The Last Nationwide Smallpox Epidemic in the Netherlands: Infectious Disease and Social Inequalities in Amsterdam, 1870–1872

Abstract The complex relationship between the history of infectious diseases and social inequalities has recently attracted renewed attention. Smallpox so far largely escaped this revived scholarly scrutiny, despite its century-long status as one deadliest widespread all diseases. Literature demonstrated important differences rural urban communities, cities, but failed to address intra-urban disparities due varying living conditions disease environments. This article examines last nationwide upsurge smallpox in Netherlands through lens Amsterdam’s 50 neighborhoods period 1870–72. We use a mixed methods approach combining qualitative spatial analysis OLS regression investigate which part population was affected most by epidemic terms age sex, geographic distribution across city, underlying sociodemographic neighborhood characteristics such relative wealth, housing density, crude death rate, birth rate. Our analyses reveal significant patterning mortality that can be explained existing environment. Lacking universal vaccination, not socially neutral, laid bare some deep-seated health city.