HEALTH HERCW Edward Jenner METROPOLITAN LIFE INSURANCE COMPANY Pacific Coast Head Office HOME OFFICE Canadian Head Office San Francisco NEW YORK Ottawa HEALTH HEROES Edward Jenner By Grace T. Hallock, formerly Associ- ate Director Division of Publications American Child Health Association and C. E. Turner, Associate Professor of Biology and Public Health, Massa* chusetts Institute of Technology. Copyright, 1926, by Grach T. Hallock and C. E. Turnfr Cover portrait from the Xew Internationa] Encyclopedia by permission of Dodd, Mead & Company Edward Jenner Edward Jenner was born on May 17,1749, at Berkeley in Gloucestershire, England. His father, Stephen Jenner, was the vicar there. This was a quarter of a century before the war of the American Revolution. Edward Jenner's boyhood was spent in the country and, like other boys and girls who love outdoor life, he studied the habits of birds and animals, and collected fossils. His interest in natural history lasted all through his life. Although Jenner was just an everyday sort of boy, he was destined to become one of the greatest heroes of the human race, a hero in the war against smallpox. For centuries this giant disease had been striding up and down over the face of the earth bringing death and disfigurement to the people in its path. And then one man, armed with a new weapon, vaccination, showed us how to overcome the giant. When Jenner was a little boy, smallpox was a very common disease. It was so dangerous that many people used to have a doctor give them a mild form of the disease as a protection against a severe attack. This practice was called "inoculation against the smallpox." The usual method of inoculation was to take matter from the sores or pocks of a patient with a mild case of smallpox and place it in three or four scratches on the body of the person to be inoculated. This ordinarily gave a mild form of smallpox to the person treated. Before inoculation the patient usually had to go through a preparatory process. 3 METROPOLITAN LIFE INSURANCE COMPANY Jenner's Inoculation When Edward Jenner was a fine ruddy-cheeked boy of eight, his family decided to have him inoculated. With many others he was put through the preparatory process. This trying procedure lasted six weeks. He was first bled to find out whether his blood was "fine." Then he was purged until his rosy cheeks became pale and thin. During all this time he was kept on a scanty diet and dosed with some drink which was supposed to sweeten his blood. At the end of this time he was inoculated with smallpox. By good luck his attack of the disease was mild, but it is often said that he could never sleep as well afterward and he sometimes imagined that he heard strange noises. This experience of little Edward Jenner is especially interest- ing because it was he who was to put an end to the practice of inoculation by the development of the simple and harmless procedure of vaccination. In order to under- stand what a great service Jenner rendered to humanity, it is necessary to know something of the history of smallpox up to his time. The History of Smallpox Today we can scarcely imagine what smallpox meant to people in the days before vaccination. Figures may help us a little. About 150 years ago, ten out of every hundred deaths were caused by smallpox. Out of every hundred children who died before they were ten years old thirty-three died of smallpox. More than half of all the people living were scarred and disfigured by it. It is estimated that 60,000,000 of the inhabitants of Europe died from smallpox in the 18th century. It attacked persons of every rank, from the peasant to the king. An expanded Life of Edward Jenner by the authors of this story wilt be published in 1927 by D. C. Heath and Company, New York City. 4 HEALTH HEROES-EDWARD JENNER Smallpox is no respecter of persons So common was smallpox before 1796 that an adult person who had not had smallpox was scarcely met or heard of in the United Kingdom. " If a fugitive from justice had happened never to have had an attack of smallpox, and, therefore, was not pock-marked, this fact was mentioned as a means of identification. Imagine the laughter that such a means of identification would excite today. Today, on the contrary, if he happened to be pock-marked, that fact would be advertised as a means of identification.'''* According to tradition, smallpox had its origin in India. It was also known in China at a very early period. The disease traveled west through Arabia, Ethiopia, and neighboring countries, and was brought to Alexandria in Egypt by the Arabs in A. D. 640. The first epidemic of smallpox in Europe took place about the latter part of the 16th century. Smallpox is very contagious and a severe attack means either death or disfigurement. A person who has had it usually cannot take it again. Is it any wonder that many people preferred to have a doctor deliberately give them a mild form of the disease as a protection against a severe attack? *W. W. Kebn, M.D., "Personal Experience in Three Epidemics of Smallpox." Saturday Evening Post, February 28, 1925. 5 METROPOLITAN LIFE INSURANCE COMPANY The History of Inoculation Inoculation is said to have been practiced first in India over 1,000 years before Christ and we know that it was an old custom in China. From Asia and Africa the practice of smallpox in- oculation passed into Europe by way of Con- stantinople where it was known in the latter part of the 17th century. Among the Arabs the custom was called "buy- ing the smallpox.'" Dr. Patrick Russell, a phy- sician at Aleppo, wrote a letter to his brother in 1726 in which he ex- plained why this expres- sion was used. This method of pro- curing the disease is termed the buying of smallpox on the follow- ing account. The child to be inoculated carries a few raisins, dates, sugar-plums or suchlike and showing them to the child from whom the matter is to be taken, asks how many pocks he will give in exchange. The bargain being made, they proceed to the operation. When the parties are too young to speak for themselves the bargain is made by the mothers. Inoculation was introduced into England by Lady Mary Wortley Montague. Lady Montague was the wife of the British Ambassador at the Ottoman (Turkish) Court. She saw inoculation practiced in Turkey An advertisement for a fugitive from justice who was not poc^mar^ed, in the days before vaccination 6 HEALTH HEROES-EDWARD JENNER and was very enthusiastic about the results. In 1717 she wrote to a friend: I am going to tell you a thing that I imagine will make you wish yourself here. The smallpox, so fatal and general amongst us, is here entirely harmless by the invention of engrafting, which is the term they give it. There is a set of old women who make it their business to perform the operation every autumn in the month of September, when the great heat has abated. People send to one another to know if any of their families has a mind to have the smallpox. They make parties for this purpose, and when they are met (commonly fifteen or sixteen together), the old woman comes with a nutshell full of the matter of the best sort of smallpox, and asks what veins you please to have opened. She immediately rips open that which you offer to her with a large needle(which gives you no more pain than a common scratch), and puts into the vein as much venom as can lie upon the end of her needle, and after binds up the little wound with a hollow bit of shell; and in this manner opens four or five veins. The children or young patients play together all the rest of the day and are in perfect health until the eighth day, then fever seizes them and they keep their beds two days, very seldom three. They have rarely about twenty or thirty (pocks) on their faces, which never mark, and in eight days' time they are as well as before their illness. Everywhere thousands undergo this open ation, and the French Ambassador says pleasantly that they take the smallpox here by way of a diversion, as they take the waters in other countries. There is no example of anyone that had died in it, and you may well believe I am satisfied of the safety of the experiment, since I intend to try it upon my dear little son. I am patriot enough to take pains to bring this useful invention into fashion in England. Inoculation in England Lady Montague had her little son inoculated in 'March, 1717. This was the first time that the Eastern method of inoculation was performed on a British subject. When Lady Montague returned to England she com tinned her crusade for inoculation. Most people, however, were afraid to try it until they had seen its results. 7 METROPOLITAN LIFE INSURANCE COMPANY In August, 1722, six criminals in Newgate Prison were offered their freedom if they would submit to the operation of inoculation. They agreed, the inoculation was success' ful, and the criminals were set free. Caroline, Princess of Wales, ordered the operation to be performed on some charity children, and as the results satisfied her, she had two of the young princesses inoculated. With this royal approval, the practice gained steadily in England, and many English physicians became skillful inoculators. Inoculation in America The inoculation of smallpox was introduced into America during the smallpox epidemic in Boston in 1721. This was Boston's sixth epidemic. The city then had a population of 11,000. There were 5,989 smallpox victims during the epidemic and 894 died, a proportion of about one in seven. Cotton Mather became interested in inoculation through reading accounts of it as practiced in Turkey and neighboring countries. He wrote a letter to the physicians of Boston on June 6, 1721, urging them to call a meeting for the consideration of inoculation. He said in his letter: I will only say that inasmuch as the practice of suffering and preventing the Small'pox in the way of inoculation has never yet (as far as I have heard) been introduced into our Nation; where there are so many that would give great sums to have their lives insured from the dangers of this dreadful Distemper, nor has ever anyone in all America ever yet made the trial of it (tho' we have several Africans among us, as I now find, who have tried it in their own Country) I cannot but move that it be warily proceed- ed in. Dr. Zabdial Boylston was the only physician who listened to Cotton Mather. On June 26, 1721, he inoculated his son Thomas, six years of age, and two of his negro slaves. Dr. Boylston and Cotton Mather 8 HEALTH HEROES-EDWARD JENNER both became very unpopular because of their championship of inoculation. Against Dr. Boylston people were so enraged that his family was hardly safe in his house and he often met with insults in the streets. Many people were struck with horror and thought that if any of his patients should die, he ought to be treated as a murderer. An entry in Cotton Mather's diary on July 16, tells of the behavior of the people: At this time I enjoy an unspeakable consolation. I have in- structed one physician in the new method used by the Africans and Asiatics to prevent and abate the Dangers of Small-pox, and infallibly to save the lives of those that have it wisely managed upon them. The Destroyer, being enraged at the proposal of anything that may rescue the lives of our poor people from him, has taken a strange possession of the people on this occasion. They rave, they blaspheme, they talk not only like idiots but also like Frantic\s, and not only the physician who began the experi- ment but I also am an object of their Fury; their furious Oblo- quies and Invectives. 9 METROPOLITAN LIFE INSURANCE COMPANY Objections to Inoculation But now we come to a new stage in the history of smallpox. Inoculation was far from satisfactory. Although the inoculated smallpox was much milder than the natural smallpox it was just as contagious and was often the cause of spreading the disease widely around. People had always shunned houses where natural smallpox raged because it was natural to flee from a plague that carried off one-third or one-fourth of those it attacked. But when they saw that the inoculated smallpox was fatal to one only in 150, they lost their horror of the disease and no longer tried to stop the spread of the infection. Another objection to the inoculated smallpox was that it often caused other diseases to break out after the attack, just as natural Riots in Boston, directed against the champions of smallpox inoculation 10 HEALTH HEROES-EDWARD JENNER smallpox did. More- over, it frequently left scars or pits on the face of the inoculated person. It is fortunate that at just this time, when inoculation was begin- ning to prove an ac- tual menace to the public health, vaccination, a new protection against smallpox, was discovered. What is vaccination? If you have studied Latin you know that it comes from the Latin word vacca, meaning cow. People who worked in dairies milking cows, some- times caught a disease from the cows. This disease was called cow-pox, because the sick cows had sores which were very like the pocks that broke out on people with smallpox. It had been known for a long time in farming communities that the people who had had cow-pox did not take smallpox when they were exposed to it. The first person who made use of this knowledge was a farmer named Benjamin Jesty. In 1774 this man took his wife and children to a dairy farm, and there introduced some of the matter from a cow-pox sore into their arms with a darning needle. Jesty never made his experiment gen- erally known. To Edward Jenner we must give the credit for introducing and applying the practice of vaccination as a protection against smallpox. Benjamin Jesty vaccinating his wife and children 11 SMALJLPOX SjD2^<sad METROPOLITAN LIFE INSURANCE COMPANY The Life of Edward Jenner At the age of 13 Edward Jenner decided to be a doctor and he was apprenticed by his father to a firm of surgeons in Sodbury, near Bristol. He stayed with this firm for six years. During his apprenticeship a young country woman came to him one day for medical advice. The subject of smallpox came up, and she exclaimed: "I cannot take it for I have had cow-pox." This statement is said to have made a deep impression on Jenner and apparently he never forgot it. When he finished his apprenticeship, Jenner went to London, where he became a house pupil of the famous anatomist, John Hunter. Jenner formed a lasting friendship for his great master, and on his return to Berkeley, in 1773, to practice medicine, he used to send Hunter observations on natural history to help him in his studies of animal physiology. It is said that Jenner often discussed the subject of smallpox with Hunter and that one time when telling him of his hopes of substituting vaccination for inoculation, Hunter replied: "Don't think, Jenner, but try." Some years after his return to Berkeley, Jenner married a Miss Kingscote and his married life was a long and happy one. In 1780 Jenner took up the study of smallpox. He often used to discuss it with his friend Edward Gardner. In describing Jenner, Gardner says: He was rather under middle'size, but robust, active and well formed. He was particular in his dress, and when I first met him ... he was clad in a blue coat with yellow buttons, buckskins, welbpolished- jockey boots with handsome silver spurs, and carried a smart whip with a silver handle. His hair after the fashion of the time was done up in a club, and he wore a broad' brimmed hat. 14 HEALTH HEROES-EDWARD JENNER The History of Vaccination Jenner collected a great many descriptions of cases of people who had had cow-pox and had afterward resisted smallpox contagion. He finally had a chance to put his theories to the test. Cow-pox broke out on a farm near Berkeley and a dairy maid, Sarah Nelmes, was infected with the cow-pox from her master's cows. Jenner selected a healthy boy about 8 years old, James Phipps, for the purpose of inoculating him with the cow-pox. He took some matter from a sore on Sarah Nelmes' hand and inserted it, on May 14, 1796, into the arm of the boy by means of two scratches, each about half an inch long. If you can remember what happened when you were vaccinated, Jenner's description of the first vaccination will probably remind you of your own experience. On the seventh day James Phipps complained of soreness in his armpits. On the ninth day he became a little chilly, lost his appetite, and had a slight headache. He felt sick all day and was restless that night, but on the next day he was perfectly well. The sores on his arms gradually healed without causing the least trouble. In order to find out whether the boy was protected against smallpox after such a slight illness, Jenner inoculated him on July first with matter taken from a smallpox patient, but no sign of the disease followed. He was again inoculated, several months afterward, with the same result. The Spread of the Practice of Vaccination Today vaccine is never taken from the arm of another person. It is taken from a calf which has been vaccinated along a clean, shaved surface of its body. Great care is exercised to be sure that the calf is healthy. The quality and purity of the vaccine is assured. 15 METROPOLITAN LIFE INSURANCE COMPANY After making his first experiments Jenner published in June, 1798, his famous pamphlet entitled An Inquiry into the Cause and Effects of the Variolae Vaccine or Cow-pox. This pamphlet caused a great deal of discussion and most people treated Jenner's discovery with scorn. However, some physicians gave it a trial. Mr. Cline of London vaccinated a child successfully in July, 1798, and on August 2 he wrote: I think the substitution of Cow-pox poison for smallpox promises to be one of the greatest improvements that has ever been made in medicine. The more I think on this subject the more I am impressed with its importance. Jenner was, however, opposed by many influential physicians. In 1799 he went to London and gathered around him a small band of enthusiastic supporters. He was encouraged by gaining the interest of the King, the Queen, and the Prince of Wales. Royal approval aided in the spread of vaccination throughout England. Vaccination in America Vaccination was first made known in America by Dr. Waterhouse of Cambridge, Massachusetts. At a meeting of the American Academy of Arts and Sciences presided over by John Adams, President of the United States, the subject was considered and no time was lost in procuring a supply of vaccine matter. It was received in June, 1800, and on July 8 Dr. Waterhouse vaccinated one of his sons, five years old, the first person to be vac- cinated in America. He afterward vaccinated other members of his family. The children resisted smallpox infection and Waterhouse exclaimed: "One fact in such cases is worth a thousand arguments."" Later Thomas 16 HEALTH HEROES-EDWARD JENNER The subject of vaccination discussed before a meeting of the American Academy of Arts and Sciences Jefferson became interested and he had members of his family vaccinated in August, 1801. Thus the practice spread in the United States. Vaccination in Europe Vaccination was taken up with enthusiasm on the continent of Europe. Napoleon had all his soldiers, who had never had smallpox, vaccinated. He was so grateful to Jenner that he never refused him a favor. Once Jenner sent a petition to Napoleon asking for the release of an English prisoner at a time when the little Corporal was feeling very bitter against England. He received the 17 METROPOLITAN LIFE INSURANCE COMPANY petition when he was seated in his coach with the Empress Josephine waiting for his horses to be exchanged. Glancing at the paper he exclaimed to the driver: "Away! Away!" But the Empress, examining the paper closely, cried out: "But stay, you see from whom this comes- Jenner !" Napoleon's manner changed immediately. He said, "What that man asks is not to be refused," and he released the prisoner. Among the most enthusiastic supporters of Jenner's vaccine was the Empress of Russia. She urged her sub- iects to be vaccinated and ordered that the first child who submitted to the operation should receive the name of Vaccinoff, and be educated at the public expense. The young Vaccinoff, after vaccination, was conveyed to St. Petersburg in one of her Majesty's Imperial coaches and, after being educated at the public expense in the Foundling Hospital, received a pension for life. The Empress in commemoration afterward presented Jenner with a diamond ring. Vaccinoff rides to St. Petersburg in an Imperial coach 18 HEALTH HEROES-EDWARD JENNER Religious processions receive the "blessed vaccine" in Sicily The government of Spain dispatched an expedition in 1803 for the purpose of introducing vaccination through' out Spanish possessions in the old and new world. The vessel in which the expedition sailed carried twenty-two unvaccinated children who were to be vaccinated on the voyage in order to preserve the vaccine by passing it from arm to arm. In Sicily and Naples, where smallpox was raging, vaccination was received with great enthusiasm. Re- ligious processions were formed for receiving the " blessed vaccine.11 The practice of vaccination was introduced into Italy, by Dr. Sacco, who wrote to Jenner in January, 1808: "During eight years I reckon more than 600,000 vaccinated by my own hand.11 In June, 1802, Jenner was given a grant of ten thousand pounds by Parliament as a reward for his labors 19 METROPOLITAN LIFE INSURANCE COMPANY in perfecting his discovery and his generosity in making it public. He might have kept vaccination a secret and made a fortune by practicing it, because people in that day would, as Cotton Mather wrote, "give great sums to have their lives insured from the danger of this dreadful distemper." Opposition to Vaccination Notwithstanding the success and support that vac' cination was now receiving in all parts of the world, there were many who still opposed the practice and pamphlets were constantly published by the antiwaccinationists. Some people went so far as to assert that vaccination would cause a person to grow horns like a cow. In spite of this unreasonable opposition, vaccination made steady progress. Jenner had many warm friends, and they rallied to his support with unanswerable arguments in favor of the practice. It was shown "that vaccination is not infectious and, in the opinion of the most experienced practitioners, has never proved fatal, that it causes no other disease, and that it leaves behind it one of the greatest blessings ever bestowed on man, that of a perfect protection against smallpox.11 Honors Heaped on Jenner In 1812, at Berlin, the discovery of vaccination was celebrated by a Jennerian feast. Diplomas poured in upon the discoverer from all parts of the world. One was received from the Red Indians of North America, which read: Brother! Our Father has delivered to us the book you sent to instruct us how to use the discovery which the Great Spirit 20 HEALTH HEROES-EDWARD JENNER made to you whereby the smallpox, the fatal enemy of our tribe, may be driven from the earth. We have deposited your boob in the hands of a man of skill whom our Great Father employs to attend us when sick or wounded. We shall not fail to teach our children to speak the name of Jenner and to thank the Great Spirit for bestowing upon him so much wisdom and so much benevolence. We send with this a belt and string of wampum in token of our acceptance of your precious gift, and we beseech the Great Spirit to take care of you in this world, and in the land of spirits. In June, 1806, Jen- ner was given a grant of 20,000 pounds by Parliament. A national vaccination establish- ment was instituted for the purpose of de- veloping a supply of pure vaccine. In 18n Jenner visited London for the last time. Here he was presented to the Allied Sovereigns of Europe who were in London for a confer- ence. Emperor Alex- ander of Russia told him of the astonishing effect of vaccination in Russia, where it had nearly sub- dued smallpox throughout that great country. Jenner died on January 26, 1823. He lived long enough to see the complete triumph of his great discovery, and to know that it affords protection against one of the The Indians of Nfirth America send gifts to Jenner 21 METROPOLITAN LIFE INSURANCE COMPANY most dreadful scourges of mankind. The following epitaph is inscribed on his tomb: Within this tomb hath found a resting place The great Physician of the human race, Immortal Jenner! Whose gigantic mind Brought life and health to more than half mankind. Let rescued infancy his worth proclaim, And lisp out blessings on his honored name; And radiant Beauty drop one grateful tear, For Beauty's truest friend lies buried here. The Principle of Vaccination Cow-pox is really smallpox in the cow, but the germs do not find such favorable living conditions in the cow as they do in human beings. Their struggle for existence in the cow weakens them, just as a man might become weak- ened by having to work very hard for his living, and yet not make enough to buy the necessary food to keep his body well and strong. By overcoming the weakened germs that are drawn from a cow sick with cow-pox, the body is enabled to protect itself against virulent smallpox germs. Suppose a country is attacked by one tribe of a great race. This tribe is not strong enough to overthrow the country, but in fighting it, the country develops its defenses. Then, when the main forces of the enemy enter the country, they find it prepared and they are unable to conquer it. In much the same way the body prepares itself, by fighting the weakened smallpox germs, to repel an invasion of the deadly germs of the same disease. Modern Epidemics of Smallpox We cannot say that mankind has won a complete victory over smallpox until it has been completely wiped out. One case in a community is enough to start a great 22 HEALTH HEROES-EDWARD JENNER epidemic. Dr. William Osler tells the story of how one case did infect a whole city not so many years ago. In 1885, a sick Pullman porter was taken to a hospital in Montreal. At first the doctors didn't recognize his sick- ness as smallpox. There was a great unvaccinated popula- tion in Montreal because of people's indifference to vaccination. As a result of this one case, 3,164 people in a city of only 185,000 inhabitants died of smallpox. This meant probably that there were over 20,000 cases as the proportion of deaths to cases is about one in seven. Another great epidemic happened more recently. When the United States took over the Philippines there were about 40,000 deaths there every year from smallpox. Then Dr. Victor G. Heiser was made Director of Health for all the Islands and he started vaccination everywhere. In the provinces surrounding Manila there had usually been 6,000 deaths from smallpox every year. After Heiser's vaccination was completed the deathrate was reducted to zero. For the seven years before 1914 not a death from smallpox occurred in the city of Manila. After 1914 vaccination was not effectively carried out and there grew up a huge unvaccinated population. Then came the epidemic of 1918, when there were 50,000 deaths from smallpox. This meant about 250,000 cases. In 1918-1919 among 5,422 vaccinated troops in the Philip- pines, though surrounded by smallpox, only one soldier contracted the disease. Then real vaccination was re- established, and smallpox vanished as promptly as before. In forty states in the United States, in the District of Columbia, and in eight Canadian provinces in 1924 there were 52,395 cases of smallpox. This figure is nearly double the number of cases for 1923, and is the result of the growing number of unvaccinated people in our communities. 23 METROPOLITAN LIFE INSURANCE COMPANY Vaccination is the only way that we can prevent epidemics of smallpox from spreading through our com* munities. It is such a simple, harmless means of protection that an outbreak of smallpox is a disgrace to any civilized nation. How many boys and girls in your school wear the little white mark that means personal protection against one of the oldest enemies of the human race? May we not fail to use the life-saving knowledge which Jenner gave us! REFERENCES This story, Edward Jenner and Vaccination, is based on the follow* ing books and articles: The History of Inoculation and Vaccination, Lecture Memoranda, American Medical Association meeting, Minneapolis, 1913, Borroughs and Wellcome, London. The Three Original Publications on Vaccination Against Smallpox, by Edward Jenner, M.D., in the Harvard Classics, Volume 2, P. F. Collier and Son, New York, 1910. Edward Jenner, in Eminent Doctors: Their Lives and Their Wor\, by G. T. Bettany, John Hogg, 1885. 24 1 MADISON AVENUE NEW YORK METROPOLITAN LIFE PRESS'-(a) 433 LW-PRINTED IN U.S.A.