The key to success: The role of local government in the organization of smallpox vaccination in Sweden

Medical History

Volumn 44, Issue 2, 2000, Pages 201-226

  Sköld, Peter ^a  

^a UMEÅ UNIVERSITY   (Sweden)

Author keywords

[No Author keywords available]

Indexed keywords

SMALLPOX VACCINE;

ARTICLE; COMPARATIVE STUDY; GOVERNMENT; HISTORY; HUMAN; ORGANIZATION AND MANAGEMENT; PREVENTIVE HEALTH SERVICE; SMALLPOX; SWEDEN; VACCINATION;

HISTORY, 18TH CENTURY; HISTORY, 19TH CENTURY; HUMANS; IMMUNIZATION PROGRAMS; LOCAL GOVERNMENT; SMALLPOX; SMALLPOX VACCINE; SWEDEN; VACCINATION;

EID: 0034167130     PISSN: 00257273     EISSN: None     Source Type: Journal    
DOI: 10.1017/s0025727300066400     Document Type: Article

References (149)

1. The importance of the clergy has already been stressed by R Norrman, 'Prästerna och vaccinationen. En regional undersökning avseende Uppsala län 1811-1820', Kyrkohistorisk Årsskrift, 1979, 80: 100-31, on p. 122.
2. For a detailed compilation of instructions, letters and texts involved in the discussion, see Handlingar angående medicinska kunskapers inhämtande af blifvande prester, för att dermed kunna gå Församlingarnes innevånare tillhanda, Stockholm, 1816. The compilation is signed H. It was probably made by Sven Hedin, Royal Physician and member of the Medical Board.
3. R Å Gustafsson, Traditionernas ok. Den svenska hälso- och sjukvårdens organisering i historie-sociologiskt perspektiv, Falköping, Esselte Studium, 1987, pp. 246-9.
4. A Björverud, 'Prästmedicinen. Debatten i Sverige i början på 1800-talet', Sydsvenska Medicinhistoriska Sällskapets Årsskrift, 1990, 20: 219-38. Något om Prest-medicin. Hämtadt ur en Dansk Journal (signed S.P.L.), Uppsala, 1810.
5. A Björverud, 'Prästmedicinen. Debatten i Sverige i början på 1800-talet', Sydsvenska Medicinhistoriska Sällskapets Årsskrift, 1990, 20: 219-38. Något om Prest-medicin. Hämtadt ur en Dansk Journal (signed S.P.L.), Uppsala, 1810.
6. In each church the pastor had one or two assistants. One was responsible for the music, and the other was called the klockare (church bell ringer), who would assist in practical matters, and it was the latter who were mostly involved with vaccination. H Wentz, Klockaren i helg och söcken, Lund, Ekstrand, 1980, pp. 163-65.
7. C G Stjernswärd, Oförgripelige tankar, om medel, till winnande af en mera allmän och förbättrad sjukvård, i synnerhet i rikets conquettereade provincer, utan statens och allmänhetens betungande, Christianstad, 1812.
8. Behörig granskning af de så kallade, oförgripliga tankar, hwilka herr majoren och riddaren C. G. Stjernswärd innewarande år från trycket utgifwit, om medel, till winnande af en mera allmän och förbättrad sjukvård, i synnerhet i rikets conquettereade provincer, utan statens och allmänhetens betungande, Örebro, 1812.
9. Wentz, op. cit., note 5 above, pp. 163-5.
10. Gustafsson, op. cit., note 3 above, pp. 246-9.
11. J Rogers, 'Hälsovårdsutvecklingen i Sverige under den epidemiologiska transitionen. En jämförelse med England och Tyskland', Sydsvenska Medicin-historiska Sällskapets Årsskrift, 1990, 20: 103-17, on p. 106.
12. J Söderberg, Civilisering, marknad och våld i Sverige 1750-1870. En regional analys, Stockholm, Almqvist & Wiksell International, 1993, pp. 154-8, 228-36, 244-6.
13. G Miller, The adoption of inoculation for smallpox in England and France, Philadelphia, University of Pennsylvania Press, 1957, pp. 70-90.
14. A Mercer, Disease, mortality and population in transition: epidemiological-demographic change in England since the eighteenth century as part of a global phenomenon, Leicester University Press, 1990, p. 72.
15. Provincial doctorernes til Kongl. Medical Board inlemnade Berättelser, rörande deras ämbets förrättningar, desse senare åren, i synnerhet sedan siste Riksdag, Stockholm, Lars Salvius, 1761, pp. 84-6.
16. Royal letter to Medical Board, 31 March 1756 (EIA6:17), Medicinalstyrelsens äldre arkiv (The Medical Board Archive), Riksarkivet (National Archives, Stockholm).
17. Medical Board record, 16 March 1770 (A1A:23, 11:3), Medicinalstyrelsens äldre arkiv, Riksarkivet. This was an important step which led to the emphasis on the physician's persona in biomedical practice. K Finkler, 'Sacred healing and biomedicine compared', Med. Anthropol. Q., 1994, 8 (2): 178-97, pp. 187-8.
18. Royal letter of 31 March 1756, signed Adolph Fredric (E1A:6, 16:77), Medicinalstyrelsens äldre arkiv, Riksarkivet.
19. Kongl. Maj:ts Förnyade Nådiga Instruction for dess Collegium Medicum. Gifwen Stockholms Slott den 28 October 1797, Stockholm, 1798.
20. The Collegium Medicum was founded in 1663, and held the overall responsibility for health care in Sweden. In 1737 the Sundhetskommissionen was established with a certain responsibility for the control of epidemic diseases. The practice of the latter was discontinued in 1766. I Flygare, 'Den centrala medicinalförvaltningen', in W Kock (ed.), Medicinalväsendet i Sverige 1813-1962, Stockholm, AB Nordiska Bokhandelns Förlag, 1963, pp. 7-101, on pp. 9-13.
21. Kongl. Sundhets-Commissionens kundgörelse, angående et Koppympnings Hospitals Inrättande i Stockholm, Stockholm, Lars Salvius, 1760.
22. P Sköld, The two faces of smallpox: a disease and its prevention in eighteenth- and nineteenth-century Sweden, Umeå, Demographic Data Base, 1996, pp. 309-14.
23. A Bäck, Introduction to Berättelser till riksens höglofl. Ständer rörande medicinal werkets tillstånd i riket, Stockholm, Lars Salvius, 1769, p. A 5.
24. P J Bergius, 'Ron; om en koppo-smitta, som liknar ympning; jämte skäl til koppo-ympningens antagande här i riket, in Kongl. Vetenskaps Academiens Handlingar for or 1766, Stockholm, 1766, pp. 40-1.
25. Gustafsson, op. cit., note 3 above, p. 221.
26. R McGrew, Encyclopedia of medical history, London, Macmillan, 1985, p. 155.
27. Sköld, op. cit., note 21 above, pp. 292-2, 327-32.
28. D Schultz, 'Annual report to the Medical Board, 7 January, 1765', in Berättelser, inlämnade til Kongl Medical Board, rörande medicinalwerkets tilstånd i riket, Stockholm, Lars Salvius, 1765, pp. 8-22.
29. Inrikes Tidningar, no. 15, 21 February 1765.
30. Physicians often had to deny rumours like this. Two children inoculated by Peter Johan Bergius were later reported as having contracted smallpox but when the physician saw them it was apparent that it was chickenpox, not smallpox. P J Bergius, 'Berättelse om koppympningen', in Berättelser, inlämnade til Kongl Medical Board, rörande medicinal-werkets tilstånd i riket, Stockholm, Lars Salvius, 1765, pp. 258-60.
31. Medical Board record, 26 February 1781 (AIA33:17(7)), Medicinalstyrelsens äldre arkiv Riksarkivet.
32. Sköld, op. cit., note 21 above, pp. 316-18.
33. G Risse, 'Medicine in the age of Enlightenment', in A Wear (ed.), Medicine in society: historical essays, Cambridge University Press, 1992, pp. 149-96, on p. 191.
34. M Larsson, Kroppens rationalisering. Folkhälsoupplysning under 1700-talets första hälft, Stockholm, Sociologiska Institutionen vid Stockholms universitet, 1993, pp. 22-25.
35. P Sköld, 'From inoculation to vaccination: smallpox in Sweden in the eighteenth and nineteenth centuries', Popul. Stud., 1996, 50 (3): 247-62.
36. For a comparative discussion of health care organization in Sweden, Germany and England, see Rogers, op. cit., note 10 above, pp. 103-17.
37. E P Hennock, 'Vaccination policy against smallpox, 1835-1914: a comparison of England with Prussia and Imperial Germany', Soc. Hist. Med, 1998, 11 (1): 49-72.
38. Letter from the Medical Board to the Royal Office, Stockholm, 4 October 1802, Letters from the departments, nos. 2492 1802, Kungl. Maj:ts arkiv (Archive of the Royal Office), Riksarkivet.
39. Vaccination report from Carl Trafvenfeldt, Stockholm, 25 October 1802 (E4:1), Medicinalstyrelsens äldre arkiv, Riksarkivet. The Inoculation House was founded in 1766. When vaccination was introduced in 1801, it kept its original name until 1805 when it was changed to 'The Inoculation and Vaccination House'. In 1816 the name was changed to The Vaccination House'. For simplicity's sake I use the final form for references after 1801.
40. Medical Board record, 20 May 1803 (AIA: 55 (423-30:3)), Medicinalstyrelsens äldre arkiv, Riksarkivet.
41. Compulsory vaccination was introduced into Bavaria in 1807, Denmark in 1810 and Norway in 1811. These laws in these countries did actually state indirect obligation. In Denmark, for example, people needed a vaccination certficate in order to get confirmed or married. The Swedish law had no such links, it simply stated that a fine was payable by those parents who had not vaccinated their children before the age of two years. J Stein, 'Die Pockenvakzination in Preussen bis zum Reichsimpfgesetz von 1874 unter besonderer Berücksichtigung des Regierungsbezirkes Frankfurt (Oder)', Zeitschrift für ärtzliche Fortbildung, 1987, 20: 1081-83; A Völker, 'Einige Markierungspunkte aus der Geschichte der Pockenschutzimpfung', Zeitschrift für die gesamte innere Medizin und ihre Grenzgebiete, 1990, 13: 392-96 ; O Malm, Kopper og Vaccinationen i Norge, Kristiania, H Aschehoug, 1915, pp. 71-4; and P Thestrup, Vaccinations-kommissionen og befolkningsstatistikken', in K Hjort (ed.), Spor-arkiver og historia, Copenhagen, Riesarkivet, GAD, 1987, pp. 339-61, on pp. 342-6.
42. Compulsory vaccination was introduced into Bavaria in 1807, Denmark in 1810 and Norway in 1811. These laws in these countries did actually state indirect obligation. In Denmark, for example, people needed a vaccination certficate in order to get confirmed or married. The Swedish law had no such links, it simply stated that a fine was payable by those parents who had not vaccinated their children before the age of two years. J Stein, 'Die Pockenvakzination in Preussen bis zum Reichsimpfgesetz von 1874 unter besonderer Berücksichtigung des Regierungsbezirkes Frankfurt (Oder)', Zeitschrift für ärtzliche Fortbildung, 1987, 20: 1081-83; A Völker, 'Einige Markierungspunkte aus der Geschichte der Pockenschutzimpfung', Zeitschrift für die gesamte innere Medizin und ihre Grenzgebiete, 1990, 13: 392-96 ; O Malm, Kopper og Vaccinationen i Norge, Kristiania, H Aschehoug, 1915, pp. 71-4; and P Thestrup, Vaccinations-kommissionen og befolkningsstatistikken', in K Hjort (ed.), Spor-arkiver og historia, Copenhagen, Riesarkivet, GAD, 1987, pp. 339-61, on pp. 342-6.
43. Compulsory vaccination was introduced into Bavaria in 1807, Denmark in 1810 and Norway in 1811. These laws in these countries did actually state indirect obligation. In Denmark, for example, people needed a vaccination certficate in order to get confirmed or married. The Swedish law had no such links, it simply stated that a fine was payable by those parents who had not vaccinated their children before the age of two years. J Stein, 'Die Pockenvakzination in Preussen bis zum Reichsimpfgesetz von 1874 unter besonderer Berücksichtigung des Regierungsbezirkes Frankfurt (Oder)', Zeitschrift für ärtzliche Fortbildung, 1987, 20: 1081-83; A Völker, 'Einige Markierungspunkte aus der Geschichte der Pockenschutzimpfung', Zeitschrift für die gesamte innere Medizin und ihre Grenzgebiete, 1990, 13: 392-96 ; O Malm, Kopper og Vaccinationen i Norge, Kristiania, H Aschehoug, 1915, pp. 71-4; and P Thestrup, Vaccinations-kommissionen og befolkningsstatistikken', in K Hjort (ed.), Spor-arkiver og historia, Copenhagen, Riesarkivet, GAD, 1987, pp. 339-61, on pp. 342-6.
44. Compulsory vaccination was introduced into Bavaria in 1807, Denmark in 1810 and Norway in 1811. These laws in these countries did actually state indirect obligation. In Denmark, for example, people needed a vaccination certficate in order to get confirmed or married. The Swedish law had no such links, it simply stated that a fine was payable by those parents who had not vaccinated their children before the age of two years. J Stein, 'Die Pockenvakzination in Preussen bis zum Reichsimpfgesetz von 1874 unter besonderer Berücksichtigung des Regierungsbezirkes Frankfurt (Oder)', Zeitschrift für ärtzliche Fortbildung, 1987, 20: 1081-83; A Völker, 'Einige Markierungspunkte aus der Geschichte der Pockenschutzimpfung', Zeitschrift für die gesamte innere Medizin und ihre Grenzgebiete, 1990, 13: 392-96 ; O Malm, Kopper og Vaccinationen i Norge, Kristiania, H Aschehoug, 1915, pp. 71-4; and P Thestrup, Vaccinations-kommissionen og befolkningsstatistikken', in K Hjort (ed.), Spor-arkiver og historia, Copenhagen, Riesarkivet, GAD, 1987, pp. 339-61, on pp. 342-6.
45. Sköld, op. cit. note 21 above, pp. 450-60.
46. Gustafsson concludes "that the united department, firmly establishing medical leadership over Sweden's medical organization, appeared more than sixty years before modern breakthroughs in science". Gustafsson, op. cit., note 3 above, pp. 230-43. Letter from the Medical Board to the Royal Office, Stockholm, 25 May 1824, (48:331), Kungl. Maj:ts arkiv, Riksarkivet.
47. Dr Carro of Vienna had vaccinated the Count de la Gardie's only son and had then been told that the Swedish King was a keen partisan of vaccination; "Le Comte a communiqué cette inoculation á Májesté, qui lui a ecrit unne lettre de felicitation & d'approbation dávoir su profiter d'une decouvérte, jui promet dáusi grands avantages a l'humanité". C F Liljewalch, 'Bref til Kongl. Collegium Medicum ansående en Utländsk Resa', Läkaren och Naturforskaren, Strängnäs, 1805, 14: 376.
48. Letter from the Medical Board to the Royal Office, 21 January 1802, vol. 145, Kungl. Maj:ts arkiv, Riksarkivet. C Zetterström, Initia historiae vaccinationis in Srecia, Uppsala, Zeipel & Palmblad, 1816-1821, pp. 98-9.
49. Royal letter to the Medical Board, 26 January 1802, Kungl. Maj:ts arkiv, vol. 145, Zetterström, op. cit., note 44 above, pp. 99-200. The King and the Parliament continued to support vaccination. In 1818 a Swedish medical journal stated that "It must be generally concluded that there has not been any other country where vaccination from its beginning was so tenderly supported by the government, so unselfishly and carefully carried out by physicians, and so unhindered and unopposed by the prejudice of the nation, than in Sweden". Kort öfversigt af Svenska Medicinal-Verket. Medicinsk Tidning, no. 16, 17 December 1818.
50. Royal letter to the Medical Board, 26 January 1802, Kungl. Maj:ts arkiv, vol. 145, Zetterström, op. cit., note 44 above, pp. 99-200. The King and the Parliament continued to support vaccination. In 1818 a Swedish medical journal stated that "It must be generally concluded that there has not been any other country where vaccination from its beginning was so tenderly supported by the government, so unselfishly and carefully carried out by physicians, and so unhindered and unopposed by the prejudice of the nation, than in Sweden". Kort öfversigt af Svenska Medicinal-Verket. Medicinsk Tidning, no. 16, 17 December 1818.
51. Stockholms-Posten, no. 257, 10 November 1801. Zetterström, op. cit, note 44 above, pp. 28-9.
52. Stockholms-Posten, no. 257, 10 November 1801. Zetterström, op. cit, note 44 above, pp. 28-9.
53. Inrikes Tidningar, no. 16, 11 January 1802. Zetterström, op. cit, note 44 above, p. 102.
54. Inrikes Tidningar, no. 16, 11 January 1802. Zetterström, op. cit, note 44 above, p. 102.
55. Medical Board record, 8 February 1802 (AIA:54), Medicinalstyrelsens äldre arkiv, Riksarkivet. Zetterström, op. cit., note 44 above, p. 102.
56. Medical Board record, 8 February 1802 (AIA:54), Medicinalstyrelsens äldre arkiv, Riksarkivet. Zetterström, op. cit., note 44 above, p. 102.
57. 'Kongl. Collegii Medici underdåniga Utlåtande till Kongl. Maj:t om Vaccinationen', Stockholms-Posten, no. 238, 19 October 1802.
58. Royal letter, 13 October 1802 (E2:58), Medicinalstyrelsens äldre arkiv, Riksarkivet. Royal letter, 13 October 1802. Inrikes Tidningar, no. 121, 5 November 1802.
59. Inrikes Tidningar, no. 133, 3 December 1802.
60. A Wistrand, Svenska Läkarbefattningar och deras Innehavare, Karlshamn, Svenska Läkareförbundets Förlagsaktiebolag, 1943, pp. 7-8.
61. Vaccination report from Dr Noraeus, Kristianstad, 4 October 1804. Vaccination reports 1802-1805 (E4:1), Medicinalstyrelsens äldre arkiv, Riksarkivet.
62. Vaccination report from Dr Noraeus, Kristianstad, 4 October 1804. Vaccination reports 1802-1805 (E4:1), Medicinalstyrelsens äldre arkiv, Riksarkivet.
63. Letter from the Medical Board to the Royal Office, Stockholm, 13 May 1805, vol. 145 (22: 1420), Kungl. Maj:ts arkiv, Riksarkivet.
64. Royal letter, 19 June 1805 (E2:60), Medicinalstyrelsens äldre arkiv, Riksarkivet. A Wistrand, Författningar angående Medicinalväsendet i Sverige, Stockholm, P A Norstedt & Söner, 1860, vol. 2, p. 54.
65. Production and distribution of consistently high quality vaccine were major problems also during the first WHO campaign to eradicate smallpox in 1959. J W Hopkins, The eradication of smallpox: organizational learning and innovation in international health, Boulder, CO, Westview, 1989, p. 7; J G Rigau-Pérez, 'Strategies that led to the eradication of smallpox in Puerto Rico, 1882-1921', Bull. Hist. Med., 1985, 59 (1): 75-88.
66. Production and distribution of consistently high quality vaccine were major problems also during the first WHO campaign to eradicate smallpox in 1959. J W Hopkins, The eradication of smallpox: organizational learning and innovation in international health, Boulder, CO, Westview, 1989, p. 7; J G Rigau-Pérez, 'Strategies that led to the eradication of smallpox in Puerto Rico, 1882-1921', Bull. Hist. Med., 1985, 59 (1): 75-88.
67. Vaccination report from Dr Almroth, Stockholm, 30 November 1802, Vaccination reports 1802-1805 (E4:1), Medicinalstyrelsens aldre arkiv, Riksarkivet.
68. Vaccination report from Dr Almroth, Stockholm, 30 November 1802, Vaccination reports 1802-1805 (E4:1), Medicinalstyrelsens aldre arkiv, Riksarkivet.
69. Medical Board record, 20 May 1803 (A1A: 55 (423-30:3)), Medicinalstyrelsens äldre arkiv, Riksarkivet.
70. Letter from the Medical Board to the Royal Office, Stockholm, 16 November 1812, vol. 145 (26:668), Kungl. Maj:ts arkiv, Riksarkivet.
71. Letter from the Medical Board to the Royal Office, Stockholm, 2 November 1812, vol. 145 (28:641), Kungl. Maj:ts arkiv, Riksarkivet.
72. Letter from the Medical Board to the Royal Office, Stockholm, 29 August 1814, vol. 145 (28: 540), Kungl. Maj:ts arkiv, Riksarkivet.
73. Kongl. Maj:ts nådiga reglemente för vaccinationen i riket. Gifwit Stockholms slott den 6 Mars 1816, Stockholm, 1816.
74. Bidrag till Sveriges Officiella Statistik (BiSOS) 1851-60, vol. K Health care, Stockholm, 1861, p. 58.
75. Bidrag till Sveriges Officiella Statistik (BiSOS) 1873, vol. K Health care, Stockholm, 1873, p. 63.
76. Letter from the Medical Board to the Royal Office, Stockholm, 23 October 1826, vol. 145 (52: 462), Kungl. Maj:ts arkiv, Riksarkivet.
77. Kongl. Maj:ts Sundhets-Collegii Circulaire till wederbörande Chefs-Embeten, angående Revaccinationen of Recrüter; utfärdadt den 15 Febntari 1849, Stockholm, 1849.
78. F Fenner, D A Henderson, I Arita, Z Jezek, I D Ladnyi, Smallpox and its eradication, Geneva, World Health Organization, 1988, p. 515.
79. Norrman, op cit., note 1 above, pp. 105-6. Kongl. Collegii Medici kungörelse, om wissa föreskrifter och underrättelser til vaccinationens almännare och säkrare befrämjande i riket. Med Kongl. Maj:ts nådigste samtycke. Gifwen Stockholms slott den 14 Julii 1810, Stockholm, 1810. Kongl. Maj:ts nådiga reglemente för vaccinationen i riket. Gifwit Stockholms slott den 6 mars 1816, Stockholm, 1816. Kungl. Maj:ts Instruction för provinsial-läkare i riket. Gifwen 13 Juni 1822, Stockholm, 1822, § 12. Kongl. Sundhets-Collegii till Kongl. Maj:t inlemnade underdåniga förslag till förnyadt Nådigt Reglemente för skyddskoppympningen i Riket, Stockholm, 1852, pp. 8-9. In renewed instructions for vaccination in Sweden some of the responsibility previously held by district physicians was given to the county governors. The physicians were to supply the vaccinators with vaccine lymph and send in reports. Nevertheless, they were dominant in the drawing up of the new instruction. Medicinalstyrelsens underdåniga skrifvelse med anledning af de särskilda yttranden, som af Kongl. Maj:t infordrats öfver Styrelsens förslag till nytt vaccinalionsreglemente, Supplement to Hygiea, 1896, 58 (1): 1-107, p. 107.
80. Norrman, op cit., note 1 above, pp. 105-6. Kongl. Collegii Medici kungörelse, om wissa föreskrifter och underrättelser til vaccinationens almännare och säkrare befrämjande i riket. Med Kongl. Maj:ts nådigste samtycke. Gifwen Stockholms slott den 14 Julii 1810, Stockholm, 1810. Kongl. Maj:ts nådiga reglemente för vaccinationen i riket. Gifwit Stockholms slott den 6 mars 1816, Stockholm, 1816. Kungl. Maj:ts Instruction för provinsial-läkare i riket. Gifwen 13 Juni 1822, Stockholm, 1822, § 12. Kongl. Sundhets-Collegii till Kongl. Maj:t inlemnade underdåniga förslag till förnyadt Nådigt Reglemente för skyddskoppympningen i Riket, Stockholm, 1852, pp. 8-9. In renewed instructions for vaccination in Sweden some of the responsibility previously held by district physicians was given to the county governors. The physicians were to supply the vaccinators with vaccine lymph and send in reports. Nevertheless, they were dominant in the drawing up of the new instruction. Medicinalstyrelsens underdåniga skrifvelse med anledning af de särskilda yttranden, som af Kongl. Maj:t infordrats öfver Styrelsens förslag till nytt vaccinalionsreglemente, Supplement to Hygiea, 1896, 58 (1): 1-107, p. 107.
81. Norrman, op cit., note 1 above, pp. 105-6. Kongl. Collegii Medici kungörelse, om wissa föreskrifter och underrättelser til vaccinationens almännare och säkrare befrämjande i riket. Med Kongl. Maj:ts nådigste samtycke. Gifwen Stockholms slott den 14 Julii 1810, Stockholm, 1810. Kongl. Maj:ts nådiga reglemente för vaccinationen i riket. Gifwit Stockholms slott den 6 mars 1816, Stockholm, 1816. Kungl. Maj:ts Instruction för provinsial-läkare i riket. Gifwen 13 Juni 1822, Stockholm, 1822, § 12. Kongl. Sundhets-Collegii till Kongl. Maj:t inlemnade underdåniga förslag till förnyadt Nådigt Reglemente för skyddskoppympningen i Riket, Stockholm, 1852, pp. 8-9. In renewed instructions for vaccination in Sweden some of the responsibility previously held by district physicians was given to the county governors. The physicians were to supply the vaccinators with vaccine lymph and send in reports. Nevertheless, they were dominant in the drawing up of the new instruction. Medicinalstyrelsens underdåniga skrifvelse med anledning af de särskilda yttranden, som af Kongl. Maj:t infordrats öfver Styrelsens förslag till nytt vaccinalionsreglemente, Supplement to Hygiea, 1896, 58 (1): 1-107, p. 107.
82. Norrman, op cit., note 1 above, pp. 105-6. Kongl. Collegii Medici kungörelse, om wissa föreskrifter och underrättelser til vaccinationens almännare och säkrare befrämjande i riket. Med Kongl. Maj:ts nådigste samtycke. Gifwen Stockholms slott den 14 Julii 1810, Stockholm, 1810. Kongl. Maj:ts nådiga reglemente för vaccinationen i riket. Gifwit Stockholms slott den 6 mars 1816, Stockholm, 1816. Kungl. Maj:ts Instruction för provinsial-läkare i riket. Gifwen 13 Juni 1822, Stockholm, 1822, § 12. Kongl. Sundhets-Collegii till Kongl. Maj:t inlemnade underdåniga förslag till förnyadt Nådigt Reglemente för skyddskoppympningen i Riket, Stockholm, 1852, pp. 8-9. In renewed instructions for vaccination in Sweden some of the responsibility previously held by district physicians was given to the county governors. The physicians were to supply the vaccinators with vaccine lymph and send in reports. Nevertheless, they were dominant in the drawing up of the new instruction. Medicinalstyrelsens underdåniga skrifvelse med anledning af de särskilda yttranden, som af Kongl. Maj:t infordrats öfver Styrelsens förslag till nytt vaccinalionsreglemente, Supplement to Hygiea, 1896, 58 (1): 1-107, p. 107.
83. Norrman, op cit., note 1 above, pp. 105-6. Kongl. Collegii Medici kungörelse, om wissa föreskrifter och underrättelser til vaccinationens almännare och säkrare befrämjande i riket. Med Kongl. Maj:ts nådigste samtycke. Gifwen Stockholms slott den 14 Julii 1810, Stockholm, 1810. Kongl. Maj:ts nådiga reglemente för vaccinationen i riket. Gifwit Stockholms slott den 6 mars 1816, Stockholm, 1816. Kungl. Maj:ts Instruction för provinsial-läkare i riket. Gifwen 13 Juni 1822, Stockholm, 1822, § 12. Kongl. Sundhets-Collegii till Kongl. Maj:t inlemnade underdåniga förslag till förnyadt Nådigt Reglemente för skyddskoppympningen i Riket, Stockholm, 1852, pp. 8-9. In renewed instructions for vaccination in Sweden some of the responsibility previously held by district physicians was given to the county governors. The physicians were to supply the vaccinators with vaccine lymph and send in reports. Nevertheless, they were dominant in the drawing up of the new instruction. Medicinalstyrelsens underdåniga skrifvelse med anledning af de särskilda yttranden, som af Kongl. Maj:t infordrats öfver Styrelsens förslag till nytt vaccinalionsreglemente, Supplement to Hygiea, 1896, 58 (1): 1-107, p. 107.
84. Norrman, op cit., note 1 above, pp. 105-6. Kongl. Collegii Medici kungörelse, om wissa föreskrifter och underrättelser til vaccinationens almännare och säkrare befrämjande i riket. Med Kongl. Maj:ts nådigste samtycke. Gifwen Stockholms slott den 14 Julii 1810, Stockholm, 1810. Kongl. Maj:ts nådiga reglemente för vaccinationen i riket. Gifwit Stockholms slott den 6 mars 1816, Stockholm, 1816. Kungl. Maj:ts Instruction för provinsial-läkare i riket. Gifwen 13 Juni 1822, Stockholm, 1822, § 12. Kongl. Sundhets-Collegii till Kongl. Maj:t inlemnade underdåniga förslag till förnyadt Nådigt Reglemente för skyddskoppympningen i Riket, Stockholm, 1852, pp. 8-9. In renewed instructions for vaccination in Sweden some of the responsibility previously held by district physicians was given to the county governors. The physicians were to supply the vaccinators with vaccine lymph and send in reports. Nevertheless, they were dominant in the drawing up of the new instruction. Medicinalstyrelsens underdåniga skrifvelse med anledning af de särskilda yttranden, som af Kongl. Maj:t infordrats öfver Styrelsens förslag till nytt vaccinalionsreglemente, Supplement to Hygiea, 1896, 58 (1): 1-107, p. 107.
85. During their travels to carry out vaccination, district physicians were given an opportunity to examine and better understand the situation, especially in the northern counties. This was of importance for the organization of medical care in general. L Öhman, Hur sjukvården kom till norr. En kulturhistorisk skildring med utgångspunkt från mellersta Lappland, Växjö, Tore Sail InfoMedia, 1987, pp. 103-4.
86. Another initiative was taken by the county governor of the district of Örebro in 1815. The plan presented was approved by the Medical Board, who even wanted to make it the general rule in Sweden. As with the other district organization plans, the basic structure was found in the Vaccination Law of 1816. Letter from the Medical Board to the Royal Office, Stockholm, 27 February 1815, vol. 145 (30:107), Kungl. Maj: ts arkiv, Riksarkivet.
87. Kongl. Maj:ts nådiga reglemente för vaccinationen i riket. Gifwit Stockholms slott den 6 Mars 1816, Stockholm, 1816.
88. Vaccination report from the southern part of Stockholm district 1807, Vaccination reports 1808 (E4:4), Medicinalstyrelsens äldre arkiv, Riksarkivet.
89. Vaccine organization in Härjedalen district 1851, Papers concerning vaccination 1851-58, vol. 1., Provinsialläkarens arkiv (District Physicians archive), Östersunds Landsarkiv. In the late nineteenth century the supervisors were criticized. In 1892 Dr Möller claimed that they had signed a record of vaccinated children without examining it. A H T Möller, 'Om förändringar i nu gällande stadgar angående skyddsympningen', Eira. Tidskrift för helso- och sjukvård, 1892, 16 (22): 693-99, p. 695. See also 'Det omredigerade förslaget till nytt vaccinations-reglemente', Eira. Tidskrift for helso- och sjukrård, 1896, 20 (2): 184-9.
90. Vaccine organization in Härjedalen district 1851, Papers concerning vaccination 1851-58, vol. 1., Provinsialläkarens arkiv (District Physicians archive), Östersunds Landsarkiv. In the late nineteenth century the supervisors were criticized. In 1892 Dr Möller claimed that they had signed a record of vaccinated children without examining it. A H T Möller, 'Om förändringar i nu gällande stadgar angående skyddsympningen', Eira. Tidskrift för helso- och sjukvård, 1892, 16 (22): 693-99, p. 695. See also 'Det omredigerade förslaget till nytt vaccinations-reglemente', Eira. Tidskrift for helso- och sjukrård, 1896, 20 (2): 184-9.
91. Vaccine organization in Härjedalen district 1851, Papers concerning vaccination 1851-58, vol. 1., Provinsialläkarens arkiv (District Physicians archive), Östersunds Landsarkiv. In the late nineteenth century the supervisors were criticized. In 1892 Dr Möller claimed that they had signed a record of vaccinated children without examining it. A H T Möller, 'Om förändringar i nu gällande stadgar angående skyddsympningen', Eira. Tidskrift för helso- och sjukvård, 1892, 16 (22): 693-99, p. 695. See also 'Det omredigerade förslaget till nytt vaccinations-reglemente', Eira. Tidskrift for helso- och sjukrård, 1896, 20 (2): 184-9.
92. When the first handbook on vaccination was distributed in 1813, Nils Rosén von Rosenstein estimated that the number of churches in Sweden was 2,444. Report from Nils Rosén von Rosenstein, Stockholm, 26 May 1813, Excerpts from vaccination reports 1817-1837 (E12B:3), Medicinalstyrelsens äldre arkiv, Riksarkivet.
93. See, for example, the record of a meeting in Säresta parish on 12 December 1802, Vaccination report from Rev. Olof Haggren, Nordhammar parish, 30 September 1802, Vaccination reports 1802-1805 (E4:1), Medicinalstyrelsens äldre arkiv, Riksarkivet. G Wikmark, Edvard Rhén. Lapplandspräst och Upplandsprost, Skytteanska Samfundets Handlinear Nr 36, Kungl. Umeå, 1989, pp. 12-16 and 44-50.
94. See, for example, the record of a meeting in Säresta parish on 12 December 1802, Vaccination report from Rev. Olof Haggren, Nordhammar parish, 30 September 1802, Vaccination reports 1802-1805 (E4:1), Medicinalstyrelsens äldre arkiv, Riksarkivet. G Wikmark, Edvard Rhén. Lapplandspräst och Upplandsprost, Skytteanska Samfundets Handlinear Nr 36, Kungl. Umeå, 1989, pp. 12-16 and 44-50.
95. See, for example, the record of a meeting in Säresta parish on 12 December 1802, Vaccination report from Rev. Olof Haggren, Nordhammar parish, 30 September 1802, Vaccination reports 1802-1805 (E4:1), Medicinalstyrelsens äldre arkiv, Riksarkivet. G Wikmark, Edvard Rhén. Lapplandspräst och Upplandsprost, Skytteanska Samfundets Handlinear Nr 36, Kungl. Umeå, 1989, pp. 12-16 and 44-50.
96. Vaccination report from the Rev. J P Wallensteen, Kuddby, 26 April 1808, Vaccination reports 1808-1809 (E4:4, no. 45), Medicinalstyrelsens äldre arkiv, Riksarkivet.
97. Vaccination report from the Rev. J P Wallensteen, Kuddby, 26 April 1808, Vaccination reports 1808-1809 (E4:4, no. 45), Medicinalstyrelsens äldre arkiv, Riksarkivet.
98. Vaccination report from Johan August Lenaeus Knutsson, Garphytte bruk, 4 February 1813, Vaccination reports 1812:2 (E4:7), Medicinalstyrelsens aldre arkiv, Riksarkivet.
99. Vaccination report from Johan August Lenaeus Knutsson, Garphytte bruk, 4 February 1813, Vaccination reports 1812:2 (E4:7), Medicinalstyrelsens aldre arkiv, Riksarkivet.
100. Letter from the Medical Board to the Royal Office, Stockholm, 12 January 1811, vol. 145 (25: 5), Kungl. Maj:ts arkiv, Riksarkivet.
101. Sköld, op. cit., note 21 above, pp. 501-15.
102. Sjukdomars härjande åren 1795-1812, Vaccinerade 1804-8, 1811-12, Bllc:1, Statistiska Centralbyråns arkiv, den äldre Tabellkommissionen (the older archive of Tabellkommissionen), No. 29, Riksarkivet.
103. Vaccination report from Dr Gistrén, Vaccination reports 1806, E4:2(60), Medicinalstyrelsens äldre arkiv, Riksarkivet.
104. Letter from the Medical Board to the Royal Office, 4 June 1804, vol. 145 (1076), Kungl. Maj:t arkiv, Riksarkivet.
105. Öfwer-Ståthållare-Embetets Kungörelse, om Det af Kongl. Maj:t, jemte widtagne anstalter til Vaccinationens befrämjande här i staden, tillika utsatte answar för dem, som underlåta at anmäla yppad naturlig koppsmitta, Stockholm, 11 April 1805.
106. Letter from the Medical Board to the Royal Office, 16 March 1805, vol. 145 (715), Kungl. Maj:ts arkiv, Riksarkivet.
107. Annual report from the first town physician, Gustaf Grähs, Stockholm, 1874, Annual reports from district physicians, E5A:44, Medicinalstyrelsens äldre arkiv, Riksarkivet.
108. Annual report from the first town physician, Gustaf Grähs, Stockholm, 1874, Annual reports from district physicians, E5A:44, Medicinalstyrelsens äldre arkiv, Riksarkivet.
109. P J Bergius, 'Anmärkningar i anledning af sista Koppe-epidemin',in Kongl. Vetenskaps Academiens Nya Handlingar, 1784, 5: 154-55.
110. Öfwer-Ståthållare-Embetets Kungörelse, om Del af Kongl. Maj:t, jemte widtagne anstalter til Vaccinationens befrämjande här i staden, tillika utsatte answar för dem, som underlåta at anmäla yppad naturlig koppsmitta, Stockholm, 11 April 1805.
111. Öfwer-Ståthållare-Embetets Kungörelse om answar för dem som underlåta at Waccinera sine barn, Stockholm, 7 April 1815.
112. Letter from the Medical Board to the Royal Office, 26 February 1807, vol. 145 (533), Kungl. Maj:ts arkiv, Riksarkivet.
113. Letter from Sundhetskollegium to the Royal Office, 14 February 1817, vol. 145, Kungl. Maj:ts arkiv, Riksarkivet.
114. Vaccination report from Carl Trafvenfeldt, 28 June 1806, Vaccination reports, E4:2 (58), Medicinalstyrelsens äldre arkiv, Riksarkivet.
115. K. Sundhets-Collegii till Kongl. Maj:t inlemnade underdåniga förslag till särskildta föreskrifter rörande skyddskoppympningen i hufvudstaden, Stockholm, 21 June 1852.
116. Över-Ståthållare-Embetets Kungörelse om åtskilliga ytterligare åtgärder till Waccinationens befodran och framgång inom hufwudstaden, Stockholm, 15 January 1816.
117. K. Sundhets-Collegii till Kongl. Maj:t inlemnade underdåniga förslag till särskildta föreskrifter rörande skyddskoppympningen i hufvudstaden, Stockholm, 21 June 1852.
118. A Emch-Dériaz, 'L'inoculation justifiée - or was it?' Eighteenth-Century Life, 1983, 7 (2): 65-72.
119. Sköld, op. cit., note 21 above, p. 571.
120. Söderberg, op. cit., note 11 above, pp. 154-8, 228-36, 244-6.
121. Ibid, pp. 148-53. H Gahn, Moralstatistiska uppgifter i Frihetstidens Tabellverk. En demografisk studie, Uppsala, K W Appelbergs, 1915, pp. 20-1.
122. Ibid, pp. 148-53. H Gahn, Moralstatistiska uppgifter i Frihetstidens Tabellverk. En demografisk studie, Uppsala, K W Appelbergs, 1915, pp. 20-1.
123. The children were claimed to have been accidentally choked to death during sleep in the bed of their mother or the woman who breast-fed them. K. G Odén, Stalislisk undersökning rörande våldsamma dödsfall i Sverige. I, Stockholm, P A Norstedt & Söner, 1875, pp. xx-xxi; E Nyström, 'The development of cause-of-death classification in eighteenth century Sweden. A survey of problems, sources and possibilities', in A Brändström and L-G Tedebrand (eds), Society, health and population during the demographic transition, Stockholm, Almqvist & Wiksell, 1988, pp. 109-29.
124. The children were claimed to have been accidentally choked to death during sleep in the bed of their mother or the woman who breast-fed them. K. G Odén, Stalislisk undersökning rörande våldsamma dödsfall i Sverige. I, Stockholm, P A Norstedt & Söner, 1875, pp. xx-xxi; E Nyström, 'The development of cause-of-death classification in eighteenth century Sweden. A survey of problems, sources and possibilities', in A Brändström and L-G Tedebrand (eds), Society, health and population during the demographic transition, Stockholm, Almqvist & Wiksell, 1988, pp. 109-29.
125. E Johansson, The history of literacy in Sweden in comparison with some other countries, Educational reports 12, Umeå University, 1977, pp. 34-6; U Högberg, Svagårens barn. Ur folkhälsans historia, Stockholm, Liber, pp. 19-23.
126. E Johansson, The history of literacy in Sweden in comparison with some other countries, Educational reports 12, Umeå University, 1977, pp. 34-6; U Högberg, Svagårens barn. Ur folkhälsans historia, Stockholm, Liber, pp. 19-23.
127. B Vahlqvist, 'Nils Rosén von Rosenstein and his textbook on pediatrics', in B Vahlqvist and A Wallgren (eds), Diseases of children and their remedies, Acta Paediatrica, suppl. 156, Stockholm, 1964, pp. 27-69; Larsson, op. cit., note 33 above, pp. 49-50; Sköld, op. cit., note 21 above, pp. 255-8.
128. B Vahlqvist, 'Nils Rosén von Rosenstein and his textbook on pediatrics', in B Vahlqvist and A Wallgren (eds), Diseases of children and their remedies, Acta Paediatrica, suppl. 156, Stockholm, 1964, pp. 27-69; Larsson, op. cit., note 33 above, pp. 49-50; Sköld, op. cit., note 21 above, pp. 255-8.
129. B Vahlqvist, 'Nils Rosén von Rosenstein and his textbook on pediatrics', in B Vahlqvist and A Wallgren (eds), Diseases of children and their remedies, Acta Paediatrica, suppl. 156, Stockholm, 1964, pp. 27-69; Larsson, op. cit., note 33 above, pp. 49-50; Sköld, op. cit., note 21 above, pp. 255-8.
130. E Arosenius, The history and organization of Swedish official statistics', in J Koren (ed.), The history of statistics: their development and progress in many countries, 1st ed. 1918, New York, Burt Franklin, 1970, pp. 535-69.
131. R Qvarsell, Vårdens idéhistoria, Stockholm, Carlssons, 1991, p. 160.
132. E Johansson, 'Prästerna i övre Norrlands kustbygd - Blad ur ett forskningsprojekt', in S Henrysson (ed.), Samer, präster och skolmästare. Ett kulturellt perspektiv på samernas och Övre Norrlands historia, Rapport nr 23, Umeå, Centrum för arktisk forskning, 1993, pp. 97-122, 118-19.
133. Hopkins, op. cit., note 56 above, pp. 51-2.
134. D Henderson, 'An end - and a beginning', World Health, Feb.-March 1975: 12-17, on p. 17; D J Sencer, 'Lessons for the future', ibid., pp. 18-21; Hopkins, op. cit. note 56 above, pp. 62-3; Fenner, et al., op. cit., note 67 above, p. 515.
135. D Henderson, 'An end - and a beginning', World Health, Feb.-March 1975: 12-17, on p. 17; D J Sencer, 'Lessons for the future', ibid., pp. 18-21; Hopkins, op. cit. note 56 above, pp. 62-3; Fenner, et al., op. cit., note 67 above, p. 515.
136. D Henderson, 'An end - and a beginning', World Health, Feb.-March 1975: 12-17, on p. 17; D J Sencer, 'Lessons for the future', ibid., pp. 18-21; Hopkins, op. cit. note 56 above, pp. 62-3; Fenner, et al., op. cit., note 67 above, p. 515.
137. D Henderson, 'An end - and a beginning', World Health, Feb.-March 1975: 12-17, on p. 17; D J Sencer, 'Lessons for the future', ibid., pp. 18-21; Hopkins, op. cit. note 56 above, pp. 62-3; Fenner, et al., op. cit., note 67 above, p. 515.
138. Kongl. Maj:ts Nådiga Circulaire Til Samtelige Landshöfdingarne och Consistorierne, om Hrad iakttagas bör i afseende på Smittosamma Sjukdomar. Gifvet Haga Slott den 25 Augusti 1813, Stockholm, 1813. Kongl. Maj: ts nådiga reglemente för vaccinationen i riket. Gifwet Stockholms slott den 6 mars 1816, Stockholm, 1816. See also Norrman, op. cit., note 1 above, pp. 105-6. 'Kongl. Maj:ts nådiga kungörelse om ändringar och tillägg uti en del Medicinal-författningar, till beredande af en förbättrad hälsowård i Landsorterne. Gifwen Stockholms Slott den 27 Februarii 1828', in Swensk Författnings Samling, 1828, no. 77, pp. 1523-7.
139. Kongl. Maj:ts Nådiga Circulaire Til Samtelige Landshöfdingarne och Consistorierne, om Hrad iakttagas bör i afseende på Smittosamma Sjukdomar. Gifvet Haga Slott den 25 Augusti 1813, Stockholm, 1813. Kongl. Maj: ts nådiga reglemente för vaccinationen i riket. Gifwet Stockholms slott den 6 mars 1816, Stockholm, 1816. See also Norrman, op. cit., note 1 above, pp. 105-6. 'Kongl. Maj:ts nådiga kungörelse om ändringar och tillägg uti en del Medicinal-författningar, till beredande af en förbättrad hälsowård i Landsorterne. Gifwen Stockholms Slott den 27 Februarii 1828', in Swensk Författnings Samling, 1828, no. 77, pp. 1523-7.
140. Kongl. Maj:ts Nådiga Circulaire Til Samtelige Landshöfdingarne och Consistorierne, om Hrad iakttagas bör i afseende på Smittosamma Sjukdomar. Gifvet Haga Slott den 25 Augusti 1813, Stockholm, 1813. Kongl. Maj: ts nådiga reglemente för vaccinationen i riket. Gifwet Stockholms slott den 6 mars 1816, Stockholm, 1816. See also Norrman, op. cit., note 1 above, pp. 105-6. 'Kongl. Maj:ts nådiga kungörelse om ändringar och tillägg uti en del Medicinal-författningar, till beredande af en förbättrad hälsowård i Landsorterne. Gifwen Stockholms Slott den 27 Februarii 1828', in Swensk Författnings Samling, 1828, no. 77, pp. 1523-7.
141. Kongl. Maj:ts Nådiga Circulaire Til Samtelige Landshöfdingarne och Consistorierne, om Hrad iakttagas bör i afseende på Smittosamma Sjukdomar. Gifvet Haga Slott den 25 Augusti 1813, Stockholm, 1813. Kongl. Maj: ts nådiga reglemente för vaccinationen i riket. Gifwet Stockholms slott den 6 mars 1816, Stockholm, 1816. See also Norrman, op. cit., note 1 above, pp. 105-6. 'Kongl. Maj:ts nådiga kungörelse om ändringar och tillägg uti en del Medicinal-författningar, till beredande af en förbättrad hälsowård i Landsorterne. Gifwen Stockholms Slott den 27 Februarii 1828', in Swensk Författnings Samling, 1828, no. 77, pp. 1523-7.
142. Towns did not follow the parish system, which forced the authorities to find alternative plans. By 1805 Stockholm had already had its first instructions about vaccination. Öfwer-Ståthållare-Embetets Kungörelse, om Det af Kongl. Maj:t, jemte widtagne anstalter til Vaccinationens befrämjande här i Staden, tillika utsatte answar for dem, som underlåta att anmäla ypppad naturlig Koppsmitta. Gifwen Stockholm den 11 April 1805, Stockholm, 1805.
143. Gustafsson, op. cit. note 3 above, pp. 246-47.
144. Several clergy were also actively practising vaccination, especially at the beginning of the organizational process. Anders Langevall in Dannemora, for example, in 1804 vaccinated many children and promoted the method in the church. When a two-year-old boy died and eight others were infected in 1807, vaccination was generally requested and Langevall knew that he could not vaccinate everyone himself. Therefore he trained two other clergymen and two church assistants. Vaccination report from Rev. Anders Langevall, Dannemora, 17 January 1808, Vaccination reports 1808 (E4:4), Medicinalstyrelsens äldre arkiv, Riksarkivet.
145. W Beskow, Kyrkobokföringen och dermed sammanhängande stadganden. Stockholm, Ivar Hæggströms Tryckeri, 1894, pp. 121-3; Norrman, op. cit. note 1 above, pp. 106-7.
146. W Beskow, Kyrkobokföringen och dermed sammanhängande stadganden. Stockholm, Ivar Hæggströms Tryckeri, 1894, pp. 121-3; Norrman, op. cit. note 1 above, pp. 106-7.
147. England, France, Prussia, and most other European countries had great problems in organizing and promoting vaccination during the first half of the nineteenth century. Sköld, op. cit., note 26 above, pp. 363-7 and pp. 383-6.
148. Fenner, et al., op. cit. note 67 above, p. 515. Leavitt States that the fight against smallpox in the nineteenth century taught Milwaukee public health officials a lot about controlling public health problems. J W Leavitt, The healthiest city: Milwaukee and the politics of health reform, Princeton University Press, 1982, pp. 120-1.
149. Fenner, et al., op. cit. note 67 above, p. 515. Leavitt States that the fight against smallpox in the nineteenth century taught Milwaukee public health officials a lot about controlling public health problems. J W Leavitt, The healthiest city: Milwaukee and the politics of health reform, Princeton University Press, 1982, pp. 120-1.