QUARANTINE LAWS. (Hansard, 18 March 1847)

§ DR. BOWRING

rose to move for the production of correspondence with respect to the quarantine laws. He said, that although the topic was an uninviting one, yet the discussions which had taken place upon it had already led to very important changes in public opinion—had removed many of the prejudices which existed on the subject of the plague—had enabled this and other Governments to modify the legislation which was founded on superstition and ignorance. The delays, the vexations, the expenses of the quarantine system, had been considerably diminished. Travellers were subjected to fewer annoyances; vessels were detained for a shorter period; merchandise was allowed to be transported with less of interference; and nobody was found to contend for a moment that these relaxations had been accompanied by a shadow of danger. He was sure, also, that every additional discussion would tend towards the same end; and it was with that view that be felt it his duty to move for the continuation of the correspondence which had taken place since the subject was last under the attention of the House. He was persuaded that the existing system was founded on the most erroneous notions as to the best means of preserving the public health; that, far from diminishing disease, the plan of confining patients to lazzarets was most calculated to increase its intensity and augment its contagious power. He was not without hope that the time was not far distant when quarantine laws would be removed altogether. The history of the plague was like that of many other diseases. Local circumstances influenced its introduction and its propagation; and in the very proportion to the circumstances which favoured its development would its ravages be. It was one of the endemics to whose spontaneous birth the climate, soil, and social habits of Egypt and other parts of the Levant, were peculiarly favourable, and thus it grew and spread in proportion to the existence and the extent of these elements which assisted its propagation. To particular climates particular diseases belonged: as the yellow 151 fever rages on the western coast of Africa—as fever and dysenteries dwell among the marshy lands of tropical regions—as typhus reigns in the crowded courts and filthy ill-ventilated lanes of our great towns—as the ague rules in the fens of Lincolnshire—so is the plague indigenous in many parts of the East—communicable only when it meets with the conditions to which it owes its birth. Plague, he repeated, like all other diseases, was materially increased when circumstances were favourable to promote its propagation, and the places where it had most raged were remarkable for their bad ventilation and gross impurities. Nothing could be more fatal to the public health than the confining and crowding people together. Such crowding and confinement would soon give a pestilential character even to a pure atmosphere. He need not refer to many instances in order to illustrate the truth of this proposition. That celebrated case in the black hole of Calcutta, where, out of 140 individuals, more than 100 perished in a single night, was a melancholy proof of it. That fact was notorious to every reader of history, and demonstrated the pernicious effects of unventilatcd and confined places. In the last Session attention had been called to the great mortality on board the Eclair; and that mortality was to be attributed to the same cause, and bore evidence to the truth of the theory to which he had called the attention of the House. He had moved for the report of Dr. M'William, who had been sent to Boa Vista to report on the character of the fever which had existed on board the Eclair, and which had been communicated to that island. He had reason to know, from personal interview with Dr. M'William, that there was nothing in that report to warrant the continuation of the existing quarantine system—that Dr. M'William attributed the infectious or contagious character of the disease solely to the circumstance of the patients being huddled together in a miasmatic and impure atmosphere—made more and more impure by the augmented number of the sick; that the causes and the intensity of the disease were greatly increased by the non-removal of the patients to a purer region—that to spread the patients about in an uncontaminated atmosphere would not tend to spread the disease, but to modify its character. He believed that if the sufferers on board the Eclair had been instantly removed from that vessel, on its arrival on our shores, 152 many valuable lives would have been saved, which had been sacrificed to the ignorant inhumanity of our quarantine system. He knew that the long and valuable experience of his hon. Friend near him, the Member for Berwick, who had been and was so largely engaged in the African trade, confirmed the opinion, that it was to the close, confined, and ill-ventilated atmosphere too frequently found on board our steamers and ships on the African coast, that the Bulam fever of the Eclair owed its destructive character. To this was to be attributed the mortality on board slave-trading vessels—the ravages of gaol fevers — the mortal character of typhus, and other similar diseases. He begged to refer the House to a very valuable pamphlet of Dr. Milroy on quarantine and the plague, which he should frequently quote as giving a valuable résumé of the facts and the arguments of the case. In a despatch which had been sent by Lord Palmerston to Lord Ponsonby in 1839, and which had been presented to the Turkish Divan, these truths had been recognised. The passage was as follows:— With reference to the proposed regulations, I have to instruct your Excellency to endeavour strongly to impress upon the Turkish Government that they would more effectually prevent the breaking out and spreading of the plague, by introducing cleanliness and ventilation in the city and suburbs of Constantinople, than by any such violent interference as is proposed with the domestic arrangements of families. It is quite certain that the plague is much aggravated, if it is not actually generated by the want of cleanliness in streets, by the want of sufficient ventilation in houses, and by the want of proper drainage in places contiguous to habitations; and, if the Turkish Government would, in the first instance, apply vigorous measures to correct those evils, they would strike at once at the causes of the disease; whereas the measures which they have now in contemplation, will only be productive of inconvenience and suffering to numerous individuals. He considered that by the progress of sanatory improvements in large cities, and not by the observance of quarantine laws, the elements of disease would be gradually removed. An amelioration in this respect was no doubt going on in Egypt, in Turkey, and in various other parts of the world; and he believed that a greater knowledge of the cases and character of the plague would tend to remove many of those apprehensions and groundless alarms which had been excited in the minds of the timid. In the time of Herodotus, Egypt was considered to be a very healthy country; but the utter neglect of cleanliness among the people—the disorders and anarchies which 153 had existed for centuries—the accumulations of filth—the disregard of the police—the swampy character of the soil, in many parts—had tended to make that country one of the most unhealthy in the world, and consequently had peculiarly fitted it for the spontaneous birth and wide development of the plague. But the prevalence of that disease in that country could be accounted for upon other grounds than the supposition that it was contagious. In Egypt itself the mortality would be found dependent on the cleanliness, civilisation, and physical comfort of the various races. Dr. Aubert stated— The relative mortality in the different races, during the great plague at Alexandria in 1835, is thus exhibited:—Negroes and Nubians lost 1,528 out of 1,800, or 84 per cent; Fellahs lost 367 out of 600, or 61 per cent; Arabs, not soldiers, lost 10,936 out of 20,000, or 55 per cent. The Negroes, Nubians, and Arabs were all living in nearly the same hygienic conditions, and were all in free pratique. With respect to the other residents in Alexandria, be estimates that the Greeks lost 257 in 1,800, or 14 per cent; Jews, Armenians, and Copts lost 482 in 4,000, or 12 per cent; Turks lost 678 in 6,000, or 11 per cent; Italians and others from the South of Europe lost 118 in 1,600, or 7 per cent; French, English, Russians, and Germans lost 52 in 1,000, or 5 per cent;— showing how completely the amount of mortality was regulated by the social condition of the different communities. An instructive illustration is afforded by Dr. Aubert:— On the banks of the canal which leads from Alexandria to the Nile, lies a property belonging to the Greek consul, M. Tossizza, who received it as a present from the Viceroy. The fellahs who work upon this property, being better treated and better fed than the fellahs of the surrounding villages, only lost, during the epidemic of 1835, 12 out of 400; while their neighbours, placed in the same conditions with respect to atmospheric influences and free communications, lost one half of their number. And the French Academy of Medicine came to exactly the same conclusion:— If it has been proved that the existence of a pestilential constitution in a country, into which the plague is imported, is necessary for the transmission and propagation of the disease, it seems nevertheless certain that imported plague will not exercise any great ravages, if it does not meet with, in the character of the climate, atmosphere, and population of the place, the conditions that are favourable for its development. It was a well-known fact that plague had never entered into any of the colder latitudes; and it was equally ascertained that it did not penetrate the tropics. It had never been found at a very high or a very low temperature. It had not visited Nubia 154 to the south-west, nor Arabia to the south-east of Egypt. But in diseases of an undoubtedly infectious character, such as small-pox, measles, or hooping-cough, no varieties of temperature checked their progress. They were found in all latitudes. The voyage was now made from Egypt to India in a very few days, and yet the quarantine laws were not in force in the British possessions in India. On the other side of the Atlantic, where great attention was paid to the health of the inhabitants, in the United States, there were also no national quarantine laws; and vessels crossed the Atlantic in a much shorter time than they did heretofore; in ten or eleven days Europe now communicated with America. The precautions taken by the different States of America were of a local character, and had mainly reference to the yellow fever; and they seemed wholly regardless of the plague of the old world. As the quarantine laws were founded in ignorance, so in ignorance they had their support, and attachment to them was found strongest in those countries where the knowledge of medicine least prevailed. In those parts of Italy, where the science of medicine was most backward, such as Naples, they were most strict in the preservation and observation of quarantine. But with the progress of inquiry, and attention to the subject, the alarm would gradually be dissipated, and the previous accounts of the contagious character of the disease would be discovered to be without foundation. The end of all this had been, that great changes were extorted from Government by the might and irresistible influence of public opinion. The quarantine laws, however, were connected with the pecuniary interests of large and influential bodies of men. By a Parliamentary return it appeared that upwards of 15,000l. a-year was spent by the Government in this country alone to salaried officers for the support of this system. More than ninety functionaries were employed upon it in Liverpool, seventy in Rochester, and in all the quarantine ports there was a numerous troop of officers. From these priests of Ephesus no doubt the cry would come, "Great is Diana of the Ephesians;" and, in the same manner, every obsolete system would find its supporters amongst those whom it employed and paid. In other countries matters were far worse, the quarantine functionaries were bound and banded together—they exercised irresponsible power—they committed the most despotic acts— 155 they violated correspondence—they arrested travellers—they taxed ships and merchandise; and all for the support of a delusion. But, to benefit a few interested individuals, would the Government continue a system which was most inconvenient to commerce and most unprofitable to the country? In the last ten years immense progress had been made. The great plagues of 1834 and 1835 had opened the eyes of medical men; and to the honour of that profession, which had been among the first to encourage prejudices and to justify quarantines, it now was furnishing irrefragable evidence of the mistakes under which their predecessors laboured. Let it not be forgotten that it was from plague countries—from physicians having the most accurate and the most extensive knowledge of the disease—that the ancient theories of contagion had received their death-blow. To such men as Clot Bey, Drs. Laidlaw, Abbott, Aubert, Rigaud, and others, a vast debt of gratitude was due. In 1838, our Commissioner at Malta, Mr. Lewis, reported that— It is notorious that the mode or modes in which plague is communicated are very imperfectly known, and that some of the maxims on which most important quarantine regulations rest, are little better than gratuitous hypotheses. In 1841, Dr. Robertson, deputy-inspector of hospitals, and serving with the British troops in Syria, thus expresses himself in his official report to Government on the plague:— In reference to the contagious or non-contagious nature of this, at times, frightful disease, I beg to state that the result of all my experience leads me to believe that the disease originates in local causes, and that it is endemic in Syria and Egypt; that it is not of a highly contagious nature; and that, if ever so at all, some other concurrent circumstances are necessary to render it so. Extreme and exclusive opinions on the doctrine of contagion are hardly warranted by the present state of our knowledge. My own firm conviction is, that the plague cannot be communicated from one person to another in a pure atmosphere, even by contact; but I am not prepared to assert that, if plague-patients are crowded together in confined and ill-ventilated apartments, infection will not be produced, just as happens in typhus fever. Mr. Brant, our consul at Erzeroum, writing about the same period respecting the then recent severe outbreak of the plague there, says— As far as my own experience goes, I have been led to doubt the contagions nature of the disease, as it showed itself here last summer; or, if it were contagious, it must have been in a very slight degree. I have had, within the sphere of my observation, many cases of the most complete 156 and extensive contact, without the disease being communicated. Mr. Sandison also, our consul at Brussa, informs us that— The cases are numerous in which persons escape the disease after contact with persons seized with it, even in its most malignant stage. There are frequent instances also of individuals being attacked by the plague, without being at all able to trace communication with any infected person or substance. But by far the most important result was reached when, in 1844, the great Commission of the Royal Academy of Medicine in France, consisting of men of the highest character for medical science, had been appointed to inquire into the subject of the plague and quarantine. During two years they had been occupied with the thorough investigation of the matter; and, if he had no other evidence to offer, their report would alone be sufficient to show that the time had come for an alteration of the quarantine laws. The conclusions to which they had come were — firstly, that the plague was spontaneous in its origin; secondly, that— In all countries where the spontaneous plague has been observed, its development may be reasonably attributed to certain determinate conditions acting upon a large portion of the inhabitants. The principal of these conditions are, residence upon marshy alluvial soils near the Mediterranean or near certain rivers, as the Nile, Euphrates, and Danube; the dwellings being low, crowded, and badly ventilated; a warm moist atmosphere; the action of putrescent animal and vegetable matters, unwholesome and insufficient food; and great physical and moral wretchedness. Thirdly, that in Egypt it was usually—for it visited Egypt every year—endemic, but that about every tenth year it became epidemic; and, fourthly, that there was no single fact to prove the transmissibility of the plague by contact—contact of person. In the words of the report— On the one hand, immediate contact with thousands of plague-patients has not been followed by any dangerous consequences to those who have been exposed to it in the open air or in well-ventilated chambers; and on the other, that there is not a single fact which indisputably proves the transmissibility of the plague by mere contact with the sick. And with respect to communication by garments the Commission says— Very numerous facts prove that the clothes and effects belonging to plague-patients, have not communicated the disease to persons who have used them, even without any previous purification. The facts, which seem to indicate an opposite result, can only be considered valuable, if they are confirmed by fresh observations made beyond 157 epidemic foci, at a distance alike from foci of miasmatic infection and from countries where the plague is endemic. In the bazaars of Turkey, plague-spotted garments produced as good a price as those which were free from the disease. In the foul wards of the lazzaret there was no record of a single death having occurred from contact with a diseased person, or from infected clothes. As regarded merchandise, equally satisfactory was the evidence. In 1835, the epidemic plague raged at Alexandria among all the servants and employés living in the magazines of the Egyptian Government. Notwithstanding this, a vast number of hales of cotton, daily handled by the plague-infected, were exported from January to June—that is to say, during the whole continuance of the epidemic—to all the great ports of Europe. There were exported this year, to England, 31,709 hales; to Marseilles, 33,812 bales; to Leghorn, 424 bales; to Holland, 150 bales; to Trieste, 32,263 bales; and to other ports, 32 bales. Now, although no precautionary means were taken in the way of disinfecting this immense quantity of an article that had always been deemed highly susceptible of retaining the infectious effluvia, not one person seemed to have been infected in consequence. Of sixteen English vessels laden with cotton, which sailed from Alexandria from the beginning of January to the end of June, eight had the plague on board; and yet their cargoes did not prove more dangerous than those of the non-infected vessels. Besides this very conclusive evidence, the Commissioners mention upon official authority that, since the year 1720, not one of the porters employed at the lazzaretto of Marseilles, in discharging and landing the cargoes of suspected ships, had ever caught the plague. The conclusion was, therefore, fairly forced upon them that— There is nothing to prove that articles of merchandise can transport the disease beyond epidemic foci." He (Dr. Bowring) moved for a return of the persons engaged in the foul departments of our lazzarets in the manipulation of infected or susceptible articles, and who had died of or been attacked by plague—that return was nil. But one of the great antagonist authorities, Sir W. Pym, himself honestly confesses that he could not ascertain that any one case of plague had been produced in consequence of the manipulation of merchandise in any one of the various lazzarets that he visited. An- 158 other most important conclusion had been come to by the Commission, and one that should at once induce the Government to admit to pratique every vessel from the Levant which arrived without disease on board, viz. that— If it be true that a fixed and absolute term cannot be assigned to the incubation of the plague, it seems, nevertheless, to be clearly proved by well-established facts, that, at a distance from countries where it is endemic and beyond or away from epidemic foci, the disease has never broken out in persons who have been exposed to its influence after an isolation of eight days. The few facts which might be regarded as exceptional to this rule, are all susceptible of another interpretation. This is a practical result, deserving the most serious consideration. The latent seeds of the plague have been by some faciful writers supposed to be undeveloped for centuries. Nay, one author traces them to the mummies of Thebes and Memphis; another avers that they are retained in garments for thirty years; a third avows that for two years they had been concealed in the clothes of a plague-patient who died in Syria; and at Genoa, at the late congress, physicians insisted that the plague might exist undeveloped for a month. But the authorities of the European Egyptian physican generally recognise seven days as the period of incubation. One limits it to two or three days. Clot Bey gives two or three days as the average; eight days as the maximum. On this subject Dr. Aubert states, that in a period of 125 years only sixty-four vessels crossing to Europe from the Levant have had the plague on board; that the cases of attack have been during the voyage, or after arrival; that no case has occurred of attack in a European port, unless there had been cases during the voyage; and that only twenty-six vessels had brought the plague with them to European lazzarets. In France, public opinion had already relieved Algiers from the oppression of the Levant quarantine laws. Greece had also been emancipated. Marseilles, the very seat of sinister interests and foolish prejudices—still under the impressions and recollections of the plague of 1720—had, in a congress comprised of contagionists, declared, "that the existing system requires modifications." At Genoa, last year, the scientific congress allowed the doctrines of contagion to be attacked and denounced; and concluded, that it might happen, a more thorough investigation and new discoveries of medical 159 science might add to a future modification of opinion; and they resolved to re-open the subject at Venice in the next congress. Austria was giving way, and Russia was inquiring. The hon. Gentleman concluded by moving— For an Address of the Copies of such correspondence, or extracts of correspondence, as may have taken place since the last Parliamentary Returns, on the subject of the Quarantine Laws.