The speckled monster. Smallpox in England, 1670–1970, with special reference to Essex

improvements, and a change in the character ofspecific diseases put forward to account for the fall in mortality during the course ofthe nineteenth century or even to assess the relative contribution of each to the mortality level of a particular city. On the latter issue, Robert Woods' own study of the sanitary condition ofBirmingham marks a significant advance in that he is able to provide a fine area breakdown of the distribution ofwells and water-closets to compare with the spatial incidence of disease. Even Woods, however, is not able to exclude the possibility that it was not the locality of residence but the standard of living of individuals that critically shortened or lengthened their expectation of life. Other contributors fare less well. Barbara Thompson, for instance, discusses the factors behind the high level ofinfant mc,rtality in Bradford, but her analysis is disappointingly inconclusive. The turn-of-the-century survey ofinfant welfare by the Westminster Children's Health Society, recently summarized by F. established that whether and for how long the infant was breast-fed was a much more potent influence on its chances ofsurvival than either the quality or type ofhousing or whether the mother was employed outside the home. If this was the situation of the inhabitants of a poor quarter of the metropolis, why should it be different for the infants of Bradford? This, at least, is the proposition that ought to have been confronted in any further account of the high rate of ninetenth-century infant mortality, particularly if the historian feels, like Barbara Thompson, that the blame lay with environmental hazards and poverty rather than elsewhere. A more general weakness with the collection ofessays is the absence ofany detailed treatment of mortality in rural areas. This may seem a somewhatchurlish criticism to level at a book specifically devoted to the study of urban disease and mortality, but it is difficult to deal adequately with the various hypotheses competing to account for the general decline in mortality unless it can be explained why life expectancy at birth in rural areas could exceed fifty years while in a number of the larger towns it failed to reach thirty-five. At one point (p. 24), Woods and Woodward allege that the early-nineteenth century witnessed a substantial advance in life expectancy in rural areas, but they offer no direct evidence. Otherwise, there is only Gillian Cronje, who shows that one of the major killers, tuberculosis, although more …