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Medical Modernization and Medical Nationalism: Resistance to Mass Tuberculosis Vaccination in Postcolonial India, 1948–1955

  • Christian W. McMillen (a1) and Niels Brimnes (a2)
Extract

In the fifteen years following World War II more was done to combat tuberculosis than at any other time in world history. On every continent, hundreds of millions received the BCG (Bacillus Calmette Guérin) vaccine and millions more benefited from newly discovered antibiotics. TB research and attempts to control the disease knit together disparate populations and places as a network of experts and a matrix of ideas spread out across the globe linking the world through a common vaccine, a battery of antibiotics, and a knowledge network. Medicine became internationalized as organizations like the WHO and UNICEF began to see diseases as global problems and not solely the concern of individual countries.

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1 See Iriye, Akira, Global Community: The Role of International Organizations in the Making of the Contemporary World (Berkeley: University of California Press, 2002).

2 Brown, Theodore M., Cueto, Marcos, and Fee, Elizabeth, “The World Health Organization and the Transition from ‘International’ to ‘Global’ Health,” in Bashford, Alison, ed., Medicine at the Border: Disease, Globalization, and Security, 1850 to the Present (London: Palgrave MacMillan, 2006), 7694.

3 Brimnes, Niels, “Vikings against Tuberculosis: The International Tuberculosis Campaign in India 1948–51,” Bulletin of the History of Medicine 81, 2 (2007): 407–30.

4 Johannes Holm, “Report on a Visit to India, February-April, 1951,” Programme Division—Asia-General, CF/RA/BX/PD/1947/T021. See also B. Fraser to Myron Schmittlinger, 18 July 1950, BCG-General, 1949–1950, A648, LF-WYH-05, UNICEF Archives. For the view that research with controlled trials was desired, but that “attempts of this kind are often opposed as ‘experimenting on human beings,’ ” see I-Chin Yuan and Carroll E. Palmer, “The WHO Tuberculosis Research Office: A Review of the First Four Years,” Public Health Reports 68, 7 (July 1953): 679.

5 “Plan for a BCG Programme in a Hypothetical Country as Requested in HQ's Letter AS.CDS.TB. DC.TB. 16 of April '53,” Asia-BCG, Programme Division, Subject Files, Asia Region, 1947–1955, CF/RA/BX/PD.1962/T004, UNICEF Archives.

6 R. Neubauer, “Report on Visit to West and Central African Territories,” Oct.-Dec., 1953, p. 147, DC-TB-AFRO, WHO Archives, Geneva.

7 Soper, Fred L., “Problems to Be Solved if the Eradication of Tuberculosis Is to Be Realized,” American Journal of Public Health 52, 5 (May 1962): 735. The speech was delivered in 1961.

8 Palmer, Carroll E., “Tuberculosis: A Decade in Retrospect and Prospect,” Journal-Lancet 78 (June 1958): 257–60; James E. Perkins, “Global Tuberculosis Eradication,” International Symposium of the Deborah Sanatorium and Hospital, Philadelphia, Pa., 20–22 Nov. 1958, in American Review of Respiratory Diseases 80, 4 (Oct. 1959): 138–39.

9 Packard, Randall, The Making of a Tropical Disease: A Short History of Malaria (Baltimore: Johns Hopkins University Press, 2007), 113, 136.

10 Comstock, George W., “Field Trials of Tuberculosis: Vaccines: How Could We Have Done Them Better?” Controlled Clinical Trials 15 (1994): 247–76; Colditz, Graham A. et al. , “Efficacy of BCG Vaccine in the Prevention of Tuberculosis: Meta-Analysis of the Published Literature,” Journal of the American Medical Association 271, 9 (1994): 698702. Brimnes, Niels, “BCG Vaccination and WHO's Global Strategy for Tuberculosis Control 1948–83,” Social Science and Medicine 67 (2008): 863–73.

11 Hugh Stott, “B.C.G. Vaccination in Kenya,” n.d., filed with papers in 1950, CO 927-181-5; Charles Wilcocks, “A Note on the Possible Use of BCG Vaccine in the Colonies,” CO 859-210-6; C. R. Jones to director of Medical Services, Georgetown, British Guiana, 20 Dec. 1950, CO 111-814-13, National Archives, UK.

12 There was organized, local resistance at the sites of vaccination in Iraq: see J. K. Henriksen, “The UNICEF/WHO/Iraq BCG Campaign in Iraq (Iraq 10): Evaluation and Assessment Report, April 1952–August 1954,” in Iraq-BCG-1954-55, Program Division, Eastern Mediterranean, Subject Files, 1952–56, CF/RA/BX/PD/1962/T024. In Vietnam there was an organized newspaper campaign: see Dr. M. Gauthier, “Final Report on the BCG Campaign in Vietnam, 30 June 1956,” Vietnam-BCG, Program Division, Subject Files, Asia Region, CF/RA/BX/PD/1962/T080. For Mexico, see: L. Eloesser, “Notes Mexico—January 20 to February 15, 1951 (Confidential),” Mexico-BCG, Program Division, Latin America Region, CF/RA/BX/PD/1962/T145, UNICEF Archives.

13 Cooper, Frederick, “Modernity,” in Colonialism in Question: Theory, Knowledge, History (Berkeley: University of California Press, 2005).

14 Packard, Randall, “‘No other Logical Choice’: Global Malaria Eradication and the Politics of International Health in the Post-War Era,” Parassitologia 40 (1998): 217–29, 220; Amrith, Sunil S., Decolonizing International Health: India and Southeast Asia, 1930–65 (London: Palgrave Macmillan 2006), 99120.

15 Scott, James C., Seeing Like a State: How Certain Schemes to Improve the Human Condition Have Failed (New Haven: Yale University Press, 1998); Adas, Michael, Dominance by Design: Technological Imperatives and America's Civilizing Mission (Cambridge: Harvard University Press, 2006).

16 Walsh McDermott, “The Role of Biomedical Research in International Development,” The National Institutes of Health International Lecture (Bethesda, 1963), 2. For a trenchant critique of the way this worked in one country, see Mitchell, Timothy, “Can the Mosquito Speak?” in Rule of Experts: Egypt, Techno-Politics, and Modernity (Berkeley: University of California Press, 2002).

17 McDermott, Walsh, “Modern Medicine and the Demographic-Disease Pattern of Overly Traditional Societies: A Technological Misfit,” Journal of Medical Education 41 (Sept. 1966): 137–62.

18 Menut, P., “The Lübeck Catastrophe and Its Consequences for Anti-Tuberculosis BCG-Vaccination,” in Moulin, A. M. and Cambrioso, A., eds., Singular Selves: Historical Issues and Contemporary Debates in Immunology (Paris: Elsevier 2001), 202–10.

19 McDougall, J. B., Tuberculosis: A Global Study in Social Pathology (Baltimore: Williams and Wilkins, 1949), 390. Bryder, Linda, “‘We Shall not Find Salvation in Inoculation’: BCG Vaccination in Scandinavia, Britain and the USA, 1921–1960,” Social Science and Medicine 49 (1999): 1158–59.

20 Anderson, R. J. and Palmer, C. E., “BCG,” Journal of the American Medical Association 143 (1950): 1048.

21 Cueto, Marcos, “The Origins of Primary Health Care and Selective Primary Health Care,” American Journal of Public Health 94, 11 (2004): 1864–74; Lee, Sung, “WHO and the Developing World: The Contest for Ideology,” in Cunningham, Andrew and Andrews, Bridie, eds., Western Medicine as Contested Knowledge (Manchester: Manchester University Press, 1997): 2445; Kunitz, Stephen J., The Health of Populations. General Theories and Particular Realities (New York: Oxford University Press 2007), 142–51.

22 Of course, the two positions are not entirely at odds and thus should not be unnecessarily dichotomized—one can believe in the power of vaccines while still advocating broader social reforms. Yet, in this article, we highlight a case where those two positions could not be reconciled.

23 Arnold, David, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: University of California Press 1993), 139–44; Bhattacharya, Sanjoy, Harrison, Mark, and Worboys, Michael, Fractured States: Smallpox, Public Health and Vaccination Policy in British India 1880–1947 (New Delhi: Orient Longman 2005), 5269, 203–25.

24 Bhattacharya, Sanjoy, Expunging Variola: The Control and Eradication of Smallpox in India, 1947–1977 (New Delhi: Orient Longman, 2006), 230–47, esp. 237–38.

25 Greenough, P., “Intimidation, Coercion and Resistance in the Final Stages of the South Asian Smallpox Eradication Campaign, 1973–1975,” Social Science and Medicine 41, 5 (1995): 633–45, esp. 638.

26 See for example Bierlich, Bernhard, “Injections and the Fear of Death: An Essay on the Limits of Biomedicine among the Dagomba of Northern Ghana,” Social Science and Medicine 50 (2000): 703–13.

27 Neubauer, “Report on Visit,” 140.

28 Feldman-Savelsberg, Pamela, “Sterilizing Vaccines or the Politics of the Womb: Retrospective Study of a Rumor in Cameroon,” Medical Anthropology Quarterly 14, 2 (2000): 159–79; Robert W. Morgan, “The Sopono Cult and Smallpox Vaccination in Lagos,” Working Paper 11, African Studies Center, Boston University, 1979. For more examples, especially from the smallpox eradication campaign, see generally Luise White, “The Needle and the State,” MS in authors' possession.

29 These figures were routinely referred to around 1950. See, for instance, Report of the Health Survey and Development Committee (Calcutta: Government of India Press, 1946), vol. 1, 97.

30 Harrison, Mark and Worboys, Michael, “A Disease of Civilisation: Tuberculosis in Britain, Africa and India, 1900–39,” in Marks, Lara and Worboys, Michael, eds., Migrants, Minorities and Health: Historical and Contemporary Studies (London: Routledge, 1997), 113–14. Brimnes, “Vikings,” 414–15.

31 The 80 percent figure was given as a “tentative conclusion” in an ITC public relations document, “The What, How and Why of the International Tuberculosis Campaign,” 1 Dec. 1948, Danish National Archives, no. 7369, box 1 (A.c). A decade later a WHO report concluded that “reliable circumstantial evidence” indicated “a degree of protection in the order of 80 per cent.” “Review of BCG Programmes: Preliminary Report by the Director-General,” 1 May 1959, Official Records of the WHO, vol. 96, 27.

32 Undated Press Note (with the note is a covering letter dated 28 May 1948). Tamil Nadu State Archive [henceforth TNSA], Health Department, no. 809, 1950.

33 Second Annual Report of the International Tuberculosis Campaign (Copenhagen: International Tuberculosis Campaign, n.d.), 47–48; J. Frimodt Moller, “Second Report on the Tuberculosis Survey at Madanapalle,” Proceedings of the Seventh Tuberculosis Workers Conference Held in Bombay November 1949, (n.p., n.d.), 80.

34 We know little about Raman. Apparently he was a longstanding servant of the Madras government and had a close relationship to Congress leadership. He claimed to have been influential in directing Gandhi's attention to sanitation in the 1920s. The magazine People's Health seems very much to have been his own enterprise. See A. V. Raman to C. Rajagopalachari, 2 Oct. 1948; and C. Rajagopalachari to A. V. Raman, 15 Sept. 1949, both in Installment V, Correspondence with: People's Health, editor of, Rajaji Papers, Jawarlahal Nehru Memorial Library, New Delhi [henceforth RP].

35 We shall refer to the government of India in New Delhi as the Union Government in order to distinguish it from the government of the Madras Province, which in 1950 became the State of Madras.

36 People's Health 3, 2: 53. The expert was not from the ITC. It is more likely that reference is made to a WHO consultant present when BCG was first used in India in August 1948.

37 People's Health 3, 5: 195.

38 See, for instance, Hindu, 14 Feb. 1949. Articles that referred to Raman's critique of BCG from Indian Express, Nagpur Times, and Sunday Times were all reproduced in People's Health 3, 5: 206–8.

39 Indian Express, 5 Feb. 1949, in People's Health 3, 5: 198. See also Hindu, 5 Feb. 1949. It should be noted that newspaper articles were reproduced in People's Health with reference to the day they were written, not the day of publication. Here, we generally assume they appeared the day after they were written.

40 Hindu, 14 Feb. 1949, in People's Health 3, 5: 204.

41 Ibid., original emphasis.

42 Ibid., 205; McMillen, Christian W., “‘The Red Man and the White Plague’: Rethinking Race, Tuberculosis, and American Indians, 1890–1950,” Bulletin of the History of Medicine 82 (2008): 608–45.

43 Hindu, 16 Feb. 1949, in People's Health 3, 5: 212. See also Madras Mail, 16 Feb. 1949.

44 See, for instance, TenBroek, Elizabeth, “The BCG Campaign in India,” People's Health 3, 11: 499510.

45 People's Health 4, 2: 56. Palmer quote: American “Public Health Abstract,” 7 Oct.1949. The phrase “uninformed criticism” was used by the Union Minister of Health Rajkumari Amrit Kaur to describe the opposition to BCG.

46 “Editorial,” Peoples Health 1, 1: 4.

47 Peoples Health 4, 11: 459.

48 Speeches in People's Health 3, 5: 213–26. See also, Hindu, 17 Feb. 1949.

49 People's Health 3, 5: 222. That BCG could not stand alone in the effort to control TB had always been the official position of WHO. See, for instance, “Expert Committee on Tuberculosis: Report of the Fourth Session,” WHO Technical Report Series 7 (1950): 19.

50 “Editorial,” People's Health 3, 5: 188–89.

51 Amrith, Decolonizing International Health, 57–63. Farley, John, Bilharzia: A History of Imperial Tropical Medicine (Cambridge: Cambridge University Press 1991), 179.

52 Report of the Health Survey and Development Committee, vol. II, 1–2.

53 Ibid., II, 3. For the advice to plan boldly, see vol. I, 2.

54 Ibid., II, 3–4.

55 Ibid., II, 159.

56 Ibid., II, 7.

57 People's Health 3, 5: 203–4.

58 Warwick Anderson has recently argued that vaccination—although often seen as epitomizing the interventionist aspirations of the colonial state—was in fact a very limited intervention compared to other hygienic measures: “Immunization and Hygiene in the Colonial Philippines,” Journal of the History of Medicine and Allied Sciences 62, 1 (2007): 1–20.

59 People's Health 4, 2: 46. The expression “black magic” first appeared in an unpublished letter to Henry S. L. Polak, 14. Oct. 1909; see Collected Works of Mahatma Gandhi [henceforth CWMG] (New Delhi: Government of India, 1959-1984), vol. IX, 479. Gandhi later used the expression several times in more public statements. See CWMG, XIX, 357, and LXV, 361.

60 For a reading of Gandhi that highlights his opposition to Western medicine, see David Arnold, Colonizing the Body, 285–88. For treatments that mention Gandhi's acceptance of elements of science—although with an emphasis on nutrition rather than sanitation—see, Alter, Joseph S., Gandhi's Body: Sex, Diet and the Politics of Nationalism (Philadelphia: University of Pennsylvania Press, 2000), 327; and Amrith, Decolonizing International Health, 32–36.

61 “Speech at Opening of Tibbi College,” Delhi, Bombay Chronicle, 15 Feb. 1921, in CWMG, XIX, 358. See also Khan, Shamsad, “Systems of Medicine and Nationalist Discourse in India: Towards ‘New Horizons’ in Medical Anthropology and History,” Social Science and Medicine 62 (2006): 2786–97.

62 “General Knowledge about Health—XXIV,” Indian Opinion, 14 June 1913, in CWMG, XII, 111. “Letter to Manilal and Sushila Gandhi,” 30 June 1929, in CWMG, XLI, 146. While Gandhi was referring specifically to vaccination against smallpox, the term vaccination in the public debate referred to the injection of various immunizing agents into the body. Also, BCG was based on bacteria from bovine tuberculosis and thus, like the smallpox vaccine, a product derived from the cow.

63 See for instance, “Speech at Opening,” in CWMG, XIX, 357.

64 “Smallpox and Cholera,” Navajivan, 30 June 1929, in CWMG, XLI, 141.

65 Svend K. Svendsen, “Indberetning om The International Tuberculosis Campaign i Indien og Ceylon,” 13 Mar. 1949, Svenska Röda Korsets Arkiv. Internationella Avdeling. Tuberkulos bekämmandet 1947–51, Overstyreslsens Tuberkuloskommittee B, vol. 2. Riksarkivet, Stockholm. Our translation.

66 Quoted in Hindustan Times, 22 Apr. 1949.

67 Handwritten note and memorandum of 4 June 1949, Health Department, no. 2617, 1949, TNSA.

68 T.S.S. Rajan was a Congress veteran, Minister for Public Health in Madras from 1949, and clearly more skeptical towards BCG than his colleague A. B. Shetty, who was health minister in the same government. On Rajan, see: http://www.thehindu.com/2003/10/28/stories/200310280001900.htm.

69 Rajan to Benjamin, typed draft letter, 15 Oct. 1949, Health Department, no. 1313, 1950, TNSA.

70 Note written by “Additional Secretary, Public Health Department,” 5 Oct. 1949, Health Department, no. 1313, 1950, TNSA.

71 C. Mani to Dr. James McDougal, 1 [second number of date illegible] Oct. 1949, “Tuberculosis: Collaboration with Regional Offices, South East Asia Region,” file 458/13/2, Archives of the World Health Organization, Geneva.

72 Letter no. 1461, Ministry of Health, Government of Madras to Government of India, 26 Apr. 1950, Health Department, no. 1461, 1950, TNSA.

73 “Draft Plan of Operations—for Continuation and Expansion of BCG Vaccination Programme in India during 1952 and 1953,” Health Department, no. 1216, 1953, TNSA.

74 The ITC ceased to operate in India on 30 June 1951, but WHO and UNICEF continued the enterprise on roughly the same lines.

75 Mahler, “Final Report on India BCG,” 36, India-BCG, FEP 30, 1955, Program Division, Asia Region, CF/RA/BX/PD/1962/T008, UNICEF Archives.

76 Mahler, “Quarterly Field Report, 1st Quarter, 1954,” India BCG Project, 23 Apr. 1954, India-BCG, FEP 30, 1955, Program Division, Asia Region, CF/RA/BX/PD/1962/T071, UNICEF Archives. UNICEF headquarters was aware of the potential dangers of anti-BCG sentiment. See United Nations Economic and Social Council, “India: Recommendation of the Executive Director for Continuation and Expansion of the BCG Anti-Tuberculosis Vaccination Campaign,” E/ICEF/L.597, 13 July 1954.

77 Mahler, “India BCG 2d Quarterly Field Report,” 11 Aug. 1954, India-BCG, FEP 30, 1954, Program Division, Asia Region, CF/RA/BX/PD/1962/T008, UNICEF Archives.

78 See Mahler, “India BCG Project, 3d Quarterly Report,” 1953, 20 Oct. 1953, India-BCG, FEP 30, 1954, Program Division, Asia Region, CF/RA/BX/PD/1962/T008, UNICEF Archives.

79 In a private letter, Raman described himself as “One, who has ruined one's own health in an attempt to serve People's Health….” A. V. Raman to C. Rajagopalachari, 15 Mar. 1951, Installment V, Correspondence with: People's Health, editor of, RP.

80 Poul Larsen, “Report on the Annual BCG Conference in India Held at Coimbatore on 13th November 1954, and the Inauguration of the Mass BCG Campaign in the State of Madras,” CF/RA/BX/PD/1962/T008, UNICEF Archives.

81 Mahler, “India BCG 4th Quarterly Field Report,” 20 Jan. 1955, India-BCG, FEP 30, 1954, Program Division, Asia Region, CF/RA/BX/PD/1962/T008, UNICEF Archives.

82 On public health campaigns as responses to crises, and thus not part of most Indians' experience, see Bhattacharya, Expunging Variola, 63.

83 “Minister Deplores Mass Hysteria against B.C.G.,” Indian Express, 20 Aug. 1955.

84 Rosenthal, A. M., “Indian Battles TB Vaccine Critic; Struggle May Affect Health Drive,” New York Times, 3 Sept. 1955: A3.

85 Poul Larsen to Brian Jones, 13 Sept. 1955, India-BCG, FEP 30, 1955, Program Division, Asia Region, CF/RA/BX/PD/1962/T008, UNICEF Archives.

86 Amrith, Decolonizing International Health, 141–42. For greater India figures see Poul Larsen to T. G. Davies, 17 Sept. 1955, India-BCG, FEP 30, 1955, Program Division, Asia Region, CF/RA/BX/PD/1962/T008, UNICEF Archives. For the precipitous decline in numbers caused by the anti-BCG forces, see also United Nations Economic and Social Council, “Recommendation to the Executive Director for an Allocation-India-BCG Anti-Tuberculosis Campaign,” E/ICEF/L.939, 29 Aug. 1956, UNICEF Archives.

87 I. N. Saxena to C. Rajagopalachari, 30 July 1955, Installment V, Subject File 135, RP.

88 “Rapport for the Third Quarter of 1955 for the Work in the BCG Campaign of India by Inger Mundt-Petersen, BCG-Nurse,” India-BCG, Program Division, Asia Region, CF/RA/BX/PD/1962/T008, UNICEF Archives.

89 [Illegible], Secretary of the Reddy Young Men's Association to Rajaji, 1 Aug. 1955, RP.

90 “Rapport for the Third Quarter of 1955.”

91 Benifrasad Bansal to Rajaji, 9 Aug. 1955, RP.

92 See M. Beddow-Bayly to Rajaji, 5 Dec. 1956, Installment V, Subject File 138, RP; M. Beddow-Bayly, “B.C.G. Vaccination Deflated,” Nov. 1956; idem, “B.C.G. Vaccination: Why You Should Wait Before Having Your Child Tested and Vaccinated,” Anti-Vivisection News, Apr. 1954. For news of Rajaji's movement in England see also “Sixtieth Annual Report of the National Anti-Vaccination League, Report for the Year 1955,” 13; and D. C. Desai to Rajaji, 6 Sept. 1955, Installment V, Subject File 135, RP. Though Desai was government inspector of railways in Bangalore he was also a member of the Anti-Vaccination League of London. Similar links with anti-vaccinationst bodies in Britain were forged in the first half of the twentieth century, when Indians opposed vaccinations against smallpox. See Bhattacharya, Harrison, and Worboys, Fractured States, 214–17.

93 Gandhi, Rajmohan, The Rajaji Story, 1937–1972 (Bombay: Bharatiya Vidya Bhavan, 1984), vol. 2, 258. The friendship between Raman and Rajagopalachari might also help to explain why Raman's opposition died down around the time Rajagopalachari assumed control of the Madras Government.

94 Lakshmanan, M., “Language and the Nationality Question in Tamil Nadu, 1938–42,” Indian Historical Review, 28, 1–2 (2001): 128–50; Washbrook, D. A., “Caste, Class and Dominance in Modern Tamil Nadu: Non-Brahmanism, Dravidianism and Tamil Nationalism,” in Frankel, F. R. and Rao, M.S.A., eds., Dominance and State Power in Modern India: Decline of a Social Order (Delhi: Oxford University Press, 1989), vol. I, 251. See also Hardgrave, Robert J. Jr., “The DMK and the Politics of Tamil Nationalism,” Pacific Affairs, 37, 4, (1964–1965): 398, 403; Barnett, Marguerite Ross, The Politics of Cultural Nationalism in South India (Princeton: Princeton University Press, 1976), 7780.

95 Hardgrave, “The DMK,” 406; Barnett, Politics of Cultural Nationalism, 243.

96 “Keeper of my conscience,” quoted from “The Wisest Man in India: Aspects of C. Rajagopalachari,” in Guha, Ramachandra, The Last Liberal and Other Essays (New Delhi: Permanent Black, 2004), 34. For his political life we have drawn on Rajmohan Gandhi, The Rajaji Story; and Copley, A.R.H., The Political Career of C Rajagopalachari, 1937–54: A Moralist in Politics (Madras: MacMillan Company of India, 1978).

97 Rajagopalachari to R. Amrit Kaur, 23 May 1952, Health Department, no. 1216, 1953, TNSA.

98 P. Parkash [sp?], M. A. to the B. Advocate to Rajaji, 9 Aug. 1955, Installment V, Subject File 136, RP.

99 P. Mohamed Ali, “Quarterly Field Report, 2d Quarter 1955,” 20 July 1955, India BCG Project, India-BCG, FEP 30, 1955, Program Division, Asia Region, CF/RA/BX/PD/1962/T008, UNICEF Archives. For Rajaji's embrace of English and other aspects of his modernity see Copley, Antony, “The Indo-British Encounter: Perspectives of an Indian Conservative,” 20th Century Studies 10 (Dec. 1973): 63, 60–75.

100 N. K. Iyengar, “B.C.G,” Statesman, 23 June 1955.

101 N. K. Iyengar to Rajaji, 2 July 1955, Installment V, Subject File 135, RP.

102 [Illegible] to Reverend Rajaji, 5 Sept. 1955, Installment V, Subject File 135, RP.

103 S. Soundararajan to Rajaji, 3 Aug. 1955, Installment V, Subject File 135, RP.

104 T. V. Subramanian to Rajaji, 30 July 1955, Installment V, Subject File 135, RP.

105 S. R. Srinivasa Raghavan to Rajaji, 6 Sept. 1955, Installment V, Subject File 135, RP.

106 Rajagopalachari to R. Amrit Kaur, 23 May 1952, Health Department, no. 1216, 1953, TNSA.

107 Rajkumari Amrit Kaur to Rajaji, 5 June 1952, Installment VI–XI, Subject File 28, RP.

108 Hindu, 8 May and 23 Nov. 1955.

109 Hindu, 8 May 1955. Again Raman, who leaned much more on Gandhian positions, did express some skepticism towards vaccination against smallpox. See People's Health 3, 5: 191.

110 As reported in Hindu, 17 May and 1 July 1955.

111 Rajagopalachari, C., B.C.G. Vaccination: Why I Oppose It (Madras: Jupiter Press, 1955), 6.

112 Ranganathan, K. S., “The Principles of B.C.G. Vaccination,” Indian Medical Forum (Feb. 1950): 5760; idem, “First Results of Mass Vaccination with B.C.G.,” Indian Medical Gazette (Feb. 1952): 62–69.

113 Hindu, 16 June 1955.

114 Hindu, 3 July 1955.

115 Hindu, 22 July 1955.

116 Hindu, 28 July 1955.

117 Hindu, 3 Aug. 1955.

118 The Truth about B.C.G: Why Government Have Launched a Mass Campaign (Director of Information and Publicity, Government of Madras, 1955).

119 Ibid., 7.

120 Truth about B.C.G., 8. Frimodt-Moller's statement from 3 August was printed in extenso as an appendix to the pamphlet; see 25–26.

121 Rajagopalachari, B.C.G. Vaccination, 9.

122 Truth about B.C.G., 9–10, wherein the following is cited: Palmer, Carroll E., “B.C.G. Vaccination and Tuberculin Allergy,” Lancet 259, 6715 (10 May 1952): 935940, see esp. 940.

123 Carroll E. Palmer, “Dr. Palmer on BCG,” Bulletin: Dedicated to the Prevention of Tuberculosis (Issued by the Tuberculosis Section, Directorate General of Health Services, Ministry of Health, Government of India, New Delhi) (Dec. 1956): 7; see also Truth about B.C.G., 8–9. For Rajaji's original use of Palmer, see B.C.G. Vaccination: Why I Oppose It, 25.

124 Resolution included in Dr. Ved Prakash Khanna to Rajaji, 10 Aug. 1955, Installment VI, Subject File 136. For an early example, see Vinayakarao Bapat, “B.C.G. Vaccination and Prevention of Tuberculosis According to Ayurveda,” pamphlet reprinted from Medical Digest, n.d., Installment VI–XI, Subject File 25, RP.

125 Croizer, Ralph C., “Medicine, Modernization, and Cultural Crisis in China and India,” Comparative Studies in Society and History 12, 3 (1970): 275–91.

126 A. B. Parisad to Rajaji, 12 Aug. 1955, Installment V, Subject File 136, RP.

127 Dr. T. R. Savan to Rajaji, 31 July 1955, Installment V, Subject File 135, RP.

128 Second quote: Rajaji to Rajkumari Amrit Kaur, 10 June 1955, Installment VI–XI, Subject File 28, RP.

129 “Efficacy of B.C.G.,” Hindu, 20 Aug. 1955; “Minister Deplores Mass Hysteria Against B.C.G.,” Indian Express, 20 Aug. 1955.

130 See the following documents: memo from A. B. Shetty, Madras Minister of Health to Rajaji, “Tuberuclosis-Report of Ill-Health of Two Children of Sri Virayya Servai … after B.C.G. Vaccination,” 12 Sept. 1955; Copy of D.O.H. No. H.3/19673/55, dated 24/8/55, from Municipal Health Officer, Madurai; memo from A. B. Shetty to Rajaji, “Tuberculosis—B.C.G. Vaccination—Alleged After Effects,” 10 Sept. 1955; “Copy of D. O. No. H3/39573/55 dated 15/8/55 from Dr. P. M. Rajaratnam, Municipal Health Officer, Madurai,” all in Installment VI–XI, Subject File 27, RP.

131 Prit Singh to Rajaji, 20 May 1955, Installment VI–XI, Subject File 26, RP; excerpt of same letter in B.C.G. Vaccination: Why I Oppose It, 39.

132 “Report of Suri Rizwan Ullah Siddiqi, Referred to the Director of Medical and Health Services, Vide His Letter No. 1014-16/C. dated 27th August, 1955”; Faizan Ullah Siddiqi to Rajaji, 15 and 20 Aug. 1955, all in Installments VI–XI, Subject File 27, RP. See also “U.P. Inquiry into B.C.G. Vaccination,” Sunday Statesmen, 4 Sept. 1955.

133 Rajagopalachari, B.C.G. Vaccination, 2.

134 Raghavan to Rajaji, 6 Sept. 1955, Installment V, Subject File 135, RP. See also Mazumdar, D. C., “Problem of Tuberculosis in India with Special Reference to B.C.G. Vaccination,” Journal of the Indian Medical Association 20, 6 (Mar. 1951): 220–23.

135 Johannes Holm, “Tuberculosis: A Problem of Different Races,” speech given at the Fourth Commonwealth Health and Tuberculosis Conference, 23 June 1955, WHO/TBC/Int./28, 3 Oct. 1955.

136 Rajkumari Amrit Kaur to Rajaji, 2 June 1955, Installment VI–XI, Subject File 28, RP.

137 Greenough, P., “Social Science and Immunization: New Possibilities and Projects,” Items: Social Science Research Council 52, 1 (1998): 19, 5.

138 Mark Nichter, “Vaccinations in the Third World: A Consideration of Community Demand”; and Greenough, Paul, “Global Immunization and Culture: Compliance and Resistance in Large-Scale Public Health Campaigns,” both in Social Science and Medicine 41, 5 (1995): 617–23, and 605–7, respectively.

139 Debabar Banerji, “Society, Health Problems, Modern Medicine, and Social Medicine: An Analysis of Their Interrelationship in a Crosscultural Context,” M.A. thesis, Cornell University, 1963.

140 P. Mohamed Ali, India B.C.G. Project, Third Quarterly Report, 30 Oct. 1955, India BCG, Program Division, Asia Region, CF/RA/BX/PD/1962/T008. P. Mohamed Ali, “India B.C.G. Project. Fourth Quarterly Report,” 20 Jan. 1956, CF/RA/BX/PD/1962/T033. See also Amrith, Decolonizing International Health.

141 Dr. Chabaud to H. E. Blatta Zaoude Belaineh, Ethiopian Minister of Health, 27 Mar. 1952, Ethiopia-BCG, 1952–1953, Program Division, Eastern Mediterranean Region, box CF/RA/BX/PD/1962/T022, UNICEF Archives.

Acknowledgments: Niels Brimnes wishes to express his gratitude to the Danish Research Council for the Humanities for supporting research trips to Geneva and Chennai in 2006, and for support toward a visit at the Institute of the History of Medicine, Johns Hopkins University, in 2007. He thanks the Institute staff for creating a pleasant and highly stimulating research environment in which early drafts of this paper were written and discussed. He also thanks Professor V. R. Muraleedharan, Indian Institute of Technology, Chennai, for his crucial and kind assistance in accessing relevant material in Chennai. He received valuable assistance from the Centre of Social Medicine and Community Health, Jawaharlal Nehru University during a visit to New Delhi in 2008, and he particularly wants to thank Dr. Rajib DasGupta for his assistance. Christian McMillen thanks the Center for Global Health at the University of Virginia for funding his research in the UNICEF, WHO, and Rajaji archives. At the Center, Joy Boissevain and Rebecca Dillingham deserve special thanks. Neeti Nair's guidance through much of modern Indian history has been invaluable. Finally, we both wish to thank the organizers of the conference “Foreign Aid: Projects and Policy in a Historical and Comparative Context,” held at Sandbjerg Estate, Aarhus University in October 2008, for providing the opportunity to present our arguments to an interested audience.

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