If you’ve been following History of Vaccines for some time, you know by now the story of the development of the smallpox vaccine by Edward Jenner in 1796. Long story short, Dr. Jenner noticed that milkmaids who had contracted cowpox seemed to be immune to smallpox. Theorizing that cowpox was close enough to smallpox in how it triggered an immune response but not in severity, Dr. Jenner inoculated James Phipps, age 8, with cowpox. Dr. Jenner then waited for the cowpox blister to heal and challenged James with smallpox by inoculating him with pus from a smallpox pustule. James didn’t develop smallpox. He didn’t get sick at all. He went home and no one in his family got sick, either. While not knowing the exact mechanism, Dr. Jenner had developed the first reported vaccine that prevented a disease without giving a person the symptoms of the disease.
By 1799, the British had begun to use the vaccine in London, England. Through observation of those who were vaccinated versus those who were not and those who were inoculated with smallpox (a way of giving the disease in a controlled manner), health authorities deemed the vaccine to be a safe and effective way to prevent smallpox. From then on, the race was on to get the vaccine to all territories of the Empire, an empire with territories on each inhabited continent around the planet. At the time, there was no way to grow the virus in the lab, and, even if it could be grown in a lab, there was no refrigeration to keep the cowpox virus viable.
In order to transfer the vaccine virus from one place to another, a person would be given the vaccine, and they would be taken to the next place where the virus was to be collected from the pustule and given to the next person. (This was also the way smallpox was transported for inoculation efforts.) This becomes an impressive feat when you realize that the fastest means of transportation at the time was horse-and-carriage over land or ships over sea. There were no trains, planes or automobiles. Going from one place to another took a long time.
A narration of what British health authorities had to do to get the vaccine from Europe to Bengal (modern day Bangladesh and India) can be found in this archived book on Google: Report on the progress of vaccine inoculation in Bengal. In it, John Shoolbred, Superintendent General of Vaccine Inoculation, reports back on the efforts to get British subjects vaccinated. It is quite a read.
In the first few pages, Dr. Shoolbred talks about the background of the vaccine and how it was welcomed by the medical community:
“The year 1798 was the auspicious era in which the world was first made acquainted with the happy discovery of Dr. Jenner. The practice of vaccine inoculation was begun in London in January, 1799, and has ever since been rapidly increasing in Europe, and gradually extending its benefits to every quarter of the globe. The accounts of the new inoculation, published in England, soon reached this country, and excited, as might have been expected, a very lively interest in all the members of the medical profession, who anticipated, with anxiety and pleasure, the acquisition of a discovery which promised an exemption from pain, misery, and premature death, to so large a portion of mankind. Impressed with these animating sentiments, they expressed an earnest desire to obtain possession of the newly-discovered disease. It was soon known, however, that the vaccine virus did not retain its infecting property long enough to permit its being transmitted, in an active state, to any part of India by sea; and that, consequently, our only means of procuring it must be by different stages overland; by Vienna and Constantinople; Bagdad, Bussora, and Bombay.”
(Constantinople is modern day Istanbul, Turkey; Bagdad is Baghdad, Iraq; Bussora is modern-day Basrah, Iraq; and Bombay is modern-day Mumbai, India.)
In March 1801, the request was made to authorities in Constantinople to send “vaccine matter” to Bombay. The request was fulfilled in September 1801, and the vaccine matter was on its way to India. After some failures, the vaccine matter was successfully produced in early 1802 in Bagdad from someone vaccinated in Constantinople. (The distance between the two cities being about 2,100 kilometers through roads today.) Those people who were vaccinated in Bagdad were taken to Bussora (about 500 kilometers through roads today.)
From the port at Bussora, after several failures (meaning that the vaccine pustule was healed and no longer infectious) people with the vaccine traveled by ship to Bombay (about 3,400 kilometers or 1,800 nautical miles). Once there, in June 1802, Anna Dusthall, age 3, was successfully vaccinated, beginning the next chain of human carriers to take the vaccine to Bengal, clear on the other side of India from Bombay. Dr. Shoolbred wrote:
“…a successful inoculation was at length effected by Dr. Scott, on the 14th of June, 1802, on the arm of Anna Dusthall, a healthy child of three years old; a circumstance which it is of importance to state, because from this patient originally emanated the whole of the vaccine virus now in use in India. In tracing the above-mentioned route of the vaccine infection, it deserves to be noticed, that, in two of the stages, the virus preserved its infecting quality longer than it is usually found to do; the distance from Bagdad to Bussora being thirty to thirty-five days journey, and the passage by sea from Bussora to Bombay not less than three weeks.”
Once in Bombay, the vaccine was taken to Madras (modern-day Chennai) on the eastern coast of India. There, John Cresswell, age 13, from Port Jackson in Australia, was vaccinated and traveled up the coast to Bengal in October. The vaccine finally arrived in Bengal in November 1802.
From there, the narrative changes to the local efforts to vaccinate the population. It seems, from reading the report, that the European settlers had no problem in taking the vaccine. They believed the physicians administering it. In one year (1803), about 11,100 people were vaccinated. The local population, however, were not as quick to take the vaccine. Dr. Shoolbred reports some local Hindu populations not wanting the vaccine because it was derived from cows, an animal they revered. Others were just not trusting of the colonizing government.
Dr. Shoolbred reports that there were some failures in maintaining the chain. Some vaccinated children were taken by their parents and not allowed to become carriers of the vaccine to other areas of Bengal. Others did not arrive in time for the vaccine to be viable. And others had a reduced effectiveness, probably due to the time between vaccination and collection of the material.
“It may perhaps be expected that a greater number of patients should appear in the register of vaccination. But when it is considered, that the natives of this country, naturally averse to all innovation, have yet not affection for the new practice; that the most authoritative class of them oppose it from interested motives; that the circumstance of its coming originally from the cow, an animal so highly revered by the Hindoos, so far from operating, as was at first expected, in its favor, has directly the contrary effect; and that the great body of the natives, the labouring class, are absolutely so stupid and insensible, as to have no perception of its inestimable value to mankind; I should hope it would still appear, that some benefit has already been derived from it, and that no inconsiderable steps have been taken to insure its permanent residence in this quarter of the globe.”
Dr. Shoolbred also conducted post-vaccination surveillance of the population and estimates how many people were saved by the vaccine. Remember, at the time, smallpox went around and wiped out about a third of all people it infected, or more if it was a particularly virulent strain or the population was malnourished. The only preventative before vaccination was inoculation, meaning that people were exposed to smallpox under the care of a physician. Even then, some developed the full-blown disease and died. With vaccination, no one got sick except for the pustule at the vaccination site. Dr. Shoolbred wrote:
“The Bramins, who practise inoculation for the small-pox, acknowledge that they lose about one in two hundred. This is probably stating the porportion of deaths lower than actually happens; but allow it to be correct, and say, that all the above 11,000 patients, instead of being vaccinated, had been inoculated for the small-pox, the number of lives saved would be fifty-five. But suppose, what might equally have happened, that the same number had taken the small-pox in the natural way, the mortality of which in India has been estimated at one in three, then the number of lives saved by vaccination in the course of last year is no less than 3666; besides the incalculable number that must have fallen sacrifices to the spreading of the contagion generated on the bodies of so many small-pox patients.”
He goes on to note that children from European parents inoculated with smallpox had a death rate of one in 300 in Europe versus one in 60 to one in 70 in the colonies. So he reports that the vaccination is saving those lives as well. The rest of the report is more on the observations of who got the vaccine, where, and how. Dr. Shoolbred also reports who didn’t, why not, and how they plan to address those issues in the future. A series of appendices talk about the vaccine material and how they plan to preserve it, about how some cases of chickenpox after the vaccine were studied (since there was worry that the cowpox would cause disease), and — in Section V — whether the cowpox virus existed in cattle in India and whether the Bramin (priests or teachers in Hinduism) practiced vaccination similarly to what Dr. Jenner discovered.
The Report by Dr. Shoolbred is one of the first written accounts of vaccination outside of “The West” in the 1800s. It is a very early look at efforts to bring smallpox under control. It would be another 180 years before the disease was eradicated. This is an excellent read if you’re into medical history, and if, like me, you like to see the early days of epidemiology. After all, that is what Dr. Shoolbred did in this report; he gave us the epidemiology of vaccinia virus in 1803 in Bengal.