History is stories, but sometimes they are not exactly true, or are only half true. As a child in an elementary school in Udhampur, I recall being told about smallpox and the discovery of the protection against it by Edward Jenner in 1798.

It was much later that I learned from British accounts of the 18th century that the story is more complicated and interesting. Edward Jenner was indeed the first to use vaccination based on cowpox, but there was a much older method of vaccination against smallpox using weakened matter from pustules that had been current in the East and Africa for centuries.

I learned about the Indian method of treatment of smallpox from a report written by Dr John Z. Holwell in 1767 for the College of Physicians in London. Titled `An Account of the Manner of Inoculating for the Smallpox in the East Indies', it not only described the system in great detail, it also provided the rationale behind it. This report is an excellent source to understand the mind of the Ayurvedic doctor of the 18th century.

Holwell was born in Dublin in 1711. He came to Calcutta as a surgeon's mate in 1732, practicing as a doctor from 1736 onwards. Temporarily the Governor of Bengal for a few months in 1760, he was a Fellow of the Royal Society.

Holwell informs that inoculators “are delegated for this service from the different Colleges of Bindoobund [?], Eleabas [Allahabad], Banaras, &c. over all the distant provinces; dividing themselves into small parties, of three or four each, they plan their traveling circuits in such wise as to arrive at the places of their respective destination some weeks before the usual return of the disease.” One would presume that they were Ayurvedic vaidyas or their assistants:

They inoculate indifferently on any part, but if left to their choice, they prefer the outside of the arm, midway between the wrist and the elbow, for the males; and the same between the elbow and the shoulder for the females. Previous to the operation the Operator takes a piece of cloth in his hand, (which becomes his perquisite if the family is opulent,) and with it gives a dry friction upon the part intended for inoculation, for the space of eight or ten minutes, then with a small instrument he wounds, by many slight touches, about the compass of a silver groat, just making the smallest appearance of blood, then opening a linen double rag (which he always keeps in a cloth round his waist) takes from thence a small pledgit of cotton charged with the variolous [smallpox] matter, which he moistens with two or three drops of the Ganges water, and applies it on the wound, fixing it on with a slight bandage, and ordering it to remain on for six hours without being moved, then the bandage to be taken off, and the pledgit to remain until it falls off itself… The cotton which he preserves in a double callico rag is saturated with matter from the inoculated pustules of the preceding year, for they never inoculate with fresh matter, nor with matter from the disease caught in the natural way, however distinct and mild the species.

Holwell claimed that when the inoculation regime was strictly followed, it is next to a miracle to hear that it 'failed in one in a million'. He added that since “this practice of the East has been followed without variation, and with uniform success from the remotest known times, it is but justice to conclude, it must have been originally founded on the basis of rational principles and experiment.”

This is how Holwell described the explanations offered to him by Ayurvedic vaidyas:

The immediate (or instant) cause of the smallpox exists in the mortal part of every human or animal form; that the mediate (or second) acting cause, which stirs up the first, and throws it into a state of fermentation, is multitudes of imperceptible animalculae [microorganisms] floating in the atmosphere; that these are the cause of all epidemical diseases, but more particularly of the smallpox; that they return at particular seasons in greater or lesser numbers…That these animalculae touch and adhere to every thing, in greater or lesser proportions, according to the nature of the surfaces they encounter; that they pass and repass in and out of the bodies of all animals in the act of respiration, without injury to themselves… smallpox is more or less epidemical, more mild or malignant, in proportion as the air is charged with the animalculae, and the quantity of them received with the food.

Holwell understood the idea behind inoculation thus: “That when once this peculiar ferment, which produces the smallpox, is raised in the blood, the immediate (instant) cause of the disease is totally expelled in the eruptions, or by other channels; and hence it is, that the blood is not susceptible of a second fermentation of the same kind.” In other words, he believed that when the disease in its natural form or when introduced in its weak form by the inoculation has run its course, the patient is safe. The difference between these two forms being that in its natural course it is often fatal, whereas when introduced through inoculation, it is only an inconvenience.

It is significant that the spread of disease was taken to be due to the imperceptible animalculae (microorganisms). This was ahead of the germ theory of disease of Pasteur, Lister and Koch that arose in the 1860s and 70s.

Scholars now believe that the cure for smallpox arose in India sometime before 1000 AD. From India, the method of inoculation spread to China, western Asia and Africa and finally, in the early 18th century, to Europe and North America. The evidence for the cure reaching China comes from Imperial Chinese records.

Interesting questions arise from the Holwell account. Was the idea of the treatment derived from agada-tantra, one of the eight branches of traditional Ayurveda that deals with poisons and toxins in small dosages? The Charaka Samhita speaks of how deadly poisons can be converted into excellent medicine and how two toxins can be antagonistic to each other. The Charaka Samhita also speaks of organisms that circulate in the blood, mucus and phlegm.

What was the sociological basis for the army of inoculators fanning out into the country? How were the different regions parcelled to the inoculators? How were the itineraries drawn up to ensure that the inoculators reached the region before the smallpox season? Were business activities organized on a similar basis?

These are questions that can be answered only with in-depth studies.