Transcriber's Note:
Footnotes have been collected at the end of the text, and are linked for ease of reference.
Dr Southwood Smith, A Retrospect
Frontispiece
DR SOUTHWOOD SMITH
A RETROSPECT
BY
HIS GRANDDAUGHTER
MRS C. L. LEWES
WILLIAM BLACKWOOD AND SONS
EDINBURGH AND LONDON
MDCCCXCVIII
TO
MY MOTHER,
CAROLINE SOUTHWOOD HILL,
I DEDICATE THIS MEMOIR
OF
HER FATHER.
PREFACE.
It is now nearly forty years since the death of my grandfather, Dr Southwood Smith, and with this distance of time lying between him and us, it may not be uninteresting to this generation to look back upon the origin of some of the great social reforms which have now reached such wide proportions, and to see these reforms as gathered round the life of a man who was in the forefront of the noble army which promoted them.
He, one of the first to seize a truth, one of the most indomitable to persevere in the promulgation of it when perceived, went straight forward until it prevailed, and thus became instrumental in conferring some of the widest benefits which have come to us in this century.
From his great grief in early manhood he but emerged the stronger. The force of his condensed sorrow produced an energy which carried all before it, and resulted in the strength of his middle age and the serenity of his latter years. In order that such a life—crowned by its humility—might not pass away without some permanent record of its nobleness, the following memoir has been written.
I must apologise for the frequent allusion, in the midst of grave public questions, to my own recollections; but since all the early years of my life were passed at my grandfather's side, it has been difficult to avoid this.
Moreover, I have hoped that something picturesque and touching would be found in the relation of the strong man and little child, who worked together at various public causes, playing together in the bright intervals, and that something of the reverent enthusiasm he inspired in that child might pass, through her, to those who read these pages.
GERTRUDE LEWES.
CONTENTS.
INTRODUCTION.
RECOLLECTIONS OF MY GRANDFATHER [1]
CHAPTER I.
EARLY LIFE, 1788-1820.
Education. Marriage. Death of his wife. Edinburgh University. Publication of the 'Illustrations of the Divine Government.' Yeovil [7]
CHAPTER II.
FIRST YEARS IN LONDON—DAWN OF THE SCIENCE OF MODERN HYGIENE, 1820-1834.
Appointment to Fever Hospital. 'Westminster Review' articles in 1825. Laws of Epidemics. Principles laid the foundation of Sanitary Reform. Its practical importance. Devotion of himself to the cause. Parliamentary attention attracted to articles. Publication of the 'Treatise on Fever,' 1830. Its phenomena, treatment, and causes. Causes the most important. Contagious and epidemic diseases. Universal origin of epidemics stated to be bad sanitary conditions [16]
LONDON CONTINUED—LITERARY AND OTHER WORK, 1820-1834.
'Penny Encyclopedia.' The Medical Schools and dissection. Body-snatching. Lectures—physiological, forensic, and popular. Lecture over the remains of Bentham. Publication of the 'Philosophy of Health' [35]
CHAPTER IV.
WORK ON THE FACTORY COMMISSION, 1833.
History of Factories. Laws previous to 1833. Apprenticeship system. Appointed Commissioner. Description of state of factories in 1833. Passing of the Factory Act. Subsequent additions to Act. Visits to see result of its working [49]
CHAPTER V.
RISE OF THE SANITARY MOVEMENT, 1837.
Outbreak of fever in London. Personal inspection of Bethnal Green and Whitechapel. First Report to Poor Law Commissioners. Ventilation in crowded districts. Overcrowding of children in workhouses. Second Report of Poor Law Commissioners, 1839. Takes the Marquis of Normanby (Home Secretary) to see spots reported on at Bethnal Green. Takes also Lord Ashley. Press and public men take up the cause [60]
CHAPTER VI.
PHILANTHROPIC AND MEDICAL WORK, 1840-1848.
Children's Employment Commission, Mines and Collieries. Improvement in the condition of women working therein. Report on Trades and Manufactures. Homes of eastern dispensary patients. "Sanatorium" founded. Letters from Charles Dickens. First model dwellings founded. Life at Highgate. My recollections of first "Health of Towns Association" Meeting. Feeling of public men [72]
CHAPTER VII.
THE TEN YEARS' STRUGGLE FOR SANITARY REFORM, 1838-1848.
Causes of delay. History of the sanitary movement at this time a series of inquiries and defeated bills. "Health of Towns Association" founded to spread knowledge and guide legislation. Address to the working classes calling upon them to petition Parliament. Final passing of the Public Health Act [102]
CHAPTER VIII.
OFFICIAL LIFE—GENERAL BOARD OF HEALTH, 1848-1854.
Appointment to the General Board of Health. Letter to Lord Morpeth. Work at Whitehall with Lord Ashley and Mr Chadwick. Cholera epidemic of 1848-49. System of "house-to-house visitation." Lord Brougham's comments on it. Cholera Report. Quarantine Report. Interment Report. Attacks on the Board in Parliament. Fear of centralisation. Triumph of the sanitary principle, but to be carried out by local authorities. Lord Palmerston's letter of thanks [127]
CHAPTER IX.
RETIREMENT FROM PUBLIC LIFE—ST GEORGE'S HILL, WEYBRIDGE, 1854-1860.
"The Pines," Weybridge. Happiness in its beauty. Need of rest. Study of modern physiology for new edition of the 'Philosophy of Health.' Publication of 'Results of Sanitary Improvement.' Lectures in Edinburgh on "Epidemics." Visit to Alnwick. Happiness in the work of his granddaughters Miranda and Octavia Hill. Appreciation of former fellow-labourers. "Recognition." His words of thanks. Joy in the success of his great cause [139]
CHAPTER X.
THE SUNSET OF LIFE—ITALY, 1861.
Visit to Milan. Death of his second wife at "The Pines." Florence. Sunset from Ponte Vecchio. Last illness. Death. Porta Pinti. "A Knight-Errant" [147]
CHAPTER XI.
THE AFTERGLOW.
Spread of the social reforms Dr Southwood Smith originated. Improvement in the public health and saving of life. Memorial bust in the National Portrait Gallery. Lines upon it. A people's gratitude [153]
APPENDICES.
I. LETTER FROM MR TAYLOR, ASSISTANT RETURNING OFFICER OF THE WHITECHAPEL UNION [159]
II. RECOGNITION OF THE PUBLIC SERVICES OF DR SOUTHWOOD SMITH [164]
INDEX [167]
PORTRAIT OF DR SOUTHWOOD SMITH [Frontispiece]
(From a chalk drawing by Miss Margaret Gillies.)
DR SOUTHWOOD SMITH AND HIS GRANDCHILD GERTRUDE [2]
OLD WOMAN CARRYING COAL [72]
CHILDREN AT WORK [74]
WOMAN DRAWING TRUCK [74]
CHARLES DICKENS'S LETTER Facsimile [84]
FIRST MEETING OF THE HEALTH OF TOWNS ASSOCIATION [106]
(From an old print.)
VIEW FROM PORTA PINTI, FLORENCE, 1861 [152]
INTRODUCTION.
RECOLLECTIONS OF MY GRANDFATHER.
My first recollection of my grandfather is of him in his study. As a little child my bed stood in his room, and when he got up, as he used to do in the early mornings, to write, he would take me in his arms, still fast asleep, carry me down-stairs to his study with him, and lay me on the sofa, wrapped in blankets which had been arranged for me overnight.
So when first I opened my eyes in the silent room I saw him there, a man of some fifty years, bending over a table covered with papers, the light of his shaded reading-lamp shining on his forehead and glancing down upon the papers as he leant over his writing, and the firelight flickering on the other parts of the room.
The silence and the earnestness seemed wonderful and beautiful. It was strange to watch him when he did not know it. It seemed to me, then, that he had been working so through the whole night, and that some great good which I could only dimly understand was to come of it.
My lying quiet, however, did not last long, for I knew the loving merry welcome I should have when, climbing—as I hoped and believed quite unperceived—up the back of his arm-chair, I should throw myself down into his lap with a loud cry of joy, and then we should have a famous game, until either he persuaded me to go back to my blankets to await a rational hour for getting up, or sent me up-stairs to be dressed. These two things—the intent, absorbed purpose, and the power of putting it aside to give himself up completely, with simple delight, to whatever he loved, whether to a child or to the beauty of nature—are the two that seem to me specially characteristic of him in all that later part of his life which comes within my remembrance.
Dr Southwood Smith and his grandchild Gertrude.
At this time we lived in Kentish Town, then field-surrounded, he going daily to his consulting-rooms in Finsbury Square, returning late and giving the early mornings and Sundays to public work. These hours were at that period (1840 to 1842) chiefly devoted to the question of the employment of children in coal-mines, the more deeply impressed on me because the report which he was then writing had illustrations showing the terrible condition of people working in mines.
I remember long bright Sunday mornings when he was at work endeavouring to remedy these evils. He let me do what little I could, such as the cutting out of extracts to be fastened on to the MS. report with wafers—and very particular I was as to the colour of these wafers! Sometimes all I could do to help was to be quiet—not the least hard work! Yet I loved these still Sunday mornings, and would not willingly have been shut out from them any more than from the afternoon ride which came later, when, perched up in front of him on his own horse, in the little railed saddle he had devised for me, we rode along the lanes towards Highgate. I can see now the sunset light falling on the grass and tree-stems of the Kentish Town fields as we went along.
Then came the day when the Act was brought into operation which was to regulate the employment of children in mines, and I tied blue ribbons on to his carriage horses and thought, with a child's hopefulness, that all the suffering was at once and completely over. "Then, now, they are all running over the green fields," I said.
My grandfather let me think it, and did not damp my enthusiasm by letting me know that this happy state of things was not arrived at in one day!
But although he often played merrily with me and entered into my childish joys, my grandfather was endowed with a most earnest nature and with a firmness of character which was very remarkable. He never swerved from a purpose, never vacillated. One of his sayings was, "Life is not long enough for us to reconsider our decisions."
It was probably this quiet determination, combined with his unfailing gentleness, that made him inspire so much confidence in his patients. I can fancy, in a house where illness was spreading anxiety and sorrow, the restfulness there would be in his calm presence, and I can remember the faces of those—often the very poor—who used to come up to him wishing to thank him for the life of some wife, or son, or child which they said he had saved. These things used to happen in the crowded city streets or courts, and sometimes in parts of London far away from the place where the illness had occurred. The fact that these faces were generally forgotten by him, whilst his was so well remembered, made a still more beautiful mystery over it. It seemed to me that there was an honour in belonging to one who was a help and support to so many. Such experiences must be familiar to those who share his profession, still I mention it as being my strong childish impression; and even now, looking back upon his life, it appears to me that he did possess, in a very high degree, not only the power of healing, but that of soothing mental suffering.
It was, in fact, this deep sympathy, joined to his remarkable insight into the relations between effects and their causes, which led him to devote his life to the promotion of sanitary reform, when once it had become obvious to him that all effort to improve the condition of the people would be impossible until its principles were known and acted upon.
CHAPTER I.
EARLY LIFE, 1788-1820.
Thomas Southwood Smith was born at Martock in Somersetshire in 1788, and was intended by his family to become a minister in the body of Calvinistic dissenters to which they belonged. He was educated with that view at the Baptist College in Bristol, where he went in 1802, being then fourteen years of age. A scholarship, entitled the "Broadmead Benefaction," was granted to him, and he held it for nearly five years.
But in the course of his earnest reading on religious subjects he was led to conclusions opposed in many ways to the doctrines he would be expected to teach; and when, in the autumn of 1807, from conscientious scruples, he felt bound to declare this to be the case, the benefaction was withdrawn. If we consider his youth and his limited means, it is clear that this avowal must have cost him no little anguish. He was at this time only eighteen. It was an early age at which to have been able to make up his mind on questions so momentous, to break away from early and dear traditions, and to face the displeasure of the Principal of the college, Dr Ryland, whom he ever revered. But honour demanded the sacrifice, and it was made.
In consequence his family cast him off at once and for ever.
During his college career, however, he had visited much at the house of Mr Read, a large manufacturer in Bristol, who was a man of noble character, and at that time one of the leading supporters of the college; and an attachment had sprung up between the young student and Mr Read's daughter Anne. This lady seems to have possessed both great personal beauty and much sweetness and strength of character; and though she in nowise changed her own religious opinions, she yet sympathised deeply with him in his earnest seeking after truth, and encouraged him to risk all—position, friends, everything—rather than act against his conscience.
Mr Read also upheld him through all his difficulties, and in the following year sanctioned their marriage, which brought with it some few very happy years. Two children were born—Caroline,[[1]] my mother, and a year afterwards her sister Emily.[[2]]
His happiness was to be but of short duration, for in 1812 the young wife died, and left him alone, at the age of only twenty-four, with two little children. With what deep grief he mourned her death his early writings show, but he met it with a noble courage and an undiminished faith.
The course he took was a strong one. Deprived of the profession to which he had looked forward, cut off from all intercourse with his family, and having lost the wife he so devotedly loved, he resolved—leaving his two children under the gentle care of their mother's relations—to apply himself to the study of medicine. Thus he entered as a student at the Edinburgh University in the year 1813.
At first he lived quite alone; but finding it more than he could bear, he returned to England to fetch his eldest child, then four years old.
The father and child (my mother) went from Bristol to Edinburgh in a small sailing vessel, and encountered a terrible storm, which lasted many days. She tells me that she still remembers that storm of eighty-five years ago, the thick darkness, the war of the winds, the toss of the waves, the flash of the lightning illuminating her father's face; but, most of all, she remembers the feeling of the strong arm round her, giving the sense of safety.
His interest in religious matters at this period was greater than ever; for the change in his opinions, in leading him to take a more loving view of the Divine nature, had increased his ardour for the truth, and his own personal sorrow had heightened his faith and made him wish to carry its comfort to others. As well, therefore, as pursuing his medical studies, he gathered round him in Edinburgh a little congregation for service every Sunday. The sermons preached by him then, seem to have an added depth of feeling when we know the circumstances in which they were given; and the following words, written by him at this time, give some insight into the calm sublime faith which upheld him, not only then, but throughout life.
"Can there be a more exalted pleasure," he writes, "than that which the mind experiences when, in moments of reflective solitude—in those moments when it becomes tranquil and disposed to appreciate the real value of objects—it dwells upon the thought that there is, seated on the throne of the universe, a Being whose eye never slumbers nor sleeps, and who is perfect in power, wisdom, and goodness? How little can the storms of life assail his soul who rests his happiness upon this Rock of Ages! How little can death itself appal his mind who feels that he is conducted to the tomb by the hand of the Sovereign of the universe! Yes! there is a reality in religion; and if that happiness, which is so often sought, and so often sought in vain—that happiness which is worthy of a rational being, and which at once satisfies and exalts him—be ever tasted upon earth, it is by him who thus, in the solitude of his heart, delights to contemplate the idea of a presiding Benignity, the extent of whose dominion is without limit, and the duration of whose kingdom is without end! It is a felicity which our Father sometimes sends down to the heart that is worthy of it, to give it a foretaste of its eternal portion."
Much interest was felt in the young pale student and his little girl. For all this time my mother, the little Caroline, lived with him, cheering his home-coming from the university to their rooms, and drinking in from him at a very early age—as I, her daughter, was destined to do many years after—lessons of self-devotion to great ends.
It was at this time of sorrow, and in the intervals of medical study, that he wrote his 'Illustrations of the Divine Government,' the object of which is to show how perfect is the Love that rules the world, in spite of that which seems to clash,—pain, and sorrow, and wrong—all that we call evil.
His medical studies only added to his impression of the great Whole as one perfect scheme, for he felt an intimate connection between the field of scientific research and those religious studies to which he had formerly devoted himself exclusively. This is shown in his own words in the preface to the fourth edition of the work, which was published in 1844.
"The contemplation," he writes, "of the wonderful processes which constitute life,—the exquisite mechanism (as far as that mechanism can be traced) by which they are performed—the surprising adjustments and harmonies by which, in a creature like man, such diverse and opposite actions are brought into relation with each other and made to work in subserviency and co-operation;—and the divine object of all—the communication of sensation and intelligence as the inlets and instruments of happiness—afforded the highest satisfaction to my mind. But this beautiful world, into whose workings my eye now searched, presented itself to my view as a demonstration that the Creative Power is infinite in goodness, and seemed to afford, as if from the essential elements and profoundest depths of nature, a proof of His love."
This book came to be a help to many of all classes and creeds, and passed through several editions.
He was often urged to reprint it in later life, but held it back, wishing to modify it slightly. Not that his opinion of its main principles had altered in the least degree, but that he thought he had passed too lightly over the sea of misery and crime that there is in the world; he thought there was rather too much of the bright hopefulness of youth about it. Sorrow he had known, certainly, in the loss of his wife; but the sorrow that comes from the loss of one who was noble and good, and who has been taken from us by death, is of quite a different kind from that which comes from a closer acquaintance with the mass of sin and misery which exists. He did not change his view that, even this, rightly understood, is consistent with the divine benevolence; but he wished to recognise more fully its existence, and to enter more largely into the subject.
Having completed his medical studies and obtained his degree, the young physician determined to take a practice in Yeovil. The following extract from a letter, dated August 5, 1816, addressed by him to a friend in Rome,[[3]] shows with what views as to his future profession he quitted Scotland.
"I leave Edinburgh this week," he writes; "I leave it with much regret, for I have found friends here whom I shall ever remember with respect, affection, and gratitude. I go to Yeovil, a little town in the west of England, where it is my intention to take charge of a congregation and at the same time to practise medicine. This double capacity of physician to body and soul does not appear to me to be incompatible, but how the plan will succeed can be determined only by the test of experience.
"My expectations are not very sanguine, but neither are my desires ambitious."
"The test of experience" proved that he was admirably qualified for the double office he had taken upon himself, and for some years he pursued faithfully the plan he had made.
But this quiet country life was not to be his always. It was decreed that he should come up to London and enter into its teeming life, to think, and write, and labour, until he had done his part towards lessening its mass of misery.
CHAPTER II.
FIRST YEARS IN LONDON-DAWN OF THE SCIENCE OF MODERN HYGIENE, 1820-1834.
On first arriving in London in 1820, my grandfather, who whilst still at Yeovil had married for the second time (Mary, daughter of Mr John Christie of Hackney),[[4]] settled in Trinity Square, near the Tower. He soon formed a considerable private practice, and was appointed physician to the London Fever Hospital, and he was thus led to give very special attention to the subject of fever. He also held the offices of physician to the Eastern Dispensary and to the Jews' Hospital, situated in the very heart of Whitechapel. And while his experience in the wards of the fever hospital taught him by what means that disease can most frequently be cured, his acquaintance with it in the homes of his East-end patients taught him more—how it might be prevented.
Almost the first writings bearing on what came to be afterwards called the "Sanitary Question" are to be found in the pages of the 'Westminster Review.' In the two first numbers of that Review, published in the year 1825, there appeared some articles on "Contagion and Sanitary Laws." These articles, published anonymously, were written by Dr Southwood Smith. It must be noted that the word "sanitary" had not then the meaning it has in these days: sanitary science was unknown, and the words "Sanitary Laws" had a no wider signification than that of the regulations of a quarantine code.
But from that time these words acquired a new meaning.
In the articles above referred to, facts were brought together which had been collected from the writings of men who had devoted years to the study of pestilences in Spain, in various ports of the Mediterranean, in Constantinople, and in the West Indies. They had gone where epidemics were raging, had risked their lives that they might increase the store of knowledge about these fearful scourges, and might, if possible, learn on what they depend. Amongst these men, one of the most distinguished was apparently a Dr Maclean, of whom the article tells us that "when he was in Spain in 1821 yellow fever attacked Barcelona, and that with his wonted zeal he hastened to the spot in order that he might fully investigate its nature." Dr Maclean is spoken of as "one of those extraordinary men who is capable of concentrating all the faculties of his mind, and of devoting the best years of his life, to the accomplishment of one great and benevolent object." We are told how, "in order to demonstrate what epidemic diseases really are, and what they are not, and to put an end to errors which have so long and so universally prevailed on this subject, errors which he believes to be the source of incalculable misery and of certain death to millions of the human race, Dr Maclean, with an energy scarcely to be paralleled, has devoted thirty years—a large portion of the active life of man. In this cause he has repeatedly risked that life, and for its sake he has encountered all sorts of suspicion and abuse."[[5]]
Generalising, then, from the facts which such men had collected and from others observed by himself, Dr Southwood Smith endeavours to establish the laws of epidemic disease. In the first place, he labours to prove that epidemic diseases are not, in the strict sense of the word, contagious, and that the laws which epidemic diseases observe offer a complete contrast to those which regulate contagious diseases.
"It was proved," he thought, to use his own words, "that the symptoms of epidemic diseases are not determinate and uniform. They vary in different countries and different seasons—even in the same country and the same season, and do not succeed each other in any determinate order.
"That epidemics observe certain seasons—the periods at which they commence, decline, and cease, hardly vary. For instance, the plague in Egypt begins in March or April, and ends in June or July. All epidemics in Great Britain, of which we have any record, have raged in the autumn.
"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.
By the articles in the 'Westminster Review' something was done towards enlightening the public mind, for I find that they attracted the attention of leading men in and out of Parliament, and were often referred to in the debates in both Houses.
Five years more of daily experience and constant thought passed before his 'Treatise on Fever' was published.[[6]] It entered fully into all the phenomena of the disease and into the question of its treatment. It added largely to the knowledge of fever existing at that time, and was welcomed by the medical profession. 'The Medico-Chirurgical Review,' the highest authority of that day, pronounced it to be "the best work on Fever that ever flowed from the pen of physician in any age or country." It was for a long time the standard work on the subject with which it dealt. The most important part of the work, however, as might be expected, is that which relates, not to the treatment of disease (which has since his time much changed) but to its causes. And here we find an elaboration of the principles laid down five years before in his articles in the 'Westminster Review.' Those articles had been the result of a rapid glance which had gone to the very root of things, though when they were written their writer had held his position at the Fever Hospital for one year only, and had therefore not acquired the large experience of fever which he subsequently attained. But the five years that had passed since they were written could not change—could only strengthen—his conviction of the truth of the principles which he had previously expounded.
In the 'Treatise on Fever,' as in the articles just quoted, it is enforced upon us, that since epidemics are everywhere the same, when they reach our own country we must expect to find conditions similar to those which produce pestilence in foreign countries. He writes as follows:—
"The room of a fever patient, in a small and heated apartment of London, with no perflation of fresh air, is perfectly analogous to a stagnant pool in Ethiopia full of the bodies of dead locusts. The poison generated in both cases is the same; the difference is merely in the degree of its potency. Nature with her burning sun, her stilled and pent-up wind, her stagnant and teeming marsh, manufactures plague on a large and fearful scale. Poverty in her hut, covered with her rags, surrounded by her filth, striving with all her might to keep out the pure air and to increase the heat, imitates Nature but too successfully; the process and the product are the same, the only difference is in the magnitude of the result. Penury and ignorance can thus, at any time and in any place, create a mortal plague."[[7]]
Dr Southwood Smith has been accused of ignoring the fact that those suffering from fever can communicate the disease to others—of "infection," as it is called. But he did not. He shows, on the contrary, that the atmosphere of a room such as that spoken of in the passage just quoted must have the power of inducing fever in others besides the patient. He even says that "the poison formed by the exhalations given off from the living bodies of those affected by fever is by far the most potent febrile poison derived from animal origin."
Then, it might be asked, of what consequence is it to insist on the disease being non-contagious? If fever-patients can give fever to others, it is a mere matter of words whether you choose to call it "contagious" or "infectious."
It is, however, of the utmost consequence to fix the attention on the difference; because, if that is done, the real seat of the danger will be clearly seen, and those whose duty it is to enter the rooms of the sick will know that their danger rarely lies in touching the patient, and may be prevented by abundance of fresh air and scrupulous cleanliness.
In order to emphasise this side of the truth my grandfather wrote as follows (and, though it may seem to require qualification, the general truth of his remark will be admitted by all): "No fever produced by contamination of the air can be communicated to others in a pure air—there never was an instance of such communication."
The form of poison given off from a fever patient is, besides, not so much to be feared as other forms of that poison, because, though it is potent, it has not a wide range; when let out into the fresh air, it is so far diluted that its power is reduced to a minimum.
An epidemic, he asserts, can only arise from some cause sufficient to affect a whole district. Continually we are brought back to observe this universal cause of fevers; to see that, whether in the sudden falling off of an army to half its numbers, or in the prostration of a whole ship's crew on approaching shore, or in the plague devastating Cairo, this one source may be traced as the true one. Bad air comes from the marsh near which the army is stationed; bad air, poisoned by decaying vegetation, comes off shore to the ship; bad air enters the houses of Cairo. We are shown that Cairo is the birthplace of the plague, because it is a city crowded with a poor population; because it is built with close and narrow streets; because it is situated in the midst of a sandy plain at the foot of a mountain, which keeps off the wind, and is therefore exposed to stifling heat; and, above all, because it has a great canal which, though filled with water at the inundation of the Nile, becomes dry as the river gets lower, and thus emits an intolerable smell from the mud and from the offensive matter that is thrown into it.
Besides being thus shown that, in all places in which epidemics appear, some sanitary defect may be found, we are shown that they come back and back to the same places, and that, if these defects are removed, the epidemics will not return. So we are led on to the great idea that they are preventible.
The facts advanced to prove these principles have not, of course, the wide range, the distinct statistical exactness, of those which the further progress of sanitary science has now enabled people to bring forward; but it is very interesting to see how all further advance has been but a development of the principles brought forward in this 'Treatise on Fever,' just as it was itself but a development of those brought forward five years before. Hardly any investigations had yet been made, but the results which research would bring to light are here foreshadowed. Even the direction which such research would take is indicated, for we are told, at the end of the chapter which treats of the "Causes of Fever," that—
"Further inquiries are necessary—such as, whether the vegetable and animal poisons we have been considering be the only true, exciting cause of fever;[[8]] by what means its general diffusion is effected; on what conditions its propagation depends; by what measures its extension may be checked and its power diminished or destroyed; what circumstances in the modes of life, in the habits of society, in the structure of houses, in the condition of the public streets and common sewers, in the state of the soil over large districts of the country as influenced by the mode of agriculture, drainage, and so on, favour or check the origin and propagation of this great curse of civilised, no less than of uncivilised, man."
Not a mere article or book contained the result of such inquiries. They occupied the greater part of his life, and that of many others. Their outcome is the present state of sanitary knowledge.
If some people think there was nothing new in the view of epidemics insisted on in this Treatise, they have only to see what was the common opinion at that time amongst medical men. A few shared the writer's opinions, but the majority of English physicians then certainly took quite the opposite view. When Asiatic cholera first broke out in 1831, it was of no avail that the physicians of Bengal had declared unanimously that "the attempt to prevent the introduction of cholera by a rigorous quarantine had always and utterly failed"; it was of no avail that the articles on "Quarantine Laws" had, six years before, urged the same truth; the London College of Physicians issued, notwithstanding, a notification that, wherever cholera appeared, the sick should be collected together in houses, which should be marked conspicuously Sick; and that, even after the sufferers had been removed, and the houses purified, Caution should be marked on them. That the dead from cholera should be buried in separate ground; that food to be delivered at a house where any one was sick should be placed outside, and only taken in when the person who brought it had gone away; and that no one who had communicated with a cholera patient should, during twenty days after, communicate with the healthy.
If cholera resisted all these precautions, and became fatal in the terrific way it had done in other countries, the authorities announced "that it might become necessary to draw a strong body of troops or police round the affected places."
This proclamation of the physicians of 1831 was published throughout the land in the form of an Order of the King in Council. It might have been more to the purpose to have cleansed the affected town.
"But," says Mr Howell,[[9]] "the strong good sense of the public averted many of the mischiefs which these scientific advisers would have produced had their counsels been carried into execution. The preventive measures, which were eventually adopted by them, consisted in prohibiting intercourse between one town and another by sea, and permitting it by land: thus communication between London and Edinburgh by stage-coach was perfectly free and uninterrupted, while communication between those capitals by sea was prohibited with such rigour that no interest, however powerful, could procure an exemption! Francis Jeffrey—at this time holding the high office of Lord Advocate of Scotland, and whose influence from his personal and official connections was very great—was unable to obtain permission for his faithful servant, in the last stage of dropsy, to go from London to Leith by water, lest he should carry with him to his native country by that mode of conveyance, not the dropsy which he had, but the cholera which he had not.
"'You will be sorry,' writes Jeffrey to Miss Cockburn, 'to hear that poor old Fergus is so ill that I fear he will die very soon. I have made great efforts to get him shipped off to Scotland, where he wishes much to go; but the quarantine regulations are so absurdly severe that, in spite of all my influence with the Privy Council, I have not been able to get a passage for him, and he is quite unable to travel by land.... He has decided water in the chest and swelling in all his limbs. The doctors say he may die any day, and that it is scarcely possible he can recover.'"[[10]]
Mr Howell adds that these examples are not adduced for the purpose of casting obloquy on the eminent physicians of that day, who vainly endeavoured to reduce to practice in the nineteenth century the standard, but obsolete, doctrines taught almost universally in the medical schools, but solely for the purpose of displaying the state of the science of Public Health in the year 1831-32, as far as the physicians of highest reputation and largest practice may be taken as its exponents.
It need hardly be said that it is with this purpose only that these facts are again cited here.
CHAPTER III.
LONDON CONTINUED—LITERARY AND OTHER WORK, 1820-1834.
The 'Treatise on Fever' held an important place in the development of that sanitary ideal to the realisation of which my grandfather afterwards devoted himself almost exclusively; but in the course of the years which are treated of in this chapter, he wrote much on other subjects.
During this time severe money losses had necessitated the breaking up of the establishment in Trinity Square; retrenchment became a duty; Mrs Southwood Smith went abroad with the three children of the second marriage[[11]] to carry on their education; and (his two elder daughters, Caroline and Emily, being engaged in teaching away from home) my grandfather once more retired to a strictly studious and professional life at his consulting-rooms in New Broad Street, giving much time to literary work, including the writing of a large number of physiological articles for the 'Penny Encyclopædia.'
Dr Southwood Smith at this period assisted in founding the 'Westminster Review.' This Review, supported as it was by men of great ability and earnest thought, took, as is well known, a leading place in the promotion of the political and social reforms of the day.
His own contributions to it were many. Besides the articles on "Quarantine and Sanitary Laws" already mentioned, the one on "Education," which appeared in the first number, may be specially referred to.
There was also one calling attention to the horrors arising from there being no proper provision for supplying the anatomical schools with the means of dissection, which led to very practical results.
"Body-snatching" is now an extinct crime. Such was the name given to the practice of robbing graves of the bodies of the dead in order to sell them for the purpose of dissection. Such practices were an outrage against all the feelings which render the resting-places of the dead hallowed spots. One can imagine the horror which the friends of the newly interred must have experienced in finding that their graves had been violated during the night; and worse still were the midnight scenes when the work was interrupted by the police, and struggles ensued.
The men who carried on this trade were called "resurrection-men": they were a depraved and dangerous class, and if the state of things then existing had caused no other evil than that of educating such a class, it would still have been worth much effort to get it remedied.
Without bodies for dissection medical education was impossible, and at that time there was only one legal means by which they could be obtained: those of executed criminals were made over to the medical profession for the purpose of dissection. But this source was, happily, even then a scanty one. Until, therefore, some other provision was made, the employment of "resurrection-men," though against the law, and in itself revolting to the professors of anatomy, was a necessity.
The difficulty was an increasing one. The wretched men whose trade it was to supply the medical schools were punished with imprisonment and heavy fines, and were, not unnaturally, regarded with abhorrence by the mob—such abhorrence that it was often difficult to protect them from its fury when arrested. In Scotland, especially, this popular feeling was so strong that disgraceful outrages were committed against those even suspected of being concerned in exhumation; the churchyards were watched, and the obstacles in obtaining subjects for the schools had become so many that the students were fast deserting them. Indeed throughout Great Britain it appeared as if there would soon be a general desertion of all the native schools, and that students would go to Paris for the education they could not get at home.
In the article by Dr Southwood Smith which first called public attention to these evils, he points out, in a very striking manner, the paramount necessity of a supply of subjects. He reminds his readers of the wild theories of former times when anatomical knowledge was not possessed, and enforces on their attention the fact that this knowledge can only be acquired, with any degree of perfection, by means of dissection. He further reminds them that no operation can be performed without torture to the living, and danger to life itself, by the hand of a surgeon unpractised in dissection; and no clear judgment formed by the physician on the diseases of the human frame—diseases generally seated in organs hidden from the eye—without a study of the internal structure.
After shortly passing over the evils of the system then prevailing, which have just been pointed out—evils which were then very generally known—he suggests the remedy,—a very simple one. It was, to cease to give the bodies of executed criminals for anatomical purposes, and thus in a measure to take off the stigma on dissection; and then to appropriate to that purpose the bodies of all those who die in hospitals and workhouses unclaimed by relatives.
Nothing was done for some time, till in 1828, three years after this paper was written, there came the horrible discovery that the difficulty of obtaining subjects from the churchyards had become so great that two men, Burke and Hare, had resorted to murder to supply the need—the temptation having been the large price to be obtained for bodies.
When things had come to this climax, legislative attention was aroused. At this time the article which had appeared in the 'Westminster Review' was reprinted as a pamphlet, under the title of 'The Use of the Dead to the Living.' In this form it went through several editions, a copy being presented to members of both Houses of Parliament.
The measures recommended in it were mainly adopted by the Legislature, and have proved completely successful.
There is something at first sight sad in a plan which lets anything that is painful in the thought of such an appropriation of the bodies of the dead fall exclusively on the poor. This did not fail to suggest itself to my grandfather's mind. But it is to the survivors alone that such pain comes, and these friendless ones would have none left to shrink from this use of their remains. Such were to be chosen for the necessary purpose, not because they were "poor," but because they were "unclaimed." Neither was any pain arising from this arrangement to be compared with that springing from the forcible seizure of bodies in the old times. Out of that arose, necessarily, scenes of horror revolting to all sense of the respect due to the dead; while their quiet removal from the hospital to the anatomical school, to be followed, after the necessary dissection, by their burial, is widely different. It seemed, moreover, that the interest of the poor specially demanded a widespread anatomical knowledge in medical men, since they, more than all others, suffered when the means of gaining it were limited. "Poverty, it is true," my grandfather writes, "is a misfortune; poverty, it is true, has terror and pain enough in itself. No legislature ought by any act to increase its wretchedness; but the measure here proposed is pregnant with good to the poor, and would tend, more than can be estimated, to lessen the misery of their condition. For it would give knowledge to the lowest practitioners of the medical art—that is, to persons who are at present lamentably deficient, and into whose hands the great bulk of the poor fall. And, after all, the true question is, whether the surgeon shall be allowed to gain knowledge by operating on the bodies of the dead, or driven to obtain it by practising on the bodies of the living. If the dead bodies of the poor are not appropriated to this use, their living bodies must be, and will be. The rich will always have it in their power to select, for the performance of an operation, the surgeon who has signalised himself by success; but that surgeon, if he has not obtained the dexterity which ensures success by dissecting and operating on the bodies of the dead, must have acquired it by making them on the living bodies of the poor."
It was said at the time by objectors that the measure in question would deter patients from entering the hospitals, and add terrors to workhouses, but experience has proved that my grandfather was right: the adoption of his plan has not been found to have the slightest effect of the kind.
In considering the work of this period of my grandfather's life, I ought not to omit to mention his lectures, which were full of the same earnestness and originality that characterised all he did. He was lecturer at the Webb Street School of Anatomy, where he gave a course on "Forensic Medicine," which made much impression at the time. He gave also courses of popular lectures on physiology at the London Institution and elsewhere. To those at the London Institution ladies were admitted—a permission unusual in those times.
One lecture, delivered on a very remarkable occasion, must be mentioned here. My grandfather was the friend and physician of Jeremy Bentham, and was called upon, after his death, to perform a duty which he had solemnly undertaken. The venerable philosopher died in 1832 at the age of eighty-five, and by will desired that his body should be used for the purposes of dissection. He intrusted to Dr Southwood Smith, in conjunction with two other friends, the task of seeing this disposition properly fulfilled, trusting that they would not be deterred by opposition or obloquy.
This disposition of his body was not a recent act. By a will, dated as far back as 1769, it was left, for the same purpose, to his friend Dr Fordyce. The reason at that time assigned for this is expressed by Bentham in the following remarkable words:—
"This my will and special request I make, not out of affectation of singularity, but to the intent and with the desire that mankind may reap some small benefit by my decease, having hitherto had small opportunities to contribute thereto while living."
By a memorandum affixed to this document it is clear that it had undergone revision as lately as two months before his death, and that this part of it, originally made when he was twenty-one, was again deliberately and solemnly confirmed by him at eighty-five.
In thus appropriating his remains to the service of mankind, Bentham carried out, to the last moment of his life, and even after his death, his principle of "Utility."
The subject of dissection was agitating the public mind: the "Anatomy Bill" was not yet passed, and the idea might well present itself to a benevolent mind such as his, that to show a thorough absence of horror or dislike to the idea of being dissected after death would be a means of lessening the prejudice which existed against it.
Whatever may be thought of the "greatest happiness principle" of this philosopher, it did not cause him to lead a selfish or epicurean life. The long calm expanse of eighty-five years was filled with simple pleasures, with hard work, and contained many sacrifices to the cause of truth.
My grandfather bears his testimony to the wonderful energy and self-devotion of Bentham during his life in these words:—
"Bentham's object was no less a one than to construct an all-comprehensive system of morals and an all-comprehensive code of laws. For the accomplishment of a work so prodigious he put forth an energy commensurate to the end. The extent of mental labour required for this undertaking, and actually brought to it, is truly extraordinary. Every day for nearly half a century did he devote to it never less than eight hours, often ten, and sometimes twelve."
And now, when this busy life was stilled, my grandfather was bound to carry out as fully as possible Bentham's wish that in death too he might be useful. He delivered the oration over the body, in the Webb Street School of Anatomy, on the evening of the 9th of June 1832. One who was there thus writes of it:—
"None who were present can ever forget that impressive scene. The room is small and circular, with no windows, but a central skylight, and was filled, with the exception of a class of medical students and some eminent members of that profession, by friends, disciples, and admirers of the deceased philosopher, comprising many men celebrated for literary talent, scientific research, and political activity. The corpse was on the table in the centre of the room, directly under the light, clothed in a night-dress, with only the head and hands exposed. There was no rigidity in the features, but an expression of placid dignity and benevolence. This was at times rendered almost vital by the reflection of the lightning playing over them; for a storm arose just as the lecturer commenced, and the profound silence in which he was listened to was broken, and only broken, by loud peals of thunder, which continued to roll at intervals throughout the delivery of his most appropriate and often affecting address. With the feelings which touch the heart in the contemplation of departed greatness, and in the presence of death, there mingled a sense of the power which that lifeless body seemed to be exercising in the conquest of prejudice for the public good, thus cooperating with the triumphs of the spirit by which it had been animated. It was a worthy close of the personal career of the great philosopher and philanthropist. Never did corpse of hero on the battle-field, with his martial cloak around him, or funeral obsequies chanted by stoled and mitred priests in Gothic aisles, excite such emotions as the stern simplicity of that hour in which the principle of utility triumphed over the imagination and the heart."
In the year 1834 my grandfather published his book entitled 'The Philosophy of Health,'[[12]] the preparation of which had been a work of great care, and had occupied much time for several years before. This book, which was, perhaps, the first attempt to bring the truths of human physiology within the comprehension of the general reader, achieved a marked success. It was full of the clearness and force which characterised all the writings of its author. The strides of modern science have now, of course, left its physiological teaching far behind, but at the time it did original educational work and added lustre to his name.
His life in chambers must have been an arduous one—first at 36 New Broad Street, afterwards at 38 Finsbury Square,—his days given up to his ever-increasing practice, his mornings and evenings to writing: the amount achieved was prodigious, and he allowed himself but little relaxation.
I may mention that it was at this time that my grandfather first visited at the house of old Mr Gillies, a city merchant of refined literary tastes and the father of the two distinguished women, Mary and Margaret Gillies (author and artist), who afterwards became the friends for life of himself, his wife, and daughters, and in whose home he—and I with him—had rooms in Kentish Town and afterwards at Highgate, though he occupied for professional purposes the rooms in the city to which I have before referred.
CHAPTER IV.
WORK ON THE FACTORY COMMISSION, 1833.
In the year 1833 it became clear that some legal interference was necessary with regard to Factories.
In order to understand the abuses which existed in factories in 1833, we must revert to the system of employment at the end of the last century and trace its gradual development.
At that period all the spinning and weaving of the country was domestic, the spinning being carried on in farmhouses and scattered cottages in rural places by the mothers and daughters of the families, and the weaving by men working in their own homes in towns and villages. This peaceful state of things did not last beyond the beginning of the present century. The "spinning-jenny" and "power-loom" were invented, and changes occurred. Large buildings were now needed to carry on the work, and mills and factories sprang up beside the streams of Nottinghamshire, Derbyshire, and Lancashire, these places being chosen because water was required to turn the new machinery. The water-wheel now did much of the work which had formerly needed the strong arms of men, but the small and nimble fingers of children were henceforth called into play, as they were found to be specially fitted for much of that which remained to be done by hand. Thus it came about that children's labour, in consequence of its greater cheapness, was substituted for that of grown people.
In order to get a sufficient supply of children, which the scanty population near the mills could not afford, manufacturers applied to the managers of the workhouses in London and other large towns, for pauper children to be taken as apprentices. Hundreds, it is said even thousands, of children were thus taken away from even the slight protection which the tender mercies of the workhouse authorities of that day might afford, and placed entirely in the power of the master manufacturer, or, worse still, of his overseer.
The evils that resulted from this apprenticeship system resembled those springing from slavery. One writer[[13]] says:—
"There is abundant evidence on record, and preserved in the recollection of some who still live, to show that, in many of the manufacturing districts, cruelties the most heartrending were practised upon the unoffending and friendless creatures who were thus consigned to the care of the master manufacturers; that they were harassed to the brink of death by excess of labour, that they were flogged, fettered, and tortured to the most exquisite refinements of cruelty; that they were in many cases starved to the bone whilst flogged to their work; and that, in some instances, they were driven to commit suicide to evade the cruelties of a world where, though born into it so recently, their happiest moments had been passed in the garb and in the coercion of a workhouse. The beautiful and romantic valleys of Derbyshire, Lancashire, and Nottinghamshire, secluded from the public eye, became the dismal solitudes of torture and of many a murder."
The Legislature interfered, and in 1802 passed an Act for regulating factories and protecting the apprentices employed in them. This Act was brought in and carried by Sir Robert Peel, the father of the statesman who repealed the Corn Laws, and himself a large manufacturer.
A further change in the history of manufacture, however, occurred. The steam-engine was invented, and when its power was applied to manufacture, it was no longer necessary to build factories where water-power was at hand; they were henceforth principally established in towns. Apprentices were now but little employed; free, paid child-labour, here to be obtained in abundance, was preferred by the mill-owners. They had never wished for apprentices; the charge of them had always entailed considerable trouble; the responsibility was felt heavily by conscientious masters, whilst the legal restrictions of Sir Robert Peel's Act prevented the avaricious and hard-hearted from profiting by the abuses of the system. Apprenticeship therefore died a natural death.
It might be thought that children employed under the new plan, receiving wages and living at home under the protection of their parents, would suffer no hardships calling for legal restraint; but representations having been made to the Government that abuses had crept in, a Royal Commission of inquiry was determined upon in 1833.
On this occasion Dr Southwood Smith was appointed by the Government a member of this Commission, conjointly with Mr Tooke and Mr Edwin Chadwick.[[14]]
Their first work was to send district commissioners into the manufacturing regions to collect evidence, and the results of those inquiries were embodied in the general Report. My grandfather took a deep interest in the subject, for the evils disclosed by the inspection, if not so great as they had been under the apprenticeship system, were still sufficiently appalling: children, some of them not more than five years old, were obliged to work the same number of hours as the adult operatives—twelve, fourteen, or sixteen hours a-day—sometimes the whole night; their health was thus often ruined for life; neither time nor strength remained for education; they were growing up totally ignorant; and they were, besides, often unkindly treated.
It is sad to see in the Report such words as these, quoted from the children's lips: "I am sick tired, especially in the winter nights." "So tired when I leave the mill that I can do nothing." "I feel so tired when I gang home that I throw myself down, no caring what I does." "So tired I am not able to set one foot by the other." "Many a time I have been so fatigued I could hardly take off my clothes at night, or put them on in the morning. My mother would be raging at me, because when I sat down I could not get up again through the house."
As to their ruined health, such sentences as these foretell it: "Many nights I do not get a wink of sleep from the pain." "My knees failed from the work." Or, "Severe pains would come on, particularly in the morning."
The evidence of the overseers and managers is scarcely less strong than that of the little sufferers themselves.
One manager says: "I have known the children hide themselves in the wool so that they could not go home when the work was over. I have seen six or eight fetched out of the stove and beat out of the mill."
Another says: "After the children from eight to twelve years old had worked eight or nine hours, they were nearly ready to faint: only kept to their work by being spoken to, or by a little chastisement to make them jump up. I was sometimes obliged to chastise them when they were almost fainting, and it hurt my feelings; then they would spring up and work pretty well for another hour; but the last two or three hours were my hardest work, for they then got so exhausted."
And a third manager says: "I have seen them fall asleep, and they were performing their work with their hands, while they were asleep, after the 'billy' had stopped and their work was over."
Two great objections were made to any legislative limitation of the number of hours of children's labour. One was, that it was impossible to shorten their hours of work without also shortening those of the adults, who could not go on without them; the other, that it was wrong to restrict the liberty of the subject.
The first of these was, truly, a difficulty; but if the evil was so very great, it appeared to my grandfather and those acting with him that some change must be made in the mode of working, rather than overtax the children to this extent. Relays of children must be obtained, or grown-up workers must be substituted as assistants.
With regard to the second objection—that it would be restricting the liberty of private individuals if the law interfered—the Report shows that children, at the age at which they suffered these injuries, were not free agents, but were let out to hire by their parents, by whom their wages were appropriated, and who were easily rendered callous to their children's wrongs by a threat of dismissal, or a bribe of an additional penny an hour of wage. If the law did not step in to protect these unfortunate little ones from parents whose selfishness and ignorance was allowing them to grow up diseased and benighted, where, argues the Report, was their help to come from?
The question as to whether it is right in any instance for the Government to intervene between parent and child, is now practically settled by the many laws and enactments which regulate children's education and hours of labour. But in those days the idea of any restriction of a parent's right over his child excited much opposition. It was regarded by many people as both impracticable and undesirable.
The reformers, however, carried their point and achieved success. That very year the Factory Act passed, and the recommendations of the Report were nearly all embodied in it. No child was allowed to be employed at all under eight years old; children between eight and thirteen were only allowed to work six and a half hours a-day; and all those employed were obliged to attend school for three hours a-day. Inspectors were appointed to see that the provisions of the Act were fully carried out.
Of course there was considerable indignation on the part of the millowners, but many of those who at first objected to the restrictions were afterwards convinced of their utility, and as time passed on this conviction spread amongst all classes and gathered strength.
The only modifications of the Act of 1833 which have been made since, have been mere extensions of its principles. The regulations, which at first applied to cotton, cloth, and silk mills only, have been extended by subsequent Acts to bleaching and dyeing works. Powers have also been given to compel the fencing of machinery, and to enforce other safeguards against injury to the workpeople.
Even after the Factory Commission had finished its work, and had ceased to exist, my grandfather continued to watch with interest the results of what had been done. Five years afterwards, the House of Commons having ordered a Return showing the working of the educational provisions of the Act, he went down himself to various mills, and I find his copy of the Return thickly pencilled with marginal notes like the following:—
"I visited this mill myself with a view to examine the school." "The whole neighbourhood was opposed to the direction of the mill. They now consider it a great blessing." "The children of the higher class of people are anxious to get employment in the mills."
It must have given him great delight to feel that, as was said by a writer eleven years later—
"The present Act has led to an amelioration of the treatment, and an improvement in the physical and moral character, of the vast juvenile population, such as was never before effected by an Act of Parliament; while the benefits resulting from it to all parties, the employers no less than the employed, are not only rapidly multiplying and extending, but are becoming more and more the subjects of general acknowledgment and gratulation. There is reason to believe that the total number employed in factory labour in the United Kingdom is little short of 1,000,000.[[15]] In one district, not by any means one of the largest, the number of children attending school was increased from 200 to 2316."
CHAPTER V.
RISE OF THE SANITARY MOVEMENT, 1837.
Perhaps the most necessary and the most tried quality in a reformer is Patience. Notwithstanding the publication of the 'Treatise on Fever' in 1830, and the tribute paid by the scientific world to its masterly exposition of the treatment and causes of the disease, notwithstanding the constant and ardent endeavours of the author to propagate his views, yet seven long years passed away before he was able to awaken the apathy of the public and the authorities.
Year after year went by, and the wards of the Fever Hospital continued to be supplied from the same districts, from the same courts and lanes—even from the very same house—as before. The preventible suffering, thus daily brought before my grandfather's eyes, was a daily reminder of the urgent need for help—of the necessity for taking practical steps to diminish it.
In 1837 the opportunity came for pressing forward in the cause. That year a frightful epidemic fever broke out in London, arousing general alarm, and demanding special inquiry. The pressure on the poor-rates became excessive, and my grandfather was appointed by the Poor Law Commissioners to report on the eastern districts of London, Drs Arnott and Kay being appointed to other districts.
The title of the Report presented by him is at once striking. He called it, "Report on the Physical Causes of Sickness and Mortality to which the Poor are particularly exposed, and which are capable of prevention by Sanitary Measures." Its opening words are,—
"Some of the severest evils at present incident to the condition of poverty, which have a large share in inducing its high rate of sickness and mortality, are the consequences of improvidence. Such evils are capable of being remedied only by bringing the poor under the influence of the inducements to forethought and prudence.
"But there are evils of another class, more general and powerful in their operation, which can be avoided by no prudence, and removed by no exertion, on the part of the poor. Among the gravest, and at the same time the most remediable, of these latter evils, is the exposure to certain noxious agents generated and accumulated in the localities in which the poor are obliged to take up their abode, and to the pernicious influence of which they are constantly, and for the most part unconsciously, subjected.
"It is the object of the present Report to direct attention to the nature and extent of this evil, and to show how important it is that its mitigation, and, as far as may be found practicable, its entire removal, should form a part of every exertion that is made for improving the physical condition of the poor."
These words would seem to strike the key-note of Sanitary Reform.
In order to make the Report more full and impressive, Dr Southwood Smith writes an exact account of what he saw. He went personally over the greater part of the Bethnal Green and Whitechapel districts. "I traversed," he says, "a circle of from six to seven miles in extent. I wrote the account of the places I am about to notice on the spot; I entered many of the houses and examined their condition as to cleanliness, ventilation, as well as the state of the people themselves, who were at the time labouring under fever."
The descriptions that follow are too dreadful to be dwelt upon in detail here. We are shown individually the houses of Whitechapel: they are piled storey above storey, and are teeming with people; the streets, courts, and alleys are so built that all current of air is blocked out, and no measures whatever are taken to secure cleanliness. We are shown Bethnal Green, flat, low, damp, wasted. Here the houses are not so closely packed—there are open spaces; but these are for the most part undrained marshes, and the air coming across them is poisonous rather than life-giving. Straggling rows of rickety cottages look out upon stagnant swamps; their miserable gardens are scattered over with uncleared dust and refuse of all kinds, and are surrounded with black and overflowing ditches, to cross which you must pass over rotting planks used as bridges: there are houses which contain only two rooms, the larger being 9 feet by 7 and 7 feet high, the smaller not able to contain an ordinary-sized bed.
If the house has more rooms, it probably contains many families, and a state of overcrowding is produced nearly as fatal as that which prevails in the parts of London where the houses stand more thickly.
The picture comes vividly before us of the dismal homes, with their melancholy gardens where the pale children play by the black ditches; their green damp walls; the rags stuffed into the broken windows to keep out the tainted outside air; and the crowds huddled together breathing the suffocating air within doors. It is easy to realise the hopeless efforts of the poor inhabitants to fight against the dirt and disease which all those efforts are powerless to overcome!
No wonder then, that, in the words of his Report, we are told that "in many parts of both these districts fever of a malignant kind and fatal character is always more or less prevalent; that in some streets it has recently prevailed in almost every house; in some in every house; and, in some few instances, in every room of every house. Cases are recorded in which every member of a family has been attacked in succession, of whom, in every such case, several have died: some whole families have been swept away. Instances are detailed in which there have been found, in one small room, six persons lying ill of fever together: I have myself seen this—four in one bed and two in another."
He once more enforces the preventibleness of this dreadful state of things—how entirely it was within the power of man to change it by wise attention to the laws of health. He points out parts of the districts which had always remained comparatively healthy, and some, formerly haunts of fever, where during the last epidemic no single case had occurred, owing to sanitary improvements.
The necessity for providing in some way for the airing of streets and courts in densely populated neighbourhoods, by the knocking down of houses or other expedients, is insisted upon. Its difficulty is admitted, but still it is urged.
"Though it might seem a hopeless task," he says, "to set about ventilating such districts as Bethnal Green and Whitechapel, yet, if the importance of the principle be duly appreciated and the object be kept steadily in view, much may be accomplished. In some of the worst localities in these districts, at moderate expense, means might be taken to introduce free currents of air, where at present the air is perfectly stagnant and stifling. Some of the improvements recently made in the City of London show to what extent it is possible to introduce good ventilation into the heart of the most densely populated part of the Metropolis."
In this Report my grandfather also draws attention to the state of the Workhouses. He was writing to the Poor Law Commissioners, and so he could efficiently bring under their notice the state of those buildings.
"From what I have observed I am satisfied," he says, "that many existing workhouses are extremely deficient in space, ventilation, and drainage."
The overcrowding in the dormitories is especially pointed out. He writes:—
"In going over the Whitechapel Workhouse I was struck with the statement of the fact that, out of 104 children (girls) resident in that house, 89 have recently been attacked with fever. On examining the dormitory in which these children sleep, my wonder ceased. In a room 88 feet long, 16-1/2 wide, and 7 feet high, with a sloping roof rising to 10 feet, all these 104 children, together with four women who have the charge of them, sleep. The beds are close to each other; in all the beds there are never less than four children, in many five; the ventilation of the room is most imperfect. Under such circumstances the breaking out of fever is inevitable.
"I was likewise struck with the pale and unhealthy appearance of a number of children in the Whitechapel Workhouse, in a room called the 'Infant Nursery.' These children appear to be from two to three years of age; they are 23 in number, they all sleep in one room, and they seldom or never go out of this room either for air or exercise. Several attempts have been made to send these infants into the country, but a majority of the Board of Guardians has hitherto succeeded in resisting the proposition.
"In the Whitechapel Workhouse there are two fever-wards: in the lower ward the beds are much too close; two fever patients are placed in each bed; the ventilation is most imperfect, and the room is so close as to be dangerous to all who enter it, as well as most injurious to the sick."
The Report mentions, in contrast, the case of the Jews' Hospital, where he had been physician. In that hospital, though at one time there had been a yearly outbreak of fever, since the number of beds in the dormitories had been reduced, and several large ventilators had been put in, the evil had entirely ceased. At the time he wrote eight years had passed since the improvements, and fever had not once returned as an epidemic.
After finishing this Report, my grandfather set to work to obtain exact statistics as to fever in other parts of London; and by the next year (1839) tables had been compiled, which proved, by a wider range of experience, the truths he had again and again brought forward. Once more he wrote a Report to the Poor Law Commissioners—of whom Mr (afterwards Sir Edwin) Chadwick was one—pointing out the facts which were proved by these figures and the duty of acting on them.[[16]]
Such accounts as those given by the three physicians appointed by the Poor Law Board to inquire, could not pass unnoticed. The press, not only in London but in all parts of England, took up the subject. Public men began to be roused.
At first the facts were doubted. It was difficult to believe that such a dreadful state of things could exist; but attention was awakened, and inquiry followed.
The Marquis of Normanby, then Secretary of State for the Home Department, was much impressed with what he had read, but he could hardly conquer a belief that there must have been some exaggeration. My grandfather took him to see some of the places in Bethnal Green and Whitechapel which the Report had described. Lord Normanby was deeply moved, as every one must have been who was brought to realise the kind of dwellings which were all that these people had for homes. "So far," he said, "from any exaggeration having crept into the descriptions which had been given, they had not conveyed to my mind an adequate idea of the truth."
Lord Ashley, too, always in the forefront to relieve the sufferings of the poor, was taken by my grandfather on two occasions to see these regions personally; and from that time forth he became one of the most ardent supporters of the Sanitary Cause, working strenuously for it both in and out of Parliament.[[17]] In a letter to a friend my grandfather writes:—
"Finsbury Square, 1841.
"I have just returned from Whitechapel and Bethnal Green, over which I have been taking Lord Ashley and his brother, and I think they have received an impression which will be lasting, and which will stimulate them to exert themselves for the removal of some of the evils which they have witnessed."
The Bishop of London had the honour of being the first to bring the question before Parliament. In an earnest and eloquent speech made in the House of Lords during the session of 1839, he moved for an extension of such inquiries as the Poor Law Board had caused to be made in London, to other towns in the United Kingdom.
It must have seemed to my grandfather a glorious moment when the principles he had so long advocated were for the first time recognised—when the country began to hear with surprise and shame of the existing state of things—and when the suffering, which he felt so deeply, seemed about to be relieved.
The movement had now begun. Surely it would go quickly, since the saving of thousands of lives each year depended on its progress?
CHAPTER VI.
PHILANTHROPIC AND MEDICAL WORK, 1840-1848.
I have now arrived at the period of my grandfather's life which comes within my own memory, and which begins with the days described in the Introduction when I used to watch him as he sat at his writing in the early mornings. He had taken me to live with him at three years old, and from that time I was with him throughout his life. If, in this chapter or elsewhere, I dwell on his care and tenderness towards myself, it is only that it may indicate the love he invariably showed to all near and dear to him.
My grandfather, though losing no opportunity of promoting the cause he had chiefly at heart—the great sanitary cause—did not limit his public work to it alone: he was at this time engaged in reforming the state of coal-mines, being a member of a Royal Commission—the "Children's Employment Commission"—the chief object of whose labours was to secure the abolition of child-labour in mines. It has been mentioned that the Report presented to Parliament by this Commission had pictures: they were drawn on the spot at my grandfather's instigation, and I believe I am right in saying it was the only parliamentary report so issued. The state of things in the mines was sufficiently appalling. Children of tender years were employed in opening and shutting little gates in narrow passages of coal. They were untaught, and seldom breathed the fresh air. They were sometimes as young as five years old (parents have been known to send them even at four years old); they sat in small niches, scooped out of the coal, for twelve hours at a time, to watch the doors, and they were alone and in the dark except when a "hurrier" with a candle fastened to his forehead passed along, on hands and knees, dragging a truck.
Old woman carrying coal.
The suffering was not confined to children; it was found that young girls, married women, and aged and decrepit women were exposed to bearing upon their backs burdens of coal weighing from three-quarters of a cwt. to 3 cwt.; often to carry these whilst wading in water up to the ankles, sometimes up to the knees, or to carry them from the bottom of the mine to the bank up steep ladders; to go through the hard work of hewing coal by the side of the men; to drag trucks on all fours harnessed by chains; and that the nature of their work, when hewing coal, constantly obliged them to dispense with most of their clothing.
Children at work.
The illustrations in the Report brought all this before my childish imagination very vividly. Perhaps they also, as the Commissioners hoped they might do, caught the attention of busy members of Parliament and learned lords who might not have waded through a lengthy "blue-book" to find the facts which these pictures showed at a glance. The object of the Commissioners was to put the facts strikingly, and in this they succeeded.
Woman drawing truck
Lord Ashley's Bill, based on this Report, encountered great opposition, especially in the House of Lords, many members of which were large proprietors of mines, and in the course of its passage through Parliament it was much mutilated. Lord Ashley had hoped to prevent any boy under thirteen from working in the mines, but the age of exemption was lowered to ten years old; and his attempt to prohibit the employment of boys and old men in the work of lowering the miners into the pit by means of ropes was also defeated.
Still, the main points were gained; for by Lord Ashley's Bill, which passed in 1844 and was founded on the labours of this and the Factory Commission, not only was it enacted that all children under ten should henceforth be prohibited from working in mines, but that such labour should also be illegal for girls of all ages and for women.
It may be worth noticing that the change in the law did not at first give satisfaction to the miners. The men considered it a great hardship to be deprived of the earnings of their wives and children, and the women themselves complained sorely of being deprived of their work. But time has proved the great benefits of the new system. The men now earn nearly as much as a man and his wife used to do, the presence of the wife in the home causes it to be better cared for, and the children are free to attend school.
The "Children's Employment Commission" instituted a further inquiry into the state of young people employed in branches of trade not as yet brought under regulation. This second Report of the Commission, on "Trades and Manufactures," related to the state of apprentices in the South Staffordshire ironworks, and of young workers in such trades as earthenware-making, calico-printing, paper-making, &c.; and although nothing could be done for them at the time, the regulations recommended in the Report have since been adopted.
These Inquiries—important and interesting as they were—occupied only the hours which my grandfather could spare from his professional work as one of the chief consultants in cases of fever, and a leading London physician.
He went daily from our home in Kentish Town to his rooms in the City, and often used to take me with him as a little child. We usually stopped first at the Fever Hospital, which was then near King's Cross. The Great Northern Railway Station stands now on its site, where I used to sit in the carriage at its gate. His connection with that Hospital was never broken (at his death he had been one of its physicians for nearly forty years), and he was, of course, much interested in its re-erection when it was removed to its present position in Liverpool Road, Islington. The new building was made with wards having no upper storeys; each ward had three outer walls and a very high ceiling, thus ensuring perfect ventilation; and there were many other advantages of arrangement.
But even the original hospital at King's Cross was very carefully managed as to fresh air, and my grandfather's implicit belief in his own doctrine of non-contagion was proved by his more than once taking me into the fever-wards, though, when I was a child and therefore peculiarly susceptible, he never would let me breathe the tainted air of the courts and lanes of which he fearlessly encountered the danger, not only in his capacity as a physician, but when making his early sanitary investigations.
Three times in the course of his life he had been stricken down with fever. In one of these attacks his life had been despaired of, but medical skill, aided by most careful nursing and by his naturally strong constitution, at length conquered the disease.
After the visit to the hospital we went on into the City to his consulting-rooms, which were first at 36 New Broad Street, and afterwards at 38 Finsbury Square; and then came the morning hours during which he saw patients there, and I amused myself until he was ready for the afternoon round. Then outdoor work again. Generally the visits led us through crowded streets where the carriage got blocked in amongst great waggons or hemmed in near high warehouses; but at times there came long drives to some patient living more in the country at Hackney, Dalston, Stoke Newington, or farther off still; and then what a happy time I had with him, sitting on his knee and asking endless questions! It was worth many hours of waiting in the carriage, outside doors, to have the times that came between.
Then there was the Eastern Dispensary and Jews' Hospital practice, in connection with which he daily went to see patients in their own poor homes. How well I remember being left in the carriage at the end of streets too narrow for it to drive down. I used to amuse myself with looking out at the people passing to and fro—children without hats and bonnets; old-clothesmen with their bags; orange-girls;—many dark faces amongst the passers-by—Jews, as I was afterwards told. I used to wonder at it all, and make up stories about the people and guess on what errands they were bent when entering their little shops and doorways; and when tired of all this—for I was still too small to see without kneeling up on the seat to look out at the window—I seated myself on the floor of the carriage and was soon deeply engrossed in some book of pictures or fairy tales, which my grandfather, in the midst of all else, had thoughtfully put into the pocket of the carriage for me to "find."
Then I would climb up again and watch for him. At last he would come! Down the dark, narrow street, looking very grave, the reflection of some scene just left still resting on his face. Out of such thoughts—produced by such places—came his afterwork.
When he came to me, however, the sad thoughts passed away, and he was ready to let his happy nature come through to cheer his little girl. He would practically work to relieve such misery as he had seen—day and night—at all cost—through all opposition,—but he would also play merrily with his little grandchild, to make joyous for her the homeward drive through the evening air.
My grandfather was much interested at this time in another effort of which I have not yet spoken. It was the institution of a "Home in Sickness" in London for those of the middle classes who might be far from their own families, or who, from some other cause, could not secure favourable surroundings in times of illness. The position of such people struck him as very desolate. There were many with homes far away—clerks, students, young men engaged in various professions, governesses, and other ladies of limited income—who might be seized with illness under circumstances when a return to their family was impossible; others who had no family to which to return. It seemed to him that chambers or lodgings which might be tolerably convenient for people in health, were utterly unsuited to give the requisite comforts when illness came: the poorer classes had the hospitals, but for this intermediate class there was no provision.
His plan was, therefore, to found an institution into which, by subscribing a small sum annually, members could secure a right to be received when they were suffering from disease. They would each have a separate room where an equal temperature could be secured, well prepared diet, superior nursing, the advantage of a medical officer in the house who could be called in at any moment, and the daily advice of skilled physicians and surgeons specially appointed; or should the patients prefer it, of their own medical advisers. For this they were to pay two guineas a-week during their residence, or less, should it be found that such an establishment could be self-supporting at a lower rate: that it should be self-supporting was, he thought, essential.
Such an institution was founded in 1840 under very good auspices, and opened under the name of "The Sanatorium" at Devonshire House, York Gate, Regent's Park, in 1842. My grandfather freely gave it his medical services, as well as his influence and supervision, for some years.
The house stood in a garden in which there were tall trees (with rooks in them), making a cool green shade and shutting out all other houses; whilst within doors the soft carpets and general feeling of quiet and order gave a sense of peace. The contrast on turning into that garden from the "New Road"[[18]] was striking. Quiet, indeed, was one of the chief boons which the Sanatorium could offer.
Charles Dickens, one of its earliest supporters, speaks forcibly of this contrast in a speech made in behalf of the Institution. He speaks of the noise of crowded streets and busy thoroughfares as—
"That never-ceasing restlessness, that incessant tread of feet wearing the rough stones smooth and glossy." "Is it not a wonder," he says,—"is it not a wonder, how the dwellers in narrow ways can bear it? Think of a sick man in such a place as St Martins Court, listening to the footsteps, and in the midst of pain and weariness obliged, despite himself (as though it were a task he must perform), to detect the child's step from the man's; the slipshod beggar from the hooded exquisite; the lounging from the busy. Think of the hum and noise always present to his senses, and of the stream of life that will not stop, pouring on, on, on, through all his restless dreams, as if he were condemned to lie dead, but conscious, in a noisy churchyard, and had no hope of rest for centuries to come."
After some time it was found that a building specially constructed, which should contain many small separate rooms, would be more suitable and less expensive than Devonshire House. To erect this it was necessary to raise a building fund. By this time the Institution was supported by a powerful list of patrons, with Prince Albert at their head; many large banking-houses and City firms had subscribed to it for the sake of their clerks and others; and more than a hundred members of the medical profession had visited it, and had signed a statement expressing their belief in the need of such an establishment, adding that the Sanatorium had supplied this need most satisfactorily, though on a small scale.
Charles Dickens then lived nearly opposite to Devonshire House, and when the building fund was opened, he and several other literary men and artists came forward and gave for its benefit the first of those amateur performances which they repeated at a later period. They acted Ben Jonson's "Every Man in his Humour," at St James's Theatre, on November 15, 1845, both audience and actors being brilliant. Charles Dickens, Douglas Jerrold, John Foster, Mark Lemon, Frank Stone, and others took part. I remember seeing them, as I peeped down from a side-box.
The Sanatorium did not, from a money point of view, succeed; but it was, nevertheless, the forerunner of all those "Home Hospitals" and "Nursing Homes" which have since proved so great a boon to the public. So that in this, also, my grandfather was a pioneer.
As the name of Dickens has been mentioned, it may be interesting to refer here to some of the letters which show the early and keen interest he felt in the removal of the evils with which my grandfather was contending, and his readiness to give his aid to the cause of the poor. Here is the first letter, alluding both to the Sanatorium and to the Children's Employment Commission:—
Letter from Charles Dickens