Introduction
|
Inoculation, the "transplantation" of live smallpox from an infected individual to the healthy, was the subject of one of the most controversial, long-lived medical debates in eighteenth century Western Europe, Spain and New Spain. The proponents of inoculation argued that the procedure provided protection against "natural" smallpox while inflicting a very small risk on the patient. Opponents questioned whether individuals should be subjected to a not inconsiderable risk of dying from inoculation (which they argued, in any case, was much greater than inoculationists would admit) against the unknown and highly uncertain risk of contracting natural smallpox. Anti-inoculationists questioned whether protecting a few individuals by means of "artificial" smallpox was worth the risk of igniting a raging epidemic of natural pox in an entire village, town or region.
In Spain, the Royal Protomedicato neither endorsed nor prohibited inoculation, but did prohibit the publication of at least two manuscripts on the subject. One of the most notorious cases occurred in 1757. A Spanish translation of a contentious treatise on inoculation, a dissertation by the French philsophe Charles-Marie de La Condamine, was denied a license and went unpublished for over two centuries (Riera and Granda-Juesas 1987). Consequently, many medical historians disparage eighteenth-century Spanish health authorities and medical doctors for their apparent backwardness in refusing to embrace a measure that seemed to offer such great benefit to humanity (Demerson 1993).
Nevertheless, the procedure was practiced in both Spain and Spanish America. In Spain, the method was often the free-lance work of private doctors (Demerson 1993). In New Spain, inoculation was used primarily by public authorities as a defense against the imminent threat of an epidemic (Cooper 1965). In New Spain, the technique was first endorsed during the smallpox epidemic of 1779-80, but was infrequently applied. Then in the mid-1790s, with the scourge of smallpox threatening once again, some 70,000 or more inoculations were performed. The 1790s campaign probably ranks as one of the largest mass smallpox inoculations ever undertaken over such a brief period of time.
Objections raised by the Royal Protomedicato in its opposition to indiscriminate inoculation have not been tested against historical experiences with the disease. Did inoculation preserve pueblos from smallpox or did it instead propagate epidemics? To try to answer this question, I examine the role of inoculation in containing and spreading the "1797" epidemic in Chiapas and briefly throughout New Spain (Romo de Rodríguez 1997; Cook 1982 [1940]).
Because some fraction of inoculated patients died from smallpox, the procedure was not as widely practiced in Western Europe or North America as often believed. One of the most celebrated experiences with transplantation occurred in the city of Boston. Nevertheless, over a period of seven decades, only 24,069 inoculations were performed in Boston. Since the city's population averaged some 15 to 19,000 inhabitants during this period, it is likely that a substantial fraction, perhaps one-fourth to one-half of the settled population, was never inoculated. In England inoculation, or "engrafting" as it was also called, was in the hands of private doctors and consequently no central registry was maintained. An authoritative estimate places the total number of inoculations during the period of most intense activity, 1766-1800, at some 200,000, or less than six thousand per year. In France, where the debate over the procedure was most intense, no more than 70,000 inoculations were conducted over the entire 18th century (Darmon 1989:70-71).
In New Spain, on the other hand, inoculation was more widespread than is commonly supposed. The campaign of 1794-98 was probably more massive in geographical sweep and in the sheer quantity of inoculations performed than any single trial in Western Europe. In Chiapas alone almost 9,000 inoculations were conducted in the space of a few months. The method was also applied in Oaxaca, Taxco, Puebla, Mexico City, Guanajuato, and as far north as Monterrey. In Durango, the capital of Nueva Viscaya, almost 4,000 people were inoculated in a matter of days, leaving only 500 residents of the city exposed to the dangers of natural smallpox. In Guanajuato, 11,015 children were inoculated in a few days. Here, almost four-fifths of those who fell ill from smallpox did so as a result of inoculation. A like number of inoculations was performed in Guanajuato's rural districts (11,104), but the rural campaign was less successful because only one-fifths of those who fell ill contracted "artificial" smallpox (Thompson 1993:440). Colony-wide the highest authorities, both secular and religious, endorsed inoculation following decades of ambivalence, and, what seemed to inoculationists, stubborn opposition. |