Outbreak

“ The findings, as to the first question, are to the effect that it appears, from the earliest recorded annals of disease, that epidemics corresponding to the present outbreak have occurred at irregular periods all up the centuries under names and conditions peculiar to the times, and following usually in the wake of some great social cataclysm, strain or upheaval, the result of wars, persecutions, famines and distress—causes which clearly illustrate the close reactive connection between the mental and physical action of disease. ”

“ In an investigation of the kind before us we must have a knowledge of all the circumstances, and therefore, even at the risk of weaving such a complicated array of events around this drama of disease that it may need the skill of a professional novelist to disentangle us from the meshes, we must glance for a moment at the condition of the weather during at least the early part of the outbreak. ”

“ The inhabitants of the exempt houses, as the outbreak of the fever extended, assumed generously nearly all the care of the afflicted families. They were daily and nightly in attendance upon the sick, and in many cases assisted in washing the linen. If this were true of the inhabitants of the houses that were exempt from the scourge, we are nearly safe in excluding personal conveyance of the germs by those who inhabited houses showing a sequence of infection. ”

“ A boy perhaps would spring to his feet and begin to rave, or some over-excited person would utter a piercing shriek, or a cry of triumph, and this would be the signal for a general hysterical outbreak, accompanied by many remarkable physical symptoms. ”

“ The Trousse-galant carries off a fourth part of the inhabitants of France in this and the following years.
1528. Wet and mild winter. Moist summer with fogs. Failure in crops, and famine in England.
1528. At the end of May: outbreak in London of the Fourth epidemic Sweating Sickness. It spreads with great malignity, and with much disturbance of social life, all over England; carries off many distinguished persons, and terminates in the winter. ”

“ How this outbreak was induced is not definitely known, and suspicions, which may be unjust, need not to be stated. ”

“ The destruction of valuable property, a senseless panic, and a relapse into the indulgence of time honored abuses, are the common results of outbreaks of typhus or typhoid fevers, of smallpox, cholera, or any other of the many diseases by which we are punished for grave derelictions of duty. ”

“ The outbreak of the war found my wife and me in Switzerland, where we were taking a cure. ”

“ 'In 1828 Professor Bianchi demonstrated how the fearful reappearance of the plague at Modena was caused by excavations in ground where, three hundred years previously, the victims of the pestilence had been buried. Mr. Cooper, in explaining the causes of some epidemics, remarks that the opening of the plague burial-grounds at Eyam resulted in an immediate outbreak of disease.'—North American Review, No. ”

“ Whether or not there is a regular periodicity of a definite number of weeks in the case of influenza, the fact remains beyond cavil that one of the dominant characteristics of epidemic influenza is its recurrence at intervals. The evidence is ample that the disease is distributed throughout many countries in interepidemic times and that intermittent outbreaks of large or small extent occur. ”

“ The true explanation of the outbreaks is doubtless to be found in the depleted physical and mental condition of the people, resulting from the wars and the frightful plagues which devastated all Europe previous to, and during these times. ”

“ To realise the horror of the Plague, let us imagine an epidemic as contagious and as infectious as influenza was some few years ago spreading everywhere, the great majority of its victims dying in the most terrible sufferings. ”

“ From this picture let us take a lesson, in case the impending epidemic should ever come to spread in the populous towns of England, and the cry of contagion be proclaimed in their streets. The very word will spread terror and dismay throughout the people, causing multitudes to be infected, who would otherwise, in all probability, have escaped an attack, and afterwards consign them to death in despair, when they find themselves the marked and fated victims of a new plague. ”

“ The Devonshire diffusion was like the spreading circles in a still pool. The spread of influenza was like the flying ripples on a broad surface of water. The spread of plague, on the occasions when it was universal, was like the massive rollers of the depths, the onward march of cholera from the East having, in our own times, illustrated afresh the same momentum. ”

“ A neighbour barricading himself within his house, at a few yards distance from infection, may escape unhurt. If pestilential contagion could be so suddenly and widely scattered over a kingdom as epidemical influenza, the earth, in a few months, would be converted into an enormous church-yard. It is not like some other exotick poisons of the exanthematous order, after enduring which once, mankind are rendered{120} invulnerable: the plague, as well as putrid fever, may attack the same person repeatedly. ”

“ Water, though perfectly dissolved, and to appearance deprived of existence in the air, may yet be precipitated from it, and pour down upon us in deluges. What happens in one case may happen in another. The infectious matter, dissolved in the air, may by some natural cause be precipitated from it, overshadowing whole regions, and, if it be not powerful enough to produce the epidemic of itself, may certainly predispose to it in such a degree, that the slightest additional cause will bring it on. ”

“ If we suppose the plague, or any other epidemic disease, to arise from some general cause, let that cause be contagion or any thing else, it ought to operate upon all who come within its sphere of action, as Dr. Mosely observes of infection. If experience shows that it does not, the argument will hold equally against a constitution of the atmosphere, putrid effluvia, heat, cold, or any thing else ”

“ For, if the special matter or germs of epidemic disorder be not present, a corrupt atmosphere, however obnoxious otherwise, will not produce the disorder. But, if the germs be present, defective drains and cesspools become the potent distributors of disease and death. Corrupted air may promote an epidemic, but cannot produce it. On the other hand, through the transport of the special germ or virus, disease may develop itself in regions where the drainage is good and the atmosphere pure. ”

“ But Examples of this kind are so very rare, that I think it must be concluded, that the Plague is usually one and the same Distemper.
In the next place I shall endeavour to shew, that the Plague has always the same Original, and is brought from Africa, the Country which has entail’d upon us two other infectious Distempers, the Small-Pox and Measles. In all Countries indeed Epidemic Diseases extraordinarily mortal, are frequently [Pg 22] bred in Goals, Sieges, Camps, &c. ”

“ This epidemic Proteus is at once a great difficulty and a most instructive fact. It opens up the very old doctrine of “epidemic constitutions” of the air, which to many moderns savours of unscientific vagueness; and it brings us face to face with degrees or kinds of infectiveness which are, in matter of fact, more wonderful or more incomprehensible than the deadlier infections, such as the plague or Asiatic cholera. The most familiar instance of the kind is influenza. ”

“ That when the Constitution of the Air happens to favour Infection, it rages there with great Violence: that at that time more especially diseased Persons give it to one another, and from them contagious Matter is lodged in Goods of a loose and soft Texture, which being pack’d up and carried into other Countries, let out, when opened, the imprisoned Seeds of Contagion, and produce the Disease whenever the Air is disposed to give them force ”

“ What were the favouring conditions?
If, as I believe, the virus of plague had its habitat in the soil, from which it rose in emanations, and if it depended therein, both remotely for its origin in some distant country, as well as immediately for its continuance in all countries, upon the decomposition of human bodies, then it is easy to understand that the immense mortalities caused by each epidemic would preserve the seeds of the disease, or the crude matters of the disease, in the soil. Buried plague-bodies would be the most obvious [Pg 36] sources of future plagues. ”

“ Facts such as these help us to understand the production and propagation of disease through the medium of an infected atmosphere, whether on a large scale, as in the case of an epidemic which rapidly extends over a nation or a continent, or on a small scale, in the sick chamber, the dissecting room, the church, and the church-yard. ”

“ Surely the places where dangerous infectious diseases are constantly propagated on a gigantic scale, and disseminated therefrom into the bodies of millions of animals and mankind, should be the very possible or probable source of epidemic disease. ”

“ It is beyond dispute, that the plague appears in a different manner in different countries; and that it appears differently in the same country in different years: for we find most other diseases alter more or less, according to the constitution and disposition of the air in the same climate: for, some years, fevers are epidemic, and very mortal: other years, they are epidemic, but not mortal ”

“ In all epidemics which increase to such a degree as to become contagious, it is of importance to distinguish which of these causes are the more powerful, the predisposing or epidemic causes, which originate the proneness to the disease, or the proximate causes, among which, in the generality of cases, contagion is the most prominent. ”

“ It is true, that as several Physicians told my Lord Mayor, the Fury of the Contagion was such at some particular Times, and People sicken’d so fast, and died so soon, that it was impossible and indeed to no purpose to go about to enquire who was sick and who was well, or to shut them up with such Exactness, as the thing required; almost every House in a whole Street being infected, and in many Places every Person in some of the Houses ”

“ The disease attacked the most robust and strong, and spread without interruption over the entire kingdom, from east to west. In a very short period vast numbers of the population fell victims to this strange epidemic. ”

“ If an epidemic begin in a definite locality and spread from that locality, and if there is no loss of infectivity on the part of the organism, it is demonstrable that a similar proportion of the population should be attacked in each zone as the epidemic spreads outward. ”

“ Medical history proves, on the subject of epidemic and contagious maladies, a marked fatality at the time of their first appearance, followed by slowly-decreasing violence from generation to generation. In our own memory the epidemic visits of cholera have diminished in frequency and intensity within a short period of time. ”

“ Such affections chiefly comprise fevers par excellence—the epidemic, endemic, and contagious or infectious disorders—which suddenly attack masses of people, which spring from different sorts of malaria, or from specific communicable poisons ”

“ The chronicles of all nations are replete with notices respecting the remarkable commotions of nature, which have proved from time to time so inimical both to the animal and the vegetable kingdoms; and on carefully reviewing the facts detailed in the histories of epidemic pestilences or diseases, it will be readily perceived that, during certain periods or seasons, ELEMENTAL DISTURBANCE has enveloped, as it were, the entire globe, carrying death and misery into every quarter. ”

“ Epidemics of many kinds, typhus, ague, plague—all diseases which were caused more or less by bad air—devastated this land and Europe in those days with a horrible intensity, to which even the choleras of our times are mild. The back streets, the hospitals, the gaols, the barracks, the camps—every place in which any large number of persons congregated, were so many nests of pestilence, engendered by uncleanliness, which denied alike the water which was drunk and the air which was breathed ”

“ These diseases also become epidemic, under the same circumstances, after inundations, and also in places where a large number of persons are crowded together with imperfect ventilation, as in ships, in prisons, and in besieged fortresses.’40 But in no case may we so securely reckon on the occurrence of epidemic diseases, as when a marshy surface has been dried up by continued heat, or when extensive inundations are followed by intense heat. ”

“ For, towards the chemical constitution of local atmospheres, it seems that the several principles of epidemic diseases stand in the same sort of fixed respective relations, as do the several principles of infective fevers towards certain elements in the blood of individual persons. Just as the infective ferment acts on man, so appears the epidemic ferment to act on locality. ”

“ That there has neither been a death nor a new case, as regards the plague or cholera for five days, and as regards the yellow fever for eighteen days, either since the isolation or since the death or cure of the last patient; 2. That all measures for disinfection have been applied; besides, if it is a case of plague, that the measures against rats have been executed, and, in case of yellow fever, that the precautions against mosquitoes have been taken. ”

“ All we can say is, we know into what dwellings cholera and fever will not come, however 'epidemic' the year; we can put towns and districts into such a state that the epidemic, like the mediæval witch, is exorcised, so that it cannot come near them. ”

“ That impure air, want of light, crowding together unwashed numbers, &c., will by predisposition contribute to the production and aggravation of disease, as we observe to be the case [210] in jails, hospitals, and in camp, I can fully understand; but that epidemic diseases, such, for instance, as plague, yellow fever, or cholera, are ever propagated by contact—contagion, I, after twenty-five years’ residence in pestilential countries, have no reason to believe ”