The history of smallpox vaccination in Germany: a first step in the medicalization of the general public.

Abstract

Although vaccination against smallpox was the first public health measure that affected nearly the whole population, its history has seldom been investigated as part of the process of medicalization which characterized the nineteenth century. The vaccine's introduction, which was sanctioned by state authorities and executed by medical professionals, marked the first time that the German population became the object of a large-scale medical action which had its origin in recent scientific discoveries. Thus it appeared as 'the first step in the medicalization of the general public and in the medicalization of the life-cycle of contemporary man'.2 Medicalization, a term first used by Michel Foucault, refers to the gradual disappearance of traditional, more or less fatalistic attitudes towards health and illness, and the extension of professional medical services to those social strata in which the professional medical practitioner had hitherto remained unknown. As the process of medicalization advanced, it became increasingly common to appeal to competent experts, to the medical professionals. This process was accompanied by a loss of independence on the part of the patient, and at the same time resulted in an increase in the power and status of the medical profession. The following article will examine several aspects of the process of medicalization, as illustrated by the case of the smallpox vaccine: the common and different interests of the state and the medical profession; the public response to this new measure of public health care, ranging from scepticism to open opposition; and finally, the strategies employed by the state to overcome these manifold forms of resistance. Although smallpox had been known in Europe since the Middle Ages, its character and consequences were long underestimated. For centuries