The Common Nature of Epidemics, and their relation to climate and civilization

by Southwood Smith

QUARANTINE AND CONTAGION.

[From First and Second Reports on Quarantine. See Introduction. Ed.]

The object of quarantine is to prevent the introduction of epidemic diseases from one country into another, and its regulations are based on the assumption of the contagiousness of the diseases with which it deals; it being supposed that such diseases are propagated by contact, direct or indirect, of the unaffected with the affected. In accordance with this view the preventive means adopted by quarantine consist of the isolation of the sick or suspected, with whom it interdicts all communication, whether by person or by articles deemed capable of transmitting contagion.

When quarantine was first established, the spread of epidemic diseases exclusively or chiefly by contagion was a doctrine universally received;[^[25]] but during the last century a change has gradually taken place in professional opinion in almost every country in Europe, particularly in France, Russia, and Austria, as well as in America, with respect at least to several of these diseases, chiefly by medical officers, who, having had the charge of the health of fleets and armies in different quarters of the globe, have been under the necessity of studying the circumstances connected with the outbreak and spread of formidable epidemics; and also by those who, having had the care of hospitals and dispensaries in large cities, have been obliged to visit the localities and abodes of the poorer classes, where these diseases are always the most prevalent.

[25]. The wide difference between the qualifications of the accomplished popular physician and the scientific investigator into the causes of epidemic sickness was strikingly exhibited in the first outbreak of Asiatic cholera in 1831, when the emergency required not merely a knowledge of the practice of medicine, but the power also of applying the philosophy of public health to the exigencies of the moment. How were these exigencies provided for?

A board, comprising all the most eminent and skilful physicians of the day, was assembled in the College of Physicians, under the presidency of Sir Henry Halford; and, after declaring, in opposition to the unanimous opinion of the physicians of Bengal, “that no measures of external precaution for preventing the introduction of the cholera morbus by a rigorous quarantine have hitherto been found effectual,” they issued the following official notification:—

“To carry into effect the separation of the sick from the healthy, it would be very expedient that one or more houses should be kept in view in each town or its neighbourhood, as places to which every case of the disease, as soon as detected, might be removed, provided the family of the afflicted person consent to such removal; and, in case of refusal, a conspicuous mark, ‘SICK,’ should be placed in front of the house, to warn persons that it is in quarantine; and even when persons with the disease shall have been removed, and the house shall have been purified, the word ‘CAUTION’ should be substituted, as denoting suspicion of the disease; and the inhabitants of such house should not be at liberty to move out or communicate with other persons until, by the authority of the local board, the mark shall have been removed.

“It is recommended that those who may fall victims to this most formidable disease should be buried in a detached ground, in the vicinity of the house that may have been selected for the reception of cholera patients. By this regulation, it is intended to confine, as much as possible, every source of infection to one spot: on the same principle, all persons who may be employed in the removal of the sick from their own houses, as well as all who may attend upon cholera patients in the capacity of nurses, should live apart from the rest of the community.

“Whenever objections arise to the removal of the sick from the healthy, or other causes exist to render such a step not advisable, the same PROSPECT OF SUCCESS IN EXTINGUISHING THE SEEDS OF THE PESTILENCE cannot be expected. Much, however, may be done, even in these difficult circumstances, by following the same principles of prudence, and by avoiding all unnecessary communication with the public out of doors: all articles of food or other necessaries required by the family should be placed in front of the house, and received by one of the inhabitants of the house after the person delivering them shall have retired. Until the time during which the contagion of cholera lies dormant in the human frame has been more minutely ascertained, it will be necessary, for the sake of perfect security, that convalescents from the disease, and those who have had any communication with them, should be kept under observation for a period of not less than twenty days.

“All intercourse with any infected town and the neighbouring country must be prevented, by the best means within the power of the magistrates, who will have to make regulations for the supply of provisions.