Page:Encyclopædia Britannica, Ninth Edition, v. 20.djvu/169

QUARANTINE 157 Europe, have been traced to other sources than the persons of the sick. Even a ship with a fever-stricken crew is dangerous, not so much because of the fever among the crew, but on account of those lurking causes of yellow fever in the ship through which the crew themselves were infected. There is an overwhelming mass of testi- mony that the real risk of importing the yellow-fever virus is always in the foul bilges of wooden ships, which had been lying in one of the endemic yellow-fever harbours. The poison is sucked in through the ship's seams ; it ferments or multiplies in her bilges, rises as miasmata to infect the hold or 'tween decks, sometimes clinging to cargo, and perhaps making no sign until the cargo is all out. Again, in temperate latitudes, the virus may be imported and do no harm, unless it meet with a tract of exceptionally hot weather, such as happened at Swansea in 1865. According to this principle, all iron ships, which have little or no bilge-water, and all clean ships whatsoever, are practically free from the risk of importing an epidemic of yellow fever, even although one or more of their passengers or crew may have developed the malady on the voyage, having come on board in the stage of its incubation. The only question of practical consequence in the case of iron steam- ships arises in connexion with the modern practice of carrying water-ballast in tanks or compartments of the ship's bottom. On the other hand a wooden ship from a yellow-fever port, espe- cially if she have open seams and had lain long in the harbour or " careenage," is not above suspicion on arriving during hot weather, even if no cases of yellow fever had occurred on board during the voyage. Such vessels have often carried the yellow-fever poison in their bilges ; in some cases they had not been suspected until it was too late, and in other cases of mysterious outbreaks they have never been suspected at all because they had no actual cases on board. The grand lesson of experience in yellow fever is that the ship's hull is infinitely more dangerous than the persons of yellow- fever patients ; and a ship's hull is dangerous only because there is a material quantity of specifically poisonous filth fermenting in the recesses of the hold. All high-class iron ships, and clean ships in general, are, for common-sense purposes, above suspicion. The persons of the sick are little likely to introduce the fever ; but foul linen, bedding, and clothes are a source of danger, especially if they have been in a box or bundle for some time (witness the slight outbreak at Madrid in 1878 on the unpacking of soldiers' baggage brought via Santander from Cuba). 3ra. Principles of Quarantine against Cholera. The peculiar dangers of cholera diffusion arise from the vomited and purged matters which are characteristic of the common type of the malady. Under certain circumstances the discharges of the sick are infective ; they are probably not infective as they come from the body ; but even minute quantities of the choleraic matters, if they have fermented in the ground, or in boxes and bundles of foul linen, bedding, or clothes, may exhale a virus which is often suddenly prostrating in its action. Thus every person with cholera, or even with choleraic diarrhoea in times of epidemic, is a source whence many more may be poisoned. When the choleraic matters percolate into wells or reservoirs the poisoning may be on a great scale. Cholera with such infective properties is an exotic to the soil of Europe and probably of all countries except south-eastern Asia ; and, if the in- fective discharges of cholera patients from the East were kept out of Western soil, no choleraic disease would be likely to become epidemic on the latter. Such exclusion has been more or less the endeavour of all Western states from the time of the first invasion through Central Asia in 1831. The only question is whether, by attempting too much, they have not lost the opportunity of con- trolling the spread of the disease by less drastic means. The instances where cholera has been kept out by a rigid cordon, or the strictest form of quarantine, are few : it is probable that Spain owed her immunity in 1849, when all the rest of Europe suffered, to her policy of exclusion ; there was a strikingly successful instance of the same in the case of Dominica in 1865, during a frightful cholera mortality in Guadeloupe, only 22 miles distant ; and it has happened more than once for Portugal to keep out the epidemic and for Sicily to protect herself for a time against the mainland of Italy. But in the great majority of instances the quarantines against cholera have been "elaborate illustrations of leakiness." Island communities have the best chances of succeeding; but in the case of the British Islands the attempt has been abandoned as impracticable. The British policy of attempting a good deal less was justified by success in 1873, when the Baltic and North Sea trade went on uninterruptedly, notwithstanding the presence of cholera at various ports across the water. In 1874 the inter- national sanitary conference of Vienna adopted an abstract resolution by a large majority approximately in favour of the British practice, though the conference of Rome in 1885 was slightly reactionary. According to this practice a case of cholera is received into the country with much the same sort of assurance as a case of typhoid fever would be. There is much reason to believe that in both cases the agency of the soil or other tertium quid is needed to give potency to the poison, and that the diffusion of both diseases can be limited by disposing of the discharges of the sick in such a way that they shall neither taint the soil or the water, nor ferment on unwashed linen or bedding. Wherever a filth- sodden soil receives the choleraic matters, poisonous miasmata will rise from it; and such miasmata will also arise even in houses or on board ship, or from bundles and boxes of effects, if cleanliness be thoroughly overpowered by the stress of events. In India such cholera-soils exist from year to year, or are capable of being made on occasion, as at great religious fairs ; and in that respect some Indian soils are to cholera what certain of the harbours and fore- shores of the western hemisphere are to yellow fever. Both dis- eases in their native seats are primarily caused by specific miasmata from the tainted soil. But in Europe the spreading power of cholera is infinitely greater than that of yellow fever because the choleraic matters are more copious, and more likely to ferment under all circumstances of climate, locality (coast and interior), states of weather, and differences of race. But there is still a reasonable prospect of finding a good substitute for quarantine against cholera in the fact that its power of spreading is certainly made subject to conditions. The maxim for cholera is Take care of the conditions, and the disease will take care of itself. Cholera is what Pettenkofer calls an " exogenous " infection : the infective matter acquires its virulence, not in or upon the body, as in a case of small-pox, but outside the body, amidst filth or other sanitary neglect. The reason why cholera is more difficult to manage than typhoid fever is that it is peculiarly a disease of the poor ; " poverty has always been the true quartermaster of cholera. The virus is transported (in the West at least) from place to place largely by emigrants, religious pilgrims (as in Russia), fugitives, tramps, or others hard pressed by circumstances ; one of the most remarkable instances of that kind is its alleged transmission, in 1833, from Kansas across the Rocky Mountains to the Pacific by parties of Indians successively infected. The danger from the wandering poor is all the greater that they would be naturally unwilling under any circumstances to sacrifice their small belongings of clothes, bedding, and the like, which are often the real media of infection. It is not to be denied that the old-fashioned detention for a week or more in a lazaret has still something to recommend it for such poor classes of travellers ; but the detention will be more likely to give vitality to any lurk- ing virus of the disease than to extinguish it, unless the lazaret be particularly well found in all the conveniences of living. HISTORY OF QUARANTINE. The first lazarets in Europe were con- structed for the plague ; and that disease was the only one for which quarantine was practised (not to mention the earlier isolation of lepers, and the attempts to check the invasion of syphilis in northern Europe about 1490) down to the advent of yellow fever in Spain at the beginning of the 19th century, and the arrival of Asiatic cholera in 1831. Venice took the lead in measures to check the spread of plague, having appointed three guardians of the public health in the first years of the Black Death (1348). The next record of preventive measures comes from Reggio in Modena in 1374. The first lazaret was founded by Venice in 1403, on a small island adjoining the city; in 1467 Genoa followed the example of Venice ; and in 1476 the old leper hospital of Marseilles was converted into a plague hospital, the great lazaret of that city, perhaps the most complete of its kind, having been founded in 1526 on the island of Pomegue. The practice at all the Mediterranean lazarets was not different from the English procedure in the Levantine and North-African trade, to which the rest of this sketch will be confined. On the approach of cholera in 1831 some new lazarets were set up at Western ports, notably a very extensive establishment near Bordeaux, afterwards turned to another use. The plague had disappeared from England, never to return, for more than thirty years before the practice of quarantine against it was definitely established by an Act of Parliament of Queen Anne's reign (1710). The first Act was called for, owing to an alarm lest plague should be imported from Poland and the Baltic; the second Act of 1721 was due to the disastrous prevalence of plague at Marseilles and other places in Provence ; it was renewed in 1733 owing to a fresh outbreak of the malady on the Continent, and again in 1743 owing to the disastrous epidemic at Messina. In 1752 a rigorous quarantine clause was introduced into an Act regulating the Levantine trade ; and various arbitrary orders were issued during the next twenty years to meet the supposed danger of infection from the Baltic. Although no plague cases ever came to England all those years, the restrictions on traffic became more and more stringent (following the movements of medical dogma), and in 1788 a very oppressive Quarantine Act was passed, with provisions affecting cargoes in particular. The first year of this century marks the turning point in quarantine legislation ; a parliamentary committee sat on the practice, and a more reasonable Act arose on their report. In 1805 there was another new Act, and in 1823-24 again an elaborate inquiry followed by an Act mak- ing the quarantine only at discretion of the privy council, and at the same time recognizing yellow fever " or other highly infectious disorder" as calling for quarantine measures along with plague. The steady approach of cholera in 1831 was the last occasion in