classes, living in certain localities, never obtains to the same
extent with diseases arising from a specific contagion, it is more
than probable that the causes engaged in the generation of the plague
are not constant, but variable and accidental; its initial cause, the
peculiar atmospheric constitution, having no power to develop the
disease, unassisted by season and local conditions.
“5. The transmissibility of plague from person to person out of the
noxious atmosphere in which it originated—the only certain test of
such a power—has not been proved by the four instances, during
thirty-eight years, in which it is alleged to have been communicated
to persons employed by the Quarantine Department of Malta, carbuncular
affections being endemic among the population of this island.
“6. Quarantine restrictions enforced by the penalties of _corporal
punishment_ and _death_, and seconded by the greatest dread of contact
with suspected persons or things, among the panic-struck populations
of Malta and Gozo, utterly failed to arrest the progress of plague; on
the contrary, where these restrictions were carried to their utmost
limits by an absolute power, there the disease persisted longest, and
the mortality was greatest.”
“All these circumstances,” says the French Dr Chervin, speaking of the
restrictions and cruelties of quarantine, “are calculated to fill with
horror the breast of every feeling and honest man; and we are really
obliged to offer violence to ourselves in not giving vent to our
indignation against the partisans of contagion, who yet desire to
continue to defend their erroneous opinions, and who, to this day,
have used all their efforts to make obscure and disfigure the subject,
to the great detriment of truth;—who have never ceased to deceive
governments, which think it their duty, with regard to this disease
[Yellow Fever], to surrender themselves to the judgment and knowledge
of medical men,—who have never ceased to describe it as contagious,
and have induced those authorities to adopt, with respect to it, the
most false and contrary measures, and to neglect the suitable,
prophylactic, and _preservative_ means, and others which might have
put an end to the disastrous epidemics of this disease;—thus it is
they have always acted contrary to truth, to the interest of
governments and of humanity.”
“I am of opinion,” says Dr Reece, of New York, “that the oppressive
features of our quarantine system should be reckoned among the relics
of barbarism which an enlightened Legislature should make haste to
abrogate for the sake of our character as a people. There is no
pretext for the perpetuation of a system founded in ignorance, and
fruitful only in public and private injustice, cruelty, and wrong.”
“Cholera,” says Professor Caldwell, of America, “though a fatal
scourge to the world, will, through the wise beneficent dispensation
under which we live, be productive of consequences favourable alike to
science and humanity. Besides being instrumental in throwing much
light on the practice of physic, it will prove highly influential in
extinguishing the belief in pestilential contagion, and bringing into
disrepute the quarantine establishments that have hitherto existed.”
If the great practical truth, taught by modern investigation and
experience, be, that the only real security against any kind and degree
of epidemic disease is an abundant and constant supply of pure air, the
prevention of overcrowding, and the dispersion of the sick; and if, as
is generally agreed, confinement in a foul atmosphere can convert common
fever into pestilence, and ventilation and dispersion can dissipate any
contagion, then quarantine must be not only useless but pernicious,
since the invariable effect of quarantine as hitherto practised in all
countries has been the congregation and confinement of the sick, and of
those who, though not actually sick, are suspected to have in them the
seeds of disease, requiring only a few days or hours for their
development,—the congregation and confinement of such persons in a
limited space, often in a filthy ship and an unhealthy locality, and
always under circumstances calculated to excite apprehension and
alarm—conditions in the highest degree favourable to the generation and
spread of disease: it follows that quarantine, instead of guarding
against and preventing disease, fosters and concentrates it, and places
it under conditions the most favourable that can be devised for its
general extension; and therefore must not only fail to accomplish its
object, but tend to produce the very calamity which it endeavours to
prevent.
* * * * *
The principal ground on which objection is made to the continuance of
quarantine is that the fundamental principle on which it is based is
fallacious, and that the only means of preventing the origin and spread
of epidemic disease is the adoption of sanitary measures. Substitution
of sanitary measures for quarantine restrictions would render the
importation of any disease from one country into another in the highest
degree improbable.
There has been and continues to be a popular impression of the
importation or the contagiousness of disease, created by the frequent
occurrence of epidemic diseases amongst itinerant classes of the
population. Seeing the occurrence of such diseases amongst those who
travel, it is an easy and apparently a natural inference that the
diseases are carried by them. Thus, the low tramps’ lodging-houses in
our towns were in the Sanitary Report shown to be throughout the country
the worst of fever-nests in each place; but they were also shown at the
same time to be the places where there was the most overcrowding and the
greatest filth. With a stationary population, with the same overcrowding
and filth, it may be confidently pronounced that the disease would be
worse. When by bad weather the tramps are detained and kept stationary,
it is worse. The tramping about from town to town and in the open
air—the movement which to superficial observation imports the disease—in
reality mitigates it. From what we have already said, it is consistent
with this general statement that tramps infected with fever in one place
may carry it with them and spread infection in another place amongst
classes of persons predisposed by the like habits and conditions, as was
exemplified in the spreading of the Pali plague. Of late times the poor
Irish emigrants are said to have imported fever into this country; they
are represented, for example, to have imported fever into Liverpool; but
the description of the places where the fever burst out, and the
overcrowding in them, displayed fever-nests sufficient to have produced
fatal results on the most robust of the stationary populations. “In one
small cellar with no window,” a gentleman, who ministered to the wants
of the poor people who had crept for shelter into damp uninhabited
houses, and who, it was stated, fell a victim to the contagious nature
of the fever, found “eighteen persons in fever, lying on wet dirty
straw. In one house he counted eighty-one, in another sixty-one, in
every stage of fever, on straw in the corners.” It would be surprising
if the poor Irish had not imported fever into the lower districts of
towns, when, as in Glasgow, they have added 10,000 annually to the
already overcrowded and wretched population of that city; just as the
miserable refugees from the infected villages of Ragpootana carried the
pestilence into the close, filthy, and already overcrowded huts of the
neighbouring villages. But the conditions in which the Irish emigrants
have arrived, and have been crowded together in the towns as well as on
shipboard, are just the conditions in which fevers arise amidst
stationary populations; and, we may confidently state, would have been
worse had the particular class of migrants been stationary.
The like delusion as to the _importation_ of disease is created by the
appearance of fever amongst the migrants at sea. It is important that
the universal effects of overcrowding, filth, and atmospheric impurity
should be known and discriminated in all cases. It will be seen that
they produce their effects at sea as well as elsewhere. It appears to be
most important also to display the facts as to the common existence of
the conditions of fever in ships themselves as at present regulated; and
that, if properly regulated, instead of being fever-nests or “the means
of importation” of the disease, a voyage in the open sea would become a
sure means of arresting any such disease. Epidemic disease is often more
severe in ships when stationary in port than when sailing, and with them
the passage in fair weather when overcrowding is avoided is a means of
mitigation.
The sanitary regulation of the ships themselves—a measure of the utmost
importance to the seafaring classes of the community—would accomplish
far more than could be hoped for or pretended to be accomplished by any
known system of quarantine, and would have, moreover, a beneficial
effect upon popular opinion by removing the fallacious appearances which
favour the belief in imported disease, while they divert attention from
the true causes of disease, the removable and preventible causes that
exist on the spot.
The basis of sanitary legislation is the evidence that has been
accumulated in relation to the whole of the epidemic, endemic, and
contagious diseases, and the latest opinions of medical authorities with
reference to them. It having been shown by indubitable evidence that the
prevalence and mortality of typhus, scarlatina, cholera, and every other
epidemic disease, are uniformly in proportion to the low sanitary
condition of the population, the Legislature has decided on attempting
to check the prevalence of these diseases by laying the foundation of
sanitary improvement.[29] It appears that the measures adopted by the
Legislature with this view should be consistently carried out and
applied to the dwellings of all classes of the population whether on
land or at sea. In the larger vessels in which well-directed care has
been exercised, the general ill-health has been reduced below the
average ill-health of populations of the like ages on shore; but from
the evidence which has been brought from witnesses at the ports, medical
men well acquainted from long practice in the mercantile marine, it
appears that the _general_ condition of merchant-vessels, and of the
forecastle in which common seamen are, for the most part, lodged,
renders them in effect cellar-dwellings, just as dark, foul, and
unventilated, as the filthy, unaired, and dismal cellars on shore with
which the Legislature has endeavoured to deal. It appears also that
typhus and other epidemic diseases do break out at sea in these movable
cellars, just as they do in the cellars of the dirtiest courts on shore;
and were it not that seamen work in a purer external atmosphere, that
they are below decks comparatively for short intervals only, and that in
general they are men at the most robust periods of life, it is probable
that epidemic disease would be still more frequent among them; an
inference supported by the fact that whenever passengers, emigrants, and
others are, owing to stormy weather, much confined to the berths below,
some form of malignant disease is almost sure to break out.
Footnote 29:
See pp. 57, 129, works executed after this was written. [ED.]
* * * * *
There are not wanting instances in which the energetic adoption of such
measures as were available, particularly the enforcement of all
practicable means of cleansing, and the resolute removal of nuisances,
warded off Cholera to a very great extent, even under circumstances in
which a formidable attack appeared inevitable; and perhaps it may serve
for encouragement and guidance to direct attention to one or two of such
examples.[30]
Footnote 30:
The two following examples are taken from “Results of Sanitary
Improvement,” by Dr Southwood Smith, 1854. [ED.]
One of the most remarkable of these occurred at Baltimore, during the
prevalence of epidemic cholera in America, in 1849.
The population of that city was about 149,000 souls. The site of the
town is naturally salubrious, and parts of it are well built; but the
districts near the river occupied by the poorer classes are low and
damp, and liable to remittent and intermittent fevers, and, therefore,
predisposed to cholera.
In the spring of 1849, the pestilence, which had attacked with great
violence several neighbouring towns, appeared to be close upon the city.
A general conviction prevailed, both among the authorities and the
citizens, that uncleanliness had much to do with the development and
spread of the disease; they therefore spared neither money nor labour to
purify the city, and they gave the execution of the cleansing operations
to experienced and energetic officers, who performed the work so
vigorously, that it was generally admitted that never before had the
town been in so clean a state, or so thoroughly purified, as during the
summer months of the year 1849.
About the middle of June, while cholera was prevailing at New York,
Cincinnati, and other places, north and west of Baltimore, diarrhœa
broke out, and became general over the whole city, accompanied by
another symptom which was universal, affecting even those who had no
positive attack of diarrhœa; namely, an indefinable sense of oppression
over the whole region of the abdomen, seldom amounting to pain, but
constantly calling attention to that part of the body.
“At that time,” says the medical officer of the city, “I felt assured
that the poison which produced cholera pervaded the city; that it was
brooding over us; that we were already under its influence, and I
anticipated momentarily an outbreak of the epidemic. In about two weeks,
however, from the commencement of this diarrhœa, and the prevalence of
the uneasy sensation which accompanied it, these symptoms began to
subside, and in a short time they wholly disappeared. Simultaneously
with their disappearance, cholera broke out at Richmond, and other towns
south of Baltimore. I then felt assured that the fuel necessary to
co-operate with this poison did not exist in our city: that the cloud
had passed over us and left us unharmed.”
No case of cholera was reported to the Board of Health or other
authorities of the town as having occurred during this time; but on
close examination, it was ascertained that four deaths had taken place
from the disease in its most virulent form.
That the cholera poison had really pervaded the city, was appallingly
evinced by an event which occurred in its immediate vicinity.
The Baltimore almshouse is situated about two miles from the city, on
sloping ground, remarkable for its beauty and salubrity, in immediate
contiguity with the country-seats of several of the wealthy families of
the town. It is surrounded by a farm of upwards of 200 acres, belonging
to the establishment, for the most part under cultivation. The building
is capable of accommodating between 600 and 700 inmates. An enclosure of
about five acres, surrounded by a wall, adjoins the main building upon
its north side. In the rear of this north wall is a ravine, which at one
point approaches the wall to within about nine feet. This ravine is the
outlet for all the filth of the establishment. It is dry in summer, but
retentive of wet after rain. The space between the wall and the bed of
the ravine is not under tillage, but is overgrown with a rank, weedy
vegetation, common in rich waste soils. The physician of the
establishment, under the same apprehension of an outbreak of cholera as
had prevailed in Baltimore, had taken the same precautions against the
disease, and had placed the establishment itself in a state of
scrupulous cleanliness.
On the first of July cholera attacked one of the inmates. On the seventh
a second attack occurred. This was followed in rapid succession by other
seizures, and within the space of one month 99 inmates of the
establishment had perished by cholera.
Within the building and grounds the most diligent search failed to
discover anything that could account for this outbreak; but on examining
the premises outside the northern wall, there was found a vast mass of
filth, consisting of the overflowings of cesspools, the drainage from
pigsties, and the general refuse of the establishment. “In short,” says
the medical officer, “the whole space included between the ravine and
the wall, upon its north side, was one putrid and pestilential mass,
capable of generating, under the ardent rays of a Midsummer sun, the
most poisonous and deadly exhalations.”
During the greater part of the time that this outbreak continued, a
slight breeze set in pretty steadily from the north, conveying the
poisonous exhalations from behind the north wall directly over the
house.
The first persons attacked were those who happened to be particularly
exposed to the air blowing from the north side of the building.
On the male side of the house there was no protection from the ravine.
The female side was partially protected by three rows of trees. The
residents on the women’s side were more numerous than on the men’s, but
the attacks were considerably less.
Among the paupers, those who slept in apartments exposed to the north
were attacked, those not so exposed generally escaped.
In the basement story of a building, opening directly to the north, and
close to a spot which received the contents of one of the cesspools, 17
lunatics were lodged, all of whom were attacked, and all died.
Eight medical students were attached to the establishment, of whom four
occupied apartments with a northern exposure, and four were lodged in
rooms with a southern exposure. The four whose rooms were exposed to the
north were attacked, the four whose rooms were not thus exposed escaped.
The manager, also, who slept in a room above that of the students
looking to the north, was attacked: his family, whose rooms looked to
the south, escaped.
Men, after some difficulty and delay, were employed to remove the filth
and drain the ravine, the whole surface of which, after having been
thoroughly cleansed by a stream of water, was thickly covered with lime,
over which was put a deep stratum of earth. The men employed in this
work were attacked with cholera, as were some of the several inmates of
the almshouse who had been dispersed throughout Baltimore, but the
disease did not spread to any other persons in the city. From the 25th
of July, the day on which the drainage was completed, the disease
suddenly declined from 11 the day previous, to 3, and, by the 9th of
August, had entirely disappeared.
* * * * *
In the case of Baltimore, and the Baltimore almshouse, a neglected spot
was severely visited by the pestilence, while, by well-directed
exertion, an entire city escaped. In our own country an instance has
lately occurred (1854) in which, by similar exertion, a particular spot
escaped, while a populous town was devastated by the plague.
No town in Great Britain has ever been so severely visited by cholera as
Newcastle, yet the garrison of Newcastle has wholly escaped.
The barracks in which the garrison of Newcastle is quartered are
situated about three-quarters of a mile from the centre of the town. In
houses at distances varying from 20 to 200 yards of the barrack gates,
numerous deaths from cholera took place, and in a village 250 yards from
the barracks the pestilence prevailed to a frightful extent for many
days, numbering one or more victims in almost every cottage.
On the outbreak of the pestilence in the town, the medical officers of
the garrison, with the sanction and assistance of their superior
officers, exerted themselves with great promptitude and energy to carry
into effect all the means at their command, calculated to lessen the
severity of an attack from which they could not hope altogether to
escape. The sewers, drains, privies, and ashpits were thoroughly
cleansed; all accumulations of filth were removed; the spots where such
filth had been collected were purified; the freest possible ventilation
was established day and night in living and sleeping rooms; overcrowding
was guarded against; the diet of the residents was, as far as
practicable, regulated; the men were strictly confined to barracks after
evening roll-call, and were forbidden to go into the low and infected
parts of the town; amusements were encouraged in the vicinity of the
barracks; every endeavour was made to procure a cheerful compliance with
the requirements insisted on, without exciting fear; and there was a
medical inspection of the men twice, and of the women and children, once
daily.
The influence of the epidemic poison upon the troops was demonstrated by
the fact that among 519 persons, the total strength of the garrison,
there were 451 cases of premonitory diarrhœa, of which 421 were among
the 391 men, irrespective of the officers, women, and children, the
attacks being in some instances obstinate, and recurring more than once.
Yet such was the success of the judicious measures which had been
adopted, that no case of cholera occurred within the barracks during the
whole period of the epidemic; and every case of diarrhœa was stopped
from passing on to the developed stage of the disease: while in
Newcastle there were upwards of 4000 attacks, and 1543 deaths.[31]
Footnote 31:
Results of Sanitary Improvement by Dr Southwood Smith, 1854.
* * * * *
The case of the “Eclair,” and the history of the Epidemic Fever which
occurred at Boa Vista in 1845, have been declared by high medical
authority to afford “conclusive evidence that Yellow Fever is sometimes
imported.” It will therefore be necessary to make a careful examination
of the circumstances relative to this Epidemic.
It has been affirmed, and generally credited, that unusual effort has
been made to ascertain the facts of this case under circumstances more
than commonly favourable to the discovery of the truth. Two official
Reports respecting it, drawn up after personal inspection on the spot,
have indeed been presented to Parliament—one by Dr McWilliam, and the
other by Dr King; and several official notices of these reports have
been published; but the evidence on which these two Reports were founded
was not collected until some time after the cessation of the epidemic.
The statements of witnesses, for the most part poor and ignorant, many
of whom had a direct interest in establishing the importation of the
disease by a British ship, have been admitted implicitly, even with
respect to dates and circumstances not of recent occurrence, and without
due examination of the credibility of their testimony; and on all
material points the reporters have arrived at directly opposite
conclusions.
On a review and comparison of the whole of the statements which have
been made with respect to this case, it appears that the steam-ship
“Eclair,” with a crew of 140 officers and men, proceeded in 1844 to the
coast of Africa, and was stationed for upwards of four months (130 days)
at the island of Sherboro, with a view to blockade the eastern outlet of
the passage at Shebar. This place is considered one of the most
unhealthy on the African coast; vessels remaining near the island very
rarely escaping an outbreak of Yellow Fever on board. The land is
represented as low lying, some parts being marshy, and the rest thickly
wooded, and abounding in rank vegetation.
According to the account of the surgeon of the “Eclair,” Mr Maconchy,
the ship on this occasion was anchored at the mouth of the river, in
position where she “was surrounded with filthy-looking river water,
urged backwards and forwards by the tides through extensive tracts of
mangrove bushes.” The fresh water used on board was also bad, holding in
solution a quantity of offensive vegetable matter, which produced in
some of the crew attacks like mild cholera. The men, in parties of from
30 to 40, were often sent up the river on boating expeditions, where
they remained for seven or eight days at a time exposed, “whether they
slept on board or ashore, perhaps after a hard day’s labour, to all the
exciting causes of fever, and a tainted nocturnal atmosphere, in the
rainy season, heavy weather having set in, and the men constantly
getting as wet as possible.”