"A tissue of the most flagrant anomalies": smallpox vaccination and the centralization of sanitary administration in nineteenth-century London.

Histories of smallpox and vaccination are both varied and voluminous. In purely epidemiological terms, smallpox has acquired for itself a position of significance far in excess of its numerical importance as a cause of death in the nineteenth century.1 Although mortality from the disease had already declined from high levels in the eighteenth century, smallpox vaccination has recently been credited for a large part of the total mortality decline in England and Wales during the second half of the nineteenth century.2 While vaccination was undoubtedly the prime facilitator for the eradication of smallpox, recent research has shown that the regional pattern of public infant vaccination take-up rates varied enormously across the country and over time, and that revaccination at puberty was not universal.3 In wider terms, vaccination also addresses important historical debates, including the state provision of free, universal (though compulsory) health care.4 It helps illustrate the success of local preventive medical services;5 and it draws attention to ideological objections to governmental interference with individual liberty-in this respect smallpox and vaccination have prompted comparison with the present-day AIDS