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.