Instructions for Vaccine Inoculation
- Written
- about 1799–1801 (catalogued as 1801)
- Place
- London
- Language
- English
- Kind of source
- medical
- Reading time
- 4 minutes
- Difficulty
- Moderate
- Intensity
- Low: describes cuts, pustules, and scabs on the arm in a matter-of-fact way; nothing graphic
SmallpoxInoculation and vaccinationDoctors and medical ideas
Jenner told doctors to keep vaccine between two squares of window glass, dried to a spot “about the size of a split pea” and wrapped in clean writing paper. Kept this way, he wrote, nothing more was needed to preserve it.
Edward Jenner (1749–1823) was a country doctor in Berkeley, Gloucestershire, in the west of England. In May 1796 he took matter from a cowpox sore on the hand of Sarah Nelmes, a young woman who had caught it from her master’s cows, and put it into the arm of a boy, James Phipps. On July 1 he inoculated the boy with smallpox matter, and no disease followed. He published his results in 1798; he called the method vaccine inoculation, and it is now called vaccination. This printed sheet of instructions, with Jenner’s name at the foot, was printed in London. It carries no date. Jenner’s biographer John Baron believed the first paper of instructions came out early in 1799, and he quotes one of these paragraphs from it. The library that holds this copy dates it to about 1801.
Jenner knew from experience how the cowpox sore should look day by day and when the matter was good to use. He did not know why it protected against smallpox. No one then knew what germs or viruses were.
These are instructions from the inventor of the method to the doctors who would use it. They record how vaccination was meant to be done, not how carefully it was done in practice.
Keep vaccination distinct from the older practice it replaced: inoculation with smallpox matter itself, now called variolation, which Jenner still mentions as a fallback. Notice, too, how much the method depended on the vaccinator’s eye.
What we know now
Vaccination spread fast. Within three years Jenner’s Inquiry had been translated into five languages, and by 1801 vaccine was in use in Constantinople, Paris, North America, Moscow, and Berlin. Many vaccinated people were later inoculated with smallpox matter as a test and did not take it (Fenner et al. 1988, 262). Keeping the vaccine active was harder. It was sent dried on threads, glass, or ivory points, but the surest way was to pass it from one person’s arm to the next (Fenner et al. 1988, 263).
Later studies found that the protection a vaccination gave waned over the years, though it still made smallpox milder decades later (Fenner et al. 1988, 52–53). The virus in twentieth-century vaccines, called vaccinia, turned out to differ from cowpox; its origin is still unknown (Fenner et al. 1988, 264, 278). Viruses themselves were first identified in the 1890s (Lvov, Alkhovsky, and Zhirnov 2022). In 1980 the World Health Assembly declared smallpox eradicated, the last natural case having occurred in Somalia in 1977 (Fenner et al. 1988, vii).
Read alongside
- A Sermon against Inoculation
Edmund Massey preached against inoculation with smallpox matter in 1722, eighty years earlier. He called it an attack on Providence and said the fear of smallpox kept people from vice. Jenner, writing for doctors, takes it for granted that preventing smallpox is good and asks only how to do it well.
- Engrafting against Smallpox
Lady Mary Wortley Montagu watched an old woman in Adrianople put smallpox matter into children’s veins in 1717. Compare her account of a folk practice with Jenner’s rules for trained practitioners, and what each says about how the matter is kept and used.
- Planting Smallpox
The Chinese imperial medical compendium of 1742 gives step-by-step rules for planting smallpox through the nose. Like Jenner, its editors teach doctors to judge the right matter and the right day by eye.
The edited translation, in simplified modern English. Bracketed words were added for clarity; [...] marks a cut. Tap a note number to read the note.
Let the vaccine fluid1 be taken, for the purpose of inoculation, from a pustule that is making its progress regularly, and which possesses the true vaccine character, on any day from the fifth to the eighth, or even a day or two later, provided the efflorescence2 be not then formed around it. When the efflorescence is formed, it is always most prudent to desist from taking any more of the virus3 from that pustule.
To obtain the virus, let the edges of the pustule be gently punctured with a lancet in several points. It will gradually ooze out, and should be inserted upon the arm about midway between the shoulder and the elbow, either by means of a very slight scratch, not exceeding the eighth part of an inch, or a very small oblique puncture.
A little red spot will appear on the punctured part on the third day, if the operation succeed, which on the fourth or fifth becomes perceptibly vesicated.4 It goes on increasing till the tenth day, when it is generally surrounded by a rose-colored efflorescence, which remains nearly stationary for a day or two. The efflorescence then fades away, and the pustule is gradually converted into a hard glossy scab of a dark mahogany color. These progressive stages of the pustule are commonly completed in sixteen or seventeen days.
A single pustule is sufficient to secure the constitution from the smallpox. But as we are not always certain the puncture may take effect, it will be prudent to inoculate in both arms, or to make two punctures in the same arm about an inch and a half asunder, except in very early infancy, when there is a great susceptibility of local irritation.
Vaccine virus taken from a pustule and inserted immediately in its fluid state is preferable to that which has been previously dried. But as it is not always practicable to obtain it in this state, we are compelled to seek for some mode of preserving it. Various means have been suggested, but from the test of long experience it may be asserted that preserving it between two plates of glass is the most eligible. Let a piece of common window glass be cut into squares of about an inch each, so that they shall lie smooth when placed upon each other. Let the collected vaccine fluid be confined to a small spot (about the size of a split pea) upon the center of one of these glasses, which should be suffered to dry in the common heat of the atmosphere, without exposure to the heat of fire or the sun. When dry, it should be immediately secured by placing over it the other piece of glass. Nothing more is necessary for its preservation than wrapping it in clean writing paper.
The virus thus preserved, when wanted for the purpose of inoculation, may easily be restored to its fluid state by dissolving it in a small portion of cold water, taken up on the point of a lancet. It may then be used in the same manner as when just taken from a pustule.
A little practice in vaccine inoculation, attentively conducted, impresses on the mind the perfect character of the vaccine pustule. Therefore, when a deviation arises, of whatever kind it may be, common prudence points out the necessity of reinoculation: first, with vaccine virus of the most active kind, and secondly, should this be ineffectual, with variolous virus.5 But if the constitution shows an insusceptibility of one, it commonly does of the other.
The lancet used for inoculation should always be perfectly clean. After each puncture, it is proper to dip it into water, and wipe it dry. The practitioner should be particularly cautious in observing that its point be free from rust, either contracted by common means, or from the action of the vaccine virus, which, even when dry and in contact with it, has a tendency, in a little time, to produce it.
Edward Jenner
Notes
- From Latin vacca, “cow”: of cowpox. In 1796 Jenner showed that a person given matter from a cowpox sore was protected from smallpox. back
- The red, inflamed ring that spreads around the pustule. back
- In 1801 “virus” meant any poisonous or infectious matter, here the fluid from the cowpox pustule. Viruses in the modern sense were discovered only in the 1890s. back
- Blistered. back
- Matter from smallpox sores, as used in the older inoculation, now called variolation. Jenner adds that a person who will not take cowpox usually will not take smallpox either. back
Let the vaccine fluid be taken, for the purpose of Inoculation, from a pustule that is making its progress regularly, and which possesses the true vaccine character, on any day from the fifth to the eighth, or even a day or two later, provided the efflorescence be not then formed around it. When the efflorescence is formed, it is always most prudent to desist from taking any more of the virus from that pustule.
Let the vaccine fluid be taken, for the purpose of inoculation, from a pustule that is making its progress regularly, and which possesses the true vaccine character, on any day from the fifth to the eighth, or even a day or two later, provided the efflorescence be not then formed around it. When the efflorescence is formed, it is always most prudent to desist from taking any more of the virus from that pustule.
- From Latin vacca, “cow”: of cowpox. In 1796 Jenner showed that a person given matter from a cowpox sore was protected from smallpox.
- The red, inflamed ring that spreads around the pustule.
- In 1801 “virus” meant any poisonous or infectious matter, here the fluid from the cowpox pustule. Viruses in the modern sense were discovered only in the 1890s.
To obtain the virus, let the edges of the pustule be gently punctured with a lancet in several points. It will gradually ooze out, and should be inserted upon the arm about midway between the shoulder and the elbow, either by means of a very slight scratch, not exceeding the eighth part of an inch, or a very small oblique puncture.
To obtain the virus, let the edges of the pustule be gently punctured with a lancet in several points. It will gradually ooze out, and should be inserted upon the arm about midway between the shoulder and the elbow, either by means of a very slight scratch, not exceeding the eighth part of an inch, or a very small oblique puncture.
A little red spot will appear on the punctured part on the third day, if the operation succeed, which on the fourth or fifth becomes perceptibly vesicated. It goes on increasing till the tenth day, when it is generally surrounded by a rose-coloured efflorescence, which remains nearly stationary for a day or two. The efflorescence then fades away, and the pustule is gradually converted into a hard glossy scab, of a dark mahogany colour. These progressive stages of the pustule are commonly completed in sixteen or seventeen days.
A little red spot will appear on the punctured part on the third day, if the operation succeed, which on the fourth or fifth becomes perceptibly vesicated. It goes on increasing till the tenth day, when it is generally surrounded by a rose-colored efflorescence, which remains nearly stationary for a day or two. The efflorescence then fades away, and the pustule is gradually converted into a hard glossy scab of a dark mahogany color. These progressive stages of the pustule are commonly completed in sixteen or seventeen days.
- Blistered.
A single pustule is sufficient to secure the constitution from the small-pox; but as we are not always certain the puncture may take effect, it will be prudent to inoculate in both arms, or to make two punctures in the same arm, about an inch and a half asunder, except in very early infancy, when there is a great susceptibility of local irritation.
A single pustule is sufficient to secure the constitution from the smallpox. But as we are not always certain the puncture may take effect, it will be prudent to inoculate in both arms, or to make two punctures in the same arm about an inch and a half asunder, except in very early infancy, when there is a great susceptibility of local irritation.
Vaccine virus, taken from a pustule, and inserted immediately in its fluid state, is preferable to that which has been previously dried; but as it is not always practicable to obtain it in this state, we are compelled to seek for some mode of preserving it. Various means have been suggested, but from the test of long experience it may be asserted, that preserving it between two plates of glass is the most eligible. Let a piece of common window glass be cut into squares of about an inch each, so that they shall lie smooth when placed upon each other. Let the collected vaccine fluid be confined to a small spot (about the size of a split pea) upon the centre of one of these glasses; which should be suffered to dry in the common heat of the atmosphere, without exposure to the heat of fire or the sun. When dry, it should be immediately secured by placing over it the other piece of glass. Nothing more is necessary for its preservation than wrapping it in clean writing paper.
Vaccine virus taken from a pustule and inserted immediately in its fluid state is preferable to that which has been previously dried. But as it is not always practicable to obtain it in this state, we are compelled to seek for some mode of preserving it. Various means have been suggested, but from the test of long experience it may be asserted that preserving it between two plates of glass is the most eligible. Let a piece of common window glass be cut into squares of about an inch each, so that they shall lie smooth when placed upon each other. Let the collected vaccine fluid be confined to a small spot (about the size of a split pea) upon the center of one of these glasses, which should be suffered to dry in the common heat of the atmosphere, without exposure to the heat of fire or the sun. When dry, it should be immediately secured by placing over it the other piece of glass. Nothing more is necessary for its preservation than wrapping it in clean writing paper.
The virus, thus preserved, when wanted for the purpose of inoculation, may easily be restored to its fluid state by dissolving it in a small portion of cold water, taken up on the point of a lancet. It may then be used in the same manner as when just taken from a pustule.
The virus thus preserved, when wanted for the purpose of inoculation, may easily be restored to its fluid state by dissolving it in a small portion of cold water, taken up on the point of a lancet. It may then be used in the same manner as when just taken from a pustule.
A little practice in vaccine inoculation, attentively conducted, impresses on the mind the perfect character of the vaccine pustule; therefore, when a deviation arises, of whatever kind it may be, common prudence points out the necessity of re-inoculation, first, with vaccine virus of the most active kind, and secondly, should this be ineffectual, with variolous virus. But if the constitution shews an insusceptibility of one, it commonly does of the other.
A little practice in vaccine inoculation, attentively conducted, impresses on the mind the perfect character of the vaccine pustule. Therefore, when a deviation arises, of whatever kind it may be, common prudence points out the necessity of reinoculation: first, with vaccine virus of the most active kind, and secondly, should this be ineffectual, with variolous virus. But if the constitution shows an insusceptibility of one, it commonly does of the other.
- Matter from smallpox sores, as used in the older inoculation, now called variolation. Jenner adds that a person who will not take cowpox usually will not take smallpox either.
The lancet used for inoculation should always be perfectly clean. After each puncture, it is proper to dip it into water, and wipe it dry. The Practitioner should be particularly cautious in observing that its point be free from rust, either contracted by common means, or from the action of the vaccine virus, which, even when dry and in contact with it, has a tendency, in a little time, to produce it.
The lancet used for inoculation should always be perfectly clean. After each puncture, it is proper to dip it into water, and wipe it dry. The practitioner should be particularly cautious in observing that its point be free from rust, either contracted by common means, or from the action of the vaccine virus, which, even when dry and in contact with it, has a tendency, in a little time, to produce it.
EDWARD JENNER.
Edward Jenner
Questions a reader might ask, with short answers and the sections they rest on. Checked in a separate review.
What happens
When should the vaccine fluid be taken from a pustule?
On any day from the fifth to the eighth, or a day or two later, as long as the red ring has not yet formed around the pustule. Once it forms, Jenner says to stop taking fluid from that pustule.
Read section 1
Where and how was the fluid put into the arm?
About midway between the shoulder and the elbow, by a very slight scratch no longer than an eighth of an inch, or by a very small slanting puncture.
Read section 2
How could vaccine be kept when no fresh pustule was at hand?
Dried in a spot about the size of a split pea between two small squares of window glass, wrapped in clean writing paper. To use it, the vaccinator dissolved it in a little cold water on the point of a lancet.
Why does Jenner advise two punctures when one pustule is enough?
Because a puncture might not take. He advises both arms, or two punctures in one arm, except in very young babies, whose skin was easily irritated.
Read section 4
Thinking further
What should a vaccinator do if the pustule does not look right?
Vaccinate again with the most active vaccine, and if that fails, inoculate with smallpox matter. Jenner adds that someone who will not take one usually will not take the other.
Read section 7
What does this sheet show about how much vaccination depended on skill?
Many steps turn on the vaccinator's judgment, from choosing the day and the pustule to spotting a faulty one, and Jenner says a little practice impresses the true pustule on the mind.
Why might Jenner warn about rust on the lancet?
He says the vaccine fluid itself tends to rust the point, even when dry, so the lancet must be kept clean, and dipped in water and wiped after every puncture. The sheet does not say here why rust matters.
Read section 8
Who and what this source names, in the original. Each name links to every source in the library that mentions it. Not yet checked.
Ideas
- Inoculation Giving a healthy person smallpox on purpose, from the scabs or matter of a mild case, so that the illness would be mild and never come again. Chinese, Ottoman and African practitioners knew it before it was tried in Boston and London in the 1720s. Sections 7.
- Smallpox An infectious disease that begins with fever and leaves pitted scars. It was unknown in the Americas until Europeans arrived, and it struck Mexico and Michoacán in 1520; most historians identify the Japanese epidemic of 735–737 as smallpox too. Sections 4.
- Vaccination Protecting a person against smallpox with matter from a cowpox sore, which Edward Jenner showed in 1796; the word comes from Latin vacca, “cow.” Sections 1, 7.
People
- Edward Jenner A physician of Berkeley, Gloucestershire, who showed in 1796 that matter from a cowpox sore protected against smallpox, and published instructions for vaccine inoculation in 1801. Sections 9.
Page images of the original object or of the printed edition, from the libraries and archives that hold them. The pages shown are copied here where the holder marks them public domain; titles link to the holder's own viewer. Click a page to see it full size.
Jenner, Instructions for Vaccine Inoculation, London [1801]
Internet Archive (Wellcome Collection copy 4). leaf n2 (the printed side). Public Domain Mark (Wellcome Collection); printed about 1801.
The printed sheet our text follows. Its last sentence is partly struck through in ink.
Difficulty: Moderate, a working doctor’s instructions, plain in order but with medical words of the time; the notes explain them.
Fits these units
- From inoculation to vaccine. How did a new way to prevent smallpox spread, and why did people resist it? (Innovation in History)
- Case study: smallpox. How did a terrifying disease become the only one ever eradicated? (Once in a Lifetime)
Key terms
- vaccine
- in Jenner’s time, of cowpox (from Latin *vacca*, cow); matter from a cowpox sore used to protect against smallpox
- pustule
- a small raised spot on the skin filled with fluid
- efflorescence
- the red ring of inflammation that forms around the pustule
- lancet
- a small, sharp, two-edged surgical knife
- virus
- in 1801, any poisonous or infectious matter, here the fluid from the pustule
- variolous
- of smallpox; variolous matter came from smallpox sores
Questions
- Comprehension
Put Jenner’s steps in order, from choosing the pustule to keeping the fluid for later. What does he say should happen on the third, tenth, and sixteenth days?
- Analysis
Jenner tells the vaccinator to judge the pustule by eye again and again. Find three places where success depends on what the vaccinator notices. Why might that have made it hard to spread the method widely?
- Analysis (reliability)
These are rules written by the inventor of the method for other doctors. What can they tell us about how vaccination was meant to be done, and what can they not tell us about how it was done in practice?
- Connection
Read Edmund Massey’s A Sermon against Inoculation. Massey feared that removing the danger of smallpox would make people careless and sinful. Jenner never mentions religion or morals. What does each writer think the question about smallpox prevention is, and why might their answers have been so far apart?
Activity
Students work in pairs as a vaccinator and an observer. Using only the sheet, the vaccinator explains each step aloud while the observer checks it off and writes down every word or judgment that would need a teacher or more experience to understand. The class then drafts a short list of questions a country doctor in 1801 might have sent to Jenner after reading the sheet.
A printable worksheet for this source · More on Hearth Learning
From the English text of the printed sheet (London: D. N. Shury, undated; about 1799–1801). Spelling, capitals, and punctuation are modernized (“colour” to “color,” “small-pox” to “smallpox,” “shews” to “shows”), and a few long sentences are split where Jenner has a semicolon; his words and their order are kept. Eight of the fourteen paragraphs are included, about half of the sheet.
- Original
- Text as printed in the named edition or on the object, read from page images. Edition: Edward Jenner, Instructions for Vaccine Inoculation, single printed sheet, two leaves with the second blank (London: printed by D. N. Shury, Berwick Street, Soho, undated; catalogued by the Wellcome Collection as “[1801?]”), Wellcome Collection, copy 4. Digital text: Internet Archive item b22010440_0004, OCR text, extracted by code and read against the page image. Long s is printed as s. Wellcome records a variant issue whose thirteenth paragraph ends at “wipe it dry”; this copy has the longer text, and the last sentence of the sheet is partly struck through in ink, as in Wellcome copies 2 and 3. The printed footnote (“Goulard’s extract of saturn”) belongs to a paragraph not included.
- Editor’s review
- Not yet.
- Specialist review
- Not yet. Readings a specialist should confirm are listed for later review.
- Rights
- Original: public domain. Edition: public domain. Our translations and notes: CC BY-SA 4.0; credit “Hearth Library, hearthinteractive.com” with a link.
Sources for the notes
- Jenner, Edward. Instructions for Vaccine Inoculation. London: D. N. Shury, [1799–1801?]. Wellcome Collection copy 4, via Internet Archive item b22010440_0004; Wellcome Collection catalogue record (works/r52f3vfj) for the date, the variant issue and the copies.
- Baron, John. The Life of Edward Jenner. 2 vols. London: Henry Colburn, 1838. Vol. 1, pages 136–138 (Phipps and Sarah Nelmes, May 14 and July 1, 1796), and the opening chapter (birth at Berkeley, 1749); vol. 2, pages 270–272 (the first paper of instructions, early 1799) and 342–343.
- Fenner, Frank, Donald A. Henderson, Isao Arita, Zdeněk Ježek, and Ivan D. Ladnyi. Smallpox and Its Eradication. Geneva: World Health Organization, 1988. Foreword, page vii (the declaration of 1980); pages 52–53 (protection waning with time); chapter 6, pages 254–264 (Jenner, Phipps and Nelmes, the Inquiry of 1798, early ways of keeping vaccine, the origin of vaccinia virus); page 278.
- Lvov, D. K., S. V. Alkhovsky, and O. P. Zhirnov. “130th Anniversary of Virology.” Problems of Virology 67, no. 5 (2022): 357–384. (Ivanovsky’s report of 1892 and Beijerinck’s work of 1898.)