The Balmis-Salvany Smallpox Expedition: The First Public Health Vaccination Campaign in South America
By Rafael E. Tarrago
The spread of smallpox to the New World was inevitable. The disease probably appeared as early as 10,000 B.C., in north-eastern Africa, but the first recorded epidemic occurred in 1350 B.C. during the Egyptian-Hittite war. Smallpox killed people of all ages and all socioeconomic classes. In the late 18th century in Europe, 400,000 people died of smallpox each year, and one-third of survivors went blind, according to Frank Fenner in his book Smallpox and Its Eradication. During the 18th century, four reigning European monarchs died of smallpox, and the Habsburg line of succession to the throne changed four times in four generations because of the deaths of the heirs.
In 1518, following the arrival of Spanish conquistadors on the island of Hispaniola, an outbreak of smallpox, unknown in the New World before the arrival of the Europeans, decimated the population. From there the disease moved rapidly throughout the Americas, exterminating most of the Aztecs and Incas. Within a century, the population of Mexico fell from about 25 million to 1.6 million, according to historian William McNeill.
Three centuries later, smallpox epidemics were still threatening the world. In Spanish America, Spain was facing serious potential losses to the Royal Exchequer as a result of the diminishing labor force. Europe had had a vaccine against smallpox for seven years, and royal officers in the New Kingdom of Granada (present-day Colombia) pleaded for the vaccine for their domains.
On September 1, 1803, King Charles IV of Spain, who had lost one of his own children to smallpox, issued a royal order to all royal officers and religious authorities in his American and Asian domains, announcing the arrival of a vaccination expedition and commanding their support to
- vaccinate the masses free of charge,
- teach the domains how to prepare the smallpox vaccine, and
- organize municipal vaccination boards throughout the domains to record the vaccinations performed and to keep live serum for future vaccinations.
The expedition to vaccinate the population in South America against smallpox was a public health undertaking of staggering proportions. A small group set out by ship and horse to traverse present-day Puerto Rico, Venezuela, Panama, Colombia, Ecuador, Peru, Chile, and Bolivia, carrying the vaccine and administering it in villages and cities along the way. The territory was not only vast but also brutally harsh, with precipitous mountains, dense jungles, and uncharted rivers. The expedition traveled in primitive riverboats and on mules when the terrain was too rugged for horses.
First Destination: Puerto Rico
The María Pita left the Spanish harbor of La Coruña on November 30, 1803, with the smallpox vaccination expedition team consisting of a director, Dr. Francisco Xavier Balmis; an assistant director, Dr. Jóse Salvany Lleopart; and several assistants and paramedics. The ship reached Puerto Rico in February 1804 with its cargo of vaccine serum preserved between sealed glass plates; also onboard were 21 children from the orphanage at La Coruña who carried the vaccine through arm-to-arm vaccinations performed sequentially during the ships journey, and thousands of copies of a treatise describing how to vaccinate and preserve the serum, recounts José Rigau-Pérez in an article on the smallpox vaccine in Puerto Rico.
Upon arriving in Puerto Rico, Dr. Balmis found that the Puerto Rican authorities had already obtained the vaccine from the Danish colony of Saint Thomas. He worked with the governor general and his chief doctor, don Francisco Oller, to organize a central vaccination board that would record the successful vaccinations performed in Puerto Rico and would keep live serum for future vaccinations. Thereafter, in all the places they stopped, the expedition teams established vaccination boards.
On to Venezuela
From Puerto Rico the expedition went to Venezuela, where, according to R. Archilas La expedición de Balmis en Venezuela, it was received with public manifestations of joy. The Venezuelan poet Andrés Bello dedicated an ode to the Spanish governor, praising him for being the instrument of the royal gift that would free Venezuela of the "flagellation" of smallpox that "devoured Venezuela's children in earlier times":
sí, Venezuela exenta del horrible azote destructor, que, en otro tiempo sus hijos devoraba, es quien te envía por mí tímido labio sus acentos.
In Venezuela the expedition divided into two groups. Dr. Balmis led one group to Mexico, Central America, and the Philippines, and Dr. Salvany led the other to countries in South America, which is the route this account traces.
On to Colombia
The ship "San Luis," carrying Dr. Salvanys section of the expedition, was wrecked on its way to the port of Cartagena de Indias, but the expeditionaries and their luggage were rescued. They entered within the walls of Cartagena in triumph on May 24, 1804, and began vaccinating the population at once, as is documented by Gonzalo Díaz de Yraola in his book La vuelta al mundo de la expedición de la vacuna.
From Cartagena, Dr. Salvany sent the vaccine to Portobelo and Panama, where thousands were vaccinated, and he made arrangements to take 10 children from the city orphanage to carry the vaccine through arm-to-arm vaccination to Santafé de Bogotá. During the rigorous, rain-soaked journey in a riverboat up the Magdalena River from the Caribbean coast to Santafé, in the highlands, Dr. Salvany developed an illness that resulted in the loss of one eye. Nevertheless, in every river port where the boat stopped, the expedition team landed to vaccinate peoplemore than 56,000 altogether.
On December 18, 1804, the expedition arrived in Santafé de Bogotá, where they were welcomed with princely honors by the viceroy and the archbishop of the city. There Dr. Salvany met Father José Celestino Mutis, himself a medical doctor familiar with the literature about smallpox vaccination. Popular enthusiasm for the vaccine was immense, because two years earlier Santafé had experienced a smallpox epidemic, and Dr. Mutis had been trying ever since to obtain the vaccine, as is documented by Marcelo Frías-Nuñes in his book Enfermedad y sociedad en la crisis colonial del Antiguo Régimen.
The expedition left Santafé for Popayán on March 8, 1805, stopping in several towns on the way to vaccinate people. On May 27 they arrived in Popayán, where, again, they were received with public manifestations of joy.
Then to Ecuador
Upon receiving word of a smallpox outbreak in the Kingdom of Quito (present-day Ecuador), the expedition hastened its journey to the capital city, Quito, where they stayed for two months because Dr. Salvany became ill again. From Quito the expeditionaries went to Cuenca, where they were welcomed with a "Te Deum" in the cathedral, and with bullfights, masked balls, and fireworks for three consecutive nights. In that city they vaccinated 7,000 people, and the authorities helped them recruit boys to carry the vaccine to Lima.
The harshness of the land journey through vertigo-inducing gorges and rugged paths in the Andes from Cuenca down to Piura, in Peru, was compensated for by the welcome the expeditionaries received in Native American villages. In the town of Loja, where they vaccinated 3,500 people, they were welcomed as saviors.
The expedition stopped for several days in Piura to allow Dr. Salvany to recover, but as soon as he felt well, they left for Trujillo. On the way to Trujillo Dr. Salvany became ill again, and they stopped in a village of Native Americans, who asked to be vaccinated. In that village they were approached by a delegation of Andean gentry from the village of Chocope, who wanted to be vaccinated. The expeditionaries arrived in Trujillo on January 17, 1806, and there they spent five days and vaccinated 2,761 people.
Dr. Salvany went on to the village of Lambayeque where, unlike in other locations, he was disappointed by the coldness of the welcome that he received from its city council. Nevertheless, he was able to vaccinate 4,000 people. From Lambayeque he went to Cajamarca; on the way, the hired muleteers stole his beasts of burden. Four days later he was rescued by a Native American passing by, who helped him obtain transport animals from a nearby farm. In Cajamarca he vaccinated 1,000 people. The Native Americans danced in his honor, and a local poet read a poem in praise of the vaccine and the philanthropy of King Charles IV.
Arriving in Lima on May 23, 1806, the expedition did not receive the accustomed welcome. The vaccine had preceded them, and the city council of Lima made clear their opinion that it was no longer necessary there. The vaccine had been sent by the viceroy of the River Plata Provinces, at Buenos Aires, where it had arrived in the summer of 1805 in the arms of vaccinated slaves from Brazil who landed in Montevideo. In Buenos Aires on August 2, 1805, 22 people had been vaccinated and sent as carriers of the serum to northern Argentina, Paraguay, Chile, and Lima.
Dr. Salvany appealed to the viceroy of Peru, don Gabriel Avilés y del Fierro, but the decrees calling for mass vaccinations in Lima issued by this viceroy were not heeded. The problem was that the vaccine was already available in that city, but it was not free of charge, and local physicians were not interested in supporting a project that would eliminate that revenue.
The serum was sold pressed between two sealed glass plates or dried on pieces of English taffeta. Dr. Salvany was concerned about the proper administration of the vaccine, and about its institutionalization. Fortunately, a new viceroy arrived in Lima on August 20, 1806, don José Fernando Abascal, who forcefully supported the expeditions endeavors. Shortly after the arrival of Viceroy Abascal, Dr. Salvany vaccinated 22,726 people in the Kingdom of Peru, according to Gonzalo Diez de Yraola.
Before Dr. Salvanys arrival in Lima, the city council had decided that the serum for the smallpox vaccine should be preserved by Dr. Pedro Belomo, a Lima doctor. Dr. Salvany developed a good professional relationship with Dr. Belomo, and through him won the confidence of the scientific community in Lima. Shortly after Dr. Salvanys arrival, the University of San Marcos at Lima granted him an honorary doctorate, and he won public praise from Dr. Hipólito Unanue, one of the most prestigious Peruvian scientists of that time.
In Chile ...
Before leaving Lima to continue his mission in Alto Peru (present-day Bolivia), Dr. Salvany commissioned his assistant, don Manuel Grajales, to lead a section of the expedition to the areas of Huarochiri, Jauja, Tarma, Huanuco, Panatagua, and Canta, in Peru, and then to go by sea to the Kingdom of Chile. The team landed at Valparaíso in November 1806, and were disappointed by the news that the vaccine had preceded them in Chile. It had arrived from Buenos Aires in September 1805, and for one year the priest don Pedro María Chaparro had been carrying out his own vaccination campaign in central Chile. But, aware of the importance of institutionalizing vaccination, don Manuel Grajales obtained the assistance of the local authorities in the Kingdom of Chile to establish vaccination boards in Chilean townships.
... and Bolivia
Dr. Salvany sent his assistant Rafael Lozano Perez to Huancavelica, Huamanga, and Cuzco before he left for Alto Peru. On his way to La Paz, Dr. Salvany stopped in Ica for health reasons, but several months later he continued on his way to La Paz, vaccinating and establishing vaccination boards in villages along the way.
Only 34 years old, Dr. Salvany died in Cochabamba on July 21, 1810, according to a death certificate issued by the pastor of the church of San Francisco, as is documented in an article in 1980 by historian M. Parrilla Hermida in the journal Asclepio.
An Enlightened Legacy
The March 21, 1799, issue of the Madrid Semanario de Agricultura y Artes published a Spanish translation of an abridgement of Dr. Edward Jenners 1798 report on his experimentation with the vaccine. That weekly periodical and the Gaceta de Madrid were widely read in Spanish America, and on January 3, 1804, the latter published a letter asserting that Dr. Edward Jenners vaccine had become known in the Kingdoms of the Indies because of the article in the Semanario. Dr. Jenner, who had demonstrated the effectiveness of the smallpox vaccine in 1796, wrote the following words on November 22, 1806, to his friend the Reverend Mr. Dibbin, referring to the vaccination expedition of King Charles IV: "I dont imagine the annals of history furnish an example of philanthropy so noble, so extensive as this."
The Balmis-Salvany expedition was the first official program of mass vaccination in Spanish America. As a public health campaign it is significant not only because of the vaccine itself but also because of the charge by King Charles IV to institutionalize the new technology in Spanish America and the Philippines by involving doctors and other interested individuals in vaccination boards that would keep records of the vaccinations performed and preserve the serum for future vaccinations, according to José Rigau-Pérez.
Since that expedition, worldwide collaborative efforts have successfully vaccinated populations to the point that in 1980 the World Health Organization was able to declare that smallpox had been eradicated. Smallpox no longer affects anyone, and the cost of getting rid of itapproximately US$313 million over 10 yearshas been repaid many times in saving of human lives and in the elimination of costs for vaccines, treatment, and international surveillance activities.
Rafael E. Tarrago is librarian for Ibero-American Studies at the University of MinnesotaMinneapolis. Mr. Tarrago is the author of The Pageant of Ibero-American Studies and other books and articles on Spanish American history and culture.