Comments re my Medical History
The history of medicine is fascinating and we often lose sight of how little we knew before the last 50 or 100 years. I've written a few short articles and I'm web-publishing a few more that I've collected. I hope these are of interest. Obviously they're not to be taken as current medical practice, though it's also interesting how little the basics have changed.
Sincerely, Mark R. Anderson, M.D.
Hammersly's NAVAL ENCYCLOPAEDIA,
pub by Lewis Hammersly, Phila. 1881
Quarantine (Ital. quarantina; L. Lat. quarentena; Fr. quarantaine; Span. cuarantena). The Cyclopedia of Commerce defines quarantine to be the "interdiction of communication to which a ship is subject for a definite period, for fear of her bringing infectious diseases."
Webster defines the word as follows: "1. A space of 40 days. 2. Specifically, the term, originally of 40 days, but now of undetermined length, during which a ship, arriving in port, and suspected of being infected with a malignant, contagious disease, is obliged to forbear all intercourse with the shore; hence, restraint or inhibition of intercourse to which a ship is subjected, on the presumption that she may be infected. 3 (law). The period of 40 days, during which the widow has the privilege of remaining in the mansion-house of which her husband died seized."
"Quarantine (verb). To prohibit from intercourse with the shore; to compel to remain at a distance, as a ship from shore when suspected of having contagious disease."
Falconer, in his dictionary, says," Quarantine, the state of the persons who are restrained within the limits of a ship or lazaretto, or otherwise prevented from having a free communication with the inhabitants of any country till the expiration of an appointed time, during which they are repeatedly examined in regard to their health. It is chiefly intended to prevent the importation of the plague."
The term quarantine is now employed not only for the detention of persons, effects, and merchandise coming by sea, but also for such detention at international or state lines, or at a cordon arbitrarily drawn within a state. There is also a quarantine of observation imposed upon vessels that have, for any cause, communicated at sea with another from an infected port, or have been boarded by men-of-war of a hostile nation.
The original period of 40 days, or 6 weeks, imposed in early times, is supposed by some to have had a connection with the penitential period of lent; by others, that it was presumed that 6 weeks was the term or limitation in which any infectious disorder must certainly show itself. However this may be, the term is, and has long been established, in the senses given above, in the language of every sea-faring or mercantile nation.
In some countries vessels from the Levant, Barbary States, Havana, or Vera Cruz, have always to undergo some days' quarantine or observation even when coming with clean bill of health. But modern experience has shown that some of the pestilential maladies, so called, are not contagious; and quarantine of persons has a constant tendency to become less severe, in northern climates especially; and a mere routine prohibition, like that just referred to, must eventually give way to more reasonable, liberal, and well-founded methods.
In 1562 a sanitary convention was held, most of the European states sending delegates, which body recognized the right of any country or countries to isolate another which was infected with plague, yellow fever, or cholera, either by sanitary cordon or by subjection to quarantine. By agreement two kinds of bills of health were recognized: one attesting the presence of disease in the country whence the vessel sailed, and the other attesting the absence of the malady. But vessels in bad sanitary condition, even if hearing the first-mentioned bill of health, were to be detained for purification whenever the authorities of the port at which she arrived deemed it necessary. The minimum of detention was agreed upon as follows for vessels from countries suspected of plague, 10 full days ; 8 to 6 days for yellow fever, and 3 to 5 days for cholera. These terms are practically often exceeded, at the discretion of the health officers, especially in southern Europe. By the convention, merchandise was divided into 3 classes: 1st. That which is always quarantined and purified. 2d. That subject to detention and purification after examination and decision by experts. 3d. Those articles always exempt. Ships were to pay a health due according to tonnage; and, while in quarantine, to pay a fixed daily rate, as must, also, persons placed in quarantine. Merchandise placed on shore at a lazaretto was to pay a special tax, by weight or valuation. England refused to agree to this convention, and took the responsibility of practically doing away with quarantine in her ports for plague, yellow fever, and cholera, except under unusual circumstances, when the power to enact quarantine lies in the crown, by an order in council. The orders in council in regard to yellow fever were revoked in 1869.
Although this is done there with impunity, at least as to the two first diseases, the wisdom of spasmodic action in regard to cholera may well be doubted. It would be impossible for countries situated in a lower latitude to follow her example. Nowhere, however, is quarantine more strictly enforced than in the British ports of Gibraltar and Malta; and the reason is that any attempt of the English government to alter the quarantine regulations of the Mediterranean colonies, without the sanction of the neighboring countries, would produce greater inconvenience than that arising from the present system. The pratique granted in those colonies would not then be recognized in the neighboring countries, and all vessels from Malta or Gibraltar would be subjected by them to a quarantine of observation.
In torrid countries, where yellow fever and cholera are endemic, quarantine is, of course, of little use, while in lat. 50-deg N. there is no fear of yellow fever. Large discretion must, however, in all cases and in all countries, be invested In the officers of health.
In 1866 another sanitary convention met at Constantinople, principally to deliberate in regard to cholera. This body again fully recognized the necessity of restrictive measures, while the importance of striking at the sources of epidemics in the places of their origin was duly set forth.
The importance of quarantine has been recognized from the earliest periods, although for ages it only consisted in the isolation of lepers. In the Middle Ages it was chiefly enforced against the plague, which had been the scourge of the Old World for so many centuries. We learn from history that the plague once prevailed at Athens, more or less severely, for 50 years. Hippocrates and Thucydides give accounts of it as far back as 880 B.C.. The disease raged throughout the Roman empire from 250 to 265 of our era, and for some time 5000 persons died in Rome every day. When the plague appeared in Alexandria, A.D. 542, more than half the population was carried off. More modern instances of its dreadful ravages in Europe, Asia, and Africa are quite familiar, and it still prevails almost every year at Bagdad, and other places upon the Tigris and Euphrates.
In later days, in addition to plague, yellow fever, cholera, and typhus have been the diseases principally combated by quarantine, and for this purpose lazarettoes have been long in use. Lazaretto is derived from Lazarus, the patron saint of lepers. It may be defined as an isolated establishment, generally walled, on or near a port, built and arranged to receive the sick and those suspected of contagion, as well as merchandise. Lazarettoes are most common on the routes of commerce and travel on the shores of the Mediterranean. They often have extensive courts and gardens for air and exercise for those detained there, as well as appliances for disinfecting men, their clothing, and goods. The lazarettoes of Genoa, Leghorn, and Marseilles are so large and well arranged that ships need not necessarily be detained there, but may unload their cargoes in bond. Important papers, and money or letters necessary to be transmitted through quarantine, are still, in many cases, punctured, fumigated, or even immersed in weak acids before being allowed to circulate.
Although lazarettoes are of considerable antiquity, they were not established until, in the Middle Ages, the plague had repeatedly swept the great commercial cities of the Mediterranean, whence it spread to those of the interior with deplorable results, more than decimating many of them. At last the idea of protection was forced upon them, and Venice, as the queen of commerce, naturally took the lead. It has been said by some writers that there are traces in her records of some attempt at health regulations about 1180, and she certainly set the example of strict inspection of arriving vessels in 1818 (?), while in 1408 the practice of isolation was introduced, the island of St. Mary of Nazareth being set apart for that purpose. Inspection of vessels was practiced at Reggio, in the Straits of Messina, almost at the same time as at Venice. Some accounts, indeed, state that Reggio preceded her. Count Barnabo, finding that those who avoided the sick generally escaped the plague, established a rough kind of quarantine, which consisted in placing those sick of the disease, found in vessels passing through the straits, in an open field, to die or to recover, and the persons engaged in handling the patients were excluded from communication with the population. In Florence the state took precautions against the spread of epidemics as early as 1848 (?). In 1458 there was a lazaretto in Sardinia. In 1448 Venice had already a digest of quarantine laws, and in 1485 a regular health commission was established and the purification of cargoes begun.
The action of Venice, the centre of commerce, went far towards preventing the wholesale mortality which threatened to depopulate much of Europe, as the pest, once introduced, was fostered by the filthy and unwholesome mode of living then prevalent among all classes.
Genoa, always a rival of Venice, speedily followed her example as to quarantine, while at Marseilles, the third great commercial city of the Mediterranean, the first measures in this direction date from the plague of 1476.
These well-intended efforts were not always successful, for, in Marseilles, in 1656, it was not possible to bury the dead from plague and they were obliged to be burnt, as has often happened elsewhere in sweeping epidemics. Marseilles, indeed, suffered from no less than 14 visitations of plague between 1505 and 1660. From the latter year, when more thorough precautions were taken, and a new lazaretto constructed, to 1720, she escaped entirely; and it has never again reached the city, although it has prevailed in the lazaretto twenty times, the last occasion being in the year 1825.
The annoying precautions necessary, and the time consumed by quarantine, have always varied with the locality, and the port from which the suspected or infected vessel came; and the severity of the rules, and the stringency with which they were insisted upon and carried out, have always excited the complaint of merchants and travelers. But as education and general intelligence extend, there is less and less position to question rules which commend themselves to every reasoning mind, and business interests and sanitary requirements are now much more in accord. In all places it is a high misdemeanor to evade or break quarantine, and there appears less disposition to do this at the present day than formerly existed. MacCulloch, in his Dictionary of Commerce, says, "In some cases, perhaps, quarantine regulations have been carried to a needless extent; but they have more frequently, we believe, been improperly relaxed." As an instance of protection afforded by quarantine we may adduce the terrible scourge of yellow fever in Barcelona, in 1821, which was transmitted by sea, thence reached Marseilles, but was excluded from that city by rigorous quarantine. The instances of a like nature in our own country, both North and South, are too numerous to mention, especially in the epidemics of yellow fever in recent times.
Sanitary cordons, connected with the stamping out of foci of disease, have recently been eminently successful in preventing the spread of plague in Southern Russia, and of yellow fever in our Southwestern States.
A ship sailing from a port to one in another country is furnished by the consul of the country to which she belongs, or by the local authorities, with a bill of health, which shows the sanitary condition of the place of departure. If good, it is called a clean bill of health; and if, on the contrary, epidemic or contagious disease prevails, it is called a foul one. A bill from a suspected port is sometimes called a touched one.
The nature of the bill of health, and the declaration of the master of the vessel, regulate the length of quarantine, if any is required. It is not obligatory upon a master to take a bill of health, but the absence of one renders the vessel a suspected one in her port of arrival.
Pilots are everywhere required to make inquiry in regard to the port of departure and state of health of vessels which they may board, and are required to anchor them in proper place, accordingly, under heavy penalties. Fine and imprisonment are the usual penalties for gross invasion of quarantine law; and in France, under certain circumstances, the punishment may be death.
In the case of a man-of-war sailing from a port, the bill of health is usually furnished gratis by the authorities; and the declaration of the commander and of the medical officer is usually received as regards the state of health upon arrival.
Much the same precautions are taken with regard to the cattle plague as with merchandise and passengers, except that, in many instances, the animals are required to be killed at once, and always are sacrificed when symptoms of disease are shown.
In this country all vessels arriving from foreign ports, at any season of the year, must be boarded and examined by the officers of health, and coasting vessels come under the same category, according to the season of the year and the geographical position of the ports from which they come.
When a vessel and her passengers have leave to communicate freely with the shore, either directly upon arrival, or after having gone through a term of quarantine, she is said to have received pratique. This is derived from the Italian pratica. In the case of infected or suspected vessels, the passengers, and their effects, are purified in the lazaretto or on board, and the hold of the vessel herself, and all cargoes of hemp, rags, paper, hides, skins, feathers, hair, and wool, are especially the objects of disinfection, while metals, lumber, sugar, live-stock, and other cargoes are treated as the discretion of the health officers may direct. In the Mediterranean all live animals, except horses, are supposed to be ready conveyors of plague, and cats more so than any others, as in Eastern countries they form part of households, which dogs do not.
On this continent the first quarantine law was enacted in the Province of Pennsylvania, in reference to yellow fever, in the year 1700. The quarantine station, still bearing the name of "Lazaretto," exists in the place in which it was originally established, a few miles below Philadelphia, and depuration of passengers and cargoes is still performed there.
The present condition of quarantine in the different States of the Union leaves much to be desired, as the States have different and sometimes conflicting laws. All provide some sort of quarantine for contagious and infectious diseases, but the practice in carrying out the necessary precautions is not uniform, and in many cases inefficient.
In 1804, Mr. Jefferson protested against the passage of a general law regulating quarantine, as an interference with States' rights; and each State has continued to have its own code, some very good, and others harassing and contradictory. A national quarantine law was proposed in 1872, but only passed one house of Congress. There is no doubt, however, that the passage of such an act is only a question of time.
The National Board of Health is now doing excellent service, not only in practical work, but in educating the people to a proper appreciation of the necessity of a general quarantine law. The following is the act of Congress establishing the National Board:
AN ACT to prevent the introduction of infectious or contagious diseases into the United States, and to establish a National Board of Health.
[deleted, text of Congressional Act]
This act was supplemented by another, approved June 2,1879, entitled "An act to prevent the introduction of contagious or infectious diseases into the United States."
This act provides for the cooperation of the National board with the State boards; and where there are no local boards, or their regulations and means of prevention are not sufficient, as is often the case, they are to be assisted by proper persons, to be detailed by the President ; and if they shall failor refuse to enforce proper rules and regulations, the President may detail proper persons to do so.
Rules and regulations shall be made by the National board by which information can be obtained of the sanitary condition of foreign ports from which contagious or infectious diseases are or maybe imported into the United States. Consuls are obliged to make constant sanitary reports of the condition of such ports; and medical officers may be detailed for residence at such ports, for the purpose of giving advice and assistance, and for seeing that vessels sailing for the United States are put in good sanitary condition. Domestic reports are also obtained from all parts of the country, by which any tendency to the development of epidemics is at once detected. The sum of $500,000 provided by this act is to be disbursed under the direction of the Secretary of the Treasury, upon estimates made by the board, and the appropriation is considered continuous. Local sanitation, except in rare cases where disinfectants and money to pay sanitary inspectors and police have been provided , is not one of the duties of the board, as no attainable appropriation would be sufficient to serve such a purpose.
This law was hardly promulgated when the board found itself confronted by an alarming outbreak of yellow fever in Memphis, as well as the occurrence of some threatening cases in New Orleans. The disease also appeared in some other localities, and the highest legal authorities recognized the obvious duty of the board to be the assistance of the local authorities in the stricken communities in their efforts to stamp out the disease and prevent its spread to other States. By the measures recommended by the board, and the pecuniary aid extended to enable the authorities to carry out the recommendations, the spread of the disease was actually restrained within narrow limits. Measures were also advised as to precautionary work during the succeeding winter, which proved so successful that a very hot summer has just passed without the occurrence of a single case of yellow fever in Memphis. This result is most encouraging. Space does not permit a reference to other functions of the National Board of Health; but we may say that the constant reports of experts received by it, with the publication of essays on drainage, ventilation, in, and cognate subjects, as well as the collection of statistics on a grand scale, have laid the foundation for a wise and scientific treatment of the whole subject of quarantine and national hygiene. Another international conference upon quarantine is to be held at Washington in January, 1881.
QUARANTINE-FLAG. A yellow flag hoisted in a conspicuous place to indicate the presence of contagious disease. It is hoisted at the fore of vessels undergoing quarantine, and is familiarly termed yellow-jack.