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Edward Jenner, Cowpox, And Smallpox VaccinationWe begin our history of vaccines and immunization with the story of Edward Jenner, a country doctor living in Berkeley (Gloucestershire), England, who in 1796 performed the world’s first vaccination. 4 Taking pus from a cowpox lesion on a milkmaid’s hand, Jenner inoculated an eight-year-old boy, James Phipps. Six weeks later Jenner variolated two sites on Phipps’s arm with smallpox, yet the boy was unaffected by this as well as subsequent exposures. 5 Based on twelve such experiments and sixteen additional case histories he had collected since the 1770s, Jenner published at his own expense a volume that swiftly became a classic text in the annals of medicine: Inquiry into the Causes and Effects of the Variolae Vaccine. His assertion “that the cow-pox protects the human constitution from the infection of smallpox” laid the foundation for modern vaccinology.

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How did Jenner, a country doctor, formulate the vaccine concept? To begin with, his discovery relied extensively on knowledge of the local customs of farming communities and the awareness that milkmaids infected with cowpox, visible as pustules on the hand or forearm, were immune to subsequent outbreaks of smallpox that periodically swept through the area. Moreover, a learned man immersed in the secular and rational doctrines of the Enlightenment, Jenner applied the scientific methods of observation and experimentation to this parochial wisdom, ultimately conducting one of the world’s first clinical trials. He thus was able to devise an alternative to variolation (the controlled transfer of pus from one person’s active smallpox lesion to another person’s arm, usually subcutaneously with a lancet), which had been practiced in Asia since the 1600s and in Europe and colonial America since the early 1700s.