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The Medical History of British of British India vaccination collection demonstrates British efforts to vaccinate the Indian population against smallpox using the latest 19th and 20th century western scientific techniques.

Smallpox vaccination in British India

Official vaccination reports reveal how smallpox vaccination was implemented in India between the mid-1800s to the mid-1900s.

Historians note that smallpox may have originated in India thousands of years ago. Inoculation was popular there, as shown through local practice and the devotion of at least two deities to the causes and symptoms of smallpox.

However, the advent of Jennerian vaccination would lead the British Empire to strike out against smallpox, particularly as 'smallpox killed more people in Calcutta in two years, than all the shot, shell and grape of the artillery, all the sabres of the cavalry, and all the bullets and bayonets of the infantry could destroy when used against large armies of English soldiers for years'. ('Report on vaccination operations in the Santhal Pergunrahs for 1867', p3)

The Bengal vaccination reports award the honour of introducing vaccination to India to the Honourable Lord Robert Clive (Clive of India) in 1802.

Organisation of vaccination in India

Reports indicate that British India was carved into separate regions with areas such as Madras, Bengal, Burma and the Punjab separated with their own command structures. A sanitation team led by a Sanitary Commissioner was supported by a staff of superintendents, inspectors and vaccinators.

The reports show that each area differed somewhat in application and distribution, for example, a wide array of vaccination measures were utilised in the Punjab, which included established dispensaries and mobile vaccination teams. The latter travelled out to villages and settlements to vaccinate a localised population.

In addition, the reports demonstrate that, as a separate measure, military cantonments were frequently used to vaccinate British servicemen present in India.

Protective circles

Bengal, while following a similar process, also utilised a system of protective barriers around the periphery of Calcutta. Dr T Edmonton Charles aimed to vaccinate all within a set circle (of which there were originally seven around Calcutta), protecting the city as it was surrounded by vaccinated areas.

In 1867 a man travelling to Calcutta contracted smallpox and died on the periphery of the city. Because the area had been mostly vaccinated, the spread of the disease was successfully contained.

Vaccination personnel

Superintendents and their direct insubordinates tended to be either British or in the employ and trust of the British Colonial Service as displayed in the reports. Titles such as Surgeon Major, Captain, Lieutenant Colonel and Dr often precede a list of credentials, including the Indian Medical Service (IMS).

However, the vaccinators and often their direct supervisors tended to be locals to the area. The reports unveil that vaccinators who travelled out or worked in the dispensaries would be both a hindrance and saviour for the vaccination program of India.

Vaccination equipment

While inoculation could be carried out with a needle and a cup of pus, vaccination required something more refined. The vaccination service in India was driven by medical personnel such as Dr Walter Gaven King, who developed new techniques and equipment to enhance the success rate of the vaccination process.

The King Institute of Preventive Medicine, Madras, opened in 1905, was named for his contributison to both sanitation and vaccination, and these aspects are clearly explored in the King Institute annual reports.

The needle-like lancet progressed to a scarifier, a cross-shaped instrument which made deep multiple scratches on the skin. It was as successful in its productivity as it was innovative in its design, because it ensured that vaccinators were performing the procedure correctly.

In 1883 the Punjab officials decreed a move to utilise six-point vaccinations with three cuts on both arms to ensure a higher success rate. This eventually dropped to four cuts in 1909 as the quality of the lymph increased.

The role of vaccine institutes

One of the main improvements in vaccination was the introduction of vaccine institutes, which occurred in areas such as Bengal, Madras and Punjab separately. Within these establishments, tests would be completed on the best way to synthesise and maintain the cowpox to allow it to be dispatched to the vaccination teams.

Experiments on transferring the disease included tests on rabbits, buffalo, donkeys and goats as attempts to synthesise the vaccine from different animals became a priority for cultural reasons.

German vaccine institutes had been working to synthesise the best lymph and sustain its potency in a solution. Experiments were carried out across the globe utilising lanoline oil, glycerine, petroleum jelly, even chloroform infused glycerine paste.

The success rate in all of the regions rose to well over 95% of vaccinations towards the middle of the 20th century. This resulted from changing transportation from boxes to blown-glass tubes, using the right sustaining substance, and taking account of changes in temperatures.


Yet the reports show that one innovation was simply the rediscovery of a vital flaw – the need for re-vaccination. Historically regarded as a deficiency in Edward Jenner’s own work and that of many of his followers, the issue of re-vaccination arose in India as cases were reported about contracting smallpox despite vaccination.

Until this time, re-vaccination was made a priority and, although statistically the success rates would be significantly lower than a primary vaccination, the judicious application of this process as argued by Dr Dyson in 1892 '… practically has the effect of abolishing smallpox'. ('Second triennial report of the sanitary commissioner for Bengal 1890-91, 1891-92 and 1892-93')

Funding and costs of vaccination

One complication of the vaccination programme was cost. The vaccination programme, staff and their training and tools, transportation and storage, distribution and cultivation of the lymph all required funding. In addition, payment was needed for the development of the vaccine institutes and their experiments with new processes.

Funding came from multiple sources. The Government in India was partially responsible for it, with contributions by local municipalities. A case study in Madras outlines that in 1889 the cost was broken down between the Government (Rs. 7,122.11.7 = cost in Rupees) and the municipalities (Rs. 1,51,455.1.5) with contributions from charitable local bodies such as the Local Fund Circles (Rs, 1,51,455.1.5) and from the native states themselves.

Wages for vaccinators

Vaccinators were paid very low wages and this was noted by the Sanitary Commissioner in 1913-1914 as potential reasons for poor service: '… the rates of pay allowed to vaccinators are absurdly low … the consequence is that men recruited for these posts are next to useless.' ('Annual report on vaccination in the Madras presidency … 1913-14')

Low wages also caused problems, not simply in the perceived ineptitude of the vaccinators but in the retaining of staff: they either vacated their position or were dismissed. In the Darjeeling Circle in Bengal in 1878 an instance of strike by vaccinators against the low pay saw the loss of nearly the whole vaccination team through dismissal or absconding.

Revenue from the vaccinated

Payment was also secured from those being vaccinated and was theoretically paid back into the vaccination service. Much of this was to make up the wages of the vaccination teams, particularly the mobile vaccinators.

In many cases the costs could not be met by the locals, who either repudiated vaccination or simply refused to pay. This was incredibly detrimental to the vaccination staff, as many were unable to draw wages and were forced to appeal to magistrates to make the locals pay.

This process proved to be unfruitful in 1901. The magistrate not only refused to demand that people pay, but also refused the enforcement of the payment through the use of local law enforcement, offering only 'moral support’ for the unpaid vaccinators.

To overcome this problem and the increasing concern of a non-vaccinated poorer population, pockets of free vaccination arose. An example of this was in Bengal, which saw an immediate increase in vaccination in areas where it was free.


The Vaccination Act of 1880 of Bengal outlawed inoculation and made it increasingly compulsory for children to be vaccinated. The reports reveal that the Act was continually updated and that similar legislation spread to other Indian regions.

Dr Edmonston Charles in 1867 highlighted the lack of legislation at the time as a lack of recognition for the severity of the prevalence of smallpox in the Bengal region.

Indian resistance to vaccination

Resistance against the British vaccination programme is revealed to have been a major hindrance.

The reports contain many accounts of resistance by local people to vaccination in both the 19th and 20th centuries. Resistance took many forms, from non-payment and simple refusals to violent physical assaults and even the attempted murder of a vaccinator in Madras in 1922.

The means of resistance were as varied as the reasons behind it. Class was also a factor in terms of those who could afford vaccination. Across all of the regions much of the opposing by the poorer locals was down to an inability to afford it: '… scarcity of food grains … made the people unwilling to spend money on vaccination …' ('Short notes report on vaccination in Bengal for the year 1906-1907', p1)

Religious objections to vaccination

Religion presented substantial difficulties to the British vaccination of their Indian subjects, particularly in light of the Caste system. Castes such as the Hindus and the Muhammadans refused the vaccination process originally because of the nature of animal lymph.

Similar in opposition in some ways to the British preoccupation with the effects of injecting something bovine into the human body, these religious concerns were raised because of the sacred nature of the cow to factions in India.

To overcome this, experiments with other animals were trialled, as the same significance was not applied to the buffalo. However, the most frequent resolution was to continue arm-to-arm vaccination, unpopular in itself because of the connotation of extracting lymph from previously vaccinated children.

Children and castes

Many parents forbade the early vaccination practice of using children as arm-to-arm vaccinators. They feared that their child could become more ill, and, in some cases children died from prolonged exposure and fatigue from being taken to other villages as vaccinators.

In addition, the caste system strictly forbade the mixing of the blood between lower and higher castes, and children used as vaccinators were often of a lower caste. However, this practice would begin to die out with the advent of substance-sustained lymph at the turn of the century.

Suspicions about British vaccination

Rumour and stories among the indigenous population presented the vaccination process as suspicious – as the instrument of a villainous empire attempting to place tracers on individual. Resistance also arose from fears that the colonists were deliberately infecting locals with plague.

The first annual report of the Ranchi Circle of vaccination in 1867-1868', p.2 describes the local belief that the vaccinators wanted 'to steal the children for some purposes of witchcraft' or to give them a Government mark which allowed them to be traced by police.

Another fear was that vaccination served to harvest the blood of children. The blood was believed to be held on British ships so should there be a shipwreck the sailors lives would be saved, but the children whose blood it was would die as forfeit.

Persistence of Indian inoculation

Arguably one of the greatest barriers to vaccination was the habit of inoculation. Similar to the plight of vaccination in Britain, inoculation was a popular and lucrative practice which had been performed for thousands of years, not merely the brief century the British had toyed with it.

Inoculation was made increasingly illegal, yet the practice persisted. British attempts to stamp it out were made difficult, as Dr Hoskins highlighted in 1867: '… the mass of the people (are) wedded to inoculation …' ('First annual report for the Ranchee circle of vaccination for 1867-1868', p.10)

Efforts were even made to indoctrinate inoculators (in some areas known as tikadars, or ‘mark-makers’) into vaccination practice. However, once unsupervised these inoculators frequently would slip into old practices over performing the vaccinations. Inoculators would also be arrested and charged for practicing their trade, but local sympathies frequently entailed release for the inoculators at the hands of a technicality or a sympathetic magistrate.

Religion and inoculation would join forces, as shown by a woman apparently possessed by the Goddess Sitala in 1864 in Bengal: '… she … amid incoherent ravings denounced the vaccinators and prophesised that everyone they operated on would die; only three vaccinations were done that year.' ('Report on the vaccinator proceedings throughout the government of Bengal'|)

Yet the vaccinators were not against using this religious slant to their advantage. The following year the same woman claimed that the Goddess had sent her permission for the vaccinators to practice their trade.

A similar incident in the same year outlines another possession which drove a women to declare publicly '… that the vaccinators were commissioned by the Goddess to cure smallpox and … and that the people should accept their services.' ('Report on the vaccinator proceedings throughout the government of Bengal')

British attitudes and responses

The vaccination reports reveal that British attitudes were increasingly critical and uncomplimentary to the work of Indians under the employ of the vaccination services, both in the mobile vaccination units and the dispensaries. Through the reports the users can explore how these attitudes and the British complaints against the local populace impeded vaccination.

From studying them, it becomes clear that the reports given to the sanitary commissioner – which were then sent to the Government of India – were frequently incorrect, exaggerated or falsified. This often led to the fining and dismissal of staff, and explains to a large degree the erroneous results that frequently appear in the statistical section of the reports.

The lack of particular training or expertise is apparent through the confusion of the vaccinators (and local medical practitioners who reported outbreaks) with other diseases such as measles. This diverted resources, as well as encouraging locals to refuse vaccination because they mistakenly believed it would cause an onslaught of disease.

Fall in smallpox mortality

The British considered their programme to reduce the devastation of smallpox to be so successful that British attention in Bengal, for example, by 1929 had shifted from smallpox to other diseases such as malaria, cholera and fever.

In 1927 malaria killed 368,691 people, and fever killed 752,007. Smallpox mortality rates, on the other hand, had fallen to under 5,000 – and this figure was particularly high for the time.

Assessment of British vaccination in India

The reports show the complex nature and the scale of ambition of the vaccination programme in India. They demonstrate the conflict and distrust between western colonial medicine and indigenous society, culture and systems.

We can assess the effectiveness and impact of vaccination in India by examining how this conflict, the inconsistencies in policy administration and the emerging science of bacteriology and new technologies shaped British efforts.

Smallpox vaccination became part of a wider health concern for the Indian nation as a whole, particularly from the 1920s.

New legislation led to decentralisation of public health and sanitation measures for combating smallpox and other infectious diseases like malaria, cholera, fevers and plague.

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