Royal Philanthropic Vaccine Expedition

From Hispanopedia
Royal Philanthropic Vaccine Expedition
Bust of Francisco Javier Balmis at the Faculty of Medicine of the UMH in San Juan de Alicante.
ObjectiveTo vaccinate the inhabitants of the viceroyalties of the Spanish Empire against smallpox
CauseHigh mortality rate in the viceroyalties of the Spanish Empire due to smallpox

The Royal Philanthropic Vaccine Expedition (Real Expedición Filantrópica de la Vacuna), also known as the Balmis Expedition after the Spanish physician Francisco Javier Balmis, was an expedition of a philanthropic nature that, from 1803 to 1806, went around the world, calling at some of the main ports of the Spanish Empire. In addition, its members provided vaccinations to Portuguese and Chinese subjects in Macau and to several towns in Chinese territory as far as Canton. On his return voyage, Balmis also inoculated the British population of the Island of Saint Helena.

The main objective of the expedition was for the smallpox vaccine to reach the greatest possible number of territories around the world, since the high lethality of the virus was causing the deaths of millions of people.

King Charles IV supported, and financed with public funds, the court physician, Doctor Balmis, in his project of mass vaccination throughout the Empire. The King's own daughter, the Infanta María Teresa, had died of the disease in 1794. It is estimated that at the end of the 18th century some 400,000 people died of smallpox in Europe every year.[1] It is considered the first international health expedition in history.[2][3] It can be understood overall as "a children's caravan bound for the New World to carry the vaccine and prevent smallpox epidemics, resulting in one of the strangest voyages in which medicine and science were the protagonists in the 19th century."[4] More than 300,000 people were vaccinated throughout Cuba.[5] In the Viceroyalty of Peru, 22,726 people were vaccinated according to Gonzalo Díaz de Yraola.[6]

Beginnings

Equestrian statue of Charles IV by Manuel Tolsá, Mexico City.

Before the vaccine proper was discovered, thanks to which smallpox has been eradicated, a technique known as variolation was used. It consisted of extracting fluid from the pustules of a person who was already in the last phase of the disease and inoculating it into another person through an incision made in the arm. The recipient became infected but rarely died, since he received a reduced dose of the virus. It became known in Europe at the beginning of the 18th century, mainly through a communication by the Italian physician Timoni, and was introduced in 1717 by Lady Montagu, wife of the British ambassador in Constantinople, who had her children variolated by a Greek physician; the children fell mildly ill and recovered quickly.

For his part, Pedro Manuel Chaparro applied inoculations from the pustules of smallpox patients to prevent smallpox in the year 1765 in Hispanic America,[7] something that proved to be a complete success, since more than five thousand people were inoculated and none of them died.[8] Fray Domingo de Soria, who had worked in the city of Valdivia alongside Chaparro in 1766,[7] was in the city of Lima, Peru, when he proposed the publication of his book Inoculación de las Viruelas.[9]

In 1796, at the time of the greatest spread of the smallpox virus in Europe, an English country doctor, Edward Jenner, who undoubtedly must have known the techniques of Montagu and Chaparro, supposedly observed that dairy milkmaids occasionally contracted a kind of "cow smallpox" or "vaccine smallpox" (cowpox)[10] through continued contact with these animals, and that it was a mild variant of the deadly "human" smallpox, against which they thus became immunized. He adapted the technique of variolation, extracting fluid from the pustules on the udder of a sick cow to inoculate it into James Philips, an 8-year-old boy. The boy showed symptoms of cowpox infection, but much milder, and did not die. The rest of the children inoculated responded surprisingly well and became immunized against human smallpox. But Jenner made another important discovery: he realized that this infection could be transmitted from one person to another. At the site where the fluid had been introduced, the recipient developed pustules, and the fluid that accumulated could be extracted and used to administer new vaccinations.

What was difficult at that time was keeping the vaccination serum in good condition, since it is only effective while the viruses it contains are active. Today we have refrigeration chambers, but back then, to make it keep for only about ten days, raw cotton was soaked with the fluid, placed between two glass plates and sealed with wax. This was what was done in Europe; but crossing the Atlantic meant far exceeding the expiration date. In America there were no cows with which variolation could be practiced. It was precisely to America that the King of Spain, Charles IV, who had lost one of his daughters, María Teresa (1791–1794), to smallpox, wanted to bring the vaccine. The vaccine had arrived in Spain in 1800, specifically in Puigcerdà, at the hands of the Spanish doctor Francisco Piguillem i Verdacer.[11][12] Francisco Javier de Balmis, a native of Alicante and court physician, translated into Spanish the book by the Frenchman Jacques-Louis Moreau de la Sarthe, which detailed the procedure for vaccinating.

There were precedents to Balmis's proposal to bring the vaccine to Hispanic America, such as the one issued on August 24, 1802 by Rafael de Malaguilla, a thirty-three-year-old surgeon who had practiced in Andalusia but was then residing in Madrid, and which was endorsed by the military officer Arturo O'Neill. It was rejected by the tribunal of the Protomedicato because of the applicant's lack of experience and the receipt of other plans, such as that of the Hispanic Guatemalan physician José Felipe Flores or that of Balmis himself.[13] The fight against smallpox had moreover gained strength in America in the last years of the 18th century, since the King had requested medical works seeking to carry out reforms to improve public health and confront the disease, such as Reflexiones acerca de las viruelas by Eugenio de Santa Cruz y Espejo in New Granada or the Instrucción que puede servir para que se cure a los enfermos de las viruelas epidémicas by José Ignacio Bartolache in New Spain. Both were published in 1785 and 1779 respectively.[14][15]

Five years after the publication of this discovery, in 1803, Charles IV, advised by Balmis, ordered the organization of an expedition to extend the vaccine to all the Overseas dominions (America and the Philippines). The intention was not only to vaccinate the local population but to establish vaccination boards in the cities visited that would guarantee the preservation of the fluid and the vaccination of future generations. In 1805, with the approval of the Board of Surgeons of the Chamber, a royal decree (real cédula) was promulgated ordering that a room be set aside in every hospital to preserve the vaccine fluid.[16]

The main problem facing Balmis, to whom this mission was entrusted, was how to make the vaccine survive the entire journey in perfect condition. The solution occurred to Balmis himself, and it could be called live human transport. A group of unvaccinated people would go on board. Two of them would be inoculated with the virus and separated from the rest. Toward the end of the course of the disease, fluid would be extracted from their pustules and given to the next two people, and so on until reaching South America. No volunteers were sought for this human chain of the virus; Balmis chose to take with him 22 orphaned children (foundlings) between three and nine years of age.[17]

Course of the expedition

Route of the expedition.
Route of the expedition.

The operation began with the chartering of the corvette María Pita, which carried the twenty-two children;[18] Balmis, two assistant physicians, two practitioners, three nurses and the rectress of the La Coruña orphanage Casa de Expósitos, Isabel Zendal Gómez.[19]

On November 30, 1803, the ship set sail with 37 people from the port of La Coruña. Among the twenty-two children, six came from the Casa de Desamparados of Madrid, another eleven from the Hospital de la Caridad of La Coruña and five from Santiago. The vaccine had to be carried by children who had not had smallpox, and it was transmitted from one to another every nine or ten days. Among the children were Isabel's own son, Benito Vélez, nine years old, and Andrés Naya (8 years), Antonio Veredia (7 years), Cándido (7 years), Clemente (6 years), Domingo Naya (6 years), Francisco Antonio (9 years), Francisco Florencio (5 years), Gerónimo María (7 years), Jacinto (6 years), José (3 years), Juan Antonio (5 years), Juan Francisco (9 years), José Jorge Nicolás de los Dolores (3 years), José Manuel María (6 years), Manuel María (3 years), Martín (3 years), Pascual Aniceto (3 years), Tomás Melitón (3 years), Vicente Ferrer (7 years), Vicente María Sale y Bellido (3 years) and one more child who died during the voyage.[20]

The corvette María Pita, chartered for the expedition, departing from the port of La Coruña in 1803 (engraving by Francisco Pérez).

The rules of the expedition clearly indicated the care the children were to receive. None of them returned to Galicia.

[...] They shall be well treated, maintained and educated until they have an occupation or position with which to live, in accordance with their class, and those who were taken out on that condition shall be returned to their native towns.

— Rules governing matters of the Royal Expedition

Each child received a bundle containing two pairs of shoes, six shirts, a hat, three pairs of trousers with their respective linen jackets and another pair of woolen trousers for the colder days. For personal hygiene: three neckerchiefs, another three handkerchiefs for the nose and a comb; and for eating: a glass, a plate and a complete set of cutlery.[21]

The mission succeeded in bringing the vaccine to the Canary Islands, Venezuela, Colombia, Ecuador, Peru, New Spain, the Philippines, China and the British island of Saint Helena.[22] The ship carried surgical and scientific instruments, as well as the translation of the Tratado práctico e histórico de la vacuna by Moreau de la Sarthe, to be distributed by the vaccination commissions that were to be founded.

The expedition arrived at Santa Cruz de Tenerife, where it spent a month vaccinating, and left the Canaries on January 6, 1804, arriving in Puerto Rico on February 9, 1804. It was not necessary to vaccinate the population of Puerto Rico, since the vaccine had been brought to the island from the Danish colony of Saint Thomas. On May 26, 1804, it arrived at the port of Havana, where its members were surprised to observe that vaccination against smallpox had already been carried out thanks to the activity of Tomás Romay.

Captaincy General of Venezuela

The expedition split up in La Guaira:

New Spain (1805)

In the territory of present-day Mexico, Balmis gathered twenty-six children to keep the vaccine alive during the crossing of the Pacific Ocean, aboard the galleon Fernando de Magallanes of the Manila Galleon.[24][25] They departed on February 8, 1805 from the port of Acapulco bound for Manila, arriving in that city on April 15, 1805.

Captaincy General of the Philippines

Route of the expedition in the Philippines.

In the Philippines, the expedition received important help from the local Church in organizing the vaccination of the natives. On August 14, 1809, the bulk of the expedition returned to Acapulco, while Balmis, ruling out a return to the lands of New Spain, continued onward toward China. Isabel would remain in Puebla with her son; they would never return to Spain.

China

Knowing that the vaccine had not reached China, Balmis requested permission to go to Macau, permission which was granted to him, and he departed from Manila on September 3, 1805.

Balmis finally arrived, after an eventful voyage, at the Portuguese colony of Macau, and on October 5 of that same year he went into Chinese territory. He vaccinated the population of several cities until reaching the province of Canton.[26]

Saint Helena Island

On his way back to Spain, Balmis managed to persuade the British authorities of Saint Helena Island (1806) to agree to the vaccination of the population, which he finally achieved.

Return to Spain

Monument in the port of La Coruña in tribute to the children of the expedition.

The expedition finally arrived in Lisbon on August 14, 1806.[18]

Once in Spain, Balmis was commissioned by the Central Junta of Seville to make his last voyage to America and continue his public health campaign. Unfortunately, there are no detailed records of the expedition, since the diary that Balmis kept disappeared during the looting of his house perpetrated by the French invaders. Francisco Javier Balmis died in Madrid on February 12, 1819.

One of the pioneers in the application of the smallpox vaccine in Europe, Edward Jenner, wrote about the expedition:

I cannot imagine that the annals of History furnish an example of philanthropy more noble and more extensive than this.[27]

On the same event, Alexander von Humboldt wrote in 1825:

This voyage will remain the most memorable in the annals of history.[27]

Monument in the port of La Coruña in tribute to the children of the expedition.

The expedition in fiction

  • 2006: The Dominican-American novelist Julia Álvarez wrote a fictional account of the expedition from the perspective of the rectress of the orphanage, Isabel Zendal Gómez, in Saving the World (2006).
  • 2010: The expedition was also recreated by the Madrid writer Almudena de Arteaga in her novel Ángeles custodios, from 2010.[28]
    • 2016: The TVE film 22 ángeles, by Miguel Bardem, is based on the novel Ángeles custodios (2010).[29]
  • 2011: This expedition is the central theme of Antonio Villanueva Edo's novel Los héroes olvidados (2011).
  • 2013: The Zaragoza writer Javier Neveo novelizes the expedition, narrated by one of the children, in Los niños de la vacuna (2013).[30]
  • 2015: The writer and journalist Javier Moro wrote that year a novel about the story of these children, entitled A flor de piel. It is a novel full of adventures in which the main figure is Isabel Zendal and her travels through the Spanish colonies carrying the vaccine against the dreaded smallpox.[31]
  • 2017: The Spanish writer María Solar recounts in her book Los niños de la viruela (ISBN 978-84-698-3355-1) the story of Isabel Zendal Gómez as director of the Casa de Expósitos orphanage, and of how she came to be part of the expedition.
  • 2018: The comic Nuevo Mundo. Isabel Zendal en la expedición de la vacuna (ISBN 978-84-94954-91-7), whose author is El Primo Ramón, was published.
  • 2021: Correos issued a stamp dedicated to Francisco Javier de Balmis y Berenguer.[32]

See also

References

  1. ↑ Asensi Botet, Francesc (2009-12). "La real expedición filantrópica de la vacuna (Xavier de Balmis/Josep Salvany): 1803-1806". Revista chilena de infectología (in español). 26 (6): 562–567. doi:10.4067/S0716-10182009000700014. ISSN 0716-1018. Retrieved 2023-02-27. {{cite journal}}: Check date values in: |date= (help)
  2. ↑ "La Coruña: A progressive city" Archived 2004-12-09 at the Wayback Machine, historical information about La Coruña.
  3. ↑ José Salvany y la expedición de la vacuna de la viruela por Sudamérica.
  4. ↑ The book by Díaz de Yraola, Gonzalo, begins with these words: La vuelta al mundo de la expedición de la vacuna. Seville. Escuela de Estudios Hispanoamericanos, CSIC, 1948, p. 1.
  5. ↑ "Expedición Balmis (1803-1810)" (in español).
  6. ↑ "La expedición Balmis-Salvany de vacunación contra la viruela, primera campaña de salud pública en las Américas Por Rafael E. Tarrago". www3.paho.org (in español). Retrieved 2023-02-27. {{cite web}}: line feed character in |title= at position 111 (help)
  7. ↑ 7.0 7.1 Infante Martin, Javier Francisco Jesús (2015). "Curas, Frailes y otros alborotadores". Revista de Estudios Histórico-Jurídicos (in español) (37): 503–520. ISSN 0716-5455. Retrieved October 11, 2016.
  8. ↑ Vicente, de Carvallo y Goyeneche (1875) [1796]. "XCVIII". Descripción Histórico-Geográfica del Reino de Chile (in español). Vol. 2. pp. 310–311. Retrieved October 10, 2016.
  9. ↑ Inoculación de las Viruelas (in español). Vol. Tercero. Imprenta de los Niños Huérfanos. 1778. Retrieved October 10, 2016. {{cite book}}: |first= missing |last= (help)
  10. ↑ "Cómo una ordeñadora de vacas le dio a Edward Jenner la clave para descubrir la vacuna contra la viruela (y lo convirtió en el médico más famoso del mundo)". BBC News Mundo (in español). Retrieved 2021-06-26.
  11. ↑ Balaguer Perigüell, Emilio; Ballester Añon, Rosa (2003). Asociación Española de Pediatría (ed.). En el nombre de los niños. Real Expedición Filantrópica de la Vacuna 1803-1806 (capítulo 4: «Viruela y vacuna en España y en los territorios coloniales de ultramar antes de la llegada de la expedición») (PDF) (in español). Madrid. p. 86. Retrieved July 31, 2015.{{cite book}}: CS1 maint: location missing publisher (link)
  12. ↑ Bruguera Cortada, Miquel. "Francisco Piguillem i Verdacer". Diccionario biográfico español (in español). Real Academia de la Historia. Retrieved August 27, 2019.
  13. ↑ Tuells, J.; Duro Torrijos, J.L. (April 2012). "Una propuesta fallida para propagar la vacuna contra la viruela en Hispanoamérica (1802)". Vacunas (in español). 13 (2): 76–80. doi:10.1016/S1576-9887(12)70042-0.
  14. ↑ Cervantes, Biblioteca Virtual Miguel de. "Escritos del doctor Francisco Javier Eugenio Santa Cruz y Espejo. Tomo II". Biblioteca Virtual Miguel de Cervantes (in español). Retrieved 2023-04-26.
  15. ↑ Rodríguez Sala y Muro, María Luisa (2016). Los médicos en la Nueva España Ilustrada (1780-1809). Roles y redes sociales (in español). Universidad Nacional Autónoma de México-Instituto de Investigaciones Sociales/Academia Mexicana de Cirugía/Patronato del Hospital de Jesús. ISBN 978-607-02-8093-1. Retrieved 2023-04-26.
  16. ↑ "La primera campaña de vacunación mundial de la historia. Francisco Javier Balmis". Historia de España (in español). 2019-10-02. Retrieved 2021-06-26.
  17. ↑ Messner, Daniel (30.0.2020). "Kleine Geschichte der Pocken, oder wie 22 Waisenkinder die Welt impften (pequeña historia de la viruela; o cómo 22 niños huérfanos vacunaron al mundo)". Die Zeit (in Deutsch). {{cite journal}}: Check date values in: |date= (help)
  18. ↑ 18.0 18.1 Juan A. Oliveira (September 24, 2016): "La corbeta María Pita y la Real Expedición Filantrópica de la Vacuna." Retrieved December 4, 2020.
  19. ↑ De Romo, Ana Cecilia Rodríguez (1997). "Inoculation in the 1799 smallpox epidemic in México: Myth or real solution?". Antilia: Spanish Journal of History of Natural Sciences and Technology.
  20. ↑ Coruña, La Opinión de A. "La rectora Isabel, al descubierto" (in español). Retrieved January 14, 2017.
  21. ↑ "Isabel Cendala y Gómez. Primera enfermera de salud pública de México" • blog.
  22. ↑ McIntyre, John W.R. MB BS; and Houston, C. Stuart MD (1999). "Medicine in Canada: Smallpox and its control in Canada". Canadian Medical Association Journal 161 (12), 1543–1547. PMID 10624414.
  23. ↑ Foffani, Enrique (September 17, 2020). "Oda a la vacuna | A propósito de la pandemia, la carta de los infectológos y la memoria en América Latina". Página12 (in español). Retrieved 2021-06-26.
  24. ↑ "Cuando 26 niños fueron las neveras de las vacunas: así viajó la inmunización contra la viruela de España a Filipinas". El País (in español). 2021-07-23. Retrieved 2021-07-25.
  25. ↑ Guitart, Luis Montalvo (2021-07-30). "La Real Expedición Filantrópica de la Vacuna (6). Subexpedición Balmis II". laplazuela.net (in español). Retrieved 2023-05-30.
  26. ↑ Balaguer Perigüell, Emilio; Ballester Añon, Rosa (2003). Asociación Española de Pediatría (ed.). En el nombre de los Niños. Real Expedición Filantrópica de la Vacuna 1803-1806 (capítulo 5: «La Real Expedición Filantrópica de la vacuna y su significado histórico») (PDF) (in español). Madrid. pp. 165–170. Retrieved July 31, 2015.{{cite book}}: CS1 maint: location missing publisher (link)
  27. ↑ 27.0 27.1 Consorcio para el Parque de las Ciencias, Granada, Spain. Vacunas Para Todos. Bicentenario de la Real Expedición. Archived 2020-06-03 at the Wayback Machine
  28. ↑ "Los ángeles custodios Archived 2021-02-08 at the Wayback Machine", on Almudena Arteaga's website.
  29. ↑ "22 ángeles, los niños de ocho años que llevaron la vacuna de la viruela a América", article published on December 12, 2016 in the newspaper ABC (Madrid).
  30. ↑ Placek, Jorge (2019-04-11). "Reseña de "Los niños de la vacuna" de Javier A. Neveo". El viajero accidental (in español). Retrieved 2021-06-26.
  31. ↑ "A flor de piel : la aventura de salvar al mundo". Biblioteca Nacional de España (in español). Retrieved August 20, 2020.
  32. ↑ Filatelia (date of issue: June 24, 2021): "Reconocimiento.- 2021. Operación Balmis y Francisco Javier de Balmis y Berenguer (1753-1819)", retrieved August 5, 2022.

Bibliography

  • Bustos, Jorge. Vidas cipotudas: Momentos estelares del empecinamiento español, La Esfera de los Libros, 2018, 256 pp. ISBN 9788491642336
  • Ludert, Juan Ernesto, Pujol, Flor H., Arbiza, Juan. Human Virology in Latin America: From Biology to Control, Springer, 2017, 474 pp. ISBN 9783319545677
  • Santamarta, Javier. Siempre tuvimos héroes: la impagable aportación de España al humanitarismo, EDAF, 2017, 256 pp. ISBN 9788441438101
  • De Arteaga, Almudena. Ángeles custodios, Penguin Random House España, 2012, 320 pp. ISBN 9788415389613
  • Moro, Javier. A flor de piel, Grupo Planeta, 2015, 489 pp. ISBN 9788432224980.
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