The world's first immunization campaign: The spanish smallpox vaccine expedition, 1803-1813

Bulletin of the History of Medicine

Volumn 83, Issue 1, 2009, Pages 63-94

  Mark, Catherine ^a   Rigau Pérez, José G ^b  

^a CSIC   (Spain)

^b UNIVERSITY OF PUERTO RICO   (Puerto Rico)

Author keywords

Balmis salvany expedition; Public health; Smallpox; Spanish america; Technology transfer; Vaccination

Indexed keywords

SMALLPOX VACCINE;

ARTICLE; ASIA; GOVERNMENT; HISTORY; HUMAN; MASS IMMUNIZATION; SMALLPOX; SPAIN; TRAVEL; WESTERN HEMISPHERE;

AMERICAS; ASIA; EXPEDITIONS; GOVERNMENT PROGRAMS; HISTORY, 19TH CENTURY; HUMANS; MASS IMMUNIZATION; SMALLPOX; SMALLPOX VACCINE; SPAIN;

EID: 67651215621     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (74)

1. Felicity T. Cutts and Jean-Marc Olivé, "Vaccination Programs in Developing Countries," in Vaccines, ed. Stanley A. Plotkin and Walter A. Orenstein (Philadelphia: W. B. Saunders, 1999), pp. 1047-73, esp. 1050.
2. Paul F. Basch, Vaccines and World Health: Science, Policy, and Practice (New York: Oxford University Press, 1994), pp. 174.
3. Frank Fenner, Donald A. Henderson, Isao Arita, Zdeno Jezek, and Ivan D. Ladnyi, Smallpox and its Eradication (Geneva: World Health Organization, 1988), pp. 236-38.
4. Arnold C. Klebs, "The Historic Evolution of Variolation," Bull. Johns Hopkins Hosp., 1913, 24 : 69-83.
5. Peter Razzell, The Conquest of Smallpox: The Impact of Inoculation on Smallpox Mortality in Eighteenth Century Britain (Firle, Sussex: Caliban Books, 1977), pp. 133, 23.
6. Francisco Gil, Disertación físico-médica en la qual se prescribe un método seguro para preservar a los pueblos de viruelas hasta lograr la completa extinción de ellas en todo el reyno (Madrid, 1784), pp. 29-30, 37-40, 76-78.
7. Luis S. Granjel, Historia de la medicina española (Barcelona: Sayma, 1962), p. 115.
8. Francisco Guerra, Epidemiología americana y filipina, 1492-1898 (Madrid: Ministerio de Sanidad y Consumo, 1999), pp. 379, 389, 393, 396, 408, 414, 419, 424, 429. For Bogotá, see also Marcelo Frías Núñez, Enfermedad y sociedad en la crisis colonial del Antiguo Régimen (Nueva Granada en el tránsito del siglo XVIII al XIX: las epidemias de viruelas) (Madrid: Consejo Superior de Investigaciones Científicas, 1992), pp. 66-68; for Chile and Peru, see Juan B. Lastres, La salud pública y la prevención de la viruela en el Perú (Lima: Ministerio de Hacienda y Comercio, 1957), pp. 39-45.
9. Antonio Rumeu de Armas, "Primeros progresos de la vacunación en España," Medicina Española, 1940, 4 : 317-29.
10. José G. Rigau-Pérez, "La difusión en Hispanoamérica de las primeras publicaciones españolas sobre vacuna, 1799-1804," Asclepio, 1992, 1 : 165-79; Guillermo Olagüe de Ros and Mikel Astrain Gallart, "Propaganda y filantropismo: los primeros textos sobre la vacunación jenneriana en España (1799-1801)," Medicina e Historia (Tercera época), 1995, 56 : 1-16.
11. The first published report on the Spanish Philanthropic Vaccine Expedition appeared as a supplement (Una relación de la Expedición de Balmis a América) to the Gazeta de Madrid on 14 October 1806, shortly after Balmis's return to Spain and reception at court.
12. For nearly eighty years thereafter, most descriptions of the expedition summarized this account. Following Eduardo Moreno Caballero's original research published as Sesión apologética dedicada al Dr. D. Francisco Xavier de Balmis Berenguer (Valencia: Ferrer de Orga, 1885), a body of literature began to develop founded on analysis of archival documents.
13. see Emili Balaguer i Perigüell, "La historiografía cientificomédica sobre Balmis y la Real Expedición Filantrópica de la Vacuna," in La Real Expedición Filantrópica de la Vacuna: doscientos años de lucha contra la viruela, ed.
14. Susana Ramírez, Luis Valenciano, Rafael Nájera, and Luis Enjuanes (Madrid: Consejo Superior de Investigaciones Científicas, 2004), pp. 41-60. One of the early studies based on comprehensive documentary review (1948) was by Gonzalo Díaz de Yraola, La vuelta al mundo de la Expedición de la Vacuna (1803-1810) [The Spanish Royal Philanthropic Expedition: The Round-the-World Voyage of the Smallpox Vaccine (1803-1810)], 2nd ed., facsimile with translation to English, trans. and ed. Catherine Mark (Madrid: Consejo Superior de Investigaciones Científicas, 2003).
15. To avoid individual footnotes documenting each incident in the expedition, we refer the reader to this publication for details. Although it is not the most recent account, it has a chronological organization, an appendix summarizing the course of the expedition, and an index of names, dates, and places that facilitates location of specific items. We provide other references for additions, corrections, and clarifications resulting from later research.
16. Francisco Javier Puerto Sarmiento, Ciencia de cámara. Casimiro Gómez Ortega (1741- 1818), el científico cortesano (Madrid: Consejo Superior de Investigaciones Científicas, 1992); Alejandro R. Díez Torre, Tomás Mallo, Daniel Pacheco Fernández, and ángeles Alonso Flecha, coords., La ciencia española en ultramar. Actas de las I Jornadas sobre España y las expediciones científicas en América y Filipinas (Aranjuez: Doce Calles, 1991); Alejandro R. Díez Torre, Tomás Mallo, and Daniel Pacheco Fernández (coords.), De la ciencia Ilustrada a la ciencia Romántica. Actas de las II Jornadas sobre España y las expediciones científicas en América y Filipinas (Aranjuez: Doce Calles, 1995).
17. José Antonio Escudero, Los cambios ministeriales a finales del antiguo régimen (Seville: Universidad de Sevilla, Tusquets, 1975), pp. 9, 35-37.
18. Rodolfo MacDonald Kanter, "Segundo centenario de la llegada de la vacuna contra la viruela en el Reino de Guatemala, 1804 -2004," Anales de la Academia de Geografía e Historia de Guatemala, 2004, LXXIX: 183-210, esp. pp. 196-97.
19. Michael M. Smith, "The 'Real Expedición Marítima de la Vacuna' in New Spain and Guatemala," Trans. Am. Philos. Soc., 1974, 64 : 1-74, esp. pp. 13-15.
20. Jacques-Louis Moreau de la Sarthe, Traité Historique et Pratique de la Vaccine (Paris: Bernard, 1801). For a facsimile reprint of the translation, see Francisco Javier Balmis, Prólogo y traducción castellana del "Tratado histórico y práctico de la vacuna," de J. L. Moreau (1803). Introductory study by Emili Balaguer i Perigüell (Valencia: Edicions Alfons el Magnànim, 1987).
21. Smith, "'Real Expedición'" (n. 15), pp. 15-16.
22. We do not have a consistent name (or spelling) for the rectoress; for the variants and their origins, see Susana M. Ramírez-Martín and José Tuells, "Doña Isabel, la enfermera de la Real Expedición Filantrópica de la Vacuna," Vacunas, 2007, 8 : 160-66. Most documents refer to her by her title, "la Rectora," and none with her signature has been found. We have chosen to call her Zendala y Gómez on the basis of documents signed by the people who knew her. The manifest of members of the expedition on arrival in Manila, 15 April 1805, signed by Balmis and sent to Spain twice in copies signed by different persons, both times identified her as Isabel Zendala y Gómez: Archivo General de Indias de Sevilla, Indiferente General, Legajo 1558A (henceforth AGI, IG 1558A). Antonino Gutiérrez, in his petition in Mexico, 8 January 1812, also calls her Isabel Cendala y Gómez: Archivo General de la Nación, Mexico, Epidemias, vol. 17: 293.
23. Archivo General de Puerto Rico, San Juan, Puerto Rico, Spanish Governors, Box 146, Legajo 1379, Francisco Xavier de Balmis to José Antonio Caballero, San Juan, 27 February 1804.
24. José G. Rigau-Pérez, "The Introduction of Smallpox Vaccine in 1803 and the Adoption of Immunization as a Government Function in Puerto Rico," Hisp. Am. Hist. Rev. 1989, 69 : 393-423.
25. José Esparza and Germán Yépez Colmenares, "Viruela en la Venezuela colonial: epidemias, variolización y vacunación," in Ramírez et al. (n. 11) La Real Expedición Filantrópica de la Vacuna, pp. 89-119.
26. Smith, "'Real Expedición'" (n. 15), p. 34.
27. A Havana newspaper with the news reached Puerto Rico before Balmis's departure for Venezuela; see Rigau-Pérez, "The Introduction of Smallpox Vaccine" (n. 20), p. 412.
28. Smith, "'Real Expedición'" (n. 15), pp. 22-23; José López Sánchez, Vida y obra del sabio médico habanero Dr. Tomás Romay Chacón (Havana: Librería Selecta, 1950), pp. 121-30.
29. Patricia Aceves Pastrana and Alba Morales Cosme, "Conflictos y negociaciones en las expediciones de Balmis," Estudios Hist. Novohispan. 1997, 17 : 171-200.
30. Smith, "'Real Expedición'" (n. 15), p. 49.
31. AGI, IG 1558A, Balmis to Caballero, Manila 18 August 1805.
32. Smith, "'Real Expedición'" (n. 15), p. 58.
33. Thomas B. Colvin, "Arms Around the World: The Introduction of Smallpox Vaccine Into the Philippines and Macao in 1805," Revista de Cultura, 2006, 18, 70-88.
34. C. Michele Thompson, "The Nguyen Initiative to Acquire Vaccinia, 1820-1," in Acta: First International Conference on History of Medicine in Southeast Asia, ed. Harold J. Cook and Laurence Monnais. Wellcome Series in the History of Medicine (Amsterdam: Rodopi, in press), ch. 8.
35. Smith, "'Real Expedición'" (n. 15), p. 62; Moreno Caballero, Sesión apologética (n. 11), pp. 34 -35.
36. Susana M. Ramírez Martín, La mayor hazaña médica de la colonia. La Real Expedición Filantrópica de la Vacuna en la Real Audiencia de Quito (Quito, Ecuador: Ediciones Abya-Yala, 1999), p. 287.
37. AGI, IG 1558A, extract of letter from Viceroy Amar, Bogotá, 19 June 1805.
38. Isabel Morais, "Smallpox Vaccinations and the Portuguese in Macao," Review of Culture, 2006, 18 : 113-24; Ramírez Martín, La mayor hazaña (n. 32), p. 323. Vaccine transportation from Brazil to Angola was not successful until 1819; see Dauril Alden and Joseph C. Miller, "Out of Africa: The Slave Trade and the Transmission of Smallpox to Brazil, 1560-1831," J. Interdiscip. Hist., 1987, 18 : 195-224, esp. pp. 211-12.
39. Ramírez Martín, La mayor hazaña (n. 32), pp. 323-25; Lastres, La salud pública (n. 8), p. 55.
40. Miguel Parrilla Hermida, "Biografía del Doctor José Salvany Lleopart," Asclepio, 1980, 32 : 303-10.
41. Ramírez Martín, La mayor hazaña (n. 32), p. 419.
42. Gregorio Marañón, "Prologue," in Díaz de Yraola, Vuelta al mundo (n. 11), pp. 7-12.
43. Basch, Vaccines and World Health (n. 2), pp. 40-45.
44. Ricardo Archila, "La Expedición Balmis en Venezuela [Parte I]," in IV Congreso Panamericano de Historia de la Medicina (Guatemala: Ministerio de Educación, 1970), pp. 171-203, esp. 173.
45. A. M. Ward, "Smallpox and Vaccination in the Armed Forces From the Eighteenth Century Onwards," St. Bartholomew's Hospital Journal, 1960, 64 : 197-99; John S. Keevil, Medicine and the Navy, 4 vols. (Edinburgh: E & S Livingstone, Ltd., 1957-1963), 3 : 350-51; and Niels Brimnes, "Variolation, Vaccination and Popular Resistance in Early Colonial South India," Med. Hist., 2004, 48 : 199-228.
46. John Z. Bowers, "The Odyssey of Smallpox Vaccination," Bull. Hist. Med., 1981, 55 : 17-33; Michael Bennett, "Passage Through India: Global Vaccination and British India, 1800-05," J. Imp. Commonw. Hist., 2007, 35 : 201-20.
47. David Arnold, "Smallpox and Colonial Medicine in Nineteenth-Century India," in Imperial Medicine and Indigenous Societies, ed. David Arnold (Manchester: Manchester University Press, 1988), pp. 45-65; Bowers, "The Odyssey of Smallpox Vaccination" (n. 42), pp. 23-24.
48. Arnold, "Smallpox and Colonial Medicine" (n. 43), p. 56.
49. Bennett, "Passage Through India" (n. 42), pp. 201-20.
50. Brimnes, "Variolation, Vaccination and Popular Resistance" (n. 41), pp. 202-3.
51. Ricardo Archila, "The Balmis Expedition in Venezuela. Part II: Founding of the Central Vaccination Board, 1804," in Aspects of the History of Medicine in Latin America, ed. John Z. Bowers and Elizabeth F. Purcell (New York: Josiah Macy, Jr. Foundation, 1979), pp. 142-81; Susana M. Ramírez Martín, "El legado de la Real Expedición Filantrópica de la Vacuna (1803-1810): las Juntas de Vacuna," Asclepio, 2003, 56 : 53-61.
52. Alexandra M. Stern and Howard Markel, "The History of Vaccines and Immunization: Familiar Patterns, New Challenges," Health Affairs, 2005, 24 : 611-21.
53. Abraham M. Lilienfeld, "Ceteris Paribus: The Evolution of the Clinical Trial," Bull. Hist. Med., 1982, 56 : 1-18.
54. Francisco Xavier de Balmis, Demostración de las eficaces virtudes nuevamente descubiertas en las raíces de dos plantas de Nueva-España, especies de ágave y de begónia, para la curación del vicio venéreo y escrofuloso y de otras graves enfermedades que resisten al uso del mercurio y demás remedios conocidos (Madrid: Viuda de Joaquín Ibarra, 1794).
55. Even after all the vaccinations he conducted around the world, Balmis indicated to Minister Caballero in Madrid (AGI, IG 1558A, 12 February 1807) that "vaccine . . . did not cause the least harm, the least risk, to those who received it."
56. Donald R. Hopkins, Princes and Peasants: Smallpox in History (Chicago: University of Chicago Press, 1983), p. 85.
57. AGI, IG 1558A, Opinion of the President of the Council of the Indies, Marqués de Bajamar, 26 May 1803.
58. Previous historians of the expedition have not mentioned that the documentation in the AGI, IG 1558A also contains the notes and comments of Mssrs. León and Salcedo, the clerks in charge of correspondence. Balmis, in a letter to Viceroy Venegas (Mexico, 31 January 1811) mentions one of them: "Mr. Antonio Salcedo, senior official at the Secretaría de Gracia y Justicia, through whose desk our expedition is handled" (Archivo General de la Nación, Mexico, Epidemias, vol. 17: 250).
59. Bruce E. Seely, "Historical Patterns in the Scholarship of Technology Transfer," Comparative Technology Transfer and Society, 2003, 1 : 7-48; esp. p. 8.
60. Edward Beatty, "Approaches to Technology Transfer in History and the Case of Nineteenth-Century Mexico," Comparative Technology Transfer and Society, 2003, 1 : 167-200, on which the rest of the paragraph is based.
61. AGI, Audiencia de Santo Domingo, Legajo 2322, deposition of Juan Antonio Dorado, surgeon of the San Juan ("Fixed") Regiment, 1 March 1804.
62. Smith, "'Real Expedición'" (n. 15), p. 49.
63. Ramírez Martín, La mayor hazaña (n. 32), p. 419.
64. Alden and Miller, "Out of Africa" (n. 34), p. 112.
65. Ann F. La Berge, Mission and Method: the Early Nineteenth-Century French Public Health Movement (New York: Cambridge University Press, 1992), p. 272.
66. Susana M. Ramírez Martín, "Juan José Heydeck, un alemán en la corte de Carlos IV: experimentos contra la viruela," Asclepio, 2006, 58 : 165-202.
67. AGI, IG 1558A, José Salvany to Antonio Caballero, Lima, 1 October 1806. This episode is entirely misrepresented in Díaz de Yraola, La vuelta al mundo (n. 11), p. 181.
68. Smith, "'Real Expedición'" (n. 15), p. 32.
69. Ibid., p. 35.
70. Ramírez Martín, La mayor hazaña (n. 32), pp. 585-664. See also Ramón Navarro García, "Análisis de los documentos esenciales sobre la Real Expedición de Balmis-Salvany," in Ramírez et al., La Real Expedición Filantrópica de la Vacuna (n. 11), pp. 61-75, and additional documentary sources in Susana M. Ramírez Martín, "Los perfiles de Francisco Xavier Balmis," in La colección Balmis del Real Jardín Botánico. Retorno ilustrado del viaje a Oriente de la Expedición de la Vacuna (1803-1806), ed. María Pilar de San Pío Aladrén (Madrid: Lunwerg Eds., 2006), pp. 31-53.
71. Angela T. Thompson, "To Save the Children: Smallpox Inoculation, Vaccination, and Public Health in Guanajuato, Mexico, 1797-1840," The Americas, 1993, 49 : 431-55.
72. Ana Irisarri Aguirre, "La vacunación contra la viruela en la provincial de San Luis Potosí tras la expedición de Balmis: 1805-1821," Fronteras de la Historia, 2007, 12 : 197-226.
73. Ann Jannetta, The Vaccinators: Smallpox, Medical Knowledge, and the "Opening" of Japan Stanford, Calif.: Stanford University Press, 2007), pp. 25-52.
74. An international group of scholars interested in the Balmis-Salvany expedition maintains a forum for discussion and comment, information postings, queries, document and file exchange, etc. Participation is welcomed; the site can be found at http://groups.yahoo.com/group/balmis/