A treatise on the plague; more especially on the police management of that disease. Illustrated by the plan of operations successfully carried into effect in the late plague of Corfu, with hints on quarantine

Front matter

A

TREATISE ON THE PLAGUE.

TREATISE ON THE PLAGUE

Dedication

regulated Police Establishment, in forcibly crushing, and finally extinguishing, in a very short time, this formidable malady, which seems to carry with it a peculiarity of character that renders it distinct from all other diseases with which we are acquainted.

In the Plague which appeared in Cephalonia, about the same time, and the introduction of which was attributed to the same cause — viz., smuggling, — a similar vigorous management by police restraint was adopted, and with equally happy effects.

That the Laws of Quarantine require modification, I admit ; but that they should be abrogated and overturned with impunity, as useless, I cannot too strongly deprecate ; for my strongest conviction is, that in doing away with these laws altogether, our commerce would be restricted rather than enlarged, and this sad calamity would, sooner or later, find its way to our shores.

Chapter I

Diversity of opinion respecting plague — Considered a disease depending on contagion — Persons, however, sometimes escape it, though in close contact with plague-patients — Ancients of the opinion that plague is contagious — The word plague used indefinitely by them — They were unable to account for its introduction into a place — This circumstance explained by moderns on the principle of contagion — The true plague well known to the ancients — They were aware of its being propagated by intercourse with the sick, though probably not, that it could be introduced by persons or effects coming from a distant place where plague was raging 55

Chapter II

The Jewish Legislator acquainted with contagion, and aware that disease was propagated thereby — In aggravated cases, Moses directs the garments to be burned, and the houses to be purified — Modern writers of the same opinion as to plague — Plague effluvia considered — How introduced into the system — Inoculating for the plague 64

Part II

ON THE ORIGIN AND HISTORY OF THE PLAGUE, WITH AN ACCOUNT OF ITS SYMPTOMS AND PROGNOSIS.

CHAPTER I.

Egypt supposed to be the focus of plague — The diffusion of plague ascribed to preternatural phenomena, meteors, earthquakes, hurricanes, &c. — Plague an imported disease — It excited much attention about the time of the Crusades — Precautionary measures adopted against it about the viii

CONTENTS.

same period — How quarantine laws came to be established, and gradually perfected — The exemption of Europe ascribed to these laws — Dreadful effects of fatalism among the Mahometans — Differently evinced among them and Christians — Fatalism on the decline in Turkey — The malady capable of being diminished, if not entirely expelled from plague countries — for instance, from Turkey in Europe, — unless owing to local causes, which cannot be removed or controlled — Doubts whether or not the plague is indigenous in Turkey in Europe — Policy of the Ottoman Porte with respect to plague — Quarantine laws, if successful in expelling the plague from civilized Europe, why should they not be so in expelling it from Turkey in Europe — Plague continuous there — Introduction of plague into civilized Europe attributed to imported contagion 71

CHAPTER II.

Plague imported by sea — Shown to be an imported disease by its being suppressed in lazarettos — Plague also imported by land — Generally accompanying the Mahometan armies— Thus traced to Jassy, Moscow, &c 82

Chapter III

The Franks escape by shutting up — Plague most destructive in crowded places, and among the attendants on the sick — The Foundling Hospital in Moscow! preserved by the jealous care of De Mertins, in keeping it insulated— /-Danger of permitting intercourse with, and of receiving strangers in the time of plague 85

Chapter IV

The plague not communicable, like epidemic diseases, through the medium of the atmosphere — The efficacy of well-regulated cordons, as a security against the malady, as seen in Lefchimo — The sense of danger a good preservative — The foolhardy and those who violated the laws of quarantine the sufferers — Persons impested sometimes unconscious of their being so 89

Chapter V

Sad consequences of dilatory measures on the breaking out of plague — Necessity of choosing for the management of plague-matters men of practical experience and integrity— Necessity of liberally rewarding and placing above temptation persons in plague-service — Danger of being thrown off our guard by the lulling or apparent cessation of the malady — Plague not so regular in its periodical visitations as has been supposed — Prevailing notion of the Franks on this subject — In plague countries, the malady is not always in the same state of activity at the

CONTENTS.

ix same periods— Is not affected by extremes of heat and cold— These may, however, modify its type — Any supposed benefit arising from these extremes not to interfere with the plan of management for suppressing the calamity 92

Chapter VII

Pestilential contagion usually very violent at the beginning : occasionally so during its course — March of the plague — Inquiry how it has been introduced : often by means of contraband goods, or mismanagement in health-offices — Great advantage of the early application of the proper remedies in suppressing it exemplified in Cephalonia — The general principles for its suppression always the same — Separation and segregation— Difficulties to be encountered in arranging the classifications 103

Chapter VIII

The necessity of shutting up on plague being proclaimed* — Of avoiding all intercourse, and of impressing this on the public mind — Several of the people of Lefchimo guilty of violating the laws— Indisposition during the period of quarantine .115

Chapter IX

Plague-contagion considered as capable of being transported from place to place — Has been imported into England — May be so again— Merchants anxious to have quarantine restraints removed .120

Chapter X

Safest, and perhaps in some circumstances cheapest, to destroy a plague-ship at once, rather than to expurgate her — The health of a ship's crew not sufficient proof that there is no plague-contagion on board — Indemnification from governments for impested property destroyed — Impossibility sometimes of ascertaining at once whether a ship has the plague on board or not — Such ship should not be allowed pratique until that point is ascertained — Manner in which goods may be impested — The plague said not to proceed in an easterly direction — Is probably influenced by season — Uncertainty of the period plague-contagion may retain its activity — Modification or relaxation of the quarantine laws of England — Why expurgators in England have so long escaped the plague — Dealers in old clothes said not to contract the plague 125

X

CONTENTS.

Chapter XI. Page

On the symptoms of the plague — The supposed characteristic symptoms sometimes absent — Collateral circumstances to be considered in order to enable us to decide on its actual existence — Symptoms of the celebrated plague mentioned by Procopius — Of that which attacked the British army in Egypt — Of that in Lefchimo — Of the prognosis . .135

Chapter II

Propagation of the calamity in the upper district — First in the village of Marathea — Mr. Tully sent to inquire into the sickness prevailing there — Did not consider it to be the plague — Measures of restraint entered upon — The sickness superstitiously imputed to an evil spirit — Propagated by the priests in the villages of Perivoli and Anaplades — In Argirades — Troops sent into the district — Also medical officers — Melancholy occurrence among the troops from a violation of quarantine — Propagation of the calamity in the village of Rumanades — In Neocori — In Cuspades — In Clomo — Another distressing occurrence among the troops from a violation of quarantine — Saint Dimitri impested — Also Critica — The other villages of Upper Lefchimo not impested — Necessity of some restraint in places not impested — Want of confidence necessarily existing in the time of plague .158

Chapter III

Propagation of the plague in Lower Lefchimo — Saint Theodoro impested — Also Melechia — People anxious to conceal indisposition in the time of plague — A pest hospital ought not to be established in a town if it can possibly be avoided — Cruelty and inexpediency of burning impested houses — Removal of the susceptible effects from impested houses — Effects of persons simply suspected — Permission granted in Lefchimo to the class of simply suspected to take their effects along with them to the camps — Punishments sometimes necessaiy . . . 1 74

CONTENTS.

xi

Chapter I. Page

Concentration of the sick and suspected — The district divided into compartments, and no intercourse allowed between them— Mischief arising from not attending to the regular shutting-up of camps — Medical inspections in the impested villages— The people unwilling to submit to them — In ordinary indisposition, the people allowed to remain in their houses, and receive medical attendance there — Good effects of these measures — Felons employed in duties where there is the most danger — Persons once recovered from plague not likely to be attacked by it again — Advantages of employing convalescents from plague in the most dangerous duties 184

Chapter II

On expurgation — Examination of the impested houses — Purification of the impested houses — Removal of the depots of impested things to a general depot — Valuation of the effects sent to this depot — Burning of the depot resolved on — And carried into execution 192

Chapter III

Expurgation of the churches— Securing the plague graves — Concealed effects — Rewards granted for their discovery — Duties of the medical officer in charge of the camps, or places of segregation — The length of time plague contagion may remain in the system without showing itself .202

Chapter IV

On camps — The provisions to be placed at a particular spot — Difficulty of sometimes ascertaining what property ought to be expurgated and what should not be interfered with — Prevailing opinion in Lefchimo concerning property destroyed there 213

Chapter V

Removal of the people in the camps to their villages — Great difficulty of provisioning the people — Sir Thomas Maitland's kind consideration for them — Necessity of bringing matters to a speedy termination on account of the expected remittent fever — The people's houses to be repaired before they are sent home — Some of the persons, very weak from ordinary complaints, to be removed — Minute examination of xii

CONTENTS.

all the people previous to their removal — Necessity of employing civic guards to assist the troops — Reasons for subjecting the persons returned from the camps to further quarantine — Great joy of the people on being liberated — Further means adopted to discover concealed effects — Highly improper conduct on the part of the priests — The people who were hitherto shut up in their villages, liberated before those belonging to them were sent back from the camps — Period of quarantine in the class of highly suspected shortened from forty to twenty-five days, that of the class of simply suspected from forty to seventeen days — On cases of supposed plague — The difficulty of managing individual convalescents from plague — On the pestilential bubo — A place of security to be prepared for the performance of the quarantine of convalescents from plague — Examination of these previous to their being encamped — Are to be well washed and receive fresh clothes — Those of Lefchimo directed to give up any effects they may have concealed — Amulets worn . by several of them, to which they attributed their recovery ...217

Chapter VI

The people returned from the camps unwilling to occupy their houses— Not fewer than three persons supposed sufficient to prove an impested house — Considerable anxiety whilst such proofs were going on — The people now remaining in the camps permitted to draw supplies from their villages — The corps of expurgators diminished — Directions to the medical officers whenever sickness should occur in the district — The people permitted to pull their flax, but not to steep it for the present — A discovery of concealed goods made by accident — An alarm of plague in Marathea — Craftiness and ingratitude of certain inhabitants of Lefchimo 236

Chapter VII

On congregations of people in the time of plague — Certificate of the health of Lefchimo — Free pratique proclaimed within the district itself, but not between it and the rest of the island — Dissensions respecting property among the people of Lefchimo — The pest hospital broken up — The troops at the principal cordon very sickly from the remittent fever — Another alarm of plague in the village of Cuspades — The first fortnight of a general pratique always a critical period — Short account of the autumnal fever in Lefchimo — A case of sudden death from apoplexy — Necessity of withdrawing the troops from the villages, on account of the sickness among them 248

Chapter VIII

Expurgation of the pest hospital — Urgent necessity, on account of the sickness among the troops, of speedily winding up the plague matters —

CONTENTS, xiii

PAGE

The quarantine of the convalescents diminished from eighty to fiftydays — They are not placed under restraint on their return home, as had been done with the suspected — Those who died of the prevailing fever not buried until the bodies were examined— The pest hospital proved as the other plague houses had been — All quarantine restraints removed, and the district of Lefchimo placed in free pratique with the rest of the island- — Some troops, and several medical gentlemen left for a short time in the district 262

Part V. On The Cure Of The Plague

Bleeding — Cold bathing — Diaphoretics — Emetics — Purgatives — Cordials — Opium — Saline mixtures — iEther — Camphor — Mercury — Blisters— Poultices— Bark 276

Conclusion 295

Appendix 307

Preface

I had already committed to writing the following observations on the plague, without having fully made up my mind to publish them, when a work appeared on the same subject by Mr, Tully, surgeon to the forces ; in which he treats, like myself, of the particular plague of Corfu. On perusing his work, I could not help thinking it defective in two essential points, — namely, in the description of the extension of the calamity from place to place, and in the detail of the police treatment adopted on the occasion. The latter defect was probably owing to his want of official documents, which, from the time I took the charge, were all in my possession ; and it was impossible for any one from memory alone to give in a regularly detailed form the proceedings which took place in Lefchimo.

Had Mr. Tully's work appeared to me sufficiently explicit on the two important points I have mentioned, it is not probable that my observations on the same identical subject would have ever seen the light, especially as we perfectly agree in the opinion, that the plague is a disease depending on contagion alone, and as we both equally appreciate the advantages to be derived from a well organized and efficient police, in not only arresting the progress of the disorder, but in suppressing, and finally extinguishing it: on which last point I have dilated more than is usually done in a work of this kind, from my full

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PREFACE.

conviction that more is to be achieved by proper police towards diminishing and subduing the plague, than has ever yet been done by any medical treatment.

But while this imperfection in the details of Mr. Tully's work operated as a powerful inducement with me to give my observations to the public, from the minuteness of which, at least, I presume some benefit may be derived in the future management of plague, another somewhat singular, though evidently a designed omission in the same work, in some degree compels me, however reluctantly, to obtrude myself upon the public as an author. Mr. Tully, in his work, has studiously concealed the circumstance of his having but acted under my orders for the greater part of the time in the plague of Lefchimo ; and has carefully avoided so much as once mentioning my name, from first to last. Whatever were his motives for making such an omission, no one, I believe, will ascribe them either to modesty or candour.

Far be it from me to detract from Mr. Tully's merits in the plague service. On the contrary, I feel much pleasure in acknowledging him to have been a most zealous and active officer. It is, however, but justice to others, as well as myself, to state what really was the position he held.

In order to place Mr. Tully's merits and claims in their proper light, — a subject which I should not have thought of meddling with, had I not felt it incumbent upon me to do so in self-defence, — it is necessary for me to say, that on my arrival in Corfu with Major-General Sir Charles Phillips, after the army of the Mediterranean had been broken up in the month of March, 1816, his Excellency Sir Thomas Maitland, the Lord High Commissioner of the Ionian Islands, appointed Major- General Phillips to the supreme direction of the plague duties, and myself to the superintendence of the plague district ; consequently, to the immediate charge of the executive within that district : and in a few days afterwards, I was put in the general orders of the army as such, as will be seen by an extract from

PREFACE.

vil them, signed by Lieut-Colonel Jordan, Deputy Adjutant General, a copy of which I subjoin : —

(Letter I.)

Adjutant- General's Office, General Order, No. 8. Corfu, March 23, 1816.

Staff- Surgeon White will repair to Egrippos, to take charge of the plague district.

(Signed) John Jordan,

Dep. Adj. Gen.

In virtue of this, I was of course to supersede Mr. Tully in every charge and responsibility ; and, in fact, I did so from the moment I went down to the plague district. This was not done in a corner, but in the face of the whole army, and indeed of the whole population of the island. Mr. Tully knows full well that his authority ceased from the time I went down to Lefchimo, which was a few days after my appointment : and, in taking that charge upon me, he also knows that I became the only organ of correspondence with the government relative to all matters of plague.

It is not for me to enter upon the reasons which induced his Excellency General Sir Thomas Maitland to supersede Mr. Tully and to appoint me to the charge ; but had they not been good and substantial ones, I am very sure I should not only not have been called upon, but that I should not have been permitted to interfere in any way, even had I wished to do so.

Yet, with a knowledge of these facts, and knowing also that, on whatever part of the service he was detached, it was his duty to report to me, as his superior, every transaction, — which, had he failed to do, must have been considered a breach of military orders, for which he would have been held responsible^ — he makes it appear that he was the only individual in authority on the occasion.

It has no doubt frequently happened that superior officers have taken credit to themselves for the exertions of those serving under them, without bestowing on the individuals

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PREFACE.

who assisted them that commendation to which they were fairly entitled ; but I believe it is very uncommon for a writer to enter largely on a subject, and that regarding an important service, on which he had been employed, without once mentioning the name of the superior officer under whom he was serving for the greater part of the time, and to whom he was almost daily transmitting his reports.

In both my public and private dispatches, I always spoke favourably of Mr. Tully ; and I think he will not deny that, during the time he served under my orders, I made his duty as pleasant to him as any duty of the kind could well be made. As the omission of my name in his work is calculated to mislead certain individuals whose esteem I value, and to affect my character with the army medical board, I owe it to myself in particular, and to the medical officers employed with me in general, to declare that all concerned were uncommonly zealous and active in the suppression of the malady, and that a degree of unanimity, together with the most unremitting and indefatigable exertion, pervaded all ranks, which, perhaps, has seldom been equalled on a similar occasion, and could not well be surpassed.

I trust, therefore, that it will not be construed into egotism on my part merely to mention, that my own personal exertions have been commended by the Lord High Commissioner; by Major- General Sir Charles Phillips, under whose immediate orders I served ; and by the Senate of Corfu ; as also that the government has in some degree rewarded me for them, by confirming to me, at the recommendation of the Director-General, a step of promotion I formerly held at the fall of Genoa, on which occasion I was employed as the second medical officer on that service. I here subjoin the letters referred to.

PREFACE.

ix

(Letter II.)

Copy of a Letter from Sir Frederick Hankey, public and private Secretary to the late Lieut.- General Sir Thomas Maitland, Lord High Commissioner of the Tonian States, to Dr. A. White, Superintendent of the Plague in Corfu.

Brighton, 3rd December, 1841.

Dear Sir, — I have received your letter, in which you request me to bear testimony in respect to your services in the plague of Corfu in 1816.

I have retired from public service ; and therefore, generally speaking, abstain from meddling with public affairs ; nevertheless, in justice to you, I will do what you ask ; and having been the public and private Secretary to the late Lieut. -General Sir Thomas Maitland during the whole period of his administration, as the Lord High Commissioner in the Ionian States, I trust that I shall not be deemed presumptuous in saying what follows in the matter in question.

Sir Thomas Maitland landed in Corfu in February, 1816. He was aware that previously, for two or three months, there had existed in the district of Lefchimo, in the south-eastern part of the island, a disease : it was called fever. However, Sir Thomas having examined into details, at once pronounced it to be plague, and made proclamation accordingly.

He had great experience in matters of plague. He was, as you know, a man of singular firmness, and, I will venture to say, more fitted in every respect and for the emergency than almost any other man in the world. He proceeded on the principle that plague was only to be checked by preventing contact, and he cut off all communication between the infected district and the city of Corfu, by the active agency of the troops ; and he then adopted the most efficient measures in the district of Lefchimo to extirpate the disease ; all founded on the same principle of preventing contact. The result was, that he saved the island ; the plague never appeared in the city of Corfu, and was soon extinguished in the infected district, out of which it never escaped. In that district, you were employed as the principal medical officer; and I well know that he was perfectly satisfied with your conduct throughout. The mortality was great ; for the malady was, as I have said already, plague in its most violent form. But it was conquered by the establishment of infected and suspected camps, the whole of which were under your personal care, and your duties were harassing in the greatest degree.

As soon as the plague began to subside, Sir Thomas quitted Corfu, being called to Malta by public business ; but he left a most active and able officer at Corfu, Major-General (now Sir Charles) Phillips, who fulfilled the duty delegated to him by Sir Thomas most completely.

I am sure Sir Charles would not withhold his testimony of your valuable services in the plague of Corfu, which would have more weight than mine.

I remain, dear sir, yours very truly,

(Signed) Fred. Hankey.

Dr. A. White, Deputy Inspector of Hospitals, London.

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PREFACE.

(Letter III.)

Letter from Major- General Phillips, on the issue of the Proclamation for Free Pratique betwixt the District of Lefchimo and the rest of the Island of Corfu.

Corfu, 26th July, 1816.

Sir, — It is with infinite pleasure I enclose the Proclamation announcing the general pratique given to the district of Lefchimo with the whole of the Island of Corfu.

You will perceive that the unlimited and free intercourse commences to-morrow, the 27th instant.

You will distribute the enclosed copies of the Proclamation, and announce this most joyful news to all concerned.

I most heartily congratulate you on having realized this happy period, and of having terminated your tedious and most fatiguing duties with so much credit to yourself, and with such serious and important advantages to the community at large of these islands.

I remain, Sir,

Your most obedient servant, (Signed) C. Phillips, Major- General.

P.S. You will report to Lieut. -Colonel Jordan, Deputy - Adjutant - General, to-morrow, and you will arrange with him any duties you may have to perform, as well as the time you can give up the charge you have been entrusted with in the district of Lefchimo.

Boats will be sent down this evening to bring up and to tow the several persons in quarantine. Be very careful that they are not mixed, as they are to be kept exactly according to their respective dates in the Lazaretto for some days.*

To A. White, Esq., &c. &c. &c, Superintending the plague district of Lefchimo.

* Note by the Author. — As those persons consisted of a corps of expurgators from Malta, some soldiers belonging to foreign regiments in our service about to be disbanded, felons who had been employed in various plague duties, and others, it was not considered expedient that they should be let loose at once in the city, until the government had decided, and arrangements were made, as to their final disposal.

PREFACE.

(Letter IV.)

Copy of a Letter of Thanks from the President of the Senate of Corfu to Staff- Surgeon Andrew White, for his services in the Plague of Lefchimo.

Corfu, 13th February, 1817.

Sir, — The Senate of Corfu having learned your departure from this place, requests you will be so kind as to accept the testimony of its most sincere regret for your going away, and its satisfaction for the zeal and attachment which you have always showed in your public functions, as superintendent of the district of Lefchimo, named to this important charge by his Excellency the Lord High Commissioner, Sir Thomas Maitland, during the plague in that district.

In rendering justice to your merit, I declare to you that your services have been of the greatest utility, as well for the relief of the human suffering kind, as for the absolute extirpation of the dreadful plague which afflicted this island during six months : adding to your glory, and that of the officers under your orders, that the measures transmitted to you by his Excellency had, in their execution, the most sudden and happy success, which was to be expected only from your prudence and your indefatigable activity.

I have the honour to express to you the sentiments of my high esteem and consideration.

The President of the Senate of Corfu,

(Signed) B. Theotoky.

Mr. White, Staff Surgeon, &c. &c. &c.

Corfu.

(Letter V.)

Copy of a Letter from the President of the Senate of Corfu to Dr. White, for his service in the Plague, and thanking him also for his having settled the compensation accounts for the loss of property during the Plague.

Corfu, a 7 Decembre, 1816.

Monsieur le Docteur, — J'ai re^u la lettre que vous m'avez fait l'honneur de m'ecrire, datee du 3 de ce moi, avec toutes les pieces que vous avez bien voulu me faire parvenir.

Agreez, je vous prie, Monsieur le Docteur, les sinceres assurances de l'estime et du respect avec laquelle j'ai l'honneur d'etre, Monsieur le Docteur,

Votre tres humble et tres obeissant serviteur, (Signed) B. Theotoky,

President du Senat de Corfu.

A Monsieur Monsieur le Docteur White, Chirurgien de l'Etat Major, &c. &c. &c, a Corfu.

* Settling the plague compensation accounts. — A. W.

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PREFACE.

Any one must see, on reading Mr. Tully's work, that he wishes it to be understood that he had been the only medium of correspondence with the government of Corfu, from first to last ; and, in order to fix this persuasion on the minds of his readers, he quotes, in his note, page 122, a portion of a letter from General Phillips (the only one), and that, too, but of a demiofficial nature, which he received during the whole time he remained in the district after my arrival there. This letter was on a particular subject immediately concerning himself; audi think was enclosed in my dispatches, and transmitted by me to him. As it concerned only himself, in order to save time, he was ordered by me to reply to it to the General directly, which he accordingly did.

But, in order to prove that I was not in the position which Mr. Tully, from his silence respecting me, would lead one to believe, I may mention, that I received from the General upwards of 130 public and private dispatches, all, with one exception, written by his own hand, dming the time I was in the plague district, and all of which I have now in my possession ; and that during the same period, my letters to him alone, of which I have kept copies, all in my own hand- writing, amount to 129, independent of almost daily orders and instructions, which I had to send throughout the district ; and of my having to attend to all reports which required immediate notice. Even all this was but a small part of the duties I had to perform ; for I was obliged to have a watchful eye on the whole of the executive ; to attend to the health of the troops, and the wants of the inhabitants ; to make my tours of inspection ; to overlook the expurgation ; and ascertain, from ocular demonstration, everything that was going on, in order to form my reports against a certain hour, for the information of the government ; to examine in person every house, hole, and corner where the plague had appeared throughout the whole of the upper district,