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The Politics of Vaccination: Practice and Policy in England, Wales, Ireland, and Scotland, 1800-1874 (review)
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The Politics of Vaccination examines the expansion of state intervention in the provision of smallpox vaccination in the British Isles and explains how the medical profession reacted to this development. A major strength of the book is the inclusion of Ireland (and to a lesser extent Scotland) in its coverage. There was separate legislation and distinctive approaches to vaccination in England, Wales, Ireland, and Scotland. (It should be noted at the outset that there is very little on Wales despite its appearance in the title—the author considers the legal entity of "England and Wales" rather than the principality itself, which does not even appear in the index.) The book fills a gap in the historiography in this topic, since, as Deborah Brunton points out in her introduction, the main areas covered by historians looking at this topic are the life and "heroic career" of Edward Jenner at the beginning of the century and the anti-vaccination movements at the century's end.

Vaccination provision at the beginning of the nineteenth century was part of a wave of public registering and monitoring after the organisation of the first census throughout Britain in 1801. Following a failed attempt in 1815 to introduce a free vaccination service for all children, Parliament did not debate the issue again until the 1840 Vaccination Act, which set up an effective public vaccination service for England and Wales that lasted virtually intact until the end of the nineteenth century. Under the Act, the Board of Guardians set up vaccination stations in every Poor Law Union: "in practice, public vaccination was tacked on to the provision of relief" (33). This legislation marked the starting point of systematic state provision of vaccination and the reduction in the role of private practitioners. A second Vaccination Act in 1853 introduced compulsory vaccination in England and Wales.

Brunton successfully uses a variety of medical journals to explain medical practitioners' positions on public vaccination. However, she refers to the activities of medical societies in this campaign in a general way as representative of the medical profession without highlighting the debates among practitioners themselves. Brunton states in her introduction that she "deliberately chose" to use published rather than unpublished materials in order to outline the profession's reactions to the arrival of public vaccination (9). The views represented therefore come from the columns of the medical press, including the Lancet and the Dublin Medical Press, and also from the published memorials of professional agencies including the Royal College of Physicians of Edinburgh (RCPE).

In chapter 4 the author argues that by the mid-nineteenth century "public vaccination policy . . . followed wider patterns of government growth; in the 1850s and 1860s, a range of government departments employed experts to assist their administration and to inspect schools, factories and some forms of transport" (54). This may be so; however, the author's claim that the shift in vaccination policy "also reflected a desire . . . to introduce 'state medicine'" is overstated despite her narrow identification of state medicine as "a coordinated national administration able to ensure proper standards of practice and provision in all health matters" (54).

The Politics of Vaccination demonstrates that Ireland's public vaccination policy was not modelled on provisions for England and Wales, though they both originated in the same 1840 act that provided vaccination free of charge to the whole population under the Poor Law. Before this legislation, there was just one dedicated vaccination charity in Ireland—the Dublin Cow Pock Institution, founded in 1804—which received an annual subsidy from central government and survived until 1889. Outside the capital, thousands more children were vaccinated in the hospitals and dispensaries collectively known as the medical charities. By the 1840s a network of infirmaries, fever hospitals, and 615 dispensaries provided medical care to all poor persons—with dispensaries alone reaching more than one million people. This pre-existing system of health care was not aided by the imposition of vaccination machinery through the newly created Poor Law in Ireland, as boards of guardians were unable or unwilling to provide the necessary funds for the service. Two major pieces of legislation distinctive to Ireland followed this failure: the 1851 Medical Charities Act and the 1858...