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),1 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

1 Children of this marriage: Herman Southwood Smith, born 1819, died 1897; Spencer, Christina, both died in childhood.

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

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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.” 1

1 Westminster Review, 1825, p. 519.

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