Makers of Modern Medicine Part 5

[Footnote 1: The life of Edward Jenner, M.D., F.R.S., Physician Extraordinary to His Majesty Geo. IV, Foreign a.s.sociate of the National Inst.i.tute of France, &c. &c. &c. With ill.u.s.trations of his doctrines, and selections from his Correspondence by John Baron, M.D., F.R.S., Late Senior Physician to the General Infirmary, Consulting Physician to the Lunatic Asylum at Gloucester, and Fellow of the Royal Medical and Chirurgical Society of London. In two Volumes. London: Henry Colburn, 1838.]

The subject is indeed so surprising that I prefer to quote the pa.s.sage with regard to these experiments directly from Dr. Baron:

"In November, 1789, he inoculated his eldest son Edward, who was then about one year and a half old, with swine-pox matter. The progress of the disease seemed similar to that which arises from the insertion of true smallpox matter when {97} the disease is very slight. He sickened on the eighth day: a few pustules appeared; they were late and slow in their progress, and small. Variolous matter (this would mean material from a smallpox patient calculated to give that disease) was carefully inserted into his arms at five or six different periods, subsequently without the slightest inflammation being excited in the part.

"On Thursday, April 7th, 1791, variolous matter was again inserted by two small incisions through the cutis, [beneath the skin]. Then the following notes of observed conditions day after day are made: 9th, Evidently inflamed. 10th, An efflorescence of the size of a shilling spread round the inferior wound. 11th, The incision a.s.sumed a kind of erysipelatous elevation: the efflorescence much increased.

12th, These appearances much advanced. 13th, A vesicle, containing a brownish fluid, and transparent, about the size of a large split-pea on the superior incision, the inferior about twice as big; the surrounding parts affected with erysipelas. The erysipelas extended to the shoulder, and then pretty quickly went off. The child showed no signs of indisposition the whole time."

"March, 1792. E. Jenner was again inoculated: the matter was taken from a child that caught the disease in the natural way, and had it pretty full. It was inserted fresh from the pustule. The same evening an inflammation appeared round the incision, which, at the end of twenty hours, increased to the diameter of a sixpence, and some fluid had already been collected on the lips of the scratch, which the child had rubbed off."

It was not for five years after this time, however, that Jenner was able to make his crucial experiments in the matter. On the 14th of May, 1796 (the date is still recalled as Vaccination Day in Germany, especially in Berlin), vaccine {98} matter was taken from the hand of a dairy maid, Sarah Nelmes, and inserted by two superficial incisions in the arms of James Phipps, a healthy boy of about eight years of age. The boy went through an attack of cowpox in a regularly satisfactory manner. After this, however, it was necessary to determine whether he was protected from smallpox. After waiting two months Jenner inoculated him with variolous material. The result of this experiment can best be learned from the following letter written to his friend Gardner:

"Dear Gardner:

"As I promised to let you know how I proceeded in my inquiry into the nature of that singular disease the Cow Pox, and being fully satisfied how much you feel interested in its success, you will be gratified in hearing that I have at length accomplished what I have been so long waiting for, the pa.s.sing of the Vaccine Virus from one human being to another by the ordinary mode of inoculation.

"A boy of the name of Phipps was inoculated in the arm from a pustule on the hand of a young woman who was infected by her master's cows. Having never seen the disease but in its casual way before; that is, when communicated from the cow to the hand of the milker, I was astonished at the close resemblance of the pustules, in some of their stages, to the variolous pustules. But now listen to the most delightful part of my story. The boy has since been inoculated for the smallpox which, as I ventured to predict, produced no effect. I shall now pursue my experiments with redoubled ardour.

"Believe me yours, very sincerely, "Edward Jenner.

"Berkeley, July 19, 1796."

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Notwithstanding the complete success of this experiment, Jenner did not rush into print with it. Two years later, at the end of June, 1798, his "Inquiry into the Causes and Effects of the Variolae Vaccinae" was published. In the mean time Jenner had succeeded in demonstrating the protective quality against smallpox of vaccination, contracted either casually or by direct inoculation, in some twenty-three cases. Sixteen of these had occurred accidentally in the course of occupations connected with cows and horses; the rest were done under Jenner's directions. Among the persons inoculated was Jenner's own little second son, Robert Fitts Harding Jenner, an infant eleven months old. Jenner demonstrated conclusively that the cowpox protects the human const.i.tution from the infection of smallpox.

After Dr. Jenner had made his tests he prepared a pamphlet for publication. Before publishing, however, he thought it better to make a visit to London, so that he might have the opportunity to introduce the subject personally to friends, and demonstrate the truth of his a.s.sertion to them. He remained in London for nearly three months without being able to find any one who would submit to vaccination.

The medical profession generally took very little interest in the subject and seemed to consider him sadly visionary. Under the circ.u.mstances it is not surprising that Jenner went back to Gloucestershire, and his country practice, rather disappointed. It happened, however, that soon after his return home, a distinguished London surgeon named Cline resolved to make a trial of the vaccine material which Jenner had left with his friends. The surgeon's purpose in using it, however, was not altogether to test its efficacy as a prophylactic against smallpox, but with the notion that the counterirritation thus obtained might be useful in a case which he had under treatment. Those {100} were the days when the seton and the issue were still in common use, and counterirritation was considered one of the most important remedial measures at the command of the surgeon.

The patient was a child suffering from a form of chronic hip-joint disease that at this distance of time, and with rather incomplete descriptions, seems to have been the ordinary tuberculosis of the hip.

The vaccine material was inoculated over the joint and, surprising though it may appear now, the vaccine vesicle ran rather a normal course and healed kindly. The little patient was afterward inoculated with smallpox and found to be incapable of acquiring that disease.

This case attracted considerable attention. It is not, however, a matter for congratulation as regards the openness of mind of the medical men of the period to find that this was the only sort of a case that was considered suitable for such an experiment. It is very easy to understand that in a child in a run-down condition the vaccine material might very well have provoked a rather serious local reaction. In a way, the fate of vaccination hung in the balance and good luck was in its favor. Mr. Cline, however, after this, became a strong advocate of vaccination, and brought it very decidedly before the London physicians. There was still a feeling of opposition, as indeed there always is against any novelty in medicine, but this gradually disappeared, to give place to a suspension of judgment, until more accurate and detailed information could be obtained from further observations and tests.

It was not long before the opposition to the practice of vaccination took definite form. One of the best-known London physicians of the time, Dr. Ingenhouz, became the leader of a strong faction of the medical profession of London, who not only would have nothing to do with vaccination, {101} but proclaimed openly that it was a dangerous innovation, absolutely unjustifiable, and communicated a disease without protecting against any other. On the other hand, there were overzealous advocates of vaccination, who insisted on its value but did not know how to recognize the true cowpox from other lesions sometimes confounded with it, nor the exact stage of the disease in which the vaccine material obtained would prove effectively protective. A number of these used vaccine material so contaminated by secondary infections of one kind or another that no wonder serious sores were reported as a result.

Physicians who have for many years known how difficult it is to bring certain people to a recognition of the benefits that have been conferred on modern civilization by vaccination, will appreciate how many difficulties and prejudices and misunderstandings Jenner himself must have encountered during the original introduction of vaccination.

Some of the supposed objections to vaccination wear a very modern air, and come from physicians whose only purpose apparently is to bring out the truth, and yet who are evidently led to the drawing of conclusions much wider than their premises by the fact that they know they will have an attentive audience among the anti-vaccinationists at least.

A fair example of one of these old-time objections against vaccination may be found in the following pa.s.sage from a letter by Dr. Jenner written to Mr. Moore. Corresponding objections have been made in much more modern times, and the pa.s.sage will arouse the sympathetic amus.e.m.e.nt of present-day physicians:

"You probably may not have seen a pamphlet lately published by Dr.

Watt of Glasgow, as there is nothing in its t.i.tle that develops its purport or evil tendency: 'An Inquiry into the Relative Mortality of the Princ.i.p.al Diseases of {102} Children,' &c. The measles, it seems, have been extremely fatal in the city of Glasgow for the last four or five years among children, and during this period vaccination was practised almost universally. Previously to this, the measles was considered as a mild disease. Hence Dr. Watt infers that the smallpox is a kind of preparative for the measles, rendering the disease more mild. In short, he says, or seems to say, that we have gained nothing by the introduction of the cow-pox; for that the measles and small-pox have now changed places with regard to their fatal tendency. Is not this very shocking? Here is a new and unexpected twig shot forth for the sinking anti-vaccinist to cling to. But mark me--should this absurdity of Mr. Watt take possession of the minds of the people, I am already prepared with the means of destroying its effects, having inst.i.tuted an inquiry through this populous town and the circ.u.mjacent villages, where, on the smallest computation, 20,000 children must have been vaccinated in the course of the last twelve years by myself and others. Now it appears that, during this period, there has been no such occurrence as a fatal epidemic of measles. You would greatly oblige me in making this communication to the Board, with my respectful compliments."

Fortunately only a few colleagues were so illogical, and an excellent idea of how much Jenner's discovery was appreciated by his contemporaries may be obtained from the number of honors, diplomas, addresses and communications from public bodies and distinguished individuals which he received. A chronological list of these may be found at the end of Dr. Baron's Life of Jenner. Among them may be noted the diploma of LL.D. from the Senate of Harvard University, Cambridge, Ma.s.s., under the presidency of Dr. Willard; also the Diploma of Doctor in Medicine, honoris {103} causa, which Jenner especially appreciated, as he says in one of his letters, because he understood that the University conferred this degree in this way only once or twice in a century. There is a diploma as Fellow of the American Society of Arts and Sciences in Ma.s.sachusetts, as well as a Diploma as a member of the American Philosophical Society at Philadelphia. The diploma from Boston bears the signature of John Adams as president, that from Philadelphia the signature of Thomas Jefferson. Most of the prominent medical and scientific societies of Europe had elected him a member or had sent him some special token of recognition.

One of these doc.u.ments, expressive of the grat.i.tude of the senders for the great benefit his work had conferred upon the human race, which Jenner valued the highest, was an address from the Five Indian Nations which, with a Wampum Belt, was delivered to him on November 8, 1807.

In reply to this Dr. Jenner wrote to the American agent through whom the insignia had been forwarded:

"Sir:

"Your kindness in delivering to the Five Nations of Indians my Treatise on vaccination, and in transmitting to me their reply, demands my warmest thanks.

"I beg you to make known to the Five Nations the sincere gratification which I feel at finding that the practice of vaccination has been so universally received among their tribes, and proved so beneficial to them; at the same time, be pleased to a.s.sure them of the great thankfulness with which I received the belt and string of Wampum, with which they condescended to honour me, and of the high estimation in which I shall for ever hold it. May the active benevolence which their chiefs have displayed in preserving the lives of {104} their people be crowned with the success it deserves; and may that destructive pestilence, the smallpox, be no more known among them.

"You also, Sir, are ent.i.tled to the most grateful acknowledgments, not only from me, but from every friend of humanity, for the philanthropic manner in which you originally introduced the vaccine among these tribes of Indians.

"I have the honor to remain, &c, "E. Jenner."

The general trend of American appreciation for Dr. Jenner's work, at least among the intelligent cla.s.ses, may be gathered from the following letter sent to Dr. Jenner by Thomas Jefferson while he was president, May 14, 1806:

"Monticello, Virginia, May 14, 1806.

"Sir:

"I have received the copy of the evidence at large respecting the discovery of the vaccine inoculation, which you have been pleased to send me, and for which I return you my thanks. Having been among the early converts in this part of the globe to its efficacy, I took an early part in recommending it to my countrymen. I avail myself of this occasion to render you my portion of the tribute of grat.i.tude due to you from the whole human family. Medicine has never before produced any single improvement of such utility. Harvey's discovery of the circulation of the blood was a beautiful addition to our knowledge of the human economy; but on a review of the practice of medicine before and since that epoch, I do not see any great amelioration which has been derived from that discovery. You have erased from the calender of human afflictions one of its greatest.

Yours is the comfortable reflection that mankind can never forget that you have lived; future nations will know by history only that the {105} loathsome small-pox has existed, and by you has been extirpated. Accept the most fervent wishes for your health and happiness, and a.s.surances of the greatest respect and consideration.

"Th. Jefferson."

Almost more interesting than the story of Jenner, the experimental scientist, the true harbinger of modern experimental medicine, the founder of experimental pathology, and the discoverer of the pregnant idea which was to mean so much for nineteenth century medicine in the hands of Pasteur and his successors, is the story of Jenner the man, the husband, the friend, and the physician of the poor. In spite of his intense preoccupation in his experimental work and the amount of time it must have required to make his observations, he found opportunities to care for the poor and to interest himself in all their concerns as well as their health. He made many firm friends among people of his own social status and generally was considered a most amiable, as well as a liberal, and humanitarian man. He was deeply religious, and, as we shall allow his earliest biographer Dr.

Baron to tell, was not ashamed to exhibit his religious feelings by word and deed when the proper occasion presented itself. This part of his life deserves to be studied as carefully and remembered as faithfully as that in which he made his discoveries, since it is the complement that shows the character of the man in its entirety.

Jenner's personal character may be very well understood from a paragraph of his biographer, who had been his bosom friend for many years. He says:

"But Dr. Jenner was not only humble in all that concerned this, the greatest incident of his life (the successful discovery of vaccination); he continued so after success had crowned {106} his labors, and after applause greater than most men can bear had been bestowed upon him. This most estimable quality was visible at all times; but it was particularly conspicuous when he was living in familiar intercourse with the inhabitants of his native village. If the reader could in imagination accompany me with him to the dwellings of the poor, and see him kindly and heartily inquiring into their wants, and entering into all the little details of their domestic economy; or if he could have witnessed him listening with perfect patience and good humor to the history of their maladies, he would have seen an engaging instance of untiring benevolence. He never was unwilling to receive any one, however unseasonable the time may have been. Such were his habits, even to the latest period of his life. I scarcely know any part of his character that was more worthy of imitation and unqualified respect than that to which I have alluded. I have never seen any person in any station of life in whom it was equally manifest; and when it is remembered that he was well 'stricken in years;' that he had been a most indefatigable and successful laborer in the cause of humanity; and that he might have sought for a season of repose, and the uncontrolled disposal of his own time, the sacrifices which he made are the more to be valued. In the active and unostentatious exercise of kindness and charity he spent his days; and he seemed ever to feel that he was one of those 'qui se natos ad homines juvandos, tutandos, conservandos arbitrantur,' who consider themselves born to help, protect, and cherish their fellow men.

"His kindness and condescension to the poor was equalled by his most considerate respect and regard to the feelings and character of the humblest of his professional brethren. I have often been struck with the total absence of everything that could bear the semblance of loftiness of demeanor. {107} Few men were more ent.i.tled to deliver their sentiments in a confident or authoritative tone; but his whole deportment was opposed to everything of that description, and he did not hesitate to seek knowledge from persons in all respects his inferiors. All his younger brethren who have ever had the happiness to meet him in practice, must have been deeply impressed with this part of his character."

Many a member of the medical profession who is not a genius will find an excuse for allowing disorder about his rooms from the example which is said to have been set by Jenner. He was interested in nearly every branch of science and specimens from many departments were constantly around him. He himself, it is said, had the key to the apparent confusion. Most of the others who allow themselves to drift into careless habits in the same direction insist that they too have the key. Some of their friends, however, are inclined to doubt it. It is curiously interesting under these circ.u.mstances to have Jenner's biographer tell of the confused state of affairs that existed in his room and yet his defence of it. Perhaps in this matter it is well to remember what Augustin Birrell says at the end of his essay on Carlisle:

"Don't let us quarrel with genius; we have none of it ourselves and the worst of it is we cannot get along without it."

"The objects of his studies generally lay scattered around him; and, as he used often to say himself, seemingly in chaotic confusion.

Fossils, and other specimens of natural history, anatomical preparations, books, papers, letters--all presented themselves in strange disorder; but every article bore the impress of the genius that presided there. The fossils were marked by small pieces of paper pasted on them, having their names and the places where they were found inscribed in his own plain and distinct handwriting.

{108} His materials for thought and conversation were thus constantly before him; and a visitor, on entering his apartment, would find in abundance traces of all his private occupations. He seemed to have no secrets of any kind; and, notwithstanding a long experience with the world, he acted to the last as if all mankind were as trustworthy and free from selfishness as himself. He had a working head, being never idle, and acc.u.mulated a great store of original observations. These treasures he imparted most generously and liberally. Indeed his chief pleasure seemed to be in pouring out the ample riches of his mind to everyone who enjoyed his acquaintance. He had often reason to lament this undoubted confidence; but such ungrateful returns neither chilled his ardor nor ruffled his temper."

It is interesting to note what was Jenner's opinion with regard to two subjects that are very much discussed at the present time. These are the questions of religious training in education, and the advisability of making nature study a part of the course for children. Jenner considered that no education could possibly be complete which did not include both of these subjects. Religious training he deemed absolutely indispensable. Nature study he advised for somewhat different reasons from those for which it is now urged. He thought there was a depth of interest in the study of the objects of nature that could scarcely fail to lessen the burden of education for the child, but the main reason for its study to his mind was that children intent on the wonders of nature could scarcely help but realize the power of the Creator and, learning to admire Him more and more, be thus drawn to respect His laws, to acknowledge His supremacy and to devote themselves to bringing about the fulfilment of His will in this world to the fullest extent in their power.

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Jenner's religious opinions and beliefs must be left to the expression of the biographer already mentioned, who gives them very fully. He says:

"One of the most remarkable features in Jenner's character, when treating of questions of a moral or scientific nature, was a devout expression of his consciousness of the omnipresence of the Deity. He believed that this great truth was too much overlooked in our systems of education; that it ought to be constantly impressed upon the youthful heart, and that the obligations which it implied, as well as the inward truth and purity which it required, should be rendered more familiar to all. Mrs. Jenner was constantly occupied in teaching these lessons to the poor around her, in schools which she established for the purpose of affording a scriptural education.

He, building upon this foundation, wished to add instruction of a more practical description, deduced from their daily experience, and ill.u.s.trated by a reference to those works of wisdom and beauty which the universe supplies. He always contended that some aid of of this kind was necessary to impress completely upon the character of the lower ranks those maxims which they derived from their teachers. He had other views, too, in recommending such a plan; he thought that the lot of the poor might be ameliorated, and many sources of amus.e.m.e.nt and information laid open to them which they are at present deprived of; that the flowers of the field and the wonders of the animal creation might supply them with subjects of useful knowledge and pious meditation."

His wife, as is often, though unfortunately not always, the case, seems to have had that precious uplifting influence over him which served continually as an incentive to higher things and kept him from the sterile materialism which an exclusive absorption in scientific studies, with lack of the {110} exercise of faith and of a.s.sociation with human suffering, seems to bring to many men. Dr. Baron says on this point: