The two faces of smallpox : a disease and its prevention in eighteenth- and nineteenth-century Sweden

Abstract: This study deals with the history of smallpox in Sweden between 1750 and 1900 and the two preventive measures that were used against it: inoculation during the eighteenth and vaccination during the nineteenth Century. Between 1750 and 1800 300,000 children died from smallpox in Sweden. During the nineteenth Century smallpox death rates decreased considerably and by the end of the Century the disease was very rare. The purpose of this study has been to examine the occurrence of smallpox at local, regional and national levels and to explain the changes in the light of general models of the epidemiologic transition. Smallpox mortality has been analyzed by demographic variables such as age, sex, and social class. The adaptation and practise of inoculation and vaccination has been examined by using a model of preventive health care behaviour.When smallpox mortality decreased sharply at the beginning of the nineteenth century, a greater proportion of adults were represented. More men than women died. Due to diminished immunity most of those who were vaccinated became susceptible about ten years later. There is only a slight tendency that smallpox impaired a persons fertility. Sterility, however, often resulted from an infection. Disfiguring facial pockmarks were also a serious complication of smallpox infection. Those who had been infected from smallpox married later in life than those who were susceptible or vaccinated.Inoculation was never widely accepted in eighteenth-century Sweden since a fatalistic attitude did not encourage preventive measures. The physicians monopoly and a general lack of organization were other important impediments. Vaccination was successfully implemented in 1802 and became the single most important factor for the decrease in smallpox mortality. By employing the clergy and allowing everyone to practise vaccination a great majority of the new-born were immunized. Vaccination rates were raised further when the method was made compulsory in 1816. Since there were no risks involved and after experiencing the advantages of vaccination during smallpox epidemics the inhabitants of Sweden were easily to persuaded of its benefits. By then smallpox had changed from a fatal killer to a rare disease.