P.N. Shrestha, ‘History of Smallpox’, Journal of the Nepal Medical Association, 10, 2 (1972), 107–11. Dr Purushottam Narayan Shrestha was medical officer-in-charge of Nepal’s Smallpox Eradication Project. Nepali uses the Devanagari script. Spelling of Nepali names using the Roman script varies; in this article I will mostly use the version given by the author in the specified source.
Daniel Wright, History of Nepal (New Delhi: Rupa & Co, 2007 ), 53 and 266. While in Kathmandu Wright collected documents and took many back to Britain. The Vansāvalı̄, or Genealogical History of Nepal, according to the Buddhist recension, was translated by Munshi Shew Shunker Singh and Pandit Shri Gunanand. Also see: John Whelpton, ‘A Reading Guide to Nepalese History’, Himalaya, the Journal of the Association for Nepal and Himalayan Studies, 25, 1 (2005), Article 5.
See, for example, Donald R. Hopkins, The Greatest Killer: Smallpox in History (Chicago and London: University of Chicago Press, 2002), 150.
Henry Ambrose Oldfield, Sketches from Nipal (London: W.H. Allen, 1880), Vol. 1, 253–4. Oldfield was Residency Surgeon at the time.
Alfred W. Crosby, ‘Smallpox’, in Kenneth F. Kiple (ed.) The Cambridge World History of Human Disease (Cambridge: Cambridge University Press, 1993), 1008–13. [Online]. The Cambridge World History of Human Disease. Available from: Cambridge Histories Online doi:10.1017/CHOL9780521332866.190 (Accessed 22 June 2016).
Arnold, David, Science, Technology and Medicine in Colonial India (Cambridge: Cambridge University Press, 2000), 71.
Packard, Randall M., A History of Global Health: Interventions into the Lives of Other Peoples (Baltimore: Johns Hopkins University Press, 2016).
Paul R. Greenough, ‘Variolation and Vaccination in South Asia, c. 1700–1865: A Preliminary Note’, Social Science & Medicine, 14D (1980), 345–7.
Ibid., 346; Niels Brimnes, ‘Variolation, Vaccination and Popular Resistance in Early Colonial South India’, Medical History, 48, 2 (2004), 199–228. Edward Jenner published his results using cowpox in 1798. For the worldwide dissemination of the vaccine within a few years, although not to Japan, see Ann Jannetta, The Vaccinators: Smallpox, Medical Knowledge, and the ‘Opening’ of Japan (Stanford, California: Stanford University Press, 2007), 34–52.
Andrea Rusnock, ‘Catching Cowpox: The Early Spread of Smallpox Vaccination, 1798–1810’, Bulletin of the History of Medicine, 83 (2009), 17–36.
Sanjoy Bhattacharya and Niels Brimnes, ‘Introduction: Simultaneously Global and Local: Reassessing Smallpox Vaccination and Its Spread, 1789–1900’, Bulletin of the History of Medicine, 83, 1 (2009), 1–16.
Hopkins, op. cit. (note 3), xiv.
Bhattacharya, Sanjoy, ‘International Health and the Limits of its Global Influence: Bhutan and the Worldwide Smallpox Eradication Programme’, Medical History, 57, 4 (2013), 461–486.
Sanjoy Bhattacharya, Expunging Variola: The Control and Eradication of Smallpox in India 1947–77 (New Delhi: Orient Longman, 2006), 1. Randall Packard’s recent overview of the history of global health also emphasises continuities. Packard, op. cit. (note 7).
Letters to India 1816. IOR/R/5/37 and IOR/R/5/38. British Library, India Office Records (hereafter IOR) R/5 Nepal: Kathmandu Residency Records c1792–1872. Fort William was headquarters of the Bengal Presidency. Wright’s spelling of Gardner as Gardiner is incorrect, op. cit. (note 2), 53. He should also not be confused with Lieutenant-Colonel Gardner – his cousin William.
F/4 Board of Control Records 1784–1858. IOR/F/4/550/13379.
Fisher, Michael H., Indirect Rule in India: Residents and the Residency System 1764–1857 (Delhi: Oxford University Press, 1991), 172.
Nicholas B. Dirks, The Hollow Crown: Ethnohistory of an Indian Kingdom (Cambridge: Cambridge University Press, 1987). For more nuanced interpretations, see C.A. Bayly, Empire & Information: Intelligence Gathering and Social Communication in India, 1780–1870 (Cambridge: Cambridge University Press, 1996) and Tony Ballantyne, ‘Colonial knowledge’, in Sarah Stockwell (ed.) The British Empire: Themes and Perspectives (Malden and Oxford: Blackwell, 2008), 177–97.
Much of Nepal shares a border with India. Endeavouring to take advantage of a political factional dispute in Nepal, the East India Company had concluded a commercial treaty with the government of Nepal in 1801. Captain William Knox was appointed Resident but the treaty proved unworkable and Knox withdrew in 1803. Only after 1816 was the relationship permanent.
Christine Holmberg, Stuart Blume and Paul Greenough (eds), The Politics of Vaccination: A Global History (Manchester: Manchester University Press, 2017). I am grateful to Paul Greenough for letting me read a draft of his chapter.
The country’s foreign policy later became closely aligned with that of British India.
Daniel R. Headrick, ‘The Tools of Imperialism: Technology and the Expansion of European Colonial Empires in the Nineteenth Century’, Journal of Modern History, 51, 2 (1979), 231–63.
Sanjoy Bhattacharya, Mark Harrison and Michael Worboys, Fractured States: Smallpox, Public Health and Vaccination Policy in British India (New Delhi: Orient Longman, 2005); Brimnes, op. cit. (note 9), 199–228. For a reassessment of the introduction and spread of smallpox vaccination 1789–1900, see a special issue, edited by Bhattacharya and Brimnes, of the Bulletin of the History of Medicine, 83, 1 (2009). Harish Naraindas suggests another interpretation: in the transition from variolation to vaccination the narrative changed from a therapeutic mode and individual care to that of prophylaxis. Harish Naraindas, ‘Care, Welfare, and Treason: The Advent of Vaccination in the 19th Century’, Contributions to Indian Sociology 32, 1 (1998), 67–96.
See, for example, Ludwig F. Stiller, S.J., The Rise of the House of Gorkha (Kathmandu: Educational Publishing House, 2017).
Although the Nepalese denied the Resident direct access to the king, Gardner was able to gather information from sources within the court.
Gardner to Adam, 17 December. IOR/R/5/38.
Key officials held land in the productive Tarai. For the vital economic significance of this region to Nepal and the desire of the Governor-General to have a defined and stable boundary, see Ludwig Stiller, S.J., The Silent Cry: The People of Nepal: 1816–39 (Kathmandu: Sahayogi Prakashan, 1976). Misra was also a signatory of the Treaty of Sagauli.
See both ibid.and Stiller, op. cit. (note 24).
Robert M. Worth and Narayan K. Shah, Nepal Health Survey 1965–66 (Honolulu: University of Hawaii Press, 1969), 70–1. This was the first national health survey.
P.N. Shrestha, D.A. Robinson and J. Friedman, ‘The Nepal Smallpox Eradication Programme: Description and Analysis’, World Health Organization, 1977, SME/77.1, 20; F. Fenner, D.A. Henderson, I. Arita, Z. Jezek and I.D. Ladnyi, Smallpox and Its Eradication (Geneva: World Health Organization, 1988), 792.
Greenough, op. cit. (note 8), 345. This also applies more widely within the history of medicine.
B.S. Cohn, Colonialism and Its Forms of Knowledge: The British in India (Princeton: Princeton University Press, 1996). Also see Ballantyne, op. cit. (note 18) and Bayly, op. cit. (note 18). Bayly concluded (p. 113) that as Britain watched Nepal ‘Nepal was equally sagacious in its careful surveillance of the British and in promoting an information order which opened outward, but not inward’. Lauren Minsky, however, discusses the biases of colonial archives and popular sources – why the lower classes are unrepresented and elite versions unquestioned and so looks to other ways to investigate smallpox ideas and practices. Lauren Minsky, ‘Pursuing Protection from Disease: The Making of Smallpox Prophylactic Practice in Colonial Punjab’, Bulletin of the History of Medicine, 83, 1 (2009), 164–90.
Arnold, David, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley, Los Angeles and London: University of California Press, 1993), 117.
Raj, Yogesh and Onta, Pratyoush, The State of History Education and Research in Nepal (Kathmandu: Martin Chautari, 2014).
Stiller, op. cit. (note 27).
Ibid.; Mahesh C. Regmi, Landownership in Nepal (Berkeley, Los Angeles and London: University of California Press, 1976).
Stiller, op. cit. (note 27), 32.
Brimnes, op. cit. (note 9), 199; Richard Burghart, ‘The Formation of the Concept of Nation-State in Nepal’, Journal of Asian Studies, 44, 1 (1984), 101–25. Elite families employed tutors. Wright, op. cit. (note 2), 31. State responses to vaccination were varied; in Japan, physicians who knew Western medicine became the primary disseminators. Bhattacharya and Brimnes, op. cit. (note 11).
While leading families often had their own ‘baids, or medical men’, no services existed for the poorer classes. Wright, op. cit. (note 2), 44.
That the situation was changing is evident after the great earthquake of 1934, when concern for the threat of epidemics led to vaccine being imported from other countries. Brahma Shumsher Jung Bahadur Rana, The Great Earthquake in Nepal (1934 A.D.), trans. by Kesar Lall, (Kathmandu: Ratna Pustak Bandar, 2013). First published in Nepali in 1934, the author was Director of Hospital Management; but as he was also a member of the elite ruling Ranas, Yogesh Raj urges caution. Yogesh Raj, ‘Management of the Relief and Reconstruction after the Great Earthquake of 1934’, Studies in Nepali History and Society, 20, 2 (2015), 375–422.
Raj, Yogesh, Aryal, Deepak and Mishra, Shamik, ‘Documents Related to the Early Hospitals in Nepal’, Studies in Nepali History and Society, 21, 2 (2016), 347–400.
Stiller, op. cit. (note 24).
Oldfield, op. cit. (note 4), 8–11.
Stiller, op. cit. (note 27), 34–8. The service reached both eastern and western borders.
Oldfield, op. cit. (note 4), 11.
Oldfield, op. cit. (note 4), 47.
Wright, op. cit. (note 2), 3.
Colonel Kirkpatrick, An Account of the Kingdom of Nepaul being the substance of observations made during a Mission to that country in the year 1793 (New Delhi: Manjusri Publishing House, 1969), 4 and 1.
Ibid., 101. The Kathmandu Valley was often referred to as ‘Nepaul proper’.
Bephen (Purbutti), Tou Ryê (Newar). Ibid., 238.
Shrestha, op. cit. (note 1), 108.
ESCAP, Population of Nepal. Country Monograph Series No. 6 (Bangkok: United Nations, 1980), 11. This report draws on Nepali-language documents. Early British enumerations of the population of Nepal are considered unreliable.
Kirkpatrick, op. cit. (note 51), 160.
Worth and Shah, op. cit. (note 29).
Baburam Acharya, ‘King Prithvi Narayan Shah’. Regmi Research Series (Kathmandu), 8, 8 (1976), 154.
See Minsky, op. cit. (note 32).
Smallpox Epidemic in Chisapani, royal order to Subedar Antya Khawzas and Subedar Niranja. Regmi Research Series (Kathmandu), 20, 11 (1988), 160. In the Nepali calendar this is shown as 1862.
Population of Kathmandu Valley, 1856. Regmi Research Series (Kathmandu), 2, 5 (1970), 117–8. Today the city is known as Bhaktapur.
Report on Routes by Explorer Hari Ram, Records of the Survey of India8 (Dehra Dun: Survey of India, 1915), part 2, 386.
Shrestha, Robinson and Friedman, op. cit. (note 30), 10.
After unification of Nepal, the Newar were a conquered people.
This limited knowledge would change. For the scholarly contribution of Brian Houghton Hodgson, see David M. Waterhouse (ed.), The Origins of Himalayan Studies: Brian Houghton Hodgson in Nepal and Darjeeling 1820–58 (London and New York: RoutledgeCurzon, 2004).
Kirkpatrick, op. cit. (note 51), 183–4. I would like to thank one of my anonymous reviewers for this comment.
K.L. Pradhan, Brian Hodgson at the Kathmandu Residency, 1825–43 (Delhi: Spectrum Publications, 2001), 8.
Shrestha, op. cit. (note 1), 109.
Oldfield, op. cit. (note 4), 186. The Newar had a well-established caste system.
Tax Exemption (Ashadh Badi 9, 1887) . Regmi Research Series (Kathmandu), 7, 2 (1975), 26. The name Vaidyasuggests he was a practitioner of Ayurvedic medicine.
21 September. IOR/F/4/550/13379. Later accounts suggest that some cultural resistance to vaccination existed among some groups, notably the Newar.
Minsky, op. cit. (note 32), 185.
Oldfield, op. cit. (note 4), 253. Such influence probably reflected Jang Bahadur’s powerful position – more powerful than that of Bhimsen Thapa in 1816.
No mention is made of the vaccination status of Gurkha troops recruited and employed by the East India Company.
Interviews undertaken by the author in the Newar town of Kirtipur, May 2017.
Oldfield, op. cit. (note 4), 285–6. Brahman astrologers, reflecting many people’s unhappiness with the socially unacceptable relationship between Girvana’s parents, spread a rumour that their child would die of smallpox. Chittaranjan Nepali, ‘Reign and Abdication of King Rana Bahadur Shah’. Regmi Research Series (Kathmandu), 3, 1 (1971), 8.
This supports the view that Sitala was more than a village/folk deity. Fabrizio M. Ferrari, Religion, Devotion and Medicine in North India: The Healing Power of Śı̄talā (London: Bloomsbury, 2015), xx.
Minsky, op. cit. (note 32), 171.
Field Visit Report on Smallpox Control Pilot Project, Nepal WHO Project: Nepal 9 by Dr A. Zahra, Regional Adviser in Communicable Diseases, 23–6 May 1962. SEA/Smallpox/4. 10 August 1962.
Vaccination continued to be offered at the British Residency.
Fisher, op. cit. (note 17), 414–22. The origins of the residency system in India lay in the rapid expansion of the Company’s activities in India with the first resident appointed in 1764.
After the fall of Bhimsen Thapa in 1837 political factions divided the Nepal court even more than usual, enabling the Resident Brian Hodgson to acquire a greater influence, albeit without the full support of the Company. Hodgson was recalled in 1843. In a treaty in 1923 Britain formally recognised Nepal’s independence.
Whelpton, John, A History of Nepal (Cambridge: Cambridge University Press, 2005), 1.
Ibid., 37. See also: Bernardo A. Michael, Statemaking and Territory in South Asia: Lessons from the Anglo-Gorkha War (1814–16) (London and New York: Anthem Press, 2012).
Stiller, op. cit. (note 24), 330–2.
H.T. Prinsep, History of the Political and Military Transactions in India during the Administration of the Marquess of Hastings, 1813–23 (London, 1825), 1, 133. Quoted in Sir Penderel Moon, The British Conquest and Dominion of India (London: Duckworth, 1990), 377.
Stiller, op. cit. (note 27), 100.
Fisher, op. cit. (note 17), 415.
Bayly, op. cit. (note 18), 108–13.
16 March 1816, Enclosure No. 14 Governor-General’s Minute, Papers respecting the Nepaul War, 964. East India Company, Papers regarding the Administration of the Marquis of Hastings in India (London: J.L. Cox, 1824), Papers respecting the Nepaul War, 972. In these letters he is referred to as Lord Moira (the Earl of Moira), but in December 1816 he became the first Marquis of Hastings, by which name he is better known.
17 July. IOR/F/4/550/13379.
P.N. Shrestha, ‘Smallpox Eradication in Nepal’, 9. WHO/SE/78.107.
Brimnes, op. cit. (note 9).
Ibid. In Britain opposition to vaccination occurred from the beginning.
Fisher, op. cit. (note 17), 207.
Arnold, op. cit. (note 33), 134.
Gardner to Adam, 17 July. IOR/F/4/550/13379. Gardner often used the terms ‘vaccination’ and ‘inoculation’ interchangeably, rather than using ‘inoculation’ to refer to ‘variolation’. The overlap in form and method between variolation with variola crusts and vaccination with vaccinia crusts also helps explain Gardner’s use of the term ‘inoculation’ to refer to both variolation and vaccination.
Near Patna, in Bihar state, was the military station of Dinapore – the closest senior British station to Kathmandu. Patna was a staging post for communications with Calcutta. Waterhouse, op. cit. (note 67), 3. Although Gardner refers to Everest as Surgeon, his rank was Assistant Surgeon.
Gardner to Adam, 17 July. IOR/F/4/550/13379.
Adam to Peter Cochrane, President, and Members of the Medical Board, 3 August. IOR/F/4/550/13379.
Robert Leny to Adam, 7 August. IOR/F/4/550/13379.
Gardner to Leny, 14 September. Misc letters sent June 1816–March 1817. IOR/R/5/112.
Crosby, op. cit. (note 5), 1012.
14 September. IOR/R/5/112. Distant Banepa was Bhimsen Thapa’s choice.
Gardner to Adam, 25 September. IOR/R/5/37.
Today we talk about ‘vaccine hesitancy’.
Gardner to Adam, 17 July. IOR/F/4/550/13379.
Gardner to Adam, 2 November. IOR/R/5/38.
Ibid. At this time the need for revaccination, which became part of the later protocols, was not recognised.
Gardner to Adam. IOR/R/5/38.
Ibid. The young prince was three years old.
Fisher, op. cit. (note 17), 65.
Gardner to Adam, 18 November. IOR/R/5/38.
Gardner to Adam, 20 November. IOR/R/5/38. This was the news referred to by Shrestha at the beginning of this article and in other accounts.
Stiller, op. cit. (note 27), 252.
Gardner to Adam, 17 December. IOR/R/5/38.
Stiller, op. cit. (note 27), 276.
See, for example, Ian Harper, Development and Public Health in the Himalaya: Reflections on Healing in Contemporary Nepal (London and New York: Routledge, 2014). For an overview, however, of the historical development of Nepal’s health services, see Hemang Dixit, Nepal’s Quest for Health, 4th edn (Kathmandu: Educational Publishing House, 2014).
Bhattacharya, op. cit. (note 13), 461.
After the king’s death on 20 November the Resident’s letters did not refer to vaccination or any extension of activities. The Company file about the introduction of vaccination into Nepal also ceased and the documents were forwarded to London. They are to be found in the Company’s political files, attesting to their significance in the political environment of the time.
The Residency of Hodgson (1833–43) was an exception. The ongoing supply of troops for the army became a key aspect of Britain’s relationship with Nepal. See Asad Husain, British India’s Relations with the Kingdom of Nepal 1857–1947: A Diplomatic History of Nepal (London: George Allen and Unwin, 1970).
Oldfield, op. cit. (note 4), 253–4.
G.H.D. Gimlette, Nepal and the Nepalese (London: H.F. & G. Witherby, 1928), 155.
Babu Ram Marasini, ‘Health and Hospital Development in Nepal: Past and Present’, Journal of Nepal Medical Association, 42 (2003), 306–11; Dixit, op. cit. (note 127).
Perceval Landon, Nepal, (New Delhi: Asian Educational Services, 1993 ), Vol. 2, 184.
Raj, Aryal and Mishra, op. cit. (note 43). These small institutions were often situated where there were leading government officials.
Erez Manela, ‘A Pox on Your Narrative: Writing Disease Control into Cold War History’, Diplomatic History, 34, 2 (2010), 299–323.
Eugene Bramer Mihaly, Foreign Aid and Politics in Nepal: A Case Study, 2nd edn (Lalitpur, Nepal: Himal Books, 2002 ), 204–7.
Ludwig F. Stiller and Ram Prakash Yadav, Planning for People ([Kathmandu], Nepal: Human Resources Development Research Center, 1993).
Shrestha, Robinson and Friedman, op. cit. (note 30), 17. In 1962 a joint Nepal Government/WHO smallpox-control pilot project began in the Kathmandu Valley.
Hopkins, op. cit. (note 3), 305. Four of these were in Asia and two in Africa.
Fenner et al. op. cit. (note 30), 715.
Henderson, D.A., Smallpox: The Death of a Disease: The Inside Story of Eradicating a Worldwide Killer (New York: Prometheus Books, 2009), 185.
Packard, op. cit. (note 7).