Chapter 5 explores the early spread of vaccination in continental Europe. If news of Jenner’s discovery quickly spread abroad, the delivery of vaccine in a viable state proved a major challenge. Diplomatic and medical networks explain its early arrival in Germany and Austria. From 1799, Dr De Carro made Vienna a major centre for the spread of the practice, with the samples sent to Lord Elgin in Istanbul seeding the practice in Greece. The British military build-up in the Mediterranean opened new channels for the dissemination of English cowpox. By vaccinating sailors aboard ship, Drs Marshall and Walker brought fresh vaccine to Gibraltar and Malta and Marshall established vaccination in Sicily and southern Italy early in 1801. Dr Sacco’s discovery of a local source of cowpox in cattle in Lombardy in late 1800 led to important trials and, over the following decade, an impressive vaccination programme in northern Italy. In the interstices of war in Europe, the practice developed as an international enterprise with several important new hubs.

Chapter 6 discusses how France, hesitant about smallpox inoculation, embraced cowpox inoculation and the Napoleonic regime provided strong support and direction. After the first successful vaccination in Paris in August 1800, vaccine was rapidly distributed through France. In 1803, the Minister of Interior instituted a central vaccination committee in the capital and instructed prefects to form subordinate committees to support the practice in the provinces. Napoleon himself was committed to the practice and the practice prospered under a regime that had no doubts as to its merits and potential contribution to the nation’s welfare and prosperity. In the context of large-scale military mobilisation, several million citizens were vaccinated before 1815. The French system, ill-funded but quite effective, was extended to the client states and annexed territories of the Napoleonic empire, providing further scope for Dr Sacco’s enterprise in Italy and laying firm foundations for the practice in the Netherlands.