Part 17

“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. 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.

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.