The Gardener's Boy

I

On 14 May 1796, in a garden in Berkeley, a country doctor made two cuts in the arm of an eight-year-old boy and put inside them pus from the hand of a milkmaid.

The boy was called James Phipps and he was the son of Edward Jenner's gardener; the doctor was his father's employer. The milkmaid was called Sarah Nelmes and she had cowpox, a mild disease that comes out on the hands of whoever milks and goes away on its own.

Phipps had a few days of malaise, some fever and a sore at the site of the cuts [nine days, according to the note]. Nothing more.

On 1 July, six weeks later, Jenner cut his arm again and inoculated him with human smallpox. Real smallpox, the kind that killed one in three.

Nothing happened: no pustule, no fever, no disease. He repeated it several more times over the following years and nothing went on happening.

It is worth pausing on what that means as a procedure. The experiment consisted of deliberately infecting a healthy child with a fatal disease to see whether the prior treatment protected him [two cuts, six weeks of waiting, and let us see]. If Jenner had been wrong, the boy would have died.

He was not wrong. That is the whole moral argument there was.

There is a detail of class that usually falls out of the account. Jenner had to hand children of families who depended on him and he used them: besides Phipps, he inoculated the small son of his own household and several children of the village and the workhouse. They were not volunteers in any sense we would recognise today —they were the ones there were, and they were nearby—.

II

The idea was not his and he never said it was.

The milkmaids knew it: those who went through cowpox did not catch the other, and in some places in England it was already done as a family custom. Before that there had been variolation, brought from the East: inoculating softened human smallpox. It worked fairly well except for one detail —it killed one or two in every hundred and could start an outbreak—.

What Jenner did was replace the dangerous material with a harmless one and write it down.

The word he invented comes from cow, and that is why all the vaccines in the world are called what they are called. The first was called that because it came out of an udder.

What he did supply was the method and the insistence. He sent his work to the scientific society of London, which rejected it; he published it on his own account in 1798, with seventy-five pages and his own plates; and he spent the following years sending impregnated thread by post to whoever asked for it [free, and sometimes with instructions in his own hand] so that it could be repeated in other countries.

The vaccine travelled in envelopes, between sheets of paper; that is how it reached Spain, and from Spain to America in the arms of twenty-two foundling children who were infected in turns during the crossing.

III

I do not have the mark and my mother does.

It is a circle barely a centimetre across on the left shoulder, with thinner skin and an irregular relief; like a badly struck coin. It was made on her as a girl with a bifurcated needle. For decades, that mark was the way of knowing, looking at a bare arm on a beach, who had been born before a certain date.

I have touched it a few times, as an adult, with that silly curiosity of touching somebody else's scar. The skin there is softer than the skin around it.

I do not have it because by my time they no longer gave it. They stopped giving it because the disease had ended, and it had ended because for almost two centuries everybody carried that mark.

It is the only case in this series in which the body of now has nothing to tell. There is no dose, no adverse effect, no price and no box in the drawer.

I have nothing because the thing worked. That is the whole inheritance: an absence on the shoulder.

There is a strange asymmetry in that and it will not leave my head. Of all the molecules in this series, this is the only one whose success is measured by its story being boring for whoever came after. The others leave boxes, prices, effects and timetables. This one leaves a gap where a scar should be, and a second-hand memory on my mother's skin.

At my mother's house there is a vaccination card from the sixties, made of card, with ink stamps and a different signature on each line. I have looked at it with the curiosity with which one looks at an old banknote. The handwriting of the country doctors of the time was better than it is now, and each stamp cost a journey to a village [bus, wait, journey back].

IV

What goes on inside is not chemistry, and that is why this piece is odd within the file.

There is no molecule occupying a lock and no enzyme left holding on. What goes into the arm is a whole virus, alive, similar to but not the same as the dangerous one, and what the body does is the only thing needed.

Some cells that live under the skin and spend the day picking up pieces of whatever passes carry fragments of that virus to a nearby node, which is a small room where the ones that decide gather. There they show the fragment [an identity parade, with millions of suspects]. Among the millions of available defences there are a few whose shape happens to fit that particular piece, and those receive the order to multiply.

They take one to two weeks, which is the reason a vaccine is of no use at all if you have it on the day you are infected.

Out of that multiplication come two things. Some cells that make antibodies now, for this fight, and others that do nothing and stay [the memory ones, which are the invention]. Those second ones are the point. They stay in the marrow and in the nodes for years, sometimes for a whole lifetime, doing nothing, waiting for the same shape to appear again.

When the real virus arrives, it does not meet a body starting from zero. It meets a body that already has the mould made and that responds within hours.

That is why Phipps's protection was not in his arm. It was in his marrow, and there it stayed until he died.

That is also why a vaccine is not a drug in the sense the others are. A drug does something while it is inside and stops doing it when it leaves. This does nothing: it teaches somebody else to do it, goes away within a few days, and what goes on working for fifty years is the body of the vaccinated person.

V

Smallpox is the only human disease we have eliminated from the planet.

The last natural case was in Somalia, in 1977: a hospital cook called Ali Maow Maalin, who survived. The following year a medical photographer died in Birmingham from a laboratory leak [the virus by then existed only in two freezers], and in 1980 the world health organisation officially declared that the thing was over.

That means that, for once, a story of medicine does end well, and it has to be said without embellishment, because it happens once every two hundred years.

What does not end well is the procedure. Jenner experimented on his gardener's son, that is to say on a child whose father worked for him and could hardly say no. Afterwards he gave him a house [with a garden, in the same village]. Both things are true and the second does not fix the first.

VI

The objection against me is simple and it discomforts me more than others.

I do not carry the mark, and I do not carry it because I happened to be born on the right side of a temporal border drawn by others. I write about the risk an eight-year-old boy ran in 1796 from the position of somebody who benefited from that risk without having put anything in.

And there is a second thing that is not fixed by writing it. Everything I know about smallpox I know from photographs; there is nobody left around me who has seen it. The complete disappearance of a disease has that side effect: it takes with it the memory of why something had to be done.

VII

Of James Phipps little more is known. He lived in Berkeley, had children, Jenner gave him a house with a garden and revaccinated him a good few times over the course of his life, probably to check that the thing was still working.

He died in 1853, at sixty-five, in the same village where the cuts were made. His house is still shown; they call it “Phipps's cottage”.

On his gravestone none of this appears; not one line.

14 May 1796, two cuts in an eight-year-old arm.

1 July 1796, the test with human smallpox.

1977, the last natural case in the world.

1980, the official declaration.

Cost of a dose for me, today: the dose does not exist.