Edward Jenner (17 May 1749 – 26 January 1823) was an English physician and scientist who pioneered the concept of vaccines and created the smallpox vaccine, the world's first vaccine.[1][2] The terms vaccine and vaccination are derived from Variolae vaccinae ('pustules of the cow'), the term devised by Jenner to denote cowpox. He used it in 1798 in the title of his Inquiry into the Variolae vaccinae known as the Cow Pox, in which he described the protective effect of cowpox against smallpox.[3]
In the West, Jenner is often called "the father of immunology",[4] and his work is said to have saved "more lives than any other man".[5]:100[6] In Jenner's time, smallpox killed around 10% of the global population, with the number as high as 20% in towns and cities where infection spread more easily.[6] In 1821, he was appointed physician to King George IV, and was also made mayor of Berkeley and justice of the peace. He was a member of the Royal Society. In the field of zoology, he was among the first modern scholars to describe the brood parasitism of the cuckoo (Aristotle also noted this behaviour in his History of Animals). In 2002, Jenner was named in the BBC's list of the 100 Greatest Britons.
Early life
Jenner's handwritten draft describing the first vaccination is held at the Royal College of Surgeons in London
Edward Jenner was born on 17 May 1749[7] in Berkeley, Gloucestershire, England as the eighth of nine children.[8] His father, the Reverend Stephen Jenner, was the vicar of Berkeley, so Jenner received a strong basic education.[7]
Education and training
When he was young, he went to school in Wotton-under-Edge at Katherine Lady Berkeley's School and in Cirencester.[7] During this time, he was inoculated (by variolation) for smallpox, which had a lifelong effect upon his general health.[7] At the age of 14, he was apprenticed for seven years to Daniel Ludlow, a surgeon of Chipping Sodbury, South Gloucestershire, where he gained most of the experience needed to become a surgeon himself.[7]
Jenner's 1802 testimonial to the efficacy of vaccination, signed by 112 members of the Physical Society, London
In 1770, aged 21, Jenner became apprenticed in surgery and anatomy under surgeon John Hunter and others at St George's Hospital, London.[9]William Osler records that Hunter gave Jenner William Harvey's advice, well known in medical circles (and characteristic of the Age of Enlightenment), "Don't think; try."[10] Hunter remained in correspondence with Jenner over natural history and proposed him for the Royal Society. Returning to his native countryside by 1773, Jenner became a successful family doctor and surgeon, practising on dedicated premises at Berkeley. In 1792, "with twenty years' experience of general practice and surgery, Jenner obtained the degree of MD from the University of St Andrews".[2]
Later life
Jenner and others formed the Fleece Medical Society or Gloucestershire Medical Society, so called because it met in the parlour of the Fleece Inn, Rodborough, Gloucestershire. Members dined together and read papers on medical subjects. Jenner contributed papers on angina pectoris, ophthalmia, and cardiac valvular disease and commented on cowpox. He also belonged to a similar society which met in Alveston, near Bristol.[11]
He became a master mason on 30 December 1802, in Lodge of Faith and Friendship #449. From 1812 to 1813, he served as worshipful master of Royal Berkeley Lodge of Faith and Friendship.[12]
Zoology
Jenner was elected fellow of the Royal Society in 1788, following his publication of a careful study of the previously misunderstood life of the nested cuckoo, a study that combined observation, experiment, and dissection.
Jenner described how the newly hatched cuckoo pushed its host's eggs and fledgling chicks out of the nest (contrary to existing belief that the adult cuckoo did it).[13] Having observed this behaviour, Jenner demonstrated an anatomical adaptation for it–the baby cuckoo has a depression in its back, not present after 12 days of life, that enables it to cup eggs and other chicks. The adult does not remain long enough in the area to perform this task. Jenner's findings were published in Philosophical Transactions of the Royal Society in 1788.[14][15]
"The singularity of its shape is well adapted to these purposes; for, different from other newly hatched birds, its back from the scapula downwards is very broad, with a considerable depression in the middle. This depression seems formed by nature for the design of giving a more secure lodgement to the egg of the Hedge-sparrow, or its young one, when the young Cuckoo is employed in removing either of them from the nest. When it is about twelve days old, this cavity is quite filled up, and then the back assumes the shape of nestling birds in general."[16] Jenner's nephew assisted in the study. He was born on 30 June 1737.
Jenner's understanding of the cuckoo's behaviour was not entirely believed until the artist Jemima Blackburn, a keen observer of birdlife, saw a blind nestling pushing out a host's egg. Blackburn's description and illustration were enough to convince Charles Darwin to revise a later edition of On the Origin of Species.[17]
Jenner's interest in zoology played a large role in his first experiment with inoculation. Not only did he have a profound understanding of human anatomy due to his medical training, but he also understood animal biology and its role in human-animal trans-species boundaries in disease transmission. At the time, there was no way of knowing how important this connection would be to the history and discovery of vaccinations. We see this connection now; many present-day vaccinations include animal parts from cows, rabbits, and chicken eggs, which can be attributed to the work of Jenner and his cowpox/smallpox vaccination.[18]
Marriage and human medicine
A lecturer's certificate of attendance given to Jenner. He attended many lectures on chemistry, medicine and physics.
Jenner married Catherine Kingscote (who died in 1815 from tuberculosis) in March 1788. He might have met her while he and other fellows were experimenting with balloons. Jenner's trial balloon descended into Kingscote Park, Gloucestershire, owned by Catherine's father Anthony Kingscote.[19] They had three children: Edward Robert (1789–1810), Robert Fitzharding (1792–1854) and Catherine (1794–1833).[8]
He earned his MD from the University of St Andrews in 1792.[20] He is credited with advancing the understanding of angina pectoris.[21] In his correspondence with Heberden, he wrote: "How much the heart must suffer from the coronary arteries not being able to perform their functions".[22]
Invention of the vaccine
Edward Jenner advising a farmer to vaccinate his family. Oil painting by an English painter, c.1910Jenner's discovery of the link between cowpox pus and smallpox in humans helped him to create the smallpox vaccine.
Inoculation was already a standard practice in Asian and African medicine but involved serious risks, including the possibility that those inoculated would become contagious and spread the disease to others.[23] In 1721, Lady Mary Wortley Montagu had imported variolation to Britain after having observed it in Istanbul. While Johnnie Notions had great success with his self-devised inoculation[24] (and was reputed not to have lost a single patient),[25] his method's practice was limited to the Shetland Isles. Voltaire wrote that at this time 60% of the population caught smallpox and 20% of the population died from it.[26] Voltaire also states that the Circassians used the inoculation from times immemorial, and the custom may have been borrowed by the Turks from the Circassians.[27] In 1766, Daniel Bernoulli analysed smallpox morbidity and mortality data to demonstrate the efficacy of inoculation.[28]
The steps taken by Edward Jenner to create vaccination, the first vaccine for smallpox. Jenner did this by inoculating James Phipps with cowpox, a virus similar to smallpox, to create immunity, unlike variolation, which used smallpox to create an immunity to itself.
By 1768, English physician John Fewster had realised that prior infection with cowpox rendered a person immune to smallpox.[29][30] In the years following 1770, at least five investigators in England and Germany (Sevel, Jensen, Jesty 1774, Rendell, Plett 1791) successfully tested in humans a cowpox vaccine against smallpox.[31] For example, Dorset farmer Benjamin Jesty[32] successfully vaccinated and presumably induced immunity with cowpox in his wife and two children during a smallpox epidemic in 1774, but it was not until Jenner's work that the procedure became widely understood. Jenner may have been aware of Jesty's procedures and success.[33] A similar observation was later made in France by Jacques Antoine Rabaut-Pommier in 1780.[34]
Jenner postulated that the pus in the blisters that affected individuals affected by cowpox (a disease similar to smallpox, but much less virulent) protected them from smallpox. On 14 May 1796, Jenner tested his hypothesis by inoculating James Phipps, an eight-year-old boy who was the son of Jenner's gardener. He scraped pus from cowpox blisters on the hands of Sarah Nelmes, a milkmaid who had caught cowpox from a cow called Blossom,[35] whose hide now hangs on the wall of the St. George's Medical School library (now in Tooting). Phipps was the 17th case described in Jenner's first paper on vaccination.[36]
Jenner's Hypothesis:
The initial source of infection was a disease of horses, called "the grease", which was transferred to cattle by farm workers, transformed, and then manifested as cowpox.
Jenner performing his first vaccination on James Phipps, a boy of age 8, on 14 May 1796
Jenner inoculated Phipps in both arms that day, subsequently producing in Phipps a fever and some uneasiness, but no full-blown infection. Later, he injected Phipps with variolous material, the routine method of immunization at that time. No disease followed. The boy was later challenged with variolous material and again showed no sign of infection. No unexpected side effects occurred, and neither Phipps nor any other recipients underwent any future 'breakthrough' cases.
Jenner's biographer John Baron would later speculate that Jenner understood one could be inoculated against smallpox by being exposed to cowpox by observing the unblemished complexion of milkmaids, rather than building on the work of his predecessors. The milkmaids story is still widely repeated even though it appears to be a myth.[37][38]
Known:
Smallpox is more dangerous than variolation and cowpox less dangerous than variolation.
Hypothesis:
If target is infected with cowpox, then target is immune to smallpox.
Test:
If variolation after infection with cowpox fails to produce a smallpox infection, immunity to smallpox has been achieved.
Consequence:
Immunity to smallpox can be induced much more safely than by variolation.
Donald Hopkins has written, "Jenner's unique contribution was not that he inoculated a few persons with cowpox, but that he then proved [by subsequent challenges] that they were immune to smallpox. Moreover, he demonstrated that the protective cowpox pus could be effectively inoculated from person to person, not just directly from cattle."[39] Jenner successfully tested his hypothesis on 23 additional subjects.
James Gillray's 1802 caricature of Jenner vaccinating patients who feared it would make them sprout cowlike appendages.1808 cartoon showing Jenner, Thomas Dimsdale and George Rose seeing off anti-vaccination opponents
Jenner continued his research and reported it to the Royal Society, which did not publish the initial paper. After revisions and further investigations, he published his findings on the 23 cases, including his 11-month-old son Robert.[40] Some of his conclusions were correct, some erroneous; modern microbiological and microscopic methods would make his studies easier to reproduce. The medical establishment deliberated at length over his findings before accepting them. Eventually, vaccination was accepted, and in 1840, the British government banned variolation–the use of smallpox to induce immunity–and provided vaccination using cowpox free of charge (seeVaccination Act).
The success of his discovery soon spread around Europe and was used en masse in the Spanish Balmis Expedition (1803–1806), a three-year-long mission to the Americas, the Philippines, Macao, China, led by Francisco Javier de Balmis with the aim of giving thousands the smallpox vaccine.[41] The expedition was successful, and Jenner wrote: "I don't imagine the annals of history furnish an example of philanthropy so noble, so extensive as this".[42]Napoleon, who at the time was at war with Britain, had all his French troops vaccinated, awarded Jenner a medal, and at the request of Jenner, he released two English prisoners of war and permitted their return home.[43][44] Napoleon remarked he could not "refuse anything to one of the greatest benefactors of mankind".[43]
1873 sculpture of Jenner vaccinating his own son against smallpox by Italian sculptor Giulio Monteverde, Galleria Nazionale d'Arte Moderna, Rome
Jenner's continuing work on vaccination prevented him from continuing his ordinary medical practice. He was supported by his colleagues and the King in petitioning Parliament,[45] and was granted £10,000 in 1802 for his work on vaccination.[46] In 1807, he was granted another £20,000 after the Royal College of Physicians confirmed the widespread efficacy of vaccination.[2]
Jenner was later elected a foreign honorary member of the American Academy of Arts and Sciences in 1802, a member of the American Philosophical Society in 1804,[47] and a foreign member of the Royal Swedish Academy of Sciences in 1806.[48] In 1803 in London, he became president of the Jennerian Society, concerned with promoting vaccination to eradicate smallpox. The Jennerian ceased operations in 1809. Jenner became a member of the Medical and Chirurgical Society on its founding in 1805 (now the Royal Society of Medicine) and presented several papers there. In 1808, with government aid, the National Vaccine Establishment was founded, but Jenner felt dishonoured by the men selected to run it and resigned his directorship.[5]:122–125
Returning to London in 1811, Jenner observed a significant number of cases of smallpox after vaccination. He found that in these cases the severity of the illness was notably diminished by previous vaccination. In 1821, he was appointed physician extraordinary to King George IV, and was also made mayor of Berkeley[2] and magistrate[5]:303 (justice of the peace). He continued to investigate natural history, and in 1823, the last year of his life, he presented his "Observations on the Migration of Birds" to the Royal Society.[46]
Jenner was found in a state of apoplexy on 25 January 1823, with his right side paralysed.[5]:314 He did not recover and died the next day of an apparent stroke, his second, on 26 January 1823,[5] aged 73. He was buried in the family vault at the Church of St Mary, Berkeley.[51]
Neither fanatic nor lax,[52] Jenner was a Christian who in his personal correspondence showed himself quite spiritual.[5]:141 Some days before his death, he stated to a friend: "I am not surprised that men are not grateful to me; but I wonder that they are not grateful to God for the good which He has made me the instrument of conveying to my fellow creatures".[5]:295
Jenner's House, The Chantry, Church Lane, Berkeley, Gloucestershire, EnglandBronze statue of Jenner in Kensington Gardens, LondonEdward Jenner's name as it appears on the Frieze of the LSHTM Keppel Street building
Near the Gloucestershire village of Uley, Downham Hill is locally known as "Smallpox Hill" for its possible role in Jenner's studies of the disease.[61]
Built around 1970, The Jenner Health Centre, 201 Stanstead Road, Forest Hill, London, SE23 1HU[70]
Jenner's name is featured on the Frieze of the London School of Hygiene & Tropical Medicine. Twenty-three names of public health and tropical medicine pioneers were chosen to feature on the Keppel Street building when it was constructed in 1926.[71]
Koyama Shisei[ja], Japanese vaccinologist (1807-1862) who improved upon the Jennerian smallpox vaccine
Related Research Articles
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating the body's adaptive immunity, they help prevent sickness from an infectious disease. When a sufficiently large percentage of a population has been vaccinated, herd immunity results. Herd immunity protects those who may be immunocompromised and cannot get a vaccine because even a weakened version would harm them. The effectiveness of vaccination has been widely studied and verified. Vaccination is the most effective method of preventing infectious diseases; widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the elimination of diseases such as polio and tetanus from much of the world. According to the World Health Organization (WHO), vaccination prevents 3.5–5 million deaths per year. A WHO-funded study by The Lancet estimates that, during the 50-year period starting in 1974, vaccination prevented 154 million deaths, including 146 million among children under age 5. However, some diseases have seen rising cases due to relatively low vaccination rates attributable partly to vaccine hesitancy.
Cowpox is an infectious disease caused by the cowpox virus (CPXV). It presents with large blisters in the skin, a fever and swollen glands, historically typically following contact with an infected cow, though in the last several decades more often from infected cats. The hands and face are most frequently affected and the spots are generally very painful.
The smallpox vaccine is used to prevent smallpox infection caused by the variola virus. It is the first vaccine to have been developed against a contagious disease. In 1796, British physician Edward Jenner demonstrated that an infection with the relatively mild cowpox virus conferred immunity against the deadly smallpox virus. Cowpox served as a natural vaccine until the modern smallpox vaccine emerged in the 20th century. From 1958 to 1977, the World Health Organization (WHO) conducted a global vaccination campaign that eradicated smallpox, making it the only human disease to be eradicated. Although routine smallpox vaccination is no longer performed on the general public, the vaccine is still being produced for research, and to guard against bioterrorism, biological warfare, and mpox.
The vaccinia virus is a large, complex, enveloped virus belonging to the poxvirus family. It has a linear, double-stranded DNA genome approximately 190 kbp in length, which encodes approximately 250 genes. The dimensions of the virion are roughly 360 × 270 × 250 nm, with a mass of approximately 5–10 fg. The vaccinia virus is the source of the modern smallpox vaccine, which the World Health Organization (WHO) used to eradicate smallpox in a global vaccination campaign in 1958–1977. Although smallpox no longer exists in the wild, vaccinia virus is still studied widely by scientists as a tool for gene therapy and genetic engineering.
The Royal Philanthropic Vaccine Expedition, commonly referred to as the Balmis Expedition, was a Spanish healthcare mission that lasted from 1803 to 1806, led by Dr Francisco Javier de Balmis, which vaccinated millions of inhabitants of Spanish America and Asia against smallpox. The vaccine was transported through children: orphaned boys who sailed with the expedition.
James Phipps was the first person given the experimental cowpox vaccine by Edward Jenner. Jenner knew of a local belief that dairy workers who had contracted a relatively mild infection called cowpox were immune to smallpox, and successfully tested his theory on the 8-years-old James Phipps on 17 May 1796.
Edgar March Crookshank was an English physician and microbiologist.
Benjamin Jesty was a farmer at Yetminster and Worth Matravers in Dorset, England, notable for his early experiments in inducing immunity against smallpox using cowpox.
Artificial induction of immunity is immunization achieved by human efforts in preventive healthcare, as opposed to natural immunity as produced by organisms' immune systems. It makes people immune to specific diseases by means other than waiting for them to catch the disease. The purpose is to reduce the risk of death and suffering, that is, the disease burden, even when eradication of the disease is not possible. Vaccination is the chief type of such immunization, greatly reducing the burden of vaccine-preventable diseases.
The history of smallpox extends into pre-history. Genetic evidence suggests that the smallpox virus emerged 3,000 to 4,000 years ago. Prior to that, similar ancestral viruses circulated, but possibly only in other mammals, and possibly with different symptoms. Only a few written reports dating from about 500 AD to 1000 AD are considered reliable historical descriptions of smallpox, so understanding of the disease prior to that has relied on genetics and archaeology. However, during the 2nd millennium AD, especially starting in the 16th century, reliable written reports become more common. The earliest physical evidence of smallpox is found in the Egyptian mummies of people who died some 3,000 years ago. Smallpox has had a major impact on world history, not least because indigenous populations of regions where smallpox was non-native, such as the Americas and Australia, were rapidly and greatly reduced by smallpox during periods of initial foreign contact, which helped pave the way for conquest and colonization. During the 18th century the disease killed an estimated 400,000 Europeans each year, including five reigning monarchs, and was responsible for a third of all blindness. Between 20 and 60% of all those infected—and over 80% of infected children—died from the disease.
Variolation was the method of inoculation first used to immunize individuals against smallpox (Variola) with material taken from a patient or a recently variolated individual, in the hope that a mild, but protective, infection would result. Only 1–2% of those variolated died from the intentional infection compared to 30% who contracted smallpox naturally. Variolation is no longer used today. It was replaced by the smallpox vaccine, a safer alternative. This in turn led to the development of the many vaccines now available against other diseases.
William Woodville was an English physician and botanist. Convinced by the work of Edward Jenner, he was among the first to promote vaccination. His four volume book on medical botany published between 1790 and 1794 with 300 illustrations of medicinal plants by James Sowerby was an important reference work for physicians in the nineteenth century with a second edition in 1810 followed by a revision in 1832 by William Jackson Hooker and George Spratt.
John Fewster was a surgeon and apothecary in Thornbury, Gloucestershire. Fewster, a friend and professional colleague of Edward Jenner, played an important role in the discovery of the smallpox vaccine. In 1768 Fewster realized that prior infection with cowpox rendered a person immune to smallpox.
A statue of Edward Jenner, the physician, scientist and pioneer of the world's first vaccine, is located in Kensington Gardens in London. A work of the sculptor William Calder Marshall, the bronze was originally unveiled by Albert, Prince Consort in Trafalgar Square on 17 May 1858, before being moved to its present location in 1862. It is a Grade II listed building.
Inoculation is the act of implanting a pathogen or other microbe or virus into a person or other organism. It is a method of artificially inducing immunity against various infectious diseases. The term "inoculation" is also used more generally to refer to intentionally depositing microbes into any growth medium, as into a Petri dish used to culture the microbe, or into food ingredients for making cultured foods such as yoghurt and fermented beverages such as beer and wine. This article is primarily about the use of inoculation for producing immunity against infection. Inoculation has been used to eradicate smallpox and to markedly reduce other infectious diseases such as polio. Although the terms "inoculation", "vaccination", and "immunization" are often used interchangeably, there are important differences. Inoculation is the act of implanting a pathogen or microbe into a person or other recipient; vaccination is the act of implanting or giving someone a vaccine specifically; and immunization is the development of disease resistance that results from the immune system's response to a vaccine or natural infection.
Onesimus was an African man who was instrumental in the mitigation of smallpox in Boston, Massachusetts.
Derrick Baxby was a British microbiologist and authority on Orthopoxviruses. He was a senior lecturer in medical microbiology at the University of Liverpool.
Indian Vaccination Act of 1832 is a US federal law passed by the US Congress in 1832. The purpose of the act was to vaccinate the American Indians against smallpox to prevent the spread of the disease.
Maria Isabel Wittenhall van Zeller (1749–1819) was a pioneer in the use of vaccination against smallpox in Portugal. She became notable for promoting the use of smallpox vaccination at the beginning of the 19th century, particularly in the Porto area.
War Against Smallpox: Edward Jenner and the Global Spread of Vaccination is a 2020 book by historian and academic Michael J. Bennett. It describes "the devastating and disfiguring impact of smallpox still at large "in the shrinking eighteenth-century globe." It shows how increasing recourse to smallpox inoculation, a risky procedure, prompted Edward Jenner's early experimentation with cowpox as a prophylaxis for smallpox.
↑ "Observations on the Natural History of the Cuckoo". By Mr. Edward Jenner. In a Letter to John Hunter, Esq. F.R.S. Jenner, E Philosophical Transactions of the Royal Society of London (1776–1886). 1788. 78:219–237 (Archived Text)
↑ Sealy Spencer G (2011). "Cuckoo chicks evicting their nest mates: coincidental observations by Edward Jenner in England and Antoine Joseph Lottinger in France". Archives of Natural History. 38 (2): 220–228. doi:10.3366/anh.2011.0030.
↑ (Letter to Hunter at the Royal Society, as above)
↑ The Biographical Dictionary of Scottish Women. 2006.
↑ Richard B. Fisher, Edward Jenner (Andre Deutsch, 1991) pp. 40–42 [ISBNmissing]
↑ "A brief history of the University". University of St Andrews. Retrieved 11 February 2018. Through the centuries many great minds have been attracted to St Andrews:...Edward Jenner, pioneer of the smallpox vaccine (MD, 1792)
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