Question: Did you know that smallpox inoculation started in India before the
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
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,
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:
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.