Did You Know?
By D.P. Agrawal & Lalit Tiwari
Question: Did you know that smallpox inoculation started in India before the West?
Smallpox inoculation is an ancient Indian tradition and was practiced in India before the West.
Smallpox was not known to Hippocrates, and probably not to Galen or his successors either. The earliest Western references which seem to describe it are those of early medieval chroniclers. The turning point comes with the great physician and alchemist Abu Bakr Muhammad ibn Zakariya al-Razi (865 to ca.923 AD), whose Kitab al-jadari wa’l-hasba (On the variola and the measles) is still regarded rightly as a landmark in the history of medical literature. It gave the first clear account of these diseases and their differentiation in the Western world. But in China smallpox was accurately described several centuries earlier than in Islam. The key passage occurs in the Chou hou pei chi fang (Handy therapies for emergencies) finished by the great physician and alchemist Ko Hung about 340 AD, and revised by Thao Hung-ching (also a great physician and alchemist), in the around 500AD.
But as far as the inoculation is concerned, the earliest reference to smallpox inoculation is in the book Wan Chhuan on smallpox and measles, Tou chen hsin fa, first published in1549 AD and reprinted half a dozen times in the Chhing dynasty. The next step concerns the Chu family, who practised medicine through several generations. A book of Chu Shun-ku )ca. 1634 AD to1718 AD) entitled Tou chen ting hun (Definitive discussion of smallpox, 1713 AD) describes inoculation (Sivin 2000).
In ancient times in India smallpox was prevented through the tikah (inoculation). Kurt Pollak (1968) writes, “preventive inoculation against the smallpox, which was practiced in China from the 11th century, apparently came from India”. This inoculation process was generally practiced in large part of Northern and Southern India, but around 1803-04 the British government banned this process. It’s banning, undoubtedly, was done in the name of ‘humanity’, and justified by the Superintendent General of Vaccine (manufactured by Dr. E. Jenner from the cow for use in the inoculation against smallpox).
Worship related to Smallpox
S. C. Dube (1955) says that in ancient times disease was regarded as a punishment from the god and goddesses, or the work of evil sprites, or supernatural powers. People think that propitiation of the god or goddesses was the sure antidote against these diseases. Worship of goddess is also connected with the smallpox and organized annually in the South. The village community organizes this annual worship of Pochamma on Thursday or Saturday in the month of Shravan (July-August). The Muslims also participate in this festival but don’t participate in worship, as they dont believe in Hindu god, but were as afraid of the village gods and goddesses as the Hindus.
Smallpox in the 17th Century and Traditional Inoculation
Dharmapal (2000) has quoted British sources to prove that inoculation in India was practiced before the British did.
In the seventeenth century, smallpox inoculation (tikah) was practiced in India. A particular sect of Brahmins employed a sharp iron needle to carry out these practices. In 1731, Coult was in Bengal and he observed it and wrote (Operation of inoculation of the smallpox as performed in Bengall from Re. Coult to Dr. Oliver Coult in ‘An account of the diseases of Bengall’ Calcutta, dated February 10, 1731):
The operation of inoculation called by the natives tikah has been known in the kingdom of Bengall as near as I can learn, about 150 years and according to the Bhamanian records was first performed by one Dununtary, a physician of Champanagar, a small town by the side of the Ganges about half way to Cossimbazar whose memory in now holden in great esteem as being through the another of this operation, which secret, say they, he had immediately of God in a dream.
There method of performing this operation is by taking a little of the pus (when the smallpox are come to maturity and are of a good kind) and dipping these in the point of a pretty large sharp needle. Therewith make several punctures in the hollow under the deltoid muscle or sometimes in the forehead, after which they cover the part with a little paste made of boiled rice. When they want the operation of the inoculated matter to be quick they give the patient a small bolus made of a little of the pus, and boiled rice immediately after the operation which is repeated the two following days at noon.
The place where the punctures were made commonly festures (sic) and comes to a small suppuration, and if not the operation has no effect and the person is still liable to have the smallpox but no contrary if the punctures do suppurate and no fever or eruption ensues, then they are no longer subject to the infection.
The puncture blacken and dry up with the other pustules.
The fever ensues later or sooner, according to the age and strength of the person inoculated, but commonly the third or fourth days. They keep the patient under the coolest regimen they can think off befor the fever comes on and frequently use cold bathing.
If the eruption is suppressed they also use frequent cold bathing. At the same time they give warm medicine inwardly, but if they prove of the confluent kind, they use no cold bathing, but (keep) the patient very cool and give cooling medicines.
I cannot say anything of the success of this operation or their method of cure in this disease, but I intend to inform myself.
Dr. J.Z. Holwell writes the most detailed account for the college of Physicians in London in 1767 (An account of the manner of inoculating for the smallpox in the East Indies, by J. Z. Holwell, F.R.S. addressed to the President and Members of the College of Physicians in London). He wrote:
Inoculation is performed in Indostan by a particular tribe of Bramins, who are delegated annually for this service from the different Colleges of Bindoobund, Eleabas, Benares, & c. over all the distant provinces: dividing themselves into small parties, of three or four each, they plan their traveling circuits in such wise as to arrive at the places of the operation consists only in abstaining for a month from fish, milk, and ghee (a kind of butter made generally of buffalo’s milk); the prohibition of fish respects only the native Portugese and Mahomedans, who abound in every province of the empire.
When the Bramins begin to inoculate, they pass from house to house and operate at the door, refusing to inoculate any who have not, on a strict scrutiny, duly observed the preparatory course enjoined them. It is no uncommon thing for them to ask the parents how many pocks they choose their children should have: Vanity, we should think, urged a question on a matter seemingly so uncertain in the issue; but true it is, that they hardly ever exceed, or are deficient, in the number required.
They inoculate indifferently on any part, but if left to their choice, they prefer the outside of the arm, midway between the elbow and shoulder for the females. Previous to the operation the Operator takes a piece of cloth in his hand, (which becomes his perquisite if the family is opulent) and with it gives a dry friction upon the part intended for inoculation, for the space of eight or ten minutes, then with a small instrument he wounds, by many slight touches, about the compass of a silver grout.
The instrument they make use of, is of iron, about four inches and a half long, and of the size of a large crow quill, the middle is twisted, and the one end is steeled and flatted about an inch from the extremity, and the eight of an inch broad; this extremity is brought to a very keen edge, and two sharp corners; the other end of the instrument is an earpicker, and the instrument is precisely the same as the Barbers of Indostan use to cut the nails, and depurate the ears of their customers. The operators of inoculation holds the instrument as we hold a pen and with dexterous expedition gives about fifteen or sixteen minute scarifications with one of the sharp corners of the instrument, and to these various little wounds, I believe may be ascribed the discharge which almost constantly flows form a part in the progress of the disease. I cannot help thinking that too much has been said (pro and con) about nothing, respecting the different methods preferred by different practitioners of performing the operation; provided the matter is thrown into the blood, it is certainly, a consideration of most trivial import by what means it is effected; if any claims a preferences, I should conclude it should be that method which bids fairest for securing a plentiful discharge from the ulcer.
Just making the smallest appearance of blood, then opening a linen double rag (which he always keeps in a cloth round his waist) takes from thence a small pledget of cotton charged with the variolous matter, which he moistens with two or three drops of Ganges water, and applies it to the wound, fixing it on with a slight bandage, and ordering it to remain on for six hours without being moved, then the bandage to be taken off, and the pledget to remain until it falls off itself; sometimes (but rarely) he squeezes a drop from the pledget, upon the part, before it applies it; from the time he begins the dry friction, to tying the knot of the bandage, he never ceases reciting some portions of the worship appointed, by the Aughtorrah Bhade, to be paid to the female divinity before mentioned, nor quits the most in a double calico rag, is saturated with matter from the inoculated pustules of the preceding year, for they never inoculate with natural way, however distinct and mild the species. He than proceeds to give instructions for the treatment of the patient through the course of the process, which are most religiously observed; these are as follows:
He extends the prohibition of fish, milk and ghee, for one month from the day of inoculation; early on the morning succeeding the operation, four collans (an earthen pot containing about two gallons) of cold water are ordered to be thrown over the patient, from the head downwards, and to be repeated every morning and evening until the fever comes on, (which usually is about the close of the sixth day from the inoculation) then to desist until the apperance of the eruptions, (which commonly happens at the close of the third complete day from the commencement of the fever) and then to pursue the cold bathing as before, through the course of the disease, and until the scabs of with a fine sharp pointed thorn, as soon as they begin to change their colour, and whilst the matter continues in a fluid state. Confinement to the house is absolutely forbid, and the inoculated are ordered to be exposed to every air that blows; and the utmost indulgence they are allowed when the fever comes on, is to be laid on a mat at the door; but, in fact, the eruptive fever is generally so inconsiderable and trifling, as very seldom to require this indulgence. Their regimen is ordered to consist of all the refrigerating things the climate and season produces, as plantains, sugar-canes, water melons, rice, gruel made of white poppy-seeds, and cold water, or thin rice gruel for their ordinary drink. These instructions being given, and an injunction laid on the patients to make a thanks giving Poojah, or offering, to the goddess is a pund of cowries, equal to about a penny sterling, and goes on to another door, down one side of the street and up on the other, and is thus employed from morning until night, inoculating sometimes eight or ten in a house. The regimen they order, when they are called to attend the disease taken in the natural way, is uniformly the same. There usually begins to be a discharge from the scarification a day before the eruption, which continues through the disease, and sometimes after the scabs of the pock fall off, and a few pustules generally appear round the edge of the wound; when these two circumstances appear only, without a single eruption on any other part of the body, the patient is deemed as secure from future infection, as if the eruption had been general.
Thus far the system of practice pursued by the Bramins will, I imagine, appear rational enough, and well founded; but they have other reasons for particularly prohibiting the use of these three articles, which to some may appear purely speculative, if not chimerical. They lay it down as a principle, that the immediate (or instant) cause of the smallpox exists in the mortal part of every human and animal form; that the mediate (or second) acting cause, which stirs up the first, and throws it into a state of fermentation, is multitudes of imperceptible animalculae floating in the atmosphere; that these are the cause of all epidemical diseases, but more particularly of the small pox.
That the great and obvious benefit accruing from it, consists in this, that the fermentation being excited by the action of a small portion of matter (similar to the immediate cause) which had already passed through a state of fermentation the effects must be moderate and benign; whereas the fermentation raised by the malignant juices of the animalculae received into the blood with the ailment, gives necessarily additional force and strength to the first efficient cause of the disease.
Holwell’s detailed account, not only describes inoculation, but also shows that the Indians knew that microbes caused such diseases.
In 1787 the Government erected a hospital for smallpox inoculation at Dum Dum in Calcutta. There were some restrictions included before and after inoculation, such as the breastfeeding children were not inoculated, but children above one year of age were considered old enough for the operation, no member of an inoculated household was permitted to mix with the outside world, and no permission from another village was permitted to enter a house having an inoculated person, etc.
Smallpox in 18th and 19th Centuries:
During the 18th century smallpox was widely prevaialent in India, and killed more people here than in other countries. At Calcutta in mid 18th centaury, the yearly death rate from smallpox was, on an average, 12,000 per million.
In 1798, Edward Jenner discovered that the cowpox inoculation-vaccination protected a person against the smallpox. Only four years after the discovery, vaccination was introduced in India under the guidance of Lord Clive. This was the time when British Government banned this traditional inoculation practice.
In Calcutta, around the 1802-03 inoculation was banned under the Bengal Presidency. At first, in Bengall people rejected this vaccination because operation of inoculation was very ancient and widespread. But in 1804, Dr. Shoolbred drew attention to the determined opposition of the Brahmin inoculators. He tried to convert the numerous ticcadars (inoculators) into vaccinators, and, to an extent, he succeeded in his attempts. On April 23, 1805, after a visual demonstration of the effect of vaccination, 26 Brahmin inoculators declaring their full faith in the power of vaccination to prevent smallpox signed a statement.
Dr. T. P. Wright, civil surgeon of Bhagalpur wrote in 1868 (Annual report of the Sanitary commissioner, India, Pp. 333.):
“There is a very strong prejudice against vaccination in almost all parts of the district, and in five years, only 1519 operations have been performed….”
In 1900, smallpox inoculation was still in practice in Bengal, Assam, North-West Frontier Provinces, Punjab and the Maratha state.
In olden times tikah (inoculation) against smallpox was very common in Southern and Northern parts of India, chiefly at Calcutta. A special sect of the Brahmins practiced this inoculation operation. It was a technical operation carried through the sharp needle. Pollack asserts this operation was practiced in China from the 11th century and it definitely reached there from India. Around 17th Century it was very common in India but after the introduction of the smallpox vaccine in India by the Britishers, this traditional inoculation practice was banned under the Bengal Presidency.
Sources and Further Reading
Dharampal. 2000. Indian Science and Technology in the Eighteen Century. An Account of the manner of inoculating for the Smallpox in the East Indies. Mapusa, Goa: Other India Press., Vol 1.
Dube, S. C. 1955. Indian Village. London: Routlege and Kegan Paul.
Leslie, Charles. 1998. Asian Medical systems: a comparative Study. Delhi: Motilal Banarasidass.
Pollack, Kurt. 1968. The Healers, the Doctor, then and now. English Edition. Pp. 37-8.
Sivin, Nathan. 2000. Science & Civilisation in China. Vol.6. Part VI. Medicine. Cambridge: Cambridge University press.