An Estimate of the True Value of Vaccination as a Security Against Small Pox

The Story

The narrative begins by establishing the terrifying context of smallpox, which the author describes as the greatest scourge to have ever afflicted humanity. Before the nineteenth century, the disease was a constant, lethal threat; in many cases, one in five or six of those infected died, while survivors often faced permanent disfigurement, blindness, or chronic poor health. The author traces the history of early attempts to control the virus, specifically the practice of inoculation—the artificial communication of smallpox—which was first championed in England by Lady Mary Wortley Montague.

While inoculation saved some individuals, the author argues that it simultaneously acted as a public health disaster. Because it created new sources of infection and often required the isolation of the patient, the general population remained at risk. The author presents statistical evidence from the London Bills of Mortality to show that during the mid-eighteenth century, mortality rates from smallpox actually climbed, occasionally reaching one in five deaths. Thus, while inoculation was an individual good, it was a profound general evil.

The turning point occurs with the introduction of vaccination, derived from the cowpox observations of Edward Jenner. The author addresses the common skepticism regarding the "new" disease, particularly the observation that some vaccinated individuals still contracted a form of smallpox. He counters this by demonstrating that such cases are incredibly rare and, crucially, that the resulting illness is almost always mild and non-lethal, having been stripped of the "terrific accompaniments" associated with the natural disease.

The arc of the argument concludes with a moral imperative. The author points to the success of vaccination in foreign locales like Peru, where the disease was entirely extinguished without government mandates. He asserts that if the public—especially the wealthy and educated—would simply ensure all children are vaccinated, the disease could be eradicated globally. The book ends not with mere medical advice, but with a challenge: to ignore the evidence for vaccination is to disregard the lives of one’s neighbors and the future of society. He frames the choice as a "momentous moral question," arguing that we owe our own existence to the protection of earlier, successful health measures and must now pay that debt forward by securing the future against the virus.

How It Unfolds

The scale of the threat The author establishes the horrific historical toll of smallpox, asserting that it surpassed even the plague in its destruction of human life. He uses the writing of Sir Gilbert Blane to underscore the necessity of a total "consummation"—the complete extirpation of the disease.

The failure of inoculation The text moves into an examination of the eighteenth-century practice of "engrafting" smallpox, noting that while it was technically an advancement, it backfired by keeping the virus in constant circulation. The author relies on historical data to show that this period saw a tragic increase in mortality rates.

The shift to vaccination The focus turns to Edward Jenner’s discovery in Gloucestershire, where the cowpox virus provided a safer, milder alternative to the natural disease. The author distinguishes between the "natural" Small Pox and the mild, modified symptoms seen in those who have been vaccinated.

Addressing the skeptics The author tackles the fear of "secondary Small Pox" by analyzing cases where vaccinated individuals still experienced outbreaks. He concludes that these are rare, manageable, and do not invalidate the overall efficacy of the vaccine.

The moral conclusion The book culminates in a call to action, framing the universal adoption of vaccination as a civic duty. The author insists that the data proves a massive number of lives have already been saved, and that the total eradication of the virus is a reachable, logical goal.

The People

The author, T. M. Greenhow, presents himself as a professional, calm, and evidence-based surgeon. He acts as the rational guide, seeking to replace "misapprehension and some prejudice" with hard data. He is deeply concerned with the "lower orders of society," believing that seeing the mild nature of post-vaccination sickness will convince them more than abstract lectures.

Lady Mary Wortley Montague appears in the historical analysis as the pivotal, if controversial, figure who brought inoculation to England. Her determination to protect her daughter, even against the advice of physicians, represents the early, desperate search for security that the author contrasts with the more reliable science of vaccination.

Dr. Jurin, cited as a "calm man, well skilled in calculation," serves as the model for the author’s own approach. By using Jurin’s meticulous study of the London bills of mortality, the author creates a bridge between the era of failed inoculation and the modern scientific era.

Finally, the parents of the nineteenth century are the true protagonists of the book’s conclusion. The author addresses them directly, appealing to their power to influence their communities. They represent the barrier to progress; his goal is to move them from a state of "ignorance or doubt" to a state of enlightened, proactive responsibility for the health of their children and their neighbors.

In Its Own Voice

“And in order to stimulate the wise and good to aim strenuously at this consummation (the total extirpation of Small Pox), let it be constantly borne in mind, that the adversary they are contending with is the greatest scourge that has ever afflicted humanity.”

The author begins his argument by framing the eradication of smallpox not as a medical trend, but as a moral necessity against a historic enemy.

“I should, therefore, strongly recommend it to every practitioner to take advantage of any opportunities that may be afforded him of pointing out this most marked distinction between the natural and modified Small Pox.”

The author encourages his fellow doctors to use clinical observation to demystify the virus for parents who fear the "terrific name" of the disease.

“If then any be ignorant on this momentous subject, let him not delay to obtain information; if any doubt, let him use every exertion to satisfy himself.”

The book concludes with a stern finality, placing the burden of responsibility squarely on the individual to educate themselves for the safety of the public.

What It's Really About

At its core, the book is a study in public health advocacy and the difficulty of shifting societal belief. The author is not merely presenting a medical argument; he is attempting to reframe vaccination as an essential component of modern civilization. He explores the tension between individual choice and the collective good, arguing that when an individual avoids vaccination, they are not simply making a private decision—they are endangering the community. The book also wrestles with the "law of uncertainty," acknowledging that while no human intervention is infallible, the pursuit of perfection should not lead us to discard a proven, life-saving tool. It is a document of a transition period, where the fear of a known, lethal enemy clashed with a new, misunderstood, but ultimately life-saving scientific practice.

Why Read It Today

Readers interested in the history of medicine will find this work fascinating, as it captures the raw, argumentative energy of a field in the middle of a paradigm shift. It feels remarkably modern in its tone: the author deals with "misapprehension," "prejudice," and the difficulty of communicating scientific truths to a skeptical public. For those who study the history of pandemics, it offers a window into how early practitioners used statistics to fight misinformation.

However, the reader should be prepared for the book's period-specific style. It is written in the formal, somewhat dense prose of the early nineteenth century, and the statistical tables—though vital to the author’s argument—can be dry and repetitive. The author’s direct, sometimes impatient tone toward those who hesitate to vaccinate shows how high the stakes felt at the time. You will likely walk away with a profound sense of the precariousness of life before modern medicine; the author's descriptions of the "natural" smallpox are chilling and serve as a potent reminder of why he feels such an urgent, moral duty to push his message. It is a sobering, precise look at a time when a simple medical procedure was the only barrier between a community and a devastating, transformative illness.