Smallpox, politics and power in Kathmandu

The smallpox virus plagued Nepali communities throughout the 19th and early 20th centuries. As historian Susan Heydon has written about in a recent essay called ‘Death of the King’, smallpox destroyed families rich and poor alike, with tremendous personal and political consequences. 

In the late 1790s, smallpox erupted in Kathmandu Valley. Little is known about the outbreak, but at the time the Valley's cities were still recovering from Prithvi Narayan Shah's conquest three decades earlier. Kathmandu's population lived and worked on streets that one British visitor described as ‘excessively narrow, and nearly as filthy as those of Benares'.

In 1799, King Rana Bahadur's favorite wife, Kantivati, came down with smallpox, igniting a series of events that reshaped court politics. Seeing his wife gravely ill, Rana Bahadur dedicated himself to prayers for her, and even abdicated the throne in favour of his two-year old son, Girvana. His efforts were to no avail: Kantivati succumbed to the disease. Rana Bahadur, distraught and furious, desecrates and destroys the temple of Hariti Ma (known to Hindus as Sitala) at Swayambhu.

Rana Bahadur also orders children with the disease removed outside the Valley, all the way across the Tama Kosi in the East or the Marsyandi in the West. Because of the Valley's demographics, these were Newar children. A traditional Newar song recounts what happens. Called 'Sitalamaaju Mye', the song is addressed to 'Mother Sitala,' the smallpox goddess. 

Part I: Big story of smallpox in Nepal

Part II: The smallpox virus in British India

Part IV: How Nepal eradicated the smallpox virus

Part V: Viruses past, present and future

'Oh Mother Sitala,' the first line goes, 'behold the piteous state of your people! The children were driven out of the country, surrounded by soldiers.' 

The song describes the stages of the disease, which touched most Nepali families at one point or another, through its appeal to three different deities. ‘We pray to Mother Kachala, who brings forth the smallpox blisters, to Mother Sitala, who fills them with water, and to Mother Bachala, who carries off the afflicted.’

Parents faced heartbreaking difficulties. 'They led them away, carrying one child on the back, one child under the arm and dragging along a third child.' After a week, the families reach the Tama Kosi. There, a child dies. Unable to say goodbye the proper way, the devastated parents throw the body into the river. 

One of the legacies of these distant events, the 'Sitalamaaju Mye' song appears to use the tragic expulsion of families to symbolise the mistreatment and dukha Newars faced since the takeover of the Valley by the Shah regime in the 1770s. Observers this month have noted that the song speaks to the hardships faced by many Nepali migrant laborers, displaced from their worksites by Covid-19, trying to return to village homes.

Rana Bahadur ends up in exile in India, and takes along with him a young Bhimsen Thapa. He returns to power in 1804, but is killed in 1806, opening the door for Thapa to seize power and go on to become one of the most important rulers in Nepal's early history.

Smallpox struck again in 1816, and again shapes the power struggles in Nepal's tumultuous Darbar. Bhimsen Thapa still held power, but King Girvana, now 21, was a clear threat.

The disease appeared first in the west of the country but found its way to Kathmandu by July. As historian Vikram Hasrat has documented, ‘Smallpox became so virulent in the country that hundreds and thousands of men, women and children, old and young, were swept away. The rivers, tanks, and canals were crowded with dead and dying; and in the streets a man had scarcely room to walk and the dogs dragged away the neglected and putrefied corpses and vultures died with surfeit of human flesh.’

Fear gripped the palace. King Girvana had not contracted the disease as a child. He also had young children. Officials requested vaccinations from the British, who had been trying to spread the new practice in India for over a decade.

As historian Heydon has documented, the British sensed possible political advantage: ‘It would not only be an act of humanity to introduce the Vaccination,’ the British resident Edward Gardner wrote his superiors in India on July 17, ‘but be a desirable object, perhaps to have the Raja and the Officers of the Court inoculated by us.’

The British organised vaccinations around the Valley, beginning in Banepa. It is hard to say how many people actually got vaccinated. But one thing we do know: the king was not among them. 

The exact reasons why are lost to history, but not the consequences. In late October, both of the king's children showed fever and then rash. One perished on 2 November. Gardner passed along news of the king's family to Calcutta: ‘His youngest son a child under two years of age I am sorry to add died this morning of that distemper and his eldest & only remaining male child has also taken the disease.’ 

Two weeks later, on 18 November, Gardner learned that 'the Raja had unfortunately taken the smallpox'. He died two days later. The resident reported the event: ‘Alarming symptoms it seems made their appearances during the night which continuing unabated, the Raja was according to the usual custom in this country conveyed early in the morning to the temple at Pusputhnath, where he breathed his last about 11 o’clock am. As was Hindu custom, preparations were underway quickly for his funeral.’ Girvana's senior queen, Siddhi Rajya Laxmi, threw herself on her husband's funeral pyre, as tradition demanded.

Gardner regretted the missed chance to prevent the king's death. ‘Many opportunities have unaccountably been neglected for him receiving the vaccination.’ It's hard to know why. There was, however, as historian John Whelpton notes, 'speculation about foul play'. 

The young prince Rajendra recovered and was placed under the regency of Tripura Sundari, a longtime ally of Bhimsen Thapa. Girvana's death and Tripura Sundari's installation as the young king's regent helped Bhimsen Thapa retain his grip on power, a grip he would not yield for another two decades.  

Over the next century and a half, as Heydon shows, smallpox showed itself routinely in Nepal. Every spring communities would make prayers to ward off the disease. But periodically epidemics raged. One observer in east Nepal in 1885, for instance, noted that a wave of smallpox had ‘carried off a large number of the inhabitants of Khumbu’.

“Nepal is a microcosm of all of the changes in world health”, Nepali Times

Vaccination use was sporadic, and government efforts weak. At mid-century, the Kathmandu-based British doctor Henry Oldfield noted that Jang Bahadur Rana held ‘great faith’ in vaccination and had his children and other royal children inoculated, but did little else. In the 1920s, British journalist Perceval Landon noted, 'Vaccination is not compulsory but it is free to those who choose to avail themselves.' 

Several reasons explain why Nepalis did not use vaccination. Some people, particularly some Newars and Tarai groups, disliked the vaccine. But a far greater problem was that the Rana governments did little to make it widely available or to promote it. They never set up a health system to promote sound practices across Nepal. 

In contrast, in India by the early 20th century, the British campaign to spread vaccination had found its legs. Millions of ordinary Indians in Madras and other parts of the country started getting vaccines. In 1947 alone, the year the British left India, 21.3 million Indians received vaccinations or re-vaccinations.

Nepalis who studied or traveled in India and those who served in the British Army noticed how little health service the Rana regime provided their countrymen. Smallpox was one of many diseases and ailments that modern medicine could help with. The Ranas' lack of concern about the people's health and welfare helped fuel the growing movement to drive them from power. 

After the 1951 revolution, successive Nepal governments tried to set up a modern health care system in the towns and villages. They implemented disease control programs, including a nationwide malaria eradication effort, launched in 1959 with the help of the US and the WHO. A smallpox campaign for the Kathmandu Valley was launched in 1961 and became a nationwide eradication program in 1966.  

After tormenting Nepalis for centuries and sometimes shaping their politics, smallpox was finally eradicated from Nepal in 1975. It is a tremendous success story -- a story of strong bureaucratic organisation, impressive scientific work, and tenacious implementation. But it is also a story of occasional heavy handedness by a government given unprecedented powers in the effort to maintain public health. 

This is the third in a series of articles about the history of disease in Nepal. The fourth installment will explore the eradication campaign in the 1960s against smallpox. Tom Robertson, PhD, is researching the environmental history of Kathmandu Valley.