However, by the 1840s smallpox was a minor cause of death, suggesting that the decline of smallpox mortality played a major role in the reduction of all-cause mortality, at least in urban areas.
Section II describes the patterns of smallpox mortality in St Martin's, in particular the rapid decline in adult smallpox burials after c. 1770.
Such a change in the nature of smallpox mortality in London is corroborated by various aspects of Landers's analysis of the London Bills.
Since this phenomenon of precipitous changes in the age structure of smallpox mortality appears in a local study, we need to establish that it is not a product of some local peculiarity in the care of smallpox sufferers.
85 The changes in the age pattern of smallpox mortality in Geneva are strikingly similar to those evident in the St Martin's population earlier in the 1770s, and consistent with the diffusion of a novel viral strain.
71 Therefore it is probable that any shift in the average age of infection to younger ages would have resulted in a greater level of under-recording of smallpox mortality.
Both provaccinationists and antivaccinationists relied heavily on time series of smallpox mortality rate data, which showed a general decline over the 19th century overlaid by several smaller epidemic peaks and the large pandemic peak of 1870 1873.
For example, if it were assumed that vaccination rates increased in 1867, when cumulative penalties were introduced and fewer dared to challenge the vaccination law, and not in 1871, when the smallpox pandemic accelerated, then the rate of decline of smallpox mortality rates was lower when vaccination was more prevalent.
65 In addition, rural inoculation should not have affected the age pattern of smallpox mortality among children in London, whereas an increase in transmission of smallpox should have reduced the average age at infection in rural areas, and could have had a similar effect in London, if the same processes were at work in the metropolis.
Landers was able to demonstrate that much of the rise in childhood mortality (ages 1 9) in the Quaker sample in the early eighteenth century, and its rapid fall especially from the 1770s, was due to the rise and fall of smallpox mortality at these ages.
