In relation to their effects upon the public health, the arrangement and cleansing of privies deserve some notice in this place. It has been long admitted that the effluvia which issue from these receptacles of human ordure are highly deleterious, and have been known to occasion a species of ophthalmia, diarrhæa, and dysentery, while in a more concentrated form these emanations have proved suddenly fatal,[[166]] by producing an affection named by the French Nosologists[[167]] the Plomb, or the Asphyxia of privies. M. Dupuytren has given us many particulars respecting this affection; sometimes the patients are strongly asphyxied, and death takes place in a very short period; at others, the symptoms are less intense, and if the patients be carried into the open air, after a short interval, they make deep inspirations, and the breathing is gradually restored, although it continues laborious; the motion of the heart becomes perceptible, nevertheless the pulse is weak and small; the digestive and loco-motive apparatus have lost their contractile force; the functions of the brain are suspended; and if the patient finally recovers, he is a long time in re-establishing his strength. An emetic appears to be the remedy upon which the nightmen rely for relief.
The above observations are sufficient to shew the propriety of placing these establishments under police regulations, especially where the deleterious influence of their emanations are more decidedly remarkable, as in hospitals, prisons, and barracks. The governments of different countries have sought to prevent the evil, by various laws, edicts, and ordinances.[[168]]
In this country, we apprehend their supervision belongs to the very ancient and extensive jurisdiction of the Commissioners of Sewers,[[169]] who although not engaged like the Œdiles of ancient Rome, in superintending magnificent aqueducts, are occupied in directing the far more stupendous and wonderful works which extend beneath the foundations of our mighty city, and dispense to its inhabitants the essential requisites for comfort, cleanliness, and health.
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.