At two weeks, scabs formed. They ‘encrust most of the body’, historian Fenn writes. The pain was awful, ‘any movement excruciating.’ The itching could be unbearable. Death, if it was to visit, normally arrived by this point.
The disease also tore apart the lungs, heart, and liver. Smallpox consumed its human hosts ‘as a fire consumes its fuel, leaving spent bodies, dead or immune, behind,’ writes Fenn.
In Nepal, as in much of north India, people thought of smallpox in religious terms, as a visitation by the goddess Sitala, ‘the cool one’. This understanding of disease came with its own remedy: ‘Smallpox was conceptualised,’ historian Arnold writes, ‘not as a disease but rather as a form of divine possession, and the burning fever and pustules that marked her entry into the body demanded ritual rather than therapeutic responses.’
Sufferers showed respect and honour to Sitala with the proper prayers and offerings. ‘Oh Mother Sitala,’ 19th century Newaris used to sing, ‘do not afflict us! Deliver the people, we beg you a thousand times!’
In addition to prayers to Sitala, some South Asians, including Nepalis, used inoculation to head off the disease. They intentionally give their children mild cases of smallpox, hoping that death would not result. Once recovered, the patient would have life-long immunity.
Inoculation carried risks and did not work as well as the vaccine developed from cowpox by Edward Jenner in the 1790s, especially after it was improved during the mid 19th century. But inoculation did save many people from death. Otherwise, smallpox killed one in three of those who got it.
As early as 1802, and for much of the nineteenth century, the British tried to introduce Jenner’s vaccine into its Indian colony. But they ran into lots of obstacles, many of their own creation, so it took until the early 20th before vaccinations became common.
What happened? For starters, until the 1850s, the British vaccine was not as effective as they thought, especially in India’s heat. Vaccination required person to person contact. Vaccination also cost more than the British wanted to pay, so they did not build the necessary health and education infrastructure.
In addition, cultural gaps surrounding the belief in Sitala, which the British tried to crush instead of to accommodate, also interfered. Many resisted vaccination. ‘To some Hindus,’ Arnold explains, ‘recourse to any form of prophylaxis or treatment was impious, likely to provoke the goddess and further imperil the child in whose body she currently resided.’
Ultimately, he emphasises, the big problem was that the British administration and medical system in India was‘culturally and politically distant from the lives of its subjects’.
But by the early 20th, the British had improved the vaccine and its delivery, done a better job of explaining its benefits, and begun to meet with more success. In the decade after 1935, for instance, each year roughly 4.3 million people in Madras alone, almost 10% of the population, received vaccinations.
Just as in India, the smallpox virus periodically ravaged Nepal, causing tremendous suffering, killing many, and leaving behind scarring and blindness. It affected all levels of society, even Nepal’s royal family on several occasions in the 19th century.
This is the second in a series of articles about the history of disease in Nepal. Forthcoming columns will explore the role of smallpox in Kathmandu’s power struggles in the 19th century, and its eradication campaign in the 1960s. Tom Robertson, PhD, is researching the environmental history of Kathmandu Valley.