November 25, 1887.] 



SCIENCE. 



259 



we may feel comparatively safe. But the efficient president of the 

 Louisiana State Board of Health cannot guarantee that all ave- 

 nues of approach are securely guarded, inasmuch as some of these 

 Avenues are quite beyond his control. This is e.xemplified by the 

 Biloxi epidemic of 1886. Local outbreaks, such as that at Biloxi, 

 and the epidemic at Key West and at Tampa during the present year, 

 show that the conditions upon our Gulf coast are no less favorable 

 to the presence of yellow-fever than they were in former years, and 

 that our immunity depends solely upon the exclusion of an exotic 

 germ. Unfortunately, also, the Biloxi epidemic illustrates the very 

 greatest liability of physicians to fall into error with reference to 

 the diagnosis, when yellow-fever unexpectedly makes its appear- 

 ance outside of its habitual range. History repeats itself in this 

 particular. The early cases in an epidemic, which are often mild, 

 are pronounced to be malarial-fever; and this diagnosis is often sus- 

 tained by those who have committed themselves to it, when' no 

 reasonable doubt remains in the minds of unprejudiced physicians 

 as to the true nature of the malady. 



" The question whether it is practicable to make a city, which 

 lies in the area subject to invasion, proof against epidemics of yel- 

 low-fever and cholera, is one of very great importance. At the In- 

 ternational Sanitary Conference at Rome the delegates from England 

 and from India opposed all quarantine restrictions as unnecessary, 

 ■and pointed to the fact that for years there .has been constant and 

 free communication between cholera-infested ports in India and 

 the seaport cities of England, but that cholera has not effected a 

 lodgement in that country. Dr. Thorne Thorne, of the local gov- 

 ernment board, a delegate to the conference, ascribed this immunity 

 to the sanitary improvements which have been carried out in Eng- 

 land during the past ten or twelve years. He stated, that, during 

 the period included between the years 1875 and 1884, an amount 

 exceeding six and one-quarter millions sterling per annum had been 

 expended in England ' under private and public acts mainly of a 

 sanitary character.' Dr. Thorne Thorne, in his report of the pro- 

 ceedings of the conference referred to, says, — 



" • Lastly, I would note that I took occasion to explain to the tech- 

 nical commission that expenditures such as I have referred to are, 

 with only very trivial exceptions, voluntarily incurred in the interests 

 of public health. 



" ' I then went on to show, in connection with this expenditure, that 

 the average annual mortality for England and Wales was now 

 only 19 as opposed to 22 per 1,000 in the decennial period 

 1S61-70, and this notwithstanding increase in population of some 

 5,000,000; and taking the continued fever mortality of this country 

 ■as that which, in point of causation, most nearly resembled cholera, 

 I pointed out, that whereas, in the five years 1865-69, this mortality 

 was at the rate of 934 per 1,000,000 living, it had steadily fallen to 

 428 per 1,000,000 during the period 1880-82, and that it is now only 

 307 per 1,000,000.' 



" In a later communication, published in the Practitioner for 

 October, 1887, Dr. Thorne Thorne gives fuller details of the Eng- 

 lish system of protection against cholera as follows : ' Having de- 

 liberately abandoned the system of quarantine, we began many 

 years ago to organize the system of medical inspection with isola- 

 tion. The medical inspection comes first into operation on our 

 coasts. The customs officers board the vessel coming into our 

 port, and they at once communicate to the sanitary authority the 

 occurrence of any case of cholera, choleraic diarrhoea, or suspected 

 cholera. A vessel so affected is detained until the medical officer of 

 health has examined every member of the crew and passengers. 

 Those actually sick of cholera or choleraic diarrhoea are at once 

 removed to the port sanitary hospital, and any person certified to be 

 suffering from any illness which that officer suspects may prove to 

 be the cholera is detained for a true period of observation not ex- 

 ceeding two days. The medical inspection is thus followed by iso- 

 lation of the sick. Unlike a quarantine system, this process does 

 not interfere with the healthy, or expose them to risk by herding 

 them together with the sick; but the names of the healthy, and the 

 places of their destination, are taken down, and the medical officers 

 of health of the districts in question are informed of the impending 

 arrivals. This part of our system has been named our first line of 

 defence, but it would be of little value if we stopped there. Our 

 main trust is in the promotion of such local sanitary administration 



in every part of the country as shall rid us of the conditions under 

 which alone cholera can spread. In periods of emergency, as dur- 

 ing the past three years, a special medical survey of such districts 

 as are most exposed to risk is organized under the supervision of the 

 medical oflicer of the local government board, and, where needed, 

 the sanitary authorities are urged to action. Important as have 

 been the results of the recent survey, they would go for little were 

 it not for the steadily maintained work of the sanitary authorities 

 and their officers throughout the kingdom ; and we who have been 

 taunted abroad for opposing quarantine, because its restrictions 

 touched our commercial interests and pockets, may justly feel 

 proud that in England and Wales alone the people have, during 

 the past ten years, of their own accord, and apart from government 

 dictation, spent, by way of loan or in current expenditures, over 

 _£8o,ooo.ooo sterling for purposes mainly of a sanitary character. 

 And we may fairly ask whether any corresponding expenditure has 

 in other countries given evidence of real faith in a quarantine 

 system.' 



" Without denying the value of the sanitary improvements which 

 have been carried out in England, and the possibility that her immu- 

 nity from cholera is largely due to them, the delegates from more 

 exposed countries, such as France and Italy, demanded a quaran- 

 tine station upon the Suez Canal, and pointed out the fact that their 

 seaport cities were not in such a sanitary condition that they could 

 hope to escape the ravages of the pestilence, in case of its introduc- 

 tion, and that to place them in such a state of defence would re- 

 quire time and the expenditure of large sums of money. It was 

 noticeable that those countries (such as Turkey, Egypt, and Spain) 

 where sanitary improvements have made the least progress were 

 the most exacting with reference to quarantine restrictions. They 

 evidently looked upon these as their only hope, and were advocates 

 of the old-fashioned time-quarantine, which, as carried out in these 

 countries, has often been attended with barbarities which are intol- 

 erable for civilized nations. Self-preservation is, indeed, the first 

 law of nature ; but it is barbarous to sacrifice the life of another to 

 save our own, and, in guarding the lives of a community, we are 

 bound to show due consideration for the health and comfort of 

 those who are believed to be the possible bearers of disease-germs. 



" Recognizing this humane principle, a majority of -the delegates 

 to the sanitary conference of Rome were anxious to effect a com- 

 promise between the old-fashioned time-quarantine and the British 

 practice, which they could not rely upon for the countries of south- 

 ern Europe. It was believed that such a compromise was practi- 

 cable, and that the plan agreed to by a majority of the delegates 

 present was more reliable than a simple quarantine of detention. 

 I must refer you to the published transactions for the details of this 

 plan ; but in brief it consisted of a sanitary supervision of ships at 

 the port of departure, when this was an infected port or in com- 

 munication with an infected locality ; in the sanitary supervision of 

 ship and passengers while in transit, by a properly qualified physi- 

 cian upon all passenger-ships; and in such detention at the port of 

 arrival as might be necessary for the disinfection of the ship, the 

 personal effects of the passengers, etc. If one or more cases of 

 cholera should appear on board during the voyage, they were to be 

 isolated, and rigid measures of disinfection carried out, and the ac- 

 tion of the health authorities at the port of arrival was to depend 

 upon how effectively this had been done. In short, the treatment 

 of the vessel and its passengers was not to be determined in ad- 

 vance by arbitrary rules, but was to be governed by an intelligent 

 consideration, by an expert, of all the circumstances relating to the 

 sanitary history of the ship from the date of its departure from the 

 infected port. This rational quarantine service, which is far less 

 burdensome to the commerce of a country than the arbitrary time- 

 quarantine of former days, has proved itself to be also more effec- 

 tual in accomplishing the end in view. This is amply proved by 

 recent experience in our own country, where, to a large extent, the 

 principles indicated control the action of the health-officers of our 

 principal seaports. Look at the city of New Orleans, where epi- 

 demics of yellow-fever were formerly so frequent as to lead to the 

 belief that the disease was endemic, and a necessary evil appertain- 

 ing to the situation of the Crescent City. Happily, under an effi- 

 cient quarantine service, she has now a record of seven years' ex- 

 emption from the dreaded pestilence." 



