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Viewed in broad, historiographical terms, the rise of the public health movement in Canada has been chronicled from two different perspectives. The first approach attributes the rise of sanitary reform, quarantine regulations, pure water supplies, and immunization to the impact of various epidemics that visited North America in the nineteenth century. These outbreaks, combined with the medical discoveries of such pioneers as Budd, Lister, Snow and Pasteur laid the scientific foundations for the public health movement. This story is usually told in terms of progress, individual achievement, and altruism. The second approach focuses on motivation, and concludes that public health services were not implemented until the leaders of society realized that diseases could be transmitted from the poor to the wealthy. Both interpretations are based largely on society's reactions to outbreaks of cholera in the 1830s, typhoid in the 1840s, and smallpox in the 1880s. Most historians, however, have overlooked the fact that smallpox differed from other contagious diseases. Physicians might not know what caused it or how to cure smallpox, but they did possess the means to prevent it. Society’s leaders could protect themselves from the ravages of smallpox without resorting to universal, compulsory vaccination, which was not the case with other epidemic diseases. The following examination of the evolution of smallpox vaccination on Prince Edward Island illustrates that public interest in vaccination fluctuated between humanitarianism and self-interest, and that although compulsory vaccination laws buttressed the struggle against disease, the key to effective protection depended more on public health education than on compulsion and the availability of prophylaxis.

Smallpox management on Prince Edward Island, 1820–1940: From neglect to fulfilment