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Revisioning Smallpox, ver. May 17, 2000 1

“Revisioning smallpox in Mexico City-Tenochtitlán, 1520-1950:

What difference did charity, quarantine, inoculation and vaccination make?”

Robert McCaa, University of Minnesota

Large bumps spread on people, some were entirely covered.

They spread everywhere, on the face, the head, the chest, etc.

[The disease] brought great desolation; a great many died of it.1

1.1. Smallpox first erupted in Mexico Tenochtitlán, the ancient capital of the Mexica, in

1520. While the siege and conquest of the City by Hernán Cortés’s army and his native

allies took less than four months (April 28-August 13, 1521), conquering smallpox took

more than four centuries. In 1950, the City’s last smallpox deaths were recorded, four

years before the virus was permanently eradicated from the Republic of Mexico, and

almost three decades prior to its extinction from the planet. If mortality from any single

smallpox epidemic in the City was never as great as Cortés’s murderous siege of 1521,

over the centuries periodic eruptions of the disease killed thousands, even tens of

thousands, often in a matter of weeks. Total smallpox deaths over the intervening 430

years probably exceeded those caused by the many invasions, wars, rebellions, and

revolutions which afflicted the City.

1.2. Almost every Mexican school child can recite the dates of the nation’s major wars,

but the chronology of smallpox in the City is not well known, even by historians.

Likewise much of the history of the numerous, heroic efforts by City authorities to

contain, prevent, and, finally, eradicate the disease remains to be written. The story of

the virus in the City reveals much about the evolution of notions of charity, the nature of

1 LOCKHART, We People Hear, p. 182.


charitable initiatives, the class and character of the beneficiaries, and ideologies

concerning public health.

2.1. Chronology. The first smallpox epidemic to strike the City is precisely known

because in ancient times the disease was completely alien to the Americas, until

introduced, inadvertently by Christians or their vassals, to the Caribbean in 1518.

Almost two years passed before the disease spread to the Aztec capital, Tenochtitlan.

Indian auxiliaries from Cuba accompanying an expedition to capture the rebellious

Cortes provided the reservoir. Spanish chroniclers, aware of the foreboding omen for

the native populations of the appearance of the pestilence on tierra firme, precisely

identify the disease’s leap ashore in May 1520. The agent of transmission was one

Francisco Eguia, a Black slave.2 The desultory spread of this virgin soil epidemic from

the coast to the Mexica capital is surprising. Some four months were required to

traverse a distance of 400 kilometers—over what must have been frequently traveled

routes. Finally in late September or early October 1520, the smallpox plague erupted in

Tenochtitlan. Transmission of the virus was, once again, by natives because the

outbreak began at least two, but more likely three, months after the deadly flight of the

Spanish invaders from the City on “noche triste,” June 30, 1520. In that battle, all

captured Christians were sacrificed without delay. Therefore, months later when the

epidemic erupted in the City itself, none were still alive to aid in containing the disease

or caring for its victims, should any have been inclined to do so.3 2 PREM, Disease, p. 24.

3 There is much confusion among historians about the actual date of eruption in Tenochtitlán, although

the native sources are completely consistent on the matter. The problem is that all eyewitness accounts

are written in Nahuatl, and the cycle of months changes from year to year in the Mexica calendar. Then

too, Nahua annals generally report the 20-day month in which events occurred, rather than a precise date.

Finally, “[i]n the Nahua tradition of historical writing, it is the calendar that marches along step by step


2.2. A native chronicle written in Nahuatl provides the best description of this first

smallpox outbreak in the City:

It began in Tepeilhuitl [at the end of September according to the

contemporary Spanish gloss]. Large bumps spread on people, some

were entirely covered. They spread everywhere, on the face, the head,

with no abbreviation or deviation, while actions that occur are individual episodes inserted somewhere in

the framework” (LOCKHART, We People Here, p. 12).

Disease determinists favor Spanish sources (usually in English translation) which often ascribe the

outbreak of the deadly scourge to the Christian god, who mercifully succored his chosen people in their

darkest hour—a comforting myth that arose among the Christians decades after the event.

Diseaseologists mistakenly claim that the pox entered the City as the Spanish and their native allies fled,

on the “noche triste,” June 30, 1520 (McNEIL, Plagues and People, p. 2; OLDSTONE, Viruses, pp. 3,

32). CROSBY (Columbian Exchange, p. 48) telescopes these events with agreeable rhetoric and

obscures the dating by giving voice to one of Cortes’s party: “‘When the Christians were exhausted from

war, God saw fit to send the Indians smallpox...’” (perpetuated in COOK’s recently published Born to

Die, p. 68). WATTS expansively places the outbreak between the noche triste and the fall of the City

more than four hundred days later, on August 13, 1521 (Epidemics and History, p. 89).

The Mexican authority, Dr. Miguel E. BUSTAMANTE, narrows the window to sixty days, between

noche triste and September 7, wholly discounting the testimony of the only source cited (La viruela en

México, p. 68), which is reproduced here in paragraph 2.2. The translation of the annals of Tenochtitlan

(Cronica Mexicanayotl) by the accomplished native linguist, Fernando Alvarado Tezozomoc, who wrote

in Latin and Spanish as well as Nahuatl, does not date the epidemic, but his account narrows the

chronological window. Alvarado Tezozomoc places the accession of Cuitlahuactzin to the rulership of

the City on 16 September and his demise from pustules (“totomonalliztli”, “ampollamiento”) eighty days

later, on the third of December (at the end of the month “Quecholli”; pp. 159-160). The epidemic lasted

sixty days, according to native chronicles. If Cuitlahuactzin’s death came at the very end of the epidemic

then the date of eruption would be the beginning of October, or, if stretched to ninety days, September at

the earliest (McCAA, Spanish and Nahuatl Views). THOMAS dismisses as “extravagant” the notion that


the chest, etc. [The disease] brought great desolation; a great many died

of it. ...

The disease of the pustules lasted a full sixty days; after sixty days it

abated and ended. ...

It broke out in Teotl eco, and it abated in Panquetzaliztli. The Mexica

warriors were greatly weakened by it.4

2.3. For most historians, a crude Darwinism explains the greater devastation of native

peoples attacked by virgin soil epidemics, such as that of 1520.5 The conventional

argument made by many historians of the early Americas is that natives lacked genetic

immunity against the disease. Yet among geneticists and immunologists the notion that

Europeans enjoyed genetic immunity against the smallpox virus remains an unproven,

even unproveable, hypothesis.6

smallpox affected the outcome of the struggle for the City (Conquest, p. 741 n. 78). He favors late

October (Conquest, p. 445).

4 LOCKHART, We People Hear, p. 182.

5 STEARN and STEARN, The Effect of Smallpox, p. 15; JENNINGS, The Invasion of America, p. 22;

BUSTAMANTE, 400 años de viruela, p. 71.

6 BLACK, Why Did They Die?, 1739; BIANCHINE and RUSS, The Role of Epidemic Infectious

Diseases. Bustamante, an ardent advocate of the genetic immunity thesis, reiterates the fallacy in his

publications on smallpox. The following is representative of his thinking: “Human beings isolated in

America for thousands of years formed an immunologically autochthonous population, with factors of

susceptibility and resistance different from those of the people of the Ancient World” (BUSTAMANTE,

La viruela en México, p. 71).

JENNINGS crudely reduces the story to a matter of the survival of the fittest: “...the Europeans’ capacity

to resist certain diseases made them superior, in the pure Darwinian sense, to the Indians who

succumbed.” And, “smallpox was smallpox...the Indians on the north [bank of the Rio Grande] had as

little biological immunity to this epidemic scourge as the Aztecs had” (The Invasion of America, p. 22).


2.4. Was the greater destruction a matter of genes or care? Epidemiology may offer a

means of resolving this conundrum. Since dehydration often leads to death in poorly-

treated fever-causing viral infections such as smallpox, virgin soil mortality is

heightened by the fact that adults, who might provide fluids, care and comfort for what

is normally a childhood affliction, are themselves often deathly ill. Upon first exposure

to smallpox, all adults—including Mexica warriors, according to the Nahuatl texts—as

well as children succumbed to the disease. Mortality was unusually high due to a lack

of healthy adult caregivers to provide water, food, or even a comforting word.

2.5. Chroniclers, native and Spanish alike, lament that the first epidemic was so great

that there was no one to provide care, or even prepare tortillas, the staple of every

Mexica meal. Unfortunately tortillas must be prepared fresh, otherwise they toughen

CROSBY is more restrained: “those creatures who have been longest in isolation suffer most, for their

genetic material has been least tempered by the variety of world diseases” (Conquistador y Pestilencia, p.

322). The Stearns also discern evolution at work: “even in the nineteenth century when some immunity

had already been acquired by this race...” (p. 15). Unfortunately genetic immunity has become standard

fare in English language colonial Latin American history texts.

WATTS challenges the genetic hypothesis by citing examples of catastrophic smallpox mortality in

Europe, such as Iceland and Foula Island (Epidemics and History, p. 102). GORODEZKY’s Genetic

Difference is a technically sophisticated discussion of the battle between foreign antigens and T-cell

receptors, but no direct evidence is presented regarding smallpox.

The contemporary relevance of the issue continues. The campaign to destroy remaining stocks of the

virus (abruptly terminated when President Clinton ordered, wisely I think, their continued preservation)

was motivated by the fear that should the virus escape, a great pandemic would ensue among an

increasingly, immunologically naive global population (BARQUET and DOMINGO, Smallpox;

OSTERHOLM Interview; PRESTON, Demon in the Freezer). If peoples of Old World origin developed

genetic immunity is it so readily lost? McNEIL (Plagues and People, p. 8, 49) insists that both acquired

and hereditary immunity is necessary to explain the heavy die-off.


and sour quickly if not consumed soon after preparation. Europeans enjoyed

advantages, indeed, but they were above all epidemiological, rather than genetic. In

Europe, the disease occurred with sufficient regularity so that most were afflicted in

childhood. The immune systems of the overwhelming majority of survivors were tuned

to successfully repel further infection from the virus. If genetic adaptation occurred, it

was more likely in the DNA of the extremely short-lived, although highly stable,

orthopox-virus than in much longer-lived humans.7

2.6. In 1538, a second smallpox outbreak occurred in Mexico Tenochtitlán. The

authoritative pictorial year signs for the City, the Codex “Telleriano-Remensis,” depicts

a male and female adult pair with “spotted bodies”, their “closed eyes” signifying death.

The accompanying Spanish gloss explains that in that year “many people” died of

smallpox,8 as opposed to “a great many” in the epidemic of 1520. That many adults

were also victims of the outbreak of 1538 suggests that the virgin soil epidemic of 1520

was not universal, even in densely settled Tenochtitlán.

2.7. Curiously, for the entire sixteenth century, there is only one additional reference to

the disease in or near the City and that for an earlier episode in 1531/32. The native

chronicler Chimalpahin, writing in Nahuatl almost a century after the fact, stated: “Also

in this year the epidemic of smallpox [çahuatl] proliferated and they were small pustules

from which died [many] children.” For 1532, he continues, “In this year there was a

great die-off in Chalco because of the smallpox; many elderly died in Tlalmanalco and

in all of Mexico.” Other contemporary sources, texts and native pictographs attribute

the cause of this second, less devastating, pestilence introduced by the Christians to

measles.9

7 McCAA, Spanish and Nahuatl Views.

8 QUIÑONES KEBER, Codex Telleriano Remensis, f45v, p. 236.


2.8. Throughout the sixteenth century great epidemics abound in the former

Aztec capital, now renamed Mexico City, reconstructed, and increasingly

Hispanized. Attributed variously to measles (zahuatl tepiton), mumps, cocoliztli

(great pestilence), typhus (matlazahuatl), or multiple symptoms, which cannot

be identified as specific diseases, smallpox is wholly absent from the list.10

Spaniards knew the smallpox scourge first-hand, from centuries of experience

with epidemic outbreaks. Natives rapidly became familiar with the disease,

coining, at first contact, the words “totomonalliztli” (pustules) and “huey

zahuatl” (the great spots or leprosy) to identify it. Thus, there was little

confusion among Spaniards or natives in recognizing an outbreak of smallpox.

Then too, had there been further deadly eruptions of the disease it is unlikely

that both chroniclers and authorities would have failed to seize the opportunity

to attribute another massive die-off to the hand of god, rather than the hand of

man.

3.1. Epidemic smallpox. Historians of smallpox in Mexico see the disease recurring

with great regularity, endorsing the interpretation of the distinguished eighteenth

century German scientist baron Alexander von Humboldt. Humboldt wrote that after

1520 smallpox seemed to strike the capital every seventeen or eighteen years.11 In fact,

after 1538, a prolonged respite of almost eight decades ensued, with the next great

smallpox epidemic striking the City in 1615. The succeeding bout erupted in 1653, a

lapse of almost four decades. Then, the baron’s rule seems to have taken hold. Over

the next century and a half smallpox culled 5-10% of the City’s population every decade

or two. Significant epidemics are recorded for 1663, 1673, and 1696, totaling five for

10 GIBSON, Aztecs, pp. 448-450; PREM, Disease; MARQUEZ MORFÍN, La evolución cuantitativa.


the seventeenth century. Six outbreaks occurred in the eighteenth: 1711, 1733/34, 1748,

1761/62, 1779/80 and 1797/98.12

3.2. Then, in 1804, Jenner’s vaccine became available in Mexico, thanks to a

worldwide philanthropic expedition sponsored by the Spanish king Charles IV

and led by a Spanish naval officer, Dr. Francisco Javier de Balmis.13 Popular

acceptance of the new procedure was widespread, yet, after the first campaigns,

vaccination was practiced intermittently, until a new epidemic threatened. From

1811 to 1825, City officials recorded only 33,736 vaccinations. To reward

parents who cooperated with this increasingly desultory campaign small coins

and even pastries were offered to obtain serum from the arms of their children.14

3.3. Following the epidemic of 1797 in which widespread inoculation was resorted to

for the first time, smallpox deaths were halved by means of, first, inoculation, then from

1804, arm-to-arm vaccination. The three greatest smallpox outbreaks of the nineteenth

century (1804, 1829/1830, and 1840) struck down a few thousand children each, a

minor fraction of the norm for the eighteenth century—notwithstanding the City’s

continued demographic growth. From the late eighteenth century, each succeeding

epidemic claimed fewer victims than the last, falling from over 14,785 deaths in 1779 to

7,147 in 1797 and 2,878 in 1840. City authorities understood the success of their

efforts, explaining that in 1840 “the number of victims was much less than in prior

invasions by the same illness.” Aid was organized block-by-block. Mass vaccinations

were conducted with as many as 7,000 in a single week, as in 1839.15

12 GIBSON, Aztecs, p. 448-450; MARQUEZ MORFÍN, La evolución cuantitativa.

13 FERNANDEZ DEL CASTILLO, Los Viajes.

14 AACM, vol. 3678, leg. 19, 20.


4.1. Endemic smallpox and vaccination. But deaths were not reduced to zero,

and in the 1860s, a concerted arm-to-arm vaccination campaign funded by the

municipality was begun to contain the disease. The policy of providing

vaccinations free of charge was now made general. Vaccinations were to be

conducted by trained city health employees. Since in Mexico the vaccine was

maintained by arm-to-arm vaccination, the human reservoir had to be

replenished every ten days or so. Beginning in 1864 Luis Muñoz, chief

vaccinator of the City, instituted a program of paying one peso to as many as

twenty-five mothers per month for the privilege of vaccinating and subsequently

harvesting “good vaccine granules” from their babies.16 Dr. Muñoz’s report for

1864 reveals that the authorities knew exactly what they were about and what

the benfits of the campaign would be:

The vaccine, more widely extended than inoculation had ever been,

diminished in a considerable way the number of people at risk (“aptas”),

and at the same time removed the reservoir (“focos”) of contagion which

was necessary for the disease to thrive.

4.2 Thus, in the words for Dr. Muñoz, “in these parts the great epidemics of

smallpox were seen to recede or disappear, and only small epidemics

remained”.17

4.3. This assessment was true only as long as vaccination did not languish, as Dr.

Muñoz recognized. Unfortunately, in 1870, only 2,457 vaccinations were performed,

and the number did not rise substantially in 1871. A killing epidemic got underway in

January 1872 with 552 deaths in a single month attributed to the disease. The

17 MUÑOZ, Resumen de los trabajos, p. 18.


authorities immediately redoubled their efforts, vaccinating over 4,000 children in a few

weeks.18 Vigilance continued with over 19,000 vaccinations in the following year, but

the total for the entire decade still fell short of 100,000. In 1882, a municipal ordinance

requiring mandatory vaccination of new-bornes by six months of age was enacted. The

policy was instituted without public outcry or opposition—or full compliance, one must

add.

4.4. Compliance was substantial, nonetheless, with over 30,000 vaccinations performed

in the capital annually from 1894 to 1903.19 By the 1890s smallpox mortality in the

City was pushed to insignificant levels. From 1892 through 1901 of 176,332 deaths

recorded, only 0.9% (1,522) were due to smallpox.20 In 1903, compulsory vaccination

was extended to the entire republic, and the following year deaths attributed to smallpox

fell to 102 in the City.21 Thus, over the course of the nineteenth century, the disease was

slowly transformed from epidemic to endemic, thereby greatly reducing smallpox

mortality.

4.5. Smallpox remained in check as long as vaccination was nearly universal. In 1910,

as revolution erupted on the northern border of the Republic, annual smallpox mortality

in the City fell to a half-century low of 90. Then the figure began to rise, to 390 in 1911

and 429 in 1912. As warring and banditry worsened, migration increased and the

instinct for survival overpowered charitable inclinations of both parents and public

officials. In 1915, the last great smallpox epidemic in the City’s history erupted. Yet, it

was a faint shadow of former bouts. From a weekly average of 10 cases (not deaths)

over much of 1914, 18 cases were recorded in the first week of 1915, rising to 50 per

19 México, Boletin Demografico, p. 787.

20 AHSS, box 5, exp. 2, Convención sanitaria internacional.

21 PANI, Hygiene, p. 192; or 159 according to the Anuario Estadística, 1907, p. 27.


week in March and 70 in April. Total deaths for the year surged by nearly one-third to

25,000, but smallpox accounted for only a tiny fraction of the increase. Hunger and

typhus were the big killers in 1915.22 Three years later, when annual cause of death

statistics for the City become available again, smallpox mortality had fallen to a mere

140 cases.23

5.1. Eradication. In the 1920s, the battleground against smallpox became the states and

territories, because migrants now accounted for most deaths from the disease in the

Capital. Justification for a centralized final assault against smallpox was inscribed in

the Constitution of 1917, which provided for a National Public Health Department

charged with improving conditions throughout the Republic. This provision finally lay

to rest the helter-skelter vaccination policies of state and local health authorities, which

prevailed throughout the nineteenth century. The effort was aided by a shift from the

dangerous human to safer animal vaccines. A laboratory to produce animal-cultured

smallpox vaccine had already been established in 1915, following a half-century

campaign to replace the dangerous arm-to-arm method introduced by Balmis in 1804.

Arm-to-arm vaccination—tenaciously supported by the Muñozes throughout their

careers, and defended until 1907 by the Mexico City medical establishment—was

finally abandoned in 1919. Note that this was a mere two decades after the use of

human vaccine was made illegal in England.24

5.2. In 1931, there occurred a deadly surge in smallpox, with 15,003 fatalities reported

for the entire republic. With this tripling of the annual average during the late 1920s, a

new strategy was instituted. Mobile vaccination brigades were formed to be on constant

alert to encircle and suffocate outbreaks before a more generalized eruption could

24 LANDA, Apuntes; Fernandez del Castillo, La Viruela; BAXBY, Jenner’s smallpox vaccine, p. 180.


spread. The goal became to eradicate smallpox from the entire nation, not by

attempting the impossible task of vaccinating everyone, but rather focussing efforts on

every instance of the disease, encircling all cases by means of quarantine and

vaccinating all those who may have come into contact with the infected. Dr. Miguel E.

Bustamante, who developed the strategy, commanded a bold troop of young doctors and

nurses to respond to the first signs of an outbreak. Over the first ten years of the

program, total deaths due to the disease declined by 90%, to 1,341 in 1940 for the entire

Republic.25

5.3. If the national effort was to succeed, an effective quarantine along the nation’s

borders was also required. With the disruption of World War II, millions of Mexican

guest workers migrated to labor-short factories and fields in the United States. Annual

smallpox fatalities in Mexico doubled and then tripled, reaching 4,115 in 1942. In the

capital, deaths rose from single digits to 64 in 1943—indirect casualties of war.

Nevertheless, by war’s end, Bustamante’s mobile brigades had regained their

effectiveness, and fatalities for the entire nation plunged to 54 in 1951. From that year,

no further smallpox deaths have ever been recorded in Mexico City. In 1954, the last

smallpox fatality in the entire republic was reported, two decades before it was

extinguished from the planet.26 Meanwhile the Mexican national public health

bureaucracy had grown enormously and its mission expanded to battle yellow fever,

typhus, malaria, and similar threats to the general welfare.

26 México, Anuario Estadístico, various years. The victory against smallpox in Mexico was officially

declared won on June 12, 1952, but smallpox deaths continued to occur over the next two years,

according to the Anuario Estadístico (1954, p. 86 and 1955-56, p. 89; BUSTAMANTE, La viruela en

México).


6.1. Charity. Over the centuries the battle against smallpox led to new, more charitable

attitudes toward public health and a shift from programs to alleviate suffering to

prevention, and ultimately eradication, of the disease. The struggle was prolonged not

for a lack of charitable impulses—on the contrary enormous efforts were made from the

first years of Spanish rule—, but for a lack of effective means. Five phases may be

discerned in this struggle: 1520, native methods; 1538-1779, curative; 1797, preventive

by quarantine and inoculation; 1804-1882, reactive vaccination; 1882-1931, proactive

vaccination; and 1931-1954, eradication.

6.2. The idea that ancient Mexico was exempt from severe epidemics, and thus had no

notions of care against disease, is no longer sustainable. Pre-columbian Mexico was no

paradise, as attested by the panoply of gods, remedies, incantations, and expressions for

sickness, including pestilence, in the ancient Nahuatl language, iconography,

pictographs and written records. Pestilence is recorded in year signs of the codices, such

as the Telleriano-Remensis, but annals, narrative texts written down from oral accounts,

provide a great many more details. The Annals of Cuauhtitlan are particularly

informative on these matters because they report on a region, rather than a single town

(altepetl), and are rich in apocalyptic events. “Depopulated because of pestilence” read

the annals for five places (variously, towns, districts, or provinces) in the half-century

prior to the Spanish conquest.27 Typhus, diphtheria and influenza have been suggested

as possible causes.28

7.1. Nahua treatments. The first phase of the battle against smallpox was limited to the

outbreak of 1520, when the Nahua sought to fight the disease with conventional

indigenous treatments for fevers and pustules. Only native remedies were available in

Tenochtitlán because Spaniards, who might have provided aid in the same way that


captured Christian crossbow-men were used to shoot arrows at their comrades, had

already fled or were dead. For the Nahua, quarantine was a completely alien notion, but

treatment or care for skin diseases was not. There are no sources to tell us exactly

which remedies were attempted, but the exceedingly thorough historian of the conquest,

Hugh Thomas, portrays a plausible scenario:

A special fortune-teller, a tlaolchayauhqui, was asked, as usual, to

determine the cause of the new disease by observing the pattern of grains

of maize or beans on a white cotton cloak. On this occasion he must

have been baffled. The old remedies must have been tried: “The core [of

the sore] is removed with a pine resin and squashed black beetles are

spread there”.29

7.2. What astonished the Nahua was not the failure of conventional remedies but the

absence of care, not for lack of a caring impulse, but for a lack of caregivers. The

testimony is direct, descriptive, and despairing:

Before the Spaniards appeared to us [again], first an epidemic broke out,

a sickness of pustules. They could no longer walk about, but lay in their

dwellings and sleeping places, no longer able to move or stir. They were

unable to change position, to stretch out on their sides or face down, or

raise their heads. And when they made a motion, they called out loudly.

The pustules that covered people caused great desolation; very many

people died of them, and many just starved to death; starvation reigned,

and no one took care of others any longer.30

30 LOCKHART, We People Hear, p. 181-82.


7.3. The accompanying pictures, drawn by native artists a half century after the event,

seemingly contradict the text. They show a native woman caring for five prostrate,

pockmarked adults. The ill show great pain, despair, or resignation as they lie on

petates of plaited rushes and pillows of folded cotton mantas, wrapped in large cotton

blankets. Portions of upper torsos and faces are visible. One is crying out, attempting

to pull herself from the mat. A second, seemingly near death, is tightly wrapped from

neck to feet, but the ominous signs of the pocks are visible on her toes. The caregiver,

with grave assurance, tenderly succors a third with her bare hands and soothing voice.

Unfortunately her speech goes unrecorded.31

7.4. Perhaps the written testimony that “no one took care” should not be taken literally.

Or perhaps the pictures reflect care giving as practiced in a subsequent bout with the

disease, such as in 1538. What is certain is that care changed as natives quickly adopted

Spanish cultural techniques, honed by centuries of experience with the pox. Natives

were taught to prepare themselves for the eruption of the pustules. Once erupted, they

were comforted, given water, food, and blankets, and cautioned not to bath or scratch

until the scabs had fallen away.32

8.1. Christian charity. Practices of Christian charity were also introduced from earliest

times, providing not only the sacraments, but also water, food, care and solace.

Sahagún observed that, since an entire household would often fall ill at a stroke, “there

was no one who could give even a jar of water . . .and knowing this the religious walk

house to house providing confession and consolation.” In the matlazahuatl epidemic of

1576, Viceroy Martin Enriquez encouraged Spaniards to distribute food, also by going

house to house with no suggestion of distinction by race or reputation, class or color.33

Acts of charity are confirmed by annals, authored by anonymous native intellectuals.


The most prolific is for Tlatelolco, twin city of Tenochtitlán, with four references over

the sixteenth century of aid campaigns by religious and secular officials, two where

food was given “in our homes,” including the provisioning of meat on one occasion.34

8.2. These annals also reveal the beginnings of grand religious processions and public

prayer. The procession of the Virgin of Remedios, first recorded in 1575, became

favored for smallpox epidemics in Mexico City.35 Her intercession was sought

throughout the seventeenth and eighteenth centuries. In the last great outbreak of the

colonial era, 1797-98, three processions were organized: la Virgen de los Remedios

(week 10 of the epidemic), Santísimo Christo Renovado de Santa Teresa (week 11) and

finally, la Virgen de Guadalupe (week 13), for which the Viceroy ordered an eight day

holiday.36 The processions in 1797 came as the disease peaked and then declined as

shown in Figure 1.

Figure 1 near here

8.3. Although Totlaçonantzin (“our precious Mother”, as Our Lady of Guadalupe was

called in the Nahuatl37) had long been a revered symbol of the native born, Creole and

Indian alike, it is noteworthy that this was the only time that she was called upon to

succor her people from smallpox. While it was 1531 when she first appeared to the

“humble commoner” Juan Diego (according to the most authoritive source although

written over a century later), it was not until 1544 that her miraculous powers against

epidemics, a great plague, or cocoliztli, were proven. Indeed, this is her only

intercession against epidemics of the miracles recounted in the classic account of her

many miraculous appearances, published in 1648. The account for 1544 reads in part:

37 SOUSA, POOLE and LOCKHART, Story of Guadalupe, p. 39.


The precious friars gathered a great many children, female and male,

who had just reached the age of six or seven; they went along flogging

themselves. … As soon as they arrived at her churchly home, the friars

offered very many prayers. And God the giver of life willed that through

the intercession and prayers of the compassionate personage, his

precious, revered mother, the epidemic would begin to subside. The next

day, not many people were being buried any longer, and finally perhaps

two or three people as the epidemic came to an end.38

8.4. Charity, both secular and religious, was made routine over the centuries, assisted by

various institutions. By 1525, Hernán Cortes had erected the first hospital in the City.

Twelve were in operation by the beginning of the nineteenth century. During crises,

whether due to famine, flood, or epidemic, the number of hospitals often doubled or

even tripled as public and private quarters were converted into temporary shelters for

the afflicted. In 1612, the Junta de Policia was established and charged with the

organization of charitable relief and quarantine efforts.39 In 1646, the doctors’ guild, the

protomedicato, was founded. As in Spain, the protomedicato certified doctors and

pharmacists for practice and acted as medical counsel to the city government and the

viceroy.

8.5. Over time, charitable relief became systematized, better documented, and probably

greater in scope. In the matlazahuatl epidemic of 1737, the viceroy allotted four doctors

and six druggists to provide medical assistance to the poor at a cost of 43,661 pesos.

For comparison, wages of an ordinary worker amounted to a peso for four days labor

when paid in cash, or four marks (rayas) in a patron’s account book when paid in kind.


Thus charitable expenditures for 1737 was equivalent to remuneration of over 150,000

workdays, in a city that numbered fewer than 100,000 inhabitants.40

8.6. In the campaign of 1779-80 expenditures more than doubled the previous record,

even though the population had scarcely grown. Donations were collected entirely from

individuals and corporations. According to the official report, $109,355 pesos in

medicine, food, clothing and other assistance were distributed to 38,461 people who fell

ill with the pox. 14,785 died in the epidemic. Some 2,000 of these were felled before

the charity campaign began. Another 3,000 died beyond the purview of the councils.

An unspecified number of fatalities occurred among the 8,332 City residents who did

not require charitable assistance. Within the City, which numbered 105,000 inhabitants

according to an archbishopric census taken earlier that year, more than one-in-three fell

ill (36.5 percent) and more than one-in-eight died.

8.7. The authorities blamed their relative lack of success on the extraordinary indigence

of the vast population of the City. In comparison with any European capital, “here one

sees an infinite number of people, unfortunately, who in good health do not have a shirt

to wear or a bed to rest in”.41 These enormous losses notwithstanding, the campaign

made a difference. On the outskirts of the City, where no public assistance was

provided, the case fatality rate exceeded twenty-five percent, one-third greater than for

the City proper.42

9.1. The “1797” epidemic. Seventeen years later, the greatest campaign against

smallpox in the City’s history got underway on October 26, 1797. The pestilence—still

epidemic rather than endemic after one-quarter of a millennium in the circum-Caribbean

41 JUNTA PRINCIPAL DE CARIDAD, Noticia, p. 8.

42 These are my computations from BNMR, Ephemeris astronomica, fol. 141; and AGI, Varios, vol. 38.


—entered the viceroyalty of New Spain, in March 1793. From the beginning authorities

fought the disease relentlessly, as did Viceroy Marqués de Branciforte, upon his arrival

in New Spain two years later. He meticulously plotted the course of the disease, issuing

precise orders on quarantine, inoculation and the collecting of information. The disease

spread slowly, thanks to draconian efforts at quarantine. In a great roundabout, from

Campeche on the southeast Gulf Coast the pox moved haltingly through Chiapas (1794)

and then south to the Pacific Coast (1795), before crossing the Tehuantepec peninsula

and turning north toward Oaxaca (December, 1796) and central Mexico (1797). This

was the longest, most sustained battle to contain any epidemic in two and one-half

centuries of Spanish rule, but ultimately the effort failed.43 In late August 1797, several

cases of smallpox appeared inside the confines of the capital. Inoculation, first approved

by the Viceroy on February 28, 1797 and again on August 10, began en mass in

September for the first time in the City’s history. Over 3,000 were inoculated in six

weeks, with only a handful of deaths.44

9.2. Finally, on October 26, 1797, Branciforte ordered the mobilization of Councils of

Charity, block-by-block as in the 1779 campaign. By the epidemic’s end three months

later, 127,894 pesos in aid had been collected from private sources and distributed to

44,516 infected needy, of whom “only” 7,147 died. This figure was one-half that of the

previous crisis. Branciforte was pleased as were the City authorities, and, one imagines,

the thousands of citizens who participated in the campaign, as well as parents whose

children survived.45

9.3. Initially, the Councils of Charity garnered the credit for the success. Indeed, the

final report recommended that in future epidemics Councils be established at the first

sign of an outbreak.46 However by 1814, inoculation was credited with the major role in


reducing mortality in the 1797 outbreak. This was the unanimous opinion of Mexican

medical historians, until a few years ago, when Dra. Rodríguez de Romo began to

question the efficacy of both care and inoculation in the outbreak of 1797.47 She argues

that the statistics are woefully inadequate, and perhaps deliberately distorted. I too

doubted the efficacy of inoculation, not only for Mexico in 1797, but for most times and

places. The research for this paper, however, has forced me to accept at least partially

and reluctantly, the conventional wisdom on the role of inoculation, with the twist in my

view that inoculation broke the quarantine and helped spread the disease.

9.4. The fact remains that there were more than half as many deaths in the 1797 episode

than in 1779—7,147 to 14,785, according to more reliable counts derived from parish

books. The Council’s figures of only 4,451 make the picture look even better, by

including, in the numerator, only deaths among those who actually received assistance,

and in the denominator, all people who received assistance whether they were infected

or not. Rodríguez de Romo spies deliberate deception in these figures. In contrast, the

1779 report, although incomplete in many respects, refers simply to “contagiados” and

“muertos”, yet it, as well as the latter report, omits smallpox deaths occurring before the

initiation of the charity campaign as well as those occurring beyond the Council’s

jurisdiction. Contentious as these data may be, there is a persuasive coherence among


the various sources, including eye-witnesses to both tragedies who express no doubts

that fewer deaths occurred in the latter.48

9.5. Inoculation was important in saving lives in 1797-98, as we shall see, but the case

for care is more difficult to make. Cooper, Price and Rodríguez de Romo question

whether care was effective in the battle against smallpox. Since no cure for smallpox

was ever developed, their skepticism is warranted and their conclusions are supported

by a regression analysis of data on assistance for the city’s 173 districts. Although 75%

of the variance in survivors from one block to another can be explained by expenditures

on three items (food, clothing, including blankets, and medicine, but not expenditures

on doctors) the finding is spurious. The Council seems to have allocated its resources

on an entirely laudable basis, that is per capita—with some distinction as to reputation

(calidad) and class, as noted in the report itself.49 An analysis of assistance per capita

reduces the correlation from 75 to 5%. Although this model is statistically significant

(P<.04), none of its effects are. This finding is all the more surprising because survival

rates at the block level varied considerably (from 73 to 98%), as did average assistance

(from 0.6 to 8.8 pesos per “sano”). If we accept the Council’s judgment, the smaller

number of deaths in 1797 was due to greater, more timely assistance, but the regression

equation points to a saving of fewer than 400 lives from this enormous mobilization of

charity. Perhaps the Council’s assessment was based on a comparison with the 1779

campaign or on an intuitive appraisal of what happened within the City and without.

Care provided comfort and showed great compassion, but it does not seem to have

affected levels of survivorship at the block-level, by any considerable degree.

10.1. Inoculation. Inoculation made a difference, but its direct impact is easily

exaggerated. While inoculation reduced the likelihood of dying by 90 percent, the


procedure was voluntary and in a City of 100,000 only some 3,000 individuals availed

themselves of the prophylactic. Had all susceptibles been inoculated, total deaths would

have fallen from thousands to hundreds. Since the case fatality rate for “natural”

smallpox in 1797-98 was ten percent, inoculation directly saved fewer deaths than care

(270 lives versus 400; for the former [[.1-.01]*3000]=270), leaving 7,000 avoided

deaths unexplained. The success rate for Mexico City is similar to that for Boston in

1752, when the fatality rate among the 2,124 who were inoculated was 1.4%, compared

to 9.7% among the 5,545 who fell ill in a natural way.50 The difference is a matter of

scale. Mexico City’s immunologically naive population was ten-times greater than

Boston’s.

10.2. Inoculation may have had an indirect effect as well. An artificially assisted (or

induced) epidemic seems to have reduced the malignity of the natural pox. In south-

eastern New Spain (Chiapas), where statistics were even more carefully recorded, the

direct saving of lives was many times greater than in Mexico City because three times

as many people were inoculated. While the natural death rate was twice as great in the

Southeast, it was half the figure for the epidemic of 1780. Moreover in Chiapas,

susceptible adults, whose natural death rate was higher than for children, were most

likely to be inoculated. A regression analysis of the Chiapas data explains half the

reduction in mortality at the village level as due to the indirect effects of inoculation.

The unexplained remainder might be attributable to the reduced malignancy of the

outbreak.51 Unfortunately detailed statistics on inoculation do not exist for Mexico City

so no further analysis is possible.

10.3. The City of Durango offers the sole example in Mexican medical history of

general inoculation. Here too, inoculation was a success. Eighty-seven percent of the


susceptible population (4,400 individuals) was inoculated in a matter of days, of whom

about one percent died. Among those infected with the natural pox, the fatality rate was

ten times as great. The risks for the few women who were pregnant at the time were, in

contrast, horrifying. Of nine who were inoculated, one died and two aborted. Natural

pox struck three. One died, and all aborted.52 Although the numbers are small, it seems

that quarantine, rather than inoculation, would have been the less risky treatment for

pregnant women. Indeed, effective quarantine would have been less risky for all.

It required the cruel stimulus of an epidemic to advance the cause of inoculation,

not because of scientific opposition to the principle,

but because of a certain fear of the common people...53

10.4. Contrary to this epigraph, much opposition was based on principle and common

sense, although few historians recognize this. The fact that inoculation saved lives in

the outbreak of 1797 does not mean that this was the general rule. On the contrary, only

during an epidemic was inoculation justified—two centuries of inoculationist

propaganda notwithstanding. The rational choice was to delay the dangerous procedure

(recall that one percent or more died from the treatment) as long as possible, that is,

until the much higher risk of death from the natural pox was imminent. To undergo a

one per cent chance of immediate death against a future unlikely risk is not a rational

choice. The inoculationists (and later, unquestioning diseaseologists) played an

epidemiological shell game, by focussing attention on the ten-fold advantage of

mortality rates from the artificial versus the natural pox. The likelihood of dying from

smallpox was not simply a matter of the advantage of artificial over natural exposure,

but one of timing as well. Once exposure to natural smallpox was imminent,

immediate, general inoculation was desirable. Otherwise one should forego the


considerable risk of death from artificial pox. There are lessons here for the use of

dangerous prophylactics in our own time.

If there be anything that can counteract the effects of agreeable rhetoric,

it is perhaps statistics.54

Figure 2 near here

11.1. Quarantine. The more serious objection to the artificial pox from the public health

view is that it broadcast the natural pox, unless stringent quarantine was imposed.

Critics of inoculation understood both these points. The pre-eminent Spanish medical

authority of his day, Francisco Gil, affirms as much in his Disertación (paragraph 42;

republished in Mexico City by Viceroy Branciforte in 1796): “I am not opposed to

inoculation, if it is administered with the necessary precautions.” Gil argued that

“inoculation propagates the pestilent effects of smallpox, if exact measures are not taken

to quarantine both the natural and artificially infected.” He correctly cited that the

successful experience in Vienna was precisely based upon inoculation with quarantine.

Turning to London, Gil cited evidence from the Bills of Mortality (paragraph 41)

showing that a substantial increase in smallpox deaths followed the general adoption of

inoculation in the City after 1747. His analysis was correct (and unnoticed), whatever

the defects of the London Bills. The ratio of smallpox to other deaths for London over

the eighteenth century follows an unexpected pattern (see Figure 2). Before 1747, that

is, before inoculation became frequent (although never general), the ceiling for the nine-

year moving average was 0.1 (one-smallpox death for every ten from all other causes).

After the practice of inoculation became common and for the next half century, this

figure became the floor. Only when vaccination displaced inoculation at the beginning

of the nineteenth century, did a secular decline in smallpox mortality occur. William


Heberden, from his study of the Bills published in 1801, concluded, “the inoculation of

the wealthy keeps up a perpetual source of infection [in London]”.55 Benjamin Franklin,

a witness to the 1752 epidemic in Boston, wrote, “they ‘spread the infection likewise

more speedily among those who did not chuse Inoculation’”.56

11.2. Inoculationist propaganda has distorted opposition to the procedure as a battle of

empiricism versus dogma, enlightenment against ignorance, reason versus prejudice,

modernism against antiquity, science versus religion, arithmetic versus theology, etc.57

While some opponents did at times base opposition to the procedure on one or more

spurious grounds, authoritative objections were often based on a very important

empirical principle of public health—one which inoculationists studiedly ignored.

Raised by Gil and others, inoculationists refused to address the fact that inoculation

spread the disease, unless it was accompanied by quarantine (much as the new

experimental AID vaccines have been found to spread AIDS as well, although, unlike

for the more contagious smallpox, AIDS requires a comingling of bodily fluids). The

cost of a couple of weeks of confinement following inoculation could be borne only by

the wealthy. Then too, general inoculation was impossible in large cities, such as

London, Paris, Madrid or Mexico.

11.3. Inoculationists sought to evade or ignore increasingly stringent quarantine

regulations in Europe as well as in the Americas. Boston’s first inoculationists, Cotton

Mather and Abdiel Boylston, were criticized in 1722 by Dr. William Douglass for

mischievously “propagating the Infection in the most Publick Trading Place of the

Town”.58 The famous English inoculator Daniel Sutton was placed on trial in 1766 for

igniting an epidemic by allowing his patients to roam at will. We know now that his


defense, that artificial pox did not spread natural pox, was false, although he persuaded

the jury otherwise.59

11.4. In the case of Mexico City, Viceroy Branciforte rescinded the quarantine

restriction on the doubly dangerous prophylactic on August 31, 1797, after months of

lobbying by the medical establishment. The order permitted voluntary inoculation in

the City without confinement.60 It is possible, indeed I think likely, that inoculationists

9 CHIMALPAHIN, Relaciones, v.2:184-5. MOTOLINÍA describes it as measles (“sarampión”),

transmitted by a Spaniard (Memoriales, p. 22):

Despues, dende a once años, vino un otro español herido de sarampión, y de el saltó en los

indios, e si no que hobo mucho aviso que se les mandó y defendía, y aún se les predicaba que no

se bañasen y otros remedios contrarios a esta enfermedad; y con esto plugó al Señor que no

murieron tantos como de las viruelas; y a este también llamaron el año de la pequeña lepra, y al

primero el año de la grande lepra.

11 STEARN and STEARN, Effect of Smallpox, p. 42.

15 CIUDAD DE MÉXICO. AYUNTAMIENTO. Manifiesto, p. 7; for 1779, see BNM Raros, Ephemeris

astronómica, f. 141; AACM vol. 3680, exp. 67, 76.

16 AACM Vacunas, vol. 4776, exped. 8

18 AHSS, Salubridad Pública, box 1, exp. 51, Oficios de remisión del Gobierno del Distrito Federal al

Consejo Superior de Salubridad, para aplicar las medidas pertinentes para contrarrestar una epidemia

de viruela and box 1, exp. 29, Informe del Inspector General de la Vacuna Luis Muñoz, 27 de febrero de

1872. To combat ignorance and lassitude of parents (“ignorancia y flojera”), Dr. Muñoz employed roving

vaccinators, paid them bounties, and required detailed records be kept for each child vaccinated,

including, in addition to name, date, place of vaccination, name of parents and address, the origin of the

vaccine (name of the child donor—essential to trace any cases of suspected transmission of syphilis), and,

a detailed description of the reaction determined by a follow-up visual inspection 8-12 days later. Donors

were selected with extreme care to prevent the inadvertent transmission of syphilis or other

communicable diseases. These lists, many of which still survive in the archives, testify to the

humanitarian and scientific spirit of Dr. Muñoz and his assistants. Dr. Muñoz received his lancet and


actually accelerated the eruption of the disease in Mexico City, because some

inoculatorsy worked in secret without quarantining their patients, days or weeks before

the Viceroy finally relented.

11.5. An anonymous poem, “scurrilous verses” according to the authorities, alleges as

much. Historians continue to misread opposition to the practice as unenlightened

superstition. Note, however, that the author of this poem, as well as the opponents to

lymph from his father, Dr. José Miguel Muñoz, in 1842, and was chief vaccinator in the City for thirty

years. In turn, his father received “el grano vacuno y la lanceta” from Dr. Balmis in 1804 (MUÑOZ,

Cartilla, p. iii).

22 AHSS, Salubridad Pública Epidemiología, box 11, exp. 1-2.

23 AHSS, Salubridad Pública Estadística, box 10, exp. 27.

25 BUSTAMANTE, La viruela en México; México, Anuario Estadístico, 1939, p. 177, 1942, p. 273.

27 VELÁZQUEZ, Códice Chimalpopoca, pp. 58, 59, 60. Fr. Bernardino de Sahagún’s monumental

ethnolinguistic encyclopedia of the Nahuatl contains two proverbs on great pestilences:

The sea, the conflagration. This saying was said when there befell a great war, or a great

pestilence [vei cocoliztli]. It was said: ‘It is as if there came upon us, or there passed over us,

the sea, the conflagration’—that is, pestilence [cocoliztli] or this same war (Sahagún, Florentine

Codex, vol. 6, p. 244).

Our lord bringeth cold water, icy water, upon us. This saying is said of the time when our lord

brings something upon us—affliction, pain, or sickness (cocoliztli), or famine. Then it is said:

‘our lord hath brought cold water, icy water, upon us. Our ears, our flanks have been tugged.

Our lord hath pierced us, hath admonished us with that which is like a thorn, a bone awl

(Sahagún, Florentine Codex, vol. 6, p. 254).

28 VIESCA, Epidemiologia, 175-76;

29 THOMAS, Conquest, p. 444.

31 SAHAGÚN, Códice florentino, vol. 3, book 12, chapter 29, folio 53.

32 CERVANTES DE SALAZAR, Crónica, p. 98; MOTOLINÍA, Memoriales, p. 22.

33 SAHAGÚN, Historia General, vol. 3, p. 356.


inoculation within the Spanish medical establishment, appeal to evidence, experience,

sight and empirical reasoning, not authority, religion, tradition or superstition. The

verses read:

Inoculations have been invented by the most poor and needy doctors

…

One sees that the inoculated are infected

34 MONJARÁS-RUIZ, Obras, vol. 2, pp. 280-299.

35 Gacetas de México, vol. 2, pp. 177-78.

36 Although Cooper states that the Virgin of Remedios was not called upon in 1797, because of her poor

performance in 1779 (Epidemic Disease, p. 142), there is contemporaneous archival evidence that the

procession was held (AGN Epidemias, vol. 1, exp. 7, f. 502). In France, according to a comprehensive

catalogue of saints, there were 123 for fevers, 85 for childhood illnesses, 70 for dangers of childbirth, 53

for plague, 27 for conjugal sterility, 20 for toothache, 18 for colic, 17 for rabies, 12 for leprosy and 10 for

convulsions—but, apparently none specifically for smallpox (BROCKLISS and JONES, Medical World,

p. 74).

38 Ibid., p. 96-7.39 COOPER, Epidemic Disease, p. 18.

40 MOLINA DEL VILLAR, Por voluntad divina, p. 61.

43 WIDMER, Pólitica sanitaria, p. 73; McCAA, Inoculation.

44 COOPER, Epidemic Disease, p. 106-131; PRICE, State Church Charity, p. 361; RODRÍGUEZ DE

ROMO, Inoculación.

45 COOPER, Epidemic Disease, pp. 86-147; Rodríguez de Romo, Inoculación.

46 COOPER, Epidemic Disease, p. 147.

47 Inoculación; the City’s Junta Superior was the first to credit inoculation with the major role

(Instruccion formada, written in 1814, published in 1824), p. 14:

Si en la epidemia inmediata pasada de viruelas del año de 1797 se socorrieron por la Junta

Principal de Caridad de esta Capital, como ocho mil enfermos mas que en la anterior del año de

1779, y en esta murieron un duplo mas que en aquella, debe atribuirse el buen éxito de la de

1797 (a mas de las activas providencias que por la Junta se tomaron, y el distinto tratamiento


Unfortunate Mexico, one regrets that the poor doctors have infected you

With experience one sees the evidence for this

The very poor and hungry doctors who bring the smallpox have invented

[inoculation].61

curativo) a la inoculación de la viruela, que aunque no adaptada generalmente por capricho y

timidez, con todo se verificó una gran parte de lo principal de esta Capital, y aun en muchos

pobres, ratificándolos para que se dexasen inocular...

Inoculation receives unconditional credit, contrary to the above citation, from the following authors:

COOK (The Smallpox Epidemic of 1797), FERNANDEZ DEL CASTILLO (Los Viajes, p. 64),

BUSTAMANTE (La viruela en México), COOPER (Epidemic Disease), LANNING (The Royal

Protomedicato), and PRICE (State Church Charity), among others.

48 RODRÍGUEZ DE ROMO (Inoculación) argues that the “sanos” figure for 1797 includes any that

received relief, not simply those who were “contagiados” as in 1779. I am not persuaded, because the

number of “sanos” in 1797 equals about one-third of the population of the City, that would have been

born since the 1779 outbreak. PESCADOR’s detailed study of Santa Catarina parish leads him to label

1779 a “super-crisis” with 700 deaths, in contrast to the ordinary “crisis” of 1797 (Bautizados, pp. 98,

103).

49 AGI, Estado 27, No. 38, Branciforte sobre extinción de la viruela en Mexico y PueblaCArta no. 598,

28/ii/798:

Es menester hallarse tan tocado, como VE. de la calamidad publica pa. percivir la dulce sensacn.

qe. causan en el alma las ideas reunidas de muchos millares de infelices, que yaciendo en el

olvido, en la oscuridad, en el polvo, y en la inmundicia de sus chozas, y pequeños reductos;

repentinamte. fueron vuscados, sublevados, y auxiliados por los sacerdotes y primeros

republicanos aqnes. se encomendo su cuidado, al abrigo qe. se daba a los unos, las medicians qe.

se aplicaban a otros, los alimentos, y el aseo qe se procuraba en todos el pasto espiritual

abundante, y los socorros [i.d. 59] que universalmte. se les entraban por las puertas, sin tener el

trabajo de pedirlos: qe otra cosa habian de producir sino un agradable contraste de la miseria y


12.1. General inoculation. A sympathetic account of this first “general” inoculation

notes that those who benefited were the educated, the old aristocracy, the wealthy,

bureaucrats, military officers and the medical profession. Although the authorities

made a serious attempt to inoculate all groups,62 less than ten percent of the population

was treated, absurdly short of a “general” inoculation. The viceroy’s order in a laudably

libertarian, but epidemiologically indefensible, spirit insisted that inoculation was to be

de la abundancia, decidido al fin por el estremo mas favorable.

Con la gente de mas modo fue necesario otro govierno y tambien se hizo distincion de calidades

y clases en la distribucn. de ropas.

50 BLAKE, Public Health, p. 87.

51 McCAA, Inoculation.

52 ESQUIVEL, Sermon eucaristico, pp. 19-22.

53 LANNING, The Royal Protomedicato, p. 372.

54 CREIGHTON, History of Epidemics, vol. 2, p. 454.

55 Observations, p. 36.

56 BLAKE, Public Health, p. 86.

57 For the inoculationist camp, none is better than the sophistry of MOREL’s Disertacion written to

persuade the viceroy to permit inoculation in the City to combat the epidemic of 1779. The dissertation’s

arguments were accepted but few people were inoculated. For examples in English, see the recent

statements in: WATTS (Epidemics and Empire, p. 114: “During much of the eighteenth century,

university-trained doctors steadfastly opposed inoculation” [and] “...continued to rely on the theories of

the Ancients”); BROCKLISS and JONES, Medical World, p. 470-72: “The initial prejudice within the

medical community to inoculation was perfectly reasonable. In a rationalist age, critics were

understandably suspicious of a prophylactic that defended the patient by giving him a dose (albeit mild)

of the disease, when there was no rationale underpinning the practice (which, to boot, was of Turkish

origin).” RISSE, Medicine in the Age of Enlightenment, p. 190: “lower-class fatalism, fear of accidental

contagion, and religious scruples based on the argument that the procedure attempted to interfere with

God’s work, were all barriers to its popularization.”


voluntary. Without quarantine, the order was a death sentence for one-in-ten of the

susceptible population and a serious illness for the remainder.

12.2 “General” inoculation could not work in a dense, urban center, such as Mexico

City, with it large mass of oppressed indigent. In Boston, an educated citizenry and a

democratically elected town council could effectively regulate inoculation at least to a

considerable extent. The first line of defense against smallpox was quarantine, a policy

that enjoyed nearly complete support from the Boston citizenry. Inoculation was

resorted to, only when quarantine failed. The procedure was voluntary, but those who

elected to not be treated were warned to remove themselves from the City. In Mexico

City, on the other hand, there was no warning. On the contrary, the “vulgar voice”

viewed the authorities with suspicion as the following account by a block leader

illustrates:

It is not easy to ascertain the number ill because many women assure that

their children have already suffered from the pox, when this is not the

case, only because of fear introduced by the vulgar Voice that by means

of force their children will be taken from them to be inoculated, the well

and the healthy, and to conduct the ill ones to the hospitals.63

For a reasoned assessment of the risks of inoculation, none is better than Francisco GIL’s Disertación

(see paragraphs 40-42, 77, 84). In English, see HEBERDEN, Observations, p. 35 or the modern authority

on smallpox, BAXBY, Jenner’s smallpox vaccine, p. 30. LANDERS’s assessment of the London Bills is

more cautious: “The practice of inoculation in the capital itself may have reduced mortality among

London-born children, but the evidence on this point is insufficient for any definite conclusions to be

reached” (Death and the metropolis, p. 356).

58 cited in BLAKE, Public Health, p. 57, emphasis in the original.

59 SMITH, The Speckled Monster, pp. 44-5.



12.3. In the colony’s smaller towns and the countryside, inoculation could be relatively

successful, as in Chiapas, Tehuantepec, and Durango, but not in the largest urban areas

such as Mexico City, Puebla, Guadalajara or even Oaxaca.

13.1. Conclusion. With the introduction of vaccination into Mexico in 1804,

inoculation was no longer an issue. Vaccination was neither life threatening to the

patient nor contagious to others. Once vaccination was introduced, Mexican medical

professionals immediately abandoned inoculation, and its use was recommended only as

a measure of last resort, when an epidemic was imminent and no vaccine available.

Vaccination was enthusiastically and almost universally accepted by all classes of

people in all regions of Mexico. To completely eradicate the disease, however,

unceasing vigilance by the authorities was required to smother the pox before it could

erupt.

13.2. Unfortunately, with independence taxes proved difficult to collect, public

resources were redirected to the political and military elite, and a certain malaise

infected the City’s bureaucracy. This meant that thousands of its residents, mainly the

children of the poor, died needlessly. In three decades, three large smallpox epidemics

engulfed the city. Although none were as leathful as any of previous centuries, all

could have been prevented by mass vaccination when an imminent outbreak was

suspected. Finally with the epidemic of 1840 the lesson was learned that thousands of

lives and hundreds of thousands of pesos could be saved by an annual allocation of as

little as a thousand pesos for a City-wide vaccination program. The expensive charity

campaigns of colonial times were never enough to succor the victims nor stem the

spread of disease. Charity was at best a palliative to the poor—not a preventive. More

effective was a couple of salaried vaccinators. Ultimately, compulsory vaccination,


which became law in 1882, not only forced parents to protect their children in a timely

way, but the same law forced authorities to provide ready, inexpensive access for all to

a prophylactic that was less expensive than charity, less troublesome than quarantine,

less deadly than inoculation, and more effective than all three combined: vaccination.

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Endnotes


62 COOK, La epidemia de viruela de 1797, p. 306.

63 AACM Salubridad, vol. 3678, exp. 2, f. 2.

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