Dr. Southwood Smith: A Retrospect

by Gertrude Hill Lewes

"That epidemic diseases prevail most in certain countries, in certain districts, in certain towns, and in certain parts of the same town. They prevail most in those countries which are the least cultivated; in those districts which are the most woody, the most exposed to particular winds and to inundations; in those towns which are placed in low and damp situations, and which are unprotected from certain winds; in those streets and houses, and even in those apartments of the same house, which are the most low and damp, the worst built, and the least sheltered.

"That epidemics commence, spread, and cease in a manner perfectly peculiar. They arise, for example, in some particular quarter of a town, and do not attack the other districts which happen to be nearest it in regular succession, but break out suddenly in the most distant and most opposite directions. People are attacked, not in proportion as the inhabitants of the affected mix with the inhabitants of the unaffected places, but in proportion as the inhabitants of the unaffected expose themselves to the air of the affected places.

"That the termination of epidemics is peculiar, since they cease suddenly at the exact period when the greatest number of persons is affected by them, and when the greatest mortality prevails. This fact is inexplicable under the supposition that epidemics owe their spread from person to person. To suppose that a disease which is propagated by contagion can rapidly decline and even suddenly cease, just when most persons are affected and the mortality is greatest—that is, when the contagious matter is proved to be in its most active and malignant state—is utterly absurd.

"That epidemics attack the same person more than once, and that relapses are frequent amongst those suffering from them, whereas contagious diseases seldom affect the same individual a second time, and relapses are most uncommon."

From all this it will be clear that the object of these articles was to prove that all epidemics have their origin in the bad sanitary conditions (as we now say) of the places in which they arise.

It happened then, as very frequently happens in all sciences when the time is ripe for a discovery, that those working in different fields of observation noticed, at the same period, the same facts—some, as for example Dr Maclean, in their posts of observation during the epidemics in distant countries; Dr Southwood Smith in the fever-haunts of London. But it remained for him, collecting together all the experience and generalising from it, to announce the law on which they depend.

Those who thus arrived at the great principle of the connection between defective sanitary conditions and disease, laid the foundation of Sanitary Reform. That connection is an old truth now,—one of those about which it is difficult to realise that it could ever have been unknown to the world; but in those days it was unknown and unrecognised, and amongst the few who began to recognise it, there were scarcely any who saw to what wide practical results such truths ought to lead.

My grandfather, however, saw that if the principle were once established, not only would the quarantine laws, at that time absurd and inefficacious, be modified; not only would our merchant ships be released from spending long weary months in unhealthy ports, while their crews were perhaps contracting, from their confinement, the very diseases which they were supposed to have brought with them from foreign lands; not only would the poor sufferers from plague and yellow fever cease to be imprisoned in the poisoned districts whose air had just given them the pestilence;—not only would these false precautions cease, but the true ones would be taken: the causes of disease would be removed; and thus, wherever a knowledge of this law spread and was acted on, disease and death would diminish.

Might not, he thought, something practical be done now and here if these facts were once generally known? Epidemics throughout follow the same laws. Were not the very causes which produce plague in Egypt operating now to produce typhus fever in Bethnal Green and Whitechapel? We might not be able to stop the pestilential, moisture-laden wind that came down to Cairo each year at the time of the inundation of the Nile, but could we not do something towards purifying that which crept into the rooms of our own poor from undrained courts and stagnant pools? Could we not, if people once believed and acted on their belief, banish the yearly epidemic fever from the back-streets of our large towns?

Dr Southwood Smith believed that this great result would follow from the general acceptance of the truth of the principle he had announced. He gave his life to spreading the knowledge of it.