{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T12:09:05Z","timestamp":1783166945275,"version":"3.54.6"},"reference-count":147,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2018,12,17]],"date-time":"2018-12-17T00:00:00Z","timestamp":1545004800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Med. Hist."],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:p>This article explores the introduction of smallpox vaccination into Nepal in 1816 at the request of the Nepalese government; the king, however, was not vaccinated, contracted the disease and died. British hopes that vaccination would be extended throughout the country did not eventuate. The article examines the significance of this early appearance of vaccination in Nepal for both Nepalese and British, and relates it to the longer history of smallpox control and eventual eradication. When the Nepalese requested World Health Organization (WHO) assistance with communicable disease control in the mid-twentieth century little had changed for most Nepalese. We know about the events in 1816 through the letters of the newly imposed British Resident after Nepal\u2019s military defeat in the Anglo-Nepal War (1814\u201316). By also drawing on other sources and foregrounding Nepal, it becomes possible to build up a more extensive picture of smallpox in Nepal that shows not only boundaries and limits to colonial authority and influence but also how governments may adopt and use technologies on their own terms and for their own purposes. Linking 1816 to the ultimately successful global eradication programme 150 years later reminds us of the need to think longer term as to why policies and programmes may or may not work as planned.<\/jats:p>","DOI":"10.1017\/mdh.2018.61","type":"journal-article","created":{"date-parts":[[2018,12,17]],"date-time":"2018-12-17T11:32:16Z","timestamp":1545046336000},"page":"24-43","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Death of the King: The Introduction of Vaccination into Nepal in 1816"],"prefix":"10.1017","volume":"63","author":[{"given":"Susan","family":"Heydon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2018,12,17]]},"reference":[{"key":"S0025727318000613_r50","unstructured":"Wright, op. cit. (note 2), 3."},{"key":"S0025727318000613_r24","unstructured":"See, for example, Ludwig F. Stiller, S.J., The Rise of the House of Gorkha (Kathmandu: Educational Publishing House, 2017)."},{"key":"S0025727318000613_r48","unstructured":"Oldfield, op. cit. (note 4), 11."},{"key":"#cr-split#-S0025727318000613_r30.1","unstructured":"4. P.N. Shrestha, D.A. Robinson and J. Friedman, 'The Nepal Smallpox Eradication Programme: Description and Analysis', World Health Organization, 1977, SME\/77.1, 20"},{"key":"#cr-split#-S0025727318000613_r30.2","unstructured":"5. F. Fenner, D.A. Henderson, I. Arita, Z.??Jezek and I.D. Ladnyi, Smallpox and Its Eradication (Geneva: World Health Organization, 1988), 792."},{"key":"S0025727318000613_r45","unstructured":"Stiller, op. cit. (note 24)."},{"key":"S0025727318000613_r36","unstructured":"Ibid., 12."},{"key":"S0025727318000613_r34","volume-title":"The State of History Education and Research in Nepal","author":"Raj","year":"2014"},{"key":"S0025727318000613_r56","unstructured":"ESCAP, Population of Nepal. Country Monograph Series No. 6 (Bangkok: United Nations, 1980), 11. This report draws on Nepali-language documents. Early British enumerations of the population of Nepal are considered unreliable."},{"key":"S0025727318000613_r76","unstructured":"No mention is made of the vaccination status of Gurkha troops recruited and employed by the East India Company."},{"key":"S0025727318000613_r26","unstructured":"Gardner to Adam, 17 December. IOR\/R\/5\/38."},{"key":"S0025727318000613_r95","unstructured":"17 July. IOR\/F\/4\/550\/13379."},{"key":"#cr-split#-S0025727318000613_r23.1","unstructured":"12. Sanjoy Bhattacharya, Mark Harrison and Michael Worboys, Fractured States: Smallpox, Public Health and Vaccination Policy in British India (New Delhi: Orient Longman, 2005)"},{"key":"#cr-split#-S0025727318000613_r23.2","unstructured":"13. Brimnes, op. cit. (note 9), 199-228. For a reassessment of the introduction and spread of smallpox vaccination 1789-1900, see a special issue, edited by Bhattacharya and Brimnes, of the Bulletin of the History of Medicine, 83, 1 (2009). Harish Naraindas suggests another interpretation: in the transition from variolation to vaccination the narrative changed from a therapeutic mode and individual care to that of prophylaxis. Harish Naraindas, 'Care, Welfare, and Treason: The Advent of Vaccination in the 19th Century', Contributions to Indian Sociology 32, 1 (1998), 67-96."},{"key":"S0025727318000613_r60","unstructured":"Baburam Acharya, \u2018King Prithvi Narayan Shah\u2019. Regmi Research Series (Kathmandu), 8, 8 (1976), 154."},{"key":"S0025727318000613_r20","unstructured":"Christine Holmberg, Stuart Blume and Paul Greenough (eds), The Politics of Vaccination: A Global History (Manchester: Manchester University Press, 2017). I am grateful to Paul Greenough for letting me read a draft of his chapter."},{"key":"S0025727318000613_r63","unstructured":"Population of Kathmandu Valley, 1856. Regmi Research Series (Kathmandu), 2, 5 (1970), 117\u20138. Today the city is known as Bhaktapur."},{"key":"S0025727318000613_r18","unstructured":"Nicholas B. Dirks, The Hollow Crown: Ethnohistory of an Indian Kingdom (Cambridge: Cambridge University Press, 1987). For more nuanced interpretations, see C.A. Bayly, Empire & Information: Intelligence Gathering and Social Communication in India, 1780\u20131870 (Cambridge: Cambridge University Press, 1996) and Tony Ballantyne, \u2018Colonial knowledge\u2019, in Sarah Stockwell (ed.) The British Empire: Themes and Perspectives (Malden and Oxford: Blackwell, 2008), 177\u201397."},{"key":"S0025727318000613_r14","unstructured":"Sanjoy Bhattacharya, Expunging Variola: The Control and Eradication of Smallpox in India 1947\u201377 (New Delhi: Orient Longman, 2006), 1. Randall Packard\u2019s recent overview of the history of global health also emphasises continuities. Packard, op. cit. (note 7)."},{"key":"S0025727318000613_r83","unstructured":"Fisher, op. cit. (note 17), 414\u201322. The origins of the residency system in India lay in the rapid expansion of the Company\u2019s activities in India with the first resident appointed in 1764."},{"key":"S0025727318000613_r8","unstructured":"Paul R. Greenough, \u2018Variolation and Vaccination in South Asia, c. 1700\u20131865: A Preliminary Note\u2019, Social Science & Medicine, 14D (1980), 345\u20137."},{"key":"S0025727318000613_r7","doi-asserted-by":"crossref","DOI":"10.56021\/9781421420325","volume-title":"A History of Global Health: Interventions into the Lives of Other Peoples","author":"Packard","year":"2016"},{"key":"S0025727318000613_r122","unstructured":"Stiller, op. cit. (note 27), 252."},{"key":"S0025727318000613_r6","doi-asserted-by":"publisher","DOI":"10.1017\/CHOL9780521563192"},{"key":"S0025727318000613_r12","unstructured":"Hopkins, op. cit. (note 3), xiv."},{"key":"S0025727318000613_r25","unstructured":"Although the Nepalese denied the Resident direct access to the king, Gardner was able to gather information from sources within the court."},{"key":"S0025727318000613_r31","unstructured":"Greenough, op. cit. (note 8), 345. This also applies more widely within the history of medicine."},{"key":"S0025727318000613_r92","unstructured":"See note 19."},{"key":"S0025727318000613_r133","unstructured":"Babu Ram Marasini, \u2018Health and Hospital Development in Nepal: Past and Present\u2019, Journal of Nepal Medical Association, 42 (2003), 306\u201311; Dixit, op. cit. (note 127)."},{"key":"S0025727318000613_r40","unstructured":"While leading families often had their own \u2018baids, or medical men\u2019, no services existed for the poorer classes. Wright, op. cit. (note 2), 44."},{"key":"S0025727318000613_r15","unstructured":"Letters to India 1816. IOR\/R\/5\/37 and IOR\/R\/5\/38. British Library, India Office Records (hereafter IOR) R\/5 Nepal: Kathmandu Residency Records c1792\u20131872. Fort William was headquarters of the Bengal Presidency. Wright\u2019s spelling of Gardner as Gardiner is incorrect, op. cit. (note 2), 53. He should also not be confused with Lieutenant-Colonel Gardner \u2013 his cousin William."},{"key":"S0025727318000613_r46","unstructured":"Oldfield, op. cit. (note 4), 8\u201311."},{"key":"S0025727318000613_r29","doi-asserted-by":"crossref","unstructured":"Robert M. Worth and Narayan K. Shah, Nepal Health Survey 1965\u201366 (Honolulu: University of Hawaii Press, 1969), 70\u20131. This was the first national health survey.","DOI":"10.1515\/9780824885199"},{"key":"S0025727318000613_r49","unstructured":"Oldfield, op. cit. (note 4), 47."},{"key":"S0025727318000613_r43","first-page":"347","article-title":"Documents Related to the Early Hospitals in Nepal","volume":"21","author":"Raj","year":"2016","journal-title":"Studies in Nepali History and Society"},{"key":"S0025727318000613_r98","unstructured":"Ibid. In Britain opposition to vaccination occurred from the beginning."},{"key":"S0025727318000613_r44","unstructured":"Ibid."},{"key":"S0025727318000613_r35","unstructured":"Stiller, op. cit. (note 27)."},{"key":"S0025727318000613_r139","unstructured":"Ibid., 22."},{"key":"S0025727318000613_r79","unstructured":"This supports the view that Sitala was more than a village\/folk deity. Fabrizio M. Ferrari, Religion, Devotion and Medicine in North India: The Healing Power of \u015a\u0131\u0304tal\u0101 (London: Bloomsbury, 2015), xx."},{"key":"S0025727318000613_r84","unstructured":"After the fall of Bhimsen Thapa in 1837 political factions divided the Nepal court even more than usual, enabling the Resident Brian Hodgson to acquire a greater influence, albeit without the full support of the Company. Hodgson was recalled in 1843. In a treaty in 1923 Britain formally recognised Nepal\u2019s independence."},{"key":"S0025727318000613_r52","unstructured":"Ibid., 101. The Kathmandu Valley was often referred to as \u2018Nepaul proper\u2019."},{"key":"S0025727318000613_r38","unstructured":"Stiller, op. cit. (note 27), 32."},{"key":"S0025727318000613_r126","unstructured":"Ibid., 282\u20133."},{"key":"S0025727318000613_r1","doi-asserted-by":"crossref","unstructured":"P.N. Shrestha, \u2018History of Smallpox\u2019, Journal of the Nepal Medical Association, 10, 2 (1972), 107\u201311. Dr\u00a0Purushottam Narayan Shrestha was medical officer-in-charge of Nepal\u2019s Smallpox Eradication Project. Nepali uses the Devanagari script. Spelling of Nepali names using the Roman script varies; in this article I will mostly use the version given by the author in the specified source.","DOI":"10.31729\/jnma.1219"},{"key":"S0025727318000613_r62","unstructured":"Smallpox Epidemic in Chisapani, royal order to Subedar Antya Khawzas and Subedar Niranja. Regmi Research Series (Kathmandu), 20, 11 (1988), 160. In the Nepali calendar this is shown as 1862."},{"key":"S0025727318000613_r39","doi-asserted-by":"crossref","unstructured":"Brimnes, op. cit. (note 9), 199; Richard Burghart, \u2018The Formation of the Concept of Nation-State in Nepal\u2019, Journal of Asian Studies, 44, 1 (1984), 101\u201325. Elite families employed tutors. Wright, op. cit. (note 2), 31. State responses to vaccination were varied; in Japan, physicians who knew Western medicine became the primary disseminators. Bhattacharya and Brimnes, op. cit. (note 11).","DOI":"10.2307\/2056748"},{"key":"S0025727318000613_r47","unstructured":"Stiller, op. cit. (note 27), 34\u20138. The service reached both eastern and western borders."},{"key":"S0025727318000613_r28","unstructured":"See both ibid.and Stiller, op. cit. (note 24)."},{"key":"S0025727318000613_r51","unstructured":"Colonel Kirkpatrick, An Account of the Kingdom of Nepaul being the substance of observations made during a Mission to that country in the year 1793 (New Delhi: Manjusri Publishing House, 1969), 4 and 1."},{"key":"S0025727318000613_r21","unstructured":"The country\u2019s foreign policy later became closely aligned with that of British India."},{"key":"S0025727318000613_r87","unstructured":"Stiller, op. cit. (note 24), 330\u20132."},{"key":"S0025727318000613_r121","unstructured":"Gardner to Adam, 20 November. IOR\/R\/5\/38. This was the news referred to by Shrestha at the beginning of this article and in other accounts."},{"key":"S0025727318000613_r55","unstructured":"Shrestha, op. cit. (note 1), 108."},{"key":"S0025727318000613_r81","unstructured":"Field Visit Report on Smallpox Control Pilot Project, Nepal WHO Project: Nepal 9 by Dr A. Zahra, Regional Adviser in Communicable Diseases, 23\u20136 May 1962. SEA\/Smallpox\/4. 10 August 1962."},{"key":"S0025727318000613_r68","unstructured":"Kirkpatrick, op. cit. (note 51), 183\u20134. I would like to thank one of my anonymous reviewers for this comment."},{"key":"S0025727318000613_r19","unstructured":"Much of Nepal shares a border with India. Endeavouring to take advantage of a political factional dispute in Nepal, the East India Company had concluded a commercial treaty with the government of Nepal in 1801. Captain William Knox was appointed Resident but the treaty proved unworkable and Knox withdrew in 1803. Only after 1816 was the relationship permanent."},{"key":"S0025727318000613_r59","unstructured":"World\u00a0 Health Organization, \u2018Frequently asked questions and answers on smallpox\u2019. http:\/\/www.who.int\/csr\/disease\/smallpox\/faq\/en\/(Accessed 18 January 2017)."},{"key":"S0025727318000613_r112","unstructured":"Gardner to Adam, 17 July. IOR\/F\/4\/550\/13379."},{"key":"S0025727318000613_r53","unstructured":"Bephen (Purbutti), Tou Ry\u00ea (Newar). Ibid., 238."},{"key":"S0025727318000613_r16","unstructured":"F\/4 Board of Control Records 1784\u20131858. IOR\/F\/4\/550\/13379."},{"key":"S0025727318000613_r37","unstructured":"Ibid.; Mahesh C. Regmi, Landownership in Nepal (Berkeley, Los Angeles and London: University of California Press, 1976)."},{"key":"S0025727318000613_r61","unstructured":"See Minsky, op. cit. (note 32)."},{"key":"S0025727318000613_r2","unstructured":"Daniel Wright, History of Nepal (New Delhi: Rupa & Co, 2007 [1877]), 53 and 266. While in Kathmandu Wright collected documents and took many back to Britain. The Vans\u0101val\u0131\u0304, or Genealogical History of Nepal, according to the Buddhist recension, was translated by Munshi Shew Shunker Singh and Pandit Shri Gunanand. Also see: John Whelpton, \u2018A Reading Guide to Nepalese History\u2019, Himalaya, the Journal of the Association for Nepal and Himalayan Studies, 25, 1 (2005), Article 5."},{"key":"S0025727318000613_r65","unstructured":"Shrestha, Robinson and Friedman, op. cit. (note 30), 10."},{"key":"S0025727318000613_r11","doi-asserted-by":"crossref","unstructured":"Sanjoy Bhattacharya and Niels Brimnes, \u2018Introduction: Simultaneously Global and Local: Reassessing Smallpox Vaccination and Its Spread, 1789\u20131900\u2019, Bulletin of the History of Medicine, 83, 1 (2009), 1\u201316.","DOI":"10.1353\/bhm.0.0194"},{"key":"S0025727318000613_r22","doi-asserted-by":"crossref","unstructured":"Daniel R. Headrick, \u2018The Tools of Imperialism: Technology and the Expansion of European Colonial Empires in the Nineteenth Century\u2019, Journal of Modern History, 51, 2 (1979), 231\u201363.","DOI":"10.1086\/241899"},{"key":"S0025727318000613_r125","unstructured":"Stiller, op. cit. (note 27), 276."},{"key":"S0025727318000613_r100","unstructured":"Arnold, op. cit. (note 33), 134."},{"key":"S0025727318000613_r13","doi-asserted-by":"publisher","DOI":"10.1017\/mdh.2013.63"},{"key":"S0025727318000613_r114","unstructured":"Ibid."},{"key":"S0025727318000613_r85","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/CBO9781107050860","volume-title":"A History of Nepal","author":"Whelpton","year":"2005"},{"key":"S0025727318000613_r72","unstructured":"Tax Exemption (Ashadh Badi 9, 1887) [1830]. Regmi Research Series (Kathmandu), 7, 2 (1975), 26. The name Vaidyasuggests he was a practitioner of Ayurvedic medicine."},{"key":"S0025727318000613_r73","unstructured":"21 September. IOR\/F\/4\/550\/13379. Later accounts suggest that some cultural resistance to vaccination existed among some groups, notably the Newar."},{"key":"S0025727318000613_r118","unstructured":"Ibid. The young prince was three years old."},{"key":"S0025727318000613_r128","unstructured":"Bhattacharya, op. cit. (note 13), 461."},{"key":"S0025727318000613_r32","unstructured":"B.S. Cohn, Colonialism and Its Forms of Knowledge: The British in India (Princeton: Princeton University Press, 1996). Also see Ballantyne, op. cit. (note 18) and Bayly, op. cit. (note 18). Bayly concluded (p. 113) that as Britain watched Nepal \u2018Nepal was equally sagacious in its careful surveillance of the British and in promoting an information order which opened outward, but not inward\u2019. Lauren Minsky, however, discusses the biases of colonial archives and popular sources \u2013 why the lower classes are unrepresented and elite versions unquestioned and so looks to other ways to investigate smallpox ideas and practices. Lauren Minsky, \u2018Pursuing Protection from Disease: The Making of Smallpox Prophylactic Practice in Colonial Punjab\u2019, Bulletin of the History of Medicine, 83, 1 (2009), 164\u201390."},{"key":"S0025727318000613_r4","unstructured":"Henry Ambrose Oldfield, Sketches from Nipal (London: W.H. Allen, 1880), Vol. 1, 253\u20134. Oldfield was Residency Surgeon at the time."},{"key":"S0025727318000613_r17","first-page":"172","volume-title":"Indirect Rule in India: Residents and the Residency System 1764\u20131857","author":"Fisher","year":"1991"},{"key":"S0025727318000613_r64","unstructured":"Report on Routes by Explorer Hari Ram, Records of the Survey of India8 (Dehra Dun: Survey of India, 1915), part 2, 386."},{"key":"S0025727318000613_r66","unstructured":"After unification of Nepal, the Newar were a conquered people."},{"key":"S0025727318000613_r67","unstructured":"This limited knowledge would change. For the scholarly contribution of Brian Houghton Hodgson, see David M. Waterhouse (ed.), The Origins of Himalayan Studies: Brian Houghton Hodgson in Nepal and Darjeeling 1820\u201358 (London and New York: RoutledgeCurzon, 2004)."},{"key":"S0025727318000613_r93","unstructured":"Bayly, op. cit. (note 18), 108\u201313."},{"key":"S0025727318000613_r124","unstructured":"Ibid."},{"key":"#cr-split#-S0025727318000613_r42.1","unstructured":"78. That the situation was changing is evident after the great earthquake of 1934, when concern for the threat of epidemics led to vaccine being imported from other countries. Brahma Shumsher Jung Bahadur Rana, The Great Earthquake in Nepal (1934 A.D.), trans. by Kesar Lall, (Kathmandu: Ratna Pustak Bandar, 2013). First published in Nepali in 1934, the author was Director of Hospital Management"},{"key":"#cr-split#-S0025727318000613_r42.2","unstructured":"79. but as he was also a member of the elite ruling Ranas, Yogesh Raj urges caution. Yogesh Raj, 'Management of the Relief and Reconstruction after the Great Earthquake of 1934', Studies in Nepali History and Society, 20, 2 (2015), 375-422."},{"key":"S0025727318000613_r69","unstructured":"K.L. Pradhan, Brian Hodgson at the Kathmandu Residency, 1825\u201343 (Delhi: Spectrum Publications, 2001),\u00a08."},{"key":"S0025727318000613_r115","unstructured":"Ibid. At this time the need for revaccination, which became part of the later protocols, was not recognised."},{"key":"S0025727318000613_r70","unstructured":"Shrestha, op. cit. (note 1), 109."},{"key":"S0025727318000613_r74","unstructured":"Minsky, op. cit. (note 32), 185."},{"key":"S0025727318000613_r75","unstructured":"Oldfield, op. cit. (note 4), 253. Such influence probably reflected Jang Bahadur\u2019s powerful position \u2013 more powerful than that of Bhimsen Thapa in 1816."},{"key":"S0025727318000613_r54","unstructured":"Ibid."},{"key":"S0025727318000613_r77","unstructured":"Interviews undertaken by the author in the Newar town of Kirtipur, May 2017."},{"key":"S0025727318000613_r80","unstructured":"Minsky, op. cit. (note 32), 171."},{"key":"S0025727318000613_r111","unstructured":"Today we talk about \u2018vaccine hesitancy\u2019."},{"key":"S0025727318000613_r88","unstructured":"Ibid., 319."},{"key":"S0025727318000613_r91","unstructured":"Fisher, op. cit. (note 17), 415."},{"key":"S0025727318000613_r94","unstructured":"16 March 1816, Enclosure No. 14 Governor-General\u2019s Minute, Papers respecting the Nepaul War, 964. East India Company, Papers regarding the Administration of the Marquis of Hastings in India (London: J.L. Cox, 1824), Papers respecting the Nepaul War, 972. In these letters he is referred to as Lord Moira (the Earl of Moira), but in December 1816 he became the first Marquis of Hastings, by which name he is better known."},{"key":"S0025727318000613_r120","unstructured":"Gardner to Adam, 18 November. IOR\/R\/5\/38."},{"key":"S0025727318000613_r96","unstructured":"P.N. Shrestha, \u2018Smallpox Eradication in Nepal\u2019, 9. WHO\/SE\/78.107."},{"key":"S0025727318000613_r99","unstructured":"Fisher, op. cit. (note 17), 207."},{"key":"S0025727318000613_r101","unstructured":"Gardner to Adam, 17 July. IOR\/F\/4\/550\/13379. Gardner often used the terms \u2018vaccination\u2019 and \u2018inoculation\u2019 interchangeably, rather than using \u2018inoculation\u2019 to refer to \u2018variolation\u2019. The overlap in form and method between variolation with variola crusts and vaccination with vaccinia crusts also helps explain Gardner\u2019s use of the term \u2018inoculation\u2019 to refer to both variolation and vaccination."},{"key":"S0025727318000613_r102","unstructured":"Near Patna, in Bihar state, was the military station of Dinapore \u2013 the closest senior British station to Kathmandu. Patna was a staging post for communications with Calcutta. Waterhouse, op. cit. (note 67), 3. Although Gardner refers to Everest as Surgeon, his rank was Assistant Surgeon."},{"key":"S0025727318000613_r103","unstructured":"Gardner to Adam, 17 July. IOR\/F\/4\/550\/13379."},{"key":"S0025727318000613_r104","unstructured":"Adam to Peter Cochrane, President, and Members of the Medical Board, 3 August. IOR\/F\/4\/550\/13379."},{"key":"S0025727318000613_r117","unstructured":"Gardner to Adam. IOR\/R\/5\/38."},{"key":"S0025727318000613_r71","unstructured":"Oldfield, op. cit. (note 4), 186. The Newar had a well-established caste system."},{"key":"S0025727318000613_r105","unstructured":"Robert Leny to Adam, 7 August. IOR\/F\/4\/550\/13379."},{"key":"S0025727318000613_r89","unstructured":"H.T. Prinsep, History of the Political and Military Transactions in India during the Administration of the Marquess of Hastings, 1813\u201323 (London, 1825), 1, 133. Quoted in Sir Penderel Moon, The British Conquest and Dominion of India (London: Duckworth, 1990), 377."},{"key":"S0025727318000613_r106","unstructured":"Gardner to Leny, 14 September. Misc letters sent June 1816\u2013March 1817. IOR\/R\/5\/112."},{"key":"S0025727318000613_r107","unstructured":"Crosby, op. cit. (note 5), 1012."},{"key":"S0025727318000613_r108","unstructured":"14 September. IOR\/R\/5\/112. Distant Banepa was Bhimsen Thapa\u2019s choice."},{"key":"S0025727318000613_r138","unstructured":"Ludwig F. Stiller and Ram Prakash Yadav, Planning for People ([Kathmandu], Nepal: Human Resources Development Research Center, 1993)."},{"key":"S0025727318000613_r109","unstructured":"Ibid."},{"key":"S0025727318000613_r113","unstructured":"Gardner to Adam, 2 November. IOR\/R\/5\/38."},{"key":"S0025727318000613_r116","unstructured":"Ibid."},{"key":"S0025727318000613_r119","unstructured":"Fisher, op. cit. (note 17), 65."},{"key":"S0025727318000613_r127","unstructured":"See, for example, Ian Harper, Development and Public Health in the Himalaya: Reflections on Healing in Contemporary Nepal (London and New York: Routledge, 2014). For an overview, however, of the historical development of Nepal\u2019s health services, see Hemang Dixit, Nepal\u2019s Quest for Health, 4th edn (Kathmandu: Educational Publishing House, 2014)."},{"key":"S0025727318000613_r129","unstructured":"After the king\u2019s death on 20 November the Resident\u2019s letters did not refer to vaccination or any extension of activities. The Company file about the introduction of vaccination into Nepal also ceased and the documents were forwarded to London. They are to be found in the Company\u2019s political files, attesting to their significance in the political environment of the time."},{"key":"S0025727318000613_r9","unstructured":"Ibid., 346; Niels Brimnes, \u2018Variolation, Vaccination and Popular Resistance in Early Colonial South India\u2019, Medical History, 48, 2 (2004), 199\u2013228. Edward Jenner published his results using cowpox in 1798. For the worldwide dissemination of the vaccine within a few years, although not to Japan, see Ann Jannetta, The Vaccinators: Smallpox, Medical Knowledge, and the \u2018Opening\u2019 of Japan (Stanford, California: Stanford University Press, 2007), 34\u201352."},{"key":"S0025727318000613_r131","unstructured":"Oldfield, op. cit. (note 4), 253\u20134."},{"key":"S0025727318000613_r78","unstructured":"Oldfield, op. cit. (note 4), 285\u20136. Brahman astrologers, reflecting many people\u2019s unhappiness with the socially unacceptable relationship between Girvana\u2019s parents, spread a rumour that their child would die of smallpox. Chittaranjan Nepali, \u2018Reign and Abdication of King Rana Bahadur Shah\u2019. Regmi Research Series (Kathmandu), 3, 1 (1971), 8."},{"key":"S0025727318000613_r137","unstructured":"Eugene Bramer Mihaly, Foreign Aid and Politics in Nepal: A Case Study, 2nd edn (Lalitpur, Nepal: Himal Books, 2002 [1965]), 204\u20137."},{"key":"S0025727318000613_r132","unstructured":"G.H.D. Gimlette, Nepal and the Nepalese (London: H.F. & G. Witherby, 1928), 155."},{"key":"S0025727318000613_r130","unstructured":"The Residency of Hodgson (1833\u201343) was an exception. The ongoing supply of troops for the army became a key aspect of Britain\u2019s relationship with Nepal. See Asad Husain, British India\u2019s Relations with the Kingdom of Nepal 1857\u20131947: A Diplomatic History of Nepal (London: George Allen and Unwin, 1970)."},{"key":"S0025727318000613_r90","unstructured":"Stiller, op. cit. (note 27), 100."},{"key":"S0025727318000613_r135","unstructured":"Raj, Aryal and Mishra, op. cit. (note 43). These small institutions were often situated where there were leading government officials."},{"key":"S0025727318000613_r136","doi-asserted-by":"crossref","unstructured":"Erez Manela, \u2018A Pox on Your Narrative: Writing Disease Control into Cold War History\u2019, Diplomatic History, 34, 2 (2010), 299\u2013323.","DOI":"10.1111\/j.1467-7709.2009.00850.x"},{"key":"S0025727318000613_r27","unstructured":"Key officials held land in the productive Tarai. For the vital economic significance of this region to Nepal and the desire of the Governor-General to have a defined and stable boundary, see Ludwig Stiller, S.J., The Silent Cry: The People of Nepal: 1816\u201339 (Kathmandu: Sahayogi Prakashan, 1976). Misra was also a signatory of the Treaty of Sagauli."},{"key":"S0025727318000613_r142","unstructured":"Fenner et\u00a0al.\u00a0op. cit. (note 30), 715."},{"key":"S0025727318000613_r140","unstructured":"Shrestha, Robinson and Friedman, op. cit. (note 30), 17. In 1962 a joint Nepal Government\/WHO smallpox-control pilot project began in the Kathmandu Valley."},{"key":"S0025727318000613_r141","unstructured":"Hopkins, op. cit. (note 3), 305. Four of these were in Asia and two in Africa."},{"key":"S0025727318000613_r143","first-page":"185","volume-title":"Smallpox: The Death of a Disease: The Inside Story of Eradicating a Worldwide Killer","author":"Henderson","year":"2009"},{"key":"S0025727318000613_r58","unstructured":"Worth and Shah, op. cit. (note 29)."},{"key":"S0025727318000613_r144","unstructured":"Packard, op. cit. (note 7)."},{"key":"S0025727318000613_r57","unstructured":"Kirkpatrick, op. cit. (note 51), 160."},{"key":"S0025727318000613_r5","doi-asserted-by":"publisher","DOI":"10.1017\/CHOL9780521332866.190"},{"key":"S0025727318000613_r10","doi-asserted-by":"publisher","DOI":"10.1353\/bhm.0.0160"},{"key":"S0025727318000613_r123","unstructured":"Gardner to Adam, 17 December. IOR\/R\/5\/38."},{"key":"S0025727318000613_r97","unstructured":"Brimnes, op. cit. (note 9)."},{"key":"S0025727318000613_r110","unstructured":"Gardner to Adam, 25 September. IOR\/R\/5\/37."},{"key":"S0025727318000613_r82","unstructured":"Vaccination continued to be offered at the British Residency."},{"key":"S0025727318000613_r33","first-page":"117","volume-title":"Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India","author":"Arnold","year":"1993"},{"key":"S0025727318000613_r86","unstructured":"Ibid., 37. See also: Bernardo A. Michael, Statemaking and Territory in South Asia: Lessons from the Anglo-Gorkha War (1814\u201316) (London and New York: Anthem Press, 2012)."},{"key":"S0025727318000613_r134","unstructured":"Perceval Landon, Nepal, (New Delhi: Asian Educational Services, 1993 [1928]), Vol. 2, 184."},{"key":"S0025727318000613_r3","doi-asserted-by":"crossref","unstructured":"See, for example, Donald R. Hopkins, The Greatest Killer: Smallpox in History (Chicago and London: University of Chicago Press, 2002), 150.","DOI":"10.7208\/chicago\/9780226189529.001.0001"},{"key":"S0025727318000613_r41","unstructured":"The over-four-thousand pages of the Regmi Research Series have been digitised and can be accessed through the Digital Himalaya Project (http:\/\/www.digitalhimalaya.com\/) and searched through http:\/\/ebooks.library.cornell.edu\/r\/regmi\/."}],"container-title":["Medical History"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0025727318000613","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T06:43:31Z","timestamp":1694501011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0025727318000613\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,17]]},"references-count":147,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,1]]}},"alternative-id":["S0025727318000613"],"URL":"https:\/\/doi.org\/10.1017\/mdh.2018.61","relation":{},"ISSN":["0025-7273","2048-8343"],"issn-type":[{"value":"0025-7273","type":"print"},{"value":"2048-8343","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,17]]},"assertion":[{"value":"\u00a9 The Author 2018. Published by Cambridge University Press.\u00a0","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}