Aaron Emery was a beef and ham dealer from Marylebone. His son, William, died in 1869 aged only 4 months, and 5 weeks after smallpox vaccination. They are both interred in the family grave at Highgate Cemetery in London (Figure 1).

The Emery family grave, Highgate Cemetery, London. Photo taken by Peter McCartney.

On their memorial it was recorded by the sculptor Mr Mills that William died from ‘erysipelas coming on after vaccination’.1 I have walked past this grave many times over the years: as a GP and occasional vaccinator it made me ponder. Those feelings became stronger with the COVID-19 pandemic and the subsequent outbreak of vaccine scepticism, so I decided to investigate.

Smallpox was killing 400 000 Europeans per year in the 18th century.2 It must have been great news when vaccination was developed by Edward Jenner in 1796.3 He did this by using fluid from a cowpox blister on the hand of milkmaid Sarah Elmes to produce immunity from smallpox in James Phipps, the 8-year-old son of his gardener. He transferred this ‘lymph’ to James’s arm (Figure 2) using a lancet (Figure 3).

The inoculation of James Phipps by Edward Jenner. Lithograph by Gaston Mélingue (circa 1894). Public domain.

Edward Jenner’s lancet. Photo taken by Peter McCartney, with permission from Dr Jenner’s House. © Dr Jenner’s House.

This was an uncontrolled trial with a sample size of one. Perhaps to make up for the small sample size, Jenner challenged the boy with live smallpox(!) more than 20 times (a dangerous procedure for both Jenner and Phipps) to prove immunity.4

Smallpox vaccination became a ‘requirement’ at 3 or 4 months of age in England by the second Vaccination Act of 1853,5 and was provided on an arm-to-arm (child-to-child) basis. It …