"A Tissue of the most Flagrant Anomalies": Smallpox Vaccination and the Centralization of Sanitary Administration in Nineteenth-Century London

Medical History

Volumn 41, Issue 3, 1997, Pages 261-290

  Mooney, Graham ^a  

^a UNIVERSITY OF LONDON   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

SMALLPOX VACCINE;

ARTICLE; GOVERNMENT; HISTORY; HUMAN; MORTALITY; PUBLIC HEALTH; SANITATION; SMALLPOX; UNITED KINGDOM; VACCINATION;

GOVERNMENT; HISTORY, 19TH CENTURY; HUMANS; LONDON; PUBLIC HEALTH; SANITATION; SMALLPOX; SMALLPOX VACCINE; VACCINATION;

EID: 0031179110     PISSN: 00257273     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0025727300062694     Document Type: Article

References (141)

1. Even during the final major epidemic in England and Wales (1871-72), smallpox claimed a total of only 4.2 per cent of all national deaths. These figures are calculated from the 34th and 35th Annual Reports of the Registrar-General (henceforth ARRG), 1871 and 1872.
2. J Landers, Death and the metropolis: studies in the demographic history of London 1670-1830, Cambridge University Press, 1993, ch. 3; A Mercer, Disease, mortality and population in transition: epidemiological-demographic change in England since the eighteenth century as part of a global phenomenon, Leicester University Press, 1990, p. 157; P E Razzell, The conquest of smallpox, Firle, Sussex, Caliban, 1977.
3. J Landers, Death and the metropolis: studies in the demographic history of London 1670-1830, Cambridge University Press, 1993, ch. 3; A Mercer, Disease, mortality and population in transition: epidemiological-demographic change in England since the eighteenth century as part of a global phenomenon, Leicester University Press, 1990, p. 157; P E Razzell, The conquest of smallpox, Firle, Sussex, Caliban, 1977.
4. J Landers, Death and the metropolis: studies in the demographic history of London 1670-1830, Cambridge University Press, 1993, ch. 3; A Mercer, Disease, mortality and population in transition: epidemiological-demographic change in England since the eighteenth century as part of a global phenomenon, Leicester University Press, 1990, p. 157; P E Razzell, The conquest of smallpox, Firle, Sussex, Caliban, 1977.
5. N Williams, 'The implementation of compulsory health legislation: infant smallpox vaccination in England and Wales, 1840-1890', J. hist. Geogr., 1994, 20: 396-412.
6. R Lambert, 'A Victorian National Health Service: state vaccination 1855-71', The hist. J., 1962, 5: 1-18; R G Hodgkinson, The origins of the National Health Service, London, Wellcome Historical Medical Library, 1967, pp. 28-31; R M MacLeod, 'Law, medicine and public opinion: the resistance to compulsory health legislation 1870-1907. Parts I and II', Public Law, 1967: 107-28 and 189-211.
7. R Lambert, 'A Victorian National Health Service: state vaccination 1855-71', The hist. J., 1962, 5: 1-18; R G Hodgkinson, The origins of the National Health Service, London, Wellcome Historical Medical Library, 1967, pp. 28-31; R M MacLeod, 'Law, medicine and public opinion: the resistance to compulsory health legislation 1870-1907. Parts I and II', Public Law, 1967: 107-28 and 189-211.
8. R Lambert, 'A Victorian National Health Service: state vaccination 1855-71', The hist. J., 1962, 5: 1-18; R G Hodgkinson, The origins of the National Health Service, London, Wellcome Historical Medical Library, 1967, pp. 28-31; R M MacLeod, 'Law, medicine and public opinion: the resistance to compulsory health legislation 1870-1907. Parts I and II', Public Law, 1967: 107-28 and 189-211.
9. A Hardy, The epidemic streets: infectious disease and the rise of preventive medicine, 1856-1900, Oxford University Press, 1993, pp. 110-50.
10. D Porter and R Porter, 'The enforcement of health: the British debate', in E Fee and D M Fox (eds), AIDS: the burdens of history, Berkeley, University of California Press, 1988, pp. 97-120.
11. R J Evans, Death in Hamburg: society and politics in the cholera years, 1830-1910, Oxford University Press, 1987, pp. 218-26; G Kearns, 'Cholera, nuisances and environmental management in Islington, 1830-55', in W F Bynum and R Porter (eds), Living and dying in London, Medical History Supplement No. 11, London, Wellcome Institute for the History of Medicine, 1991.
12. R J Evans, Death in Hamburg: society and politics in the cholera years, 1830-1910, Oxford University Press, 1987, pp. 218-26; G Kearns, 'Cholera, nuisances and environmental management in Islington, 1830-55', in W F Bynum and R Porter (eds), Living and dying in London, Medical History Supplement No. 11, London, Wellcome Institute for the History of Medicine, 1991.
13. William Fair was appointed to the staff of the General Register office in 1839, where he served successively as the Compiler of Abstracts and then Superintendent of the Statistical Department until his retirement in 1880. For a detailed history of his life and works, see J M Eyler, Victorian social medicine: the ideas and methods of William Farr, Baltimore, Johns Hopkins University Press, 1979.
14. The Times, 7 August 1861.
15. R P B Taaffe, 'Various topics in public medicine', Br. med. J., 1886, ii: 316-19, p. 319.
16. E Chadwick, 'London centralized', Contemp. Rev., June 1884, p. 794.
17. Editorial, 'Sanitary mismanagement in the metropolis', Sanit. Rec., 15 September 1886, NS 8: 117.
18. An Act to Provide for the Regulation of Municipal Corporations in England and Wales 1835 (5 & 6 Wm. IV c. 76). W A Robson, The government and misgovernment of London, London, George Allen and Unwin, 1939, p. 21. The Act created municipal boroughs outside London.
19. Metropolis Local Management Act 1855 (18 & 19 Vict. c. 120).
20. The Metropolitan Poor Act 1867 (30 Vict. c. 6).
21. Chadwick reserved particular venom for the MBW, a creation of Benjamin Hall's Metropolis Local Management Act 1855 (see note 14 above), which he believed had destroyed the opportunity for unity in sanitary management. S E Finer, The life and times of Sir Edwin Chadwick, London, Methuen, 1952, pp. 504-5.
22. E Lankester, 'Notes on recent sanitary legislation in the Metropolis', Trans. Natn. Ass. Promotion Soc. Sci., 1860, pp. 666-75, pp. 667-8. L Parkes, 'London vestries, and the administration of sanitary law in the metropolis, Part I', Sanit. Rec., 15 April 1886, NS 7: 474-77, p. 477. Cf. T Orme Dudfield, 'Metropolitan sanitary administration', Sanit. Rec., 15 November 1883, NS 5: 235-40, p. 237, who argued that although the vestries were, "much-abused bodies", their labours had "made London to be the best paved, the cleanest, the best lighted, the best drained, and, may we not say, the healthiest city in the world".
23. E Lankester, 'Notes on recent sanitary legislation in the Metropolis', Trans. Natn. Ass. Promotion Soc. Sci., 1860, pp. 666-75, pp. 667-8. L Parkes, 'London vestries, and the administration of sanitary law in the metropolis, Part I', Sanit. Rec., 15 April 1886, NS 7: 474-77, p. 477. Cf. T Orme Dudfield, 'Metropolitan sanitary administration', Sanit. Rec., 15 November 1883, NS 5: 235-40, p. 237, who argued that although the vestries were, "much-abused bodies", their labours had "made London to be the best paved, the cleanest, the best lighted, the best drained, and, may we not say, the healthiest city in the world".
24. E Lankester, 'Notes on recent sanitary legislation in the Metropolis', Trans. Natn. Ass. Promotion Soc. Sci., 1860, pp. 666-75, pp. 667-8. L Parkes, 'London vestries, and the administration of sanitary law in the metropolis, Part I', Sanit. Rec., 15 April 1886, NS 7: 474-77, p. 477. Cf. T Orme Dudfield, 'Metropolitan sanitary administration', Sanit. Rec., 15 November 1883, NS 5: 235-40, p. 237, who argued that although the vestries were, "much-abused bodies", their labours had "made London to be the best paved, the cleanest, the best lighted, the best drained, and, may we not say, the healthiest city in the world".
25. 35th ARRG, 1872, op. cit., note 1 above, p. 1i.
26. C Bellamy, Administering central-local relations, 1871-1919: the Local Government Board in its fiscal and cultural context, Manchester University Press, 1988; E P Hennock, 'Central/local relations in England: an outline 1800-1950', Urban Hist. Yb., 1982: 38-49; and R Lambert, 'Central and local relations in mid-Victorian England: the Local Government Act Office, 1858-72', Victorian Stud., 1962, 6: 121-50.
27. C Bellamy, Administering central-local relations, 1871-1919: the Local Government Board in its fiscal and cultural context, Manchester University Press, 1988; E P Hennock, 'Central/local relations in England: an outline 1800-1950', Urban Hist. Yb., 1982: 38-49; and R Lambert, 'Central and local relations in mid-Victorian England: the Local Government Act Office, 1858-72', Victorian Stud., 1962, 6: 121-50.
28. C Bellamy, Administering central-local relations, 1871-1919: the Local Government Board in its fiscal and cultural context, Manchester University Press, 1988; E P Hennock, 'Central/local relations in England: an outline 1800-1950', Urban Hist. Yb., 1982: 38-49; and R Lambert, 'Central and local relations in mid-Victorian England: the Local Government Act Office, 1858-72', Victorian Stud., 1962, 6: 121-50.
29. J Davis, Reforming London. The London government problem, 1855-1900, Oxford, Clarendon Press, 1988; and D Owen, The government of Victorian London 1855-1889, ed. R MacLeod, Cambridge, Mass., Belknap Press, 1982.
30. J Davis, Reforming London. The London government problem, 1855-1900, Oxford, Clarendon Press, 1988; and D Owen, The government of Victorian London 1855-1889, ed. R MacLeod, Cambridge, Mass., Belknap Press, 1982.
31. The main exception being, K Young and P L Garside, Metropolitan London, politics and urban change 1837-1981, London, Edward Arnold, 1982, especially chs 2 to 4.
32. 35th ARRG, 1872, op. cit., note 1 above, p. 1i.
33. Robson, op. cit., note 13 above, pp. 71-3.
34. E C Seaton, 'On public vaccination in England and Wales', Trans. Natn. Ass. Promotion Soc. Sci., 1857: 460-73, pp. 469-70.
35. Editorial, 'Vaccination and smallpox mortality', Sanil. Rec., 28 June 1878, 8: 406.
36. L Parkes, 'London vestries, and the administration of sanitary law in the metropolis. Part II'. Sanit. Rec., 15 April 1886, NS 7: 532-34, p. 534.
37. Ibid., pp. 532-3.
38. The population at risk used to calculate these mortality rates is the mean population given in the two censuses either side of any given date. For example, London's population at risk in 1855 is the mean of the London populations given in the 1851 and 1861 censuses. The figures for London's share of national smallpox deaths for the period 1854-1905 are given in A Hardy, 'Smallpox in London: factors in the decline of the disease in the nineteenth century', Med. Hist., 1983. 27: 111-38, p. 121.
39. Vaccination Act 1853 (16 & 17 Vict. c. 100).
40. The epidemic in England actually began towards the end of 1870 and lasted until the early months of 1873. In London, the deaths were heavily concentrated in 1871 (7,982 deaths) rather than 1872 (1,747 deaths).
41. The population at risk for the 1-4 year olds in Figure 2 is calculated in exactly the same way as described in note 28 above. However, two points of clarification should be made. First, the age structure in single year age groups for the under-fives was not given in the 1851 census. For the years 1851-60, then, the 1861 structure was used for the population at risk in these ages. Second, the number of live births in an individual year was used as the population at risk for infants.
42. Williams draws attention to the likelihood that high rates of population turnover in other British cities contributed to their high levels of smallpox mortality during the epidemic of 1871-72, in Williams, op. cit., note 3 above, pp. 406-8. A similar point has been made for Stockholm in the 1850s and 1860s in M C Nelson and J Rogers, "The right to die? Anti-vaccination activity and the 1874 smallpox epidemic in Stockholm', Soc. Hist. Med., 1992, 5: 369-88, p. 378.
43. Williams draws attention to the likelihood that high rates of population turnover in other British cities contributed to their high levels of smallpox mortality during the epidemic of 1871-72, in Williams, op. cit., note 3 above, pp. 406-8. A similar point has been made for Stockholm in the 1850s and 1860s in M C Nelson and J Rogers, "The right to die? Anti-vaccination activity and the 1874 smallpox epidemic in Stockholm', Soc. Hist. Med., 1992, 5: 369-88, p. 378.
44. S F Murphy, 'The causes of the present diffusion of smallpox, and the means which should be adopted for its prevention', Sanit. Rec., 15 March 1881, NS 2: 346.
45. Editorial, 'Vaccination and smallpox mortality', Sanit. Rec., 28 June 1878, 8: 404-6. See also Williams, op. cit., note 3 above, pp. 397-9.
46. An Act to Extend the Practice of Vaccination 1840 (3 & 4 Vict. c. 29); An Act to Amend an Act to Extend the Practice of Vaccination 1841 (4 & 5 Vict. c. 32). Hodgkinson, op. cit., note 4 above, p. 28; M W Rinn, 'Medical services under the New Poor Law', in D Fraser (ed.). The New Poor Law in the nineteenth century, London, Macmillan, 1976, pp. 45-66, on pp. 51-2.
47. MacLeod, op. cit., note 4 above, and D Porter and R Porter, 'The politics of prevention: anti-vaccinationism and public health in nineteenth-century England', Med. Hist., 1988, 32: 231-52; A Beck, 'Issues in the anti-vaccination movement in England', Med. Hist., 1960, 4: 310-21.
48. MacLeod, op. cit., note 4 above, and D Porter and R Porter, 'The politics of prevention: anti-vaccinationism and public health in nineteenth-century England', Med. Hist., 1988, 32: 231-52; A Beck, 'Issues in the anti-vaccination movement in England', Med. Hist., 1960, 4: 310-21.
49. Williams, op. cit., note 3 above, pp. 401-3.
50. S M F Fraser, 'Leicester and smallpox: the Leicester method', Med. Hist., 1980, 24: 315-32.
51. In 1882, Henry Stevens - one of Simon's team of medical inspectors at the Privy Council - suggested that despite the penalties introduced under the 1874 Registration Act, there was "a very large class of people, and I am afraid a very increasing class . . . who do not have the births of their children registered, or who register with false addresses on purpose to avoid vaccination", Royal Commission on Smallpox and Fever Hospitals, Parliamentary Papers (henceforth PP) 1882, xxix, p. 197.
52. Williams, op. cit., note 3 above, p. 402.
53. Public Health Act 1858 (17 & 18 Vict. c. 95).
54. R J Lambert, Sir John Simon, 1816-1904: and English social administration, London, MacGibbon and Kee, 1963, pp. 312-17.
55. Edward Cator Seaton was a leading authority on vaccination and worked closely with Simon. He was secretary of the Epidemiological Society's Vaccination Committee and succeeded Simon as Medical Officer of the Local Government Board in 1876. George Buchanan was the MOH for St Giles district in London and had been physician at the London Fever and Sick Children's Hospitals. Buchanan replaced Seaton as Medical Officer at the LGB after the latter's retirement and death in 1879. Ibid., pp. 252-3, pp. 317 and 574.
56. E C Seaton and G Buchanan, 'Report on the state of public vaccination in London, and on the recent epidemic of smallpox', Report of the Medical Officer of the Privy Council, 1863 (henceforth RMOPC), PP 1864, xxviii, Appendix 1. This report is also discussed in Hardy, op. cit., note 5 above, pp. 116-28. The peripatetic inspectors' other county-by- county reports are similar in conception, structure and content to that for London. Seaton later noted "that the districts into which the Kingdom is divided for the purpose of public vaccination exhibit every shade of variety as to the extent to which vaccination is carried out, - from complete observance of the law, to the most culpable and reckless disregard for it". He was particularly scathing of vaccination administration in all large cities. E C Seaton, A handbook of vaccination, London. Macmillan, 1868, pp. 257 and 367.
57. E C Seaton and G Buchanan, 'Report on the state of public vaccination in London, and on the recent epidemic of smallpox', Report of the Medical Officer of the Privy Council, 1863 (henceforth RMOPC), PP 1864, xxviii, Appendix 1. This report is also discussed in Hardy, op. cit., note 5 above, pp. 116-28. The peripatetic inspectors' other county-by- county reports are similar in conception, structure and content to that for London. Seaton later noted "that the districts into which the Kingdom is divided for the purpose of public vaccination exhibit every shade of variety as to the extent to which vaccination is carried out, - from complete observance of the law, to the most culpable and reckless disregard for it". He was particularly scathing of vaccination administration in all large cities. E C Seaton, A handbook of vaccination, London. Macmillan, 1868, pp. 257 and 367.
58. RMOPC, 1863, op. cit., note 44 above, p. 93. There were 232 vaccinators in London, attending a total of 260 stations.
59. Ibid, p. 93.
60. Ibid., p. 95.
61. Ibid., pp. 98-9.
62. An Act to Facilitate Proceedings Before the Justices Under the Acts Relating to Vaccination 1861 (24 & 25 Vict. c. 59). However, it should be noted that the appointment of these officers was not compulsory until the Vaccination Act 1871 (34 & 35 Vict. c. 98).
63. RMOPC, 1863, op. cit., note 44 above, p. 99. The inspectors were of the general impression that "[w]hile many of them [Guardians] would not have demurred to such proceedings in the abstract, they considered that these measures ought to be taken by a public prosecutor, independent of local ties".
64. Ibid.
65. Ibid., p. 100. Stepney and Mile End Old Town were the two primary offenders in this case.
66. Ibid., p. 103. Thirty-six per cent did not list unsuccessful vaccinations; re-vaccinations were not always defined separately from primary ones; and the source of lymph was listed in only 10 of the 205; and dates were frequently omitted or only irregularly entered.
67. Ibid.
68. Ibid., pp. 104-5. The registrars themselves were not exonerated completely. Of the 135 in the capital, a total of 118 only could be said to have complete registers.
69. MacLeod, op. cit., note 4 above: Beck, and Porter and Porter, op. cit., note 36 above.
70. RMOPC, 1863, op. cit., note 44 above, pp. 104-5.
71. Between 1879 and 1890 in England and Wales, the number fined for non-compliance with the acts was 10,660, whilst 113 had been imprisoned. Return of convictions under Vaccination Acts 1889-90, PP 1890. lix. pp. 595-621.
72. Anon., 'Non-vaccination', Sanit. Rec., 18 December 1875, 3: 440.
73. Stevens, op. cit., note 39 above.
74. Anon., 'Vaccination prosecutions at Mile End Old Town', Sanit. Rec., 18 July 1874, 1: 52.
75. Hardy, op. cit., note 5 above, pp. 121 and 132.
76. RMOPC, 1863, op. cit., note 44 above, pp. 93-4. Hardy, op. cit., note 5 above, p. 118.
77. Ibid., p. 93. Hardy, op. cit., note 5 above, p. 117.
78. RMOPC, 1863, op. cit., note 44 above, p. 93.
79. Ibid., p. 94.
80. G Mooney, 'The geography of mortality decline in Victorian London', PhD thesis. University of Liverpool, 1994, p. 196.
81. Sometimes a recently vaccinated child was sent for to provide fresh lymph. In the opinion of the inspectors this situation, although providing for arm- to-arm vaccination, was to be discouraged on two counts. First, it may still have resulted in the use of lymph from second-rate scars, the alternative being preserved lymph. Second, it was argued that the fetching of the child and the maintenance of the arm- to-arm method at any event tended to lower both the station and the operation itself in the eyes of the public, "who come to regard the vaccination of their children as a private favour done to the vaccinator". RMOPC, 1863. op. cit.. note 44 above, p. 97.
82. Seaton, op. cit., note 44 above, pp. 365-6.
83. J Simon, Papers relating to the history and practice of vaccination, London, HMSO, 1857, p. 1xxii.
84. Acting upon orders from the Privy Council, the local authorities were at pains to step up their activities during the epidemic. All the unions bar three issued special placards regarding vaccination arrangements, temporary vaccinating officers were employed and twelve unions ordered either periodical reports or set up monitoring committees. Islington and Clerkenwell unions paid three times the normal rate to ensure the admittance of their smallpox victims to the Highgate Hospital, while most other unions provided special accommodation when the hospital was full. For the vestries and district boards, MOHs conducted special inspections of schools and produced reports on the progress of smallpox in their districts. RMOPC, 1863, op. cit., note 44 above, pp. 110-11.
85. If the VO failed to receive a certificate, the subsequent investigation into the circumstances of non-compliance could lead to prosecution, as stipulated in the 1867 Vaccination Act.
86. Unfortunately, the data on "successful" public infant vaccinations are given only at county level. Further, this data refers to years ending on 29 September. In order to construct Table 4, the chronological mismatch between the public vaccinations and the total vaccinations was corrected by assuming that the percentage of births publicly vaccinated in any given year ending 29 September applied to the calendar year. All the caveats outlined earlier in the paper concerning the accuracy of the public vaccinators' registers should be borne in mind when assessing these figures.
87. Not until 1873 were revaccinations and primary vaccinations separated in the published tables. However, the overwhelming majority of infant vaccinations, if not all of them, were primary, so this should not unduly affect the figures.
88. G Buchanan, Supplement to the 11th annual report of the Local Government Board, containing the report of the Medical Officer, 1881 (henceforth RMOLGB), PP 1882, xxx part 2, p. vii.
89. Order of Council, 'Signs of successful vaccination and of successful revaccination (Gregory, revised by Ceely and Marson)', RMOPC, 1859, PP 1860, xxix, pp. 214-15.
90. The danger of secondary infection from arm-to- arm vaccination was only recognized by legislation in 1898, when it was prohibited and glycinerated calf-lymph was used.
91. RMOPC, 1863, op. cit., note 44 above, p. 100. They were of the opinion, "that fully half of those who operated by puncture were satisfied with an amount of local effect inadequate for satisfactory protection".
92. Some schools required vaccination as a condition of entry, although the inspectors found that in practice the difference between these and other schools in terms of the proportion of children vaccinated was minimal.
93. H Stevens, 'Memorandum on smallpox in London in 1881. with special reference to its relation to public vaccination', RMOLGB, 1881, op. cit., note 75 above, Appendix 8, pp. 45-56, Table E on p. 52. Of the 35 deaths to publicly vaccinated children under 10 years of age, Stevens revealed that 12 were vaccinated whilst incubating the disease and of the other 23 he reckoned that only one had been vaccinated to the standard required by the LGB.
94. In Buchanan's opinion, Stevens' findings intensified the argument against private vaccination, since it was the offspring of the upper classes that constituted the bulk of privately vaccinated children, yet they were less likely to be exposed to smallpox infection than poor children, op. cit., note 75 above.
95. Stevens, op. cit., note 39 above, p. 199.
96. RMOPC, 1863, op. cit., note 44 above, p. 115.
97. Ibid., p. 116. They would also aid private practitioners who could rely on the stations to supply fresh lymph.
98. RMOPC, 1863, op. cit., note 44 above, pp. 118-20.
99. Report from the Select Committee on the Vaccination Act 1867, PP 1871, xiii, p. 306. Lambert notes that criticism of this policy was forthcoming from the Lancet, the PLMOs and William Farr. See Lambert, op. cit., note 42 above, p. 445.
100. The proportion of total national smallpox mortality occurring in the under-five age group fell from 55 per cent in 1867, to 34 per cent in 1870 and 30 per cent in 1872. Seaton also claimed that of the metropolitan districts in 1871-72, only in Bethnal Green did this proportion "remain at the average of the period preceding the Act of 1867". In all the others, the proportion was below. This probably refers to the ten years 1851-60, since the only mortality data giving under-five mortality by district appears in the Registrar-General's decennial Supplements. See Mooney, op. cit., note 67 above, pp. 199-200 and Figures 8.7 and 8.8. The greater proportion of adults dying from smallpox was often used as an argument for the value of revaccination at puberty.
101. Mention should be made of the method used to calculate the mortality rates shown in Table 5. Smallpox deaths in E C Seaton, 'On the recent epidemic of smallpox in the United Kingdom, and its relation to vaccination and the vaccination laws', Report of the Medical Officer of the Privy Council and Local Government Board, 1874 (henceforth RMOPCLGB), PP 1875, xl, Appendix 5, are given for the under-five age group and all ages. For the under-fives, the population at risk used for each registration district, London and England and Wales, is that given in the 1871 census. However, because some babies born in 1871 will have died before the census enumeration, the under-one age group is subtracted and replaced with the total number of live births in that year, taken from the 34th ARRG, 1871, op. cit., note 1 above, p. 32.
102. Mention should be made of the method used to calculate the mortality rates shown in Table 5. Smallpox deaths in E C Seaton, 'On the recent epidemic of smallpox in the United Kingdom, and its relation to vaccination and the vaccination laws', Report of the Medical Officer of the Privy Council and Local Government Board, 1874 (henceforth RMOPCLGB), PP 1875, xl, Appendix 5, are given for the under-five age group and all ages. For the under-fives, the population at risk used for each registration district, London and England and Wales, is that given in the 1871 census. However, because some babies born in 1871 will have died before the census enumeration, the under-one age group is subtracted and replaced with the total number of live births in that year, taken from the 34th ARRG, 1871, op. cit., note 1 above, p. 32.
103. See B Luckin and G Mooney, 'Urban history and historical epidemiology: the case of London, 1860-1920', Urban Hist., 1997, 24 (1): 37-54.
104. On London's "redistribution" problem, see N Williams and G Mooney, 'Infant mortality in an "Age of Great Cities": London and the English provincial cities compared'. Continuity and Change, 1994, 9: 185-212, pp. 188-90.
105. The figures are taken from, Return of the number of vaccinations for the war ended 29 September, 1870, PP 1871, lix, p. 505.
106. Seaton, op. cit., note 88 above, p. 78.
107. Shortly before the outbreak of smallpox in 1871, the clerk of St George Southwark was alleged to have commented that, "[w]e've done nothing, Sir, and we don't intend to do anything". Ibid.
108. E C Seaton, 'Digest of the Vaccination Officers' returns, so far as received down to January 31st 1874, with regard to children born in the year 1872', RMOPCLGB, 1874, op. cit., note 88 above, Appendix 1: 17-34, p. 18.
109. Tenth ARLGB, 1880-81, PP 1881, xlvi, p. xciii, and 17th ARLGB, 1887-88, PP 1888, xlix, p. cxliii.
110. Tenth ARLGB, 1880-81, PP 1881, xlvi, p. xciii, and 17th ARLGB, 1887-88, PP 1888, xlix, p. cxliii.
111. Stevens, op. cit., note 80 above, p. 50.
112. Royal Commission on Smallpox and Fever Hospitals, PP 1882, xxix, p. vii. The problem of smallpox hospitals is discussed in Hardy, op. cit., note 5 above, pp. 137-42.
113. The Vaccination Act 1871 (see note 49 above); The Local Government Board Act 1871 (34 & 35 Vict. c. 70).
114. Stevens, op. cit., note 39 above, p. 195.
115. Public health (Metropolis) bill, PP 1877, v, pp. 541-87.
116. Editorial, 'Public health Metropolis bill', Sanit. Rec., 20 July 1877, 7: 42. Upon complaint against a local sanitary authority, the LGB could order that authority to enforce the provisions of the legislation.
117. Editorial, 'Public health Metropolis bill'. Sanit. Rec., 6 July 1877, 7: 7.
118. Editorial, 'Public health Metropolis bill', Sanit. Rec., 20 July 1877, 7: 38-39.
119. Editorial, 'Public health Metropolis bill', Sanit. Rec., 27 July 1877, 7: 56.
120. G Sclater-Booth, Hansard's Parliamentary Debates, 3rd Series, 19 July 1877. House of Commons, col 1,534.
121. Orme Dudfield, op. cit., note 17 above.
122. Bill for better government of London, PP 1884, v, pp. 115-16.
123. Robson, op. cit., note 13 above, pp. 73-4. The immediate cabinet wranglings leading up to this measure can be found in Young and Garside, op. cit., note 21 above, pp. 39-63.
124. Young and Garside, op. cit., note 21 above, pp. 48-51.
125. He recognized that for nostalgic reasons the new central authority might "become in fact as in name the Corporation of London", but practical evidence of the work carried out by the MBW suggested that the new authority should adopt the title of that body. Orme Dudfield, op. cit., note 17 above, pp. 237-8.
126. Robson, op. cit., note 13 above, p. 77. Following the announcement in the Queen's speech of the intention to reform the Corporation, the Special Committee spent a total of nearly £20,000 between 1883 and 1885.
127. London government bill summary, PP 1884, v, p. 2. On the Corporation's opposition to Harcourt's Bill, see T B Smith, 'In defense of privilege: the City of London and the challenge of municipal reform', J. soc. Hist., fall 1993: 59-83, on pp. 66-9.
128. London government bill summary, PP 1884, v, p. 2. On the Corporation's opposition to Harcourt's Bill, see T B Smith, 'In defense of privilege: the City of London and the challenge of municipal reform', J. soc. Hist., fall 1993: 59-83, on pp. 66-9.
129. Editorial, 'The London government bill', Sanit. Rec., 15 May 1884, NS 5: 548. The journal itself was of the conviction that "[t]he composition of the vestries has except in a few districts where public opinion has recently quickened, steadily retrograded. The new central council may be fairly expected to attract men of a distinctly higher mental character than those who now compose the Corporation and the vestries; and gradually the whole tone of municipal life will thus be raised".
130. Only one vestry supported the Bill. See Davis, op. cit., note 20 above, pp. 78 and 81.
131. Orme Dudfield, op. cit., note 17 above, pp. 235-6.
132. Hardy, op. cit., note 28 above, p. 115; idem, op. cit., note 5 above, pp. 141-2.
133. A Wilkinson (now Hardy), 'The beginnings of disease control in London: the work of the medical officers in three parishes, 1856-1900', DPhil thesis. University of Oxford, 1980, p. 161; Hardy, op. cit., note 5 above, pp. 147-50. During the 1893 epidemic. London's mortality rate stood at 7 per 100,000 population, compared to 67 in Sheffield, 91 in Manchester and 99 in Bristol. These rates are calculated by the method used in Figure 1 (see note 28 above) and are taken from the tables contained in the 56th ARRG, 1893.
134. A Wilkinson (now Hardy), 'The beginnings of disease control in London: the work of the medical officers in three parishes, 1856-1900', DPhil thesis. University of Oxford, 1980, p. 161; Hardy, op. cit., note 5 above, pp. 147-50. During the 1893 epidemic. London's mortality rate stood at 7 per 100,000 population, compared to 67 in Sheffield, 91 in Manchester and 99 in Bristol. These rates are calculated by the method used in Figure 1 (see note 28 above) and are taken from the tables contained in the 56th ARRG, 1893.
135. Hardy, op. cit., note 5 above, p. 111.
136. They did. however, become responsible for the payment of half the salary of their MOH. Local Government Act 1888 (51 & 52 Vict. c. 41).
137. Robson, op. cit., note 13 above, p. 81.
138. London Government Act 1899 (62 & 63 Vict. c. 14).
139. Public Health (London) Act 1891 (54 & 55 Vict. c. 76).
140. See G Mooney, 'The prevention and control of infectious childhood diseases in late nineteenth- and early twentieth-century London: the case of diphtheria and measles', in R King and M L Gentileschi (eds), Questioni di popolazione in Europa: una prospettiva geografica, Bologna, Pàtron, 1996, pp. 255-71.
141. C Lawrence, Medicine in the making of modern Britain, 1700-1920, London, Routledge 1994, p. 50.