Relocating Pastorian Medicine: Accommodation and Acclimatization of Pastorian Practices against Smallpox at the Pasteur Institute of Chengdu, China, 1908-1927

Argument Revising the diffusionist view of current scholarship on the Pasteur Institutes in China, this paper demonstrates the ways in which local networks and circumstances informed the circulation and construction of knowledge and practices relating to smallpox prophylaxis in the Southwest of China during the early twentieth century. I argue that the Pasteur Institute of Chengdu did not operate in a natural continuity with the preceding local French medical institutions, but rather presented an intentional break from them. This Institute, as the first established by the French in China, strove for political and administrative independence both from the Chinese authority and from the Catholic Church. Yet, its operation realized political independence only partially. The founding of this Institute was also an attempt to satisfy the medical demand for local vaccine production. However, even though the Institute succeeded at producing the Jennerian vaccine locally, its production needed to accommodate local conditions pertaining to the climate, vaccine strains, and animals. Furthermore, vaccination had to conform to Chinese variolation, including its social and medical practices, in order to achieve the collaboration of local Chinese traditional practitioners with French colonial physicians, who were Pastorian-trained and worked at the Pasteur Institute of Chengdu. Thus the nature of the Pastorian work in Chengdu was not an imposition of foreign standards and practices, but rather a mutual compromise and collaboration between the French and the Chinese.

[The court physician, the clergyman, a learned society and smallpox]

Variolation was introduced in England in the first half of the 18th century. The positive effects of this new method for preventing smallpox were already known in the Netherlands around 1720, one of whom was the Dutch physician Boerhaave. In spite of this, it took another 30 years before variolation was used in the Netherlands. Despite receiving positive advice and information from his learned English friends Sloane and Sherard, Boerhaave did not apply nor advise the use of variolation. There were various arguments for this restrained approach. In 1754 Thomas Schwencke found that conditions were favourable for the introduction of variolation in The Hague. There was support from the House of Orange-Nassau (the current royal family in the Netherlands) and from a learned society; a highly motivated clergyman acted as ambassador for the new technique and the court physician Schwencke was willing to take the lead. A similar combination had previously been effective in England, though the ambassador there was not a clergyman but an influential noble lady.

The prevention and eradication of smallpox: a commentary on Sloane (1755) 'An account of inoculation'

Sir Hans Sloane's account of inoculation as a means to protect against smallpox followed several earlier articles published in Philosophical Transactions on this procedure. Inoculation (also called 'variolation') involved the introduction of small amounts of infectious material from smallpox vesicles into the skin of healthy subjects, with the goal of inducing mild symptoms that would result in protection against the more severe naturally acquired disease. It began to be practised in England in 1721 thanks to the efforts of Lady Mary Wortley Montagu who influenced Sloane to promote its use, including the inoculation of the royal family's children. When Edward Jenner's inoculation with the cow pox ('vaccination') followed 75 years later as a safer yet equally effective procedure, the scene was set for the eventual control of smallpox epidemics culminating in the worldwide eradication of smallpox in 1977, officially proclaimed by WHO in 1980. Here, we discuss the significance of variolation and vaccination with respect to scientific, public health and ethical controversies concerning these 'weapons of mass protection'. This commentary was written to celebrate the 350th anniversary of the journal Philosophical Transactions of the Royal Society.

Dummheit

Immunizing against influenza is tricky; against measles is not. Influenza comes in many constantly evolving strains, but one measles shot in childhood confers lifelong immunity. Unlike the flu, measles was wiped out. Its return represents an outbreak not of disease, but of stupidity. The matrix of stupidity is, however, reinforced by strong strands of malice, as when Andrew Wakefield's fraudulent 1998 paper linked the MMR vaccine to autism. The fraud was unmasked and the vaccine-autism link disproven, but the evil influence continues. Measles offers an illustration of Virchow's insights that medicine is a social science and that politics is medicine writ large. It is this "inconvenient truth" that is being suppressed by muzzling the Chief Public Health Officer (CPHO) and attacking public health for addressing "social determinants."

The role of the Immunisation Adverse Events Clinic at The Children's Hospital at Westmead

Specialist immunisation clinics review and manage children who have experienced an adverse event following immunisation and provide advice to parents and health care providers regarding the revaccination of these children. Information collected by these clinics supplement passive surveillance data and allow the investigation of suspected safety signals associated with the delivery of immunisation programs. This paper reviews the role and experience of the Immunisation Adverse Events Clinic at The Children's Hospital at Westmead and identifies areas for development.

[Were the Turks in the 18th century variolated against smallpox? the analysis of a typical example of misconception in medical cross-cultural transmission]

There has been a continuing misconception for almost three centuries since the transmission of variolation from Turkey (actually the Ottoman Empire) to England that this was a practice of the Turkish Muslims. There are many sources of cogent evidence that variolation in the 18th century in the Ottoman Empire was opposed by Muslims due to their religious beliefs. This article uses cultural anthropology in its analysis of the reasons for the misconception.

Pursuing protection from disease: the making of smallpox prophylactic practice in colonial Punjab

Focusing on colonial Punjab, this article explores how agrarian lower-class families' pursuit of safe and effective protection from smallpox shaped the region's prophylactic practices during the late nineteenth and early twentieth centuries. Specifically, the article explains shifts from variolation in conjunction with Sitala (smallpox goddess) worship to vaccination in conjunction with Sitala worship; from vaccination with crusts to vaccination with human and animal lymph; and from vaccination with fresh lymph to vaccination with tubed lymph. The article also illustrates how, regardless of the particular technologies employed at any given point in time, the demand for, and efficacy of, vaccination varied with seasonal fluctuations in labor and disease. More broadly, this article challenges the assumptions of elite agency and linear cultural change that animate national and global histories of vaccination by demonstrating the importance of regional socio-environmental factors and the creative, productive agency of the agrarian lower classes.

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

The last two decades have seen a reawakening of scholarly interest in the history of smallpox prevention. Accounts of vaccination and others efforts at controlling smallpox have moved away from heroic narratives toward more nuanced and contextualized understandings. It is now accepted that several viruses traveled under the vaccine label from the outset, and it has been demonstrated that a variety of techniques were used to perform vaccination operations. The character of nineteenth century sea voyages that took the vaccine to distant territories has also been re-examined; sometimes the spread of the vaccine was caused by private networks and ad hoc decisions, while at other times it was the result of enterprises with close resemblances to contemporary centralized vaccination campaigns. Looking beyond Europe and North America we encounter a variety of state attitudes toward vaccination, ranging from concentrated efforts to spread the technique to efforts more uncertain and diluted. Although the reluctance to accept vaccination has been amply documented, recent studies emphasize this should not be attributed to simplistic dichotomies of modernity versus tradition or science versus culture; instead, instances of resistance are best studied as specific contextualized interactions. Indeed, factors like favorable geography, strong bureaucratic structures, and the absence of variolation seem to have helped the relatively smooth transfer of vaccination technologies. Perhaps most important, recent research encourages us to continue to study smallpox vaccination as a phenomenon that was simultaneously global and local.

Borrowing, adapting, and learning the practices of smallpox: notes from colonial Goa

In this article I will address colonial state policies toward smallpox in nineteenth-century Goa. The picture that emerges from the analysis of health services documents suggests a broad variety of coexisting practices. While the actions of some of the Portuguese head physicians epitomized the conflict between state-sponsored vaccination policies and local preferences for smallpox inoculation, others showed sympathy for and developed arguments in favor of inoculation as practiced by indigenous experts. Still others observed the existence among the population of hybrid practices combining elements of vaccination and inoculation. The diversity of Goan combinations along the violence/collaboration continuum should be interpreted within the context of current trends in the analysis of smallpox in British India--which replace the paradigm of vaccination: variolation :: state violence: native resistance with a more nuanced understanding of a variety of combinations throughout the subcontinent in the nineteenth century.

Smallpox and cowpox under the Southern Cross: the smallpox epidemic of 1789 and the advent of vaccination in colonial Australia

In histories of smallpox and vaccination, little attention has been paid to their progress in the southern latitudes. In this paper, I focus on the appearance of smallpox around Sydney Cove in 1789 and the introduction of cowpox (vaccine) to New South Wales in 1804. I demonstrate the connections, historical and virological, between the two events and examine the role of variolation in the spread of smallpox and in anticipating vaccination. I argue that imported "variolous matter," perhaps obtained in Cape Town, may have been the source of infection in the catastrophic epidemic among the Aborigines in 1789. I likewise examine the means by which vaccine was brought to Australia in relation to comparable initiatives around the Indian Ocean. I assess the significance of the early history of vaccination in Australia in relation to subsequent developments and as a remarkable demonstration of the global reach of the new prophylactic.

Jennerian vaccination and the creation of a national public health agenda in Japan, 1850-1900

Vaccination played a leading role in transforming the social and political status of medicine in Japanese society in the second half of the nineteenth century. The process began well before the Meiji Restoration of 1868 created a centralized government under the Japanese emperor. At the beginning of the century, medicine was a private business. There was no oversight from an interested government, and there were no medical societies or journals in which to debate and formulate opinion about medical practice. Medical knowledge was transmitted privately through personal lineage structures whose members jealously guarded their medical techniques. For almost a half century before live vaccine could be imported, knowledge of vaccination was limited to a small group of Japanese physicians who could read Dutch. This special knowledge created a medical elite whose members managed the transmission of vaccination after the vaccine arrived, and dominated the new medical and public health bureaucracies created by the Meiji state. By the end of the century, a rigorous vaccination program was in place, smallpox mortality had fallen, and Japan's Western-oriented physicians were in control of a national public health bureaucracy that could monitor the vaccination status of individuals in households throughout Japan.

John Freind: physician, chemist, Jacobite, and friend of Voltaire's

John Freind (1675/76-1728) achieved distinction in several walks of life, first as a classical scholar, then as a physician and as a chemist who advocated Newtonian philosophy. His clinical practice was generally conservative and he was against the newly introduced practice of inoculating the smallpox. His principles were Tory and High Church; his loyalty to the house of Stuart involved him in the Jacobite plot of 1722, and a spell in the Tower of London. His money was part of the foundation of Dr Lee's benefaction to Christ Church, which still survives in name in scientific posts in Oxford. He was among the circle of friends that Voltaire formed during his two-year stay in England and, 50 years later, Voltaire took him and his son as the principal characters in a conte philosophique defending a deistic attitude against both atheism and revealed religion.

The introduction of variolation ‘A La Turca’ to the West by Lady Mary Montagu and Turkey's contribution to this

AIMS

This study deals with the history of variolation as the oldest immunization method to be transferred from East to West, with emphasis on Turkey's role in this transmission.

SCOPE

The technique of variolation was used by various ancient civilizations such as those in India, Tibet and many other parts of Asia. It was based on the subcutaneous inoculation of attenuated pustule material in patients. The method was brought to Anatolia by the Seljuks through the Caucasus and was widely used by the Ottomans for a long period of time. The West learned of this method for the first time mainly through the writings of Dr. Timoni and Lady Mary W. Montagu in the 18th century. Lady Montagu not only wrote letters explaining this method, but also worked actively to introduce it in Europe.

CONCLUSION

Since variolation carried the risk of infection, it was replaced by a safer method called vaccination discovered by Jenner (1789), which led to the eradication of smallpox from the world. Despite the fact that vaccination ultimately superseded variolation in Western medical practice, Turkey played a key role as a bridge between civilizations in the transfer of this earlier treatment method to the West.

Imagining inoculation: Smallpox, the body, and social relations of healing in the eighteenth century

People in colonial New York adopted inoculation for smallpox as quickly and as thoroughly as did people anywhere in the British Atlantic world. Such adoption was not dependent upon the authority of formal medicine, but rather upon everyday epistemology. Inoculation became accepted as local knowledge because ordinary New Yorkers integrated it imaginatively into common ideas about the body and disease, reconceptualized its theological meaning, and incorporated it into familiar social relations of healing.

The History Of Vaccines And Immunization: Familiar Patterns, New Challenges

Human beings have benefited from vaccines for more than two centuries. Yet the pathway to effective vaccines has been neither neat nor direct. This paper explores the history of vaccines and immunization, beginning with Edward Jenner's creation of the world's first vaccine for smallpox in the 1790s. We then demonstrate that many of the issues salient in Jenner's era-such as the need for secure funding mechanisms, streamlined manufacturing and safety concerns, and deep-seated public fears of inoculating agents-have frequently reappeared and have often dominated vaccine policies. We suggest that historical awareness can help inform viable long-term solutions to contemporary problems with vaccine research, production, and supply.

[A comparative study on Inoculation in China and Japan]

There are two ways of planting smallpox. One is inoculation and the other is vaccination. Chinese inoculation was invented in China and was in use in the country up to the mid-20 th century. Inoculation in Japan was brought from China in 1744, and it produced fairly good results until the mid-19th century, when vaccination was introduced to the country and spread rapidly. Inoculation then was forgotten almost completed, despite the satisfactory result it had produced. Undoubtedly, however, inoculation affected the rapid spread of vaccination in Japan. Looking back on the historical process of inoculation, both in China and Japan, I looked into the difference in the way inoculation has been evaluated in the two countries. There are two big differences; one technical and the other methodological. First there is a difference in the way the poison was diluted, and in the choice of the sprout, which led to the difference in effectiveness and safety of inoculation. Secondly, the government supported inoculation and spread it actively in China. In Japan, on the contrary, each domain (han) promoted vaccination, influenced by the trend of the time to accept Western culture positively.

[First attempts at smallpox engrafting (variolation) in the18th-century in Bologna]

In Bologna in the mid 18th century some brilliant doctors were among the first in Italy to carry out smallpox engrafting (variolation), obtaining interesting results. Academics and Scientific Establishment censured the activities of these experimenters, such that one of them had to continue his work in Padova, where he went to teach and continued the practice of variolation. However, Bologna's Curia pronounced a positive theological judgement on such experiments. Forty years later, in 1801, Bologna's Senate called upon Luigi Sacco to organize campaigns to vaccinate and thereby smallpox infection. Bologna had been scourged by a new epidemic that year. What happened in Bologna during the 18th century regarding scientific research reflected the demographic, economic and political situation that the city was experiencing. This trend was to come to an end only with the unification of Italy.

A brief history of the prevention of infectious diseases by immunisations

Infectious diseases have always been a terrible scourge for humans. The appearance of these plagues, as they were called without distinction, was generally connected to various conditions: asters, climatic changes or religious reasons. The concept of contagious, and then infectious, diseases came slowly. Variolation, i.e. transmission of 'virulent' matter to induce a natural disease and the immunity against it, was brought from Constantinople to England by Lady Montague, in 1721. This 'variolation' technique was also often performed in veterinary medicine against diseases like sheep-pox or pleuropneumonia. As 'vaccination' is the term generally accepted for 'immunisation', variolation can be the word designating such a technique. The second period of the history of immunisation began, in 1880, with the studies of Pasteur and his collaborators. A great number of bacterial vaccines were developed: dead, live but attenuated or only parts of pathogens. The viruses were produced in animals, then in eggs and at last, in tissue cultures. Second generation vaccines appeared with genetic engineering: recombinant vaccines, vector vaccines, nucleic acids vaccines, and markers vaccines, among others. These novel technologies can permit the development of new ones and improve the quality of the vaccines already existing.

[The Tuberculosis outbreak due to whooping cough inoculation at Iwagasaki-machi in 1949]

Due to pertussis inoculation, 65 infants were accidentally infected by tuberculosis in Iwagasaki-machi, Miyagi Prefecture in 1949. The GHQ/SCAP record on Tuberculosis in Iwagasaki documented the details of this affair and the clinical reports about the victims, and they were the first to be treated by Streptomycine in Japan. The following three causes of mycobacterium tuberculosis contamination due to pertussis vaccine were considered, but no conclusive solution was decided. 1) Adulteration by manufacturer. 2) Carelessness of doctor. 3) Adulteration by a third person for unknown reason. The Japanese official records do not provide extensive information about it, except for the medical articles of Kosankinkenkyuzasshi (Sendai). The parents of the 65 victims, including 2 dead infants, had accused the governmental official administrator of the responsibility for reparation of the accidental inoculation, but they dropped the case against the government 5 years later. There is no detailed record about the judicial aspects of this incident.

[The history of polio in Brazil and its control through immunization]

The article analyzes the scientific and political discussions and activities surrounding the problem of polio in Brazil during the twentieth century. It examines the issues that shaped disease control policy and led to the 1980 introduction of National Vaccination Days.

[Brazil's national immunization program: origins and development]

The article discusses the central aspects of the trajectory of the National Immunization Program as regards the dynamics of sectoral policy. Heir to successful experiences of the past yet conceived at an entirely different moment, the Program followed the triumphant Campaign to Eradicate Smallpox and inaugurated a new phase in the history of public policy in the field of prevention. Under one sole command, the Program came to articulate a set of practices that had previously been spread across a number of government agencies and jurisdictions. The article examines the process by which the Program was conceived, structured, and developed within government health policy, and also underscores the main determinants of this policy, its institutional actors, and the political and ideological conflicts born of its implementation, whose success was an important component in the structuring of a vaccine market in Brazil.

[Producing an immunizing agent: images from the production of a yellow fever vaccine]

Through analysis of a set of photographs on the production of a yellow fever vaccine in Brazil, the article discusses the use of images as a research source in the history of medicine and public health. part of a historical archive belonging to the Fundação Rockefeller, stored at the Casa de Oswaldo Cruz/Fiocruz the photographs were produced between the 1930s and 1940s by the Fundação Rockefeller and Brazil's National Yellow Fever Service, institutions then responsible for research and control of the disease in Brazil. The article raises some questions generally posed by those who employ images as sources or objects of interpretation in the production of historical knowledge, and also points to the theoretical, conceptual, and methodological aspects involved in this process of analyzing images. It goes on to interpret these photographs from the beginning of the yellow fever vaccine.

[Centenary of the Health Council of the Netherlands. IV. Infectious diseases]

Many advisory reports of the Health Council of the Netherlands in the past century have dealt, directly or indirectly, with infectious diseases. One example is vaccination against smallpox. At the start of the last century, advice on this subject was important: initially, vaccination was compulsory by law, but people became increasingly aware of the associated side effects. A second example is immunisation against acute anterior poliomyelitis, which became a reality during the fifties. The advice also contained a discussion of which vaccine should be chosen: the inactivated 'dead' (Salk) form or the attenuated 'live' form (Sabin). Due to sound national organisation and associated logistics, a high level of vaccination was (and still is) achieved and the clinical disease known as polio disappeared from the Netherlands. Food-borne infections form the third example. The effect of the advice published by the Council on this subject (from 1960 onwards) has been limited, for a large part due to the significant economic consequences of the proposals for beef farming. The developments in the field of infectious diseases, immunology and vaccinology, together with social developments make it likely that in the coming years the Council will also frequently be asked for advice in the field of infectious diseases and the fight against them.

Emil von Behring and serum therapy

Emil von Behring is the father of serum therapy. We present an overview of the development of this important tool in the treatment of diphtheria. In a historical context Behring's work reflects the scientific spirit of fin de siècle Berlin.