Introduction: simultaneously global and local: reassessing smallpox vaccination and its spread, 1789-1900

Transoceanic pathogen transfer in the age of sail and steam

In the centuries following Christopher Columbus's 1492 voyage to the Americas, transoceanic travel opened unprecedented pathways in global pathogen circulation. Yet no biological transfer is a single, discrete event. We use mathematical modeling to quantify historical risk of shipborne pathogen introduction, exploring the respective contributions of journey time, ship size, population susceptibility, transmission intensity, density dependence, and pathogen biology. We contextualize our results using port arrivals data from San Francisco, 1850 to 1852, and from a selection of historically significant voyages, 1492 to 1918. We offer numerical estimates of introduction risk across historically realistic ranges of journey time and ship population size, and show that both steam travel and shipping regimes that involved frequent, large-scale movement of people substantially increased risk of transoceanic pathogen circulation.

The beginnings of smallpox vaccination in Spain seen through the correspondence of Ignacio María Ruiz de Luzuriaga (1801-1802)

Edward Jenner's discovery of the smallpox vaccine spread rapidly across Europe. In Spain, vaccinations first took place in December 1800 and the practice flourished upon the private initiative of doctors, surgeons, state officials and members of the nobility in different parts of the country. Ignacio María Ruiz de Luzuriaga, secretary of the Royal Academy of Medicine of Madrid, is considered in medical historiography as a key figure of the introduction of the smallpox vaccine in Spain. Ruiz de Luzuriaga had a major role as a disseminator of the Jennerian technique and as a distributor of the vaccine fluid. Given his prestige as a doctor and his position in the Royal Academy, he was commissioned to establish a scientific and academic corpus on preventive measures to foster their understanding, uptake and good practice among Spanish vaccinators. He also attempted to create a Central Vaccine Committee, such as that existing in other European countries. The Royal Academy kept records of his activity which have been filed and catalogued in a documentary set entitled 'Papeles sobre la vacuna' [Vaccine Papers]. This archive has not been studied in depth to date. These documents allow identifying a network of correspondents set up by Ruiz de Luzuriaga. He provided these correspondents with the vaccine and asked them to report back on the vaccination progress made in their municipalities. This correspondence provides an account of how the first immunisations in Spain unravelled, as well as of the initial concerns that accompanied the introduction of the vaccine.

Death of the King: The Introduction of Vaccination into Nepal in 1816

This article explores the introduction of smallpox vaccination into Nepal in 1816 at the request of the Nepalese government; the king, however, was not vaccinated, contracted the disease and died. British hopes that vaccination would be extended throughout the country did not eventuate. The article examines the significance of this early appearance of vaccination in Nepal for both Nepalese and British, and relates it to the longer history of smallpox control and eventual eradication. When the Nepalese requested World Health Organization (WHO) assistance with communicable disease control in the mid-twentieth century little had changed for most Nepalese. We know about the events in 1816 through the letters of the newly imposed British Resident after Nepal's military defeat in the Anglo-Nepal War (1814-16). By also drawing on other sources and foregrounding Nepal, it becomes possible to build up a more extensive picture of smallpox in Nepal that shows not only boundaries and limits to colonial authority and influence but also how governments may adopt and use technologies on their own terms and for their own purposes. Linking 1816 to the ultimately successful global eradication programme 150 years later reminds us of the need to think longer term as to why policies and programmes may or may not work as planned.

Control, containment and health education in the smallpox-vaccination campaigns in Mexico in the 1940s

This article examines some of the changes that the Mexican vaccination programs underwent starting in 1943, the year when the National Smallpox Campaign (Campaña Nacional contra la Viruela) was established. It analyzes why a uniform and coordinated vaccination method was adopted to counter the outbreaks of this endemic disease, especially in central Mexico; the actions of its numerous and heterogeneous staff; and the reasons why smallpox vaccination was considered critical to establish a culture of prevention. In summary, the article examines why selective vaccination was chosen and the expansion of the health-education programs, topics that have been seldom addressed in historical research.

The Global Menace

The history of medicine has gone 'global.' Why? Can the proliferation of the 'global' in our writing be explained away as a product of staying true to our historical subjects' categories? Or has this historiography in fact delivered a new 'global' problematic or performed serious 'global' analytic work? The situation is far from clear, and it is the tension between the global as descriptor and an analytics of the global that concerns me here. I have three main concerns: (1) that there is an epistemic collusion between the discourses of universality that inform medical science and global-talk; (2) that the embrace of the 'global' authorises a turning away from analyses of power in history-writing in that (3) this turning away from analyses of power in history-writing leads to scholarship that reproduces rather than critiques globalisation as a set of institutions, discourses and practices.

Another vaccine, another story: BCG vaccination against tuberculosis in India, 1948 to 1960

Through an examination of mass BCG vaccination against tuberculosis in India between 1948 and 1960 this article draws attention to the diversity of the history of vaccination. The features of vaccination campaigns often differed from those of the celebrated campaign to eradicate smallpox. Due to differences between smallpox and tuberculosis as well as between the vaccines developed against them, an analysis of BCG mass vaccination against tuberculosis seems particularly well suited for this purpose. Three points of difference are identified. First, in non-Western contexts BCG vaccination procedures were modified to a greater extent than vaccination against smallpox. Second, tuberculosis lacked the drama and urgency of smallpox and BCG vaccination campaigns suffered more from recruitment problems than did the more "heroic" smallpox eradication campaign. Third, the BCG vaccine was contested in medical circles and was much better suited than the vaccine against smallpox as a vehicle for the articulation of concerns about post-colonial modernization.

The discontinuation of routine smallpox vaccination in the United States, 1960-1976: an unlikely affirmation of biomedical hegemony

This article seeks to understand the discursive context of the cessation of routine smallpox vaccination in the United States in the early 1970s. The United States has a long tradition of opposition to compulsory smallpox vaccination, usually expressed in terms of concerns about personal liberties, the extent of state authority, and challenges to the hegemony of orthodox biomedicine. The practice of routine smallpox vaccination continued in the United States until its termination in the 1970s, following a 1971 recommendation against the practice issued by the United States Public Health Service. This history investigates the ways in which opposition to compulsory smallpox vaccination in the 1960s and 70s was articulated and understood by contemporaries through an analysis of the rhetoric used in leading medical journals and popular newspapers. It finds that this ultimately successful movement to end routine smallpox vaccination drew upon the language of biomedical authority rather than political protest.

A case of exemplarity: C. F. Rottböll's history of smallpox inoculation in Denmark-Norway, 1766

Smallpox inoculation was one of the great discoveries of the 18th century and has been written into the grand narrative of medical progress, describing the taming of epidemic disease. Setting the perspective of progress aside, the article explores how this medical innovation was situated in 18th-century society and culture. The aim is to investigate how medical practice was intertwined with social structure and cultural patterns. The article takes its case from a book published in Copenhagen in 1766 by Professor C. F. Rottböll, former Head Physician of the Royal Inoculation House in Copenhagen. Being the first medical treatise on inoculation in Denmark-Norway, the book also has a historical section followed by a collection of reports and letters written by a number of other authors from various parts of the kingdom. Through close reading, the article explores how the introduction of the new technique was described in the texts. The reports were written to present practice and discuss cases. In doing so, they also presented a variety of other concerns so that a diversity of aims and intentions are added to the medical ones. The social and rhetorical strategies employed illuminate social ambition and systems of patronage, as well as understandings of history and of truth.