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.