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Medicine 1798

An Inquiry into the Causes and Effects of the Variolae Vaccinae

Edward Jenner

A mild dose of cow-pox teaches the body to defeat deadly small-pox — the first vaccine.

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In depth · the introduction

A country doctor noticed that milkmaids never seemed to catch smallpox — and turned that clue into the world's first vaccine.

The big idea

Smallpox was one of history's great killers: it took about a third of the people it infected and left the rest scarred or blinded. Edward Jenner found a way to defeat it that sounds almost too simple. Give a person a tiny, safe dose of a related but mild disease — cowpox, caught from cattle — and their body learns to fight off smallpox without ever facing the real thing. He named it vaccination, from vacca, the Latin for cow.

It works because the immune system remembers what it has fought. Cowpox looks enough like smallpox that a body which has beaten the mild cousin recognises the deadly one on sight and destroys it before it can take hold.

How it came about

In Jenner's day the only protection was variolation — deliberately giving someone real smallpox and hoping for a mild case. It often worked, but it sometimes killed, and the patient could spread the disease to others. Jenner kept hearing a piece of dairy-country folklore: milkmaids who had caught cowpox didn't get smallpox.

In 1796 he tested it. He took matter from a cowpox sore on the hand of a milkmaid, Sarah Nelmes, and scratched it into the arm of an eight-year-old boy, James Phipps. The boy was mildly ill for a day, then well. Weeks later Jenner exposed him to real smallpox — and nothing happened. He published his results in a slim 1798 pamphlet. He was not quite the first to try cowpox — a farmer named Benjamin Jesty had done it to his own family twenty years earlier — but Jenner investigated it carefully and argued for it until the world listened.

Why it mattered

Vaccination was far safer than variolation, and it could be passed from one person's arm to the next, so it could reach whole populations from a single source. It grew into the science of immunology and the practice of modern vaccines, and it set off the only campaign that has ever eradicated a human disease: smallpox was declared gone from the world in 1980. Every vaccine since — for polio, measles, COVID — walks the path Jenner opened.

A way to picture it

Think of it as showing your immune system a wanted poster. Cowpox is a rough sketch of the criminal — not the real culprit, but close enough that when smallpox finally walks in, the body's guards recognise the face at once and seize it at the door. A modern vaccine is just a sharper, safer version of the same poster.

Interactive epidemic: a grid of 96 people. Drag the vaccination-coverage slider to immunise more of them; a case is seeded at the centre and an outbreak runs. Below the herd-immunity threshold the disease sweeps the unvaccinated; above it the chain breaks and even the unvaccinated are spared.

Where it sits

Before Jenner there was folk practice and the risky art of variolation; after him came a science. A century on, Louis Pasteur generalised the idea to rabies and anthrax and, in tribute, kept Jenner's word vaccine for all of them. It belongs on the same shelf as the Library's other turning points in medicine — Harvey tracing the circulation of the blood, Fleming stumbling onto penicillin — each a moment when careful observation rewrote what a body could be protected from.

The original document
Original source text
Edward Jenner · An Inquiry into the Causes and Effects of the Variolæ Vaccinæ · London, 1798
The deviation of Man from the state in which he was originally placed by Nature seems to have proved to him a prolific source of Diseases. From the love of splendour, from the indulgences of luxury, and from his fondness for amusement he has familiarised himself with a great number of animals, which may not originally have been intended for his associates.
[ … ]
There is a disease to which the Horse, from his state of domestication, is frequently subject. The Farriers have termed it the Grease. … Thus the disease makes its progress from the horse to the nipple of the cow, and from the cow to the human subject.
[ … ]
Case XVII.
The more accurately to observe the progress of the infection I selected a healthy boy, about eight years old, for the purpose of inoculation for 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, into the arm of the boy by means of two superficial incisions, barely penetrating the cutis, each about half an inch long.
On the seventh day he complained of uneasiness in the axilla, and on the ninth he became a little chilly, lost his appetite, and had a slight headache. During the whole of this day he was perceptibly indisposed, and spent the night with some degree of restlessness, but on the day following he was perfectly well.
In order to ascertain whether the boy, after feeling so slight an affection of the system from the cow-pox virus, was secure from the contagion of the small-pox, he was inoculated the 1st of July following with variolous matter, immediately taken from a pustule. Several slight punctures and incisions were made on both his arms, and the matter was carefully inserted, but no disease followed.
Several months afterwards he was again inoculated with variolous matter, but no sensible effect was produced on the constitution.
[ … ]
I presume it may be unnecessary to produce further testimony in support of my assertion that the cow-pox protects the human constitution from the infection of the small-pox.
Thus far have I proceeded in an inquiry founded, as it must appear, on the basis of experiment; in which, however, conjecture has been occasionally admitted in order to present to persons well situated for such discussions objects for a more minute investigation. In the mean time I shall myself continue to prosecute this inquiry, encouraged by the hope of its becoming essentially beneficial to mankind.
Edward Jenner · Berkeley, Gloucestershire · 1798