Part 16

Few will question that the progress of the opinion of observers in Europe during the last half-century has been steadily towards a material modification, if not an entire abandonment, of the doctrine of contagion with reference to the majority of epidemic diseases, taking the word contagion in its strict sense, that is, the communicability of disease exclusively by contact: direct, that is, with the body or breath of an infected person; or indirect, with something which an infected person has touched.

Cholera may be taken as an example of the diseases of the epidemic class. When cholera first invaded Europe in 1831, the belief in its contagious nature was almost universal, and in this country in particular there was scarcely a medical man who did not entertain this conviction; but as in India, where this disease is known, the belief in its contagious nature is universally abandoned, so in Europe it gradually diminished in proportion as opportunities of observing the disease increased; and now in Russia, Poland, Prussia, France, Belgium, and England, the contrary view, with few exceptions, is maintained.

Footnote 26:

See note p. 61.

There has been much confusion of terms in respect to the use of the words contagion and non-contagion. Professional men have avowed their belief of the contagiousness of typhus, and stated that they had experienced it in their own persons. When asked for the evidence on which the belief was founded, they have usually related some circumstances showing, not the contagiousness, but the infectiousness of the disease. Contagion is a term applicable to a different set of circumstances. According to the hypothesis of contagion, no matter how pure the air, no matter what the condition of the fever ward, if the physician only feels the pulse of the patient, or touches him with the sleeve of his coat, though he may not catch the disease himself, he may communicate it by a shake of the hand to the next friend he meets; or that friend, without catching it himself, may give it to another; or if the physician wash and fumigate his hand, but neglect the cuff of his coat, he may still convey the deadly poison to every patient whose pulse he feels during the day. If this were so, the track of a general practitioner who attended one patient labouring under a specific epidemic disease would be marked by the seizure of the rest of his patients; if it were true of cholera and typhus, the members of the General Board of Health must have fallen by these diseases, who from morning until night received inspectors that came from places where these epidemics were rife; and if any disease of common occurrence really possessed such powers of communication and diffusion, it is difficult to conceive how it is that the human race has not been long since extinguished. To assume the method of propagation by touch, whether by the person or of infected articles, and to overlook that by the corruption of the air, is at once to increase the real danger, from exposure to noxious effluvia, and to divert attention from the true means of remedy and prevention. It is not in human power to take from any disease the property of contagion, if this property really belongs to it; but it is in our power to guard against and prevent the effects of any contagion, however intense; and it is equally in our power to avoid communicating to common disease an infectious character, and aggravating it into pestilence.

Footnote 27:

In January, 1866, the members of the Aberdeenshire Cattle Plague Association being much interested in the question as to how the disease could possibly have reached Pitmillan, Fovernan, no suspicious communication by beast or otherwise having taken place with the farm for weeks, Mr Hay, veterinary surgeon, inspector for the county, gave the following explanation of the matter in a letter to Mr Barclay, the hon. secretary:—“I am happy to be able to satisfy the public mind as to how the disease was brought to Pitmillan. About Christmas Mr Fraser got from Mr Duncan, flesher, Aberdeen, a quantity of beef rolled up in packsheet, which had apparently paid several visits to London round carcases, and doubtless mingled there with many of its kind from various places of the kingdom. After being removed from the beef at Pitmillan, this packsheet was thrown aside for some time, when one of the servant girls took and used it (unwashed) as an apron for a considerable period before the first cow got bad, and was carrying the kail in it to the cow after she was taken ill. You see by this that we are liable to get the disease at any time. Tons of packsheet return weekly by railway, and no surer agent could be employed to bring rinderpest to the country.” The secretary having some doubt about the guilt of the packsheet (which however, was gravely accused in both Houses of Parliament), reported his opinion that the contagion was conveyed by the wind! [ED.]

If indeed the emanations thrown off from the living body formed permanent and powerful poisons, like miasms connected with the products of decomposition, and if they were, like such products, capable of being conveyed unchanged to great distances, we should be able to live only in solitude; we could never meet in society, for we should poison each other; the first symptom of illness would be the signal for the abandonment of the sick, and we should be compelled by a due regard to self-preservation to withhold from persons afflicted with disease every kind and degree of assistance that required personal attendance.

Happily, we are not so constituted, and the evidence that has been adduced of the narrowness of the sphere even of the most virulent contagion, shows the groundlessness of the alarm sometimes entertained respecting this dreaded agent, while it points to the certain means of destroying it. The London Fever Hospital is separated from the Small-Pox Hospital only by the space of between thirty and forty feet, and the windows of the wards of both establishments are immediately opposite each other: yet there is no instance of the communication of small-pox to the typhus patients, nor of typhus to the small-pox patients; nor of either disease to the convalescent, or to the official inmates of the adjoining establishment. There does not appear to be a single instance on record, in any country, of the extension of infection beyond the walls of an hospital, or even of a lazar-house, so as to injure in any manner the nearest inhabitants.

But though it appears that modern experience and research have shed considerable light on the origin and progress of epidemic diseases, yet there are still some circumstances connected with their propagation which the present state of our knowledge does not enable us to understand, and which therefore appear to us as difficulties.

These cases are sometimes termed exceptional; but they are only apparent, not real, exceptions; as in all other departments of human research, they are merely indications of the imperfection of our knowledge, and advancing science will unquestionably one day so elucidate these very exceptions, as to render them additional confirmations of the true conditions.

In the present state of popular opinion it has been deemed requisite to enter into this detailed consideration of the general subject of contagion, because it appears that in proportion as undue weight is attached to this dreaded agent the effect is mischievous; since, “it diverts attention from the true source of danger, and the real means of protection, and fixes it on those which are imaginary; creates panic; leads to the neglect and abandonment of the sick; occasions great expense for what is worse than useless; and withdraws attention from that brief but important interval between the commencement and the development of disease, during which remedial measures are most effective in its cure.”

It is also necessary to examine the questions of contagion and quarantine apart from each other, because there are points of obscurity, and therefore grounds for controversy, which, in the present state of our knowledge, may be reasonably considered as belonging to the former, that do not attach to the latter. The inquiry with reference to quarantine, indeed, is simple, and lies in a narrow compass. The sole question to be determined is, whether or not it accomplishes, or is capable of accomplishing, its professed object, and this is a mere question of evidence and experience.

The object of quarantine is to prevent the introduction of epidemic diseases from one country into another, and the agency which it employs for this purpose is the isolation of the sick; the detention of, and the placing under inspection for a given period, persons who come from an infected country or district, though they may not be actually sick; and the purification of articles of commerce presumed to be capable of imbibing and conveying pestilential virus, before such articles are landed and dispersed.

It appears that facts and observations place beyond all reasonable doubt the utter inutility of this system.

If there be any truth in the preceding representation, that epidemic diseases are universally and inseparably connected with an epidemic atmosphere, the question is at once decided. Quarantine can exercise no more control over this epidemic atmosphere than over the electricity and temperature of the common atmosphere, and the direction and force of the wind.

If it be true that epidemic diseases, such, for example, as influenza and cholera, traverse the globe in determinate courses or zones, and often spread from country to country, and through the vast populations of their great cities, in single weeks, and even days, it must be futile to array such a machinery as that of quarantine, that is to say, a vessel placed at the entrance of one or two seaport towns, a line of soldiers guarding a few miles of the frontier, of a particular country against morbific agents, which pursue their course like the blight that destroys the vegetation of a country in a night, and which extend their influence over the greater part of the habitable globe.

If it be true that the epidemic influence precedes the actual outbreak of epidemic disease—that that epidemic influence is present in a country, creating a predisposition or susceptibility to disease before the epidemic appears in its true and recognized form,—quarantine must be futile, because, before it takes its precautions or erects its barriers, such as they are, the epidemic is already in the country busy in action, vitiating the blood of the most susceptible of the population, and preparing the way for its general attack.

If it be true, as ancient and modern authorities are agreed, that, without the essential preliminary of an epidemic atmosphere on the spot, foreign contagion is inert, and that, unless both concur, no pestilence ensues, quarantine under any circumstances must be useless; for in the absence of an epidemic atmosphere it must be useless, because then no disease will spread beyond the individual affected; and with the presence of an epidemic atmosphere it must be useless, because then the disease will spread wherever the infected atmosphere goes and finds favouring conditions.

If the preceding principle be true, it must be futile to place vessels coming from infected countries in quarantine, unless those vessels are capable of bringing with them an epidemic atmosphere, and unless quarantine can control such an atmosphere when imported; and the uselessness of this procedure will be placed in a still stronger light when recent experience as to the comparative insusceptibility of Europeans, though resident on the spot, to plague itself is considered.

Footnote 28:

Dr W. H. Burrell, Deputy Inspector-general of Hospitals, who was three years Principal Medical Officer at Malta, presented, in 1852, to the General Board of Health, an elaborate examination on the plague which had formerly raged in that island. The following are the conclusions to which he had arrived:—

“1. There is no evidence to prove, or even to render it probable, that the plague was introduced either into Malta in 1813 or into Gozo in 1814 by importation.

“2. There is every reason to believe that the plague existed in Malta at the time of the arrival of the ship supposed to have introduced the disease; and that in Gozo the first case (a stranger) contracted the disease from local causes, which enhanced by quarantine, produced it in others.

“3. The lower orders, and those occupying the lowest, most crowded, and worst ventilated dwellings, furnished the great majority of cases; which decreased in proportion with improvement in these respects.

“4. As this discriminative preference of the disease to attack certain 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.”