Medical Jurisprudence, Volume 1 (of 3)

by John Ayrton Paris; J. S. M. Fonblanque

OF QUARANTINE, LAZARETTOS, AND OTHER ESTABLISHMENTS OF PLAGUE POLICE.

The histories of different ages and countries furnish numerous records of the occasional prevalence of certain diseases, generally of the febrile class, which at one period have occasioned the most destructive mortality, while at others, they have assumed so mild a form as to have affected only few, and to have destroyed scarcely any of the population. Such diseases, when they attack a great number of individuals about the same time, or in rapid succession, are very properly designated by the term Epidemic (from επὶ upon and δημος the people) and whenever their course is attended with considerable mortality, they are moreover said to be Pestilential. No fact in the history of medicine has been the subject of more general and anxious enquiry, or of more keen controversy, than that of the origin of Epidemic diseases, and of the immediate cause of their propagation and decline; and although the field has been industriously explored by the most able and experienced philosophers and physicians, the subject still remains involved in considerable obscurity; indeed, such different and even opposite views have been entertained upon the question, that writers have not even agreed upon the exact import of the terms employed in their descriptions, but each author appears to have acknowledged a latitude of acceptation according to the particular theory which he has been anxious to support. The term Epidemic ought in strictness to signify a disease which, as we have before stated, attacks numbers at or nearly the same time, without any reference to the cause from which it may have originated, or be diffused; but this construction has been considerably limited by many writers, who have applied it, exclusively, to denote those maladies which derive their origin solely from a noxious state of the atmosphere, and which are incapable of being communicated from one person to another; distinguishing diseases of the latter kind by the epithet Contagious.[^[170]]

A similar ambiguity involves the terms Contagion and Infection, which are regarded by many authors as synonymous and convertible expressions, signifying the matter or medium by which certain diseases are communicated from one individual to another; while others, on the contrary, confine the term Contagion, as its etymology would suggest (con and tango) to the communication of those diseases, which can only be transferred by actual contact of the sick, or of the palpable matter from their bodies; and apply the term Infection to the communication of those other diseases which spread by means of invisible effluvia. Now we would observe in the first place, that according to the most correct rules of philology, the import of words is not necessarily to be deduced from their derivation, but frequently to be either assumed conventionally according to a definition, or to be adhered to in the sense affixed to it by established usage; in the next place, the distinction which the etymologist would thus establish between the terms Contagion and Infection is not accurate, for in every case of infection, there is an actual contact of morbific matter, whether visible or not, and some diseases, as the Small-pox, are communicated both by palpable matter and by imperceptible effluvia.[^[171]] Our best writers[^[172]] have therefore agreed to consider the word Contagion as expressing the morbid poison, or the means of transferring a disease, and Infection as denoting the operation of the poison, or the act of communication of the disease. Dr. Hancock[^[173]] very justly observes that in almost all the best Latin writers on medicine, Contagium, and Contagio are the only words used to denote the effluvia, or emanations arising in disease, which are capable of infecting the sound, whether mediately by the air, or by infected goods called Fomites, or immediately by the touch: to limit contagion therefore to the propagation of disease by contact only, would be to disallow the more comprehensive use of the term in our best authors.

Those diseases which occur among the inhabitants of a particular region or place, are said to be Endemic, or Endemial; thus Intermittent, and Remittent fevers, which are occasioned by the miasmata of marshy grounds are Endemic in low countries: the Goitre, or bronchocele, connected with that peculiar intellectual imbecility which characterises the Cretin, is Endemic among the Alps; in these instances, some local cause obviously exists which produces the disease in the respective districts: the disease therefore belongs to the districts, and affects those that reside there, but extends no farther; and hence the distinction between Endemic and Epidemic diseases is obvious and important.

Having thus determined the value and signification of the terms, as used by different authors, and which must necessarily be introduced on the present occasion, we come to the consideration of that momentous question, which has excited so keen an interest in the political, mercantile, and medical circles of the present age, and which has been farther heightened by the late reference of the subject to the Legislature—Whether Epidemical diseases be ever propagated by Contagion?——It is impossible to imagine a question of deeper importance; it not only involves the general safety of mankind, but is intimately connected with the commercial welfare of nations; for, as it has been truly observed, if these diseases be not contagious, Quarantine laws are absurd, and commerce needlessly burthened: the establishment of lines of circumvallation, guarded by cordons of troops, and the appointment of armed police to confine the diseased to their habitations, among their yet uninjured friends and relatives, are perverse and barbarous regulations, and the fears thus unnecessarily induced are as dangerous to the community as they are pernicious in their effects to the common feelings of humanity. But, on the other hand, if the doctrine be true to the extent our most accurate observers have deliberately reported, municipal restraints cannot be too rigidly enforced, nor can the conduct of those speculative theorists be too severely reprehended, who, by lulling the ignorant and unwary into false notions of security, not only deprive them of the obvious means of safety, but render them even the intermediate agents of disease and death, to their families and neighbours.

The term Plague has been applied to various epidemical diseases attended with great mortality; and we find in the Hebrew, Arabic, Greek, Latin, and in all the other ancient languages with which we are acquainted, words having a corresponding import, and signifying, generally, an extensive and destroying malady. It appears, however, that these raging epidemics have consisted of different maladies in different instances, having been sometimes the Remittent Fever originating from marsh effluvia, and sometimes the true Plague, modified by circumstances and situations: even in our own times some doubt has existed respecting the true nature of the different pestilences which have raged in Europe.[^[174]] The term Plague is now more correctly limited in its acceptation, and it is exclusively understood to denote “a contagious and malignant fever, which is accompanied by buboes and carbuncles.”[^[175]] As the nature of maladies of high degree virtually includes that of all minor affections, the Plague, in its relations to the doctrine of Contagion, may on this occasion be considered as the representative of every species of Typhus; while for the same reason the Pestilential Epidemic which is generally known by the name of the Yellow Fever may be regarded as including in its history all the subordinate varieties of Bilious Remittents.

It is scarcely necessary to observe that it would be as foreign to the object of this work, as incompatible with the plan of its execution, to enter into any historical details upon the subject of Pestilence, or upon the controversies which have been carried on respecting the manner in which Epidemics are propagated; nor is such a review now required to complete the medical literature of the subject; for Dr. Hancock[^[176]] has lately supplied the chasm by a very able critical examination of the principal writers which have appeared at different times on the subject of Epidemic and Pestilential diseases, and to this work we beg to direct the reader’s attention, although as medical Jurists we are not disposed to concur in those half measures of Quarantine which the result of his researches might incline some to adopt. We may state in general terms, that the concurrent testimony of different ages and countries sanctions the opinion that Plague arises from specific contagion—is communicated immediately by contact,[^[177]] or mediately by the agency of infected goods[^[178]] (Fomites); and that its progress may be arrested by a vigilant system of Police, cutting off every communication between the infected and the healthy. The contagious nature of Plague has however been denied, and many thousand lives have paid the forfeit of the delusion; it was thus during the Plague of Marseilles in 1720, that in consequence of the physicians in Paris having decided against its contagious nature, a plan, in conformity with that opinion was adopted in the treatment of the sick, and Sixty Thousand people fell victims to the disease in the space of seven months. A similar prepossession induced the faculty of Sicily to declare the Plague which ravaged Messina in 1743, not to be contagious, but the loss of Forty-three Thousand lives gave a practical refutation to the hypothesis.

In our own times, a work characterised by singular arrogance and sophistry, has appeared from the pen of Dr. Charles Maclean,[^[179]] the object of which is to shew that “a belief in the contagious nature of the Plague constitutes one of the most destructive errors in the whole circle of human opinions;” in the very commencement of this work he betrays an ignorance which is not uncommonly associated with that species of unbecoming confidence, which so strikingly characterises the writings of this author. “It is unequivocally ascertained,” says he, “that the doctrine of contagion, as the cause of epidemic diseases, was unknown to the ancient physicians; by whom these maladies were expressly attributed to the air:” and he then proceeds to state that the prevalent notion of contagion being an inherent quality of pestilential fever, is derived from a Popish plot of the sixteenth century; an assertion which has not even the merit of originality[^[180]]. Hippocrates and Celsus do not certainly take any notice of the subject of contagion; but Aristotle, Thucydides, Livy, Virgil, Lucretius, Ovid, Galen, and Arctæus all contain passages which prove most unequivocally their belief in the contagious nature of Epidemics; the limits of this work will not allow us to be prodigal in illustrations, we must therefore refer the reader to a very interesting memoir upon the subject by Dr. Yeats. (Journal of Science and the Arts.) With respect to the work of Dr. Maclean we would further observe, that he has artfully brought together all those facts which are calculated to afford any support to his doctrine, while he has so ingeniously tortured those that make against it, as to disguise their force and true bearings. Mr. Tully[^[181]] has lately furnished the public with some striking instances of the total want of candour with which Dr. Maclean pursued his researches, but the fact is that he determined on the Plague being non-contagious long before he ever visited those countries where it prevails; and hence all the advantages which he possessed, and the opportunities of investigation which his residence in the Levant afforded, have not contributed one fact to the elucidation of the subject, but have, on the contrary, thrown additional obstacles in the path of the honest inquirer.—What can be the organization of that man’s mind, who goes into the Greek Pest Hospital at Constantinople, and, according to his own statement, is attacked on the fifth day after he entered it, with the Plague, and yet continues to assert that the malady is non-contagious?

To Dr. Maclean, however, the medical world are certainly greatly indebted, for had not his Researches been published, it is more than probable that the question of Contagion would not have received the many able elucidations which the experience and science of this country has since afforded it:[^[182]] nor would an opportunity have occurred by which the most eminent physicians, and those practically acquainted with the malady, could have delivered a viva voce opinion before a Committee of the House of Commons.[^[183]] It may be thought extraordinary that a work, so unphilosophical as that to which we allude, should have created so strong a public sensation; but when we consider the eagerness with which mankind seize any circumstance, however weak, that points towards the removal of burdens under which they are suffering, we shall cease to feel surprised that a work of such bold, and promising assertions, should have soon found its way, through commercial channels, to the table of the Privy Council; nor is it strange that government, naturally anxious to relieve commerce of unnecessary burdens, should have instituted an inquiry to ascertain whether Quarantine regulations were actually necessary, and how far they might be relaxed with safety to the country. A report was accordingly requested from the College of Physicians; who, in order to meet the wishes of the government, appointed a committee from their own body to undertake the requisite examination; it is almost unnecessary to state the conclusion at which they arrived; their report is virtually included in that of the Committee of the House of Commons (for which see Appendix, p. 185.) With respect to the contagious nature of those fevers which have lately committed their ravages in these dominions, especially in Ireland, the proofs appear to be so satisfactory and evident, that we question the stability of that man’s mind who can doubt, and still more who can deny it. But although the question of contagion as relating to certain epidemics appears to be firmly established, we are by no means insensible to the difficulties and anomalies with which the subject is embarrassed; several of which are so important in relation to Police legislation, that we feel it necessary to offer a few observations upon each of the following questions, and which appear to include all the leading points of controversy.

I. Are all Epidemic Fevers contagious?

II. Does the matter of Contagion require the aid of a certain state of the air (Pestilential constitution) to give effect to its powers, and propagation; and to what causes is the decline and cessation of a contagious pestilence to be attributed?

III. Can filth and animal putrefaction generate contagion?

IV. Can a Fever produced by fatigue, unwholesome food, &c. be rendered contagious in its career by animal filth, impure air, &c.

I. Are all Epidemic Fevers contagious?

It has been maintained by Cleghorn[^[184]], Hamilton[^[185]], Clark[^[186]], and Fordyce[^[187]], that all fevers are naturally contagious; a position which, if less mischievous in its tendency, is equally erroneous in principle, as that which rejects the doctrine of contagion altogether. It is most probable that none of those fevers which are produced by marsh miasmata are ever propagated from one individual to another by contagion; ample evidence of this truth is afforded by the writings of Dr. James Lind[^[188]], where it appears that the most malignant and fatal species of fever have been contracted on shore, but which had never been communicated to the ship’s company. Dr. Trotter[^[189]] also says, “in a voyage down the coast of Guinea, in the Assistance, in the year 1762, we had scarcely a man indisposed. We wooded and watered at the island of St. Thomas, and with a view to expedition, a tent was erected on shore, in which the people employed on these services were lodged during the night. On the middle passage every man who slept on shore died, and the rest of the ship’s company remained remarkably healthy.” For similar facts see Medical Observations and Inquiries, vol. iv, p. 156; Clarke’s Observations on the Diseases which prevail in long Voyages to Hot Countries, p. 124; and Dr. Robertson’s Meterological and Physical Observations, &c. 4to, p. 32, 33, and 98. And in connection with this subject, it becomes our duty to offer a few remarks upon the nature of that peculiar Epidemic, called The Yellow Fever.[^[190]] Its doubtful affinity with bilious intermittent and remittent fevers, has furnished a subject for keen controversy; and while its contagious quality has been pertinaciously maintained by one set of Physicians,[^[191]] it has been as warmly denied by others. The malady has raged repeatedly as an Epidemic in the United States, and was considered for some time as Endemic to that country. “The interests of humanity,” says Dr. Rush,[^[192]] “are deeply concerned in the admission of the rare and feeble contagion of the yellow fever, and Philadelphia must admit the unwelcome truth sooner or later that the yellow fever is engendered in her own bowels; or she must renounce her character for knowledge and policy, and perhaps with it, her existence, as a commercial city.” In the year 1811, one of the most acute and learned works[^[193]] that has graced the literary annals of our country, appeared from the pen of Dr. Bancroft, in order to prove that the yellow fever is no other than an aggravated form of that multifarious disease, which is well known to result from the action of those exhalations commonly denominated marsh miasmata, and that, like all fevers from that cause, it possesses no contagious quality; but he adds, “it is indeed probable that the miasmata of particular towns, mostly either sea-ports, or accessible to shipping, in which the aggravated forms of yellow fever have almost exclusively prevailed in the West Indies, the United States of America, and the Southern parts of Europe, differ from the common exhalations of marshes, in quality, as well as degrees of concentration: but whether this difference be occasioned merely by the greater heat which, at such times, commonly exists in these towns than in the surrounding country, and which may exalt the powers of such miasmata, by perfecting the decompositions which produce them, or whether it be partly the result of a difference in the organized matters decomposed by that excessive temperature, I am unable to determine.” We must refer the reader to Dr. Bancroft’s[^[194]] work for farther information upon the subject; and we have little doubt but that, after an attentive consideration of the rich store of facts and observations which this author has presented to us, he will be led to a conclusion in favour of the general non-contagious nature of this malady, although we by no means intend to deny that it never assumes the character of a contagious Epidemic. Sir Gilbert Blane, whose testimony upon this subject must necessarily have great weight, has made the following observations. “In that district of the globe in which are situated the islands called the Great and Little Antilles, also in the continental regions round the gulph of Mexico, and along the coast of South America, the fevers which prevail there have certain symptoms peculiar to themselves, and not occurring in any other part of the globe, except when carried from thence, which they sometimes have been, particularly to the sea-port towns of North America, and the South of Europe.

The peculiarities alluded to, consist in a universal yellowness of the skin, and the vomiting of a dark coloured fluid, resembling the grounds of coffee.

Sir Gilbert Blane considers, that the yellow fever may proceed from three remote causes, very distinct in their nature. The First, is that which consists in the exhalations of the soil, such as produce the endemic fevers in other countries and climates, and prevailing chiefly in autumn. The Second, is that which consists in foul air engendered on board of ships on long voyages, in circumstances of personal filth, and want of ventilation, frequently combined with hardships and privations, and is the same with those stagnated and corrupted effluvia of the living human body, which produce typhus fever. The Third cause is that in which there is no suspicion of foul air, either from the soil, or from the living human body, but merely from circumstances of intemperance, fatigue, and insolation, affecting chiefly, and almost exclusively, new comers from temperate and cold climates.[^[195]] The first of these, he says, may be distinguished by the appellation of the Endemic; the second, by that of the Pestilential, Malignant, or Typhus Icterodes; the third, by that of Sporadic.[^[196]] And Sir Gilbert adds, that it has been for want of making this distinction, and from classing all these three under one head, that the endless and acrimonious controversies regarding contagion have arisen. There is not the least suspicion in any rational mind, that the endemic and sporadic species are contagious, this is only alleged with regard to the pestilential or typhus species; but it may be asked what proof there is that this last is specifically different from the other two? To this Sir Gilbert answers, that it is a matter of history; that besides the endemic and sporadic fevers prevailing at all times in the above-mentioned regions, there has occurred at various intervals of time, a raging epidemic,[^[197]] which could be traced to the arrival of a ship or ships in the circumstances above recited, and at a season in which the ordinary malignant fevers do not prevail. To those engaged in researches upon this obscure subject we would farther recommend the perusal of a work lately published by that veteran in the cause, Dr. Jackson, on the subject of the Andalusian Fevers[^[198]]; in which he examines the evidence in support of the supposed introduction of the yellow fever into Spain, and of its real or supposed propagation by contagion. The importation of the disease from a foreign country is credited by the authorities and mass of people in Spain, though the author thinks it has never been proved by evidence, or even brought to reasonable probability; the events of the year 1820 stripping the assumption of every claim to credence, as no attempt has been made to trace the disease, in that instance, to foreign origin. The belief universally obtains through Spain, that the disease is personally contagious; that is, capable of propagation from individual to individual, by contact or proximity; Dr. Jackson, however, considers that this opinion, confidently as it is maintained, is invalidated by authentic facts and records; but we must proceed to the consideration of our second problem, viz:

II. Does the matter of Contagion require the aid of a certain state of the air, (“Pestilential Constitution of the atmosphere.”) to give effect to its powers, and propagation; and to what causes are the decline and cessation of a contagious Pestilence to be attributed?

It was laid down as a fundamental principle by Dr. Mead, that a “corrupt” state of the air is indispensable to the diffusion of a plague; and although we are at this day unable to ascertain in what this vitiated state of the air consists, yet there are too many stubborn facts on record to allow us to deny, or even to doubt the necessity of its existence for the propagation of a contagious fever. How are we otherwise to explain the fact of a malady like the plague, which, although it shall never be entirely absent from a city, rages only epidemically and fatally at particular times? Thus it is collected from the bills of mortality of London, that, although there were but four great plagues in this metropolis during the seventeenth century, viz. the years 1603, 1625, 1636, and 1665, (in the two first of which about 35,000, and in the last 68,000 died) yet that there were but three years, from the commencement of the bills of mortality in 1603 until 1670, which were entirely free from the plague.[^[199]] Diemerbroeck also remarks, that whenever the plague has been excited out of its proper season it has not spread; a fact corroborated by Russel and Hodges.[^[200]] It seems probable that a particular state of the atmosphere, in its relation to temperature and humidity, is one of the conditions, subordinate perhaps, of this “pestilential constitution.” Dr. Russel has observed that, in winter, when infected persons have come to places about Aleppo, some of whom have died of the disease in the families where they lodged, the distemper was not by such means propagated. Dr. Pugnet says that the susceptibility of a person for the contagion of plague is greatly increased by a moderately warm and moist atmosphere; and Dr. Bancroft[^[201]] has adduced some observations made by himself in proof of the influence of atmospheric heat and cold, in both their extremes, in rendering the contagion dormant. The singular career which a pestilential epidemic runs, having a beginning, height, and decline, can only be explained on the idea of the pestilential constitution of the air undergoing corresponding changes; and it is probable that the return of a plague is a revival of infection that has been latent, or dormant, until a particular state of atmosphere rouses it to action.

III. Can Filth and Animal Putrefaction generate Contagion?

We have already made an allusion to some of those facts that must assist us in the solution of this problem, under the head of Public Health (see page [98].) “The putrefaction of animal matter,” says Dr. Bancroft,[^[202]] “is but a natural separation of organized bodies, previously held together by animal or vegetable life, by which there can be no chance, nor even possibility of thus generating any thing so wonderful, and so immutable as contagion; which resembling animals and vegetables in the faculty of propagating itself, must, like them, have been the original work of our common creator, and must have been continued in existence by the energies of a living principle, exerted successively in the different bodies, through which it has been transmitted from one generation to another; as well might we revive the forever exploded doctrine of equivocal generation, and believe, as formerly, that insects and reptiles are the offsprings of mere corruption, as to believe that a substance so analogous to them, in that most mysterious and essential function of self-propagation, could originate from that cause, or from any operation of chemical agencies alone.” We are not disposed to believe that the specific contagion of typhus can thus be directly generated, but may not typhus be excited by causes independent of contagion, and having been once generated become contagious? If, says Dr. O’Brien, the opinion that contagion is the only source of typhus be true, we are at once reduced to the necessity of supposing that all contagious diseases were derived from Adam himself. It is an indubitable fact that the plague has always first appeared, and established its head quarters, in the filthiest parts of crowded, ill constructed, and large cities. Blackmore remarks that the impurity and filth, connected with the galleys and slaves at Marseilles, filled the air with offensive smells easily perceivable by those who passed along the adjoining shore; and in 1720 the plague broke out there; in London, Dr. Heberden also observes, that the plagues of 1626 and 1636 broke out at Whitechapel, a part of the town which abounded with poor, and with slaughter-houses. The importance of cleanliness is also shewn by the exemption of Oxford[^[203]] and other places from pestilential diseases, as recorded by different authorities, in consequence of regulations for ensuring it; while the late dreadful increase of contagious fever in Cork sufficiently demonstrates the evils which arise from deficient ventilation and accumulated filth, and to which causes Dr. Barry, in his report, ascribes the awful afflictions to which we allude. Erasmus, in a letter to Franciscus, Cardinal Wolsey’s physician, ascribes the sweating sickness, which was a species of plague, in a great measure to the incommodious form, and bad exposition of their houses, to the filthiness of the streets, and to the sluttishness within doors.[^[204]] That particular species of typhus, which is called from its origin the Jail Fever, is evidently the offspring of filth and deficient ventilation. The Lord Chancellor Bacon has made the following observation upon this subject: “The most pernicious infection next to the plague is the smell of the jail, where prisoners have been long, close, and nastily kept; whereof we have had, in our time, experience twice or thrice, when both the judges that sat upon the jail, and numbers of those who attended the business, or were present, sickened upon it, and died.”[^[205]] Dr. Bancroft, who has dwelt very fully upon the subject of jail fever,[^[206]] considers it as a species of typhus, the contagious essence of which is not generated, but merely lighted up by the filth of prisons.

IV. Can a Fever produced by fatigue, unwholsome food, &c. be rendered contagious in its career by animal filth, impure air, &c.?

We have no hesitation in answering this question in the affirmative, and our opinion will receive ample support from the history of the different epidemic fevers which have raged in our own times. Dr. Prichard[^[207]] is persuaded that a contagious fever may have a spontaneous origin, that is, that the ordinary sources of derangement may occasion such a kind of disordered action, that the excretions or effluvia from the subject of it shall, under certain circumstances, produce a specific effect upon another. The truth of this position is amply confirmed by comparing the different phenomena which, according to Dr. Prichard,[^[207]] are displayed by the epidemic in St. Peter’s Hospital, and the Bristol Infirmary; in the former house the medical wards are very small, having been originally destined, not for the accommodation of the sick, but for the abode of paupers; in consequence of which it became necessary to place the beds very near to each other, and to crowd the rooms with patients; under these circumstances the disease was manifestly contagious, while in the well-ventilated Bristol Infirmary, notwithstanding the indiscriminate manner in which the patients with fever were scattered through the wards, not a single instance occurred of its propagation. The Dublin Reports of Drs. Grattan[^[208]] and Crampton[^[209]] are equally satisfactory upon this question; atmospheric vicissitudes, intemperance, fatigue, suppressed perspiration, the depressing passions, &c. when excessive, will induce fever; and under these circumstances, the accumulation of animal effluvia, in filthy, crowded, and ill-ventilated dwellings, will generate contagion, which of course accelerates the march of the epidemic.

Having thus, as briefly as the nature of the subject would allow, enumerated the several questions to which the doctrine of contagion has given rise, we now proceed to the consideration of those legislative enactments, by which different nations are enabled to ward off the calamities of Plague. It is generally admitted, that the plague has not originated in this country; and therefore, from its insular situation, the infection can only be introduced through the medium of ships. Egypt, the Levant, and other parts of the Mediterranean are seldom free from it, and hence it is chiefly through the medium of the commerce with these countries that the importation of the contagion is to be apprehended. To guard against this danger, the different governments require all ships sailing from any of these parts, to bring certificates from the magistracy of the port they last came from, declaring their country free from any contagious distemper: these are called “Bills of Health,” and are distinguished as clean or foul, as the place they come from may be healthy or infected. On the production of these bills it is determined by the Guardians of Health (in England, Custom-house officers) whether the vessel shall be permitted to trade or communicate, or, as it is technically expressed, be permitted to pratique till she has performed a Quarantine[^[210]] of as many days as the superintendants may in their judgment or caprice be pleased to direct. A period of forty days (hence the term Quarantine) has been generally fixed upon as the maximum of this seclusion, on the expiration of which it is customary abroad for physicians, accompanied by some members of the board of health, who are frequently merchants of the place, to examine the ship’s crew; and strict search is made on board, by persons appointed to see whether the number of sailors and passengers corresponds with those mentioned in the bills of health, and if any difference appears it will be difficult in any country to obtain admission to pratique, or at least it will be necessary to perform a full quarantine from the time of such detection.

Such commodities however as are deemed incapable of retaining or communicating the infectious taint, as corn, &c. are permitted to be landed immediately by the mariners themselves, at proper places provided for that purpose, which are generally called Lazarettos, some of which in the principal ports of the Mediterranean are of very considerable extent, and as to division and appropriation appear so well calculated for their intended purposes as to be worthy of imitation. The best praise of their regulation is indeed to be found in their success; for though twelve months never elapse but that the plague rages in some part of the Levant and of the coasts of Barbary, the infection has seldom reached the coasts of Italy, France, or Spain. Terrible exceptions may be adduced to this remark, yet they may generally be traced to some clandestine violation of the Quarantine laws, rather than to their imperfect execution, as in the recent instance of the plague[^[211]] at Malta in 1813, when the cupidity of a poor cobler in smuggling some materials from a Greek or Turkish vessel in the harbour of Valetta, introduced the pest into the island, to which he and his family fell the first victims.

The objections to the Quarantine laws, as executed in the Mediterranean, arise more from the indiscriminate and vexatious application of them to cases for which they were not provided, than from any general relaxation or want of vigilance in the officers appointed to enforce them: occasionally indeed the courtesy of these gentlemen will deem a governor or wealthy noble to be incapable of communicating infection, though from the most suspected port, while a whole fleet of merchantmen, arriving with clean bills from the Atlantic, will be detained for some weeks, ex abundanti cautela, without admission to pratique; from such instances travellers who have been annoyed, and merchants who have been injured, have imbibed a very general prejudice against these laws; nor have they wanted learned authorities to contend with them for their abolition, on the grounds of their abstract inutility in preventing infection (admitting the contagious nature of the disease which some have denied), and the injurious tendency to the general interests of commerce.

We have drawn the readers attention to the regulations of the Mediterranean, because we are convinced that if there be any value in the system it must be made complete in all its parts, and ought to be as much the subject of international as of local legislation; unless all countries, and more particularly those in more immediate contact or communication with the infected regions, concur in the restrictions, it will be vain to enforce them in Great Britain. In the instance of the plague, the want of precaution among the Mahomedans allows the disorder to spread from Constantinople to every part of Greece, from Smyrna to the whole African coast of the Mediterranean, while the European shores are free from its calamitous progress.

By the statute 26 Geo. 2, all vessels, persons, and goods, coming from places from whence the plague may be brought, were subject to perform Quarantine in such places as shall be appointed by his Majesty in Council,[^[212]] and notified by proclamation in the London Gazette; this and all other acts relating to Quarantine were repealed by the 45th Geo. 3, c. 10, by which these laws were more extensively regulated, certain duties are levied for the maintenance of the system, and until they are paid according to the tonnage (see 26 Geo. 3, c. 60) of the vessel, she cannot be permitted to clear inwards; it is enacted that all ships and vessels, as well his Majesty’s ships of war as all others, coming from or having touched at any place, from whence his Majesty in Council shall have adjudged and declared it probable that the plague or any other infectious disease highly dangerous to the health of his Majesty’s subjects, may be brought; and all ships, vessels, or boats, which may have received any person, goods, letters, &c. from such vessels, &c. shall be considered liable to Quarantine within the meaning of the Act, and to any order of the King in Council, published by Proclamation in the London Gazette. “And whereas certain goods and merchandize are more especially liable to retain infection, and may be brought from places infected into other countries, and from thence imported into Great Britain or the islands aforesaid,” his Majesty is enabled to make special orders as to any particular goods or vessels liable to any alarming or suspicious circumstances. In cases of emergency, the privy council, or any three of them, may make such orders as they shall think necessary; and this not only as to ships and merchandize, but generally in case of infectious disease appearing in Great Britain. This clause deserves very particular attention, for though we have been happily free from any very severe visitation of contagious disease, yet there are instances where local regulations would have been highly expedient, at least to the extent of directing the destruction of the clothes and beddings of persons dying of highly infectious disorders, and securing the purification, fumigation, and ventilation of their rooms or houses; some doubt may indeed arise whether the words of the clause are sufficiently strong to warrant such measures, “and in case of any infectious disease or distemper appearing or breaking out in Great Britain or the islands aforesaid, to make such orders, and give such directions, in order to cut off all communication between any persons infected with any such disease or distemper and the rest of his Majesty’s subjects, as shall appear to the said Lords of his Majesty’s privy council, or any three or more of them, to be necessary or expedient;” nothing is here said of goods.

The Quarantine Laws may also from time to time be mitigated if necessary by the Privy Council. Sec. 12.

Ships liable to quarantine must make signals on meeting other ships within four leagues of the United Kingdoms, or the Islands of Guernsey, &c. under penalty of £200. Sec. 14.[^[213]]

Masters of vessels coming from abroad must give an account to the pilot of the places at which they have laden or touched. Sec. 16. And must answer inquiries made by an appointed officer of the customs, on oath or not as he may be required. Sec. 18.

Pilots are bound to take vessels liable to quarantine into appointed places. Sec. 17. And if the vessel arrive at any other place, she may be forced to repair to that appointed. Sec. 19.

Any Master having touched at infected places, &c. and omitting to disclose the same, or to hoist prescribed signals,[^[214]] shall be guilty of felony without clergy. Sec. 19.

Commanders must deliver up bills of health, manifest log book and journal, under penalty of £100. Sec. 20.

Masters quitting vessels or permitting others to quit them, or for not conveying vessels to the appointed places, subject to a penalty of £500. Persons leaving vessels before they are discharged are subject to a penalty of £200, and six months imprisonment; and any person may use necessary force to compel them to return on board, on their attempting to quit such vessel. Sec. 21.

A penalty of £200 on improperly landing goods from a vessel which has performed quarantine in any foreign Lazaret. Sec. 22.

Disobedience or refractory behaviour in persons under or liable to quarantine, or persons having intercourse with them, may be punished by force, and persons escaping from, or refusing to repair to, a lazaret vessel or place appointed, are guilty of felony, without benefit of clergy. Sec. 23. Persons so escaping may be seized by any one for the purpose of being carried before a Justice of the Peace, who by warrant may direct their conveyance to the vessel or lazaret from which they have escaped, or confine them in such place of custody, (not being any public jail,) and under such restrictions as to having any communication with any other persons, as may in the discretion of such Justice of the Peace or Magistrate, (calling to his aid, if he shall see fit, any Medical person,) appear to be proper. Sec. 25.

Goods liable to quarantine shall be opened and aired, as directed by order in council. Sec. 29, 31.

Forging certificates is felony without benefit of clergy. Sec. 30.

In case it shall happen that any part of Great Britain, Ireland, or the Isles of Guernsey, Jersey, Alderney, Sark or Man, France, Spain, or Portugal, or the Low Countries, shall at any time be infected with the plague or any other such infectious disease or distemper as aforesaid, it shall be lawful for his Majesty to prohibit and restrain all small boats and vessels under twenty tons, from sailing out of any port until security be first given by the Master in a bond of three hundred pounds, conditioned not to touch at such places; penalty for sailing without giving such security, forfeiture and twenty pounds per man. Sec. 32.

Publication in the London Gazette to be sufficient notice. Sec. 33.

Offences, not being felonies or subject to specific punishments, may be determined before two Justices, who may fine not exceeding fifty pounds, or imprison not exceeding three months. Sec. 38. Offences may be tried in any county. Sec. 42. The general issue may be pleaded to actions brought against persons for any thing done in execution of this act, which action must be commenced within two months, and treble cost shall be recovered on judgment for the defendant. Sec. 43.

For other points see the act itself, which is further extended by the 44th Geo. 3. c. 98; by this act the signal for the plague being actually on board, is appointed to be a flag of eight breadths, divided quarterly of black and yellow by day and two large lanthorns one over the other at the main-topmast-head by night. Sec. 1.

The Privy Council may order ships coming from America or the West Indies when the Yellow Fever, &c. prevails there, to go to certain places without being liable to quarantine, unless it shall be afterwards specially ordered. Sec. 6. For other regulations, see the Stat.

In Ireland the system of quarantine is regulated by the 40th Geo. 3. c. 79, the general outline of which is the same as in the English acts, but with some additional severity towards health officers neglecting their duty, the infliction of which may occasionally be necessary.[^[215]]

It now only remains for us to offer a few remarks upon the practical question to which all our preceeding researches have naturally tended: Whether the regulations of Quarantine might not be relaxed and modified without increasing the hazard of infection? Before this subject can be seriously entertained, or any concessions safely granted in favour of the mercantile interests, it must be upon the perfect understanding, and unreserved admission, that the maladies against which they are directed, are in the most extensive signification of the term, Contagious. No claim to indulgence or exemption can be admitted, on the ground of professional scepticism, as it relates to the subject of infection, for notwithstanding the remarks of Dr. Adams,[^[216]] and the male sedula nutrix of Ovid, of which he so sarcastically reminds us, we are still unphilosophical enough to maintain that “one cannot be too cautious.”

To those who consider our long immunity from plague a sufficient guarantee for our future security, it may be observed, that although the Island of Malta is, from many causes, much more exposed to this infection than Great Britain, yet it was free from plague for one hundred and thirty-eight years, a period which we must remember has been exceeded in our own case by only sixteen years; at the same time we are ready to admit with a periodical writer, that Quarantine regulations might be amended, and rendered less inconvenient to commerce; they might for instance be modified as to the required period of segregation. Dr. Harrison, in his examination before the select committee of the house, stated a fact in connection with this subject, that deserves particular notice: that while passengers, who have made a long voyage, are liable to perform quarantine, couriers, who come in the least possible time, are not under such restrictions.