Jenner and Vaccination

The speckled monster

Smallpox killed around one in three of the people it infected in the eighteenth century, accounted for perhaps a tenth of all deaths in Britain, and left most survivors scarred and some blind. Nobody knew what caused it. Two things were known: that a survivor never caught it again, and, in the villages of Gloucestershire, that milkmaids who had caught the mild cowpox from their cows seemed never to catch smallpox at all. The first fact produced inoculation. In 1721 Lady Mary Wortley Montagu, who had seen the practice in Turkey, had her daughter deliberately infected with matter from a mild smallpox case; the patient got a mild dose and lifelong protection, unless the dose was not mild, which killed around one patient in fifty. It spread through the century, made the Sutton family rich, and was itself a source of infection to everyone near the patient. The second fact produced vaccination. On 14 May 1796 Edward Jenner, a country doctor at Berkeley, took cowpox from the hand of a milkmaid, Sarah Nelmes, and scratched it into the arm of James Phipps, aged eight, the son of his gardener. Six weeks later he inoculated the boy with smallpox, and nothing happened. He published 23 cases in 1798. It took Parliament six years to reward him, fifty-seven to make his method compulsory, and a further forty-five to make it voluntary again in the face of riots and marches. AQA asks what inoculation and vaccination were, why vaccination was resisted for reasons that made sense to the people resisting, what government did, and which factor mattered most. This module gives you the dated evidence and the four question shapes.

Five words the examiners use

Each definition ends with the moment it mattered, because a bare definition earns nothing in an 8-mark answer.

Prevention, in order

Put these six events in the order they happened.

• Lady Mary Wortley Montagu brings inoculation from Turkey and has her daughter inoculated
• The Sutton family make a fortune inoculating tens of thousands with a milder method
• Jenner vaccinates James Phipps with cowpox and then fails to give him smallpox
• Parliament grants Jenner 10,000 pounds and the Royal Jennerian Society is founded
• Vaccination of infants is made compulsory
• After the Leicester march and the Anti-Vaccination League, Parliament allows conscientious objection

Why was vaccination resisted for so long?

Jenner published in 1798 and Parliament rewarded him in 1802, yet vaccination was still being fought in the streets in 1885. Which explanation best accounts for the opposition?

• The people who made a living from inoculation, including the Suttons and thousands of local practitioners, lost their trade if vaccination won; clergy and many patients thought it unnatural and ungodly to put matter from a cow into a human child, which the Gillray cartoon of 1802 played on; Jenner could not say why it worked and some early vaccinators used contaminated lymph, so failures were real and doubt was reasonable; and when the state made it compulsory in 1853 and added fines in 1871, opposition became a matter of liberty as well as medicine.
• People in the nineteenth century were too ignorant to understand science.
• Vaccination did not actually work until Pasteur improved it.
• The government banned vaccination until 1853.

Inoculation and vaccination

The similarity question asks how two developments compare. Set the two methods side by side and both the likenesses and the differences are on the card.

Question 1: how useful is a source?

Source A: a description of a cartoon by James Gillray published in 1802, titled The Cow-Pock, or the Wonderful Effects of the New Inoculation. In a crowded room a doctor scratches the arm of a frightened woman while an assistant ladles cowpox from a tub; around them patients who have already been vaccinated are sprouting small cows from their arms, faces and backsides, and one man has grown horns. On the wall hangs a picture of worshippers kneeling before a golden calf. AQA Question 1 asks how useful the source is to a historian studying opposition to vaccination. Tap the TWO details a top-level answer would use.

• The vaccinated patients sprout cows from their bodies, which shows the popular fear that putting animal matter into humans would make them animal, an objection the clergy and the public shared.
• The room is crowded.
• The picture of the golden calf on the wall presents vaccination as idolatry, which shows that the opposition was religious as well as medical and that Gillray expected his readers to see it that way.
• The assistant uses a ladle.
• The cartoon was published in 1802.

What government did

Select the THREE statements that correctly describe the part played by government in vaccination.

• Parliament rewarded Jenner with 10,000 pounds in 1802 and 20,000 in 1807, after the Royal Society had refused to publish his paper, which was the first time the British state had paid for a medical discovery.
• Vaccination was made free for the poor in 1840, compulsory for infants in 1853, and enforced from 1871 with fines and imprisonment for parents who refused, so that the state for the first time required a medical procedure of every citizen.
• The Anti-Vaccination League founded in 1866, the march of some 80,000 through Leicester in 1885 and the repeated prosecution of parents forced Parliament to add a conscience clause in 1898, allowing objectors to refuse, though smallpox deaths had already fallen to a fraction of their 1840 level.
• The government banned inoculation in 1796 to help Jenner.
• Vaccination was provided by the National Health Service from 1802.
• The army was used to vaccinate the population by force in 1853.

Which factor mattered most in prevention?

The 16-mark question names one factor and asks whether it was the main one across a period. For the prevention of smallpox the strong answer weighs the factors with dated evidence and notices that government arrived last and left first. The individual made the discovery: Lady Mary brought inoculation home in 1721 against the advice of the doctors, and Jenner tested a milkmaid saying on a child in 1796 and published when the Royal Society would not. Chance supplied the saying and the cowpox on the hand of Sarah Nelmes. Communication spread it: the Inquiry of 1798 reached Europe and America within a decade, and the cartoon of 1802 spread the opposition just as fast. Religion worked against it, in the pulpit and on the wall of the Gillray room. Science and technology were absent until Pasteur explained it in the 1880s, which is why the doubters had a case. Government paid Jenner in 1802, made vaccination free in 1840 and compulsory in 1853, and retreated in 1898; it turned a discovery into a national practice, and it did so fifty years late and under protest. This meant that the individual made prevention possible and government made it general, and a judgement that says which of the two the eradication of 1980 depended on, and shows with dates that neither alone would have done it, reaches the top level.

In the shoes of Jenner and the state

Four decisions between 1796 and 1898. Choose what was actually done, and notice what each choice cost or won.

• May 1796. You are Jenner. A milkmaid, Sarah Nelmes, has cowpox sores on her hand, and the village believes milkmaids never catch smallpox. You have no way to prove it except on a person. What do you do?
• 1797. You have sent your paper to the Royal Society and it has been returned with the advice not to risk your reputation on something so at odds with established knowledge. What do you do?
• 1853. You are Parliament. Vaccination has been free for the poor since 1840, but many parents do not bother and smallpox still kills thousands. What do you do?
• 1885. Some 80,000 people have marched through Leicester against compulsion, the Anti-Vaccination League is prosecuting cases in the press, and magistrates are jailing parents. You are Parliament. What do you do?

From cause to consequence

Because a survivor of smallpox never caught it again, Lady Mary Wortley Montagu brought _____ home from Turkey in 1721, and the rich paid to be given a mild dose that killed one patient in fifty. Because milkmaids who had caught _____ seemed never to catch smallpox, Jenner tested the saying on James Phipps in 1796 and found a method with almost no risk. Because the Royal Society refused his paper, he published the Inquiry himself in _____ and the method spread through doctors rather than institutions. Because inoculators lost their trade, clergy objected to animal matter in a Christian body and nobody could explain why it worked, opposition was reasonable as well as self-interested. And because free vaccination from 1840 was not enough, Parliament made it _____ in 1853, added fines in 1871, and retreated to a conscience clause in _____ after the marches.

What Parliament paid

Parliament granted Jenner 10,000 pounds in 1802 and a further 20,000 pounds in 1807. How much did the state pay him in total for vaccination?

Question 3: in what ways were they similar?

AQA Question 3 might read: Compare inoculation and vaccination. In what ways were they similar? Explain your answer with reference to both. It is marked on similarities explained with support from both, for 8 marks. Which answer scores in the top level?

• Both worked by giving a healthy person a deliberate mild infection to protect them from smallpox, inoculation with a scratch of smallpox matter from 1721 and vaccination with cowpox from 1796, and both rested on observation without explanation, since neither Lady Mary nor Jenner could say why a survivor was safe and the mechanism waited for Pasteur in the 1880s. Both were also resisted by the medical establishment of their day: the doctors warned Lady Mary against the Turkish practice in 1721, and the Royal Society refused to publish Jenner in 1797.
• Both were ways of stopping smallpox.
• Vaccination used cowpox and was safe, and Jenner published 23 cases in 1798.
• They were different because inoculation could kill and vaccination could not.

Question 2: significance, marked

Question 2: Explain the significance of the work of Edward Jenner in the prevention of disease. The significance of Jenner at the time was that he replaced a dangerous method with a safe one. Inoculation, in use since 1721, protected the patient by giving them smallpox itself, which killed around one in fifty and infected their neighbours; Jenner showed on 14 May 1796 that cowpox, which killed nobody, gave the same protection, and proved it by inoculating James Phipps with smallpox six weeks later and seeing no disease. This meant that, once he had published his 23 cases in 1798, prevention could be offered to everyone rather than sold to the rich, and within a decade vaccination had reached Europe, America and India and Parliament had paid him 30,000 pounds. The longer significance is twofold. His method became the first medical procedure the state required of its citizens, free from 1840 and compulsory from 1853, which made government a factor in health for the first time; and once Pasteur explained in the 1880s why a weakened germ protects against a strong one, vaccination became a method for other diseases, which is why the eradication of smallpox in 1980 and the vaccines of the twentieth century both trace back to a country doctor and a milkmaid. His limit is part of the significance: he could not explain his own discovery, and that gap is why it was resisted for eighty years. What earned the marks: significance explained at the time with dated support; the link phrase this meant that; significance over the longer term in two directions, government and method; and the limit stated as part of the significance. Both timescales, tied together, are what reach the top level of the 8-mark significance question.

Question 4: the 16-mark factors judgement

Has government been the main factor in the prevention of disease in Britain since c1750? Explain your answer with reference to government and other factors.

• One paragraph on government with at least three dated actions: the grants of 1802 and 1807, free vaccination in 1840, compulsion in 1853 and fines in 1871, the conscience clause of 1898, and what each did and did not achieve
• At least two paragraphs on other factors from the AQA list, each with dated support: the role of the individual (Lady Mary, Jenner), chance (the milkmaids), communication (the Inquiry of 1798, the cartoon of 1802), religion as an obstacle, and science and technology arriving late with Pasteur

Question 4: the judgement, tested

A student has argued that government was the main factor in the prevention of smallpox. Which is the strongest point to set AGAINST that judgement, in the way the top level of Question 4 requires?

• Government arrived last and left first: it had nothing to compel until an individual had found something worth compelling, since Jenner made his discovery in 1796 without state help and published without the Royal Society, and the state waited until 1853 to require what had been available for fifty-seven years and retreated in 1898 when it was resisted; so government was the main factor in making prevention universal and the individual the main factor in making it possible, and a judgement should give each its stage rather than one the whole.
• Compulsion was wrong, so government cannot have been the main factor.
• It was all chance because of the milkmaids.
• Parliament paid Jenner 30,000 pounds, so government was the main factor.