A Treatise on the Plague and Yellow Fever / With an Appendix, containing histories of the plague at Athens in the time of the Peloponnesian War; at Constantinople in the time of Justinian; at London in 1665; at Marseilles in 1720

by James Tytler

SECTION IV.

Of the best Methods of Preventing the Plague.

THESE methods may be classed in the following manner: 1. Those most proper for avoiding the infection, supposing the disease to be infectious. 2. The proper mode of resisting or removing those local causes which may give rise to it, or may co-operate with the infectious matter in giving greater force to the disease, should it happen to be introduced; and, 3. The best method of preparing the body for resisting pestilential attacks, should we happen to be so situated that no external method of defence could be used.

With regard to the first of these intentions the flying from places infected has been so universally recommended, and so generally received, that the precept has been made up into the following proverbial Latin distich:

“Hæc tria tabificam tollunt adverbia pestem
Mox, longe, tarde, cede, recede, redi.”

These words prevent the plague’s infectious pain,
Go quick, fly far, and slow return again.

This maxim hath been put in execution in all ages, but often with so little regard to humanity that it cannot by any means be recommended without very considerable limitation. The reparation of the sick from all promiscous intercourse with the sound, in times of pestilence, seems to be dictated by common sense; but this may be done without killing them, or leaving them to expire in the miserable state to which they are reduced by the disease. Mr. Howard informs us that in some places ships which have the plague on board are chased away and burnt; and instances of cruelty with regard to infested individuals have been formerly mentioned. Dr. Mertens is of opinion that cutting off all the communication between the infected and healthy is the only means of preventing the disease from spreading. The good of this practice was observed in one of the hospitals at Moscow. All the avenues to it were shut up, but one which was strictly guarded, and every suspected article prohibited from entering. Infected clothes and utensils were burned, and the houses where the sick had lived were purified by the fumes of vinegar and gun-powder.

In this mode of prevention it is of the utmost consequence to ascertain the distance to which the contagion extends; in the next place to know whether by means of clothes, cotton or other kinds of merchandise it may be imported from one place to another; and in the third place how long the infection may remain in these kinds of goods; so that people may know when the danger is over. As to the distance, it seems to be generally agreed, that it is but small. Some of the answers to Mr. Howard by the physicians of whom he inquired, have been already related. Of the infection of the plague he speaks in the following manner:

“In my opinion this distemper is not generally to be taken by the touch, any more than the gaol-fever or small-pox; but either by inoculation, or by taking in with the breath the putrid effluvia which hover round the infected body; and which, when admitted, set the whole mass of blood into fermentation, and sometimes so suddenly and violently as to destroy its whole texture, and to produce putrefaction and death in 48 hours. Those effluvia are capable of being carried from one place to another, upon any substance where what is called scent can lodge; as upon wool, cotton, &c. and in the same manner that the smell of tobaco is carried from one place to another.

“The infection in the air does not extend far from the infected object, but lurks chiefly (like that near carrion) to the leeward of it. I am so assured of this, that I have not scrupled going, in the open air, to windward of a person ill of the plague to feel his pulse. The rich are less liable to the plague than the poor, both because they are more careful to avoid infection, and have more large and airy apartments, and because they are more cleanly, and live on better food, and plenty of vegetables; and this I suppose is the reason why Protestants are less liable to this distemper than Catholics during their times of fasting, and likewise why the generality of Europeans are less liable to it than the Greeks, and particularly Jews.

“It is remarkable that, when the corpse is cold of a person dead of the plague, it does not infect the air by any noxious exhalations. This is so much believed in Turky, that the people there are not afraid to handle such corpses. The governor of the French hospital at Smyrna told me, that, in the last dreadful plague there, his house was rendered almost intolerable by an offensive scent; especially if he opened any of those windows which looked towards the great burying-ground, where numbers every day were left unburied; but that it had no effect on the health of himself or family.”

It is likewise a matter of the utmost importance to ascertain the time at which the disease is introduced into any town or district. Dr. Canestrinus, in a treatise on this distemper, published at Saltzburg, complains greatly of the dissensions among physicians concerning the nature of the distemper, owing to which its existence is frequently denied, and thus its ravages are propagated immensely beyond the limits which might otherwise circumscribe them. Of this he gives the following remarkable instance: “In the year 1770 a disease with uncommon symptoms prevailed at Bodrogh in Upper Hungary, which carried off a number of persons in a short time. A physician of the county of Zemplin was sent to inquire into the nature of the malady. He reported that the disease was of a suspicious nature, having a great resemblance to the plague. His report was received by the nobility and health-officers with indignation, as if untrue. Another was sent, who, without hesitation, pronounced the disease an epidemic scurvy. In the mean time the disease, being left to itself, spread wider, and raged with such violence as to carry off seventeen persons in one house. The nature of the disease now becoming apparent, proper measures were taken, and the infected separated from the sound, by which means the disease was confined within a small district.[110]” With regard to the infection of the disease, or contagion, as it is commonly called, he expresses himself as follows: “The air is not capable of diffusing the contagion to any considerable distance from the infected subject unimpaired in its power, but, like other poisonous matter, it is capable of dilution in the atmosphere, so as to be rendered at length innoxious. The contagion of the plague will be entirely prevented from spreading if all access to, and all intercourse with, the sick be strictly prohibited: whence the following forms a safe and infallible prophylactic of the disease:

“Mox, longe, tarde, cede, recede, redi.
Go quick, fly far, and slow return again.”

“No change in the habit takes place previous to the action of the contagion, but the body is from the first equally susceptible of it as of the itch, or any other infectious disease. Whilst the plague ceases in the civilized parts of Europe spontaneously, or by human precautions, its revival is prevented, from the care that is bestowed in purifying or destroying every infected substance. In the east, on the contrary, this precaution is totally neglected; whence it is probable that the disease is not reproduced anew, but that it is perpetuated by the former fomes, as happens with us in the small-pox. The matter producing the ordinary epidemics is widely diffused in the atmosphere, and capable of infecting through a widely extended space. The pestilential poison, on the contrary, is confined to the vicinity of the affected body, and becomes so dilute at the distance of a few paces only as to be incapable of further action. Hence it appears that the plague is much easier avoided than epidemic disorders. The more abundant the contagious matter is, the further probably is the power of its infection carried. This is the reason that the mere separation of the sick and suspected from the healthy is so much more efficacious in destroying it at its commencement than at a later period. To restrain epidemics within bounds is impossible; but with the contagion of the plague, it is certain that it can be confined by art to a narrow spot.”

Of the truth of this last assertion our author gives a remarkable, instance in his own practice about the time that the plague stopped at Bodrogh. Having been sent into Cassovia, along with two other physicians, they were informed by the surgeon of the lazaretto, that an unusual disease had broken out in the district of Zboina, which had suddenly proved fatal to many. On inquiry it was found that it had come from Bodrogh in the following manner: Two young men, returning from the vintage at Tokay, slept a night in an infected house, and stole some clothes belonging to those who had died of the plague. He who carried the clothes died by the way: his father carried home the bundle, kept them unpacked for some weeks, but having at last worn them, he and all his family fell victims to the same disease. The pestilence began to spread, and shewed an appearance of great malignity. Our author did not hesitate to declare its true nature, and in consequence of his declaration all communication was cut off between the adjacent countries and the infected spot, by a cordon of the military. The infected were separated from such as were only suspected, and these last from the sound: three infected houses were destroyed by fire, and other means (to be afterwards related) were used with a view to destroy the contagion itself. Thus the disease was prevented from spreading; and none but such as had been previously suspected were seized.

To the same purpose the Abbe Poiret thinks it an easy matter to extinguish the plague entirely. He was a witness to the ravages of the disease in Barbary, and thinks it the most easily avoided of any distemper; but the misfortune is, that there are many things in their own nature very easily accomplished, which the inattention or perverseness of mankind render utterly impracticable. Such, it is to be feared, is the extinction of the plague by the means just mentioned; for though these means might be enforced in a country district or small town, yet, where the pestilence enters a large and populous city, there are so many modes of concealing its existence, and the unknown intercourse of the sick with the sound must be so frequent, that it seems scarce possible to prevent the malady from spreading.

In London, whether it arose from a neglect of using the precautions for too long a time, or from any other cause, cannot well be known; but the attempts of the magistrates to separate the sick from the sound certainly were not attended with any good consequence. “The consternation (says Dr. Hodges) of those who were thus separated from all society, unless of the infected, was inexpressible, and the dismal apprehensions it laid them under made them but an easier prey to the devouring enemy. And this seclusion was on this account much the more intolerable, because, if a fresh person was seized in the same house but a day before another had finished the quarantine, it was to be performed over again; which occasioned such tedious confinements of sick and well together, as sometimes caused the loss of the whole. Moreover, this shutting up of infected houses made the neighbours fly from theirs, who might otherwise have been a help to them on many accounts; and I verily believe that many who were lost might have been alive, had not the tragical mark upon their doors driven proper assistance from them. And this is confirmed by the examples of other pestilential contagions, which have been observed not to cease until the doors of the sick were set open, and they had the privilege of going abroad.” The Doctor sets forth also the arguments on the other side; but whatever might have been the advantages of a separation of the sick from the healthy, if conducted in a manner less capable of hurting the feelings of humanity, it is evident that in the London plague the methods attempted to prevent the disease at least did no good.

In countries where the plague generally prevails, and the Europeans are united in the opinion that it is necessary to separate themselves from the natives, the method of shutting up is attended with the most salutary effects, as has been attested by almost every traveller who has resided there for any time. Accidents among them are very rare, though not altogether without example. At Alexandria in Egypt, M. Volney tells us, that as soon as the plague makes its appearance the European merchants shut themselves up in their khans and have no communication with the rest of the city. Their provisions are deposited at the gate of the khan, and received there by the porter, who takes them up with iron tongs, and plunges them into a barrel of water provided for the purpose. If it is necessary to speak to any one, they keep at such a distance as to prevent touching with their clothes, or breathing on one another; by which means they preserve themselves from this dreadful calamity, unless by some accidental neglect of these precautions. Some years ago a cat, which passed by one of the terraces into the houses of the French merchants at Cairo, conveyed the plague to two of them, one of whom died. This state of imprisonment continues for three or four months, during which time they have no other amusement than walking in the evening on the terraces, or playing at cards.

The doctrine of predestination, and still more the barbarism of the government, have hitherto prevented the Turks from attempting to guard against this destructive disease: the success, however, of the precautions taken by the French, has of late begun to make some impression upon many of them. The Christians of the country who traffic with the French merchants, would shut themselves up like them; but this cannot be done without permission from the Porte. A lazaretto was some years ago established at Tunis; but the Turkish police is every where so wretched, that little can be hoped for from those establishments, notwithstanding their extreme importance to commerce and the safety to the Mediterranean states. The very last year afforded a proof of this; for as violent a plague as ever was known broke out there. It was brought by vessels coming from Constantinople, the masters of which corrupted the guards, and came into port without performing quarantine. Water carriers have never been attacked by it.

Mariti says, that in the island of Cyprus, and on the continent of Syria, every European, on the slighted appearance of the plague, after taking the necessary precautions, shuts himself up with his family. The Mahometans alone, more intrepid, go abroad as usual, converse with each other, give such assistance to each other as may be necessary, and often fly to the relief of a Christian when deserted by his friends. This arises from their belief in predestination. The Mahometans of Syria, however, less familiarized with this scourge, make use of some precautions, which were augmented in 1760. They published an ordonnance forbidding every vessel attacked by the plague to enter their ports: but their vigilance in this respect was so remiss, that it was not sufficient to prevent the contagion. The governor of Acre checked the progress of this plague, by giving the inhabitants the means of retiring from its ravages; and these means, though absolutely contrary to the dogmas of the Mahometan religion, were eagerly embraced. The Europeans became their models; and the governor, after deriving from them every necessary information, shut himself up, after their example, together with his numerous family. The mufti alone, being the protector of the Mahometan law, cannot imitate a conduct which that law condemns. Instead of shutting himself up in a prudent confinement, he thundered forth against this new method, reproached the governor for his conduct, and, having treated him as an impious person, threatened him with all the vengeance of Heaven. The governor, however, only laughed at this pious folly of the mufti, and sent a detachment of soldiers to impose on him a fine of two hundred and fifty sequins, for having dared to ascribe to him, in matters of religion, an ignorance, from every suspicion of which his age ought to have secured him.

In the time of plague, the proper precautions are, to shut one’s self closely up, and to receive no provisions or other things, except those on which the plague has no influence. The people of Syria, however, in 1760, admitted every kind of provisions without fear, but not without using certain precautions. They did not receive warm bread; flesh of every kind was thoroughly washed, and milk was strained through a linen cloth, in order to free it from the smallest particle of animal hair. All kinds of pulse were soaked in water, and they abstained from peaches, apricots, and other fruits which are covered with a downy rind. Fowls were cooked out of the house, for fear that some small feather might adhere to them. Flowers were altogether proscribed. Letters were opened by the person who brought them; and they were never read until they had been steeped long enough in vinegar to be purified without effacing the writing. Every thing was received into the house by means of a rope of herbage suspended from a window. The governor employed every precaution which he thought likely to guard him from the contagion; and, by shutting himself closely up, he set an example which the rest of the Mahometans did not neglect to follow. Besides this he caused the streets to be cleansed; and carried his vigilance so far as to forbid the caravans which arrived from Damascus, where the plague swept off four or five thousand people every day, to enter the city. He obliged them to submit to a proof of eight days without the walls, and established regulations of the same kind respecting vessels coming from Alexandria or Damietta. One precaution taken in the time of plague is, to prevent cats from entering houses: an open war is therefore declared against these animals; and, wherever they are found, they are knocked on the head with large clubs. This is a cruelty absolutely necessary; for there is no vehicle that will convey the infection with more certainty or rapidity than the hair of cats. Rats and mice multiply in consequence of their destruction; but there is no instance of their ever having propagated the plague. This disease, when it attacks men, spares quadrupeds and birds. The furs of the one, and the feathers of the other, however, attract and communicate the infection. People ought particularly to keep from goats and sheep; from horses and oxen little is to be apprehended.

All these precautions were sometimes ineffectual. The French at Acre, who there, as well as throughout Syria, are collected into one quarter, used every precaution that could be thought of, yet, on the 30th of March, 1760, five of them were infected. They belonged to the hospital of the Holy Land, and the monks were instantly ordered to shut themselves up. They did so; and eight of them died, one only escaping.

Mr. Howard likewise gives particular accounts of the precautions used in several different countries through which he travelled. In Malta two kinds of quarantine are performed; one for ships with clean bills, the other for those with foul. The former lasts 18 days.[111] The crews and passengers are allowed to buy provisions, and converse by means of enclosures with stone posts and palisadoes. A letter received from a Turkish ship was taken by a pair of iron tongs, dipped in vinegar, put into a case, and laid for about a quarter of an hour on a wire grate under which straw and perfumes had been burnt; after which the letter was taken out and opened by one of the directors. In this island ships with foul bills must perform quarantine eighty days; but, at the end of forty, may change their station. The different kinds of goods are separated and placed in proper order under cover. The cottons are taken out of the bags containing them, and placed on rows of piles on boards, laid on stone pillars about 18 inches from the floors; and, in repacking them they are flung over a man who gets into the bags, and treads down the cotton; the consequence must be the exposing him to great danger, should any infection remain.

Mr. Howard took a voyage to Venice in a ship with a foul bill, on purpose to know every thing relative to the performance of quarantine. “A messenger (says he) came in a gondola to conduct me to the new lazaretto. I was placed, with my baggage, in a boat fastened by a cord ten feet long to another boat in which were six rowers. When I came near the landing place the cord was loosed, and my boat was pushed with a pole on the shore, where I was met by the person appointed to be my guard. Soon after unloading the boat, the sub-prior came and showed me my lodging; a very dirty room, full of vermin, and without table, chair or bed. That day and the next morning I employed a person to wash my room; but this did not remove the offensiveness of it, or prevent that constant head-ach which I had been used to feel in visiting other lazarettos and some of the hospitals in Turky. My guard sent a report of my health to the office, and, on the representation of our consul, I was removed to the old lazaretto. Having brought a letter to the prior from the Venetian ambassador at Constantinople, I hoped now to have had a comfortable lodging. But I was not so happy. The apartment, consisting of an upper and lower room, was no less disagreeable and offensive than the former. I preferred lying in the lower room, on a brick floor, where I was almost surrounded by water. After six days, however, the prior removed me to an apartment in some respects better, and consisting of four rooms. Here I had a pleasant view; but the rooms were without furniture, very dirty, and no less offensive than the sick wards of the worst hospital. The walls of my chamber, not having been cleaned perhaps for half a century, were saturated with infection. I got them washed repeatedly with boiling water, to remove the offensive smell, but without any effect. My appetite failed, and I concluded I was in danger of the slow hospital fever. I proposed whitewashing my room with lime slaked in boiling water, but was opposed by strong prejudices. I got this, however, done one morning through the assistance of the British consul, who supplied me with a quarter of a bushel of fresh lime for that purpose. The consequence was, that my room was immediately rendered so sweet and fresh, that I was able to drink tea in it in the afternoon, and to lie in it the following night. On the next day the walls were dry, as well as sweet, and in a few days I recovered my appetite. This room was lime-whited in November, and in a very rainy season. In the following March, in complaining to the under sheriffs in Newgate of their inattention to the clause which orders this in the act of parliament for securing the health of prisoners, their excuse was, that they were afraid of dampness.”

An health-office was established at Venice in 1448, in the midst of a very destructive pestilence. The old and new lazarettos are both built on little islands, surrounded not only by canals, but high walls. They have only a ground floor, and one over it, and are divided and subdivided into a great number of apartments, each having an open court in front, with plats of grass, which is not suffered to grow too high; nor are any trees suffered to grow within this district, or a good way from it. The internal government is managed by a prior, who must not be related to the magistracy nor any of its ministers. He must have no interest nor concern in shipping nor in trade. He must see all the gates and doors of the apartments locked every evening by sunset; he takes the keys into his possession, and suffers them not to be opened before sunrise; and, in case of any suspicion of infection, the gates must be kept constantly locked, and opened only for necessary occurrences in presence of the prior. He must not suffer dogs, cats, &c. to lodge in the lazaretto. He must neither buy nor sell, nor suffer others to do so, within the lazaretto. No fishing boats or other small craft to come within a certain distance, or keep communication with those performing quarantine. Provisions are received by poles seven or eight feet long, and the money dipped in vinegar and salt water before it is received. The prior and his substitute must carefully avoid touching either goods or passengers in quarantine, and for this purpose they keep a cane to make those who approach them keep their proper distance; but if by an unfortunate accident they should be contaminated, they must perform quarantine. Any person maliciously touching them is liable to punishment.

Ships are strictly forbid to use any ropes but such as are tarred. Wool, silk, cotton-wool, woollen and linen clothes, and furs especially, are accounted the most dangerous goods. Animals with long hair are subject to full quarantine; but short haired ones purged by swimming ashore; feathered animals, by sprinkling with vinegar till wet.

The celebrated Dr. Mead, though an enemy to the cruel mode of abandoning the sick, or treating them with any kind of harshness, was perfectly sensible of the necessity of using every precaution for preventing pestilential contagion from being imported. In his opinion it is not sufficient that ships should perform quarantine, “the only use of this being to observe whether any die among them. For infection may be preserved so long in clothes among which it is once lodged, that as much, nay, more of it, if sickness continues in the ship, may be brought on shore than at the beginning of the forty days, unless a new quarantine be begun every time any person dies; which might not end but with the destruction of the whole ship’s crew.” He is therefore of opinion that lazarettos ought to be established on small islands near the sea-coast; and in this Mr. Howard agrees with him. The latter recommends the lazaretto at Leghorn as the best in Europe. Dr. Mead also very much insists on the utility of destroying the clothes of the sick, because, says he, they harbour the very essence of the contagion. He quotes in favour of this opinion what Boccacio says he saw at Florence in 1348; viz. that two hogs, finding in the streets the rags which had been thrown out from off a poor man dead of the disease, after snuffling upon them, and tearing them with their teeth, fell into convulsions, and died in two hours. This is one of the things which Dr. Moseley looks upon to be incredible. It is indeed very marvellous, and seems to be contradicted by M. Deidier’s account of the dog at Marseilles who swallowed with impunity the filthy pus and pestilential matter adhering to the dressings of plague sores: but, when a person of credit informs us that he saw any thing, we scarce know how to contradict him. The evidence of pestilential contagion adhering to clothes, does not depend on such accounts. That lately quoted from Dr. Canestrinus is decisive on the subject; and he informs us that one of the methods used by himself to stop the plague in Zboina, above mentioned, was, the burning of the clothes of infected persons. He says that the pestilential contagion resembles that of the small-pox, in being of a fixed nature; and that all who studiously avoided communication with the sick, or with whatever fomes might carry the contagion, escaped it altogether. “That the contagion of the plague (says he) may lie dormant for a considerable time, and be carried to a great distance by the medium of packages, &c. and again revive with its former violence, is proved by various circumstances. Chenot relates, in his treatise on the plague which raged in Transylvania, that the infection was revived a whole year after it had disappeared; and other similar instances are adduced.” If this revival happened from infected clothes or soft goods, it shows them to be dangerous in the extreme; but of this we have not any direct proof, neither indeed is such a belief quite consistent with what takes place in all plagues, viz. that the clothes of the infected are worn by the sound, without producing any reinfection. In the great plague at London, for instance, where an hundred thousand probably perished, and a much greater number must have been infected, we cannot suppose that all the clothes belonging to such an immense multitude were burned, or never made use of again. It is of necessity therefore that we suppose the pestilential contagion to become effete, and to lose its virulence, after some time; and this seems to be very much hastened by exposure to the atmosphere. The doing of this, however, by obliging people to put their naked arms into bales of suspected goods, has such an appearance of cruelty, that Dr. Mead has proposed to judge of the presence or absence of infection by allowing little birds to fly about among them; “because (says he) it has been observed, in times of the plague, that the country has been forsaken by the birds; and those kept in houses have many of them died.” But, though he says this upon very great authority, no less than that of Diemerbroeck, yet we can by no means look upon the fact to be absolutely determined. Dr. Russel indeed says that the desertion of the birds is looked upon by the Turks to be the sign of an approaching plague; but this failed in 1760. Thucydides says that birds of prey deserted the territory of Athens during the great plague in his time; and he supposes them to have been poisoned by feeding upon the bodies of such as died of the disease. It is possible that such food might be disagreeable to them, but no proof is brought of any of them having been actually poisoned by it. As for birds kept in houses, it is possible that in a time of general calamity they might have been neglected, and died for want of proper food, &c. Dr. Mead also quotes an instance which cannot be credited in a consistency with undoubted testimonies that pestilential contagion does not extend but for a very little way. Upon opening an infected bale of wool in the field near Cairo, “two Turks employed in the work were immediately killed, and some birds which happened to fly over the place dropped down dead.” Such accounts have arisen from a supposition that the whole mass of atmosphere was violently infected; but this would be totally inconsistent with the life of any human creature, and we may well put down this, as that of pestilential infection arising from cities like a cloud, as merely chimerical.[112] It is too well known that pestilential contagion, instead of soaring in the air, keeps very near the ground.

We now come to the second mode of prevention, viz. removing these local causes which, in the opinion of some, may produce a plague in any country, and, in that of others, may increase or set in action the contagion previously existing. These causes have been enumerated by the late Dr. Smith,[113] in a Dissertation on the pestilential Diseases which at different times appeared in the Athenian, Carthaginian and Roman armies, in the neighbourhood of Syracuse. They are, 1. The climate and season. 2. The situation of the armies; and, 3. Their condition. The climate of the island of Sicily in general he observes is extremely pleasant at some seasons of the year; in the neighbourhood of Syracuse particularly storms are so infrequent during the former part of the year, that the sun is never obscured for a whole day. Even in the month of January, however, the weather is warm, and as the season advances the heat becomes insupportable. In autumn it is rendered somewhat unpleasant and unhealthy by the frequent rains and chillness of the evenings. But, in particular places, during the hottest season, nothing can exceed its unhealthiness. According to Barichten, “the least stagnant water is sufficient, in the heats of summer, to poison the atmosphere: its effects on the countenances of the poor people who live in its vicinity are evident; and a stranger who travels through the island in this season ought to avoid ever passing a night near them.” De Non says, that “as soon as the sun enters the Lion, this country becomes the house of death: fevers of the most malignant kind seize on the imprudent or unfortunate wretch that spends a night near them (ponds and marshes) and few escape with life when attacked by so virulent a disorder.”

To the poisonous effluvia of these marshes the Doctor attributes, in an especial manner, the plagues which took place in the armies. In the second year of the Peloponnesian war, the Athenian army was encamped, as we are told by Thucydides, “upon marshy and unwholesome ground;” and that such kind of encampments will produce diseases in an army is well known. In the time of Dionysius, when the Carthaginian army under Imilco suffered so dreadfully, or rather was totally destroyed, his camp was situated on an eminence between two morasses, the heat at that time being excessive. Hannibal, the predecessor of Imilco, had also lost great part of his army by a plague, though he had been encamped in a healthy situation; but, in order to raise a wall which should overlook the city, he had taken the materials of the tombs found in the common burial place, the city at that time containing two hundred thousand inhabitants. “From the uncovering and disturbing of so many dead bodies (says our author) arose a terrible pestilence, which carried off immense numbers of the Carthaginians, and amongst the rest the general himself.” To the unhealthy situation of the armies also the Doctor ascribes the plague which took place in the Roman and Carthaginian camps in the time of the second punic war; and the Carthaginians suffered most, by reason of their being nearer to the marshes. The state of mind, the cleanliness of the person, &c. also must be taken into account; and our author shows that neither of these could be supposed favourable to the Carthaginians.

That personal cleanliness, and breathing pure air, should contribute to the health of individuals, or to any number of them collected into camps or cities, seems to be agreeable to reason and common sense; nevertheless we find that this has been denied, and even Dr. Canestrinus says that “in the plague of Lyons and Marseilles it was observed, that the most populous parts of these cities, where the streets were narrow and filthy, suffered less from the disease than those which were more airy and clean. At the time of the plague in London in the time of Charles II, the physicians advised that all the privies should be opened and exposed; the fetid odour from which having pervaded the city, the plague was stopped! Is it from this cause (the author asks) that the plague has seldomer visited Spain, the towns of which are intolerably offensive from their want of cleanliness?”[114]

This certainly seems a very strange doctrine, nevertheless the fact that Spain is but little subject to the plague seems undeniable, and as it is no less certain that the towns are excessively filthy, it would seem that cleanliness is not effectual in preventing it. But, however agreeable the smell of human excrements may be to the Spaniards, or to the English physicians in former times, it seems to be less so at present. “I am persuaded (says Dr. Ferriar) that mischief frequently arises from a practice common in narrow back streets of leaving the vaults of privies open. I have often observed that fevers prevail most in houses exposed to the effluvia of dunghills in such situations.” In Spain the opinion seems to have been but lately eradicated; for some years ago, an order having been issued by government that the streets of Madrid should be kept somewhat cleaner, the people were so much exasperated at being threatened with the loss of the savoury odour, that a rebellion had almost ensued, and the physicians declared the smell of human excrements to be the most wholesome thing in the world.[115]

That the confinement of human effluvia, along with heat and want of water, will produce a malignant fever, is certain from the example of the unfortunate people confined in the Black Hole at Calcutta. In this case the distemper seems to justify the opinion that plague may be artificially produced, perhaps more than any other upon record; for Dr. Ferriar informs us that it was attended with eruptions resembling those of the true plague. In this case, however, the confinement was beyond example in any situation which can be supposed incident to a city or camp. There is no country in the world where the inhabitants are equally numerous with those of the empire of China, its population at present being estimated by Sir George Staunton at three hundred and thirty-three millions, a number equal to one third of the supposed inhabitants of the whole globe; of consequence the cities must be immensely crowded with inhabitants; yet it remains free from plagues. Human effluvia therefore, in the most populous state in which mankind can exist in society, are not able to taint the atmosphere of a country or city. The following is Dr. Clark’s account of that celebrated empire: “The whole empire of China is represented to be extremely delightful; the soil rich, the air pure, and the industry of the inhabitants astonishing. As it produces every luxury and necessary of life, it is justly esteemed one of the most fertile countries in the world. As the Chinese prohibit emigration, and seldom or never engage in war, their country is extremely populous. Every river maintains a proportion of inhabitants adequate to the land, whose families live continually in boats, without having any other place of residence. Their number of people lays them under the necessity of carrying industry to the greatest height; for otherwise their country, fertile as it naturally is, would be insufficient to maintain the inhabitants. Every inch of land is cultivated; no forests nor woods, nor even a single tree, is suffered to obstruct the labours of the husbandman. Canals are cut every where to water the fields, and marshes are manured for the cultivation of rice. By these means health and plenty are, in a great measure, the portion of its inhabitants through all the seasons of the year. The only terrible and fatal diseases to which they seem to be subject are the small-pox and leprosy.”

But, though our author determines in general that the air of China is pure, this cannot apply to every part of it without exception. On the contrary he describes in the following manner Wampoa, a village about fourteen or sixteen miles below the city of Canton, on Canton river: “It is the usual station of all European ships in this river. On one side the land is low, marshy, and covered with water, forming swamps fit only for the cultivation of rice. The extent of these swamps is considerable; the tide rises high, and overflows great part of them; but the intersection of the rivers renders them more pure than they would otherwise be; and consequently the air is much healthier than one could expect from the unfavourable aspect.”

In like manner Canton city he says “is built on a very extensive plain, and is large and populous. Here the government allow the English, Dutch, French, Danes and Swedes separate factories on the banks of the river. The city, though paved, is very wet in rainy weather; and the water makes its way under the factories of the different nations every tide. The houses are built with bricks; the apartments are in general small, and not very lofty, and the ground stories are very damp. When the business of the season is over, the supercargoes remove to Macao, a Portuguese island, subject to the Chinese government. The city of Macao is situated on a rising ground; the whole island is dry, rocky and barren; it is, however, plentifully supplied with provisions by the Chinese; and, though the air is very sultry, yet it is tolerably healthy.”

From the preceding account it is plain, that the causes which operate in the production of plagues and epidemic diseases in other countries, though they exist in China, do not act there with equal efficacy. At Wampoa the marshes in the neighbourhood must, in the hot season, emit noxious effluvia as well as any where else, and there can be no certainty that the overflowing of the tide is sufficient to put a stop to their malignant influence. At Canton the water penetrates below the floors of the houses, and we have seen from Dr Fordyce[117] that in other countries the sprinkling of a floor with clean water, and the encampment of an army upon ground where water was found at a small depth below the surface, were sufficient to produce fevers; yet here it is not so. In this city also the inhabitants are numerous, and the apartments small; so that neither the perspiration of multitudes, nor the moist exhalations from water stagnating in the streets, nay, under the houses themselves, are able to produce the diseases in question. Again, at Macao the sultry heat of the air has as little effect as the rest.

Lastly, in Pekin, the capital, the population and the crowd are immense. According to Sir George Staunton,[118] the city is about one third larger than London; but, as he supposes[119] it to contain three millions of inhabitants, the population must be twice and a third-part as great as that of London in proportion to its bulk. “The low houses of Pekin (says he) seem scarcely sufficient for so vast a population; but very little room is occupied by a Chinese family, at least by the middling and lower classes of life. In their houses there are no superfluous apartments. A Chinese dwelling is generally surrounded by a wall six or seven feet high. Within this enclosure, a whole family of three generations, with all their respective wives and children, will frequently be found. One small room is made to serve for the individuals of each branch of the family, sleeping in different beds, divided only by mats hanging from the ceiling. One common room is used for eating.”

Where diseases are prevalent, circumstances of the kind just mentioned would certainly be urged as evident causes of them; but in China we see that something disarms such causes of their power. People, however, seldom want a salvo for any thing. “The crowds of people, at Pekin (says our author) do not prevent it from being healthy. The Chinese indeed live much in the open air, increasing or diminishing the quantity of their apparel according to the weather. The atmosphere is dry, and does not engender putrid diseases; and excesses productive of them are seldom committed.” But, if the dry air at Pekin contributes to the health of the people, why does not the moist air of Canton produce diseases? Besides, in this empire there are multitudes of people who live entirely upon the water, in a kind of houses constructed upon junks, employed in carrying grain from place to place, or for other purposes.[120] Sir George Staunton computes the number of inhabitants on a branch of a single river to be no less than an hundred thousand. What then must they be throughout the whole empire! Yet these people, though continually exposed to moisture, as well as to an almost inconceivably crowded situation, are yet no more subject to epidemics than others. Our author does not specify the excesses which produce disorders. Intemperance in drinking no doubt is one of them; but Dr. Patrick Russel expressly says, that he never saw an instance of the plague being brought on by intemperance.

Lastly, with regard to living in the open air, Mr. McLean has ascribed to the vicissitudes of this element the principal if not the only cause of epidemics. “A fact worthy of notice (says he) is, that aged persons and children are both seldomer and less severely attacked by epidemics and pestilential disorders than the young and middle aged, and women seldomer and less severely than men. Now, if contagion was the source of these diseases, the case would be exactly reversed. Old people, women and children, being more in the way of contagion, would be more frequently and more severely attacked. But the young and middle aged, being more exposed to the vicissitudes of the atmosphere, the principal source of those diseases, they are consequently more severely attacked. It has been a puzzling question to solve why old people and children are less exposed to plague, &c. but the solution will be no longer difficult if it should be proved that these diseases are always produced by certain states or vicissitudes of the atmosphere, together with the application of other powers co-operating in the production of indirect debility.” In the country we speak of, however, this solution fails in a manner almost as evident as can be imagined. “The removal of the embassy, (says Sir George Staunton) was a disappointment to several persons belonging to it, who had made arrangements for passing the winter at Pekin. Judging of its temperature by the latitude of the place, a few minutes under 40° north, they were not aware of the violent effect of the great range of high Tartarian mountains, covered perpetually with snow, upon that capital, where the average degree of the thermometer is under twenty in the night during the winter months, and even in the day time is considerably below the freezing point. The usual inhabitants were guarded against cold, not only by habit, but by an increase of clothing in proportion to its intenseness, consisting of furs, woollen clothes and quilted cottons. They are not accustomed to the presence of fire. They have no chimneys, except to kitchens in great hotels. Fires, on which Englishmen chiefly depend against suffering by the sharpness of the atmosphere, could not well answer that purpose in houses which are so constructed as to admit the external air almost on every side. Stoves are, however, common in large buildings. These stoves are situated frequently under the platforms on which the inhabitants sit in the day time, and rest at night. The worst weather experienced in that capital might be considered as mild by the Tartars, coming from a climate still more rude; but other foreigners are said to feel themselves less comfortable at Pekin in the winter than in the summer, though the heat is then raised to the opposite extreme. In both they seem to require a seasoning. Several individuals of the embassy fell ill during their stay; and all did not recover. The human frame seems calculated for the hottest rather than the coldest atmosphere, and to exist at the equator rather than the pole.”

Here we are involved in difficulties much greater than before. It appears that even the fine climate of China is healthful only to its own inhabitants. They can bear the vicissitudes of the air, which Europeans cannot. The prevention of plagues or mortal diseases then must consist in some mode of living by which people can accommodate themselves to the country which they inhabit, and without which every other precaution will be ineffectual. The diseases with which the attendants of the ambassador were seized could not be owing to any slovenliness or dirtiness in their lodgings or food, or to want of apparel; nor were they more exposed to the inclemencies of the air than others; only they were in a strange country, where that inexplicable constitution of the elements acted upon them in a manner different from what it did on the natives, and, while it was friendly to the latter, proved pernicious to the former. But there was a time when even China was as unhealthy as other countries; for the great plague in 1346 began in the northern part of it. We have seen, in a former section, that this was preceded by the most dreadful and violent wars throughout the whole Asiatic continent. Since the cessation of these violent wars the Chinese have staid at home, and applied themselves to the arts of peace, particularly to agriculture, which they have carried, we may say, to its utmost perfection. This seems therefore to be the true method of removing all those local causes which produce epidemics, or at least of preventing them from doing hurt; and, without attention to the natural duties and occupations of man, it is to be feared that all artificial modes of prevention will be found not only precarious but ineffectual.

Dr. Smith in the dissertation above mentioned observes, that “it may be doubted whether any moral cause would be sufficient to protect, for a long period, an unaccustomed resident in a marshy situation from the usual consequences.” This is no doubt very probable but, from the example of Lord Macartney’s attendants in China, it appears equally probable that it makes little difference whether the country be marshy or not. Dr. Lind has many excellent observations upon the subject of unhealthy countries, and gives particular directions for strangers how to act, when obliged to expose themselves to the inclemencies of the weather; but none of these being effectual in preventing the access of the true pestilence, we must still adhere to the old Latin adage already quoted, p. [302]. Flight seems to be the most effectual method. To avoid migrations to those countries where it usually rages, and, if it were possible to persuade the inhabitants of such countries, to imitate the example of Chinese industry, instead of allowing the greater part of the territories they possess to lie waste, would in all probability gradually lessen both the frequency and violence of this terrible disease. Migrations of large bodies of people, especially for the purposes of war, are greatly to be dreaded. If a few Englishmen, possessed of every thing necessary, could not keep their health at Pekin, what must have been the probable consequence of landing an army of an hundred thousand, with a view to conquest? Or what could we expect if the Chinese were to “pour forth by millions” into other countries in order to conquer them? Dr. Lind takes notice that even of the first Portuguese adventurers to Africa, such as escaped the first sickness continued afterwards to enjoy good health. He likewise observes that many who left Britain, after being seasoned to the countries to which they went, chose rather to remain abroad for life, than to run a new risk by going back to their own country. It is not therefore so much the greater unhealthiness of the country to which we go, as the change, which is to be dreaded. If therefore great bodies of men will employ themselves in constant rambling from one country to another, no wonder that diseases break out among them, unknown, either in the countries they have left, or those to which they go.

We come now to the third mode of prevention, viz. that of destroying the infection after it has begun to exist. This is varied according to the nature of those things which we suppose to be infected. The general notion of infection taking place in the atmosphere has been already spoken of; but the uncertainty of this hypothesis, and the apparent impossibility of altering a constitution of the atmosphere, must certainly leave very little room for hope in this case. It hath, however, been attempted by various methods. Hippocrates adopted the opinion that all diseases were produced by the air, and from him it was borrowed by Lucretius, as we are informed by the annotator on Creech’s Translation of that author. “In his book de Flatibus (of winds) says the annotator, after a long narration of the effects that the air produces, he at length falls on the subject of diseases, all of which he affirms to be bred and generated in the bodies of animals by means of the air. First (says he) I will begin with the most common fevorous disease, which accompanies, in a manner, all diseases whatever. For there are two sorts of fevers, one that is promiscuous, and common to all, and is called the plague; the other, by reason of unhealthful diet, is peculiar only to such as use that diet; but of both these kinds of fevers the air is the sole author and cause, for the common fever or plague happens alike to all, because they all breathe the same air; and it is certain that the like air, being alike mingled in like bodies, must beget like fevers.” In consequence of his theory, this great physician advised to have recourse to fire as a purifier of air in times of pestilence. But experience doth not warrant the success of this method; neither indeed can we suppose that it could be successful, unless people were able to kindle such fires as would absorb the whole atmosphere of a country. This method was tried in London without the least success; nay, seemingly with bad effect; for, the very night the fires were lighted, more than four thousand people died; and, a few days after, an end was put to the experiment by such violent rains as extinguished all the fires at once.

The burning of infected clothes has already been taken notice of; but though this must certainly prevent any new infection from arising from these clothes, it will not prove that the infection may not evaporate during the time of burning, and, being volatilized even beyond its natural pitch, by the heat, may do mischief at a greater distance than could have happened had they been let alone. The instance, formerly quoted from Dr. Huxham, of the small-pox being disseminated by the smoke of burning infected clothes, if not a proof, affords at least a strong presumption, of the danger of such a practice. The only way of perfectly ensuring safety in such a case would be to burn them by the sea-side, when the wind blows from the shore. Were the smoke allowed to pass over land, and great piles burnt at once, it is impossible to say how far the contagion might be carried.[121]

Another mode of purification is by exposing suspected goods to heat, to the vapour of vinegar, &c. fumigating with gun-powder, sulphur, &c. and on this principle various powders of fumigation have been invented; some of which are said to have been very successful in Russia; and the composition of one is given by Dr. Alexander Russel in his Natural History of Aleppo; but all these are undervalued by Dr. Guthrie,[122] who calls the practice of fumigation or smoaking, an “inadequate and ineffectual ceremony.” Dr. Mitchel, also discommends them, saying that they are advised “without any proof that these destroy pestilential matter, and while, at the same time, it is certain that they diminish more or less the wholesomeness of the atmosphere with which they are mingled.”[123] Of late the vapours of pure nitrous acid (the nitric, according to the new nomenclature) has been recommended, with the boldest appeal to experience; but the consideration of this naturally belongs to the second part of this work, where we shall have occasion also to consider the theory of the septic acid. In the mean time we must go on with some farther account of the different modes of fumigation.

“There is no better corrective (says Allen from Diemerbroeck[124]) of a pestilential air, than fire; as much experience has taught us. Hippocrates subdued and extinguished that famous plague, which came amongst the Grecians from Ethiopia; for he commanded great fires to be kindled throughout the whole city, especially in the night time, to purge away the pollutions of the air. It is believed that a fire made with juniper-wood or ash, tends much to correct the venomous corruptions of the air. The kindling of sulphur and gun-powder purify the air, and drive away its corruptions; so does the burning of amber, pitch, frankincense, &c. so do the fumes of vinegar raised with red-hot irons, or bricks.” According to Etmuller, “Hippocrates drove away that famous plague in Greece by the use of sulphur; the fumes of it are very much commended to correct the air, and make drink more wholesome; it prevents all manner of corruptions and alterations, as well as the putridinous alteration of the blood. In a great degree of malignity, the shirt and clothes may be impregnated with the fume of sulphur.”

Here we have accounts of a disease, called that famous plague, driven away by two different methods; and, to complete our dilemma, Dr. Canestrinus tells us that the plague at Athens is said to have been staid “by sprinkling the streets with wine.” What an expensive remedy, when the odour of privies was afterwards found to answer as well! “Whilst the plague was raging at Oczakow, an earthquake[125] happened on the very day that it began to decline. In this case did any vapour issue from the earth destructive of the pestilential contagion? or did former noxious exhalations cease in consequence of the convulsion of the earth?[126] Sorbait relates, that, in the time of the vintage in the neighbourhood of Moselle, the plague ceased like a miracle, while the must was in a fermenting state. At Vienna likewise it was observed that, during and at the close of the vintage, the disease manifestly declined; which may have been owing to the great quantity of fixed air in the atmosphere.”

To this our author adds, that “places adjoining to spice-shops have generally remained free from infection; and, in the plague of London, all those employed in shipbuilding escaped the disease. Smiths also and cooks remained uninfected.” M. Volney tells us that, in Egypt, water-carriers are exempted; and Baldwin, that oilmen are in the same happy predicament; while on the other hand Allen quotes Boerhaave saying, that “Forestus, Diemerbroeck, the French, English, and Germans, observed, that all dealers in soap, washers, and all who by their business used soap, nay, who only wore shirts washed with soap, presently died of the plague.”

From so many and so discordant opinions, the only conclusion we can draw is, that, when once a pestilence has invaded a country, there is not any possibility of operating upon the contagion in such a manner as to destroy it. If the plague ceases, it must do so naturally, and we cannot accelerate this cessation. This is entirely conformable to the opinion of Dr. Patrick Russel. Speaking of the decline of the plague at Marseilles, and the vigorous exertions of the magistrates to put a stop to it, he says, “The causes now enumerated might no doubt have some effect, but a more powerful and general cause had begun long before to restrain the havock of the pestilence, which had declined visibly in the month of September, and in those of October, November and December declined with a rapidity not ascribable to the exertions of the most vigorous police. This cause is generally supposed to be some change in the constitution of the air; but which has hitherto been defined with no better success than that peculiar state of the atmosphere which, in conjunction with contagion, is absolutely necessary to render the plague epidemical.”

Dr. Russel takes notice of the methods of extinguishing contagion already mentioned, by kindling fires, &c. and disapproves of them. We shall not therefore spend more time in considering whether or not there is any probability of eradicating or mitigating the violence of a plague when once it is introduced. However this may be impracticable in so large a space, it seems that it certainly may be done in smaller spaces, ships for instance; or, if not with the true plague, at least with malignant and infectious fevers. Dr. Trotter, in his Medicina Nautica, has laid down methods for accomplishing this, and expresses the highest confidence in their success. He adopts the doctrine of contagion, of which he gives the same definition that in this treatise is given of infection, viz. “Something propagated from diseased bodies, or from substances that have been in contact with them, producing a similar disease in other persons[127]—the propagation of contagion, as well as its reception into the healthy body. A more aggravated degree of malignity will generate a greater quantity of infection, and, as it may be confined in a larger or smaller space, it will be less or more noxious. A fever may be called malignant, when, with the symptoms of debility, there is a cadaverous smell arising from the body, an unusual fœtor of the breath, stools, and other excretions, the tongue black and parched, the eye dusky or yellow, the countenance bloated and dejected, and the skin sallow. In approaching a sick bed of this kind, a person not much accustomed to such visits will be very liable to receive the infection; and the unpleasant smell will be much sooner perceived than by the physician or other attendants. We conclude that a malignant typhus is more apt to generate contagion, because slight cases are found not to extend to others, even though no mode of precaution has been used. The disease itself is incapable of generating infection, till after a certain period; but this period is uncertain: it seems to depend on the nature of the symptoms, whether they are mild or malignant. We are assured of this fact, from a timely separation having prevented the farther progress; and by this means ALONE, I apprehend, we eradicate contagion in SHIPS, or ANY WHERE ELSE. In the small-pox[128] the disease seems incapable of infecting another person before the second or third day of the eruption. With the measles it is otherwise. The disease may be propagated at the most early stage of the eruption; and, if I was to be allowed to conjecture on the subject, I would say, that the contagion is the offspring of the catarrh (the cough and hoarseness resembling a cold) which accompanies the measles.

“Substances imbued with the exhalations from infected bodies, if not exposed to the air, have their powers of communicating the disease increased; or, in other words, the infection from fomites (infected cotton, clothes, &c.) is said to become more virulent than it was when first separated from the body.

“I am of opinion, with others, that the exhalations or excretions of the sick are the vehicles of contagion. It is these which impregnate the atmosphere with noxious matter: they affect in like manner bed-clothes, or apparel, and every thing that can imbibe them, when in contact with the diseased body. When bed-clothes, or body-linen, but particularly silk or woolen cloth, have been exposed to these exhalations, and then heaped together for a length of time, the noxious effluvia are, as it were, multiplied, and will more certainly infect others than they did at first. The bales of goods which brought the plague to Marseilles, and affected the people that opened them so suddenly, had their virulence increased by not being duly ventilated. When the jail-fever was brought into court by the prisoners at Oxford assizes, and more lately at the Old Bailey, the fever was propagated from the clothing of the prisoners; no doubt, from being confined in impure, ill-aired cells, this infection became more virulent. The highly concentrated state of contagion, in the bales of goods, could only have been brought to that degree of virulence from the closeness of the package: it cannot be supposed that human beings could have put them together otherwise. The nurses of hospitals know well, as Dr. Lind tells us, that there is most danger of catching a fever when they pile heaps of bed-clothes or body-linen together for a few days, before it is carried to the wash-house. The washer-women at Haslar have also told me the same thing. They know when a dangerous fever is in the hospital by the bad smell of the clothes: this makes them air them abroad, till the smell is gone, and then they can wash them with safety. But, if it happened, from the hurry, that this could not be done, or if it was neglected by design, many of them were seized with the sickness. The porters and people employed in cleaning and fumigating the blankets and beds at Haslar are well acquainted with this fact, and they measure the danger by the badness of the smell. This ought to instruct every body to stand to windward of these infected substances when they are opened; as the current of air would then carry it the other way. In one of the courts of justice, the people who stood between the prisoners and a window, into which the wind blew, escaped the infection, while those on the other side were sufferers.

“In the summer of 1793, while the Orestes brig, commanded by Lord Augustus Fitzroy, lay at Plymouth, she was anchored very near and to leeward of an army transport, which had on board a very malignant fever among the soldiers. While the soldiers were moved on deck, to go on shore to the hospital, the crew of the Orestes, from curiosity, walked on deck to look at them. Such was the concentrated state of the contagion among the clothing and bedding of these troops, on bringing them from below, that eighteen people belonging to the brig were quickly seized with the same fever, the infection of which had been conveyed by the current of wind. It did not, however, extend much farther in the Orestes, from the attention of her commander. But this ought to be a caution for ships to keep clear of those that have fevers on board, as a virulent CONTAGION may be conveyed to a considerable distance.

“Dr. Lind is inclined to think that washing the bed-linen in hot water, even when first shifted, is attended with much risk; and that the noxious matter may be volatilized by the heat of the water, and affect the woman. For this purpose he has recourse to his favourite process, of fumigation, to insure the washer-woman. The heat of his fumigating furnace would no doubt dry the linen, and exhale any moisture; but our practice in the Charon (the hospital ship) was, to plunge everything as it came from the bed into a tub of hot water kept ready on purpose. The linen was washed and dried immediately after. We had in that hospital many malignant cases of typhus, and some deaths, yet no infection was ever spread there.”

Our author next proceeds to inquire into the cause of this excessive concentration of the infectious matter in fomites, or clothes, bed-clothes, bale-goods, &c. The most plausible reason, he says, that could for some time be assigned for this, “was, the generation of animalcula; the cotton or woollen clothing was said to serve as a nest for the corpuscles to multiply; and thus the contagion was thought to increase seven fold.” This theory had an effect on the practice of physicians, both as to the prevention and cure of fevers supposed to proceed from thence. Our author looks upon the hypothesis to be chimerical, because none of these animalcules have ever been made visible by the best microscopes. But there is no necessity for supposing the animalcules to be invisible to the naked eye. They may creep on the ground, or fly in the air, without being observed by us. Mr. Baker’s discovery of the insect which not only poisoned eleven hundred thousand times its bulk of water, but infected a much greater bulk of air, with its effluvia,[129] shows that such a thing may be possible; and in dubious matters bare possibility ought always to produce inquiry. If the perspiration of human bodies when confined becomes noxious, why may not that of a multitude of insects be so too? There is no necessity for supposing that an insect must be swallowed, or inhaled by the breath, before it can do hurt. What Dr. Trotter says of the variolous contagion emitted from the human body will apply equally to insects. “What has been called the insensible perspiration (says he) which arises from the surface and the lungs, we have a right to believe carries with it in solution a portion of the variolous matter which charges the atmosphere with the contagion of small-pox, even in such quantities as to impregnate the clothing of attendants and visitors; by which means it has been frequently carried to families and villages many miles distant from its source.” The smallness of size of insects can be little objection here. A skunk is but a small animal, yet it spreads its odour farther than an hundred diseased human bodies could propagate the plague.[130]

On this subject, however, we may remark, that though the nurses and attendants on hospitals measure the degree of infection by the smell, yet people are by no means safe in approaching patients about whom no smell can be perceived. We have already seen, from Dr. Fordyce, that what may be called the pure infection of fevers is not perceptible by any of our senses; and there are examples of very offensive smells issuing from diseased bodies without any contagion ensuing. Dr. Trotter tells us, that “a patient in typhus was sent from the Venerable to the hospital ship, with a fœtor about him, that exceeded any thing of the kind that ever came within the Doctor’s knowledge. After being washed and shifted, it still continued, and was perceived at a considerable distance. He died in a few days, yet nobody was infected from him, either in his own ship, or in our hospital. There was probably some peculiarity of constitution here.” In M. Deidier’s experiments, above related, the dog which eat the dressings of the plague sores, after being infected with the disease, emitted a very disagreeable odour, but we do not find that the odour was in any way infectious. In the Encycloped. Britan, art. Med. Hydrophobia, we find an account of an hydrophobic patient (and a patient who recovered) in whom the blood drawn from a vein was as black as ink, and stunk abominably, yet this stench was attended with no bad consequence. There is therefore no essential connexion between offensive smells and contagion; yet, as they are sometimes united, the absence of the smell ought not to encourage us rashly to go into suspicious places, neither ought the presence of it to deter us from venturing where we have otherwise good reason to do so.

Having given up the doctrine of animalcula, the Doctor goes on to explain the doctrine of concentrated contagion in a manner very similar to that given in this treatise, viz. from the decomposition of some kind of gas. “The fœtor of the breath (says he) perspirable matter, &c. evidently demonstrate that they differ from the healthy state. The smell, to our senses, comes very near what is called sulphurated-hydrogenous gas. Some of the fluids within the body would seem to be in some degree in a state of actual decomposition; unless we can suppose the mucous glands of the lungs secreting a fluid that taints the expired air in this manner. The decomposition of the fat, which sometimes disappears very suddenly in fevers, may give some ground for the supposition that a large portion of these exhalations are composed of hydrogenous gas. But, whether we can go thus far or not, what is separated from the body, it is plain, is more disposed to decomposition than when the body is in health. Now this process will still go on, whether exposed to the atmosphere or not, with this difference, that, by exposing substances which have imbibed the exhalations of the diseased to a free air, the noxious gases will be dissipated as quickly as they are evolved; while, on the other hand, by laying the clothes in a heap, packing them firm in a chest, or making up cloth into small bales, the gases are concentrated into a small space; and woe to the man who first inspires them. . . . Now this does not hold out an idea that the powers of contagion are multiplied, as by generation; for that would be to say, that these gases are themselves what we call the matter of infection. I would only go so far as to assert that they are the vehicles of it, till more certain experience shall determine farther.”

With respect to fumigations with nitrous acid, our author repeatedly declares that he has no confidence in them; nay, he brings instances where they seemed to have bad effects. But as the dispute about fumigation has no connexion with the true plague, nitrous acid having never been used as a preventive for it, we shall defer any farther consideration of it to the second part of this treatise, to which it naturally belongs.

We come now to the fourth and last mode of prevention, viz. a consideration of those means by which an individual, without separating himself from society, and who is daily obliged to have communication with the sick, may yet secure himself against infection. Here the means recommended are extremely various, and some of them so opposite, that we can scarce avoid suspecting them all. The misfortune is, that though a person should go, without fear, among the sick, though he should constantly take a medicine, and should never have the distemper, yet we cannot say whether the medicine did preserve him or not. Were it possible to know the particular constitution of the body which disposed some to resist the attack of the disease, attempts might be made to bring the constitutions of others to the same standard, but unfortunately our ignorance here is so great, that any attempt to alter the constitution of the body has generally proved unfortunate even in other diseases. Dr. Lind informs us, that the first Portuguese adventurers in Africa, having observed, that “such as had the good fortune to escape a fit of sickness or death, soon after their arrival, enjoyed afterwards a pretty good state of health, thence concluded, that the blood of such persons had been entirely changed by the diet of the country. Upon this erroneous principle they adopted a most fatal method of seasoning people to these unhealthy climates. They, by small quantities, frequently repeated, took away as much blood as they supposed to be contained in the body, and thus they reduced the patient to a state of extreme weakness.” From its being observed that people of delicate constitutions are less liable to the plague than others, such a mistake probably has also been made with regard to this distemper, but with equally bad success. Allen tells us from Diemerbroeck, “Phlebotomy, though mightily cried up by many of the ancient and modern physicians, yet we reject it altogether, as very dangerous and detrimental; for it appeared by experience that those who made use of it for prevention’s sake were seized with the plague soon after bleeding, wherefore we forbad it to all.” This may seem surprising, as we find bleeding so much recommended by Sydenham as a remedy; but by others it is equally reprobated; nay, Dr. Hodges tells us that he never knew but one who recovered from the disease after the use of it. Issues seem more likely, if not to prevent, at least to render the disease more mild if it should attack. They are recommended by Diemerbroeck, and Russel speaks of them as, “by some authors, represented as almost infallible.” He cannot, however, recommend them from his own experience, having never seen them opened for the purpose of preventing the plague; and he justly observes, that when habitual on any other account, they may perhaps lose their effect in this. “Multitudes (says he) of both sexes at Aleppo had issues in their arms, it being there a very common remedy in a variety of chronic disorders: but, notwithstanding those outlets, numbers perished; and I did not remark that those who had them were in any degree less liable than others to be infected.”

Tobacco has been recommended as an excellent preservative, particularly by Diemerbroeck, who writes with a kind of enthusiasm in its favour. “Being called (said he) to visit a patient afflicted with the plague, as soon as I entered his chamber I felt a most offensive smell of excrements (for he had a diarrhœa) with which I was greatly affected. Leaving the house after a very short visit, I instantly found myself seized with giddiness, nausea, and uneasiness at the heart; so that I had no doubt of my having caught the pestilential contagion. Laying aside all business, therefore, I immediately returned home, and smoked five or six pipes of the best tobacco; by the use of which all the above-mentioned symptoms so totally vanished, that I felt not the least uneasiness any more. Then, being again desirous to go abroad and visit other sick people, I took a drachm of theriaca, and from thence-forward was in perfect health. The same thing happened to me three or four times during the time of this pestilence; and without loss of time, according to the quantity of infection I supposed that I had taken in, I had recourse to the more plentiful use of tobacco, by which my health was restored. I always looked upon tobacco to be an excellent preventive remedy, and its smoke I have sometimes found useful to myself even in an incipient attack of the disease.[131]” He then proceeds to inform us of a report that in a violent plague at London all the dealers in tobacco were exempted. At Nimeguen, however, they were not so fortunate; yet of the family of the principal tobacco merchant (Thomas Peters, an Englishman) which was very large, none were infected, excepting only one servant maid, and she quickly recovered.

On this remedy Dr. Russel makes the same remark as on the issues. “The custom of smoking (says he), is universal among both men and women at Aleppo. This too, from its being habitually practised, might perhaps lose part of its prophylactic virtue: at the same time those who use it as a preservative must always be supposed in some degree accustomed to it, otherwise the violence of its operation on most persons, on their first beginning to smoke, might prove hurtful. It should further be observed, that the tobacco commonly used in Syria is much milder than the American, and that the oriental smokers seldom or never spit.”

It hath been observed that the plague is stopped either by great heat or great cold, but more readily by the former than the latter. “It has generally been supposed (says Dr. Canestrinus) that the cold of winter was destructive of contagious matter; but various instances of the contrary may be collected. The plague in Transylvania continued through the very severe frost in 1709. On the contrary it has been found, that excessive heat has extinguished, or at least diminished, pestilential diseases. During the plague at Aleppo the weather was unusually hot in the beginning of July, and it was remarked that the disease declined considerably; and in general Dr. Russel observed, that the plague ceased at the hottest season of the year. The plague at Ockzacow, which raged in the years 1738 and 1739, began in the month of April, and continued with violence till July, when it declined considerably, and entirely ceased in the month of September; in February of the year following it re-appeared, and totally ceased in July.”

From these facts we might be led to suppose that a warm regimen, or occasionally exposing the body to great heat, might be advantageously used by way of prevention; but Dr. Russel justly observes, that the human frame, “could it support such an application of fire and smoke as is necessary to expel or destroy contagion from infected substances, would probably receive little benefit from it, if infected; nor could those in health sustain, without prejudice, the heat and dense smoke which is probably required for the perfect extinction of the infectious effluvia floating in the confined atmosphere of a morbid body.” He is of opinion, however, that some kinds of fumigations may be of use, and he mentions some of these, but says that the perfumes ordered by the college are perhaps as proper as any, though their forms might be rendered more simple. Heat alone can scarce be thought very proper for prevention, and, when the disease is once begun, is said to be detrimental. Dr. Guthrie quotes Baron Ash saying, that “in heated rooms the disease is ungovernable: it is only in free air that it is to be treated.” But of late a discovery has been made of a surprising power in heated oil of removing this disease, insomuch that, if we can believe what has been published of it, we must suppose it to be little less than a specific. So great indeed has been the confidence put in this method, that, by order of the Academy of Sciences at Lisbon, it has been translated into Arabic, French and Portuguese.[132] “The method was first proposed by George Baldwin esq. agent for his Britannic Majesty, and consul-general at Alexandria. He communicated his method to Lewis de Pavia, chaplain and agent to St. Anthony’s Hospital at Smyrna; who, after five years experience, pronounces it to be the most effectual remedy hitherto made use of in the hospital of which he has had the management for twenty-seven years. Immediately after a person is perceived to be infected with the plague, he must be taken into a close room; and, over a brazier of hot coals, with a clean sponge, dipped in warm olive oil, his body must be very briskly rubbed all over; for the purpose of producing a profuse sweat. During the friction, sugar and juniper berries must be burned in the fire, which raise a dense and hot smoke, that contributes to the effect. The friction ought not to be continued more than four minutes, and a pint of oil is enough to be used at each time. In general the first rubbing is attended by a very copious perspiration; but, should it fail of this effect, the operation may be repeated, first wiping the body with a warm, dry cloth; and, in order to promote perspiration still farther, the patient may take any warm sudorific drink, such as elder-flower water, tea, &c. It is not necessary to touch the eyes; and other tender parts of the body must be touched gently. Every possible precaution must be made use of to prevent the patient from taking cold, nor must the linen be changed till the perspiration has entirely subsided. The operation should be repeated once a day, until evident symptoms of recovery begin to appear. If there are already tumours on the body, they should be gently and more frequently rubbed, till they appear to be in a state of suppuration, when they may be dressed with the usual plasters. The operation ought to be begun on the first appearance of the symptoms of disease; if neglected till the nerves and the mass of blood are affected, or a diarrhœa has commenced, little hopes can be entertained of a cure; but still the patient should not be despaired of, as, by an assiduous application of the means proposed, some few have recovered, even after diarrhœa had commenced. During the first four or five days the patient must observe a very abstemious diet; the author allows only a small quantity of vermicelli, simply boiled in water. Nor must any thing be taken for thirty or forty days, except very light food, as, he says, an indigestion in any state of the disorder might be dangerous. He does not allow the use of wine till forty days. There is no instance of the person rubbing a patient having taken the infection. He should previously anoint himself all over with oil, and must avoid receiving the infected person’s breath into his mouth or nostrils. The precaution to be used in all circumstances is that of carefully anointing the body, and living upon light and easily digestible food. Mr. Baldwin observes, that among upwards of a million of people carried off by the plague in Upper and Lower Egypt, in the space of four years, he could not discover a single oilman, or dealer in oil.” Lisbon, July, 1797. By Royal Permission.

With regard to diet, and the use of spiritous liquors, opinions, as may well be imagined, have been very discordant. Allen quotes Diemerbroeck advising poor people to take two or three spoonfuls of the best white wine vinegar every morning, which he looked upon to be one of the best preservatives: he recommends also the frequent application to the nostrils of a spunge dipped in treacle vinegar. With regard to himself he says that his principal care was to avoid uneasy passions of the mind; and that when he found himself any way disturbed by these, he cheered his heart by three or four glasses of wine: his common drink was beer, and also white wine, small, or moderately strong, which sometimes he drank to cheerfulness, but never to drunkenness. Dr. Patrick Russel also says, that “a glass of generous wine, or any other cordial more agreeable to the choice, may be taken before dinner, in case of languor, or oppression at the stomach, from fatigue, fœtor, or apprehension. I found a rummer of old hock very agreeable on such occasions.” Allen goes on to inform us from Diemerbroeck, that, “as to diet, it is advisable in a pestilential disposition to use temperance, which very much contributes to the preservation of health; but all sudden changes are dangerous; wherefore it is most dangerous suddenly to alter the usual rule of diet. It is very ill in the plague to go abroad with an empty stomach: hog’s flesh is looked upon to be very pernicious: all sweet things are to be avoided: wine moderately made use of is good, but the abuse of it very dangerous.—Mercurialis testifies, that among the Patavians and Venetians, most of the tipplers died, who thought to drive out the plague with strong wines.” Mr. Howard informs us, that a person in high station at Constantinople, attributed his recovery entirely to the use of green tea, others to brandy. He also mentions a Mr. Hare, master of a merchant vessel at Senegal, who, during the prevalence of a malignant fever there, was very much exposed to the infection, and who out of humanity waited upon a negro, whom nobody would go near. He took no medicines, neither did he taste either spiritous or fermented liquors, and was the only European that entirely escaped the contagion.[133]

These accounts seem to evince that little or nothing is to be expected from a change of diet. This is an attempt to change the constitution of the body, and cannot be expected to succeed any more than bleeding. There is a certain quantity, and a certain species, both of food and drink, different in different persons, necessary to preserve health, and those who require both in larger quantity or better quality than others, are no more to be charged with intemperance than those who are supported by the smallest quantity of the coarsest fare. In times of danger, therefore, those who have been accustomed to spiritous liquors ought not to give them over; neither ought those to begin the use of them who have not used them before. From the account formerly given of the structure of the human body, it appears to be furnished with an apparatus for exhaling or throwing out a perspirable matter as well as for inhaling or taking in one equally subtile. How far the skin may be able to inhale or rather imbibe surrounding effluvia, may be doubted; but with the lungs there cannot be any doubt; and the effluvia taken into them must unquestionably affect the blood, and of consequence the vital principle, almost without any medium. To deprive the body of its due portion of nourishment therefore is to throw a temptation in its way (if I may use the expression) to absorb any thing; and the same effect must ensue from any other mode of debilitating it, either by intemperance, terror, or the like; and hence to visit infected places while under any such debility must be very imprudent. Dr. Russel agrees that it is a general and rational precept, never to go abroad fasting. For those who cannot easily bear fatigue without eating between breakfast and dinner, some light food may be proper, at an intermediate hour, in order to avoid going into the chambers of the sick with an empty stomach in the forenoon. “In such circumstances (says he) after a long and fatiguing morning, I have often found myself disagreeably affected in my latter visits, and have been sensible of slight giddiness, and of the appetite flagging at dinner, as if something lay on the stomach. I have known others much more strongly affected in this manner, and consequently much more alarmed. In such cases much no doubt may depend on the fancy; but in those times the power of the imagination requires management. So intimately is it connected with the accidental state of the body, that the same risk, from which a man shrinks in a state of languor and fatigue, he will encounter undauntedly after a temperate meal: the strange, unusual sensations, which amount almost to a persuasion of having caught the infection, will often, like the phantoms of a vision, vanish after a few glasses of wine.[134] Whether any slight degree of real infection can be thus dissipated, I shall not take upon me to determine; it is sufficient for the present purpose to indicate the means of restraining those alarming sensations which, when aggravated by imagination, are apt to depress the spirits, and, according to the general opinion, to reduce the human body to that relaxed, inhaling state peculiarly susceptible of contagion.”

As to other modes of precaution, the Doctor advises that such as are about the sick “should guard the mouth and nostrils with vinegar, avoid drawing in the breath while close to the bed side, or swallowing their spittle while in the infected chamber. Before they approach the bed in order to examine the eruptions, the bed-clothes ought to be removed, to give time for the dispersion of a confined steam which immediately discovers itself to the senses; and it will be advisable to dip the hands in vinegar before examining the parts. On coming out of the chamber it will also be proper to rinse the mouth, and wash the hands, with vinegar, plain or camphorated.” He advises also to fumigate the clothes with nitre, sulphur, and juniper berries, burnt on a red-hot iron.

“Upon returning home it may be advisable to shift clothes immediately, hanging those taken off upon lines in a small chamber, to be again smoked, and afterwards aired. The mouth and hands ought once more to be well washed, and the hair might be fumigated with a little nitre and sulphur, by means of a pipe, so as not to incommode the lungs.”

One other mode of prevention, not of the disease, but of incurring danger from it, is inoculation. This is greatly recommended by Baron Ash above mentioned, and not only for the plague among the human species, but for that among cattle, which frequently destroys great numbers of those necessary animals. The case of Mathias Degio related p. [272], shows the practicability and the safety of it. The only solid objection that can be made to it is, that those who have once had the plague are not secure from having it a second time, or oftener. Yet, if we consider the extreme fatality of the disease when it attacks in the natural way, and that the number of those who have the plague only once is much greater than of those who relapse, this practice will certainly be found to merit consideration, and, unless some objection to it be discovered greater than any that has yet appeared, seems likely to be advantageous to the human race in general.