The medical fraternity hardly deserved that name, for it fully reflected the British penchant for class or grade distinctions. The Royal College of Physicians, proud of its establishment by Henry VIII in 1518, limited its “associate” memberships to some fifty men who had taken a degree at Oxford or Cambridge, and its “licentiate” memberships to about fifty other distinguished practitioners. These hundred men served as a kind of House of Lords to the medicos of England. They earned substantial incomes, sometimes as high as twenty thousand pounds a year. They could not become peers, but they could be knighted, and might aspire to a baronetcy. Of markedly lower status was the Royal College of Surgeons, established in 1800. Below these were the accoucheurs, male midwives, who specialized in drawing embryos out of their warm security into the competitive world. At the bottom of the healers were the apothecaries, who provided nearly all the medical care available in rural areas.
Neither of these “colleges” offered medical education except for occasional lectures by famous physicians. Neither Oxford nor Cambridge had a school of medicine; students who desired university training in medicine had to seek it in Scotland. Otherwise the training of English doctors was left to the private schools that grew in the neighborhood of the great hospitals raised by private philanthropy. Sir Thomas Bernard spent much of his wealth in reforming the famous “Foundlings’ Hospital” in the north of London, and shared with other wealthy men in financing, in London and elsewhere, free clinics for the treatment of cancer, ophthalmia, and hernia. But the poor sanitation of the cities spread diseases, or generated new ones, as fast as medicine could cure them.
In 1806 London recorded a singular event: it had gone a full week without a death from smallpox—that pustulous, feverish, face-marring, and infectious disease which had once been epidemic in England, and might at any time swell again into a deadly plague.
A modest English physician, Edward Jenner—addicted to hunting, botany, composing poetry, and playing the flute or the violin—made the miracle week possible by a decade of inoculations that finally overcame the conservatism of British society. The prevention of smallpox by inoculation with weakened virus from a smallpox-infected human being had been practiced by the ancient Chinese; Lady Mary Wortley Montagu had found it customary in the Constantinople of 1717; on her return to England she recommended the procedure there. It was tried upon criminals, then upon orphans, with considerable success. In 1760 Drs. Robert and Daniel Sutton reported that in thirty thousand cases of smallpox inoculation they had had twelve hundred fatalities. Could a surer method of preventing smallpox be found?
Jenner was led to a better way by noting that many milkmaids in his native Gloucestershire contracted cowpox from infected nipples of cows, and that these women were thereafter immune to smallpox. It occurred to him that a like immunity might be established by inoculating with a vaccine (vacca is Latin for cow) made from virus of a pox-infected cow. In a paper published in 1798 Jenner recounted a venturesome procedure which laid the foundations of experimental medicine and immunology.
… I selected a healthy boy, about eight years old, for the purpose of inoculation for [with] the Cow Pox. The matter was taken from a sore on the hand of a dairymaid who was infected by her master’s cows, and it was inserted, on the 14th of May, 1796, in the arm of the boy…. On the seventh day he complained of uneasiness,… and on the ninth he became a little chilly, lost his appetite, and had a slight headache…. On the following day he was perfectly well….
In order to acertain whether the boy, after feeling so slight an affection of the system from the Cow Pox virus, was secure for the contagion of the Small Pox, he was inoculated, the 1st of July following, with variolous matter [variola is Latin for smallpox] immediately taken from a pustule…. No disease followed…. Several months afterwards he was again inoculated with variolous matter, but no sensible effect was produced in the constitution.9
Jenner went on to describe twenty-two other cases of similar procedure with completely satisfactory results. He met with condemnation for what seemed to be human vivisection, and he tried to atone for using a consenting minor by building a cottage for him and planting a rose garden for him with his own hands.10 In 1802 and 1807 Parliament voted Jenner £30,000 to improve and spread his methods. In the course of the nineteenth century smallpox almost disappeared from Europe and America, and when it occurred it was in unvaccinated individuals. Vaccination was applied to other ailments, and the new science of immunology shared with other medical advances, and with public sanitation, in giving modern communities as much health as is allowed by the harassments of poverty, the fertility of ignorance, the recklessness of appetite, and the patient inventiveness of disease.