Chapter IV: Preface (3)

The Emperor himself was suffering from a persistent cold and was told that Corvisart, instead of following the traditional method of feeling the pulse, looking very wisely at the tongue and then gazing learnedly into space, conducted an actual examination of the chest and sounded it carefully all over, in order to determine where abnormal conditions might exist. This struck Napoleon as a very practical and possibly valuable feature of diagnosis. Accordingly Corvisart was summoned to give his professional opinion. After the consultation he was made the Emperor's private physician. When Corvisart took up the subject of percussion of the chest, it was practically unknown in Europe outside of Vienna. Even in the city of its origin, as we have seen, it was not well appreciated. Auenbrugger's little book had fallen into oblivion. Corvisart obtained his hint as to the possible value of percussion from Stoll's and Eyerel's appreciative remarks with regard to it. The Frenchman used the method to some extent and, realizing its value, resolved to call the attention of his countrymen and the medical world to this very helpful aid in diagnosis. It was at this time that he came upon Auenbrugger's original monograph. Instead then of writing himself on the subject, he translated {76} Auenbrugger's little book into French and made a commentary on it.

Corvisart was Laennec's patron in medicine, his favorite teacher, and the man to whom the great French physician owed much of his early inspiration. It is no little merit in Corvisart's career thus to have been the connecting link between the men who did most for the practical science of medicine, and especially for the important but obscure chapter of diseases of the chest. He did not attempt at all to claim for himself any of the merit that he felt should rightfully go to Auenbrugger, and while his own observations and writings established percussion upon a firm basis and extended its knowledge, he shares the immortality of his discoverer, and comes down to us in medical history as an example of the reward of having rendered faithfully what was due, where it was due. It has been the custom to praise Corvisart for his justice toward Auenbrugger. Mere justice seems scarcely a worthy reason for praise of a great man, yet the history of medicine is so full of failures on the part of subsequent observers to acknowledge priority of discovery, that perhaps the praise does not seem quite as futile as it otherwise would.

It is not surprising then that Corvisart's pupil Laennec should have appreciated very thoroughly the value of Auenbrugger's discovery. In the preface of his book on Mediate Auscultation, Laennec bewails the fact that men are generally neglectful of discoveries made in their own time, and fail to give them the attention they deserve. He attributes this neglect rather to the well-known carelessness of men than to any deliberate failure to recognize the merit of contemporary work. He says:

"Lack of attention is an extremely common failing of all men. What
it takes years and hard labor to acquire, is not {77} infrequently
passed over without notice. Auenbrugger's method, published some
fifty years ago, though capable of being learned in a few days, and
without difficulty, and of being put into practice without the use
of any instruments, although snatched from oblivion by my
illustrious preceptor, Professor Corvisart, and made clearer than it
had been left even by the author himself, is not as yet in ordinary
use among physicians. Even the wonderful invention of the
illustrious Jenner, though received with so much praise, and with
regard to whose efficaciousness numberless confirmatory observations
have been made, is already somewhat less prominent in the minds of
men than it should be, or at least it would be, only for the fact
that the governments of many countries, provinces and cities, the
foresight of the clergy, of the authorities of all kinds, and the
advice of the best physicians have exerted all their influence to
keep it at public expense constantly in practice."

After about ten years of service at the Spanish military hospital, Auenbrugger resigned his position there and took up private practice. In this he was eminently successful, being, as might be expected, especially in demand for cases involving affections of the thorax. His practice appears to have been to a great extent among the better class of people, but he seems never to have neglected the poorer patients whom he had come to know during his hospital experience. There are traditions in Vienna of his unfailing willingness to assist the poor and even to put himself to considerable inconvenience in order to be of service to them.

Tradition tells that he was very conscientious in the pursuit of his vocation as a physician, and among the family relics there is preserved a small lantern which he kept always by his bedside, to light him on his visits to the sick when called out at night. It must not be forgotten that city streets {78} were not regularly lighted at the end of the eighteenth century, and night calls even in city work must have been a source of great annoyance and discomfort. There is a family tradition, too, that the night bell at his house was connected directly with Auenbrugger's room, so that the others of the household might not be disturbed when night callers came for him. Every tradition points to him as a man among men in his unselfish readiness to save others trouble, and do all the good in his power.

Auenbrugger was, according to well-grounded traditions, especially admirable in his relations toward other members of the medical profession. This may not seem a very significant sign of amiability to those outside the profession, but it is well recognized that even great physicians have not always been known to get on well with brother practitioners. Auenbrugger has, besides, the pleasant reputation of having been of great material assistance to a number of needy medical students during the time of their university careers, and to have frequently lent a helping hand to young practitioners in the city, who probably found it quite as discouraging, beginning practice in those days, as any of their young confreres of this generation find it at the present time.

To physicians and medical students when ill, Auenbrugger was almost unceasing in attention. Two or three physicians of the generation immediately after his attributed to his unselfish care and devotion to them their recovery from what would otherwise have been mortal illnesses. In this way Auenbrugger seems to have been a man whom everyone who came to know him, even slightly, learned to love and respect. His relations to his family and relatives were always of the most happy, kind character, and family traditions show that his fatherly care was befittingly returned to him in his old age. The number of his friends was very great, {79} and he counted among them some of the most distinguished inhabitants of the Austrian capital.

Notwithstanding his devotion to his practice, Auenbrugger did not cease to make observations that occasionally he considered worthy of being committed to paper. He was especially careful in the study of his cases, and left fully written records of over 400 important cases that he had studied very faithfully. His attention seems to have been attracted particularly to certain mental diseases. This work was done half a century before even the first beginnings of the modern classifications of mental diseases were attempted. He wrote a short article with regard to mania and its treatment, and a longer article on melancholia. How well he recognized the essential feature of this latter affection and the main symptom that must be guarded against, can be gathered very well from the title of his paper, which he called "The Still Madness, or the Impulse to Self-Murder."

It is about the time that he was engaged in the study of melancholia, perhaps as a contrast to sadder things, that he wrote a comic opera, of which we shall have more to say presently. His description of the conditions that he saw during an epidemic of dysentery that occurred in Vienna show how exact and careful a clinical observer he could be, and that the demands of his practice did not absorb all his attention to the detriment of his faculty for observation. He seems himself to have suffered from a severe attack of typhus fever which raged epidemically in Vienna in 1798.

Auenbrugger had a wide circle of interests beyond the subject of medicine. There is a family tradition that he had a magnificent library. He seems with true Viennese spirit to have been a great devotee of the opera, and to have had an especial liking for music. He wrote the text, {80} score, and libretto of a comic opera with the title, "The Chimney Sweep." This operetta evidently enjoyed more than a _succes d'estime_, and further writing in this line was confidently expected from him by his friends. There is even a story to the effect that the Empress Maria Theresa, of whom he was an intimate friend, and who made use, it is said, of his counsel in political matters more than once, asked him why he did not follow up his first success in operatic writing. His blunt reply shows how intimate must have been his relations with the great empress. He said he had things much better with which to occupy himself than the writing of comic operas.

Seeing that he was so favored at court, it is not surprising to find the family tradition that Auenbrugger was associated with many of the most prominent persons in the Austrian capital during his lifetime. He was a special friend of and spent a great deal of time with the famous philosopher, Werner. As he grew older he delighted especially in music, and spent many hours at the house of Baron Zois, where many of the distinguished European musicians were to be found and where famous matinee concerts were given every Sunday from twelve to two. The day and the time may seem strange to foreigners, but Vienna still has concerts at this time on Sunday, and after the Viennese have gone to Mass in the morning they think that they could not occupy themselves better than with listening to good music in the middle of the day.

Toward the end of his life, Auenbrugger lived during the summer time in the suburb of Rossau and cultivated a little garden, taking the greatest pleasure in spending his time at this simple occupation. It is a source of satisfaction to find that though Auenbrugger's medical work failed during his life to attract the attention it deserved, he had his reward, {81} for his patient investigations in earlier life, in a peaceful and contented ending to a career that had been so worthy of what was best in the man. He lived to celebrate his golden wedding in 1804 and was especially happy in the almost constant companionship of the good wife who had proved so faithful a helpmate during her long life. After her death, which took place the year following the celebration of their jubilee, his vitality and his contentment with life seemed to abandon him. He was a changed man and kept himself for the most part to his room. He went to bed very early and did not care to see anyone but his near relatives. His last illness was the result of a cold, and his advanced age, eighty-seven, left him little resistive vitality. He retained his consciousness until the very end, and said the day before his death that the next day would be his last.

Shortly before noon of the day of his death he looked at the clock in his room and said that when the hands would point to two o'clock he would be no more. His prophecy came true.

Vienna has never had the reputation of honoring its great geniuses during their lifetime, unless they happened to belong to the higher nobility. The exclusiveness of court society at the capital made itself felt in all circles, and the consequence was that genius sprung from the lower orders was almost sure not to receive its due share of attention. The comparative neglect of Auenbrugger does not seem so bad when we recall the case of Mozart. Music has always been one of the special fads of the Austrian and the Viennese pride themselves on their appreciation of it. Mozart, however, perhaps the greatest musical genius that ever lived, received some attention during his life, but passed away almost unnoticed at the early age of thirty-five, was buried in a common trench with the poor people of the city, and now Vienna cannot {82} find his resting place. There is a magnificent monument to him, but his bones lie with his own people forever.

Outside the circle of his personal friends Auenbrugger did not receive much attention, so that even the year of his death was until recently more or less uncertain and the resting place of his remains continues to be unknown. The present generation of medical men has done more to afford the due meed of praise to Auenbrugger than any preceding generation. The interest in tuberculosis particularly has led medical men to appreciate all the significance of Auenbrugger's work, and the practical importance of his discovery for the early recognition and consequently for the cure of the disease. The appreciation of Auenbrugger in our time has been so flattering as quite to make up for previous neglect. His name has been linked with that of Laennec as the great discoverers of physical diagnosis in chest diseases.

At the opening of his address as President of the American Climatological Association, some five years ago, Dr. Edward O. Otis, of Boston, said:

"It is quite improbable, I think, that we should be here to-day, or,
indeed, have an existence as a society largely devoted to the
consideration of diseases of the chest, were it not for the methods
of thoracic examination which Auenbrugger and Laennec have given us
in their discoveries of percussion and auscultation. Without these
two precious methods of investigation we could scarcely have arrived
at any degree of precision or certainty in thoracic pathology and
might have been not unlike the old physicians and surgeons, 'who
would swear,' as Morgagni says, 'that there was fluid in the chest
when in reality there was not a single drachm, or perform
paracentesis of the thorax upon a duke for an empyema which did not
exist.'"

His tribute is only an echo of many others not less {83} appreciative of Auenbrugger's important original work than have been expressed by modern medical men of all nations. The simple old German practitioner, who had the annoyance of seeing his discovery neglected by his contemporaries for so many years, has at last come into his own. There is scarcely an important medical meeting held anywhere in the world in which diseases of the chest are discussed without a mention of Auenbrugger's name. This is not surprising in Germany, but is quite as true of France, and England, and America. As Dr. Otis said, in closing the address from which we have just quoted:

"Although we possess but meagre and fragmentary records of
Auenbrugger's life, there is yet enough to enable us to fill in the
lines and gain a distinct idea of his personality and character.
With some persons one does not need to be acquainted with much of
the detail of their lives in order to know what manner of men they
are; a few characteristic illustrations here and there in their
career redeem the spirit and motives of their lives, and show the
kind of men just as they are, quite as well and clearly as an
extended and continuous biographical narrative. Always
enthusiastically devoted to the study of disease, Auenbrugger
escaped the not infrequent misfortune of the student, a loss of
sympathy with one's kind. His love for his fellow-men, for suffering
humanity, for struggling students in his own profession, kept pace
with his love for medical study. He never sacrificed the man for the
scientist, nor did he lose his interest for other things in life, as
happens sometimes with men intensely devoted to one pursuit. A man
of original powers, as some one has truly remarked, can never be
confined within the limits of a single field of activity.

"He was interested in music, philosophy and the drama, and well
illustrates what Dr. Da Costa has so happily styled {84} 'the
scholar in medicine.' With dignity, sympathy, enthusiasm in his
profession, even to the last; ever seeking to improve and add to his
art; modest, like most great men; never refusing to give what is
best to suffering humanity, he richly lived out his long life. As we
teach our students percussion, as a matter of just recognition and
due honor let us tell them something of the life of the discoverer,
and at least his name, which I fear but few, who avail themselves of
the result of his long and arduous labors, know."

Auenbrugger's German biographer, Professor Clar, of Gratz, says of his early life that from his parents he received an excellent early training, especially edifying because of the exemplary Christian family life he saw about him, the piety of his father and mother, and of the other members of the family. The baptismal register of the parish church at Gratz is one of the important documents in his life history, for there is some dispute as to the exact date of his birth, as there is also with regard to his death. In 1798 he suffered from a severe attack of typhus fever, which at the time was epidemic in Vienna, and some of his biographers report his death in this year as a consequence of it. His descendants, however, have shown, by the burial register of the parish church in Vienna, that his death did not take place until May 17, 1807; from this church, of which he had been for half a century a faithful member, he was buried.

Few of the lives of the great discoverers in medicine have in them more of encouragement for the busy practitioner of medicine than that of Auenbrugger. He began his medical career by a series of practical observations that stamped him for all time as one of the great geniuses. When his discoveries failed to meet with the acceptance they deserved, he was not disturbed, and, above all, he did not insist on acrid controversy. He took up the practice of medicine and {85} demonstrated how much his discovery could help in the diagnosis of the obscure chapter of the diseases of the chest. In the mean time he went on his way placidly doing the good that he found to do, taking care of his poor patients and faithfully tending brother-physicians who happened to be ill. He found an avocation to fill the moments spent apart from his vocation, and added to the pleasure of humanity by his work in music. All the time he remained a simple, faithful believer in the relation of Providence to man, and considered that somehow the inexplicable things of this life would find an explanation in the hereafter. He was probably the best-liked member of the profession in Vienna during his lifetime, and the profession of his native town are very proud to recall the example that he sets physicians generally in all the ethical qualities that make a physician's life not only successful in the material sense, but also in inspiration for those around him to do their duty rather than seek the fulfilment of merely selfish aims.

{86}

{87}

EDWARD JENNER, THE DISCOVERER OF VACCINATION

{88}

"It helps a man immensely to be a bit of a hero worshipper, and the
stories of the lives of the masters of medicine do much to stimulate
our ambition and rouse our sympathies. If the life and work of such
men as Bichat and Laennec will not stir the blood of a young man and
make him feel proud of France and of Frenchmen, he must be a dull
and muddy-mettled rascal. In reading the life of Hunter, of Jenner,
who thinks of the nationality which is merged and lost in our
interest in the man and in his work! In the halcyon days of the
Renaissance there was no nationalism in medicine, but a fine
catholic spirit made great leaders like Vesalius, Eustachius,
Stenson and others at home in every country in Europe."
--Osler, _Aequanimitas and other Essays_.

{89}

EDWARD JENNER, THE DISCOVERER OF VACCINATION.

A very striking life in its lessons for the serious student of medical problems is that of Edward Jenner, who first demonstrated to the world that a simple attack of mild, never fatal, cowpox, deliberately acquired, might serve as a protective agent against the deadly smallpox, which before that time raged so violently all over the civilized world. His successful solution of this problem has probably saved more lives and suffering than any other single accomplishment in the whole history of medicine. While this fact is apparently not generally appreciated, Jenner's discovery did not come by mere chance, but was the result of his genius for original investigation, which led him to make many other valuable observations covering nearly the whole range of medicine; nor indeed was his activity limited to medicine alone, but extended itself to many of the allied sciences, and even to scientific departments quite beyond the domain of medicine.

In medicine we owe to Jenner the first hint of the possible connection between rheumatism and heart disease. He pointed out, at a discussion in a little English medical society, how often affections of the heart occurred in those who had suffered from previous attacks of rheumatism. He was among the first, perhaps the very first, to hint at the pathological basis of angina pectoris. While Heberden's name is usually connected with this discovery, there seems good reason to think that already Jenner had independently noted and called attention to the frequency with which {90} degenerative affections of the arteries within the heart muscle itself were to be found where during life heart-pang had been a prominent and annoying symptom.

Besides these important advances in medicine made by him, and his great discovery of the identity of cowpox and smallpox, Dr. Jenner was an interesting observer of phenomena in all the biological sciences, and in geology and palaeontology. He was a great friend of Dr. John Hunter, who frequently suggested to him the making of such experiments and observations as were more likely to succeed in the country than in the city, and one cannot help but be struck with the determination evinced all his life to take nothing on authority, but to test everything by actual observation, and above all not to theorize where he did not have the actual data necessary for assured conclusions; and even where he thought he had them, his wonderful faculty for waiting until they had properly matured, and their true significance had become evident, stamped him for all time as a model for scientific investigators.

Undoubtedly Jenner's greatest work was that of determining the value of vaccination. His patient investigation of this subject, the thorough conservatism with which he guarded himself from publishing his conclusions until he had tested them in every way, the absence of that haste to rush into print so characteristic of most present-day medical investigators, and which is the cause of so much disappointment in modern medicine, all distinguished this country physician as one of the greatest investigating geniuses that medicine has produced. His life is a mirror for the medical student and the investigating practitioner of medicine. His discovery was so complete when he finally announced it that but very little has been added to it since. His invention came from his mind as Minerva from the brain {91} of Jove fully armed for the conflict that was sure to come. In this Jenner resembled very much Laennec and the other investigating geniuses in medicine. As a matter of fact only one improvement has been made in the preparation of vaccine material since Jenner's time, and that is the incorporation of glycerin in very recent years, which gradually destroys any micro-organisms that may be present, leaving the vaccine virus itself unimpaired in its efficacy, though without the possibility of inflicting those secondary infections which for so long cast a shadow on vaccination.

Dr. Edward Jenner was the third son of an Anglican clergyman, his mother being the daughter of a clergyman who had been at one time prebend in the cathedral of Bristol. The family held considerable property in Gloucestershire. He received his early education at Wotton-under-Edge and later at Cirencester, the old Roman town in Gloucestershire. While he acquired a good working knowledge of the classics, from his earliest years he was interested in natural history. Before he was nine he made a collection of the nests of the dormouse. The hours that other boys spent at play he devoted to searching for fossils or other interesting natural curiosities.

After his preliminary education had been finished he was apprenticed to Mr. Ludlow, an eminent surgeon at Bristol, and after two years here he went to London, where he had the privilege of residing as a favorite pupil in the family of John Hunter for two years. At this time Jenner was in his twenty-first year, John Hunter in his forty-second. Hunter was not then a public lecturer, but he had been for two years surgeon to St. George's Hospital, and for nearly five years had been engaged in studying the habits and structure of animals in a menagerie and laboratory which he had established at Brompton. The inspiration of Hunter's original {92} genius meant much for young Jenner. He learned not only to respect the teacher but to love the man. In Hunter's unquenchable desire for knowledge and love of truth there was something very congenial to the spirit of Jenner, who was himself, above all things, an inquirer.

After completing his two years of work with Hunter he still remained intimately associated with him by letter. Though later in life Jenner's correspondence became very voluminous, these letters from Hunter were always very carefully preserved in a special cover, and they serve to show how stimulating to the young man must have been Hunter's virile enthusiasm for truth as it could be deduced by observation and experiment.

It was to Hunter that Jenner once wrote that he had heard it said in Gloucestershire that the dairy workers who suffered from a certain disease caught from the udders of cows and called cowpox were protected thereafter from attacks of smallpox. He added that this tradition interested him very much and that he intended to think about it. "Don't think," wrote Hunter to him, in return; "make observations, investigate for yourself the truth of the tradition." Jenner did so, and the result is now known to all.

These letters from Hunter contained many other interesting suggestions. For instance, it was under Hunter's direction that Jenner succeeded in finding out that in hibernating animals the temperature is very much reduced and the respirations are very slow, while the rate and force of the pulse are often so much diminished as to be scarcely more than noticeable at the extremities. Between Hunter and Jenner it had already been discovered that the sap in trees will not freeze at temperatures much lower than that at which the same fluid freezes when withdrawn from the tree, and the same thing seemed to be true with regard to {93} the blood of hibernating animals. He learned that notwithstanding the low temperature to which it is reduced the animals are not affected particularly by the cold, though their store of fat is consumed and they awake very hungry in the spring-time.

Besides hibernation Jenner also investigated the habits of the cuckoo, that crux of the biologist which insists on foisting its eggs upon other birds and allowing its orphan young to be brought up in alien nests, while the real young of the deceived foster-parents are often pushed out of their nests by this burly intruder which grows so fast and strong. It is needless to say, this subject interested John Hunter very much and there are a number of letters which passed between them on the subject.

It must not be supposed, however, that young Jenner was entirely occupied with his scientific work to the exclusion of social life and recreation. He was one of the best-known men of the county, and was looked upon as a genial companion from whom might be expected on almost any occasion pleasant jests and epigrams, not too biting, with regard to friends and acquaintances. Some of these have been preserved and we quote several of them as indicative of his special vein of humor.

ON THE DEATH OF A MISER.

"Tom at last has laid by his old niggardly forms,
And now gives good dinners; to whom pray?--the worms."

ON LORD BERKELEY'S HUNTSMAN, WHO DIED IN THE CHASE.

"Determined much higher to hoist up his name,
Than Nimrod the hunter, in annals of fame,
'Hark forward!' cried Charles, and gallantly whirled
His high-mettled steed o'er the gates of the world."

{94}

DEATH AND MR. PEACH.
A Short Dialogue. N. B.--Mr. P. died in April.

"P.--Awhile forbear thy horrid gripe,
Do pray, dread Sir! remember
Peaches are never fairly ripe
'Till August or September."

"D.--To gratify my longing taste,
And make thy flavour fine,
I had thee in a hot-house placed,
And moistened well with wine."
"Mr. Peach had shortened his life by the too free use of the bottle."

We have said that Dr. Jenner's supreme accomplishment in science was the working out of the vaccination problem to a great humane conclusion. His discovery was no mere accident, nor chance confirmation of a medical tradition. He devoted himself for many years to the study of cowpox, as he had the opportunity to see it, and it is what we know of this investigation, his patience and care in eliminating all the factors of error, that stamped Jenner as a medical scientist worthy of honor. When he began practice in Berkeley, he made many inquiries among his professional brethren, with regard to their opinion of the protecting power of cowpox, but most of them had either paid no attention to such reports, or shook their heads at once, and said they were at most popular traditions, due merely to coincidences and unsupported by any credible evidence. In the face of this, Jenner began to follow John Hunter's advice to investigate. The first careful investigation dates from about 1775, and it took him more than five years to clear away the difficulties surrounding the solution of the question, in which he was interested.

As Pasteur found in the next century, when investigating the silkworm disease, Jenner soon learned that there was {95} more than one disease called cowpox, and that the confusion consequent upon the existence of at least two specific diseases and a number of skin affections of the hands of various kinds, which existed among dairy workers, made the recognition of the protective power of true cowpox extremely difficult. After he had differentiated genuine cowpox, however, there was no difficulty in tracing its apparent protective power. He soon found, however, that the protection was not afforded unless the cowpox had been communicated at a particular stage of the disease. In other words, after the true vaccinia has run its course, secondary affections of the skin of the cows usually take place, and if dairy workers became infected from these lesions, then no protection against smallpox is afforded them. Another important observation that Jenner made at this time was that the disease known as grease in horses is the same affection as cowpox, and that both of these diseases are smallpox as modified by the organism in which they develop. It may be said at once that this opinion so difficult to arrive at, more than a century ago, when so little was known of comparative pathology, is held at the present day, and was confirmed by the last series of investigations made under the auspices of the Jenner Society, in England.

One difficulty that confronted Jenner in his researches was the fact that cowpox was scarce in his part of the country, and he had no opportunity of making inoculations with the disease in a proper stage, so as to put his suspicions to an absolute test. He collected much information, however, and stimulated others to the making of observations, so that when his discovery was announced the mind of the medical profession was more ready to receive it. In 1788 he carried a carefully made drawing of a case of cowpox as it occurred on the hands of a Gloucester milkmaid to London, and {96} showed it to a number of medical men, whose opinions he wished to obtain. Among these was Sir Edward Holme, who agreed that there was a distinct similarity between it and certain stages of smallpox and considered that the question of a connection between the two diseases was an interesting and curious subject. He did not share any of Jenner's views, however, with regard to the practical importance of his discovery in this matter, and gave little encouragement to the idea that a possible prophylactic for smallpox might be discovered.

Something of Jenner's enthusiasm for experiment may be gathered from the fact that he did not hesitate even to inject various materials related to cowpox into the arm of his own children. We know Mrs. Jenner to have been a very wonderful woman, quite as deeply interested as the doctor himself in securing the great benefit to humanity that would result from the demonstration that cowpox protected against smallpox, but it is a little bit difficult for us in these days to understand how her mother-heart could have permitted some of the experiments which Dr. Jenner's biographer, Dr. Baron, describes. [Footnote 1]

[Footnote 1: The life of Edward Jenner, M.D., F.R.S., Physician
Extraordinary to His Majesty Geo. IV, Foreign Associate of the
National Institute of France, &c. &c. &c. With illustrations 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 passage 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 assumed
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 passing 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."

{99}

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 constitution 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 assertion 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 circumstances 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 passage from a letter by Dr. Jenner written to Mr. Moore. Corresponding objections have been made in much more modern times, and the passage will arouse the sympathetic amusement 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 title that develops its
purport or evil tendency: 'An Inquiry into the Relative Mortality of
the Principal 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 instituted an inquiry
through this populous town and the circumjacent 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, Mass., 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 Massachusetts, 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 documents, expressive of the gratitude 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 assure
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 entitled 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 classes, 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 gratitude
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 assurances 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 entitled 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."