Archives ofDisease in Childhood 1996; 74: F77-F78 F77 Arch Dis Child Fetal Neonatal Ed: first published as 10.1136/fn.74.1.F77 on 1 January 1996. Downloaded from PERINATAL LESSONS FROM THE PAST

Dr (1749-1823) of Berkeley, and against

Peter M Dunn

Edward Jenner was born on 17 May 1749, the eighth child of the Reverend Stephen Jenner, vicar of Berkeley in the county of Gloucestershire. Both his parents died when he was 5 and he was then looked after by his eldest brother. Educated at Wotton-under- Edge and Cirencester, at the age of 13 he was apprenticed for seven years to Daniel Ludlow, a surgeon of Sodbury near Bristol.' In 1770 he travelled to London to become a house pupil of John Hunter and a student at St George's hospital. Three years later, resisting the sug- gestion that he practise in London, Jenner returned to Berkeley to become a country physician: perhaps because he was a keen nat- uralist. Besides being both curious and observant, he kept meticulous notes and possessed a happy combination of common sense and scientific logic. Spurred on by John Hunter with whom he had developed a warm friend- ship and who wrote, 'Why think? Why not try the experiment?', Jenner studied such subjects as the temperature of hibernating hedgehogs, the life history of eels, and the migration of Dr Edward J7enner in 1801.

birds. His best known observations were on the http://fn.bmj.com/ cuckoo. This bird was known to lay its eggs in their eldest son, Robert, was born. Hunter the nests of other birds, particularly the hedge- became his godfather. A daughter and second sparrow, and to depend on the foster parents to son followed. In 1792 Jenner was made MD by hatch and feed its chicks. Philosophers since the University of St Andrews. This enabled the days of Aristotle had puzzled as to how the him to practise as a physician in the fashion- foster parent's own chicks came to be ejected able spa of Cheltenham. He also helped to from the nest and left to die. Jenner discovered establish two local medical societies and on September 26, 2021 by guest. Protected copyright. that the cuckoo chick was itselfresponsible and presented papers on such matters as mitral demonstrated by dissection that the latter had stenosis and, importantly, on the association of a hollow on its back that enabled it to obtain a angina pectoris with coronary artery disease. good purchase. In one instance he recorded He was also interested in botany and in 1798 observing two cuckoo hatchlings in one nest. was elected a fellow of the Linnaean Society. He wrote: 'The contest was very remarkable. In the 18th century every 10th person in The combatants alternately appeared to have Europe died of smallpox and the survivors were the advantage, as each carried the other several often terribly scarred. Against this background times to the top of the nest, and then sunk Jenner, as an apprentice in 1768, first heard a down again, oppressed by the weight of its dairy maid claim: 'I can't take the smallpox, for burden; till at length, after various efforts, the I have already had the '. During the fol- strongest prevailed'. After his findings had lowing years he discussed the matter with been presented to the Royal Society in 1788, Hunter and others, with little response. Indeed, Department of he was elected FRS.2 his friends in the west country Convivio- Perinatal Medicine Jenner was a conscientious and successful Medical Club threatened him with expulsion if and Child Health, doctor, a vigorous countryman, and adept at he brought up the subject again. In 1796 Jenner University ofBristol, in Southmead Hospital, social gatherings. He took pride his appear- put the theory to test and sent his findings to Sir Bristol BS10 SNB ance, enjoyed good food, singing and playing Joseph Banks, President of the Royal Society. P M Dunn the flute and the fiddle, and he wrote poetry His manuscript was not accepted. Two years Correspondence to: about the countryside. In 1788 he married later, after further studies, Jenner published his Professor P M Dunn. Catherine Kingscote and the following year 'Inquiry'3 privately. He began by describing a F78 Dunn Arch Dis Child Fetal Neonatal Ed: first published as 10.1136/fn.74.1.F77 on 1 January 1996. Downloaded from number of people previously infected with cow an infant newly born, my nephew, Mr pox who had then failed to respond to inocula- Henry Jenner, at my request inserted the tion with smallpox or to catch the disease. Next virus into the arm of a child about he described his crucial experiment: 20 hours old. His report to me is that the child went through the disease without 'The more accurately to observe the apparent illness, yet that it was found progress of the infection, I selected a effectually to resist the action of variolous healthy boy (James Phipps), about eight matter with which it was subsequently years old, for the purpose of inoculation inoculated'. for the Cox Pox. The matter was taken from a sore on the hand of a dairymaid Jenner also noted that cowpox was not trans- (Sarah Nelmes), who was infected by her mitted to others sharing the same bed, and that master's cows, and it was inserted, on the a young woman with several lesions on her 14th ofMay, 1796, into the arm ofthe boy hand failed to transmit the disease to the infant by means of two superficial incisions, she was nursing. Almost in passing he was also barely penetrating the cutis, each about the first to describe an allergic reaction; it half an inch long. On the seventh day he occurred in a woman, Mary Barge, inoculated complained of uneasiness in the axilla, with variolous matter in 1791 who had had and on the ninth he became a little chilly, cowpox 31 years earlier. lost his appetite, and had a slight head- The response to Jenner's report was mixed, ache. During the whole of this day he was ranging from disinterest, ridicule, and opposi- perceptibly indisposed, and spent the tion to gathering enthusiasm, especially night with some degree ofrestlessness, but abroad. Within a few years many hundreds of on the day following he was perfectly well. thousands of people had been vaccinated The appearance of the incisions in their around the world and the mortality from small- progress to a state of maturation were pox dramatically reduced. Jenner was show- much the same as when produced in a ered with honours. Parliament awarded him similar manner by variolous matter. The ,£30 000 and he was given the Freedom of the only difference which I perceived was, in City of London. He was received by George the state of the limpid fluid arising from III, the Tsar, and the King of Prussia, while the action of the virus, which assumed Napoleon made his famous comment 'Ah! rather a darker hue, and in that of c'est Jenner. Je ne puis pas refuser a Jenner'. In the efflorescence spreading round the 1813 Oxford University made him a Doctor of incisions, which had more of an erysipela- Physic. But he remained a modest and loved tous look than we commonly perceive country practitioner living at the Chantry in when variolous matter has been made use Berkeley (now the Jenner Museum). Nearby of in the same manner; but the whole died he built a cottage for James Phipps. away (leaving on the inoculated parts He had a strong faith, and also became a scabs and subsequent eschars) without free-mason and a magistrate. In 1815 his wife giving me or my patient the least trouble. and eldest son died, probably from tuberculo- In order to ascertain whether the boy, sis, and in 1823 at the age of 74 his own life

after feeling so slight an affection of the ended following a stroke. He was buried with http://fn.bmj.com/ system from the Cox-Pox virus, was secure his family in Berkeley Church. So passed away from the contagion of the Small-Pox, he one of the greatest benefactors and scientists was inoculated on the 1st ofJuly following known to mankind. with variolous matter, immediately taken from a pustule. Several slight punctures and incisions were made on both his arms, Addendum and the matter was carefully inserted, but Dr Michael Underwood, a London physician on September 26, 2021 by guest. Protected copyright. no disease followed. The same appearances and contemporary ofJenner, wrote: '... if (vac- were observable on the arms as we com- cination) were universally adopted, the small- monly see when a patient has had variolous pox would in a few years become entirely matter applied, after having either the Cox- extinct'. However, vaccination was not made Pox or the Small-Pox. Several months compulsory in England until 1853, and afterwards, he was again inoculated with another 126 years were to pass before smallpox variolous matter, but no sensible effect was was finally eradicated by the WHO vaccination produced on the constitution.' campaign of the 1970s. Jenner went on to test the effect of protective 1 Underwood EA, Campbell AMG. Edward _Jenner: the man vaccination with lymph taken direct from sores and his work. Britsol: John Wright & Sons Ltd, 1966. 2 Fisher RB. Edward J7enner, 1749-1823. London: Andre on cow's teats, and also of arm to arm vaccina- Deutsch Ltd, 1991. tion. In his second edition (1800) he wrote: 3 Jenner E. An inquiry into the causes and effects of the variolae vaccinae, a disease discovered in some ofthe western countries of England, particularly Gloucestershire and known by the name 'Wishing to see the effect of the disease on of the cow-pox. London: Sampson Low, 1798.