Compared to the great attention paid to vaccination, German medical history has treated inoculation against smallpox as a poor relation. This form of immunization against one of the most dreaded and lethal epidemic diseases of the early modern period is usually covered as a precursor of the real thing, a small step for humankind before the giant leap that would ultimately lead to the eradication of smallpox in the 1970s. Jennifer D. Penschow's book tries to shift this disbalance and give inoculation its due. Published 300 years after the first inoculations performed in Europe in 1721, she aims to explore the cultural and social attitudes towards preventive measures against smallpox, from the introduction of inoculation in Germany in the 1720s to the emergence of vaccination as a superior alternative in the first years of the nineteenth century.

Penschow relies exclusively on printed material, as she found archival sources to be too few in number and of little use, and she turns to vast numbers of medical dissertations, articles in the periodical press, and literary works that fill two bibliographical appendices covering almost thirty pages. On this basis, Penshow develops her history of inoculation in eighteenth-century Germany. After a short introduction setting out her argument, the first chapter deals with general attitudes towards inoculation – and by extension smallpox – in the population. Chapters 2 and 3 focus each on a specific social group who played important roles as early adopters and propagandists for the new prophylactic practice: the ruling class and nobility as well as academics and physicians. While many noble families were open to inoculation as a means to protect their lineage from an unpredictable menace, some monarchs saw it also as a means to improve the numbers and quality of their subjects and decided to propagate the practice. For that they relied on experts, whom they found at German universities.

The next two chapters deal with the role of the print media for spreading knowledge about and encouraging the use of inoculation. First Penschow traces the presence of inoculation in the periodical press and finds that attitudes were mostly positive but unevenly spread by region and religious denomination. The fifth chapter is dedicated to the presence of women in literary works about inoculation. As mothers, they were considered crucial targets for health advice, while younger women had to be protected from disfigurement, loss of beauty, and bleak prospects on the marriage market. Authors tried to reach this audience by using female protagonists in novels and plays.

The sixth chapter shifts the focus back to a specific social group, pastors. Often the only educated persons in rural settings, they had an important role as intermediaries between the state and the local population, communicators of governmental health advice, and authority figures. Although not all pastors were comfortable with endorsing inoculation and enthusiasts often met resistance from the peasant population, some were effective in convincing their parishioners and helped spread inoculation to the countryside.

The seventh and final chapter portrays a shift in attitudes towards inoculation among its proponents during the last decades of the eighteenth century. Due to a growing medical consensus regarding the contagiousness of smallpox as opposed to its supposed innateness, the prospect of eradicating the disease appeared for the first time realistic. This resulted in a reevaluation of inoculation, as it regularly caused local outbreaks and contributed to the spread of the disease.

Penschow paints a rich panorama of inoculation in eighteenth-century Germany based on an enormous number of printed sources. She includes elite, learned, and popular attitudes towards inoculation and provides a special focus on women and their representation in literature. Yet, despite those achievements, Penschow's book left this reviewer slightly unsatisfied.

This is mostly due to conceptual issues. First, the geographical scope of the book is uneven. Despite its title, it deals mostly with Protestant northern Germany. Penschow mentions southern and Catholic states sporadically, while Austria is, apart from a look at Empress Maria Theresa and her family's troubles with smallpox, mostly absent. This is probably due to the geographic slant of the printed sources on which the book is based, but never properly addressed. Second, the author's position towards the book's subject would have required further consideration. This is particularly evident in the first chapter, on the public's attitudes towards smallpox and inoculation. To declare the ineffectiveness of folk medicine, including the use of magic as based on “misconceptions” (39) of smallpox reveals – a misconception. To measure past medical theories and treatments by today's medical standards can only result in evaluating them as deficient but does not explain their purpose and underlying worldviews. Third, Penschow at times lacks the required critical distance from her sources. Thus, she takes the biases of the authors of those texts at face value and reproduces them. Of course, learned and enlightened physicians would describe the attitudes of the rural population towards smallpox as superstitious and those peasants as unenlightened. This says more about them and their position towards the people they were paid to serve than about the peasants’ views. Fourth and finally, Penschow fails to engage with much of the scholarly discourse on medicine in eighteenth-century Germany and its role in the broader process of state formation, such as medicalization or the medical police. Those concepts are almost entirely absent from the book, but they would have provided valuable context for the interpretation of sources and drawing connections between the different chapters. They would have offered an opportunity to gain more profound insights into the history of inoculation and connect Penschow's book more firmly with the existing historiography. Thus, Battling Smallpox before Vaccination offers a broad but at times superficial contribution to the cultural, social, and medical history of early modern Germany.