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This article is a reponse to Davenport, Schwarz, and Boulton’s article, ‘The decline of adult smallpox in eighteenth-century London’. It introduces new data on the parish of St Mary Whitechapel which casts doubt on the pattern of the age incidence of smallpox found by Davenport et al. However, it is concluded that there was a decline in adult smallpox in London, accompanied by a concentration of the disease among children under the age of five. Davenport et al.’s argument that the shift in the age incidence was due to the endemicization of smallpox in England is challenged, with an alternative view that these age changes can be accounted for by the practice of inoculation, both in the hinterland southern parishes of England and in London itself. A detailed discussion is carried out on the history of inoculation in London for the period 1760-1812. It is suggested that inoculation became increasingly popular in this period, rivalling in popularity the practice of vaccination. This was associated with a class conflict between the medical supporters of Jenner and the general population, with many of the latter being practitioners of the old inoculation.