A COMPARATIVE REVIEW 
OF 
QUARANTINE 
AND 
Maritime Sanitation. 
JL LETTER 
EXCERPTED FROM THE 
NEW ORLEANS MEDICAL AND SURGICAL JOURNAL FOR JUNE, 1885, 
PUBLISHED BY THE 
NEW ORLEANS MEDICAL PUBLISHING ASSOCIATION, 
L. Graham X Son, Printers, 99 & 101 Gravier St. 
1885. THE NEW 
Quarantine System. 
BY 
JOSEPH HOLT, NT. D., 
Pres't Pa. State Board of Health. 
Reprinted from the June No. of New Orleans Med. and Surg. Journal 
PUBLISHED BY 
THE NEW ORLEANS HED18AL PUBLISHING ASSOCIATION. 
L. Graham & Son, Printers, 99 & 101 Gravier. St., 
1885. May 2, 1885. 
Dr. Joseph Holt : 
Dear Sir-The editors of the New Orleans Medical and 
Surgical Journal would regard it as a very great favor if 
you would write them a short article setting forth the pecu- 
liar features and merits of the new system of quarantine, 
now being established for this port. 
The proposed plan, as it appears to us, not only in- 
volves health and commercial interests of the greatest 
magnitude, but offers an experimental test of certain un- 
settled questions concerning the appearance and move- 
ments of cholera, and particularly of yellow fever, of 
the highest practical value. 
It is essential that medical men should be especially 
well informed in a mattei* of so great consequence to 
themselves ascitizens, physicians, and as the exponents 
of preventive medicine, of which this may be cited as an 
example of the highest order. The subject, however, 
seems to be be very little understood by the profession 
of the city and State, and we know of no one who 
.could enlighten them so well as yourself. 
Hoping to hear from you at an early date, we are 
Very truly yours, 
Eds. N. O. Med. and Surg'l Journal. THE NEW QUARANTINE SYSTEM. 
A LETTER FROM DR. JOS. HOLT, PRESIDENT OF THE 
LOUISIANA STATE BOARD OF HEALTH. 
Editors N. O. fifed and Surg. Journal: 
Gentlemen-In reply to your kind invitation, I present 
the following explanation of the "new system of quaran- 
tine " now being inaugurated on the Mississippi, below 
New Orleans. 
It is impossible within the scope of this article to accom- 
plish more than a cursory review of the entire question of 
quarantine, showing briefly the necessities demanding the 
discontinuance of old methods and the substitution of new, 
distinctly formulated as a complete system. 
To prevent the spread of pestilence by cutting off com- 
munication with the infected is the instinctive first idea 
that has ever suggested itself as the most natural and 
(theoretically) effective. Its premises admit of such 
definite statement that the results seem logically inevitable. 
Unfortunately, after an experience beginning in the re- 
motest history of the human race, elaborated by every 
nation representing every phase of civilization, modified and 
enforced in every conceivable way, the hedging of pesti- 
lence by the instinctive method of non-intercourse has 
proven itself uniformly an experimental failure of the most 
disastrous kind. 
In exceptional instances, the cordon sanitaire or shot- 
gun quarantine, may have protected some isolated neigh- 
borhood, or even a town, but the testimony of centuries 
has confirmed the utter inadequacy of all such obstacles 
attempted against the onward march of epidemics. 
Not only have efforts of protection by detention in quar- 
antine or by absolute non-intercourse been a failure against 
epidemics, but in addition they have intensified the mis- 
chief through interference occasioned to commerce and 
the industries dependent upon it. As much as has been 4 
possible, they have assisted to insure famine as the con- 
comitant of pestilence. 
No casual observer can realize the amount of incon- 
venience, the deprivation, the actual suffering occasioned 
by these unwise measures of enforced idleness. While the 
capitalist suffers pecuniary loss, the laboring classes are 
made to feel the pinchings of poverty. 
The history of quarantine in Louisiana, extending over a 
period of sixty-four years, furnishes a singularly clear ex- 
hibition of the whole question. 
The first quarantine, established in 1821, was strictly 
primitive in being one of isolation from infected regions. 
Although it annihilated the most extensive branches of 
commercial interest, the people were willing to endure it 
as the only possible exemption from the terrors of yellow 
fever. 
The first year of its trial was marked by complete free- 
dom from the scourge. A proclamation of Thanksgiving 
and popular rejoicings, the winter following, emphasized 
the public satisfaction and confidence that in quarantine 
was discovered the solution of the yellow fever problem. 
The next summer seemed to confirm all of their hopes 
and ardent expectations, until about the middle of August, 
when a fearful epidemic broke out. 
Not despairing, they determined to do better the next 
year by enforcing their regulations to the extremest point. 
They did so, and again yellow fever prevailed epidemi- 
cally. 
Faith in quarantine was completely quenched, and the 
people, with one voice, demanded its abrogation upon the 
ground that it had failed utterly to keep out pestilence, but 
was destroying commerce. 
It was discontinued by legislative act in 1825. 
Re-established in 1855, it has continued to the present 
time, with a record of epidemics of cholera and yellow 
fever, time and again, during its maintenance. 
The complete failure of the experiment of exclusion by 
detention, compelled Boards of Health to invoke sanitation 
and disinfection as additional measures. 5 
This was a new idea engrafted upon the old, and des- 
tined to overshadow and supplaaaart' it entirely. 
In keeping with a universal law of creation and develop- 
ment, the first efforts of maritime sanitation were crude 
and feeble in the extreme. 
Had there been one particle of truth in the old system, 
this idea would never have been born ; but the utter falsity 
in practice of isolation alone as a protection against the 
spread of disease not only necessitated its existence, but 
urged its development, so that the " New Quarantine 
System" is simply an elaboration, through a regular pro- 
cess of development, out of all the struggles and the errors 
of the centuries behind us, looking to the consummation of 
one great purpose, the control by limitation of pestilence. 
Gathering the experience of all nations through all time, 
bending to its purposes the highest elucidations of modern 
science, putting into harness for practical use the startling 
discoveries of Pasteur, Koch, the Brazilian Commission 
under the auspices of the learned Emperor, now innocula- 
ting yellow fever virus cultivated specifically, Maritime 
sanitation, resting its faith upon the immutability of the 
laws of nature, and formulated as a defined and consist- 
ent system, offers itself, not as positive, but as affording 
the highest relative guarantee of protection. It does not 
say that yellow fever shall never again occur in. New Or- 
leans ; it simply furnishes the highest assurance within the 
scope of reason that it shall not enter by way of the Gulf 
through the Mississippi. It does not hold itself responsible 
for the possible introduction through other assailable 
avenues of entry, or the spontaneous or untraceable ap- 
pearance of the disease. Against the introduction of 
cholera it is even more positive. 
It stands upon the same plane of assuring security as 
that occupied by the Fire Department, the Levees, the 
criminal law with its machinery of courts, police, etc. 
It gives the highest relative but not an absolute guaran- 
tee against the importation of disease, and at the same time 
removes from commerce the fatal impediments of pro- 
tracted detention or actual interdiction. 6 
A quarantine of ten days as effectually destroys com- 
merce , eventually, as non-intercourse. 
The necessities of modern civilization are wholly in the 
direction of rapid transit. If a particular port does not 
choose to adapt itself to this higher law, it must endure the 
consequences in a complete transfer of its trade to ports 
in competition where wisdom and shrewdness combine for 
the preservation of the public interest. 
When New Orleans closes her gate-ways she starves her 
own children and feeds the hungry multitudes of New 
York and Baltimore. Can any but an enemy or a fool 
saturated with ignorance insist upon a continuance of such 
a monstrous course ? 
The history of the old system is one of continual disap- 
pointment and grossest absurdity. 
A detention of three days was extended to five, ten, 
twenty days, and finally the abandonment of faith in quar- 
antine altogether, and in its-steafl'a to non-intercourse, 
in violation of law, and submission to the abject instinct of 
fear. 
Forty days' quarantine is non-intercourse technically 
within the pale of law. 
So completely has a quarantine of detention betrayed 
every confidence, that it has become the rule, established 
by precedent, to begin the season with the milder term of 
ten days' detention, to be followed by non-intercourse upon 
the advent of the " danger f eriod" of summer. 
Under the blighting influence of such restrictions, our in- 
dustries have declined through a steady course of retro- 
gression until we have reached that extreme of abasement 
when a change of methods has become an imperative ques- 
tion of commercial salvation. 
The principal element of sanitation in the present or 
" Old System," consists in burning a few pots of sulphur 
in a ship's hold ; a process usually harmless to such germs 
as rats and roaches. 
So feeble and ridiculously inadequate are all the provis- 7 
ions for disinfection and general sanitation, that the officers 
in charge of the work, while faithfully performing their 
duties, are moved with pitiful contempt of such absurd 
measures ; and yet the " old system " is the one now en- 
forced, with slight modifications in different localities, in 
all the sea-ports of this Continent and of Europe. 
In our case, infected and healthy ships are crowded in 
the same station, and all alike have access to the inhabited 
shores. 
After nightfall there is nothing to prevent free traffic be- 
tween the ships and negroes and low whites who visit them 
to dispose of fresh vegetables, poultry, eggs, or whatever 
they may have to sell. 
In the case of a cholera-infected vessel, where would 
this people stand with such a quarantine? 
Its protective efficiency is exhibited in the following table 
compiled from the records in the office of the Board of 
Health, including fifteen of rigid enforcement. 
Years. (j 
* Cases. 
Deaths. 
i869 
9 
3 
1870 
587 
1871 
IT4 
54 
1872 
83 
39 
1873 
1288 
226 
i874 
20 
11 
i875 
IOO 
61 
1876 
83 
42 
1S77 
1 
1878 
4046 
i879 
48 
T9 
1880 
2 
1881 
• • • 
1882 
4 
1883 
I 
*1 
Total. ... 
5096 
*The death on the 7th of November, 1883, occurred after quarantine 
had ceased. 8 
Here is a failure twelve times out of a possible fifteen, 
with a final abandonment of quarantine for non-intercourse ; 
itself a most vulnerable barrier. While we were blockad- 
ing the mouth of the river, passengers with their full com- 
plement of baggage were arriving four or five days direct 
from Havana, and coffee twenty-five days from Rio, via 
New York and Baltimore, besides many other like 
evasions. 
A proclamation of non-intercourse is simply an incentive 
to evasion. 
The new system of "Maritime Sanitation" is 
founded squarely upon this proposition : 
If small-pox, cholera and yellow fever can be demon- 
strated to exist within a circumscribed and definite limit, 
as within the compass of a hypodermic syringe, on the point 
of a scalpel, or within the hull of a ship, and are 
capable of indefinite extension beyond that limit, it 
is conclusive that the essential cause, or virus, having 
powers of reproduction, is a living organism ; and, there- 
fore, being an entity definable in loco, it can be destroyed 
in loco. 
If an infected trunk or ship can be destroyed by fire, the 
virus within can likewise be destroyed. 
The same line of reasoning extends to other agents than 
fire. If every known organic form of life can be destroyed 
by boiling water and the laundry hot iron, by concentrated 
sulphurous acid fumes and a solution of the bi-chloride of 
mercury, the inference is inevitable that hypothetical or- 
ganic forms can likewise be destroyed. 
All the teachings of scientific experiment confirm the 
conclusion. 
Small-pox declared itself in nine distinct foci, during the 
past winter, in the most crowded parts of this city. Being 
treated with these agents of destruction applied with the 
extremest exaction .of scientific requirement, the disease 
did not spread beyond the room of the primary cases. In 
one instance a nurse was infected. 
The Board of Health has simply extended these mea- 
sures to its quarantine service. 9 
A few words will suffice to outline the methods of ap- 
plication. 
The new system contemplates the detention of a ship 
only so many hours as may be required to cleanse her by 
the aid of powerful appliances, as speedily as can be 
effected. 
The time will vary from ten hours to two or three days, 
according to size of vessel, nature of cargo, sanitary con- 
dition, and probability or not of special danger. 
In order to isolate vessels actually infected, that they 
may not spread contagion to other vessels or to the in- 
habited shore, a lower or supplemental quarantine station 
will be established in Pass-a-L'Outre, an unused outlet of 
the Mississippi. 
Withdrawn from the track of commerce, the sick will be 
cared for in hospital, the vessel subjected to thorough and 
repeated sanitation, and detained until, in the opinion of 
the Board of Health, she may be allowed to proceed to 
the city. 
Her case is exceptional, and must be dealt with excep- 
tionally. 
With such a station at this'time, we could regard, almost 
with indifference, the entry of a cholera-infected ship into 
the Mississippi. 
The upper or general station, twenty-eight miles nearer 
the city, is the one now in use. 
When a vessel arrives from a port against which 
quarantine precautions are required, she is brought along- 
side the wharf, where she finds every arrangement for the 
rapid discharging and reloading of cargo, if required. All 
on board, officers, crew and passengers, with their effects, 
are at once taken ashore, where, in a room provided, 
everything they carry, apparel and baggage, is subjected 
to powerful disinfection. 
All clothing and articles that will admit of it will be 
laundried, and in this process subjected to boiling water 
and the hot iron. The clothing worn is presently ex- 
changed for other already treated, and this, in turn, disin- 
fected. 10 
The passengers and crew will be received in commodious 
quarters, comfortably prepared for them, there to undergo 
the prescribed detention for observation determined ac- 
cording to circumstances of the possibility of their being 
infected with the disease in its incubatory stage. 
If one should fall ill, he is at once removed to a properly 
isolated hospital, distantly located 
The period of observation concluded, without evidences 
of infection, these people will be returned aboard their 
ship which, during their absence, has been cleansed and 
disinfected in every part. 
A strict surveillance will be continued over all shipping 
in port. 
The first division of the new system provides for the 
supplemental station for infected vessels only. The second, 
for the management of persons arriving at the upper or re- 
gular station. These having been described, there re- 
mains to be considered the third, for the sanitary treat- 
ment of cargo and ship. 
A detailed account of this process is unnecessary here. 
It is sufficient to mention that its speedy and effective ac- 
complishment is assured in the employment of a full corps 
of acclimated stevadores, a powerful tug-boat provided with 
flushing hose, steam siphon, abattery of twelve furnances for 
the energetic evolvement of germicidal gases (we will use 
sulphurous acid gas), driven into the ship's hold by a pow- 
erful fan at the rate of sixtejpfr thousand cubic feet per 
minute. 
In this manner, after thorough washing, the gas in im- 
mense volume and with tremendous force is driven into the 
limbers and air-strakes, into every crevice and part of that 
ship until she is completely filled. We go through her with 
an atmosphere, as it were, of fire. 
In doing this we displace the mephitic and dangerous at- 
mosphere closedin her when she started from Rio, we will 
suppose, and which, if allowed, would have been set free 
at our levee-the infected atmosphere of Rio to commingle 11 
with the atmosphere of New Orleans, deadly ripe, perhaps, 
for its reception. 
We have displaced this not only with a non-infected at- 
mosphere, but with one intensely germicidal-one that de- 
stroys organic elements in the air, or on exposed surfaces, 
with instant greediness. 
The decks, ballast and all such parts as are usually 
treated with carbolic acid or other disinfectant fluids, 
objectionable on account of odor, staining or inefficiency, 
will be subjected to the action of an odorless, colorless solu- 
tion of the bi-chloride of mercury, the most powerful and 
unsparing germicidal agent known. 
This was adopted for the first time in quarantine service 
last summer, in the stations of this State, and has since 
been introduced into other important stations of this 
country. 
There is no danger to be apprehended, except from 
drinking the solution, which is true of every other agent 
used. 
Its cost is about eighty per cent, cheaper than crude car- 
bolic acid. 
Our standard solution is six ounces, with a like quantity 
of muriate of ammonia, dissolved in a half gallon of water, 
and added to forty gallons of the latter. Salt water is also 
a solvent. 
After a few hours the hatches are removed and pure air 
is driven in to facilatate clearing the ship of fumes. She 
is reloaded, her freight perhaps already sent by barge, she 
proceeds at once to the city, there to be discharged only 
by an acclimated gang. Her export freights must be ready. 
She is at once reloaded and starts on her voyage. 
This general plan, with its specifications, as exhibited, 
constitutes the new system of quarantine. Having once 
been enforced, we may boldly proclaim that, for the first 
time in the history of quarantine, a ship has been actually 
cleansed, disinfected, purged of suspicion, by appliances 
adequate to the work. 12 
Against such a vessel there remains no cause of accusa- 
tion. Let her go free, and land her boldly along these 
wharves ! 
CLASSIFICATION OF VESSELS ARRIVING IN THE MISSISSIPPI 
RIVER. 
1. Vessels from non-infected ports. 
2. Vessels arriving from suspected ports. 
3. Vessels arriving from infected ports. 
4. Vessels which, without regard to the port of depart- 
ure, are infected. That is to say, vessels which have yel- 
low fever or other infectious or contagious diseases on 
board at the time of arrival, or have had the same during 
the voyage. 
Vessels of the first class to be submitted to thorough ma- 
ritime sanitation at the upper quarantine station, without 
detention of either vessels or persons more than is neces- 
sary to place the vessel in a perfect sanitary condition if 
demanded. 
Vessels of the second class to undergo the same condi- 
tions, with detention for observation of persons for a 
period of five full days from the hour of departure from 
suspected port. 
Vessels of the third class must undergo the same condi- 
tions with the detention of persons for a period of seven 
full days from the hour of departure from infected port. 
Vessels of the fourth class to be remanded to the lower 
Quarantine Station, there to undergo thorough sanitation 
and detention of vessel and persons such length of time as 
the Board of Health may order. 
Begging your indulgence for the unaviodable length of 
this communication, 
I remain, gentlemen, with great respect, 
Yours very truly, 
Joseph Holt, M. D.,. 
President Board of Health, State of Louisiana,