1 A more ‘popular’ and much abbreviated version of this paper appeared in the Times Higher Education Supplement, 18 June 1976. It was also delivered in a variety of forms to historical and medical seminars in Cambridge, London, Manchester and Bolton. I am grateful to all those who offered comment and criticism. My greatest debt, however, is to the late Professor H. J. Dyos, both for his advice on an earlier draft, and for many other kindnesses over the years.

2 A recent contributor to the debate qualifies what seem to be guardedly ‘optimistic’ conclusions by stating that: ‘The data on mortality rates in early nineteenth century cities seems damning enough, and I find myself in sympathy with the recent shift in emphasis to environmental factors’. Von Tunzelmann, G. N.. ‘Trends in real wages, 1750–1850, revisited’, Economic History Review, 2nd ser., xxxii, 1 (1979), 49.Google Scholar

3 Foucault, M., The Birth of the Clinic, translated by Sheridan, A. M. (1973)Google Scholar and Abel-Smith, Brian, The Hospitals, 1800–1948: A study in social administration in England and Wales (1964).Google Scholar

4 The classic article is Ackerknecht, Erwin H., ‘Anticontagionism between 1821 and 1867’, Bulletin of the History of Medicine, xxii (1948), 562–93.Google Scholar

5 See, for example, Rosen, G., A History of Public Health (New York, 1958)CrossRefGoogle Scholar and ‘Disease, debility and death’ in Dyos, H. J. and Wolff, Michael (eds), The Victorian City: Images and reality, vol. II (1973), 625–67.Google Scholar

6 For a typically dazzling and deeply considered synopsis see Needham, Joseph (with Gwei-Djen, Lu), ‘Medicine and Chinese culture’ in Joseph Needham, Clerks and Craftsmen in China and the West (1970), 263–93.Google Scholar

7 Cipolla, Carlo M., Cristofano and the Plague: A study in the history of public health in the age of Galileo (1973)Google Scholar and Public Health and the Medical Profession in the Renaissance (1976).

8 Thomas, Keith, Religion and the Decline of Magic (1973), 209–52.Google Scholar However, the social and sociological frameworks within which historians might more fruitfully examine interactions between ‘specialist’ and ‘non-specialist’ world-views have only recently begun to be discussed. For a brave venture in this field see Blackman, Janet, ‘Popular theories of generation: the evolution of Aristotle's Works. The study of an anachronism’, in Woodward, John and Richards, David (eds), Health Care and Popular Medicine in Nineteenth Century England (1977), 56–89.Google Scholar

9 Appleby, Andrew B., ‘Disease or famine? Mortality in Cumberland and Westmorland 1580–1640’, Economic History Review, 2nd ser, xxvi, 3 (1973), 403–33Google Scholar and idem, ‘Nutrition and disease: the case of London, 1550–1750’, Journal of Interdisciplinary History, vi, 1 (Summer, 1975), 1–22.

10 Illich, Ivan, Limits to Medicine: Medical nemesis (1977)CrossRefGoogle Scholar; Ariès, Phillipe, Western Attitudes Towards Death: From the Middle Ages to the present (Baltimore, 1974).Google Scholar Illich's study contains a superlative bibliography on the history and sociology of medicine and disease.

11 Finer, S. E., The Life and Times of Sir Edwin Chadwick (1952)CrossRefGoogle Scholar; Lewis, R. A., Edwin Chad-wick and the Public Health Movement 1832–1854 (1952)Google Scholar; Lambert, R. S., Sir John Simon 1816–1904 and English Social Administration (1963).Google Scholar These seminal studies have now been complemented by Margaret Pelling's scholarly account of medical and epidemiological thought, Cholera, Fever and English Medicine 1825–1865 (1978).

12 Exceptions include Razzell, Peter, The Conquest of Smallpox: The impact of inoculation on smallpox mortality in eighteenth century Britain (1977)Google Scholar and Armstrong, Alan, Stability and Change in an English County Town: A social study of York 1801–1851 (1974), 108–54.Google Scholar

13 The arguments contained in these articles have now been restated and expanded in McKeown, Thomas, The Modern Rise of Population (1976).CrossRefGoogle Scholar

14 Murchison, Charles, The Continued Fevers of Great Britain (3rd edn., 1884), 52–3Google Scholar; Report of the Medical Officer of Health: Shoreditch (1862), 19Google Scholar; Report of the Medical Officer of Health: Strand (1859), 11Google Scholar; and Report of the Medical Officer of Health: Holborn (1866), 53–4.Google Scholar

15 Admissions material for London for the period 1848–70 is to be found in Murchison, op.cit., 74–5. Data for the final 30 years of the century may be abstracted from the Minutes of the Metropolitan Asylums Board and, from 1887 onwards, from the annual Reports of the Board's Statistical Committee. Both the Minutes and the Reports of the Statistical Committee may be consulted at County Hall, Westminster. The University Library, Cambridge, also keeps a complete run of the Reports of the Statistical Committee. These detailed and beautifully presented records, and particularly the meticulously shaded scatter maps which show the annual incidence of infectious disease at district level from 1887 onwards, are among the richest, and least exploited, source materials for the urban historian of disease.

16 Local differentials in levels of rent have not yet been studied in depth but there is much relevant and penetrating material in Hunt, E. H., Regional Wage Variations in Britain 1850–1914 (1973).Google Scholar On dietary history see Oddy, D. and Miller, D. (eds), The Making of the Modern British Diet (1976)Google Scholar and the trenchant remarks in Smith, F. B., The People's Health 1830–1910 (1979).Google Scholar The interpretative historical literature in English on this topic is still underdeveloped. For recent work in French, much of it influenced by the Annates school, see Illich, op.cit.

17 On the Thames question at this time see Royal Commission on the Supply of Water in the Metropolis, PP, 1828, IX. 122–23 and 200. On St Helens, see Checkland, S. G., TheRise of Industrial Society in England 1815–1885 (1971), 170–1.Google Scholar

18 The most important pioneer in the field of applied water analysis was the chemist, Edward Frankland. For a brief biographical note see Partington, J. R., A History of Chemistry, vol. IV (1964), 500–1.Google Scholar The crucial figure in the development of the monitoring of atmospheric pollution was the influential Angus Smith. See MacLeod, Roy M., ‘The Alkali Acts Administration 1863–84: the emergence of the civil scientist’, Victorian Studies, ix (1965), 85–112.Google Scholar

19 This topic has been discussed by, among others, Jones, Gareth Stedman, Outcast London (1971)Google Scholar and Wohl, A. S., The Eternal Slum: Housing and social policy in Victorian London (1977).Google Scholar See also Chapman, S. D. (ed.), The History of Working Class Housing: A symposium (1971).Google Scholar

20 Information of this kind is available for the London Fever Hospital and for institutions which came under the jurisdiction of the Metropolitan Asylums Board.

21 See note 16 above.

22 Snyder, John C.. ‘The typhus fevers’, in Rivers, Thomas M. (ed.), Viral and Rickettsial Infections of Man (2nd edn, Philadelphia, 1952), 578–610Google Scholar, and McKeown, Thomas, Brown, R. G. and Record, R. G., ‘An interpretation of the modern rise of population in Europe’, Population Studies, xxvi (1972), 345–82CrossRefGoogle Scholar and, particularly, 356.

23 The general ‘hygiene’ argument has been put forward by Razzell, P. E., ‘An interpretation of the modern rise of population in Europe—a critique’, Population Studies, xxviii (1974), 5–17.Google Scholar On typhus see Chambers, J. D., Population, Economy and Society in Pre-Industrial England (1972), 103–4.Google Scholar

24 This is the general explanation proposed by McKeown, op.cit. But note the suggestive qualifications proposed by Woods, Robert, ‘Mortality and sanitary conditions in the ld;Best governed city in the world”—Birmingham, 1870–1910’, Journal of Historical Geography, iv, 1 (1978), 35–56.CrossRefGoogle Scholar

25 George Rosen in Dyos and Wolff, op.cit., 650.

26 Braudel, Fernand, Capitalism and Material Life, translated by Kochan, Miriam (1974)Google Scholar; Henry, Louis, ‘The population of France in the eighteenth century’, in Glass, D. V. and Eversley, D. (eds), Population in History (1965), 448Google Scholar; Chambers, op.cit., chapter 4. The subject is also clearly examined in Post, John D., ‘Famine, mortality and epidemic disease in the process of modernization’, Economic History Review, 2nd ser., xxix, 1 (1976), 14–38.CrossRefGoogle Scholar There is much that is germane to this topic in McNeill, William H., Plagues and Peoples (1977)CrossRefGoogle Scholar, an ambitious interpretation of ‘ecological history’, based on wide-ranging medico-historical documentation.

27 Burnet, MacFarlane and White, David O., The Natural History of Infectious Disease (1972).Google Scholar

28 Slack, Paul, ‘Disease and the Social Historian’, Times Literary Supplement, 8 03 1974.Google Scholar

29 McKeown, Thomas and Record, R. G., ‘Reasons for the decline of mortality in England and Wales during the nineteenth century’, Population Studies, xvi (1963), 94–122Google Scholar, reprinted in Flinn, M. W. and Smout, T. C. (eds). Essays in Social History (1974), 218–55.Google Scholar Scarlet fever is discussed at several points in this influential article but see, in particular, 243.

30 In the period between about 1830 and 1900 case fatality rates ranged fairly consistently between 25 and 40 per cent. Fifth Annual Report of the Poor Law Commission, PP, 1839, XX, appendix C2, 113Google Scholar; annual Reports of the Statistical Committee of the Metropolitan Asylums Board 1887–1900; Goodall, E. W., A Short History of the Infectious Epidemic Diseases (1934), 88.Google Scholar

31 Briggs, Asa, ‘Cholera and society in the nineteenth century’, Past andPresent, xix (1960–1961), 79–96.Google Scholar

32 Popular hostility towards the medical profession is well described by Durey, M., The First Spasmodic Cholera Epidemic in York, 1832, Borthwick Papers, no. 46 (York, 1974).Google Scholar

33 The literature is now becoming voluminous. A basic bibliography, excluding unpublished Ph.D. and M. A. theses, would include McGraw, R. E., Russia and the Cholera 1823–32 (Madison, 1965)Google Scholar; Chevalier, Louis (ed.), Le Choléra: la première épidémie du XIXe siècle (La Roche sur Yon, 1958)Google Scholar; Rosenberg, Charles, The Cholera Years: The United States in 1832, 1849 and 1866 (Chicago, 1962)Google Scholar; Morris, R. J., Cholera 1832 (1976).Google Scholar A more exhaustive bibliography is contained in Pelling, op.cit., in the footnote to page 4.

34 The Society for the Social History of Medicine provides a stimulating point of contact for those engaged upon research in this field. Its journal, the Bulletin of the Society for the Social History of Medicine, contains regular summaries of work in progress.