- The Two Faces of Smallpox: A Disease and Its Prevention in Eighteenth- and Nineteenth-Century Sweden
This book, as the author explains, is intended to portray the eighteenth-century face of smallpox, then the most feared of all diseases, and a second face typifying the nineteenth century, when smallpox mortality declined precipitously as vaccination came to be widely applied.
Based on the all-too-limited data available, smallpox mortality rates began to decline in the mid-to-late 1700s in those parts of Europe where variolation began to be practiced, and then plummeted dramatically when, in the early 1800s, vaccination was introduced. However, there exists little detailed information about smallpox epidemiology, and few quantitative measurements of the impact of inoculation and vaccination, because of the incompleteness of national mortality and morbidity data before the mid-eighteenth century.
Sweden is the exception in having reasonably complete data on smallpox deaths since 1747, as well as some information as to the numbers inoculated and vaccinated. Peter Sköld has clearly made a formidable effort to compile and analyze the available information from Sweden. In a book of more than 650 pages, he presents his findings in a veritable tidal wave of tables and maps, including some unusual parameters such as the relationships between smallpox immunity and fecundity and fertility, and the choice of marriage partner by immunity status.
Despite the massive quantity of data presented, I found little here that was really new or particularly interesting. Unfortunately, Sköld has little to offer regarding the influence of inoculation on smallpox deaths because very few inoculations appear to have been performed in Sweden. Case-fatality rates over time would have been of the greatest interest, but information on cases and deaths is available only for the period 1862–74. Vaccine-efficacy data are similarly lacking because the data needed for such estimates were simply not collected.
We are thus left with a formidably long book with more tables and maps than we can begin to digest. It is suggestive of a thesis at the end of a first draft. One would hope that the author might distill from this a more succinct version of perhaps 100–150 pages that would focus on the more important data, trends, and relationships. It is quite possible that buried under the massive data sets there are important insights that even this especially motivated reader may have missed.