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“Variolation” and Vaccination in Late Imperial China, Ca 1570–1911

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History of Vaccine Development

Abstract

The first reliable record of smallpox in China can be dated to the fifteenth century [1]. By early Song period, around the tenth century, smallpox had become essentially a childhood disease, but it remained one of the most fatal childhood diseases until the nineteenth century.

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Notes

  1. 1.

     There are different hypotheses as to the time when smallpox was first recorded in China. The most authoritative argument remains that of Fan Xingzhun, who dates the first specific record of smallpox to the fifth century.

  2. 2.

     Several variolation practitioners of the seventeenth century claimed that the technique was invented by a sixteenth century doctor. It is very likely that variolation was practiced in the sixteenth century before it was written down in the following century.

  3. 3.

     The five viscera are: xin (orb of the heart), gan (hepatic orb). pi (splenic/pancreatic orb), fei (pulmonic orb), shen (renal orb).

  4. 4.

     An eighteenth century variolator regretted that not many northerners were inoculated, so thousands of children died during epidemics. Such tragedies were much less frequent in the south [9].

  5. 5.

     These strategies include creating sites for seclusion (biduosuo) during smallpox epidemics, ­setting-up “smallpox secretariat” to handle the banishment of all smallpox patients thirteen miles from the city wall with their families, forbidding those members of the imperial family who had never had smallpox to enter the capital. When the first Manchu emperor died at 23 of smallpox in 1662, the Kangxi Emperor was chosen to be the successor and not his elder brother precisely because he had had smallpox as a child and had a better chance to have a longer reign.

  6. 6.

     One very interesting list is found in box 4717 of the “Imperial Pharmacy” section of the Qing Archives in the No 1 Archives in Beijing. This box contains documents dated 1744, 1749, and 1755. Though this list is not dated it should be of the mid-eighteenth century. It contained 73 names of inoculated children of the red and white banner troops stationed in Chahar in Manchuria, the oldest of whom was 18 sui, the youngest 3 sui, implying that these Manchu children were inoculated at a much older age than Chinese children.

  7. 7.

     Lee, Wang, and Campbell claim that child mortality of the Machu nobility fell from 400 hundred per 1,000 during the early eighteenth century, to 100 and below by the late eighteenth century, at the same time, life expectancy at birth doubled from the low twenties to the high forties. They suspect that variolation could have contributed to this change.

  8. 8.

     One of the earliest account of the activities of the Canton establishment is by Rev. William Milne, in his Life in China, London, 1859

  9. 9.

     A report by Pearson on 19 March 1821 stated that vaccination had, by that time, spread to the provinces on Jiangxi (Kiangsi), Fujian (Fukien), Jiangsu (Kiangsu), and reached Beijing. The French surgeon was sent by Vannier, Minister of Cochinchina. Ibid, p 40.

    The Chinese historian Chen Yuan (1880–1971) found out from Chinese sources that vaccination was spread chronologically in the 1820s from Canton to Hunan, Peking, Fujian, Jiangsu, Jiangxi, Sichuan. Some vaccinators paid wet nurses with infants to travel from one spot to another to transmit the vaccine arm to arm.

  10. 10.

     Pearson reported in 1816 on the first vaccination in 1805–1806, “it was from the beginning conducted…by inoculation at stated periods among the native, and of them, necessarily, the poorest classes, who dwelt crowded together in boats or otherwise … ”

  11. 11.

     On the number of bureaus: See Angela Leung, “Charitable institutions of the Ming and Qing”. Unpublished research report, National Science Council, Taipei, Taiwan, 1991. I have used more than 2,000 local gazetteers to count different types of charitable institutions in this project. For vaccination bureaus the preliminary count in 1991 was 34, but after recent checking, I found out at least nine bureaus had been erroneously left out. This is certainly still an underestimation.

  12. 12.

     Sanjiao, the biggest of the six bowels (liufu), consisted of the three portions of the body cavity, commanding the circulation of fluid and air (fi). Some western medical doctors believe that the reflexive points commanding the sanjiao actually are controlling glandular excretion. The two reflexive points corresponding to sanjiao are called the xiaoshuo and the finglengyuan.

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Authors and Affiliations

  1. Sun Yat-sen Institute for Social Sciences and Philosophy, Academia Sinica, Taipei, Taiwan

    Angela Ki Che Leung

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Correspondence to Angela Ki Che Leung .

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  1. , Emeritus Professor of Pediatrics, University of Pennsylvania, Philadelphia, 19104, Pennsylvania, USA

    Stanley A. Plotkin

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Leung, A.K.C. (2011). “Variolation” and Vaccination in Late Imperial China, Ca 1570–1911. In: Plotkin, S. (eds) History of Vaccine Development. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1339-5_2

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