Smallpox inoculation in Ming-Qing China: Regional spread, knowledge dissemination, and bacterin production

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This article investigates the popularization of smallpox inoculations during the Ming and Qing Dynasties and discusses the processes of knowledge dissemination, bacterin production, and marketing, as well as the regional and social aspects of smallpox inoculation. According to earlier scholars, smallpox inoculation began in Ningguo, Anhui, between 1567 and 1572. However, as this study demonstrates, it is highly possible that smallpox inoculation originated in the Jiangxi region. Following the discovery that smallpox inoculation protects people from smallpox, the technique spread throughout the Jiangxi, Huguang, Anhui, Jiangsu, Zhejiang, Fujian, and Guangdong regions. Not until the 1670s did physicians arrive in Beijing to inoculate the upper-class community. In 1678, Emperor Kangxi introduced smallpox inoculation to the Palace, and it became a royally approved medical technique. Shortly thereafter, the Court transferred this technique to Mongolia and the surrounding regions. Local officials, however, were never ordered by the Court to actually perform or promote the inoculation procedure, so it was mainly disseminated by scholars and physicians. In the early stages of the inoculation's dissemination, only handwritten knowledge was circulated; the techniques themselves were not made public. In 1713, the inoculation procedure first appeared in printed medical books. In 1741, medical books dedicated to smallpox inoculation began to be published. In 1742, royal physicians included the procedure in their version of the Yizong Jinjian, and the knowledge was widely circulated by this royally approved and continually reprinted book. Soon thereafter, more and more medical books on inoculation were published, and smallpox inoculation became increasingly widespread. Ningguo, Anhui, and Deqing, Zhejiang, were famous manufacturing centers for the bacterin, although some private clinics also specialized in producing the bacterin. In addition to purchasing the bacterin, many physicians also developed their own versions. Since this bacterin was a profitable medical product, there were numerous fake products on the market, which resulted in various aftereffects. In the beginning of the 19th century, smallpox inoculation was widely available, yet only the upper-class was inoculated. Smallpox inoculation was much more prevalent in the south of China than in the north.

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