A number of historians have been working on different aspects of the history of smallpox prevention and treatment in the South Asian sub-continent. We provide here a taster of four fascinating studies, which have helped move our understanding of this important subject forward.

Rural lady vaccinator, North India, 1973,
private collection of Dr. Sanjoy Bhattacharya.

A note by Dr. Niels Brimnes, Associate Professor, Department of History, Aarhus University, Denmark (E.Mail: hisnb@hum.au.dk), on his project on smallpox prevention in early colonial South India.

When studying Indian history it is important not to lose sight of regional differences. This also applies to the social history of medicine. Thus, the history of smallpox prevention is often written based on evidence from Bengal. This might be so because Bengal is one of the best researched parts of India, but it might also be due to the fact that variolation – or inoculation with variolous matter – was widely practised in that province. This technique originated in Asia and was imported to Europe from Constantinople in 1721 by Lady Mary Wortley Montagu. The existence of a rival and not obviously inferior preventive technique to vaccination made it possible to see the early history of smallpox prevention in Bengal as an interesting contest between an indigenous and a colonial preventive technique.

But what about the areas of India where variolation was virtually unknown? In the Madras Presidency – covering a large portion of eastern coastal India as well as the southern tip of the peninsula – the colonial authorities launched a campaign in 1800 to promote variolation. When the cowpox vaccine reached the Presidency in the latter half of 1802, the provincial authorities had to redirect their campaign from promoting a technique with strong roots in India to promoting a technique with a purely Western origin. This again caused an interesting and clearly visible change in the rhetoric accompanying the campaign.

Before the arrival of Jenner's vaccine the colonial authorities took care to promote variolation with reference to its indigenous roots and indigenous initiative. In a circular letter from Guntur district, for instance, variolation was promoted with reference to the established practice of the Brrahmins of Orissa (Woodiah Brahmins) and the initiative taken by a local zamindar or local magnate (Rajah Vasereddy Vencatadry Naidoo):

“The practice of Inoculation has been known from time immemorial in the Northern part of the Circars, and most of the [Woodiah] Zemindars Inoculate their Children; It is well known that it has been introduced, tho’ lately in this Circar, by Rajah Vasareddy Vencatadry Naidoo, who first submitted to it himself and who now employs Native Doctors to inoculate such of the Inhabitants of this zemindary as are willing to submit to it.”
[Source: British Library, London: Oriental and India Office Collections F/4/96, Board's Collections no. 1953, fols 45-6]

After 1802 on the other hand, it became possible to represent vaccination as part of the British civilising mission in a way that had not been possible before. In the advertisement explaining to the south Indian population that variolation was no longer an accepted way of preventing smallpox, the colonial authorities wrote:

“The same spirit of benevolence which guided the labours of these persons in Europe, led to the adoption of the means best calculated to convey the fruits of the happy discovery to India; and this humane object having been after much care effected the Inhabitants of India may, by following the example of the European Nations be for ever freed from further apprehension or danger from the small pox”

[Source: British library, London: Oriental and India Office Collections F/4/153, Board's Collections no. 2613, fols 69-75]

References to indigenous initiative had been replaced with an appeal to follow the example set by the European nations. In this way, it can argued that the promotion of vaccination intersected with a larger attempt to construct the Indians as an irrational and superstitious 'other'. This process might be identified all over India, but it is particularly clear in the South Indian context how vaccination fitted nicely into this process.

This serves as yet another reminder that we should not forget regional variation when we write the history of smallpox prevention in India – or anywhere else.

A note by Prof. Michael Bennett, Department of History, University of Tasmania, Australia (E. Mail: mjb@postoffice.utas.edu.au), on his work on Jennerian vaccination, British India, and globalisation.

The introduction of cowpox into India followed hard on its spread through Europe, and needs to be seen in the context of its global dissemination between 1798 and 1805. It was the work of a group of enthusiasts who regarded cowpox as a blessing for the whole of mankind. In India itself a wide range of people, often on their own initiative and at their own expense, took up the cause as freelance vaccinators. Nonetheless the imperial framework was hugely important. Jenner and his friends saw India as emblematic of empire, and their concern to secure the vaccine’s passage there attests to a growing sense of imperial mission in Britain. As Tony Ballantyne has observed, it is important to see empires as ‘assemblages of networks, complex threads of correspondence and exchange that linked distant components together and ensured a steady, but largely overlooked cultural traffic’. A largely overlooked commodity in this traffic, cowpox inoculation played a highly significant role, materially and symbolically, in the construction of empire. Although it was not introduced as imperial policy, vaccination readily commended itself to the British governors as a project that promised material and moral dividends. The proconsular regimes were able to act in matters of public health with an energy and determination wholly lacking in Britain. They provided the metropolis with experimental data on cowpox, preservation methods and promotional strategies, and indeed were able to secure its transmission further east. In British India well on the way to a million Indians had been vaccinated by the end of 1805, largely through the enlistment of indigenous practitioners, and death and suffering had been alleviated on an unprecedented scale. The imperial push was also in some measure counter-productive, breeding hostility and suspicion to measures that seemed brutalising and religiously offensive. The first vaccination campaign created tensions and rigidities that both revealed and widened the growing distance between imperial masters and colonial subjects. Above all, the campaign was unsustainable, given the scale of its ambition and the universal problem — compounded in parts of India by a preference for traditional variolation — of maintaining vaccination rates without a measure of compulsion. Still, alongside spectacular but unsustainable successes some solid foundations were laid. Indeed the first vaccination campaigns in India provided inspiration, as well as valuable experience, for the vaccination cause worldwide.

A note by Dr. Lauren Nauta Minsky, Assistant Professor, Department of History, North Carolina State University, Campus Box 8108, Raleigh,NC 27695-8108, USA (E.Mail: lenauta@chass.ncsu.edu), on her work on smallpox prevention in colonial Punjab.

I received my Ph.D. from the University of Pennsylvania in 2006, and am currently an Assistant Professor of History at North Carolina State University. My primary interest in smallpox is to understand the regionally distinctive histories of both the disease and prophylactic measures in colonial South Asia. Focusing on Punjab, my research explores how this region’s particular physical and social environment shaped both smallpox mortality and efforts to develop the most effective means of smallpox prevention.

To start, my work reconstructs the disease environment of the semi-arid Punjab plains during the late nineteenth and early twentieth centuries. I show that smallpox, like other major diseases, was neither homogenous nor unchanging with regards to its regional distribution, seasonal incidence, and likelihood of affecting different social classes and age groups. I also illustrate how Punjab’s disease environment included a variety of ‘eruptive’ fevers with symptoms similar to smallpox, including measles, chickenpox, and bubonic plague in humans, and rinderpest in bovines. All of these ‘eruptive’ fevers reached their peak incidence during the rabi (spring) harvest when labor demands, labor migration, and seasonal hunger rose. Thus, the threat of smallpox in Punjab, and the challenge of preventing it each year, did not occur in isolation from efforts to prevent and treat other contagious and deadly diseases during a critical time of production in the agricultural calendar.

Building upon these findings, I study the ways in which people living in Punjab fashioned the substance of smallpox prophylaxis to meet their preventative health needs. I find that the actions of a wide range of rural social groups – including peasants, nomadic pastoralists, and migrant laborers – went well beyond simply accepting or resisting novel vaccination technologies and practices as imposed upon them by British and Punjabi medical practitioners. Specifically, I document how, through an on-going series of struggles and negotiations, these rural social groups shaped the administration of vaccination as a seasonal, voluntary practice that maximized their ability to migrate and labor for the spring harvest. I also show how these groups worked to improve the efficacy of early vaccination practice (which was frequently associated with serious side-effects and uncertain results) by immunizing their children only when directly threatened by a smallpox outbreak; undertaking both vaccination and variolation as circumstances and crust/lymph supplies necessitated; coupling vaccination with consumption of Sitala’s ‘cooling’ dairy offerings in order to mitigate common side-effects and complications like fever, skin abscesses, and secondary infections; modifying vaccinators’ itineration practices to increase consideration of their children’s existing state of health and follow-up inspection and care; forcing the use of bovine rather than human vaccinifers in order to prevent both human disease transmission and the severe complications suffered by child vaccinifers; and, finally, by refusing to provide local calves of questionable health for lymph production in favor of sterilized and tested bovine lymph manufactured in central depots. I further document how the cost of the vaccination establishment, as other medical services in Punjab, was increasingly ‘localized’ around the turn of the twentieth century. I suggest that financial constraints facing local government bodies due to imperial finance policy, not ‘popular resistance’, was the key factor limiting the efficacy of smallpox vaccination practice in Punjab by the 1920s.

Ultimately, my work argues for the need to understand the creative role played by ‘ordinary’ rural social groups and local governments in the development of smallpox vaccination in different regional contexts in South Asia. My research on smallpox and vaccination is part of a larger doctoral study on regional medical development in Punjab during the late nineteenth and early twentieth centuries. In support of my research, I have received several awards, including a Fulbright-Hays fellowship, an SSRC International Dissertation Research fellowship, and a Doris Quinn fellowship, among others. Currently, I am revising my dissertation manuscript for future publication.

A note by Dr. Mridula Ramanna, Reader and Head, Department of History, S.I.E.S. College, University of Mumbai, India (E.Mail: mridularamanna@hotmail.com), on her work on the development of smallpox vaccination in colonial Bombay

My work focuses on Indian responses to smallpox vaccination in nineteenth century Bombay. By this time, the growing commercial importance of the city had made it urbs prima in Indis. While the colonial government wanted to immunise only soldiers, initially, the epidemic nature of the disease made them promote vaccination as a policy. In fact, it was introduced to India via Bombay, as early as 1802. Under the direction of the governor of Bombay, Mountstuart Elphinstone (1819 -1827), a program was launched to propagate vaccination, through Indian vaccinators, under the supervision of European officials. However, they found it was no easy task, as they had to contend with various obstacles. There was the deep rooted belief in Shitala devi, worshipped as the goddess of smallpox, who was not to be thwarted but appeased with cooling offerings. The patient was presented to her and hence received no medical treatment, and a number of vows had to be fulfilled, after the patient recovered. There was also the widely used practice of inoculation of attenuated ‘variolous matter,’ sanctified by ‘holy’ water. To discourage this practice, the Bombay government paid traditional inoculators to learn vaccination instead. But inoculation was regarded as more compatible to religious sentiments and vaccination was seen as European, alien, and the British design to Christianise India. A proposal, made as early as 1835, to make the latter compulsory, was rejected as being too premature. To propagate the benefits of vaccination, a paper was prepared, by government, explaining Jenner’s discovery and its difference from inoculation, and was translated into the languages spoken in the Bombay Presidency. Yet, the acceptance of vaccination was very limited by the mid- nineteenth century.

It was, with the emergence, from 1851, of the first batches of Indian doctors, trained in western medicine at Grant Medical College, like Bhau Daji Lad, Narayan Daji Lad and Atmaram Pandurang Tarkhadkar, that vaccination came to be promoted more successfully. To most Indians, the arm to arm method of transferring lymph was ritually polluting, and the so-called ‘upper castes’ objected to ‘vaccinifers’ being from the so-called ‘lower castes’. On the recommendations of Charles Morehead and John Peet, professors at the college, the campaign was systematized, with the island city being divided into divisions, each under an assistant vaccinator, who resided within its limits and checked on the vaccinated children. They were supervised by an Indian superintendent of vaccination, who was familiar with the local languages. Ananta Chandroba Dukhle, was appointed superintendent, in 1858, and for over two decades, laboured on, supervising six vaccination stations, including one on the veranda of the house of his classmate, J. C. Lisboa. In the annual vaccination reports that he filed, Dukhle has described the difficulties he encountered: superstition, apathy, the belief that vaccination offered slight immunity, and ‘procrastination’. Mothers would conceal their infants or give false addresses, or not bring their children for inspection. The fear of Shitala Devi’s wrath led to abstention from vaccination, if smallpox were to appear, even in the lane in which they resided. There were propitiatory ceremonies to be performed after vaccination and hence some would forgo or postpone it, if they could not afford the expenditure. Some declared they would rather their children died of smallpox than subject them to what they perceived as an intervention, which Dukhle regretted was a false sense of tenderness toward children. There were also rumours that vaccination led to syphilis and leprosy. Doubts and fears magnified, when some vaccinated cases succumbed to smallpox. There were at times abuse and assaults on his assistants. Dukhle recorded his own initial diffidence, in view of the lack of success of the previous fifty years, but at the end of his career, in the 1880s, he asserted that his faith in the efficacy of vaccination remained unshaken. The government recorded its gratitude, for his zealous and unremitting labours during epidemics, which regularly appeared.

Animal vaccination was introduced, in 1869, where the lymph was collected from calves, which had been inoculated, and was used to vaccinate. Some castes objected to this method, for being harmful to the calves, but others, who had opposed the arm to arm method, for being polluting, were now willing. The Act of 1877 made vaccination, compulsory for all babies born within the Bombay municipal limits and for all unprotected children up to the age of fourteen, arriving from outside the city. It is important to note that its acceptance was also facilitated by the endorsement of civic leaders and the contemporary Indian language newspapers. The latter called for the registration of births, the circulation of handbills, and public notifications, with the beating of the drum, to disseminate information. Vaccination was made compulsory in Karachi, in 1879. It is significant that in other cities of Bombay Presidency, like Poona and Ahmedabad, animal vaccination was not initially accepted. However, it was the preferred method as was to be seen on the occasion, when the extension of the act, in 1892, to the whole province, saw much debate in the local press. While the opposition was to the clause in the act, providing for the arm to arm method to be used, if animal vaccine was unavailable, reformist newspapers played a positive role in countering and criticising the objections for being ‘uneducated.’ By this decade, as superintendent Shantaram Kantak showed, a larger number of the population was vaccinated in Bombay, in comparison to Calcutta and Madras, and it was not done seasonally, but throughout the year. He also found that a higher percentage of male children than female, were brought to vaccination stations, because of parental reluctance to bring girls out into the public.

By the end of the century, the number of smallpox deaths had declined, the frequency of epidemics had reduced, and when they did occur, were more manageable, due to the Indian doctors, the vital intermediaries, who discounted anxieties, persuaded and propagated. This subject is deserving of greater attention.

We are, of course, extremely interested in receiving more short reports (750-1500 words) of other projects dealing with the history of smallpox in South Asia, for posting on this site. Please write to Dr. Sanjoy Bhattacharya (smallpoxhistory@ucl.ac.uk) with the write up, and affiliation and contact details – we aim to update this site twice a year and new entries can, therefore, be put up pretty quickly (the Wellcome Trust Centre retains the right to reject contributions, if the content is deemed to be inappropriate).

This page last modified 18 July, 2006 by [Stormtree Internet Services]