DR. WHITE ON PLAGUE AND . QUARANTINE.
DR. WHITE is a veteran who served in the Army of Egypt ; and en- oyed practical opportunities of studying the plague, as be had to form a sick-depot when the plague broke out among the Sepoys that accompanied Baird's division from India. In 1816 he had a fuller opportunity of investigating the disease, by being appointed superintendent of the plague district in Corfu, with full authority in all matters of medical treatment and police. Having formed the strongest opinion, not merely that the plague is contagious, but that it is only disseminated by touch, or by inhalation of vapour from the patient's body within the distance of a few feet, our author threw together the whole of his views upon plague and quarantine, when the abrogation of the quarantine-laws was under consideration, some twenty years ago. The work, however, was not then published; and probably would not have seen the light at all, had not Mr. Tully, a junior medical officer at Corfu, written upon the subject of the plague in that island, and passed himself off as chief medico, sinking Dr. White altogether. The particulars and proofs of this alleged conduct of Mr. Tully are stated at length in Dr. White's preface; but the affair has no general interest except as it gave rise to the publication of this volume.
Dr. White's Treatise on the Plague is divided into five sections be- sides an introductory discourse; but the matter really consists of two subjects,—the author's views upon the nature and treatment of plague, as derived from reading and experience ; and his descriptions of what he considers quarantine should be, when the plague has really broken out. His ideas of plague police are illustrated at ample length by refer- ence to general principles, and the particular story of the great event of his medical life, the management of the plague at Corfu, and its suppression by isolation. As a contribution of facts to the store of those already existing for the history of the plague, this part is not without value; but we scarcely see its practical drift, unless perhaps in reference to a future plague in Malta or the Ionian Islands. The regulations esta- blished and enforced by Dr. White were so stringent that they would hardly be borne in the freer states of Europe ; and indeed could hardly be carried out among a dense population, and not at all in large towns, from the want of a sufficient military force by whose rigid obedience to orders they could alone be upheld. As Dr. White considered, with the contagionists, that touch was the only mode in which the plague could be promulgated, his first object was classification and separation. A cordon having been drawn across the island to divide the sane from the infected portion, each village in the latter part was placed in a state of siege ; even the healthy places being interdicted all communication with each other. Daily inspections were made by the subordinate medi- cal officers; as soon as symptoms of plague appeared upon any one, he was removed to the hospital ; and all his family or persons with whom he could be proved to have had contact were marched off under military escort to camps, where they were arranged in two classes. The first class was ranked under the head of " high suspicion" ; and embraced those who had had, or morally speaking must have had, communication with a person stricken by the plague. The second was denominated " simply suspected" ; and consisted of persons known to have had communication with a family one of whose members had been infected. These people were allowed to carry their effects with them, if they could ; and might occupy themselves in exposing them to the air and other modes of disinfection. If no signs of plague appeared at the end of fif- teen days, they were dismissed to their homes : if the plague appeared on any one of the simply suspected, the whole " ward " at once fell under the head of high suspicion. To prevent the needless detention that would follow from continually receiving new comers into the same ward, it was soon sealed up, and a new one opened. The treatment of the "high sus- picion" class did not greatly differ from that of the other ; but their houses, and the furniture left behind (and not stolen in their absence) had to be disinfected by the expurgators. Notwithstanding all the diffi- culties occasioned by the unwillingness and arts of the people, the bad conduct of a few soldiers, and of several plague-attendants, (who were chiefly taken from the class of the condemned,) the plague was sup- pressed in six weeks from Dr. White's assuming the medical superintend- ence ; and, he thinks, entirely in consequence of these stringent regu- lations. It was " cut off," and died.
Without denying this conclusion, we could suggest some reasons against it. The plague broke out in December, (in consequence of the landing of smuggled goods from an infected place,) and terminated in May, the season in which the virulence of plague is always the greatest. It may be argued with truth, that the disorder wears itself out, (the latter cases seeming always to be the mildest,) and that the plague, as in other places, died of itself, not of the regulations. Weight is also to be ascribed to the fact that the weakest and most susceptible perish first, and some- thing to the hygienic rules under which the population were finally placed. We say this to put the question in a true point of view, not to dispute Dr. White's opinion on the subject of contagion. It is indeed possible, that, like many contagionists, he may allow too little for such concurrent circumstances as a state of the atmosphere, the condition of the people in respect to dirt and diet, and a general constitutional power of resist- ance, or a temporary tendency to disease. But the contagion view is the safe view ; it is well supported by reasoning ; and the facts seem to be in its favour, for those alleged in favour of the noncontagion principle would allow no transmission of any disorder save perhaps the smallpox : and we think the weight of authority greatest on the con- tagion side. That the quarantine regulations might be improved and the time shortened, is very true—Dr. White thinks fifteen days is a safe period : that it is easy for a smart tourist, or a litterateur on the look- oat for a topic, to throw ridicule on the fears and formalities of a laza- retto, we know ; but it is better for a few to bear some needless de- tention and inconvenience than to run the risk of introducing the plague amongst our population. Unless the statements of Mr. Chadwick, Dr. Southwood Smith, and others, are greatly exaggerated, the pestiferous filth of Cairo itself might be more than rivalled in the courts and allies of our great cities.
Dr. White adduces various cases in support of the effects of contagion from substances : but they are generally inconclusive, because the persons had been connected with patients, and might have had the disease lurking in them. The following is the strongest case.
" Shortly after its breaking out in the village of Perivolir some of the robes be- longing to one of the clergymen, who had died of the prevailing disease, were car- ried to one of the churches as a place of security, (for at this period it was not generally believed that the malady was plague,) and were shut up there in the small room where they were usually kept. " Soon after this, Lieutenant Peretti, of the Corsican Rangers, with a party of his regiment and some expurgators, were sent down thither, to purify the place, and enforce quarantine measures. "About two months from the time the disease appeared, when they were clear- ing away the things from the impested houses, and placing them in a depot for safety, until it should be finally determined by the Government what was to be done with them, another papa, belonging to the village, mentioned to Mr. Peretti that there were some of the church robes in the church, in which, I believe, Mr. Peretti was living at the time; adding, that be wished to get possession of them; doubtless conceiving them not to be impested, and wishing to prevent their being sent to the depot with the other articles. Without knowing or reflecting on the consequences of complying with this request, as doubts were entertained whether they really were impested or not, at the same time being importuned by the priest, who said he was quite sure they were not impested, (and we must at least give him full credit for his belief,) as a period of two months had elapsed since they had been placed there, and nearly forty days from the last case of plague in the village, Mr. Peretti gave him permission to have them examined to ascertain in what state they were; for during these two months the room had. been carefully
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shut up, and no person whatever permitted to enter it, at least during the time of that officer's stay there. As soon as the priest began to handle them, he was taken ill with staggering, stupor, and other symptoms of plague. A few hours after, he was ordered to be earned to the pest hospital, distant about a mile, by the con- dennati, and died before he reached it, no glandular affection or petechhe being ob- served on his body."
Not much if any new light is thrown upon the nature or treatment of the disease. The variety of its symptoms, its apparently capricious nature, but the steadiness with which it advances to one termination, and the little power of medicine, if not its powerlessness, are once again recorded. It has been maintained, and the view derives some countenance from statistics, that a patient lives or dies irrespective of art ; that in a sufficiently extensive number of cases the deaths and recoveries will be much the same, however various or even opposite the treatment. If this rule be false in general, it is true of plague. The appearance of vibices, (large purple spots appearing under the skin,) or petechite, (a speck resembling a flea-bite,) was ever fatal. " Buboes and carbuncles were very common symptoms, particularly after the first ebullition of the disease was over. When they came to suppuration it was considered favourable; but in the cases in which this could not be effected, and where they continued indolent and painful, with much fever, dryness, and beat of the skin, they almost always brought the disease to a fatal termination. Some few of the buboes were dispersed by resolution, and the patients did well. These, how- ever, were not frequent; for of all the patients with buboes who entered the laza- retto near the Casapoliti, only five recovered, whose buboes were discussed. Those whose buboes continued hard and painful generally died. In them the powers of nature seemed unequal to the task of bringing on suppuration, and the patients sank under the disease." The conclusion from the facts seems to be, that the only rational treat- ment is, to support the constitution, and prescribe for the symptoms : though the question still arises, can the constitution be supported, and will alleviation of the symptoms be of any use? " The hospital in the camp district being situated on the edge of the pea afforded us the beat means for the trial of sea-bathing in this complaint, particu- larly at its commencement. In a variety of cases it was adopted; in some of them with evident good effects, more especially in those cases where there was a high degree of action, attended with delirium and affection of the head. It was wonderful on those occasions to remark the sudden alteration which sometimes took place. From a state of almost frenzy, the patient become on a sudden calm and tranquil after immersion in the sea. On a return of the paroxysm, the im- mersion was again had recourse to, and with the same relief. Some of the patients in a state of furious delirium escaped from the hospital, which was open only on the sea-side, and threw themselves into the sea, from which they were taken out more tranquil. In one patient, the paroxysm came on with furious delirium ap- proaching to madness. He was frequently taken out and bathed in the sea, which always had the effect of rendering him more calm and composed. This poor man, however, was carried off in one of these dreadful paroxysms, the recurrence of which could not by any means be prevented. "Cold bathing I consider, therefore, an useful auxiliary to other remedies in the cure of this disease; and several of those who recovered had been subjected to this plan; but I must also state that many of those died on whom it was tried. Perhaps the indiscriminate use of the cold bath is improper; and I give it as an that it ought to be confined to cases of high febrile action, with heat of s : but where a contrary state exists, attended with stupor, shivering, and other symptoms indicating great debility, I conceive it would do harm, as 1 have reason to believe has happened on some occasions. "I have mentioned dryness of the skin as symptomatic of plague; and this I remember was particularly remarkable among my patients in Egypt; and there it was so very obstinate that I could not succeed in removing it by any sudorific which I employed. Indeed, my opinion at that time was, that if I could have but produced a free perspiration, I should have succeeded in curing the disease. Al- though this dryness of the skin is not an uncommon symptom in plague, I ap- prehend it was more common than usual there, from the naturally dry state of the skin among the inhabitants of India in the cold weather which prevailed at that season of the year; and which they seemed to feel very severely, so that their skins were dry like parchment.
"I could not learn that the warm bath was used at any period in the plague of Lefchimo; but various diaphoretics were used, which in many cases had the effect of bringing on a free perspiration. In some of the cases, this appeared to be of service; but it was not attended with that benefit which 1 had formerly expected, or which we are accustomed to expect in other complaints; for many of the patients were carried off in these violent paroxysms after a very profuse perspiration had come on."
Attempts were made to imitate the action of nature by endeavouring to forward suppuration of the swellings by poultices, blisters, and open- ing them by the lancet ; but without much benefit. Calomel Dr. White found of no effect in his own practice, though be thinks it might be useful; and, administered in the large doses some practitioners employed in in- cipient cases of cholera, it might possibly be found a preventive: but the difficulty of mere medicines seems to be, that the disorder is more rapid than they are; so that the poison has hold of the constitution before they can begin to act, even if they have any power. Venesection operates immediately ; and Dr. White thinks it may be allowed when the symptoms seem to require it. Indiscriminate bleeding appears to be a fatal practice.
It will have been seen that Dr. White must have been trained under the
old school of medicine ; and his literature is of the same age. The arrange- ment of the Treatise on the Plague is elaborately formal, and the com- position is open to the same objection. There is a needless reference to
Moses and the Classics, and frequent repetitions from the five or six fold manner in which the author has divided his book. The consequence is, that the really useful matter is in much less proportion to the quantity of words than it needed have been.
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