The Politics of Vaccination: Practice and Policy in England, Wales, Ireland, and Scotland, 1800-1874

Deborah Brunton's The Politics of Vaccination is a useful addition to the historiography of vaccination in the United Kingdom during the nineteenth century. The book explores why the development of public vaccination against smallpox was so “startlingly different” (3, 106, 141) in the four major divisions of the United Kingdom. The author suggests that “the major factor that drove public vaccination along [its] different paths … was a debate about the relationship of medical practitioners to the state” (4). As one example, certain groups of medical men protested that the appointment of a corps of public vaccinators divided any potential unity of the profession and denied patients “the right to a free choice of practitioners” and further ignited fears about “state interfer[ence]” in the matters of the medical profession (4–5) (in this and a few other statements, Brunton's material suggests certain similarities between the nineteenth century vaccination debates and contemporary public health issues). But, she contends, the training and practice of medicine was deeply fragmented along national lines and thus there was no unified medical profession to guide an integrated scientific and legislative approach to public vaccination policy. In England and Wales, particularly under the powerful—but not uncontested—leadership of John Simon (within the Medical Office of the Privy Council), the dominant view was that the medical profession should be hierarchical, led by a small group of experts whose role would include advising government on medical matters and supervising the implementation of medical policy. Consequently, the Medical Office increasingly had the power to oversee a national system of vaccination, not just advise authorities on local sanitary improvements and specific vaccination practices (89–91, 105, 164). In contrast, in Scotland and Ireland, though in quite different and independent fashion, an alternative view dominated; there, a vision emerged of a more democratic profession in which all practitioners possessed the same qualifications and enjoyed reasonably equal access to vaccination work. In Ireland and (to a lesser degree) in Scotland, public vaccination policy and work was to be shared out among large numbers of practitioners who were, as a result of their general medical training, deemed competent to themselves decide when, where, and how to conduct vaccination (165).

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