The Balmis Expedition: The Spanish Empire's War against Smallpox

THE BALMIS EXPEDITION

THE BALMIS EXPEDITION

The Spanish Empire’s War against Smallpox

DAVID R. PETRIELLO

FORT WORTH, TEXAS

Copyright © 2023 by David R. Petriello

Library of Congress Cataloging-in-Publication Data

Names: Petriello, David, author.

Title: The Balmis Expedition : the Spanish Empire’s war against smallpox / David R. Petriello.

Description: Fort Worth, Texas : TCU Press, [2023] | Includes bibliographical references and index. | Summary: While the Spanish are often remembered for bringing smallpox and other diseases to the New World, little attention is paid to their efforts to eradicate one of the greatest killers in human history. In the middle of the Napoleonic Wars, King Charles IV funded and dispatched a humanitarian mission aimed at inoculating all of the imperial colonies in Latin America and Asia. Known as the Balmis Expedition, it was launched in 1803 and utilized Edward Jenner’s new method to vaccinate people against smallpox. Using a human daisy chain of two dozen orphans, Dr. Francisco Balmis was able to bring the live virus across the Atlantic Ocean and later the Pacific. Yet, despite saving hundreds of thousands of lives, the history of the expedition was largely forgotten for the next 200 years. Many at the time resented the Scientific Absolutism that the mission represented, doing away with old methods and cures, as well as its economic implications. Finally, the onset of revolutions in the region only a few years later resulted in a rewriting of history which necessarily eliminated any positive accomplishments of the Bourbons. The Expedition became yet another victim of the Black Legend in Latin American historiography. A voyage which Jenner himself once called an example of philanthropy so noble, so extensive, which served as the precursor for future world efforts at disease management, became forgotten. Yet despite this, its effects on the population and on public health efforts in the region were profound. The Balmis Expedition represented a perfect confluence of the tenets of the Scientific Revolution, the Enlightenment, and Absolutism, and bridged the divide between medieval and modern public health management—Provided by publisher.

Identifiers: LCCN 2023036101 (print) | LCCN 2023036102 (ebook) | ISBN 9780875658575 (paperback) | ISBN 9780875658629 (ebook)

Subjects: LCSH: Balmis, Francisco Xavier de. | Jenner, Edward, 1749–1823. | Expedición Marítima de la Vacuna (1803–1810) | Medical expeditions—Spain—History. | Smallpox—Vaccination—Latin America—History—19th century. | Diseases and history—Spain.

Classification: LCC RA644.S6 P485 2023 (print) | LCC RA644.S6 (ebook) | DDC 614.5/210946—dc23/eng/20230907

LC record available at https://lccn.loc.gov/2023036101

LC ebook record available at https://lccn.loc.gov/2023036102

TCU Box 298300

Fort Worth, TX 76129

www.tcupress.com

Design by Julie Rushing

Dedicated to that iris that blooms and inspires . . .

In the Spring a livelier Iris changes on the burnish’d Dove; In the Spring a young man’s fancy lightly turns to thoughts of love.

—ALFRED, LORD TENNYSON

As well as to those brave historians who battle the Black Legend.

Contents

INTRODUCTION

CHAPTER 1: A HISTORY OF DISEASE IN SPAIN

Disease and Spanish History

The Health of the Habsburgs

Spain and Smallpox

CHAPTER 2: HEALTH IN NEW SPAIN

Disease and Exploration

Disease Treatment in Pre-Columbian America

Disease and Its Treatment in New Spain

CHAPTER 3: THE ENLIGHTENMENT AND DISEASE

CHAPTER 4: SPANISH EXPEDITIONS OF THE EIGHTEENTH CENTURY

CHAPTER 5: JENNER AS JOHN THE BAPTIST

CHAPTER 6: SURGEONS, SMALLPOX, SOVEREIGNS, AND ORGANIZING THE EXPEDITION

New Spain

Guatemala

New Granada

Bourbons and Smallpox

1802 Epidemic

CHAPTER 7: BALMIS IN THE AMERICAS

Balmis Expedition

CHAPTER 8: A RETURN TO CAJAMARCA

CHAPTER 9: BALMIS IN ASIA AND AFTER

Aftermath of the Expedition

The World’s Response to Jenner and Balmis

Scientific Absolutism and Latin American Revolutions

CHAPTER 10: THE IMPACT OF THE EXPEDITION

Continuing Efforts in Latin America

CHAPTER 11: DAMNATIO MEMORIAE

CONCLUSION

NOTES

INDEX

Introduction

ON SEPTEMBER 11, 1978, Janet Parker died at the Catherine-de-Barnes Isolation Hospital outside of Solihull, in England. Though she previously had been unknown beyond her local community, newspapers around the world carried the announcement in extended columns, often displacing other events on the front page. Parker’s death was truly an extraordinary event, as she represented the last recorded fatality of smallpox on the planet. While working as a medical photographer for the University of Birmingham, Parker had contracted the illness through air ducts that connected her office to the lab of virologist Professor Henry Bedson. Bedson had been working with several virulent strains of the virus and had inadvertently allowed the illness to spread. Parker fell ill around the middle of August, though it would take over a week for her to be properly diagnosed and confined to an isolation hospital. Despite around-the-clock care, Parker succumbed to the illness three weeks later. Extreme measures were quickly taken to examine and isolate all who had come into contact with her. Both her parents were quarantined, with her father dying of an alleged heart attack and her mother successfully fighting off the illness, thanks to being treated quickly. Just as tragically, Professor Bedson subsequently cut his own throat, killing himself because of his involvement in the careless conditions that led to the misfortune.¹ Finally, the room in which Parker died was sealed off and left untouched for five years, serving as both a precaution against the spread of smallpox and a memorial to the last victim of this dreaded disease.²

Just under two years after Parker’s death, the World Health Organization announced on May 8, 1980, that smallpox had finally been eradicated as a threat to humans. Centuries of efforts fighting against the disease, which culminated in an unprecedented twenty-year global campaign after WWII, finally had removed the scourge from the face of the planet. Janet Parker was the last victim of a disease that had claimed human lives for 3,100 years, a period of time that stretched back to Ramses V. With three hundred million dying of smallpox in the twentieth century alone, the destructive power of the disease dwarfed that of the two world wars and even the horrors of communism.³ Donald R. Hopkins’s sobriquet for smallpox, the Greatest Killer, was well earned.

Diseases have plagued mankind from the beginning, evolving alongside humans and expanding with them. As the Neolithic Revolution produced the growth of population centers, so too did it introduce endemic disease into this environment. Traditionally, early humans employed both religion and natural cures to prevent or drive off pestilence. Yet the continued presence and increasingly destructive impact of diseases over thousands of years shaped not only the history of humankind but also its institutions.

The presence of disease served as much as any other factor to drive the advent and expansion of civic government. Tribal rulers and, later, state leaders worked in conjunction with shamans and priests to appease nature and deities. Apart from an active concern for their subjects, these rulers sought to co-opt the influence of religious authorities in the management of disease to increase their own power and the power of their state. English and French medieval monarchs’ claims to possess the inherent power to cure scrofula, Chinese emperors’ ceremonies to prevent diseases, and even Henry Clay’s call for a day of prayer and thanksgiving to avert the cholera pandemic striking America in 1832 are all examples of this process in action. The story of humanity’s battle against disease is a tale that highlights the growth of science as well as the growth of government.

The decline in the power of the Roman Catholic Church and the rise in the power of the throne following the Protestant Reformation, the Enlightenment, and the Age of Absolutism saw similar growths in governmental interest in the prevention and treatment of disease. What was once viewed as falling within the bailiwick of God—through prayer or religious figures providing medical care—now became a field of activity for man and secular society. The contemporaneous onset of the Scientific Revolution also brought disease management into the realm of possibility. While Galen’s millennium-old medical theories still held sway, new discoveries in the nature and treatment of disease were emerging.

This fits in well with Rudolf Kjellén’s and Michel Foucault’s ideas concerning the concepts of geopolitics and biopolitics. Both men pushed for the concept of a defined nation-state, with the health and well-being of its members being one of the primary concerns of the legitimate government. Attempts in the twentieth century by socialist and fascist states and Western democracies to perfect the health of their citizens through requirements and legislation are merely a continuation of this process. Apart from viewing their citizens’ health as merely a paternalistic concern, leaders in the early modern period began to connect the health of their subjects to the economic prosperity and military strength of the nation. Frequent studies in the twenty-first century of the negative impact of smoking and childhood obesity are continuations of these trends.

Spain in the eighteenth century witnessed a sudden convergence of these factors that would lead to the Balmis Expedition, arguably the first attempt by a nation to confront the health of its citizens on a large scale. By the middle part of the century, the Scientific Revolution, the Enlightenment, and the notions of absolutism were all securely in place in Iberia. The combination of these three movements produced a notion of scientific absolutism: the idea of the state using science to enforce its goals. This new phenomenon could be driven by political, military, or strategic interests or, in keeping with notions of the Enlightenment and traditional Catholic mores, be motivated entirely by humanitarian concerns. Charles III of Spain, who reigned from 1759 to 1788, represented perhaps the epitome of this concentration of ideologies. Over the course of nearly three decades on the throne, he dispatched a number of botanical expeditions to various parts of the Spanish Empire. While ostensibly scientific in nature, these voyages also focused on issues of public health and on Madrid’s political and economic interests in various parts of the planet. Scientific absolutism also sought to standardize the views of nature and the practice of science undertaken in the far corners of Spain’s colonial holdings. Carolus Linnaeus’s system of classification was often wielded as a blunt cudgel to unite the scientific thinking of the people as the Catholic Church united their spiritual thinking. Absolutism, be it scientific, political, or economic, bore mixed results for the Spanish Empire.

At the same time, individuals were making immense leaps in the field of medical science and public health. Edward Jenner, while not the first to discover the connection between cowpox and smallpox immunity, was able to spread knowledge of the practice of vaccination through his writing and persistence. Francisco Javier de Balmis, who had worked to treat outbreaks of the disease and other illnesses in both Spain and the New World, became interested in the topic in 1800, as soon as news of it reached the Continent. His translations of works by French authors discussing vaccination were some of the first to be published on the process in Spain. Yet it would take a perfect storm of occurrences for the Balmis Expedition to be launched, including a massive smallpox epidemic striking the Spanish colonies, the need for public and economic support during the Napoleonic invasions, the personal interests and pleas of Spanish viceroys, the Bourbon family’s own heartbreaking experience with the disease, and the collision of the ideas of the Enlightenment and absolutism.

Despite its immense success, however, the expedition has been largely forgotten from the collective historical and cultural memory of much of the world. Balmis’s triumph has been lost under the weight of the Black Legend and Latin American nationalism. Yet the expedition’s preservation of millions of lives is worthy of record. Perhaps equally as important was its function as a perfect meeting point of so many philosophical, religious, and political movements. A king with the power of life and death, an attempt to challenge the inevitability of the grave, and a reliance on experimentation and reasoning, the ideas of absolutism, the Enlightenment, and the Scientific Revolution were all brought together in the Balmis Expedition.

By the turn of the twentieth century, most developed nations were actively seeking to eradicate disease within their countries. Mass vaccination campaigns were launched as public health became not only a right but a responsibility. By the onset of the Cold War, the fight to eliminate pestilence had moved into Latin America, Africa, and parts of Asia. Under the auspices of the United Nations, global campaigns were developed to inoculate whole continents against some of the greatest killers of human history. Interwoven with notions of humanitarianism, economic concern, political necessity, and Cold War politics, these efforts closely paralleled those of Spain’s King Charles IV. One of the greatest imitations involves the US President’s Emergency Plan for AIDS Relief (PEPFAR). Launched under George W. Bush in 2003, PEPFAR used a variety of techniques and more than $80 billion to help save over a million lives in Africa.⁴ Francisco Balmis and Charles IV began a two-century-long effort in the West aimed at eliminating world disease. In fact, the traditional narrative of public health efforts arising in England, or perhaps Germany, spreading to North America, and from there slowly infiltrating the underdeveloped parts of the planet is largely a myth in that it ignores these early Spanish efforts in Latin America that influenced opinions on the matter in the young United States and Europe.

This book will trace the role of disease in the development and history of Spain as well as of its colonies. A narrative will develop of a nation that was historically defined by illness. Likewise, the philosophical underpinnings of the expedition will be explored in an attempt to show that their roots were deeply imbedded in the history of both Spain and the Catholic Church. Finally, a thorough accounting of the aftermath of the voyage will seek to address the reasons the expedition’s impact on subsequent public health campaigns has largely receded from the public memory. Balmis’s philanthropic expedition was a product of many unique causes and represented a paradigm shift in scientific and civil practices.

CHAPTER 1

A History of Disease in Spain

I will punish that nation with the sword, with famine, and with pestilence.

—JEREMIAH 27:8

CONTRARY TO THE PROPHET JEREMIAH’S preferred ordering of punishment, disease has killed far more humans throughout history than war or want has. In fact, disease was often a natural ally of war and want. Most major wars, up until the mid-twentieth century, saw more casualties from disease than from arrows, swords, or bullets. Disease decimated Germany during the Thirty Years’ War, stopped Napoleon’s invasion of Russia, and helped to drive General Cornwallis’s British army from the southern American colonies. As late as World War I, more soldiers died from disease in the trenches than from the enemy’s machine guns. Concurrently, three times as many humans perished on the planet from influenza than died in all the battles of the Great War. Likewise, famine bred sickness, which became the causative agent for most deaths during times of scarcity, such as Jamestown Colony’s Starving Time and Ireland’s Great Famine. Finally, even outside of war and famine, illness stood as the main cause of death throughout human history. Disease has always been the greatest scourge of humanity, and perhaps no pestilence was more feared or possessed a more storied history than smallpox. To understand and appreciate the launching of the Balmis Expedition, the role that disease, particularly smallpox, played throughout Spanish history must first be explored.

DISEASE AND SPANISH HISTORY

Spanish history, like every other nation’s history, was intertwined with the presence of disease. Individual illnesses, local epidemics, and regional pandemics continuously directed the unfolding of events on the Iberian Peninsula since the Neolithic period. The pandemics that helped to bring down the Roman Empire, including the Antonine and Cyprian Plagues, almost certainly struck the Iberian Peninsula as harshly as they did the rest of the Mediterranean world. Their effects were one of the catalysts for the Germanic migrations that eventually overran the region, including the future lands of Spain. Likewise, the Justinianic Plague of the sixth century would have decimated the population of early medieval Hispania to the same extent it did other areas of Europe. Additionally, as nearly all warfare before the twentieth century was heavily affected by disease, the almost constant campaigns of the Reconquista saw many episodes of illness. Finally, the various monarchs and personalities that populate Spanish history saw their personal lives and political activities driven or limited by pestilence. Disease was a factor that shaped, drove, and delineated the history of the Iberian Peninsula.

The first major recorded epidemic to shape Spanish history was the Justinianic Plague in the sixth century. This early emergence of what is often presumed to be bubonic plague first appeared on the Iberian Peninsula in the year 541 and periodically returned to the region over the next century. An estimated 25 percent of the world’s population succumbed to the illness over the course of a hundred years, perhaps fifty million people in total.¹ Historians have long surmised that the pandemic, in addition to causing massive loss of life, also helped to solidify the rise of Islam in the Near East and to facilitate its conquest of parts of the Byzantine Empire and North Africa.² This movement westward set the expanding Islamic Empire on a collision course with the Iberian Peninsula. As it is reasonable to assume that the Visigothic and Byzantine lands of Spain were equally devastated by the Justinianic Plague, the epidemic would have facilitated the Islamic invasion. This conquest defined the history of the peninsula for the next thousand years.

The next pandemic of importance occurred during the fourteenth century, at the height of the Middle Ages. The Black Plague arrived in Spain in 1348, most likely carried along the coastal trade routes from Genoa and Marseilles. The disease quickly overran Aragon. By 1349, the southern reaches of the peninsula, including Granada, had been breached as well. Despite the ongoing pandemic, King Alfonso XI of Castile launched a campaign in August of 1349 aimed at taking the fortress of Gibraltar. The importance of the promontory was demonstrated by the frequent sieges of it that took place between the various Christian and Islamic rulers of the peninsula during the fourteenth and fifteenth centuries. Alfonso’s 1349 campaign to gain control of the fortress was the monarch’s fifth such attempt to do so and seemed to promise the greatest chance for success. Coming on the heels of the Battle of the Río Salado, which had decimated the Islamic armies of Granada, the Castilian monarch felt confident in victory. However, despite his impressive host and determination, the Islamic garrison continued to hold out. Five months into the siege, the Black Plague struck the Spanish army, killing thousands, including Alfonso XI. As one chronicler recounted, It was the will of God that the King fell ill and had the swellings, and he died on Good Friday, 27 March of the year of our Lord Jesus Christ 1350.³ The Castilians were forced to abandon their siege and withdraw. Alfonso was the only monarch in Europe to succumb to the plague during its first great outbreak. Gibraltar itself would remain in Islamic hands for another century, before finally falling to the Spanish in 1436.

The loss of one Spanish monarch and the ending of a siege were not the greatest effects of the Black Plague. The disease caused an estimated 3.5 million deaths in the Iberian Peninsula and was particularly devastating in the urban centers and the island of Majorca, which lost 80 percent of its population.⁴ Barcelona experienced a death rate of around 40 percent, and almost two-thirds of all clergy members there died. The high rate of death among the clergy was common throughout Western Europe.⁵ Barcelona witnessed the typical chaos, breakdown of civic order, and rise of religious fanaticism that accompanied the pestilence in most European cities. Construction on most public buildings in Barcelona was halted, apart from churches, and Jewish residents of the city were frequently targeted. The El Call section of Barcelona was destroyed as residents feared that the Jews who inhabited the district had either physically caused the plague or else simply invited the wrath of God through their presence. Pedro IV attempted to keep order, but the almost total annihilation of the Council of One Hundred by the disease led to a breakdown in his ability to manage the population. In some areas of the region, serfs rose up and gained additional rights or economic opportunity, while in other areas, the landed aristocracy seized additional lands as peasant families perished.⁶ The chaos and disorder that accompanied the pandemic would not be forgotten by political leaders in subsequent centuries.

Though the plague may have prevented Spanish power from expanding into Granada during this period, the epidemic aided in the preservation of Aragon. The Union of Valencia, an anti-royalist clique formed in the thirteenth century, had been battling to reduce Catalonia’s power for several decades. By 1347, open conflict had erupted between the unionists and the royal court of King Peter IV. After several skirmishes and a failed attempt at a negotiated peace, Peter was captured and imprisoned. But the arrival of the Black Plague dramatically altered the situation in Valencia. Peter was freed from captivity amidst the unprecedented level of death and chaos caused by the disease. He quickly built an army and defeated the unionist forces at the Battle of Épila. The Black Death preserved royal power in Aragon, furthering the path toward Spanish unification a century and a half later.

The plague continued to ravage the Spanish peninsula periodically during the fifteenth century. Seville in particular suffered its effects in 1400 and again in 1410. The archbishop of the city, Gonzalo Mena Roelas, even fled from his seat in 1401 amidst the death and suffering, only to succumb to the illness a short time later. In Barcelona, the disease reappeared roughly every decade during the ensuing century, continuing to decimate the population. The outbreak of 1408–10 most likely led to the death of King Martin of Aragon. He had no surviving heir, and a short interregnum period ensued, ending with the ascension of King Ferdinand I in 1412 and the rise of the house of Trastámara, whose members would unite Spain at the end of the century. Outbreaks also occurred in Zaragoza in 1490 and 1495 and in Valencia in 1450