The state of vaccination: British doctors, indigenous cooperation, and the fight against smallpox in colonial Burma

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THE STATE OF VACCINATION: BRITISH DOCTORS, INDIGENOUS COOPERATION, AND THE FIGHT AGAINST SMALLPOX IN COLONIAL BURMA

by

Atsuko Naono

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (History) in The University of Michigan 2005

Doctoral Committee: Professor Victor B. Lieberman, Chair Professor Rudolf Mrazek Professor Joel D. Howell Associate Professor Hitomi Tonomura

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UMI N um ber: 3192737

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©Atsuko Naono All Rights Reserved

2005

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To my parents

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TABLE OF CONTENTS DEDICATION

ii

LIST OF FIGURES

vi

LIST OF TABLES

vii

LIST OF APPENDICES

viii

CHAPTER ONE. INTRODUCTION

1

The Emergence of Vaccination

3

Imperial Medicine

10

Imperialism and Indigenous Medicine

17

Structure of Dissertation

24

TWO. A DISTANT CORNER OF THE EMPIRE: SPREADING THE VACCINIA VIRUS TO 1902

27

Transporting Lymph

28

Towards a Solution for Inter-provincial Transport: A Supply in Burma

39

Cow-to-Arm Vaccination

48

Cattle Availability for Lymph Manufacture

53

Conclusion

60

THREE. THE EMERGENCE OF THE MEIKTILA VACCINE ESTABLISHMENT, 1902-1933 Railways in Burma

62 63

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Establishing Local Depots

68

A Central Depot at Meiktila

73

Lymph Preservation

75

Conclusion

88

FOUR. VACCINATORS

91

Vaccination Department

92

Early Indigenization of Vaccination Staff

101

Supervision

110

Systematic Training

119

Conclusion

124

FIVE. INOCULATORS & INOCULATION: THE INDIGENOUS OBSTACLE

127

Inoculation

128

Ignorance and Distrust

134

Conversion

148

Persecution and Legislation

155

Conclusion

161

SIX. COMMUNICATING DISEASE: PROPAGANDA AND THE VACCINATION EFFORT Hearts and Minds

163 166

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Missionaries, Languages, and Minorities

173

Mason and his Medical Book

178

Medicine, Language, and Treatises

185

Conclusion

201

SEVEN. LEGISLATION

203

The Pursuit of Legal Authority

204

Municipal and Popular Resistance

227

Conclusion

240

EIGHT. CONCLUSION

242

APPENDICES

253

BIBLIOGRAPHY

267

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LIST OF FIGURES

Figure

Page

1. Map Showing the Major Rail Linkages in the Colonial Period

65

2. Map Showing the Centers for the Local Production of Calf Lymph in Burma during the Colonial Period

71

3. Map Showing the Extension of the Vaccination Act, 1880, to Municipalities, Towns, and Cantonments as of 13 March 1891

215

4. Map Showing the Extension of the Vaccination Act, 1880, to Additional Municipalities, Towns, and Cantonments from 14 May 1891 to 1900

216

5. Map Showing the Extension of the Vaccination Act, 1880, to Additional Municipalities, Towns, and Cantonments after 1900

217

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LIST OF TABLES

Table

Page

1. Directors and Superintendents of the Meiktila Vaccine Depot, 19021922

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2. Vaccination Operations, 1901 -1922

87

3. Vaccination Staff During the First Decade of Operations, 1867-1877

97

4. Vaccine Establishment, 1898-1925

113

5. Vaccination Instruction at the Meiktila Vaccine Depot and Training School, from May 1906 to 1923

122

6. Vaccination Instruction at the Meiktila Vaccine Depot and Training School, from May 1923 to 1935

124

7. Deaths From Smallpox in Burma, 1891-1920

219

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LIST OF APPENDICES

Appendix

Page

1. Burma Prohibition of Inoculation and Licensing of Vaccinators Act, 1908 (Burma Act 6 of 1908)

253

2. Original Burmese text for the Vaccination entry into Mason’s Materia Medica

259

3. Hsaya Tout’s entry for Vaccination

261

4. Nisbet’s 1869 Treatise on Vaccination

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CHAPTER ONE INTRODUCTION

There has been, and is, a plague of smallpox amongst the children of Mandalay. Few are vaccinated, and the weather is too hot to allow of its being properly done now, so that death after death occurs. What a terribly loathsome disease it is; it looks as though every part of the body is rotten and corrupt, and could never be sound again. I think English-anti-vaccinationists need only step over to Burmah to be convinced of the general utility of vaccination.1

James A. Colbeck, Mandalay, June 1879

In May 1833, after John Taylor Jones arrived in Bangkok, he wrote a letter to Reverend L. Bolles of the Board of the American Baptist Mission in Boston. Taylor related the terrible ordeal his family had experienced in Burma due to Smallpox and urged others to submit to proper vaccination before coming to Burma. Jones’ child had already been vaccinated twice previously in Maulmein and Singapore, but unsuccessfully in both cases. Jones had also been vaccinated twice elsewhere. Apparently, he believed that 1 George H. Colbeck (ed.), Letters from Mandalay: A Series o f Letters by the Late James Alfred Colbeck (London: Alfred W. Lowe, 1882): p. 35.

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vaccination had been a failure in his case as well, for he decided to have himself, as well as his child and his wife, inoculated in order to escape the ravages promised by Smallpox which was then raging in Bangkok. There was simply no alternative, for vaccination was not available in Bangkok and because it is known that one will develop smallpox in a ■j

much milder way than catching it naturally. Taylor was reacting in the only way he could to the harsh medical reality 06 life for Americans and Europeans in Southeast Asia in the 1830s: the unavailability of vaccination (the insertion of Cowpox matter), seemingly uncontrollable epidemics of Smallpox, and the availability of the indigenous practice o f inoculation (the direct insertion of Smallpox virus matter). The imperial vaccination project in Burma, and elsewhere in Southeast Asia would focus on these three conditions for the remainder of the colonial period. This dissertation examines the introduction of vaccination, the fight against inoculation, and the eradication of Smallpox among the indigenous population of British Burma from the nineteenth century to the beginning of the twentieth century. The British vaccination effort,

in the end, created an increasingly

complex

Vaccination

administration that was both top-heavy and frustrated by the pursuit of an elusive, invisible enemy. Ultimately, by the end of colonial rule, this struggle to convince the indigenous population to voluntarily accept vaccination failed and depended more upon laws and punishment than on any indigenous acceptance of the ‘gift’ of vaccination. The colonial commitment to vaccination had developed out of dogged competition with both inoculators and the anti-vaccination movement in Britain. When vaccination was introduced into Southeast Asia, imperial medical men thus brought with

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them a long heritage o f extensive debates over the efficacy of vaccination, the problems of inoculation, and a kind of over-confidence, almost a zealousness, that vaccination was the superior method for fighting Smallpox. To these men, it was irrelevant whether or not the indigenous population would recognize the efficacy of vaccination when it was introduced by colonial governments in Burma and elsewhere. Some believed that this recognition would be forthcoming, while others did not. However, whatever the indigenous reaction, they would be vaccinated. There was no time to wait for the development of a general consensus among the indigenous population that vaccination was a positive step toward fighting Smallpox. Indeed, anti-vaccinationists at home in Britain continued to oppose the operation until the end of the nineteenth century and beyond. Instead, the colonial medical establishment would focus its energies on carrying out vaccination on the indigenous population without the latter’s assent. This would prove to be a major problem, for the colonial doctors and the indigenous population did not share a prior text concerning the Smallpox debates and would continue to confuse the operations the differences between them that appeared so clear to imperial doctors.

The Emergence of Vaccination

Vaccination was first ‘discovered’ in 1798 by Edward Jenner in Britain. Jenner had come across local accounts of how those who handled cows and were thus exposed to cowpox had demonstrated a degree of immunity to the human Smallpox virus. After conducting his own experiments and successfully vaccinated a patient, Jenner published his findings 2

Letter from John Taylor Jones to the Reverend L. Bolles, 30 May 1833, Bangkok m American Baptist Missionary Magazine 16.6 (1836): p. 300.

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and was hailed as many as the innovator of this preventative operation. However, Jenner’s real contribution was in using the scientific method to demonstrate that vaccination worked at. The print revolution discussed by Benedict Anderson in his Imagined Communities in the context of the spread of ideas of nationalism, helped make Jenner’s discovery accessible to readers around the world. Within a few years, Jenner’s book was translated into at least six other European languages, including Dutch, French, German, Italian, Spanish, and the language of European science and medicine at that time, Latin.3 James Bryce, who was an early advocate of vaccination, congratulated its apparently quick success as follows:

Nor is it to the inhabitant of Britain alone, that the advantages arising from the inoculation of cowpox [i.e. vaccination] are confined; in the sister kingdom it had also been practiced with equal success; from France likewise, from Germany, Holland, America, the West Indies, & c.& c. reports are daily arriving, proclaiming the efficacy of cowpox as a sure preventive of smallpox, and pronouncing blessings on the head of the thrice happy Jenner.4

However, alongside praise, the adaptation of vaccination using cowpox matter met early opposition in Britain. There was also opposition to vaccination due to its usage of animal lymph. The fear and disgust at the insertion of a non-human object into the human body was expressed in various ways, especially in caricatures and pamphlets. Some medical

3 Donald Hopkins, The Greatest Killer: Smallpox in History, With a New Introduction (Chicago and London: The University o f Chicago Press, 2002): p. 81. 4 James Bryce, Practical Observations on the Inoculation o f Cowpox (Edinburgh, 1802): p. 13.

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doctors even published a treatise which included some illustrations of “a cow-poxed, ox­ faced boy” and emphasized that vaccination with cowpox matter produced a disease in humans which belonged commonly to cattle.5 The cowpox vaccines which were used in the initial period o f vaccination efforts also caused Smallpox cases that killed some recipients and thus hurt the image of the safety of the vaccination operation. Dr. Woodville, who was the head of the Smallpox and Inoculation Hospital in London, was opposed to the introduction of vaccination because his experiments in vaccination upon five hundred patients had resulted in general failure.6 However, Peter Razzell argues that this failure was due to Woodville’s mismanagement, for he had accidentally contaminated all of the early strains of cowpox in his samples with Smallpox, thus leading to an outbreak o f severe cases of natural Smallpox.7 Due to this misfortune, the reputation of Jenner’s vaccination of cowpox matter suffered, driving him from London to Berkeley to seek out a more receptive audience. A more serious challenge to Jennerian vaccination, however, came from inoculation. By the time that vaccination was introduced, the method of direct inoculation using Smallpox matter had already acquired significant popular trust because it was also

5 The History o f Inoculation and Vaccination fo r the Prevention and Treatment o f Disease, p. 85. 6 Dr. William Woodville stated in Reports o f a Series o f Inoculations fo r the Variolce Vaccince or Cowpox, with Remarks and Observations on this Disease, Considered as a Substitute fo r the Smallpox (1799): p.149: “But, it must be acknowledged, that in several instances the cowpox has proved a very severe disease; in three or four cases out o f five hundred, the patients has been in considerable danger, and one child, as I already observed, actually died under the effect o f the disease. Now, if it be admitted that at an average one in five hundred will die o f the inoculated cowpox, I should not be disposed to introduce this disease into the inoculation hospital, because, out o f the last five thousand cases o f variolous inoculation, the number o f deaths has not been exceeded one in six hundred.” Cited in Bryce, Practical Observations on the Inoculation o f Cowpox, pp. 42-3. 7 Peter Razzell, Edward Jenner’s Cowpox Vaccine: The History o f a Medical Myth (Sussex: Caliban Books, 1977): p. 15.

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undergoing scientific analysis and also benefited from technical improvements that made it a viable competitor with vaccination at that time. The depth of incision made to introduce the Smallpox virus into the patient was found to determine the severity of negative symptoms associated with the treatment. Previously, British inoculators had made a deep incision into the dermis to apply the Smallpox matter. Razzell suggests two reasons for this: ( 1) the concern that a slight (not a deep) incision would not produce an effective form of Smallpox and thus not lead to immunity and (2) the belief in humoral theory, in which the ‘seeds’ of the disease “had to be expressed through the eruption of o

smallpox” before one acquired good health. Robert Sutton, however, abandoned the method of cutting deeply into the dermis in favor of a slight cut for the introduction of viral matter:

[he used] a lancet charged with the smallest possible quantity of the unripe, crude or watery matter from the pustules, and then insert it under the cuticle obliquely in the outer part of the arm, between the scarf and the true skin, barely sufficient to draw blood and not deeper than the sixteen part of an inch.9

8 Peter Razzell, The Conquest o f Smallpox: The Impact o f Inoculation on Smallpox Mortality in Eighteenth Century Britain (Sussex: Newhaven Press, 1977): p. 6. 9 The History o f Inoculation and Vaccination fo r the Prevention and Treatment o f Disease. Lecture Memoranda. XVIIth International Congress o f Medicine, London (London: Burroughs Wellcoms & Company, 1913): p. 48.

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Since this method was proved to give permanent immunity and only produced a very mild form of Smallpox, many inoculators began to adhere to this practice. According to Donald Hopkins, Sutton initiated some public health measures by recommending in some cases the isolation of inoculation recipients from others while they recovered from the disease and insisting in other cases that everyone in the same community should undergo inoculation at the same time as a group.10 Sutton’s new methodology was apparently successful. The Sutton brothers soon claimed to have inoculated forty thousand patients causing only five deaths.11 Despite all of these difficulties, Jenner’s connections with Britain’s elite led to official acceptance and the British government began to promote the advancement of Jennerian vaccination. The British Parliament decided to grant ten thousand pounds to Jenner in 1801. Jenner came back to London and founded a Jennerian Institution, with royal support: the queen became a patron and the king bestowed on the institution the title of “The Royal Jennerian Society for the Termination of the Smallpox.”12 This institution was crucial to extending vaccination to the general population, at home and abroad:

Thirteen stations were opened in London, and in eighteen months they announced that 12,288 inoculations [with cowpox matter, hence really

10 Hopkins, The Greatest Killer, p. 59. 11 Hopkins, The Greatest Killer, p. 60. 12 The History o f Inoculation and Vaccination fo r the Prevention and Treatment o f Disease, p. 83.

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vaccination] had taken place, and 19, 352 charges of cowpox virus had been supplied to different parts of British Empire and foreign countries.13

Although this institution failed after a few years, the British government once again came to Jenner’s aid and maintained its commitment to the promotion of Jennerian cowpox vaccination. In 1806, the House of Commons again reviewed Jenner’s contribution and decided to grant him another twenty thousand pounds. It also asked Jenner to establish another institution which would succeed the Royal Jennerian Society.14 The importance o f this event is that the government took the initiative to determine which prophylactic methods should be used despite the opposition of some medical authorities and the anti-vaccinationists in general. The debate on the efficacy of vaccination, however, continued throughout the nineteenth century in metropolitan Britain. There were many publications by medical men who tried to disprove the efficacy of Jennerian vaccination. Dr. Charles T. Pearce, for example, claimed that the practice of vaccination was ‘a mockery’ since:

lymph taken from the cow has passed by transference from subject to subject possibly ten thousand times....It is likely that at our national vaccine stations,

13 The History o f Inoculation and Vaccination fo r the Prevention and Treatment o f Disease, p. 83. 14 The History o f Inoculation and Vaccination fo r the Prevention and Treatment o f Disease, p. 89.

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where no fresh supply of lymph has been procured for perhaps twenty or thirty years, vaccination is efficiently performed?15

Pearce also cited many reports by contemporary medical men who had witnessed those cases in which vaccination became fatal to their patients or produced severe symptoms. Further, vaccination promised lifetime immunity and this had been proved wrong. Robert Grosvenor, for example, who had been vaccinated ten years earlier by Jenner, developed Smallpox. Although Jenner attended him until he recovered from this severe attack, this incident “served to revive the agitation against vaccination, and caused quite a panic amongst those who had had their children vaccinated.”16 Despite vaccination’s problems, the British medical establishment remained convinced o f the efficacy o f vaccination. A kind of medical dogma emerged which led Vaccinationists to ignore or reject out of hand early criticisms of vaccination. Vaccination had become associated, rightly or wrongly, with scientific methodology, while inoculation became identified as an inferior medical approach. Another layer involved class. The British Government had determined that vaccination would be the ideal public health measure at home. There, it had made vaccination compulsory through a series of vaccination acts and with the enactment of laws such as the New Poor Law in order to reinforce the effect of the vaccination acts. As Nadja Durbach argues, the Anti­ vaccination movement became associated with the uneducated working class who sought to avoid state interference in their lives and bodies, while vaccination became a symbol

15 Charles T. Pearce, Vaccination: Its Tested Effects on Health, Mortality, and Population (London: H. Bailliere, 1868): p. 18. 16 The History o f Inoculation and Vaccination fo r the Prevention and Treatment o f Disease, p. 90.

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of state intervention.17 This view of the vaccination-inoculation and vaccination-antivaccination debates would provide one framework for the role of imperial medicine in the colonies.

Imperial Medicine

Jenner’s discovery of Smallpox vaccination coincided with the expansion of European empires in Asia in the late eighteenth and early nineteenth centuries, so that vaccination efforts followed European rule at roughly the same time in both the European metropoles and European colonial possessions. This included metropolitan Britain as well as its colonial empires of India and Burma. In the decades that followed, the vaccination effort soon spread as well to uncolonized countries such as Japan that-sought to adopt Western medical techniques. Like their fellow vaccinationists at home in the metropole, the imperial medical men sent out to the colonies continued to ignore or reject the counter-claims of the inoculators. This would also be generally true of indigenous medical technologies and methodologies in the colonies. With important exceptions, some of which will be discussed in later chapters, imperial medical men ignored indigenous medicine as a potential agent in treating disease or informing the Western medical project. Michael Adas, for example, who focuses on Western impressions of indigenous medicine as part of Western constructions of Asia in his book Machines as the Measure o f Men (1989),

17 Nadja Durbach, ‘“ They Might As Well Brand U s’: Working-class Registration to Compulsory Vaccination in Victoria England.” History o f Medicine 13.1 (April 2000): pp. 44-62.

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explains that Western people saw Chinese medicine as "little better than herbals" and the Chinese dependency on Western medicine and technology as a sign of their backwardness. The Nineteenth century Western medical approach to disease control generally ignored indigenous perceptions of the disease, leading to significant indigenous resistance and failures. Ray Ileto, for example, examines American medical and sanitary projects in the Philippines during an outbreak of Cholera in 1899-1902.

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The American

medical program directed against the spread of Cholera included quarantining patients and placing suspected carriers in detention camps, the burning of the houses of Cholera patients, and the cremation of those who died from the disease. This American biological treatment of Cholera, Illeto explains, was not in agreement with the indigenous Filipino understanding which “refused to dissociate the disease from the network of social relationships in which it appeared.”19 Paul Kelton also examines the Southeastern Native Americans’ innovative and spiritual responses to outbreaks of Smallpox which enabled them to contain epidemics (this is intended as a partial answer to the question of why the Native Americans survived the impact of epidemics).20 Sometimes, colonial medical and public health control damaged the advantages of indigenous medical practice. Frank Dikotter examines China's opium culture, the stigma of its ‘evil’ opium problems, and its trade through the Opium Wars. By investigating the Chinese way of using opium as a medicine to alleviate pain as well as to relax, and its moderate usage in late imperial

18 Reynald C. Ileto, “Cholera and the Origins o f the American Sanitary Order in the Philippines.” In David Arnold ed., Imperial Medicine and Indigenous Societies (Manchester and New York: Manchester University Press, 1988): pp.125-148. 19 Ibid, p. 135 20 Paul Kelton, “Avoiding the Smallpox Spirits: Colonial Epidemics and Southeastern Indian Survival,” Ethnohistory 51.1 (winter 2004): p.45-71.

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China, Dikotter argues that the system of the prohibition of opium that the British imposed upon the Chinese was “a public health disaster” and caused many more serious narcotic-related problems.21 One of the major themes of historiography on imperial medicine is that the imperial medical project prioritized the health of the Europeans rather than that of the indigenous population. This depended, of course, on the type colony, the numbers or even presence of European settlers, and the goals of the of colonial administration. In the early years of British rule in Burma, for example, the target of vaccination efforts shifted as the needs of colonial rule changed. Efforts at vaccination were first made to help increase the population of such underpopulated Burmese territories as Arakan and Tenasserim so that the colonies could develop economies sufficient to pay for the costs of British rule. As Tenasserim became more heavily peopled by European settlers, the European community monopolized the attention of British medical authorities. Indeed, as British rule spread throughout Lower Burma after the Second Anglo-Burmese War (1852-3), while provinces with European settlements became a focus of government vaccination

efforts,

those

without

substantial

European

populations,

such

as

Tharrawaddy, were initially ignored.22 The relationship between European settler health and indigenous health was also very complicated. Regardless of colonial medical prioritization, European health in the colonies was often regarded as inseparable from that of the general health of the

21 Frank Dikotter, Lars Laamann, and Zhou Xun. Narcotic Culture: A History o f Drug in China. Chicago. The University o f Chicago Press, 2004. 22 See, for example, the delay in government vaccination efforts in Tharrawaddy District in Burma Gazetteer: Tharrawaddy District, vol. A, (Rangoon: Superintendent, Government Printing and Stationery, Union o f Burma, 1959): p. 126.

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indigenous population, at least to a certain degree. Once the European population of Tennasserim grew to a significant size, for example, it was realized that as long as the indigenous population remained unvaccinated, they would present a continual health threat to British administrators, soldiers, and traders as carriers of smallpox. As we shall see, in the latter decades of the nineteenth century, British medical officers in Burma thus directed most of their attention to fighting Smallpox among the indigenous population, at least among those who lived in the towns. Yet, the emphasis on European health and ‘comfort,’ the latter generally not being discussed as a factor in the treatment of the health of the indigenous population, did become clear on many occasions. While fighting an especially severe Smallpox epidemic in late nineteenth century Burma, British medical authorities afforded considerable privileges to European patients that were far better than the treatment given to indigenous sufferers. Despite imperial rhetoric of ‘high humanity,’ the bringing the benevolence of ‘modem’ Western medicine to the “uncivilized,” “unscientific,” and societies of the ruled,

“backward”

many scholars have found major discrepancies between the

colonial rhetoric and colonial medicine as practiced.23 The imperial medical project was also utilized to legitimate and reinforce colonial control over the ruled. Scholars of public health in British India, such as Mark Harrison, have argued that the British attempted to use vaccination as a tool for legitimizing British rule by using vaccination as a symbol of their commitment to the health of their subjects as well as of British cultural and

23 See Anil Kumar, Medicine and the Raj: British Medical Policy 1835-1911 (New Dehli: Sage, 1998)

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scientific

superiority.24 Vaccination,

it was

believed,

demonstrated

either the

advancement of European civilization (suggesting British cultural or scientific superiority) or their commitment to the health and welfare of the general population (giving British rule moral legitimacy).25 The relationship between state medicine, such as vaccination, and political control is clear in other ways as well, and link both the metropole and the colony together as joint fields for the growing intrusion of the state into people’s lives. In Great Britain, the state began to use vaccination as a public health measure to strengthen state power and to exert its control over peoples’ bodies. This was also true of the colonial world. After years of contention over medical practice and policy in the nineteenth century, the British Government made vaccination the official medicine through the Vaccination Act. After the gradual establishment of a public health bureaucracy, the vaccination measures served as political tools to extend their authority. In its overseas Empire, they did the same, but more extensively in the process of ruling. This process was the shared experience of the participants of colonialism. They carried out a colonial practice of constructing ‘others’ in which they stigmatized their differences and labelled them as a filthy, contagious, and unscientific people who might endanger the health of the colonizing population. Tropical medicine and disease, as Laura Briggs observes, was useful for imperialist rhetoric as a category representing the non-Western ‘other,’ because it “constructed a singular, metonymic, relationship among race, place, and disease, albeit newly triangulated by

24 Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859-1914 (Cambridge: Cambridge University Press, 1994): p. 82. 25 Harrison, Public Health in British India, p. 82.

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microorganisms.”26 With this self-endorsed legitimacy for their domination, they enforced various public health measures. For example, Briggs shows that the colonial government even invaded its subjects’ “private’ sphere,” by attributing negative sexual stereotypes of indigenous women and by stressing their domesticity during the American colonization of Puerto Rico.27 In the colonies, the technology of control was discovered, operated, reinforced, and retained. This sort of technology was in the metropole as well, and may have developed reciprocally. The intensification of vaccination measures in British Burma from the 1880s seems to have developed partly in response to the medical environment of metropolitan Britain. While the British government was intensifying its efforts over the vulnerable body of the people in metropolitan Britain through the coercive measure of compulsory vaccination, British colonials reinforced vaccination programs to contain Smallpox epidemics in Burma after the Second Anglo-Burmese War. However, the realization of this aim faced a variety o f obstacles. Among them was the fact that until 1858, Tenasserim, Arakan, and Pegu were governed by the British East India Company, which had an interest in keeping costs at a minimum. The Company was thus reluctant to give full attention and funding to build Burma’s infrastructure. The government, because of the success of anti-vaccinationists in Britain, was even more determined to experience the success of vaccination in colonial Burma. The colonial government might have done this out of a belief in their own benevolence as they claimed in British India. Or, the colonial medical officers, just as those in metropole

25 Laura Briggs, Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico (Berkeley: University o f California Press, 2002): p. 35. 27 Briggs, Reproducing Empire, p. 22.

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Britain, might have felt responsible for the health of the colonial subject. As Porter and Porter point out, the leaders of the public health service in nineteenth century Britain “considered themselves to be the embattled vanguard of preventive for medicine” and they viewed the concessions of the Vaccination Act won by the anti-vaccinationists not as “bringing about more responsible medicine” but rather “a major obstacle to preventive •jo

medicine.”

However, the issue of authority is more relevant to the case of British

Burma. What drove the government of British Burma and their medical officials was their determination to retain authority which could be realized by clarifying the differences between those who controlled and those who were controlled. While working class and middle class British citizens were fighting to find ways to take some control away from the government in the metropole, the British colonial government in Burma was making sure that the authority of those who were in control was secure. They did so by further enforcing the Vaccination Act, investing in the establishment of vaccine depots in Burma, refusing Burmese medical collaboration, and continuing to label the Burmese as an ‘indifferent’ and ‘ignorant’ people. Through compulsory vaccination, the British government attempted to increase its authority and control over its subjects in both metropolitan Britain and colonial Burma in the nineteenth century. In both places, the Compulsory Vaccination Act was enforced, giving greater supervising authority to public health personnel. As Porter and Porter argue, in the metropole, increasingly popular ariti-vaccination movements among the middle-class and working-class citizens fought and won changes in the Act. They did so

28 Dorothy Porter & Roy Porter, “The Politics o f Prevention: Anti-Vaccinationism and Public Health in Nineteenth-century England,” Medical History 32 (1988): p. 236.

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by raising doubts concerning the efficacy of vaccination based on the dangers which vaccination posed to them, and by making use of their legal rights as “conscientious” citizens of the British Empire.

7Q

The colonial Burmese population, regardless of its strong

opposition, did not experience this success.

Imperialism and Indigenous Medicine

Aside from colonial control and indigenous resistance, Western medicine proved almost irresistible over the long term, but not without significant accommodation with indigenous society and beliefs. The relationship between the indigenous population and imperial medical projects, such as the enforcement of prophylactic medicine against contagious diseases, hygiene control, and public health have been examined at multiple levels in the prevailing literature. The attempt to locate accommodation and non­ accommodation to the indigenous population in imperial medical projects has provoked a broader inquiry into the essence of imperialism itself and the ways in which imperial medicine penetrated indigenous society. Numerous works on imperial medicine have moved beyond the somewhat unilateral transmission model provided by the “tool of empire” approach.

•)A

t

In doing so,

new approaches and methodologies were created to identify the counter-impact of indigenous resistance and medical beliefs on incoming Western medical knowledge and

29 “The Politics o f Prevention: Anti-Vaccinationism and Public Health in Nineteenth-century England,” p. 236. 30 Daniel R. Headrick, Tools o f Empire: Technology and European Imperialism in the Nineteenth Century (Oxford: Oxford University Press, 1981).

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colonial medical projects. David Arnold, for example, examines the colonial medical project in British India and the Indigenous population’s response to it, informed by their Hindu understanding of disease and its causes. Arnold argues that we should not view the introduction of Western medicine from metropolitan Britain to India as a simple transition. Rather, Arnold directs us to pay close attention to the dialectical relationship between Western medicine and Indians responses emanating from their religious and cultural ways of understanding disease and medicine as the determining factors in the complex transmission of Western medical knowledge.31 In order to understand the intricate medical relationship between the rulers and the ruled, it is necessary to understand systems of indigenous medicine and other “nonwestern” medicine, since they continued to survive and receive support from indigenous populations as an alternative to Western medicine. The contributors to Charles Leslie’s edited work on the plural medical systems of “non-Western” medicine in Asia show that indigenous medical systems were not static nor homogeneous entities, for they were evolving, and they were not merely simple or unscientific systems.32 Various indigenous medical systems and beliefs continuously diffused, competed, and contested with each other. Hartmut O. Rotermund, for example, examines Edo Japan’s multiple local interpretations of Smallpox. Local perceptions of the disease varied dramatically, from magico-religious approaches which sought cures in spells, anything colored red, or the marking of the body, to scientific ones which viewed Smallpox as a contagious disease

31 David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India. (Berkeley, Los Angeles, and London: University o f California Press, 1993) 32 Charles Leslie (ed.), Asian Medical Systems. A Comparative Study. Berkeley: University o f California Press, 1976. 18

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and recommended its containment through avoidance and the segregation of carriers from away from the healthy population.33 At the same time, as Waltraud Ernst explains, there is a risk in categorizing “non-westem” medicine or medical systems, especially in “dichotomously arranged categories.” In such a view, Ernst observes, Western medicine is perceived as scientific, and since non-Western medicine is the binary opposite of the former, the latter must therefore be completely unscientific.34 This creates an artificial and inaccurate framework, absent of the potential for nuance. Such a preconceived model of “indigenous medicine,” then, might lead one to assume, wrongly, that the specific case of indigenous medicine before them includes characteristics, principles, and practices that it really does not it, and vice versa. Like David Arnold, this dissertation also finds that the colonial vaccination project in Burma was only a partial success if gauged by the popularization of the operation. Arnold blames the mixed success of vaccination in India on the colonial violation of Indian culture and on colonial administration which was “culturally and politically remote from the lives of its subject.”35 The British colonial government in Burma tried to control the health of Burma in various ways. As they had done in metropolitan England, they attempted to use public health measures such as vaccination to strengthen the colonial grip on the colonized population. This attempt proved to be a

33 Hartmut O. Rotermund, “Demonic Affliction or Contagious Disease? Changing Perceptions o f Smallpox in the Late Edo Period,” in Japanese Journal o f Religious Studies 28.3-4 (2001): pp. 373-398. 34 Waltraud Ernst, “Plural Medicine, Tradition and Modernity. Historical and Contemporary Perspectives: Views from Below and from Above,” in Waltraud Ernst (ed.), Plural Medicine, Tradition and Modernity, 1800-2000 (London and New York: Routledge, 2002): pp. 2-3. 35 David Arnold, ‘Smallpox and colonial medicine in nineteenth-century India’ in David Arnold ed., Imperial medicine and indigenous societies. Manchester and New York: Manchester University Press, 1988.

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failure, however, because the medical administration erected to grant greater colonial control was riddled with internal problems. The vaccine lymph that was promoted by colonial medical authorities as a superior alternative to indigenous inoculation, for example, continued to fail. Some of these technical problems were resolved, as in the case of the establishment of a single vaccine depot and experiments that eventually produced local and dependable lymph in sufficient supply for the needs of the colony. Nevertheless, these solutions generally did not bring the colonial vaccination project any closer to success because of the British failure to establish a bilateral communication of medical knowledge between themselves and the indigenous population. The British effort to overcome technical problems did not involve very much indigenous collaboration. In other words, the colonial vaccination project remained an attempted unilateral transmission of knowledge that still did not enter the realm of what James Scott calls indigenous ‘practical knowledge,’36 through which such information could otherwise be embedded locally, developed, disseminated and shared. The British did not completely reject indigenous collaboration in vaccination and wound up mobilizing a number of Burmese vaccinators. However, the colonial vaccination project failed to instil in these vaccinators and in the general population the belief that vaccination was superior to inoculation as a means of fighting Smallpox. This was partly due to the colonial approach to ruling the indigenous population in general. Certainly, a lack of sufficient funding and administrative disorganization was partly at fault. The missing ingredient for the success of the colonial vaccination project, however,

36 James C. Scott, Seeing Like a State: How Certain Schemes to Improve the Human Condition Have Failed. New Haven and London: Yale University Press, 1998.

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was the British lack of trust in and commitment to the indigenous vaccinators and inoculators. One device intended to ensure ‘correct’ indigenous collaboration was new legislation, including regulations for licensing of indigenous vaccinators. The indigenous population saw the new licenses as symbols of state power. Further, the power associated with paper certificates entered into the indigenous peoples’ know-how, to exercise authoritative power. Indigenous vaccinators also manipulated this know-how to legitimate their inoculation instead. I chose the topic of Smallpox vaccination as my case study for two main reasons. First, the colonial vaccination project was quintessentially a colonial experience for the Burmese. The experience of local treatments and remedies for Smallpox had been far different than the coercion used by the British to enforce vaccination. Smallpox was a universal disease and not simply a tropical disease. Smallpox was ubiquitous, therefore, locally discovered, tested, and effective remedies and treatments had been developed all over the world and transmitted rapidly. Medical treatises explaining the treatment of Smallpox had been written, read, translated, and shared by many who had suffered from this horrible disease. The colonial vaccination project skipped many of these essential steps by “ignoring or suppressing metis and local variation.”37 More importantly, secondly, related to the first point, I chose the smallpox vaccination because the British used it as a symbol of modem medical science against the “unscientific” indigenous treatment, namely inoculation. It is a conjuncture of two different systems which carried more than their technical and medical differences.

37 Scott, Seeing Like a State, p. 340.

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The

colonial

vaccination

project

never

satisfactorily

resolved

early

misconceptions. Because inoculation was not state-endorsed like vaccination, colonial medical authorities continued to see inoculation as the indigenous rejection of colonial rule. Rather than attempt to understand how Burmese viewed Smallpox, why they practiced inoculation and why vaccination remained unpopular, they labelled inoculation as an evil that needed to be eradicated, just as much as the disease is, and they, sought to protect the indigenous population against. Because inoculation, and thus the failure of vaccination, was seen as much as an administrative as a medical problem, since vaccination was clearly superior in their eyes, they frequently pursued administrative solutions rather than engage with the Burmese in a medical discourse. Attempts by some civil surgeons, for example, to bridge the communication gap regarding the pros and cons of vaccination and inoculation, received scant support from the colonial medical administration in Burma. The indigenous population was thus left out of the emerging colonial discourse on how best to fight Smallpox in Burma. While the colonial medical bureaucracy mushroomed it also continued to suffer from indigenous disinterest in vaccination until the end of colonial rule. While the colonial vaccination project in Burma had mixed results, just as in the case of India, as discussed by David Arnold, there were crucial differences. Arnold agrees that Indians began to see vaccination as a symbol of foreign rule and thus entered into nationalist discourse. In Burma, however, the failure of the British to educate the indigenous population about vaccination meant that many were confused about exactly what operation they were undergoing. The absence of caste also removed a potentially 22

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volatile reaction regarding the sharing of blood through Arm-to-arm vaccination, as occurred in India. Furthermore, the limited British reach beyond the towns, due in large part to their failure to develop substantial and effective indigenous collaboration meant that inoculators were able to perform their operations on rural populations more because of greater access than because of successful counter-arguments against vaccination. Indeed, many Burmese avoided both vaccination and inoculation. In the end, the frustrated colonial medical administration in Burma turned to increasingly severe punishments and legislation against inoculators. Yet, aside from a training school for vaccinators, until the end of colonial rule, little effort was made to convince the indigenous population as a whole of the benefits of vaccination, until quite late in the colonial period. Thus, this dissertation views the colonial vaccination project not as a medical failure, for medical technical problems were gradually resolved over time. Rather, the vaccination project failed for the same reasons that brought down the colonial state, with which its fortunes were intimately related. As Adas argues, nineteenth century Europeans viewed technology as a measure of the level of civilization. If the British were to rule, they had to be superior to the Burmese. Thus, the major underlying problem was that the colonial medical administration was continually confused as to why the Burmese did not voluntarily submit to their ‘superior’ medicine. At the same time, however, taking inoculation as anything but resistance to the state, that is, as a competing medical system, could potentially lead to a discourse which could raise questions about the complete superiority of vaccination over inoculation, and, by extension, British superiority over the Burmese, and thus the former’s legitimacy to rule. 23

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This view began to change by the early 1920s. By 1922, the colonial medical authorities realized

the unsatisfactory progress of Vaccination program. They now

completely changed their attitudes toward indigenous medicine and medical doctors. The colonial medical establishment now offered training in Western medicine to indigenous doctors (the hse-hsayas) At the same time, more importantly, the colonial medical establishment formed a Committee of Inquiry into Indigenous Medicine, appointing U Ba Ket, an anglophile doctor as chair. This Committee’s purpose was to identify and understand genuine Burmese medicine, to be determined after consulting numerous Burmese cultural specialists, historians, and hundreds of indigenous medical practitioners whom they had previously ignored, ridiculed, punished, excluded, and stigmatized for the latter’s “unscientific” methodology. These two developments in the 1920s together marked the first time in which the colonial medical establishment in Burma admitted the possibility that their own efforts could not succeed without allowing a place for indigenous medicine. I will return to this shift in colonial medical perspectives in the conclusion.

Structure of Dissertation

This dissertation is divided into seven chapters. I first examine the technological fight against Smallpox, and how issues regarding vaccine lymph hindered the progress of vaccination in British Burma until the beginning of the nineteenth century. In Chapter Two, I examine the inter-provincial and intra-provincial problems of the transmission of vaccine lymph as well as the British plan to produce lymph locally to overcome these 24

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difficulties. In Chapter Three, I examine the British attempt to establish vaccine depots throughout Burma and how, after these efforts failed, they ultimately, and successfully, focused on the establishment of a central vaccine depot at Meiktila. I also examine how the development of the state railway system in Burma and problems with acquiring and maintaining stocks of cattle proved to be significant determining factors in these developments. I also discuss further innovations in the cultivation of effective vaccine lymph carried out by Major Entrican and other British Civil Surgeons. Experiments for the better preservation of lymph and with cooling devices were carried out so extensively, that they made Burma a kind of scientific laboratory, but still did not yet involve the indigenous population or indigenous medicine. I then shift to the human problems regarding colonial vaccination and focus on the two competitors in the fight to control Smallpox in Burma, the vaccination establishment and the indigenous inoculators. The British medical establishment desperately needed to obtain trust from the indigenous population of Burma and finally realized the necessity of having local collaboration in their vaccination efforts. Vaccinators, inoculators, propaganda, and legislation are the central subjects of investigation. In Chapter Four, I will begin with colonial blame for the failure of vaccination being directed at indigenous vaccinators, and examine the ways in which they tried to produce capable indigenous vaccinators as part of the colonial indigenization process of vaccination, although it failed. In this chapter, I will examine how issues of the internal administrative disorganization of the Vaccination department, inadequate funding, a failed medical educational institution, and the unpopularity of vaccinators among the general population all contributed to the failure of this project. In Chapter 25

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Five, I will focus on the stages in which the British initially tried to collaborate with the indigenous inoculators by converting them into vaccinators. The British medical authorities counted on the latter’s moral influence among the Burmese in the hopes of getting the indigenous population to abandon inoculation. When this failed, the colonial medical authorities tried to control the indigenous population through law and punishment. I also argue that indigenous inoculators learnt from the British how to impose authority and took advantage of them. The dissertation then turns to colonial efforts to win over the hearts and minds of the Burmese population to the vaccination cause. In Chapter Six, I examine how and why the British vaccination establishment failed to find a way to communicate medical knowledge to the indigenous population. By focusing on the language qualifications of the British medical officers as well as efforts at propaganda supporting vaccination in British Burma, I argue that the British colonial government lacked both ability and interest in transmitting their medical knowledge to the indigenous population. This becomes clearer in comparison with the efforts of Western missionaries to make their medicine understood by the indigenous people. In Chapter Seven, I look at the ways in which the British relied on legislation, compulsion, and prohibition to extend their power. Legislation, however, was slowed and hindered by the diversity of decisions by the local municipalities. I also examine how the British enacted the Law Amendment Act for Compulsory Vaccination, targeting Indian coolies who were immigrating into Burma and who were portrayed as the carriers of contagious diseases.

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CHAPTER TWO A DISTANT CORNER OF THE EMPIRE: SPREADING THE VACCINIA VIRUS TO 1902

Although the medical policies and predominant medical methodologies of British India or metropolitan Britain frequently influenced those of British Burma, the experience in British Burma diverged from them as locally-based colonial medical officers coped with a number o f challenges peculiar to the medical and other conditions they found in Burma. As British medical officers devoted their attention to identifying the physical and timely characteristics of the movement of the Smallpox virus into and around Burma in order to find clues that would help them to fight it, they began to significantly shape the strategies that would characterize vaccination efforts in British Burma for the remainder of the colonial period. There was also an especially considerable shift in the way in which colonial doctors in British Burma tackled the problem of ineffective lymph. Early vaccination operations depended fully on the lymph transferred to them from Britain or British India, but this method of transfer had substantial limitations, leading very frequently to ineffective lymph. Instead, as British medical officers in Burma slowly began to find alternatives to the movement of the vaccinia virus across great distances, to seek out ways to improve vaccination’s efficacy, and to determine what the proper method of delivery into the human body should be, the vaccination effort in Burma assumed its own 27

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unique shape. In this chapter, I will examine the technical problems of moving vaccinia lymph from Great Britain and India to Burma and how other problems regarding transportation, an important part of the establishment of the vaccine depots, were resolved.

Transporting Lymph

The biggest problem facing the vaccination program in colonial Burma was the failure of lymph. Lymph (derived from Latin lympha, ‘spring water’) usually refers to the clear bodily fluid associated with the lymphatic system, but in the context of modem vaccination of Smallpox it came to refer specifically to infected matter, such as a scab, pustule, papule, or other tissue, containing lymph vesicles. In the case of human lymph, this infected tissue would be taken from an infected area of a person who has already been vaccinated with a particular strain of cowpox virus known as Vaccinia (genus Orthopoxvirus). In the case of animal lymph, and during the colonial period this was most commonly bovine (cow) lymph, the tissue would be taken from an animal containing naturally occurring cow-pox or artificially induced Vaccinia. The reliance of Vaccination (from the Latin vacca, meaning cow) on cowpox strains was the major difference between it and the operation of inoculation, in which raw Smallpox vims (Variola or humanpox vims) was transferred from one person to another causing Smallpox artificially to encourage immunity to this disease. People in various populations that had domesticated cattle had noticed the relationship between exposure to cowpox and immunity to Smallpox in those who handled cows, especially milkers, and there 28

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appear to have been proto-vaccination operations using infected cowpox matter prior to the late eighteenth century. Nevertheless, it was Britain’s Edward Jenner who first committed his own success in transferring benign cowpox virus from Sara Nelmes, a milkmaid, to a Mr. James Phipps on 14 May 1796 to writing, earning him the title of the ‘father of vaccination.’ The reason that cowpox was effective for vaccination purposes was that it had “only minor serological differences” from the Smallpox virus, but the two were ‘anti-genically related’ and cowpox, unlike Smallpox, would not produce the same deadly effect on humans. Instead, the body would react to the cowpox virus by producing TO

anti-bodies which would effectively fight Smallpox. Bad vaccine matter, continually referred to with agony in government vaccinators’ reports in colonial Burma, referred to vaccine pustules or crusts that did not remain effete in transport or in storage until they could be used to infect a human subject and produce a positive response (i.e. the production of cowpox and thus vaccination). Vaccination with bad vaccine lymph would cause the development of large numbers of pustules all over the body, high fever, and/or “unhealthy ulcers of more or less severity.”39 Obtaining good vaccine matter, which did remain effete, presented a continual problem for government vaccinators in colonial Burma, although strenuous efforts were made to identify both good matter and technique. Howard Malcom, a roving informant for the American Baptist Mission in the mid-nineteenth century, mentioned

38 Birendra Nath Ghosh, A Treatise on Hygiene and Public Health (Preventive and Social Medicine) 15th ed. (Calcutta: Scientific Publishing Co., 1969): p. 529; Donald R. Hopkins, The Greatest Killer: Smallpox in History (Chicago: University o f Chicago Press, 2002): p. 79, 88; Robert F. Kahrs, Viral Diseases o f Cattle, 2nd edition, (Ames: Iowa State University Press, 2001): p. 201, 202; John H. Dirckx, Stedman’s Concise M edical Dictionary fo r the Health Professionals, illustrated 4th edition (Philadelphia: Lippincott Williams & Wilkins, 2001): p. 577. 39 Report on the Administration o f the Province o f British Burmah fo r 1866-67, compiled by Albert Fytche (Calcutta: Foreign Department Press, 1867): p. 82.

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one factor in the 1840s in the context of his travels through Burma: “[mjatter has been brought from Bengal, Madras, England, France, and America; put up in every possible mode, but in vain.”40 Lymph that proved effective elsewhere continually proved inert by the time it reached vaccinators in Burma. British medical officers and vaccinators constantly reported the failed vaccination due to failed lymph. For example, lymph from England failed in 1876 and in 1881-2, lymph from Simla failed in 1860, and lymph from Calcutta failed in 1873. The general problem of bad lymph can be separated into two sub-problems. In the long-term, an important part of improving lymph was locating an ideal strain of the vaccinia virus that would prove most suited to fighting Smallpox. At first, over the course of the nineteenth and twentieth centuries, various strains of the virus were experimented with, although that used in Britain in the first half of the twentieth century came from a Prussian soldier infected by Smallpox in 1870. Later, attempts were made to strain the virus through different animal mediums, including cows, rabbits, and monkeys.41 Although this problem remained important in the global attack on Smallpox, the fight in Burma was more concerned with the second, more technical problem, of conveyance. The time required and space covered in carrying the virus from Europe or other areas more closely associated with the metropole, such as India, to Burma provided the opportunity for the natural elements (heat, for example) or human failures to cause the lymph to fail.

40 Howard Malcom, Travels in South-Eastern Asia, Embracing Hindustan, Malaya, Siam, and China; With Notices o f Numerous Missionary Stations, and a Full Account o f the Burman Empire. 2nd ed. (Boston: Gould, Kendall, and Lincoln. 1839): pp. 1.195-6. 41 Ghosh, A Treatise on Hygiene and Public Health, p. 529.

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The problem o f lymph conveyance affected Burma in two different ways. There were the problems, within the context of the British Empire, of inter-provincial and of intra-provincial transport. Inter-provincial transport involved moving vaccine virus from the place of origin to Burma which remained one of the British Empires provinces most distant from the European metropole and was thus disadvantaged due to the distance and number of transhipment points. The National Vaccine Establishment in London (established in 1808) or the Royal Dispensary in Edinburgh usually sent the supply of vaccine lymph to vaccination establishments in various places in India such as Simla and Calcutta, and only then, from these last locations, to Burma. Vaccine which was received from Great Britain, through India, thus often proved to become ineffective after a long voyage in a harsh climatic conditions.42 British India, one of the places from where British Burma was obtaining fresh lymph, had a problem in importing fresh lymph from Europe. However, those vaccines sent from Britain “remained spasmodic, and the potency of the lymph that ultimately did arrive would very often be damaged during the journey to India.”43 There was also always a danger of further delay since lymph packages could be held up at any stop along the British mailing routes.44 Vaccine lymph produced in India presented similar problems regarding transport to Burma. For some time, British medical authorities in Burma tried vaccines from different areas of India. Vaccine matter from Calcutta, they found, “generally failed.”

42 Hopkins, The Greatest Killer, p. 80. 43 Sanjoy Bhattacharya, “Re-devising Jennerian Vaccine?” in Pati, Biswamoy and Harrison, Mark eds. Health, Medicine, and Empire: Perspectives on Colonial India (New Delhi: Orient Longman Limited, 2002): p. 218. 44 Bhattacharya, “Re-devising Jennerian Vaccine?” p. 218.

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Among the first such experiences occurred when government aid was requested in the mid-1830s, when Smallpox began to hit the bazaar in, Maulmain in 1835. British authorities had contacted the government vaccinator assigned to Fort William (the Headquarters for the British East India Company in Calcutta), for vaccine matter. This matter, although sent, proved to be ineffective, for some inexplicable reason: “from some cause hitherto unexplained it has in every instance totally failed of the proper effect.”45 Eventually, vaccine matter from Simla apparently remained effective longer than Calcutta vaccine matter, and was effective in vaccination efforts in Rangoon for a time, but this too experienced additional problems which will be discussed further below.46 The frequent failure of vaccine lymph caused civil surgeons in Burma a great deal of anxiety. In 1869, Dr. Keith Norman MacDonald, the noted Scottish violinist, composer, author, and, at that time, the civil surgeon of Prome, for example, reported with frustration, “Is there any use in vaccination as practised with the kind of lymph procurable, and if so to what extent?”47 As Dr. A. J. Cowie, the first Sanitary Commissioner for British Burma, somberly commented in 1869, “I only desire that good vaccine lymph may be forwarded and not the filthy spurious virus which had been lately received.”48 This chronic problem of bad vaccine lymph led civil surgeons in Burma to seek private supplies of effective lymph. Dr. Charles Parker, civil surgeon of Toungoo

45 Letter from E. A. Blundell to H. T. Prinsep, 25 February 1835, in Selected Correspondence and Letters fo r the Years 1825-26 to 1842-43 in the Office o f the Commissioner Tenasserim Division (Rangoon: Office o f the Superintendent, Government Printing, Burma. 1929): p. 134. 46 Report on the Administration o f the Province o f Pegu fo r 1859-60 (Calcutta: n.d.): 35. 47 Report on Public Health and Vital Statistics fo r 1869 (Rangoon; Chief Commissioner’s Office Press, 1870): appendix, pp. iv-v. 48 Public Health and Vital Statistics fo r 1869, appendix, p. iii.

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obtained lymph privately from ‘the medical officer, H.M. 76th Regiment’ in Madras in 1868.49 Dr. John W. T. Whitaker, civil surgeon of Tavoy, to personally request of another surgeon, Dr. G. E. Marr, civil surgeon of Maulmain, to forward fresh lymph to him.50 Some British medical authorities were even driven to carry lymph personally to their stations, as in the case of the Assistant Apothecary, and Civil Medical Officer of Myanaung, Mr. H. Godbier, who carried ‘some tubes of fresh Calcutta lymph’ on board a steamer to Myanaung.51 An important underlying part of the failures of transport from India or from Great Britain via India to Burma (or intra-provincial to another place within Burma) was the crude nature of the technologies used. The first and most reliable method of transport for some time was arm-to-arm, using children as the carriers. As David Arnold explains, the first vaccine virus brought to India from Britain in June 1802, was carried “through a relay of children from arm-to-arm from Baghdad to Bombay.”52 Sealed capillary glasstubes containing pustules and dried crusts from infected tissue were adopted for transport by sea,53 but this technique was notoriously faulty in the nineteenth century, and like their British India counterparts, colonial doctors in Burma continued to turn to children as reliable carriers. Dr. Denonath Doss explained,

49 Report on Public Health and Statistics in British Burma fo r 1868 (Rangoon: Chief Commissioner’s Office Press, 1870): p. 202. 50 Vaccination Report 1867-68 (Rangoon: Rangoon Times Press, 1868): p. 52. 51 Report on Public Health and Vital Statistics fo r 1869, appendix, p. viii-ix. 52 David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: University o f California Press, 1993): p. 140. 53 Arnold, Colonizing the Body, p. 140.

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In vain did I say that to vaccinate children [with] fresh lymph taken from a successful case, from the 6th to the 8th days counting from the day on which the insertion of the virus was made, is much more certain of success than when the operation is performed with dry crusts or lymph is in tubes, which often lose their power by heat, exposure, and during their transit to this distant place.54

When Fort William’s supply, sent from Calcutta to Moulmein, failed in 1835, Commissioner E. A. Blundell explained that the population desired “undergoing vaccination by adopting the only steps that seem likely to propagate the virus.” Blundell thus requested that the government dispatch two or more children infected with Smallpox to Tenasserim to provide a living source of Smallpox vaccine matter.55 Using children as carriers did not guarantee a dependable supply of lymph. As Malcom explained in the 1840s: “Fifteen or twenty healthy persons, in the full course of cow-pox, were sent to Maulmain, a few years since, at the expense of the East India Company, from whom many were vaccinated, but only a few successfully; and from those it could not be propagated again.”56 The method of using child carriers experienced enough success for exasperated doctors in Burma to continue to rely upon it. How to procure children for the purpose, however, was a problem for the few army medical officers recently stationed in Burma,

54 Report on Vaccination, fo r 1868 (Maulmain: Advertiser Press, 1870): appendix, pp. iv-v. 55 Letter from E. A. Blundell to H. T. Prinsep, 25 February 1835, in Selected Correspondence and Letters fo r the Years 1825-26 to 1842-43, p. 134. 56 Malcom, Travels in South-Eastern Asia, pp. 1.195-6.

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who had to worry not only about the health of the local population but also of the regiments stationed in the area to which they were attached and with which they were primarily concerned. It required special relationships with authorities outside of the employ of the British East India Company, especially with those with more than solely administrative or medical relationships with the indigenous population. Dr. Forsyth complained in 1854 to then Major Arthur P. Phayre, Commissioner of Pegu, that vaccination needed to be re-introduced, because all “efforts hitherto made to effect that object have not been successful,” but did not suggest to the overburdened commissioner how children could be obtained to be used as carriers of the virus.57 Fortunately for Forsyth (and for Phayre as well), an American Baptist Missionary jumped at the opportunity, paving the way for a long-term pattern of cooperation between the American Baptist Mission in Burma and the government’s vaccination project. Dr. Dawson, who would later gain notoriety for his efforts to gain exemption from land taxes and even from local levies for night watchmen through connections to colonial authorities,58 offered to enlist and accompany children to Bengal in exchange for free passage on government steamers for both himself and two unnamed associates for apparently unrelated activities. Dawson’s plan was to take six Burmese children, infect them with the virus in Calcutta and use them as carriers of the virus back to Rangoon. Phayre recommended the proposal for its convenience (and, one suspects, economy): “it is

57 Letter from Arthur Phayre to Secretary to the Government o f India, Foreign Department, dated Rangoon 10 November 1854, National Archives o f Myanmar, box no. 1854(3), f. 1. 58 National Archives o f Myanmar, “Memorial o f Dr. Dawson on Behalf o f the American Baptist Mission for the Exemption o f Land and Houses from Usual Taxes in Rangoon,” Box no. 1857 (3), ff. 1-3; Letter from R. Macrae, Moulmein, to Colonel D. Brown, Commissioner o f Tenasserim Division, dated Moulmein, 10 August 1867, in 1/1(A) 1032, 1867,425, “Mr. Dawson’s Refusal to Pay Night Watch Tax in Moulmein,” Box 1867 (9), f. 4.

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seldom that the services of a medical man can be procured to have charge of children while conveying vaccine from one place to another as now proposed.”59 Missionary inroads into Burma, made easier by the expansion of the British East India Company’s rule into Burma, helped make this plan possible. The ‘Burmese’ children proposed were actually Karen, an ethnic group that was the target of sustained and largely successful missionary efforts at proselytization, and apparently were members of Dawson’s Christian ‘flock.’ Dr. Dawson took the Karen children to Calcutta in 1855 and had them vaccinated both in Calcutta and again on-board ship on the return voyage to Rangoon. Over the course of late January to the end of February (and presumably into March) 1855, for about six weeks, Rangoon thus had a good supply of vaccine matter.60 In 1858, as well, another child was sent to be vaccinated in Calcutta and allowed Dr. Griesback to successfully vaccinate seventy-six Karens and Burmans at Henzada and in Rangoon and the vaccine matter thus produced allowed for thirty-one further successful vaccinations before the matter became effete.61 As will be discussed more fully in later chapters, missionary and colonial complicity played an important part in the eventual victory of British vaccination efforts in Burma. Resistance to using children as carriers, however, grew as the nineteenth century progressed. These were both health-oriented and culture-determined. There were serious medical drawbacks, for example, with the arm-to-arm method that raised objections in Burma, just as it did in Britain and in India. Problems with the method that were shared

59 National Archives o f Myanmar, “Introduction o f Vaccination into Pegu,” box no. 1854 (3), ff. 1-2. 60 Report on the Administration o f the Province o f Pegu, For 1855-56 (Calcutta: n.d.): p. 43. 61 Report on the Administration o f the Province o f Pegu, For 1858-59 (Calcutta: n.d.): p. 600.

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in all three societies, such as the risk of infection, were enough to provoke resistance or at least non-cooperation. The possibility of secondary infection through the “arm-to-arm” method directed the vaccination personnel to seek a new method elsewhere in the British Empire. The regular vaccination practice of arm-to-arm vaccination was found to be the culprit in transmitting other infectious viruses, diseases such as leprosy, syphilis or erysipelas were reportedly passed by arm-to-arm vaccination. This appears to explain why Burmese vaccinated at Pyinmana in 1891-92 rendered the vaccination operation useless after it was introduced into their bodies. As the civil surgeon complained, “the people...are adverse to the removal of lymph from the vaccine vesicles, and that immediately after the operation they frequently apply medicaments to destroy the vaccine virus.”62 The search for children for the continuation of vaccination gradually ceased in response to the growing concern upon the safety of “arm-to-arm” operation in England and other countries in Europe. There were also cultural and social issues specific to each society. In British India, for example, as David Arnold discusses, the caste system was an obstacle to the continuation of “arm-to-arm” operation, as parents did not like to mix the blood of the other children with that of their own children. This was not true of either Britain or Burma. Unlike either Britain or India, both possessing well-established rail and road transport networks, in Burma a poor transportation infrastructure combined with a sparse rural habitation to make the prevailing “arm-to-arm” method of vaccination difficult to say the least. The vaccinators had to take vaccinated children from one distant village to another in order to provide fresh lymph to vaccinate other children. It was very difficult,

62 Report on Vaccination in Burma fo r the Year 1891-92 (Rangoon: Superintendent, Government Printing Burma, 1892): p. 5.

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however, to convince a Burmese mother to take away her children as vehicles of vaccine to other villages across great distances. Although attempts were made by vaccinators to retain fresh lymph in a tube so that the lymph’s quality would remain, this resulted in chronic failure. When Simla vaccine matter failed in Burma in 1860, the Superintending Surgeon o f Rangoon planned to carry the vaccine matter into the interior districts in inoculated bodies, but it is unclear if this plan was carried out.63 Children remained critical to Burma’s vaccination efforts into the 1890s. In each country, vaccination authorities found ways to shift blame away from themselves. In Burma, the main recipients of the blame were parents. In a colony in which a state school system had not been established and with only a skeletal state administration, indigenous parents were held solely responsible for the acts of their children. Parents were blamed, for example, for all kinds of failures in supervising their children, sometimes to an unreasonable degree given the relatively recent and slight introduction of Western sanitary measures or other, more physical aspects of ‘modernization,’ such as paved roads or sidewalks. In a colony without such things, parents were chastised for allowing their children to play in dirt which exposed their unprotected arms to pollution, thus complicating the success of vaccine vesicles. Allowing their children to sleep on hard mats, although no other form of bedding was widely available, also drew criticism, because it was suggested to have caused to break vesicles, thus reducing the quality of the potential vaccine matter.64 As Mr. C. E. Pyster, Civil Medical Officer of Sandoway, lamented in 1868:

63 Report on the Administration o f the Province o f Pegu fo r 1859-60, p. 35. 64 Report on Vaccination during the year 1871-72 (Rangoon: The British Burma Press, 1873): p. 5.

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The children here are very careless and more so the parents, who allow them to destroy the vesicles when developed so that no lymph can be obtained and much less a crust, though instructions on all points are duly given to them.65

Towards a Solution for Inter-provincial Transport: A Supply in Burma

The emergence of a local distribution center at Rangoon for the redistribution of lymph to out-stations in the interior led to new problems as the borders of the East India Company possessions (which were absorbed by the British crown in 1858 after the Indian Mutiny), and its vaccination efforts, expanded into the Burmese hinterland. Despite British confidence in tackling the health problems of the indigenous population, the prevention o f small pox continued to evade them. The problem of ineffective lymph continued to plague government vaccination efforts, all of which failed during the first few years of the British occupation o f Rangoon (following 1852). In 1857-1858 it was admitted that efforts at vaccination were not any more successful than they had been. Dr. H. G. Graham, the Superintending Surgeon of the Pegu Division of British Burma and later Deputy Inspector General of Hospitals, found that although he had received sufficient vaccine matter for the division’s military stations, the matter was only successful in Rangoon.66

65 Report on Vaccination, fo r 1868, appendix, p. ix. 66 Report on the Administration o f the Province o f Pegu, For 1857-58 (Calcutta: n.d.): pp. 42-43.

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As British doctors increasingly discovered, although lymph could be collected at Rangoon, they still faced the kinds of problems in moving lymph from Rangoon to distant stations at Prome or Toungoo, and even more so to Arakan, that had been experienced in transporting lymph from Great Britain to India and from India to Burma. The methods they used, carrying vaccine virus using dried crusts and pustules in capillary tubes, did not protect against the adverse effects of extreme heat or the limits of normal lymph longevity during the long, time-consuming trips, into the Burmese interior. In 1855, after Calcutta lymph proved initially successful, however, Dr. Forsyth, the Superintending Surgeon, found that by the end of March, the vaccine matter so produced “had become altogether effete.”67 The problem of heat was already identified, even regarding lymph used within Rangoon, when Dr. E. J. Dickenson, the civil surgeon of Rangoon, found in 1857 that he was only able to vaccinate one hundred subjects before the “pustule suddenly ceased to be reproduced.”68 Blame was directed at the chronic problem of the climate’s negative effects on vaccine lymph.69 The following year, Dr. Morton at Toungoo and Dr. Rankin at Thayetmyo also failed to successfully vaccinate using government-supplied lymph.70 After Cowie attempted to vaccinate 423 subjects with the Simla lymph at Prome in 1860, he found that the vaccination failed, even though it had been successful in 1859.71 The same Simla vaccine matter was even less effective

67 Report on the Adm inistration o f the Province o f Pegu, For 1855-56, p. 43.

68 Report on the Administration o f the Province o f Pegu, For 1857-58, p. 43. 69 Report on the Administration o f the Province o f Pegu, For 1857-58, p. 44. 70 Report on the Administration o f the Province ofPegu, For 1858-59, p. 600. 71 Report on the Administration o f the Province o f Pegu fo r 1860-61 (Calcutta: n.d.): p. 31.

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in other Burmese districts, such as Bassein and Henzada, and failed altogether in interior districts such as Tharrawaddy and Toungoo.72 Again, Burma suffered from a transportation infrastructure relative to those of India which contributed to the chronic problem of bad lymph. The inability to transport lymph quickly to distant out stations tormented vaccinators in these outlying stations in multiple ways. Among the most serious, the failure of lymph while en route to stations, was due to the reliance on the government postal service for delivering requests for lymph and return shipments of it between government stations and sources of lymph supply. When, for example, Dr. Foster, the civil surgeon at Mergui, complained in 1869 about the delay in receiving good lymph at his station, Dr. A. J. Cowie, in his capacity as the first appointed Sanitary Commissioner for British Burmah, observed that Foster’s problems were due to the infrequent communication and poor timing of shipment to Mergui. As he explained, a regular communication between Mergui and Rangoon, via the government steamer Defiance, used for the government postal service, took place on a monthly basis. As this communication was not coordinated with the date of the monthly shipment of government mail from Rangoon, “opportunities of sending letters and packages are frequently lost, thus a detention of two months at a stretch may occur.” Moreover, requests and shipments carried through the government post had to be coordinated in the context of seasonal change. As Cowie further commented on Foster’s report: he (Foster) applied for vaccine lymph in the month of September and did not receive a supply until the 9th of December; tubes and crusts of these

72 Report on the Administration o f the Province o f Pegu fo r 1859-60, p. 35.

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prophylactic are not usually received here from the Presidencies earlier than at the end of October, because it has been found utterly useless to perform the operation of vaccination with such lymph in British Burma in the rains—this together with the fact that the Mergui Steamer may have left before the arrival of the Rangoon mail, which is often the case, probably account for the delay or no receipt of virus at Mergui until a late date.73

Other factors, beyond the quality of lymph itself, began to receive special attention in the Administration Report fo r 1869-70. Additional factors cited included misjudgement in choosing good vaccine from bad vaccine, and the unskillfulness of the operator (that is, the careless treatment of vaccine lymph). The continued failures of the lymph produced considerable concern among colonial doctors in Burma, leading them to direct blame at each other, rather than against the more obvious problems of the tropical climate. One example o f the problems in preparing vaccine in Rangoon occurred in 1869. Sanitary Commissioner Cowie and Mr. Henry Summerhayes, the latter officiating as the civil surgeon of Rangoon, levelled charges and counter-charges at one another in letters written to higher government authorities.

The disagreement was over bad lymph

delivered from Rangoon to Prome by two indigenous vaccinators. The two vaccinators had brought four glass tubes supposedly containing fresh vaccine lymph. When the lymph proved ineffective, Cowie wrote that this was due to three of the tubes being “not sealed at one end” and thus, “the contents were dry and consisted of purulent matter and

73 A. J. Cowie, “Sanitary Report for British Burmah for 1869,” in Public Health & Vital Statistics fo r 1869, pp. 139-140.

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were consequently perfectly unfit for use.”74 Cowie thus disposed of the lymph. As for the contents o f the fourth tube, they were found to be good. Cowie initially speculated that the reason for the differing condition of this last tube was that it had “evidently been received in Rangoon via Calcutta,” implying that the other three tubes were prepared poorly by the Rangoon depot.75 Summerhayes, who, as officiating as civil surgeon in Rangoon, would have been responsible for the three bad tubes if Cowie’s suggestions were correct, took offense. Summerhayes wrote a letter (‘Regarding a supply of bad lymph’) to the Home Department of the Government of India, in which he accused Dr. Cowie of making a false accusation when he claimed that the fourth tube, the only one containing good lymph, had been sent from Calcutta via Rangoon. Summerhayes explained that “no vaccine lymph in tubes was received from Calcutta by his Department during the past season,”76 and thus his depot was the source of the mixture of good lymph found in the fourth tube. As for the three bad tubes, Summerhayes suggested that they too had contained good lymph, but that it was clear that the tubes had been broken in transit. Dr. Cowie then counter-charged that Summerhayes was now merely trying to conceal his responsibility for the lymph that had gone bad:

74 Public Health & Vital Statistics fo r 1869, appendix, p. vi. 75 Public Health & Vital Statistics fo r 1869, appendix, p. vi. 76 Letter from A. J. Cowie to Horace Spearman, dated Prome, 3 May 1869 in Public Health & Vital Statistics fo r 1869, appendix, p. x-xiv.

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Mr. Summerhaye’s efforts to shield his own Department from blame for forwarding bad vaccine lymph to Prome, by impugning very unguardedly in my opinion, my statement makes it imperative that I should in examine the value of his remarks, maintain my own position.77

Cowie also chastised Summerhayes for misreading his initial report. First, Dr. Cowie argued that he had not said “one word ... in the extract about ‘broken tubes’,” but simply that the three tubes had not been “sealed at one end.” Second, Cowie now provided greater detail about how these three tubes had been prepared, in his opinion rather crudely.

The three short ones had been slovenly and very imperfectly filed, with dark yellow brown matter. They were dirty looking and the attempt to seal them had been still more carelessly done. The truth is, these tubes were one and all blackened at both ends as if they had been thrust into the flame of a common tallow candle, and although their mouths at one end had been closed up, at the other they remained open.

By contrast, the fourth, longer, tube, the length of which one would have supposed, Cowie pondered, would have been the first one to be broken:

77 Letter from A. J. Cowie to Horace Spearman, dated Prome, 3 May 1869, appendix, pp. x-xiv.

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contained clear and translucent lymph. It was filled, clean and very neatly sealed by a small clear bead of glass at either end, and evidently had been, when contrasted with the others, manipulated by a practised hand.

Cowie did not stop there. He continued to point out the discrepancies between Summerhayes’ explanation and his own observations. O f Summerhayes’ defence that his department at Rangoon did not receive vaccine lymph in tubes from Calcutta, Dr. Cowie was extremely doubtful. Dr. Cowie, from his personal experience of having earlier served for five years as the civil surgeon at Rangoon, remembered that his department had always received vaccine lymph in tubes from Bengal from the Superintendent General of Vaccination at Simla, and his observations of the fourth tube convinced him that that tube definitely been sent in the usual manner from Calcutta to Rangoon and then forwarded to the station at Prome. The confrontation hinted at the attempts by some vaccination authorities to redirect blame for early lymph failures and the lack of accountability that predominated in the Vaccine establishment in Burma at this time. The numerous and inconsistent sources of lymph made it easy for medical authorities to shift blame elsewhere and if challenged, made such accusations just as difficult to prove. Such medical authorities could only make accusations based on supposition or circumstantial evidence. Summerhayes, for example, could not remember who actually filled the tubes, suggesting that they could have been filled by himself, by Dr. Shortt in Madras, or, in actuality, that virtually anyone involved in the supply of lymph to Burma could be at fault; he simply did not know. Summerhayes attempted to avoid blame for this situation by criticizing the 45

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dominant procedures of the depot, for which he could not be held accountable since he was only officiating as the medical officer in charge. As he explained:

a custom which obtains here of mixing lymph containing tubes received from the Presidencies with tubes filled here appears to me reprehensible as it prevents all comparison of the relative goodness of the lymph procured from different sources.

Cowie, who had demonstrated on other occasions an extreme zealousness for detail and accountability that drew criticism from his superiors, continued to press the matter. Since Summerhayes could not offer reliable information, Cowie judged that Summerhayes had at the very least been negligent in his supervision of the preparation of vaccine lymph at Rangoon, especially since “ ...Mr. Summerhayes never saw the tubes himself.” Indeed, Cowie re-asserted, the explanation for the one good tube of lymph had to be that it, alone among the four tubes, had been sent from the Presidencies. Dr. Cowie seems to have won his argument regarding accountability for the failed lymph, for the correspondence on the matter does not continue. But the exchange had raised an important issue regarding the vaccine establishment in Burma. This controversy, for example, occurred at a critical time when the Government's plan to establish a special vaccine department was under consideration. Observing the premature condition of the vaccine establishment in Burma, Dr. Cowie suggested a halt to the custom of using vaccine lymph which was delivered from India and mixed in Rangoon before being forwarded to medical stations elsewhere in Burma. Instead, he suggested that sole 46

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reliance should be made on lymph sent from the Presidencies directly to those stations until an efficient staff could be appointed at the Rangoon depot. Others shared similar opinions. In 1868, the Deputy Commissioner of Sandoway (Arakan District), for example, reported the ineffective vaccine and indirectly suggested his hope for lymph to be sent directly from England or Simla.78 In order to reduce the rate of unsuccessful operations at critical times, the British Government provided new glass capillary tubes and ivory points to each station. This was not considered sufficient and calls were made for the establishment of local vaccine depots in outlying areas of British Burma so that local medical authorities would not have to depend on external sources (either from India or from Rangoon) for the supply of vaccine matter. These calls took into consideration what the British had come to realize about the adverse effects of tropical heat on lymph. One early suggestion, made in 1868, was that a vaccine depot should be established in Prome since its especially dry climate, compared to that o f other towns in British Burma (Upper Burma was not yet annexed), made it an ideal place for producing vaccine.79 The plea to establish a vaccine depot was made again in the report for 1869-70. When the plea for the establishment of a depot other than at Rangoon was eventually made in 1869-1870, it was suggested that the depot should be built independently from a hospital or dispensary. The reason for this suggestion was connected to the difficulty in getting children for vaccination purposes. The underlying logic of separating the hospital from the vaccination center, mentioned above, was that

78 Report on Vaccination fo r 1868, appendix, p. ii. 79 Annual Report upon Vaccination in British Burma, fo r the year ending 3 Is' December 1868, p. 18.

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parents of the child from whom vaccinators would be able to obtain fresh lymph would not agree to bring their child to such an institution “if their parents had to mingle with persons seeking assistance at such an institution.”80 In other words, if a depot was in any way connected with the presence of sick people, child-carriers of vaccine matter could not be obtained.

Cow-to-Arm Vaccination

Not everyone was satisfied with arm-to-arm vaccination. Concerns over secondary infections such as the transmission of Syphilis and Leprosy argued for an alternative to the arm-to-arm method and thus against humanized lymph. In the colonies, British doctors already knew the dangers regarding the transmission of other infectious disease such as Syphilis through arm-to-arm vaccination from their experience in metropolitan England for Smallpox was not a “tropical disease,” but a universal malady. In Britain and elsewhere in Europe, growing concerns regarding the safety of the ‘arm-to-arm’ mode of the vaccination operation had pressured British medical authorities to search for a better method of transferring and preserving good vaccine lymph. The European solution was to replace the child with the cow as a carrier of cowpox. Instead of passing cowpox from arm to arm among children, British medical authorities began to inoculate cows with cowpox and take the infected cows to the doorsteps of childrens' houses, vaccinating

80 Report on Vaccination in British Burma fo r the year 1869-70 (Rangoon: Central Gaol Press, 1870): p. 7.

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children directly from the cows.81 According to Hopkins, this method was first perfected in Naples in 1843, adopted in France in 1864, Germany in 1865, and England in 1881.82 Using cows presented one solution. Since lymph taken directly from cows was fresh, cow-to-arm vaccination was becoming more popular among colonial doctors by the mid-nineteenth century.83 In Burma, this was true by 1877, when it was reported that “[a]rm to arm vaccination is seldom practised.”84 Due to the short longevity of the cowpox virus and the impracticability of transporting infected cows themselves overseas, however, the adoption of cow-to-arm vaccination required locally-produced animal vaccine lymph in India and Burma. Additionally, the late adoption in the British metropole of animal vaccine lymph encouraged a further delay in its colonies. Yet even more obstacles were presented by the climate and cultures of India and Burma. The tropical climate had had adverse effects on experiments with animal lymph for decades. Even more intimidating was cultural resistance in India to using cowpox virus. British medical authorities in India and Burma thus did not commit to calf lymph until after the mid-nineteenth century. The first experiments with obtaining lymph from calves occurred as early as 1832 in Bombay and Bengal, and attempts to produce it in the late 1850s in Bombay and in Madras in the 1870s resulted in failure due to a combination of poor results and hostile indigenous reaction. It was not until 1880 that experiments at Madras

81 Hopkins, The Greatest Killer, p. 88. 82 Hopkins, The Greatest Killer, pp. 88-9. 83 Hopkins, The Greatest Killer, p. 88. 84 Report on the Administration o f British Burma During 1877-78, p. 76.

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succeeded in producing calf lymph which was sufficiently reliable to make calf-to-arm vaccination a viable alternative to arm-to-arm vaccination in India.85 Experiments in Burma roughly coincided with those in India. One of the early experiments with producing lymph from calves in British possessions in South Asia, for example, was conducted in British Tenasserim in the 1830s. The problems of obtaining a good supply of lymph had led Dr. M. F. Anderson, the Assistant Surgeon in medical charge of Mergui, to engage in a vaccination experiment in Tenasserim Province, in 1837. Anderson faced a difficult situation, as two or three people were dying daily of small pox in the town. Anderson found that the government-supplied vaccine was not working effectively.86 Supplied only with unreliable, useless, government matter from India, Anderson thus determined to experiment with a new vaccine matter. The Assistant Apothecary J. Starkenburgh had found a single pox pustule on the udder o f an “otherwise healthy cow.” From this single cow pustule, Anderson produced new vaccine matter.87 Using the new “cow pox” vaccine matter, from 1 July 1837 to 1 November 1837, Anderson vaccinated 584 people in Mergui. According to Anderson’s data, the 584 vaccinated subjects included three European children, ten Indo-British children, and thirty-one Indian convicts. Other subjects included indigenous Burmese in dangerous circumstances:

85 Bhattacharya, “Re-devising Jennerian Vaccine?” p. 223; Arnold, Colonizing the Body, 140; Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859-1914 (Cambridge: Cambridge University Press, 1994): p. 85, and on 267, citing James, Smallpox and Vaccination, p. 32. 86 Maulmain Chronicle (18 November 1837): p. 127. 87 Maidmain Chronicle (18 November 1837): p. 127.

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several natives, both adults and children were vaccinated, when their parents, brothers, sisters, or other relations were suffering from small pox in the same room with them— others, whose parents or relations had died some days before from the disease.. .88

Anderson found that for the first two months, the number of small pox cases decreased, and all the individuals in the above-quoted categories avoided death from the disease. In July and August 1837, many of the subjects developed a large number of pustules and high fever, but all survived. Even at this stage, however, the indigenous population was experiencing the disease to a greater degree of severity. The indigenous children, for example, developed more pustules than the Indo-European children. In September and October, non-Burmese were recovering and the “vaccination progressed regularly in one or two pustules on each arm, with scarcely any constitutional disturbance.” The Indian convicts as well showed no symptoms of the disease. Among the Burmese, however, the infection continued to get worse, with higher fevers and pustules all over the body. Seven Burmese died during this period five or six days after the pustules had disappeared. Anderson attributed six of the deaths to pulmonary disease. For the seventh death, Anderson speculated that the Burmese child was “treated by some ignorant Burmans for “acute dysentery.” While the majority of Burmese would seem to have survived, their especially painful experience and the deaths of seven treated for Smallpox may have made the cure appear worse than the disease.

80

88 Maulmain Chronicle (18 November 1837): p. 127. 89 Maulmain Chronicle (18 November 1837): pp. 127-128.

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Aside from their early experiment with locally-produced cowpox matter in Tenasserim in 1837, colonial doctors in Burma would not try this method of propagating cowpox vaccine in cows again until the 1880s, just after the success of experiments with the cowpox vaccine in British India. Prior to reliable preservation methods, vaccinators or medical officers would lead calves from one village to another, directly vaccinating unprotected villagers from cow to person. Or sometimes,

“Calves were taken through the streets in a covered cart and often calves were sent to rice-mills, where the coolies employed were vaccinated.”90

Surgeon-Major Thomas at Maulmein even recommended that at least the principal towns should receive an inoculated calf monthly.91 However, in response to the length of time it would take to move cattle around from village to village to conduct direct vaccination, and to the difficulties of preserving lymph for the journey from foreign vaccine production centers, colonial medical authorities in Burma authorities began to plan for the establishment of a vaccine depot for producing vaccine just as Britain and British India already had. These plans came to fruition under Dr. Griffith, who headed the first efforts to produce animal lymph at a depot located at Thayetmyo. He failed, blaming the lymph obtained from Brussels as having already lost its effectiveness by the time it reached Thayetmyo.92 However, from 1884 more positive

reportsemerged

90 Report on Vaccination in Burma fo r the Year 1889-90, p. 5. 91 Report on Vaccination in Burma fo r the Year 1889-90, p. 5. 92 Report on the Administration o f British Burma during 1881-82 (Rangoon: Government Press, 1882): p. 128.

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concerning

the success of this new method. Dr. Pedley, a health officer of Rangoon, successfully continued to raise calf lymph with which the effective vaccination of twenty-six thousand people around Rangoon was produced.93 Calf vaccination gradually began to replace arm-to-arm vaccination in the British colony. In Moulmein in 1889, for example, Surgeon Major Thomas reported the termination of arm-to-arm vaccination because of the abundance of animal lymph.94 In 1902, it was reported that vaccination was carried out using calf lymph generally throughout British Burma, making arm-to-arm vaccination available only when calf lymph was found to be inert.95

Cattle Availability for Lymph Manufacture

By 1890, Cattle had become a significant part of the extension of vaccination in Burma. The difficulty in obtaining fresh lymph from abroad was an incentive for the civil surgeons and the government to look for a way to raise vaccine locally. Further, they could replace cows with children as vaccine carriers: from arm-to-arm operation to cowto-arm operation, since a lack of collaboration from the Burmese parents was apparent and had become long-lasting predicament.

93 Rangoon Gazette Weekly Budget, 18 July 1890. “No fewer than 32, 742 vaccinations were performed in these districts, o f which number 10, 484 primary vaccination and 15, 779 revaccinations were successful. The percentage o f successful vaccination for the province amounted to 86.1 for primary cases and 69.73 for re-vaccination. The latter resulted in considerably better than that obtained in 1888.” 94 Report on Vaccination in Burma fo r the Year 1889-90 (Rangoon: Superintendent, Government Printing, Burma, 1890): p. 5. 95 Triennial Report on Vaccination in Burma fo r the Years 1899-1900-1901-02 (Rangoon: Superintendent, Government Printing, Burma, 1902): p. 4.

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Despite its major advantages, animal vaccination was not a perfect solution. Even though there were no religious obstacles to using cattle such as the British found in India, the civil surgeons and the Vaccination Department in Burma faced a number of practical problems regarding the maintenance of a sufficient stock of cattle as fresh cowpox carriers and an effective strain of lymph. Sufficient numbers of calves were necessary for the cultivation of lymph since all the cows inoculated did not necessarily succeed in raising effective lymph. In 1889, for example, only four out of nine calves were successful.96 A harsh climate could easily affect the raising of effective lymph in cows. High temperatures weakened calves’ health and the calf lymph strain by causing a continual passing of weaker and weaker strain of lymph. In the worst cases, the lymph strain lost its effectiveness altogether. Some colonial doctors blamed the Burmese cow for lymph failure. Calf lymph raised by using Bangalore lymph was considerably more effective than that of local Burmese calf lymph. Burmese calves, it was claimed, did not develop vesicles as much or as good as Indian counterpart.97 Captain C. E. Williams, the officiating health officer of the Rangoon Municipality, comparing the Burmese calves with those of England, reached the same conclusion about the inferiority of Burmese calves. However, these was also some suggestion that it was not the inferior quality of Burmese calves per se but rather the inferior health condition of Burmese calves that was the true cause of the poor results.

96 Report on Vaccination in Burma fo r the Year 1889-90, p. 5. 97 Report on the Administration o f Burma fo r the year 1901-02 (Rangoon: Superintendent, Government Printing, Burma, 1902): p. 91.

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There were a number of conditions that were disadvantageous for the maintenance o f healthy cows. Periodic outbreaks of cattle-disease such as foot and mouth disease reduced the available numbers of healthy cows.98 At the beginning of the 1900s, the Meiktila Vaccine Depot lost all its fresh and effective lymph strain due to cattle disease. In order to reinstate the good vaccine strain, Bangalore, Shillong and Rangoon sent their lymph to the Meiktila depot, but in vain. Finally, the director called for a young child from Mandalay to bring, as a carrier, an effective strain of the cowpox lymph which was inoculated successfully into calves and “a new strain of lymph started.”99 The outbreak o f epidemics in the herd was feared because it could cause various kinds of damage to the production of lymph. Both foot-and-mouth disease (aftosa or aphthouse fever) and cow plague (rinderpest), claimed many numbers of cows. For example, ninety-one calves died due to the severe epidemic of foot-and-mouth disease and cow plague during 1899-1900.100 At the Meikila Vaccine depot, 150 calves in 19091910 and eighty-eight calves during 1910-1911 died from both Hemorrhagic Septicemia (Pasteurella Multocida) and cow plague.101 These infectious diseases killed many cows, weakened otherwise healthy cows, and staffs at the vaccine depots were unable to

98 Triennial Report on Vaccination in Burma fo r the Years 1899-1900-1901-1902, pp. 4-5. 99 Triennial Report on Vaccination in Burma fo r the Years 1902-03 to 1904-05, p. 4. 100 Notes and Statistics on Vaccination in Burma fo r the Year 1899-1900 (Rangoon: Superintendent, Government Printing, Burma, 1900): p.l 1. 101 Triennial Report on Vaccination in Burma For the Years 1908-1909 to 1910-1911 (Rangoon: Office o f the Superintendent, Government Printing, Burma, 1911): p. 7.

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maintain the strain o f vaccine lymph. It also worried civil surgeons that they might render the lymph to contain other unwanted viruses such as syphilis.102 Different animal epidemics had differing impacts on the depot’s cattle stock. Cow plague, “the most devastating bovine disease,” is highly fatal but, “bestow[ed] relatively solid immunity on survivors.” It can contaminate equipment and stables for only a short period. Thus, although the stock would be severely depleted, no major overhaul of facilities was required.103 Foot and mouth disease, deadly but at a lower rate than cow plague, however, demanded significant additional expenditures for the maintenance of cow stables and facilities to keep cows. Foot-and-mouth disease is an especially persistent and ubiquitous disease that required as much dealing with the animal’s environment as it did the animal itself, for it threatens to give affected areas ‘permanent epidemic status’ if the disease is not eradicated. Depopulation of animal stocks is only part of the solution, the animal’s living areas must also be disinfected and the stables must be vacated for at least a month.104 In several Burmese vaccine depots, such outbreaks necessitated ‘thoroughly overhauling the calf shed[s],”105 while simultaneously requiring accommodation for quarantining the vulnerable cattle. Animal epidemic outbreaks were also costly because the vaccine depots could not dispose of calves during

102 Report on Vaccination in Burma fo r the Year 1889-90 (Rangoon: Superintendent, Government Printing, Burma, 1890): p. 5. 103 Kahrs, Viral Diseases o f Cattle, pp. 293, 299. 104

Kahrs Viral Diseases o f Cattle, p. 278.

105 Notes on the statistics o f Vaccination in Burma fo r the Year 1899-1900. (Rangoon: Superintendent, Government Printing, Burma, 1900): p. 11.

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the epidemics, in part because diseases such as cow plague were spread mainly through cattle trading, which increased the feeding costs for numerous calves.106 Other doctors did not think that cow-to-arm was an economically viable alternative to arm-to-arm. By the late nineteenth century, the great difficulty in obtaining cows in Burma was a continual obstacle for the manufacture of lymph as well as for cow-to-arm animal vaccination. The importance of cows to the indigenous agricultural population and unpredictable market forces made it difficult for depots running on tight government budgets. The British usually purchased calves from farmers in the each district and the local bazaar. The price of the calf depended upon the various agricultural, environmental, and climatic conditions of that season. It was not a serious concern for British doctors to obtain numbers of cows before the end of the 1880s, thanks to local butchers’ generous donation or free loan. However, soon these generous offers halted. Local butchers and milkmen began to stop having their calves inoculated “for fear of losing them.”107 This reduced the numbers of potential calves which could be used for raising lymph. At Thayetmyo, the civil surgeon pessimistically reported, “it was only from the jail dairy farm and local contractors that calves could be obtained.”108 These fears soon subsided and cattle became available from local butchers for purchase again. In the late 1890s, however, as the necessity for calves for the cultivation o f lymph and cow-to-arm vaccination, increased local butchers again

106 Notes on the statistics o f Vaccination in Burma fo r the Year 1909-10, p. 3; Kahrs, Viral Diseases o f Cattle, p. 298. 107 Report on Vaccination in Burma fo r the Year 1891-92, p. 7. 108 Report on Vaccination in Burma fo r the Year 1891-92, p. 7.

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began to charge for each calve for hire instead of donating them.109 This system of hiring cattle was based on the contract between the vaccine depot and the local owners of calves. At Rangoon, for example, calves were loaned for seven rupees per head and used for the cultivation of lymph. After they raised the lymph, they were returned to the original owners.110 This hiring system turned out to be a financial saviour because the initial costs of calves were lower than purchasing them and feeding cost was also lower due to the limited period of feeding them. Further, a lower mortality rate was also achieved by this system. For the Vaccination Department, this was a “financially economical” system.111 However, it still experienced difficulty in obtaining calves “in good condition” sometimes because of the fear of the fanners being unable to sell their cows after inoculation especially in years of failed crops.112 The costly operation of animal vaccination caused the termination of its practice in some vaccine stations. As early as 1889, the trouble regarding the acquisition of cows had threatened the continuation of cultivation of lymph.113 In Akyab in 1890, the civil surgeon, Dr. Evans, complaining of the high price of animal vaccination wrote “its advantages were more than counterbalanced by its excessive cost; 13 annas in 1887-1888

109 Notes on the statistics o f Vaccination in Burma fo r the Year 1899-1900. (Rangoon: Superintendent, Government Printing, Burma, 1900): p. 16. 110 Notes on the Statistics o f Vaccination in Burma fo r the Year 1899-1900 (Rangoon: Superintendent, Government Printing, Burma, 1900): p. 14. 111 Notes on the Statistics o f Vaccination in Burma fo r the Year 1911-1912, p. 4. 112 Triennial Report on Vaccination in Burma fo r the Years 1905-1906 to 1907-1908 (Rangoon: Office o f the Superintendent, Government Printing, Burma, 1908): p. 6. 113 Report on Vaccination in Burma fo r the Year 1889-90, p. 5.

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and Rs. 1 for each case in 1889-90.”114 Although calves would only be needed temporarily, they had to be purchased, as the indigenous population sometimes resisted loaning their cows to medical authorities who were clearly going to infect them. In 1891 in Thayetmyo, for example, the civil surgeon complained:

the milkmen and butchers would not allow their calves to be vaccinated for fear o f losing them, and that it was only from the jail dairy farm and local contractors that calves could be obtained.115

The civil surgeon, however, only understood part of the concerns. Such resistance was not simply based on the fear of cow death, which was unlikely with coxpox, but probably from the more justified concern that lesions from cowpox, a disease that affected bovine teats, could bring mastitis and lower milk productivity, thus reducing the economic value of the animal.116 During bad harvests, it was difficult to find healthy cows for purchase or even a market for cows once they were no longer needed for vaccine conveyance.117 Likewise, external events sometimes produced adverse market conditions. During World War I, Britain set up prisoner of war camps in Burma for captured Muslim Turkish soldiers who could not eat pork like the Burmese and thus depended upon beef. Such

114 Report on Vaccination in Burma fo r the Year 1889-90, p. 5. 115 Report on Vaccination in Burma fo r the Year 1891-92 (Rangoon: Superintendent, Government Printing Burma, 1892): p. 7. 116 Kahrs, Viral Diseases o f Cattle, p. 201. 117 Triennial Report on Vaccination in Burma fo r the Years 1905-1906 to 1907-1908 (Rangoon: Office o f the Superintendent, Government Printing, Burma, 1908): pp. 6-7.

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Turkish Prisoner-of-war camps in Burma boosted the price of cows beyond affordability and it was even claimed that “fodder also reached famine prices.”118 In sum, such predicaments made some civil surgeons feel that it was nearly impossible to carry out animal vaccination, much less maintain a continuous supply of fresh calf lymph.119 As for the problem of the longevity of the lymph, the ‘fresh’ quality of cow-to-arm vaccination presented problems of preservation, the topic to which we shall turn in the following chapter.

Conclusion

Effective vaccine lymph was difficult to obtain in Burma for most of the nineteenth century. Even though civil surgeons were sometimes lucky in acquiring effective lymph from London or from India, this valuable lymph in many cases lost its efficacy while being transferred to interior of Burma. The resistance of the indigenous population to voluntarily provide their children as vehicles for carrying the vaccine virus around Burma also presented a serious predicament. These practical problems of inter-provincial and intra-provincial transportation of vaccine lymph led colonial medical authorities to seek for a solution locally for transferring lymph. They attempted to resolve these problems by producing vaccine lymph within Burma using Burmese cows as both producers as well as

118 As J. Entrican reported, “The average cost per calf was Rs. 13-8-0 and the price realized on sale Rs. 9-00, so that the loss per calf was Rs. 4-8-0, to which must be added feeding charges amounting to Rs. 3-6-0 per calf-making the total cost o f each calf Rs. 7-14-0.” Triennial Report on Vaccination in Burma fo r the Years 1917-1918 to 1919-1920 (Rangoon: Office o f the Superintendent, Government Printing, Burma, 1921): pp. 4-6. 119 Report on Vaccination in Burma fo r the Year 1889-90, p. 5.

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carriers of the vaccine lymph. This solution partially improved the situation, however, medical authorities again faced economical and financial problems in acquiring cows. This series of challenges in obtaining effective lymph forced British medical authorities in Burma to consider local conditions closely more than ever. The road to successful vaccination would depend more on the local circumstances which changed frequently and unpredictably. Even after the emergence of the local production of lymph in Burma, however, other problems regarding lymph supply emerged as well. The desire for local lymph led local British medical officers in Burma to begin to produce lymph at local stations scattered around Burma which made it difficult for lymph manufacture to keep up with the fast pace of new medical discoveries. Even when a single, central, vaccine depot was decided upon, the location, the methodologies to be pursued, and a range of other practical considerations produced new challenges. These problems are the subject of the next chapter.

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CHAPTER THREE THE EMERGENCE OF THE MEIKTILA VACCINE ESTABLISHMENT, 1902-1933

By the end of the nineteenth century, civil surgeons in Burma were still facing the problem of chronic lymph failures. Vaccine lymph from India or Europe was said to have lost its efficacy en route to Burma. By 1880, the government had realized the necessity of establishing local vaccine depots in Burma. However, even with the success in the cultivation of local lymph, they could not bring about successful vaccination. There were still multiple obstacles that the colonial medical establishment in Burma had to face such as high atmospheric temperature and the poor longevity of the efficacy of the lymph. In the early twentieth century, several local vaccine depots were developed into one centralized depot at Meiktila. In this process, the scientific search for the better preservation of lymph took off under one enthusiastic British doctor, J. Entrican. Nevertheless, his drive and abilities occurred in a context of changing approaches to lymph and vaccination that helped to make his research possible. Civil surgeons throughout Burma were solving, at the local level, the problems of obtaining cows for vaccination purposes. This was in response to another development, the universal change in vaccination style from arm-to-arm vaccination to cow-to-arm vaccination. The development of s state railway system in Burma also sped up the transfer of lymph to a 62

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growing number o f places. As a result, the conditions were right for a series of experiments that made Burma a scientific laboratory for better lymph. This chapter is divided into three sections. First, this chapter will look at the reasons why rail transport during the colonial period had a limited impact on the vaccination program in Burma. Second, the move by the Vaccination Department to attempt to create numerous local depots will be examined. The attempt to find the best location for a vaccine depot resulted in many failures and finally led them to Meiktila. The third section examines the establishment of a central depot at Meiktila and the experiments conducted there by J. Entrican to find a better preservation technique to enable fresh lymph to increase its longevity in the tropical climate of Burma.

Railways in Burma

One of the major difficulties for the successful distribution of even locally (within the province) cultivated lymph was that the lymph quite frequently deteriorated during its transit across long distances.120 When the British began to annex parts of Burma following the First Anglo-Burmese War (1824-1826), they found that road transportation networks existed, but were rudimentary and large areas of Burma were only accessible overland with great difficulty. At that time, the multiple riverways of the Irawaddy, Salween, Sittang, Chindwin and their tributaries were the main lines of communication and internal trade. This began to change with the gradual establishment of the colonial railway networks later in the nineteenth century. Improving the transit period for vaccine

120 Triennial Report on Vaccination in Burma fo r the Years 1902-03 to 1904-05, p. 4.

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throughout the whole province in Burma was not the reason for the British to build the railways. It was more the Indian Mutiny that gave incentive for the Government of India to construct railways to ease military operations.121 The construction of the railway system in Burma was also subject to considerable delay and remained poor, at least by comparison to India, even at the end of colonial rule. The reasons for the delay, as Maung Shein explains, was poor information and the colonial budget. Most of the railway lines intended to be opened up in Burma, for example, would be in virgin territory of which the colonial government lacked significant information. More importantly, the colonial government was very reluctant to sanction the construction of future railways until they promised commercial success.122 The colonial railway project did not begin until 1874 at Prome. The line between Rangoon to Prome, covering a distance of 161 miles, was completed in 1877 and the line from Rangoon to Toungoo followed in 1885. After the seizure of Upper Burma in 1886, the British immediately started to build a railway from Rangoon to Mandalay and finished by 1888.123 Railway mileage expanded to 886.25 miles from 1877 to 1896.124 The railway was then extended to Myitkyina in the Chinese border in 1898 and Lashio in 1902. The private Burma Railways Company had purchased the lease of the State

121 J. S. Fumivall. Colonial Policy and Practice: A Comparative Study o f Burma and Netherlands India. (Cambridge: At the University Press, 1948): p. 78. 122 Maung Shein, “State Investment in Burma Railways, 1874-1914,” Journal o f the Burma Research Society 44.2 (Dec. 1961): p. 169. 123 Thant Myint-U. The Making o f Modern Burma (Cambridge: Cambridge University Press, 2001): p. 223. 124 Josef Silverstein, “Politics and Railroads in Burma and India,” Journal o f the Burma Research Society 45.1 (June, 1962): p. 80.

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M ap Showing the M ajor Hall Linkages In the Colonial Period

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railways in 1896, and the railway project had continued opening railway lines to Bassein in 1902 and to Moulmain in 1907.125 With the opening of the railway line in Moulmain, “one could travel across Lower Burma from east to west by land without having to force a way by footpaths and ford innumerable creeks.”126 However, in reality, the railway lines were extended quite vertically from Rangoon to Mandalay; they extended to the north-east in the direction of Mytkyina and Lashio, and westward from Rangoon to Prome, stretching to Bassein from the middle of that line, and extending Southeast to Moulmain. This development still left a majority of Burma’s vast interior outside of rail communication.127 Some towns such as Taunggyi in the Southern Shan States, where the government opened a vaccine depot in 1896, was shut down in 1901 in part because it was located too far from the main railway lines.128 In 1908, three decades after the initial construction o f the first railway line in Burma, Major Williams complained of the long length of time for the transport of lymph. Frustrated with the delayed development of suitable transportation in Burma, Williams wrote:

125 Fumivall, Colonial Policy and Practice, p. 78. 126 Fumivall, Colonial Policy and Practice, p. 78. 127 Silverstein, p. 80. 128 Notes and Statistics o f Vaccination in Burma fo r the Year 1899-1900 (Rangoon: Superintendent, Government Printing, Burma, 1902): p. 91.

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there is no doubt that this takes place to a greater extent in this province than in India, where communications by rail and road are so much more advanced...129

Even in 1921, Major Entrican, a former head of the Meiktila Vaccine depot and at that time officiating as Superintendent of Vaccination in Burma, considered the percentage of successful vaccinations in 1919-20 as “a fair result” only because a considerable length of time was still required for the lymph to reach numerous stations:

I hope it represents the true state of affairs, but in pessimistic moments I cannot help wondering how some vaccinators in far away lonely places, with lymph sometimes 3 or 4 weeks old, can get just as good result as are got in Rangoon or Meiktila, the two places where lymph is always obtainable, fresh, vigorous, and newly made.130

Some districts were especially isolated. Arakan, separated from the rest of Burma by the Arakan Yoma mountain range, for example, had the most limited access of any region in Burma. During the First World War, when sea communication from Rangoon was reduced over the fear o f German submarines, it was approachable only overland via Calcutta.

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Therefore, it took at least two to three weeks for vaccinators there to obtain

129 Triennial Report on Vaccination in Burma fo r the Years 1905-06 to 1907-08, p. 6. 130 Triennial Report on Vaccination in Burma fo r the Years 1917-18 to 1919-1920, p. 4. 131 Triennial Report on Vaccination in Burma fo r the Years 1917-18 to 1919-1920, p. 4.

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lymph. Generally, Arakan always appeared lowest among other districts in Burma in terms of successful vaccination results.

Establishing Local Depots

As mentioned in the previous chapter, the chronic failure of lymph considerably delayed the extension of vaccination in Burma. In 1880, 51,106 vaccinations were carried out, of which about one fifth were unsuccessful. This was an unacceptable figure for the government, which considered that three times more operations was needed to protect the population from Smallpox.132 Many civil surgeons blamed ineffective lymph brought from India or Europe via India as the main cause of unsuccessful vaccinations. They made suggestions and requests to the government to organize vaccine depots for the local cultivation of vaccine lymph. However, some British medical authorities did not consider ineffective lymph as the sole culprit. Some sanitary commissioners, for example, believed that “little care on the part of the Medical Officers” could have overcome the difficulty in maintaining fresh lymph.

1

The growing pleas of civil surgeons to government authorities in Burma to obtain effective lymph gradually convinced the latter of the necessity to establish local vaccine depots. The first step came with a sanction to Dr. Griffith, the civil surgeon of Rangoon, who proposed the organisation of Establishment at Thayetmyo “for the supply of animal

132 Report on the Administration o f British Burma During 1881-82 (Rangoon: Government Press, 1881): p. 128. 133 Report on the Administration o f British Burma During 1878-79 (Rangoon: Government Press, 1880): p. 81.

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lymph.”134 However, this first attempt failed due to the chronic problem of fresh lymph from Europe losing its efficacy in transfer before it reached Thayetmyo, thus preventing experiments there in lymph cultivation. The government made the decision to resume the experiments at Thayetmyo later, making use of lymph obtained from Bombay-.135 The Vaccination Department sought a suitable location for the establishment of depots for the cultivation of lymph. While attempts failed at Thayetmyo and Toungoo, the vaccine station at Rangoon was successful, which encouraged the government to arrange an establishment of vaccine depot at Rangoon.136 Dr. Pedley, the health officer in Rangoon succeeded in cultivating animal lymph from 1883 and distributed it among practitioners around Rangoon.137 From 1888 to 1890, he personally inoculated more than 456 calves and sent out 1,073 tubes of lymph to other practitioners and vaccinators even to some beyond the municipal limits.138 This was a benchmark event, drawing praise from his colleagues. Dr. Sinclair, for example, openly applauded the successful results of Dr. Pedley’s continuous efforts.139 Experiments were carried out in other vaccine stations as well. For example, Dr. Baker was successful in producing lymph in Akyab in 1883-

134 Report on the Administration o f British Burma During 1880-81 (Rangoon: Government Press, 1881): p. 127. 135 Report on the Administration o f British Burma During 1881-82, p. 128. 136

Report on the Administration o f British Burma During 1882-83, p. 143.

137 Report on the Administration o f British Burma During 1883-84 (Rangoon: Government Press, 1884): p. 88 . 138

Report on Vaccination in Burma fo r the Year 1889-90 (Rangoon: Superintendent, Government Printing, Burma, 1890): p. 5. 139 Rangoon Gazette, 18 July 1890.

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84.140 Surgeon-major Thomas was also successful in inoculating a calf when fresh lymph was needed.141 The Rangoon Vaccine Depot headed by Dr. Pedley was emerging as a dependable facility capable of serving as a center for the supply effective vaccine throughout Lower Burma. In fact, the Rangoon Vaccine Depot was under the Rangoon Municipality, and as a municipal institution was not technically responsible for providing lymph throughout the colony. Through a special arrangement, the provincial government provided funds amounting to 850 rupees per year in exchange for lymph supplies from Rangoon.142 In the 1880s and 1890s, the Rangoon depot thus provided cultivated vaccine paste for free to medical officers, sanitary officers, and to public and private vaccinators.143 The negative side of the Rangoon Vaccine Depot’s status as a municipal institution was that it was subject to the challenges of convincing local business and social leaders on the Municipal Council, its largest source of funds, of the need for increased funding to keep pace with its growing activities. As a result, the limited funds provided by the council prevented an updating o f equipment, and the Rangoon Vaccine Depot’s facilities were becoming dangerously old and outdated. In 1906, the Superintendent of Vaccination W. G. King was so disgusted by the lack of care for cultivated vaccine lymph in Rangoon that he claimed that “vaccine pulp gather[ed] in this depot” was something he would

140 Report on the Administration o f British Burma During 1884-85, p. 66. 141 Report on Vaccination in Burma fo r the Year 1889-90, p. 5. 142 Triennial Report on Vaccination in Burma fo r the Year 1896-97-98-99. (Rangoon: Superintendent, Government Printing, Burma, 1899): p. 18. 143 Triennial Report on Vaccination in Burma fo r the Year 1896-97-98-99, p. 18.

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M ap Showing the Centers for the Local Production o f Catph Lymph Id Burma during the Colonial Period

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