Sweden: Failure to Flourish
“The late establishment of the variolation house in Stockholm, for which von Schulzenheim had immediately argued should be a basic priority, was described in a public notice in 1760 as ‘desirable’ by the Health Commission, yet it was only opened in 1766, by which time a total of just 1,038 persons had been variolated; the reason for procrastination with this, and for similar requests by district physicians throughout the second half of the century: there was no money.” (Grant, 2019, p. 201)
As the Swedish Empire entered the 18th century, it boasted a centrally organized and well-staffed healthcare network (the Collegium Medicum), supported a mercantilist philosophy which saw the citizenry as the wealth of a nation, and could reasonably contend for status as a great power. Yet for all these advantages, Sweden failed to promote variolation to protect its citizens from smallpox, as was done by its neighbors Russia and Great Britain. Understanding this failure of public health is as informative as studying the successes.
The story of variolation in Sweden began in the aftermath of the disastrous Battle of Poltova (1709), when King Charles XII was forced to seek asylum in the Ottoman Empire in an area that is now part of Romania. The king noticed and took interest in variolation and had a treatise on the subject written by Dr. Emanuel Timoni and then shared the document with his personal physician and surgeon. And yet when the treatise was returned to Sweden by Charles's surgeon, it merely accumulated dust among other medical records.
This was the first of many setbacks. A medical account for variolation would not see publication in Sweden until 1737, when Prof. Hermann Spöring reported on events in England. Official action, however, was more than a decade away. In 1753, King Adolf Frederick prodded the Collegium Medicum to try experimenting with variolation in the country. The Collegium consented, but forbid further action until a doctor returned from England with an official report, which would not arrive until the end of 1755. Some variolation was performed before the medical emissary returned, but this was not because the Collegium Medicum recognized the efficacy of variolation, but because surgeons outside the body had begun to offer the procedure to patients and the Collegium feared they would lose prestige and income for being behind the times. Even when variolation was formally approved, the Collegium continued to hinder public health campaigns by ruling "no inoculation, without the presence of an experienced medical doctor may be made" (Grant, p. 115). The physicians' variolation monopoly prevented qualified midwives, surgeons, clerics, and other medical professionals and volunteers from contributing their skills and labor to the campaign.
Beyond the conservatism of Swedish physicians, variolation efforts were hindered by the significant money troubles of the Swedish government. Decades of on-and-off warfare and defeat by the Russian Empire wrecked the treasury: in 1718, the Swedish government was running a 80 million kroner deficit. Financial problems were exacerbated by the reluctance of the nobility to patronize variolation independently and the inability of many peasants to pay the 12 kroner fee for variolation.
A lack of leadership also proved detrimental to the variolation campaign. While English aristocrats, French intellectuals, and American clerics leveraged their clout to promote variolation, Swedish leaders either did not make the effort to endorse variolation or failed to make their advocacy effective. The Countess de Geer, Charlotte Ribbing, had her children publically variolated in 1756, but this exhibition only appears to have roused the interest of other elite families. Even when looking at other Scandinavians, the Swedish monarchy's response appears sluggish. By the time King Adolf Frederick had his children publicly variolated (1769), his Danish counterpart, King Frederick V, had opened a hospital that offered free variolation (1755), ordered the public dissemination of two esteemed medical articles to counteract variolation skepticism, and had the Royal Prince variolated (1760).