Jennifer D. Penschow. Battling Smallpox before Vaccination: Inoculation in Eighteenth-Century Germany. Clio Medica Series. Leiden: Brill, 2022. Illustrations. 312 pp. $150.00 (cloth), ISBN 978-90-04-46513-8; $155.00 (e-book), ISBN 978-90-04-46537-4.
Reviewed by Theo Dekker (Universiteit Leiden)
Published on H-Sci-Med-Tech (May, 2022)
Commissioned by Penelope K. Hardy (University of Wisconsin-La Crosse)
Despite (or perhaps because of) the triumph of vaccination programs in the twentieth century, the COVID-19 epidemic reminded us that the acceptance of vaccination is not self-evident. This was also the case in eighteenth-century Germany. Even though one in three to four sufferers might have died of smallpox, there was widespread resistance to inoculation. Jennifer D. Penschow's excellent book aims to explain the rejection and adoption of inoculation by various social groups in German society. Through her focus on social, economic, regional, and cultural differences, she offers an enlightening perspective on the acceptance of preventative medicine for both historians and policymakers.
In the historical literature, inoculation has often been studied from a medical perspective and as the forerunner of vaccination. Especially around the turn of the twentieth century, scholars argued that inoculation aided the later public acceptance of vaccination. Recent scholarship has already disproven this supposition, since most people rejected the insertion of smallpox matter into the skin of themselves or their children. Penschow, however, offers a social history of smallpox and inoculation by showing which groups were encouraging inoculation and how those groups structured their various approaches. Moreover, she examines the responses these groups encountered in various communities, the strategies that were adopted, and the factors that influenced the various approaches.
To answer her questions, she used a wide variety of sources: published sources, dissertations, statutes, letters, reports, books, articles, novels, reviews, and poetry. Four chapters are devoted to the considerations and reflections of inoculation in various groups of society: the ruling class, medical practitioners, women, pastors, and peasants. The other three chapters demonstrate the impact of cultural and practical obstacles, the discourses in print media, and the role of political and cultural developments at the core of the inoculation debate. Consequently, Penschow's book paints a broader picture of inoculation than the ones that have previously emerged.
This combination of sources enables Penschow to demonstrate how the initial optimism about inoculation among various medical practitioners and the authorities was quashed by public resistance. For most people, smallpox was such a common childhood affliction that medical help was rarely sought. Moreover, smallpox tended to be regarded as God's punishment for worldly sins, and therefore inoculation could be perceived as interfering with divine providence. Penschow, however, goes further. Through her examination of the domestic dilemmas that parents faced, Penschow's analyses prove to be more in-depth and closer to the everyday reality of society. This provides an insight into the harsh reality of poor peasants who deliberately exposed their children to smallpox to save food supplies. Furthermore, she demonstrates how cultural and emotional beliefs hindered the acceptance of various innovations. For example, most people were unable to think in terms of the statistical reality that more children were killed by naturally acquired smallpox than the number who died from inoculation. Parents' fear of unbearable guilt if their child were to die from the procedure tipped the scale.
Familiarity with the practice helped to encourage people to inoculate themselves and their children; however, the driving force behind inoculation was initially not medical scholars. Pastors, (noble)women, and local medical practitioners were more influential. Especially in rural parishes, pastors were a medical resource for most people and tended to be great promoters of doctors' medical advice. They were supported by the discourse in print media, which played a crucial role as well. The public debate was shaped by German translators who seemed very selective about the opinions they chose to translate. In general, they only favored journals and books that showed great enthusiasm for inoculation. Taking the number of journal articles and books on inoculation into account, Penschow concludes that it must have been a widely debated topic among almost all strata of society.
Studying print media also resulted in new insights into other motives to get inoculated, besides the argument that it saved lives. Even though women were mostly excluded from the public discourse, and the commentary about smallpox treatments and the benefits of inoculation was largely left to the men, the genre of "smallpox poetry" was concerned with the lives of women (p. 131). Together with the occasional mother who put pen to paper, Penschow offers a new perspective on how the lives of women especially could be ruined, even when they survived. Besides risking blindness, or becoming crippled, someone's beauty could be destroyed. Since a woman's future was often determined by appearance, women often embraced inoculation to save their beauty and that of their children.
There is much more to learn from Penschow's book, such as the different reactions between Catholic and Protestant regions on inoculation, the factors for success of smallpox inoculations in two large rural areas, the influence of Enlightenment ideas, and the repercussion of the Coalition Wars and the French Revolution. Even though late eighteenth-century politics was marked by optimism and the sentiment that smallpox could be defeated by a united effort, the local practice turned out to be more tenacious.
In sum, Penschow offers an outstanding analysis of the understanding and perception of smallpox and inoculation in eighteenth-century German society. By demonstrating the complexity and down-to-earth dilemmas that society faced, she offers a versatile and nuanced perspective on the history of smallpox and inoculation. Although uncensored manuscripts, such as diaries and chronicles, could have enriched Penschow's conclusions even more, her book is not only a pleasure to read but also one of the most sophisticated contributions to the literature on inoculation in the early modern period.
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Theo Dekker. Review of Penschow, Jennifer D., Battling Smallpox before Vaccination: Inoculation in Eighteenth-Century Germany.
H-Sci-Med-Tech, H-Net Reviews.
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