The Temple of Vaccinia
The Overlook
By Tom Clavin
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Way back in April – admit it, you’re shocked that October is here already – I wrote a column about the outbreak of smallpox in Boston in 1721. In it I referred to the first smallpox vaccine, created by Dr. Edward Jenner. More recently, I came across an article in The New York Times that described how, ironically, a museum devoted to Dr. Jenner is struggling to keep its doors open because of the ongoing pandemic.
First, who was this man and how was it that he initiated the most successful effort to eradicate smallpox? Edward Jenner was born on May 6, 1749 in Berkeley, Gloucestershire, England. At the age of 14, he was apprenticed for seven years to Daniel Ludlow, a surgeon, and he gained most of the experience needed to become a surgeon himself. In 1770, Jenner became apprenticed in surgery and anatomy at St. George’s Hospital in London. Returning to his native countryside by 1773, Jenner became a successful family doctor and surgeon.
By this time, there were many examples of the impacts of smallpox on civilizations and events in history. The origin of smallpox as a natural disease is lost in prehistory. It is believed to have appeared around 10,000 bc, at the time of the first agricultural settlements in northeastern Africa. It probably spread from there to India by means of Egyptian merchants. The earliest evidence of skin lesions resembling those of smallpox is found on faces of mummies from the time of the 18th and 20th Egyptian Dynasties (1570–1085 bc). The mummified head of the Egyptian pharaoh Ramses V bears evidence of the disease. Smallpox was described as early as 1122 bc in China and is mentioned in ancient Sanskrit texts of India. Smallpox was introduced to Europe sometime between the fifth and seventh centuries and was frequently epidemic during the Middle Ages. The disease greatly affected the development of Western civilization. The first stages of the decline of the Roman Empire coincided with a large-scale epidemic -- the plague of Antonine, which accounted for the deaths of almost 7 million people (!). The Arab expansion, the Crusades, and the discovery of the West Indies all contributed to the spread of the disease.
In the New World, smallpox was introduced by the Spanish and Portuguese conquistadors. The disease decimated the indigenous population and was instrumental in the fall of the empires of the Aztecs and the Incas. Similarly, on the eastern coast of North America, the disease was introduced by the early settlers and led to a decline in the native population. The devastating effects of smallpox also gave rise to one of the first examples of biological warfare: During the French-Indian War, Sir Jeffrey Amherst, the commander of the British forces in North America, suggested the deliberate use of smallpox to diminish the American Indian population hostile to the British. Another factor contributing to smallpox in the Americas was the slave trade because many slaves came from regions in Africa where smallpox was endemic.
In the 18th century in Europe, 400,000 people died annually of smallpox, and one third of the survivors went blind (!!). The symptoms of smallpox, or the “speckled monster” as it was known then, appeared suddenly and were devastating. The case-fatality rate varied from 20% to 60% and left most survivors with disfiguring scars. The case-fatality rate in infants was even higher, approaching a truly tragic 80% in London (!!!).
It was common knowledge that survivors of smallpox became immune to the disease. As early as 430 bc, survivors of smallpox were called upon to nurse the afflicted. During medieval times, many herbal remedies as well as cold treatment and special cloths were used to either prevent or treat smallpox. Some physicians treated patients by allowing no fire in the room, leaving the windows permanently open, drawing the bedclothes no higher than the patient's waist, and administering 12 bottles of small beer every 24 hours.
The most successful way of combating smallpox before the discovery of vaccination was inoculation, which is the subcutaneous instillation of smallpox virus into non-immune individuals. The inoculator usually used a lancet wet with fresh matter taken from a ripe pustule of some person who suffered from smallpox. The material was then subcutaneously introduced on the arms or legs of the non-immune person. Inoculation was likely practiced in Africa, India, and China long before the 18th century, when it was introduced to Europe by travelers from Istanbul.
It was the English aristocrat Lady Mary Wortley Montague who was responsible for the introduction of inoculation in England. In 1715, she suffered from an episode of smallpox, which severely disfigured her face. Her 20-year-old brother died of the illness 18 months later. In 1717, Lady Montague's husband, Edward Wortley Montague, was appointed ambassador to the Sublime Porte. A few weeks after their arrival in Istanbul, Lady Montague wrote to her friend about the method of inoculation used at the Ottoman court. She was so determined to prevent the ravages of smallpox that she had the procedure performed on her young children.
In 1757, an eight-year-old boy was inoculated with smallpox in Gloucester, one of thousands of children inoculated that year in England. The procedure was effective, as the boy developed a mild case of smallpox and was subsequently immune to the disease. His name was Edward Jenner.
As an adult physician, Jenner not only knew all about inoculation but noticed that milkmaids were generally immune to smallpox. He surmised that the pus in the blisters that milkmaids received from cowpox (a disease similar to smallpox, but much less virulent) protected them from smallpox. In May 1796, he tested his hypothesis by inoculating an eight-year-old boy who was the son of Jenner's gardener. He scraped pus from cowpox blisters on the hands a milkmaid who had caught cowpox from a cow. (The hide of that cow, named Blossom, now hangs on the wall of the St. George’s Medical School.) The boy developed a fever but no full-blown infection. No unexpected side effects occurred. Jenner successfully tested his hypothesis on 23 additional subjects.
Jenner continued his research and after revisions and further investigations, he published his findings on the 23 cases, including his 11-month-old son Robert. The medical establishment deliberated at length over his findings before accepting them. Eventually, the Jenner vaccination was accepted, and in 1840, the British government banned inoculation and instead provided vaccination using cowpox free of charge. The success of Jenner’s discovery soon spread around Europe.
In addition to honors in Great Britain, Jenner was elected a foreign honorary member of the American Academy of Arts and Sciences, American Philosophical Society, and other organizations. No surprise, he became president of the Jennerian Society, concerned with promoting vaccination to eradicate smallpox. In 1821, he was appointed physician extraordinary to King George IV and was also made mayor of Berkeley and 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. He died on January 26, 1823, age 73, and was buried in the family vault at the Church of St. Mary in Berkeley.
When Jenner had dispensed the smallpox vaccine at his home, he had done so from a small building in his garden he had dubbed the Temple of Vaccinia. Many years later it became the Dr. Jenner House, Museum and Garden. It was shut down when the pandemic began and now, because of not having had revenue from visitors for 18 months, it may never reopen. That’s rather sad. It should be mentioned that one huge source of revenue does not exist because Dr. Jenner never patented his vaccine. To eradicate smallpox as rapidly as possible (it did not disappear globally until 1980), he gave the vaccine away and taught other doctors how to do the procedure. Alas, Dr. Jenner’s museum may go the way of the disease he defeated.
Tom Clavin is the bestselling author/co-author of 18 books, including the forthcoming Lightning Down: A World War II Story of Survival, to be published by St. Martin’s Press on November 2. To pre-order, please go to your local bookstore or to Bookshop.org, Amazon.com, or BN.com. (Psssst: It’s really good.)