Antilia. Vol. II. Fraga. Eng.

ANTILIA
REVISTA ESPAÑOLA DE HISTORIA DE LAS CIENCIAS DE LA NATURALEZA Y DE LA TECNOLOGÍA SPANISH JOURNAL OF HISTORY OF NATURAL SCIENCES AND TECHNOLOGY
Historia de la Biología. Facultad de Biología. Universidad Complutense de Madrid.
DL: M-34954-1995.	ISSN: 1136-2049.

INOCULATION IN THE 1799 SMALLPOX EPIDEMIC IN MEXICO: MYTH OR REAL SOLUTION?

Ana Cecilia Rodríguez de Romo
Departamento de Historia y Filosofía de la Medicina.
Facultad de Medicina, Universidad Nacional Autónoma de México.
México 1, D. F. C. P. 06020 (México).

Smallpox caused one of the most interesting demographic collapses in history. Although historians do not agree with each other concerning mortality rate, everybody accepts that the New Spain population decreased dramatically after the Conquest because of smallpox and sicknesses that were unknown in America before the Spaniards' arrival (1).

Smallpox was a major problem in New Spain. The society and the government tried to combat it in different ways: Through religious beliefs, popular customs, the knowledge they had of the sickness. Inoculation was one of these measures. This paper studies the inoculation campaign led by the authorities in Mexico in the 1797 smallpox epidemic.

Leaders on those days assumed that inoculation could be a way to preserve life against a multiple menace. Death menace because those infected did not survive, social menace because their faces became horribly scarred, and economic menace because the workforce was obliterated by the sickness.

This epidemic is significant for many reasons, but three are particularly relevant:

1) Original material exists on the 1797 smallpox epidemic in archives and libraries throughout Mexico. The quality and quantity of this information is amazing and it is sufficient to enable us to study the epidemic from the point of view of any researcher, sociologist, public health administrator, historian, economist, etc.
2) It was the first time in the history of smallpox epidemics in Mexico that inoculation was used by the government as a measure to control an important health problem.
3) This epidemic was the last one before Edward Jenner (1749-1823) published his discovery of vaccination (2) and before the Spanish physician, Francisco Xavier de Balmis (1753-1819) began the vaccination campaign in Latin America and the Philippines (3).

Most of the original documents cited here have never been published, they were found in three of the most important historical archives in Mexico City. Archivo General de la Nación (AGN), (the National General Archive), Archivo del Palacio de Minería, (the Archive of the Palace of Mining) and Archivo del ex-Ayuntamiento, (the Archive of the Former Municipal Government) (4). We know that abundant material exists in other Mexican cities and in South America. In Europe, el Archivo General de Indias (Seville) and the Wellcome Institute (London) have important material that was impossible to consult (5).

Several authors have studied the 1797 smallpox epidemic in Mexico (6), the works of Sherburne F. Cook and Donald B. Cooper stand out. Cook focused on demography, while Cooper made a thorough historical inventory of the facts. The present essay takes a different approach: the study of the medical, political, social and economic consequences of inoculation based on unpublished relevant documents.

In order to understand both the epidemic and the inoculation program, we first need to understand the viceroyalty's administrative system for health care services (8).

1) Non-personal services such as garbage collection or sewage disposal,
2) hospital health care,
3) control of health care professions and
4) political and normative affairs concerning health policies (9).

The structure of these measures was organized under several "instancias" in a way similar to the Spanish system, although the degree of responsability was not the same for each of them. On the one hand the Ayuntamiento or Cabildo (Municipal Government) together with the Protomedicato (Medical Board) were the principal authorities responsible for health policies. On the other hand, the Viceroy, the Audiencia (Supreme Court of Justice) and the Church acted occasionally on health matters, though mainly in emergency situations such as epidemics.

The Ayuntamiento or Cabildo was the most important local authority, its duties included the cleaning of the city, the water supply, the sanitary inspection of pharmacies, food stores and jails. Sometimes the Ayuntamiento did some improvements in sanitation since it had the money and the authority to take action. In most of the cities and towns, the Ayuntamiento was the main authority in charge of health services and sometimes acted as Protomedicato in places where there wasn't any. It regulated situations potencialy dangerous for the population, e.g. the inconvenient location of cemeteries and the isolation in epidemics (10).

The Protomedicato, a board of licensed physicians, was the consultative organ for medical affairs. It had two principal functions:

1. To certify medical practitioners and academic functions related to the organization and teaching of medicine. They examined people who wanted to practice whatever kind of medical activity; phlebotomist, midwives, barbers, pharmacists and, of course, physicians. The Protomedicato also controlled surgery and pharmacy.
2. To regulate medical practice and administrative functions wich involved supervising the correct operation of pharmacies and allocating funds arising from permits and fines. The Protomedicato also had the control over new knowledge in medicine. Some medical information came to the public from the Protomedicato. Usually, they put this information in simple terms. This attitude is significant considering that in those times language and learning were pompous (11).

The church took care of hospitals and cemeteries. The religious role in medicine was very important during viceregal. The strong Catholic current in New Spain considered attending to sick people as a kind of charity, a moral duty, a mission. Consequently, the Church took charge of maneging the hospitals. If it was necessary to make a political decision concerning hospitals' or cemetaries' control, the arbishop did it. The cemeteries were usually located around the churches. This situation caused problems, especially during epidemics, because the abundance of corpses provented correct burial, and since the churches were public places, they became a focus of contagion. Besides, people did not want their loved ones buried outside of far from cemeteries, so it was a difficult problem. In 1877 it was forbidden to bury people in churches.

The Audiencia had a minor role in health matters. It acted when the viceroy was absent, it was a kind of judge for matters concerning health, fir instance, in medical labor problems or in Medical Board's veredicts. The Audiencia also played the role of "Juez de Hospitales", but it seems this position only existed in the Royal Indian Hospital of Mexico City (12).

The greatest authority in this complex system was the viceroy. He was the one who determined health policies. He had a normative role, made most of the major decisions and exerted control over the other groups concerned with health matters (13). For example, the responsability for combating the spread of an epidemic fell on the viceroy or governer, not on the medical authorities. Only the viceregal government had the means to deal with such disasters as epidemics. However, his authority was restricted in hospitals and cemeteries, he had many political and administrative duties, and his actions were often obstructed by the extension of the viceroyality and the economic problems. Usually New Spain did not have funds to combat epidemics, so the viceroy urged individuals and corporations to make personal contributions to combat the spread of the diease.

In short, there was no central authority responsible for health policies during the viceroyalty. This situation was the origin of duplication of functions and inefficiency. Health care relied on charity, and preventive medicine was neglected. The predecessor of modern Social Medicine was conditionde by political, economic, religious and cosial circumstances.

The 1797's smallpox epidemic showed up in 1793 for the first time in South America. By April 11, eight persons had already died in Campeche (Southern Mexico) (14). On July 14, 1796, Viceroy Branciforte announced the presence of smallpox in the south of Mexico and ordered the quarantine and isolation of the infected persons (15).

At first news of the sickness, and probably in anticipation of the problem, the government tried to prevent its spread and prepare the people to fight the epidemic. In February and May 1796, the New Spain newspaper, Gaceta de México, published two articles (16) praising the advantages of inoculation and recommending the interruption of comercial business in the affected places.

In August 1796, Viceroy Branciforte ordered to reprint the dissertation by the Spanish physician Francisco Gil (17), whose work dealt mainly with caring for the infected, but was opposed to inoculation. It had first been published in 1784 in Madrid (18), and afterwards in Mexico in 1788 (19). Howerver, illiteracy undoubtedly limited the difusion of this information. Moreover, the relatively low impact of care compared with prevention in understandable.

On February 28, 1797, in an effort to prevent the arrival of the epidemic to Mexico City, Viceroy Branciforte proclaimed an important edict (20). The three main ideas conveyed in this proclamation were:

1) isolation an quarantine were vital,
2) the dead had to be beried far away from the cities and
3) inoculation was recomended.

Branciforte was very careful about inoculation, it would be the final measure against smallpox and it would not be mandatory. The document was distributed throughout the country. In spite of it being a viceroyal order, some governors wrote back to him, specifying that it was difficult to apply because they had insufficient funds for it.

Two ideas arise an this point. Branciforte's position concerning inoculation seemed ambiguous. On the one hand, he ordered the publication of the Gaceta de Mexico's articles in which inoculation is promoted, but on the other, he also ordered the re-edition of Gil's dissertation against inoculation. Moreover, in his edict he is cautious about this method. Probably Branciforte believed in the inoculation's usefullness, but at the same time knew it was as dangerous as the sickness itself. Inoculation could cause "viruelas benignas" ("benign smallpox") but also a major infection. It was impossible to know what could happen.

In July and August 1797, smallpox broke out almost simultaneously in the sities of Puebla, Orizaba, and Mexico City (21). The very first case we find reported in Mexico City was in May, 1797. A "meco" (indian) with smallpox was received at the Hospital Real de Naturales (Royal Indian Hospital) (22). From then on smallpox spread rapidly.

Although Branciforte had ordered that the slightest appearance of smallpox had to be reported and victims were to be sent to a hospital or into isolation, people, preferred to hide the sick and refused to allow the removal of their relatives to what they considered certain death.

By the beginning of August, the situation was critical. At this point, the government and the Church considered that a program of inoculation should begin (23). However, inoculation was not applied on a large scale. In this case the problem was the lack of clarity over the authorization order.

The Viceroy had been vague about the method in his February 28th edict, not specifying whether inoculation was to be applied or not. August 31, Branciforte "ratified" the inoculation order (24). Nevertheless, 10 days before, on August 21, Branciforte addressed a public statement to the people of Mexico City telling them that they were not facing a real epidemic. "No estamos, ni quiere Dios ponernos, ante una verdadera epidemia,..." (25). Two centuries latter, the authorities reacted in a similar way when cholera broke out along the Southern border of Mexico.

Besides his role in the epidemic actions, the Vireroy was an attractive personage. Miguel de la Grúa Talamanca y Branciforte, Marqués de Branciforte, was from Sicilia, Italy. His wife, Antonieta de Godoy was the sister of Manuel de Godoy, the Spanish Prime Minister and lover of the Queen María Luisa de Parma. History recalls Branciforte with three words: corruption, nepotism and rapacity. He was the New Spain Viceroy from 1794 to 1798. His bad behavior contrasted drastically with the excellent labor of his predecessor, Juan de Güemes Pacheco de Padilla, segundo Conde de Revillagigedo, one of the best New Spain Viceroys.

Very loyal to Charles the Fourth, he never stopped sending money to Spain, which was mainly used in the war against England (1796). During the smallpox epidemic, he lived in Orizaba, a town between the port of Vercruz and the capital, five hundred kilometers from Mexico City. This behavior was criticized. All his administrative business was done by mail and most of his correspondence still exists. When he returned to Spain, he took with him 3 million pesos from the government a 2 million from private sources (26).

By the beginning of September, Mexico City was totally invaded by smallpox. On September 11th, Branciforte was informed that the inoculation program was underway, by September 15th, 373 people had been inoculated (27).

By September 23, the Medical Board orderd the re-edition of the essay Instructions on the Method of healing smallpox by José Ignacio Bartolache (28). This work was published for the first time in the 1779 epidemic in Mexico City. In his instructions, Bartolache explained what smallpox was and how to cure it, and mentioned tne circumstances that had to be avoided. The care of smallpox victims was so clearly explained in it that the Medical Board undoubtedly considered it useful. Bartolache thought smallpox was the way in which an organism expelled bad humors and waste materials inherited from the mother.

1) Archbishop Nuñez de Haro sent a booklet to many churches in different places around Mexico City. It was called Método claro, sencillo y fácil para practicar la inoculación. (A clear, simple and easy method of inoculation) (29). Thus, both aspects were relevant: the method itself and its diffusion. 2) Two months after the ratification of the official order of inoculation, on October 26th, the Junta de Caridad (Board of Charity) was created (30).

The booklet was addressed mainly to the rural or illiterate population, since it explained how to inoculate in very simple terms. We will talk more about this later.

The Junta was a group of prominent citizens who acted as a comitee with considerable authority. Its goal was to collect funds and distribute them in critical situations. At the head of the Junta was Archbishop Nuñez de Haro, an open-minded and intelligent man whose actions were very important during the epidemic. He had also been very active in the 1779 smallpox epidemic. The Junta had a representative for each of the principal government groups but curiously there was no representative from the Medical Board (31). A reason could have been that physicians did not like to be involved in medical matters of bad prognosis, then the case of smallpox. The Tribunal on Mining, which had a great influence on the Junta, was very important in New Spain because it managed tne mining resources and was an independent and powerful organization. It donated twelve thousand pesos the day after the Junta was created (32). Althoug two month before Branciforte had asked them for help, the Tribunal of Mining told him that it was difficult to donate money because the war and flooding had consumed funds (33).

The Tribunal of Mining was very interested in stopping the epidemic, not for humanitarian reasons, but because minnig output was falling with the indians' and blacks' death. This economic argument to control an epidemic was not new. In the epidemic of 1779, the physician Esteban Morel presented a very complete dissertation in favour of inoculation to the municipal government. He also described inoculation as an excellent measure to increase wealth and power (34).

The concrete action derived from the creation and economic support of the Junta was the organization of the program of inoculation by establishing an inoculation center in each of the eight headquarters in to which the city of Mexico was divided.

Inoculation consisted essentially in introducing the smallpox secretion from one human being into another. The idea was to produce a kind of "weak smallpox" (viruelas benignas), but this sometimes caused serious infections (35). Inoculation was in use throughout the 18th century in Europe. The wonderful stories of Lady Mary Montagu were well known (36). The method had not been extensivly employed in Latin America. One reason could be religion: it was difficult to accept that a part of a human being, probably related to the soul, was introduced into another. In the smallpox epidemic of 1779 people did not accpt inoculation and the government did not support the method strongly, even though a place to inoculate people was established in the San Hipólito Hospital (37).

In the 1797 outbreak, however, it was the Church that first supported inoculation. Meanwhile, the underlying ambiguity of Branciforte's attitude towards inoculation is understandable. It could be dangerous because inoculated people ("viruelas ingeridas") could acquire smallpox just the same as those who became infected naturaly ("viruelas naturales").

At this point, it is interesting to mention the possible way in which the inoculation method arrived in New Spain. Here is not the place to discuss how, since antiquity, the Asiatic people had known that inmunity against smallpox could be achieved through inoculation taken from the secretion of pustules of the infected. Nor is it the goal of this work to explain how this knowledge reached Europe at the beginning of the eighteenth century, or the controversy that it caused there (38).

Timonis and Pylarinos were the first authors to publish works on inoculation (39), but their studies did not reach Mexico. Somolinos d'Ardois (40) thinks the Spanish priest Benito Gerónimo Feyjóo could have introduced the concept to America through his monumental work: Demostración apologética del Teatro Crítico Universal, (1724-40). The work consists of nine books and shows a remarkable body of knowledge for the time. Feijóo knew the method and wrote about it (41). It is difficult to know when Feyjóo's work arrived to New Spain but we know other works concerning inoculation were located in the library of the Universidad Pontificia (42). The society of New Spain lay between a highly enlightened influence on one side and a religious, baroque tendency on the other (43). Demerson thinks that inoculation was used in America by 1746 (44). In any case it is difficult to know when inoculation arrived to New Spain, but educated people were certainly interested in new knowledge, in spite of the religious, baroque milieu where new currents and old traditions ran together. For instance, it is interesting to read about the healing of smallpox with plants similar to smallpox' scars or pustules, such as "tunas cimarronas" and "hierba de la viruela" (45).

However, it is important to consider the position of the indians towards inoculation. They were the largest group in the population of New Spain and the most sensitive to the smallpox. The following paragraph is quite illustrative.

The authorities were aware of this situation, and it could have been the reason why the documents praising inoculation were addressed to simple people and were written very simply, but at the same time, the indians' behaviour was understandable. It seemed senseless to them "to prevent smallpox by catching it", and they could not expect anything good from a class tha usually treated them badly. The Church was important in trying to convince indians of getting inoculated.

The work of Esteban Morel on inoculation is vey important because it was the first to commend the method to the government in the 1779'2 epidemic. Its goal was to convince the authorities of the advantages of inoculation.

Morel was a peculiar figure and his origin is obscure. There is no background on him in original sources. In his paper he said he studied in Aix and Montpellier, but this is not enough to prove he was French. It seems he was also Jewish, since he was persecuted by the Inquisition and ran away to South America where the trail ends. Perhaps he was also running away when he left France. "In the August 9th, 1795 auto de fe, he was condemned in statue. He was professor of medicine, formal heretic, deistic, materialistic voluntarily suicidal and apparently atheistic" (48).

During the 1779 epidemic he informed the Ayuntamiento that inoculation was useful in combating smallpox. They asked him to write about it and offered to publish his work. Morel wrote the work and also inoculated some people at his own expense. The government never published his paper and, after a claim against the authorities, he was paid off in 1782 (49).

The document is very long, consisting of 60 pages, it is clear that it is addressed to the elite. He presented his argument defending inoculation mainly on economic grounds. As has already been mentioned, he said it would increase political power. Inoculation had particular advantages for the upper class. For example, it said to preserve femenine beauty (50), and the weather in Mexico City was said to be favorable to inoculation.

Esteban Morel developed a long political dissertation (51) and a profound historical precedent in his work. He mentioned the work of Charles de la Condamine who had published a paper on inoculation in Paris in 1754 (52). According to D. B. Cooper, he could have introduced the method to New Spain (53).

Morel did his study on inoculation when the 1779 epidemic was almost over in Mexico City. This reveals the lack of foresight on the part of the authorities who knew perfectly well that smallpox was terrible, yet did not take advantage of Morel's work and did not organize a contingency plan for future catastrophies.

It has already been mentioned that on July 14, 1796, Branciforte announced that smallpox had reached the south of the country. However, in August, 1795, a smallpox case was discovered in the "Real Hospital de San Pedro" in Puebla, a town 300 km from Mexico City (54). The patient was isolated far from Puebla but the "Comisario" of the Hospital, Ignacio Doménech, convinced of the advantages of inoculation, and remembering the awful experience of 1779, went to the Viceroy to ask for his permission to write a booklet on inoculation.

This is the beginning of an interesting chapter in the 1797 smallpox epidemic. Branciforte approved the proposition and Doménech wrote the booklet in a hurry because he saw the seriousness of the matter. On March 11, 1796, in order not to waste time, he asked for the work to be reviewed by notable physicians from Puebla instead of being sent to the Medical Board in Mexico City (55). However, his request was ignored and the manuscript was sent to the Medical Board. The reply was signed by José Ignacio García Jove, José Francisco Rada and Joachim Pío de Eguía y Muro, the three members of the group. In a long criticism, they said the work merely gave instructions to inoculate but did not discuss the care of inoculated people.

Doménech made the suggested correction and the order to print the booklet was given on April 17, 1796.

By november 19, 1796, the work was still not in print because the "only correct" publisher in Puebla was in Mexico City (57). Doménech engaged another publisher who gave him the proofs on November 23 (58).

On December 31, 1796, the work was sent to the "fiscal" but the Medical Board continued to criticize it (59). January 5, 1797, Branciforte got it back to Puebla and on January 7th he ordered its publication (60), but Doménech was informed that the Medical Board had still to approve the preface, while he had to make corrections to the style and send back the corrected proofs.

This is the last document concerning the Doménech affair we found in the AGN. The hand-written or published document itself has not been found. Was it really published? Where is the original manuscript?

When Archbishop Nuñez de Haro sent the booklet Método claro, sencillo y fácil para practicar la inoculation to the different districts of Mexico City, he did not mention who the author was or when it was written. Considering the time when it was sent, one could think that it was probably prepared before the official approval of Branciforte in August 1797. The booklet is no signed. At the top, above the title, it says "Royal Medical Board", (Real Tribunal del Protomedicato). It is difficult to believe that it was prepared by the medical board itself, if we bear in mind that the head of the Medical Board was García Jove, a narrow-minded man who thought epidemics were a "divine flagellum". On October 28, the method was published in the Gazeta de México (61). This publication is also unsigned.

1. Ignacio Doménech's work went through a long bureaucratic process before it was accepted by the authorities (March 11, 1796 to January 7, 1797). Yet we do not actually know if it was ever published or not. The bureaucracy, which is still the same in Latin America, was the social and political obstacle that blocked the application of a measure that could have been preventive.

2. The Medical Board knew Doménech's work perfectly, its members criticized it and made their reply. Is it possible that Método claro, sencillo y fácil para practicar la inoculation, was the work of Doménech, or that it was based on his study? This is just a question. It is usefull to remeber that it was not a habit to sign up publications in those days.

The booklet explains the inoculation method in simple terms. The secretion from a smallpox pustule should be removed with a lancet or a needle and introduced just under the skin. The best place to do this is between the thumb and the index finger. The booklet also explains how to take care of them before and after the inoculation, how to feed, dress and take care of them before the sickness, during the sickness, and after the smallpox pustules have broken out.

Even though the document was addressed to rural people, once again, its usefulness is doubtful because only a minority of the population could read.

After Branciforte's approval in August 1797, inoculation became free to anyone, and everyone was encouraged to avail themselves of the method.

On November 20, inoculation reports stopped (62). Cooper thinks this happend because the educated people were all inoculated, since the program was well accepted by the upper classes.

On January 18, 1798, Viceroy Branciforte declared the smallpox epidemic was over (63).

On February 17, 1798, the municipal government published its report and the Junta de Caridad was closed (65).

Actually, the goal of this paper and the most important aspect of the 1797's inoculation campaign is to know if inoculation decreased the mortality rate in comparison with the previous smallpox epidemics. There are several figures in papers and books about inoculation, but they are ambiguous and incomplete and their origin is unknown, so they are difficult to analize. Several authors affirm that inoculation was effective, give numbers, but do not explain how they got them. For instance, Swann and Cook say that 3.5% of inoculated and sick people died (66) Smith says that in Morelia, 1.5%-2.0% of 6,800 inoculated died. In the same city, 14% of not inoculated died (67). Tate Lanning states that of 1,908 naturally infected, 98 died against 5 of 728 inoculated (68). Considering these numbers, we could assume that inoculation was efective; but searching in primary sources, we can develop a different point of view. According to the Robin Price's Catalogue of Medical Americana (69), these are the three most reliable reports

1) The Resumen General, the "Junta de Caridad" 's municipal reports from february 17, 1798. However, it is not complete because it does not include what happened in hospitals, private and charity houses. It only states what happened in the eight headquarters of Mexico City.

2) The report made by the Archbishop on February 20 and published on April 11. It is considered the best because its data comes from parochial archives which collected data from everywhere.

3) El Estado General, a report from the Medical Board made on March 21. It seems to be the most dificient of these three (70).

El Resumen General pointed out that in the 1797 smallpox epidemic, 44,516 people were cared for ("socorridos") in Mexico City and 4,451 of them died, compared to the 1779 smallpox epidemic, in which 36, 865 had been cared for ("socorridos") and 8,000 had died. It seems that there was a 20% death rate in 1779 versus a 10% rate in 1797. This would make us think that the inoculation was effective because it was applied in 1797 and there were less deaths than in 1779. However, by further analizing the government report, we can conclude the following.

When the 1797 epidemic ended, 7,060 smallpox deaths were registered among which 2,617 died before the inoculation program (between May and September) and 4,451 after the program (between september 11 and November 20), 21 deaths were due to the inoculation itself. The report states that 44,516 were cared for, including the 4,451 deaths. The other 40,065 are mentioned as healthy but we can conclude that this number includes the ones that received help for another reason, the ones that got sick and recovered and the ones that were inoculated, did not become importantly ill and were saved. It would have been more valuable to know how many were inoculated ant then compare the number of deaths in both epidemics, one with an inoculation and another without it. The term "socorridos" is confusing because it includes both, the healthy ones and the ones that became ill and died after seaking help.

The report then mentions what happened in the 1779 epidemic. It only says that among 36,865 people that were cared for, 8,000 died. Here, by cared for ("socorridos"), we can understand people who received help for some other reason and smallpox survivers. There were no inoculations.

The archbishop report states that there were 7,147 deaths between September 9 and January 26 (71). This report includes the population on the Resumen General plus the one of the parishes. Therefore, the number of cared for people must have been greater than 44,516 but the number is not specified. Furthermore, Cooper thinks that there must have been more than 7,147 deaths because the ones who obtained these numbers specified that many deaths were not included for several reasons. The Medical Board report informs that there were 5,951 deaths of 56,169 cared for ("socorridos") people (72).

To conclude, it is true that proportionally, there weremore death in the 1779 epidemic than in the 1797's. It is also true that handling data does not permit to assure that inoculation was the clear cause of the smaller number of deaths in the 1797 epidemic (fig. 1). It is also unanimously stated that the 1779 epidemic was particularly bad.

Jose Joaquín Izquierdo studied the same epidemic in Puebla and the data that he reports does not permit to know the effectivness of the inoculation (73) either. However, he considered that the inoculation did not help to stop the advance of the epidemic.

Curiously, a Swedish study on the same subject and the same time, reveals the same conclusion as Izquierdo in very similar conditions to the Mexican ones (74).

By the end of the 18th century, inoculation was nat only accpeted, but it was even recomended in New Spain. However, the indians, the most important part of the population from the numerical point of view, still refused to be inoculated, though they were forced to do so by their masters, the priest or other authorities. This attitude explains the simple and friendly tone in which the information concerning inoculation was written. It has already been mentioned that the smallpox epidemic of 1797 in Mexico probably bagan somwhere in South America. In 1794, in Guatemala, the physician José Flores wrote another document on inoculation (75). That country suffered the same epidemic before Mexico did.

The Guatemalan document is much more complete and better produced than the Mexican booklet. In 21 pages, it explains what inoculation means, how to convince indians to be inoculated, how to choose the most inteligent people and teach them how to inoculate others and how to take care of the sick. The following paragraph is particularly attractive:

This document is the first to relistically emphasize that inoculation can only be succesfull if the indians are well treated and are not forced to do what they do not want.

It also specifies how to take care of the patients after inoculating them, according to sex, age and occupation and if the women are pregnant. It ends by explaining the punishment for those who do not observe the quarantine.

Since it is in the AGN, it is reasonable to conclude that probably it was sent to the New Spain authorities by the author.

José Felipe Flores, the author of these instructions, was born in Chiapas (Southern Mexico). An intelligent and versattile man, he worked as a physician, but was also a naturalist and a physicist. He studied in Paris and in Italy with Galvani. In 1789, he made anatomical models in wax to teach anatomy. He was named physician to Charles IV for his merits. It is worth mentioning that in 1779 he applied to the Cátedra de Prima Medicina at the University of Guatemala, and the subject he developed in his dissertation was: Ventajas de la inoculación de las viruelas y necesidades de establecer esta operación en este Reino para precaver los estragos de esta funesta enfermedad (77).

Smallopox worried the authorities. The first time money was retained in New Spain instead of being sent to Spain, was during the 1797 epidemic.

On November 30, 1798, Charles IV ordered inoculation to be carried out in the colonies (78). In 1800 he received Jenner's work. Smallpox was so serious that the king discussed at the "Consejo de Indias" the advantages of sending a vaccine expedition to the colonies. José Felipe Flores' opinion was important for taking a positive decision, and he was even proposed as head of the expedition. Finally, Francisco Xavier de Balmis was chosen (79). The group left from the port of Coruña, Spain, on November 30, 1803. Balmis' expedition took two years, they travelled to Colombia, Ecuador, Peru, the Phillipines and China. In Mexico, the vaccine reached the most important parts of the country.

The last smallpox case in Mexico was reported in June, 1951 (80). President Meguel Alemán declared smallpox eradicated on June 16, 1952. The smallpox vaccine no longer is included in the vaccination program for Mexican children.

Smallpox was one of the worst plagues in the history of New Spain. The 1797 epidemic is particularly interesting because of the amazing number of original documents that still exist, because its control involved political, economic, social and cultural factors and because a program of inoculation was put into operation. It is clear that the inoculation program implied a big effort of the part of the government. Even though reports conclude that inoculation decreased the rate of illness and death, the fine analize does not permit to assure that inoculation stopped the epidemic. The handling of data is not clear and possibly many people were inoculated after they had already been infected.

The applicability of the inoculation program revealed important problems submerged in a vicious circle. On the one hand, the highest authority of New Spain was the Viceroy, but he was overwhelmed by many tasks -political, religious, military and economic- so that health questions became important only when the epidemics or health problems were already very serious. There was a total dispersion of authority in public health and since the Viceroy was the only one who was allowed to take decisions, preventive medicine failed. At the end of the 18th century, the main concern of Viceroy Branciforte was to satisfy the monetary claims from Spain and himself.

On the other hand, the position of the indian population, the biggest group in New Spain, played an important role. Indians were the most susceptible part of the population, they catched smallpox easily, and since they constituted the work force, their deaths originated economic losses. Indians did not accept inoculation. It is true that they were ignorant to a large extent, but it is also true that they could not expect positive actions from a class that normally repressed them, that took their lands, destroyed their religion and subjected them to conditions of misery and exploitation. Moreover, it was difficult to make them understand they would not catch smallpox, "by catching smallpox".

With these reasons in mind, S. Cook's opinion is a little excessive when he asserts that the indians were a group of savages who refused all help, and that they were indifferent towards the problem (81).

The initially ambiguous position of Branciforte towards the epidemic was clear; he was aware of the seriousness of the situation, but he was also aware of the risks of inoculation and the fact that there were no lazaretos to isolate the people. In addition to the social dimension, he also considered the economics of the situation. In his edict of February 28, he ordered the quarantine in the interest of general welfare. But when the managers of mines discretely suggested to him that the quarantine was doing great damage to the minig of silver, an exception to general welfare was made (82).

In 1803, King Charles IV, ordered the campaign of vaccination headed by Francisco Balmis. We could ask ourselves why the Spanish king accepted the benefit of an English contribution if the problems with England were not totally over. Probably, again, for economic reasons, a very personal opinion is that he lost his daughter María Teresa because of smallpox, so he himself had suffered as a result of this plague (83). Smallpox in the 18th century, like AIDS in the 20th, did not differentiate between social and economic classes.

It is incorrect to say that inoculation could have been the miraculous solution to one of the biggest plagues that ever attacked the American population after the Spaniards' arrival, but certainly it must have made an important contribution. Besides, inoculation prepared the way for the discovery of vaccination. If inoculation had been applied with a method, it would have been possible to test its efectivness. For example, it was very well known that winter was particularly favorable to the appearance of smallpox, so it would have been useful to organize an inoculation program before the winter arrived.

The study of the 1797 smallpox epidemic es fascinating and is far from being completely exhausted. I focused my interest mainly on inoculation. The epidemic is one of the rare cases in which the original material is so abundant and complete, that it is possible to approach the subject from many points of view: to reconstruct the story on a day-by-day basis, to understand the difficulty the authorities had in taking decisions, to look at the ambitions and intrigues of the elites in power, to study the social impact of scientific revolutions. The history of the 1797 smallpox epidemic makes one wonder if history is repeated in a astonishing way.

I gratefully thank W. Lebel, R. McCaa, E. Morman and P. Sköld for the material they kindly sent to me, D. Cooper for the suggestions, Mónica Salinas for the revision of the English version and R. Romo. The research was partially funded by Consejo Nacional de Ciencia y Tecnología, CONACyT, D113-904688, Dirección General de Asuntos del Personal Académico, DGAPA, UNAM, IN402996 and the HANNAH Visitor professor scholarship from Canada that allowed me to consult Canadian libraries.

1. Francis J. Brooks, "Revising the Conquest of Mexico: Smallpox, Sources and Population". Journal od Interdisciplinary History, 24 (1993), p. 1. W. George Lovell, "Heavy Shadows and Black Night: Desease and Depopulation in Colonial Spanish America". Annals of Association of America Geographers, 82-3 (1993), pp. 426-43. Robert McCaa, "Spanish and Nahuatl Views on Smallpox Demographic Catastrophe in Mexico". Journal of Interdisciplinary History, 25-3 (1995), 397-431.

2. Edward Jenner, An inquiry into the causes and effects of the variolae vaccinae, a disease discovered in some of Western counties of England, particulary Gloucestershire, and known by the name of the cow pox. (London, 1789).

3. Francisco Fernández del Castillo, Los Viajes de Don Francisco Xavier de Balmis), 2d ed. (México, Sociedad Médica Hispano- Mexicana, 1985).

4. The AGN and the Archivo General del Ex-Ayuntamiento are organized in "ramos". A "ramo" is a serie of bound volumes dealing with a specific subject. The Archivo del Palacio de Minería is organized in "cajas". A "caja" deals also with a specific subject. The same citation that is followed in those archives is used in this paper.

5. According to Robin Price, the Wellcome Institute have 26 documents about the epidemic. "State Church Charity and Smallpox: An epidemic crisis in the City of Mexico 1797-98". Journal of the Royal Society of Medicine, 75 (1982), p.357.

6. Angela Thompson T. "To save the children: Smallpox inoculation, vaccination, and public health in Guanajuato, México, 1797- 1848". The Americas, 49-4 (1993), pp. 431-55.

7. Sherburne F. Cook, visited Mexico City and consulted AGN's collection. It seems he prepared a catalogue. But it has been impossible to track this down; nobody remembers it, so I do not know if it actually exists. "The smallpox epidemic of 1797". Bull. Hist. Med., 7 (1939), pp.937-969. Donald B. Cooper, Las epidemias en la ciudad de Mexico, 1761-1813. (México, Colección Salud y Seguridad Social, Serie Historia, IMSS, 1980).

8. José Alvarez Amézquita et al. Historia de la Salubridad y Asistencia en México, vol. 1. (México, Secretaría de Salubridad y Asistencia, 1960). John Tate Lanning, The Royal Protomedicato, ed. John Jay Tepaske. (Durham, Duke University Press, 1985), p. 351.

10. Enrique Moreno Cueto et al. Sociología histórica de las institutciones de salud en México. (México, Instituto Mexicano del Seguro Social, 1982), pp. 16, 19-20.

11. Cooper, Las epidemias..., op cit, pp. 47-51. Lanning, The Royal..., op cit, p. 359.

14. Cook, Bull. Hist. Med..., op cit, 941-2. Lovell, Annals of the Association..., op cit, p. 259. Price, Journal of the Royal..., op cit, p. 359.

16. Anonymous, "Disertación apologética sobre la inoculación de viruelas". Gazeta de México, 20 febrero 1796, tomo VIII, p. 35. Anonymous, "Noticia importante", Gazeta de México, 10 mayo 1796, tomo VIII, p. 80.

17. Francisco Gil, Disertación Físico-Médica, em la cual se prescribe un método seguro para preservar a los pueblos de viruelas, hasta lograr la extinción de ellas en todo el Reyno. (México, D. Mariano de Zúñiga y Ontiveros, 1796).

18. Francisco Gil, Disertación Físico-Médica, en la que se describe un método seguro para preservar a los pueblos de Viruelas hasta lograr la completa extinción de ellas en todo el Reyno. (México, Joachim Ibarra, Impresor de la Cámara de S. M. 1784).

19. Francisco Gil, Disertación Físico-Médica. Extracto de la obra publicada en Medrid en 1784. (México, 1788).

20. AGN, Ramo Epidemias, vol. XVI, exp. 8, ff. 1-3v. S. F. Cook published the english version of the edict in: "Smallpox in Spanish and Mexican California: 1770-1845". Bull. Hist. Med., 7 (1939), pp. 158-163.

25. "We are not facing a real epidemic, nor would God want us to suffer one". AGN, Ramo Epidemias, vol. XVI, exp. 6, f. 22.

26. José Antonio Calderón Quijano, Los Virreyes de la Nueva España en el reinado de Carlos IV. (Sevilla, Escuela de Estudios Hispano-Americanos de Sevilla, 1972). Manuel Rivera Cambas, Los Gobernantes de México. Desde Cortés hasta Juárez, tomo I. (México, Imprenta de J. M. Aguilar, 1872), pp. 480-495. Vicente Riva Palacio, Resumen integral de México a través de los siglos, tomo II, Virreinato. (México, Compañia General de Ediciones, S. A., 1951), pp. 459-64. Price, The Journal of..., op cit, p. 357.

28. Bartolache, José Ignacio, "Instrucciones sobre el método para curar viruelas", Gazeta de México, 25 septiembre 1797, tomo VIII, pp. 341-344.

29. AGN, Ramo Epidemias, vol. XI, exp. 2, f. 151. Método claro, sencillo y fácil que para practicar la Inoculación de de viruelas presenta al Público el Real Tribunal del Protomedicato de esta N. S. por Superior orden del Exmo. Señor Marqués de Branciforte Virrey de este Reyno. (México, sin pie de imprenta, 1797).

34. Archivo del Ex-Ayuntamiento, Ramo Policía, Salubridad, Epidemia Viruela, 1779, legajo 1, vol. 3678, exp. 2, f. 7v.

35. The modern concept of vaccination involves the introduction of a weak form of a disease, processed in a laboratory, into the body as a protection against the disease.

36. Anne Marie Moulin et Pierre Chauvin, Lady Mary Montagu. L'Islam au péril de femmes. (Paris, Editions la Découverte, 1987).

37. Ex-Ayuntamiento, Ramo Policía, Salubridad, Epidemia-Viruela, vol. 3678, tomo I, exp. 1, fojas 36. Cooper, Las epidemias...op cit, p.86.

38. Genevieve Miller, The adoption of inoculation for smallpox in England and France. (London, 1957).

39. Emmanuel Timonis, "An account of the history and of the procuring of the small-pox by incision of inoculation, as it has for some time been practised at Constantinople", Philosophical Trans., 29 (London, 1714-16) pp. 78-86. Jacomo Pylarinos, "Nova et tuta variolas excitandi per transplantationem methodus nuper inventa et in usum tracta", Philosophical Trans., 29 (London, 1714-16), pp. 393-99.

40. Germán Somolinos D'ardois, "La viruela en la nueva España". In: Enrique Florescano et al. Ensayos sobre la Historia de las Epidemias en México, tomo I (México, Colección Salud y Seguridad Social, Serie Historia, IMSS, 1982), p.241.

41. Benito Gerónimo Feyjóo y Montenegro, Demostración Crítico- apologética del Teatro Crítico Universal, discurso XI, cap XIV, (Pamplona, España, 4a. impresión, Benito Coscullulla, 1781), pp. 328-331. Ana Cecilia Rodríguez de Romo, et al. Tesoros de la Biblioteca Histórica doctor Nicolás León. Libros de Medicina de los siglos XVI, XVII y XVIII. (México, Facultad de Medicina, UNAM, 1996), p. 52.

42. See for example, Anton de Haen, Quaestiones saepius motae super methodo inoculandi variolas, and cuas directa eroditorum responsa Hucusque desideratur; indirecta Minus satiefacere vederitur:... (Naepoli, Felicis Ippoliti Bibliopolae, 1778). Rodríguez de Romo, Tesoros de la Biblioteca...,op cit, p. 63.

43. Historia General de México, tomo 1, 3 ed. (México, El Colegio de México, 1981) pp. 661-665. AGN, Ramo Epidemias, vol. VI, exp. 1, f. 9.

44. Paula Demerson, "La práctica de la variolización en España", Asclepio, 45-2 (1993), pp.30-31.

47. Ex-Ayuntamiento, Ramo Policía, Salubridad, Epidemia-Viruela, vol. 3678, tomo I, exp. 2.

49. Ex-Ayuntamiento, Ramo Policía, Salubridad, Epidemia-Viruela, vol. 3678, tomo I, exp.3.

52. Charles de la Condamine, Memoire sur l'inoculation de la petite vérole. (Paris, 1754).

54. José Joaquín Izquierdo, Raudón cirujano poblano de 1810, (México, D. F., Ediciones Ciencia, 1949) p. 63.

61. "Método claro, sencillo y fácil para practicar la inoculación de las viruelas", Gazeta de México, sábado 28 de octubre de 1797, tomo VIII, pp. 352-55.

62. AGN, Ramo Epidemias, vol VII, Exp. 7, f. 576. Vol. I, exp. 7, ff. 492, 497v, 500v, 501v.

64. It is important to remember that according to the first population census published in 1790, Mexico had 4'530, 436 inhabitants. 1'147,973 were living in the "Intendencias" of Mexico City. The capital itself was bordered by "garitas" and divided into eight "cuarteles"; the number of people living in this internal area is calculated an 112,926. Primer Censo de Población en la Nueva España, 1790. Censo de Revillagigedo, "Un Censo condenado", (México, Secretaría de Programación y Presupuesto, Dirección General de Estadística, 1977), p. 105.

65. Archivo del Ex-Ayuntamiento, Ramo Policía, Salubridad, Epidemia Viruela, 1797, legajo 1, vol. 3678, exp. 5, f. 5.

66. Michel M. Swann, Tierra adentro: Settlemente and Society in Colonial Durango, (Bouler, Colorado, Westview Press, 1982), pp. 154, 169. Cook, Bull. Hist. Med..., op cit, pp. 955-56.

67. Michael M. Smith, The "Real Expedición Marítima de la Vacuna" in New Spain and Guatemala. Transactions of the American Philosophical Society, New series, vol. 64-1, (Philadelphia, The American Philosophical Society, 1974) p.11.

69. Robin Price, An Annotated Catalogue of Medical Americana in the Library of the Wellcome Institute for the History of Medicine, (London, The Wellcome Institute for the History of Medicine, 1983).

70. The Resumen General was the only that was possible to consult because it has been published (Fernández del Castillo, Los viajes de...,op cit, p. 64, Price, An Annotated..., op cit, p. 109), the other two reports were not found in the AGN, the information here is from the Price's Catalogue.

71. Price, An annotated..., op cit, p.98. Cooper, Las epidemias..., op cit, p. 195.

72. Price, An Annotated..., op cit, p. 130. Curiously, Tate mixes the Resumen General and the Medical Board figures. For him, the cared are 44, 516, inoculated ones included, and 56,169 are naturaly sick, "naturales". The Royal...,op cit, p. 376.

74. Peter Sköld, "From inoculation to vaccination: Smallpox in the 18th and 19th century Sweden". Unpublished paper consulted thanks to the courtesy's author.

75. José Flores, "Instrucción sobre el modo de practicar la inoculación de las viruelas y método para curar esta enfermedad, acomodado a la Naturaleza y modo de vivir de los indios y demás castas de gente rústica de los Pueblos del Reyno de Guatemala". AGN, Ramo Epidemias, vol. VII, exp. 10, f. 428-438.

77. "The advantages of inoculation of smallpox and the need to establish this operation in this Kingdom to prevent the consequences of this terrible illness." Martha Eugenia Rodríguez, "El doctor José Felipe Flores, primer Protomédico de Guatemala", Boletín Mexicano de Historia y Filosofía de la Medicina, 13 (1990), pp.111-123.

79. Balmis had a lot of experience of smallpox, moreover, he had translated Moreau's treatise on vaccine. J. L. Moreau de la Sarthe, Tratado histórico y práctico de la vacuna, trans. Francisco Xavier de Balmis, (Madrid, Imprenta Real, 11803).

80. 400 Añoz de Viruela, (México, Secretaría de Salubridad y Asistencia, 1953), p. 271.

83. Andrés Muriel, "Historia de Carlos IV". En: Biblioteca de Autores Españoles, (Madrid, Editorial Atlas, 1959), p. 59.

ANTILIA

INOCULATION IN THE 1799 SMALLPOX EPIDEMIC IN MEXICO: MYTH OR REAL SOLUTION?

Ana Cecilia Rodríguez de Romo Departamento de Historia y Filosofía de la Medicina. Facultad de Medicina, Universidad Nacional Autónoma de México. México 1, D. F. C. P. 06020 (México).

Ana Cecilia Rodríguez de Romo
Departamento de Historia y Filosofía de la Medicina.
Facultad de Medicina, Universidad Nacional Autónoma de México.
México 1, D. F. C. P. 06020 (México).