In 1862, Henry Littlejohn was appointed to the newly created position of medical officer of health (MOH) for Edinburgh. Three years later, he published his methodological and statistically rigorous Report on the Sanitary Condition of Edinburgh, which offered a comprehensive picture of the city's sanitary problems and a vision for improvement. To make the report more accessible to scholars, Laxton and Rodger present a fine-grained interpretative commentary of Littlejohn's ‘extraordinary nineteenth-century account’ (p. xv) combined with a facsimile of the original report. The result is not only a meticulous examination of the context of Littlejohn's report and the Edinburgh he described, but also a beautifully illustrated account that enriches our understanding of the sanitary conditions and urban politics of Edinburgh from the early to mid-nineteenth century.

Laxton and Rodger have, like Littlejohn, undertaken painstaking research. If at times the intricacies of urban politics dominates Insanitary City, Laxton and Rodger build on long-established historiographical traditions to provide more than a simple commentary on the background of Littlejohn's investigation. They reveal the interconnections between community health and public administration in shaping debates about public health in Edinburgh and in Littlejohn's report. In exploring how questions of public health were deeply rooted in a broad Scottish vision of civic responsibility and in urban governance, they expose the multiple agendas, agents, arguments and administrative struggles that contributed to the messy and contested nature of public health in Edinburgh. Continuities rather than changes in Edinburgh's public health history emerge as crucial.

In chapters 1 and 2, Laxton and Rodger provide insights into Littlejohn's background and the influences on him, and emphasize the importance of locating social and public health policy in Edinburgh within a framework of medical policing and debates about poor relief in Scotland. For Laxton and Rodger, these are crucial for interpreting public health and the paralysis of social policy. Chapters 3 to 5 deal with the making of the report, its reception and impact to present an intricate picture of administrative structures, personalities and politics. The fragmented nature of Edinburgh's urban administration and the problems this created are at the heart of chapter 3. Here, Laxton and Rodger address how prior to 1863 public health was defined and managed through the work of the Police Commission to present a detailed picture of growing public concern, the strength of localism, the important shift to civic registration, the micro-politics of debates about the water of Leith affair, shifting political alliances, paralysis and financial concerns. From examining the intricate background to Littlejohn's appointment as MOH, in chapter 4 Laxton and Rodger guide the reader through the contents of the report, exploring how it represented medical jurisprudence in action, with Littlejohn's spatial approach and practical short-term solutions being almost anti-Chadwickian. Littlejohn emerges as a dispassionate empiricist, a geographer and an historian; a critical but obedient public servant whose recommendations ‘exhibit’ Enlightenment credentials (p. 173). In presenting Littlejohn's report as transformative in providing an empirical basis for health policy that cemented the role of the expert in Edinburgh's governance and created a new social geography of the city, Laxton and Rodger celebrate Littlejohn's ‘monumental’ achievements, while in chapter 5 they address the immediate legacy of the report. In these chapters, the press emerges as a crucial source and an important agent in debate, not only breaking careers but also revealing the contentious questions surrounding public health and the controversial civic improvement programme that aimed to reshape Edinburgh, which form the focus in chapter 5. If Littlejohn becomes a marginal figure in chapter 5, chapter 6 explores his influence on public health between the publication of the report and the Royal Commission on Housing for the Working Classes. Littlejohn emerges as a sensitive political networker whose vision saw death rates in Edinburgh fall, but, as Laxton and Rodger hint, there were limits to what Littlejohn could achieve.

Given their meticulous contextualization, and how Laxton and Rodger locate the report within the politics and environment of Edinburgh, often little space is left for the wider context of sanitary reform or day-to-day sanitary work. For example, Laxton and Rodger examine Littlejohn's concerns about urban food supplies but pay less attention to why diseased meat emerged as a source of concern in the 1860s. Equally, more might be made of recent historiographical trends in research on public health and sanitary knowledge, while the use of terms such as ‘public engagement’ or ‘the media’, or comparing Littlejohn's appendices to a ‘modern spreadsheet’, are jarring. These are minor gripes. Laxton and Rodger have produced an impressively researched book that is far more than an interpretative commentary. Insanitary City not only offers a rich examination of the sanitary problems facing Edinburgh and Littlejohn's report, but also a penetrating analysis of urban governance in the early to mid-nineteenth century.