The nineteenth century also saw epidemics of yellow fever, smallpox, diptheria, scarlet fever, dysentery, typhus and typhoid. Tuberculosis was ever-present.

It tells the story of a rich heiress who takes in and refines a beautiful London flower-seller. In present-day Kent on the Castle estate of her ancient aristocratic family, Lady Lucille Ingleshaw, aged seventeen, encounters squalid, nameless poverty in the form of a beautiful, emaciated girl of her own age, whom she finds sleeping exhaustedly in the grounds and takes home to nurse. The servants are horrified. One calls the girl, who knows herself only as Bess, offal. The governess clearly thinks she is either a fallen woman or worse. She tries to prevent contact between the two, exclaiming, in what readers would have recognized as an allusion to the legislation of prostitution through the Contagious Diseases Acts: She may have some contagious disease—smallpox, perhaps. Her protégée does indeed transmit scarlet fever to Lady Lucille (who almost dies from it), but she is, as in Shaw 's Pygmalion, cleaned up, renamed Elizabeth May, and installed in the house in the shifting role of servant, pupil, nurse, and companion to her rescuer. When a maid offers herself as a model, the sharp-witted (and we later learn, Radical) Elizabeth retorts You're the pattern I'm to cut myself out upon? I'd rather look higher, and imitate Lady Lucille.

An anonymous doctor was credited in IB 's preface with the authorship of both The Rearing and Management of Children, and Diseases of Infancy and Childhood and the medical chapter. The former chapter supports maternal breastfeeding and smallpox vaccination, now made mandatory by the state, and focuses on infant physiology, development, and illnesses, rather than all aspects of childrearing.The Doctor contains numerous treatments and remedies for common illnesses such as cholera, even including instructions on how to bleed a patient in an apoplectic emergency if a doctor is unobtainable. Other portions of the Book of Household Management also touch on medical matters, such as the section on Invalid Cookery, the discussions of the duties of nurses and wet nurses, and the general emphasis on sanitation. In her discussion of nursemaids, IB quotes Florence Nightingale 's Notes on Nursing in support of good hygeine, nutrition, and fresh air. The legal chapter, contributed by a lawyer, is short and mostly matter-of-fact, summarizing the practical aspects of such matters as leases, debts, wills, and the legal status of women. Unlike the bulk of the book, it assumes a male rather than a female reader.

Epidemics of smallpox ran through the United Kingdom, killing over 42,000 people, mostly babies and young children.

The Vaccination Act or (Act to Extend the Practice of Vaccination) was the first of a series of such acts passed in response to an epidemic of smallpox among the poor between 1837 and 1840.