Am.  Jour.  Pliarni.  ] 
April,  1885.  j" 
Editorials. 
223 
to  the  work  which  has  to  be  performed  at  foreign  ports,  and  the  establish- 
ment of  refuge  stations  at  points  on  our  own  coast  for  the  detention  and 
treatment  of  infected  vessels  arriving  from  foreign  ports,  should  undoubtedly 
be  borne  by  the  National  Government,  and  not  by  individual  States  or 
municipalities ;  for  the  benefits  accruing  therefrom  are  general,  and  not 
restricted  to  localities,  although  some  ports  and  cities  on  the  coast  may  have 
a  more  immediate  interest  in  the  matter  than  others  in  the  interior.  It  is 
probable,  however,  that  this  national  protective  work  ma}^  not  be  sufficient. 
Local  Safeguards. — It  will  undoubtedly  delay  and  lessen  the  chances  of 
invasion,  but  it  may  not  prevent  invasion.  The  poison  of  the  disease  is 
subtle,  and  may  effect  an  entrance  into  the  country  at  some  unguarded 
point.  The  funds  necessary  to  the  stamping  out  of  the  disease  in  a  particu- 
lar locality,  and  to  the  prevention  of  its  spread  to  other  localities,  might  in 
some  instances  be  borne  by  the  municipality  or  State  affected  ;  but  should 
the  disease  occur  in  a  locality  which  has  failed  or  is  unable  to  make  pro- 
vision for  the  occurrence,  its  spread  to  other  cities  and  States  would  be 
imminent.  The  want  of  means  at  the  infected  point  would  be  disastrous 
to  many  others.  Congress  has  recognized  the  necessity  for  aid  to  State  and 
local  boards  of  health  under  similar  conditions  in  the  case  of  yellow  fever. 
In  1879  the  sum  of  $500,000  was  appropriated,  and  placed  at  the  disposal  of 
the  National  Board  of  Health;  and  the  records  show  that  of  this  sum 
$160,000  was  employed  in  combating  the  epidemic  of  that  year.  We  there- 
fore recommend  that  the  influence  of  this  Conference  be  used  with  the  view 
of  having  appropriated  by  the  National  legislature  the  sum  of  $500,000,  to 
be  used,  or  as  nuich  thereof  as  may  be  needful,  in  case  of  a  cholera  inva- 
sion, in  stamping  out  the  disease  from  the  infected  localities,  and  in  pre- 
venting its  spread  from  State  to  State. 
The  removal  of  local  unsanitary  conditions  favorable  to  the  development 
of  cholera  is  the  special  work  of  State  and  local  boards  of  health.  Much 
has  been  done  already  in  sonje  States,  but  much  remains  which  should 
receive  inmiediate  attention.  Where  it  can  be  done,  State  sanitary  inspec- 
tors should  be  appointed  to  visit  all  towns  and  cities  specially  liable  to  the 
disease,  to  counsel  with  the  local  authorities  as  to  the  best  methods  of  pre- 
vention. This  work  should  be  vigorously  prosecuted  before  the  disease 
reaches  our  shores. 
Advice  to  Citizens. — The  cause  of  cholera  is  contained  in  the  discharges 
from  persons  afltected  by  the  disease,  or  in  things  infected  by  such  dis- 
charges. Should  the  disease  reach  our  shores,  the  first  case,  and  after  this 
the  first  case  which  reaches  any  given  community,  should  be  strictly 
isolated.  All  infective  material  from  these  and  from  any  subsequent  cases 
should  be  destroyed  in  such  manner  as  to  stamp  out  the  disease.  Intelli- 
gent sanitary  precautions  beforehand,  and  scientific  disinfection  and  treat- 
ment in  the  presence  of  the  disease,  should  take  the  place  of  the  necessary 
cruelties  of  a  panic.  In  case  any  city  or  town  is  infected,  the  same  princi- 
ples of  isolation  should  in  general  be  applied  to  the  city  as  to  the  infected 
individual.  Intercourse  with  other  cities  and  places  should  be  under  sani- 
tary supervision,  substantially  as  set  forth  in  the  rules  and  regulations  of 
the  National  Board  of  Health  respecting  the  inspection  of  travelers,  dis- 
infection of  effects,  vehicles,  etc. 
Health  officers  and  inspectors  appointed  by  State  or  provincial  boards  of 
health  should,  in  addition  to  other  sanitary  work,  see  that  the  localities 
have  set  apart,  erected,  or  planned  to  be  so  set  apart  or  erected,  structures 
which  shall  possess  the  sanitary  requirements  of  an  isolation  hospital.  But 
as  regards  all  necessary  work  by  local  boards  of  health,  most  State  and  pro- 
vincial boards  of  health  have  printed  and  issued  documents  which  give 
ample  instruction. 
Your  Committee  recommend  that  when  this  Conference  adjourns  it  be  to 
meet  in  Washington,  D.  C,  the  second  Wednesday  in  December,  1884,  and 
that  the  Secretary  of  this  conference  be  directed  to  invite  the  attendance  at 
that  time  of  the  ({uarantine  officers  and  the  health  ofticers  of  the  principal 
cities  in  the  United  States  and  Canada  ;  and  that  all  delegates  to  that  meet- 
