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

Two different preventive measures were used against smallpox before this disease was finally eradicated from the world in the 1970s. Inoculation which was based on folk medicine experiences-was brought to Europe and North America in the early eighteenth century. This method aimed to give immunity to smallpox by putting matter from a smallpox pustule into the arm of a susceptible child, thereby causing a mild infection. At the beginning of the nineteenth century, vaccination was employed throughout the world. The difference between inoculation and vaccination was that the latter used matter from cowpox, which did not involve any risk of causing natural smallpox. There were, however, other dissimilarities between the two methods. In this study, the organization of these preventive activities will be compared. The crucial question is why inoculation faced great problems in Sweden, while vaccination was immediately very successful. In its high vaccination rates, Sweden also differed from many other countries, where the method met with resistance or faced problems of organization. Many of the differences between the organization of inoculation and vaccination in Sweden also explain why its vaccination rates differed from those of other countries during the first half of the nineteenth century. The key elements were the local administration and the role of the clergy and their assistants.' The role of the clergy within the medical system dominated medical discussion from 1810;2 this discussion originated with a proposal which Dr Carl Trafvenfeldt, a member of the Medical Board, sent to Parliament in 1809. He suggested that theological and medical education should be brought closer together and that theological students should learn some medicine so they could provide a basic service in their parishes,3 and in this way the countryside would receive better health care. In the absence of a sufficient number of physicians, the church