THE

MEDICO-CHIRURGICAL

REVIEW.

OCTOBER, 1846.

I. RAPPORT A L'ACADEMIE ROYALE DE MEDECINE SUR LA PESTE ET LES QUARANTAINES, FAIT, AU NOM D'UNE COMMISSION, par M. le Dr. Prus; accompagné de Pieces et Documents, et suivi de la Discussion dans le Sein de l'Academie. Ire et IIe Parties. 8vo. pp. 663. Paris, 1846. Bailliere.

II. CORRESPONDENCE RESPECTING THE QUARANTINE LAWS, SINCE THE CORRESPONDENCE LAST PRESENTED TO PARLIAMENT. Presented by Command to the House of Commons, in pursuance of their Address of May 19, 1846. Folio, pp. 48.

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Ir must surely be quite unnecessary to say a single word in the way of soliciting our readers' patient and most attentive consideration of the facts and reasonings which we are about to bring under their notice. The subject of the Quarantine Laws is one of public and very general interest. All persons are more or less immediately concerned in their operation and effects; for whatever interferes with the free and unrestrained intercourse of one nation with another, cannot fail to affect the common welfare. the medical man the subject is, as a matter of course, doubly and trebly interesting; some of the most curious and important questions, connected with the natural history of epidemic diseases, are involved in its right adjustment. It is to medical doctrines and to medical opinions that we owe the present system of prohibitory restrictions, which so seriously interfere with the social comforts and commercial success of numerous countries; and therefore for this reason alone, if there was no other, it well becomes the members of our profession to be foremost in making a calm and candid examination of those doctrines and opinions from which such grave consequences have followed. Now, every one who has made himself acquainted with the subject, be he physician or merchant, traveller or statesman, has of late years, without exception, come to the decided conviction that it is high time for a thorough revision and a very material modification of the quarantine laws, such as they now exist, to take place. The absurdly foolish and most ridiculous principles which they embody, the vexatious and oppressive restrictions which they impose, the wretchedness and suffering which they almost necessarily give rise to, and the great increase of mortality which, we have reason to believe, they often occasion, are surely sufficient grounds for the scrutinizing investigation that is No. 106. 20

so generally demanded. For some years past the British Government and that of France have been using their best exertions to effect a change, and have been trying to get the other Continental powers to co-operate with them in their good work. With this view, they have proposed that a Congress of Delegates from the different States of Europe should be held in Vienna, or elsewhere, for the purpose of agreeing upon some general and uniform system of Quarantine regulations to be adopted in the ports of the Mediterranean. Many difficulties, we regret to say, have been thrown in the way of this most equitable proposal by Prince Metternich, on the part of Austria, and by the representatives of some of the minor powers." * Will it be believed that, in several of the Italian States, the quarantine boards of health are actually independent of the government?-they possess a sort of patent vested right in the profligate exaction of their fees of office! Still, we must not be dicouraged, nor diverted from the reform that is so loudly called for. Truth will assuredly prevail in the long run, despite the opposition of ignorant bigotry on the one hand, and of the basest mercenary intolerance on the other. We have only to keep the subject prominently and steadily before the public mind, by collecting accurate and well-authenticated facts from every quarter, and by not ceasing to expose the enormous fallacies and absurdities which prevail, and we may be confident that, ere long, the system which has so long existed to the serious detriment of commerce and to the disgrace of common sense, not to talk of science and humanity, will be made to undergo such changes as the present state of general enlightenment and sound knowledge requires.

It will be seen, from the following pages, that neither the French nor the English government has at all relaxed in their efforts for this most desirable end. Both have been accumulating materials for information, and collecting the opinions of competent authorities, in order that they may be ready to meet the objections or overcome the prejudices of their opponents.

In August, 1844, the Royal Academy of Medicine in France appointed a Commission to examine all the varied questions connected with the Plague and with Quarantines. This Commission was composed of the following members-men, we may remark, of the highest professional and scientific attainments-MM. Adelon, Begin, Dubois (d'Amiens), Dupuy, Ferrus, Londe, Melier, Pariset, Poiseuille, Prus, and Royer-Collard. M. Ferrus was named the president, and M. Prus the secretary and reporter. The Commissioners were engaged in their deliberations for upwards of twelve months, and had every facility granted them by the French government, to render their enquiry as complete and as accurate as possible. At length, the report was drawn up and read at the sittings of the Academy, on the

* It is only doing justice to the Austrian government to state that it has already made some very useful practical reforms in its quarantine regulations. While France has been talking and planning, Austria, in imitation of the example set by this country, has been acting. Passengers from Alexandria can now reach Paris, via Trieste or Southampton, considerably sooner than by going to Marseilles, in consequence of their detention in the lazaretto there!

1846.]

THE SUPERIOR VALUE OF RECENT RESEARCHES.

287

5th, 10th, 17th, and 24th of March and the 5th of May of the present year. It is certainly a very elaborate and instructive work, replete with most valuable facts and data, which cannot fail to be truly acceptable to every enquirer upon the great questions under consideration, whether he admits the soundness of the conclusions adopted by the majority of the Commission or not. It is for this reason that we have thought it right to bring before the attention of our readers, with as little delay as possible, a faithful summary of its contents, in order that they may be able to judge for themselves of the value of the original.

Although the Plague has so often ravaged the world and there has been no lack, as a matter of course, of books and memoirs published at different times upon the subject, it must be confessed that the number of instructive and really accurate narratives of well-observed facts is by no means very considerable. The epidemics, of which we have the most trustworthy histories, are the following:-that of Nimeguen in 1635, described by Diemerbrock; that of London, in 1665, described by Sydenham and Hodges; that of Marseilles in 1720, by Chicoyneau, Verney, Deidier and Bertrand; that of Transylvania in 1755, by Chenot; that of Moscow in 1771, by Mertens, Orrous, and Samoilowitz; and those of Egypt in 1798, 1799 and 1800, which have been so well described in the writings of Desgenettes, Larrey, Pugnet, and Louis Frank.

But, however valuable the records of the epidemics now mentioned may be, it must be admitted, we think, by all who have attentively studied the history of the plague, that it is only within the last ten or twelve years that we have anything like a positive and truly scientific acquaintance with the disease. Dr. Aubert-Roche was the first to display that brave and generous devotion to humanity and science, which has since been followed by so many of his professional brethren, when he brought himself in direct contact with his friend Dr. Fourcade, who died of the plague at Cairo on the 20th of February, 1835.*

Shortly afterwards, numerous plague patients were received into the hospital of Esbekie, at Cairo. Clot-Bey, anxious to give the most complete authenticity to the observations which might be made of these cases, proposed to MM. Gaetani, Lacheze, and Bulard to join with him in forming a committee or board for the purpose of attending together upon all the patients in the successive stages of the disease, and of making post-mortem examinations. These four gentlemen carried through this task with the greatest zeal and devotedness. The infected were waited upon like other patients; they were freely touched whenever there was occasion to do anything for their relief, or for the investigation of their symptoms. The bodies of those who died were taken to the dissecting amphitheatre, and every organ was most attentively inspected. The results of each visit in common were carefully reported in a register, and each report was regularly signed by all four. This register (which was submitted to the perusal of the government Commission) is the chief basis of the works, which have been published by Clot-Bey† and Bulard.

*De la peste et du typhus d'Orient. Paris 1840, p. 90.

This indefatigable person has sent no fewer than 50 memoirs, at different

Subsequently to these researches, the professors of the medical school at Abouzabel (about four leagues from Cairo) personally attended upon 140 plague patients, of whom 38 died. Professor Perron has communicated a report of the observations and post-mortem examinations then made, in a memoir which he addressed to the Academy.

Drs. Aubert-Roche and Rigaud, attached to the great hospital at Alexandria, displayed no less courage and disinterestedness in their enquiries. The latter gentleman died of the plague, leaving behind him an account of 68 dissections which he had made of fatal cases." * The former has published an account of his observations, collected either by himself or in conjunction with his lamented colleague.

The conduct of M. Lesseps, the French consul-general at Alexandria, has been the theme of universal admiration. By his own example, he powerfully contributed to dissipate the exaggerated apprehensions of visiting and even touching plague-patients. His conduct towards Dr. Rigaud, up to the last moment of his friend's life, was a memorable instance of noble generosity. Since 1835, the medical men resident in Egypt have continued their efforts to render our knowledge of the plague more and more complete. In 1837, an epidemic broke out at Adana, in the corps of the Egyptian army that then occupied Syria. In 1841, Damietta, Cairo, and a number of the towns or villages in the Delta were visited by the pestilence. It is also to be remembered that not a year has passed since the great epidemic of 1835, without a greater or less number of sporadic cases occurring every now and then in different parts of Lower Egypt.

But the plague has been studied of recent years in other countries besides Egypt. To confine our notice to modern works only, we may mention Dr. Brayer's Neuf années à Constantinople; Dr. Gosse's account of the plague in Greece during 1828 and 1829; and the reports of Dr. Morea on the plague of Noja in 1817, and of M. Hemso on that of Morocco in 1818.

M. de Segur du Peyron, although not a physician, has rendered great services to medicine by the publication of the three reports which he addressed, in the years 1834, 1839, and 1846, to the minister of commerce, and which contain a great mass of observations collected by him in the principal ports of the Mediterranean.

Lastly, the Academy has received a memoir on the plague and quarantine, published in 1845 by Dr. Moulon, physician of the lazaretto at Trieste; and also a printed report on the transmission of the plague and the yellowfever, that was drawn up by a committee of the medical society of Marseilles, and unanimously approved of and adopted in August, 1845.

Besides the published works above enumerated, a number of very valu

times, on the subject of the plague to the French Academy. Many of these memoirs, written by able men who have had ample opportunities of studying the disease, well deserve to be published.

* In the very valuable pamphlet on Oriental Plague and Quarantines, published by Dr. Bowring in 1838, it is stated that Dr. Rigaud, after having been, during the most fearful crisis of the pestilence (1835), constantly engaged in visiting and assisting the living or in dissecting the dead, at length fell a sacrifice "just as the plague was ceasing, when its violence appeared wholly exhausted, and the season of its disappearance was about to arrive."

1846.]

VARIOUS SOURCES OF INFORMATION.

289

able manuscript documents have been submitted to the examination of the Commissioners.

Among these, we may mention the original papers respecting all the cases of plague that have occurred in the lazaretto of Marseilles since 1720, along with a letter and memoir from Dr. Robert, one of the physicians of this lazaretto;-the register kept in Egypt and Syria, during the years 1828, 1829 and 1830, by the plague commission, of which M. Pariset was the president; the report, addressed in 1842 to the minister of commerce, by Dr. Delaporte of his mission to Constantinople, Smyrna, and Alexandria, for the purpose of studying the plague in these places;-a statistical statement of 506 epidemics of the plague drawn up by Dr. Rossi of Cairo, who, like Dr. Delaporte, nearly fell a sacrifice to an attack of the pestilence; -the statistic report of all the cases of plague observed in the lazaretto of Alexandria since 1835, by Dr. Grassi, who has been physician of that establishment since 1831;-a memoir on the plague in Persia by Dr. Lacheze; -one on the plague in Algeria, from the year 1552 down to 1819, by M. Berbrugger, corresponding member of the Institute, and conservator of the library and museum of Algiers ;-a memoir on the contagiousness of the plague by MM. Pezzoni, Leval, and Marchand, members of the council of health of the Ottoman empire, dated June, 1842;--and lastly, a memoir on the antiquity and endemicity of the plague in the East, and especially in Egypt, by Dr. Daremberg, the learned librarian of the French Academy.. In addition to these numerous sources of information, the Minister of Foreign Affairs granted to M. Prus the privilege of consulting the dispatches of the French ambassadors and consuls in the Levant on all topics connected with his enquiries. The dispatches of M. Lesseps, (to whom we have already alluded,) during the frightful epidemic of 1835 in Egypt, were found to be especially valuable. The Minister of Marine also put all the official documents under his control at the free disposal of the Commissioners.

With the view of rendering their enquiry as complete and comprehensive as possible, the Commissioners invited to their meetings the attendance of medical men and others, who might feel inclined to give any verbal communication. In this way, they received much valuable and interesting matter. The Report is divided into four parts or sections.

In the first, the following points are examined and determined :—the countries where the plague has been observed to become spontaneously developed ;-the causes of spontaneous plague ;-the disappearance of the plague, whenever these causes have ceased to exist ;-the countries where the persistance of these causes renders the plague endemic, or at least makes the return of the spontaneous disease to be apprehended-and, lastly, the measures that are really and truly prophylactic against spontaneous plague.

In the second part, the three following questions are answered:- -1. Has the plague always exhibited the characteristic features of epidemic diseases, whenever it has raged in Africa, Asia, and Europe? 2. What are the distinctive characters between epidemic and sporadic plague? 3. Does the plague spread after the manner of epidemic diseases; i. e. by the migration of certain atmospheric influences, and independently of the agency of those persons who are infected by it?