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.