JENNER AND SMALLPDX
By E. ASHWORTH UNDERWOOD
THE recent deaths in this country of six persons who con- tracted smallpox while at sea is a timely reminder of the severity of the disease and of the grave risks which are run by those who contract it. In all, twelve cases occurred as a result of infection on the voyage, and of these six died. There is no infectious disease likely to attack the inhabitants of Western European countries which has a higher case mortality than this ; and the fact that very mild forms of smallpox do occur gives a sense of security which may be dangerous. The number of persons in this country—even including doctors and nurses—who have ever seen this severe type of disease is very small. Those who have will appreciate its loathsomeness and the comparative readiness with which the people of eighteenth-century England accepted the practice of inoculation—which bestowed upon each successfully inoculated individual an attack of the disease, quite often mild, but too frequently fatal. As an indication of the comparative popularity of this practice figures may be cited at random. For example, we may take two small towns in the county of Gloucestershire, in which vaccination was to be discovered later. In consequence of an epidemic of smallpox at i'ainswick in 1786, one doctor alone inoculated 738 persons in five weeks. At Dursley in 5797 a doctor inoculated 1,475 persons in three months. When it is remembered that each inoculated person could transmit smallpox to others, and hence was a focus of infection, the prospect appears rather grim. .
On Tuesday, May 17th, the bi-centenary of the birth of Edward Jenner will be celebrated. Hailed rb the "discoverer of vaccination," Jenner had fame thrust upon him_ almost overnight, and there are few men in the annals of the history of medicine whose work has
been so much misunderstood. He has been the recipient of both extreme adulation and virulent abuse, and this occasion is fitting for a note on the man and his work. Edward Jenner, a son of the Rev. Stephen Jenner, rector of Rockhampton and vicar of Berkeley in Gloucestershire, was born on May 57th, 1749, at the Old Vicarage at Berkeley. After a good preliminary education he was taken from school at the age of thirteen, and during the next eight years he received a thorough practical training in the practice of medicine, as apprentice to a surgeon at Sodbury. He then spent two years in London in the coveted position of a house-pupil of the great John Hunter. Jenner had everything necessary to enable him to carve out a distinguished career in London. Instead, his love of the country and of his native town called him back to practise at Berkeley, and there—apart from brief intervals in London and numerous short visits to Cheltenham—he spent the remainder of his life.
Jenner had a great interest in natural history, and his observation had been trained by his habits—and by John Hunter. During the next twenty years he corresponded frequently with Hunter, who encouraged him in natural-history pursuits, and badgered him for' specimens of the most diverse kinds. It was mainly as a result of Hunter's encouragement that Jenner undertook an investigation into the life and habits of the cuckoo. In 1788 his paper was read before the Royal Society and' printed in its Philosophical Transactions. Jenner gave accurate data of the time of arrival of the cuckoo in Gloucestershire, the time of its departure, the number of eggs which it laid, their colour and size-relation to that of the eggs of the foster- parent. In particular he described the remarkable manner in which the young cuckoo clears the nest for itself. Although he was discredited in the nineteenth century, his rightness has since been proved by photography. As a result of this investigation Jenner was elected a Fellow, of the Royal Society.
It was a common belief among country-folk that a person who had had cowpox could not take smallpox, and it was later shown that a farmer—Benjamin Jesty—had inoculated his wife and children with cowpox to this end. But such observations had no practical conse- quences whatever. Jenner accumulated evidence that those who had had cowpox were immune to smallpox. He then succeeded in trans- mitting the cowpox virus to another individual from a natural case of cowpox in a human being. This had never been done before. He also transmitted the virus in this wai to several individuals through succeeding generations of the virus. At the end, the cowpox lymph was still able to protect against subsequent inoculation with smallpox matter. These results he published in his famous work, An Inquiry' into the Causes and Effects of Variolae Vaccinae (1798). Though the observations were few, according to modern standards, the method— and, indeed, the whole idea—was quite new. In it was implied the wide range of the immunity methods of today.
The method quickly became widely known, and vaccination was extensively practised in England. Within two years it had spread to the United States, France, Spain, Germany and other European countries, and was making headway in Asia. The Inquiry was ' translated into many languages. Jeimer was given numerous honours. He continued his work, vaccinated large numbers of people gratuitously, attended meetings, and dealt with a very large corre- spondence on vaccine matters. This correspondence he kept up until his death, and, in his own words, he became "the vaccine clerk of the whole world." In 1802 Parliament voted him a grant of £ ro,000, and in t8o6 a further L20,000. There is no doubt that his vaccina- tion work had involved him in considerable financial loss. He died at Berkeley on January 26th, 1823.
Jenner had many difficulties to overcome, and some could not have been surmounted with the knowledge of that time. It was, perhaps, unlucky that he was led to believe that an attack of cowpox would always give permanent immunity to smallpox. This is all the more remarkable, since he certainly knew that smallpox does not always give lasting protection against subsequent attacks. But the work which he did gave a rich harvest in his lifetime, and it is to his credit that his head remained unturned. He was a courteous country gentleman, and a man whose sole ambition, perhaps, was to be of some lasting benefit to the human race.
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