V
		
, W:M •:	i	
		;
		
		
	!''i	! •-•
■ •>■;/■ ;'.;:[.{-!':i!.	<: <	
	!:'	i;:<
■,'•;;;■; ',:',;'.i:r'!|;	i <	i :
           f}X\ 'M*t&,...
mi"-.^''^- ■■■' ^^lijyi-^iili^^"-: t'
:^l,ti;'il4l.'K-ti;..i^;-,.'.:■'■-  '■





	n "■■if'
	
	

*!i!Hif!ii!«;:,:';
m>:
fe'l^fiii^l:
•iiliiite^.Cift
iHtiwHhj;;,;,,;
fJ>
rr:
t1.'
6073�87257613�608�61��3�9���085986715867 
W-/A
£. /A
C/C >- -' - ✓^2—«—■—
T
'./
^
:/u -,'O.QT, -/O.QfO£/l -/uQtKO'U QOQ'UQO
18
|j  Surgeon General's Office  k>
Jecrfton
 
 
 
QUARANTINE REGULATIONS
AS APPROVED BY THE
NATIONAL
QUARANTINE  AND  SANITARY ASSOCIATION
UNITED  STATES.
18 6 0.
u.
            BOSTON:
GEO.  C. RAND & AVERY, CITY PRINTERS,
            No. 3 C O IE .V II I t L •
               1*60. 
N 2.176% 
QUARANTINE   REGULATIONS.
   At  the  Third National Quarantine and Sanitary Association, held
in New  York, April, 1859, the  following Resolutions were adopted,
and the undersigned were appointed a Committee in accordance there-
with :—
   Resolved, That the operations  of quarantine should  not be confined
to the  warm months  of the year; inasmuch  as a vessel, arriving in
midwinter, with smallpox or typhus on board, is as  legitimate  a sub-
ject for quarantine as one arriving in midsummer.
   Resolved, That the adoption, by the commercial nations, of a sound
and  well-digested code  of  marine hygiene, and of  the  necessary
measures for insuring its strict enforcement, would tend  greatly to al-
leviate the evils of the present system of quarantine, and promote the
comfort of passengers and crew.
   Resolved, That this Convention appoint a Committee to consider
and report  in  what manner the foregoing resolutions  may be  most
effectually carried out.
   Resolved, That the Committee report, at the  next meeting of this
Convention, (in Boston, June 14, I860,) specific recommendations of
principles and measures of quarantine, as severally applicable to yellow
fever, cholera, typhus fever, and smallpox, having reference also to the
variations which different localities require.
   The Committee, to whom the above  resolutions  were referred, have
taken much pains to obtain all the information possible on the subjects
to which they relate; and they are under lasting obligations  to the
Honorable  Lewis Cass, Secretary of  State, and to  the  Honorable
John  Appleton, Assistant Secretary of State, for the procurement
of printed copies of the quarantine regulations  of the principal  com-
mercial nations; also  to the Health Officers of the  chief seaports of
the United  States, for the  health  regulations  and  ordinances which
have  been,  or are  now, in  use in  our  own  country.   From these
and some other resources, the Committee on External Hygiene  have
had abundant means  for appreciating the Quarantine Regulations of
different nations and places, and of comparing them  together in such a
manner as to promise a fair prospect  of  presenting a  code  of marine
hygiene applicable to all the varying circumstances of  commerce.
   The strongest evidence of human progress is the conquest of science
over error  and superstition.   When, in 1831,  the  cholera left India
for a tour of Europe, after having travelled over the  continent of Asia,
every government it approached  essayed to put a stop  to its progress 
4
Quarantine Regulations.
by the powers of quarantine.   Equally vain were the like  forcesi o
the continent of America.   The  cholera  rode  over all ^"J""1^
restraints. — bid defiance to all such antiquated barriers.   About tnis
same period of time, Chkrvin. the great student of yellow fever, w.is.
battling against the quarantine ordinances of France, as worse than
useless for the protection of the French frontiers against  this disease ,
and the triumph of cholera over the quarantine which was to keep out
yellow fever, was regarded by  Chervin as a strong argument in  tavor
of his  views  against quarantine, — for  the  abrogation ot the odious
ordinance of l^l'l.  Confidence  in  quarantine  regulations  tor trie
prevention of plague was also forfeited in a great degree by frequent
recurrences of that disease  in  places the most rigidly guarded, whilst
other places, exempt from stringent quarantine regulations, were tree
from this much-dreaded disease.
  The conquest of Algeria by  the French  placed the  government of
that country under the  necessity of reducing, from time  to  time, the
burdens of quarantine which had been previously imposed, even when
the States  of Barbary were free  from the plague.   These reforms,
however,  were   strenuously opposed,  particularly  by the  sanitary
authorities of Marseilles, who had been for a long time accustomed to
exercise the most arbitrary powers in this regard; also by the  Health
authorities of Italy, who went so far as to  accuse France of opening
the port of Marseilles to the plague.
   in  spite of these oppositions, however, reform steadily advanced.
Two Commissions confided to M. dc Segur Dupeyron, the Inspector of
Quarantine, who, though a contagionist, clearly displayed in his reports
the vices and incoherences of the system ; a collection  of the pub-
lished  opinions of many men distinguished in science, by M. Aubert-
Roche; the exemption experienced by the French  mail-boats; and,
finally, the remarkable  report of the Academy of Medicine, of Paris,
upon the plague and quarantines, — all concurred in the propriety of a
complete reform.*
  On the 18th of August, 1847, a royal ordinance of  France declared
the first recognition of  truths based upon the opinions of medical men,
that many of the restrictions of quarantine were unnecessarily burden-
some, and therefore abolished.  Still  other reforms were established
by decrees, on the  10th of August, 1849, and on the 10th of  Decem-
ber,  1850.  But  it was not  enough  for  the eminent sanitarians of
France to have accomplished a reform in  their own  country, and  for
their own commercial ports; this  was  only a beginning vof the  work.
They  proposed to show that it  was to the interest of the commerce of
other nations to accept  the reforms which they had effected for France.
And Dupeyron suggested to the Ministers  of  Commerce the idea of a
Sanitary Congress, formed by delegates from the divers powers having
seaports on the Mediterranean.   The Government adopted his opinion,
but, on attempting negotiations, failed in  accomplishing  its intended
purpose.
  In 185', M. Melier, member of the consulting committee on public
hygiene, renewed the proposition of Dupeyron, and with more success.
Melier submitted a programme, which was agreed to by all the  govern- 
Q1/a ran tine R egidatiuns.
ments  interested ; and  a convention was formed by delegates from
France, England, Austria, Spain, the Two  Sicilies, the Roman States,
Greece, Portugal, Russia. Sardinia, Tuscany, and Turkey.   This  con-
vention soon after met in Paris, and, after  long discussion, proposed
an international code of quarantine laws, which has since been ratified
by the nations represented; and  this code is now  observed in all  the
ports of the Mediterranean.  Meanwhile, the  sanitary reform, which
began in England about twenty years ago, under the provisions of the
" New Poor Law," attacked no less vigorously the ancient fallacies of
quarantine, which had been in vogue in  that country since  the Great
Plague of  1666.  The General Board of Health, instituted by an  Act
of Parliament in 1848, persisted in repeated efforts  against the quar-
antine  regulations, for  plague, cholera,  and yellow fever;  protesting
that protection from pestilential disease does not consist in quarantine
regulations,  but in internal sanitary   measures, that is  to say, in
measures which have for their object the suppression and prevention
of conditions without which  the diseases regarded as quarantinable
would not  exist.   The industry, the boldness, and the  enthusiasm of
Chadwick, of  Guy, of  Southwood Smith,  of Duncan, of Ferrier, of
Currie, of  Toynbee, of Milroy,  and  others of like  stamp,  astounded
the United Kingdom, and astonished the world by reports which im-
plied accessory murder of thousands of human  beings, by the  very
authorities whose office it should be to protect them.
   The  measures proposed by the General Board of Health were the
destruction of fomites, — all sources of infection in town and country ;
sanitary improvement  of habitations;   a  full  supply  of wholesome
water and  wholesome food, — extending to the personnel and  materiel
of commerce. — and, finally, if, in spite  of these precautions, pestilence
manifests  itself in any place, abandonment of the  locality  until the
cause of the pestilence is found out and eradicated.   These theories,
though for a long time  silently believed  in by many physicians of emi-
nence,  were now for the first time openly proclaimed,  and pressed upon
the  authorities as the only safeguards against the recurrence of appall-
ing  epidemics.   And when the first International Sanitary Convention
met in Paris, in 1850, the delegates  from France had already a  well-
matured programme as a basis of discussion ; — the chief feature of
the  Convention was the abrogation of useless  quarantine restrictions,
and the inculcation of municipal hygiene in their stead.
   However lamentable the  devastations of cholera, since  its exodus
from  India, in 1831, it is to  our better  acquaintance  with   the
 habitudes  of this disease that the commercial world is indebted for the
progress  already made,  in the  removal  of pernicious  influence  to
health, and restrictions burdensome  to  commerce and  navigation.
 Quarantine  reform has  been a  prominent  feature in the  sanitary
improvement of Europe for nearly thirty years, and it is with  chagrin
that your  Committee on External Hygiene, after diligent investigation,
finds that  the quarantine regulations of the United States  are  nearly
identical with  the most odious restricti ms of Europe thirty years ago.
They are,  in effect, the same  laws as  those  imposed  by England, in
colonial times, for the protection  of America  from " plague  or  other 
6
Quarantine Regulations.
malignant distempers,"  and in several of the States it yet remains  an
indictable offence, with a large penalty, for any person to come into the
State from any place infected with  contagious disease. _  The  quaran-
tine laws still presume that certain diseases are communicable from the
sick to the well, under  all  circumstances, and that such diseases are
capable of being transmitted to new and distant localities, independent
of all conditions.   They also presume that the germs of all  diseases
regarded  by quarantine  officials  as  contagious  or infectious, may
lie  dormant  in  the systems of  persons who are  apparently  well,
but who may afterwards sicken, and then become the radiating centres
of infection.   Based upon these  conclusions, the time and duration  of
Quarantine pretend to depend upon the real or suspected presence  of
the apprehended disease, in the personnel of any vessel during the
voyage  and at the time of arrival, the kind of cargo, and whether there
has been  any communication with other vessels, persons, or things,
during  the voyage.   These requirements, however, are of short dura-
tion, and usually limited to the warm season of the year.  This riutme
is a fair  representation  of the Quarantine regulations of the United
States, while there are no exceptions to the incongruities herein stated.
  It has been justly remarked by Mc'Julloch, in his Commercial Dic-
tionary, that " the complaints of quarantine grievances and oppressions
are almost wholly occasioned by want  of proper facilities for its per-
formance."  But,  while we may properly  admit  the  truth of this
assertion,  as applicable especially to the view which commercial men
must naturally take of  this subject, we think it must appear to scien-
tific observers that  the defective facilities  to which McCulloch has
referred are mainly owing to the prevailing indefiniteness of opinions
and official practices relating to quarantine and  to  febrile infections.
As medical men, therefore, your Committee  frankly acknowledge that
the medical profession, and quarantine officers  themselves, are  partly
responsible for the defects of our external sanitary defences.
  Before enumerating the points  which we believe to be essential to
the provision and perfection of the external sanitary system  of mari-
time cities and large commercial towns, your  Committee would briefly
note the special defects and wants that are  acknowledged to  exist in
all, or at least most, of the ports in the civilized world.

I. THE DEFECTS THAT  RELATE TO THE SICK AND  TO  SANITARY
                           PROTECTION.
II.   THE  DEFICIENCIES  THAT   RELATE TO COMMERCIAL TRANSAC-
                TIONS  AND PUBLIC  CONVENIENCE.
  Under the first head are included :  1st.  Hospitals,— their  location,
construction, and fitness ; the  facilities for the reception, distribution,
and care of the patients.   2d. The construction and management of
docks and warehouses for quarantine purposes, with reference to sani-
tary protection.
  Under the second head we enumerate :  1st. The needless delay of
vessels.  2d. The  unnecessary detention of cargoes.  3d. the damage
to such cargoes and vessels at Quarantine.  4th. The inconvenience
and expense of lighterage.   5th.  Loss of time and the use of vessels. 
Quarantine  Regulations.
7
   As all these points under the second head are connected with the
general question of quarantine docks and warehouses,— their location,
capacity, and special adaptation,— it is manifestly right, and eminent-
ly proper, that the interests and requirements of commerce should be
provided for, and made  perfectly consistent and harmonious with all
the conditions and provisions which  are necessary for the protection of
the public health.   These  points include the grounds upon which ob-
jections are  made respecting deficient facilities as well as burdensome
restrictions  of quarantine establishments.  We propose to make a fair
and full statement of the points, without attempting their discussion.
But we feel warranted in making the following general statement, in-
volving all these points incidentally, and at the  same time affirming
what is conceded to  be necessary to the arrangement of a quarantine
establishment.
                        I. —THE  SICK.

  Humanity and public policy alike demand that, wherever there is a
quarantine establishment, or wherever and whenever there is any de-
tention of vessels and the sick, in the  nature  of quarantine, there, in
the immediate vicinity of the quarantine  anchorage, should  be pro-
vided ample facilities for the proper care of all  such cases of disease
as may not, with safety to the public and to the patients, be removed
to more suitable places.
  The nature  and  extent  of hospital  provisions  required at any
quarantine station must be in no  small measure dependent upon  the
nature and extent of hospitals, and  the internal sanitary arrangements
of the city or place requiring a quarantine establishment.
  For the welfare of  the sick it is required that the location of  the
hospitals  should be within a convenient distance of the quarantine
station, and that the facilities of access to them from the quarantine
anchorage be such as to secure the  greatest safety to the sick, and the
least danger to the  public; and lastly, such location, distribution, and
special management of the sick, as shall prevent the general contami-
nation of the hospital in which they may be placed for treatment, and
also preclude liability to any dangerous exposure to subsequent  infec-
tion, or to any other unhealthy influences.
  Both the public safety and the welfare of the  sick in hospitals,
require  that effectual provisions be  made for the immediate and
thorough disinfection of all  baggage and  personal clothing liable to
infection.
     II. —QUARANTINE  DOCKS AND  WAREHOUSES.

  If it is admitted that the security of  the public health against cer-
tain diseases demands the protracted detention or exclusion of vessels
or cargoes that are liable to convey and propagate those diseases, then
it may justly be claimed that the interests of commerce require special 
8
Quarantine  Regulations.
docks and warehouses for tint  class of quarantined vessels  and car-
goes, while experience has fully demonstrated the great importance oi
such special  facilities, no less  for public safety than for commercial
convenience.                                                    .
  To illustrate the nature and extent of the deficiencies of quarantine
establishments, we would refer  to the statements on this subject as
embodied in the Report on  External  Hygiene, adopted by this l on-
vention last year.*  We would also mention  the testimony given on
the same subject, particularly as regards  deficient provisions  for  the
sick, by the British Quarantine Commissioners, in their First Report.T
And in regard to the testimony respecting those special deficiencies
that embarrass commerce and incommode the  public, it  is painfully
evident that the judicious author  of the Commercial Dictionary speaks
truly  when he  asserts  that, were the proper  facilities  afforded  to
enable merchants and others to comply with quarantine and all needed
external  health  regulations,  "the burdens  it  (quarantine)   imposes
would be  comparatively light, and we do  not  know that many more
important services could be rendered to the country than by construct-
ing a proper quarantine establishment."  Continuing his  remarks on
this subject,  Mr. McCulloch states "there  is not  on the Thames  a
lazaretto where a ship  from  a  suspected  place may discharge  her
cargo  and refit, so that it  is  detained, frequently at an enormous
expense, during the whole period of quarantine."
  This statement, which applies  to ports that less  than almost any
other  large maritime  cities  require such  special  external   sanitary
provisions, has been  strongly corroborated by the testimony of boards
of trade and chambers of commerce in  the  principal  ports  of both
America and  Europe.
  As  respects medical and  official testimony, generally, we find none
more decided than that adopted by this Convention  at its  last session,
in answer to the question,  " What reforms are  required  to make
quarantines more efficient and less burdensome ? "   In  that report  it
is stated that " we must be prepared to denounce, as worse than use-
less, every system of quarantine which, either from  incorrectness of
the principles upon which it is founded, or from the  careless and ineffi-
cient manner in which it is executed, as inadequate to guard the com-
munity against the introduction of disease from  abroad."
  The Quarantine Commissioners of Great Britain, in their first report
to the General Board of Health, in 184.S. concisely sum  up  the defi-
ciencies  and  objections of British quarantines, by stating that " the
Quarantine establishments of this and every other country, of which
we have information,  are tvholly  insufficient, even on the assumption
on which they have hitherto been maintained, to prevent the  introduc-
tion and  spread of diseases.
   • That these establishments are of a character calculated to inflict
on  passengers extreme and  unnecessary inconvenience,  and to sub-

  * Sec Iteport of Convention, IRoO, pp. 321, 322, ft seq.
  t Si i; First Report of the Quarantine Commissioners to the General Board of Health of
Great Britain, pp. r;J-/0. 
Quarantine Regulations.
9
ject such of them  as  may be sick to increased suffering and danger,
while they maintain false securities in relation to the means of  pre-
venting the spread of disease."
   (By vote of the  Convention, it was resolved " that the Report  of
the  Committee upon the Utility of Wet Docks in Connection with
Quarantines be  referred  to the Committee  on  External  Hygiene,
with powers.")
   " The Committee to whom, at the  Third National Quarantine and
Sanitary Convention, the Resolution, that a Committee be appointed  to
inquire into the propriety and usefulness of enclosed wet docks on the
Atlantic  coast and Gulf of  Mexico,  together with  the  requisite
Lazaretto  for the  protection of  vessels and  merchandise,  and the
care of the sick  subject to  Quarantine, the same  to  be  placed under
the charge and  jurisdiction of  the United  States," was referred,  in
presenting their  Report,  beg leave to premise that —
   Whereas, The  statements which  will appear  in  the sequel have
been in a great  measure derived from  personal  observation, it will
be  necessary to  allude very  frequently to the Quarantine  at  New
York, as  it  is not improbable  that many of  the defects  in that
establishment have existed  in others of a similar kind, and should
no appropriate measures be  adopted to obviate them, may appear
again.
   Since the organization  of Quarantines, we will  venture to say
that in no part  of the  globe,  in an equal space of time, have  so
many  sick persons been  admitted  into a  Quarantine Hospital,  or
Lazaretto, as there have been into the Marine Hospital at New York.
   According to  the report  of Dr. Bissell, an ex-physician-in-chief  of
the  Marine Hospital,  to the Legislature of New York, for the  year
1857, there were admitted into said Hospital, from the  year 1798  to
1857,  inclusively, a period  of sixty  years, 72,595 patients, of which
number 10,4!)3,  a seventh  part, died.  During the period  embraced
by the years 184s and 1853, at which time the Reporter was one  of
the physicians of this hospital. 35,690 of  the  above aggregate were
admitted, — nearly one half of the whole number in one tenth part  of
the time.   Hence he has  had an  unusual  opportunity  of  witnessing
much  of  the  inconvenience and  suffering, as well as many of the
defects of a Quarantine establishment, some of which will be presented
in the sequel.
   In order fully to appreciate the wants  of a Quarantine  establish-
ment,  it is necessary to  have been a spectator of some of its  woes.
In reading the history of Quarantines as they have existed in various
parts of the world, as well as legislative  and  other reports  and com-
munications relating thereunto, the paramount and  almost exclusive
subjects of inquiry have been,  How shall we protect our  citizens
against the invasion of pestilential disease ?  How can we lighten the
burdens which  Quarantines impose upon commerce ?  The  speeding
of the weary voyager and the  care of the  sick being regarded  as  of
minor importance, too  often  is  the poor  squalid immigrant, as  he  is
frequently called, shunned,  loathed,  and,  if sick,  even viewed  as a
• 
10
Quarantine Regulations.
culprit.  We are not apt to appreciate their miseries, destitute, home-  ^
less as they are; fleeing from famine and oppression abroad ; long pent
up in the hold of an  ill-ventilated vessel;  their sickness their misfor-
tune, not their fault.
  The following incident, related by the General Board  of Health, in
their Report to the British Parliament  in  1849, presents but a faint
idea of the feelings of many who, when almost  touching their desired
haven, are  arrested at Quarantine.

  A young unmarried lady, who arrived in a steamer from Hamburg, and
was stopped at Quarantine in the Thames, thus writes: —
  " It is all  very well to say, ' Don't be afraid of the Cholera,' but those who
have seen what I have in the last few days, will feel differently.  On arriv-
ing at Gravesend, a custom-house  officer eame alongside, and told the cap-
tain that the ship must be kept at Quarantine, and that it' he allowed any of
the passengers or crew to land he might be shot.  They then took away our
letters without coming on board, and said they would send every day for
our letters.  You can imagine our consternation and alarm ;  and  then  the
horrid yellow flag ! and we were told if  any one were taken ill or died, we
should be detained, 1 know not how long !  Another ship was  near us, also
in Quarantine, and with a sailor in it who had died.  Soon, we saw this ship
moving slowly down the river to the Nore, that the body might be committed
to the deep.  Although it  rained in torrents, we saw all  the passengers
standing on the deck, as they were afraid to go below for fear of the
Cholera. If you could have seen that melancholy sight!   1 shall  never
forget it. Need I endeavor to paint to you our feelings, not knowing how
soon we might be in the same sad predicament. How we counted the hours,
and how we rejoiced when the welcome news reached us that we might land
once more in England !"

  If such  be the feelings of a passenger while in health, how  sad
must be the condition of the friendless, destitute stranger when struck
down by a  formidable malady?   Having left  his home with most san-
guine hopes of reaching a happy land, where  he expects to enjoy that
liberty and the facility for acquiring property which are less liberally
granted in  his native country;  just as he is on the point of reaching
his destined haven, he is  seized with a contagious disease, the Quar-
antine arrests his further  progress, and his fond hopes  are well-nigh
blasted !  Does not such a forlorn stranger demand our commiseration,
solicitude,  and our  best services?  Health  and life are as precious to
him as they are to us, and in his desolate, helpless state, far from the
solace and  sympathy of near and  dear friends, surrounded by strange
faces, his heart sinks, and  he requires our  kindest and  best efforts to
rouse his drooping spirits and cheer  him up  to health.   But what is
the first step towards the  alleviation  of his sufferings?   The ship has
dropped anchor at Quarantine.   The Health Officer is on board.  Ihe
vessel may be a mile or more from the landing-place.   Are there any
sick passengers on  board ?  If so, a signal from one of the boatmen
communicates the intelligence  to the  shore, and  immediately one or
more boats put off to the ship to bring the sick to land.   Now it is the
method of landing the sick, which  was generally adopted while the
writer was  stationed at Quarantine, together  with  the examination of
the philanthropic Dr. Howard's plate of the  Lazaretto San Leopoldo 
Quarantine Regulations.
11
at Leghorn, that suggested to his mind the great benefits which would
accrue were Wet Docks  constructed, if only for the purpose of alle-
viating the sufferings which attended the method of landing the sick
at the  S. I. Quarantine.  According to  the plan of the Lazaretto San
Leopoldo, there is  a dock almost entirely inclosed, but without any
lock, into which vessels detained at Quarantine  enter, and are safely
moored.  The vessel in the first place proceeds to the remote extremity
of the dock, where the sick  and other  passengers are landed directly
from the vessel, from which they are conducted or conveyed, and  we
presume as gently as possible, by an ambulance, sedan, or rail-car, when
too ill  or feeble to walk, to their appropriate ward or tenement.  The
passengers being landed, the vessel is hauled alongside the wharf, on
which  piazzas  or warehouses  are erected for the reception of cargo,
and its expurgation.
  It very often happens,—indeed, it  is most frequently the  case,—
that emigrant packet-ships arrive in our port during the prevalence of
easterly winds, and in stormy weather.  Masters of vessels are gene-
rally impatient of delay, and anxious to  get rid of their sick, that they
may proceed to the pier  in the city as quickly as possible.  While,
then, the Health Officer is on  board inspecting the passengers, or soon
after he leaves the vessel, the sick are brought up from between decks,
lifted over the side, and carried down a vibrating  ladder some twenty
feet long, into the  boat below.  (We judge the distance to be at least
twenty feet, many  of these ships being from twelve to fifteen hundred
tons'  burden, and  rising  very high above the  surface of the water.)
The sick are then rowed to  land, sometimes thinly clad, oftentimes
through rain, or sleet, or snow, at the risk of extinguishing the linger-
ing spark of life, which by greater care might have been fostered and
revived.  Frequently are  they landed wet to the skin and chilled to
the bone, and even in a hopeless moribund condition.
   Dr.  F. Campbell Stewart, an ex-physician of the Marine  Hospital,
N.  Y., in his Report to the Legislature of New York,  March 25, 1860,
says:  '-The  condition  of the  sick sent on  shore from on  board of
ships,  is sometimes  deplorable.  They often  die in a few hours after
admission, and occasionally in  the  boats in which they are landed, or
as they leave the vessel."
   Besides, the sick are frequently landed in a hurry, and consequently
more or less roughly.   We have  known as many as one  hundred and
fifteen sick persons, in various stages of disease, landed in the space
of  twelve or fourteen hours, and as many as two hundred and fifty-nine
patients, most of whom had Ship Fever, brought from on board of  one
vessel.  (The  latter  were from the Penelope in 1801, when a great
many  cases  of this disease were  admitted from several vessels into
Marine Hospital.)
   The packet-ship  Great Western, from Liverpool, of  1,443 tons'
burden, anchored  at Quarantine  on the 14th of January, 1852.   It
was very stormy weather.  Her  complement of passengers  was 791,
sixty of whom were brought on  shore with Ship Fever, and fifty-five
doubtful  cases, in whom it was apprehended this  disease would soon
be  developed.  Dr. Doane, the Health Officer, labored hard all day in 
12
Quarantine Regulations.
assisting the  sick on shore, and without sufficient nourishment, unti
ten o'clock at night.   Wet and weary he went  home.  On the next
day he was taken ill, and  died from  Petechial Typhus on the 21 th ot
January.  So sure  as  effect follows  adequate  cause, doubtless  had  a
plan similar  to  that of landing sick passengers  at the San Lorenzo
Hospital been established, the  life of this humane, learned faithful,
  d  indefatigable physician would not have been sacrificed on this
an
occasion
  We shall recur to the sick under the second part of the Resolution.
  In the construction and equipment of a Quarantine establishment,
in addition to precautionary measures against the introduction of con-
tagious  diseases of a malignant  character  by the seaboard, not only
every needless impediment to commerce should be avoided so far as is
compatible with the prime object in view, but  every facility should be
afforded for the speedy release of vessels from quarantial restraint, as
well as for the protection of property detained, at Quarantine.
  "There is  not on the Thames," says Mr. McCullough in his Dic-
tionary on Commerce, " a Lazaretto where a  ship from a  suspected
place may discharge cargo and refit, so that it is detained frequently at
an enormous expense during the  whole period of  Quarantine, while, if
she had  perishable goods on  board, they may be materially injured.
The complaints of Quarantine grievances  and oppressions are almost
wholly occasioned by the want of proper facilities for its performance.
Were these afforded, the burdens  it imposes would  be comparatively
light,  and we do not know that any more  important service could be
rendered the country than by constructing a proper Quarantine estab-
lishment."
  Again, in examining again  the plan of the Lazaretto San  Leopoldo,
as represented by Dr. John Howard, in his "Account of the  Principal
Lazarettos in Europe," 2d ed., 4°. London, 1791, we  were forcibly
impressed with the  superior advantages which would be derived from
suitable Wet Docks, in  which  vessels might be securely moored during
their Quarantine ordeal.  Such docks should be water-tight, closed by
locks, which would readily admit the ingress and egress of  vessels in
compliance with the orders of the Health  Officer.
  Judging from what we have observed in New York Bay,  the lower
bay especially, of the uneasy  manner in which vessels ride at  anchor,
rolling and tossed to and fro  by the turbulent billows, even under  a
moderate  breeze, and the danger to which such vessels are exposed
during tempestuous weather, the difficulty and risk  of transshipping
their cargoes into lighters alongside, we have thought that such docks
would  afford  adequate protection to  vessels against  the violence of
storms; secure their merchandise from  plunder  and  accidental loss;
expedite the introduction of  goods  into the market; and even allow
foul vessels to receive their return cargoes and clear out to sea  should
the difficulty of expurgating them deter  their approach to the  city.
The vessel,  having  entered  the dock, might proceed immediately to
the place appointed  for landing the sick and other  detained passen-
gers, which being done, she might be hauled  alongside the  wharf, on
which piazzas and warehouses have been erected for the reception and 
Quarantine Regulations.
13
purification  of  the cargo.  When  merely ventilation,  drying,  and
•cleansing the interior of packages are deemed  necessary,  inasmuch as
this would require only a brief detention, piazzas should be preferred;
but when the cargo requires  a protracted  detention, warehouses, on
account of the  security they afford, would  be most suitable.   Bal-
last as well as  cargo,  being discharged,  the  vessel should  be cast
off and  anchored in the  centre of  the  basin,  there  to be  expur-
gated,  after  which she might be permitted to proceed to the city,
or  place of  destination,  or to an  export dock  adjacent,  for  the
reception of goods brought down in lighters, obtain her Custom-House
clearance, and put off to sea with her return cargo.
   If everything were removed from the vessel, it would occupy but a
few days to purify and cleanse her, unless she should be  very foul, in
which case she should be floated into a dry dock in proximity with the
wet dock, for more thorough  expurgation.  We venture to suggest
such a structure as a dry dock for raising vessels completely out of the
water, in order that they may  be thoroughly overhauled and  every-
thing pernicious ejected; but blacks only, or those  who have  had
the Yellow Fever, should be employed in cleansing them.
   On this topic we beg leave to digress, as we  consider a dry dock to
be  a very important appendage to a Quarantine establishment.
   The great mortality which has been produced by Yellow Fever on
board of foul ships, whether this disease has originated spontaneously
or  from some external source, has given rise to  numerous inventions
for their expurgation.   Hundreds  of persons, especially  on  board of
men-of-war,  have been  attacked with Yellow  Fever,  attended with
great  mortality, in  consequence of  inhaling the morbid exhalations
from a ship's  hold ;  hence, no pecuniary consideration should be per-
mitted to operate against the employment of any plausible means, cal-
culated to prevent their elimination, to expel or destroy them.   Fumi-
gants, disinfectants, and deodorants have disappointed the expectations
of  those who  have confided in them.   The pumping out of bilge-water
and drenching the  hold with salt water have often  proved inefficient;
and even freezing mixtures only lock up the miasm for the time being,
without altering its nature, and  afterwards leave the vessel  in  an
unhealthy state  of humidity,  with increase of filthiness.  They are
evanescent.   The most  offensive smells are by no means the most per-
nicious.   They warn us  of danger,  and compel us to resort to ventila-
tion for their expulsion.  The most deadly miasms  are imperceptible
by  the senses, and indetectable by chemical tests, (unless it be the air
test of Dr. Angus  Smith, spoken of  by  Miss  Florence  Nightingale,
which we have not  seen,) and are produced by  the  action of moisture
gradually, but persistingly decomposing the planks  and timber  of the
vessel.   We  can get rid  of bilge-water  by pumping it  out, and  its
smell  by  flooding   the  vessel;  but  the  moisture remains,  though
pumped  ever so dry,  causing mustiness  and  mouldiness, and  the
development  from  the  fabric  of the vessel of a  pernicious febrile
miasm, similar to that evolved from external vegetable  decomposition,
but rendered  more virulent by concentration in the close,  ill-ventilated
hold of the vessel.  Cleanse  and ventilate as much as you may; 
14
Quarantine Regulations.
while humidity exists, the morbid  exhalations will persist.   J^Tj^ [
therefore, is essential to thorough expurgation.  While the hold oi thu
vessel  is sunk  below the surface of the water, this can scarcely D
   omplished ;  but elevated on. a dry dock, it would be, completely ana
ace
expeditiously.                                          .  .       ,
  To show the importance of dryness in overcoming  pernicious exha-
lations, the  ship Regalia, which sailed  from the  coast of Africa  in
1815, with  black  recruits, affords evidence.   This vessel, whiles on
the coast, took on board a large  quantity of green wood ; her ballast
was  what  is  called shingle  ballast, composed  of small stones, with a
considerable mixture of mud and other impurities; besides which, the
ship was leaky, and the water-casks leaked.  After she got to sea  the
Yellow Fever broke  out, and all  hands on board except  the blacks
were attacked therewith.  After the ship  arrived at Barbadoes  she
was cleansed and ventilated, notwithstanding which the disease  con-
tinued until the hold had been exposed for a time to the  concentrated
heat of many stoves, after which it ceased, the moisture having evap-
orated.
  But on this topic we cannot dwell, and must therefore beg  leave to
refer to Dr. 11. La Roche's elaborate and  valuable  Treatise on Yellow
Fever, vol. ii. chap, xxii., where the causes of  Yellow Fever  on  ship-
board, and  the different methods  adopted for expurgation, are fully
detailed.
  In our opinion, the principal, if not the sole  means upon which we
can rely for the thorough expurgation of a  foul ship, are ventilation,
cleansing, and the drying process, all of which can be most effectually
performed while the vessel is exposed on a dry dock to the heat of the
sun, at the same time that she is undergoing the necessary repairs, after
which the timber, planks, and other wood-work of the vessel should be
coated interna//// with a composition  impervious to water, and incom-
bustible.
  With regard to vessels of  war with ordnance  on board, the  difficulty
and expense of raising them upon a dry dock would be too great for a
Quarantine  establishment.   Such  vessels, after landing  their  sick,
should steer for the frigid zone and clean up there.
  To resume: The protection which Wet Docks afford to vessels in
Quarantine is not limited to the dangers  which may accrue from stormy
weather while riding at anchor in an open bay or roadstead.   Such
docks being, as it were, insulated, are more easily guarded against de-
predations of every kind, whether the cargo still remains in bulk, or is
in process of unlading.  '• Previously to the construction of Wet Docks
on  the  Thames, the  property  annually  pillaged from  vessels  was
estimated  to amount to £500,000 sterling," though  Mr. McCullough,
from whom we quote, thinks this estimate to be somewhat exaggerated.
Dr.  Bissell, ex-physician-in-chief of Marine Hospital, in  his Report
for 1857, to the New York Legislature, states:  " For years  past, and
until the organization of the metropolitan police, there was no protec-
tion to the  property of importers and ship-owners arriving in the city
of New York.   Burglary and larceny were perpetrated by thieves and
robbers at pleasure,  and with almost perfect  impunity; and if the 
Quarantine Regulations.
15
losses of our  commercial men in this respect could be  named, the
amount would be  startling.  These  depredations  were committed  by
emigrant runners  and  boatmen  at  large, who are constantly on the
alert to prey upon vessels, cargoes, and passengers, by day as well as
by night, while these vessels are lying at anchor, requiring a large and
vigilant police force to prevent such  depredations."
  That the construction of Wet Docks has done much to attract and
facilitate commerce, is  an historical fact.  " The first Wet Dock in
Great Britain was constructed  in  Liverpool about the year 1708, at
which  time Liverpool  was but an  inconsiderable  town.   This,  how-
ever, was the commencement of her commercial importance ; and the
accommodation afforded by her Wet Docks is one of the circumstances
that has most strongly conduced to her extraordinary  increase in
population, commerce, and wealth."   The  Liverpool  Docks  now
enclose an  area of ninety  acres of water.

  The West India Docks were the first constructed on the Thames.   They
were commenced in February,  1800,  and partially opened in 1802.  The
Export Dock is eight hundred  and  seventy yards long by one  hundred and
thirty-five wide.  Its area about twenty-five  acres.  The  Import  Dock is of
equal length, and one hundred and sixty-six yards wide.   The South Dock,
which is appropriated to both import and export vessels, is one thousand one
hundred and eighty-three yards long ; the locks at each end are  forty-five
feet wide, large enough to  admit of vessels  of one thousand  two hundred
tons.  At the highest  tides the depth of water in the docks is twenty-four
feet, and the whole will contain with ease six hundred vessels of from two
hundred and fifty to five  hundred tons.  There are other docks  pertaining
to this department, which, together with the above and the warehouses,
comprise an area of two hundred and ninety-five acres.

  This spacious and magnificent structure was formed by subscription,
and  vested in the West India Dock Company,  their  capital being
£1,380,000 sterling,  and  has proved a profitable as well  as  beneficial
investment.  In addition, there  are on  the Thames, the  East India,
London, and St. Catharine's Docks.   For  further information on this
subject, we refer to McCullough's Commercial Dictionary.   But  these
docks are on a much  more extensive scale than is  needed for quaran-
tine purposes.  Being intended  chiefly  for yellow-fever vessels, a
dock capable of accommodating thirty or forty vessels at a time would
be sufficiently capacious, for, after discharging cargo, they would haul
off to the middle of the basin for expurgation.
  That docks of such moderate dimensions would answer  every need-
ful  purpose, we judge  from the number of vessels which  arrive  from
ports where yellow fever  prevails during the quarantine  season.   Dr.
Whiting, ex-Health  Officer, in his  testimony before  a Committee of
the Legislature, stated that the number of sickly  vessels,  with yellow
fever on board, from the  13th of March,  1848, until January 1, 1849,.
a period of nine and a half months, was 44.   According to the Report
of Dr. R. H. Thompson, late  Health Officer, 47 infected  vessels  from
twelve ports, from the 1st of April  to the 1st of August, 1856, sent
into Marine Hospital, fifty-eight cases of yellow fever; and from the 16th 
16
Quarantine Regulations.
of April to the 1st of August, 1858, forty-three vessels from nine ports,
sent to the Hospital ninety-eight cases of the same disease; and Dr. Wis
Harris, an ex-physician-in-chief of the Marine Hospital, reports seventy-
nine infected vessels from April 10 until October 4,1856, of which num-
ber fortv-one arrived in  July, twentv in August, and ten in Septem-
ber.  Now, when we take into consideration  that all such vessels aie
not detained at quarantine at  the same time, and that as many  sickly
vessels arrive in New York as at any  other port of the United  btates,
the dimensions of the dock need not be larger than  above mentioned.
   The advantages which Wet Docks possess over  a breakwater consist,
not merely in accommodation  and  economy, but  also  in affording
greater  protection to the shipping.   Major  Delafield, of  the  U. fe-
Engineers, testified  before a  Committee  of  the  N. Y. Legislature,
" that a breakwater has no tendency to protect a vessel  from the force
of the winds; their fury and  power in  driving vessels  from their
moorings,  is  the same with as  without a breakwater.   It  is only in
resisting the force of the waves and heavy seas that such a structure
is of any service."
   Inasmuch as a  bill has been introduced   into the  Senate  of the
United  States, by the Hon. Charles Sumner,  to abolish all  appropria-
tions to -Marine Hospitals, and the tax on Seamen, — which tax, so far
as it goes, has hitherto been applied  towards defraying the expenses
attendant  upon the care of sick  sailors, — it might be deemed of little
utility to discuss the  second  part of  the  Resolution  under  considera-
tion,—which relates to placing Quarantine Hospitals and their appur-
tenances under the  jurisdiction  and  charge  of the General Govern-
raeilt) — until the fate of this  bill is decided.  Nevertheless, as there
are, in  our opinion, cogent reasons  why  the United  States  should
possess the control and charge, as well as the appointments of a Quar-
antine establishment, we  will  notice  some of the grounds on  which
this latter part of the Resolution was  based.
   In  the  first place, we  consider  that  a quarantine,  from its close
connection with  the  U.  S. Revenue  Department, and  the  important
bearing which  it  has upon  commerce, (which  Congress  alone  can
regulate,) and upon travellers soon to  be dispersed throughout different
and distant States of the  Union, is  a national,  rather  than a State
concern, and we  cannot  conceive that a uniform system  of  quarantine
can be established throughout the Union unless it be organized,  almost
exclusively, as a national institution.
   The following extract from the able Report of Dr. Wm.  T. Wragg,
presented to the Third National  Quarantine  and  Sanitary Convention,
respecting the feasibility of a Uniform System  of  Quarantine, coin-
cides  in a measure with this view of the subject.

   We find, says Dr. Wragg, in Brightley's Digest, p. 810, under  the head of
Quarantine and Health Laws,  an act  of Congress, passed  February 25,
1779,  the third section of which reads thus :—
   There shall be purchased or erected, under  the order  of the President of
the United  States, suitable warehouses,  wharves, and inclosurcs, where
goods and  merchandise may be unladen and deposited from any vessels sub- 
Quarantine  Regulations.
17
 ject to quarantial or other restraint, pursuant to the  Health Laws of any
 State as aforesaid, at any convenient place or places therein as the safety of
 the public revenue and the observance of such laws require.

   We will now refer to an almost unanimous decision of the last Con-
 vention,— that fomites,  in  the form of foul merchandise, clothing,
 and baggage of various  kinds, is  a  more  public medium for the con-
 veyance of yellow fever  than the body of the sick afflicted therewith.
 That the sick, when divested of fomites, may be  permitted  to enter
 a city with impunity, whilst vessels, merchandise, baggage,  and cloth-
 ing, in  certain conditions, brought from the same place, with or  apper-
 taining to the sick, must be detained until thoroughly expurgated.
 Such seems to be the interpretation of the resolution alluded  to, and
 consequently ships, merchandise, clothing, bedding, and other kinds of
 baggage are, so far as yellow fever is  concerned, the  principal things
 and materials for quarantial restrictions.
   Forasmuch, then, as it appears from the preceding extract from Dr.
 Wragg's Report, that foreign merchandise, while detained at quaran-
 tine, is in charge of the General Government, or under its  protection,
 and as it is customary for Revenue Officers to inspect cargoes, examine
 the  trunks, boxes, and  baggage of immigrants, with  the view  of de-
 tecting contraband  articles,  or  smuggled goods,  these officers must
 unavoidably,  in the  discharge  of their duty, come  in contact with
fomites, and  consequently would incur but  little  additional  risk i»
 supervising the purification  of  articles deemed foul, or   capable of
 inducing and  propagating disease, the manipulations being performed
 either by  negroes,  or by persons who have had the yellow fever,
 under  their   direction  and  control.    And  furthermore,  as fomites
 enclosed in baggage, and jjossibly in merchandise, may be conveyed to
 parts remote from  the port  of entry, and even to distant  States, the
 entire Union may be considered as interested in the faithful discharge
 of  quarantine duties, no matter where the quarantine is  located;
 hence  one  individual State should  not be burdened with the ex-
 pense  of  sustaining a  precautionary system which  is calculated to
 benefit the whole.   It is evidently a  national concern, or  should be.
 We consider that goods, while in the public stores  at quarantine, are
 under the supervision and protection of the General Government.
              Respectfully submitted,
                      John W. Sterling,  M.  D.,  }
                      Alex. H. Stevens, M.  D.,   [-Committee."
                      J. McNulty, M.  D.,        )


   With such testimony, and with the various quarantine codes of civ-
 ilized nations before your committee, and from the  results of their own
 personal  observations,  strongly corroborating such statements, they
 feel that the task  imposed  upon them by the resolutions  of the last
 Convention possesses such  a degree  of practical  importance, and in-
 volves  such a  variety  of questions and interests, that " the specific
                     3 
18
Quarantine Regulations.
recommendations of principles and measures of quarantine,  called
in this Report, need to be very carefully considered and clearly state .
   Having been directed to report  to the fourth meeting of this I (in-
vention "specific recommendations of principles and measures  ot qu  -
antine, as severally applicable  to yellow  fever, cholera, tyPhus.^  '
and smallpox, having reference, also, to the variations which  djttcr<r"
localities require," this Committee will now  endeavor  to comply w
the direction, in accordance with the design of the resolutions.
        SPECIFIC MEASURES  OF QUARANTINE,
severally  applicable  to  yellow  fever,  cholera, typhus,
        and  smallpox,  with  the  variations  which
                different localities require.
 , As the specific measures of an efficient system of external sanitary
police, to guard against the several diseases here enumerated, will, in
particular cases, relate  to persons, clothing, cargoes,  or  vessels,  the
special provisions required may be included under the following heads :

 I.—QUARANTINE   HOSPITALS,  AND  THE  PROPER  CARE  OF  THE
      SICK.

II.--QUARANTINE  WAREHOUSES AND  DOCKS, AND  THE   PROPER
      DISPOSAL  AND  CARE  OF INFECTED  THINGS.

  First.— Quarantine Hospitals, and the Care of the Sick.—It must
be admitted that the welfare  of the sick and the interests of the public
health  require  that  the sick with  pestilent  diseases should receive
medical  attendance and hospital care immediately upon their  arrival at
quarantine, or at the first place of detention of vessels by quarantine
authority.  Ample provisions, therefore, should be made for the im-
mediate and proper care of the sick  at every quarantine station.
  The extent and variety of such hospital provisions, required for par-
ticular quarantine  stations, will  manifestly depend upon  the number
of patients liable to be received, and the yariety of infectious maladies
to be treated.
  Distribution of the Sick.—It is plain that no two or more of the
pestilent maladies enumerated in this Report should ever be introduced
together into the same ward, and, if possible,  they  ought to be treated
in separate buildings.
  While facts do not warrant the conclusion that any disease is neces- 
Quarantine  Regulations.
19
sarily and  inevitably infectious or contagious under all circumstances,
it is so true of smallpox and  of  typhus that they do certainly spread
by personal contact, limited infection of apartments, and also by per-
sonal fomites,—it is  manifestly the duty of the sanitary authority to
insure the  entire  seclusion of each of those maladies.   As regards both
yellow fever and  cholera, it will  be generally admitted that  it is due
to public quietude, even if it  is not known  to be absolutely necessary
for  public safety, that persons arriving at quarantine with either of
those maladies should be provided for  in secluded hospitals.  But it
is  safe  to  recommend that the local sanitary authority of any city or
port should decide whether special hospitals be established exclusively
for  the  sick arriving at quarantine, or whether  the special  hospitals,
established for the seclusion of the same  diseases occurring in such
city or port, be also used for the same classes of patients arriving from
abroad.   One hospital establishment for typhus fever, and one small-
pox lazaretto,  may, in certain  places, be so located and furnished as to
answer well for the sick  from abroad as well  as at home,  and also pro-
mote the efficiency and economy of both the external and internal san-
itary police.
  It  is probable that the proper distribution of the sick may some-
times be  best secured by such a combination of the hospital arrange-
ments of  the external and the internal  sanitary systems  of  particular
places, but proper  distribution and  the safe seclusion  of the sick with
pestilent diseases should be secured in every quarantine establishment.
  Location of Quarantine Hospitals.—First, they should be so con-
venient of access  and so situated  with reference to the quarantine
anchorage  and the quarantine warehouses and  docks, as to offer  the
best possible facilities for the  immediate medical care of the sick arriv-
ing, and of the laborers or other persons becoming ill at the quarantine
station.
   Character and Construction of  Quarantine Hospitals.—First, they
should be so located as to enjoy a pure  and  dry air; and consequently,
should be sufficiently remote from the warehouses and  infected vessels
to be safe from any danger from that quarter, nor should they be land-
locked by  elevations around  them, or too much  sheltered from  the
windward.
  Whether erected on the shores, or floating, the number of separate
hospitals should  be  sufficient to give at least one for each of the  dis-
eases that are  to  be provided for  at any one period; and the  hospitals
should be so arranged as to secure—
  1.  Perfect cleanliness.
  2.  Ample space  for patients.
  3.  Complete and controllable ventilation.
  4.  The best facilities for the reception and care of the sick.
  5.  The  requisite means for cleansing and disinfecting  bedding  and
clothing.
  There can be no better test of the good management of  hospitals
for pestilent diseases than that the hospital wards be so free from con-
tamination that they do not become infected places.  To  preserve a
typhus-fever or a smallpox ward from  infectious  contamination, and, 
20
Quarantine  Regulations.
consequently, to secure the welfare  of its inmates, it is indispensably
necessary that the air-space be  much greater than  has  usually
provided in our hospitals.  In the wards for cholera and  tor  ye
fever, the welfare of the sick, if not the safety of attendants, requir
a liberal and constant supply of fresh air.                 .      feVcr
  To attain such  a degree of sanitary security in  quarantine or
hospitals, it is necessary that ample space be allotted to the sl°k-  ",
less than two thousand  five hundred cubic feet  of  air-space should  v
allotted to each  patient, unless the facilities for insuring the constant.
supply of fresh air from without, by means of arrangements for plenu
ventilation, be of  an unusual character.  But  it  is not the design 01
this  Report to enter upon any details of hospital construction.
  The main objects of reference to this  subject have been attained in
the  foregoing remarks, on the proper distribution and care of the sick
at quarantine.  But we need to  add in this place a few suggestions
upon an indispensably important branch of service, connected with the
management of  hospitals, particularly those pertaining to a quarantine
establishment.   We refer to the best means for the  cleansing and disin-
fection of clothing, etc., from liospital wards, or from injected vessels.
  There cannot be a more highly  important  regulation in any hospital
than that which secures the immediate  cleansing of every utensil and
every article of  personal and  hospital clothing, as  soon as soiled;  and
in the arrangement of a quarantine  establishment,  none is more essen-
tial than that which provides for the immediate and thorough disinfec-
tion  of all articles of clothing, bedding, etc.,  both from infected vessels
and  hospital wards.  It is not only desirable, but necessary, that every
quarantine  establishment should  be provided  with ample means  for
effecting such purification and disinfection, as a grand measure of san-
itary protection  against all personal and common  fomites of pestilent
diseases.
  Notwithstanding the  general impression  regarding the uncertainty
of the ordinary chemical disinfectants, so called, it will not be denied
that all articles of clothing may, and certainly ought to be, completely
disinfected  and thoroughly cleansed by some speedy and effectual pro-
cess, at every quarantine  establishment.
  By referring to the  able report  that was adopted by the Convention
last  year, on  disinfectants, it will be seen that for the disinfection of
apartments or things contaminated with the infectious cause of pestilent
diseases, free ventilation  must  be the main reliance ;  and it  is truly
stated in that report, that " a disinfectant for the  yellow fever is a de-
sideratum."   Nearly as much  may be  said of other specific febrile
infections.  In the present state of our knowledge respecting the essen-
tial  nature of these infections, and their relations  to physiological and
atmospheric chemistry, it is not to be expected  that  positive chemical
disinfectants will be successfully applied ; but we recommend, however,
that, for the disinfection of  all fomites   and apartments  contami-
nated with  yellow fever or any other febrile poison, full experiment be
made with steam or with dry heat above  200  degrees  Fahrenheit, as
an  effectual mode  of  disinfection  and purification, whenever and to
whatever such heat may be safely applied.   This recommendation  is 
Quarantine Regulations.
21
based upon obvious principles and varied observations that need  not
be  stated here, particularly as  they have been embodied in a special
memoir for this Convention, by a member of this Committee.  But in
this Report, suggestions respecting extreme temperatures, forced ven-
tilation, etc., are made solely with reference to the piact'cal  applica-
tions of reliable means for such processes of  disinfection as may readily
and effectually be put in requisition in hospitals, contaminated apart-
ments, quarantine warehouses, and infected vessels.
  And for this purpose the Committee recommend :  That in connection
with every quarantine establishment,  at the warehouses as well as at  the
hospitals, properly constructed steam-generators and  steam chambers or
vats, be provided for the disinfection  of all personal, hospital, and ship's
clothing and  bedding, together with  such other  in feted goods or things
as may properly be subjected to high  steam heat.
  It is also recommended that experiment  be made to test the utility
of steam as a disinfectant in vessels  contaminated with yellow fever or
any other febrile poison that is not readily  destroyed or dissipated by
other agencies.
  It  is also  recommended that  at  every quarantine establishment it
shall  be an  established rule that all articles  of clothing, bedding, or
dunnage on board of vessels suspected of being contaminated with yel-
low fever or  cholera,  and liable  to  propagate  the same, shall be sub-
jected to high steam or dry heat for the purpose of disinfection ; and
that this duty be attended to as soon as  convenient  after  the arrival of
the infected vessel or  things;  and especially, that, without such pro-
cess having  been performed, no  article or thing whatsoever shall  be
thrown overboard or otherwise disposed of, except  by rapid  incinera-
tion or by being securely sunken under the water.
  It  is also  recommended  that  in  every quarantine hospital it be  an
established  rule, that all articles of personal  clothing,  bedding, and
every kind of absorbent material  pertaining to the furniture and uten-
sils  of the wards, or  the care of the sick  or the dead, be removed to
the steam-vats as soon as they become soiled or contaminated ;  and it is
further  recommended  that, in  addition  to   means  for ventilation,
provision be  made for the application of heat, by steam  or otherwise,
in the wards where pestilential infection is  liable to be perpetuated.
  In the case of fomites of smallpox and  of  typhus fever, the same
rule is recommended to all  sanitary authorities, connected either with
the internal or the external police of cities.
  The foregoing suggestions and  recommendations embrace  the most
important measures,  which are  of essential importance in the execu-
tive management of  quarantine hospitals;  and all  specific regulations
that the  Committee would recommend on this subject may be concisely
summed up under the heads of —
1.  Ample air-spare and effectual  ventilation.
2.  Proper supply and control of sunlight in the wards.
3.  Such construction  and such material for hospital wards as not to
     favor the  retention   and perpetuation of  febrile  poisons  and
     pestilent emanations.
4.  Means for immediate and safe disinfection of  all clothing,  bed-
     ding, etc. 
22
Quarantine Regulations.
5. Facilities  for  the  reception of the sick, and for the removal and
     burial of the dead without the observation of the patients in tn
     wards.                                               .       i
6. A resident medical  officer, who shall have control of the interna
     management and police of the hospitals.


Location, Construction, and the Executive Management of
             Quarantine Docks and Warehouses.

  In a former part of this Report  reference has already been made to
the universal defect of all modern  quarantine establishments, viz : the
absence  of suitable  docks and warehouses for  infected vessels and
cargoes.   This is a subject of such vast importance to commerce, and
of such vital  interest to the  public health, that the Committee would
deem it their duty to present  the full argument in favor of the recom-
mendation they desire clearly to express in the declaration of the pro-
posed code.   But, happily for  the brevity of this Report, as well as
for  the complete statement of the various propositions connected  with
the subject, a special report on wet docks and quarantine warehouses
will also be presented to the Convention*   On this subject, therefore,
the Committee need only to enunciate the following general statements :
  1. Ample  and safe warehouse  facilities, and  convenient and  safe
dockage for infected  vessels  and their cargoes are indispensable re-
quisites for every quarantine establishment where  yellow fever, cholera,
or the plague are liable to be  perpetuated by exotic fomites.
  2. Though not indispensably necessary to enable the  sanitary au-
thorities  to guard  against the introduction of  typhus  or  smallpox,
such special quarantine docks and warehouses might often be of  great
service.
  3. At any port where a considerable number of vessels with  their
cargoes is liable to protracted detention at quarantine, wet docks and
capacious  warehouses, exclusively devoted  to quarantine purposes, are
recommended; and it is further recommended, that, in all cases where
a vessel is reasonably suspected of being  infected with yellow  fever,
it shall not, even after discharging cargo, be permitted by the health
officer, or  the  local  council, to approach nearer to the city than the
quarantine docks, or warehouses, until thoroughly disinfected.
  4. For the general security of the public health of all cities in  mari-
time communication, no less than  for  the  convenience and benefit of
commerce, it is recommended that a dry dock, or  a marine railway, be
constructed in connection with the quarantine docks and warehouses,
for the purpose of enabling merchants to overhaul and  repair  their
vessels, and to enable the sanitary authorities to make such inspections
as they may deem expedient in connection with such repairs.
  5. The quarantine docks, warehouses, and anchorage,  should be
located at a sufficient  distance from any populous neighborhood to in-
sure seclusion, and be free from any  liability  of communicating the
infection of any disease to any persons not employed at the quarantine
•See p. 9, et seq. 
Quarantine Regulations.                   23
establishment.   To this end, it is recommended that the docks, ware-
houses, and anchorage be located at least two miles from any populous
neighborhood, however rural, and, when practicable, at a much greater
distance from cities or large towns.
   6. The warehouses should be " so constructed as to secure  the best
natural ventilation, and to that should be added appliances and power
to afford to each store-loft and apartment the most complete provisions
for artificial ventilation and disinfection."  It is further recommended
that at every quarantine establishment there should be constructed, in
connection with the warehouse or warehouses, an apartment, or cham-
bers, with suitable appliances  for special disinfection, by high  steam,
dry heat,  refrigeration, chemical disinfection, and forced ventilation ;
and that facilities be supplied for the speedy  and safe delivery and
shipment of goods that have been subjected to such disinfecting pro-
cesses.
   7.   It is recommended that the executive  management and control
of quarantine warehouses and docks, and the goods and persons  there-
in, be under a competent scientific officer, who shall te approved  by the
health officer of the port, and the local sanitary council.
   As the  special regulations which the  Committee would  recommend
respecting the unlading,  detention, and pra'ique of cargoes, will  be
stated in  the declarations of the code submitted, we will  not extend
our suggestions on this subject.
   It will  be observed that this report assumes, without argument or any
narration of reasons  or opinions, that both yellow fever and cholera
are diseases capable of being transmitted  and propagated  from place
to place beyond their indigenous habita's.
   In the  case of  yellow fever, having satisfactory evidence that such
transmission is effected generally, if not always, by means of inanimate
fomites, the Committee have no  occasion  to renew the discussion of
questions which  were so fully entered upon  by the Convention  last
year.  But it  will be observed that the  suggestions and recommenda-
tions  contained  in this report, so far as  they relate to the sick with
yellow fever, contemplate such care and  seclusion as to answer the de-
mands of those among us who  still believe in the personal communi-
cability of that scourge of the tropics, while providing for the simply
humane interests of  the sick.
   In respect  to  Asiatic  cholera, the report coincides with  the high
authority of the most reliable commissioners and committees that have
specially  investigated the history and progress of that fearful malady.
With  the conclusions of Doctors Baly and Gull, as expressed  in the
able Report of the British Royal College of Physicians, your Commit-
tee believe that" human  intercourse is certainly only one cause of the
propagation of disease,"  and that " the  propagation of the disease  by
human intercourse does not  prove  its contagious  nature;"  all of
which may  be affirmed  with equal truth of the propagation of yellow
fever.   But " the possibiVty that cholera is occasionally communicated
by a virus produced in, and emanating from  the sick," is admitted.
   As regards  the utility of quarantine  restrictions against cholera, it
may safely be stated in the language of the Royal College of  Physi- 
24
Quarantine Regulations.
cians,  that  "quarantine  has undoubtedly often failed of its object,
partly from its being evaded  by the  crews of infected  ships, partly,
perhaps, from the  ships being placed so near to habitations on shore,
that the imperfect  air of the ships would be carried to them by atmos-
pheric currents ;  and, in  some cases, probably, because clothes, still
containing infectious matter, were conveyed on shore during or subse-
quent to the period of quarantine."
   This report also adopts the conclusion of the able document from which
the preceding paragraphs have been quoted, that " it cannot be doubt-
ed that ships are more or less fitted to convey the disease, or its cause,
from port to port,  in proportion to their want  of cleanliness, defective
ventilation, and overcrowded state ; and that if these evils, of which the
two former are so flagrant in the smaller trading vessels, and the two lat-
ter in ships  carrying passengers, could be removed, the danger of the
importation  of cholera would be  greatly lessened."  The language of
this  most recent  and reliable authority on this subject so fully ex-
presses the views of your Committee, that we beg permission to quote
the  following, as the best that can be given on this  point  in our re-
port.
   "  While,  therefore, it is much to be desired on general grounds, that
measures should be adopted for inculcating and enforcing the attention
to cleanliness and free ventilation, in the whole mercantile marine, the
special application of measures of this kind to ships coming from  ports
where  cholera prevails, as far as  may be  practicable,  is imperatively
called for.   A close inspection of all such vessels should be made  on
their coming into  port, and it would not be  unreasonable to  require
that there should be brought with each ship coming from an  infected
port an official certificate  of its having  been inspected, and found
cleanly and  not over-crowded, and the crew healthy at the time of its
sailing."
   " On the  arrival of ships having persons ill of cholera on board, or
having had  deaths from that disease during the voyage, more active
measures must be adopted ;  1, .and the best that have been recommend-
ed seem to be, the removal of the siek to a hospital ship, moored at a
distance from the other shipping  in the harbor, or to a special hospital
in an isolated and  airy situation on shore ;  2, permission to the rest of
the crew to land after exchanging their dress for fresh clothes provided
from the shore ; 3, the thorough exposure of articles of dress and
baggage to the air and disinfecting agents before they are  removed
from the ship (or  from quarantine warehouses); and,  4, the use of
disinfecting agents in every part of it, but especially in the parts  occu-
pied by the crew and their baggage."
   In the foregoing concise statement is embodied all that need be said
on this subject of quarantine for cholera, though  there is  stronger
ground for quarantine restrictions against that disease in America than
can exist on the Eastern continent.
   As regards typhus fever and smallpox, this report recommends that
all specific directions or regulations for the m magement of both the
sick and the vessels in which they arrive be committed to the discre-
tion of the  local sanitary authorities; yet the Committee, desiring  to 
Quarantine  Regulations.
25
 fulfil the commission intrusted to them, feel it incumbent on  them  to
 report  as follows regarding the quarantine regulations demanded by
 those diseases :—
   It is well known that typhus  fever and smallpox are diseases that
 prevail most  frequently in  cold weather, and that persons  laboring
 under these  maladies,  and  also infected  goods, are not  subjected  to
 quarantine.  It has been well observed that a ship arriving with typhus
 fever or smallpox at midwinter is  as legitimately  a subject for quar-
 antine  restrictions  as one  with yellow  fever on  board arriving in
 midsummer.   Nor will it  be denied that  the  danger of contagion in
 smallpox and from infection in ship fever is  far  more to be  dreaded
 than any danger from persons sick  with  yellow fever  at any season.
 While the fomites of  yellow fever,  existing independent of  persons,
 though active only during hot weather, are much  less subject to con-
 trol than the fomites of typhus fever and smallpox.
   Should a single doubt linger in  the mind of any one on this ques-
 tion, let it be remembered that the foul  atmosphere of a ship at sea
 is oftentimes  produced during cold weather  or in cold latitudes, by
 overcrowding,  and by  the  exclusion of pure  air, impoverished  diet,
 and want  of  proper  attention  to cleanliness.  Such  a condition  of
 things has repeatedly happened, and disease has been  introduced into
 our ports by the arrival of emigrant, and  other vessels, in midwinter,
 after a  protracted voyage, or where the  ship's  company consisted of
 a squalid, filthy, half-fed, and intemperate collection of passengers, at
 the same  time the vessel laboring under a leaky hold,  and  having
 a perishable  cargo on board.   It  is, indeed,  well established that
 febrile, infectious, and pestilential diseases are  liable to occur wherever
 and whenever  there  is overcrowding of   human  beings in  close  or
 filthy places, especially on shipboard when deficiency of space, paucity
 of  fresh air, the presence of extreme humidity, bilge-water gases, and
 idiomiasmata  are peculiarly active causes  of  fatal  fevers and diffusi-
 ble infection.
   The frequent and destructive  outbreaks of pestilent  fevers  in naval
 transports, and  the  peculiar experience   of  quarantines at  all our
 Atlantic ports where foreign  immigration  has  furnished its painful
 illustrations of the  evils of overcrowding in passenger  ships, suffi-
 ciently enforce the importance of practical attention to the condition of
 this class of vessels on their arrival in port, while  their records point-
 edly illustrate  the  necessity  for  improvement  in naval or  marine
 hygiene.  Indeed, nothing  more strikingly illustrates the importance
 of  this  subject  than the  frequent  instances of  the  propagation  of
 pestilent fevers  from ships'  holds after  arrival and unlading at the
 wharves of our cities.
  The propagation of all such diseases as are generated or  may be
 transported by ships, is subject to such varied  contingencies as to ren-
 der it manifestly desirable  that in every port the local sanitary author-
 ity  or board of health should exercise such  surveillance and control over
 the  imported  sources of disease as  may be found necessary  for the
 protection  of  the public health.  But it is evident that in all places
where  the same diseases are indigenous, naturalized, or locally preva-
                        4 
26
Quarantine  Regulations.
lent, as in the case of typhus, scarlatina, and smallpox,—in nearly all
the cities of Christendom,— the special restrictions of  quarantine for
those maladies should not exceed, but fully harmonize with, the scope
and spirit of the  restrictions and  regulations of the internal  sanitary
regulations, in each  port or city respectively.   As stated under the
head  of Distribution of the  Hick,  considerations of  efficiency and
economy may often  render  it  desirable  to  combine the appliances of
the internal with  those of the external sanitary police.
   In  regard to smallpox, there can  justly be  no  relaxation  of such
restrictions as are necessary  to insure seclusion of its  victims  and the
personal fomites  of  that malady, until the great prophylactic_ vac-
cination has been universally applied.   But fortunately the ordinary
cargoes of merchandise are  very rarely liable to become in  any degree
infected with the virus  of smallpox,  typhus, or cholera.   The  readi-
ness with which a vessel  contaminated with these maladies may be dis-
infected, should relieve  commerce from onerous  burdens which  these
diseases inflict.   The actual detention or cost being only for  the pur-
pose of securing  complete  ventilation and cleansing.   Yet, for even
these purposes, we regard the preparation of special docks and ware-
houses desirable; and  for the security of most  of the Atlantic and
Mediterranean  ports, such  special  facilities should  be regarded as
absolutely necessary in carrying out any plan for the effectual  relief
of the burdens inflicted  by yellow fever and the plague.   Whatever
may be learned  in  the  future respecting  the propagation of yellow
fever, cholera, and the  plague, it is highly important to maintain all
those  sanitary restrictions which are  requisite to insure the exclusion
of those maladies from healthy ports.
CODE  OF MARINE  HYGIENE.
                       DECLARATIONS.

   1. Every organized government  has the right  of protecting itself
against the introduction  of  infectious diseases, and of putting any
country, place, or thing in quarantine which  would introduce infec-
tious diseases; provided,  however,  that no sanitary measure  shall
go so far as to exclude or drive from port a vessel, whatever  may be
her condition.
   2. The only diseases at present known, against the introduction of
which  general quarantine  regulations should be enforced, are—plague,
yellow   fever,  cholera,  smallpox, and  typhus  fever.   As   regards'
plague, the European Congress  at  Paris had the  right to settle the
question for the nations there represented ; and, inasmuch  as they and 
                     Quarantine Regulations.                   27

the other  nations  of the eastern continent have reason  to  subject
the plague  to quarantine restrictions,  the States of America  yield
implicit obedience to that convention.
  3. All quarantine regulations, of anyplace whatever, should bear with
equal force against the toleration or propagation of disease as against
its introduction; and authority to prevent the introduction of disease
in any place should be equally applicable against its exportation.
  4.  All quarantinable diseases are chiefly introduced and propagated
by the materiel of commerce ;  and it is therefore against it that quaran-
tine restrictions should be instituted, and  not against the personnel;
excepting, however, persons  with no evidence of  vaccination, and
known to have been exposed  to smallpox; such persons shall be vac-
cinated as soon as possible,  and detained until the vaccinia shall have
taken effect; otherwise, they  may be detained fourteen  days from the
time of the known exposure.
  5.  The application of quarantine regulations shall be regulated by
the official declaration of  the  constituted sanitary authority at the port
of departure where the malady exists.   The cessation of these  meas-
ures shall be determined by  a  like declaration  that  the malady has
ceased,—after, however,  the  expiration of a fixed delay of thirty days
for the plague, fifteen days for yellow  fever, and ten days  for cholera.
  6.  It is obligatory on all vessels to have a bill of health; this
shall consist of two kinds  only, a clean bill and a gross bill, the first for
the attested  absence of disease, and  the second  for  the attested
presence of disease.  The bill  shall  state the hygienic state  of the
vessel; and  a vessel in  a  bad  condition, even with a  clean bill  of
health, shall be regarded as a vessel having a gross  bill, and shall be
submitted to the same regime.
  7.  The plague, yellow  fever,  and cholera being the  only maladies
that entail  general measures, and  place in quarantine those  places
whence they proceed, the restrictions  enforced against  these diseases
shall not be applied to any other suspected or diseased vessel.
  8.   The power of applying the general principles of  this code, and
of acceding to its provisions,  are expressly reserved  to  those nations
and governments  who  consent  to accept the obligations it imposes;
and all the administrative measures proceeding from it shall be  deter-
mined by international  sanitary regulations, or by a convention of the
representatives of the governments which have adopted it.
  9. This code  shall  continue  in force and vigor  among the govern-
ments adopting it for five years, and it shall  be the duty of any party
wishing to withdraw from its observance, at the end  of that time, to
officially  declare his intention six months before the term expires; if
there  be  no such notice, the  code shall be regarded as in force one
year longer, and thus it  shall continue year after year, with all  the
governments accepting it, until  after due notice,—six months before
withdrawal. 
28
Quarantine Regulations.
                 PROVISIONS  IN  DETAIL.

            I. — measures relating to departure.

  10. Measures relating to departure comprise observation, inspection,
and  the ascertaining of the  sanitary state of the place and vicinity ;
the examination and ascertaining of the hygienic state of the vffseJ,
which is about leaving, of its  cargo and  provisions, of the health of
the crew, and, if there are any passengers, of their health also; and
lastly, of the bill of health, and  all relating thereto.   These observa-
tions, inspections, and examinations shall be confined to the authorities
hereinafter designated.
  11. All vessels before lading,  must be visited  by a delegate of  the
sanitary authority, who  shall be a doctor of  medicine, and  submit to
hygienic measures, if deemed necessary.   The vessel  shall be visited
in all her parts, and  her hygienic  state ascertained.    The authority
shall  inquire  into the state of the provisions and beverages, in par-
ticular of  the potable water  and  the means of preserving  it; he shall
also inquire into the state of the crew, and in general into every thing
relating to the  maintenance  of health  on board.  If any person has
been  shipped, having a  transmissible  disease, such  person  shall  be
forthwith discarded.
  12. Charges shall not be made until after the visit, and the accom-
plishment  of  the measures  judged  indispensable by the  sanitary
authority.
  13. Captains and masters shall furnish to the sanitary authority all
the information and all the evidence, to the  best of their knowledge,
demanded  of  them.   If the sanitary  authority judges necessary,
and does not believe  himself  sufficiently informed by the captain or
other persons in charge, he can proceed to a new visit, after the lading
of the ship, in order to assure himself if all the prescribed hygienic
measures have been observed.
  14. These various visits shall be made without delay, and in such a
manner as to avoid unnecessary loss to the ship.
  15. Vessels carrying a foreign flag shall be visited by the sanitary
authority, with the  consul or  consular  agent of the  nation to  which
the vessel  belongs.
  16. The  number of passengers  embarking on sailing vessels  or
steamers, the arrangement of their accommodations, and the quantity
of provisions on board for the probable length of voyage  shall be  de-
termined by  the  particular  regulations of different  governments
adopting this code.   But in no case should the number of individuals
to be  accommodated on board any vessel, or in any apartment provided 
Quarantine  Regidations.
29
 for the accommodation of crew or passengers, exceed in ratio one indi-
 vidual to every four hundred cubic  feet of air space, together with
 provision for effectual ventilation in all weathers.
   17. Passenger vessels  of whatever size,  and all vessels carrying j
liv^y persons, or a smaller number, including crew, shaH furnish' ttow-
 HEIvm with the necessary medicines  and apparatus for the treatment
 of the most ordinary diseases and accidents likely to happen on board.
 And it shall be the duty of the  sanitary administration of each gov- ~"
 eminent to make out  a catalogue of the  medicines and apparatus, and
 detailed instructions for  their use on board all vessels of this class.
   18. All sea-going passenger vessels and all vessels having a larger
 number of  persons on board than named in the last preceding article, .
 shall carry a doctor of medicine, approved of by the sanitary authority.£ .
   19. Bills of health  shall not hereafter be delivered until after the
 fulfilment of the regulations herein specified.
   20. Vessels of the navy and revenue vessels shall not be subject to
 the preceding regulations.
   21. In  ordinary  times,  fishing-vessels, pilot-boats, vessels  in  the
 coasting trade,  of the same  country,  and canal boats, need not carry a
 bill of health;  the sanitary regulations of this class of vessels shall be
 determined by  the local authorities.
   22. No vessel shall have  more  than one bill of health.
   23. Bills of  health shall  be delivered  in the name of the local gov-
 ernment by the sanitary  authority, vised by the consuls or commercial
 agents, and be  of credit in  the ports  of all governments adopting  this
 code.
   24. The bill of health shall  contain  the  name of the  vessel, the
 name of the captain, or master,  and the results of the examination,
 relating to  the tonnage, merchandise, crew, and passengers; it  shall
 state the exact  sanitary condition of the place, the hygienic state of
 the ship, and whether there are any  sick on board.  In short, the bill
 shall contain all the information  that can enlighten the sanitary au-
 thority of the port of destination, to give him as exact an idea as pos-
 sible of the public  health at the place of departure and environs; of
 the state of the ship, her  cargo, the health of the crew and passen-
 gers.   The  environs  are those places in  habitual communication with
 the port of departure, and possessing the same sanitary relations.  The
 bill of health for all parties adopting this  code shall conform to the
 annexed model: — 
BILL OF HEALTH.
Name of vessel............
Nature of vessel...........
Flag.......................
Tonnage...................
Guns......................
Port of Registry..........
Destination................
Name of Captain..........
Name of Physician.......
Equipage.—All complete..
Passengers................
Cargo.....................
Hygienic state of ship.....
Hygienic state of Equipage,
  Cordage, Sails, etc.......
Hygienic state of Passen-
  gers .....................
Food, Provisions, etc......
Water.....................
Disease on Board.........
Sanitary state of place and
  environs.................
  and  that.................


   Delivered        th       of
18   at     o'clock.
oft
0)

flttittil   Stfttt*   0f   %mxiw.
No.
  SANITABY REGULATIONS.


BILL  OK1  HEALTH.
  Port of  __________________________
  We       of the Health Department in           certify that the vessel hereinafter i
named, left this port in the following condition, namely:

                                     !'  Hygienic state of the ship.
/I Name of vessel........
y[v Nature of the vessel...
«5riag...................
 |A Tonnage...............
 (JJ Guns..................
 I Port of Registry.....
   Destination...........
*T\ Name of Captain......
 \j Name of Physician—
l£s Equipage.—All Compl
Hygienic state of Equipage,
  Cordage, Sails, etc.........

Hygienic  state of Passen-
  gers.......................
Food, Provisions, etc.

Water................
NJ\ Cargo.............
 j] Disease on Board.
      We also certify that the Sanitary state of the place and environs

   the
      In testimony of which we have delivered the present Bill of Health, at
   18   at   o'clock.

        (Signed.)
  and that I


 'th of


[SEAL.]
CO
o
1
S3 
Quarantine Regulations.
31
  25. Whenever there  prevails at the  place  of departure, or in its
environs, one of the three maladies reputed to be importable or trans-
missible, and  when the  sanitary  authority shall have  declared its
existence, the bill shall give the date of  the declaration.   It shall give
the date of the  cessation of the same when the cessation shall have
been established.
  26. In conformity to the provisions of Article 6, the Bill of Health
must be either Clean or Gross.  The sanitary  authority  shall  always
pronounce  upon the existence or nonexistence of disease at the port of
departure.   Doubtful  cases shall be interpreted in the most prudent
sense,—and the bill shall be gross.   In regard to passengers, for those
whose   health may be  suspected, the sanitary authority may demand
the  certificate of a doctor of  medicine, known to him to be of  good
standing, and if any proposed passenger is thus found to be in a condi-
tion comprising the health  of the ship or of persons on board, he shall,
upon the direction of  the sanitary authority, be prohibited.
  27. Bills of  Health  can only be considered  as  valid when  they
have been  delivered within the forty-eight  hours last preceding de-
parture.  If the departure is delayed beyond this period, the bill must
be vised by the authority delivering it, stating whatever  change may
have taken place.
  28. The existence of  transmissible  or importable  disease  in the
quarantine establishment of any place  shall not alone be considered
cause sufficient for a gross bill  of health.

        II.--SANITARY  MEASURES  DURING  THE  VOYAGE.

  29. All vessels at sea shall be kept  in a good state of ventilation
and cleanliness.   And  to this end it shall be the duty  of  the sanitary
authority at the port of departure, to see that every vessel is provided
with the necessary means, and that captains  and masters are  suffi-
ciently  conversant with the use of those means, for the purposes  indi-
cated.
  30.  Captains and masters shall  conform to  the instructions of the
sanitary authority ;  otherwise, on arriving, they shall be considered as
having  a gross bill of health, and be treated accordingly.
  31. Physicians attached to sea-going  vessels  shall be considered as
the agents of the sanitary  authority, and it shall be their special mis-
sion to  watch the health of the crew and  passengers, to see that the
rules of hygiene are observed,  and, on the arrival of the vessel, to
give an account of the circumstances of the voyage.   They must also
keep an exact record of all circumstances  of interest to the public
health,  meteorological observations, etc., and note with particular care
the history and treatment of all the diseases and accidents that occur.
  32.  In  vessels  carrying  no  physician, it shall be the duty of the
master  or captain  to fulfil, as  far as practicable, the obligations of
the last preceding article.
  33. All  captains or  masters touching at  or  communicating with a
port, shall have their bills  of health vised by the sanitary authority; 
32
Quarantine Regulations.
or, in default of such authority, by the delegated officer of the local
police.                                                     ,
  34. It is forbidden to the sanitary authority at  the  port where a
vessel touches, or holds  communication, to retain the bill  of health
given at the port of departure.
  35. In  cases of death at sea from a  disease  of  a  suspected  char-
acter, the wearing apparel and bedding which have been used by  the
deceased in the course of his sickness, shall be burnt  if the ship is at
anchor; if en  route,  thrown into the sea, with the necessary precau-
tion that they shall not float.   Other  articles belonging to the  de-
ceased shall be immediately aired or otherwise purified.

             III. — SANITARY  MEASURES  ON ARRIVAL.

  36. All vessels on arrival shall submit to an examination and ques-
tioning.   The examination and questioning shall be made by the sani-
tary authority delegated  for that purpose; and the  result shall be re-
corded upon a special register.
  37.  All  vessels, furnished with a clean  bill of health, which have
had during the voyage  no  disease  or communication of a suspected
nature, and which present  a satisfactory hygienic  condition, shall  be
admitted to free pratique immediately after examination.
  38.  There being no evidence that any disease was ever introduced
into a community by persons who had been quite  healthy during  the
voyage, and were so on  arrival, such persons should  not be detained
under the apprehension that disease may be dormant in their systems.
All well persons shall be  allowed  free pratique,  excepting only the
temporary delay provided in Article 4 for smallpox, immediately after
arrival.
  39.  Whenever there are sick  on board, they shall be  removed as
promptly as possible from the vessel to clean and airy rooms on  shore,
or to a floating hospital moored in a healthy situation.  The detention
of  such persons  in an infected  ship is  obviously  most objectionable,
and should be allowed under no circumstances whatever.
  40. The experience of quarantine shows that the  fears of pestilen-
tial disease being introduced by the ordinary cargoes of dry and im-
perishable goods is groundless, and that with the temporary exceptions
hereinafter provided, such cargoes shall be admitted  to free pratique im-
mediately after examination. Nevertheless, there are  numerous articles
of  commerce which should not  be landed except under  special  re-
strictions,  and apart from all populous neighborhoods.
   41. The application  of sanitary  measures to merchandise shall be
arranged in three  classes: 1.  Merchandise to  be submitted to an
obligatory quarantine and to purification;  2.  Merchandise  subject to
an  optional quarantine;  and 3.  Merchandise  exempt from quarantine.
   The 1st class comprises clothing, bedding,  personal baggage  and
dunnage, rags, paper, paper-rags, hides, skins, feathers, hair, and all
other remains of animals, woollens, and silks.
    The 2d class comprehends cotton, linen, and hemp; and cattle. 
Quarantine  Regulations.
33
  The 3d class comprehends all merchandise not enumerated in the
other two classes.
  42.  With  a gross bill and existing  quarantinable disease on board,
or if  there has been any such disease on board within the ten  days last
preceding, merchandise of the first class shall always be landed at the
quarantine warehouse or other place provided, distant at least  two
miles from all populous  neighborhoods, and  there  submitted to the
necessary measures for purification.   Merchandise of the second  class
may be admitted  to tree pratique immediately, or transferred to the
warehouse, according to  circumstances,  at the option of the  sanitary
authority,  with due regard to the sanitary regulations of the port.
Merchandise of the third class shall  be declared free and  admitted
without unnecessary delay.
  43.  In all cases of a gross bill, letters and papers shall be submitted
to the usual purifications; but articles of merchandise, or other things
not subject to purifying measures, in an envelope officially sealed, shall
immediately  be admitted  to free pratique, whatever may be the bill of
health.   And if the envelope is of a substance considered as op-
tional, its admission shall be equally optional.
  44.  A foul ship is much more to be dreaded, as a vehicle of intro-
ducing disease, than anything she has on board; and vessels in a fil-
thy, unwholesome state,  whether there has  been sickness on board or
not, should not be allowed to enter a crowded port, or to lie alongside
a wharf or other ships, until they have been broken out, duly cleansed,
and ventilated.
  45. If a vessel, though furnished  with  a  clean bill of  health, and
having had during the voyage no case  of sickness, yet be found in a bad
or infected state, or in a condition which the sanitary authority judges
compromising to  the public  health, the  vessel and cargo  shall be de-
tained until the case  has been considered  by the authority; his de-
cision however, shall be rendered  within twenty-four hours.
  46.  If in the judgment of the sanitary authority the vessel requires
it, he  may order the following hygienic  measures :   Baths and other
bodily care for the personnel, washing or disinfecting means for cloth-
ing;  displacement of merchandise, onboard  or a  complete breaking
out;   subjection  to  high steam,  incineration  or  submersion  at a
distance, in  the  sea, of  infected articles;  the destruction of tainted
or spoiled food or beverages ; the complete ejection of water; thorough
cleansing of the hold, and the disinfection  of the well; in short, the
complete airing and  ventilation of the vessel in all her parts, by the
use of force-pumps, steam, fumigation, washing, rubbing, or  scraping,
and finally sending to an  isolated anchorage ground.   Whenever these
divers operations are  deemed necessary,  they shall be executed in the
more or less complete  isolation of the vessel, according to circum-
stances, but always before admission to free pratique.
  47.  All  vessels  having no  bill  of health, which, by reason of the
place from whence they came, could not obtain One, or in case of acci-
dental loss of bill, shall submit to restrictions according to circum-
stances,  depending upon the judgment of the  sanitary authority, in
conformity with the provisions herein established.
  48.  All bills showing evidence of erasure or alteration shall be con-
                5 
34
Quarantine  Regulations.
sidered null, and shall incur the conditions of the last preceding arti-
cle, without prejudice to the proceedings which  may  be instituted
against the authors of the alterations.
  49. A doubtful case, reported in an unsatisfactory manner, shall al-
ways be  interpreted in the most prudent sense.   The vessel shall be
provisionally detained.
  50. Admission to free pratique shall be preceded by as many visits to
the vessel as the sanitary authority may judge necessary.
  51. No vessel can be put in quarantine, without a stated decision of
the sanitary authority.   The  captain or master of the vessel shall be
informed immediately after of this decision.
  52. A vessel shall  have the right, except  when they have plague,
yellow fever, or  cholera on board, of putting to sea, in  preference to
being quarantined;  and in the exercise of  this  right, if the  vessel
has not arrived at the port of destination, the bill of health  shall be
returned; the sanitary authority, however, shall  mention upon such
bill the length and circumstances of the detention, also the condition of
the vessel on reputting to sea.   But before the exercise of this right,
the sanitary authority must assure himself that the sick  will   be taken
care of for the  remainder of the voyage; and take  charge of such of
the sick as prefer to remain.
  53. Besides the specific measures in the foregoing regulations, the
sanitary authority of  each country or port  has the  right, according to
Article 1, in the presence of immediate danger, to take the responsi-
bility of  applying  such additional  measures as may be  deemed indis-
pensable for the protection of public health.
  54. Notwithstanding the  preceding regulations, whenever  the sani-
tary state is positively healthy, vessels going from one port to another
in the same country  can, in  virtue of the particular sanitary regula-
tions of each country, be freed from sanitary examinations.   And, in
ordinary times, by virtue of declarations exchanged between the con-
tracting  nations, all vessels, proceeding or intending to proceed from
one of two countries to the ports of the other, may also be  free from
examination.

                IV. — EXECUTIVE ARRANGEMENTS.

  55. Every seaport town requiring the  obligations of  quarantine,
should have a quarantine hospital for sick persons,  warehouses for in-
fected goods, with  the necessary docks, and  a designated anchorage
ground for  infected  vessels; these several parts of the establishment
shall  be  at such  a  distance and  direction  from  each other, and all
populous neighborhoods, infectious and infectable places, as to endan-
ger the life of no one.
  56. On  the arrival of infected vessels at  the quarantine  establish-
ment, all well persons shall be admitted to free pratique as soon as possi-
bly consistent with the foregoing regulations; sick  persons  shall be
immediately transferred to the quarantine hospital, or to hospital ships,
and the vessel unladen as soon as  practicable.  All merchandise shall 
Quarantine  Regulations.
35
be  placed  in  capacious and  perfectly secure warehouses, and there
freely exposed to the  air, and moved from time to time to insure its
perfect ventilation.
  57.  Merchandise coming from different vessels and places in quar-
antine, at different times, shall be kept separate, and placed as much
as possible in different warehouses.
  58.  Merchandise of the first class (Art. 41) shall be submitted to
such measures of purification as the sanitary authority shall judge
necessary.   No putrefied animal or vegetable substances, or substances
likely  to putrefy, shall  be admitted  into the  warehouses.   All such
substances shall be rendered innoxious or destroyed.
  59.  The clothes and dunnage of passengers contaminated with the
infection of different diseases shall be exposed to ventilation in differ-
ent places.
  60.  Each Quarantine establishment shall have one or more ware-
houses specially appropriated to the  reception of purified merchandise,
to which all merchandise may be removed so soon as it shall be deem-
ed by  the sanitary authority admissible to pratique.
  61.  Letters or dispatches shall be so  purified that the writing may
not be affected.  Consuls and representatives of foreign countries have
the right to be present at the  opening and purification of letter-bags,
or other mail packages addressed to them or designed for their country.
Postmasters shall have the same right as consuls and  foreign repre-
sentatives.
  62.  All  governments and places  adopting this code shall  as soon
as practicable  provide the necessary arrangements and  appurtenances
for fulfilling the obligations it imposes.
  63.  In case of the arrival of infected vessels at a port not provided
with a quarantine establishment, vessels or hulks may be appropriated
to the  service  of the sick, and also for the reception of  merchandise;
but in such cases they shall be disposed  in such a manner as will  per-
mit the separation of the sick and assure the best conditions of hygiene,
— especially ventilation.  But under no circumstances whatever shall
sick persons be  kept in proximity with infected goods.   Well  persons
shall have  their  liberties as soon as practicable, consistent with the
preceding regulations; and all other  measures essential for the protec-
tion of public health, shall be instituted according to the exigencies of
the case, provided they are not inconsistent with the tenor and spirit of
these regulations.

                  V.--SANITARY  AUTHORITIES.

  64.  Sanitary authorities shall be  established upon a uniforn basis
by  the countries or governments  adopting  this code, and shall be
composed :  First, of a responsible  agent of the  government, who
shall be a doctor of medicine;  and, Second, of a  local Sanitary Coun-
cil or Board of Health.
  In addition  to  the  above Report, presuming it to be adopted, your
Committee beg leave to offer the following resolutions:
  1. Resolved, That this  Report  be  referred back to the  Committee, 
36
Quarantine  Regulations.
with  directions to negotiate with our National Government or Depart-
ment of State, to secure, by convention or otherwise, the national and
international adoption of a code based upon the principles hereinbefore
set forth.
   2.  Resolved, That a committee of one from each State  represented
in  this Convention  be designated   by the delegates of  the  several
States, and appointed by the Chairman of the Convention, with power to
confer with the  governments of their respective States for the adop-
tion of such code.*
   3.  Resolved,  That  the local sanitary authorities of  the  several
States and  municipalities in the United States be furnished  with a
copy of this Report,  and that they are hereby  respectfully requested to
carry into effect all its  specific recommendations, and the general pro-
visions of the code,  without waiting for  their national and interna-
tional adoption.
       Respectfully  submitted,
                                      A.  N. BELL, Chairman ;
                                      ELISHA HARRIS,
                                      WILSON  JEWELL,
                                      R.  D. ARNOLD,f
                                      H.  G.  CLARK.
  * By vote of the Convention, it was Resolved, " That the Committee on External Hy
giene have power and be directed to select a suitable person from each State, not repre-
sented in this Convention, to aid in carrying out the objects of the second resolution of
their Report."—The following  persons were appointed from the States represented :
Gov. Emerson of Penn.; Dr. Guun, N. Y.; Dr. Snow, R. I.; Dr.  Moriarty, Mass.: Dr. J.
A. Nichols, N. J.;  Dr. G. 1$. Guthrie, Tenn.; Dr. Thompson, Ohio; Dr. Kemp, Md.
  t It was voted, on motion of the Chairman of the Committee submitting the Report on
External Hygiene, " that two additional members, appointed by the Chair, should be
added to that Committee.  Drs. It. D. Arnold and H. G. Clark were appointed. 
Quarantine  Regulations.
37
                  BRIEF  SUMMARY

ON THE IMPORTANCE OF ESTABLISHING AN INTERNATIONAL SYSTEM
   OF QUARANTINE, BY DR. D. B. REID,* MADISON, WISCONSIN. ^

  There are few civilized  nations in which the  progress  of medical
science has not  led to important changes in the administration of
quarantine.  Discoveries in chemistry  and mechanics, the  power of
heat, cold, ventilation, and disinfecting agents, and a better knowledge
of the nature and characters of disease, have  all tended to lessen the
severity of the practice of former times, to remove restrictions on com-
merce, and to  place increased resources in the hands of the practitioner
in securing the right  conduct of an efficient  quarantine, wherever it
may be necessary.
  It has been a growing conviction  with medical men, however, that
too little attention is still paid to the  condition of ships' cargoes, crews,
and passengers at the port of embarkation, and that in consequence of
this  defect they often start with disease, or in a condition that leads to
its development when  they are at sea, that might have been prevented,
or at least largely reduced.  From this  cause  an unnecessary increase
in the severity of quarantine restrictions, and consequently in the cost,
becomes imperative  at ports of arrival.
  As it is manifest that health on board ship  must depend essentially
on the condition in which it leaves the port of embarkation, the con-
duct of the voyage, and the position in which  it is placed at the port
of arrival, it  is impossible to do full  justice  to this question, or to
secure those measures that the best protection  against the production
of disease, and the most effective modes of controlling it, unless the
authorities, both  at  the port of  embarkation  and arrival, as  well as
those  who direct the  voyage  at  sea, shall concur in the  necessary
measures to  do adequate justice  to this question.   Foreign govern-
ments must concur  in lending their  mutual aid to the solution of the
principal problems it involves.  A quarantine  system is  essentially a
sanitary question; and the broader the basis on which it is founded,
the greater the advantages attending it. and the  more certain  its suc-
cess in improving the  system and lightening the burdens attending it;
and though it is only required between such nations as are engaged in
commerce, and more especially within certain latitudes, the more cos-
mopolitan the character of any arrangements that may be entered into
by treaty or otherwise, the more likely are they to be generally adopted,
and to promote the preservation of health both  at sea  and  on shore.
  Such  being the  circumstances under which  the  attention of the
Committee was directed to the subject  under consideration, the author

  * Dr. Reid was appointed a member of the Committee on External Hygiene, but owing
to unavoidable causes he was unable to participate in the work of the Committee submittiug
the Report.  His " lirief Summary " was received after the Report was made out.
                                    A. N. Bell, Chairman of the Committee. 
38
Quarantine  Regulations.
of the following summary has endeavored to  place  in  the appended
resolutions a scheme that may be rendered a general basis of action in
leading commercial nations to a united effort for the promotion of this
case.   Twenty years have elapsed  since he directed the execution of
works for ships  in warm climates, (the coast of Africa and the in-
terior,) and he has since directed other works in different classes of
ships, more especially during the prevalence  of severe disease among
British troops in  China, and latterly at New York, in the construction
of the Rus>iau frigate, the General Admiral, in which  his plans for
ventilation were introduced.   Since the meeting  of  the Sanitary Con-
vention last year  at New York, he  has had  a special opportunity of
bringing this subject under the  notice of  one  of the members of the
Cabinet  at London, the  President  of the Board of Trade, the Hon.
Mr. Milner Gibson, the details previously submitted to His Excellency
the President at Washington,  and has received  from another, the Jit.
Hon.  Lord John Russell  to different embassies on  both sides of the
Atlantic  to  facilitate  his proceedings  on this  question,  though he
desires to state explicitly that  he has no authority nor right to connect
the names of these parties with the resolutions that follow, which are
brought forward on his own responsibility alone.   But from the varied
opportunities he has had of inquiry as to the points at issue, he enter-
tains  the conviction that their discussion has  already been attended
with the most important results, and that it requires only the continued
co-operation of the medical  profession to secure a proper attention to
their  importance, and to the improvement of the condition of the sailor
and passenger at sea, as well as  when detained on shore, and the re-
moval of  restrictions  on commerce to the greatest degree compatible
with the public health.
  It is proposed accordingly, with every deference to the views of the
Committee, that it recommend  the following  resolutions  to the con-
sideration of the  Sanitary and Quarantine Convention to be held this
year at Boston :—
  I.  That the objects contemplated  by  quarantine would  be more
effectually attained, and with less interference to commerce, individual
comfort, and personal liberty, were an international system established,
recognizing  more fully than  hitherto  the  importance  of  sanitary
arrangements on board ship and at  all ports, and  by giving efficiency
to this recognition by an adequate system of international laws, in-
spection, and local regulations.
  II.   That  the medical  and  other authorities at quarantine stations
should not only superintend the  quarantine of vessels as they arrive,
but also, with  such assistance as may  be suitable,  give advice  and
directions that may assist in securing proper sanitary arrangements  in
vessels loading for special ports, and in maintaining them in action
during the progress of the voyage.
  III.  That as modern science has developed numerous new resources
for  preventing and controlling disease, the  physician  in chief  at
quarantine, or other responsible medical  authority, should, under pre-
scribed regulations, have more power than is usually granted to him  to 
Quarantine  Regulations.
39
extend  or relax  the period or measures required for quarantine in
individual cases.
   IV.  That with the view of facilitating the labors of the medical
profession, and other  authorities,  in  directing measures  for the im-
provement of quarantine, all governments taking a practical interest in
this question shall be invited to concur in providing a series of colored
illustrations  with explanatory letter-press  in  the  English,  French,
Spanish, and German languages, presenting  such information  as to the
sanitary improvement of ships and  ports, as may assist in directing a
more extended attention to these questions among all parties interested
in them, including particularly the following subjects :—
   a.  The ventilation of ships.
   b.  The fumigation of ships.
   c.  The warming, drying, and cooling of ships and cargoes.
   d.  The best mode of destroying noxious refuse, or condemned goods,
          or clothing.
 .  e.  The construction of steam tugs, especially in crowded  seaports,
          having the means of placing the power of the whole or part
          of their  machinery on the ventilation, fumigation, warming,
          cooling, or drying of ships, cargoes, or special materials.
  /.  The introduction of similar  resources in  some ports by the aid
          of  engines, fixed ventilating shafts  or other machinery on
          shore, so that when a vessel is laid alongside  an appropriate
          quay by proper connections with  a  tabular channel in  the
          quay, more power may be brought to bear on.the ship, crew,
          and passengers, or cargo, in half an hour, than can be secured
          under ordinary circumstances by any  prolonged detention at
          quarantine without such  resources.
  g.  The construction of quarantine hospitals, with all the varied re-
          sources  that can now be advantageously applied  to them,
          whether afloat or on shore.
   V. That the Sanitary and  Quarantine Convention  recommend the
appointment of two or more members of the  medical  profession who
shall  have had practical experience  at a quarantine  station in  the
United  States to  communicate  with  the  Federal  Government  at
Washington on this subject, to urge its importance  as the deliberate
recommendation of the Convention, to suggest  the meeting of a cos-
mopolitan assembly on quarantine in some city in Europe or the United
States, to  which the  Federal Government shall be requested to send a
representative.
  VI. That inventors and  others  be  invited to transmit models and
drawings of all improvements for promoting health on board ship, in
quarantine hospitals, and at quarantine  stations, or on other matters
connected with quarantine to this assembly.
                                                  D. B. REID.
  Madison,  Wisconsin, May 5, 1860. 
 
 
miflji:-
III; 
pf
mm
National Quarantine and Sanitary Convention-
National Library of Medicine
Bethesda, Maryland
Condition on Receipt:  The volume was in an original
cloth binding which was broken in places; it had been
crudely repaired.  Most of the pages were discolored,
acidic,  weak and brittle.   A few pages had been
repaired with pressure-sensitive tape.
Treatment Report:  The pH was  recorded before and
after treatment: before 4.5, after 9.66.  The inks
were tested for solubility.  The head and tail were
dry cleaned and tha pages were nonaqueously buffered
(deacidlfied) with methoxy magnesium methyl carbonate 
I i  »i
1 -.■■ :Wrr ,, f(.jj: , ,
'■: ■  ■:V'r*>;-:.ii.i;:f||i,iR::i
 '  '•""'V -rt^'.. :• ' 'j'rl'-'' '"'! '■











■Atm
 ■ -«
li!:i.i:!ii{fi<i|i:'I!iiiljitf!,!:.'!i!!:|ii1
   It1'.  i! : =' '

iMImMW
m
n'ill;!1
•.7 .iFiM;?