The Cowpox Controversy: Memory and the Politics of Public Health in Cuba
Vaccination played an important role in the formation of a national consciousness in Cuba, and vaccination’s earliest promoters dominate nationalist narratives of medical achievement on the island. This article investigates the intense hostility exhibited by the creole medical elite toward a pivotal figure in the history of smallpox vaccination in Cuba, Spanish physician Dr. Vicente Ferrer (1823–83), the first in the Americas to mass produce smallpox vaccine using calf vaccinifiers. I argue that anger and mistrust of both Ferrer and his innovatory vaccine production technology originated in the relationship between medical politics and cultural identity in late nineteenth-century Cuba. By the late nineteenth century, smallpox vaccination was linked to glorified memories of a Cuban creole-led vaccination program and a disinterested medical profession. Both Ferrer and his private institution for the mass production of “cowpox” became associated with destructive changes in public health, challenging cultural narratives and regional power structures.
cowpox, smallpox, vaccination, Cuba, history
Since the introduction of the smallpox vaccine to Latin America in the early nineteenth century, vaccination has been a symbol of development and effective state outreach.1 In Cuba, mass vaccination played [End Page 110] an important role in health policy and in the formation of a national consciousness even during the colonial period. The history of medicine in Cuba is marked by national icons such as Dr. Tomás Romay y Chacón (1764–1849), an elite creole physician who after receiving the smallpox vaccine in 1804 created the Central Vaccine Board for the production, preservation, and dissemination of vaccine.2 The “most important center for the development of sanitation services in the Caribbean,” the Central Vaccine Board also fostered the creation and maintenance of a professionalized vaccine corps of licensed creole medical practitioners that lasted well into the 1860s.3
A lesser known innovator in Cuban medical historiography is Spanish physician Dr. Vicente Ferrer (1823–83), the first on the island to mass produce smallpox vaccine using calf vaccinifiers.4 Secretary of Cuba’s colonial Health Council and inspector of the vaccine during the turbulent 1860s, Ferrer conducted a whirlwind tour of Europe from February 1867 to March 1868 in search of “legitimate” cowpox vaccine and the skills for mass production of this preservative against the dreaded smallpox. Vaccine applied directly from the calf had some advantages over what was known as “Jennerian” or arm-to-arm vaccination, which consists of the transfer of cowpox vaccine matter from the pustules of one vaccinated person to another. With calf vaccination, physicians hoped to avoid the accidental transmission of syphilis, leprosy, and erysipelas from person to person along human vaccination chains. Popular resistance and the [End Page 111] problems of supply that often resulted could also be more easily overcome; parents would not have to return their children to vaccinators for the sometimes painful extraction of virus, and via the calf vaccine could be produced in much greater quantities. Just a few decades after the introduction of smallpox vaccination on the island in 1804, postvaccinal mortality, infection, and ineffective takes had abetted public resistance to what was often a painful surgical operation; and health officials across the globe had high hopes for the new procedure.5
Emboldened by the triumph of what he perceived as a major scientific advance in preventive medicine, Ferrer temporarily left his post as administrative official and field vaccinator of the colonial public health service to bring the benefits of this technical innovation to Cuban shores. Ferrer’s first stop was Naples, where Dr. Guiseppe Negri had for decades been running an institute based on extraction of vaccine directly from the calf. From Negri’s Institute, Ferrer traveled to France, Belgium, and Spain to visit similar animal vaccine production centers and consult medical experts, eventually bringing two inoculated calves from the port of Cadiz to Havana in the spring of 1868. Just a few months later, on August 27, the secretary’s hopes were realized by royal decree; the Crown granted him permission to establish the “Practical Institute for Animal Vaccine in Cuba and Puerto Rico” as a private institution, at no cost to the state.6 Ferrer’s original plans for the institute were ambitious. He sought not only to create a permanent fount of cowpox vaccine available to both authorities and the public but to build a research center dedicated to the investigation and discussion of animal vaccine. Modeled after research centers he had investigated in Italy, France, and Belgium, the institute would allow professors from the Spanish Antilles to congregate, conduct experimentation, and promote their work in a refuge “all the more necessary for the Americas because of its distance from centers of scientific innovation.”7 The institute was the first of its kind in the Americas, and preceded the establishment of a similar center on the metropolis by four years. In the midst of public health dislocation and the dismantling of smallpox vaccination services, Ferrer was also the first private institute to consistently [End Page 112] offer preventive treatment to the public. By 1872, the former secretary boasted to the Academy of Medicine in Madrid that he had vaccinated over twenty thousand people using the new technique in both city and countryside.8 Although most of these were paying customers who purchased vaccine directly from Ferrer’s institute, donations to public officials kept a steady supply of vaccine flowing in moments of scarcity. The confluence of public and private interest also led the former secretary to publish seminal tracts of public health propaganda in favor of cowpox vaccination. Ferrer dedicated the last years of his life to enhancing the prestige of his institute and technique and was recognized by authorities with the Cross of Isabel la Católica for his service in bringing calf vaccine to the colony.9
Not all contemporaries lauded Ferrer’s accomplishments. Creole medical elites tarnished Ferrer’s image and soured this native European’s victories.10 While conflict over the relative merits of cowpox vaccination was a relatively common feature of preventive health in the 1860s and 1870s, disputes between members of the predominantly creole Royal Academy of Science and Ferrer’s advocates were unusually prolonged and acerbic. Former colleagues, some of whom had struggled with Ferrer against the devastating smallpox epidemics of the late 1860s, turned their backs on his newest project, offering a bitter estimate of his service to the public and profession well after his death.11 Certainly, his projects hit rocky waters as the colonial administration’s shifting and contingent financial situation precluded institutional expansion from a production depot to a Caribbean-wide research center. In this case however, Ferrer’s procedure eventually dominated supply. Despite the acrimonious reception, calf vaccine spread gradually but consistently for decades after its introduction, with calf lymph supplying even Cuba’s Royal Academy by the 1890s.
This article explores the ways in which culturally and politically resonant vaccination technologies inspired resistance to medical innovation. [End Page 113] The historiography of smallpox vaccination and empire offers one lens with which to understand the relationships between medical technology and identity formation in colonial settings. Some of the first critical scholarly perspectives, such as those of David Arnold and Anil Kumar, utilize postcolonial theory to invert traditional representations of vaccination as a beneficent Western medical initiative upon grateful colonial populations.12 They instead portray the procedure, together with those who apply it, as a “tool of empire,” which literally and figuratively marked its resistant subjects with a symbol of invasive state power. More recent historians have addressed problems with the use of the postcolonial lens to investigate vaccination in empire, particularly the tendency to reduce complex professional and cultural identities within dualities of European/indigenous, scientific/traditional, and colonial imposition/resistance. Lauren Minsky, for instance, renewed interest in the technical difficulties of maintaining and transporting fresh lymph over long distances and/or in certain environmental contexts in South Asia, bringing attention to the process of adaptation and indigenization of vaccines by local practitioners.13 Other scholars disentangle the nuanced ideological underpinnings of smallpox vaccination campaigns and their impact upon professionalization in colonial settings. Sanjoy Bhattacharya depicts smallpox vaccination under the Raj as a multilayered complex of institutions rife with intergovernmental conflict over vaccination strategy, technique, and organization.14 In the process, he reveals a rich multitude of players with different agendas and opinions about the proper definition of and approach to the public good in a colonial setting.
Much of the historiography on smallpox vaccination in colonial Latin America focuses on the Crown-sponsored Balmis Expedition, which transported fresh vaccine across Latin America, the Philippines, and China between 1803 and 1810. While this campaign often lent itself to uncritical, heroic narratives, revisionist scholars such as Susana Ramírez Martín and José Rigau Pérez investigate the circumstances behind close [End Page 114] intercolonial collaboration and intraprofessional conflict between licensed creole physicians and Spanish expeditionary members.15 Together with recent literature on the history of science and technology in colonial Latin America, these studies dispel simple dualities of colony and empire, presenting spaces to investigate the complex process of identity formation in the adaptation of medical technologies. In highlighting the shifting allegiances of administrative, professional, and popular actors, recent scholarship also opens analytical avenues to reveal the specific circumstances that led to political radicalization of many creole physicians in colonial Latin America.16
By all accounts, early nineteenth-century institutionalization of smallpox vaccination services in Havana and other outposts throughout the island colony was uniquely successful. Adrián López Denis argues that close collaboration between creole physicians and Spanish colonial administrators grew from the shared economic priority of protecting valuable African slave property and their white, creole masters in Cuban slave society.17 Early triumphs against regular epidemics of smallpox prompted some creole medical elites, notably physician Dr. Tomas Romay, to imagine creole identities shaped by immunity to the “African” contagion of smallpox and “European” susceptibilities to yellow fever. The synergies between a growing, self-consciously creole medical community and Spanish colonial administration did not last long in the context of political repression, war, and structural changes in the economy. By the latter half of the nineteenth century, historians Pedro Pruna and Steven Palmer argue that medicine was a fundamentally creole preserve that drew the ire of colonial administrators for its protonationalism and deep ties to [End Page 115] reformist political movements.18 Though elite creole medical and scientific institutions such as the Royal Academy of Science and the Instituto Histo-bacteriológico y de Vacunación Antirrábica enjoyed official sanction and a privileged position among creole civil associations, their membership and attempts to found sovereign, Cuban sciences in the colony made them suspect in times of political strife.19
In the case of smallpox vaccination, late nineteenth-century administrative reorganizations in the realm of public health created a source of serious conflict between creole physicians and Spanish colonial authorities. Targeted for reform as early as the 1830s, creole institutions dedicated exclusively to smallpox vaccination were subject to complete dissolution from 1868 to 1871. Using Vicente Ferrer’s life and work as lens, this article investigates the professional divestment that soured the creole medical establishment to Spanish colonial initiatives and to Ferrer’s cowpox vaccine technologies. What political and professional motives, in the midst of war, ethnic strife, and professional dislocation, would creole medical elites have for rejecting the introduction of calf-based, smallpox vaccination? How did institutional overhaul challenge colonial understandings of state responsibility? What creole cultural narratives developed with regard to smallpox vaccination, and how were they disaggregated from an early sympathy with Spanish colonial policy?
Origins of the Practical Institute for Animal Vaccine in Cuba and Puerto Rico
Dr. Vicente Ferrer, a native of Madrid and graduate in medicine and surgery from the Royal College of San Carlos, was an ambitious physician in the Spanish naval forces during the 1840s. Immigrating to Cuba in 1857, the young doctor used his contacts and professional acumen to quickly rise through the ranks of the colonial bureaucracy, eventually becoming one of the island’s most prominent sanitary officials. Promoted secretary of the Junta de Sanidad in 1863, he organized the Civil Sanitation Corps for medical inspection of ships at port and passed multiple regulatory frameworks for the maintenance and reform of public health.20 [End Page 116]
Ferrer’s most important work however was in the extension and promotion of smallpox vaccination services across the island of Cuba. Fellow professionals and administrators praised the secretary for his contributions as inspector of the vaccine in Cuba during the turbulent epidemic years of the 1860s, citing his excellent work in the introduction, organization, and supplementation of vaccine stores in the sugar-rich plantation zones of provincial Havana and Matanzas (Figure 1).21 His administrative recommendations helped significantly broaden vaccinators’ reach and power. Traditionally, the service had been targeted toward African slaves and those “enlightened” free persons who voluntarily chose to protect themselves and their children with the procedure. But by the late 1860s, populations deemed epidemiologically dangerous extended well beyond the slave barracones to include the growing urban poor and working classes dedicated to tobacco manufacture in Havana and Matanzas.22 Ferrer pressed for measures that would extend coverage, including the use of compulsion in case of resistance. Vaccination was made obligatory, and vaccinators conducted door-to-door sweeps of neighborhoods where smallpox smoldered. The strategy worked. Ferrer’s key role in extinguishing one of the worst epidemics in the history of this region won him the coveted “Cross of Charity” award in 1866, an honor of service to which very few medical practitioners could aspire.
Despite his success, Ferrer was deeply affected by his experience as a public health official trying to staunch the flames of the island’s recurring smallpox epidemics on the island. The secretary experienced particular frustration with the significant popular resistance to the procedure that accompanied vaccinators throughout their campaigns. Vaccinators struggled against an almost constant scarcity of vaccine, as free parents of all classes resisted bringing their recently vaccinated children to return lymph, an operation “no mother tolerates without repugnance and pain and which the majority resist.”23 Moreover, many despondently encountered the “vociferous protests of the vulgar and uncultured [working class], who don’t believe in the efficacy of the vaccine.”24 Only with the aid of local authorities and the threatening presence of a regular police escort was a truly expansive mass vaccination program possible in many neighborhoods. [End Page 117]
Vaccinators may have blamed popular ignorance for resistance to their preventive imposition, but complaints about degenerated vaccine were not limited to the popular classes. Debate over the relative effectiveness of different smallpox vaccines, in both Europe and the Americas, had a long history. During the 1840s and 1850s, the number of persons who, vaccinated as children, were later confirmed as having contracted smallpox as adults had increased to a notable degree. Physicians in the Academy of Paris began to seriously consider the immunity offered by smallpox vaccine as limited in time and sought scientific consensus on the need for revaccination after a certain number of years to ensure continued protection.25 The failure of lifelong immunity became entangled with doubts about the current vaccine’s potency. Prominent Parisian scientific figures such as the oft-cited Jean-Baptiste Bousquet argued that revaccination was essential not only because of the vaccine’s natural limitations but also because the original material had “degenerated” in its long passage via human transmission and was in need of “rejuvenation” with its protean source.26
Professional and local rejection of a significant pillar of nineteenth-century preventive medicine left an impression on Ferrer, who began to [End Page 118] publicly argue in the 1860s that the problem of vaccine scarcity and public fear would be resolved only with a technical advance in the source and application of vaccine. According to the secretary, the people needed “true cowpox . . . that was always effective” and capable of “dissipating their concerns” with respect to the transmission of disease and the return of children for lymph extraction after vaccination.27 For Ferrer the problem was more than just an ineffective source of prevention, it was systemic. Alongside many other officials associated with the service, Ferrer became convinced that the institutions responsible for vaccination on the island were “dysfunctional” and in need of a serious overhaul. As inspector of the vaccine during the 1860s he submitted a series of impassioned proposals to rationalize the service while maintaining the basic integrity of a vaccination corps funded by state coffers.28 Though many of his recommendations were taken up by royal authorities, Ferrer was deeply disillusioned by an official vaccine service that seemed unable to surmount public apathy and resistance. After his return from Europe he lamented that “the most categorical laws, the most explicit instructions to governors, all sort of pecuniary sacrifice, and the creation of vaccine deposits were not enough to awaken desire for vaccine amongst the vulgar.”29 Ferrer was convinced that whatever measures the government undertook in favor of this service, “they all broke down before public indifference.”30
His disillusionment with public service probably played a role in his desire to create a private institution for the production of vaccine. After all, resistance and apathy could not be overcome without effective lymph. The creation of permanent deposits in the Juntas de Sanidad (by Royal Edict in 1857) had clearly not resolved the issue of either vaccine scarcity or popular anxiety about the material in circulation. By being the first to bring calf vaccination to the colony, Ferrer could work around public health inadequacies and help supply the government with the latest in vaccine technology. He could also enhance his prestige as a scientist and medical professional, all while turning a profit with a service that had always been considered a government obligation and a free public good. Ferrer’s underlying justification for the superiority of both his production method and vaccine was that both came from the same original and “spontaneous” form of cowpox (Figure 2) used by Jenner in the late 1780s. [End Page 119]
Whatever the relative weight of public versus private motivation, Ferrer returned to the island determined to aggressively promote his method and Institute. In 1872, in the midst of much medical controversy over the relative virtues of cowpox versus arm-to-arm vaccination, he published what was to be one of a series of short tracts dedicated to popularizing knowledge about his method. The Propagator of Vaccine: War Against Smallpox, [Written] by a Friend of Children and Dedicated to All Mothers was directed to a wide audience (including the rural population), and can be considered one of very few public health manuals dedicated exclusively to smallpox vaccination on the island. The tract included staged dialogue in response to general queries about vaccination; “does the vaccine revolve the humors, does the vaccine produce smallpox, is it safe to vaccinate during an epidemic?”31 But a great deal of the content was intended to prove the superiority and distinctiveness of Ferrer’s innovation. According to the institute’s genesis story, Ferrer’s cowpox was undiluted by “incessant passage through infinite generations of persons with herpes, syphilis, and [End Page 120] tuberculosis” and was thus a uniquely different substance from the “human” vaccine.32 Not since Jenner’s original extraction of virus (or the discovery of cowpox-ridden calves in Passy, France, in 1836) had the original material been in circulation outside Negri’s Institute in Naples. Ferrer considered it his “mission” to bring this vaccine back to the colony, at his expense, for investigation and distribution.33 Exact replicas of sketches produced by the Academy of Medicine in Paris (Figure 3) dramatically illustrated the differences in virtue between Ferrer’s vaccine (on the left) and its human variant (shown at right).
The Politics of Public Health
Ferrer’s innovation arrived at a tense moment in creole/peninsular relations. From the late 1860s onward, creole hopes that imperial administrators would consider reforms that integrated Cuba into the peninsular system as a “province” rather than a “colony” were repeatedly run aground.34 In October of 1868, small-scale sugar planter Manuel Cespedes launched his “Grito de Yara” in Oriente province, a declaration of independence that inaugurated a vicious ten-year war (1868–78). The violence, and two more bloody wars for independence that followed (1880–83 and 1895–98), shook the colonial structure to its core and exacerbated ethnic and political tensions between creoles and Spanish immigrants looking to preserve their political and economic privileges under the colonial system. Although all the revolutions began and thrived in the economically depressed and demographically distinct Eastern region, in Havana sympathizers formed underground associations to help the rebellious regions. Money, arms, and men flowed to the centers of conflict from both the capital and centers of Cuban exile in the Atlantic world. Numerous cafés of Havana teemed with the whispers of a dissatisfied creole majority, as plans and programs of dissent and even independence were launched [End Page 121] by young educated creoles inspired by the potential for political change in the Atlantic world.35
The large Spanish population and a vacillating Spanish colonial policy exacerbated the atmosphere of rebellion. From 1869 to 1871, armed peninsular militias (the “Volunteers”) patrolled the city and exerted vigilante justice on any intimation of disrespect to either the Crown or Spain.36 These “insolent armed mobs,” as Captain General Domingo Dulces referred to them, composed largely of the peninsular immigrant working class, managed to occupy the capital and oust reformist authorities sent from Madrid to negotiate a settlement.37 Intransigent militias were subsequently reined in by Spanish authorities, and some significant economic and political reforms (particularly concerning freedom of the [End Page 122] press and associational life) were gained in the late 1870s and 1880s.38 However, continuing friction and the onset of hostilities allowed hard-line governors and local militias to periodically take on the mantle of intransigent colonial antireformism.
Havana’s Royal Academy of Science, a bastion of creole medical prestige founded in 1861 and dedicated to the principles of “science, detached observation and experimentation,” was not immune to the peninsular paranoia that followed the first or subsequent wars of independence. Indeed, beginning with the onset of the first war of independence (1868–78), hard-line captain generals periodically railed against a “refractory spirit without due respect to authority” that reigned in the halls of the academy, an attitude they considered suspiciously “alien for individuals pertaining to ‘enlightened’ corporations.”39 Separatists and even many reformist members suspected of sympathies with the rebel cause were harassed, arrested, and/or exiled. Disagreements over scientific problems and/or administrative protocol quickly became political, risking the very integrity of the academy. Particularly from 1868 to 1872 and from 1891 to 1898, the academy teetered on the brink of imperial administrative intervention and/or dissolution.40 After the American intervention of 1898, famed academic Manuel Delfín remembers that the academy halls were “deserted” by members who had been lost to political conflict and an atmosphere of fear. Attendees “did not dare raise their voice, because over our heads dangers hovered and because under this roof we did not feel safe.” Every presentation of work was “measured, every gesture calculated, all thought silenced or enveloped in robes of the finest dissimulation.”41
In times of hardline colonial revanchism, official suspicions were not staunched by either the comparatively mild reformism of most members or the many services the academy rendered to the colonial government. Indeed, the problem was systemic and based on a prejudice against medical practitioners more generally. Among professionals, creoles were disproportionately represented in the medical sphere and physicians were thus particularly suspect for treason during periods of repression. Blocked from obtaining many desirable public and administrative posts by [End Page 123] colonial policies that favored the Spanish-born and economically squeezed by technological and financial transformations in the sugar sector, creoles of the middle and upper-middle classes sent their sons to medical school.42 Indeed, in the University of Havana, a hotbed of creole dissent, the only licensure available to most creoles was in law and medicine; the medical profession offered middle-class creoles the opportunity to reproduce their social status and forged paths of upward mobility for the lower classes. For political as well as socioeconomic reasons, Cuba in 1899 continued to have one of the highest ratios of physicians per person in the world.43
Whether via overt administrative pressures on established creole associations or the closure of “seditious” periodicals, the Spanish state responded to the insurrectionary potential of this medical ethos. During the first war of independence, vigilantes and hard-line governors acted precipitously to quash what they considered to be creole centers of treasonous activity. In one of the most notorious acts of violence, forty-four medical students and a celebrated creole medical professor were arrested by peninsular authorities and collaborating voluntarios on November 25, 1871. Charged by a military tribunal with desecrating the grave of prominent Spanish conservative Gonzalo Castañon, many were sent to prison or deported. Eight (including a sixteen-year-old boy) were executed as traitors to the mother country in an act that outraged creoles, shocked Spanish liberals, and reverberated across the Atlantic world.44
The Royal Academy Responds
Overall, colonial officials were enthusiastic about Ferrer’s project. Ferrer’s promise to use his institute to serve royal authority and “facilitate animal vaccine at whatever hour for all its necessities of service no matter how great” fell upon sympathetic ears during increasingly alarming epidemic outbreaks in both Cuba and Puerto Rico.45 Cuba’s own Junta de Sanidad wanted to make Ferrer a salaried, official inspector of not one but three centers of animal vaccine to be located in Havana, Puerto Principe, and Santiago de Cuba.46 Although government support for such an ambitious [End Page 124] plan of public/private collaboration faltered, by the spring 1872 two more modest centers for the conservation and propagation of animal vaccine were being constructed in Matanzas and Santiago de Cuba.47 Municipal governments across the island clamored to acquire the highly regarded cowpox lymph; free donations of lymph to various public and private corporations across the island continued into the 1890s.
Yet the political resonance of smallpox vaccination in colonial Cuba obstructed mutual understanding between Vicente Ferrer and the creole medical elite of the Royal Academy. Antonio Mestre, creole reformer and one of the most preeminent medical figures in Cuban society, had envisioned the Royal Academy as a “republic of science,” a haven where politics and personal difference had no place.48 Imbued with positivist ideology of scientific certainty, Mestre and other academics believed that the scientific arena had the potential to “bring men together rather than drive them apart,” and utilized the idea of “objective” science as their main defense of a largely creole institution dominated by reformers.49
Of all scientific initiatives capable of fostering fraternity and a sense of shared mission between Spanish and creole, smallpox vaccination was one of the most emotionally charged. Introduced to the island in 1804, vaccination long served as a model of close collaboration between Spanish administrators and creole medical practitioners. Spearheaded by creole medical “high priest” Dr. Tomás Romay y Chacón (1764–1849), the Central Vaccine Board of Havana erected that same year was a center for licensed medical practitioners to formulate scientific standards that would justify a monopoly on a relatively simple surgical procedure.50 Participation in the Vaccine Board created professional platforms and collaborative spaces for aspiring creole public servants to back up their claims of sociopolitical and economic relevance with direct intervention upon a significant percentage of the colonial population. Their social mission, framed as a sacred obligation, was in many ways a “tool of empire,” primarily geared toward augmenting productivity among epidemiologically susceptible slave populations.51 Long after the colonial pact between [End Page 125] creoles and Spanish administrators began to fray in the 1820s and 1830s, the maintenance of this “preferential” service bolstered powerful discourses of imperial paternalism and stymied the articulation of any serious resistance to Spanish policy among creole medical practitioners.52
Between 1868 and 1871 however, the corps was liquidated by the newly installed Liberal government in the metropolis and public health services, including vaccination, were in large part decentralized to the municipalities. Responsibility for vaccination was no longer entrusted to a special corps; all licensed medical personnel could perform the procedure. Preservation of the vaccine lymph devolved to newly constructed charitable associations, the Casas de Socorro, and municipal physicians who were to give the vaccine no more preference than their other obligations. Not only was the colonial pact broken, but a professional trust in a paternal and benevolent state was deeply shaken in the context of violence and war.
Ferrer’s institute served as a potential refuge for professionally disappointed vaccinators to initiate research and spur reforms in the public administration of the vaccine. Yet in a milieu of war and creole/peninsular strife, disillusionment with both Ferrer and the Spanish colonial vaccination reform was reflected in marked hostility toward Ferrer and his innovatory production techniques. The Royal Academy had been running its own vaccination services based on the arm-to-arm method since 1869.53 Headed by former dean of the Central Vaccine Commission Rafael Hondares (who was not a member of the academy) and former vaccinator Tomás Mateo Govantes, the Sub-commission of the Vaccine reserved at least one day a week for free, public vaccination in the academy’s elegant salon. As advisor to the government the academy’s obligations included a review of the scientific merit of medical innovations, and the colonial government requested a report on Ferrer’s institute soon after its installation. The Commission of Public Hygiene coldly acknowledged the royal order authorizing the establishment of the institute and in September 1869 submitted a scathing report against him and the institute.
According to the report, members of the commission were offended by Ferrer’s argument for the superiority of animal vaccine over the current arm-to-arm method. Ferrer’s exaggerated claims about the absolute advantages of animal vaccine regarding transmission of disease (like syphilis), [End Page 126] productive capacity, and preventive potency were interpreted by the commission as a scientific and professional insult to their own vaccination efforts on the island. As asserted in the report, “a vaccinator who fulfills his duty would never draw vaccine unless it was from a healthy child and triumphs over, as they have to this day, resistance to returning lymph.”54 Moreover, Ferrer offered no conclusive evidence about the possibility of animal-to-human transmission of bovine diseases such as tuberculosis and “that the same repugnance [toward vaccination among certain sectors of the public] would be produced with inoculation using a sick animal.”55 Claims about the relative potency of animal vaccine and its lifelong preservation of an individual from a bout with smallpox struck the commission as unsubstantiated and unscientific propaganda.
An overt current of anger toward Ferrer’s professional and pecuniary ambitions ran through the report. The private nature of his endeavor was condemned as impermissible under the regulatory structure of public vaccination on the island.56 Vaccine should be free and tubes of vaccine virus distributed without charge to any solicitor (particularly hacendados). The sale of vaccine to the well-endowed was a threat to public health, for as one academic argued after the report was concluded, “the people always seek and follow the coattails of the rich, and unable to reach it, they will not get vaccinated.”57 What was worse, Ferrer was trying to discredit human vaccine when his professional credentials included a service award for the eradication of epidemics in western Cuba during the early 1860s, campaigns that relied almost exclusively on the arm-to-arm method. Ferrer’s petition was portrayed as a self-interested and hypocritical attack on both human vaccine and Cuban administration of the smallpox preventive, which “with more than 50 years of experience, has plainly justified its good and sound effects; as Sr. Ferrer has himself proved, his brilliant success due to the benefits of the current system.”58
The commission’s conclusion was categorically against the legitimation and institutionalization of animal vaccination on the island. According to the report, Ferrer had not provided sufficient evidence to conclude that animal vaccination enjoyed any advantages over the arm-to-arm method. The new technique should be admitted only for research and comparative study, “taking care that nothing prejudices the application of the current method.”59 [End Page 127] If its superiority is proven scientifically and with rigor, the academy could accept the institutionalization of animal vaccination under Ferrer’s proposed framework, with the exception of its general disposition on the sale of vaccine. This latter clause is “inadmissible, because this would serve as an obstacle to the propagation of vaccine . . . and should be removed so that with more extensive dissemination come more beneficial results [for the population].”60
A heated debate ensued after Govantes read the commission’s report and continued into the late evening, during which a few academics demonstrated more sympathetic opinions of Ferrer’s proposal. Secretary Dr. Antonio Mestre, widely considered an exemplar of scientific objectivity in the academy, admitted that diseases such as syphilis could be transmitted “with the least lack of caution” via the arm-to-arm method and that cases of syphilis transmission “are now numerous enough to draw attention and seek a means of preventing contagion.”61 Mestre agreed with the report in that the relative superiority of animal vaccination had not been resolved scientifically, but asserted that each technique had advantages and disadvantages to take into consideration. In his discussion of contemporary debates in the Academy of Paris, the secretary seemed to favor a moderate approach, whereby “both [human and animal vaccines] are cultivated simultaneously so that the administration of good virus is always assured.”62
Other academics went further. Upon hearing Secretary Mestre play devil’s advocate with the costs and benefits of animal vaccination, Dr. Joaquín Lebredo (a member of the commission) abruptly changed course. Arguing that the report should not have been presented with such a scarcity of data, Lebredo thought that the commission’s conclusion prematurely discarded both the practice and research of animal vaccination, “when in reality animal vaccination should be accepted and established, not as a special comparative study, but as a method which also has established standards of proof and is already applied in enlightened nations.”63 Although he along with other members of the commission insisted that vaccination be free, Lebredo understood that the institute’s vaccination fees “could not be avoided, as it is a private business; just as the public cannot be obligated to refer to this center.”64 [End Page 128]
An addendum to the final government response reflected the impact of these tempered voices. Without accepting Ferrer’s claims concerning the superiority of animal vaccination, the commission conceded that the technique was backed by scientific evidence, as attested by its practical administration in some “enlightened” countries. The academy was therefore “not opposed” to the establishment of the institute as stipulated in the Royal Order.65 However, the academy approved the commission’s original conclusions and qualified this last show of acceptance. President Gutierrez had been alerted that some Ayuntamientos on the island had already requested animal vaccine from the institute. Without evidence to suggest that animal vaccination should substitute the arm-to-arm method, he argued for human vaccination’s preservation. Faced with the threat of both official sanction and public/private partnerships, the addendum asserted that the government “cannot establish such an institute in an official or obligatory manner,” since such a measure would prejudice human vaccine.66 Responding to Ferrer’s messianic exaggeration of animal vaccination’s benefits, the academy seemed to look upon both the institute and the practice of animal vaccination as threats to their professional primacy in any state-led public health initiative against smallpox.
A flurry of heavily edited publications, composed in their majority by second-generation vaccinator and scion of a prominent medical family Dr. Tomás Mateo Govantes and his close colleague Lic. Francisco A. Sauvalle, appeared in the Anales soon after submission of the report. All reaffirmed a binary vision of smallpox vaccination in which animal vaccine in Europe and on the island was framed as a dangerous innovation that was comparatively ineffective and prone to mercenary “trafficking” and monopoly.67 Although a heavy silence eventually enveloped the issue and some exceptions to this position emerged in later years, the academy converted itself into the scientific and practical bastion for the defense of the arm-to-arm method and human vaccine until independence in 1898.68 Many academics became convinced that the reason for government inability to enforce thorough and extensive vaccination was its adherence to animal vaccine. As Dr. Mestre declared during the great smallpox epidemic of 1878, [End Page 129]
The affinity for vaccination in the Academy can be explained not only because of the fear of a bout with smallpox; but because, with the Casas de Socorro unable to rely on anything more than calf vaccine ministered by [Ferrer’s] Instituto, many physicians preferred the arm-to-arm method vaccine and counseled in favor of this in the heart of families and amongst clientele.69
The Science of Rejection
As Cuban historian of medicine Pedro Pruna argues, academic skepticism of calf vaccination did not necessarily demonstrate a retrograde attitude toward a hygienically and scientifically superior process.70 Even as cowpox vaccine became established throughout Western Europe in the late 1860s and early 1870s, problems with successful “takes” led some corporations to rely at least partially on the arm-to-arm method for the duration of the nineteenth century. In Madrid, consolidation of a state-sponsored vaccine institute that would centralize a scattered and inefficient public health infrastructure was hampered by the quality and quantity of cowpox vaccine. In late 1870s Paris, Brussels, and Madrid, even fervent supporters of the superiority of cowpox began to consider it prudent to conserve both methods simultaneously to ensure the flow of good vaccine.71
Yet the academy’s reaction went above and beyond a response based on empirical detachment and objectivity, articulated as a complete repudiation of a technique with scientifically authenticated benefits (particularly as regards vaccine supply and assurance against disease transmission). Such an acerbic response is surprising considering the generally positive opinion of cowpox among the medical establishment prior to Ferrer’s project. From patrician vaccinator Tomás Romay onward, vaccinators and laymen alike had conducted recurrent searches for a spontaneous outbreak of cowpox on Cuban soil.72 In both the Cuban medical press and [End Page 130] the Anales, various historical and scientific pieces on vaccination praised efforts to “rejuvenate” the vaccine by taking it directly from the cow, its original source.73 Interest in rejuvenation dovetailed with excitement over veterinary medicine’s potential contributions to the control of anthrax, rabies, sarna, and typhus as well as smallpox. Such interest increased exponentially with the late nineteenth-century bacteriological revolution. Pasteurian methods of serum and vaccine production, which relied heavily upon animal experimentation, offered creole medical reformers hope of developing preventive technologies for tropical climates deemed insalubrious for European civilization.74 Clearly, the rejection of Ferrer’s cowpox did not rest upon precedent or a lack of enthusiasm for the incorporation of veterinary medicine in prevention efforts, but was a political attack upon him and the colonial administration that embraced his initiative.
In an atmosphere of militarism and creole/peninsular conflict, personal and political prejudice against a colonial administrator of the defunct Vaccine Corps tarnished the image of his institute and the cowpox. A naval physician who moved up the ladder to become a high-ranking civil health administrator on the island, Ferrer represented in his very person the professional exclusion of creoles in the realm of military and civil public health. The trans-imperial circulation of peninsular military physicians such as Ferrer filled a growing need as colonial administration embraced regions and populations outside Havana and Santiago.75 Peninsular physicians used their posts on the island as stepping stones in their professional peregrinations or as permanent footholds for the establishment of private practices and/or work in charitable and civil health organizations. Even as their numbers increased, Spanish authorities systematically excluded creole physicians from most administrative opportunities in this trans-imperial [End Page 131] medical circuit and “were always concerned about the risk of Creole doctors organizing independent health structures.”76
As inspector of the vaccine, Ferrer’s intraprofessional conflicts with creole academic vaccinator and former dean of the Vaccine Corps Rafael Hondares damaged his chances at compromise with the creole medical elite. During his tenure as secretary of the Junta de Sanidad and inspector of the vaccine (1863–68), Ferrer had openly clashed with the longtime vaccinator and dean over his inadequate professional credentials, calling him a “simple surgeon” who “should never have taken on such a public responsibility.”77 The dean’s post, with its comparatively generous salary, was subsequently eliminated in proposals for rationalization of the service based upon merit, since the officeholder “enjoys the highest salary and has the least work.”78 Making matters worse, Ferrer’s critiques of the vaccine in currency on the island intensely annoyed Hondares and offended his cultural sensibilities. The dean bristled at repeated calls for importation of cowpox vaccine from Europe and North America, considering them a professional condemnation of the corps and a waste of resources. Hondares and a team of vaccinators had already, according to a few accounts, managed to find cowpox among domestic cattle and successfully “replenished” the preventative some years prior. The extant vaccine became the object of regional pride that would be tarnished through importation of “foreign” elements, for “if ours is good and of proven efficacy in critical circumstances, why substitute it with another of foreign origin, whose virtues are in doubt.” According to the indignant dean, the virus in circulation “is originally of the cow and I have had the Glory of having obtained it on our own soil.”79
It was however Ferrer’s legacy as a reformer that most impacted the reception of his innovation among creole academics. As inspector of the vaccine, Ferrer railed against all that was “anomalous, irregular and dysfunctional with respect to the service such as the distribution of personnel and their income scales” and attempted to institute reforms in a detailed proposal submitted to Havana’s Superior Junta in 1866. The inspector’s proposal had not been radical in content or intended to dismantle the Central Vaccine Corps. Ferrer’s suggestions, including the distribution of equitable salaries and merit-based promotion, were intended to [End Page 132] rationalize the vaccination service and extend its effective power during epidemics. However, the close concurrence between Ferrer’s critique and the destruction of a Central Vaccine Corps widely perceived as “dysfunctional” and inefficient sealed his association with professional divestment. Hondares and other former vaccinators quickly associated him with the destruction of both their professional livelihoods and the public health. Acting representative of the academy’s Vaccine Subcommittee, Hondares helped author the report condemning Ferrer’s institute. He subsequently became cowpox vaccination’s most acerbic critic.80
Although other academics demonstrated more moderation in their views of Ferrer and his institute, a strong association between the institutionalization of cowpox vaccination and the destruction of public health infrastructure became generalized throughout the academy. The seven Casas de Socorro, which combined public health services such as vaccination with charitable relief, were particularly targeted for censure. Accusations that the newly installed casas relied solely on (ineffective) cowpox vaccine and actively suppressed press announcements of Jennerian vaccination appeared in the Anales shortly after the academy’s censure of Ferrer’s institute.81 The initial scarcity of public concurrence for vaccination in the casas and the publication of information on unsuccessful “takes” among the few who did get treated in these establishments only added fuel to the fire.82 Antonio Mestre, widely considered a voice of disinterest and reason in the academy, found it “lamentable that the foundation of these Casas came just two months after vaccine service . . . was suppressed,” as this prejudiced many against what should have been a progressive development in public health.83 Yet even Mestre came to believe that these institutions had disgraced their own reputation by suppressing Jenner’s vaccine and the extinguished commission, an aggression that amounted to “a neglect of science and humanity.”84
As cowpox became directly associated with destructive changes in public health, arm-to-arm vaccination was linked to a disinterested medical profession and glorified memories of a formerly effective vaccination [End Page 133] program staffed and led by creoles. During the particularly fierce smallpox epidemic of 1871, Hondares could proudly declare to the academy that thirteen vaccinators associated with the recently extinguished commission decided “not to abandon such an important institution” and continued their service “with the same zeal, interest and efficacy as in previous eras when such important work was remunerated.”85 More than fifteen years later in 1886, Hondares’s successor Tomás Mateo Govantes was lauded for his contribution to the same effort “at the same moment that the service was being dismantled in favor of the Casas de Socorro and protection of the cowpox.”86 Just as the commission had successfully extinguished epidemics in the past, these vaccinators would work to counterbalance a clearly inadequate system of preventive health provision.
Their “humanitarian” professionalism, contrasted implicitly with Ferrer’s rude pecuniary ambition, was defined not only by their charitable preservation of the old organization, but by the preventive technique they utilized. According to Dr. Tomás Mateo Govantes, vaccinator of the old commission and Hondares’s successor in the academy, comparison between the two systems demonstrated that “much more benefit is observed for humanity if vaccinators, without any other interest than that inspired by [the public health], devote themselves exclusively to propagating Jenner’s vaccine.”87 Their steadfast sense of duty not only multiplied vaccination sites in times of epidemic, but “averted the disappearance of the richest source of prophylaxis against smallpox.”88 The academy, whose responsibility it was to watch over “the application and disinterest of the professional practice of medicine,” subsequently rewarded the old corps with an official and unanimous vote of thanks.89
Academics’ reaction is testimony to the powerful effect of vaccination on the formation of a localized medical ethic among medical professionals. Academics did not feel the need to justify their arguments with references to late Enlightenment interpretations of the physicians’ “politic ethics” that bound the medical scientist to the betterment of society and state and had formed the intellectual foundation of the vaccination project.90 Nor did they cite influential medical ethicists such as John Gregory [End Page 134] (1724–73) or Thomas Percival (1740–1804) on the fiduciary responsibilities that linked medical professionals to a disinterested service on behalf of their patients and were models for later deontological prescriptions.91 Even as these philosophical predecessors certainly informed their broader professional consciousness, over sixty years of free vaccine provision for the wider population seemed precedent enough. The service had become idealized as the ultimate demonstration of governmental beneficence and support for its subjects. Creole vaccinators, in turn, represented exemplars of the kind of moral authority that validated professional distinction and countered age-old negative stereotypes against licensed physicians.
Ferrer never directly responded to charges of professional and scientific negligence in either the popular or medical press. If anything, he was sincerely pleased “for both the country and common sense” that the two periodicals that had published critiques against him had subsequently shut down.92 However, the controversy spread widely enough that he felt the need to address it in his popular health manual, El Propagador de la Vacuna, in 1872. Directed to a wide audience (including the rural population), the manual steadfastly defended both Ferrer and his method against detractors. The issue was largely posed as one of professional self-interest and human nature. Vaccinators were waging “a ferocious war” against him because “no one loves a physician less than another physician.”93 Just as early inoculators of smallpox resisted Jennerian vaccination as a scientific advance, vaccinators feared losing trust in a well-known procedure and (it was implied) their professional niche. To some degree, his opponents’ motives transcended professional interests, as “it was the law of human nature to doubt and negate all that is unknown.”94 Ferrer’s institute was portrayed as just the latest scientific advance to suffer from defamation due to ignorance and fear. Ferrer dismissed attacks on his own economic interests and neglected to discuss the public health implications of a reorganized vaccination routine. As director of the institute, his only interest was to rescue the reputation of cowpox from what he believed was a very public libel. [End Page 135]
Public health officials charged with public vaccination, however, could not afford to wax poetic about human nature when confronted with accusations of imperial maladministration. In the midst of a devastating Ten Years’ War for independence (1868–78), a tense political atmosphere compelled many colonial officials to address public complaints. Inspector of the vaccine and member of the Ayuntamiento Dr. Vicente Hernández approached secretary of the academy Antonio Mestre personally in the spring of 1871 to clear up what proved to be the first wave of resistance to official management of vaccination. Hernández was well aware that physicians accused him “of working to destroy the beautiful edifice that our greatest men had built for the vaccine; taking the jobs of public health workers, [and] giving preference to calf vaccine, without the foundation or sanction of science.”95 He admitted that the slow installation of the casas (which at time numbered only two) had resulted in few new jobs for physicians and that public concurrence was still scarce.96
But Hernández vociferously denied accusations that these institutions were trying to monopolize vaccination. On the contrary, the inspector believed that the procedure “could and should be performed by any medical doctor [and] loudly protested” against rumors that he suppressed publication of vaccinations outside the Casas de Socorro.97 Hernández passionately disavowed any discrimination against Jenner’s method, asserting “has always been completely convinced of the prophylactic efficacy of Jenner’s vaccine; but not being of an exclusionary opinion, believed that calf vaccine has offered and continues to offer services that should not be underestimated.”98 Although for reasons of supply calf vaccine predominated in these casas, Hernández assured the academy that the human variant was not excluded and requested that the academy “prove a true disinterest and love of humanity” by remitting some human lymph to further its propagation.99
Mestre, true to his reputation as impartial arbiter, warmed to the arguments of Dr. Hernández. Although Mestre clearly preferred the arm-to-arm method, he recognized that the inspector was a “zealous functionary who above all wanted to obtain good and abundant material.”100 He even conceded that cowpox vaccine could offer good results under certain [End Page 136] conditions. A few academics were even more constructive in their handling of the controversy. Famed statistician Dr. Ambrosio González Del Valle, together with veteran vaccinators Rafael Hondares and Tomás Mateo Govantes, drafted a proposal for the service that restored a shadow of the old corps infrastructure. The obligations of municipal physicians, local authorities, and regular police toward vaccination were carefully delineated and codified. Public practitioners were granted space for the exchange of ideas in monthly meetings “endeavoring always to focus their studies on the preservative pustule and the means for its conservation, so as to make this resource inexhaustible.”101 Although reliance on human lymph is implied throughout the text and directly regulated in some of the statutes, the issue of cowpox vaccine was at least formally disaggregated from institutional reform in that no specific preventative variety was explicitly cited as preferable.
However, this moment of understanding and compromise between the academy and official vaccinators was relatively short-lived. Similar pro-academy challenges to the colonial administration of vaccination on the island soon resurfaced in the medical and popular press. During the particularly deadly smallpox epidemic in the winter of 1878, the Ayuntamiento of Havana published an invitation to public vaccination in the Casas de Socorro, all of which were freshly supplied with lymph from both England and Ferrer’s institute. A few weeks later, an anonymous article appeared in the Crónica Médica Quirúrgica de la Habana, accusing the ayuntamientos of public health maladministration during times of crisis. Official solicitation of virus from other corporations, domestic and foreign, was proof that vaccine stocks were empty in the casas. Failure to maintain a steady supply of virus had furthermore “forced a great movement of persons to the Royal Academy in search of vaccination; thanks to which we [Cubans] do not find ourselves completely deprived of virus.”102 Seven years after the permanent dissolution of the Central Vaccine Board, the use of cowpox as vaccine material remained intimately interlaced with concerns about colonial administration of vaccination. Faced with a dire public health situation, the provincial government had failed to adopt practical measures “in harmony with the precepts of sanitary science,” such as the creation of isolation houses for the sick, house calls in stricken neighborhoods, and police intervention in cases of resistance to [End Page 137] obligatory vaccination.103 The Ayuntamiento had also fallen victim to the “whim of fashion” in their adherence to what many physicians, domestic and foreign, considered the comparatively ineffective (and even dangerous) cowpox vaccine.104
The government’s response was swift. Inspector of the vaccine Dr. D. José Argumosa would not be as considerate as his predecessor in addressing accusations of administrative shortcomings. Argumosa blasted the anonymous pamphleteer for trying to diminish the prestige of the only municipal medical service in Havana. According to the Inspector, the municipality had procured abundant material for the fourteen vaccinators in the casas, spread ample propaganda to stir public opinion, quickly opened a new isolation house for the sick and gotten the police involved in enforcing vaccination. The municipality’s only “crime” had been its adherence to the highest public health authorities’ counsel.105 Doubts raised by the government’s handling of the crisis and the integrity of available vaccine material had the potential to compromise public health outreach; already the inspector noted a flurry of publications for popular remedies “very discordant with the precepts of sanitation.”106
As for the use of calf vaccine, Argumosa unapologetically announced that, although he believed both vaccines to be effective, he personally preferred the cowpox and sarcastically lamented that eminent doctors on the island could not reach agreement with the many “foreign and civilized nations which continue to rely on this method.”107 The inspector furthermore considered vaccine from Ferrer’s institute as good as the foreign supplies and was pleased that upon official request, “the distinguished Director provided it [vaccine] in abundance and gratis.”108 While he praised the academy’s disinterest and zeal, he thought the pamphleteer’s efforts unnecessarily divisive. It was not necessary to degrade the efforts of others “in order to make [the academy’s work] shine more brightly.”109 The academy was just one of many institutions and private individuals providing vaccine service; physicians tied to such institutions had an obligation to “mutually help and promote one another to serve the common good.”110 [End Page 138]
After almost ten years of colonial militarization and ethnic polarization in the midst of war, the local situation did not offer propitious ground for public criticism of what was now a mature municipal public health service. The pamphleteer, who eventually revealed himself as academic Dr. Eduardo F. Pla, consequently rescinded much of his original critique against state ineptitude when confronted by the inspector and the vociferous protests of the loyalist press. With somewhat exaggerated airs, Pla announced that he was “deeply affected that the Inspector had wanted to interpret his refutation as an offense against respectable institutions and a censure of his public works” when this had not been the intention.111 Much to the inspector’s satisfaction, the rest of their interchange (and Pla’s critique) would be limited “only to opinions regarding the use of calf and human vaccination.”112 Amid the language of high science and a polite exchange of articles, political critique became subsumed and at least superficially disaggregated from the controversy over the virtues of cowpox vaccination.
The cowpox controversy contributes to our understanding of the political, social, and cultural bases of scientific method and belief systems. By the late 1860s, smallpox vaccination had become an integral part of Cuban medical identity and political ethic. It was the institutional, moral, and cultural bedrock of creole medical professionals in a context of broadening state responsibility for the public good. Although the arm-to-arm method had been globally dominant during the first sixty years of smallpox vaccination, there was no inherent revulsion to cowpox or the use of calves as vaccinifiers (or “rejuvenators” of the human variant) until the introduction of this technique coincided and clashed with the dismemberment of the old Vaccine Corps.
The “dark shadow” of public dislocation and private interest haunted public administration of the cowpox for decades. Only in 1894 could the secretary Luis Montane publicly state that rumors about calf vaccine’s defects were absolutely unsubstantiated.113 Political dissent against the cowpox and all it symbolized had emerged and flourished under the guise of scientific controversy. Resistance to calf vaccine may have been [End Page 139] tempered and almost entirely dissolved by the early 1890s, but until independence in 1898 (and even as the Royal Academy relied on vaccine from two institutes dedicated to the production of calf lymph), cowpox remained associated with imperial neglect and the dislocation of both public health workers and their public.
Ferrer’s scientific and professional legacy was another casualty of conflict. While Ferrer and his son, who inherited his institute after his death in 1883, briefly appear in a few historical works about the vaccine, his impact upon preventive medicine in Cuban history remains largely unrecognized. Intraprofessional conflict combined with anticolonialism to create a caustic mix for the European immigrant who first mass produced smallpox vaccine on Cuban shores. In nationalist narratives of medical progress, Ferrer disappeared into the dustbin of Spanish scientific backwardness and colonial penury. [End Page 140]
Stephanie H. Gonzalez is an assistant professor of history in the Department of Liberal Arts and Sciences at the St. Louis College of Pharmacy. Her research interests include the history of politics and public health initiatives in Latin America. She is currently preparing a book for publication on the history of smallpox vaccination and its role in Cuban identity formation. She lives in St. Louis, Missouri.
The international research necessary for this work could not have been initiated without the generous funding provided by the MAGNET fellowship in the City University of New York. For their tireless research assistance, I would like to thank the archivists at the Archivo Nacional de Cuba and the Biblioteca Nacional “José Martí” in Havana, the Archivo Histórico Nacional and the Biblioteca de la Real Academia Nacional de Medicina in Madrid, and the New York Academy of Medicine. I would also like to thank my advisors, Dr. Herman Bennett and the late Dr. Alfonso Quiroz, for their readings and insight on early versions of this article. Helpful suggestions and commentary by Dr. Dennis Doyle and the several anonymous reviewers and editors at the Bulletin were also critical to the improvement of the final drafts.
1. In 1796, the English physician Edward Jenner conducted and published experiments confirming that inoculation with material from cattle infected with cowpox (the more benign bovine virus related to smallpox) provided an effective protection against smallpox and could be used as a preventive. Sanjoy Bhattacharya and Niels Brimnes, “Introduction: Simultaneously Global and Local: Reassessing Smallpox Vaccination and Its Spread, 1789–1900,” Bull. Hist. Med. 83, no. 1 (Spring 2009): 1–16, quotation on 3–5.
2. Romay’s place in Cuban medical history was engraved by numerous nineteenth-century histories of the vaccine, and he appears prominently in the memoirs of elite Cuban physicians Antonio Mestre, Ramón Zambrana, and Nicolás Gutiérrez. In the twentieth century, medical historian José López Sánchez emerged as Romay’s most prolific biographer, compiling all of Tomás Romay’s work in Obras Completas (Havana: José Maceo ECAG, 1965–66) and writing a definitive biography translated into English by Mary Todd Haessler as Tomás Romay and the Origin of Science in Cuba (Havana: Ensayo Book Institute, 1967). See also César Rodríguez Expósito, Bicentenario de Tomás Romay (Havana: Consejo Científica, Ministerio de Salud Pública, 1964). In 1964, Romay’s remains were transferred to a mausoleum erected in his honor at the Carlos J. Finlay Historical Museum of Medical Sciences.
3. Susana María Ramírez Martín, La mayor hazaña médica de la colonia: La Real Expedición Filantrópica de la Vacuna en la Real Audiencia de Quito (Quito: Abya-Yala, 1999), 447.
4. A notable exception is the short article on Ferrer’s public propaganda by José Antonio López Espinosa, “El doctor Vicente Luis Ferrer y la revista El Propagador de la Vacuna,” Cuban J. Health Info. Professional Commun. 12, no. 1 (2004), http://bvs.sld.cu/revistas/aci/vol12_1_04/aci08104.htm (accessed May 1, 2014).
5. Donald Hopkins, Princes and Peasants: Smallpox in History (Chicago: University of Chicago Press, 1983), 88–89; and Sanjoy Bhattacharya, Mark Harrison, and Michael Worboys, Fractured States: Smallpox, Public Health and Vaccination Policy in British India, 1800–1947 (New Delhi: Orient Longman, 2005), 38–47.
6. “Solicitud: Creación del Instituto Práctico de Vacunación de Cuba y Puerto Rico,” August 27, 1868, Ministerio de Ultramar, no. 4711, file 20, Archivo Histórico Nacional, Madrid, Spain (hereafter AHN).
7. “Solicitud: Creación del Instituto Práctico de Vacunación de Cuba y Puerto Rico,” December 6, 1867, Ministerio de Ultramar, no. 4711, file 20, AHN.
8. Vicente Luis Ferrer, “Memoria presentada a la Real Academia de Medicina de Madrid,” February 14, 1872, file 124, doc. 5791, Biblioteca de la Real Academia Nacional de Medicina, Madrid, Spain.
9. “Concesión de la Gran Cruz de Isabel la Católica a Vicente Luis Ferrer,” August 29, 1876, Ministerio de Ultramar, no. 4725, file 22, AHN.
10. The term “creole” here refers to Cuban-born persons of any race, though creoles of African descent were prohibited from acquiring a degree in either surgery or internal medicine from the University of Havana through “purity of blood” entrance requirements. The creole licensed medical population of Cuba was therefore overwhelmingly of European descent.
11. “Informe respecto al Instituto de Vacunación Animal,” Anales de la Real Academia 22 (1885): 193.
12. See David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: University of California Press, 1993); Anil Kumar, Medicine and the Raj: British Medical Policy, 1835–1911 (New Delhi: Sage, 1998); Deepak Kumar, “Unequal Contenders, Uneven Ground: Medical Encounters in British India, 1820–1920,” in Western Medicine as Contested Knowledge, ed. Andrew Cunningham and Bridie Andrews (Manchester: Manchester University Press, 1997), 172–211. For a more recent treatment in the case of Cuba, see Adrián López Denis, “Disease and Society in Colonial Cuba, 1790–1840” (Ph.D. diss., University of California, Los Angeles, 2007), 110–47.
13. Lauren Minsky, “Pursuing Protection from Disease: The Making of Smallpox Prophylactic Practice in Colonial Punjab,” Bull. Hist. Med. 83, no. 1 (Spring 2009): 163–89.
14. Bhattacharya, Harrison, and Worboys, Fractured States (n. 5), 14–75.
15. Ramírez Martín, La mayor hazaña médica de la colonia (n. 3); José G. Rigau Pérez, “The Introduction of Smallpox Vaccine in 1803 and the Adoption of Immunization as a Government Function in Puerto Rico,” Hisp. Amer. Hist. Rev. 69, no. 3 (August 1989): 393–423. Excellent examples of the selective appropriation of global medical vaccine technologies to suit local agendas and meet local needs can also be found in Angela T. Thompson, “To Save the Children: Inoculation, Vaccination, and Public Health in Guanajuato, Mexico, 1797–1840,” Americas 49, no. 4 (April 1993): 431–55.
16. Recent examples of this historiographical trend in the history of science and medicine in Latin America include Antonio Lafuente, “Enlightenment in an Imperial Context: Local Science in the Late Eighteenth Century Hispanic World,” Osiris 15, no. 1 (2001): 155–73 and Luis Carlos Arboleya, “La ciencia y el ideal de ascenso social de los criollos en el Virreinato de Nueva Granada,” in Ciencia, técnica y estado en la España ilustrada, ed. Joaquín Fernández Pérez and Ignacio González Tascón (Madrid: Ministerio de Educación y Ciencia, 1990), 193–225.
17. Adrián López Denis, “Communities of Immunity in the Iberian Atlantic World” (paper, International Seminar on the History of the Atlantic World, 1500–1825, Cambridge, Mass., August 6, 2009).
18. Pedro M. Pruna, “National Science in a Colonial Context: The Royal Academy of Sciences of Havana, 1861–1898,” Isis 85, no. 3 (September 1994): 412–26; and Steven Palmer, “From the Plantation to the Academy: Slavery and the Production of Cuban Medicine in the Nineteenth Century,” in Health and Medicine in the Circum-Caribbean, 1800–1968, ed. Steven Palmer, Juanita de Barros, and David Wright (London: Routledge, 2009), 53–75.
19. Pedro M. Pruna, La Real Academia de Ciencias de La Habana (Madrid: Consejo Superior de Investigaciones Científicas, 2004), 204–12, 292–313.
20. López Espinosa, “El doctor Vicente Luis Ferrer” (n. 4).
21. Manuel Zambrana, Memoria de los trabajos de la comisión sanitaria de Pueblo Nuevo (Matanzas: Imprenta El Ferrocarril, 1867), 12.
22. An excellent analysis of the growth and political activism of the nineteenth-century working class can be found in Joan Casanovas’s Bread and Bullets! Urban Labor and Spanish Colonialism in Cuba, 1850 to 1898 (Pittsburgh: University of Pittsburgh Press, 1998).
23. Ferrer, “Memoria presentada” (n. 8).
24. Zambrana, Memoria (n. 21), 12–13.
25. “Vacuna,” Repertorio Médico-Habanero y Boletín Científico 2, no. 4 (December 1843): 110–11; and Jean-Baptiste Bousquet, “Vacuna: Diversos modos de considerarla,” Repertorio Médico-Habanero y Boletín Científico 2, no. 6 (January 1844): 160–68.
26. Jean-Baptiste Bousquet, “De la inoculación de virus vacuno en la vaca, y de los efectos de esta inoculación sobre la vacuna” Repertorio Médico-Habanero y Boletín Científico 2, no. 10 (March 1844): 255–60.
27. “Al Capitán General,” October 25, 1866, Junta de Sanidad, Havana, no. 19, file 52, Archivo Nacional de Cuba, Havana (hereafter AN).
28. “Secretario a la Excmo Junta Superior de Sanidad,” December 18, 1866, Junta de Sanidad, Havana, no. 19, file 52, AN.
29. Ferrer, “Memoria presentada” (n. 8).
31. Vicente Luis Ferrer, El Propagador de la Vacuna: Guerra contra la viruela por un amigo de los niños quien dedica este trabajo a todas las madres (Havana: [s.n.], 1872), 14–16.
32. Ibid., 27.
33. Most of Ferrer’s nineteenth-century contemporaries never doubted the cowpox origins of either “degenerated, human” vaccine or Negri’s calf variant. Revisionist historians of smallpox vaccination, however, have detailed the existence of a multiplicity of “Jennerian” vaccines in circulation during the nineteenth and early twentieth centuries, including horsepox and attenuated smallpox. Whatever their origin, over time local experimentation with production and application of lymph usually created vaccines that were unique to the region. See Bhattacharya and Brimnes, “Introduction” (n. 1), 3–5.
34. From 1837 onward, Cuba and Puerto Rico were governed by “special laws” that granted special economic and political privileges to the Spanish-born peninsulares. For reformist arguments against these colonial laws, see Eliseo Giberga’s Apuntes sobre la cuestión de Cuba por un autonomista (Miami: Editorial Cubana, 2006).
35. Dick Cluster and Rafael Hernández, History of Havana (New York: Palgrave Macmillan, 2008), 85.
36. Ibid., 87–89.
37. Pruna Goodgall, La Real Academia (n. 19), 197.
38. See Alfonso W. Quiroz, “Orígenes de la sociedad civil en Cuba: La Habana y Puerto Príncipe en el siglo XIX,” Ibero-Americana Pragensia-Supplementum 18 (2006): 89–112. For its relationship to political reformism and the growth of the working class, see Mildred de la Torre, El autonomismo en Cuba, 1878–1898 (La Habana: Editorial de Ciencias Sociales, 1997).
39. Pruna Goodgall, La Real Academia (n. 19), 209.
40. Ibid., 204–12, 292–313.
41. Manuel Delfín, “Sesión solemne del 19 de Mayo de 1899,” Anales de la Real Academia 37 (1900): 13–14.
42. Reinaldo Funes Monzote, El despertar del asociacionalismo científico en Cuba (1876–1920) (Madrid: Consejo Superior de Investigaciones Científicas, 2004).
43. Ibid., 55.
44. Pruna Goodgall, La Real Academia (n. 19), 211; and Cluster and Hernández, History of Havana (n. 35), 89–94.
45. “Solicitud; Creación del Instituto Práctico de Vacunación de Cuba y Puerto Rico,” December 1867, Ministerio de Ultramar, no. 4711, file 20, AHN.
46. “Solicitud; Creación del Instituto Práctico de Vacunación de Cuba y Puerto Rico,” May 14, 1868, Ministerio de Ultramar, no. 4711, file 20, AHN.
47. Ferrer, El Propagador (n. 31), 45.
48. Pedro M. Pruna and Rosa María González, Antonio Mestre en la cultura científica cubana del siglo XIX (Havana: Editorial Academia, 1987).
49. “La vacuna en las Casas de Socorro,” Anales de la Real Academia 7 (March 1871): 551.
50. Stephanie Gonzalez, “The Double-Edged Sword: Smallpox Vaccination and the Politics of Public Health in Cuba” (Ph.D. diss.: Graduate Center, City University of New York, 2014), 49–59.
51. López Denis, “Disease and Society” (n. 12), 110–47. See also Palmer, “From the Plantation to the Academy” (n. 18), 56–83.
52. In the case of smallpox vaccination, Cuban/Spanish collaboration was unusually successful. For an amusing portrait of the more common experience of conflict between Balmis and the creole medical elite, see Rigau Pérez, “The Introduction of Smallpox Vaccine” (n. 15).
53. Pedro M. Pruna Goodgall, Ciencia y científicos en Cuba colonial: La Real Academia de Ciencias de la Habana, 1861–1898 (Havana: Editorial Academia, 2001), 141.
54. “Higiene pública; Vacunación animal,” Anales de la Real Academia 7 (October 1870): 205–15, quotation on 206.
55. Ibid., 206.
56. Ibid., 208.
57. Ibid., 214.
58. Ibid., 207.
59. Ibid., 207, emphasis original.
60. Ibid., 208.
61. Ibid., 212.
62. Ibid., 213.
63. Ibid., 213.
64. Ibid., 211.
65. Ibid., 215.
66. Ibid., 214.
67. See, for example, Francisco A. Sauvalle, “Revista científica: Vacuna animal o de ternera,” Anales de la Real Academia 7 (November 1870): 324–28; Rafael Hondares, “Vacuna de brazo,” Anales de la Real Academia 7 (December 1870): 426–27; and Tomás Mateo Govantes, “Vacuna animal: Estudio comparativo,” Anales de la Real Academia 7 (December 1870): 428–31.
68. Pruna Goodgall, La Real Academia (n. 19), 350–55.
69. “Estado sanitario: Viruela,” Anales de la Real Academia 14 (June 1877): 533.
70. Pruna Goodgall, La Real Academia (n. 19), 350.
71. Ricardo Campos Marín, “El difícil proceso de creación del Instituto de Vacunación del Estado, 1871–1877,” Asclepio 56, no. 1 (2004): 79–109; and “La vacunación antivariólica en Madrid en el último tercio del siglo XIX: Entre el especialismo médico y el mercantilismo,” Medicina y Historia 4, no. 4 (2001): 2–15.
72. Romay’s earliest efforts to obtain spontaneous cowpox in Cuban rural areas later achieved epic status as a demonstration of great personal sacrifice. See, for example, Domitila García de Coronado, A la humanitaria Sociedad de Recreo y Beneficiencia el Centro Gallego al propagar la vacuna gratuitamente al pueblo en 1887, dedica estos breves apuntes históricos del ilustre Cuba Dr. y maestro, D. Tomás Romay y Chacón, a quien debe Cuba este beneficio eterno (Havana: Imprenta de Howson y Heinen, 1888), 17.
73. Tomás Mateo Govantes, “Higiene: Memoria,” Anales de la Real Academia 1 (April 1865): 384–90; Bousquet, “De la inoculación” (n. 26), 259; and Juan G. Hava, “Breves consideraciones sobre la vacuna en la isla de Cuba,” Anales de la Real Academia 3 (April 1867): 433–38.
74. “Medicina veterinaria,” Anales de la Real Academia 7 (February 1871): 543–45. For the case of rabies, see Nancy Díaz-Arguelles García, “Breve bosquejo histórico del Laboratorio Histobacteriológico e Instituto de Vacunación Antirrábica de La Habana,” Anuario: Centro de Estudios de la Historia y Organización de la Ciencia 1 (1998): 170–99.
75. Francisco Javier Martínez Antonio, “Public Health and Empire in Isabellin Spain (1833–68): The Case of Military Health,” História, Ciências, Saúde-Manguinhos 13, no. 2 (2006): 139–73; and “Lost in Colonialism: La Sanidad Española en Cuba Antes y Después de la Guerra de los Diez Años,” Scripta Nova 16, no. 418 (November 2012), http://www.ub.edu/geocrit/sn/sn-418/sn-418–20.htm.
76. Martínez Antonio, “Public Health and Empire” (n. 75), 157.
77. “Del Secretario a la Excmo Junta Superior de Sanidad,” December 18, 1866, Junta de Sanidad, Havana, no. 19, file 52, AN.
79. “El Decanato de la Comisión Central de la Vacuna,” September 19, 1867, Junta de Sanidad, Havana, no. 19, file 52, AN.
80. A. G. C., “Historia de la Vacuna en Cuba,” Revista Bimestre Cubana 6 (July–August 1911): 373–428. Hondares even refused to vaccinate the children of Duke de la Torre with calf vaccine he had acquired from England, confessing his lack of trust in the substance.
81. “Correspondencia,” Anales de la Real Academia 7 (February 1871): 542. These accusations, and the government inadequacies in preventive care they revealed, were directly linked to Hondares’s participation in the academy’s Sub-commission of the Vaccine. See “Correspondencia,” Anales de la Real Academia 7 (September 1870): 172–73.
82. Govantes, “Vacuna animal” (n. 67).
83. Ibid., 430.
84. Ibid., 430–31.
85. “Vacuna de brazo,” Anales de la Real Academia 7 (December 1870): 427.
86. “Obito,” Anales de la Real Academia 21 (Abril 1885): 459.
87. “La vacuna en las Casas de Socorro” (n. 49), 555.
88. Ibid., 555.
89. “Voto de gracias,” Anales de la Real Academia 7 (December 1870): 417–18.
90. For an introduction to enlightenment “politic ethic,” see Albert R. Jonsen, A Short History of Medical Ethics (New York: Oxford University Press, 2000); and Robert B. Baker and Laurence B. McCullough, eds., The Cambridge World History of Medical Ethics (New York: Cambridge University Press, 2008).
91. Scottish Enlightenment thinkers John Gregory and Thomas Percival played important roles in the early nineteenth-century formation of a secular, professional medical ethic based on service and compassion. Laurence B. McCullough, John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine (Dordrecht: Kluwer, 1998).
92. Ferrer, El Propagador (n. 31), 30–31.
93. Ibid., 17–26.
94. Ibid., 17.
95. “La vacuna en las Casas de Socorro” (n. 49), 551.
96. Ibid., 551. The inspector believed these weaknesses would be overcome when the seven Casas de Socorro, with its fourteen doctors, were established and the public grew more aware of their vaccine services.
97. Ibid., 552.
98. Ibid., 551.
99. Ibid., 552.
100. “Vacuna,” Anales de la Real Academia 7 (March 1871): 601.
101. Ambrosio González del Valle, “Proyecto de reglamento para el servicio de vacuna,” Anales de la Real Academia 8 (May 1872): 647.
102. Eduardo F. Pla, “Variedades: La viruela y la vacuna,” Crónica Médica Quirúrgica de la Habana 4 (February 1878): 94.
103. José Argumosa, “Cuatro palabras sobre cuestiones de vacuna por el Dr. D José Argumosa,” Crónica Médica Quirúrgica de la Habana 4 (April 1878): 190.
104. Eduardo F. Pla, “Variedades: La viruela y la vacuna (cont.),” Crónica Médica Quirúrgica de la Habana 4 (May 1878): 228.
105. Argumosa, “Cuatro palabras” (n. 103), 189–90.
106. Ibid., 188.
107. Ibid., 186.
108. Ibid., 185.
109. Ibid., 184.
110. Ibid., 184.
111. Pla, “Variedades: La viruela y la vacuna (cont.)” (n. 104), 228.
112. José Argumosa, “Dos palabras sobre cuestiones de vacuna, por J. D. Argumosa,” Crónica Médica Quirúrgica de la Habana 4 (June 1878): 268–69.
113. Secretario Luis Montané, “Resumen de los trabajos de 1893 y 1894,” Anales de la Real Academia 31 (1894): 27–28.