Plague : papers relating to the modern history and recent progress of Levantine plague / prepared from the time to time by direction of the president of the Local Government Board, with other papers ; sented to both House of Parliament by Command of Her Majesty.

  • Radcliffe, Netten.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Plague : papers relating to the modern history and recent progress of Levantine plague / prepared from the time to time by direction of the president of the Local Government Board, with other papers ; sented to both House of Parliament by Command of Her Majesty. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    72/82 (page 66)
    otherwise than very lax. And at all events for many years past it has, in every medical sense, been abolished. Also with its virtual extinction, the establishment for giving it effect has declined. As successive governments advanced further and further in relinquishing what probably at its best was only a sham of quarantine, corresponding reductions of establishment were made. And the result of the entire process may be told in these very few words,—that, at the present moment England has not in readiness the means of properly quarantining even a single ship.* It is not for me to say that this state of things may be deemed final. But if reversal of the policy which it expresses were ever so much desired, it could not be effected offhand. Enormous first expenditure of money in creation of proper lazarets would be wanted, as well as subsequent very large annual outlays for maintaining the necessary establishments. And the time which would be required for bringing the organisation into work forbids the supposition that this could ever be done on emergency. So, for England, under present circumstances, quarantine against cholera, as existing in the countries which are nearest to us, is a precaution of which there can be no serious thought. Were the country ever so ready to endure those extreme restrictions without which the whole thing is fruitless and absurd, the means for imposing them do not exist, t To extemporise b. coi^don sanitaire is simply and totally impossible; and no partial quarantine can be relied on for national purposes. Not only as regards cholera, but generally as regards all contagious disease, the position, which now has to be recognised and dealt with, is—that contagions cmTcnt on the continent of Europe must be deemed virtually current in England. Having regard, however, to our entire unprotectedness by quarantine against any contagions which may threaten us from abroad, I feel it additionally incumbent on me to insist on the present very imperfect state of our sanitary laAV and administration. Especially in view of the present re-infection of Europe by Asiatic cholera the necessity for a better state of things seems to me of the most urgent kind. On the one hand I w^ould beg leave again to refer to the evidence which is summed up in my last report, and is corroborated by new instances in the present one, as to the very extensive inoperativeness of the Nuisances Removal Acts in England. And on the other hand I would refer to the observations, wdiich conclude my letter (Appendix No. 9) J addressed to the Lord President in April last, on the powerlessness of local authorities in regard of certain dangers of contagion. The footing on which the country now stands in relation to foreign contagions is, I apprehend, this ;—that they have to be dealt with like our ordinary home-bred contagions ; that for preventive purposes, no action, or at least no effectual action, can be taken by the general executive of the country; that, so far as any good is to be got out of proceedings directly against contagion, this, like the good of indirect proceedings, has to be sought in the vigour of local authorities. It, therefore, becomes quite essential that the position of local authorities generally, in regard of contagion, should be reviewed. As to contagions already current in the country, practically any diseased person scatters his infection broadcast almost where he will—typhus or scarlatina, typhoid or small-pox, or diph- theria; and, under present circumstances, if cholera were in a district, the patient with choleraic diarrhoea would form no exception to the general license. I cannot say that the exceptional case of the foreign infection seems to me of more importance than the every day case of our native diseases ; but I would venture to submit that wdth regard to both classes indifferently, the present unlimited license seems urgently to demand restriction. As in the case of typhus or typhoid, so also in the case of cholera; or to use one general description, in the case of any dangerous contagious disease; the local authority, I submit, ought to have the power of requiring from the diseased person that, in regard of residence and otherwise, he shall so conduct himself as not unnecessarily to multiply the chances of extending his infection to others. * It may be proper to mention that the ceremonies to which, under the name of quarantine, certain traus- atlautic ships are subjected, on tlieir arrival in this country, have not, properly speaking, any medical significance in relation to this country, but are part of an international obligation contracted for commercial reasons. f When cholera last year broke out so vehemently at Alexandria, and was hitherto not in Europe, it would have been, comparatively speaking, a trifle to quarantine arrivals from that one port; not only because of their being few, in comparison with the innumerable arrivals from the ports of continental Europe, but also because, with the long voyage, the object of quarantine would generally have accomplished itself before arrival. And medically, of course, such a precaution was to be desired. But while my Lords still had it under consideration, whether to establish this amount of quarantine, and to provide the means of conducting it, cholera had already almost ceased at Alexandria, and had shown itself in other various ports. Before proper quarantine arrange- ments against Alexandria could have been organised, no quarantine would have been self-consistent which had not bnen a quarantine against France, Turkey, Spain, Italy, and Germany, as well as against our own posses-' sions of Malta and Gibraltar ; and doubtless the contagium of cholera was in Southampton long before any effective arrangements could have been called into existence for excluding it. J [Not reproduced, in these papers, from the original Report.]