, except for intervals at London and Cheltenham, where he bought an estate in 1810, for the rest of his life. Following an unhappy love affair in 1778, Jenner in 1788, aged 39 years, married Katherine Kongscote.

In 1792 Jenner obtained the medical doctorate – by way of correspondence – from the University of St. Andrews in Fife, Scotland. He then abandoned the less reputed, and poorer paid, profession of surgery for that of a physician. Until 1815 he practiced as a balneologist at the spa Cheltenham.

In 1813 the University of Oxford awarded Jenner an honorary M.D. degree.

Later years
Jenner, although he received worldwide recognition and many honours, made no attempt to enrich himself through his discovery and actually devoted so much time to the cause of vaccination that his private practice and his personal affairs suffered. Jenner not only received honours but also aroused opposition and found himself subjected to attacks and calumnies, despite which he continued his activities on behalf of vaccination. When his wife, who bore him four children, fell ill with tuberculosis, and died in 1815, Jenner retired from public life. One of his sons was mentally retarded and died in 1810.

He resumed his study of natural history and finished an article on bird migrations, in which he showed that birds appeared to migrate into England in summer for the purpose of reproduction, and that the ovaries of the female and testes of the male were enlarged at that time. The article was first published after his death. Jenner also served as justice of the peace at Berkeley.

A kind and gentle man, Jenner built a cottage for his first vaccination patient, James Phipps, and personally planted the rose garden.

The day before his death he walked to a neigbouring village, where he ordered that fuel be provided for certain poor families. In 1820 he had suffered a mild stroke, and on January 25, 1823, he was found unconscious on the floor of his library. His right side was completely paralysed. He died early the next morning.

Edward Jenner was buried near the altar in Berkeley church. The principal monument to commemorate his great contribution is in Kensington Gardens. He sits there reflectively, chin in hand, but only the name "Jenner" was inscribed on his pidestal. The statue is virtually forgotten. It was sculptored by William Calder Marshall, RA.

Edward Jenner must be considered the founder of immunology. In vaccination he was the first to use attenuated virus for immunization. For his coining the term virus, his efforts to describe the natural history of the cowpox virus, and his description of anaphylaxis, he must be considered the first pioneer in the new science of virology, and made possible the extermination of smallpox.

Edward Jenner was a free mason - Worshipful Master Royal Berkeley Lodge of Faith and Friendship Berkeley, Gloucestershire 1812. In 1825 his lodge brothers raised a monument to him in Gloucester Cathedral.

SIGNS OF RAIN

The hollow winds begin to blow,
The clouds look black, the glass is low,
The soot falls down, the spaniels sleep,
And spiders from their cobwebs creep.
Last night the sun went pale to bed,
The moon in haloes hid her head,
The boding shepherd heaves a sigh,
For, see! a rainbow spans the sky;
The walls are damp, the ditches smell,
Closed is the pink-eyed pimpernel;
Hard how the chairs and tables crack!
Old Betty's joints are on the rack;
Her corns with shooting pains torment her
And to her bed untimely send her.

Lous quack the ducks, the peacocks cry,
The distand hills are looking nigh;
How restless are the snorting swine!
The busy flies disturb the kine;
Low o'er the grass the swallow wings;
The cricket, too, how sharp he sings!
Puss on the hearth with velvet paws;
Sits wiping o'er her whiskered jaws;
Through the clear stream the fishes rise,
And nimbly catch the incautious flies;
The glow-worms, numerous and bright,
Illumed the dewy dell last night;
At dusk the squalid toad was seen
Hopping and crawling o'er the green;
The Whirling dust the wind obeys,
And in the rapid eddy plays;
The frog has changed his yellow vest,
And in a russet coat is dressed;
Though june, the air is cold and still,
The merry blackbird's voice is shrill;
My dog, so altered in his taste,
Quits muttonbones on grass to feast;
And se yon rooks, how odd their flight!
They imitate the gliding kite,
And seem precipitate to fall,
As if they felt the piercing ball.

Twill surely rain - I see with sorrow
Our jaunt must be put off tomorrow.

Sir Edward Jenner, M.D.

    Shall I, who even in the morning of my days sought the lowly and sequestered paths of life, the valley and not the mountains; shall I now my evening is fast approaching, hold myself up as an object for fortune and fame? Admitting it as a certainty that I obtain both, what stock should I add to my little fund of happiness? My fortune, with what flows in from my profession, is sufficient to gratify my wishes; indeed, so limited is my ambition, . . . that were I precluded from further practice, I should be enabled to obtain all that I want. And as for fame, what is it? A gilded butt, forever pierced with the arrows of malignancy.
    Letter to John Hunter.

    The scepticism that appeared, even among the most enlightened of medical men when my sentiments on the important subject of cow-pox were first promulgated, was highly laudable. To have admitted the truth of a doctrine, at once so novel and so unlike any thing that ever had appeared in the annals of medicine, without the test of the most rigid scrutiny, would have bordered upon temerity.
    A Continuation of Facts and Observations
    Relative to the Variolae Vaccinae, or Cow-Pox.

    The joy I felt at the prospect before me of being the instrument destined to take away from the world one of its greatest calamities . . . was so excessive that . . . I have sometimes found myself in a kind of reverie.
    Quoted by John Baron in Life of Edward Jenner, volume I, chapter 4.

    The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases.
    An Inquiry into the Causes and Effects of the Variolae Vaccinae. . ..

    I shall endeavour still further to prosecute this inquiry, an inquiry I trust not merely speculative, but of sufficient moment to inspire the pleasing hope of its becoming essentially beneficial to mankind.

    I hope that some day the practice of producing cowpox in human beings will spread over the world -- when that day comes, there will be no more smallpox.


The terms pox and vaccine
The word vaccination comes from vacciniae, which is derived from the latin vacca, meaning cow. Cowpox was also called vaccinia.

The disease has also been called variola, from the Latin word varius, meaning "stained," or from varus, meaning "mark on the skin. The word was was used for the first time by Bishop Marius of Avenches (near Lausanne, Switzerland) in AD 570.

The word "pox" is the plural form of pock (pocke meaning sac); the spelling "pox" is phonetic; "pocks" is the correct form. The name "small pox", which first occurs in Raphael Holinshead's Chronicles (1571), was given to this disease to distinguish it from syphilis, which was then known as great pockes and which attained the proportions of an epidemic in Europe about 1494. The expression "The Pox" in older medical literature always refers to the Lues Venereal.

Smallpox was also commonly referred to as "he speckled monster."

To describe the matter producing cowpox Jenner introduced the term "virus"

It was Louis Pasteur who, as early as 1881, honored Edward Jenner by christening the process "vaccination", for the vaccinia virus of cowpox.

The history of variolation and vaccination until 1800
Jenner's invention of vaccination against smallpox was the medical breakthrough which saved most lives before the era of antibiotics. Before him, smallpox was a killer disease, the majority of its victims infants and young children. And, except for the skin lesions, there is nothing small about smallpox. In the seventtenth century it killed more than 60 million people in Europe alone, and in the twentieth century, before it was eradicated, it killed more than 300 million - three times the number of deaths from all the century's wars and battles combined. Smallpox was a mjor reason that the European population grwe only slowly in the centuries before 1800. Affecting all social groups, smallpox also ravaged the royal houses of Europe, particularly the Habsburgs. One of its surviving victims was queen Elizabeth I of England.

Based on mortality and contagiousness, the American Publichealth Association has classified epidemic diseases into nine groups. In group one, the most virulent, smallpox �reigned� together with the plague, cholera, and yellow fever.

As late as in the early 20th century 400.00 people died of smallpox in Russia and Poland, out of 134 millions. In Germany, with a population of 65 millions, only 386 people succumbed to the disease. This was due to to the fact that a two-step vaccination with cowpox matter had been made obligatory from 1874. In England, where vaccination was invented, 5.000 of a population of 45 millions died, as vaccination was voluntary.

The last reported case of smallpox occurred in Somalia. There, on October 26, 1977, a youth named Ali Maow Maalin recovered from a rash caused by the disease. He was pronounced the last case of natural smallpox in the woerld. In 1980, as a result of Jenner's discovery, the World Health Assembly officially declared "the world and its peoples" free from endemic smallpox.

The scourge of mankind
Smallpox has been one of humankind's greatest scourges since time immemorial. It is believed to have appeared at the time of the first agricultural settlements in northeastern Africa, around 10 000 BC. It probably spread from Africa to India by means of Egyptian merchants in the last millennium BC. The earliest evidence of skin lesions resembling those of smallpox is found on the faces of mummies from the time of the 18th and 20th Egyptian Dynasties (1570 to 1085 BC). The mummified head of pharaoh Ramses V (died c. 1156 BC) bears evidence of the disease. The first recorded smallpox epidemic occurred in 1350 BC during the Egyptian-Hittite war.

The disease is referred to in ancient Sanskrit texts of India, ponting to its existence in Hindustan at least 1000 B.C. One hindu account alludes to an ointment for removing the cicatrices of eruption. During the epidemic in Athens in 430 BC, Thucydides noted that those who survived the disease were later immune to it. These observations were reiterated by Rhazes (Abu Bakr Muhammad Ibn Zakariya al-Razi), to whom we owe the first medical description of smallpox, De variolis et morbillis commentarius, which was written in about AD 910. Rhazes also noted that the illness was transmitted from person to person. His explanation of why survivors of smallpox do not develop the disease a second time is the first theory of acquired immunity.

A matter for biological warfare
Smallpox greatly affected the development of western civilization. The first stages of the decline of the Roman Empire, around AD 180, coincided with a large-scale epidemic: the plague of Antonine, which killed between 3.5 and 7 million persons. The Arab expansion, the Crusades, and the discovery of the West Indies all contributed to the spread of the illness. Unknown in the New World, smallpox was introduced by Spanish and Portuguese conquistadors. It decimated the local population and was instrumental in the fall of the empires of the Aztecs and the Incas. When the Spanish arrived in 1518, Mexico had about 25 million inhabitants; by 1620, this number had diminished to 1.6 million. The devastating effect of smallpox gave rise to one of the first examples of biological warfare. In a letter written to Colonel Henry Bouquet in 1763, Sir Jeffrey Amherst, commander-in-chief of British forces in North America, suggested grinding the scabs of smallpox pustules into blankets that were to be distributed among disaffected tribes of Indians.

In the beginning were the Chinese
Whoever believes himself to have made a major discovery, had beter first consult the Chinese. Usually they have been there before you.

Smallpox was described in China as early as in 1122 B.C. It was the desperate pressure to escape from this disease which almost three centuries later lead to one of the greatest breakthroughs in medicine, and subsequently the eradication of one of the gretest scourges of mankind. This process started in China with variolation, or inoculation. From China this procedure spread to Europe and became the foundation for modern scientific immunology.

The origin of inoculation in China is somewhat cloudy. It is known that the technique originated in the southern province of Szechuan. South west in this province is a famous mountain named O-Mei Shan, known for its association with both Buddhism and the Chinese religion Taoism. The taoist alchemists who lived as eremits in the caves of this mountain are are said to have known the secret of inoculation as early as the tenth century B.C. How much earlier the knew about it, is unknown, but the first written record of vaccination, The Correct Treatment of Smallpox, is attributed to a Buddhist nun practicing during the 11th century.

The inoculation technique first became generally known after the elder son of the prime minister Wang Tan (957-1017) [Sung-dynasty] died of smallpox. The prime minister did not want more of his family to suffer the same fate, and called on physicians, sages and magicians from all over the empire to find a remedy. One of them was an eremit from O-Mei-Shan, but we do not know if this was a man or a woman. The eremit was said to have been a specialist in "internal alchemy", which usually ment that the person worked with elixirs of immortality. This munk or nun brought along the technique of inoculation and introduced into the capital. Some sources, however, refers to the method as going back to the 6th century.

With a little bit of luck
The Chinese were familar with the fact that inoculation has certain advantages and dangers that separates it from the later technique of vaccination. When the virus has been introduced into the body, it causes life-long immunity - if you are lucky. But the process can also cause a direct contagion, producing smallpox. With vaccination only temporary immunity is achieved, thus vaccination has to be repeated with few years interval with so-called boosters. This is so because vaccination uses dead virus or some other form of denaturated virus, maybe related, which cannot cause the disease.

Inoculation against smallpox at first glance may look like madness. Were not people infected all the time? The answer is no, and here we meet the subtlety of the chinese inoculators. They used several methods to attenuate the deadly virus, so that the danger of catching the disease was minimalized and the chance of acquiring immunity was maximalized.

First of all it was prohibited to use smallpox matter from people who had the disease. It was known that this would only transfer the disease. The method used was placing the pox matter on a cotton tampon which was introduced into the nose of a healthy person. Another method was blowing powdered scabs of smallpox pustules into the nose through a tube. The pox matter was thus absorbed by the mucous membrane in the nose, and by inhalation. The method of scratching the skin and place smallpox matter in it seems to have been developed much later, possibly in Central Asia when the technique spread westwards.

In China, 100 years before Edward Jenner, healthy persons took pills made from the fleas of cows to prevent smallpox; this is the first recorded example of oral vaccination.

The Chinese preferably did not used smallpox matter from smallpox patiens, but from persons who had been inoculated and developed a few scabs. The Chinese also knew the difference between the two types of smallpox, Variola major og Variola minor, and chose matter from the latter, which was a less virulent form. The ideal was considered taking matter from someone who had been inoculated with matter from someone who had been inoculated with matter from someone who had been inoculated . . . i.e. an attenuation over several generations of repeated inoculations. In 1761 (Chï'ing-dynasty) Chang Yen described a method for further attenuation of the virus.

It is belived that 80 percent of the smallpox virus used but the Chinese for inoculation were dead and could not infect anybody with smallpox. Instead they aimed for, like in vaccination, to stimulate the body intro producing antibodies against smallpox, as well as the substance interferon which strengthens the immune system in general.

Despite all this knowledge, according to the author Yü T’ien Ch’ih inoculation against smallpox was not generally known and practiced on a large scale before the period 1567-1572 (Ming dynasty). The author Yü Ch’ang has a vivid description of the practice in his book Ideas on medicine/Medical ideas from 1643.

In India, variolation took several forms, the most common of which was the application of scabs or pus from a person with smallpox to the intact or scarified skin of a healthy person.

Over to Europe
From China and India the technique of variolation was spread by the caravaners; for these travvelling merchants, persons, protection against smallpox was obviously a great advantage.

Variolation was known and practiced frequently in the Ottoman Empire, where it had been introduced by Circassian traders around 1670. Women from the Caucasus, who were in great demand in the Turkish sultan's harem in Istanbul because of their legendary beauty, were inoculated in childhood in parts of the body where scars would not be seen. These women must also have brought variolation to the court of the Sublime Porte.

Variolation came to Europe at the beginning of the 18th century with the arrival of travelers returning from Istanbul. Instrumental in this transit were two Greek physicians and a woman of the English aristocrasy.

The Greek effort
In 1714 The Royal Society of London received a communication from Emmanouel Timonis and another in 1716 from Jakovos Pylarinos. These reports described the Turkish method of cutaneous inoculation. Pylarinos had undertaken three successful inoculations in 1701, and the technique had been reported to the Royal Society in 1713 by a friend of Dr. E. Timonis, Dr. Woodward (probably John Woodward, 1665-1728), to whom Timonis had sent his description of his technique as it was practised in Constantinople. Two years later Pylarinos presented his observations to the same medical society/body.

Emmanouel Timonis (died 1741) was a physician in Constantinople until in 1691, when he was elected professor at the Univeristy of Padova. He was the first to direct the attention of the scientific community to the inoculation which was practiced in the Greek and Armenian population.

Jakovos Pylarinos(1659-1718), also known as Giacomo Pilarino, is said to have been an espcically bright fellow who contributed importantly to Greek seventeenth-century culture. As a pioneer in inoculation he travelled extensively with Timonis. Pylarinos was life physician to the princes of Serbia and Moldova, and chief physician to Peter the Great (1672-1725; tzar from 1682) in Russia .

One of Pylarinos monographs is Nova et tuta Variolas excitandi per transplantationem methodus nuper inventa, in usum tracta, qua rite per acta immuniaa in posterum praesenvatur ab hujus modi contagio corpora (Venice, 1715: "New and safe method to excite smallpox by inoculation, just invented and put into use, performed routinely, by which the bodies acquire immunity against this infection in later years."

These gentlemen, however, did not change the ways of conservative English physicians, despite the rate at which smallpox was ravaging the country at that time. Nobility, on the other hand, always has the advantage.

Lady Mary Wortley Montagu
The person responsible for the introduction of variolation into England was the English aristocrat Lady Mary Wortley Montagu (n�e Pierrepoint; 1689-1762), most colourful Englishwoman of her time, friend of Alexander Pope (1688-1744) and herself a brilliant and versatile writer. In 1715 she had an episode of smallpox that disfigured her beautiful face, and her 20-year-old brother died of the illness 18 months earlier. In 1717, Lady Montagu's husband, Edward Wortley Montagu, was appointed Ambassador to the Sublime Porte; the family left for Istanbul on 15 March. Two weeks after her arrival, Lady Montagu wrote to her friend Sarah Chiswell (who died of smallpox 9 years later) and described the method of variolation used at the Ottoman court. She called it "ingrafting"; it was a procedure done by old women, who made four or five scratches or a slight puncture on the arm and introduced material taken from smallpox pustules from patients who had mild cases of the disease.

Lady Montagu was so determined to prevent the ravages of smallpox and so impressed by the Turkish method that she ordered the Embassy surgeon, Charles Maitland, to inoculate her 5-year-old son in March 1718. On returning to London in April 1721, she had Maitland inoculate her 4-year-old daughter in the presence of the physicians of the court. Among these physicians was Sir Hans Sloane (1660-1753), President of the Royal Society and the king's physician. This was the first professional variolation performed in England.

Word of these practices spread and reached the Princess of Wales and other members of the Royal Family. Charles Maitland was granted royal license to perform a trial of variolation on six prisoners at Newgate on 9 August 1721; these prisoners were promised a full pardon if they submitted to the so-called Royal Experiment. The trial was observed by the court physicians and 25 members of the Royal Society and the College of Physicians. All of the prisoners survived and were released. One was exposed to two children with the illness and proved to be immune. Maitland later variolated six charity children in London and successfully treated the two daughters of the Princess of Wales on April 17, 1722. Not surprisingly, the procedure gained general acceptance after this last success. The ascent of theHanoverian Royal family to the throne had earlier been facilitated by the smallpox deaths of more immediate heirs. Now they ensured their own succession.

Demise of the speckled death
The primary side effect of the procedure was the appearance of smallpox itself; however, in 1722, in one of the first applications of statistics to a medical and social problem, James Jurin (1684-1750) observed that the smallpox-associated case-fatality rate was 1:14 in noninoculated children and 1:91 in inoculated children. With new improvements that reduced the likelihood of serious infection, the technique became widespread in England and reached towns and rural communities by the 1740s. In 1745, the London Smallpox and Inoculation Hospital was founded; this center was dedicated exclusively to the treatment and prevention of smallpox.

Indeed, Jenner himself was variolated at 8 years of age.

Other countries
James Kilpatrick, an early American physician, was the author of An essay on inoculation, occasioned by the smallpox being brought into South Carolina in the year 1738.

In 1765 the Swdish-born botanist, pharmacologist and physician Johann Andreas Murray (1740-1791), obtained his medical doctorate with a dissertation, followed up by a book two years later, on variolation in Sweden.

But the farmer was first
Although Edward Jenner is rigtfully credited the smallpox vaccine, he was not first. The only two persons known to challenge Jenner's priority in the use of cow-pox material, are the English farmer Benjamin Jesty (1737-1816) from Yetminster in Dorset, and later the Dutch schoolmaster Peter Plett. Benjamin Jesty is reputed to have performed successful cow-pox vaccination in 1774, thus preceding Jenner by more than twenty years.

Benjamin Jesty was living in Yetminster with his pregnant wife Elizabeth, two sons, Robert and Benjamin, aged three and two, and a baby also called Elizabeth. During the spring and summer of 1774 smallpox raged in the area. Having had smallpox himself as a child, Benjamin Jesty feared for the health of his wife and children.

At this time, the Jesty's had two dairymaids, Ann Notley and Mary Reade. Both of these girls had previously had cowpox, and both cared for two boys in their family during the current epidemic. Benjamin was fully aware of the age-old tradition that people who had earlier cought the mild disease of cowpox did not catch the normally fatal disease of smallpox. Noticing that neither of the dairymaids caught the disease, Benjamin decided on his subsequent course of action.

As luck would have it, an outbreak of cowpox occurred in the farm of Mr. Elford at nerby Chetnole. Benjamin immediately took his wife and sons there, the baby Elizabeth was considered too young. In the open field, Benjamin took infected pus from the udder of a cow. With the point of a stocking needle he scratched his wife's arm just below the elbow and inserted the pus. The first authenticated vaccination had taken place. He then repeated the process on his two sons.

Over the next few days the mild disease of cowpox ran its normal course in the two boys who were soon recovered and running about as normal. Elizabeth however was not so lucky and became extremely ill. She ran a high fever and nearly lost her arm because of severe inflammation. Fearing for the safety of his wife and unborn child he called in the local doctor to treat the fever. Fortunately the fever subsided and Elizabeth recovered fully and lived for another fifty years.

Word got around of what Benjamin had done and Elizabeth and the boys became the object of their neighbours derision, who fully expected them to turn into cows, or at the very least to grow horns. Benjamin, as contemporary accounts relate, was "hooted at, reviled and pelted whenever he attended markets in the neighbourhood. He remained undaunted and never failed from this cause to attend to his duties". It is not known how long this scorn lasted.

None of the Jestys developed smallpox during later epidemics, and variolation done in them several years later induced no reaction.

A pioneer farmer at work
In 1797 the Jesty family moved to Worth Matravers in the Isle of Purbeck. It is here that we find clearly documented evidence that Benjamin also performed vaccinations on other people. In the parish church there is a tablet in memory of one Mary Brown which states that her mother, Abigail Brown, was vaccinated by Benjamin Jesty. The same inscription can be found on the gravestone in the churchyard. It is not known how many others were vaccinated as people who were vaccinated probably kept quiet about it in view of the derision the Jestys had received.

Despite a review by a medical commission, Benjamin Jesty never received credit for his pioneering work, all the credit, and financial rewards going to Jenner. Jenner himself never accepted that he had been pre-empted by Jesty.

The Jestys however freely admitted that they were probably not the first with vaccination, as indicated by the inscription on their gravestone behind the Parish Church in Worth Matravers: "having been the first person known to that introduced the cow-pox by inoculation, and who from his great strength of mind made the experiment from the cow on his wife and two sons in the year 1774."

A schoolmaster named Peter Plett performed vaccinations in 1791. Plett, who had been a tutor in Schönweide, Holland, knew of the variolation technique and had been told by milkmaids that cowpox protected against the human disease. Later, as a tutor for another family in Hasselburg, Holstein, Plett vaccinated his employer's two daughters and another child with material taken from cows; these children were the only survivors of a smallpox epidemic in Holstein 3 years later. However, the hand of one of the children became severely inflamed and this dissuaded Plett, like Jesty, from performing further trials.

Jenner and Sutton's method
When Jenner began medical practice at Berkeley, he was frequently asked to inoculate persons against smallpox. Inoculation was evidently not a common practice in the English countryside until about 1768, when it was improved by Robert Sutton of Debenham, Suffolk. Sutton required the patient to rest and maintain a strict diet for two weeks before inoculation. He inoculated by taking, on the point of a lancet, a very small quantity of fluid from an unripe smallpox pustule and introducing it between the outer and inner layers of the skin of the upper arm without drawing blood. He used no bandage to cover the incision.

Jenner began to inoculate against smallpox using Sutton�s method, but he soon found some patients to be completely resistant to the disease. On inquiry he found that these patients had previously had cowpox. Jenner, however, familiar with this folklore, concluded that cowpox not only protected against smallpox, but could be transferred from one human being to another as a deliberate mechanism of protection.

As early as 1780 Jenner learned that the eruptions of the teats of infected cows differed. All were called cowpox and all could be communicated to the hands of the milkers, but only one kind created a resistance to smallpox. He called this type �tru cowpox�. Jenner subsequently found that even true cowpox conferred immunity against smallpox only when matter was taken from the cowpox pustules before they were too old (as had been the case with Sutton�s smallpox fluid). At that period of time, smallpox was at a low ebb in the Vale of Berkeley and it was some time before he could put his theory to the test.

In 1791 one Mary Barge, who had had cowpox many years previously, was inoculated with smallpox. A pale red inflammation appeared at the inoculation site and spread extensively, but it disappeared within a few days. Jenner noted how remarkable it was that the smallpox virus should produce such inflammation more rapidly than it could produce smallpox itself. He also observed that although cowpox gave immunity to smallpox, it did not confer similar immunity to the cowpox itself.

Breakthrough
The story of the great breakthrough is well known. In May 1796 a farm in Jenner's district was struck with cowpox, and Jenner met a young maid, Sarah Nelmes, who had fresh scars of cowpox on her finger. Sarah was described as a Berkeley milk maid but in fact was from an old highly respected local family, and certainly no peasant.

On May 14, 1796 Jenner obtained consent for a risky experiment from the parents of James Phipps, an eight year old boy with no known history of either cowpox or smallpox. Removing pus from Sarah, Jenner deposited it over scratches he had made on the boy's arms. The boy developed cowpox symptoms a week later, then recovered shortly afterward.

On July 1, 1796, Jenner performed a more daring experiment. He inoculated Phipps, this time with pus from a smallpox patient. James did not develop smallpox, even after repeated inoculations. The protection was complete.

Some of Jenner's medical colleagues awaited the results with excitement while others condemned him for the risk he was taking. James Phipps, however, lived to a ripe old age. Sir Walter Farquhar said to Jenner that if he chose to preseve it a secret he might make one hundred thousand pounds by it, but Jenner was determined to give it to the world, and he was as good as his word.

As early as 1881, Louis Pasteur honored Jenner by christening the process "vaccination", for the vaccinia virus of cowpox.

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