De vreselijkste aller harpijen : pokkenepidemieen en pokkenbestrijding in Nederland in de achttiende en negentiende eeuw : een sociaal-historische en historisch-demografische studie

This study examines the fight against smallpox in the Netherlands in the 18th and 19th centuries. Smallpox mortality dropped in an unprecedented way from about 1810, generating a substantial reduction in the urban child mortality rate. The impact of vaccination on the acceleration of the Dutch population growth since the early 19th century should be seen in relation to the fact that smallpox was of minor importance in smaller towns and rural areas long before preventive measures became effective. Experiments with cowpox started as early as 1799. Vaccination was successfully implemented in the first decade of the 19th century, and it became the single most important factor for the decrease of the incidence of smallpox. Setting aside annual fluctuations, vaccination rates (expressed as the number of vaccinations on people of all ages as a proportion of the total number of live-births) were, on average, above 50 % from the 1810s to the 1860s. Vaccination coverage was raised further to 70-80 % when it was made compulsory for children attending primary school in 1872 (Contagious Diseases Act). The geographical pattern of vaccination coverage is systematically examined, as are differences between religious denominations. Until the 1870s, the differences between regions in the uptake of vaccination were more striking than those between denominations. After 1872, these regional differences decreased and the religious differentials became more evident. Traditionally, antivaccination feeling was strong among strict Calvinists. This study also makes an assessment of the importance of vaccination for medicalization.