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Vaccination’s Forgotten Origins

2017; American Academy of Pediatrics; Volume: 139; Issue: 4 Linguagem: Inglês

10.1542/peds.2016-2833

1098-4275

P.J. Pead,

Poxvirus research and outbreaks

The histories of pediatrics and vaccinology are linked, for most primary attempts at vaccinating against smallpox during the 18th century involved children. Today, of course, vaccinations form a universal and essential part of preventative medicine for the very young. Commonly hailed as a "discovery" or a "medical breakthrough," the first vaccinations against smallpox with cowpox were really a development from variolation (inoculation with smallpox itself), a technique popularized among the English gentry as "The Inoculation" in the early 1700s by Lady Mary Wortley Montagu. The later introduction of cowpox avoided potential hazards of variolation, which sometimes resulted in death or the transmission of smallpox into areas where it was previously absent.The story that Dr Edward Jenner was the first to vaccinate in 1796 is one of the best-known medical myths,1,2 yet this misinformation is still presented in the media and most popular history books. Jenner was preceded nearly one-quarter of a century before by the Dorset farmer Benjamin Jesty, who vaccinated his wife Elizabeth, along with his 2 sons, Robert (age 3 years) and Benjamin (age 2 years), in the spring of 1774.3–8 Jesty was born in the village of Yetminster, Dorset, England. He became a dairy farmer and was a member of the Yetminster Vestry. His duties included arranging for health care of the poor. He would have known the local physicians and apothecaries personally, and he understood the risks of variolation. Jesty had experienced cowpox first-hand as an occupational disease in his youth. He was aware of the folklore of cowpox and discussed its apparent protective effects with his dairymaids, Elizabeth Notley and Mary Reade.9 Both women had acquired cowpox during their work and later nursed relatives afflicted with smallpox without contracting the disease themselves.Faced with a local outbreak of smallpox in 1774, Jesty devised the idea of inoculating his family with cowpox as a safer alternative to the conventional variolation method. To achieve this goal, he took his family to the hamlet of Chetnole (at 3.7 km distant), where he had heard there were cows with symptoms of cowpox. Jesty transferred material from lesions on the cows' teats to the skin of the arms of his 3 subjects by insertion with a stocking needle. This act occurred 22 years before Jenner's vaccination of James Phipps.The story of Jesty's endeavor emerged when Elizabeth's arm became inflamed at the site of vaccination. Dr Trowbridge and Mr Meech from nearby Cerne Abbas were called, and Jesty was obliged to tell them what he had done. Elizabeth recovered quickly, but the news soon spread among neighboring medical and clerical fraternities. Jesty was reviled by the locals, who subjected him to verbal and sometimes physical abuse when he attended markets. Cattle markets were held regularly in Dorset at Sherborne, Blandford, Shaftesbury, and Dorchester; these venues afforded an effective means of transmission of gossip. Correspondence uncovered by the author's archival research indicates that knowledge of Jesty spread over a significant area of the south of England. This extraordinary event was validated and chronicled by sources in Dorset, including letters from William Dolling, the Reverend Hermann Drew, and the noted physician Dr Richard Pulteney.10 Direct evidence was recorded by the Reverend Andrew Bell,9 who interviewed Jesty at Swanage, and again later by the officers of The Original Vaccine Pock Institution11 in London. Jesty permitted his sons to be challenged with smallpox by variolation in 1789 (Robert and Benjamin) and again in 1805 (Robert). They were shown to be unaffected. All 3 recipients of his vaccinations lived into old age and were repeatedly exposed to outbreaks of smallpox without harm. Jesty received some recognition from the Original Vaccine Pock Institution but never from the Jennerian Society or the Royal Society.Was Jesty really the first vaccinator? Some names mentioned in the historical record before Jesty were associated with descriptions of the protective effects of naturally acquired cowpox and must be excluded.12–14 Similarly, claims from other English "cowpoxers" cannot be verified by independent sources.15 A number of invalid claims were sent to Dr George Pearson during 1802, when a House of Commons Committee debated financial rewards for Jenner.16,17 However, there was significant interest in cowpox in the county of Dorset before Jenner, and from examination of archived correspondence, it would seem appropriate to recognize Jesty's priority as the first in the world to devise and perform the procedure of vaccination in 1774.18In reviewing the pre-1796 cowpox activity in Dorset, it is pertinent to consider 2 questions. Did Edward Jenner have medical contacts in that county before he vaccinated Phipps? He did. Second, was he given confidence to proceed with his experiment by knowledge of Jesty after years of hesitation? Although Jenner made no mention of Jesty in his writing,19 it should be noted that he rarely gave credit to the work of predecessors. These included his friend John Fewster, who had discussed cowpox with Jenner at length. Fewster must have influenced Jenner, rather than the dairymaid fable created by Jenner's biographer John Baron,20 which has now been discounted.21 After Jenner's death, much of his correspondence was burned without permission by Sir Everard Home, but recent scrutiny of associated communications with practitioners in Dorset indicates ways that he could have had knowledge of Jesty.18 In 1807, Jenner had published a sevenfold classification of the human intellect, and it is clear from his "fair summary of the common eighteenth century wisdom on mental attitudes" that, believing himself descended from gentry (Baron Kenelem Jenour), he would never have acknowledged a tenant farmer from the "middling sort" class as having the intelligence to conceive and perform a vaccination procedure.22Clearly, Jesty's motivation stemmed from a desire to protect his immediate family. Unlike Jenner, he had no means of formally publishing news of his vaccinations. Jenner experimented on 7 children of other parentage before vaccinating his own son. Informed consent was not a consideration at that time, but in 2007, Davies constructed a hypothetical meeting of a 1795 "Berkeley Local Research Ethics Committee" to consider an application from Jenner to proceed with his project.23 Jenner's submission includes the argument that it was more likely that children would not have had smallpox or cowpox previously, factors that would have affected his results. He defends his intention to challenge some of his young subjects with smallpox by stating that he would have offered them variolation anyway in the normal course of his work.The objective of this author's investigations is not to denigrate Jenner's achievements but to seek increased recognition for Jesty and to challenge misconceptions that persist in the history of the origins of vaccination. When Sir Francis Darwin said during his Galton Lecture that "in science the credit goes to the man who convinces the world, not to whom the idea first occurs," he was voicing an observation, not creating a precedent. The author's opinion is that Jenner is rightly celebrated as the person who brought vaccination to the world, but the intellectual property for this process rests firmly in the ownership of Benjamin Jesty. Whether Edward Jenner had knowledge of Jesty before vaccinating Phipps cannot be confirmed absolutely, but recent investigations suggest his work did not take place in a vacuum.18 The world will be forever grateful that he took the risk.Those wishing to probe this topic further are invited to visit www.benjaminjesty.com.