INTRODUCTION OF VACCINATION TO INDIA AND THE EAST.
The enthusiasm for cowpox in England was reproduced with fury among
the English in India. It is always so. What is the fashion at home
is an intenser fashion abroad.
When we say India, we speak as of a country when we are dealing
with a continent--of not one but many peoples, of races numerous
and tongues various: wherefore, in naming India, I would be
understood as limiting my remarks to the portion designated, and
to the population affected by English influence. In several parts
of India smallpox is endemic--begotten in permanently unwholesome
conditions of life, and cultivated and propagated by inoculation.
When, therefore, it was heard that cowpox might be substituted for
smallpox, and that the mild served every purpose of the severe
disease, there arose a demand among the English for the virus,
alike for their own and for native use. Dr. Underwood, writing to
Jenner from Madras, 28th Feb., 1801, observed--
I have read with very great pleasure your publications on Cowpox,
and feel particularly anxious to introduce and extend it in this
country, under the greatest confidence that it would save many
lives. I have hitherto embraced every opportunity of inoculating
with variolous matter, but the loss of a beautiful little patient
has humbled me, and I confess I never now take up a lancet but
with fear and trembling.[231]
It was easier to ask than to obtain. There was no cowpox to be
heard of in India, and the long voyage round the Cape, and the
tropical heat were fatal to its transmission. Repeated attempts
were made, but all ended in failure. Jenner proposed to place a
number of picked men on board an East Indiaman, and to have them
successively vaccinated in the course of the voyage, so as to
land with fresh virus in Bombay or Calcutta; but the East India
Company declined the proposal. An attempt was then made to raise
a subscription for the purpose, Jenner putting his name down for
1,000 guineas; though it was difficult to imagine where the 1,000
guineas were to come from, unless out of the pockets of some of his
admirers.[232]
These efforts were, however, superseded by the energy and ingenuity
of Dr. De Carro, of Vienna. Lord Elgin, British ambassador to the
Porte, had made acquaintance with De Carro, and had received virus
from him with which his infant son and others were vaccinated at
Constantinople. The news spreading abroad, Lord Elgin was entreated
to meet the Indian demand, sending the vaccine overland to Bombay
by way of Bagdad and Bussora. He made several futile attempts, and
thereon determined to place the matter in the hands of De Carro;
and for that purpose addressed himself to the Hon. Arthur Paget,
British ambassador at Vienna, saying--
I have so many applications for Vaccine Virus from Bussora, the
East Indies, and Ceylon, that I beg you will immediately apply to
Dr. De Carro, and request him to send some by every courier.[233]
De Carro accepted the commission with alacrity. He had already had
an application from Bagdad, and, dismissing the vehicles which
had been tried and failed, such as lancets of steel, silver,
gold, and ivory, and threads enclosed in quills, he saturated
lint with virus, and, placing it between glasses, in one of which
was a cavity for its reception, tied them together, sealed the
edges, and, taking them to a wax chandler, had them dipped until
enclosed in a ball of wax, which was packed in a box stuffed
with shreds of paper. In this manner virus was conveyed through
Constantinople, across the deserts to Bagdad, where it was received
on 31st March, 1802, still liquid, and was used “with complete
success.” The like success was reported from Bussora, Muscat, and
Bushire. From Bussora virus was conveyed to Bombay, arriving,
after a three weeks’ voyage, early in June. Twenty or thirty were
inoculated with the Vienna virus, but only one “took,” namely, Anna
Dusthall, a child about three years of age, who was operated upon
by Dr. Helenus Scott. The progress of the case was watched with
intense anxiety, and correspondent satisfaction when the symptoms
developed according to the recognised description. On the eighth
day five children were vaccinated from Dusthall’s arm, and loud
was the rejoicing when it was known that for India was secured
the genuine Variolæ Vaccinæ. From Bombay “the precious fluid” was
in due course conveyed to Ceylon, Madras, Calcutta, and wherever
English influence prevailed. De Carro was naturally elated with his
success. The virus he transmitted was originally obtained from the
stock of Dr. Sacco, of Milan, who had it off some Lombard cows.[234]
Jenner wrote to De Carro to congratulate him, 28th March, 1803--
Since the commencement of our correspondence, great as my
satisfaction has been in the perusal of your letters, I do not
recollect when you have favoured me with one that has afforded
me pleasure equal to the last. The regret I have experienced at
finding that every endeavour to send the Vaccine Virus to India
in perfection has again failed, is scarcely to be described to
you; judge, then, what pleasure you convey in assuring me that my
wishes are accomplished.[235]
The imported cowpox was diffused and recommended with energy
and with fraud. Jenner, writing to Dunning, 2nd November, 1804,
observed--
Conceiving it might be a gratification to you to see how
systematically they manage vaccine affairs in India, I have sent
you a copy of a paper just transmitted to me from the India
House. Would to Heaven we could boast of such arrangements here!
Here is the paper which sets forth the energetic policy pursued--
FORT-WILLIAM, _15th January, 1804_.
With a view of extending the practice of Vaccine Inoculation
throughout the East India Company’s territories in India,
the Governor-General in Council of Bengal has appointed a
Superintendent-General of Vaccine Inoculation at the Presidency,
and established subordinate superintendents at several of the
interior stations of the country; namely, at Decca, Moorshedabad,
Patna, Benares, Allahabad, Cawnpore, and Farruckabad. These
superintendents are the surgeons of the stations, and are to
act under the orders of the Superintendent-General in whatever
regards Vaccine Inoculation. The civil surgeons also at the
several judicial and revenue stations are to co-operate with
these superintendents for the purpose of forwarding the general
object.
Vaccine Inoculation has also been introduced with success
into Prince of Wales Island, and it is intended to extend the
practice to Malacca and other places to the eastward; and a
confident expectation is entertained that the benefits of this
valuable discovery will be diffused throughout Asia. It is even
in contemplation to extend it to China; but as the suspicious
disposition of the Chinese might possibly ascribe any attempt to
introduce this novel practice to sinister motives, it has been
postponed until the opinion of the Company’s servants there can
be obtained.
Much of this policy was due to the Marquis Wellesley, the
Governor-General, whose habit it was to convert conviction without
delay into performance. To what extent it was found practicable to
substitute vaccination for variolation among the natives does not
clearly appear. It was comparatively easy to operate upon those
immediately dependent upon their conquerors; but it was a different
matter to disarm the aversion of the external myriads. Supposing
the variolators preferred their ancient practice because it was
more lucrative, a number of them were brought to Calcutta, and
inquiry made as to the amount of their gains, which ascertained,
they were offered double pay if they would adopt vaccination.
The offer was readily accepted, and other variolators, hearing
of it, volunteered their services on similar terms, and were
instructed and enrolled as official vaccinators. A declaration was
drawn up and signed by twenty-six of these converted variolators,
recommending vaccination to the Eastern world. The declaration was
published in the _Calcutta Gazette_, printed in four languages, and
widely circulated throughout India.[236]
So much was possible to Government; but other means of persuasion
were not neglected. It was at first imagined that pox from the
cow would exactly suit people who held that animal in reverence;
but, on the contrary, the fact was converted by the Brahmins into
an argument against its use, they contending, and justly, that
cowpox was impure. To meet this difficulty, various pious frauds
were attempted. It was pretended that vaccination was no novelty
in India, and that it was known, sanctioned, and practised from
time immemorial. Baron, Jenner’s biographer, relates these details
without animadversion--
A native physician of Bareilly put into the hands of Mr. Gillman,
who was surgeon at that station, some leaves purporting to be
an extract from a Sanscrit work on medicine, entitled “Sud’ha
Sangreha,” by a physician named Mahadeva, to this effect--
“Take the matter of pustules, which are naturally produced on the
teats of Cows, carefully preserve it, and before the breaking out
of Smallpox make with a fine instrument a small puncture (like
that made by a gnat) in a child’s limb, and introduce into the
blood as much of that matter as is measured by a quarter of a
ratti. Thus the wise physician renders the child secure from the
eruption of the Smallpox.”
The Sanscrit work from which this passage was asserted to be
taken was never forthcoming, and by competent authorities was
pronounced “nothing more than a well-meant device for the reduction
of ignorant prejudices,” the native physician who put the leaves
into the hands of Mr. Gillman being included in the fiction. Baron
continues--
In order to overcome these native prejudices the late Mr. Ellis,
of Madras, who was well versed in Sanscrit literature, actually
composed a short poem in that language on Vaccination. The poem
was written on old paper, and was said to have been _found_, that
the impression of its antiquity might assist the effect intended
to be produced on the minds of the Brahmins while tracing the
prevention to their sacred cow.
The late Mr. Anderson, of Madras, adopted the very same
expedient, in order to deceive the Hindoos into a belief that
Vaccination was an ancient practice of their own. It is scarcely
necessary to observe that had any authentic record of such a
practice existed these gentlemen would never have resorted to
such contrivances to gain their object.[237]
These impostors were not priests, but medical men; not Jesuits, but
Protestants; not Levantines, but Englishmen in the service of the
Honourable East India Company. To what extent their frauds were
operative is not related. They were probably too contemptuous of
native acumen. For good and for evil the Hindoo listens to English
advice courteously and without contradiction, but persists in his
accustomed way of life with the equanimity of indifference. That
vaccination was an ancient practice in India came to be repeated
in Europe and seriously believed, when, Jenner’s originality being
impugned, the truth came out, that old Indian vaccination was a
device limited to Indian circumstances, and never designed for
Western acceptance.
In Madras vaccination was practised with much energy. Jenner,
writing on 7th May, 1808, said, “Wonderful to relate, the numbers
vaccinated in that Presidency in the course of last year amount
to 243,175.”[238] In Bombay it was claimed that smallpox was
extirpated; Dr. Helenus Scott reporting, 5th December, 1806, that
“in this island, swarming with mankind, no loss from smallpox has
been suffered for several years since the introduction of vaccine
inoculation.”[239] It was not pretended that all the inhabitants
of Bombay had been vaccinated, or even a considerable portion of
them; but the early vaccinators appear to have regarded vaccination
as a sort of charm, the possession of which kept off smallpox;
that by the vaccination, say, of one-tenth of any population,
the unvaccinated nine-tenths were protected. This faith in the
vicarious efficacy of vaccination was not expressly avowed, but
was implied in the numerous reports of extirpated smallpox in
circumstances where no attempt was made, or was indeed possible, to
effect universal vaccination.
Confuted and frustrated in England, it was Jenner’s habit to sigh,
and turn from his ungrateful country to the vast realms of Europe
and Asia and America. Writing to Dunning, on 23rd December, 1804,
he observed--
Foreigners hear, with the utmost astonishment, that in some parts
of England there are persons who still inoculate for Smallpox.
It must, indeed, excite their wonder when they see that disease
totally exterminated in some of their largest cities and in
wide-extended districts around them.
Mark the words--Smallpox totally exterminated in some of the
largest cities in 1804; that was to say, after, _at the utmost_,
five years’ acquaintance with vaccination! A miraculous time--was
it not? Jenner went on--
Let us not, my friends, vex ourselves too much at what we see
here. Let us consider this country as but a speck when compared
with the wide surface of our planet, over which, thank God!
Vaccinia has everywhere shed her influence. From the potentate
to the peasant, in every country but this, she is received
with grateful and open arms. What an admirable arrangement is
that made by the Marquis of Wellesley, the Governor-General of
India, for the extermination of the Smallpox in that quarter of
the globe! Contrasted with our efforts here, what pigmies we
appear.[240]
_Omne ignotum pro magnifico est._ What inference worth a straw
could Jenner or anyone else draw from the introduction of
vaccination to India? The number of the various Indian peoples
was unknown; and the periods and prevalence of smallpox among
them; also the extent to which they practised variolation. In the
absence of such elementary information, tales of the triumphs of
vaccination in India were so much romance.
So far as vaccination displaced variolation, it might be taken
as the substitution of a less evil for a greater; and much is
accounted for in some of the early records of vaccination when it
is remembered that the new practice was welcomed as a deliverance
from the inconveniences and horrors of the old; and that the
discredited practice was frequently abandoned without resort to
its successor. A cessation of variolation was a cessation of the
culture and diffusion of smallpox; and vaccination had often the
credit of the reduction of smallpox when the credit was due to
the abatement of variolation. As to the propagation of smallpox by
variolation, no one was more emphatic than Jenner, as for example--
Where Variolous Inoculation is put in practice, Smallpox must
necessarily spread.[241]
Smallpox will never be subdued so long as men can be hired to
spread the contagion by Inoculation.[242]
If then it be taken as conceded that variolation spread smallpox
wherever practised, can it be fair to omit the consideration of
the consequences of its abatement when estimating the results
of the introduction of vaccination? Yet scarcely an advocate of
vaccination permits the fact to enter into his reckoning!
The gratitude of the English in India to Jenner did not evaporate
without substantial expression. A subscription was started, and
between 1806 and 1812 he received remittances to the amount of
£7,383, the contributors being--
Bengal, £4,000
Bombay, 2,000
Madras, 1,383
An amusing instance of Jenner’s ignorance of India is found in
a letter to Dunning, 14th March, 1807, wherein he ascribes his
English money from India to the gratitude of Hindoo women--
You will be pleased to hear that the _dingy_ Hindoo ladies are
convincing me of their grateful remembrance, not merely in
words, but by a _tangible_ offering, while my _fair_ Christian
countrywomen pass me unheeded by.[243]
Jenner, in returning thanks to Dr. Fleming, of Calcutta, for the
first remittance of cash in 1806, took occasion to communicate some
English news, which is not without interest at this day. He wrote--
To say the truth, this country has been dreadfully supine in
the matter of Vaccination hitherto. Some pamphlets, full of the
grossest misrepresentations and forgeries, have been spread; and
the common people became so terrified, particularly when told
that their children, if vaccinated, would take the similitudes of
bulls and cows, that a great dislike to the practice has arisen
among them; and these accounts have been circulated through the
country with peculiar industry. The consequence has been the
re-introduction of Variolous Inoculation, which has produced an
epidemic Smallpox through the metropolis and the whole island,
except in those parts where Vaccination had previously been so
generally adopted as to forbid its approach. This, now too late,
has opened their eyes, and they see the powers of the Cowpox. The
folly of the oppositionists has gone so far as to exhibit prints
of children undergoing transformation from the human being into
that of the brute.[244]
These prints were, many of them, intended for fun, and could have
no serious influence. The decline of faith in vaccination was due
to the general discovery that it did _not_ prevent smallpox, and
that it _did_ excite other ailments. “It made smallpox milder”
was the apology even then coming into vogue. As for the epidemic
of smallpox raised in London and the whole island by the neglect
of vaccination and a return to variolation, it was a creation of
Jenner’s fancy. There was less smallpox in London in 1806 than in
1805; but if there was not more, the bold Jennerian would answer,
there _ought_ to have been, and it could only be through the mercy
of Providence that there was not.
Throughout the century, the English in India have spared no pains
to diffuse and enforce vaccination among the inhabitants, numerous
medical men finding place and pay in the futile occupation.
Smallpox can only be overcome by systematic sanitation, which is
laborious and difficult; and among peoples whose conditions and
habits of life freely generate zymotic disease, vaccination is
as likely to be effective as any other sort of incantation. Sir
Richard Temple states the position at this day in these words--
Smallpox is universally prevalent in India, carrying off tens
of thousands of victims, children especially, in almost every
province year by year, and impairing or disfiguring others for
life. The Government has for many years made persistent efforts
to arrest the disease by means of Vaccination, with remarkable
success in some districts, like that of Kumaon in the Himalayas,
but generally with indifferent success, and often without any
perceptible result. The practice of Vaccination not being in
vogue, Inoculation used to be largely adopted by the natives in
many districts, but has now been prohibited, though not always
prevented actually. The State everywhere undertakes or encourages
Vaccination. Hundreds of native vaccinators are employed, and
returns are rendered of large numbers of persons said to be
successfully vaccinated. Nevertheless Smallpox appears again and
again with terrible manifestations before the people, and causes
them to disbelieve the efficacy of Vaccination.[245]
We now come to Ceylon, in which vaccination was held to have had
a perfect triumph. “To Sweden and to Ceylon,” says Baron, “Dr.
Jenner was in the habit of pointing when he wished to prove what
his discovery might accomplish; or when he lamented that fatal
obstinacy of his fellow-creatures which, with such examples
before them, could induce them to reject blessings within their
reach.”[246] Sweden we shall discuss in another chapter, and of
Ceylon I may observe that a portion of the island was taken by the
British from the Dutch in 1795, and that in several parts it was
extremely unhealthy. Smallpox was a frequent and deadly epidemic,
but to what extent there is no evidence save hearsay and estimates
from hearsay. The Dutch did not concern themselves with the health
of the natives, but when the English took over their settlements in
1800 in the midst of a severe epidemic, they opened hospitals for
smallpox and for inoculation with smallpox under the supervision
of Dr. Christie.[247] He, hearing the glad tidings of vaccination,
resolved to introduce the practice, and having in 1802 received
virus from Dr. Scott, of Bombay, he set to work with systematic
energy and perseverance. Supported by the authority of successive
Governors, he closed the hospitals, forbade variolation, organised
a staff of vaccinators, and kept them employed, until the greater
part of the population under English influence was vaccinated. In
the words of Moore, writing in 1816--
At length the priesthood submitted to Vaccination, the last to
adopt this innovation upon their ancient customs; and the remains
of the Smallpox were happily extinguished in all that part of the
island which belonged to Great Britain.[248]
That smallpox had been exterminated by vaccination in Ceylon was
set forth by vaccinators as something indisputable; but there were
two observations to make--first, that smallpox was often suppressed
in the sense that for a time there was no smallpox in a certain
population, and especially subsequent to a severe epidemic; and
second, that variolation was suppressed. Granted that smallpox
ceased in Ceylon coincidently with the introduction of vaccination,
it may be fairly held that the exhaustion induced by the preceding
epidemic, and the cessation of variolation, were sufficient to
account for the phenomenon. What remains to be said of Ceylon, I
shall leave Dr. George Gregory, physician of the London Smallpox
and Vaccination Hospital, to say for me. He wrote--
Ceylon was the British colony where the Government earliest
interfered and most vigorously encouraged the practice of
Vaccination. Salaried vaccinators were scattered over the
whole island. So successful were their labours, that up to the
beginning of 1819, it had often been said that the experiment of
exterminating Smallpox had been made and successfully carried out
in Ceylon. In July, 1819, however, a severe epidemic Smallpox
broke out there. In 1830 a second epidemic overspread the
island--in 1833 a third, and in 1836 a fourth. In these four
epidemics, 12,557 persons were attacked, of whom 4,090 died,
being at the rate of 33 per cent., or one out of every three.
In each of these epidemics a certain number of vaccinated
persons took Smallpox. The proportion of the vaccinated to the
unprotected varied. In the third epidemic, out of a total of 460
attacked, 341 represented themselves as vaccinated.[249]
Vaccination was introduced to China from the English factory at
Canton, and Sir George Staunton translated into Chinese a tract on
Cowpox, and had it printed at Canton in 1805, the translator’s name
and the foreign origin of the practice being suppressed. Jenner,
writing to Dunning, 10th December, 1806, said--
From Canton I have a most curious production--a pamphlet on
Vaccination in the Chinese language. Little did I think, my
friend, when our correspondence first began, that Heaven had in
store for me such abundant happiness. May I be grateful!
The Chinese had their own system of variolation, namely, the use
of pulverised smallpox scabs as snuff; but some of them accepted
vaccination, tried it, and dropped it when they found it did not
keep off the disease as warranted. Smallpox in China is almost
exclusively a disease of childhood, and is little dreaded. Dr. D.
F. Rennie, medical officer to the British Embassy at Peking in
1861-62, says of that city--
Since 1820 vaccination (introduced from Canton) has been
practised to a limited extent among the population--probably
one-fifth may be vaccinated. At one time it was believed to
afford protection, Smallpox not having been so common immediately
after its introduction. Of recent years, however, confidence in
it has considerably diminished, owing to the frequency with which
those are attacked who have been vaccinated.[250]
Persia was sometimes referred to in the ravings that went on as
to the triumphs of vaccination in the East; but what was known
of Persia? The practice was introduced where Europeans were
resident, but it never became general. Dr. C. J. Willis has
recently described surgery and medicine in Persia as extremely
rude and superstitious, and that “vaccination is not in favour,
whilst inoculation, or the direct communication of the disorder,
by placing the patient in the same bed with one suffering from
smallpox of the most virulent type, is the method pursued.”[251]
It was natural enough for Jenner, in presence of failure and
contempt in England, to appeal to success in the East, and to try
to overwhelm his adversaries with evidence which they could not
overtake; but any one of judicial temper must have perceived that
if vaccination was to be vindicated, data of a very different order
would have to be forthcoming. Where the number of the population
in a distant region was unknown, where the ordinary prevalence
of smallpox among the people was undefined, where the extent of
artificial variolation was unspecified, and the existence and
intensity of related forms of zymotic disease were undescribed,
what conclusion could be drawn as to the efficacy of vaccination
that a man of science was bound to respect? Why should certain
knowledge in England be surrendered for assertion from abroad.
FOOTNOTES:
[231] Baron’s _Life of Jenner_, vol. 1. p. 410.
[232] Baron’s _Life of Jenner_, vol. i. p. 409.
[233] _Ibid._ vol. i. p. 419.
[234] _Histoire de la Vaccination en Turquie et l’Orient._ Par Jean
de Carro. Vienne, 1804.
[235] Baron’s _Life of Jenner_, vol. i. p. 428.
[236] _The History and Practice of Vaccination._ By James Moore.
London, 1817. P. 236.
[237] Baron’s _Life of Jenner_, vol. i. pp. 556-559.
[238] Baron’s _Life of Jenner_, vol. ii. p. 359.
[239] _Ib._, vol. ii. p. 92.
[240] Baron’s _Life of Jenner_, vol. ii. p. 24.
[241] Letter to Dunning, 23d December, 1804.
[242] Letter to Worthington, 4th May, 1810.
[243] Baron’s _Life of Jenner_, vol. ii. p. 356.
[244] Baron’s _Life of Jenner_, vol. ii. p. 89.
[245] _India in 1880._
[246] _Life of Jenner_, vol. i. p. 426.
[247] _An Account of the Introduction, Progress, and Success of
Vaccination in Ceylon._ By Thomas Christie, M.D. London, 1811.
[248] _The History and Practice of Vaccination._ By James Moore.
London, 1817. P. 242.
[249] _Lectures on the Eruptive Fevers._ London, 1843. P. 210.
[250] _Peking and the Pekingese._ London: 1865.
[251] _British Medical Journal_, 26th April, 1879.