Thomas Southwood Smith, the son of William Smith and Catherine Southwood, was born at Martock, Somerset, on 21st December 1788. In 1803 he entered the Baptist academy at Bristol, headed by Dr John Ryland, with the intention of becoming a minister. Smith eventually rebelled against his inherited Calvinism and left the academy in 1808. His parents cut him off, and he never saw them again. (1)
On 25th May 1808 he married Anne Read, the daughter of a Bristol manufacturer. Two daughters were born, Caroline and Emily, before Anne's death in 1812. He moved to Edinburgh to train as a doctor. While in the city he took charge of the city's Unitarian congregation, and succeeded in increasing weekly attendance from 20 to 200. (2)
On 28th July 1813 he played a prominent part in the formation of the Scottish Unitarian Association in Glasgow. A fellow member, James Yates (1789–1871), commented that Smith was "a sensible and intelligent man, though not furnished with the advantages of education". (3)
After attaining his MD from Edinburgh University in 1816 Smith settled in Yeovil, as physician and minister to the Unitarian congregation. In 1820 he married Mary Christie and they moved to London. A member of the Royal College of Physicians, he practised privately and served as physician to the Jews' Hospital, and to the London Fever Hospital. By 1821 he had joined the circle of intimates around Jeremy Bentham. This included James Mill, John Stuart Mill, Edwin Chadwick, Francis Place, and Neil Arnott. (4)
In 1827 he published a pamphlet entitled The Use of the Dead to the Living, in which he defended his belief that the dissection of corpses was an important means of improving medical knowledge and ascertaining causes of death. At the time there was a great deal of prejudice against dissection and medical schools had difficulty in obtaining dead bodies. (5)
A thriving black market arose in corpses, that led to the creation of the profession of body snatching. In April 1828, Sir Astley Cooper, a leading surgeon estimated that there were 700 medical students at the London anatomical schools and that each of them required two bodies for dissection and a third on which to practise surgical procedures. Cooper complained that doctors had to deal with the "lowest dregs of degradation" in order to obtain these corpses. (5a)
In 1828 William Burke and William Hare, killed 16 people who sold the corpses to Doctor Robert Knox for dissection at his anatomy lectures. The resulting public outcry led to the passage of the Anatomy Act 1832, which increased the legal supply of corpses for dissection. (6)
Smith took a keen interest in epidemics and in 1830 he wrote Treatise on Fever. It had previously been believed that diseases such as cholera and yellow fever were contagious, however, Smith demonstrated that insanitary conditions were the main factors leading to the spread of these diseases, and that they were therefore avoidable. "The immediate or the exciting cause of fever is a poison formed by the corruption or the decomposition of organic matter. Vegetable and animal matter, during the process of putrefaction, give off a principle, or give origin to a new compound, which, when applied to the human body, produces the phenomena constituting fever." (7)
Jeremy Bentham died in 1832 and in his will he stated that he wished his body to be used for medical research by Thomas Southwood Smith. He decided to dissect it in public, accompanied by a lecture on anatomy. "While the lecture was taking place, a loud thunderstorm broke out, which even Smith found disconcerting. His audience reported that he continued to lecture and dissect, but with a face almost as ashen as that of Bentham's corpse!" (8)
In 1833 Thomas Southwood Smith was appointed, with Edwin Chadwick and Thomas Tooke to the royal commission on the employment of children. Harriet Martineau welcomed Smith's involvement in government and told her good friend, Henry Brougham, that he was superb at creating and moulding public and political opinion. (9)
In 1836 Thomas Southwood Smith advocated "a unified profession as against the English separation into oligarchically run corporations of physicians, surgeons, and apothecaries, and denounced the social presumption underlying much English practice." (10) He argued in the Westminster Review that "disease is not aristocratic and plebeian, not to be cured in the gorgeous apartments of the noble and the rich by a refined, elaborate, and recondite skill inapplicable to the chambers of the ignoble and the poor". (11)
In 1837, Parliament passed a Registration Act ordering the registration of all births, marriages and deaths that took place in Britain. Parliament also appointed William Farr to collect and publish these statistics. In his first report for the General Register Office, Farr argued that the evidence indicated that unhealthy living conditions were killing thousands of people every year. (12)
Water consumption in towns per head of population remained very low. In most towns the local river, streams or springs, provided people with water to drink. These sources were often contaminated by human waste. The bacteria of certain very lethal infectious diseases, for example, typhoid and cholera, are transmitted through water, it was not only unpleasant to taste but damaging to people's health. As Alexis de Tocqueville pointed out: "The fetid, muddy waters, stained with a thousand colours by the factories they pass, of one of the streams... wander slowly round this refuge of poverty." (13)
Thomas Southwood Smith associated with a group of Unitariansn in London. This included John Stuart Mill, Harriet Taylor, James Leigh Hunt, William Macready, Margaret Gillies, Mary Gillies, William Johnson Fox, Richard Henry Horne, Robert Browning and Eliza Flower. In 1838, Smith left his wife and set up home with Margaret Gillies. He was joined by Richard Henry Horne and Mary Gillies. This upset most of his Unitarian friends, although Harriet Martineau told her brother, James Martineau, that Smith was "the most wrongfully injured of men". (14)
In 1838 the Poor Law Commission became concerned that a high proportion of all poverty had its origins in disease and premature death. Men were unable to work as a result of long-term health problems. A significant proportion of these men died and the Poor Law Guardians were faced with the expense of maintaining the widow and the orphans. The Commission decided to ask three experienced doctors, Thomas Southwood Smith, James P. Kay-Shuttleworth, and Neil Arnott, to investigate and report on the sanitary condition of some districts in London. (15)
Thomas Southwood Smith, carried out a study of Bethnal Green in London and argued that there was a link between sanitation and disease: " Into this part of the ditch the privies of all the houses of a street called North Street open; these privies are completely uncovered, and the soil from them is allowed to accumulate in the open ditch. Nothing can be conceived more disgusting than the appearance of this ditch for an extent of from 300 to 400 feet, and the odour of the effluvia from it is at this moment most offensive. Lamb's Fields is the fruitful source of fever to the houses which immediately surround it, and to the small streets which branch off from it. Particular houses were pointed out to me from which entire families have been swept away, and from several of the streets fever is never absent." (16)
On receiving details of the doctor's investigation, the Poor Law Commission sent a letter to the Home Secretary, Lord John Russell, suggesting that if the government spent money on improving sanitation it would reduce the cost of looking after the poor: "In general, all epidemics and all infectious diseases are attended with charges immediate and ultimate on the poor-rates. Labourers are suddenly thrown by infectious disease into a state of destitution for which immediate relief must be given: in the case of death the widow and the children are thrown as paupers on the parish. The amount of burdens thus produced is frequently so great, as to render it good economy on the part of the administrators of the poor laws to incur the charges for preventing the evils, where they are ascribable to physical causes, which there are no other means of removing." (17)
Thomas Southwood Smith continued in public service and served on the royal commission on the employment of children, and was involved in the first government report on the mining industry. He suggested that the report employed an artist to produce woodcuts to show what it was like for children to work underground. It was later claimed that it was these illustrations that deeply impressed public opinion. During this period he also gave support to the Chartist movement. (18)
After the 1847 General Election, Lord John Russell became leader of a new Liberal government. The government proposed a Public Health Bill that was based on some of Edwin Chadwick's recommendations. There were still a large number of MPs who were strong supporters of what was known as laissez-faire. This was a belief that government should not interfere in the free market. They argued that it was up to individuals to decide on what goods or services they wanted to buy. These included spending on such things as sewage removal and water supplies. George Hudson, the Conservative Party MP, stated in the House of Commons: "The people want to be left to manage their own affairs; they do not want Parliament... interfering in everybody's business." (19)
Supporters of Edwin Chadwick argued that many people were not well-informed enough to make good decisions on these matters. Other MPs pointed out that many people could not afford the cost of these services and therefore needed the help of the government. The Health of Towns Association, an organisation formed by Thomas Southwood Smith, began a propaganda campaign in favour of reform and encouraged people to sign a petition in favour of the Public Health Bill. In June 1847, the association sent Parliament a petition that contained over 32,000 signatures. However, this was not enough to persuade Parliament, and in July the bill was defeated. (20)
A few weeks later news reached Britain of an outbreak of cholera in Egypt. The disease gradually spread west, and by early 1848 it had arrived in Europe. The previous outbreak of cholera in Britain in 1831, had resulted in the deaths of over 16,000 people. In his report, published in 1842, Chadwick had pointed out that nearly all these deaths had occurred in those areas with impure water supplies and inefficient sewage removal systems. Faced with the possibility of a cholera epidemic, the government decided to try again. This new bill involved the setting up of a Board of Health Act, that had the power to advise and assist towns which wanted to improve public sanitation. (21)
In an attempt to persuade the supporters of laissez-faire to agree to a Public Health Act, the government made several changes to the bill introduced in 1847. For example, local boards of health could only be established when more than one-tenth of the ratepayers agreed to it or if the death-rate was higher than 23 per 1000. Chadwick was disappointed by the changes that had taken place, but he agreed to become one of the three members of the central Board of Health when the act was passed in the summer of 1848. (22)
The new central Board of Health was to have three members, Edwin Chadwick, George Howard, Lord Morpeth and Anthony Ashley Cooper. Some people thought it was a good choice as "there would be no lack of enthusiasm, knowledge and energy at the core." However, The Lancet, the leading medical journal in the country described them "a benighted triumvirate" who should be ostracised and "left to the vacillations of their acknowledged ignorance". (23)
Thomas Southwood Smith was later appointed to remedy the initial lack of a medical member. The Public Health Act was passed too late to stop the outbreak of cholera that arrived in Britain that September. The board took emergency action to ensure the regular cleansing of streets and waste removal. In the next few months, cholera killed 80,000 people. Once again, it was mainly the people living in the industrial slums who caught the disease. As Henry Mayhew pointed out: "The history of the late epidemic, which now seems to have almost spent its fatal fury upon us, has taught us that the masses of filth and corruption round the metropolis are, as it were, the nauseous nests of plague and pestilence." (24)
As Peter Mandler has pointed out Edwin Chadwick tended to upset the government with his proposals: "Chadwick pressed upon them, and upon the new unitary commission for London, the replacement of the traditional brick sewers by his favoured comprehensive system of self-flushing, narrow diameter, glazed earthenware pipes, preferably conveying the sewage to farmers for use as manure. This dogma antagonized many engineers, as his earlier administrative dogmas had antagonized doctors. In autumn 1849, after a brief collapse brought on by overwork and possibly over-combativeness, Morpeth had to remove him from the metropolitan sewers commission." (25)
Michael Flinn has argued that there were a variety of different reasons why Chadwick had difficulty getting the full support from the government: "Personal dislike of a man in whose make-up arrogance and self-righteousness had a slighty disproportionate share can only partly explain it; the machinations of interested parties - representatives of the old, closed vestries, shareholders of private water companies, or slum landlords - may explain another part of it: probably resentment at the intrusion of meddling reformers in the business of the traditional governing classes led to some of the most destructive opposition." (26)
In 1854 the Earl of Aberdeen appointed Lord Palmerston as his new Home Secretary. Palmerston was a supporter of public health reform. However, he came to the conclusion that Chadwick was so unpopular it would be impossible to persuade the House of Commons to renew the powers of the Board of Health while he remained in charge of the organisation. In order to preserve the reforms that he had achieved, Chadwick agreed to resign and was granted a £1000 per annum pension. (27)
Smith also lost his position that had given him a salary of £1,200. His application for other government positions was refused, and he was denied a pension on the ground that he had had only four years of paid employment. A public subscription was raised in 1856, and two years later he was belatedly given a pension of £300. (28)
Thomas Southwood Smith died in Florence on 10th December 1861.
Lamb's Fields: An open area, of about 700 feet in length, and 300 feet in breadth; of this space about 300 feet are constantly covered by stagnant water, winter and summer. In the part thus submerged there is always a quantity of putrefying animal and vegetable matter, the odour of which at the present moment is most offensive. An open filthy ditch encircles this place, which at the western extremity is from 8 to 10 feet wide. Into this part of the ditch the privies of all the houses of a street called North Street open; these privies are completely uncovered, and the soil from them is allowed to accumulate in the open ditch. Nothing can be conceived more disgusting than the appearance of this ditch for an extent of from 300 to 400 feet, and the odour of the effluvia from it is at this moment most offensive.
Lamb's Fields is the fruitful source of fever to the houses which immediately surround it, and to the small streets which branch off from it. Particular houses were pointed out to me from which entire families have been swept away, and from several of the streets fever is never absent.
In several houses in Collingwood-street fever of the most severe and fatal character has been raging for several months. Part of the street called Duke Street is often completely under water. This street consists of about 40 houses. In 12 of them all the members of the families residing in them have been attacked with fever, one after another, and many have died.
Hare Street Fields. An open space, close to the former, containing about 300 feet square, a large portion of which in rainy weather is completely inundated. It is surrounded on all sides but one with small houses, and several streets branch off from it. In all the houses forming the square, and in the neighbouring streets, fever is constantly breaking out, and the character of the fever in this neighbourhood has lately been very malignant.
Mape's Street. Running along the front of Mape's Street, and the back of Southampton buildings, is a large open sewer, one branch of which also passes for a considerable extent along the backs of the houses in Teal Street. The privies of the houses, placed close to the street, pour their contents into this open sewer. Part of Mape's Street consists of houses of a good description, with gardens neatly cultivated; but all of them terminate at the margin of this open and filthy sewer.
Alfred and Beckwith-rows consist of a number of buildings, each of which is divided into two houses, one back and the other front: each house is divided into two tenements, and each tenement is occupied by a different family. These habitations are surrounded by a broad open drain, in a filthy condition. Heaps of filth are accumulated in the spaces meant for gardens in front of the houses. The houses have common privies open, and in the most offensive condition. I entered several of the tenements. In one of them, on the ground floor, I found six persons occupying a very small room, two in bed, ill with fever. In the room above this were two more persons in one bed, ill with fever. In this same room a woman was carrying on the process of silk-winding.
Amongst the charges which have been unavoidably disallowed are many which increasing experience proves it necessary to submit for the sanction of the Legislature for their allowance... those charges caused by nuisances by which contagion is occasionally generated and persons reduced to destitution....
In general, all epidemics and all infectious diseases are attended with charges immediate and ultimate on the poor-rates. Labourers are suddenly thrown by infectious disease into a state of destitution for which immediate relief must be given: in the case of death the widow and the children are thrown as paupers on the parish. The amount of burthens thus produced is frequently so great, as to render it good economy on the part of the administrators of the poor laws to incur the charges for preventing the evils, where they are ascribable to physical causes, which there are no other means of removing.
(2) George Chryssides, The Elements of Unitarianism (1998) page 86
(3) James Yates, letter to Richard Astley (4th January 1813)
(5a) Sir Astley Cooper, interviewed by a parliamentary committee (April, 1828)
(6) Philip Cheung, Public Trust in Medical Research? (2007) pages 33-35
(7) Thomas Southwood Smith, Treatise on Fever (1830)
(8) George Chryssides, The Elements of Unitarianism (1998) page 87
(9) Harriet Martineau, letter to Henry Brougham (April, 1833)
(10) R. K. Webb, Thomas Southwood Smith : Oxford Dictionary of National Biography (2004-2014)
(11) Thomas Southwood Smith, Westminster Review (1836)
(12) John M. Eyler, William Farr : Oxford Dictionary of National Biography (2004-2014)
(13) Alexis de Tocqueville, Journeys to England and Ireland (1835) page 104
(14) Harriet Martineau, letter to James Martineau (30th January, 1834)
(15) Michael Flinn, Public Health Reform in Britain (1968) page 27
(16) Thomas Southwood Smith, Account of a Personal Inspection of Bethnal Green and Whitechapel (May, 1838)
(17) Poor Law Commission, letter to Lord John Russell, the Home Secretary (14th May, 1838)
(18) R. K. Webb, Thomas Southwood Smith : Oxford Dictionary of National Biography (2004-2014)
(19) George Hudson, speech in the House of Commons (3rd July 1847)
(20) Michael Flinn, Public Health Reform in Britain (1968) page 31
(21) Roy Porter, The Greatest Benefit to Mankind (1997) page 411
(22) Michael Flinn, Public Health Reform in Britain (1968) page 32
(23) Sandra Hempel, The Medical Detective (2006) page 112
(24) Henry Mayhew, Morning Chronicle (24th September 1849)
(25) Peter Mandler, Edwin Chadwick : Oxford Dictionary of National Biography (2004-2014)
(26) Michael Flinn, Public Health Reform in Britain (1968) page 32
(27) Peter Mandler, Edwin Chadwick : Oxford Dictionary of National Biography (2004-2014)
(28) R. K. Webb, Thomas Southwood Smith : Oxford Dictionary of National Biography (2004-2014)