The Eradication of Smallpox: Edward Jenner and the First and Only Eradication of a Human Infectious Disease (review)

Hervé Bazin. The Eradication of Smallpox: Edward Jenner and the First and Only Eradication of a Human Infectious Disease. Translated by Andrew Morgan and Glenise Morgan. San Diego, Calif.: Academic Press, 2000. xx + 246 pp. Ill. $49.95 (0-12-083475-8).

The definitive history of the worldwide eradication of smallpox was provided by Frank Fenner, D. A. Henderson, et al. in their 1988 publication Smallpox and Its Eradication. Henderson, an American epidemiologist, directed the World Health Organization-sponsored eradication effort, and Fenner, an Australian virologist, was chairman of the commission that certified the successful completion of the task. Their book belongs on every medical historian's bookshelf. However, that book is hardly for the casual reader, for it covers the history of smallpox and its eradication comprehensively and in technically accurate detail in a little less than 1,500 pages. The eradication of smallpox was an epic event in world history that deserves to be chronicled in a suitable format for the laity; this was, apparently, immunologist Bazin's purpose in writing this 246-page book. Furthermore, the possible reintroduction of smallpox into the human population as a weapon of mass destruction dictates the need for widespread knowledge about the disease, its mode of transmission, and the methods by which it can be contained and eliminated. All of these issues are covered in Bazin's book.

The book comprises fourteen chapters divided into three sections. In the first section, Bazin describes the disease and provides a history of major epidemics up to the end of the eighteenth century, as well as the origins of variolation and its introduction into Western Europe by Lady Mary Montegu, wife of the British ambassador to Turkey. In the second section, Bazin discusses the life and work of Edward Jenner, the inventor of vaccination. Seven chapters review Jenner's education, his natural-history investigations, his clinical-pathology observations, the development of cowpox vaccination, and the adoption of "Jennerian" vaccination throughout the world. In the third section, the author discusses the antivaccination movements of the nineteenth century, reviews the eradication actions, and considers the controversial issue of what to do about the remaining known stocks of smallpox virus. The potential use of smallpox as a weapon of biological warfare is briefly considered. The book contains 120 illustrations, a substantial glossary, and an extended list of references. It has been translated from the original French text.

Although Bazin tells the story of smallpox comprehensively, the coverage of particular topics is quite uneven. For example, the description of Jenner's investigation of the protective effect of natural cowpox infection, his subsequent artificial inoculation of cowpox, and his evaluation of the effectiveness of the procedure are covered in less than two pages of text. Similarly, the actual eradication program is described in less than three pages, and nowhere in the description is the critical strategy of surveillance and containment explained. It was this strategy, not mass vaccination, which made possible the final eradication of smallpox from the Indian subcontinent and East Africa. On the other hand, whole chapters are devoted to the opposition to Jenner's original conclusions and the antivaccination movements that flourished during the late nineteenth and early twentieth centuries.

The copious illustrations are of considerable interest, but many have been excessively miniaturized. Readers may also be somewhat put off by the occasionally tortured syntax of the translation. Because of its inadequate coverage of a number of critical issues, Bazin's book cannot be recommended for the lay reader as the definitive history of smallpox and its eradication. Historians of medicine and of public health may want to add it to their collections principally for its illustrations and extended references.