- Email: [email protected]
Putting Jenner back in his place
CORRESPONDENCE
Adults with congenital heart disease Sir—In their excellent Review (Oct 18, p 1305),1 Judith Therrien and Gary Webb discuss congenital cardiac defects in adult patients, and outline an approach to management of these individuals. I would like to remind readers that all the congenital cardiac lesions discussed in the Review often have a genetic basis and can be hereditary.2–5 Further management of these patients, apart from surgical intervention and follow-up of complications, should include taking a detailed family history of congenital heart lesions. Because of intrafamilial variability and pleiotropy of the causative gene in question, other noncardiac congenital defects should also be sought in the patient and their family to ensure optimum management. Referral to a medical geneticist for further assessment and counselling might also be appropriate.
aristocratic social standing”.3 Certainly there were clear precedents, notably Benjamin Jesty,3,4 and Jenner’s key scientific contribution was not cowpox inoculation per se, but inoculation (of an 8-year-old boy) with subsequent smallpox challenge—an experiment questionable on ethical grounds. There are problems of attribution of this major medical breakthrough to one individual.5 Although the name of Jenner is well remembered, only a few will know of Sarah Nelmes (the milkmaid), James Phipps (the young boy), and Blossom (the cow)—any one of whom would make a fine subject for a statue in Trafalgar Square. J S Huntley Musculoskeletal Research Unit, Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK (e-mail: [email protected]) 1 2
Nicola C Ho National Institute of Child Health and Human Development, National Institutes of Health and Johns Hopkins Medical Institutions, Bethesda, MD 20814, USA (e-mail: [email protected]) 1
2
3
4
5
Therrien J, Webb G. Clinical update on adults with congenital heart disease. Lancet 2003; 362: 1305–13. Goldmuntz E, Bamford R, Karkera JD, et al. CFC1 mutations in patients with transposition of the great arteries and double-outlet right ventricle. Am J Hum Genet 2002; 70: 776–80. Eldadal ZA, Hamosh A, Biery NJ, et al. Familial tetralogy of Fallot caused by mutation in the jagged 1 gene. Hum Molec Genet 2001; 10: 163–69. Wilson DI, Goodship JA, Burn J, Cross IE, Scrambler PJ. Deletions within chromosome 22q11 in familial congenital heart disease. Lancet 1992; 340: 573–75. Johansson BW, Sievers J. Inheritance of atrial septal defect. Lancet 1967; 1: 1224–25.
Putting Jenner back in his place Sir—There is competition for an empty plinth in London’s Trafalgar Square. Gabriel Scally and Isabel Oliver are championing the case for Edward Jenner (Oct 4, p 1092).1 They laud him as “perhaps the first international medical hero”. Elsewhere he has been hailed as “one of the greatest benefactors to mankind and as the father of immunology”.2 His statue occupies but a humble site in Kensington Gardens. Jenner has also been described as “a political opportunist who obtained priority in the discovery of vaccination (1796) through his reputation and
1942
3 4 5
Scally G, Oliver I. Putting Jenner back in his place. Lancet 2003; 362: 1092. Bailey I. Edward Jenner (1749–1823): naturalist, scientist, country doctor, benefactor to mankind. J Med Biogr 1996; 4: 63–70. Horton R. Myths in medicine. Stud BMJ 1995; 3: 40. Plotkin SA, Mortimer EA, eds. Vaccines. Philadelphia: WB Saunders, 1988: 1. Cook GC. Author’s reply. J Med Biogr 1997; 5: 241.
Sir—In addition to Gabriel Scally and Isabel Oliver’s Commentary on the relocation of the Jenner statue to Trafalgar Square in London,1 The Lancet has a long history of interest in the monument sculpted by noted 19th century artist, Calder Marshall. May I draw your attention to several references? First, an article in the Feb 21, 1852, issue2 cautions that the funding strategy for the statue risks failure. The article states: “With even the suspicion of private purpose about what should be a purely public ovation to a great man, subscriptions will not flow freely or cheerfully from those who most revere the name of JENNER”. Second, after the funding had been accomplished by an international effort and the statue had been erected, The Lancet bristled at the limited contributions by the English population. In an article in the June 12, 1858, issue,3 the following statement appeared: “But the statue cries shame on the niggard apathy of the people of England whose contributions amount to less than one-third of the subscription; shame that foreign states have so easily surpassed them in respect to their own son; shame that the scanty list of pounds does not even repay the labour of the artist . . .; shame that years
have passed ere one poor bronze statue has found a maker and a site. . .; shame, too, on the ladies of England, whose seamless beauty this man may claim a part of his gift, and who have forgotten to offer the smallest of their coins in his honour”. Third, when agitation arose in Parliament for the removal of the statue from Trafalgar Square, The Lancet reacted in an article in the May 15, “Mr. THOMAS 1858, issue4: DUNCOMBE, the defender and supporter of quackery in the House of Commons is sorely annoyed that a statue of the great and good JENNER should be placed in a position of honour. It is humiliating, indeed, to find any man, particularly a member of Parliament, at this time so ignorant to utter such nonsense”. Fourth, and finally, after the removal of the statue from the Square, in a poignant editorial in the February 15, 1862, issue,5 the following appeared: “During the last week the public have been surprised, on visiting Kensingtongardens to find the statue of the illustrious Jenner standing, or rather sitting, with its air of placidity, on a new pedestal in the vicinity of the stone bridge spanning the Serpentine . . . . Happily, however, it is beyond the power of any official stupidity or individual crochet to place the statue of Jenner anywhere within the ken of humanity without its being able to impose respect and to appeal for gratitude from the passer-by.” Last year on a sunny Sunday afternoon in June, my wife and I visited the statue. As we sat admiring the sculpture, children were playing joyfully in the ponds that surround the fountains of the Italian garden, watched over by the venerable doctor. We could not help wondering whether, perhaps, this is not a better venue than Trafalgar Square for the great benefactor. Warren Winkelstein Jr School of Public Health, University of California, Berkeley, CA 94720, USA (e-mail: [email protected]) 1 2 3 4 5
Scally G, Oliver I. Putting Jenner back in his place. Lancet 2003; 362: 1092. Editorial. [Untitled]. Lancet 1852; 59: 199–200. Editorial. A monument to Jenner. Lancet 1858; 71: 588. Editorial. [Untitled]. Lancet 1858; 71: 485. Editorial. Dr. Jenner in Hyde Park. Lancet 1862; 97: 181.
DEPARTMENT OF ERROR Dargie HJ.  blockers in heart failure. Lancet 2003; 362: 2–3. In this Commentary (July 5), an acknowledgment was omitted: “HJD has received research support and honoraria from GlaxoSmithKline and Roche Pharmaceuticals.”
THE LANCET • Vol 362 • December 6, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet publishing Group.
Adults with congenital heart disease Sir—In their excellent Review (Oct 18, p 1305),1 Judith Therrien and Gary Webb discuss congenital cardiac defects in adult patients, and outline an approach to management of these individuals. I would like to remind readers that all the congenital cardiac lesions discussed in the Review often have a genetic basis and can be hereditary.2–5 Further management of these patients, apart from surgical intervention and follow-up of complications, should include taking a detailed family history of congenital heart lesions. Because of intrafamilial variability and pleiotropy of the causative gene in question, other noncardiac congenital defects should also be sought in the patient and their family to ensure optimum management. Referral to a medical geneticist for further assessment and counselling might also be appropriate.
aristocratic social standing”.3 Certainly there were clear precedents, notably Benjamin Jesty,3,4 and Jenner’s key scientific contribution was not cowpox inoculation per se, but inoculation (of an 8-year-old boy) with subsequent smallpox challenge—an experiment questionable on ethical grounds. There are problems of attribution of this major medical breakthrough to one individual.5 Although the name of Jenner is well remembered, only a few will know of Sarah Nelmes (the milkmaid), James Phipps (the young boy), and Blossom (the cow)—any one of whom would make a fine subject for a statue in Trafalgar Square. J S Huntley Musculoskeletal Research Unit, Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK (e-mail: [email protected]) 1 2
Nicola C Ho National Institute of Child Health and Human Development, National Institutes of Health and Johns Hopkins Medical Institutions, Bethesda, MD 20814, USA (e-mail: [email protected]) 1
2
3
4
5
Therrien J, Webb G. Clinical update on adults with congenital heart disease. Lancet 2003; 362: 1305–13. Goldmuntz E, Bamford R, Karkera JD, et al. CFC1 mutations in patients with transposition of the great arteries and double-outlet right ventricle. Am J Hum Genet 2002; 70: 776–80. Eldadal ZA, Hamosh A, Biery NJ, et al. Familial tetralogy of Fallot caused by mutation in the jagged 1 gene. Hum Molec Genet 2001; 10: 163–69. Wilson DI, Goodship JA, Burn J, Cross IE, Scrambler PJ. Deletions within chromosome 22q11 in familial congenital heart disease. Lancet 1992; 340: 573–75. Johansson BW, Sievers J. Inheritance of atrial septal defect. Lancet 1967; 1: 1224–25.
Putting Jenner back in his place Sir—There is competition for an empty plinth in London’s Trafalgar Square. Gabriel Scally and Isabel Oliver are championing the case for Edward Jenner (Oct 4, p 1092).1 They laud him as “perhaps the first international medical hero”. Elsewhere he has been hailed as “one of the greatest benefactors to mankind and as the father of immunology”.2 His statue occupies but a humble site in Kensington Gardens. Jenner has also been described as “a political opportunist who obtained priority in the discovery of vaccination (1796) through his reputation and
1942
3 4 5
Scally G, Oliver I. Putting Jenner back in his place. Lancet 2003; 362: 1092. Bailey I. Edward Jenner (1749–1823): naturalist, scientist, country doctor, benefactor to mankind. J Med Biogr 1996; 4: 63–70. Horton R. Myths in medicine. Stud BMJ 1995; 3: 40. Plotkin SA, Mortimer EA, eds. Vaccines. Philadelphia: WB Saunders, 1988: 1. Cook GC. Author’s reply. J Med Biogr 1997; 5: 241.
Sir—In addition to Gabriel Scally and Isabel Oliver’s Commentary on the relocation of the Jenner statue to Trafalgar Square in London,1 The Lancet has a long history of interest in the monument sculpted by noted 19th century artist, Calder Marshall. May I draw your attention to several references? First, an article in the Feb 21, 1852, issue2 cautions that the funding strategy for the statue risks failure. The article states: “With even the suspicion of private purpose about what should be a purely public ovation to a great man, subscriptions will not flow freely or cheerfully from those who most revere the name of JENNER”. Second, after the funding had been accomplished by an international effort and the statue had been erected, The Lancet bristled at the limited contributions by the English population. In an article in the June 12, 1858, issue,3 the following statement appeared: “But the statue cries shame on the niggard apathy of the people of England whose contributions amount to less than one-third of the subscription; shame that foreign states have so easily surpassed them in respect to their own son; shame that the scanty list of pounds does not even repay the labour of the artist . . .; shame that years
have passed ere one poor bronze statue has found a maker and a site. . .; shame, too, on the ladies of England, whose seamless beauty this man may claim a part of his gift, and who have forgotten to offer the smallest of their coins in his honour”. Third, when agitation arose in Parliament for the removal of the statue from Trafalgar Square, The Lancet reacted in an article in the May 15, “Mr. THOMAS 1858, issue4: DUNCOMBE, the defender and supporter of quackery in the House of Commons is sorely annoyed that a statue of the great and good JENNER should be placed in a position of honour. It is humiliating, indeed, to find any man, particularly a member of Parliament, at this time so ignorant to utter such nonsense”. Fourth, and finally, after the removal of the statue from the Square, in a poignant editorial in the February 15, 1862, issue,5 the following appeared: “During the last week the public have been surprised, on visiting Kensingtongardens to find the statue of the illustrious Jenner standing, or rather sitting, with its air of placidity, on a new pedestal in the vicinity of the stone bridge spanning the Serpentine . . . . Happily, however, it is beyond the power of any official stupidity or individual crochet to place the statue of Jenner anywhere within the ken of humanity without its being able to impose respect and to appeal for gratitude from the passer-by.” Last year on a sunny Sunday afternoon in June, my wife and I visited the statue. As we sat admiring the sculpture, children were playing joyfully in the ponds that surround the fountains of the Italian garden, watched over by the venerable doctor. We could not help wondering whether, perhaps, this is not a better venue than Trafalgar Square for the great benefactor. Warren Winkelstein Jr School of Public Health, University of California, Berkeley, CA 94720, USA (e-mail: [email protected]) 1 2 3 4 5
Scally G, Oliver I. Putting Jenner back in his place. Lancet 2003; 362: 1092. Editorial. [Untitled]. Lancet 1852; 59: 199–200. Editorial. A monument to Jenner. Lancet 1858; 71: 588. Editorial. [Untitled]. Lancet 1858; 71: 485. Editorial. Dr. Jenner in Hyde Park. Lancet 1862; 97: 181.
DEPARTMENT OF ERROR Dargie HJ.  blockers in heart failure. Lancet 2003; 362: 2–3. In this Commentary (July 5), an acknowledgment was omitted: “HJD has received research support and honoraria from GlaxoSmithKline and Roche Pharmaceuticals.”
THE LANCET • Vol 362 • December 6, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet publishing Group.