Christie’s New York sale of the late Haskell Norman’s magnificent medical library included a first, second, third, and first American edition of Edward Jenner’s famous Inquiry into the Causes and Effects of the Variolae Vaccinae. This reminds us that it is 200 years since Jenner published his initial evidence that inoculated cowpox was a safe alternative to inoculated smallpox (variolation) for the prevention of smallpox. The Inquiry is regularly included in summaries of the most important medical books and in histories and encyclopaedias of medicine. That it transcends subject boundaries is shown by its inclusion in Printing and the Mind of Man, which charts the impact of printing on the evolution of Western civilisation.
Those seeking basic information about what Jenner did, however, might look no further than such summaries, many of which undervalue or exaggerate Jenner’s achievement. For example, some, including Printing and the Mind of Man, mention the vaccination of only James Phipps in 1796, and ignore the more important series of arm to arm vaccinations done in 1798. Others, including Haskell Norman, confidently assert that Jenner vaccinated 23 people; presumably because he arranged his data as 23 “cases.” However, 15 “cases” described circumstantial epidemiological evidence that natural cowpox was safe and prevented smallpox. In fact, the number vaccinated, though small, is unknown because “case 21” comprised one named individual and “several children and adults.” Also, some suggested that the immunity to smallpox in all those vaccinated was tested by variolation; in fact, only four were challenged.
Unjustified credit is sometimes given to Jenner for introducing the terms virus (already long used to indicate a transmissible poison) and vaccination (introduced by his friend Richard Dunning in 1800. Jenner used vaccine as an adjective in 1799; it was used as a noun in mainland Europe by 1800). Jenner is also generally credited with being the first to suggest, in his later monographs, that smallpox could be eradicated. However, in 1793, John Haygarth of Chester had published a plan to “exterminate” smallpox by variolation, isolation, rewards, and punishments. It needed the replacement of variolation by vaccination to make it workable, but important elements of Haygarth’s plan were used in the WHO’s smallpox eradication campaign.
At the same time, few acknowledge Jenner’s important distinction between true cowpox, which conferred immunity to smallpox, and spurious cowpox—for example, other bovine zoonoses, or badly contaminated material—which did not. Without this information the introduction of vaccination would have been considerably delayed.
Jenner’s own words still make fascinating reading, and those wishing to try this have various choices. First editions of the Inquiry regularly fetch five figure sums ($32 200 (£20 000) at the Norman sale). Second and third editions fetch four figures, but in fact are more useful because they include Jenner’s later monographs of 1799 and 1800. However, don’t despair. Many large medical libraries have copies, and William LeFanu’s Bibliography of Jenner (St Paul’s Bibliographies, 1985) lists their availability, as well as various reprints and facsimiles.