Expunging Variola: The Control and Eradication of Smallpox in India, 1947-1977 by Sanjoy Bhattacharya (review)

Health& History • 9/2 • 2007 179 At times, most clearly in his chapter on retrospective diagnosis, Bates9use of medical language is not fully explained to the reader who has no medical training. The lay reader may struggle with sentences such as: 'An even more tentative attributionis a macerated child born at Old Sandwich in Kent, thoughthedescriptiondoes suggest encephalocoele, polydactyly and limb deformity' (p. 190). While Bates largely succeeds in his argument that people depicting early modern monstrous births created believable depictions and thatreadersexpected as much, the readermay be left wondering about the broader implications of this position. The religious implications, for instance, are hinted at in his work, but they are not his main preoccupation. Therefore, his work may inspire further investigation into monstrous births by historians. Overall, Emblematic Monsters, with its fusion of historical andmedical perspectives, is of interestto earlymodern European medical historians, historians of religion, intellectual historians, and medical practitioners. KATHERINE WALKER MCMASTER UNIVERSITY, HAMILTON, ONTARIO, CANADA Sanjoy Bhattacharya, Expunging Variola: The Control and Eradication of Smallpox in India, 1947-1977 (New Delhi: Orient Longman, 2006). ISBN 81 250 3018 2. 326 + xv pp + Index. InExpunging Variola:TheControland Eradication of Smallpox inIndia, 1947-1977, Sanjoy Bhattacharyahas writtena thorough investigation intothepolitical andtechnical aspects of apost-war public health programme. His book is an account of the efforts of the Indian government and the World Health Organisation (WHO) to eradicate smallpox on the subcontinent, drawing on official sources that have previously been left unexamined. In analysing in great detail the memoranda, reports and statistics concerningtheIndianNationalSmallpox EradicationProgramme (NSEP), Bhattacharyahas sought to uncover the ways in which this projectwas hamperedby myriaddivisions andconflicts, not 180 BOOK REVIEWS only between the Indian government and WHO, but between the many levels of the Indian government and within WHO as well. This attemptto complicate an assumption thatmonolithic government and international organisations drove the NSEP with unified aims and expectations is the greatest strength of Expunging Variola.In an exhaustive analysis of archival Indian and WHO material Bhattacharya shows how technical and financial problems, policy disagreements, political interests and hostility combined to make the NSEP a lurching and faltering project requiringrepeated resuscitation by negotiation and hard work. Financial and technical shortcomings were perennial problems encountered by the project. Shortage of money meant that programmes were restricted by a lack of staff, while the distances involved in covering districts for vaccination work revealed to many observers the ineffectiveness and danger of using liquid instead of freeze-dried vaccines. Poorly trainedand inexperienced vaccinators were also seen as a problem, and at the Smallpox WorkersConference in New Delhi in December 1964 some who spoke placed the blame on WHO plans from the late 1950s and the pressure from senior officials to meet vaccination targets. This pressure meant that, in order to reach targets, data would be falsified or multiple vaccinations would often be carriedout on whoever was accessible instead of those people most in need. Bhattacharya also shows how significant were the differences in ambitions and expectations of officials at different levels of Indian government, between WHO and the Indian government and between WHO headquartersin Geneva and the Organisation's South-East Asia Regional Office. India continued in the 1950s and most of the 1960s to insist on using outdated liquid vaccines, in large partbecause it was equipped to make liquid vaccine and India was reluctant to give up the prized self-reliance this provided. India also gained some measure of regional influence because of its ability to provide neighbouring countries with vaccine. For WHO in Geneva, eradication, as opposed to control, was a fundamental part of international public health policy, yet Bhattacharya shows that the regional office felt experience had shown this aim to be misguided. Similarly local government officials in India persistently doubted the very possibility of eradication. These Health& History • 9/2 • 2007 181 disagreements lead to considerable problems in regard to cooperation . At district level, foreign WHO experts working to reform the programme after 1967 often encountered hostility from public health officials who were critical of the aim of eradication andjealous of their autonomy. Bhattacharya's book is therefore an account that does the importantwork of closely analysing archival sources in orderto better understandthe kinds of complicated divisions...