Smallpox Epidemics in Cities in Britain

and was greatly feared from the time of the final visitation of bubonic plague in I666 until the end of the nineteenth century, when it ceased to be endemic in England. Relatively rare as a fatal disease in England until the I630s, after I666 it replaced plague as the most feared of diseases. Many accounts suggest that a particularly virulent strain began to afflict people of all ages in the middle and later decades of the seventeenth century, and the evidence points to a gradual but significant increase in the virulence and case fatality rate from the later sixteenth through to the end of the nineteenth century.1 By the first half of the eighteenth century, almost everyone had suffered at some time from the disease and it was thought to be directly, or indirectly, responsible for one death in every five. After 1750, inoculation or variolation began to be administered more widely among the educated and affluent, but there was a time lag of about ten to twenty years before the same degree of acceptance reached the northern counties of Cheshire, Cumberland, Lancashire, and Yorkshire. Although smallpox remained unconquered, a rising proportion of the population had been