The University of London 1836–1986. An illustrated history

s monograph does not completely fill this gap; but in its modest and carefully researched way it presents us with the best account yet-albeit one essentially geographically circumscribed to the Eastern Counties-of the social response to surely the most serious and feared epidemic disease from Stuart to Edwardian times. Smith's local researches in Essex confirm that smallpox mortality was often extremely high. Plenty of Georgian reports speak of villages being deprived of a tenth, or even a sixth of their inhabitants. But the costs were much wider, for the closing of markets and the curbing of economic activity which outbreaks required often brought misery and poverty to communities (and as a result, heightened susceptibility to other diseases). Smith shows that magistrates under the Old Poor Law were often generous and active in coping with outbreaks, and numerous pesthouses were brought into operation. But the real breakthrough came with the activities of the Sutton family, and other local general practitioners, in pioneering cheap, fast, efficient, and largely safe inoculation from mid-century. Here Smith confirms Zwanenberg's earlier account of the positive success of Suttonian inoculation. He also underlines how astute were the Suttons as businessmen (they even hired a clergymen to sing the praises of inoculation from the pulpit), and how speedily their services were adopted by magistrates and corporations. One wishes Smith's analysis were equally full on the Victorian period, for scholars have yet to explain in detail why the advent of vaccination made relatively slow inroads into these lethal epidemics, and also why religious and libertarian opposition to vaccination steadily grew to a peak around the 1 890s. Organized anti-vaccination opinion was never very powerful in Essex, unlike in some counties, though a group of religious fundamentalists around Southend, the Peculiar People, successfully defied the law in the 1890s. Smith hints that the shift from essentially "private enterprise" inoculation to vaccination within the legal framework of Victorian public health may have triggered resistance; but further research is required before we shall know for certain whether the anti-vaccination leagues-were true barometers of public opinion or little more than noisy but narrow cliques. Dr Smith combines local and national concerns with skill, and makes particularly effective use of newspaper sources. His book is strongly to be recommended to all interested in the fine texture of medical and social responses to epidemic diseases. Negley Harte made his debut as a historian of higher …