Education, marriage, and medical practice in Gloucestershire

Only five of Edward's siblings survived childhood, and he was named after a brother who died in April 1749 aged five. Jenner's parents both died in 1754 and, although his education was probably planned by his elder brother Stephen, it is likely that the necessary home environment was provided by his aunt, Deborah Hooper, of Clapton Farm near Berkeley.

In 1757 Jenner attended the grammar school at nearby Wotton under Edge, but he soon transferred to Cirencester grammar school. His education was directed towards medicine from 1763, when he began training with Daniel Ludlow, an apothecary in Chipping Sodbury, and in August 1764 he was apprenticed to George Hardwicke of Sodbury. The greatest influence on Jenner's career was John Hunter (1728–1793), with whom he trained as a private pupil and as a student at St George's Hospital, London, between 1770 and 1772. Here, in addition to receiving invaluable training, Jenner made important contacts such as Joseph Banks, later president of the Royal Society, and Everard Home and Henry Cline, both later presidents of the Royal College of Surgeons. Hunter, a stern taskmaster, evidently thought well of Jenner and recommended that he should help to arrange and catalogue the specimens brought back by Banks from Captain Cook's first Pacific voyage. It was planned that Jenner should accompany Banks on the second voyage, but in the event neither went.

On his return to Berkeley in 1772 Jenner set up in general practice, living at first with his brother Stephen. He continued in Berkeley despite the offer by Hunter of a partnership in 1775; however, the two men maintained a lively correspondence, in which Jenner was encouraged in a variety of anatomical and physiological experiments, until Hunter's death in 1793. In 1785 Jenner bought Chauntry Cottage (The Chantry), Berkeley, and on 6 March 1788 he married Catherine Kingscote (1760/61–1815) of Kingscote near Berkeley. They had three children: Edward (1789–1810), Catherine (1794–1833), and Robert Fitzharding (1797–1854). Their family life was happy, marred only by the death of young Edward from tuberculosis, and the chronic ill health of Jenner's wife, caused by the same disease. Edward Gardner of Frampton-on-Severn described Jenner in early middle age as being:

under the middle size … robust but active … dressed in a blue coat and yellow buttons, buckskins, well-polished jockey boots with handsome silver spurs … and a smart whip with a silver handle. His hair, after the fashion … was done up in a club, and he wore a broad-brimmed hat.

Baron, 1.15–16

Jenner's practice, which required him to make visits on horseback in all weathers, covered some 400 square miles and involved climbs of 700–800 feet. Social visits included regular rides to Stroud, Frampton, Sodbury, Bath, and particularly Cheltenham. A visit to Kingscote during a severe frost in 1786 caused him to suffer hypothermia, of which he left a detailed account.

Jenner kept a good table and fancied himself a musician and poet, his 'Address to a Robin' perhaps being his best-known work. He belonged to two local medical societies: the 'medico-convivial' society, which he co-founded in 1788 and which met at The Fleece inn, Rodborough; and the 'convivio-medical' society, which met at The Ship inn, Alveston. These names, by which Jenner referred to them, indicated the order of priorities.

It is inappropriate to regard Jenner, as some have done, as simply a country doctor. He had a modest private income and belonged to the minor landed gentry. His contacts through Lord Berkeley and the Kingscote family ensured his social position in the immediate neighbourhood, and Hunter and Banks also provided contacts in London and Cheltenham. Jenner's qualifications and status ensured he had a good clientele among the gentry and aristocracy. He fitted well into fashionable Cheltenham life and was founder and first president of the Cheltenham Literary and Philosophical Society.

Jenner and vaccination

Most individuals in populous areas of Britain in the eighteenth century could expect to catch smallpox, which killed 20 per cent or more of those infected. Before Jenner introduced vaccination, smallpox could be prevented by variolation—the deliberate inoculation of matter from smallpox pustules into the skin in the hope that a mild but protective infection would result. This was introduced into British society in 1721 by Lady Mary Wortley Montagu, who had seen it used in Constantinople. Variolation had an overall mortality of about 0.5 per cent, but occasional disasters occurred and there was also the risk that those in contact with variolated individuals would contract fully virulent smallpox.

Jenner, an experienced variolator, had unpleasant memories of his own variolation when he was eight years old, and with his background and training it was perhaps not surprising that he became interested in safer alternatives. Common in rural areas then was the idea that those who recovered from cowpox, a mild, localized disease traditionally acquired when milking infected cows, were thus rendered immune to natural and inoculated smallpox. Jenner probably knew of this before he went to London and certainly discussed it with Hunter and members of the Medico-convivial Society, and by the late 1770s he was collecting data to test this hypothesis. Some of the cases of cowpox had occurred many years before and could not have been seen by Jenner, but he did see some cases from 1782 onwards. Information about immunity to smallpox was gradually collected during routine variolations done after 1792 by Jenner and his nephew Henry. Data were collected on twenty-eight individuals in all, and represented cases where cowpox had occurred recently or many years before, where it had been acquired directly from a cow or a horse, and where immunity to smallpox was assessed by natural exposure and/or variolation. Jenner appreciated the value of working in a rural area where smallpox was uncommon, and of ensuring as best he could that any immunity was due to cowpox and not to previous smallpox or variolation.

In 1789 Jenner and another doctor, John Hickes, inoculated some individuals, including the infant Edward Jenner, with material from a disease variously described as swinepox, pigpox, and cowpox. This confused some later analysts, but there is no record of the use of any animal disease here. Jenner and Hickes clearly regarded the material as coming from a variety of smallpox, and the topic was not pursued.

In 1792, with twenty years' experience of general practice and surgery, Jenner obtained the degree of MD from St Andrews. This simply required recommendations from two reputable doctors, and his colleagues Caleb Parry and John Hickes acted for him. Now able to style himself physician and surgeon, Jenner left most general practice matters to his nephew and assistant, Henry Jenner, and took on the role of consultant. From 1795 he established a second home in Cheltenham where well-to-do patients of his London colleagues could consult him when they visited the fashionable spa.

Jenner performed the first documented cowpox inoculation on 14 May 1796. This was probably not the first ever vaccination, but others, by people such as Benjamin Jesty, a Dorset farmer, came to light only after Jenner's work became known. As such any earlier vaccinations had no impact on medicine. Just before his forty-seventh birthday, however, Jenner inoculated eight-year-old James Phipps with cowpox material taken from a dairymaid, Sarah Nelmes. The boy recovered uneventfully, and six weeks later he successfully resisted variolation. Jenner was tempted to publish his data at this stage, but he was advised informally by the Royal Society that it would harm his reputation to publish such slender evidence. He collected more epidemiological information, conducted more vaccinations in March–April 1798, and published his results privately in his famous Inquiry into the causes and effects of the variolae vaccinae a disease … known by the name of the cow-pox (1798). The extra vaccinations were the important addition, but their total is not known; Jenner named only ten, though more were performed at that time. Jenner showed that cowpox could be transferred serially by arm-to-arm inoculation, and that the first and last in the series resisted variolation, though as with Phipps this challenge was made after only a few weeks.

Jenner's conclusions were that cowpox, which could be maintained by arm-to-arm transfer, was a safe alternative to variolation and produced lifelong immunity to smallpox. He also believed that cowpox originated from an equine disease called 'grease', which could be passed to cows by the hands of milkmen who had also tended infected horses, but that the vaccine needed to come from the cow in order to give consistent results. He provided preliminary information that there were different types of cowpox: ‘true’ cowpox, which gave the expected result, and ‘spurious’ cowpox, which did not protect and/or produced unacceptably severe lesions. At first 'cowpox inoculation' and 'vaccine inoculation' (from vacca, ‘cow’) were used to describe the process, but 'vaccination' was soon the generally accepted term. The information Jenner had been collecting was already known to some, and the first detailed analysis of the Inquiry of 1798, by George Pearson, was published in November that year. The Inquiry reached the United States in January 1799, and by 1801 it had been translated into Latin, German, French, Italian, Dutch, and Spanish.

Inevitably the Inquiry received a mixed reception. There was strong criticism from some variolators who saw the loss of a lucrative monopoly. There was also some religious opposition to inoculating humans with animal material, and caricatures showing humans with bovine characteristics appeared. There was general scepticism about the origins of cowpox in 'grease', about the idea of ‘spurious’ cowpox, and of the claims that vaccination gave lifelong immunity; the last could only be tested by the passage of time after the first two issues had been clarified. However, there was considerable support for the basic idea that inoculated cowpox would protect against smallpox, though everyone, including Jenner, appreciated the need for more work.

In his second monograph, Further Observations on the Variolae vaccinae (1799), Jenner provided more information on ‘true’ and ‘spurious’ cowpox, in particular defining four categories of the latter: ‘spurious’ cowpox resulted from (a) other bovine diseases infectious to humans; (b) improperly stored, or (c) old material in both of which the cowpox virus had been inactivated and which in modern terms contained pathogenic bacteria; and (d) material obtained directly from horse grease. However, ‘spurious’ cowpox was at times used to explain away the failures of genuine vaccine to protect completely.

There was some initial confusion over the appearance of the lesions of inoculated smallpox and cowpox, and early attempts by William Woodville to confirm Jenner's conclusions were compromised by the use of cowpox material contaminated with smallpox virus. In fact Jenner had contributed to this confusion by ambiguities in the Inquiry, but he helped to resolve the problem in his third monograph, entitled A Continuation of Facts and Observations Relative to the Variolae vaccinae or Cowpox (1800).

Jenner's seminal contribution to vaccination is contained in the three monographs discussed above. He continued to vaccinate using his own and other vaccines, but his claim, that smallpox could be prevented by use of an animal virus, was confirmed and extended by others. By 1801 vaccines were established from horsepox. So, though Jenner erred in using the term 'grease', there was some truth in this part of his hypothesis. However, after initial criticism, after 1799 Jenner quickly dropped all public mention of this idea. Nevertheless, it is clear from then unpublished sources that he made extensive use of horsepox vaccines after this date. It is also evident that some of Jenner's views were formed early and held consistently. Two manuscripts of the Inquiry exist, written in 1797, in which reports of the arm-to-arm vaccinations of 1798 were obviously absent. However, these early drafts included all the other ideas, particularly the basic distinction between ‘true’ and ‘spurious’ cowpox, even if expressed in a less clear form than later. In the case of vaccination, diaries and letters indicate that Jenner was well aware of the need for routine revaccination; he even revaccinated his own family, though his published work emphasized that vaccination, properly done, would provide lifelong protection.

Jenner continued to publish short pamphlets: he defended his priority for the introduction of vaccination in On the Origin of the Vaccine Inoculation (1801); he offered advice on vaccination procedure in Instructions for Vaccine Inoculation (1802); and he insisted that vaccination properly done would induce lifelong protection in Varieties and Modifications of the Vaccine Pustule (1804), in Facts … Respecting Variolous Contagion (1808), and in his Circular Letter (1821). Letters on the same general topics written for publication, usually in the Medical and Physical Journal, have been listed by Baron and LeFanu.

With some private income, a rich social life, and varied interests in science and medicine, Jenner perhaps led the dilettante life of a country gentleman restricted only by his medical practice. There is no evidence that he initially spent as much time investigating cowpox as his supporters later claimed. However, from 1798 his life was dominated by vaccination. He maintained a house in London, at considerable expense, but only spent short periods there. In the course of his vaccination crusade he corresponded with and was received by George III and Queen Charlotte, and by the prince of Wales. He was received in London by the tsar and the king of Prussia, and he corresponded with Napoleon. These contacts no doubt helped to make Jenner famous, as did the spread of the use of vaccine. It was adopted by the army and navy (Jenner was awarded a gold medal on the behalf of British naval officers in 1801), and was quickly taken up in many countries throughout the world. Jenner himself dealt with correspondence from all over the world, and William Wilberforce remarked that there was 'no man who is so much inquired after, by Foreigners when they arrive in this country' (Fisher, 112). Jenner also gained support from London's medical élite: in 1800 John Ring, a staunch defender of vaccination, organized a testimonial signed by a number of eminent physicians and surgeons supporting vaccination after attacks had been made on Jenner's work. Similar declarations of support were made in York, Leeds, Chester, Durham, and Oxford. Ring continued to be the most loyal of Jenner's defenders and received encouragement in his task from Jenner himself. In December 1801 Jenner attended a party given in London by Lord and Lady Spencer where he met, among others, Lord Lucan, Lord Macartney, and Lord Campden, possibly in an attempt to smooth the path of his application to parliament for a grant.

Jenner could evidently be awkward, but at the age of forty-nine vaccination had totally changed his life. He wrote petulant letters about insufficiently supportive colleagues, and fought acrimonious battles with supporters of variolation. He and George Pearson quarrelled over the allocation of credit, and Pearson opposed Jenner's parliamentary petition. The Royal Jennerian Society, later the National Vaccine Establishment, was founded in 1803 with Jenner as president of its medical council, but he eventually withdrew after disagreement about his role.

Jenner's other medical and scientific work

From childhood Jenner had shown an interest in natural history and had collected fossils and nests. Later his fossil specimen of a plesiosaurus was the first to be identified in Britain, and he was made an honorary member of the Geological Society in 1809. About 1812–14 Jenner was also a member of the Barrow Hill Club, a group of friends interested in geology. Other members included Edward Gardner and John Baron, later Jenner's official biographer. He also undertook other minor projects on topics as diverse as manures, distemper in dogs, and tuberculosis, and his general interests in natural history were acknowledged in 1798 by his election to fellowship of the Linnean Society. In 1784, soon after both the Montgolfiers' pioneering flight and the first flight in Britain, Jenner was involved in the flight of an unmanned balloon. He also made various observations on anatomy and physiology which were incorporated into John Hunter's papers. In 1783 he published an improved method for preparing pure emetic tartar (potassium antimony tartrate) by recrystallization, and in 1799 Caleb Parry acknowledged Jenner as the first to associate the clinical features of angina pectoris with its underlying anatomical changes.

Jenner's interest in ornithology merits special mention. It had been long known that female cuckoos laid eggs in the nests of other birds. However, it was not known how the nestlings of the foster parents were disposed of. In the original manuscript of the paper on cuckoos read before the Royal Society on 29 March 1787, Jenner concluded that the cuckoos' foster parents ejected their own nestlings. Jenner could not have seen this—he may have heard the explanation from his nephew—and he had to withdraw the paper before publication in the Philosophical Transactions when he saw what really happened: ejection by the newly hatched cuckoo. Jenner went on to describe the transient anatomical modification to the young cuckoo's back which facilitates this action. He also reasoned that the behaviour of the mother cuckoo was determined by the fact that she did not stay long enough in Britain to rear her young. Jenner published his revised observations in the Philosophical Transactions for 1788, and the following year he was elected to fellowship of the Royal Society. His published account was not universally accepted until confirmed by photography. That he eventually observed what really happened rather than guessed is proved by his recognition of the transient anatomical modification.

At about the same time as his election to the Royal Society, Jenner started the work on bird migration which was completed just before his death. At a period when some still believed that birds hibernated, he helped to confirm that they did migrate. He also showed, by dissection, that this behaviour was connected to changes in the reproductive system and not due to climatic changes or to food shortage. The results of his work were published posthumously in the Philosophical Transactions for 1824.

Rewards

Despite some scepticism, vaccination was accepted quickly, particularly so given the uncertainty about the duration of immunity, which could only be resolved by the passage of time. Jenner's role was also generally acknowledged by individuals and by official commissions set up in Britain and overseas. Parliamentary grants of £10,000 in 1802 and £20,000 in 1807 helped to compensate for the fact that he made his findings freely available.

Already received by British and foreign royalty, during the wars with France letters from Jenner to Napoleon secured the release of English prisoners. Jenner also received honours, testimonials, and diplomas from all over the world. These are listed by Baron in the second volume of his Life of Edward Jenner (1838, pp. 449–56), and include fellowships of colleges and societies in America, France, Italy, Russia, Spain, and Sweden; freedom of the cities of London, Edinburgh, Glasgow, and Dublin; and honorary doctorates from Oxford and Harvard universities. Although he accepted the fellowship of the Royal College of Physicians of Edinburgh, he declined to be put forward for fellowship of the Royal College of Physicians of London because it involved sitting a Latin examination.

Shortly before his seventy-second birthday Jenner was made physician-extraordinary to George IV, a purely honorary title. However he did not receive a knighthood. This may have been due to his allegiance to Queen Caroline, whose daughter he attended in 1808, and for whom he apparently had some sympathy in her dispute with the king.

Later years and death

Jenner did not enjoy good health after middle age. He had serious attacks of typhus, or more likely typhoid, in 1794 and 1811, and suffered bouts of depression particularly following his son Edward's death in 1810. He served terms as mayor of Berkeley and commissioner of Cheltenham, and as magistrate in both places. Despite having close family associations with the Church of England, Jenner apparently showed no more than routine interest in religious matters, though he was vice-president of Cheltenham Auxiliary Bible Society. He was a freemason by 1804 and served some official role in a Berkeley lodge in 1811. His mobility and perhaps enjoyment of his new-found fame was marred by increasing concern over his wife's illness. Catherine Jenner died from tuberculosis on 13 September 1815 and Jenner, increasingly depressed, spent his remaining years in Berkeley. He had a minor stroke in 1821 but still continued to see patients occasionally, until just before his death. He died from a stroke on 26 January 1823 at his home, The Chantry, Berkeley (now the Jenner Museum), and was buried in Berkeley parish church on 3 February.

At his death Jenner's household and personal effects, including more than 800 books, 648 bottles of port, and 200 gallons of ale, were officially valued at £2477 19s. 0d. His executor and nephew William Davies estimated the total estate as less than £35,000, though Jenner had settled £13,333 on his daughter the year before. Jenner's papers were left for his executors to dispose of by publication or destruction as they thought fit. Although very few were published at the time, many survived and have since been published and analysed.

Reputation

Jenner's reputation has suffered from over-enthusiastic supporters as well as critics. Of the former, John Baron and later Saunders depicted Jenner as a genius, whereas many popular accounts describe him as the simple country doctor fascinated by milkmaids' tales. However, all his critics claim that he was lazy and evasive, and to Creighton he was a charlatan whose cuckoo and vaccination studies were a hoax (Creighton, 49). In fact Jenner, though no genius, was a well-trained physician and surgeon, competent at formulating and testing hypotheses. Some, particularly Creighton, Crookshank, and more recently Razzell, have argued that, although Jenner conducted some preliminary work with cowpox, the bulk of nineteenth-century vaccine was established—by others—from modified smallpox virus. If so, this would severely dent Jenner's reputation. However, many vaccines were established from cowpox and horsepox, and modern studies discount the role of smallpox virus in the origin of smallpox vaccine.

Jenner's claims, based on few vaccinations (not all of which were tested by variolation and then after a very short interval), and his original cuckoo observations, show that he was inclined to make conclusions based on incomplete or dubious evidence. However, even when this is taken into account it has to be accepted that Jenner's use of an animal virus to induce immunity to smallpox marks a distinct break with previous practice. This, together with his analysis of ‘true’ and ‘spurious’ cowpox, without which vaccination could not have been developed, justifies the credit he has been given. Jenner's major error was not to acknowledge publicly that vaccination did not provide lifelong protection. However, vaccination and revaccination, properly carried out, continued to reduce the impact of smallpox, and culminated in the final eradication of this disease—an outcome forecast by Jenner in 1801.