Lancet owned by Edward Jenner. Wellcome Library, London
How does a medical innovation come to be accepted and adopted as a common practice? Historians of medicine have long-since recognised that the force of an idea alone is insufficient to change paradigmatic practices that are reinforced by the power and inertia of institutions. To make a success of something new depends, amongst other things, on the power – social weight, personal prestige, institutional placement – of the innovator. For the would-be medical pioneer, connections and reputations smooth the path from experimentation to acceptance.
We are living through a renewal of controversies about the safety and efficacy of vaccinations of all different kinds. Much of the public discourse is determined not by medical knowledge or expertise, but by the weight of influence that public commentators bring to bear. There are echoes of the original vaccination controversy, that came with Edward Jenner’s pioneering work in protecting people from the ravages of small pox by inoculating them with cow pox. Though by no means secure as a practice by the time of Jenner’s death in 1823, at least not in England, Jenner had made tremendous headway in persuading the institutions of medicine that vaccination was the greatest humanitarian boon ever conceived. While the public remained sceptical in certain quarters, the ultimate success of the campaign against small pox seemed to have been secured by the acquisition of the backing of the medical establishment. This backing was acquired despite not knowing how vaccination worked, how long it lasted, what side effects it might have, or why it sometimes didn’t seem to work at all. A great deal of faith was put in the power of vaccination. With some modifications, that faith would transpire to have been well placed. But in the early days of the practice, that faith depended on the power of Jenner’s personality.
The life of a gentleman in the early nineteenth century depended on the reputation that preceded him. Honour was everything. Jenner’s peripheral presence in the medical establishment made him all the more guarded about his good name, even though he had no desire to be at the centre of things. Cranks and quacks were an irritation, but disrespect from within the respectable establishment could not be tolerated. The man who brought the worst out in Jenner, was George Pearson. Pearson had attempted to steal Jenner’s glory by being the first to establish an institution for vaccination in London. Pearson suggested some token role for Jenner, who saw only a transparent attempt to remove him to the sidelines. He responded by mocking the supposed ‘honour’ Pearson offered, and reminded him that if the ‘vaccine inoculation, from unguarded conduct, should sink into disrepute (and you must admit, Sir, that in more than one instance has its reputation suffered) I alone must bear the odium’. The practice of vaccination and the reputation of its discoverer were intertwined.
Sparked into action by fear of defamation, Jenner set about planning his own institution, which would prepare the way for the establishment of the Royal Jennerian Society in 1803. Working with the advantages of personal connections, he persuaded such luminaries as the Duke of York to withdraw patronage from Pearson’s scheme. The faintest whiff of dishonour on Pearson’s part had the medical establishment flocking to Jenner’s cause. If there were to be an institution at all, it would be by Jenner’s design. The Royal Jennerian proved to be short-lived, in part because Jenner oversaw it like a prima donna. Inter-personal squabbling caused a loss of focus, and Jenner spared nobody who dared challenge the orthodoxy of his knowledge and methods concerning vaccination. When deviations threatened, Jenner could rally MPs, peers, bishops and other clergy to his side. He effectively acquired, through his own institution, the connections and the means to attempt to control the vaccination narrative, and to shut down opponents.
Everywhere, Jenner saw his opponents endeavouring ‘to ruin [his] private character’. Anti-vaccination rhetoric had become deeply personal. The success of vaccination was therefore bound up with the publicly unimpeachable character of Jenner himself. Two petitions to Parliament, for which Jenner did much of the agitating, ensured that Jenner was handsomely rewarded from the public purse for his discoveries. To the chagrin of his enemies, such endorsement from on high was the guarantor of his good name. Even though his own institution collapsed in disarray, the National Vaccine Establishment that followed it continued to work according to Jenner’s practices and to celebrate his achievement. The weight of reputation, honour, and institutional support ensured the success of vaccination. Knowledge about how and why it worked would only come much later.
Today, immunological knowledge is secure. But as we are seeing, knowledge alone is not sufficient to withstand fearmongering when it is generated by people of influence, whose (non-medical) reputations precede them.
Rob Boddice is an historian of science, medicine and the emotions, based in Berlin and Montreal. Educated in York, he has published books on the history of human-animal relations, anthropocentrism, and pain. His book, Edward Jenner: pocket GIANT, will be published by The History Press later this year.