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QUARANTINE. 



QUARANTINE. 



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The contagious diseases which quarantine regulations are intended 

 to guard against are plague and yellow-fever, and latterly cholera. We 

 are not aware whether small-pox has ever been made a subject of 

 quarantine regulations ; but this question is now of no practical 

 moment, since vaccination has supplied a preventive of small-pox far 

 more efficacious than any quarantine regulations could be. 



The most important disease, with reference to quarantine regulations, 

 is the plague of the Levant ; and in practice, quarantine regulations are 

 i>f little importance except with respect to the intercourse by land and 

 sea with Turkey, Asia Minor, and Egypt, and some other of the 

 Mi'h.immedan countries bordering on the Mediterranean. 



In the article PESTILENCE there is an explanation of the nature of 

 the disease styled plague, which, although formerly prevalent over the 

 whole of Europe, is now nearly confined to the Levant ; and it is there 

 stated that its symptoms, morbid changes, history, and mode of propa- 

 gation, bear so close a resemblance to those of the malignant typhus of 

 this country, that it is difficult to regard them otherwise than as 

 dilierent types of the same disease. It is also shown in the same article 

 that the plague of the Levant appears to be generated by the same 

 causes which generate typhus in this country, namely, filthy, crowded, 

 and ill-ventilated dwellings, want of personal cleanliness, defective 

 drainage, and insufficient or unwholesome food (Report of Dr. Arnott 

 and Dr. Kay, in the Appendix to the ' Fourth Annual Report of the 

 Poor-Law Commissioners,' p. 103), and that when the disease has been 

 generated, it may, particularly under the influence of any of the 

 causes which originally produced it, be communicated from one person 

 to another. It appears likewise that its communication from one 

 person to another is promoted not only by filth, want of ventilation, 

 Mi'l the other usual accompaniments of squalid poverty, but also by 

 certain atmospheric causes, such as a certain state of heat, moisture, 

 &c., respecting which we are as yet imperfectly informed. The plague, 

 therefore, is both epidemic and contagious ; that is to say, it may either 

 be generated by local causes, which simultaneously affect a large 

 number of the inhabitants of a country, or it may be communicated 

 directly from one person to another. Where a disease is both epidemic 

 and contagious, it is difficult to determine what proportion of the cases 

 of it are due to local causes and what proportion to contagion. The 

 analogy of typhus in this country would lead us to believe that the 

 number of cases of plague in the plague countries produced by contagion 

 is small as compared with the number produced by local causes. The 

 invisible nature of the ordinary causes of plague and other epidemic 

 diseases, and the simultaneous seizure of many persons in the same 

 district, the same street, or the same house, have naturally led to the 

 belief that the disease is in every case communicated from one person 

 to another; according to the fallacy ingeniously exposed by Dr. 

 Radcliffe, who, on being asked his opinion respecting the contagiousness 

 of epidemic diseases, answered : " If you and I are exposed to the 

 rain, we shall both get wet ; but it does not follow that we shall wet 

 one another." 



This view of the ordinary causes of plague is likewise confirmed by 

 the undoubted fact which is adverted to in the article PESTILKXCK, 

 that the poor are the chief sufferers by it, and that it prevails most in 

 the filthiest and worst quarters of towns. Dr. Patrick Russell, in 

 writing of the plague at Aleppo in 1762, makes the following remarks : 

 " The villages appeared to suffer in a singular degree, owing perhaps 

 to the structure of the huts and cottages, which are small, with few or 

 no windows, and stand crowded together. In this they resemble the 

 Keisariaa within the city, which are inhabited by the lower class of 

 people, and in which the contagion spreads also with great fury. The 

 inhabitants of the city of the same class, but who live in districts 

 where the houses are less connected, suffered more than the middling 

 class possessing more airy habitations, but less than the Keiwiriai. 

 The people of rank, or in higher offices, notwithstanding the prom 

 crmcdt frequenting their palaces, suffered least of all. Neither the 

 governors of the city, the cadi, nor the nakeeb, and very few of the 

 agas of superior rank, were themselves infected, though the plague had 

 penetrated into most of their harems, and many of the pages and other 

 attendants without doors were carried off by it. In these great harems, 

 however, the contagion seldom spreads much ; of perhaps about forty 

 i, not more than four or five being infected. ... Of all 

 people, the Jews appear to have the strongest dread of the plague, 

 a circumstance in one light rather fortunate, no place being more 

 favourable to its propagation than the habitations of the lower class of 

 that nation. The houses are small, or, if large, the different apartments 

 are crowded with different families. Many of the houses are more 

 than a story below the level of the street, in a condition half ruinous, 

 dirty in the extreme, damp, and badly aired, from the nature of the 

 situation : and the wretched inhabitant? are clothed in rags. When 

 one of them is taken ill, and known to have the plague, he is immedi- 

 ately abandoned to the care of an attendant, and the rest of the family 

 neck refuge, if possible, at some distance. The families lodged in the 

 other apartments, all not having it in their power to fly, are obliged to 

 remain, but avoid approaching the chamber of the sick, and restrain 

 their children from going into the court-yard. Thus pent up, they 

 guffcr all the inconveniences of the hot season in the midst of perpetual 

 dread, till at length, what often happens, they also are attacked with the 

 distemper. It was not without horror I descended into these dreary 

 mansions." (Russell's ' Historical Journal of the Plague," pp. 61-64.) 

 ARTS A5D SCI. DIV. VOL. VI. 



From the fact of the plague prevailing principally among the poor, 

 and rarely attacking the rich, it may be inferred either that the plague 

 is produced exclusively by the filth, crowding, and bad food to which 

 the poor are subject ; or that, if it be contagious, the contagion does 

 not in general take effect upon the inhabitants of spacious and cleanly 

 houses, who are clean in their persons, orderly in their habits, and have 

 a sufficient supply of wholesome food. We see that diseases which 

 appear to be contagious under nearly all circumstances prevail equally 

 among the rich and poor, and that none of the physical advantages 

 possessed by the rich afford any security against it. Thus, before 

 the introduction of vaccination, small-pox was equally destructive to 

 persons of all ranks in society; and the contagious diseases which 

 attack children, as measles and hooping-cough, make no distinction 

 between the children of the rich and the poor. 



There seems to us to be no reasonable doubt that the plague is con- 

 tagious in other words, that it can be communicated directly from 

 one person to another provided there be circumstances favourable to 

 its transmission. A quarantine for men may therefore be expedient 

 for countries where the spread of the plague, supposing it to be intro- 

 duced, is not improbable. The duration of this quarantine ought to 

 depend upon the time during which the disease may be latent in a 

 person who has taken it by contagion or otherwise. 



Since the plague is a peculiarly malignant and destructive fever, and 

 runs its course with a rapidity far greater than typhus, there seems a 

 fair ground for concluding that its poison would not be long latent in 

 the human body. The answers of the protomedico of Malta respecting 

 the plague in Malta of 1813, state that " the periods at which the 

 disease made its appearance in different individuals after communica- 

 tion were various. It was generally from the third to the sixth day ; 

 sometimes longer, even to the fourteenth day, but not later." (Dr. 

 Maclean, ' On Epidemic and Pestilential Diseases,' vol. ii. p. 29.) M. 

 Segur Dupeyron, the secretary of the Council of Health in France, 

 states, in his Report on Quarantine to the Minister of Commerce (May, 

 1834), that " the physicians who have made a close study of the plague 

 are pretty generally of opinion that its poison cannot be latent in the 

 human body more than fifteen days ; and the cases of plague intro- 

 duced into the lazarettoes confirm this opinion " (p. 48). We believe 

 that the cases of plague which have in recent times occurred in the 

 lazarettoes of Valletta, Marseille, and Leghorn have broken out either 

 at sea or shortly after the ship's arrival. When the line of French 

 steamers was first established, in 1837, between Marseille and the 

 Levant, it was arranged that the steamers coming from the Levant 

 should perform their quarantine at Marseille. But in consequence of 

 several cases of plague having broken out on board the steamers before 

 they could reach Marseille, the French government decided that they 

 should perform their quarantine at the nearest practicable station, 

 namely, Malta. 



It is commonly assumed that actual or nearly actual contact is 

 necessary in order to communicate the plague. " All measures against 

 the plague (says M. de Segur Dupeyron) are founded on the opinion 

 that, except within a very small distance from the body, contact alone 

 can give the disease. Consequently goods taken from ships with 

 different bills of health are often placed in the same warehouse ; and 

 physicians who have visited plague patients, without having touched 

 them, are not put in quarantine, and are permitted to go about imme- 

 diately after their visit " (p. 76). We believe the idea that actual con- 

 tact is necessary for the communication of the plague to be utterly 

 erroneous ; and we entertain no doubt that under circumstances 

 favourable to its communication, such as filth, crowding, and want 

 of ventilation, the poison of the plague might be introduced into 

 the human body by inspiration through the lungs. We account 

 for the escape of the physicians, guardians, and others, who come 

 within a short distance of the plague-patients in lazarettoes, by the 

 supposition that in the isolation, cleanliness, and good ventilation of 

 a well-managed lazaretto, the contagion of the plague is exceedingly 

 feeble. 



With respect to the quarantine of animals, it may be remarked that, 

 according to the belief commonly received in the Mediterranean, all 

 living animals are capable of communicating the plague. Accordingly 

 horses, asses, cattle, and sheep are placed in quarantine upon their 

 importation. There is, we believe, an idea among the Franks resident 

 in the plague countries, that the horse cannot communicate the poison 

 of the plague, but that it is frequently communicated by other animals, 

 especially by cats. (See Maclean, vol. i. p. 202) We suspect that there 

 is no foundation for the notion that plague can be communicated by 

 means of animals. 



Goods carried in ships or by land are subject to quarantine, accord- 

 ing as they belong to the class of susceptible or non-susceptible goods. 

 Goods which are supposed to be capable of containing and transmitting 

 the poison of the plague are called susceptible. Goods which are sup- 

 posed to be incapable of containing and transmitting the poison of the 

 plague are called non-susceptible. All animal substances, such as wool, 

 silk, and leather, and many vegetable substances, such as cotton, linen, 

 and paper, are deemed susceptible. On the other hand, wood, metals, 

 and fruits are deemed non-susceptible. In Venice an intermediate 

 class, subject to a half quarantine, is introduced between susceptible 

 and non-susceptible goods (Se'gur Dupeyron, p. 70) ; but this classifi- 

 cation appears to be peculiar to the Austrian dominions. All susceptible 



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