17 Volumi 5S May 1962

Section of the History ofMedicine

President KD Keele MsD

Meeting December 61961

PaperThomas Southwood Smith - the Man(1788- 1861)by FN L Poynter PhD FLA

(Wellcome Historical MedicalLibrary, London)

A friend of Southwood Smith's, John Stuart Mill,said in his famous 'Essay on Liberty' 'that theinitiative of all wise and noble things comes andmust come, from individuals, and generally atfirst from some one individual'. In the history ofpublic health Edwin Chadwick is usually creditedwith this initiative, especially among medical men,and it was left to Graham Wallas, a historian whomade a special study of the political economistsof the early nineteenth century, to describeSouthwood Smith as 'the intellectual father ofour modern public health system' [1]. Anothersocial historian, Professor Asa Briggs, in his 1946Chadwick Lecture, consistently coupled thename of Southwood Smith with Chadwick in dis-cussing the early history of the public health move-ment. Sir Arthur MacNalty, in his FitzpatrickLectures of 1946-7, was the first medical writer tohint at the true character of Smith's contribution,which was certainly not appreciated by Sir JohnSimon [2], Sir Benjamin Ward Richardson[3 ;1, xv-lxxiv], or Sir Malcolm Morris [4].The overpowering Chadwick was still alive

when Simon was writing, and documents, bothprinted and manuscript, have survived to remindus how quick Chadwick was to rebuke those whoseemed to question the primary nature of his ownrole in any aspect of public health reform.Richardson was Chadwick's disciple and wasunlikely to query his master's claims. Sir MalcolmMorris based his own accounts almost entirely onSimon, and all three have been the constantsource for later historians of the movement.A commemoration is not an occasion for con-

troversy, even a historical one. Chadwick's greatand lasting contributions to the making ofmodem England are self-evident and are un-assailable, but they should not be allowed toobscure the equally great - if insufficiently recog-nized - contributions of Southwood Smith. Since

Fig 1 Thomas Southwood Smith. A portrait drawn in1842 by Margaret Gillies

I first became interested in Southwood Smithabout fifteen years ago I have been surprised thatnone of the many writers on the public healthmovement - and the medical writers above all -has seemed to ask himself how it was thatChadwick, this young and briefless barrister,suddenly emerged as some kind of 'medicalgenius'. Yet so accustomed are we to regard himin this light that a serious and learned historiancould write, in the definitive biography ofChadwick published in 1952 [5, p 36], ofChadwick attending Jeremy Bentham during hislast illness in 1832 and of how well he dischargedthe 'care and responsibility for his patient'."Southwood Smith, who was Bentham's close'My italics

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friend and personal physician during the lasttwelve years of his life, is not even mentioned inthis connexion. Is this not very strange?There are a multitude of intriguing points like

this which should have aroused the curiosity ofany historian, medical or general, but thequestions have never been asked and so thecorrect answers have never been found. There is,however, one fundamental question which hasbeen asked, if only rhetorically, in an authorita-tive publication from which 1 should like to quotebefore closing this preamble. It is this:

'What, it may be asked, was Chadwick's "sanitaryidea", the root-principle which inspired his life-work?It was, according to Richardson, "that man could bygetting at first principles, and by aiming at causeswhich affect health, mould life altogether into itsnatural cast, and beat what had hitherto been acceptedas fate by getting behind fate itself, and suppressingthe forces which led up to it at their prime source".To this end, direct investigation on the spot into theremoval of the preventable antecedents of disease andcrime claimed his attention.... He dwelt on unity ofpurpose in the prevention of evil' [6].

Thiis was indeed the origin of the 'sanitary idea'but this root-principle which inspired allChadwick's life-work was not his own. It was infact embodied in lectures by Southwood Smithdelivered in Edinburgh between 1813 and 1815(when Chadwick was a boy) and published in apopular and widely praised book in 1816. Thebeginning of the sanitary idea can be traced to thefact that Southwood Smith, after a change ofreligious belief, became a Unitarian ministerbefore taking up medicine. There is no adequaterecord of that period of his life, and if I give to itwhat may seem a disproportionate amount oftime it is because I think it essential to the historyof 'the sanitary idea'. The only published bio-graphy, a personal memoir written by his grand-daughter in 1898 [7], does not even name hisparents and avoids mention of many thingswhich are important to our understanding of thelife and work of this very remarkable man and ofhis no less remarkable family.

Early Life and TrainingThomas Southwood Smith was born atMartock, near Yeovil, in Somerset on December21, 1788. He was the son of William Smith, ofKingsbury, and Catherine Southwood, who weremarried at Martock on September 21, 1785 [8].His parents were members of a strict sect ofCalvinist dissenters and in 1798 they became veryfriendly with the Reverend William Blake, who inthat year came to minister to the Presbyteriancongregation in the neighbouring town of

Crewkerne. He was to become a powerful influ-ence in the life of the growing boy, directing hiseducation, moulding his opinions and character,and, at a later stage, making a decisive interven-tion in a spiritual crisis which was to influencethe whole of his life work [9, 10].The Blakes were a well-known Somerset family.

The minister's brother, Dr Malachai Blake, wasone of the founders of the Somerset Hospital atTaunton, where his portrait still hangs in memoryof his services to the sick in the town. Amongtheir ancestors was the famous Admiral Blakewho, before achieving his high place in Cromwell'snavy, had taken part in the defence of Bristolagainst the Royalists and taken Taunton from theKing's forces. It was a family with a long traditionof dissent and independent thought as well aspublic service and it was in this tradition that theyoung Southwood Smith was now instructed. Hisparents had always thought him destined for theministry and their intention was reinforced byBlake's approval and warm encouragement. Hewrote about the boy in such glowing terms to DrJohn Ryland, the Principal of the BaptistAcademy, Bristol, that Smith was called to aninterview late in 1802, before his fourteenth birth-day, although the average age of the students atentry was 17 or 18. The Academy was an oldfoundation, dating from 1679, being an offshootof the Baptist Chapel established in Broadmead,Bristol, in 1643, and supported by prosperousmerchants and city officials. To enable youngmen of marked ability but'limited means to studyfor their ministry they had established scholar-ships known as Broadmead benefactions, one ortwo of which were awarded each year. In spite ofhis extreme youth, Smith was unanimouslyawarded this scholarship, and because of it thegrant was awarded for more than double theusual term [11].To-day the Academy, now the Bristol Baptist

College, occupies a handsome new building, butits large library, which has many old and rarebooks, still consists largely of the eighteenth cen-tury works and editions which it contained whenSmith took up his residence there in 1803. As aBroadmead scholar, great things were expected ofhim and he read long and assiduously, not only intheology, but also in history, the classics andphilosophy. The Academy also prided itself uponthe possession of a most unusual department - amuseum of antiquities, natural history and naturalphilosophy. This was considerably more than a'cabinet of curiosities' and filled a large room,having been set up by one of the tutors who hadformerly been on the staff of the British Museum,and enriched by the bequest of the collections ofDr Gifford and Dr Llewellin. There one can findto-day scientific apparatus dating from that time,

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including one of the enormous glass spheres suchas Thomas Beddoes employed in his experimentson gases in his Pneumatic Institution at Bristol.

If the graduates of the Baptist Academy wentout into the world ignorant of all but Calvinisttheology it would be entirely their own fault, foreven the older universities at that time could nothave offered greater incentives to learning. But,with all the history and poetry and naturalphilosophy, Calvinist theology was their chiefstudy and since it must have coloured their wholeview of man and the universe, as well as leavingan ineradicable mark on their character, it wouldbe as well to glance at the creed in whichSouthwood Smith was being so competentlyinstructed and which he was preparing himself topreach to his fellows. In its origins it goes farbeyond Calvin, as far as St Paul indeed, or ratherto St Augustine's interpretation of St Paul. Thatgreat father of the early Church taught that man,ever since the Fall, is born in sin and deserveseternal damnation. Only by the operation of theDivine grace can he ever abstain from sin. God'sgrace can operate only among the baptized; allothers, even infants, will go to hell and suffereternal torments. By God's will, certain of thebaptized are destined for heaven. These are theElect, living witnesses of God's mercy, just as thehosts of the damned are witnesses of His justice.This was the belief which Calvin revived andwhich was taken over by the Reformed churches.While such a creed could give great confidence tothe elect and endow them with uncommon energyand purpose, it needs little imagination to under-stand what a burden it must have been on themind of a sensitive, idealistic, and intelligentyouth such as Southwood Smith. Brought up inthe conviction of sin, his adolescence must havebeen tormented by that sense of guilt whichweigh-ed so heavily upon the poet Byron, who was alsonursed in Calvinist theology, that his whole lifewas haunted by the certainty of damnation. It isstrange to reflect that Byron was to find comfortand reassurance in a book written only a fewyears later by the boy who was now caught upin the same spiritual struggle which the poet wasnever to resolve. This was the great decade of theRomantic poets, and Wordsworth (who alsopraised Smith's first book) and Coleridge werepowerful influences on the young student.

Coleridge believed that it was God's love, andnot His justice, which was the support and hopeof man, and nothing was beyond the reach ofHis love. Was not Coleridge himself a Unitarianpreacher? And in the Unitarian chapel in Lewin'sMead, only a stone's throw from the Baptist chapelin Broadmead, was to be found Coleridge'sfriend and benefactor, the minister John PriorEstlin [12, p 218 (note)]. On Blake's advice,

Smith discussed his problems with this good andwise man. It was indeed a step into the opposingcamp, for the Unitarians held to that Arianheresy which denied the Trinity and saw in Jesusnot the Son of God but the best and greatest ofmen. For this reason they were called 'humani-tarians', a word which, from its association withtheir benevolent social causes, only later acquiredits modern connotation. It was the beliefforwhichServetus had been burned at the stake by Calvinand was the antithesis of all that Smith had beentrained to believe, for it denied salvation to none,whether he be Christian, Jew, Mohammedan orBuddhist. The connexion between social progressand an apparently remote theological belief wasclearly understood by men like Estlin. Discussingthe idea of eternal damnation, a creed acceptedalmost universally in his day, when it was even theofficial doctrine of the Church of England, hereminds us that the vast majority of all who haveever lived are so predestined. 'I know', he wrote,'that we are apt ta overlook the fate of thisimmense multitude; and a most baneful effect uponthe human mind, upon all the institutions ofsociety, and particularly upon penal jurispru-dence, has this overlooking of what others, eventhe majority, suffer' [12, p 218 (note)].

Smith's own compassionate nature respondedimmediately to these new ideas of the possible'restoration' or reformation of the wicked and avast new field of work opened up before him. Hetells us that much of the interest and zeal withwhich he carried out his later work sprang fromthis episode in his life. Abandoning what he latercame to call 'that terrible doctrine', which hadbecome 'horrible and repugnant' to him, heinformed Dr Ryland of his changed views andleft the Academy [11]. During his five years'residence there he had been accustomed to visitthe house of a certain Mr Read, a large manufac-turer in Bristol and one of the supporters of theCollege. There he had come to know, and even-tually to love, Read's daughter Anne. Both werestrict Calvinists and it says much for Smith'scharacter - and for their understanding andappreciation of it - that they supported himthroughout what must have been an ordeal for ayoung man of 19. On May 25, 1808, he and AnneRead were married at Clifton [13]. His ownparents were less tolerant. Deeply shocked atwhat they considered as the betrayal of all theirhopes and beliefs, they disowned him utterly andforbade him to return to his home. They werenever to see each other again [7, p 8].The next few years of his life are not well

documented. He was an eloquent and thoughtfulpreacher and his sermons were so popular thatmany of them were published. From them weknow that he was for a short time minister of the

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Unitarian chapel at Taunton, where he preacheda farewell sermon on October 18, 1808. In thefollowing year his first child, Caroline, was born,and in 1810 a second daughter, Emily. The deathof his father-in-law at this time probably removedfinancial support from the young family, and ithad scarcely recovered from this blow when, in1812, his wife died of fever, leaving him, at theage of 24, a widower with two small children tocare for. Casting about for a suitable profession,he probably discussed his problems again with hisfriends Blake and Estlin. Estlin's own son, JohnBishop Estlin, a former student of Guy's and afriend of Beddoes, had in that very year foundedin Bristol the ophthalmic dispensary which isnow the Bristol Eye Hospital. Blake's brother wasa prominent doctor in Taunton. There was alreadyin Edinburgh a very small congregation ofUnitarians and arrangements were made forSmith, with financial support from the UnitarianFund, to go to Edinburgh to minister to this con-gregation and simultaneously to take the course inmedicine at the university [14].

Edinburgh and the Originsof'The Sanitary Idea'He set out for Scotland in the-autumn of 1812,leaving the two children in the care of theirmother's relations, and founded the ScottishUnitarian Association, of which he becamefirst secretary, and minister to the congrega-tion which met in Skinner's Hall, Edinburgh.At first it was uphill work against strong opposi-tion and after a lonely winter he returned toBristol to take Caroline, the elder ofhis daughters,then aged 4, back with him to Edinburgh, ajourney which took many days in a sailing vesseland on which they met with a terrible storm. Hemust have been an unusual figure among themedical students of his day, who included amongtheir number Richard Bright, Thomas Addison,and Robert Knox. In 1813 he began to givefortnightly evening lectures as well as his usualsermons in Skinner's Hall, and these attracted somuch notice that the numbers who attendedincreased rapidly from 20 or 30 to 200, and onspecial occasions 500. His preaching, and thesubjects which he discussed, began to be noticedin the newspapers. In the summer of the sameyear he made a long and exhausting missionaryjourney through the Highlands and in the follow-ing year his regular congregation had grown somuch that it moved to a larger hall in Carruber'sClose [151. There were, many demands that hisevening lectures on 'divine restitution' should bepublished and in 1816 they appeared in a volumeentitled 'Illustrations of the Divine Government'[9]. It at once established his reputation as an

original and eloquent writer. The eloquence beingthat of the trained pulpit speaker is not perhapsto the modern taste, but the clear exposition of adifficult theme, the discussion, often for the firsttime, of ideas which were later to become of thegreatest importance, and the writer's own appre-ciation of the implications of his arguments makeit a remarkable performance. It was widely readand commented upon and several editions werecalled for. In the preface to the third edition, pub-lished in 1822, he wrote, 'I have considered,separately and in detail, the several classes ofevil, namely, natural and moral evil, and the evilswhich have hitherto been found inseparable fromthe social state, namely poverty, dependence andservitude.... There is a closer connection thanthere might at first sight seem between these sub-jects and those [that is, medicine and sanitaryreform] which now much more exclusively occupymy attention: the real end of both is the same; forthe object ofeach alike is to extend the knowledge,to mitigate the suffering and to increase thehappiness of mankind; and without doubt that isthe great business of life.'The influences in his book are obvious, for

although Smith was in advance of his time hisideas sprang from his own response to the greatintellectual ferment of which the establishmentof the United States and the French Revolutionwere but the outward expression, and are imbuedwith that 'Nonconformist conscience' which wasto provide the driving power of nineteenthcentury liberalism. Arnold Toynbee claims that'the historical link between sixteenth centuryCalvinism and twentieth century Communism isnineteenth century Liberalism', and it is perhapsnot so paradoxical as it seems at first sight that aman who had rejected Calvinism should, in a bookwhich denounces that creed, claim divine authorityfor a deterministic 'Law of Progress - that kind ofimprovement which can bemeasured by statistics'.Fifty years later - and even up to the outbreak ofthe First World War - the natural inevitability ofprogress was almost universally accepted, but atthe time when Smith was writing, in the year ofWaterloo, it was the existing social order whichwas regarded as predestined and immutable. Thepoor and the wretched, sinners and criminals,were not only debarred from all the amenitiesof life on earth but were condemned to eternalpunishment hereafter. Revolting with all his beingagainst the second of these 'judgments', Smithargued that if this cannot be true then there wasno moral sanction for maintaining a social systemwhich reflects it. In his own words, 'What can beimproved must be improved and will be improveduntil man in society reflects the benevolent pur-pose of the Almighty' [9, p 95]. Here, and not inChadwick's paraphrase about 'getting behind

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fate' is the origin of what has been called'Chadwick's sanitary idea and the root-principleof his life work'. Smith discusses the disease andmisery attendant upon poverty which is prevent-able and should therefore be prevented. Heacclaims John Howard as one of his earliestheroes and pays particular attention to the treat-ment of criminals, pointing out the religiousbasis for much vindictive cruelty in the law. It isimpossible to discuss this book at length here, butto give some idea of its cbaracter I will quote astriking passage where he declares that the doc-trine of 'universal restitution' which he is tryingto establish'discloses a principle which, were it properly felt andinvariably regarded in the affairs of life, would have ahappier effect on society than any other opinion whichhas ever engaged the attention of man. It leads to adistinction, which is but beginning to be observed,even by the intelligent and enlightened which ... willalter astonishingly the moral condition of the world.It leads to an exact distinction between the criminaland the crime. While it inspires us with abhorrence ofthe offence, it softens the heart with compassion forthe unhappy condition of the offender, induces us todo everything in our power to change it, to give himbetter views and better feelings.... Could it but enterthe heart of every legislator. . . prisons would not behotbeds of vice, in which the youthful offender growsinto the hardened criminal and the want of shamesucceeds the abolition of principle, but hospitals ofthemind, in which its moral disorder is removed by theapplication of effectual remedies' [9, pp 231-2].

He argues against views and theories which'tend to degrade man in the estimation ofman andrepresent him as too cheap. This low estimation ofthe value of a human being', he writes, 'this con-tempt of human nature, is fatal to human im-provement and is at the foundation of the enor-mous errors of statesmen and the gigantic crimesof warriors; they could not squander life andviolate happiness as they do, did they judge ofman as he is' [12, pp 171-2].

Forty years later, when he was approaching theend of a struggle which had taken him into scenesof such abject wretchedness that even a saintmight have despaired, Smith looked back on thisbook and 'thought that he had passed too lightlyover the sea of misery and crime that there is inthe world; he thought there was too much of thebright hopefulness of youth about it'. Brighthopefulness there may be, but it is not the crassoptimism of a youth ignorant and ill informed.The brightness is a reflection of his own spirit;there is a serenity, a warm humanity and-a calmwisdom which one would not expect in so younga man.

It was,doubtless his insight,into human naturewlich at-tracted him towards the studyJof menta

ilines during his medical,,stud4-gpd on94,pgust l;

1816, he graduated MD with a thesis on theinjurious effects of diseases on the mind. He wasapparently still deeply interested in this subjectnine years later, when he wrote a long reviewarticle dealing with the physical causes of mentalillness for the Westminster Review [16]. His viewsseem to be well in advance of his time and areworthy of attention in the study of Britishpsychiatry. On August 5, 1816, he wrote to afriend, the Hon D G Halliburton:

'I leave Edinburgh this week ... with much regret,for I have found friends here whom I shall everremember with respect, affection, and gratitude. I goto Yeovil, a little town in the west of England, whereit is my intention to take charge of a congregation andat the same time to practise medicine. This doublecapacity of physician to body and soul does notappear to me to be incompatible, but how the planwill succeed can be determined only by the test ofexperience. My expectations are not very sanguine,but neither are my desires ambitious' [see 7, p 15].

He rapidly assumed a leading role among hisco-religionists in his native county and his ser-vices as a preacher were much in demand. Severalof his sermons were published, the most notableof them being his funeral sermon on the tragicdeath in 1818 of the penal reformer Sir SamuelRomilly, who had committed suicide followingthe death of his wife, an event which clearlyaffected Smith deeply. Yet another, more per-sonal, event was to make this year a memorableone for him. A young widowed minister with twochildren was a fair target for all the match-makersin the countryside and all his friends persuadedhim that a second marriage was advisable. Thesenior officers of the Unitarian Society also agreedthat marriage would extend the usefulness of aman who had already shown himself worthy ofadmission to their councils, and it was Mary, thedaughter of their Treasurer, John Christie ofHackney, who became his second wife and borehim a son, Herman, in 1819. Accustomed to lifein the capital and ambitious for the advancementof her husband, Mrs Southwood Smith urged himto leave Yeovil and settle in London, where allkinds of opportunities both as minister andphysician awaited him. Early in 1820 they left thewest country for ever and settled at Trinity Squarenear the Tower and near the central office of theUnitarian Fund in Mark Lane.

The Bentham CircleIt was doubtless among his fellow Unitariansthat he first began tP, establish his practice inLondon. Hewalk4the wardsofoneof th Londoghpspitals - probably Guy's or St Thoma.'s - foryeas and on Jjwe 25, 1821, he was OditdtLivengl?9f tlte 1yal qollege of piaequivalent f, the modern Memb¢rtip (171i4i

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the same time he quickly took his place amongthe group of social reformers and politicaleconomists who had gathered around the ageingJeremy Bentham. Among these were the twoMills, father and son, Grote, Wakefield, FrancisPlace, Parkes, John Bowring, and others. Smith'swork - if only for its discussion of the penal laws -would certainly have been known to them all, andthere may already have existed a personal linkbetween Smith and Bentham through Romilly.They were a formidable group and Bentham

drew on the varied talents and experience of all ofthem to carry on his work of political innovationwith results which were only to become apparentafter his death. The great task of his last yearswas the framing of a vast 'constitutional code'covering every aspect of central and local govern-ment. When he came to consider that branch ofadministration concerning public health and theprevention of disease there can be no doubt towhom he turned for expert advice. Smith was theonly medical man in the group at that time. Hehad published his preliminary views on the sub-ject ten years earlier and was now acquiring muchpractical experience and first-hand information asphysician to the London Fever Hospital, and tothe Eastern Dispensary and the Jews' Hospital inWhitechapel, where his duties often took himinto some of the worst slums in the civilizedworld. He spent much time at Bentham's home inWestminster (which backed on the very housewhere John Milton had lived) helping Benthamwith his new constitution, so that the sectionsdealing with the functions and duties of the pro-posed national Minister of Health and thePreventive Service Minister may fairly be takento represent Smith's contribution.

These sections are too long to analyse here, buttheir main provisions bring under the direction ofthe Minister all that concerns public health,hospitals, lazarettos (or isolation hospitals),quarantine, laboratories, lunatic asylums, work-houses, prisons, schools and other public build-ings, water supply, sewers and drains, burialplaces, mines, factories, the medical services ofthe Army and Navy, the manufacture and storageof drugs, and even medical museums and libraries.The methods to be employed included inspectionand collection of statistics and other informationand their publication, a complete system of regis-tration not only of births, marriages and deaths,but also of ,mortality and morbidity, and fullpowers were given for acting on all this informa-tion by measures to promote improvement. It isinteresting to see that the adequate examinationand registration of medical practitioners was notoverlooked and there are even clauses designed toprevent what is called 'professional confederacy'aRingt tlK public interest [18; 9, 439-45].

What practical effect did all this have at thetime? It is generally acknowledged that this'amazing Constitutional Code was the mine fromwhich a new relation between English central andlocal government was extracted in the years thatfollowed the Reform Bill of 1832. From the incom-pletely printed manuscript Chadwick took thedetails of the new Poor Law of 1834, Parkes andPlace the details of the Municipal Reform Act of1835, Chadwick the details and even the phrasingof the Act establishing a scientific system of vitalstatistics in 1836...' [19]. It may be addedthat all the Public Health Acts, up to the estab-lishment of the Ministry of Health in 1919, werealso indebted to it.

In 1823 the 'Bentham group' decided to foundtheir own journal and in 1824 the famousWestminster Review was launched. The earlynumbers contained no less than three longarticles by Southwood Smith. All were importantand one is of special interest. Entitled 'The Use ofthe Dead to the Living', [20], it was a reasonedappeal for legislation to permit the bodies ofunclaimed paupers who died in hospitals andworkhouse infirmaries to be used for the teachingand study of anatomy. It contained a brief historyof medicine, demonstrating that good medicalpractice has always depended on a sound know-ledge of anatomy and physiology and that wherethis is deficient practice must be bad. If surgeonscannot learn from the bodies of the dead, he said,then they will be forced to learn from the livingbodies of the poor. He also pointed out thedamage to medical education and the medicalschools in England caused by the existing lawswhich were driving English and Scottish studentsto Paris for anatomical instruction. This articlemade such an impression that it was immediatelyreprinted as a pamphlet, was republished inAmerica three years later and in 1832, whenParliament was being asked to consider theAnatomy Act, a third edition was printed and acopy given to every Member of Parliament. TheTimes stated that the Act was a direct result ofSmith's article, which had led to a Parliamentaryinquiry. 'The Administration was impressed' itsays, 'the public was excited, something waspromised, a little was attempted, but nothing wasdone. Then came on the Edinburgh horrors, andnow we are thrown into a state of intense alarmlest the same horrors should be perpetrated atour own doors' [21].

Other articles which Smith wrote in 1824 dealtwith 'Contagion and Sanitary Las%s' [22]. Theydiscuss at considerable length epidemiologicaltheories which are now outdated but they doembody the basic principle of the 'sanitary idea',that epidemic diseases are associated with par-ticular places (a Hippocratic idea), but - and this

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was the novelty - this association could be tracedto particular sanitary defects in those placeswhich could be remedied and so the disease beprevented.

Just at this time, Edwin Chadwick, a youngman of 24 who, after working for five years as asolicitor's clerk, was starting to read for the Bar,took rooms in Lyon's Inn (which stood on thesite of the present Bush House). He was intro-duced to Smith, who took him, as he did severalof his friends, to some of the 'fever-nests' he hadalready come to know so well. Chadwick caughtfever and nearly died [5, p 10]. It was a lesson hewas never to forget, but neither was he to forgetthe facts and figures which accompanied Smith'sdemonstration. Three years later, in his firstarticle for the Westminster Review [23], he usedthem in a discussion of life-insurance and life-tables, arguing as authoritatively about theexpectation of life in Shoreditch and BethnalGreen and the average mortality in the Londonhospitals as if he had investigated these mattersfor himself. It is this article, by the way, which isalways cited as the 'birth of Chadwick's sanitaryidea'. Chadwick was not introduced to Benthamuntil late in 1829, and in 1830, when he had beenadmitted to the Bar but had thrown up his firstand only case in disgust, Bentham (then 82) andhis friends were looking round for something forhim to do and he was engaged as Bentham's secre-tary. It is therefore interesting - to say the least -that when Bentham wanted a good article writtenon a new penal code it was not to the younglawyer that he turned but to Southwood Smith.Edward Livingston, penal reformer and Americansenator, had written to Bentham asking him togive publicity in England to the new penal codewhich Livingston had devised for the state ofLouisiana. Bentham's reply is illuminating:

'An article on it will appear', he told Livingston, 'inThe Jurist ... written by Dr Southwood Smith, byprofession a physician; but a man of genius, philan-thropical affections and eminently extensive know-ledge.... Why and whence this physician? You know,or do not know, that your code, in its first state hasbeen republished here in London; the act of publica-tion was a spontaneous act of philanthropy on thepart of this physician. He was, and is, far from rich;he has no patrimony, no source of subsistence buthis professional practice, which is not by any meansadequate to his merits.... On the present occasion Iwrote to Southwood Smith, and he has consented towrite: I made application to the editors of The Jurist,and they have consented to publish: the Jurist, I amtold, pays no fees. . .' [18; 9, 351]1The amount of time which Smith spent on

unpaid work of this kind must have been con-

siderable. In April 1825 he had been one of thefounders of the Society for the Diffusion ofUseful Knowledge and for its publications hewrote a 'Treatise on Animal Physiology' (1829),all the main articles on anatomy, physiology, andmedicine for its Penny Cyclopedia (1832-45), and'The Philosophy of Health' (2 vols, 1836-7). Allthese works show that, despite his many pre-occupations, he kept up to date with his reading,and the last named was in fact the first work pub-lished in England to give an account of WilliamBeaumont's studies on the physiology of diges-tion [see 24]. They are all extremely well writtenand are the first examples of adequate medical andscientific books designed for popular instruction.Smith, who was a pioneer in popular education aswell as other matters, believed in education as animportant means of progress, leading people todemand reforms which could not be effectedmerely by government decree.

In 1830 he published a long monograph entitled'A Treatise on Fever' which was a detailedelaboration of his review articles of 1825. It washailed enthusiastically by the medicaljournals, theMedico-Chirurgical Review praising it as 'the bestwork on fever that ever flowed from the pen ofphysician in any age or country.' The term 'fever'then covered all the diseases which were by 1900classified as distinct infectious and epidemicdiseases. Smith's study was a survey of the litera-ture of these diseases, from plague and yellowfever to smallpox and typhus (then still undiffer-entiated from typhoid) and from this survey, madein the light of his own experience, he drew generalprinciples. Major Greenwood [25] pointed outthat Smith and Sutherland were two of ourgreatest practical epidemiologists, although theywere Galenists and believed in the 'miasmatic'transmission of disease. The history of scientificideas is one of progression through a series ofuseful hypotheses which were later abandoned,and what is important is that Smith's principlesled to the right action. He realized that individualobservations were not enough.

'Further inquiries are necessary', he wrote, 'such aswhether the vegetable and animal poisons we havebeen considering be the only true, exciting cause offever; by what means its general diffusion is effected;on what conditions its propagation depends; bywhat measures its extension may be checked and itspower diminished or destroyed; what circumstancesin the modes of life, in the habits of society, in thestructure of houses, in the condition of the publicstreets and common sewers, in the state of the soil ...drainage, and so on, favour or check the origin andpropagation of this great curse of civilized, no lessthan uncivilized, man' [26].

'The work whi Smith republished in London was Livion's Aet'Introductry Uport to the Code of Prison Discipline, pan At thrs tmeSmth held the post of lecturer inof the S3ysa of Penal Law prepared for the State of losin' forensic medicine in the Webb Street School, but

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medical practice, medical writing and medicalteaching, together with his work for penal reform,were not the limit of his activities. With Chadwickand other Benthamites he had helped to found aninstitute for adult education called the LondonLiterary and Scientific Institution and was givingthere a course of lectures on physiology to whichladies were invited - a most unusual concession.There, in April 1830, he took the chair at a largeand successful meeting held to protest at whatwere called the 'taxes on knowledge', the news-paper tax. Smith made the most convincing andpersuasive speech of the evening [3; 1, 83]. A yearlater, we find Chadwick writing an article on thesame subject in the Westminster Review (July1831) and thereafter making the subject peculiarlyhis own. As we have seen, Smith had strong andadvanced views on the role of education in reform.His very first article in the Westminster Reviewwas on the subject of education [27] and he hadhimself educated his two daughters to such goodpurpose that they both left home in their 'teens'to earn their living as teachers. They were bothto become women of great intellectual and moralpower and their early training and their father'sinfluence were to have results affecting his ownfamily life, and eventually, some aspects of lifein England to-day.A life of useful service was Smith's ideal, but

the amount of work, mostly unpaid, which he didfor all his good causes must have laid a strain onhis personal relations. Writing in 1898 his grand-daughter stated that financial stringency at thistime caused Mrs Southwood Smith to go to live onthe Continent with the boy [7, p 35). A lessguarded account was published in New York by afriend in 1849. This tells us that his secondmarriage 'was not fortunate; the dissentients hadhowever the good taste to separate amicably, andpreserve for each other a mutual respect, althoughthe incompatibility of their tempers preventedthem living together in a state of domestic happi-ness' [28]. This reasonable approach to marriageproblems was by no means unique in Smith'scircle and I mention it merely because of theeffects it was to have on his subsequent career andinfluence.A much less private event at this time was one

which followed the death of Jeremy Bentham in1832. By his will he left his body for the purposesof anatomical study and Smith was directed tocarry this out. The skeleton and embalmed headwas afterwards to be clothed in his customarydress and to be brought outet meetings of a kindof Bentham society to be founded by his follow-ers. No -society was founded And the effigyreposed in a glass case in' Siuth's consulting-r9oos ymtii 1§5O0 when he-epresent d it tor.,Jo.-s, ntilC1g -v Th . tiwbeguCpaiv,erslty6ge~~~~4, st.h ciswtola!b

in the Webb Street School while the AnatomyBill was going through Parliament and wasattended not only by medical students but bymany of the leading professors and a distinguishedgathering of Bentham's friends and associates.Pale, but undeterred by a heavy thunderstormwhich accompanied the proceedings, Smith spokewith moving eloquence of Bentham's servicesto humanity. A contemporary report says that'None who were present can ever forget that impressivescene.... In the features was an expression of placiddignity and benevolence ... at time rendered almostvital by the lightning playing over them. -. . With thefeelings which touch the heart in the contemplation ofdeparted greatness ... there mingled a sense of thepower which that lifeless body seemed to be exercisingin the conquest of prejudice for the public good, thusco-operating with the triumphs of the spirit bywhich it had been animated. It was a worthy close ofthe personal career of the great philosopher andphilanthropist' [30].

Reforms in Factories and MinesIt was in this very year that the Reform Billwas passed. Industrial unrest was reaching aclimax and in February 1833 Lord Ashley (laterthe Earl of Shaftesbury) reintroduced Sadler'sfamous Ten-Hours Bill in the House of Commons.This Bill would forbid the employment in fac-tories of children under 9 and restrict the hoursof those under 18 to ten hours a day and eight onSaturdays. Despite the opposition of the factory-owners, who saw it as a disguised attempt to regu-late the hours of adult workers (who could notcarry on without the children), the Bill wasdefeated by only one vote. Realizing that some-thing must be done, Melbourne, then HomeSecretary, appointed a Royal Commission andordered it to report within six weeks. Togetherwith Chadwick and Thomas Tooke, SouthwoodSmith was made a Commissioner, unpaid, ofcourse. On August 29 a Bill was passed whichdeparted in several important respects from therecommendations of the Commission, but didban employment of children under 9 and reduceto eight hours the working day of those under14 and to twelve hours those under 18. It alsomade provision for two hours' daily schooling forchild workers and for the appoilntment of govern-ment inspectors to see that the regulations wereenforced [5, p 65]. This was a most importantinnovation and was to prove most effective.Nevertheless, the Commissioners and the Billwere bitterly attacked by the reform parties. Eventhe Hammonds, writing nearly a century later,said that Smith 'was better employed in dissectingthe body of Bentham than in legislating for thebodies of the workers'childreq7', although, in-consistently, they went di to ;say ;f; vw

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years of the Act its fiercest critics realized itsmerits and workers were urged 'to hold first, asfor life itself, to the eight hour clause, the educa-tion clause, and the inspection clause of thepresent' [cited in 31]. Smith took a great interestin the working of the Act and for several years heused to travel to make a personal inspection of thefactories and their attached schools.

Meantime, the famous, or - as some think -infamous, Poor Law Amendment Act was passedin 1834, Chadwick being the full-time paid secre-tary in its implementation. When, in 1837, therewas an unusually severe epidemic of fever in eastLondon, placing a heavy burden on the rates,Smith was asked by Chadwick to investigate andreport on the situation to the Poor Law Com-missioners. After a personal investigation of everyfact included he presented his 'Report on thePhysical Causes of Sickness and Mortality towhich the Poor are particularly exposed, andwhich are capable of Prevention by SanitaryMeasures'. It was of such a nature that it couldnot be ignored. When published as an appendixto the Poor Law Reports [32] it created a sensa-tion. Even sympathizers, reading of conditionswhich would have disgraced a savage tribe,thought it must be exaggerated. Lord Normanby,who was to be one of the most active Members ofthe Government in the sanitary cause, was takenby Smith to see things for himself and confessedthat, far from being exaggerated, Smith's accountcould hardly do justice to the facts. Ashley wenttwice with Smith to Shoreditch and BethnalGreen, having to break off the first visit as hecould stomach no more. Charles Dickens askedto go and then wrote of what Smith had showedhim in 'Oliver Twist' and 'Bleak House' [33]. In1839 the Bishop of London, in the House ofLords, used Smith's report as the occasion forproposing a sanitary inquiry amongst the labour-ing class in other parts of England and Wales andtwo days later the Poor Law Commissioners wereordered by Lord John Russell to start the investi-gation. Three years later the report appeared, notas an official publication, for its contents wereconsidered to be too controversial, but as EdwinChadwick's celebrated 'Report on the SanitaryConditions of the Labouring Population' (1842).While Chadwick was busy writing up the

reports of all his inspectors, Southwood Smithwas involved in another Royal Commission, thistime to investigate the employment ofwomen andchildren in mines. The Factory Act had passedthem by, and children, boys and girls, from 4 and5 upwards, spent from twelve to sixteen hours aday underground; women of all ages, even whenpregnant, were harnessed like animals to haul coaltrucks through the shafts on all fours; womenworked at the coal-face with men, often in two-

or three-foot seams, and all stripped naked. Smith,recalling the horror and disbelief with which hisearlier report had been received, wondered howhe could bring these facts home to the public. Itwas no accident that he hit upon the idea ofillustrating the scenes he had witnessed, -for hehad for some years been sharing the home of tworemarkable women, the painter Margaret Gilliesand her sister Mary, a writer, the daughters of aScottish judge who was living in Kentish Town.It was Margaret Gillies who went to draw someof the scenes which were reproduced in the report,the first blue-book, I think, to contain illustra-tions. If the country had been shocked by hissanitary report, now it was stunned. Dickens con-fessed that he broke down and sobbed when heread it. Lord Londonderry, who was opening upnew collieries and building a harbour at Seaham,fiercely resented it and was indignant that 'thedisgusting pictorial woodcuts accompanying theReport of the Commissioners should have foundtheir way into the boudoirs of refined and delicateladies who were weak-minded enough to sympa-thize with the victims of industry' [34]. Disgustingor not, they had more effect than all the pages oftext and in 1844 Ashley's Bill succeeded in- bann-ing all female labour in mines as well as theemployment of boys under 10. Probably the onlypeople who resented the Bill, other than LordLondonderry and his fellow mine-owners, werethe miners themselves, who had grown to expectthe wages of their wives and children as asupplement to their own.

Just as he had embarked on this report Smithhad been going through something of a crisis inhis family. In 1832 his daughter Caroline hadbeen engaged to educate the six children of ayoung widower named James Hill, a business manwith wide liberal interests, who had been attractedby Caroline's articles on education. In 1835 theyhad married and by 1840 she had borne him threedaughters, Miranda, Gertrude, and Octavia. Inthat year, Hill went bankrupt. The children of hisfirst marriage were taken by their maternal grand-parents. Southwood Smith, who was alwayspassionately fond of children, adopted Gertrudeand settled the rest of the family in a cottage atLoughton, in Epping Forest, where a fourthdaughter, Emily, was born. After several un-successful attempts to re-establish himself - thelast at Leeds, where a fifth child, Florence, wasborn in 1843 - Hill had a complete breakdownfrom which he never recovered, and SouthwoodSmith undertook responsibility for the wholefamily. In 1844 he and Margaret Gillies set uptheir home in a house which they called 'Hillside'at Highgate, overlooking Lord Mansfield's estateand Ken Wood. All the grandchildren havespokenwith more than filial devotion of 'the daily beauty

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of his life, the serenity and sweetness of his dispo-sition'. Gertrude tells us of his daily routine,getting up at 4 o'clock in the morning to work onhis official reports, going to hospital at 10, andmaking the rounds of his patients, often onhorseback, in the afternoons, addressing meetingsor attending committees in the evenings. He tooka great interest in Margaret Gillies's work, andwas never too busy to obtain commissions forher, making arrangements for her to paint aportrait of Dickens and another of Wordsworth,which took her for a short stay with theWordsworths at Rydal Mount. Smith was also aclose friend of Leigh Hunt and Macready, theactor, and 'Hillside' was never without its inter-esting guests, Browning, William and MaryHowitt, and Hans Andersen among them. Hisown favourite poets in later life were Milton andDante, and he greatly admired Sir ThomasBrowne. Dickens was a personal friend, andamong Smith's surviving letters is an account of'The Christmas Carol', which he read in proof.Dickens was connected with another pioneer

venture of Smith's, a private hospital designed toprovide medical care for members of the middleclasses who were living alone in rooms in London.They paid a small annual subscription and, whenadmitted for treatment, a modest weekly sum.This was called 'The Sanatorium', and wasopened in May 1842 in Devonshire Place House,York Gate, Regent's Park, immediately oppositethe house where Dickens lived. Although itachieved its purpose admirably and securedPrince Albert as its Patron, it was not a financialsuccess and in 1845 Dickens and his friendsplayed in a charity performance of Ben Jonson's'Every Man in his Humour' in an attempt to keepit going [35]. Unfortunately, it had to close, butit was the forerunner of the modern nursing homeand private patients' wing. Smith was neverinterested in money and this episode provoked asneer from Chadwick that he 'was a man ofbenevolence merely who had mismanaged theSanatorium' [36]. Another contemporary, whohas left the best personal description of Smith,thought differently. For him Smith was 'a man tobe respected and loved.... Eminently practical inhis views, he is not content with pointing out theway, he helps the traveller on his errand; he islarge-handed as well as large hearted, and theperusal of his writings brings us to the conclusionthat he is large headed too'. This writer attributesthe failure of The Sanatorium to 'that apathywith which the middle classes always regard theefforts made for their good by others'. He goes onto tell us that'Dr Smith ... deliberately sacrificed a large privatepractice that he may work for the million instead ofthe few. In social life he is benevolent, gentle and con-

sistent. Beloved by his friends, he enjoys, with peculiarrelish, the quiet of rural delights; the most pleasantand intellectual delights we have enjoyed have beenwith him, wandering after the labours of the day in thefields and woods about Highgate. His conversation issingularly clear, and although slow and somewhathesitating. in his speech, the words might be takendown as uttered and sent to the printers without acorrection. He reads with peculiar force and dis-crimination. One of his efforts we particularly remem-ber; it was the greater part of "Comus", one fine Mayday, in the woods near Loughton - the only accom-paniment to the poetry of Milton being the singing ofbirds and the rustling of trees.

'In person he is short, and somewhat thickly made;but his head is very fine, and has a striking resem-blance to Napoleon's. His eyes are grey and deeply-set, his brow massive and lofty. He is passionatelyfond of music and poetry. He occasionally preaches inFinsbury Chapel. He is approaching his sixtieth yearand from his temperate habits and strong constitutionseems likely to have a long life to benefit mankind byhis labours' [28].

Sanitary ReformWe are now approaching the climax of thoselabours. Like the Medical Reform Bills, theSanitary Bills were only with difficulty fitted intothe jig-saw of contemporary politics. One of thegreatest difficulties was that Chadwick's name onthe 1842 report had identified him prominentlywith sanitary reform and Chadwick was, as TheTimes said, 'the best-hated man in England', whileDisraeli called him 'a monster in human shape'.Politicians were reluctant to act unless publicopinion could be changed and Normanby sug-gested to Smith that he might organize what weshould call now 'a propaganda campaign'. Theresult was The Health of Towns Association,which lasted from 1844 until 1849. It was, as anAmerican historian of public health has pointedout [37], the first voluntary agency for healtheducation on a national scale. Branches were setup all over the country, many ofthem by Unitarianministers who were friends of Smith's. By publicmeetings, by the distribution of nearly 100,000pamphlets, and at Liverpool by a special journalcalled The Health of Towns Advocate, edited bySutherland, the whole atmosphere was rapidlychanged. Chadwick had tried to appeal to the self-interest of the men in power. Smith realized thatno satisfactory legislation could ever be passed orgenerally accepted unless the mass of the peoplecould be aroused either to demand or accept it. Inthis cause he was the golden-tongued evangelistand on January 1, 1847, there was published forone penny his burning 'Address to the WorkingClasses' which matches Marx's, more celebrated,Manifesto published later in the same year. Inthat year too, Smith was elected a Fellow of theRoyal College of Physicians.

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I do not propose to go into the history of thefirst Public Health Act of 1848 and the firstGeneral Board of Health for this has been wellwritten by others. Three Commissioners wereoriginally appointed, none of them a medicalman, and only one of them, Chadwick, was toreceive a salary. Chadwick's low estimation ofmedical men and his contempt for many of thequalities embodied in SouthwoodSmith have beenindicted as the probable cause, but I suspect thatif we accepted this view we should be doingChadwick an injustice. The abortive Bill of 1847had also allowed for only one paid Commissioneron the Central Board and on that occasionChadwick had written to Joseph Hume that 'Itwould have been worth several salaries to havesecured the services of Southwood Smith, withhis literary skill, his special knowledge of themedical aspects of the subject, and his popularitywith the Press and the medical profession' [38].The deliberate passing over of Smith in appoint-

ing the Commissioners under the 1848 Act wasregarded as scandalous. The Lancet had a seriesof indignant editorials about the Government'sattitude towards medical men in a matter whichaffected them so closely. Smith was invited to ameeting of the Board in late August, and a fewdays later Lord Morpeth wrote to Smith invitinghim to join the Board as an unpaid Commissioner.Smith's letter of acceptance, dated September 12,1848, in which he described what he had alreadydone to prepare for the threatened choleraepidemic, concluded: 'My intimate relation withthe origin and progress of this work, and my deepconviction that it is one of the most useful towhich experience and science can be applied,would render it a satisfaction to me to spend theremainder of my life in assisting to complete it'[7, p 130]. The notice of his appointment appearedin The London Gazette on October 5, 1848, and hewas immediately plunged into the task of imple-menting the Act and at the same time fightingagainst a serious epidemic of cholera. Two yearslater he was made a salaried Commissioner andhe abandoned the remains of his practice.The brief but stormy history of the Board has

been told many times. The fury aroused by manyof Chadwick's proposals gave added strength tothe opposition and, in 1854, it became clear thathe would have to go. There were many, evenamong the opposition, who would have liked toretain the services of Southwood Smith, especiallyas another outbreak of cholera was threatening,but it was decided that, politically, the only thingto do was to make a clean sweep, and Ashley andSmith were sacrificed. Chadwick was to receive apension of £1,000 a year, which he was to enjoyuntil his death in 1890. Smith, now 66, gotnothing, the official explanation being that 'as so

much of his service had been unpaid he was noteligible for a pension'. This was a type of injusticewhich affected Chadwick keenly and he wrote to afriend that the blow had fallen heaviest on theunoffending and uncomplaining SouthwoodSmith, who 'without fault proved and indeed afterextraordinary and successful labour is dismisseda ruined man without any compensation what-ever' [39].When the new President of the Board took over

he was astonished to find how much there was tobe done, and how much his derided predecessorshad done; no three men, he observed, couldpossibly have worked harder. Smith's health wasaffected by his labours and he looked older thanhis years. He had just published a pamphlet,entitled 'The Results of Sanitary Improvement',which described the progress of another of hispioneer schemes, The Metropolitan Society forImproving the Dwellings of the Industrious Poor,which he founded in 1842. This product ofSmith's benevolence was also distrusted byChadwick who declared that a housing schemewhich brought in its promoters less than 7%could not possibly succeed. Chartered as a publiccharity by Sir Robert Peel, this had in factsucceeded, not only in providing some of theworst districts of London with decent housing atmodest rents, but in cutting the death rate in thenew dwellings to less than a quarter of the figurefor London as a whole, and not a single case ofcholera had been reported there.

In the summer of 1854 Smith was having a newhouse built for himself and his family at Wey-bridge which, when they moved into it in Septem-ber, they called 'The Pines'. He delighted in theview, in the woods and the countryside, and inhis companions, and he wrote:

'This made me feel how little is what I have lost incomparison with what I retain and what the externalworld cannot take from me. I require a full sense ofthis to sustain me now that the reality is come thateverything else is taken from me; for I never did orcould believe that no compensation whatever wouldbe given me for all I have done. So it is, however, andwe must all bear it as well as we can and find compen-sation in and from each other, where I know there willbe no disappointment' [40].

Although his official work was at an end he stillcontinued workingfor his cause and in the remain-ing few years of his life he travelled a good deal toplaces like Manchester, Liverpool, Bradford andEdinburgh, advising local authorities and address-ing meetings. In 1856 he visited Florence, wherehis second daughter, Emily, had established her-self as a teacher among the English colony ofwriters and artists there. She had become apassionate supporter of Italian Union and was a

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personal friend of Mazzini. Caroline was living atWeybridge, where, in 1857, she nursed herdaughter, Octavia Hill, through a severe illness.Octavia (still only 18) and a sister had beenrunning the Ladies' Sanitary Guild in FitzroySquare for a mere pittance until it closed down in1856 and the girls were again dependent upontheir grandfather. Looking back on these yearslater she wrote that 'We were so poor at that time,so very poor that I cannot bear to speak of it'[41, p 49]. In 1856 a public subscription was beingraised for Southwood Smith, organized by DrWaller Lewis and Mr R D Grainger. Chadwick'sname was kept off the Committee 'lest it shouldruin the whole proceedings' and a good sum wascollected. Shortly afterwards we find Smith givingmoney to Octavia and her sisters to set up a homefor themselves in London. There she was to carryon her grandfather's work with metropolitanhousing and other sanitary causes. In 1858, whenhe was 70, the Government at last acknowledgedits gratitude by awarding him a pension of £300a year. His health was not good, and after aserious illness in the autumn of 1861 he againvisited his daughter in Florence to recuperate. Inearly December he fell ill with bronchitis anddied on December 10, 1861. He was buried in theProtestant Cemetery in Florence, where his gravelies only about a hundred yards from that ofElizabeth Barrett Browning. An obelisk, with hisportrait in bas-relief, marks the spot where he isburied, and rising from the foot is a pine-tree.The memorial was designed by Margaret Gillies;the tree was planted as a reminder of Weybridge.

It is far from being his only memorial. Hiswork was carried on by his granddaughterOctavia, who bore a strong resemblance to him.She too worked with Shaftesbury and did greatpioneer work in London's slums. Caroline,who died in 1901 at the age of 92 and saw thefruits of her daughter's work, wrote, 'Dear child,the mantle has fallen upon her!' [41, p 115].Octavia also inherited Smith's love of nature andthe countryside. When only 16 she had takenparties of slum children to play in the fields at'Hillside' and she wrote to her sister, 'I hope thatI may never, as long as I live, forget the sunny,bright, happy hours I have passed there. Thereremains in my mind a recollection, a vision ofbeauty connected with it which can never beeffaced' [42]. From this 'vision of beauty' sprangthe great idea which she realized in the founda-tion ofThe National Trust. There isno SouthwoodSmith Trust - as there is a Chadwick Trust - forhe died almost as poor as he began, but his lifeand the spirit whichinspired it have their memorialin this and many other of the practical achieve-ments of what Chadwick had once called 'merelybenevolence'.

Acknowledgments: I am indebted to Mrs Ethel CMoore and Mrs E Southwood Ouvry for informa-tion and access to Southwood Smith's letters andpapers. I am grateful also to Dr Arthur Dakin,Principal of the Bristol Baptist College until hisretirement in 1953, for his courtesy in showing methe College Library and the Minutes of the BristolEducation Society recording the awards of theBroadmead Benefaction to Southwood Smith.

REFERENCES1 WallasG(1924)WilliamJohnsonFox, 1786-1864. London; p202 Simon J

(1897) English Sanitary Institutions. 2nd ed. London; p 2343 Richardson BW (1887) The Health of Nations: a Review of the

Works of Edwin Chadwick, with a Biographical Dissertation.London

4 MorrisM (1919) The Story of English Public Health. London5 Finer S

(1952) The Life and Times of Sir Edwin Chadwick. London6 Chadwick Trust (1929) The Chadwick Trust: A Short Account

of its Founder, its Objects, and its Work. London; p 77 Lewes Mrs C L (G) (1898) Dr Southwood Smith. A Retrospect.

Edinburgh & London8 PhillimoreW PW & RossDM

(1901) Somerset Parish Registers. London; 3, 879 Smith T S (1816) Illustrations ofthe Divine Government.

Glasgow, London & Edinburgh10 Smith T S (1821) 'Memoir of the Late Rev. William Blake, of

Crewkerne (d. Feb. 18, 1821)' Monthly Repository, 16, 26211 Bristol Education Society. Minutes. (MS)12 Smith T S (1822) Illustrations of the Divine Government.

3rd ed. Glasgow, London & Edinburgh13 Register of St Andrew's Parish Church, Clifton. p 134, no. 516

(MS)14 Monthly Repository (1815) 10, 118, 65315 Christian Reformer (1860) n.s. 16, 72016 Westminster Review (1824)1, 471-9217 MunkW (I87% Roll of the Royal College of Physicians of

London. 2nd ed. London; 3, 23518 Bentham J (1843) Works. Ed. J. Bowring. Edinburgh19 Wallas G (1940) Men and Ideas. London; pp 28-920 Westminster Review (1824) 2, 59-9721 The Times (1831) December 3, p 3, col. e22 Westminster Review (1825) 3, 134-16723 Westminster Review (1828) 9, 384-42124 Poynter FN L (1957) 'The reception ofWilliam Beaumont's

discovery in England' J. Hist. Med. 12, 511-225 British Medical Journal (1949) ii, 79726 Smith T S (1830) Treatise on Fever. London; p 36827 Westminster Review (1824)1, 43-7928 PowellT

(1849) Living Authors ofEngland. New York; pp 95-10529 Marmoy C F A (1958) 'The "Auto-icon" ofJeremy Bentham at

University College London' Med. Hist. 2, 77-8630 Fox W J (1832) Monthly Repository 33, 450-458, 705-71331 HoltRV (1952) The Unitarian Contribution to Social Progress.

London; pp 192-332 Supplement to the Fourth Report of the Poor Law Commis-

sion, 1838. Appendix to the Fifth Report, 183933 House H (1941) The Dickens World. London; p 191. (The

descriptions of Folly Ditch, in 'Oliver Twist', and Tom AllAlone, in 'Bleak House', are almost transcripts from Smith'sreport)

34 Vane CW (Marquess of Londonderry) (1842) A Letter to LordAshley on the Mines and Collieries Bill. London. (See alsothe anonymous reply to it by Dickens in The MorningChronickle, October 20, 1842)

35 Notice in The Times (1845) November 17. (The performancetook place in the St James's Theatre on Saturday,November 15)

36 Letter from Chadwick to Lord Lansdowne, July 31, 184437 Paterson R G (1948) 'The Health ofTowns Association' Bull.

Hist. Med. 22, 373-40238 Letter from Chadwick to Joseph Hume, July 5, 184739 Letter from Chadwick to an unknown correspondent,

August 7, 185440 Letter to Margaret Gillies, August 7, 185441 Bell EM (1942) Octavia Hill. London42 Letter from Octavia Hill to Gertrude Hill, June 11, 1854