OFFICIAL LIFE--GENERAL BOARD OF HEALTH, 1848-1854.
Immediately after the passing of the Public Health Act, Lord Morpeth
wrote to my grandfather that the changes made in the bill during its
passage through Parliament had prevented the creation of any post which
could be offered to him. Lord Morpeth said, however, that if Dr
Southwood Smith would give the department the advantage both of his
presence and counsel by accepting a seat on the Board, he hoped to
provide for him a permanent post, by means of a supplementary Act, "The
Diseases Prevention Act," which the Government expected to pass shortly.
In answer to this my grandfather wrote as follows:--
38 FINSBURY SQUARE, _Sept. 12, 1848_.
MY DEAR LORD MORPETH,--I thank you very sincerely for your kind
communication.... Thanks to your Lordship's indefatigable exertions,
a position is now gained from which it is possible to attack, with
some hope of success, the sources of excessive sickness and of
premature mortality. You have at last laid the foundation of
Practical Sanitary Improvement; but the structure is still to be
raised, and if, as your Lordship intimates, both you and the
Government are desirous that I should assist you in this labour, no
one will apply himself with a deeper feeling of responsibility, or
with greater earnestness, to what her Majesty justly calls "this
beneficent work."
Your Lordship will remember how earnest I was in December last, on
the publication of the Bishop of London's Pastoral Letter, that we
should at once avail ourselves of the power of the Contagious
Diseases Act; as well to make immediate preparation against the
threatened visitation of cholera, as to check the progress of our
own native epidemics, then and still so frightfully prevalent;
diseases manifestly dependent on conditions within our control, and
highly favourable to the spread of the pestilence then menacing, and
now still more nearly menacing us. The Bishop of London had called
earnestly upon the clergymen of his diocese to co-operate with the
medical profession in this object; and being desirous of
ascertaining the state of intelligence and feeling of this natural
class of co-operators in such a work, I visited privately every
clergyman in the Eastern District of London and discussed the
subject with them.
Without a single exception, I found them impressed with a sense of
the necessity of doing something, and with a conviction that they
might materially help the medical profession in carrying out any
plan of operation proposed by authority. The necessity of some such
general plan is greater now than it was then, on account of the
continual prevalence in their severest forms of our own epidemics,
and of the nearer approach of cholera. The new "Contagious Diseases
Act," the "Public Health Act," and the new "Metropolitan Sewers
Act," taken together, afford greater facilities for meeting this
necessity than ever before existed; and certainly it is now in the
power of the Government to do more for securing the public health,
and improving the physical condition of the population, than has
ever yet been attempted in any age or nation,--a power which, if
wisely and successfully exerted, will reflect the highest honour on
the Government and the country.
My intimate relation with the origin and progress of this work, and
my deep conviction that it is one of the most useful to which
experience and science can be applied, would render it a
satisfaction to me to spend the remainder of my life in assisting to
complete it.--I am, my Lord, with much esteem and regard, very
faithfully yours,
SOUTHWOOD SMITH.
The dates given at the head of this chapter (1848 to 1854) cover the
period when the Sanitary cause was completely successful, and when my
grandfather found himself one of the heads of a Government department
devoted to the furtherance of sanitary measures throughout the
kingdom--a department which was called the General Board of Health.
Here, at offices in Whitehall, in daily conference with Lord Ashley
(afterwards the Earl of Shaftesbury) and Mr Edwin Chadwick, he could
propagate knowledge on questions relating to the public health, and
carry out sanitary measures, as from a powerful centre, having the
authority of a Government department.
This power of carrying out his convictions to practical issues was an
immense satisfaction to my grandfather's mind, and many were the
congratulations which he received on this public appointment. The
following, from a Portsmouth physician, is interesting:--
_October 8, 1848._
SIR,--Though personally a stranger, permit me to offer my sincere
congratulations on your appointment by her Majesty's Government to
the Board of Health, where the talents you have so long displayed
will have scope for the full share of utility.
I have traced and followed you in the various publications issued by
the Government and the Health of Towns Association for several years
past, and having myself, though in a much more confined area,
mingled with public life, I know the heart-burnings, the
disappointments and annoyances, to which in such a course a man is
necessarily exposed; but if reward come at last--though the delay
has almost made the heart sick--one is then amply repaid, especially
in a case like yours, when a whole kingdom will applaud the
appointment.
Permit me again, sir, to beg your acceptance of my
congratulations.--I am, sir, your obedient servant,
To Dr SOUTHWOOD SMITH, Whitehall.
Almost the first work which the Board of Health had to do was to take
measures to resist an epidemic of Asiatic cholera. This it did by
sending down inspectors from London to instruct and aid the local
authorities in organising plans for systematic cleansing, and for the
removal of the sick. The Board also issued "Notifications" for the
purpose of instructing the public as to what precautions were necessary
to avert an attack. But above all, it organised, at my grandfather's
instance, what was called the "system of house-to-house visitation." My
grandfather was of opinion that in every instance an attack of cholera
is preceded by a period of a few days (sometimes only of a few hours) of
premonitory symptoms, which, since they are painless, escape notice; and
that, unless a specially appointed medical visitor goes round to the
houses of the less educated to inquire, and almost to cross-question, as
to the existence of these symptoms, and to treat the disease _at once_,
this stage rapidly passes on into developed cholera, when recovery
becomes all but hopeless. These facts and experiences are brought out in
the General Board of Health's Report on the Cholera Epidemic of 1848-49,
presented to Parliament in 1850.
In relation to this, Lord Brougham thus wrote to my grandfather:--
"I also proclaimed[23] your important statement of the _preventive
cure_ of cholera, bearing further testimony to the soundness of your
views from Sir J. Mordaunt's account given to me in the Malta case.
"I availed myself of the opportunity to give you just praise, and to
note your many valuable services to the country. Lord Lansdowne
amply concurred in the statement by his cheers. But such things are
never reported. Had you given a vote or an opinion on a contested
party matter, all the papers would have chronicled your merits and
our eulogies of you.--Ever yours truly,
"H. BROUGHAM."
Another of the subjects which the Board of Health took up was that of
quarantine. Their first report on that subject, issued in 1850, was
considered of sufficient importance to be translated into various
foreign languages, and was ordered to be presented to the Parliaments of
France and Italy. I think that, even if recent discoveries have modified
some of the opinions there advanced, all the progress which has been
made in the prevention of disease by quarantine regulations has been in
the direction there indicated--that is, in plans for cleanliness, for
the letting in of light and air, and for the isolation of infected
persons in pure air, thus diluting the poison--rather than in plans for
shutting them into confined quarters as was formerly done, thereby
concentrating the poison.
The question of putting a stop to burials in overcrowded churchyards was
also taken up by the Board. Their report on "A General Scheme for
Extra-mural Sepulture" was published also in the same year (1850), and
proved very clearly the evils arising from the crowded state of
churchyards at that time.
The Board proposed that a Government department should be established
which should be intrusted with the care of the whole question of the
burial of the dead; that, in future, interment should take place only in
ground remote from large towns; and that everything should be arranged
decorously and reverently. My grandfather, personally, was much
interested in adding an element of beauty in the form of exquisite and
appropriate cemetery churches and chapels. But only the preventive part
of the scheme was carried out. What was actually achieved was the
closing of the overcrowded churchyards; the provision of other grounds
has been left for private enterprise.
Thus, for six years, earnest men, at the head of a Health Department,
spread information and gave advice. The newspapers of the period
contained many notices of the various practical measures devised by this
department, together with comments and leading articles on its reports
on such large and pressing questions as cholera, quarantine, extra-mural
sepulture, and water-supply. The newspapers, indeed, began to devote
much space to the discussion of health questions in all forms, so that
at last a widespread interest was aroused.
Then came a time when the chief question was, _not_ as to the
principles, but as to what machinery could best be employed to carry out
those principles.
The fear of "centralisation," and the desire for local self-government,
which is strong in the English people, caused opposition in Parliament
to the continuance of any Government department having such large
control over the expenditure of public money on local objects; so that
in 1854 the original Board of Health ceased to exist, but did not cease
till sanitary principles and sanitary science, once unknown or despised,
were acknowledged throughout the country, and recognised as one of the
fundamental needs lying at the root of all efforts to benefit the
community.
With the ending of this department my grandfather's official life came
to a close. From a personal point of view this cessation of his public
work was somewhat softened by the following letter, written at the
desire of the Prime Minister:--
WHITEHALL, _12th August, 1854_.
SIR--I am directed by Viscount Palmerston to inform you that he
cannot allow you to quit the Board which this day ceases to exist by
the expiration of the Act of Parliament by which it was constituted,
without conveying to you the full approbation of her Majesty's
Government of the zealous, able, and indefatigable manner in which
you have performed the important duties which have belonged to your
official situation; and his Lordship desires me to express to you
the great regret which he feels, that an adverse decision of the
House of Commons as to an arrangement which his Lordship had
proposed for the reconstruction of the Board of Health has led to so
abrupt a cessation of your employment.--I am, sir, your obedient
servant,
HENRY FITZROY.
Dr SOUTHWOOD SMITH.
According to the rules of the service, my grandfather was not entitled
to a retiring allowance, because so much of the work he had done had
been unpaid. A few years afterwards, however, a Government pension was
awarded him in consideration of the services which he had rendered to
the country.
Footnote 23:
In the House of Lords.