%PDF-1.3 1 0 obj << /Type /Catalog /Outlines 2 0 R /Pages 3 0 R >> endobj 2 0 obj << /Type /Outlines /Count 0 >> endobj 3 0 obj << /Type /Pages /Kids [6 0 R 14 0 R 28 0 R 36 0 R 38 0 R ] /Count 5 /Resources << /ProcSet 4 0 R /Font << /F1 8 0 R /F2 9 0 R /F3 10 0 R >> /XObject << /I1 11 0 R >> >> /MediaBox [0.000 0.000 595.280 841.890] >> endobj 4 0 obj [/PDF /Text /ImageC ] endobj 5 0 obj << /Creator (DOMPDF) /CreationDate (D:20141227074045+00'00') /ModDate (D:20141227074045+00'00') /Title (The Politics of Vaccination: Practice and Policy in England, Wales, Ireland and Scotland) >> endobj 6 0 obj << /Type /Page /Parent 3 0 R /Annots [ 12 0 R ] /Contents 7 0 R >> endobj 7 0 obj << /Length 1890 >> stream q 381.750 0 0 120.000 34.016 687.874 cm /I1 Do Q 0.000 0.000 0.000 rg BT 34.016 676.469 Td /F1 12.0 Tf [(Published on )] TJ ET BT 99.356 676.469 Td /F2 12.0 Tf [(Reviews in History)] TJ ET BT 190.016 676.469 Td /F1 12.0 Tf [( \()] TJ ET 0.000 0.000 0.800 rg BT 197.012 676.469 Td /F1 12.0 Tf [(http://www.history.ac.uk/reviews)] TJ ET 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d 197.012 675.075 m 357.332 675.075 l S 0.000 0.000 0.000 rg BT 357.332 676.469 Td /F1 12.0 Tf [(\))] TJ ET 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d 34.391 653.743 526.499 1.500 re S BT 34.016 615.321 Td /F3 18.0 Tf [(The Politics of Vaccination: Practice and Policy in England, Wales, )] TJ ET BT 34.016 593.937 Td /F3 18.0 Tf [(Ireland and Scotland)] TJ ET BT 34.016 563.315 Td /F3 12.0 Tf [(Review Number:)] TJ ET BT 34.016 549.059 Td /F1 12.0 Tf [(692)] TJ ET BT 34.016 534.803 Td /F3 12.0 Tf [(Publish date:)] TJ ET BT 34.016 520.547 Td /F1 12.0 Tf [(Tuesday, 30 September, 2008)] TJ ET BT 34.016 506.291 Td /F3 12.0 Tf [(Author:)] TJ ET BT 34.016 492.035 Td /F1 12.0 Tf [(Deborah Brunton)] TJ ET BT 34.016 477.779 Td /F3 12.0 Tf [(ISBN:)] TJ ET BT 34.016 463.523 Td /F1 12.0 Tf [(978-1-58046-036-1)] TJ ET BT 34.016 449.267 Td /F3 12.0 Tf [(Date of Publication:)] TJ ET BT 34.016 435.011 Td /F1 12.0 Tf [(2008)] TJ ET BT 34.016 420.755 Td /F3 12.0 Tf [(Price:)] TJ ET BT 34.016 406.499 Td /F1 12.0 Tf [(50.00)] TJ ET BT 34.016 392.243 Td /F3 12.0 Tf [(Pages:)] TJ ET BT 34.016 377.987 Td /F1 12.0 Tf [(255pp.)] TJ ET BT 34.016 363.731 Td /F3 12.0 Tf [(Publisher:)] TJ ET BT 34.016 349.475 Td /F1 12.0 Tf [(University of Rochester Press)] TJ ET BT 34.016 335.219 Td /F3 12.0 Tf [(Place of Publication:)] TJ ET BT 34.016 320.963 Td /F1 12.0 Tf [(New York, NY)] TJ ET BT 34.016 306.707 Td /F3 12.0 Tf [(Reviewer:)] TJ ET BT 34.016 292.451 Td /F1 12.0 Tf [(Anne Hardy)] TJ ET endstream endobj 8 0 obj << /Type /Font /Subtype /Type1 /Name /F1 /BaseFont /Times-Roman /Encoding /WinAnsiEncoding >> endobj 9 0 obj << /Type /Font /Subtype /Type1 /Name /F2 /BaseFont /Times-Italic /Encoding /WinAnsiEncoding >> endobj 10 0 obj << /Type /Font /Subtype /Type1 /Name /F3 /BaseFont /Times-Bold /Encoding /WinAnsiEncoding >> endobj 11 0 obj << /Type /XObject /Subtype /Image /Width 509 /Height 160 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 509 /BitsPerComponent 8>> /Mask [ 255 255 255 255 255 255 ] /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 3280>> stream x[EQ㎦fVttҒ +3O{?lGDQԯDrB^.ϯ%~'0۠/2>0AG_>0j0GCfE67>rB^}@  !&y+r?INp:erc b8f=rQC!~-Wf^^zF[)G 2ޯe7V_Go3Ke GEGOo8rώ#\1ZY~N6^H}yLxS-!:412V+u\-LSO?xVvZ|GjǮT_8EYJF=Tw^ 7GxfN/S:Ʌ~ʟtt?5n÷J'JcF-GVξx{rO~tJd;#a\7}|~y'>}c2C vR}f׈**h.)_&@pfzjsx:5;S\vKhM5j=!Cn+h"u]a EUN]jn=k<,:Ք>sU!ni~6EJ)¦72?G}[y}_vc$t?iSܟ2Zݞ,VN?_`='RFK1A2qv&X_lLRWY'%:I㢖zb_UEx\>&ɆBˏ~K@ \gYØU4}$8Dv!'Q'*+Εj(UCGo[#< 2Ja(sZi9fZKE Rn`u\9r^Zmɯ׹}mstO4uc~#'jEvۼ Dx[z ޏQ4KL5,5u3>i^uÒ-53ba ~,~/pyt1fMU'CVm:qv~=Y'Es"WsφG?l_kN5}],Ow7 uh`xƫ?zMl7ٻv$A(4Dl(wwH} ?=[=S;yC]^BK>㕪9`Z'Wj;E|:bf>kCԘ#RY,iv쵗~}n'"1u" *uO΄/2^Sxr(!/DD\~mJyZ!MmrA!#u[if|99WB WΡpp}w}sh#,\ &:%˳X?D3 %W0cC?o̲^} F3XLVn]Cߖiϧ!7}yZJ#P7]=)7Ρp;>> Ye^xx{Oafw{ ;>4gfLt ʊ:q%#r/)pv!O4wGh|dS ӣݽހ-gVUC'pBxrB^} 7JA^} /'8!`:r?}}],X  }6y!`/~Br?}Q< >k7vx"] ,' .3jn{-i}|~%-};b6#U)7繎kiEw 㤳:E}[޼c"rꬊ7Dc$~"/Y&zSd:tFȌCrʙ`7u .#[-<)j ?TGS(j~oTup(hjU4PlJ=}|it.ҽ@\wʨuXÞZcx18Wo<~ikOg,ވ\^?EneyZcc0[R١z|zv7_m:_n]a?osS3~j^ hD.a_X'KfBX6w wݶ"Oa:,bvhrWH[uCF-Xfc}>x+Rz)2N-B 7y^٨;[/vg? | |2Sve}=o䑰j[vWjF0{굦?VI~}xM(_TlG__+]:#к?S} c>GŸD7 !w{S{B =x7a?oE#)+Gz:o_4Q<;n?\tt7?mGCџQGu4kņOF>F?#} hP&ђߴM#u!.СtL2^#o nIk_i.~7tr@n 1P~3?.[]=S5b߮~Yo^HFH YBi8a4iom>CKgMy*;?zqEӕ` >zB9iFzC?XF?ޟIܰ펉A}{I5ᄊx%ez#Mp@rߎpi]IOVjzuJt\۰f׺u5><,J~PTJp1)}){9N {!`/> endstream endobj 12 0 obj << /Type /Annot /Subtype /Link /A 13 0 R /Border [0 0 0] /H /I /Rect [ 197.0117 675.3895 357.3317 687.2695 ] >> endobj 13 0 obj << /Type /Action /S /URI /URI (http://www.history.ac.uk/reviews) >> endobj 14 0 obj << /Type /Page /Parent 3 0 R /Annots [ 17 0 R 20 0 R 23 0 R 26 0 R ] /Contents 15 0 R >> endobj 15 0 obj << /Length 8099 >> stream 0.000 0.000 0.000 rg 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d BT 34.016 784.469 Td /F1 12.0 Tf [(Once upon a time there was smallpox. One of the most loathsome diseases ever to afflict human kind, )] TJ ET BT 34.016 770.213 Td /F1 12.0 Tf [(smallpox not only killed but maimed. Death rates were typically between 25 and 30 per cent, and survivors )] TJ ET BT 34.016 755.957 Td /F1 12.0 Tf [(might not only be blinded and their skins scarred and pitted from the pocks, but they also suffered internal )] TJ ET BT 34.016 741.701 Td /F1 12.0 Tf [(tissue damage that affected lung function and other life processes. It was an ancient disease, and like many )] TJ ET BT 34.016 727.445 Td /F1 12.0 Tf [(other such had relations that afflicted animals, such as cowpox, horse pox and monkey pox, although )] TJ ET BT 34.016 713.189 Td /F1 12.0 Tf [(smallpox itself was specific to humans. Over many centuries, folk practices evolved in an effort to mitigate )] TJ ET BT 34.016 698.933 Td /F1 12.0 Tf [(the damage caused by the disease. The Chinese developed the practice of variolation or inoculation, )] TJ ET BT 34.016 684.677 Td /F1 12.0 Tf [(deliberately inserting smallpox matter obtained from a mild case of the disease under the skin in the hope of )] TJ ET BT 34.016 670.421 Td /F1 12.0 Tf [(achieving immunity through a relatively benign attack; elsewhere people tried for the same effect by holding )] TJ ET BT 34.016 656.165 Td /F1 12.0 Tf [(the crusts from smallpox scabs in their hands for hours, or by inhaling the dust from ground up crusts. In )] TJ ET BT 34.016 641.909 Td /F1 12.0 Tf [(rural England, it was noted in farming communities that those who had been infected with cowpox seemed )] TJ ET BT 34.016 627.653 Td /F1 12.0 Tf [(to be immune to the scarier human version. In 1796, a Gloucestershire medical practitioner, Edward Jenner, )] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(famously conducted the first ?scientific? trial of the efficacy of cowpox inoculation in preventing smallpox, )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(and demonstrated that it did indeed do so. Designated ?vaccination? in honour of the cowpox matter )] TJ ET BT 34.016 584.885 Td /F1 12.0 Tf [(\(vaccinia\), Jenner?s discovery was widely utilised in Europe and elsewhere in the two centuries that )] TJ ET BT 34.016 570.629 Td /F1 12.0 Tf [(followed, contributing eventually to the official eradication of smallpox in 1979.)] TJ ET BT 34.016 544.373 Td /F1 12.0 Tf [(Much has been written on the history of smallpox and vaccination in recent years, from the local and popular )] TJ ET BT 34.016 530.117 Td /F1 12.0 Tf [(such as J. R. Smith?s )] TJ ET BT 138.356 530.117 Td /F2 12.0 Tf [(The Speckled Monster)] TJ ET BT 245.000 530.117 Td /F1 12.0 Tf [(,)] TJ ET 0.000 0.000 0.800 rg BT 248.000 530.117 Td /F1 12.0 Tf [(\(1\))] TJ ET 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d 248.000 528.723 m 261.992 528.723 l S 0.000 0.000 0.000 rg BT 261.992 530.117 Td /F1 12.0 Tf [( to Peter Baldwin?s magisterial survey of the introduction of )] TJ ET BT 34.016 515.861 Td /F1 12.0 Tf [(vaccination legislation in nineteenth-century Europe,)] TJ ET 0.000 0.000 0.800 rg BT 288.308 515.861 Td /F1 12.0 Tf [(\(2\))] TJ ET 0.24 w 0 J [ ] 0 d 288.308 514.467 m 302.300 514.467 l S 0.000 0.000 0.000 rg BT 302.300 515.861 Td /F1 12.0 Tf [( and Stanley Williamson?s lively but unscholarly )] TJ ET BT 34.016 501.605 Td /F2 12.0 Tf [(The Vaccination Controversy)] TJ ET BT 175.340 501.605 Td /F1 12.0 Tf [(.)] TJ ET 0.000 0.000 0.800 rg BT 178.340 501.605 Td /F1 12.0 Tf [(\(3\))] TJ ET 0.24 w 0 J [ ] 0 d 178.340 500.211 m 192.332 500.211 l S 0.000 0.000 0.000 rg BT 192.332 501.605 Td /F1 12.0 Tf [( The topics have a number of claims to historical attention. Quite apart from )] TJ ET BT 34.016 487.349 Td /F1 12.0 Tf [(the impact of smallpox on human health and societies, there are practical and ethical issues surrounding )] TJ ET BT 34.016 473.093 Td /F1 12.0 Tf [(vaccination, issues of risk assessment, the promotion and practice of variolation and vaccination by different )] TJ ET BT 34.016 458.837 Td /F1 12.0 Tf [(groups, the emergence of vigorous anti-vaccination movements in the nineteenth century, the nature and )] TJ ET BT 34.016 444.581 Td /F1 12.0 Tf [(quality of vaccines, and the methods used to stamp out the disease at various times and in different contexts. )] TJ ET BT 34.016 430.325 Td /F1 12.0 Tf [(In some countries, such as India, but also in early nineteenth-century England, vaccination also raised )] TJ ET BT 34.016 416.069 Td /F1 12.0 Tf [(religious issues. Among these various historical strands, historians of smallpox in Britain have largely )] TJ ET BT 34.016 401.813 Td /F1 12.0 Tf [(focused on the mid to late nineteenth century, on the introduction of vaccination legislation and the )] TJ ET BT 34.016 387.557 Td /F1 12.0 Tf [(emergence of opposition. Anti-vaccinationism in particular has been the subject of essays by such )] TJ ET BT 34.016 373.301 Td /F1 12.0 Tf [(distinguished historians as Roy McLeod, Roy and Dorothy Porter and Logie Barrow, and a recent )] TJ ET BT 34.016 359.045 Td /F1 12.0 Tf [(monograph by Nadja Durbach.)] TJ ET 0.000 0.000 0.800 rg BT 182.648 359.045 Td /F1 12.0 Tf [(\(4\))] TJ ET 0.24 w 0 J [ ] 0 d 182.648 357.651 m 196.640 357.651 l S 0.000 0.000 0.000 rg BT 196.640 359.045 Td /F1 12.0 Tf [( For the eighteenth century, Peter Razzell has fought the priority dispute )] TJ ET BT 34.016 344.789 Td /F1 12.0 Tf [(corner \(Jenner was not the first to take up the cowpox option\) and defended the effectiveness of variolation )] TJ ET BT 34.016 330.533 Td /F1 12.0 Tf [(in reducing the burden of smallpox before Jenner. Other parts of the British story have meanwhile remained )] TJ ET BT 34.016 316.277 Td /F1 12.0 Tf [(uncharted, and the publication of Deborah Brunton?s monograph is welcome for opening up the professional )] TJ ET BT 34.016 302.021 Td /F1 12.0 Tf [(and political sides of the vaccination issue, and especially for extending the geographical focus of inquiry to )] TJ ET BT 34.016 287.765 Td /F1 12.0 Tf [(include Ireland and Scotland.)] TJ ET BT 34.016 261.509 Td /F1 12.0 Tf [(Brunton?s approach is, none the less, a somewhat restricted one. The principal focus of the book is on ?the )] TJ ET BT 34.016 247.253 Td /F1 12.0 Tf [(shaping of public vaccination ? through its formative years from 1840 ? the passing of the first Vaccination )] TJ ET BT 34.016 232.997 Td /F1 12.0 Tf [(Act ? to 1874? ? the year which saw the passing of the last enactment to enforce compulsion as well as the )] TJ ET BT 34.016 218.741 Td /F1 12.0 Tf [(end of a severe smallpox epidemic that stretched the capacity of the public services to control the disease to )] TJ ET BT 34.016 204.485 Td /F1 12.0 Tf [(its limit \(p. 2\). It contributes, therefore, another chronological section to the fragmented literature on the )] TJ ET BT 34.016 190.229 Td /F1 12.0 Tf [(broader topic. Second, Brunton?s account is derived from the perspective of the medical practitioners, )] TJ ET BT 34.016 175.973 Td /F1 12.0 Tf [(which, while novel in historical terms and providing some intriguing insights, also leaves the reader feeling )] TJ ET BT 34.016 161.717 Td /F1 12.0 Tf [(that only one side of a multi-faceted story has been told. The directed focus also helps to flatten the prose. )] TJ ET BT 34.016 147.461 Td /F1 12.0 Tf [(Part of the problem with Brunton?s account is that while her writing is clear and comprehensible, it is )] TJ ET BT 34.016 133.205 Td /F1 12.0 Tf [(decidedly lacking in colour, quotation and the evocation of personalities that bring history to life. Where, for )] TJ ET BT 34.016 118.949 Td /F1 12.0 Tf [(example, is William Farr, compiler of abstracts at the General Register Office, who is quoted by Williamson )] TJ ET BT 34.016 104.693 Td /F1 12.0 Tf [(\(p. 151\) as inveighing against the 1853 Vaccination Act:)] TJ ET BT 64.016 66.437 Td /F1 12.0 Tf [(Anyone who had the slightest administrative capacity could have foretold its failure ? What )] TJ ET endstream endobj 16 0 obj [14 0 R /Fit] endobj 17 0 obj << /Type /Annot /Subtype /Link /A 18 0 R /Border [0 0 0] /H /I /Rect [ 247.9997 529.0375 261.9917 540.9175 ] >> endobj 18 0 obj << /Type /Action >> endobj 19 0 obj [14 0 R /Fit] endobj 20 0 obj << /Type /Annot /Subtype /Link /A 21 0 R /Border [0 0 0] /H /I /Rect [ 288.3077 514.7815 302.2997 526.6615 ] >> endobj 21 0 obj << /Type /Action >> endobj 22 0 obj [14 0 R /Fit] endobj 23 0 obj << /Type /Annot /Subtype /Link /A 24 0 R /Border [0 0 0] /H /I /Rect [ 178.3397 500.5255 192.3317 512.4055 ] >> endobj 24 0 obj << /Type /Action >> endobj 25 0 obj [14 0 R /Fit] endobj 26 0 obj << /Type /Annot /Subtype /Link /A 27 0 R /Border [0 0 0] /H /I /Rect [ 182.6477 357.9655 196.6397 369.8455 ] >> endobj 27 0 obj << /Type /Action >> endobj 28 0 obj << /Type /Page /Parent 3 0 R /Annots [ 31 0 R 34 0 R ] /Contents 29 0 R >> endobj 29 0 obj << /Length 7766 >> stream 0.000 0.000 0.000 rg 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d BT 64.016 796.469 Td /F1 12.0 Tf [(hindrance these certificates throw in the way of a man whose \(vaccination\) station is full of )] TJ ET BT 64.016 782.213 Td /F1 12.0 Tf [(children, or who wants to get away to other patients or to a woman at a distance in labour, we )] TJ ET BT 64.016 767.957 Td /F1 12.0 Tf [(can easily conceive.)] TJ ET BT 34.016 729.701 Td /F1 12.0 Tf [(Brunton points out \(p. 49\) that such bureaucracy as the completion of two vaccination certificates per )] TJ ET BT 34.016 715.445 Td /F1 12.0 Tf [(operation performed was a novelty in 1853, but the immediacy of any apt illustration is omitted.)] TJ ET BT 34.016 689.189 Td /F1 12.0 Tf [(The book falls into three parts. Six chapters deal with England and Wales, two with Ireland, and one with )] TJ ET BT 34.016 674.933 Td /F1 12.0 Tf [(Scotland. \(To list Wales separately in the title is slightly disingenuous: Wales had no administrative identity )] TJ ET BT 34.016 660.677 Td /F1 12.0 Tf [(separate from England in nineteenth century.\) This unevenness of detail has something to do with the )] TJ ET BT 34.016 646.421 Td /F1 12.0 Tf [(availability of relevant historical records, but also reflects the fact that the legislative provisions for )] TJ ET BT 34.016 632.165 Td /F1 12.0 Tf [(vaccination were achieved later, and more quickly and easily, in Scotland and Ireland. The English chapters )] TJ ET BT 34.016 617.909 Td /F1 12.0 Tf [(detail the tortured history of attempts to construct a viable vaccination programme. Parliament?s initial )] TJ ET BT 34.016 603.653 Td /F1 12.0 Tf [(legislative reluctance to interfere in the free market economy and with the liberty of the individual gave way )] TJ ET BT 34.016 589.397 Td /F1 12.0 Tf [(by 1840 to a recognition that some systematic provision was needed, and a reluctance to provide )] TJ ET BT 34.016 575.141 Td /F1 12.0 Tf [(opportunities for patronage. This resulted in the establishment of an unsatisfactory system whereby free )] TJ ET BT 34.016 560.885 Td /F1 12.0 Tf [(vaccination was offered through the poor law ? unsatisfactory because popular dislike of the poor law tainted )] TJ ET BT 34.016 546.629 Td /F1 12.0 Tf [(effective delivery. At the same time practitioners? desire for social standing, financial security and liberty of )] TJ ET BT 34.016 532.373 Td /F1 12.0 Tf [(practice led them to resent and occasionally resist efforts to organise public vaccination. The issue of )] TJ ET BT 34.016 518.117 Td /F1 12.0 Tf [(payment for their services was especially sensitive.)] TJ ET BT 34.016 491.861 Td /F1 12.0 Tf [(Brunton wants us to believe that the early nineteenth-century doctors were a ?unified, politicised profession? )] TJ ET BT 34.016 477.605 Td /F1 12.0 Tf [(\(p. 53\), but her case rings somewhat hollow in the absence of a rigorous quantitative analysis of medical )] TJ ET BT 34.016 463.349 Td /F1 12.0 Tf [(correspondence and writings on the subject of vaccination and against Irvine Loudon?s depiction of a deeply )] TJ ET BT 34.016 449.093 Td /F1 12.0 Tf [(fractured and fractious profession in the years up to the Medical Act 1858.)] TJ ET 0.000 0.000 0.800 rg BT 391.604 449.093 Td /F1 12.0 Tf [(\(5\))] TJ ET 0.24 w 0 J [ ] 0 d 391.604 447.699 m 405.596 447.699 l S 0.000 0.000 0.000 rg BT 405.596 449.093 Td /F1 12.0 Tf [( As late as 1883, indeed, Lyon )] TJ ET BT 34.016 434.837 Td /F1 12.0 Tf [(Playfair could refer in House of Commons debates over the 1883 Medical Act Amendment Act to ?this long-)] TJ ET BT 34.016 420.581 Td /F1 12.0 Tf [(agitated profession?.)] TJ ET 0.000 0.000 0.800 rg BT 133.328 420.581 Td /F1 12.0 Tf [(\(6\))] TJ ET 0.24 w 0 J [ ] 0 d 133.328 419.187 m 147.320 419.187 l S 0.000 0.000 0.000 rg BT 147.320 420.581 Td /F1 12.0 Tf [( Brunton downplays the overcrowded and competitive nature of the nineteenth-)] TJ ET BT 34.016 406.325 Td /F1 12.0 Tf [(century medical profession ? the livelihoods of these men depended on their ability to gain and retain )] TJ ET BT 34.016 392.069 Td /F1 12.0 Tf [(enough fee-paying patients. She points to the formation of medical societies and medical journals in the )] TJ ET BT 34.016 377.813 Td /F1 12.0 Tf [(early decades of the century as evidence of unity and politicisation, without admitting that attrition rates )] TJ ET BT 34.016 363.557 Td /F1 12.0 Tf [(among both societies and journals were very high ? few survived more than a year or two or an issue or )] TJ ET BT 34.016 349.301 Td /F1 12.0 Tf [(three, the )] TJ ET BT 81.668 349.301 Td /F2 12.0 Tf [(Lancet)] TJ ET BT 114.332 349.301 Td /F1 12.0 Tf [( \(founded 1837\) being an exception. Some claims read oddly ? Brunton states that there )] TJ ET BT 34.016 335.045 Td /F1 12.0 Tf [(were a few large national medical societies at this period, citing the Provincial Surgical and Medical )] TJ ET BT 34.016 320.789 Td /F1 12.0 Tf [(Association \(PMSA\) founded in 1832 and the British Medical Association \(BMA\) ?founded in 1836? \(p. )] TJ ET BT 34.016 306.533 Td /F1 12.0 Tf [(23\). In fact the PMSA was the predecessor of the BMA, and the latter was not instituted as such until 1856; )] TJ ET BT 34.016 292.277 Td /F1 12.0 Tf [(the PMSA and the BMA were effectively the same society.)] TJ ET BT 34.016 266.021 Td /F1 12.0 Tf [(The insecurity of Brunton?s argument seems to be demonstrated in the context of the 1853 Vaccination Act, )] TJ ET BT 34.016 251.765 Td /F1 12.0 Tf [(which introduced compulsory infant vaccination. Whereas the 1840 Act had encountered medical opposition )] TJ ET BT 34.016 237.509 Td /F1 12.0 Tf [(orchestrated by the radical reforming editor of )] TJ ET BT 258.956 237.509 Td /F2 12.0 Tf [(The Lancet)] TJ ET BT 312.620 237.509 Td /F1 12.0 Tf [(, Thomas Wakley, the 1853 Act encountered little )] TJ ET BT 34.016 223.253 Td /F1 12.0 Tf [(opposition. The House of Commons received just seven petitions against the Bill from medical men, and, as )] TJ ET BT 34.016 208.997 Td /F1 12.0 Tf [(Brunton notes, even so the impact of these was ?dissipated? since the petitioners made different demands \(p. )] TJ ET BT 34.016 194.741 Td /F1 12.0 Tf [(47\). Surely a ?unified and politicised profession? would have co-ordinated its responses, and found )] TJ ET BT 34.016 180.485 Td /F1 12.0 Tf [(vociferous champions of their cause, even in the face of Wakley?s retirement from )] TJ ET BT 433.904 180.485 Td /F2 12.0 Tf [(The Lancet )] TJ ET BT 490.568 180.485 Td /F1 12.0 Tf [(and the )] TJ ET BT 34.016 166.229 Td /F1 12.0 Tf [(reluctance of other journal editors to organise a campaign against the Bill? Brunton sees the newly founded )] TJ ET BT 34.016 151.973 Td /F1 12.0 Tf [(Epidemiological Society, which espoused compulsion as a necessary measure, as a divisive influence. The )] TJ ET BT 34.016 137.717 Td /F1 12.0 Tf [(question remains whether the issue of compulsion would in any case have arisen further to the failings of the )] TJ ET BT 34.016 123.461 Td /F1 12.0 Tf [(1840 Act, and at a time when several other European states had already set an example in this direction.)] TJ ET BT 34.016 97.205 Td /F1 12.0 Tf [(If the situation was unsatisfactory and tangled in England, matters were not much better, initially at least, in )] TJ ET BT 34.016 82.949 Td /F1 12.0 Tf [(Ireland. Government policy towards Ireland was to bring its legislation and administration into line with that )] TJ ET BT 34.016 68.693 Td /F1 12.0 Tf [(of England and Wales, but it failed to take into account significant differences between the administrative )] TJ ET BT 34.016 54.437 Td /F1 12.0 Tf [(structures of the two countries. Thus the 1837 new poor law in Ireland permitted medical relief only within )] TJ ET endstream endobj 30 0 obj [28 0 R /Fit] endobj 31 0 obj << /Type /Annot /Subtype /Link /A 32 0 R /Border [0 0 0] /H /I /Rect [ 391.6037 448.0135 405.5957 459.8935 ] >> endobj 32 0 obj << /Type /Action >> endobj 33 0 obj [28 0 R /Fit] endobj 34 0 obj << /Type /Annot /Subtype /Link /A 35 0 R /Border [0 0 0] /H /I /Rect [ 133.3277 419.5015 147.3197 431.3815 ] >> endobj 35 0 obj << /Type /Action >> endobj 36 0 obj << /Type /Page /Parent 3 0 R /Contents 37 0 R >> endobj 37 0 obj << /Length 7431 >> stream 0.000 0.000 0.000 rg 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(the workhouse, where in England and Wales it was still allowed in the homes of the poor ? a concession )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(which facilitated the task of vaccinators. The Irish poor law authorities were still struggling to deliver the )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(new provisions, and had difficulty taking on board the 1840 provision for public vaccination, while Irish )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(medical practitioners took the same hostile view to public provision as the English. The situation was )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(resolved through further poor law reform under the 1851 Medical Charities Act, and the a vaccination )] TJ ET BT 34.016 725.189 Td /F1 12.0 Tf [(programme aligned to complementary government administrative services such as the registration of births: )] TJ ET BT 34.016 710.933 Td /F1 12.0 Tf [(public vaccination became ?an integral part of the new medical service? \(p. 125\). As in England, where John )] TJ ET BT 34.016 696.677 Td /F1 12.0 Tf [(Simon, Chief Medical Officer at the Medical Department of the Privy Council \(not the Medical Office, as )] TJ ET BT 34.016 682.421 Td /F1 12.0 Tf [(Brunton refers to it\), determined the course of vaccination provision, Irish policy was developed under the )] TJ ET BT 34.016 668.165 Td /F1 12.0 Tf [(aegis of a medical Poor Law Commissioner, John McDonnell. McDonnell, however, took a much less )] TJ ET BT 34.016 653.909 Td /F1 12.0 Tf [(controlling attitude towards his responsibilities than Simon. The loosely regulated system which he oversaw )] TJ ET BT 34.016 639.653 Td /F1 12.0 Tf [(proved much more effective in delivering results than its English counterpart.)] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(The John Simon/John McDonnell contrast introduces the second major theme of Brunton?s argument ? )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(again from the medical profession perspective ? of the rise and significance of expertise in this period. Both )] TJ ET BT 34.016 584.885 Td /F1 12.0 Tf [(Simon and McDonnell were medical experts within government. Their positions signalled both the rising )] TJ ET BT 34.016 570.629 Td /F1 12.0 Tf [(power and influence of the profession, and the emergence of further fractures within it. The British medical )] TJ ET BT 34.016 556.373 Td /F1 12.0 Tf [(profession in general was deeply suspicious of expertise, which it equated with quackery, and remained so )] TJ ET BT 34.016 542.117 Td /F1 12.0 Tf [(until at least the inter-war period. English general practitioners already regarded the Royal Colleges of )] TJ ET BT 34.016 527.861 Td /F1 12.0 Tf [(Physicians and Surgeons with considerable mistrust \(for political rather than strictly professional reasons\), )] TJ ET BT 34.016 513.605 Td /F1 12.0 Tf [(and the development of medical specialities during the nineteenth century contributed an additional )] TJ ET BT 34.016 499.349 Td /F1 12.0 Tf [(dimension of tension and mistrust. Experts could be viewed as unfair competition in an overcrowded market )] TJ ET BT 34.016 485.093 Td /F1 12.0 Tf [(for medicine, and policies designed by and favouring experts as deliberately undermining of the interests of )] TJ ET BT 34.016 470.837 Td /F1 12.0 Tf [(general practitioners. McDonnell, however, was not seen to act against the interests of his fellow )] TJ ET BT 34.016 456.581 Td /F1 12.0 Tf [(practitioners. Although he seems to have been appointed shortly after the 1851 Medical Charities Act, and )] TJ ET BT 34.016 442.325 Td /F1 12.0 Tf [(Simon not until 1856, Brunton notes that he ?showed no inclination to follow Simon?s lead? in )] TJ ET BT 34.016 428.069 Td /F1 12.0 Tf [(implementing a closely monitored system of vaccination through specially appointed public vaccinators \(p. )] TJ ET BT 34.016 413.813 Td /F1 12.0 Tf [(125\).)] TJ ET BT 34.016 387.557 Td /F1 12.0 Tf [(In both England and Ireland, specialists working within government determined the course of vaccination )] TJ ET BT 34.016 373.301 Td /F1 12.0 Tf [(policy. In Scotland, by contrast, practitioners outside government took and held the initiative. Brunton )] TJ ET BT 34.016 359.045 Td /F1 12.0 Tf [(argues that Scotland had a unique political landscape, in which links to Westminster were minimal and )] TJ ET BT 34.016 344.789 Td /F1 12.0 Tf [(which facilitated a large degree of self-regulation. The principal medical institutions, she argues, played an )] TJ ET BT 34.016 330.533 Td /F1 12.0 Tf [(important part in initiating new administrative measures. Here Edinburgh?s Royal College of Physicians, )] TJ ET BT 34.016 316.277 Td /F1 12.0 Tf [(which unlike its English counterpart claimed to represent all Scottish practitioners, took the lead in ensuring )] TJ ET BT 34.016 302.021 Td /F1 12.0 Tf [(that free vaccination was limited to paupers. As in Ireland, Scotland ended up with a flexible system and )] TJ ET BT 34.016 287.765 Td /F1 12.0 Tf [(little bureaucratic machinery of enforcement. Despite the lack of enforcement mechanisms, vaccination )] TJ ET BT 34.016 273.509 Td /F1 12.0 Tf [(against smallpox was widely accepted in Scotland ? ?surprisingly?, Brunton notes \(p. 9\). Similarly, she finds )] TJ ET BT 34.016 259.253 Td /F1 12.0 Tf [(that the results of public vaccination in Ireland ?present the historian with a conundrum ... that the successful )] TJ ET BT 34.016 244.997 Td /F1 12.0 Tf [(control of smallpox in the 1860s was achieved with a level of vaccination similar to that in England and )] TJ ET BT 34.016 230.741 Td /F1 12.0 Tf [(Wales?, while anti-vaccination sentiment was also absent ? as in Scotland \(p. 140\).)] TJ ET BT 34.016 204.485 Td /F1 12.0 Tf [(Brunton?s surprise at the absence of anti-vaccinationism and the comparative effectiveness of the loosely )] TJ ET BT 34.016 190.229 Td /F1 12.0 Tf [(regulated systems operating in Ireland and Scotland reflects perhaps on the narrow medical focus she has )] TJ ET BT 34.016 175.973 Td /F1 12.0 Tf [(chosen for her study. While Scotland and Ireland experienced sustained out-migration during the nineteenth )] TJ ET BT 34.016 161.717 Td /F1 12.0 Tf [(century, England experienced in-migration and rapidly expanding international trade; and epidemic strains )] TJ ET BT 34.016 147.461 Td /F1 12.0 Tf [(of smallpox were commonly imported from the continent of Europe. Brunton makes little reference to )] TJ ET BT 34.016 133.205 Td /F1 12.0 Tf [(epidemiological pattern, but population movements, transport and communications, and the nature and )] TJ ET BT 34.016 118.949 Td /F1 12.0 Tf [(timing of epidemic incursions are also factors to be taken into account in evaluating the comparative success )] TJ ET BT 34.016 104.693 Td /F1 12.0 Tf [(of vaccination programmes. The nature of programme delivery was also important. Brunton outlines this, )] TJ ET BT 34.016 90.437 Td /F1 12.0 Tf [(but does not seem to follow through its wider implications. Where England sought to impose a new system )] TJ ET BT 34.016 76.181 Td /F1 12.0 Tf [(of vaccination provision through the unpopular poor law, both Ireland and Scotland chose rather to work )] TJ ET BT 34.016 61.925 Td /F1 12.0 Tf [(through traditional channels of medical provision and charity ? the traditional dispensaries in the former, in )] TJ ET endstream endobj 38 0 obj << /Type /Page /Parent 3 0 R /Annots [ 40 0 R 42 0 R 44 0 R 46 0 R 48 0 R 50 0 R 52 0 R 54 0 R 56 0 R 58 0 R ] /Contents 39 0 R >> endobj 39 0 obj << /Length 6025 >> stream 0.000 0.000 0.000 rg 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(the latter dispensaries and hospitals in the cities, and church ministers, schoolmasters, midwives and other )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(lay practitioners in the countryside. The adoption of existing health providers as the dispensers of the new )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(operation may have been critical, while the influence of the church\(es\) in particular might be worthy of )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(further examination. More broadly still, class and gender factors were also important at different times and )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(in different places. Brunton?s medical world is curiously disassociated from other social spheres and from )] TJ ET BT 34.016 725.189 Td /F1 12.0 Tf [(the wider epidemiological context within which her story took place. The insights she provides into )] TJ ET BT 34.016 710.933 Td /F1 12.0 Tf [(contemporary medical issues are very valuable, but would have been enriched by placing the story within a )] TJ ET BT 34.016 696.677 Td /F1 12.0 Tf [(broader historical context.)] TJ ET BT 34.016 670.421 Td /F1 12.0 Tf [(The author is very grateful for this review, but does not wish to comment further.)] TJ ET BT 34.016 635.523 Td /F3 18.0 Tf [(Notes)] TJ ET BT 48.816 604.906 Td /F1 12.0 Tf [(1.)] TJ ET BT 64.016 604.901 Td /F1 12.0 Tf [(J. R. Smith, )] TJ ET BT 123.368 604.901 Td /F2 12.0 Tf [(The Speckled Monster: Smallpox in England, 1670?1970, with Particular Reference to )] TJ ET BT 64.016 590.645 Td /F2 12.0 Tf [(Essex)] TJ ET BT 91.340 590.645 Td /F1 12.0 Tf [( \(Chelmsford, 1987\). )] TJ ET 0.000 0.000 0.800 rg BT 194.996 590.645 Td /F1 12.0 Tf [(Back to \(1\))] TJ ET 0.24 w 0 J [ ] 0 d 194.996 589.251 m 248.984 589.251 l S 0.000 0.000 0.000 rg BT 48.816 576.394 Td /F1 12.0 Tf [(2.)] TJ ET BT 64.016 576.389 Td /F1 12.0 Tf [(Peter Baldwin, )] TJ ET BT 138.344 576.389 Td /F2 12.0 Tf [(Contagion and the State in Europe, 1830?1930)] TJ ET BT 365.348 576.389 Td /F1 12.0 Tf [( \(Cambridge, 1999\).)] TJ ET 0.000 0.000 0.800 rg BT 462.668 576.389 Td /F1 12.0 Tf [( Back to \(2\))] TJ ET 0.24 w 0 J [ ] 0 d 462.668 574.995 m 519.656 574.995 l S 0.000 0.000 0.000 rg BT 48.816 562.138 Td /F1 12.0 Tf [(3.)] TJ ET BT 64.016 562.133 Td /F1 12.0 Tf [(Stanley Williamson, )] TJ ET BT 165.020 562.133 Td /F2 12.0 Tf [(The Vaccination Controversy: the Rise and Fall of Compulsory Vaccination for )] TJ ET BT 64.016 547.877 Td /F2 12.0 Tf [(Smallpox)] TJ ET BT 108.680 547.877 Td /F1 12.0 Tf [( \(Liverpool, 2007\).)] TJ ET 0.000 0.000 0.800 rg BT 200.000 547.877 Td /F1 12.0 Tf [( Back to \(3\))] TJ ET 0.24 w 0 J [ ] 0 d 200.000 546.483 m 256.988 546.483 l S 0.000 0.000 0.000 rg BT 48.816 533.626 Td /F1 12.0 Tf [(4.)] TJ ET BT 64.016 533.621 Td /F1 12.0 Tf [(Nadja Durbach, )] TJ ET BT 142.988 533.621 Td /F2 12.0 Tf [(Bodily Matters: the Anti-Vaccination Movement in England, 1853?1907)] TJ ET BT 490.292 533.621 Td /F1 12.0 Tf [( \(Durham, )] TJ ET BT 64.016 519.365 Td /F1 12.0 Tf [(NC, 2005\).)] TJ ET 0.000 0.000 0.800 rg BT 117.680 519.365 Td /F1 12.0 Tf [( Back to \(4\))] TJ ET 0.24 w 0 J [ ] 0 d 117.680 517.971 m 174.668 517.971 l S 0.000 0.000 0.000 rg BT 48.816 505.114 Td /F1 12.0 Tf [(5.)] TJ ET BT 64.016 505.109 Td /F1 12.0 Tf [(Irvine Loudon, )] TJ ET BT 139.004 505.109 Td /F2 12.0 Tf [(Medical Care and the General Practitioner 1750?1850)] TJ ET BT 404.984 505.109 Td /F1 12.0 Tf [( \(Oxford, 1986\). )] TJ ET 0.000 0.000 0.800 rg BT 486.632 505.109 Td /F1 12.0 Tf [(Back to \(5\))] TJ ET 0.24 w 0 J [ ] 0 d 486.632 503.715 m 540.620 503.715 l S 0.000 0.000 0.000 rg BT 48.816 490.858 Td /F1 12.0 Tf [(6.)] TJ ET BT 64.016 490.853 Td /F1 12.0 Tf [(Hansard, British Parliamentary Debates, cclxxxix, 24 June 1884, col. 1263. )] TJ ET 0.000 0.000 0.800 rg BT 428.636 490.853 Td /F1 12.0 Tf [(Back to \(6\))] TJ ET 0.24 w 0 J [ ] 0 d 428.636 489.459 m 482.624 489.459 l S 0.000 0.000 0.000 rg BT 34.016 464.597 Td /F3 12.0 Tf [(Other reviews:)] TJ ET BT 34.016 450.341 Td /F1 12.0 Tf [(muse 2010)] TJ ET 0.000 0.000 0.800 rg BT 34.016 436.085 Td /F1 12.0 Tf [(http://muse.jhu.edu/journals/journal_of_the_history_of_medicine_and_allied_sciences/summary/v065/65.2.fichman.html)] TJ ET 0.24 w 0 J [ ] 0 d 34.016 434.691 m 616.988 434.691 l S 0.000 0.000 0.000 rg BT 34.016 421.829 Td /F1 12.0 Tf [([2])] TJ ET BT 34.016 407.573 Td /F1 12.0 Tf [(muse 2009)] TJ ET 0.000 0.000 0.800 rg BT 34.016 393.317 Td /F1 12.0 Tf [(http://muse.jhu.edu/journals/vic/summary/v051/51.3.jenkinson.html)] TJ ET 0.24 w 0 J [ ] 0 d 34.016 391.923 m 361.040 391.923 l S 0.000 0.000 0.000 rg BT 364.040 393.317 Td /F1 12.0 Tf [([3])] TJ ET BT 34.016 379.061 Td /F1 12.0 Tf [(oxford journals)] TJ ET 0.000 0.000 0.800 rg BT 34.016 364.805 Td /F1 12.0 Tf [(http://jpubhealth.oxfordjournals.org/content/30/3/348.full)] TJ ET 0.24 w 0 J [ ] 0 d 34.016 363.411 m 310.352 363.411 l S 0.000 0.000 0.000 rg BT 313.352 364.805 Td /F1 12.0 Tf [([4])] TJ ET 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d 34.391 360.079 526.499 1.500 re S BT 34.016 342.299 Td /F3 12.0 Tf [(Source URL:)] TJ ET 0.000 0.000 0.800 rg BT 104.672 342.299 Td /F1 12.0 Tf [(http://www.history.ac.uk/reviews/review/692)] TJ ET 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d 104.672 340.905 m 322.316 340.905 l S 0.000 0.000 0.000 rg BT 34.016 315.928 Td /F3 12.0 Tf [(Links:)] TJ ET 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