This volume, which is Kevin Siena's second monograph, contends that the plague which menaced seventeenth-century Britain left a poisonous legacy for the urban poor, in the form of alarm about their corporeal putridity. He traces this suspicion in a literature which attempted to explain the incidence of plague to its contemporaries and, after 1666, which sustained the momentum of revulsion. This book argues that the fears raised were so powerful and persistent that they were maintained ‘in a direct line from the age of plague to the age of cholera’ (p. 2), regardless of intervening intellectual and enlightenment developments. It does so largely from the perspective of London and the reading public for metropolitan publications.

Chapters 1 and 2 establish the connection between plague, poverty and the susceptibility of poor bodies to decay from a putrid constitution. The risks of fatal epidemics were kept in the eye of the literate public by reference to outbreaks abroad, medical treatises and Defoe's writings. A key role is unearthed for physician Richard Mead in connecting plague as pestilence with later irruptions of fever. Consequently, after the early 1720s, apprehensions about the return of bubonic plague were transferred to the fevers which sprang up in smelly, overcrowded settings. Prisons were a particular focus of concern, given their capacity to convey contagion from prisoners to courtrooms, to legal professionals and to the wider urban community. Therefore, Chapters 3–6 unpack in detail the long roots of John Howard's reforms as lying among the palpable nastiness of earlier decades. The body of the debtor was incarcerated with those of the perpetually poor, while hailing from the ranks of the typically comfortable. Forced proximity to the possessors of putridity was deeply unsettling, and gave rise to sporadic, fluent accounts by the formerly wealthy of recoiling from corruption. Then, in 1750, a spate of deaths among London's aldermen, judges, attorneys plus others connected to the Old Bailey mobilized latent fears about prisons and consolidated the association of malignancy with the bodies of poor prisoners. The totemic role of London in the plague was revived under a new terror. Furthermore, jail fever remained a potent topic to the end of the eighteenth century, Siena argues, because unlike other diseases it tied medical theory to moral danger. In this context, prisons were just one among a growing range of institutions which clustered the poor together. Workhouse inhabitants were less obviously flawed than criminals, although they still carried a diluted whiff of blame. The reader is reminded via reference to a convincing array of authors that, according to contemporary thinking, the poor body was inherently likely to decay, and illegal or immoral behaviour exacerbated the rate of putrescence. Worse, technical innocence was no protection for the rich against a concentration of poor bodies. Remedies were sought in hygiene (vinegar) or ventilation, but eventually in rebuilding the structures which seemed so likely to harbour contagion. A fever hospital for virtual sequestration of disease was the logical result, tried first in Manchester at the end of the century and treated in Chapter 7.

This is an unusual cultural history, which gives as much or more weight to events than to discourses. Outbreaks of ‘jail’ fever are placed centre stage. The explanations for their occurrence and the anxieties they aroused were the glue which enabled medical ideas about the poor to remain consistent or even unanimous over such a long period. The result is a physiology of class (where the pertinency of ‘class’ before 1800 is fully considered), and a reinterpretation of prison reform as an expression of class preservation. John Howard is reconstrued as courageous beyond the usual narratives of his heroic humanitarianism, namely for daring to investigate the prisons that others of his class feared to approach. His peers among coroners and jurors, for example, pushed inquests on London's prisoners into alternative venues from 1783 onwards. The menace of the offensive smell in a carceral setting hangs over this whole account.

Readers should be aware that the one drawback of the book lies in the misdirection of the extended title: this is a book about England rather than Britain. Intellectual trends in medical thinking are traced for Edinburgh men among others, but one has to look very carefully to find reference to Wales, and Ireland seems to be missing. Essentially, this is an account of London and, to a lesser extent, English provincial towns. The compensation for any potential disappointment lies in the writing style which is immediate, personal and involving. Siena has achieved a masterly piece of work about the cultural longevity of the urban epidemic, coincidentally published at a point in history when our attention is being inexorably returned to the causes and consequences of contagious disease.