still so frightfully prevalent; diseases manifestly dependent on conditions within our control, and highly favourable to the spread of the pestilence then menacing, and now still more nearly menacing us. The Bishop of London had called earnestly upon the clergymen of his diocese to co-operate with the medical profession in this object; and being desirous of ascertaining the state of intelligence and feeling of this natural class of co-operators in such a work, I visited privately every clergyman in the Eastern District of London and discussed the subject with them.

Without a single exception, I found them impressed with a sense of the necessity of doing something, and with a conviction that they might materially help the medical profession in carrying out any plan of operation proposed by authority. The necessity of some such general plan is greater now than it was then, on account of the continual prevalence in their severest forms of our own epidemics, and of the nearer approach of cholera. The new Contagious Diseases Act," the "Public Health Act," and the new "Metropolitan Sewers Act," taken together,

I

afford greater facilities for meeting this necessity than ever before existed; and certainly it is now in the power of the Government to do more for securing the public health, and improving the physical condition of the population, than has ever yet been attempted in any age or nation,—a power which, if wisely and successfully exerted, will reflect the highest honour on the Government and the country.

My intimate relation with the origin and progress of this work, and my deep conviction that it is one of the most useful to which experience and science can be applied, would render it a satisfaction to me to spend the remainder of my life in assisting to complete it. I am, my Lord, with much esteem and regard, very faithfully yours, SOUTHWOOD SMITH.

The dates given at the head of this chapter (1848 to 1854) cover the period when the Sanitary cause was completely successful, and when my grandfather found himself one of the heads of a Government department devoted to the furtherance of sanitary measures throughout the kingdom-a department which was called the

General Board of Health. Here, at offices in Whitehall, in daily conference with Lord Ashley (afterwards the Earl of Shaftesbury) and Mr Edwin Chadwick, he could propagate knowledge on questions relating to the public health, and carry out sanitary measures, as from a powerful centre, having the authority of a Government department.

This power of carrying out his convictions to practical issues was an immense satisfaction to my grandfather's mind, and many were the congratulations which he received on this public appointment. The following, from a Portsmouth physician, is interesting :

October 8, 1848.

SIR, Though personally a stranger, permit me to offer my sincere congratulations on your appointment by her Majesty's Government to the Board of Health, where the talents you have so long displayed will have scope for the full share of utility.

I have traced and followed you in the various publications issued by the Government and the Health of Towns Association for several years past, and having myself, though in a much more

confined area, mingled with public life, I know the heart-burnings, the disappointments and annoyances, to which in such a course a man is necessarily exposed; but if reward come at last— though the delay has almost made the heart sick -one is then amply repaid, especially in a case like yours, when a whole kingdom will applaud the appointment.

Permit me again, sir, to beg your acceptance of my congratulations. I am, sir, your obedient

servant,

To Dr SOUTHWOOD SMITH, Whitehall.

Almost the first work which the Board of Health had to do was to take measures to resist an epidemic of Asiatic cholera. This it did by sending down inspectors from London to instruct and aid the local authorities in organising plans for systematic cleansing, and for the removal of the sick. The Board also issued "Notifications' for the purpose of instructing the public as to what precautions were necessary to avert an attack. But above all, it organised, at my grandfather's instance, what was called the "system of house-to-house visitation." My grandfather was

of opinion that in every instance an attack of cholera is preceded by a period of a few days (sometimes only of a few hours) of premonitory symptoms, which, since they are painless, escape notice; and that, unless a specially appointed medical visitor goes round to the houses of the less educated to inquire, and almost to crossquestion, as to the existence of these symptoms, and to treat the disease at once, this stage rapidly passes on into developed cholera, when recovery becomes all but hopeless. These facts and experiences are brought out in the General Board of Health's Report on the Cholera Epidemic of 1848-49, presented to Parliament in 1850.

In relation to this, Lord Brougham thus wrote to my grandfather :

1

"I also proclaimed 1 your important statement of the preventive cure of cholera, bearing further testimony to the soundness of your views from Sir J. Mordaunt's account given to me in the Malta case.

"I availed myself of the opportunity to give you just praise, and to note your many valuable

1 In the House of Lords.