Jenner Develops Smallpox Vaccination

Date 1796-1798

English physician Edward Jenner was the first person to establish the scientific legitimacy of smallpox vaccinations through his experiments and research publications. His campaign to popularize the procedure led to its worldwide use and effectively protected millions from the often fatal disease.

Locale Berkeley, Gloucestershire, England

Key Figures

• Edward Jenner (1749-1823), English physician
• Lady Mary Wortley Montagu (1689-1792), writer and wife of Britain’s ambassador to the Ottoman Empire, who observed the practice of variolation and helped introduce it into England
• James Phipps (1788-1808), first person to be vaccinated by Edward Jenner
• Benjamin Jesty (1736-1816), English farmer who vaccinated his family against smallpox in 1774
• William Woodville (1752-1805), head of the London Smallpox and Inoculation Hospital
• George Pearson (1751-1828), a physician at St. George’s Hospital in London

Summary of Event

In eighteenth century England, smallpox was a leading cause of death, and traditional methods of treating it were largely ineffective. The practice of variolation was introduced to England from the Ottoman Empire in 1721 by Mary Wortley Montagu and gained general acceptance after some successful trials. This procedure involved inoculating patients with pus from smallpox sores in the hope of giving them a mild case of the disease and future immunity. However, the risks of a patient developing a serious, possibly lethal, case of smallpox and even creating an epidemic were significant, and there was a clear need for a safer and more effective method of protection from the disease.

Edward Jenner, a physician in Berkeley, England, in the county of Gloucestershire, began variolating patients using a refined procedure developed by Robert Sutton in 1768. Jenner found that his patients who had previously contracted cowpox, a relatively mild disease, did not react to the smallpox virus. This finding was consistent with the conventional wisdom in rural areas that cowpox conferred an immunity to smallpox, which had been supported in reports to the Medical Society of London in the mid-1760’s by several physicians, including at least two from Gloucestershire. In fact, in 1774 a farmer in Yetminster, England, named Benjamin Jesty successfully protected his wife and two sons from a smallpox epidemic by vaccinating them with the pus from the udders of cows suffering from cowpox. Jenner, however, always maintained that he was unaware of these earliest documented smallpox vaccinations.

By the early 1780’s, Jenner’s interest in the connection between cowpox and smallpox immunity led him to distinguish between two similar but distinct diseases, “spontaneous,” or genuine, cowpox, which created an immunity to smallpox, and “spurious,” or false, cowpox, which did not. In May of 1796, a young woman named Sarah Nelmes came to Jenner to be treated for cowpox. On May 14, Jenner vaccinated James Phipps, an eight-year-old boy, by placing fluid from a sore on Nelmes’s hand into two small incisions on the boy’s arm. A week later, Phipps developed the symptoms of cowpox, including infected sores, chills, head and body aches, and loss of appetite. The child recovered quickly, and, on July 1, 1796, Jenner variolated Phipps using fluid from smallpox pustules, and he had no reaction. Jenner inoculated the boy several more times in this manner with the same results.

In late 1796, Jenner submitted a paper to be considered for publication in Philosophical Transactions of the Royal Society, England’s premier scientific journal. The manuscript described the cases of thirteen former cowpox sufferers who exhibited no reaction when variolated by Jenner, as well as his experiments with James Phipps. The Council of the Royal Society rejected the article and berated Jenner in scathing terms, characterizing his findings as unbelievable and “in variance with established knowledge,” and advising him that advancing such wild notions would destroy his professional reputation. Jenner was undaunted and began experimenting again in the spring of 1798, when cowpox broke out again in Gloucestershire. Through these studies he learned that cowpox could be transferred from one patient to another by using the pus from the sores of one vaccinated person to vaccinate another, and so forth. This discovery of “arm-to-arm vaccination” made a natural outbreak of cowpox unnecessary as a source of vaccine.

In June of 1798, Jenner independently published the findings from his research to date, including reports of the cases from his first manuscript and nine other patients he had vaccinated besides Phipps. This seventy-five-page book was titled 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. The word variolae means “smallpox” in Latin, and vaccinae is from vaca, which is Latin for “cow.” In his inquiry, Jenner described the process now called “anaphylaxis,” the body’s allergic reaction to a foreign protein after a previous exposure, and coined the term “virus” to describe the mechanism of cowpox transmission.

The London medical establishment’s initial reaction to Jenner’s publication was extremely negative. Just as in 1796, some prominent physicians questioned the validity of Jenner’s findings. Others, who were profiting handsomely from variolation, attacked Jenner for fear of losing their lucrative monopoly on protecting the public from smallpox. Jenner had rejected the suggestion that he could become personally wealthy from his discovery, and he planned to share it with all of England and the world. After the publication of his findings, Jenner tried for three months to find people who would agree to be vaccinated in order to demonstrate the effectiveness of the procedure. He did not find a single volunteer because of the public attacks on his professional competence.

Instead, Jenner pursued his goal of popularizing vaccination indirectly, through London physicians to whom he provided vaccine. For example, the director of the London Smallpox and Inoculation Hospital, William Woodville, vaccinated some six hundred people in the first half of 1799. Based on vaccinations that he performed in 1799, George Pearson of St. George’s Hospital replicated Jenner’s findings and tried to take credit for the procedure. Woodville, who caused several cases of smallpox and at least one death by inadvertently contaminating some vaccine with the smallpox virus, blamed Jenner’s procedure in order to protect his own reputation. However, a nationwide survey conducted by Jenner, which documented cases of immunity to smallpox by former cowpox sufferers, clearly validated his work.

By late 1799, vaccination had gained widespread acceptance, and the procedure was being performed not only by physicians but also by schoolteachers, ministers, gentleman farmers, and others in all parts of the country. Jenner continued to report the results of his research on vaccination through publications such as The Origin of the Vaccine Inoculation (1801). In recognition of his achievements, Parliament awarded Jenner £10,000 in 1802 (the equivalent of more than $500,000 today) and an additional £20,000 in 1807. Oxford, Harvard, and Cambridge Universities honored him as well.

Significance

Edward Jenner’s work on refining and promoting the use of smallpox vaccinations, before the development of antibiotics, was a major breakthrough in preventive medicine. Countless lives were undoubtedly saved in Great Britain during the years immediately following Jenner’s efforts, given the high mortality rates during earlier smallpox epidemics.

Jenner’s method of preserving vaccine for up to three months enabled him to share his vaccination procedure with the world. As a result, an estimated 100,000 people had been vaccinated worldwide by the end of the eighteenth century. Shortly thereafter, Benjamin Waterhouse, a professor at the Harvard School of Medicine, used vaccine from England to perform the first vaccinations in the United States on his young son and servants. Jenner also shipped vaccine to President Thomas Jefferson, who had eighteen of his relatives vaccinated and established the National Vaccine Institute, with Waterhouse as its director, to spread vaccination throughout the country. In addition, mass vaccination programs were initiated in all Spanish colonies in North and South America and Asia by King Charles IV of Spain, in India by the British governor general, for the French army by Napoleon, and in numerous other countries. These programs were all undertaken in the early 1800’s using Jenner’s vaccine.

Jenner’s successful lobbying for a government-sponsored national vaccination program eventually led to the passage of the Vaccination Act in 1840, which provided for the free vaccination of infants and made the riskier practice of variolation illegal. Subsequent laws made vaccination mandatory, with severe penalties for noncompliance. By 1871, 97.5 percent of England’s population reportedly had been vaccinated.

By 1967, although smallpox had completely disappeared from North America and Europe, there were still 10 to 15 million cases reported in the world annually. The World Health Organization initiated an effort to eradicate smallpox worldwide. The campaign was declared a success in 1980. Jenner’s work is credited not only with the defeat of smallpox but also with being the foundation of the science of immunology, which has produced vaccines against numerous lethal and debilitating diseases.

Bibliography

Barquet, Nicolau, and Pere Domingo. “Smallpox: The Triumph over the Most Terrible of Ministers of Death.” Annals of Internal Medicine 127 (1997): 635-742. A detailed account of Edward Jenner’s vaccination experiments and their immediate and long-term impacts, starting with a concise history of the global spread of smallpox, the resulting epidemics, and variolation techniques.

Baxby, Derrick. “The End of Smallpox.” History Today (March, 1999) 14-16. Explains how high smallpox mortality rates in England and the dangers of variolation practices motivated Jenner to refine vaccinations and promote their use.

Fisher, Richard B. Edward Jenner, 1741-1823. London: Andre Deutsch, 1991. A complete biography, including an account of Jenner’s experiments with smallpox vaccinations and the widespread application of this technology, at his urging.

Plotkin, Susan L., and Stanley A. Plotkin. “A Short History of Vaccination.” In Vaccines, edited by Stanley A. Plotkin and Walter A. Orenstein. Philadelphia: W. B. Saunders, 2004. Discuses the migration of smallpox variolation practices to England from the Ottoman Empire in the early eighteenth century to Jenner’s work, which led to modern vaccination techniques.