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The great leveller: humanity's struggle against infectious disease

Jenner on smallpox

Illustration showing smallpox lesions on the hand of a womanSmallpox lesion on the hand of Sarah NelmesIn 1798 the surgeon Edward Jenner (1749-1823) publicised a technique which had been used by the Gloucestershire farmer Benjamin Jesty. He had protected his family and employees by using cowpox as a vaccine against smallpox.

There is evidence that this practice was widespread, and that other medical practitioners had known of it, but had not publicised it. Cowpox works as a vaccine because the outer coat of the cowpox virus contains proteins identical to those that the immune system uses to mark out the smallpox virus for destruction.

Vaccination produces a multitude of immune cells programmed to kill anything which carry these proteins. If the correct procedures are undertaken, cowpox vaccination is more successful than inoculation. Jenner was not a very meticulous scientist, whose lack of care in gathering information about his case studies and adulteration of vaccine exposed his method to a widespread anti-vaccination campaign which lasted for the next century.

Illustration showing a smallpox lesion on the arm of a childPlate 2. Smallpox lesion on the arm of a childIn fact, Jenner’s method only became so widespread so quickly because many influential people, including the medical profession, had a stake in its success. Napoleon’s generals and their opponents wanted their soldiers to die on the battlefield rather than of disease. Vaccination would also disturb the routines of industrialising societies far less than isolation and quarantine, as John Haygarth had proposed.

The illustrations shown here show the progress of the response to vaccination, in which a pale nodule grows out of the inoculation site, surrounded by a growing red halo of inflammation, which breaks down after ten days into a shallow ulcer, which scabs over ten days later.

Illustration showing a smallpox lesion on the arm of a childPlate 3. Smallpox lesion on the arm of a childThe image at the top right shows the arm of Sarah Nelmes, the daughter of a wealthy local landowner, who developed the firm ulcers of cowpox on her right hand after milking a cow.

Plate 2 and plate 3 refer to the cases, respectively, of the children John Baker and William Pead, who were vaccinated from matter taken from smallpox pustules on other cases which Jenner had treated. The arm-to-arm method of vaccination was disowned by later vaccinators.

The 1798 edition of this work bears Jenner’s own inscription: he gave it to Henry Cline, a surgeon at St Thomas’s Hospital.

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