THE PROCEEDINGS 
OF THE 
QUARANTINE CONFERENCE 
U« 
HELD IN MONTGOMERY, ALA., ' * 
On the 5th, 6th, and 7th days of March, 1889. 
The Brown Printing Company, Montgomery, Ala. PREFACE. 
By way of preface to the Proceedings of the Montgomery 
Quarantine Conference herewith published, I desire to say that 
I have printed said Proceedings just as they came to me, from 
the Editing Committee. It is, however, proper for me to 
state that the discussions given in the text have been clipped 
from the reports of the daily papers. While they are approxi- 
mately correct, they are not usually adequate reproductions of 
the remarks that were actually made by the several speakers. 
The subjoined circular letter explains, perhaps, at sufficient 
length, how and under what circumstances the Conference had 
its origin. 
Jerome Cochran, M. D., 
State Health Officer. 
Montgomery, April 10th, 1889. 
QUARANTINE CONFERENCE. 
CIRCULAR LETTER. 
This Circular Letter is specially addressed to the health authorities 
of the several States most directly interested in the protection of the 
South against invasions of yellow fever. Copies of it will also be sent 
to the Governors of the several States referred to, and to the Mayors of 
some of the more important cities for their information, and with a view 
of enlisting intelligent interest in the undertaking herein explained. 
Under a joint resolution of our General Assembly, the Governor of 
the State of Alabama has issued to the Governors of the States of Texas, 
Florida, Louisiana, Mississippi, South Carolina, North Carolina, Geor- 
gia, Tennessee, Kentucky, and Illinois, invitations to appoint delegates 
to a Quarantine Conference to be held in the city of Montgomery, be- 
ginning on Tuesday the 5th of March, next, and to continue for such 
number of days as the business in hand may render necessary. 4 
About two weeks ago Dr. C. P. Wilkinson, President of the Board of 
Health of the State of Louisiana, addressed a Circular Letter to the 
health authorities of these same States, suggesting a similar conference 
to be held in the city of Jacksonville, Florida. I have been in corres- 
pondence with Dr. Wilkinson, and the assemblage of the proposed 
Conference in Montgomery meets with his approval. 
The object of the Conference cannot he easily overrated. It is to 
formulate in a way that will command the confidence of the general 
public and of the civil and sanitary authorities of the States concerned, 
and in the light of our latest experience and information, the princi- 
ples and regulations which should govern our Southern Quarantines, 
and at the same time to arrange such plans for harmony and concert 
of action as may seem praticable and desirable. 
It is earnestly desired that all of the States included in the invita- 
tion shall he represented in the Conference by full delegations of such 
of their citizens as are best fitted to discuss the theoretical and practi- 
cal problems involved in the rational administration of quarantine in 
the South. The occasion ought to be made a very memorable one. 
The Conference proper will be composed exclusively of the duly 
accredited delegates of the States; but other persons interested in 
quarantine matters will be heartily welcomed to seats on the floor, and 
to take such part in the discussions as under the circumstances may 
seem expedient. 
To facilitate the wrork of the Conference, experts believed to be 
specially qualified, will be requested to formulate in advance for dis- 
cussion, a series of propositions covering the subjects of maritime 
quarantine, railroad quarantine, municipal quarantine, depopulation of 
infected towns, refugee camps, panics, stampedes, disinfection, health 
certificates, etc. 
We desire the assistance and co-operation of all who have had ex- 
perience in the management of quarantines, and of all who have studied 
the progress of epidemics of yellow fever. Suggestions through the 
mails will be thankfully received. 
All persons receiving this Circular Letter will confer a favor by 
acknowledging its reception, and notifying us what themselves and 
the communities they represent can be depended on to contribute to 
the success of the Conference. 
Address all communications to 
JEROME COCHRAN, M. D., 
State Health Officer. 
Montgomery, Ala., January 10th, 1889. PROCEEDINGS OF THE QUARANTINE CON- 
FERENCE HELD IN THE CITY OF 
MONTGOMERY, ALABAMA, 
March 5th, 6th and 7th, 1889. 
The Quarantine Conference met in the hall of the house of 
representatives at the capitol at 10 o’clock a. m., March 
5th, 1889. 
The Conference was called to order by Dr. Jerome Cochran, 
State Health Officer of Alabama, and the meeting opened with 
prayer by Rev. J. L. Thompson, of the Adams Street Baptist 
Church, Montgomery. 
Dr. Cochran addressed the Conference briefly, stating that 
he had expected Governor Seay to be present and deliver an 
address of welcome. lie had been informed that the governor 
was unwell and not able to be present. Dr. Cochran assured 
the delegates that Montgomery was glad to have them in her 
borders, and that they would meet a warm and generous wel- 
come among her people. He stated that the work to be done 
by the Conference would be of great importance to all the 
southern states. He wanted the Conference to cover the 
ground and complete the discussion whether it took three days 
or a week. 
Dr. Cochran then nominated Dr. John II. Rauch, of Illinois, 
for temporary president of the Conference, and Dr. E. J. 
Conyngton, of Decatur, Alabama, for temporary secretary. 
He put the motion and they were unanimously chosen as tem- 
porary officers. 
On taking the chair Dr. Rauch stated that the Conference 
was ready for business, and inquired the will of the body. 
Dr. P. Thompson, of Kentucky, moved that a committee of 
five (5) be appointed on permanent organization. The motion 
prevailed, and the committee was appointed by the chair as 
follows, viz: 6 
Dr. P. Thompson, of Kentucky, Dr. R. P. Daniel, of Florida, 
Dr. Thos. F. Wood, of North Carolina, Dr. J. D. Plunket, of 
Tennessee, and Dr. Jerome Cochran, of Alabama. 
Upon motion of Dr. Cochran, the Conference took a recess 
until 11 o’clock to enable the committee to fermulate their 
report. 
At 11 o’clock the Conference was called to order by Dr. 
Rauch, and heard the following report from the committee on 
permanent organization : 
MINUTES OF COMMITTEE ON PERMANENT ORGANIZATION. 
Your committee beg leave to report the following gentlemen 
as accredited delegates to the Southern Quarantine Conference, 
viz: 
Roll of Delegates of the Southern Quarantine Conference 
held in the city of Montgomery, Alabama, on the 
5th and 6th, and 7th of March, 1889 : 
Alabama :— 
Mr. Theodore Welch, general transportation agent, L. & N. 
R. R., Montgomery. 
Mr. B. C. Epperson, superintendent M. & M. R. R., 
Montgomery. 
Col. W. S. Reese, mayor, Montgomery. 
Dr. Jerome Cochran, Montgomery. 
Dr. S. D. Seelye, member state board of health, Mont- 
gomery. 
Dr. J. S. Weatherly, member state board of health, Mont- 
gomery. 
Dr. T. A. Means, secretary state board of health, Mont- 
gomery. 
Col. J. C. Clarke, Mobile, vice-president M. & O. R. R. 
Dr. C. II .Franklin, member state board of health, Union 
Springs. 
Dr. W. II. II. Hutton U. S. M. II. S., Mobile. 
Dr. John B. Ham n, (J, S. M. II. S., Surgeon General Ma- 
rine Hospital Service. 7 
Florida :— 
Dr. Richard P. Daniel, Jacksonville, 
Dr. J. T. Porter, Key West. 
Dr. J. D. Palmer, Fernandina. 
Dr. J. P. Wall, Tampa. 
Dr. W. H. Ross, Pensacola. 
Dr. T. J. Williamson. 
Mr. Joseph Voyle, Gainesville. 
Mr. J. E. Ingraham, Sanford. 
Mr. Win. B. Henderson, Tampa. 
Mr. W. K. Hyer, Pensacola. 
Georgia :— 
Dr. J. B. S. Holmes, Rome. 
Dr. S. C. Benedict, Athens. 
Dr. James B. Baird, Atlanta. 
Dr. W. D. Bizzell, Atlanta. 
Dr. J. McF. Gaston, Atlanta. 
Dr. E. Burkley, Atlanta. 
Dr. J. A. Dunwoody, Brunswick. 
Dr. W. B. Burroughs, Brunswick. 
Dr. Eugene Foster, Augusta. 
Dr. J. C, L. Hardy, Savannah. 
Dr. E. G. Ferguson, Macon. 
Mr. E. T. Charlton, Savannah, 
Illinois :— 
Dr. John H. Rauch, secretary state board of health. 
Dr. B. F. Griffith. 
Dr. R. E. Starkweather. 
Kentucky :— 
Dr. J. H. McCormick, secretary state board of health. 
Dr. P. Thompson, president state board of health. 
Dr. Wm. Bailey, member state board of health. 
Dr. J. 0. McReynolds, 8 
Louisana :— 
Mr. B. R. Freeman, New Orleans. 
Dr. J. W. Dupree, Baton Rouge. 
Dr. C. M. Smith, Franklin. 
Dr. Robert Layton, Monroe. 
Dr. W. G. Austin, New Orleans. 
Dr. Clement P. Wilkinson, president state board of health. 
North Carolina :— 
Dr. Thomas F. Wood, secretary state board of health, Wil- 
mington. 
Dr. R. F. Gray, Winston. 
Dr. T. A. Allen, Hendersonville. 
Dr. Joseph F. Harrell, Whiteville. 
Mr. J. L. Ludlow, C. E., member state board of health, 
Winston. 
Mr. Joseph E. Robinson, Goldsboro. 
Mr. James Norfleet, Henderson. 
Mississippi :— 
Dr. J. M. Taylor, Corinth. 
Dr. R. S. Toombs, Greenville. 
Dr. G. W. Trimble, Grenada. 
Dr. W. F. Hyer, Meridian. 
Dr. O. R. Early, Columbus. 
South Carolina:— 
Dr. T. Grange Simons, Charleston. 
Dr. H. B. Horlbeck. 
Tennessee :— 
Dr. J. D. Plunket, president state board of health. 
Dr. G. B. Thornton, Memphis. 
Dr. John E. Black, president Memphis board of health. 
Hon. R. P. Hadden, Memphis. 9 
Texas :— 
Dr. Robert Rutherford, state health officer. 
Dr. L. A. Pires. 
Visiting Guests. 
Dr. Victor M. Vaughn, Michigan. 
Dr. George M. Sternberg, U. S. A., Baltimore, Maryland. 
Dr. D. M. Burgess, U. S. sanitary inspector, Havana. 
Dr. T. C. VanBibber, Baltimore, Maryland. 
We also beg leave to report the following recommendation 
for permanent officers: 
For President—Dr. C. P. Wilkinson, Louisana. 
For Vice-Presidents—Hon. David P. Haddon, Tennessee, 
Dr. T. Grange Simons, South Carolina, Mr. E. Berkeley, 
Georgia, Dr. William Bailey, Kentucky, Mr. J. C. Clark, 
Alabama, Dr. Robert Rutherford, Texas, Dr. J. Y. Porter, 
Florida, Dr. R. F. Gray, North Carolina, Dr. B. M. Griffith, 
Illinois, Dr. J. M. Taylor, Mississippi. 
Secretaries—Dr. J. N. McCormack, Kentucky, Mr. J. L. 
Ludlow, C. E., North Carolina, Dr. J. B. Baird, Georgia. 
RULES OF ORDER. 
1. Each state shall be allowed ten votes, whenever a divis- 
ion is asked on any pending motion, said votes to be divided ac- 
cording to the pleasure of the delegation, and to be announced 
by the chairman of the delegation. 
2. Where no division is asked for the votes shall be by 
ayes and noes. 
3. In all discussions each speaker shall be limited to ten 
minutes. 
We recommend that all visiting gentlemen who do not come 
accredited by certificates of delegation from Governors of their 
states, but who are specially interested in the purposes of the 
call of this Conference, be invited to participate in all the privi- 
leges of this body, except that of voting. 10 
Order of Discussion of Subjects : 
Maritime Quarantine. 
The papers of Dr. D. N. Burgess, U. S. Sanitary Inspector 
at Havana. 
And Dr. Wilkinson, President Louisiana Board of Health. 
Inland Quarantine. 
Rail Road Quarantine. 
Local Management of Epidemics. 
The report of the committee was unanimously adopted. 
On motion, a committee of two was appointed to conduct 
Dr. Wilkinson, the permanent President, to the chair. On 
taking the chair Dr. Wilkinson expressed sincere thanks to the 
Conference for the honor conferred in making him President, 
which he took as a compliment to the State Board of Health 
of Louisiana, rather than a personal honor. His thanks were 
tendered in behalf of his colleagues, who were marching hand 
in hand with the gentlemen who composed the Conference, for 
the cause of quarantine and sanitary improvement. 
On motion of Dr. Cochran, Gov. Seay, who had arrived and 
was present in the hall, was invited to address the Conference. 
The Governor was escorted to the Speaker’s stand and spoke 
as follows : 
THE GOVERNOR’S SPEECH. 
Mr. President and Gentlemen of the Convention : 
It would be an intrusion on your consecrated time to offer more than 
a few words of welcome. 
You are here formally in answer to an invitation of the authorities 
of this State, but really in response to the profound invocation of hu- 
manity. 
Pestilence has always been the great enemy of mankind, and the 
most favored nations have not been exempt from its havoc. Science 
and government have done much, very much, to diminish its ravages, 
and I do not doubt that they will yet be sufficient to destroy it alto- 
gether. The last great enemy is death, and if it shall come under the 
foot of man, the honor will lie at the feet of science. 11 
Again, gentlemen, I acknowledge my own pleasure in welcoming you 
to this place and invoking success on your councils. 
Dr. T. Grange Simons was called to the chair, and Dr. L. P. 
Wilkinson, the President, read the following paper on “Mari- 
time Quarantine Services of the Southern Sea Ports.” [See 
Appendix II.] 
Upon motion, the paper of Dr. Wilkinson was received by 
the Conference, to be referred to an appropriate committee to 
be appointed. 
Upon motion of Mr. B. R. Foreman, the Chair appointed a 
Committee on Business, consisting of one member from each 
state represented and one each from the U. S. A. and the U. 
S. M. H. S., to whom all papers, propositions and resolutions 
shall be presented, and who shall prepare a program of order 
of business. 
The committee was named by the Chair as follows, viz: 
Alabama Dr. Jerome Cochran, 
Florida Dr. R. P. Daniel, 
Georgia Dr. W. D. Bizzell, 
Kentucky Dr. J. D. McReynolds, 
Louisiana Dr. J. W. DuPoe, 
Mississippi. .......Dr. R. S. Toombs, 
North Carolina. .. .Dr. Thos. F. Wood, 
South Carolina Dr. T. Grange Simons, 
Tennessee Dr. J. D. Plunkett, 
Texas Dr. R. Rutherford, 
U. S. A Dr. G. M. Sternberg, 
U. S. M. H. S Surg. Gen. J. B. Hamilton. 
Illinois 
Note.—After one meeting of this committee, Dr. Cochran declined to 
serve on it any longer; and his place was taken by Dr. M. C. Baldridge, 
President of the Alabama State Board of Health. 
Adjourned. 12 
AFTERNOON SESSION. FIRST DAY. 
Called to order by President Wilkinson at 3 p. m. Report 
of Committee on Business was presented by Dr. Thomas F. 
Wood of N. C., as follows: 
COMMITTEE ON BUSINESS 
beg leave to submit the following: 
Hours of meeting from 10 to 1.30 a. m. ; 3.30 to 6 f. m. ; 
8 to 10 p. m. 
Order of Business. 
1. Reading Minutes. 
2. Reports of Committees. 
3. Reading of Papers. 
4. Discussion of Papers. 
5. Unfinished Business. 
The following papers ordered for Afternoon Session, 5th 
March: 
Paper by Mr. J. C. Clarke, Y. P. M. & O. R. R., on “Rail- 
way Quarantine.” 
One by Dr. YanBibber, on “Quarantine of the Future.” 
One by Mr. Yoyle, on the “Epidemic of Yellow Fever in 
Gainesville, Fla., and the Deducions therefrom. 
The report was adopted. 
Dr. G. B. Thornton of Tenn. read the following paper, by 
Col. J. C. Clarke of the Mobile & Ohio R. R., on Rail Road 
Quarantine. [For paper, see Appendix III.] 
By motion, the paper was received and referred to a Com- 
mittee on Quarantine to be provided. 
Upon motion of Dr. Eugene Foster (Ga.), a committee was 
appointed by the Chair, consisting of one delegate from each 
of the States represented, and the U. S. M. II. S., to whom all 
papers relating to Quarantine and all propositions relating 
thereto, should be referred. 13 
Committee named by the Chair as follows, viz: 
Alabama Dr. E. J. Conyngton, 
Florida Dr. J. P. Wall, 
Georgia Dr. Eugene Foster, 
Illinois Dr. B. M. Griffith, 
Kentucky Dr. P. Thompson, 
Louisiana Dr. C. M. Smith, 
Maryland Dr. W. C. Yan Bibber, 
Mississippi Dr. W. F. Ilyer, 
North Carolina Dr. Thomas F. Wood, 
South Carolina Dr. H. B. Horlbeck, 
Tennessee Dr. G. B. Thornton, 
Texas Dr. L. A. Pires, 
U. S. M. II. S Dr. W. H. H. Hutton. 
The next business of the Conference was the reading of the 
paper by Mr. Joseph Yoyle of Fla., on the “Epidemic of Yel- 
low Fever at Gainesville, Fla., and the Deductions therefrom.” 
[For paper, see Appendix IY.] 
Conference adjourned. 
NIGHT SESSION. FITtST DAY. 
Called to order by President Wilkinson at 8.30 p. m. The 
Committee on Business presented its report by a series of topics 
for discussion. 
Upon motion of Dr. Wood (N. C.), the topics were read and 
discussed singly. 
Topic I. What form of notification shall be adopted in case 
of occurrence of yellow fever? To whom shall the first noti- 
fication be sent ? 
Dr. Thompson said that a conference which met at Memphis 
in 1878 formulated a set of rules which ought to be adopted 
all around. By this set of rules it was the duty of every health 14 
officer to notify the State health officer and the local officers. 
He thought that when a case of fever appeared at any one 
place, every place in the State or in the section ought to know 
it as quick as lightning. 
Hr. McCormack of Kentucky explained that at a quarantine 
conference held at Toronto some time ago, the health officers 
of all the State health boards in the Union had agreed to a 
blank form of notification to be sent to every other health offi- 
cer, and he knew of no single instance where the pledge or 
agreement had been violated. The pledges extended to small- 
pox and every contagious or infectious disease. 
Hr. Wilkinson said the question of notifying health boards 
was a serious question, and one that ought not to create unnec- 
essary alarm. lie was opposed to notifying anybody except 
officers of the health boards of occurrence of a case or suspi- 
cious case of any disease included in the resolution. 
Hr. Simons thought the United States Marine Hospital Ser- 
vice ought to be included in the resolution, and made a motion 
to that effect. 
The resolution was carried.* 
Hr. Thornton—A number of members of boards of health 
now here are already pledged, in honor bound, by the rules 
of quarantine conferences of 1879 and 1884, to notify each 
other whenever a case, not only of yellow fever, but even a 
suspicious case occurs. He thought every health officer in 
this country and in Canada should be officially notified, for it 
was an international affair. Hr. Holt, of New Orleans, and 
Hr. Wirt Johnson, of Mississippi, had both given notice offi- 
cially whenever cases of fever or suspicious cases had appeared 
in their fields and come to their notice. He thought notice, 
official notice of occurrence of cases or suspicious cases, ought 
to be sent to everybody interested. The question arose as to 
whether the notification ought to be sent by open or cipher 
telegram, and he was of the opinion that open telegrams ought 
to be sent. 
Upon motion of Hr. Cochran, the following was adopted 
as the sense of Conference in answer to Topic I: 
*No resolution in copy. 15 
Resolved, That this Convention urges upon all health au- 
thorities of States represented in it the importance of strict com- 
pliance with the agreement of inter-state notification adopted 
by the National Conference of State Boards of Health, and 
the Sanitary Council of the Mississippi Valley, in regard to 
all communicable diseases, and especially in regard to yellow 
fever. 
Topic 2. Under what circumstances should an epidemic be 
declared to exist ? 
Dr. Thompson said that the question had been asked many 
a time, and no satisfactory answer had ever been given. The 
universally adopted thought was that when a number of deaths 
occurred in any town from one disease, or a large number had 
been taken sick, that was an epidemic. 
Dr. Thornton stated that he once had an qccasion to decide 
this question of when an epidemic existed. During the sum- 
mer of 1878, when the fever appeared in Memphis, there was 
a considerable number of cases before he was inclined to 
believe it was epidemic. He had never officially announced to 
the world that yellow fever was epidemic until deaths from 
that disease were more than from all other diseases. 
The question was, on motion of Dr. Rauch, laid on the 
table. 
Topic 3. Should we advise the depopulation of any place 
on the appearance of yellow fever, and if so, how soon % 
Dr. Thornton was opposed to depopulation. 
Dr. Cochran would not advise depopulation on the occur- 
rence of one case or even of a dozen cases. If a case appeared 
in a portion of a town he would advise the depopulation of the 
adjacent houses and districts, but he was opposed to depopu- 
lating whole towns and cities, for such a course resulted in 
panic and stampedes and this Conference ought to rebuke this 
course severely. When the yellow fever overstepped all 
bounds it would be time to talk of depopulating towns, but 16 
he believed the fever could be kept in bounds and had no 
business ever getting out. 
Dr. Wood thought the Conference ought to say distinctly 
when it was advisable for depopulation to commence. He 
had no idea but that every physician in the Conference would 
advise some patients to get out in time of yellow fever. 
Dr. Hyer said that there need be no trouble about advising 
a man to get out of town in time of yellow fever, for when 
you went to tell him he wouldn’t be there unless all the wagons 
had gone before. The trouble was in getting people to stay. 
Dr. Cochran said this thing of depopulating whole towns 
when a few cases appeared, brought great mischief. He be- 
lieved the time was coming when yellow fever would be so 
completely under the control of physicians that when a special 
house or district was infected the people would not rebel. 
Dr. Thornton moved to refer the question of depopulation 
to the people of the towns interested. 
Mr. Yoyle said depopulation had bankrupted Gainesville, 
Fla. The people ought to be educated to take care of 
themselves, until this question could be settled. He described 
all the terrors that existed there during the epidemic of last 
summer. 
Dr. Sternberg said depopulation was one thing and a 
stampede was another. The first thing to be done in an in- 
fected locality was to remove wrell people from infected dis- 
tricts so as to keep them from exposure. He thought the 
Conference ought to adopt a resolution that depopulation of 
infected areas by health officers was an important step in check- 
ing the progress of the disease and made a motion to that 
effect. 
Dr. Hamilton seconded Dr. Sternberg’s motion, and gave 
the history of several cases of yellow fever cases in Baltimore 
in 1886, wrhen the whole city was spared an epidemic by the 
depopulation of a block. 
Dr. Cochran said that the Conference was disposing of a 
very important question in a short time. The following 
propositions covered the question : 17 
(1) In the beginning of an outbreak of yellow fever there is no need 
of depopulation at all except of infected houses or infected districts; 
hut if people who are able to afford the expense desire to leave they 
should do so quietly and deliberately, and no obstacles should be placed 
in their way; and those who leave healthy districts of the city or town 
should go wherever they please without let or hindrance. 
(2) Persons living in infected houses or in infected districts, should 
be encouraged to leave, but should be allowed to leave only under such 
restrictions as will afford reasonable guarantee of safety to the communi- 
ties in which they find asylum; and they should be sent only to such 
communities as are willing to receive them. 
(3) In the depopulation of infected houses or of special infected dis- 
tricts the inhabitants should be removed into camps of probation, or 
into vacant houses in the adjacent country. After five days detention 
if they remain Well, and under proper regulations, such as disinfection 
of baggage, they should be considered free from danger, and allowed 
to go freely into any community willing to receive them. 
(4) The depopulation of large cities is altogether impracticable. The 
depopulation of sparsely settled towns and villages is altogether unnec- 
essary, as in them it is always possible to prevent any general spread 
of the fever. *. 
(5) Refuge camps, that is to say camps for the continued residence 
of people during the prevalence of epidemics, have heretofore been of 
very small value. One reason for this is, that it is never possible to 
induce any considerable proportion of the population of an infected 
city to take refuge in the camps. Camps of probation for temporary 
detention, may often be very useful. 
(6) Panics and stampedes are always without excuse and at the same 
time excessively mischievous. At the beginning yellow fever always 
spreads slowly, and there is always time for everybody who desires to 
leave an infected place to do so without hurry and under proper regula- 
tions. 
Dr. Weatherly thought Dr. Cochran was eminently right. 
Dr. Thompson said that Dr. Sternberg’s resolution was a 
very good thing in theory, and was doubtless drawn under the 
impression that the health officers had powers to depopulate 
towns. If there was a place in the country where such power 
existed he had never heard of it. There was no power on 
earth to make a man get out of his own house when he did 
not want to. You could make him stay in, but when it came 
to making him get out that was a different thing. 18 
Dr. Seelye said the resolutions would be interpreted by 
health boards very indefinitely, and offered as a supplement to 
Dr. Sternberg’s resolution the first three propositions submitted 
by Dr. Cochran. 
Dr. Sternberg accepted the suggestion of Dr. Seelye as a 
substitute for his motion. 
Dr. Bailey thought the putting of people in camps of de- 
tention and keeping them there five days was unwise. Com- 
ing from a section that had shown it was anxious to welcome 
refugees he would much rather have refugees who stood not 
on the order of their going. lie thought depopulation in 
cases of yellow fever was wise and practicable. Yellow fever 
was the best thing in the world to run from. 
Dr. Cochran did not think any prudent people would care 
to have people taken out of infected houses or squares amongst 
them. As to refugee camps, people generally would not go to 
tham, never had gone to them and could never be expected to 
go to them. 
Dr. Ilorlbeck thought the time of probation ought to be ten 
instead of five, and a motion was made to that effect. Carried. 
Dr. Rutherford said he could not leave the time of proba- 
tion five days; he could not go back to Texas if he voted for 
that proposition. 
Dr. Cochran said we were not here to represent the views of 
our constituents like members of a legislature; our mission 
here was to give the people the benefits of scientific researches 
which would control legislation and public opinion. 
The following resolutions offered by Dr. Seelye were then 
adopted as the sense of the Conference as the answer to 
Topic 3 : 
Resolved,• In the beginning of an outbreak of yellow fever 
there is no need of depopulation at all, except of mfected houses, 
or infected districts', but if people who are able to afford the ex- 
pense desire to leave they should do so quietly and deliberately, 
and no obstacles should be placed in their way ; and those who 
leave healthy districts of the city or town should go wherever 
they please, without let or hindrance. 19 
if) Persons living in infected houses, or in infected districts 
should be encouraged to leave, but shoidd be allowed to leave 
only under such restrictions as will afford reasonable guaran- 
tees of safety to the communities in which they find asylum y 
and they should be sent only to such communities as are willing 
to receive them. 
(3) In the depopulation of infected houses or of special in- 
fected districts, the inhabitants shoidd be removed into camps 
of probation, or into vacant houses in the adjacent country. 
After ten days detention, if they remain well, and under proper 
regidations, such as disinfection of baggage, they should be con- 
sidered free from danger, and allowed to go f reely into any 
community willing to receive them. 
Conference adjourned. 
MORNING SESSION—SECOND DAY. 
Called to order by President Wilkinson at 10 a. m. The 
committee on quarantine presented its report through its chair- 
man, Dr. Eugene Foster, of Georgia. 
Upon motion, the report was read and discussed, section by 
section, as follows : 
Your committee respectfully report the following in rela- 
tion to the paper of Mr. Clark : 
That section I should read— 
There should be uniform rules adopted for the management of quar- 
antines as far.as practical, but no freight shall be received from an in- 
fected place, though freight and passengers should be allowed to pass 
through an infected place without stopping. 
Upon motion of Dr. Cochran, the following resolutions 
were adopted as the sense of the Conference in lieu of Section 
(1) above: 
Resolved, During the prevalence of yellow fever epidemics, 
passengers and freights should be brought from infected local- 20 
ities only under such regulations and restrictions as may be 
established by the state health authorities along the lines of 
the roads concerned. 
(2) The regulations and restrictions governing railroad 
transportation du ring yellow fever epidemics should be of such 
a character as to afford all reasonable guaran tees of protection 
to the communities in danger of invasion by the disease, but 
should not be more onerous than the circumstances warrant, 
and should be framed with due consideration of the extent and 
character of the danger in each particular case, and as affected 
by latitude and seasons of the year, and other qualifying con- 
ditions. 
(3) At all seasons of the year, and under all circumstances, 
the simple passage of railroad trains should be allowed, with- 
out obstruction, even when carrying sick refugees from in- 
fected places to healthy loccdities willing to receive them. 
Sec. 2. A well digested quarantine formula, making and 
promulgating the necessary rules and regulations for enforc- 
ing the same, should be prepared, ready to be put in force 
when necessary to do so, at all points where it is necessary to 
put quarantine in force. These rules should be published for 
general information, to enable all persons to comply with the 
same, and displayed by placard in every depot. 
Upon motion, Section (2) was adopted as the sense of the 
Conference. 
Sec. 3. At quarantine stations accommodations should 
be provided for caring for such persons, if any, as may be 
detained or are not permitted to pass through such stations, 
ivhile in transit, until they can be disposed of. 
Upon motion, Section (3) was adopted as the sense of the 
Conference. 21 
Sec. 4. Only competent physicians, tvho have had experi- 
ence with contagious and infectious diseases, should he made 
inspectors at quarantine stations, ivhose duty it shall he to 
inspect and examine the condition of passengers, baggage and 
express matter. All inspectors should have the poiver to ad- 
minister oaths, and to remove from the trains, and detain at 
quarantine stations such passengers, baggage or express mat- 
ter, &c., as may he found necesssary to prevent the introduc- 
tion or spread of infectious or contagious diseases of any 
hind. 
Upon motion, Section (4) was adopted as the sense of the 
Conference. 
Sec. 5. Tiiis committee recommend that section 5 be not 
adopted. 
Upon motion, Section (5) above of committee report was re- 
jected, and the Conference adopted Section (5) of Mr. Clark’s 
paper, as follows: 
5. State hoards of health should he the powers authorized to 
put quarantine in force. They should determine when, where 
and for what length of time quarantines should he maintained; 
provide the means necessary for enforcing the same, and pro 
mulgate rules and regulations for conducting quarantines. 
Presidents and secretaries of state hoards should he required 
to visit and inspect all quarantine stations, as often as practi- 
cable, during the existence of such quarantines,; and to make 
public, over their signatures and official positions, the general 
condition of the public health at the points where quarantines 
are established, and the localities affected by such quarantines. 
Local health officers, municipal or county authorities, may es- 
tablish quarantine regulations, conferring with the state hoard, 
if deemed necessary, for co-operation. The regulations for 
governing local quarantines should not he in conflict with the 
rules a?id regulations adopted by the state hoards of health for 
enforcing quarantine regulations. 22 
Sec. 6. The refuge stations as at present operated on the 
sea-coast of the United States are, in the opinion of this body, 
of infinite service, and we would recommend their continuance 
in a full equipment for all requirements. 
A substitute was offered by Mr. Foreman of Louisiana in 
lieu of Section (6); which, on motion, was tabled. For subst- 
itute, see Appendix V. 
Upon the resolution of Mr. Foreman, Dr. Austin of Louisi- 
ana, upon personal privilege being granted by the Conference, 
spoke as follows: See Appendix YI. 
Substitute offered by Dr. Thompson of Kentucky, in lieu of 
Section (6). 
Resolved, That it is the sense of this Conference that it is the duty of 
the Government of the United States to take charge of the entire mari- 
time quarantine service of this country, and to devise and execute such 
a system as will protect the country against the introduction of conta- 
gious and infectious diseases. 
On motion, substitute was tabled. 
Upon motion, Section (6) of committee report, as above, was 
adopted as the sense of the Conference. 
Sec. 7. When any suspicious case occurs, the nature of which, has 
not or can not be determined at its then present stage, or doubts arise 
as to the nature of the case, wise precaution demands that such case be 
immediately isolated from contact with all other persons until medical 
science has diagnosticated the case, and is able to determine the nature 
of it, bey ond doubt. When conclusions are reached they should be 
made public.* 
Substitute for Section (8) of Mr. Clark’s paper: 
Experience has proven that by proper precautions, closed cars bear- 
ing passengers or freight may be run through infected localities without 
danger of infection. 
By motion of Dr. Cochran, Section (8) of report was laid on 
the table, its purpose having been accomplished by another res- 
olution. 
Sec. 9. In the'depopulation of infected houses, districts or cities, 
inhabitants should be removed into camps of probation, or into vacant 
houses in the adjacent country. After twelve days detention, if they 
* It is not stated what was done with Sec. 7. 23 
remain well, and under proper regulations, such as disinfection of bag- 
gage, etc., they may be discharged from surveillance. 
Section (9) was, upon motion, tabled—its purpose having 
already been passed upon and decided. 
Sec. 10. Rail Road agents on roads under quarantine 
surveillance at way stations should he required to refuse to 
sell tickets to any persons who can not shoiv that they have 
not in twelve days been exposed to any source of infection, 
and conductors should he required hy law to refuse to trans- 
port passengers from way stations ivho are not supplied ivith 
tickets. 
Upon motion, Section (10) of committee report was adopted. 
Sec. 11. Health certificates should he required from all 
persons whenever yellow fever prevails in this country. They 
should he issued only hy the health official in charge of the 
place, under official seal, or, in the absence of such seal, under 
the seal of the municipal or county court where the certificate 
originates. In each certificate the person to whom it is issued 
should he so described as to admit of his identification, and 
should state the facts oj the case fully and circumstantially. 
And to such certificates full credence should be given by all 
health authorities. We must have honesty and mutual con- 
fidence amongst those charged ivith the protection of the pub- 
lic health. 
A uniform system of certificates should he adopted hy 
hoards of health. We would recommend the following form : 
, {Ojfice of the Board of Health.) 
{Date.) 
Health Certificate. 
Name 
Residence 
How long in 
Destination 24 
Have you or your baggage been exposed to yellow fever in- 
fection within the past thirty days t 
I solemnly swear that the answer to the above question is 
true, so help me God. 
[$mZ.] * Signed, 
(Name of Applican t.) 
Signed, (Official. 
Upon motion, Section (11) above was adopted by the Con- 
ference. 
Committee recommend Section (9) of Mr. Clark’s paper, 
with the following amendment, viz : 
In the first line add the words, “of municipalities,” after the 
word “legislatures.” 
The recommendation was adopted by the Conference. 
Upon examination of Dr. Wilkinson’s paper, this committee 
offer the following resolution : 
Resolved, That this Conference indorse the Holt quaran- 
tine and disinfection system, as at present operated at New 
Orleans, La., as the best one known for the preven tion of the 
introduction of yellow fever into the ports of the United 
States, and recommend its uniform adoption. 
The above resolution was unanimously adopted by the Con- 
ference. 
I 
Upon motion, the report of the committee, as a whole, and 
as amended, was accepted. 
Upon motion of Dr. Wood (N. C.), a joint committee from 
the two committees, to edit the two reports and put them in 
harmonious shape, "was appointed as follows, viz: 
Dr. Thomas F. Wood North Carolina, 
Dr. Eugene Foster Georgia, 
Dr. J. D. Plunkett Tennessee, 25 
Dr. W. F. Hyer Mississippi, 
Dr. T. Orange Simmons.. .South Carolina. 
Upon motion, Conference adjourned. 
AFTERNOON SESSION—SECOND DAY. 
Called to order by President Wilkinson at 3.30 p. m. Con- 
ference resumed discussion of topics presented by Committee 
on Business. 
Topic 4. Is it practicable to cause depopulation of large 
cities? 
Tabled, having already been acted upon. 
Topic 5. Are probation camps desirable? By whom should 
they be managed and supported ? What period of time should 
elapse from the time of arrival at the camp until the granting 
of free pratique ? 
Tabled, having already been acted upon. 
Topic 6. On the occurrence of a case of yellow fever, what 
immediate measures of isolation are desirable ? 
Upon motion of Dr. Cochran, the following resolutions were 
adopted as the answer to Topic 6 : 
Resolved, 1st, When one case or a few cases of yellow fever 
occur in any community, it does not follow of necessity that 
the disease must spread and become epidemic. On the con- 
trary, the experience of many countries through long periods 
of time shores conclusively that in the majority of such in- 
stances, and without the observance of any special means of 
prophylaxis, the disease fails to spread. 
2d, When one case or a few cases of yellow fever occur in 
any community, in the light of our present knowledge of the 26 
habits and modes of propagation of the disease, it is generally 
possible, by the employment of the proper prophylactic meas- 
ures, to prevent the development of an epidemic. 
3d, The golden rule for the prevention of yellow fever is 
non-intercourse—isolation—the keeping of the well away 
from the sick, away from infected things, and very especially 
away from infected localities. 
till, In the enforcement of this golden rule of non-inter- 
course two problems present themselves Jor solution, (a) To 
keep the people generally from coming into the infected houses 
and the infected localities; and (b) to keep doctors and nurses 
and other attendants, and the well members of sick families, 
from visiting and mingling with people outside of the infected 
houses and localities. The solution of the first of these prob- 
lems is comparatively easy. The solution of the second is 
sufficiently difficult. But it is possible to solve them both. 
5th, In the densely settled sections of cities guards may be 
useful for the enforcement of non-intercourse. They are 
much less needed in sparsely settled towns. In villages and 
country neighborhoods, as a rule, they are not needed at all. 
In all cases every intelligent family should be able to take care 
of itself—should be able to keep all of its members away from 
infected houses and localities, and to guard its own premises 
from invasion by dangerous persons and things. 
6th, Non-intercourse may be practiced in the very centre of 
an infected district with considerable probability of escaping 
the fever. Cloistered convents and prisons in infected cities, 
with yellaw fever raging all around them, usually escape 
invasion ; and there are numerous instances on record in 
which private families in the midst of epidemics have passed 
the ordeal safely by the vigorous enforcement of non-inter- 
course. 
Topic 7. What means of disinfection should be adopted 
for chambers and dwellings where cases of yellow fever have 
occurred ? 27 
Dr. Cochran moved the following resolutions in answer to 
Topic 7: 
1. Disinfection in yellow fever is based very largely on theoretical 
grounds. Nevertheless we believe that it may be made a valuable 
agent in checking the spread of the disease. In the beginning of an 
outbreak all the resources of disinfection should be exhausted, and these 
efforts should be continued until the epidemic is fully established. Af- 
ter the epidemic has subsided, disinfection is of very questionable value. 
2. The disinfecting agents most to be trusted are heat, especially 
moist heat; cold, both artificial and natural, and especially cold weather 
and frost; and certain chemicals, especially the bichloride of mercury 
and the fumes of burning sulphur. To -these must be added ventila- 
tion. 
3. The disinfection of beds, bedding, clothing, and articles of simi- 
lar character, is comparatively easy. The disinfection of single rooms, 
and perhaps also of single houses, is more difficult but not entirely im- 
practicable. The disinfection of yards must be regarded as very diffi- 
cult, but in the beginning of an outbreak it should be attempted. The 
disinfection of a whole city, or even of a large section of a city, seems 
not to be practicable. 
Dr. Simons said the adoption of the resolutions would 
commit this Conference to a very bad thing. 
He thought that sanitarians had differed widely on the sub- 
ject of disinfection, and moved to strike out the last sentence 
of the first resolution. Carried. Continuing his speech to 
the Conference, Dr. Simons said the Conference ought to 
allay public feeling, and ought to feel the commercial pulse. 
He moved to strike out the last section of the second resolu- 
tion. 
Dr. Daniel seconded the motion in a short speech. He said 
that disinfection did a great deal towards controlling the moral 
demoralization of the people. 
Dr. Sternberg said that yellow fever was brought to America 
from Havana or other places. The disease was a something to 
be destroyed, and he thought the effort to destroy it ought at 
least to be made. Everything indicated that the yellow fever 
germ was not very hardy and could easily be killed. He 
thought it a little less than criminal for health boards to leave 
anything in the way of disinfection at the beginning or during 
any part of the epidemic. (Applause.) 28 
Mr. Voyle related his experience at Gainesville, Fia., during 
the epidemic of last summer. 
Dr. Plunkett moved to strike out the first and last resolu- 
tions. 
Dr. Bailey thought the profession differed very materially 
on the question of disinfection. 
Dr. Vaughan said that disinfection was, in some diseases, es- 
pecially in scarlet fever and diphtheria, a sure means of pre- 
venting the spread of infection or contagion, and was even 
better than quarantine. It was going to be one of the greatest 
methods of limiting diseases in future. 
Dr. Cochran said that disinfection was a question of great 
importance. He agreed with Drs. Sternberg and Vaughan. 
He was not opposed to disinfection, but the amount of good it 
had accomplished in epidemics of yellow fever was very ques- 
tionable. He said the only place thoroughly disinfected in 
his knowledge was Plant City last summer, but even there it 
failed. After refugees were allowed to return the disease 
broke out again in a few days. Whenever infection appeared 
he was heartily in favor of going for it and using every means 
in the world to stamp it out. He thought post epidemic dis- 
infection unnecessary, and moved to refer the whole subject 
matter to a committee to be appointed by the chair. Lost. 
The following resolutions introduced by Dr. T. Grange 
Simons, of South Carolina, and Dr. Thos. F. Wood, of North 
Carolina, was adopted as the sense of the Conference in an- 
swer to Topic 7. 
Resolved, That this Conference recommend that all approved 
methods of disinfection by means of personal and municipal 
cleanliness, by ventilation, f umigation, chemical affusion, destruc- 
tion by fire of all infected or suspected things used during an 
epidemic of yellow fever and until the danger of its spread shall 
have passed, and that all fomites should be disinfected after the 
recovery of the side. 
We recommend as a basis of disinfection the processes as set 
forth by the Committee on Disinfectants, of the American Public 
Health Association. 29 
Major Hadden, of Memphis, offered the following : 
Besolved, That Decatur, Alabama, be thoroughly disinfected at once, 
and that the proper authorities are requested to do so immediately. 
Dr. Cochran said there was no use in adopting the resolution 
for he would assure the Conference that no such thing would 
be done. 
Mr. Austin, of Hew Decatur, said he, in the name of the 
women and children and united people of Decatur had urged 
on the government, state and national, to burn the bedding and 
other things now lying in a hundred houses in the town 
where fever had raged. 
He read a letter from Gov. Seay recommending that the 
United States government send an inspector there to see what 
ought to be done. He also gave a history of the Decatur 
boom. He said that the city of Decatur had appealed in the 
name of all that was dear to them, but not one had ever 
reached the heart of the state health officer. He said that he 
could make a statement to the floor that would melt a heart of 
stone. 
Dr. Cochran said all the eloquence of the gentlemen was 
based upon the assumption that the poison of yellow fever was 
still lurking in the yards and houses, and amongst the bedding 
and clothing of the people in Decatur. But if the assumption 
was wrong the eloquence and pathos would be eloquence and 
pathos still, but they ought not to have any effect in controlling 
the suffrages of this Conference. All the facts went to show 
that there wras not the shadow of proof—not a particle of evi- 
dence that the infection still existed in Decatur. If it did 
exist why didn’t those people who went back after the epi- 
demic ended have the fever? Was there a single person on 
this floor who believed that yellow fever infection remained in 
Decatur? The state of Alabama had the money to do the 
work asked for, and he had control of it, but he would cut off 
his right hand before he would do this work. The doing of it 
would only result in adding another horror to yellow fever, 
and it had enough already. If the Conference granted the ap- 
peal of Mr. Austin it would controvert the whole yellow 30 
fever history of the world. He hoped the Conference would 
not be unduly moved by such appeals. 
Mr. Voyle offered the following: 
Resolved, That the city of Decatur can furnish a valuable example of 
the efficacy or otherwise of disinfection by omitting any further action 
in that direction, and that they can perform a patriotic act of humanity 
by such action. 
Dr. Hyer, of Mississippi, thought the prayer of Decatur 
ought to be answered. 
Dr. Bizzell was opposed to the adoption of a resolution im- 
peaching the character of a health officer who had commanded 
the admiration of everybody. (Applause.) 
Dr. Baird thought it would be discourteous to the state to 
censure her governor or state health officer. 
Dr. Weatherly said that frost wTas the best disinfectant 
known. 
Dr. Thornton said he was not going to take any part in the 
local fight about the city of Decatur, but he wanted to say 3, 
few words. lie said that no man had ever stated or proved 
that yellow fever was imported to Memphis in 1879. It was 
his opinion that it had been nursed in bedding, mattresses, etc., 
which were left over from the epidemic of 1878. He thought 
Decatur ought to be thoroughly disinfected. 
Dr. Bailey thought it would not be courteous to their host 
the state of Alabama, and moved to table the resolutions and 
amendments. Adopted. 
Topic 8. What system of disinfection should be adopted 
for personal baggage of persons fleeing from an infected 
place ? 
Dr. Hamilton said that when the question of the escape of 
people from infected Florida came up last summer there was 
no time to prepare elaborate machinery for the disinfection of 
baggage. He detailed how baggage, etc., was disin fected in a box 
car at every crossing during the beginning of the Jacksonville 
epidemic, and later how a warehouse was constructed. He 
thought the government ought to construct cars with steel 31 
chambers, with super-heated steam, so as to move from place to 
place as the exigencies of the case demanded. Such plans had 
already been filed at government headquarters, and he hoped 
to have the cars ready in case they should be needed. 
Upon motion of Dr. Wilkinson, it was 
Resolved, That it is the sense of this Conference, that the 
best form of disinfectant for personal baggage is moist heat. 
Moved, that the hearing of the papers by Drs. Sternberg, 
Yaughn, Burgess, and YanBibber, be the next order of busi- 
ness for the Conference. Adjourned. 
NIGHT SESSION—SECOND DAY. 
Called to order by President Wilkinson at 8 p. m. 
The following resolution, introduced by Col. J. C. Clark, of 
Alabama, was adopted: 
Whereas, This Quarantine Conference has adopted' the report 
of the Committee on Inland Quarantine ; therefore, he it 
Resolved, That a committee of one from each state repre- 
sented in this Conference he appointed to prepare rules and 
regulations for governing quarantines, when it becomes neces- 
sary to put the same in force. And that such rules he published 
when prepared for the information of the public, and all per- 
sons to he affected thereby. And that state boards of health and 
health officers of states be requested to furnish such rules to the 
proper officers of municipal and county authorities for their in- 
formation,. 
Dr. Geo. M. Sternberg, U. S. A., read his paper on “Hunt- 
ing Yellow Fever Germs” with magic lantern illustrations. 
For paper see Appendix YII. 
By motion a vote of thanks of the states assembled was ten- 
dered Dr. Sternberg for the very entertaining address and ex- 
hibit with which he had favored the Conference. 
Dr. Yictor C. Yaughan, who had been announced to read a 32 
paper, stated that owing to the lateness of the hour he would 
address the Conference briefly upon the subjects covered by 
his paper in lieu of reading the paper. Whereupon he ad- 
dressed the Conference. 
By motion a vote of thanks of the Conference in the name 
of the states assembled was tendered to Dr. Yaughan for his 
very interesting address. 
By motion Drs. Sternberg and Yaughn were requested to 
furnish copies of their respective papers for publication with 
the Proceedings of the Conference. For Dr. Yaughan’s 
paper, see Appendix YIII. 
Adjourned. 
MORNING SESSION—THIRD DAY. 
Called to order by President Wilkinson 10 a. m. The 
Chair announced the committee proposed by Mr. Clark’s reso- 
lution of the Wednesday evening session as follows : 
Committee on Promulgation of Rules for Quarantine Manage- 
ment— 
J. C. Clark Alabama. 
J. B. Baird .’ Georgia. 
J. Y. Porter Florida. 
R. S. Starkweather Illinois. 
Wm. Bailey ,... .Kentucky. 
II. B. Horlbeck South Carolina. 
J. E. Black Tennessee. 
R. Rutherford Texas. 
R. F. Gray North Carolina. 
O. R. Early Mississippi. 
C. M. Smith Louisiana. 
Dr. Daniel M. Burgess, sanitary inspector M. H. S. at 
Havana, read the following paper on “The Sanitary Inspection 
Service at Havana, Island of Cuba.” For paper, see Ap- 
pendix IX. 
Dr. Palmer, of Florida, desired that the paper be discussed 
by the Conference. He had heard the threat often that the 33 
state of Florida would be cut off unless all intercourse between 
that state and Cuba was prohibited. 
Dr. Daniel, of Florida, made a statement as to the danger of 
Florida, and asked Dr. Burgess several questions regarding the 
inspection at Havana. 
Dr. Wilkinson took the floor and stated his experience as to 
the reliability of health certificates issued by United States 
consuls, and cited instances where the same consul had issued 
two certificates entirely different in nature, both issued the 
same day. Dr. Wilkinson then gave an outline of the methods 
of the Tampa quarantine in connection with the Plant steam- 
ship line, giving the requirements made of a passenger before 
he is allowed to land. He thought that it was useless to in- 
dulge in crimination or recrimination regarding the origin of 
yellow fever in Jacksonville; rather let Tampa quarantine be 
considered, and let it be shown whether or not it would be 
possible to introduce fever into Tampa by the Plant line of 
steamers in spite of the Tampa quarantine ? 
Dr. Wall had given the subject of the Tampa quarantine 
much study, and he was satisfied that it is not shown that a 
single case of fever was ever brought into Florida by the 
steamers of this line. Ho quarantine is perfect, but the Tampa 
quarantine was as good as any in existence. 
Mr. Ingraham, representing the Plant line, made a state- 
ment to the Conference of the methods in use on the steamers 
on that line to prevent the possibility of bringing the germs of 
yellow fever to this country. He detailed the construction of 
the vessels used and the measures of fumigation to which all 
baggage is subjected. He stated that the company had 
more than one thousand claims for damage done to fine cloth- 
ing by the fumigation. He concluded by assuring the Con- 
ference that the Plant system did not desire to endanger the 
health of the entire country, and if it was so regarded the com- 
pany would discontinue its steamers. 
Dr. T. Grange Simons, of South Carolina, thought that dis- 
infection was in a state of exneriment. and at this time the 34 
only point at which this system is in any way perfect is at New 
Orleans. He did not think there was any assurance that the 
Plant system of fumigation was at all times enforced. 
Dr. Cochran thought that the Plant system had done more 
than any line of vessels coming to this country. He was of the 
opinion that rather than increase the restrictions of the com- 
pany they should be relaxed ; that it is doing much more than is 
done on any line of vessels going to New Orleans. If anything 
is done to further protect this country, it should be at the 
port, and he suggested that a fumigation or disinfectant station 
be established at Tampa. He thought that a legitimate route 
or line of travel between Cuba and the United States would 
tend to decrease the probability of introduction of disease into 
this country. 
Dr. Porter followed, giving a detailed history of the appear- 
ance of yellow fever into Key West in 1887, and the manner 
of its introduction. He reverted to the Plant steamers, and 
gave it as his opinion that those vessels were so constructed as 
to render them very easily cleaned. Something had been said 
about Dr. Nelson’s “blue suit” which he wore from Havana to 
Tampa without disinfection. Dr. Porter said the suit which he 
was wearing had been many times in contact with yellow fever 
patients. It had never been fumigated, but still it had been 
aired, and there was absolutely no danger in it now, and no 
more was there in Dr. Nelson’s blue suit. 
Dr. Hamilton followed, giving an outline of the working of 
the consular weekly report system, with a few items of the 
cost of obtaining information by cable and the extreme diffi- 
culty of consuls to obtain correct information. He stated that 
the Spanish government at first objected to placing Dr. Bur- 
gess as a yellow fever inspector at Havana, and that he was 
only allowed to remain at the earnest solicitation of the secre- 
tary of state. He spoke of the need of physicians being at- 
tached to the consulates in countries in which epidemic diseases 
are endemic, and he hoped the Conference would adopt a reso- 
lution calling on congress to take this action. He favored the 
appointment of inspectors at every port of entry in the coun- 35 
try, and Hie increase of inspectors, but he did not think it 
would be necessary to establish more quarantine stations. He 
would recommend under the new quarantine law, that when a 
vessel reached any port in this country in a filthy condition, it 
would be subjected to ordinary fumigation, and in the event of 
the second arrival of the same ship within a year, in a 
filthy condition, it would be subjected to an extraordinary 
fumigation. The cost of these fumigations would cause the 
vessel owners to be more careful as to the cleanliness of their 
vessels. He had visited the vessels which brought yellow fever 
to Pensacola the last time that disease was brought there, and 
he had found it the filthiest ship he had ever seen. Dr. Hamil- 
ton then gave an outline of the proposed quarantine stations at 
Dry Tortugas and the Pacific coast. 
Dr. Wilkinson introduced the following resolution, which 
was unanimously adopted as the sense of the Conference. The 
resolution read as follow : 
Be it Resolved, That the secretary of the Treasury of the 
United States is hereby requested to increase the revenue patrol 
service on the coast 'of Florida to such extent as may be neces- 
sary to prevent smuggling. 
The following resolutions, introduced by Drs. Wood and 
Poster, were adopted : 
BY DR. WOOD OF NORTH CAROLINA. 
Whereas, It appears by the report which Dr. Burgess lias 
made to this conference, that sanitary inspection of vessels lohere 
yelloiv fever is endemic is of vital importance, therefore be it 
Resolved, That this conference approves the plan of having 
medical inspectors attached to those consulates where yellow fever 
and cholera are endemic, with a view of securing for our protec- 
tion definite information as to the exact sanitary condition, and 
the presence or absence of contagious diseases in such consular 
district. And that congress be urged to make the necessary ap- 
propriations to carry the plan into effect. 36 
BY DR FOSTER OF GEORGIA. 
Be it Resolved, That tlie U. S. government is hereby re- 
quested, if compatible with international and constitutional law, 
to enter into negotiations ivith Spain with a view of investing 
the U. S. sanitary inspectors at Spanish ports with such legal 
jurisdiction as may be necessary for the enforcement of such 
rides and requirements as are provided. 
Dr. Plunkett offered a resolution that the thanks of the 
conference are tendered to Dr. Burgess for his able paper, 
and that he be requested to furnish a copy for publication. 
The motion was unanimously adopted. 
Dr. W. C. YanBibber read the following paper on the 
“Quarantine of the Future.” For paper see Appendix X. 
On motion, thanks were tendered Dr. Van Bibber and a 
copy of paper requested for publication with the proceed- 
ings of the conference. 
The following resolution, introduced by Dr. Harrell, was 
tabled. For resolution, see XY. 
Dr. Gaston, of Atlanta, read the following paper, entitled 
“A Plea for Yellow Fever Inoculation as a Prophylactic 
Measure.” See Appendix XI. 
Dr. Sternberg said that he had visited Rio De Janeiro 
and made a thorough investigation of the practice of inocu- 
lation followed there by Dr. Freire. His voluminous report 
was in the hands of the president. He found Dr. 
Freire’s statistics fallacious. Of those inoculated by Dr. 
Freire a large number who had been exposed died and large 
numbers of others had the disease. Dr. Sternberg gave an 
explanation of the manner in which many of Dr. Freire’s in- 
oculations were made, and he had found no evidence that 
Dr. Freire’s method of inoculation is of any practical value. 
Dr. Wilkinson offered a resolution to return the thanks of 
the conference to Dr. Gaston for his paper, but in view of 
the fact that the theory of inoculation is new, that the reso- 
lutions bearing on the subject be laid on the table. Adopted. 
The following letter was then read by Dr. Stern- 37 
berg, and by motion a copy was requested for publica- 
tion with the proceedings. For letter see Appendix XII. 
Report of Business Committee taken up for further con- 
sideration. 
Topic 10. When may refugees safely return to their 
homes ? 
Upon motion of Mr. Hier (Fla.) the following was 
adopted as the answer to Topic 10 : 
I. After the occurrence of ice. 
After the occurrence of three (3) Jailing frosts, 
After the occurrence of no cases offever for the period of two 
(2) iveeks, and after thorough disinfection and ventilation of all 
localities infected, and bedding and such other articles as are 
capable of conveying germs. 
Topic 11. Is there any authority that yellow fever will 
hibernate from one year to another in the United States? 
Dr. T. Grange Simons took the position that it was pos- 
sible for fever to remain dormant from one year to another, 
and he thought that several instances had been cited to 
prove this. 
Dr. Early of Kentucky thought that there existed in this 
country a spore, which in itself was harmless, but which be- 
came fructified by importation and produced yellow fever. 
Dr. Wall, of Florida, gave briefly the history of the yel- 
low fever in Tampa in 1887, and the measures taken for 
protection of returning refugees. 
Dr. Hyer thought that the question was one for scientists 
and not for such a body as the conference, and after citing 
instances of supposed hibernation, which by many were 
doubted, he offered a motion that the subject be indefinitely 
postponed. Adopted. 
Dr. Ross offered the following : 
Whereas, Of late years almost, if not all the epidemics of yellow fe- 
ver which have occurred in this country, costing many millions of dol- 
lars to the citizens thereof, besides causing the loss of many valuable 
lives, have been directly traceable to infection brought to its shores 38 
from the Island of Cuba, and more especially the city of Havana; 
therefore be it 
Resolved, That it is the sense of this conference that by proper means 
the disease can be stamped out of the Island of Cuba. 
Second, That it is the opinion of this conference that the government 
of the United States should notify the Spanish government that the 
disease must be abated, or brought under control within a reasonable 
period of time; that if after the lapse of such time nothing has been 
done toward the abatement of this international nuisance, it is the opin- 
ion of this conference that the United States government should take 
control of the Island of Cuba and proceed to destroy the cause of dis- 
ease at its fountain head. 
Dr. Plunkett offered as a substitute, that a committee of 
three be appointed to report an expression of the confer- 
ence on the subject. 
The chair appointed Drs. Hamilton, Boss and Plunkett. 
The following resolution, introduced by Dr. Hamilton, 
was reported by the committee as the expression of the 
conference : 
Resolved, That this conference is of the opinion that it is a 
duty devolving on all nations to take measures to eradicate any 
plague centers from their territory, and that the existence of such 
plague centers is a menace to all other nations, and that our state 
department he requested to take measures through proper diplo- 
matic channels for the conveyance of this opinion to the govern- 
ments deemed obnoxious to the opinion as herein expressed. 
Adopted. 
Dr. Hamilton offered a resolution returning thanks of the 
conference to Dr, Jerome Cochran, State Health Officer of 
Alabama. Adopted. 
Dr. Hamilton offered a resolution, returning thanks of the 
conference to president Wilkinson, for his impartial dis- 
charge of the duties of presiding officer. Adopted. 
Dr. Foster offered a resolution, returning thanks to the 
secretary for the discharge of his duties and to the press 
for full reports of proceedings. Adopted, 
Conference adjourned sine die. 39 
The report on Quarantine Rules and Regulations is to 
be prepared, by the Committee appointed for that purpose, 
after the adjournment of the Confereuce. 
J. L. LUDLOW, C. E., 
Acting Secretary. 
BULES FOB BAILBOAD QUABANTINE. 
The rules of the government of railroad quarantines, as 
drawn up by the special committee appointed for that pur- 
pose, are here subjoined : 
The committee was composed of J. C. Clark, J. B. Baird, 
J. R. Porter, R. S. Starkweather, Wm. Bailey, H. B. Holr- 
beck, J. E. Black, R. Rutherford, R. E. Gray, O. R. Early, 
C. M. Smith. 
RULES PREPARED BY THE COMMITTEE. 
1. Quarantine should not he made against any place until 
it is officially hnown that yellow fever or other infectious or con- 
tagious disease exists at such place. 
(2. Only competent physicians slioidd he put in charge of 
quarantine stations; and only thoroughly qualified persons should 
he employed as inspectors on raihvay trains. 
3. Quarantine stations, located on railroads, should he es- 
tablished at convenient points, on one or both sides of a town or 
station, as may he deemed necessary. 
Jh If an epidemic of yellow fever or other infectious or 
contagious disease exist at a town or station, trains carrying 
passengers or freights should he required, to pass through the lim- 40 
its of such towns or stations at a speed of not less than ten [lO] 
miles per hour, without stopping at such toions or stations, but 
should stop at the quarantine station. 
5. Passengers to or from such infected point should only be 
received, or delivered at the quarantine station, under the super- 
vision of the quarantine officer in charge of the station. 
6. Pailway tickets may be sold to persons leaving an in- 
fected place to any point willing to receive them. 
7. All baggage from any infected qjoint should be properly 
disinfected. 
8. As far as practicable, the same rules proposed for rail- 
roads should be applied to vessels of every kind, stage coaches, 
or other means of travel. 
9. The passage of railroad trains through any point on the 
line of road, whether infected or not, should not be prohibited 
by any quarantine regulations. The conductors of passenger 
trains should close the windows and ventilators and lock the 
doors of cars passing through any place where a train is not 
permitted to stop. 
10. All f reight to any infected place should be delivered 
either at the quarantine station or the nearest railway station 
to such infected point, where it can be properly cared for. 
11. All mail matter from anyinfected place should be prop- 
erly disinfected by the United States Government. And mail 
matter intended for infected points should be put off the trains 
at the quarantine stations. The United States Government 
should instruct Post-Masters to receive and deliver mails at 
such quarantine stations. 
12. Railroads and Express Companies, may receive for 
transportation from any inf ected place, during the time such 
infection exists, any merchandise or traffic consigned to places 
willing to receive it. 
13. State authorities should employ competent persons on 
passenger trains, as inspectors of passengers, baggage and ex- 
press matter, as additional precaution; but the fact of inspect- 
ors being on such trains should not relieve trains carrying pas- 41 
sengers, or express matter or baggage, from stopping at quar- 
antine stations for such inspection as the officer in charge may 
determine to be necessary. 
If It is recommended that all quarantines, as jar as prac- 
ticable, should be uniform in their requirements and operations, 
which will greatly contribute to the prevention of panics, and 
tend to allay unnecessary excitement and fear on the part of 
the people. 
15. The form of health certificate adopted by the quarantine 
convention, held at Montgomery March 5, 1889, should be pre- 
pared for Health Officers to issue, to such persons as may be 
found entitled to receive the some. A copy of this certificate 
should be printed ivith these rules, and conspicuously posted at 
railway stations. 
16. It is the desire and intention of health authorities, as far 
as practicable, to throw every safe-guard around the public 
health of all localities. Municipal, county and state authorities 
are expected to co-operate in every possible way with health of- 
ficers located in towns, villages and cities, and in charge of quar- 
antine stations, to enable them to prevent the introduction or 
spread of yellow fever or other infectious or contagious diseases. 
INTER-STATE NOTIFICATION OF INFECTIOUS AND 
CONTAGIOUS DISEASES. 
The rules in regard to Inter-State Notification, adopted 
by the conference of State Boards of Health, which are refer- 
red to in these proceedings, are here subjoined for conve- 
nience of reference. 
The following are the resolutions, adopted by the Inter* 42 
national Conference of Boards of Health, at Toronto, Octo- 
ber 6th, 1886, with slight verbal modifications. 
Whereas, It is necessary for the protection and preservation of the 
public health that prompt information should be given of the existence 
of cholera, yellow fever or small pox ; be it Resolved— 
1. That it is the sense of the National Conference of State Boards of 
Health, that it is the duty of each State and Provincial Board of Health 
within whose jurisdiction any of said diseases may occur, to furnish im- 
mediate information of the existence of such disease to boards of health 
of neighboring States and Provinces, and to local boards in such States 
as have no central board, in which the duty of notification shall lie up- 
on the local boards. 
2. That upon the prevalence of rumor of the existence of pestilential 
disease in any State or Province, if positive, definite information there- 
on be not obtainable from the proper health authorities, this Conference 
holds that the health officials of another State are justified in entering the 
before-mentioned State or Province for the purpose of investigating and 
establishing the truth or falsity of such reports. 
3. That whenever practicable, the investigations undertaken under 
the preceding section shall be made with the co-operation of the State 
or local health authorities. 
4. That any case which presents symptoms leading to serious suspi- 
cion of the existence of one of the aforenamed diseases, shall be treated 
as suspicious, and reported as provided for in cases in which the diag- 
nosis is certain. 
5. That any case respecting which reputable and experienced physi- 
cians disagree as to whether the disease is or is not pestilential, shall 
be reported as suspicious. 
6. That any suspected case respecting which efforts are made to con- 
ceal its existence, full history, and true nature, shall be deemed suspi- 
cious and so reported. 
7. That in accordance with the provisions of the foregoing resolu- 
tions, the Boards of Health of the United States and Canada, represen- 
ted at this conference, do pledge themselves to an interchange of infor- 
mation as herein provided. 
The following resolutions, explanatory of the above, were 
adopted by the International Conference of State Boards of 
Health, at Washington, September 8, 1887 : 
Resolved, That the conference re-affirms the principles contained 
in the resolutions adopted by it at its meeting in Toronto in 1886, 43 
2. That the communicable diseases hereinafter mentioned, prevalent 
in certain areas, or which tend to spread along certain lines of travel, 
be reported to all State and Provincial Boards within said area or along 
said line of communication. 
3. That in the instance of small-pox, cholera, yellow fever and ty- 
phoid fever, reports be at once forwarded, either by mail or telegraph, 
as the urgency of the case may demand ; and further, that in the in- 
stance of diphtheria, scarlatina, typhoid fever, anthrax or glanders, 
weekly reports, when possible, be supplied, in which shall be indicat- 
ed, as far as known, the places implicated, and the degree of prevalence. APPENDIX 
PAPERS READ BEFORE THE 
MONTGOMERY 
QUARANTINE CONFERENCE, 
MARCH, 1889. APPENDIX I. 
PROPOSITIONS TO BE SUBMITTED TO THE QUAR- 
ANTINE CONFERENCE. 
PROPOSITIONS SUBMITTED BY DR. A. N. BELL, OF NEW YORK. 
Every organized government, State or local, has the right 
of protecting itself against the introduction of infectious or 
contagious diseases, and, to this end, of excluding any per- 
son or thing and of prohibiting communication by or with 
any country or place deemed likely to introduce infectious 
or contagious diseases of any kind ; Provided however, that 
no prohibitory measures should go so far as to exclude or 
drive from port any infected vessel; or refuse proper care 
and treatment of any persons who are afflicted with or who 
have been exposed to an infectious disease, no matter what 
may be its nature. 
With special reference to yelloiv fever: 
A filthy vessel from any place where yellow fever is wont 
to prevail, or that is in habitual communication with any 
such place, is much more to be dreaded as a vehicle of in- 
troducing the disease than any person or thing such vessel 
may have on board. No such vessel, whether there has 
been recent sickness on board or not, and no matter what 
the condition of the last port of departure of any such ves- 
sel, or her bill of health, should, in the summer time espe- 
cially, be allowed admission to any city wharf, or to lie 48 
alongside any other ship or vessel, until broken out and 
thoroughly cleansed, and all the cargo, merchandise, effects, 
ballast—material and personnel—of such vessels are more 
or less dangerous and should be treated accordingly. 
All vessels should be visited as soon as practicable after 
their arrival, always within twelve hours at the outside, and 
subjected to examination and questioning by the sanitary 
authority of the port. The history of the vessel should be 
particularly inquired into with reference to the ports she 
has visited, sickness on board and measures to which she 
has been subjected, if any, for cleansing; and the result of 
such examination should be recorded upon a special register 
kept for the purpose. 
All persons found on board a vessel infected with yellow 
fever who have not had and fully recovered from the disease 
should be removed therefrom to places of healthful sur- 
roundings as soon as possible. The detention of the sick 
in infected vessels greatly adds to the danger of a fatal 
issue; and every hour’s detention of the well in any infected 
vessel or place adds to the danger of contracting the dis- 
ease. 
Persons who have been exposed to yellow fever infection 
within five days of the time of their arrival at any place 
with an average temperature of 70° F. or upward, should 
be secluded in a healthful place, and required to divest 
themselves completely of all clothing that has been worn on 
board or exposed to the atmosphere of an infected ship, or 
to that of any place where yellow fever existed at the time, 
to thoroughly wash themselves and substitute clothing 
which has not been so exposed, before admission to inter- 
course with the inhabitants of the place, or permission to 
proceed elsewhere. These requirements being fulfilled, and 
they should always be as soon as possible after arrival, 
there is no danger of such persons propagating the disease, 
and they should be permitted liberty. 
Personal effects, merchandise and ballast which have been 
exposed to an infected ship or brought from an infected 49 
place, are more or less dangerons, according to the nature 
of the substance. Such substances may be enumerated, ap- 
proximately, in the order of their greater liability to propa- 
gate infection, as follows : 
Personal clothing, bedding, rags, paper rags, books and 
papers, hides, skins, feathers, woolens, hair, and all other 
remains of animals, porous ballast, silks, cotton, linen, hard 
ballast. 
PROPOSITIONS SUBMITTED BY DR. JNO. B. HAMILTON, SURGEON 
GENERAL MARINE HOSPITAL SERVICE. 
Topic 1.—What form of notification shall be adopted in 
case of occurrence of yellow fever ? To whom shall the 
first notification be sent? 
Topic 2.—On receiving notice of existence of yellow fever 
in any place, is it desirable that the Government should 
send an inspector, free from local influences, to verify ? 
Topic 3. Under what circumstances should an epidemic 
be declared to exist? 
Topic 4.—How soon should we advise depopulation in 
the event of the appearance of yellow fever in any place ? 
Topic 5.—Is it practicable to cause depopulation of large 
cities ? Is it necessary to secure additional legislation to 
compel persons to sojourn in camps of refuge? 
Topic 6.—Are probation camps desirable ? By whom 
should they be managed and supported ? What period of 
time should elapse from the time of arrival at camp until 
the granting of free pratique ? Should probation camps 
have separate yellow fever camps? Should the certificate 
of the officer in charge of the probation camp entitle a per- 
son to enter free any other place ? 
Topic 7.—Is it desirable to allow special trains to pass 
to mountainous regions, comparatively uninhabited ? 
Topic 8.—On the occurrence of a case of yellow fever, 
what immediate measures of isolation are desirable ? What 
restriction should be placed on physicians in attendance 50 
on a case of yellow fever? In case of death, what disposi- 
tion should be made of the body ? 
Topic 9.—What means of disinfection should be adopted 
for chambers and dwellings where cases of yellow fever have 
occurred ? 
Topic 10.—What system of disinfection should be adopted 
for the disinfection of personal baggage of persons fleeing 
from an infected place ? 
Topic 11.—Is yellow fever contagious ? What diagnostic 
signs should be agreed upon as reasonable proof of the 
presence of yellow fever? What post-mortem evidences 
should be accepted as conclusive that the person died of 
yellow fever ? 
PROPOSITIONS SUBMITTED BY DR. J. N. MCCORMACK, SECRETARY 
OF THE KENTUCKY STATE BOARD OF HEALTH. 
Resolved: (1) That it is the sense of this Convention that 
all ports on the Gulf coast, and all on the Atlantic coast 
south of, and including Charleston, not fully equipped for 
quarantine administration, in accordance with the most ap- 
proved modern methods, should be closed against vessels 
from West Indian and South American ports from the first 
of March to the first of October in each year. 
Resolved: (2) That this Convention urges upon all health 
authorities of States represented in it the importance of 
strict compliance with the agreement of inter-State notifica- 
tion adopted by the National Conference of State Boards of 
Health, and the Sanitary Council of the Mississippi Valley, 
in regard to all communicable diseases, and especially in 
regard to yellow fever. 
Resolved : (3) That upon the outbreak of yellow fever 
in any city or town, this convention urges such co-opera- 
tion in quarantine administration on the part of threatened 
States as will confine the disease to the point of initial at- 
tack, in place of the expensive, unscientific and unsatisfac- 
tory so-called quarantines at distant State lines. 
Resolved: (4) That this convention urges upon the health 51 
authorities of each State the importance of such an admin- 
istration of any quarantine they may establish as will fur- 
nish proper protection to, and show due regard for the 
rights of States lying beyond them. 
PROPOSITIONS IN REGARD TO THE QUARANTINE OF RAILROADS, SUB- 
MITTED BY DR. JEROME COCHRAN, STATE HEALTH OFFICER 
OF ALABAMA. 
(1). During the prevalence of yellow fever epidemics, 
passengers and freights should be brought from infected 
localities only under such regulations and restrictions as 
may be established by the health authorities along the 
lines of the roads concerned. 
(2.) The regulations and restrictions governing railroad 
transportation during yellow fever epidemics should be of 
such character as to afford all reasonable guarantees of pro- 
tection to the communities in danger of invasion by the 
disease, but should not be more onerous than the circum- 
stances warrant, and should be framed with due consider- 
ation of the extent and character of the danger in each par- 
ticular case, and as affected by latitude and seasons of the 
year, and other qualifying conditions. 
(3.) At all seasons of the year, and under all circumstan- 
ces, the simple passage of railroad trains should be allowed, 
without obstruction, even when carrying sick refugees from 
infected places’to healthy localities willing to receive them. 
(4.) When the transfer of passengers or freights from in- 
fected localities from one railroad to another becomes nec- 
essary, such transfers should be done under such precau- 
tions as may be deemed necessary by the health authori- 
ties of the places at which the transfers are made ; but no 
restrictions should be made that will render such transfers 
impracticable, and transfers of passengers and freights from 
places not infected should not be burdened with unnecessa- 
ry restrictions. Quarantines against all the world are il- 
legal, mischievous, and in every way unwarrantable. 
(5.) Quarantine inspectors on rail road trains should be 
under the control of the health authorities of the several 52 
States, rather than under the control of the health author- 
ities of the communities scattered along the line of the 
road. In this way quarantine regulations may be enforced 
with the smallest amount of friction and inconvenience to 
the travelling public and with the maximum of efficiency 
and economy. At the same time the wishes of the local 
authorities should be treated with all due consideration. 
(6. When circumstances require it the States should es- 
tablish quarantine camps at such places as may be most 
convenient for the detention of travellers, disinfection of 
baggage, and treatment of the sick. It is barbarous and 
inhuman to dump off travellers of any sort, and especially 
women and children and the sick, on the side of the road 
to take care of themselves the best they can. • 
PROPOSITIONS IN REGARD TO THE LOCAL MANAGEMENT OP YEL- 
LOW PEVER—SUBMITTED BY DR. JEROME COCHRAN, STATE 
HEALTH OPFICER OF ALABAMA. 
(1.) When one case or a few cases of yellow fever occur in 
any community, it does not follow of necessity that the dis- 
ease must spread and become epidemic. On the contrary, 
the experience of many countries through long periods of 
time shows conclusively that in the majority of such in- 
stances and without the observance of any special means of 
prophylaxis, the disease fails to spread. 
(2.) When one case of a few cases of yellow fever occur 
in any community, in the light of our present knowledge 
of the habits and modes of propagation of the disease, it is 
generally possible, by the employment of the proper pro- 
phylactic measures to prevent the development of an epi- 
demic. 
NON-INTERCOURSE. 
(3.) The golden rule for the prevention of the spread of 
yellow fever is non-intercourse—isolation—the keeping of 
the well away from the sick, away from infected tilings, and 
very specially away from infected localities. 
(4.) In the enforcement of this golden rule of non-inter- 53 
course two problems present themselves for solution, (a) 
To keep the people generally from coming into the infected 
houses and the infected localities ; and (b) To keep doctors 
and nurses and other attendants and the well members of 
sick families from visiting and mingling with people outside 
of the infected houses and localities. The solution of the 
first of these problems is comparatively easy. The solution 
of the second is sufficiently difficult. But it is possible to 
solve them both. „ 
(5.) In the densely settled sections of cities guards may 
be useful for the enforcement of non-intercourse. They 
are much less needed in sparsely settled towns. In villa- 
ges and country neighborhoods, as a rule, they are not need- 
ed at all. In all cases every intelligent family should be 
able to take care of itself—should be able to keep all of its 
members away from infected houses and localities, and to 
guard its own premises from invasion by dangerous persons 
and things. 
(6.) Non-intercouse may be practiced in the very centre 
of an infected district with considerable probability of es- 
caping the fever. Cloistered convents and prisons in in- 
fected cities, with yellow fever raging all around them, 
usually escape invasion ; and there are numerous instances 
on record in which private families in the midst of epidem- 
ics have passed the ordeal safely by the vigorous enforce- 
ment of non-intercourse. 
DISINFECTION. 
(7.) Disinfection in yellow fever is based very largely on 
theoretical grounds. Nevertheless, we believe that it may 
be made a valuable agent in checking the spread of the 
disease. In the beginning of an outbreak all the resources 
of disinfection should be exhausted, and these efforts should 
be continued until the epidemic is fully established. After 
the epidemic has subsided disinfection is of very question- 
able value. 
(8.) The disinfecting agents most to be trusted are heat, 54 
especially moist heat, cold, both artificial and natural, and 
especially cold weather and frost; and certain chemicals, 
especially the bichloride of mercury and the fumes of burn- 
ing sulphur. To these must be added ventilation. 
(9.) The disinfection of beds, bedding, clothing, and arti- 
cles of similar character is comparatively easy. The disin- 
fection of single rooms, and perhaps, also, of single houses, 
is more difficult but not entirely impracticable. The dis- 
infection of yards must be regarded as very difficult, but 
in the beginning of an outbreak it should be attempted. The 
disinfection of a whole city, or even of a large section of a 
city, seems not to be practicable. 
DEPOPULATION. 
(10) In the beginning of an outbreak of yellow fever there 
is no need of depopulation at all, except of infected houses, or 
infected districts; but if people who are able to afford the ex- 
pense desire to leave they should do so quietly and deliberately, 
and no obstacles should be placed in their way; and those who 
leave healthy districts of the city or town should go wdierever 
they please, without let or hindrance. 
(11) Persons living in infected houses, or in infected dis- 
tricts, should be encouraged to leave, but should be allowed to 
leave only under such restrictions as will afford reasonable 
guarantees of safety to the communities in which they find asy- 
lum ; and they should be seut only to such communities as are 
willing to receive them. 
(12) In the depopulation of infected houses, or of special 
infected districts, the inhabitants should be removed into camps 
of probation, or into vacant houses in the adjacent country. 
After five days detention, if they remain well, and under 
proper regulations, such as disinfection of baggage, they should 
be considered free from danger, and allowed to go freely into 
any community willing to receive them. 
(13) The depopulation of large cities is altogether imprac- 
ticable. The depopulation of sparsely settled towns and vil- 
lages is altogether unnecessary, as in them it is always possible 
to prevent any general spread of the fever, 55 
(14:) Refuge camps, that is to say, camps for the continued 
residence of people during the prevalence of epidemics, have 
heretofore been of small value. One reason for this is that it 
is never possible to induce any considerable proportion of the 
population of an infected city to take refuge in the camps. 
Camps of probation, for temporary detention, may often be 
very useful. 
(15) Panics and stampedes are always without excuse and 
at the same time excessively mischievous. At the beginning 
yellow fever always spreads slowly; and there is always time 
for every body who desires to leave an infected place to do so 
without hurry and under proper regulations. 
SHOT GUN QUARANTINES. 
(16) Shot gun quarantines are barbarous, and discreditable 
to our civilization. All quarantines should be under the con- 
trol of experts. 
HEALTH CERTIFICATES. 
(17) Health certificates should be required only in the case 
of persons leaving an infected place. They should be issued 
only by the health official in charge of the infected place. In 
each certificate the person to whom it is issued should be so 
described as to admit of his identification, and should state the 
facts of the case fully and circumstantially. And to such cer- 
tificates full credence should be given by all health authorities. 
We must have honesty and mutual confidence amongst those 
charged with the protection of the public health. 
PLACES OF REFUGE. 
(18) Under proper regulations refugees from infected places 
may be allowed to go anywhere without danger of carrying 
infection with them, and should generally be allowed to do so. 
Still, it is better that they should go to cooler and more north- 
erly climates, and into states and cities not ordinarily subject 
to yellow fever. In regard to this matter, a great deal depends 56 
on the season of the year. In June or July precautions may 
be wise that would be entirely unnecessary in September or 
October. 
WHEN REFUGEES MAY RETURN. 
(19) In most of our southern communities refugees from an 
infected place may return safely after the appearance of a kill- 
ing frost. In the present state of our knowledge it is not pos- 
sible to say whether or not frost kills the yellow fever poison, 
but the experience of many hundreds of epidemics shows be- 
yond all controversy that it puts an end to the prevalence of 
the fever. 
(20) Even in places where no frost is ever known, experi- 
ence teaches that after the subsidence of the fever for a reason- 
able time, there is no longer any danger. When the fever dis- 
appears the danger of contracting the fever disappears also. 
HIBERNATION. 
(21) In the extreme southern parts of our country, and in 
very mild winters, it is possible for yellow fever to live through 
the winter months and to become epidemic again on the advent 
of the following summer. But in all such instances it is kept 
alive by the occasional occurrence of scattered cases—cases 
springing up here and there at intervals of only a few weeks. 
It does not hibernate in any other way than this. It never 
goes to sleep when the cold weather comes in the autumn, to 
sleep for three, four or six months, and to be awakened into 
malignant life when the hot weather comes the next summer. 
FINANCIAL MANAGEMENT. 
(22) In yellow fever epidemics, as under other circum- 
stances, all self-respecting persons and all self-respecting com- 
munities should pay their own expenses, and take care of them- 
selves just as long as they are able to do so, and the aid of 
public charity should be invoked only in cases of real neces- 
sity. 57 
(23) In yellow fever epidemics physicians should make 
their regular charges, just as in the treatment of other diseases, 
against all persons who are able to pay ; and neither physicians, 
nor medicines, nor nurses, nor provisions, nor assistance of any 
kind should be furnished at the public expense to any persons 
except those who are really in indigent circumstances. To 
help those who are able to help themselves is an abuse of pub- 
lic charity. 
(24) The administration of the quarantine lav's should 
always be under the direction of the legally constituted health 
authorities of the community to be protected. The health 
authorities may make mistakes, but they will make fewer mis- 
takes than the political authorities will make. As quarantines 
are at present conducted in many of the states, the aggregate 
of quarantine expenses is much greater than there is any neces- 
sity for. 
(25) The quarantine of small towns is a very simple prob- 
lem, and may be managed without much expense. As the 
population increases the problem becomes more and more diffi- 
cult ; and in very large cities it requires for its wise solution 
the highest expert skill, and abundant means. 
(26) There are two sorts of quarantine fundamentally dis- 
tinct—the police quarantine and the scientific quarantine. The 
purpose of the police quarantine is to exclude everything com- 
ing from the infected locality. The purpose of the scientific 
quarantine is to exclude only such things as are dangerous. 
Yery often, especially for the protection of small communities, 
the police quarantine is the only one that is available. But as 
far as circumstances will admit of it, the scientific quarantine 
under the management of quarantine experts, should always 
be preferred. 
(27) Local quarantines, that is to say the separate quarantine 
of towns and counties should, as far as circumstances will war- 
rant, be superseded by state quarantines, and this on the 
grounds alike of economy, efficiency and convenience.. APPENDIX II. 
MARITIME QUARANTINE SERVICES OF THE 
SOUTHERN SEA PORTS. 
The quarantine systems of the Southern Atlantic and 
Mexican Gulf Ports of the United States is a matter of 
paramount interest to the members-of this conference; the 
health, prosperity and happiness of our people being inti- 
mately connected with the management of preventive 
measures against the introduction of contagious disease. 
The means of rapid communication between points in our 
country, the extensive trade enjoyed by the different cities 
with each other, the constant arrival of travellers, on busi- 
ness or pleasure bent, from one place to another, wipe out 
the imaginary geographical lines and unite the vast field 
into one common whole; the people possessed with kindred 
interests, sharing mutual joys, and facing mutual dangers, 
even though a local disaster may threaten not the well 
being of other neighboring communities, it never fails to 
excite the warmest sympathy ; and generous and substantial 
aid is never wanting to the unfortunate. When at any time, 
however, the calamity befalling one involves and threatens 
devastation to other points, the means by which such evil 
has happened, becomes the subject of proper community in- 
quiry, and measures for prevention of the repetition of such 
peril are made the one common care of all. Indeed, from a 
property standpoint the commercial damage inflicted by the 
appearance of yellow fever at one place in the South cannot 
be limited to that point. Commercial apprehension of the 
spread of the disease to other towns must necessarily 
follow, and the commercial credit of the whole country is to 
that extent impaired, and so one common danger—one 59 
common interest cannot fail to make of us co-workers in 
one common cause. 
The history of yellow fever epidemics of this country re- 
veals the fact that the largest number prevailed at the time 
of greatest and most unrestricted tropical traffic. At one 
time the disease appeared annually at every sea port, from 
Portland, Maine to New Orleans, the extent and malignancy 
of the scourge varying in different years. On the cessation 
of this traffic, by compulsion under the edicts of parliament 
in 1762, until the close of the Revolutionary War, the 
occurrence of yellow fever ceased at those ports affected by 
the edicts, to reappear on the resumption of trade, to disap- 
pear again on cessation of foreign trade under acts of Con- 
gress 1809 to 1811, and the war of 1812 to 1815, and to re- 
appear again when trade was again revived. Quarantine 
restrictions were very soon thereafter imposed at the larger 
ports which had absorbed the foreign business of neighbor- 
ing smaller ones, with varying but progressive successes 
until the usefulness of that institution has long been fully 
demonstrated. Difference in quarantine rules necessary for 
safety have not heretofore been caused by geographical and 
climatic conditions alone. Selfish interests largely domi- 
nated ; commercial influences shaped the measures of re- 
striction ; personal gain to a great degree controlled the 
actions of many men, and that form of quarantine least in 
cost—least in obstruction to the individual was strenuously 
advocated as the best by those pecuniarily interested. The 
history of quarantine at New Orleans illustrates this aptly. 
The city being at one time purely commercial, that which 
would interfere with its Marine was forcibly resisted—the 
inhabitants engaged in a fierce party war—the importa- 
tionists were overcome by those holding the doctrine of 
local origin, and thus exemption from the disease, at this 
port, was delayed for years. 
The quarantine systems of our country may be briefly 
classed into two divisions; 60 
First:—Those imposing prohibition of tropical trade 
during the warm months of the year, and— 
Second:—Those providing some form of disinfecting 
appliances, conjoining with the operation of these detentions 
in quarantine of all vessels arriving at their ports engaged 
in such tropical trade. The first secure protection at the 
cost of a certain portion of commerce, and the second, when 
sufficient, secure protection with but slight maritime em- 
barrassment. If not sufficient, safety is not obtained and all 
commerce soon becomes lost. 
Public inquiry into the manner of administration of the 
various quarantine services at the sea ports of our country 
has never been seriously undertaken, prior to this date, ex- 
cept in two instances—one in the methods in use at New 
Orleans subsequent to the yellow fever epidemic in 1878; 
and the other, those of New York on the arrival at that 
port two years ago, of the cholera infected ship Alesia. 
That the recent epidemic in Florida has given a new impetus 
to every properly interested person to make necessary in- 
vestigation into the subject is apparent, and the permanent 
organization of a qualified board of inquiry, depending for 
its authority upon community of interests, and the unwrit- 
ten law of public opinion, is now a foregone conclusion, 
should the necessity not be provided for by national legis- 
lation. The measures of disinfection adopted at all of the 
quarantine stations in the United States except that of 
New Orleans, and in a minor degree that of New York, consist 
in fumigation of vessel and effects with sulphur dioxide; 
use of solutions of copperas, carbolic acid or mercuric 
chloride over the ballast and iu the bilges, and in some 
instances whitewashing the interior of ships with calcium 
oxide, an additional measure of safety—detention in quar- 
antine more or less short or long being imposed. 
At New York chloride has occasionally been substituted 
for sulphur dioxide, and, by help of a little machine, baled 
rags are heated two or three inches from the channel of 
entrance of a pipe discharging super-heated steam. 61 
The value of methods of disinfection may be obtained by 
colaborating the experiments of chemists and those of 
practical every day use. Of the former the comprehensive 
report of the committee on disinfectants made to the Amer- 
ican Public Health Association at its meeting held in Mem- 
phis in 1886, is most instructive. Of the latter the indi- 
vidual experience of disinfecting officers is of considerable 
practical weight. 
The committee referred to assigned a low place to 
sulphur dioxide as a germicidal agent in non-spore bearing 
nicro-organisms, denied it a position for those bearing 
spores, and recommended its use in so much larger per- 
centages, and for so much longer time than had been cus- 
tomary, as to lead to candid conviction that rarely had any 
beneficial effect ever been obtained by its use at any quar- 
antine station. Disinfection of premises where had oc- 
curred cases of contagious disease, sulphur dioxide fumi- 
gation forming part of the process, from the reports of 
sanitary officers from various sections of the country appears 
to be of great value, but the individual part played by 
fumes of sulphur in the good work has not as yet been ac- 
curately assigned. The experience acquired by the officers 
of the New Orleans quarantine service, after use of the 
agent in a manner as thorough as usually obtained at other 
places, shows repeatedly that cases of yellow fever appeared 
on vessels which had been subjected to its employment. 
Other places present like testimony as to the sometimes 
inefficacy of this germicide. In a series of experiments 
conducted by Assistant Surgeon J. J. Kingyoun, at the New 
Orleans quarantine station—to which duty he was kindly de- 
tailed by Surgeon-General Hamilton—he demonstrated that 
in the customary fumigation of vessels, although the per- 
centage of gas obtained there by means of furnace and 
steam fan was greater than that from the old custom of 
burning in iron pots, no considerable number of classes of 
micro-organisms were killed. His experiments were not 
conducted with intent to ascertain the requisite percentage 62 
of gas, and time of exposure necessary to destroy a partic- 
ular class, but to determine the actual value of usual every 
day fumigation of vessels. The result revealed that sulphur 
fumigation alone usually practiced at any and all quaran- 
tine stations is most probably of very little. 
After prolonged fumigation of rooms with dense fumes of 
sulphur, it is usual to notice a large number of dead insects, 
but close observation will show a certain proportion of live 
ones. The fumigation of baggage at the Waycross station 
during the past summer was certainly as thorough as that 
practiced at any quarantine station, and yet in a letter to me 
from a gentleman at that place, he states it did not kill body 
lice. Not any number of negative facts that yellow fever has 
not appeared on vessels from infected regions subsequent to 
fumigation by sulphur will destroy the potency of one positive 
fact that it has so appeared, and of the latter there are many 
instances on record. Practical experience, therefore, warrants 
the belief that the special cause or poison of yellow fever is not 
always destroyed by exposure to sulphur dioxide in the man- 
ner hitherto practiced. 
The relative utility of mercuric chloride, carbolic acid, 
chlorine, and lime is so clearly and ably set forth in the report 
of the committee above mentioned that I will refer my listen- 
ers to the pages of the proceedings of American Public Asso- 
ciation for 1886. 
The time of detention in quarantine is a matter of consider- 
able consideration, an unnecessary detention is a matter of cost 
and inconvenience to vessels, and to that extent is an embar- 
rassment to commerce. At most of the quarantines the time 
varies from ten to forty days. The value of this portion of 
the quarantine service is sufficient or insufficient whether after 
or before disinfection of vessels. Referring only to the imme- 
diate past, a vessel from Havana lay twenty-one days at the 
Pensacola quarantine, at the expiration of that time went on to 
the wharves of the city ; among the men who began loading 
her yellow fever appeared, and an epidemic followed. A ves- 
sel forty-two days on the voyage from Rio Janeiro lay an ad- 63 
ditional ten days at the New Orleans quarantine, three days 
after leaving, making a total detention, one may say, of fifty- 
five days, two of the crew were attacked with the disease. 
Each of these vessels presented absolutely clean health records. 
Will a detention of ten days be sufficient in a case similar to 
the one at Pensacola, or will one of forty days guard against 
danger from one like that at New Orleans ? After three suc- 
cessive seasons of sufficient disinfection of vessels at New 
Orleans the period of detention has never exceeded five days 
thereafter, and I have every reason to believe that this may be 
safely reduced to three, but invariably dating the hour of 
commencing detention from the time of completed disinfec- 
tion. 
Lengthy voyages and long periods of detention in quaran- 
tine remove no source of danger, but on the contrary are full 
of peril to an over confident community. The form of quar- 
antine service compatible with safety to those parts which do 
not possess sufficient tropical trade to justify expensive and 
properly equipped sanitary apparatus may be inexpensively 
obtained, if operated in conjunction with those quarantine 
stations now and about to be established by the National Gov- 
ernment. Let these be considered as stations for the treat- 
ment of vessels then and recently infected, and the local sta- 
tions for the cleansing and observation of vessels with clean 
health record from suspected or infected ports. Not every 
vessel from contaminated ports is dangerous, but the possibility 
of positively determining its true character exists in nearly 
every instance. Observation of the records of vessels mani- 
festing infection at the port of entrance, after having been 
free from disease during the voyage and at the port of depart- 
ure, will invariably show that such manifestation has occurred 
among the laborers who first went on board and engaged in 
shifting ballast and cleaning holds, or among the sailors who 
got out from the depths of their bags and boxes articles which 
had been packed away while in an infected atmosphere and not 
since disturbed. Infection, whether conveyed thousands of 
miles by sea, during hundreds of days, at the bottom of a 64 
sailor’s bag, is as highly dangerous as that brought in a closed 
carpet sack, in as many hours, on a railroad car by land. Un- 
packing of all goods, shifting of ballast, cleaning up holds and 
all nooks and corners, pumping out bilge water, removal of 
boards along each side of the keelson, the accumulated filth 
taken out, and all of that work necessary to put a vessel in a 
perfectly cleanly and well ventilated condition being done, 
will, in the vast majority of instances, cause any existing lurk- 
ing infection to declare itself in the illness of some of those 
engaged in such labor. Usually this work is done at the 
wharves of the port of entrance, and usually at this time the 
seeds of a devastating disease are sown amongst the inhabi- 
tants. 
The question may be asked whether this work had not best 
be done by acclimated men. The fact that at few ports can 
acclimated men be found is the answer. If possible, to make 
assurance doubly sure, disinfection of everything on board 
should be practiced. By means of a pump worked by two 
men, and sufficient leads of hose, solutions of chemical disin- 
fectants can be thrown to all parts of the vessel. Should 
sulphur fumigation be decided upon all textile fabrics should 
be carried into the holds and hung loosely and separately upon 
ropes stretched across. Either the liquified anhydrous sulphur 
dioxide confined in iron flasks and liberated by means of screw 
cocks, or a simple inexpensive reverberating furnace, loaded 
with three pounds of sulphur to every thousand cubic feet of 
space to be disinfected should be fired and lowered into the 
holds, the hatches and all other openings tightly closed, and 
the fumigation proceeded with for at least twelve consecutive 
hours. Thorough ventilation of every part of the vessel should 
have been obtained by wind-sails or other means, and a certain 
amount of moisture left in the holds for greater efficiency of 
sulphur fumigation. If at the expiration of the five days after 
such cleaning and disinfection, no case of yellow fever appears 
amongst the crew of a vessel so managed and treated she may 
be safely considered harmless to any community. Liquified 
anhydrous sulphur dioxide will probably very soon take the 65 
place of the gas obtained by burning sulphur in furnaces. 
This article, liquified under pressure, is manufactured in this 
country, but the cost here is about $65.00 per hundred 
pounds. At the works of a zinc factory near Oberhausser, 
Germany, the gas will be placed on cars in suitable, safe, and 
conveniently handled flasks, or retorts, for $4.00 per hundred, 
or about the cost of that weight of rolled sulphur itself. As 
it is easily transferred from a large to smaller receptacles, and 
the cost in bulk is much less than in package,'considerable 
economy may be practiced by importing in large retorts. It 
volatilizes to about 2700 times its original bulk after being 
liberated, and this property adapts it particularly for use on 
vessels with cargo. Certainty in percentage to contained at- 
mosphere is another recommendation. An experiment will 
most probably be made with it the coming summer, and if so, 
and permission can be obtained from Surgeon-General Hamil- 
ton, the result will be published in the Weekly Abstracts of Re- 
ports of the Marine Hospital Service. The treatment neces- 
sary for actually infected vessels will require an apparatus 
more costly than the limited tropical commerce of many of 
our ports would justify. Through the liberality of the Gen- 
eral Government some stations of this character are already 
established and others soon will be, and to these stations should 
be sent all infected vessels which arrive at ports whose quaran- 
tine service is not properly equipped for the treatment neces- 
sary. Of all the quarantine systems which treat actually in- 
fected vessels, that at Hew Orleans is most assuredly the best. 
The institution of the system is due to the intelligence and 
untiring labor of Joseph Holt, M. D., wrho, after much opposi- 
tion, and much unfavorable criticism, succeeded in establishing 
methods ensuring, when properly administered, entire safety 
from danger of yellow fever, at the same time disembarrassing 
trade of hurtful restrictions. The success which this man 
achieved, disenthralling Hew Orleans from the annual sway of 
yellow fever and permitting opportunities for the indefinite 
extension of her commerce and manufactures, entitles him to 
the admiration and gratitude of his fellow men, and to a die- 66 
tinguished place in the foremost rank of philanthropic sanita- 
rians. Descriptions of this system have been so often, and so 
widely published, that full particulars are now unnecessary. 
The experiments conducted by Assistant Kinyoun at this 
station last April showed, however, that pre-eminent as its 
success had been, in protecting the country from the intro- 
duction beyond its limits of even one case of yellow fever, 
certain improvements to reach scientifically positive germi- 
cidal effect fn all classes of known pathogenic micro-organ- 
isms were necessary. In order to reach this result the 
board of health of Louisiana decided upon the erection of 
cylindrical heating chambers, 8 feet in diameter and 50 feet 
long, built of steel, and capable of safely bearing 15 lbs. 
working pressure to the square inch. These chambers are 
provided with tightly fitting heads, steam coils and jets, 
guages, thermometers, blowoffs, suspended rail tracks, and 
racks on which to hang all textile fabrics. Although not 
as yet completed, the contractors guarantee 250 degrees dry 
or moist heat, can be attained in them within 30 minutes. 
The application of a lower temperature than this, 230 to 212 
degrees under pressure, ensuring uniformity of temperature 
throughout the matter to be disinfected, will fulfill the high- 
est expectancy of success, and every requirement of the 
best practicable disinfectant recommended by that high 
authority, the committee on disinfectants of the American 
Public Health Association. By way of parenthesis I will 
state that this form of apparatus, mounted on platform 
cars, wras urgently recommended to the Surgeon General of 
the Marine Hospital Service early last summer for use at 
the outlets from Florida. I have assurances that if the na- 
tional government does not adopt this or some other good 
process for inland use, such will be built by private sub- 
scription, and placed in the hands of local authorities at 
points of egress, from any place which may in the future 
become infected. With the addition of elevated tanks from 
which solution of mercuric chloride may be thrown over 
every portion of the interior of vessels, steam fans for 67 
changing atmosphere of holds and replacing it by one 
charged with sulphur dioxide, hoisting engines for the dis- 
charge of ballast, hospitals some distance removed for the 
care of the sick, the New Orleans quarantine station is 
equipped to satisfy every demand of science, of commerce, 
and of humanity, and the practical experience of three suc- 
cessive seasons demonstrates its sufficiency to effectually 
deal with that poison which has eluded the grasp of the 
pathologist and the vision of the microscopist, the yellow 
fever germ. 
The treatment absolutely necessary for actually infected 
vessels must approach very closely to that in vogue in Lou- 
isiana, or public apprehension of the danger from vessels 
otherwise infected cannot be allayed until long years of suc- 
cessful work under those different methods practically de- 
monstrate their sufficiency. APPENDIX III. 
QUARANTINE REGULATIONS. 
COL. J. C. CLARK, VICE-PRESIDENT MOBILE & OHIO RAILROAD. 
To the Chairman of Quarantine Convention, Montgomery, Ala. 
Sir :—My experience in operating railroads, under quar- 
antine regulations, leads me to suggest : 
1. There should be uniform rules adopted for the man- 
agement of quarantines, as far as practical, which regula- 
tions should name what articles of merchandise, &e., &c., if 
any, should be permitted to be transported by railroads, to, 
from or through infected points, during the prevalence of 
yellow fever or other infectious or contagious diseases, to 
enable railroads to co-operate with boards of health, in re- 
fusing to receive for transportation, such articles as are 
prohibited. 
2. A well digested quarantine formula, making and pro- 
mulgating the necessary rules and regulations for enforcing 
the same, should be prepared, ready to be put in force 
when necessary to do so, at all points where it is necessary 
to put quarantine in force. These rules should be published 
for public information, to enable all persons to comply with 
the same, and displayed by placard in every depot. 
3. At quarantine stations, accommodations should be 
provided for caring for such persons, if any, that may be 
detained, or are not permitted to pass through such sta- 
tions, while in transit until they can be disposed of. 
4. Only first-class, reputable physicians, who have had 
experience with contagious and infectious diseases, should 
be made inspectors at quarantine stations upon railroad 69 
trains, travelling to and from designated points, whose duty 
shall be to inspect and examine the condition of passengers, 
baggage and express matter. Such inspectors should have 
the power to admininister oaths, and to remove from the 
trains, or detain such passengers, baggage or express mat- 
ter, &c., as may be found necessary to prevent the introduc- 
tion or spread of infectious or contagious diseases of any 
kind. 
5. State boards of health should be the powers author- 
ized to put quarantine in force. They should determine 
when, where and for what length of time quarantines should 
be maintained; provide the means necessary for enforcing 
the same, and promulgate rules and regulations for con- 
ducting quarantines. 
Presidents and secretaries of state boards should be re- 
quired to visit and inspect all quarantine stations, as often 
as practicable, during the existence of such quarantines; 
and to make public, over their signatures and official posi- 
tions, the general condition of the public health at the 
points where quarantines are established, and the localities 
affected by such quarantines. Local health officers, muni- 
cipal or county authorities, may establish quarantine regu- 
lations, conferring with the state board, if deemed necessa- 
ry, for co-operation. The regulations for governing local 
quarantines should not be in conflict with the rules and reg- 
ulations adopted by the state boards of health for enforcing 
quarantine regulations. 
6. The national government should take charge of and 
maintain a rigid maritime quarantine, and locate snch 
quarantnne stations at such points on the sea-coast 
and on navigable rivers, at proper points, so as to 
prevent the introduction of yellow fever or any oth- 
er contagious or infectious disease into any state or 
territory of the United States, leaving to the state authori- 
ties, the power to deal with these matters in the states, 
outside of maritime quarantine. It should be the duty of 
the general government to provide and conduct such mar- 70 
itime quarantines, so as to prevent the introduction of yel- 
low fever, or any other infectious or contagious diseases 
from being communicated to the inhabitants or people 
of any state or territory of the United States. 
If this were done, and earnest co-operation secured, 
there wonld be no conflict or friction detrimental to the 
general public health, between state and United States au- 
thorities; but a hearty, earnest effort to secure the pur- 
pose intended —the preservation of general public health. 
7. When any suspicious case occurs, the nature of 
which has not or cannot be determined at its then present 
tage, or doubts arise as to the nature of the case, wise 
precaution demands that such case be immediately isolated 
from contact with all other persons until medical science 
has diagnosed the case, and is able to determine the nature 
of it, beyond doubt. When conclusions are reached, they 
should be made public. Such a course would allay the 
fears of the people generally. 
8. Experience has proven that by proper precautions 
and constant vigilance on the part of well organized Boards 
of Health, yellow fever and other contagious and infectious 
diseases, can be kept out of the country, without resorting 
to the doctrine of absolute non-intercourse, or paralyzing 
commerce and industrial pursuits, or interdicting travel 
within or beyond the limits of state lines. 
9. The legislatures of the different States should appro- 
priate such sums of money, as a fund for protecting the 
public health in the states, as would be sufficient to meet 
all necessary expense incurred for this purpose, under a 
well digested law, throwing proper safe-guards around such 
appropriations, so as to insure economy and responsibility. 
In dealing with the subject of the general public health, this 
is a matter that admits of no pinching policy, and the 
appropriations should be large enough to fully provide the 
necessary safe-guards, and thus meet the purpose intended, 
the preservation of the general public health. With 
proper officers conducting this matter, no more money 
would be expended than is absolutely necessary. APPENDIX IV. 
THE EPIDEMIC OF YELLOW FEVER AT GAINES- 
VILLE, FLORIDA, AND DEDUCTIONS THERE- 
FROM ; BY MR. JOSEPH VOYLE, C. E. 
Before we can intelligently devise any method of quaran- 
tine, it is necessary that we understand something of the 
nature and habits of that which is to be quarantined against, 
so as to bring into accord, as near as possible, the greatest 
degree of public safety, and the least degree of public em- 
barrassment. 
When first entering upon the work of writing a history of 
the epidemic of yellow fever at Gainesville, Florida, it was 
intended to give in detail every incident that came to my 
notice. This being altogether too voluminous for reading 
here, and having much that, whilst of general interest, is 
not directly related to the subject before us, I have selected 
such portions as appeared to me to be worthy of consider- 
ation, in devising methods of prevention, or avoidance of 
yellow fever. 
I have for many years past made careful study of every 
item of information that I could obtain on this subject; 
much has been written thereon, but so entirely has this 
writing been confined to medical men, that I feel as if I was 
intruding, by offering the results of my studies on this 
subject. 
But the doctor in his noble work of relief at the bed- 
side of the individual, and the civil engineer in his work of 
controlling the insanitary conditions of the community, are 
both in a position to study the course of an epidemic, 72 
although from different standpoints. If it be made a matter 
of mutual interest, they can together do far more than either 
alone. 
Having enjoyed the intimate friendship of doctors 
eminent in their profession, and experienced in yellow 
fever; reading whatever I could find written; personally 
observing, when practicable, I have necessarily obtained 
some practical information on the subject before us; and 
this 1 have tried to classify, arrange and, as it were, to 
crystalize into a few short sentences as deductions there- 
from; and as they are from a far wider field than the local- 
ity of my short history, I give them first; then, as incidents 
are related, the mind will readily recall and compare. 
My deductions are— 
That the cause is specific and foreign to our climate. 
It is to the general public, invisible and in- 
tangible. 
Its transportation and multiplication is almost altogether 
confined to human beings, and to fluid or moist matter. 
It is strictly non-contagious. 
It is infectious; the infection is confined to certain limited 
conditions. 
It is not always epidemic. 
Epidemics occur only under certain conditions. 
Epidemic conditions are cosmic, atmospheric, terrestrial, 
and require the presence of the specific cause. 
The cosmic conditions are periodically recurrent, and 
always beyond human control, but they are partially calcu- 
lable. 
The atmospheric conditions result from the cosmic and 
terrestrial, either or both; the cosmic may be absent, the 
terrestrial is always necessarily present. 
The cosmic intensifies and extends. 
Cosmic conditions are general, over a large area. 
All necessary conditions except the specific cause, may 
exist; the conditions cannot, without the specific cause, pro- 
duce yellow fever. 73 
Atmospheric and terrestrial conditions are confined to 
limited areas, and are intimately associated with each other. 
Meteorologic, as a part of atmospheric conditions, cause 
variation in terrestrial conditions. 
Terrestrial conditions are sometimes very small in area; 
recognizable and hence avoidable. 
From observation, I give this hypothesis concerning the 
specific cause: 
That it is a distinct entity. 
That it has three periods in its life history. 
That these are: the destructive, the transformative, and 
the infective. 
That it is transferable in either form, but, under dissimi- 
lar conditions. 
That when finding a lodgment in the human body, it in- 
cubates, and takes the destructive form ; and may thus be 
carried from place to place. 
That it is ejected from the body when its destructive life 
is complete, and that when it leaves the body it is neither 
contagious or infectious. 
That if, when ejected, it finds suitable conditions, it trans- 
forms to the second stage. 
That in the second stage it is germinative and multiplying, 
producing the third stage; in which it is aerial, or aeriform, 
and infective. 
That finding suitable conditions, the second form may 
permanently remain and produce the infectious form. 
That the conditions for transformation are wet or moist 
dead vegetable matter, and a suitable temperature. 
That the infectious form will travel to a considerable dis- 
tanced a moist atmosphere at a suitable temperature. 
That the specific cause in all forms is rendered perma- 
nently inactive by low temperature and absence of moisture. 
That careful cleanliness without destruction of fcecal 
matter, is no protection against yellow fever. 
I am aware that, unsupported by well established facts, 
these sentences have little or no value for guidance in the 74 
field of action. I come from the field of action, where all 
other occupations being suspended, there was opportunity 
for observation, and, with a desire to search out the truth 
for the simple sake of the truth, and wanting nothing but 
the truth, as far as I could understand it, I collected and 
classified facts as I found them, and these are the deduc- 
tions therefrom. 
As to how far your judgment will approve my deductions, 
let my sketch of the life history of the epidemic at Gaines- 
ville, Florida, occupy your attention, and then judge for 
yourselves. 
As I have cut this history down, to save time, if any part 
be too sketchy on important points, I shall be pleased to 
give further details thereon: 
First, as to cosmic conditions— 
Quite recently there have appeared statements that there 
was evidence of periodicity in widely extended epidemics, 
and that there was probably an influence outside of the 
ordinary conditions for health; and beyond the reach of 
quarantine. It has been called a pandemic wave. Statistics 
of epidemics running back more than a hundred years, 
when graphically tabulated, show periodic wave crests, 
with ripples or smaller waves between, and these wave 
crests appear at remarkably regular distances, having an 
average of eleven and a half years. From the statistics it 
was shown that the probable return of the wave to the 
United States would be in 1887, entering at the southern- 
most point of the Atlantic States and moving northwards. 
That the period would probably be four years; and, seeing 
that it did come to Key West in 1887, and more northwards 
to Tampa, and in 1888 further northwards to Jacksonville 
and other places, I expect to see it this year, 1889, in the 
latitude of Savannah and Charleston. 
This period of eleven and a half years is the period of 
maximum and minimum sun spots, also of greatest heat and 
cold, and other phenomena. 
Permit me to call your attention to other diseases in 75 
epidemic form, co-existent with yellow fever, aod also the 
unusual epidemic of accidents. 
Call it what you will—there exists a something, from 
which nothing can save; precautions may mitigate, they 
cannot obviate. 
In positions where yellow fever is always present, its 
complete history is never known, because it never dies. In 
centers of trade, where it is usually widely spread before 
being publicly known and recognized, its history is incom- 
plete, and confused with other forms of disease. 
Instances of complete isolation and a complete history 
are rare. The epidemic at Gainesville, Florida, offers 
nearly a complete case. 
The entire community were on guard in some way ; every 
one was aware of the existence of the fever in the State; 
and also of the importance of keeping Gainesville free, as it 
was the only outlet giving to travellers from southern coun- 
ties a route distant from known infection. 
An unusually long drought prevailed during the early 
summer. The rainy season did not set in until August, 
then came, almost daily, a deluge. The atmosphere was 
highly charged with moisture, and fungi grew everywhere. 
Rooms closed for a day or two took on a bad odor. Bed- 
ding smelt mouldy even in well aired rooms. Clean beds 
were really disagreeable from the mouldy smell. 
Just here let me digress a moment to state that five cells 
containing a saturated solution of bichloride of mercury, 
used to amalgamate battery zincs, was completely covered 
with a film. An examination of this film under the micro- 
scope showed a cell formation. I intended watching the 
growth of this unexpected phenomena, but public measures 
prevented. Fungus and lichen thrived, but there was no 
sickness; the health of the community was unusually good; 
the doctors had nothing but old or chronic cases; only 
three were in practice, where at other times there had been 
eight. 
There was widespread complaint of slight nausea, pain in 76 
the forehead and in the back of the neck; rarely enough to 
be severe or disabling, but distinct. In every case after re- 
covery from the fever these symptoms left. 
There was another marked symptom; mental trouble that 
I wish to speak of as possibly referable to the pandemic 
wave; a sudden awakening, without being conscious of hav- 
ing slept, or a consciousness of a momentary lapse of mental 
action—it is indescribable—but at this time I noticed 
railroad and other accidents occurring as if they too were 
epidemic. 
In the testimony of the men, one stated that he saw the 
signals, but did not realize their importance until too late; 
why, he did not know. Others stated that they could not 
tell why they did not do as usually they had done for years 
before. 
Is there in these cases a mental lapse; a momentary sus- 
pension of brain action? It was certainly one of the symp- 
toms of yellow fever; a momentary failure to realize facts 
presented, followed by quick apparently normal action of 
thought, in total ignorance of previous lapse. 
Sanitary measures were pushed to an extreme, in some 
directions; some matters were ignored ; badly drained de- 
pressions and choked ditches retained the water that filled 
them until it was absorbed or evaporated. The city is situ- 
ated on higli ground, with good natural drainage. 
At the northern boundary a stream rises, passes under 
the S. F. & TV. R. R., runs east, then south, when due east 
of the public square it is about 400 yards distant, and is 
thirty feet below the square. It passes under the F. R. <fc 
N. R. R., then under the Fla. Southern R. R, and when due 
south of the transfer depot it is seventy feet below its 
source. Another stream rises in the northwest part of the 
city and runs west, with a fall of thirty feet in half a mile. 
Still another stream rises in the western part and flows 
south, with abundant fall. Gainesville occupies the highest 
land between the gulf and Atlantic ocean, lying north of the 
peninsular notch, its elevation is about two hundred feet 77 
above sea level. Into the streams above mentioned, ditches 
conduct the service water. There is no complete system of 
drainage; no sewerage. 
When the guard’s sickness caused alarm, plans were made 
to leave the city if it proved to be yellow fever. It was so 
announced at the churches on Sunday evening September 
16th, and all night long hurrying crowds filled the country 
roads, and by morning few remained. I was one of the 
few. On October 1st I wrote and published the following 
for information of refugees and others interested : 
Gainesville’s fever—an effort to locate the cause of it. 
The death of Maj. N. R. Gruelle, after three days of yellow fever, has 
caused a stampede among the few remaining citizens of this place, cast 
a deeper gloom around us, and shaken the faith of those who relied im- 
plicitly on the hon-infection high pine land theory. 
Theories appear to be all sadly at fault in this yellow fever matter. 
Doctors disagree and experts are at variance. 
After all the experiences of past epidemics, it is reasonable to expect 
that medical men should readily recognize the fever in its incipiency, 
take promptly a definite line of action with a high average of favorable 
results, and so inspire confidence. But since this is not so, there must 
be a grave fault somewhere. Is the fault with the doctors? The doc- 
tor’s proper realm is the treatment of disease when it appears, not the 
prevention of its appearance. From variety of surroundings cases may 
be complicated with other forms of fever, thus varying the symptoms, 
and so the indications in the experience of a doctor in one locality may 
differ essentially from that of another not similarly located, and thus 
may arise honest difference of opinion. 
There is needed careful investigation, an assemblage of facts, well 
authenticated, carefully classified and compared regardless of any the- 
ory or any one’s reputation. Such investigation should be made by 
residents of some years within the area of probable epidemic action. 
Experts, of however high repute elsewhere, are sadly misled by mis- 
taken ideas in unfamiliar surroundings, and oftener avoid than invite 
necessary information from those best able to give it in the form in 
which it will be most useful. 
A large number of plain, simple statements of the first symptoms, and 
the progress of the disease, obtained from intelligent persons who have 
passed through the ordeal of yellow fever, might be collected, classified 
for similarity and variation, and deductions therefrom be put in useful 
form for public distribution. A similar work by doctors is evidently ad- 78 
visable. TJnfamiliarity with symptoms and widely varying methods of 
treatment form the elements of the wdld terror inspired by the possi- 
bility of being a victim to yellow7 fever. Thoroughly isolated cases, 
either as communities, families, or individuals, should be sought out as 
being best calculated to give a definite, useful series of facts. 
The case of Gainesville is, to some extent, thus isolated. A com- 
pany of men in ordinary health are absent five days, their whereabouts 
during that time is strictly well knowm. They return nearly all sick. 
All apparently recover except six ; these develop yellow fever. They, 
with the friends or relatives who happened to be with them, are isola- 
ted. The fever takes its course. None of the attendants, not even in 
the case of fatal termination, take the disease. In one case the out- 
break is delayed and terminates in death. Again the attendants 
escape. 
Here we have one prominent fact, verified by seven isolated and dis- 
tinct instances, in which yellow fever is brought from afar and intro- 
duced into the midst of a thickly inhabited region, passes through all 
its stages there without communicating itself to those in immediate, 
continuous and prolonged exposure to its influence. 
Seven such clearly defined cases may rarely be found, and they form 
a nucleus around which to assemble similar ones when found; and from 
all to try to ascertain and understand the conditions of this immunity 
for future guidance. 
The question naturally arises here : Did these cases contain the ele- 
ments of contagion? and further, w'hat are the conditions necessary to 
immunity and to contagion? 
Here, sad to relate, we are not without positive information. 
When a week or more had passed the board of health deemed it ad- 
visable that the houses of refugees, which had been closed, should be 
opened and fumigated. 
Maj. N. R. Gruelle volunteered to perform this work. He told the 
writer that he found in several houses a foetid odor from decaying food 
and other matter left in the stampede. This he and his assistants re- 
moved before fumigation. 
In this work he hurried from place to place and over-exerted himself, 
as shown by his perspiring condition and fatigued appearance on a very 
hot day. Being asked why he did not keep out of town he replied, “I 
am not afraid of the yellow fever spreading in this pure atmosphere.” 
Turning to your correspondent, he said, ‘‘I do not really know7 how far 
I have been exposed, and I don’t want to go beyond prompt help.” 
Maj. Gruelle and Dr. Fitch Miller were intimately associated in busi- 
ness. The major’s office was in the same building where Mr. Ammon’s 
room was, using the same entrance. Dr. Miller’s death from the fever 
was a sad blow to him, and deepened the fear of his possible infection. 
He wras stricken down with the disease and on the third day he died. 79 
We can trace Maj. Grnelle’s whereabouts every day during the period 
of the fever brought by the guards, and know that he had not been ab- 
sent from here during that time, nor for some time previous, nor had 
any member of his large family been away recently. 
The evidence appears to be conclusive that he was infected by the 
fever brought by the guards, consequently, the fever was communi- 
cable in its most fatal form. Here we are met by one of those diffiulties 
which beset the path of investigation. Those in the constant presence 
of the disease escape without any trace of its effect on themselves; 
another, after questionable exposure, is smitten to death. There must 
be a reason for this. Yellow fever must act in accordance with nature’s 
fixed laws, and these laws are not, presumably, past finding out. 
We have here from the same introduction, cases of complete non- 
infection, and also fatal infection. Can we separate them? Like causes 
under like conditions invariably produce like results. Here we have a 
given cause, but opposite results. 
The results being different whilst the cause remains the same, the 
conditions must be different. If we can find any marked difference of 
conditions in these cases, it may form a guide to further investigation 
elsewhere, and the recurrence of similar conditions where the fever has 
become epidemic, may mark a step in progress toward the recognition, 
avoidance or removal of that one condition conducive to the spread of 
this hitherto untamable horror. 
As soon as the cases were decided to be yellow fever, all persons in 
the houses infected were confined therein, none allowed to go in or out, 
and nothing to pass out; complete isolation was strictly enforced by 
armed guards. 
In these houses conditions for infection presumably did not exist. 
What possible difference of condition could Maj. Gruelle have en- 
countered? His residence was nearly one mile east of the court house, 
just outside the city limits, and less than 200 yards beyond the house of 
Mrs. Evans, where her son, Lieut. Evans, died of the fever. Between 
these two houses there was a low place, where water stood after heavy 
rains. 
The major mentioned this wet place to your correspondent and said 
that it had puzzled him as to which was best to do, to dig a ditch to 
drain the water, and so expose fresh earth to the atmosphere, or let the 
water stand and evaporate and stagnate; that he had, however, decided 
to dig the ditch, and it was being done then. 
Now for difference of conditions. We have several persons isolated 
with cases of yellow fever, but they are neither over-worked physically, 
exposed to foul atmosphere of closed rooms, to night air, neighborhood 
of stagnant water or emanations from freshly moved wet earth in the 
immediate vicinity of a virulent cage of yellow fever. 
But we find that Maj. Gruelle encountered all of these; the exposure 80 
to night air was only the chilly time of the late evening, but at that 
time he passed into and through the atmosphere over I he wet spot. 
Now, are all of these conditions, or only one, conducive to the spread 
of yellow fever? Mr. Gruelle’s assistants were as much exposed to the 
air in the closed rooms as he was; none of them are sick. Others were 
very tired from over-exertion, got home as late as he did, but are still 
well. If the wet atmosphere is the condition others should then be also 
infected by his presence and favorable conditions. They" are. Two 
members of his family have the fever. 
The inference is thus warranted that one of the conditions under 
which yellow fever can spread is produced by the evaporation of water 
from freshly stirred wet earth, or from dead vegetable matter. 
This is only an inference, but it directs inquiry to other places where 
the disease has spread, and suggests the question : Is there always an 
area of fresh earth, or dead vegetable matter, wet enough for long con- 
tinued evaporation ? and, does the fever exist there when these spots 
are dry ? 
Let us inquire of Plant City. We are informed that this place is of 
recent origin and rapid growth, situated in a hitherto healthy pine re- 
gion. There are large areas of pine sawdust in shallow wet places; but 
pine sawdust, we are told, is healthy to have around. 
Let us look at Macclenny. It is the same condition. The sawdust 
there has been spread over the streets, fresh land has been cleared, pine 
stumps, limbs and roots are passing through ferment to decay in the 
immediate vicinity. What of Jacksonville? We find no large areas of 
sawdust there. There are handsome streets, clean as can be in any 
business city, and it is situated partially on high sand ridges, with the 
broad St. John’s river on one side and arms of the river on the other, 
with natural drainage in both directions. What can cause the epidemic 
there? We must hunt for something different, possibly akin to con- 
ditions noted elsewhere. 
At the wharves and railroads there is a large area of dead vegetable 
matter exposed, but it is dry ; in the marshes there is a large wet area, 
but it is covered with living vegetable matter. The marshes have been 
built out upon, the river margin has been built out upon. Has any newr 
work been done? No. What is the material of the filling? Princi- 
pally slabs, refuse from sawT mills, sometimes covered by a layer of 
earth, and sometimes by a cover of plank. 
Let us examine this pile of the road blocks used in the streets. Cy- 
press trees about the size of large telegraph poles are cut into blocks 
about five inches long. These are placed end up on boards, the crevices 
filled with small pieces and sand. It is claimed that, being made of 
cypress, there would be no rotting, and consequently no danger of dis- 
ease from these blocks. 
There wTas no epidemic in Jacksonville until August. 81 
During the early summer there was an unusually extended drought. 
The rainy season set in in August. 
The conditions we find in Jacksonville are that these road blocks fur- 
nish acres upon acres of dead vegetable matter. During the early part 
of the hot season the blocks were dry. When the rainy season sets in 
they present an immense surface for evaporation, each block being a 
miniature sponge. As long as this surface was dry there was no epi- 
demic. As soon as it became saturated with water the conditions for 
continuous' evaporation over a large area were complete, and coincident 
therewith the epidemic began. If then, on the return of dry weather 
the epidemic abates, it will further corroborate the evidence that evap- 
oration of water from a surface of dead vegetable matter, under a suita- 
ble temperature, is intimately associated with conditions favorable to 
yellow fever in epidemic form. 
The evidence, however, is not conclusive. It is circumstantial, show- 
ing coincidences that are very suspicious, and apparently presents a 
clew leading to the discovery of the truth. Such investigation, con- 
tinued, will surely lead to a better knowledge of conditions. Then 
their avoidance will follow, and a modification of the ravages of the dis- 
ease must result, and all the attendant horrors of stampedes, quaran- 
tines, etc., become tales of the past. 
Let us return to Major Gruelle’s family. The family was 
moved to another house, about three hundred yards distant from 
their own. This house was situated on a lot that was formerly 
a pond; a large ditch ran along the valley near the house. 
After a few days the members of the family not sick were 
taken to the quarantine hospital; leaving two sick at the house; 
one of these died. None of the attendants at this house at this 
time were sick. This house was used as a pest house, and other 
cases were moved into it; there were two deaths there; one 
attendant was taken sick there. Later after some warm misty 
weather there were at the two heads of the ditch, four cases, 
one fatal. Still later after a few days of foggy weather, there 
was a case in a house on a sandy ridge, about two hundred 
yards from this pest house, a large family of children remain- 
ed in the house, none of them or the attendant took the disease. 
Two of the original cases of guards show no subsequent cases 
traceable to them; both were in thickly populated neighbor- 
hoods, one on a sandy ridge, and no precautions taken with fe- 
cal matter, the other on rich soil, but all fecal matter chemi- 82 
cally treated. Two cases were in one house, no attendants were 
infected, the last case of the guards was also moved here, it 
was fatal ; all survivors were moved to the quarantine hospi- 
tal. The fecal matter of these three cases was disposed of at 
the closet at the back of a small garden. After the house was 
vacated, two persons visited the lane close to the closet, they 
both took the fever; at their homes none of the family took it 
from them. A colored man slept in a room near this closet; 
he took the fever. 
The other two original cases show the same immunity of 
attendants. ±Near the house occupied by one of these, is a 
ditch leading to a larger ditch ; these were nuisances ; disin- 
fectants had been freely used in them. After a period of wet 
and foggy weather, the fever entered a family living near the 
ditch, and father, mother and daughter died in quick succes- 
sion. The mother and daughter had attended the father ; two 
sons escaped. In another house right on the ditch a man and 
his wife had the fever, the husband died, the wife recovered. 
By this time the foci were so numerous that the whole 
city was considered poisoned. The U. S. M. IT. service was 
in charge of the place. 
In the beginning precautions as to complete isolation and 
non-communication were observed, and enforced by arms, and 
carried to the extent of taking all relatives away from the suf- 
ferers and placing hirelings in charge, and allowing those ta- 
ken away to take no other clothing than that upon them ; 
and, as no other was provided, smuggling was carried on ; 
clothing direct from infected houses was obtained and worn, 
and no evil effects followed. 
From avoiding the street where a yellow flag waved, through 
every gradation of crossing to the other side, not crossing to 
barely noticing; and from a wild terror of one stricken down, 
to sitting by the bedside, are the gradations through which 
our people passed. From non-intercourse to no restriction 
whatever. All of these changes in conduct appeared to make 
no change in the epidemic; an examination of the chart gives 
no evidence of these changes. 83 
When the epidemic was at its worst the State and National 
election oame on, and the polls were opened for Gainesville in 
a house where it was afterwards known that a concealed case, 
of yellow fever had been. 
Here were the usual crowdings of elections, persons with 
distinct symptoms of the fever on them were seen here, and 
an outbreak was expected ; but it did not come. One of the 
family occupying the house, the wife of the man who was 
sick there before, subsequently had the fever ; but no case was 
traceable to this mixing up of people from the infected and 
non-infected places. 
A census showed only 150 whites and — colored people 
within the city limits. Business was done between the hours 
of 9 and 3, and on sunshiny days many persons came in be- 
tween these hours; and, no case was reported where these 
hours, in fine weather, were adhered to ; but several cases oc- 
curred from visits made in wet and foggy weather. Much of 
the weather during the latter part of October and in Novem- 
ber was wet; in November very wet. 
Speaking of the house lots, the infection began in the clean- 
est places in the city, in the ordinary meaning of cleanliness. 
Shall I be understood if I say, the soil, the dirt was clean % 
Continued rains made the soil wet; during the epidemic it 
was rarely dry; and often flooded to saturation, so that drain- 
age was slow, but the temperature remained high. Up to the 
middle of November the weather was warm, never below 75 
degrees Farenheit, often 85. 
On the 20th November it turned cold, there followed a re- 
duction of cases within the next two days ; on the 23d there 
was no case reported for the first time since October 25th. 
Two were reported November 24th, 25th none; we had the 
first ice on this day ; during the next night the temperature 
was still lower and by morning ice formed one-fourth inch in 
thickness. On this day, November 26th, three cases were re- 
ported, 27th one case, 28th two, and this ended the epidemic. 
The chart shows a periodic grouping in the beginning of the 
epidemic, further on it becomes fuller between groups and 84 
probably in a longer continuance there would have been such 
an overlapping of periods as to show no grouping at all. These 
groups appear to have some significance ; especially as the 
epidemic ceased within a group period, after the first frost. 
If the chart groups show the period of incubation, then seven 
days, dating from exposure, is the least period of safety for 
quarantine of persons. 
As the character of the surroundings of residences of those 
attacked with the fever, appeared to have a decided influence, 
not only on the spreading of the disease, but in intensifying its 
effects, I have classified the cases of the whites under the 
heads, Wet surroundings : which includes proximity of drains 
or ditches, and dry surroundings. 
This shows, 
Wet surroundings 14 cases, 9 deaths, 5 recoveries. 
Dry surroundings, 30 “ 3 “ 27 recoveries. 
Nearly all wet surroundings were temporary, the result of 
long continued rains. 
The dry surroundings were the results of higher positions, 
or more porous soil. 
It is an interesting question, whether or not the fever would 
have spread beyond the original cases had the weather been 
dry. 
The introduction of skilled nurses, was by far the most im- 
portant of all the measures taken for relief and care of the 
sufferers. The nurses are held in grateful remembrance in 
Gainesville. They inspired confidence, gave hope, and the 
much needed practical instruction. 
The physician cannot be the nurse, and skilled nurses can- 
not be improvised. Kindness to the sick, it was found might, 
when unaccompanied by proper knowledge, be as fatal as neg- 
lect. 
Bedding and clothing used without disinfecting beyond or- 
dinary washing and airing, gave no trace of infection ; even 
bed-fellows were not infected where the fever was brought 
home by one of them. 
I can trace no case where the disease was carried from an 85 
infected spot bj anything, or any means other than a sick per- 
son who was him or herself infected. 
In the light of the information displayed by the epidemic 
of yellow fever at Gainesville, Fla., quarantine against this 
particular disease should be directed to human beings and 
fluids, wet, or moist material from infected regions, and that 
when the disease is introduced to a community, all fecal mat- 
ter from the diseased persons, and suspects, should be chemi- 
cally disorganized, and placed in a special receptacle; this to 
be removed for further disposal; preferably by fire for extra 
precaution. 
Under such a regime business becomes enfranchised within 
certain definite limits. Traffic is continued under definite reg- 
ulations. Travellers can know beforehand definitely the period 
of their legal detention, and make provision therefor. And 
thus the curse that fell upon the little city on the hills of Flor- 
ida may become a blessing to the people who so generously ex- 
tended their kindness to her, in her sad hour of need. APPENDIX V. 
RESOLUTIONS OFFERED BY MR. B. R. FOREMAN, 
OF NEW ORLEANS. 
Resolved, That it is the sense of this convention, that 
the time has come when Federal Resources and Federal 
power should be organized and exercised to regulate and 
control Inter-state as well as foreign quarantine, and to pre- 
vent the introduction and extension of contagious and in- 
fectious diseases in the United States, and to this end, there 
should be passed an act by the Congress of the United 
States, for the appointment of a “chief commissioner of 
health of the United States,” who should be charged with 
the collection and distribution of information relative to 
contagious and infectious diseases, and have the direction 
of the sections of the health commission when on active 
duty. 
There should also be a health commission, to be divided 
into six sections ; each section to be especially devoted to 
directing the investigation of the disease with which it is 
charged, indicating cause, origin, mode of extension and 
measures of prevention : 
1. One section for yellow fever. 
2. One for cholera. 
3. One for typhoid fever. 
4. One for scarlet fever. 
5. One for small-pox. 
6. One for diptheria. 
This health commission should adopt rules and plans for 
the prevention of the introduction into the United States of 
contagious and infectious diseases, and the prevention of 87 
their spread from one state into another, and the regulation 
of inter-state communication during a threatened epidemic. 
Whenever an epidemic of any of the diseases named is 
threatened, the governor of any state may call upon the 
chief commissioner of health, who shall then, with the aid 
of the section of the health commissioner devoted to that 
particular disease, enforce and carry out the methods and 
regulations adopted by the health commission for that dis- 
ease, and thus concentrate the powers and resources of the 
Federal Government, in aid of state and local authority, for 
the prevention of the spread of contagious and infectious 
diseases, in a peaceably, orderly and effective manner. APPENDIX VI. 
REMARKS OF DR. W. G. AUSTIN. OF NEW OR- 
LEANS. 
After the remarks made by Dr. Hyer, of Miss., in regard 
to the National Board of Health work in 1878, Dr. W. G. 
Austin, of Louisiana, asked permission of the Conference to 
make a statement in regard to the work done by the Nation- 
al Board of Health, in aiding the Louisiana State Board in 
stamping out the fever in 1879. He stated that the Nation- 
al Board of Health was not organized for work in 1878, and 
not until late in 1879. When the fever made its appearance 
in the fourth district in New Orleans the State Board had 
exhausted all its means in the epidemic of the previous 
year. We were in need of money to do the work necessary 
to stamp out the disease. We applied to the National 
Board for funds to aid us in carrying on this work ; they 
promised us aid in two weeks. We could not wait. 
Through the assistance of General Manager J. C. Clarke, 
of the Illinois Central Railroad, Dr. Herrick, the Secretary 
and myself, Acting President of the Board, borrowed the 
money from the Canal Bank to do the work until the Na- 
tional Board could come to our assistince, which they did 
in about ten days, enabling the State Board of Health, with 
the assistance of the Auxiliary Sanitary Association of New 
Orleans, to stamp out the disease in a short time, thus pre- 
venting a repetition of the dreadful epidemic of 1878 ; the 
National Board furnishing us money to pay our indebted- 
ness to the Canal Bank and all other expenses incurred. 
On visiting the Hood residence after the death of Gen. 
Hood, his wife and child, with Dr. Bell, of New York, we 89 
found the balance of the family sick. Upon examination we 
ascertained there was under the house an immense cess 
pool, in which was emptied all the feculent matter coming 
from the water closets above. This vault had no ventila- 
tion whatever, for the gases to escape, thus accounting for 
the walls of the house being perfectly saturated with the 
gasses produced from human feculent matter. The vault 
proved to be about ten feet square, lined with cement and 
covered with a large stone also laid in cement. With great 
difficulty we removed the stone, when the gas coming from 
this vault put out all our lights and drove the force from 
under the house. We emptied the vault, disinfecting it 
thoroughly, putting in large quantities of carbolic acid, sul- 
phate of iron, chloride of lime and quick lime, then filled it 
up with river sand and had all the pipes changed to a new 
vault which we prepared outside of the building. 
At the suggestion of Dr. A. N. Bell we moved the sick 
children on the other side of the hall, and they all recover- 
ed under the treatment of Dr. Bemiss, who was the physi- 
cian of the Hood family and a member of the National 
Board. 
The fever of 1879 had evidently wiotered over from the 
previous year, for the reason that it commenced exactly 
where it had left off in 1878. The odor from the walls of 
the rooms was so strong that Dr. Bell remarked that he 
would not live in the house if it were made a present to 
him. 
I make this statement for the reason that I was not cor- 
rectly reported in my remarks made yesterday, to show 
that the work by the National Government, in aiding State 
Boards of Health, will prove a success, judging from the aid 
given the Louisiana Board in 1879. APPENDIX VII. 
HUNTING YELLOW FEVER GERMS. 
DR. GEO. M. STERNBERG, U. S. A. 
Gentlemen—It would have been far more satisfactory to you 
and to me if the subject of my address this evening could have 
been announced as “the yellow fever germ.” I need hardly 
say that nothing would have given me greater pleasure than, 
in the presence of the experts in the clinical and prophylactic 
management of yellow fever here assembled, to exhibit micro- 
scopic preparations and pure cultures of the specific infectious 
agent which I have been so long in search of. I shall show 
you presently upon the screen photo-micographs of a variety 
of micro-organisms which I have encountered in the course of 
my researches, some of which are hitherto undescribed species, 
and among them some which have especially engaged my atten- 
tion as possible yellow fever germs. I shall also show you cul- 
tures and photo-micrographs of the micrococcus presented to me 
by Dr. Domingos Freire of Brazil as his microbe of yellow 
fever, of the tetragonus febris flavae of Dr. Carlos Finlay of 
Havana, and of the bacillus of Dr. Paul Gibier of Paris. 
But I must announce to you in advance that there is no sat- 
isfactory evidence that any one of these micro-organisms is the 
veritable infectious agent in the disease under consideration. 
I at first hesitated to accept the invitation extended to me to 
address you on this occasion, inasmuch as my investigations 
have not led to any definite result, and as the}' are still in pro- 
gress, and will be continued in Havana during the present sum- 
mer. But the importance of the occasion and the solicitation 
of my good friend Dr. Cochran, the efficient health officer of 
the State of Alabama, have induced me to come here for the 91 
purpose of making a brief statement relating to the present 
status of the investigation with which I am charged, and espe- 
cially for the purpose of demonstrating to you the methods 
of research employed by bacteriologists in investigations of 
this nature. 
I may say before going any further, that my faith in a living 
infectious agent as the specific cause of this disease is by no 
means diminished by my failure thus far to demonstrate the 
exact form and nature of this hypothetical “germ.” The pres- 
ent state of knowledge with reference to the etiology of infec- 
tious diseases in general, and well-known facts relating to the 
origin and spread of yellow fever epidemics fully justify such 
a belief. The a priori grounds for such faith I stated as long 
ago as 1873, in a paper published in the American Journal of 
the Medical Sciences (July, 1873); and the progress of knowl- 
edge since that date has all been in the direction of supporting 
this a priori reasoning. But yellow fever is by no means the 
only infectious disease in which satisfactory evidence of the 
existence of a living infectious agent is still wanting. In the 
eruption fevers generally no demonstration has been made of 
the specific etiological agent—at least none which has been 
accepted by competent pathologists and bacteriologists. Again, 
in the infectious disease of cattle, known as pleuro-pneumonia, 
notwithstanding very extended researches by competent inves- 
tigators in various parts of the world, no satisfactory demon- 
stration of the germ has been made. The same is true of hy- 
drophobia, in which disease we are able to say with confidence, 
the infectious agent is present in the brain and spinal cord of 
animals which succumb to rabies; this infectious agent is de- 
stroyed by a temperature which is fatal to known pathogenic 
micro-organisms (65°C), and by various germicide agents, yet 
all efforts to cultivate it or to demonstrate its presence in the 
infectious material by staining processes and microscopical ex- 
amination have thus far been unsuccessful. 
You are aware that my first effort to solve the etiology of yel- 
low fever was made ten years ago. As a member of the Ha- 
vana Yellow Fever Commission of the National Board of 92 
Health, I had an opportunity to make researches which, in ad- 
vance of the effort, I fondly hoped might lead to a demonstra- 
tion alike creditable to American science and useful as a basis 
for preventive and curative measures in this pestilential malady, 
which has destroyed the lives of so many of our fellow citi- 
zens, and has so largely interfered with the material progress 
of certain sections of the United States. I knew from personal 
experience the malignant nature of the disease, and the futility 
of the various modes of treatment which had been resorted to 
in the effort to combat it. It was therefore with the deepest 
interest, as well as with strong hopes of success, that I went to 
an endemic focus of the disease to search for the yellow fever 
germ. The recent (1873) demonstration of the spirillum of 
relapsing fever in the blood of patients suffering from this 
disease, and the recognized facts relating to the etiology of 
anthrax, considered in connection with the current notions re- 
lating to the pathology of yellow fever, lead me to hope that 
the discovery would be an easy one. I was familiar with the 
most approved methods of mounting and staining micro-organ- 
isms, and was provided with the best high powrer objectives 
that could be procured—the one-twelfth and one-eighteenth 
homogeneous oil immersion objectives of Karl Zeiss, of Jena, 
Germany. Not only did I feel that I was equipped for the 
recognition of any micro-organism which might prove to be 
present in the blood, but I was prepared to photograph it, and 
thus to show to others what I might see in blood drawn from 
the circulation of yellow fever patients. You know the result 
of this investigation—“ninety-eight specimens from forty-one 
undoubted cases of yellow fever were carefully studied, and 
one hundred and five photographic negatives were made which 
showed satisfactorily everything demonstrable by the micro- 
scope.” But no micro-organism was discovered. I shall pres- 
ently show you upon the screen a photo-micrograph of yellow 
fever blood, made in Havana at the time mentioned, so that 
you may judge of the performance of my Zeiss one-eighteenth 
inch objective, and have ocular evidence that no micro-organism 
demonstrable by this magnificent lens was present in it. I may 93 
say here that my culture experiments, made in Havana last 
spring, in which blood taken from one of the cavities of the 
heart, as soon as possible after death, was introduced into va- 
rious nutritive media, gave a like negative result. 
Out of ten cases in which I made the autopsy, in the mil- 
itary hospital at Havana, a development of micro-organ- 
isms occurred in two only. In the exceptional cases I ob- 
tained a bacillus which subsequent researches showed to 
be identical with a bacillus constantly found in the alimen- 
tary canal of healthy persons—Bacterium coli commune of 
Escherich. 
The absence of micro-organisms from blood drawn from 
the finger during life, or from the heart after death, cannot 
however be accepted as evidence that there are no parasitic 
organisms any where in the tissues. The bacillus of ty- 
phoid fever, for example, is rarely found in the circulating 
fluid, although it must be transported in the blood current 
to the various organs in which foci of growth are found 
which contain numerous bacilli. Such foci are especially 
abundant in the spleen, but even in this organ many thin 
sections may be made before a single focus of development 
is encountered. 
Having failed to find the yellow fever germ in the blood 
we may still admit that, as in typhoid, it is perhaps only to 
be found in the organs principally involved in the morbid 
process. This reasoning has led me to give special atten- 
tion to an examination of the liver and kidnej7-, both by the 
culture method and by the examination of thin sections. 
Both methods have given me positive results so far as the 
occasional presence of micro-organisms is concerned, but 
both are in accord in failing to demonstrate the constant 
presence of any particular organism. In my culture expe- 
riments made in Havana last year the micro-organism most 
frequently encountered was my bacillus a, already referred 
to as found in two out of ten cases in cultures from blood 
drawn from the heart. Naturally I have given much atten- 
tion to this bacillus, and it was only after an extended series 94 
of comparative experiments that I gave up the hope that it 
might be concerned in the etiology of the disease under 
consideration. These comparative experiments forced me 
to the conclusion that this is the same bacillus as was found 
by Emmerich in cholera cadavers at Naples, and that it 
corresponds with the Bacterium coli commune of Escherich. 
In my researches by the method of staining thin sections 
of the tissues hardened in alcohol, I have encountered sev- 
eral different micro-organisms; but no one of these has 
been found in a series of cases. One, the bacillus of Lac- 
erda a Lid Babes, I have found only in material brought 
from Dr. Lacerda’s laboratory in Brazil, and in two only 
out of nine cases represented by material from this source. 
In one of my Havana cases, in which the material was col- 
lected by my friend Dr. Burgess, in 1887, a long bacillus 
was found in the kidney, for the most part in the glomeruli. 
In a case in which I made the autopsy in Havana last spring 
a micrococcus, grouped in fours, was found in the kidney. 
Evidently, if any one of these micro-organisms was found 
in a considerable series of cases, the fact would be decided- 
ly significant, and would afford presumptive evidence that 
the parasitic organism found bore some relation to the mor- 
bid process. But, even if one and the same micro-organism 
was found in every case, the final proof of its etiological im- 
port would depend upon its isolation in pure cultures and 
the production of the characteristic phenomena of the dis- 
eases in one of the lower animals—or in the absence of a 
susceptible animal, in man himself. 
The method by cultivation is by far the most reliable for 
the demonstration of micro-organisms which will grow in 
our culture media, for isolated cocci, or bacilli might easily 
escape observation when present in small numbers, but 
would serve to start a culture. Thus the bacillus of typhoid 
fever, which, as stated, is not as a rule found in the blood 
of the general circulation, and is only found in the spleen 
in scattered clumps, may be obtained from this organ, in 
pure cultures, almost without fail, by introducing a small 
quantity of splenic pulp into a suitable nutritive medium. 95 
Moreover, this method enables us to differentiate micro- 
organisms which look alike, and which by microscopic ex- 
amination alone it would be impossible to distinguish, one 
from another. This is a fact now well recognized by bac- 
teriologists, but not generally appreciated by microscopists 
whose researches have been limited to the staining and 
mounting of sections. 
Both methods require skill and practice in the execution, 
and great caution in drawing conclusions, for there are a 
thousand traps lying in wait for the explorer in this field 
of investigation. 
It is for this reason that pseudo-discoveries are so nu- 
merous. 
Especial care is required in the microscopical examina- 
tion of stained preparations of yellow fever tissues. One 
encounters in the urinary tubules, mingled with the debris 
of the desquamated epithelium, stained masses of various 
forms which often closely resemble cocci or bacilli. These 
I believe to be fragments of nuclear material. The same 
material is often massed in the urinary tubules in the form 
of plugs, which are deeply stained by the aniline dyes. 
Again, fragmentation of nuclei of cells still in position may 
give the impression of a cell containing cocci; and the kary- 
iokinetic figures found in the cells, especially in the liver, 
often resemble bacilli so closely that it is difficult to con- 
vince any one not familiar with them that they are not 
micro-organisms. 
The “plasma cells” of Ehrlich, also, seem to have as 
their chief function the role of deluding amateur micro- 
scopists into the idea that they have made a discovery. 
They are often very abundant in the liver and in the kidney 
of yellow fever cases, and so closely resemble zoogloea 
masses of micrococci that experienced pathologists have 
been deceived by them. 
In addition to these objects which resemble micro-organ- 
isms there are dangers from the postmortem invasion of 
the tissues when the autopsy has been delayed beyond an 96 
hour or two, in the warm climates where yellow fever pre- 
vails; or even in the preserving medium, or during the 
process of staining. 
My experiments made in 1883, showed that “exposure to 
ninety-five per cent, alcohol for forty-eight hours did not 
kill the bacteria in broken-down beef tea (old stock) and 
pathologists are familiar with the picture presented by the 
postmortem invasion of tissues which have been left in 
alcohol which was not strong enough to preserve them. 
Finally, inasmuch as my culture experiments with mate- 
rial collected soon after death, from the liver and kidney, 
gave a. positive result in a certain proportion of the cases, 
it is evident that the micro-organism most frequentty found 
by this method—my bacillus a—should occasionally be en- 
countered in stained preparations. 
The possibility remains that by some method of staining 
not hitherto employed, the specific infectious agent may 
yet be demonstrated in the tissues; but the fact that my 
culture experiments with material from the liver and kidney 
of ten cases failed to demonstrate any such specific microbe 
is opposed to this view. We may, of course, suppose that 
the yellow fever germ not only requires special methods, 
yet undiscovered, for its demonstration in the tissues, but 
that it will not grow in the culture media which I have em- 
ployed in my researches. I would say in reply to this hy- 
pothesis that all known pathogenic micro-organisms may 
be demonstrated by the staining methods employed, and 
that, inasmuch as the yellow fever germ appears to find a 
favorable nidus in filth beds external to the body I have 
been inclined to believe that like the bacillus of typhoid 
fever and cholera it is not especially nice as to the charac- 
ter-of the medium in which it may develope. However, 
this may be a mistaken idea, and I propose in my future re- 
searches to make use of various culture media not yet em- 
ployed, and especially to make cultures from the tissues and 
the excreta in an atmosphere from which oxygen has been 
excluded; for it may be that like the bacillus of malignant 97 
oedema and the bacillus of tetanus the yellow fever microbe 
is anaerobic. 
While then, I admit that by some special method of stain- 
ing, or by a modification of the culture methods heretofore 
employed, the specific infectious agent we are in search of 
may yet be found in the tissues of yellow fever patients, I feel 
justified in saying that no such demonstration has yet been 
made. The negative results attending my researches in 
this direction have led me to turn my attention to the mi- 
cro-organisms present in the alimentary canal, for the pos- 
sibility suggests itself that this may after all be the habitat 
of the deadly yellow fever microbe, which is capable of de- 
stroying life within two or three days, and that the phenom- 
ena of the disease are not directly due to its presence in the 
body, but result from the absorption of a poisonous pto- 
maine produced by it, as appears to be the case in cholera. 
The famous English hygienist Parkes, from the consider- 
ation of evidence relating to the prevalence of yellow fever 
during a series of years among English troops stationed in 
Jamaica and elsewhere within the “yellow fever zone,” in 
connection with the sanitary condition of their barracks, 
arrived at the conclusion that yellow fever is a “foecal 
disease,” and there are many facts relating to the origin 
and extension of epidemics which seem to support this 
view—that is the belief that the germ finds a proper nidus 
in foecal matter external to the body. If in yellow fever, as 
in cholera, the infectious agent is located in the alimentary 
canal of those who fall sick with the disease, we can readily 
understand how it is that new centres of infection are de- 
veloped, when external conditions are favorable, in the lo- 
calities where imported cases have occurred, or as a result 
of the introduction to such localities of fomites. 
This view also accords with the demonstrated fact that 
yellow fever is not directly communicated by the sick to 
those in attendance upon them. Pathogenic germs which 
multiply in the intestine no more endanger those who are 
associated with the infected individual than the same micro- 98 
organisms cultivated, in a suitable medium in a test tube 
endanger the bacteriologist who is engaged in their study. 
The possibility that the infectious agent in yellow fever 
may have its habitat in the alimentary canal, occurred to 
me several years ago, and I determined, in advance of my 
visit to Havana last spring, to give special attention to a 
bacteriological study of the intestinal contents. 
It is well known that the excreta of healthy persons con- 
tain a vast number of micro-organisms of various species, 
and that while some of these appear to be constant, others 
are occasional, and we may say accidental tenants of the 
human intestine, being introduced, no doubt, with the in- 
gesta and especially in drinking water. 
Notwithstanding the researches of Brieger, of Bienstock, 
of Escherich, of Yignal and others this bacterial flora of 
the healthy intestine is still imperfectly known. The at- 
tempt, therefore, to explore this field for the purpose of 
finding a specific microbe in any particular disease is at- 
tended with very great difficulties, unless, as in cholera, 
this specific microbe occupies the field to the exclusion of 
the ordinary bacteria found in the intestinal contents. 
Koch found his “comma-bacillus” almost in pure cultures 
in the characteristic rice-water discharges of cholera pa- 
tients, and other bacteriologists, following his methods, 
have had no difficulty in verifying the presence of the same 
micro-organism in cases of cholera occurring in various 
parts of the world. On the other hand, extended compara- 
tive researches, including my own investigations, made in 
Havana and in Decatur, show that the “comma bacillus,” 
or rather spirillum, is not found in the alvine discharges of 
healthy persons, or in other diseases than cholera. If in 
yellow fever, as in cholera, there was a micro-organism in 
pure cultures, or in relatively great abundance, capable of 
growing in the culture media which are suitable for the de- 
velopment of a majority of the known pathogenic organ- 
isms, I ought to be able, to-night to exhibit to you cultures 
and photo-micrographs of this micro-organism. But my 99 
researches show that the micro-organism which is by far 
the most abundant, and so far as my investigations go the 
only constant form found in the excreta of yellow fever ca- 
ses, is the Bacterium coli commune of Escherich; which is 
also the most constant and abundant form found in the ex- 
creta of healthy persons. 
In Havana, my cultures were made from material from the 
stomach and intestine of fatal cases obtained at the time of 
making the autopsy. My researches did not show that any of 
the micro-organisms encountered was constantly present with 
the exception of the Bacterium coli commune—my bacillus a. 
Having excluded this bacillus by comparative researches there 
was nothing to point to any one of the micro-organisms pres- 
ent in my cultures as the probable infectious agent I was in 
search of. 
The bacillus of Dr. Paul Gibier I only encountered in three 
cases out of ten, and in these it was not present in very great 
abundance, compared with the colon bacillus for example. 
My time in Havana, limited by my orders, was too brief to 
enable me to make an exhaustive research. The epidemic in 
Florida and Alabama during the past summer gave me an op- 
portunity to continue the investigation, and, at my request, I 
was directed to proceed to the infected district for this pur- 
pose. The presence of my friend Dr. Jerome Cochran, state 
health officer, at Decatur, decided me to locate my laboratory 
in that place, where I found abundant material for the re- 
searches which I had in view. Having made a codsiderable 
number of autopsies in Havana, I determined while in Decatur 
to devote my attention especially to a bacteriological study of 
the alvine discharges collected during the different stages of 
the disease. 
Evidently if the infectious agent multiplies in the intestine, 
it should be found in the excreta during the earlier stages of 
the attack. 
The cause must be present in advance of the development 
of the morbid phenomena which characterize the disease. But, 
it is quite possible that during its later stages the etiological 100 
agent has perished, and therefore would not appear in cultures 
made from material obtained post mortem. 
While in Decatur, and after my return to Baltimore, I ex- 
amined, by bacteriological methods—Esmarch tubes—the ex- 
creta of thirty-nine cases of yellow fever, and for comparison, 
of nine convalescents and of nineteen healthy individuals. A 
detailed account of the results reached will be given in my 
final report. As was to have been expected, I have encoun- 
tered a variety of micro-organisms. Many of these I have 
isolated in pure cultures and the biological and pathogenic 
characters of several have been carefully studied by cultivation 
in various media and by inoculation experiments in the lower 
animals. It would be premature for me to attempt to give 
you the results of these researches, even if time permitted me 
to do so. But I may repeat what I said at the outset, that the 
germ of yellow fever has not yet been demonstrated. It is 
possible, however, that one or the other of the micro-organisms 
which I have isolated is the long-sought germ, although I have 
no satisfactory evidence upon which to base a claim that this is 
the case. 
My attention has been especially directed to the liquifying 
organisms found in the excreta of the thirty-nine cases exam- 
ined. In a majority of these cases the presence of liquifying 
bacilli was demonstrated, but liquifying colonies were not 
numerous as compared with the non-liquifying, among which 
the colon bacillus of Escherich was by far the most abundant. 
In a series of Esmarch tubes No. 1 would show numerous liqui- 
fying centres, usually within twenty-four hours; very often No* 
2 would contain a few liquifying colonies; while as a rule No. 
3, although containing numerous isolated colonies of the colon 
bacillus, did not contain any liquifying colonies. Further, I 
found that several different liquifying organisms were present 
in different cases, or were associated in the same case. I shall 
presently show you cultures and photo-micrographs of these 
liquifying bacilli. The one most frequently present, my bacil- 
lus o, I have since found in cultures from another source and 
am obliged to exclude it as the possible specific etiological agent 101 
of yellow fever. It has also been isolated by Dr. Booker, 
of Baltimore, from the discharges of one or more infants 
suffering from summer diarrhoea. The bacillus of Gibier I 
have only isolated from three cases, and in these it was not 
present in considerable numbers. I have made extensive 
experiments upon the lower animals, which show that this 
bacillus has interesting pathogenic properties, but give no 
special support to the view that it is the specific germ of 
yellow fever. I have never observed in my cultures the 
black pigment, which, according to Dr. Gibier, is produced 
during the development of this bacillus, and am at a loss 
to understand this discrepancy in our observation. 
So far as the pigment in black vomit is concerned, 
I have no doubt that it is of haemic origin. I have 
never failed to demonstrate, by a microscopic examination, 
the abundant presence of red blood corpuscles in the nu- 
merous specimens of black vomit which I have examined. 
The little black flocculi, are in fact, made up of agglomerated 
corpuscles which have lost their pigment and appear as 
pale discs, often more or less swollen and distorted; while 
the brownish pigment, which has been changed by the acid 
secretions of tbe stomach, remains in their vicinity in the 
form of granules or amorphous masses. The idea that 
there is something specific about this pigment, or that it is 
the secretion of a specific microbe, as has been maintained 
by Freire and by Gibier, appears to me to be untenable. 
In a majority of the non-fatal cases of yellow fever, and in 
a certain proportion of the fatal cases, there is no passive 
hemorrhage into the stomach, and consequently no black 
vomit, yet these cases must result from the action of the 
same etiological agent as those in which this symptom is 
present. 
I have found by experiment that the bacillus of Gibier, 
the micrococcus of Freire, and the tetragonous of Finlay, 
all grow after being exposed for an hour to a temperature 
of 15° C. Exposure outside of the laboratory in Baltimore 
for five days in the month of January, failed also to destroy 102 
the vitality of these micro-organisms, although the temper- 
ature, during the greater part of the time at least, was be- 
low the freezing point. 
Having thus given you a brief account of the present 
status of the investigation in which I am engaged, I pro- 
pose to devote the remainder of the time at my disposal, 
to a practical demonstration of the methods of research em- 
ployed, and to an exhibition upon the screen of the various 
micro-organisms to which I have referred. 
Note.—The illustrations are necessarily omitted here. APPENDIX VIII. 
LEUCOMAINES AND PTOMAINES AND THEIR RE- 
LATIONS TO DISEASE, 
BY 
VICTOR C. VAUGHN, M. D., 
Professor of Hygiene and Physiological Chemistry in the University of 
Michigan. 
We may divide tlie majority of internal diseases into 
two classes, the autogenous and the infectious. 
By an autogenous disease we mean one which originates 
wholly within the body, and which is the result of disturb- 
ances of physiological processes. All living things absorb 
and excrete matter. In health there is perfect adjustment 
between absorption and excretion. Disturb this relation 
either by excessive ingestion, or by imperfect elimination 
and disease more or less marked results. The medical pro- 
fession can understand and appreciate the force and im- 
portance of these assertions more fully now than it has 
been able to do at any time in the past. Recent investiga- 
tions have shown us that poisons are constantly being gen- 
erated in our bodies, and that in health we escape their ill 
effects by constant and sufficient elimination. A hasty re- 
view of some of the recent knowledge which has been 
gained on this subject may not be devoid of interest. 
Peptones, which represent the first known step in the 
breaking up of the proteid molecule, when injected directly 
into the circulation act as powerful poisons. They destroy 
the coagulability of the blood, lower blood-pressure, and in 
large quantities cause speedy death. In health the pep- 104 
tones formed daring digestion do not reach the general cir- 
culation. In the liver they are robbed of their poisonous 
properties by being converted into globulin. But it is alto- 
gether probable that at times the liver partially fails in this 
function and that the health suffers in consequence. This 
may be due to the taking of excessive quantities of proteids, 
the digestion being active and the peptones formed and 
poured into the portal circulation faster than the liver can 
convert them into globulin ; or it may be that from lack of 
exercise or other reason the liver is tardy in its action, or 
“torpid” as we say, and small quantities of peptones pass 
into the general circulation. The lassitude, depression, 
feeling of weight in the limbs, and dullness in the head oc- 
curring in the well-fed, inactive man after his meals, Brun- 
ton attributes to poisoning with peptones. The remedy is 
less food, especially less nitrogenous food, and more exer- 
cise. That some substances resulting from the proteids of 
the food is the cause of the trouble, Brunton thinks, is evi- 
denced by the fact that “the weakness and languor are ap- 
parently less after meals conisting of farinaceous food on- 
ly.” 
Brieger obtained by digesting fibrin with gastric juice a 
substance which gives reactions with many of the general 
alkaloidal reagents, and to which he has given the name 
peptotoxine. A few drops of a dilute aqueous solution of 
this substance suffice to kill frogs within fifteen minutes. 
Thus, we see that poisonous substances are formed dur- 
ing normal digestion, and that in health we are not affected 
by them because they are rendered inert by further changes 
in their structure or because they are soon eliminated. 
Pouchet, Bouchard and others have studied the basic 
substances found in the urine, and it has been shown that 
the poisonous character of this excretion is greater during 
the hours spent in work than in those spent in rest. In 
other words, the more vigorously the physiological pro- 
cesses proceed, the more rapidly are the physiological pois- 
ons generated. 105 
Brown-Sequard has condensed the exhaled, air of dogs, 
and has injected the liquid thus obtained into other ani- 
mals, causing death. The symptoms observed were dilation 
of the pupil, increase of the heart beat, slowing of the res- 
piration and a fall in temperature. Choleraic diarrhoea in- 
variably appeared. These symptoms, it should be remark- 
ed, occurred when the liquid had been boiled previous to 
being injected, and consequently they could not be due to a 
germ. From these results it is evident that expired air con- 
tains an extremely violent poison, and Brown-Sequard is of 
the opinion that the slowly exercised influence of this sub- 
stance on those living in poorly ventillated houses has some- 
thing to do with the production of pulmonary phthisis. 
These facts must suffice to convince us that sufficient 
causes for many diseases are to be found in the poisons gen- 
erated within our bodies. A man may drink only chemic- 
ally pure water, eat only that food which is free from all 
adulterations, and breathe nothing but the purest air free 
from all organic matter, both living and dead, and yet that 
man’s excretions would contain poisons, and if they are not 
eliminated with sufficient rapidity they will produce disease 
and death. These poisons originate in the metabolic changes 
by which the complex organic molecule is split up into sim- 
pler compounds. We may suppose, indeed, we have good 
reasons for believing, that the proteid molecule has certain 
lines of cleavage aloqg which it breaks when certain forces 
are applied, and that the resulting fragments have also lines 
of cleavage along which they break under certain influences, 
and so on until the end products, urea, ammonia, carbonic 
acid gas and water are formed. We know that substances 
similar in chemical composition are similar in their physi- 
ological actions, and some idea of the virulence of these leu- 
comaines can be formed when I tell you that a number of 
them contain hydrocyanic acid as a nucleus. 
It is highly probable that many of the nervous symptoms 
which accompany dyspepsia are due to the formation and 
absorption of poisonous substances. 106 
In some persons the tendency to the formation of poisons 
out of certain foods is very marked. Thus there are some 
to whom the smallest bit of egg is highly poisonous ; with 
others, milk will not agree; and instances of this kind are 
sufficiently numerous to give rise to the adage, “what is one 
man’s meat is another man’s poison.” 
That certain febrile conditions are autogenous there can 
scarcely be a doubt. These, like other diseases originating 
within the system, may be due to either of the following 
causes: (1.) There may be an excessive formation of 
poison within the body. (2.) There may be deficient de- 
struction of poisons from incomplete oxidation or other de- 
structive changes, as is probably the case with those living 
in a vitiated atmostphere. (3.) There may be undue re- 
tention of the poisons which normally are eliminated by the 
skin, lungs, bowels and kidneys. 
First, we may mention fatigue fever, which is by no 
means uncommon, and from which the busy physician not 
infrequently suffers. One works night and day for some 
time ; elimination seems to proceed normally; but after a 
few days there is an elevation of temperature of from one 
to three degrees, the appetite is impaired, and then if the 
opportunity for rest is at hand sleep is impossible. The 
tired man retires to his bed expecting to fall asleep imme- 
diately, but he tosses from side to side all night, or his 
sleep is fitful and unrefreshing. The is excited and 
refuses to be at rest. 
Fatigue fever is frequently observed in armies upon forced 
marches, especially if the troops are young and raw. Mosso 
has recently studied this fever in the Italian army. He 
states that in fatigue the blood is subjected to a process of 
decomposition brought about by the infiltration into it from 
the solid tissues of poisonous substances which, when in- 
jected into the circulation of healty animals, induce malaise 
and all the signs of excessive exhaustion. 
This fever is sometimes pronounced malarial, and quinine 
is administered, but it does no good, often harm, by in- 107 
creasing cerebral excitement. The proper treatment is pro- 
longed rest and possibly recovery may be hastened by the 
proper use of eliminatives. 
Then there is the fever of exhaustion, which differs from 
fatigue fever only in degree. It is brought on by prolonged 
exertion without sufficient rest, and often without sufficient 
food. The healthy balance between the formation and the 
excretion of poisons is disturbed, and it may be weeks be- 
fore it is re-established—indeed, it may never be re-estab- 
lished, for some of these cases terminate fatally. The fever 
of exhaustion may take on the typhus form ; delirium may 
appear, muscular control of the bowels may be lost, and 
death may result. 
Between these extremes of fatigue fever and the fever of 
exhaustion there may be every degree of fever from over- 
exertion. 
Then again, there is the fever of non-elimination which 
all physicians of experience have observed. There is a feel- 
ing of languor, the head aches, the tongue is coated, the 
breath offensive, and the bowels constipated. The physician 
fears typhoid fever, but finds that a good brisk cathartic 
dissipates all the unpleasant symptoms and the temperature 
falls to the normal. 
Bouchard has shown that normal faeces contain a highly 
poisonous substance which may be separated from them by 
analysis, and which, when administered to rabbits, produces 
violent convulsions. He estimates that the amount of pois- 
onous alkaloids formed in, and excreted by, the intestines 
of a healthy man each twenty-four hours would be quite 
sufficient to kill him if it was all absorbed. He proposes the 
term stercoraemia for that condition which results from ar- 
rest of excretion from the intestine. 
It is not supposed by any one at present that all the 
symptoms of so-called uraemic poisoning result from reten- 
tion of urea alone, but the urine contains substances a thou- 
sand fold more poisonous than urea, and these are also re- 
tained. We take the amount of urea retained as an evidence 108 
of the extent of danger, because we can estimate the amount 
of this substance definitely, just as we take the amount of 
carbonic acid gas in the air in making an estimate of the ex- 
tent to which it is vitiated, and not because we believe that 
either the urea in the one case, or the carbonic acid in the 
other, is really the dangerous substance. 
That the development of infectious diseases is largely de- 
pendent upon the condition of the person into whom the 
germs are introduced is well known. Two men may drink 
of the same water infected with the germ of typhoid fever 
or cholera, and yet one will have the disease and the other 
escape. The importance of the personal equation in ac- 
quiring infectious diseases is fully recognized. That the 
difference in susceptibility may be due to the relation be- 
tween the formation and excretion of these poisons genera- 
ted within the body, I think highly probable. 
The foregoing may be considered as a brief resume of 
what we know concerning the relations of leucomaines to 
diseases. 
A leucomaine may be defined as a chemical substance 
basic in character, which is produced by the metabolic 
changes taking place in our bodies. 
An autogenous disease may be defined as one which re- 
sults from the accumulation in the body of poisonous leuco- 
maines. 
I will now discuss with equal brevity the relation of chem- 
ical poisons to the infectious diseases. 
That certain micro-organisms are concerned in the produc- 
tion of many of the infectious diseases there can now be no 
doubt. The rules given by Koch for determining whether 
or not a given germ is the cause of a certain disease, do not 
admit of any doubt when they are fully complied with. But 
admitting that germs bear a causal relation to the disease, 
the question arises, how do they produce disease? To this 
question many answers have been proposed, and the more 
important of these will now be reviewed. 
(1) It was first suggested by Bollinger that apoplectiform 109 
anthrax was due to deoxidation of the blood by the bacilli. 
These germs are aerobic, and were supposed to deprive the 
red blood corpuscles of their oxygen. This theory was sug- 
gested most probably by the resemblance of the symptoms 
to those of carbonic acid poisoning. The most prominent 
of these symptoms are dyspnoea, cyanosis, convulsions, di- 
lated pupils, subnormal temperature, and, in general, the 
phenomena of asphyxia. Moreover, post-mortem examina- 
tion reveals conditions similar to those observed after death 
by deprivation of oxygen. The veins are distended, the 
blood is dark and thick, the parenchymatous organs are 
cyanotic, and the lungs are hypersemic. Bollinger compared 
this form of anthrax to poisoning with hydrocyanic acid, 
which was then believed to produce fatal results by robbing 
the blood of its oxygen. 
This theory presupposed a large number of bacilli in the 
blood, and this accorded with the estimate of Davaine, 
which placed the number at from six to eight millions in a 
single drop. But more extended and careful observation 
showed that the blood of animals dead from anthrax is often 
very poor in bacilli. Virchow reported cases of this kind, 
and Joffray found in some of his inoculation experiments 
that the animals died before any bacilli appeared in the 
blood. These and other investigations of a similar character 
began to cause workers in this field of research to doubt 
the truth of the theory. These doubts were soon converted 
into positive evidence against the theory. Qemler found 
that the blood, even when rich in bacilli, still possessed the 
bright red color of oxyhaemaglobin. Toussaint caused ani- 
mals which had been inoculated with the anthrax bacillus 
to breathe air containing a large volume of oxygen, and 
found that this did not modify the symptoms or retard 
death. Finally Neucki determined the amount of physio- 
logical oxidation going on in the bodies of animals sick with 
anthrax by estimating the amount of phenol excreted after 
the administration of one grain of benzol, and found that 
the oxidation of the benzol was not diminished by the dis- 110 
ease. Thus, the theory that germs destroy life by depriving 
the blood of its oxygen, has been found not to be true for 
anthrax, and if not true for anthrax, certainly it cannot be 
for any other known disease. The bacillus anthracis is, as 
has been stated, aerobic, while most of the pathogenic germs 
are anaerobic—that is, they live in the absence of oxygen. 
Moreover, in many diseases the bacteria are not found in 
the blood at all. Lastly, the symptoms of these diseases 
are not those of asphyxia. These facts have caused all bac- 
teriologists to acknowledge that this theory is not the right 
one. 
(2.) If a properly stained section of a kidney, taken from 
a Guinea pig which has been innoculated with the bacillus 
anthracis, be examined under the microscope, the bacillus 
will be found to be present in such large numbers that they 
form emboli, which not only close but actually distend the 
capillaries and larger blood vessels, and interfere with the 
normal functions of the organ. A similar -condition is 
sometimes found on microscopical examination of the liver, 
spleen and lungs. From these appearances it was inferred 
that the bacilli produce the diseased condition simply by 
accumulating in large numbers in these important organs 
and mechanically interrupting their functions. This is 
known as the mechanical interference theory. 
Klebs and Toussaint were formerly ardent advocates of 
this theory in its application to anthrax, and the latter 
thought that the symptoms and death are due to stoppage 
of the pulmonary circulation by means of emboli. How- 
ever, Hoffa studied this point by making numerous post- 
mortem examinations, and was unable to confirm it. 
In the majority of germ diseases this theory never had 
any support. There is not found any great accumulation 
of bacteria in any organ, and the number and distribution of 
the germs are such that the theory of mechanical interfer- 
ence can not be held at all. 
(3.) Another answer given to the question, “How do 
germs induce disease ?” is that they do so by consuming 111 
the proteids of the.body, and thus deprive it of its susten- 
ance. The proteids are known to be necessary for the 
building up of cells, and it is also known that micro-organ- 
isms feed upon proteids. But this theory is untenable for 
several reasons. In the first place, many of the infectious 
diseases destroy life so quickly that the fatal effect can not 
be supposed to be due to the consumption of any very large 
amount of proteid. In the second place, the distribution 
of the micro-organisms is such, in many diseases, that they 
do not come in contact with any large proportion of the 
proteids of the body. In the third place, the symptoms of 
the majority of these diseases are not those which would 
be produced by withdrawing from the various organs their 
food. The symptoms are not those of general starvation. 
(4.) Still another theory which has been offered, is that 
the bacteria destroy the blood corpuscles or lead to their 
rapid disintegration. But in many of the infectious dis- 
eases, as has been stated, the micro-organisms, although 
very abundant in certain organs, are not present in the blood 
at all. Moreover, the disintegration of the corpuscles is 
not confirmed by microscopical examination. 
(5.) Seeing the vital deficiencies in the above theorieSj 
and being impressed by the results obtained by the chemi- 
cal study of putrefaction, bacteriologists have been led to 
inquire into the possibility of the symptoms of the infec- 
tious diseases being due to chemical poisons. In investi- 
gating this theory, three possibilities present themselves : 
(a.) The micro-organisms may be poisonous per se. In 
order for the conditions of this theory to be fulfilled, the 
germs must be present in the blood before any of the symp- 
toms appear. But in many of the infectious diseases the 
micro-organisms are not found in the blood at all. Finally, 
Neucki, by chemical analysis of the substance of the ba- 
cillus anthracis, has shown that in some respects it resembles 
vegetable casein and in others animal mucin. This “an- 
thrax protein” is freely soluble in alkalies and the dilute 
mineral acids. It is not poisonous. 112 
(b.) The germs may produce a soluble chemical ferment, 
which, by its action on the body, produces the symptoms 
of the disease and death. This theory formerly had a 
number of very ardent supporters, among whom might be 
mentioned the late eminent scientist, De Bary. But Pas- 
teur proved it false when he filtered anthrax blood through 
earthen cylinders, inoculated animals with the filtrate and 
failed to produce any effect. Neuki made a similar demon- 
stration when he inoculated a two per cent, gelatine pre- 
paration with the anthrax bacillus, which liquified the 
preparation, and, on standing, the bacilli settled to the bot- 
tom. The supernatant fluid, which was clear, alkaline in 
reaction, and contained dissolved “anthrax-protein,” was 
filtered and injected into animals without producing any 
effect. 
(c.) The bacillus may produce a chemical poison by 
splitting up pre-existing complex compounds in the body. 
This theory is supported by analogy, when we remember 
that the ordinary putrefactive germs produce such chemical 
poisons, as has been demonstrated by the work of Panum 
and others. These poisons are ptomaines, and the truth of 
this theory may now be said to amount to a positive demon- 
stration. We now expect to find each specific pathogenic 
micro-organisms producing its own characteristic poison or 
poisons. The evidence on this point I will again refer to. 
I will now give what appears to me a correct definition of 
an infectious disease. 
An infectious disease arises when a specific pathogenio 
micro-organism, having gained admittance to the body, and 
having found the conditions favorable, grows and multiplies 
and, in so doing, elaborates a chemical poison, which in- 
duces its characteristic effects. 
The above definition may be illustrated by typhoid fever. 
The specific germ of this disease must be present. 
In the second place it must find in the individual the condi- 
tions suitable for its growth. Two men may drink of the 
same water containing the typhoid germ, one will have the dis- 113 
ease, the other will not. The specific germ of typhoid fever 
is now believed to be that of Eberth. In 1885 Breiger ob- 
tained from pure cultures of the typhoid bacillus a toxic 
ptomaine, which produced in Guinea-pigs a slight flow of saliva, 
frequency of respiration, dilatation of the pupils, profuse diar- 
rhoea, paralysis and death within from twenty-four to forty- 
eight hours. Post mortem examination showed the heart in 
systole, the lungs hypersemic, and the intestines contracted and 
pale. This substance Breiger considers the specific poison of 
typhoid fever, and calls it typho-toxine. 
In 1887 Mr. Hovy and the writer obtained by inoculating 
beef-tea with a germ found in drinking water which had been 
the supply of many persons, who had typhoid fever, an extract 
whieh when injected under the skin of cats caused an elevation 
in temperature of from two to four and one-half degrees. 
In one sick with typhoid fever the bacillus grows and multi- 
plies in the intestines and forms the poison, the absorption of 
which is followed by the rise in temperature and other symp- 
toms. The lesions in the intestines are probably due to the 
bacteria themselves, or possibly to the local irritating effect of 
the ptomaine. 
There are many reasons for believing that cholera infantum 
is sometimes at least due to poisoning by tyrotoxicon. The 
fact that infants nourished exclusively from the mother’s breast 
are almost wholly exempt from the disease, strengthens this 
belief. The symptoms induced by the poison agree with those 
observed in the disease, and the post mortem changes are iden- 
tical. Cholera infantum is a disease of the summer months, 
when decomposition in milk goes on most readily. It is most 
common in cities and among classes which can not obtainfresh 
milk or have not the means, necessary to keep it fresh. The 
milk is often allowed to stand in a foul atmosphere, from which 
it readily absorbs the gases and the germs of putrefaction. 
Even in country places insufficient attention is given to the 
care of milk. Cows stand and are milked in filthy barns. The 
udders are generally not washed before the milking, and the 
vessels for the milk are frequently not as clean as they should 
be. There can be no doubt that greater care given to the milk 
fed to infants will result in the saving of many lives. APPENDIX IX. 
THE SANITARY INSPECTION SERYICE AT HA- 
VANA, ISLAND OF CUBA, 
BY 
DANIEL M. BURGESS, M. D., 
Sanitary Inspector M. H. S. at that Port. 
The proximity of Havana to the United States, with its 
large and active commerce, and the fact that it is an endemic 
focus of the pestilential disease, yellow fever, which in its epi- 
demic extension, has so frequently scourged our southeru sea- 
ports, gives special importance to the Sanitary Inspection Ser- 
vice. 
This service, in connection with inspection, disinfection, &c., 
at the port of arrival and the sanitary measures enforced on 
board vessels while in transit, constitutes the line of defense, 
which is at present depended upon for the exclusion of yellow 
fever during the dangerous months. 
This is the modern method of sanitary supervision, endorsed 
by the latest International Sanitary Conference—that of Rome 
in 1885—and the results attained may properly be compared 
with those of the method which it has largely replaced, viz: 
a quarantine of detention at the port of arrival, without any 
special supervision of vessels at the port of departure and dur- 
ing transit. 
It is a matter of history, that prior to the late war, yellow 
fever epidemics occurred in certain of our southern sea-ports, 
New Orleans, Pensacola, Savannah, Charleston, &c., so fre- 
quently as to give rise to the opinion, among many physicians 
practicing in those cities, that the disease was of local origin, 115 
and, consequently, that all quarantine restrictions were useless. 
The fact, that there has been no epidemic of yellow fever in 
New Orleans since 1878, and none in Charleston since 1874, 
and none in Savannah since 1876, is a sufficient refutation of 
the local origin idea, if there is any one in those cities who still 
entertains it. That this happy exemption, for a series of years, 
in those cities in which epidemics were of almost an- 
nual occurrence, is due to the measures of protection enforced, 
and not to a change in local conditions, scarcely admits of 
question. 
In complying with the kind invitation of the state health 
officer of Alabama, to contribute something on the subject of 
Sanitary Inspection of Vessels, &c., for the consideration of 
this important Conference, I would say, that it is the object of 
the present paper to give an account, as nearly as I can, of the 
protective measures practiced at the port of departure (Havana); 
and when the facts are fully known, it will no doubt be con- 
ceded by sanitarians, that this sanitary inspection service is a 
most important factor in our system of defense. 
Indeed, an inefficient execution of the inspective service 
here would make the whole system unreliable, especially as re- 
gards the routes via some southern ports, for by these routes a 
passeDger may be landed in Charleston or Savannah within 
three days of the time of his departure from Havana. As this 
time is less than the ordinary incubative period of the disease, 
it is evident that unrestricted travel would open wide a door by 
which yellow fever might, any day during the dangerous sea- 
son, be introduced into cities which by their location are espe- 
cially susceptible to the disease, and by their long exemption 
from an epidemic have a population, which does not to any con- 
siderable extent enjoy immunity from it. 
It will be seen that the restrictions which suffice for the ex- 
clusion of the disease from the port of New York, for instance, 
which is nearly five days by sea distant from Havana, and is 
prepared to take charge of infected ships, or of cases of the 
disease, without special danger to the community, might be 
quite inadequate by routes through the southern or Gulf States. 116 
Accordingly, these restrictions have been made much more 
rigid as regards these routes ; restrictions embracing nearly 
everything, that is known to modern maritime sanitation, in- 
cluding health certificates, etc. 
The method of practicing them is more or less as follows: 
With the idea of respecting the generally entertained belief 
that the damper night atmosphere is more conducive to the 
spread of the specific cause of yellow fever than the day, and 
desiring to pay deference, to the opinion of some bacteriolo- 
gists, that the sun-light is a powerful germicide, these vessels 
are not allowed to enter the harbor of Havana until after sun- 
rise and must leave it before sunset of the same day, never 
remaining in port over night. 
They come in and sail out of the harbor to the windward 
of the city, and during their stay in it, they are moored to 
buoys (not using their anchors) in the open bay, remote from 
other vessels, far to the windward of the city, and centers of 
population, and in the direction of the prevailing northeast 
trade wind. 
The immense importance in a sanitary point of view of the 
location of a vessel in the harbor of Havana, and the great 
difference of risk of infection to crew, vessel and cargo, in con- 
sequence of its position and movements while there; as to 
whether it goes to and lays at and near wharves, or remains 
always in the open bay, will at once be recognized when the 
statistics in relation to these facts are known. 
These relate to the year ending June 30, 1888, and the 
eight years immediately previous or beginning in 1879. They 
comprise only those vessels which went to ports in the United 
States, and the tables are formulated with reference to locality 
in harbor, number, number infected and proportion. 
The following table gives the statistical port history of 548 
vessels for the year ending June 30, 1888 : 117 
TABLE—548 Vessels. 
Vessels. 
Number 
Infected 
Proportion 
infected. 
Which were only in open bay 
347 
0 
0 in 347 
Which were at wharves on Havana side of 
harbor . 
151 
15 
1 in 10 
At wharves on opposite side of harbor, 
Regia and Casa Blanca 
50 
2 
1 in 25 
This table shows that out of 347 vessels bound to ports in 
the United States, which entered the harbor of Havana during 
the year ending June 30th, 1888, and which remained in the 
open bay, not one had yellow fever occur on board, while out 
of 151 which went to wharves on the Havana, or city side of 
.harbor, 15 or one in ten were known to have had yellow fever 
occur among their crews ; and of the remaining 50 which went 
to wharves on the opposite side of the harbor, as Casa Blanca 
and Regia, only two were infected, or one in twenty five. 
This proportion of risk corresponds closely to that of the 
eight previous years, which embraced the port history of 4,852 
vessels bound from Havana to ports in the United States, and 
caves us a list of 218 infected vessels. 
Table for Eight Years preceding June 30th, 1887. 
Vessels. 
Number 
Number 
Infected 
Prop’ rtion 
infected. 
Which were only in open bay 
2,933 
6 
1 in 500 
Which were at wharves on Havana side of 
harbor 
1,246 
173 
1 in 7 
On opposite of harbor, Regia and Casa 
623 
39 
1 in 16 
Blanca 
Total 
4,852 
218 
By that table it is seen that out of nearly 3,000 vessels 
which visited this port during eight years and left for the Uni- 
ted States, and which remained in the open bay, only six, or one 
in five hundred, had yellow fever occur aboard, while of 1,246 
that went to wharves on the Havana or city side of the harbor, 118 
173, or one in seven had yellow fever, and of the 623 that 
went to the Regia and Casa Blanca wharves, on the opposite 
side of the harbor, thirty-nine became infected, or one in six- 
teen. 
It should be stated here that the six vessels which had yellow 
fever occur aboard while remaining only in the open bay, were 
brought in close proximity to, or surrounded by other vessels 
which had become infected at wharves and afterward had 
taken an anchorage in the open bay. 
These statistics then prove conclusively that, as a rule, ves- 
sels in the open bay of the port of Havana, and remote from 
others, do not become infected by yellow fever, and that ves- 
sels on which practical exemption from it is desired, must be 
limited in their movements to such localities. Hence, the class 
of vessels, by them alluded to, are restricted in their move- 
ments to the open bay, and never approach wharves. 
Ho person is allowed to go aboard of the vessels referred to 
without a permit from the sanitary inspector, and no passenger 
can purchase a ticket or take passage, who has not a health cer- 
tificate from said inspector. This certificate sets forth that he 
is acclimated to yellow fever, either by a previous attack, or 
by a continuous residence of several years, five or more, in 
towns and cities habitually subject to it in an epidemic form, 
or where it usually prevails endemically, and who has passed 
through at least one severe epidemic ; or that he is a native of 
places frequently visited by it, and that there is practically no 
danger of his conveying the disease. 
In cases of applicants for health certificates in whom the 
inspector personally knows the above conditions to exist, and 
that by virtue of them the person enjoys immunity from yellow 
fever, there is no reason why a certificate to that effect should 
not be given at once—or in other words his health certificate. 
But there are numerous cases which present themselves for 
a certificate, in which the inspector in order to satisfy himself 
that the conditions required exist, has to adopt methods of in- 
vestigation to corroborate even the sworn statement of the ap- 
plicant, and the details are very much as follows : 119 
Applicants for “health certificates” in Havana can for con- 
venience be divided into four classes, viz: Foreigners, Spani- 
ards, foreigners who are natives of places where yellow fever 
occurs frequently and endemically, and Cubans. 
First-class; as to foreigners.—Their own statements as to 
length of time passed continously in places subject to yellow 
fever as well as having had the disease, &c., must be sup- 
ported by the following documentary evidence. Their cedulas 
(a paper) which give a personal description of them, their age, 
nativity, profession, and the place where they habitually reside 
and passports, also certificate of the consul of their nation, to 
the effect that to his knowledge they have made correct state- 
ments ; certificate of some well-known and respectable busi- 
ness house or banking institution that they are reliably in- 
formed of the length of time the applicant has passed in the 
tropics, and where, and as to his having had yellow fever. 
If he claims to have had the disease in question, the legalized 
certificate of the physician who attended him must be pro" 
duced, or in case he had it in a hospital the certificate of the 
director of the hospital. In addition the person is questioned 
closely and cross-questioned in regard to the symptoms he had 
when taken sick, and throughout his illness how he felt and 
suffered, in what town he lived at the time, and who attended 
him, how he was nursed, and other questions, wFich the in- 
vestigation suggests, are put. 
Second-class ; as to Spaniards.—They must produce the doc- 
uments which identify them ; such as cedulas, passports, &c. 
The certificate of the inspector of vessels stating the time 
when they arrived on the island. 
Another certificate from the alcalde of the ward in which 
they live, saying how long they have lived there, and in case 
of removal that of other alcaldes, &c. Also certificate of some 
respectable mercantile or banking house stating how long they 
have lived in Cnba, or other provinces, and in what places. If 
the applicant claims to have had yellow fever, the certificate 
of the physcian who attended him, or that of the hospital in 
which he may have passed through it, must be produced with 
the proper seal attached. 120 
He is questioned as in the ease of class first, what symptoms 
he had, &c., when he was sick from it, and in some cases satis- 
factory answers are given which assist in making a decision. 
Third-class; foreigners from a country or locality where 
yellow fever exists in an endemic form or habitually.—The 
certificate of his consul stating that he has lived in such 
places continuously for many years or is a native of them, or 
and in addition the certificate of a commercial or banking 
house of good reputation, stating how long he has lived in 
those localities, and that he is a native of them. 
Fourth-class/ when the applicant is a Cuban.—He must 
present his cedula for his personal identification, which also 
must state where he was born, his age, and where he lives. 
Also a certificate from the alcade of the ward where he re- 
sides, saying how long he has lived in the ward and city. 
Furthermore, a certificate from some thoroughly respectable 
and reliable source that he has liv.ed more than five consecutive 
years in one of the sea-ports of the island. All questions per- 
tinent to the examination must be answered candidly, upon 
honor, or if deemed necessary, under oath. 
The above methods are pursued with all the vigor that the 
case under investigation may require, until the sanitary in- 
spector feels himself reasonably justified, in giving or refusing 
to grant the health certificate. While not a few are refused it 
is a source of satisfaction to be assured that among the several 
thousands who have received the health certificate and have 
gone to ports in the United States in not one instance has 
yellow fever developed afterward. 
This fact is of service in confirming the correctness of the 
opinion that the passengers were protected from yellow fever. 
When small-pox exists at any place on the island these 
health assurance certificates also certify that the individual 
from that place is protected from that disease, by a former at- 
tack of it, or by successful vaccination, and that the inspector 
has re-vaccinated the individual. 
Persons who have never had small-pox or been successfully 
vaccinated, are now vaccinated and detained six or seven days- 121 
to observe the result of the vaccination, and if this proves to 
be successful he gets his certificate, but if not successful he is 
vaccinated again and given a certificate to that effect, and that 
he is considered safe. It is but just to say in this connection 
that no person has been known to fall sick with small-pox after 
getting such a certificate. 
To prevent fraud, exchange of certificates, and impositions, 
a system of personal description forms part of the health cer- 
tificate for some routes, and the passenger is confronted aboard 
by the inspector with the certificate. Dirty persons are re- 
quired to take a bath before going aboard. The baggage of 
passengers must not only be clean but be known to come from 
houses and hotels in which there is no yellow fever or it will 
not be received aboard. These houses are visited to ascertain 
the fact. As soon as the baggage is aboard each article is 
taken out and separately sprayed over with a solution of bi- 
chloride of mercury 1 part to 1,000, and trunks and other re- 
ceptacles for it, which have been treated in the same man- 
ner are put in the close, clean, hold, and fumigated by the 
dioxide of sulphur, burning in the process from three to five 
pounds of sulphur to each 1,000 cubic feet. When sulphur 
only is used for disinfecting baggage, &c., the articles are hung 
up or laid loosely around so that the sulphurous acid gas can 
reach all parts of them. The vessel then without any particu- 
lar detention can and usually does proceed to sea while the 
sulphur fumigation is going on, the hold remaining closed as 
long as possible, eight hours, or more. 
No bedding of any description is received, or upholstered 
furniture, or furniture of any kind, unless it is absolutely new, 
is taken aboard. No article which can reasonably be suspected 
of being fomites for the conveyance of yellow fever is allowed 
to be shipped as freight. 
The vessels are thoroughly inspected each trip, in holds, 
engine and fire rooms, bilge-spaces, water-closets and urinals, 
and spaces under and around them, fore-castle, glory-hole, 
galley, pantry, cupboards, drawers, and recesses, wash-rooms, 
officers-rooms, state-rooms and cupboards in them, apart- 122 
merits for second-class passengers, and such conveniences as may 
be provided for them, the bedding of the ship, the condi- 
tion of decks, and other surfaces, in short, all parts of the ship. 
Good ventilation in all apartments must be maintained (when 
fumigation is not going on) by all the means made for that 
purpose in the construction of the vessel and by wind-sails. 
When the quarantine, or dangerons season begins, the car- 
pets and heavy woolens of winter use are removed. 
Although the use of the best disinfectants and germicides 
known, is continued all winter, at this time they are resorted 
to systematically and in much greater quantity. 
All bedding, &c., in the officers and crews apartments are, 
beside the necessary washing, taken out and aired at least once 
a week, when the ceilings, walls and floors and all surfaces of 
the rooms are sponged over or wet down with the usual mer- 
curic solution of 1 part to 1,000, and washed with fresh water 
and soap. 
State-rooms and all apartments for passengers are washed 
and treated in the same way twice a week, or always after a 
trip to Havana, and bedding washed, cleaned and aired. 
All urinals, as well as apparatus for holding them, are kept 
thoroughly clean and frequently washed with a solution of 
chloride of lime or zinc. 
All other apartments in the vessel are treated in a similar 
manner. 
All water-closets are washed two or three times daily, and 
much oftener if necessarjq employing at this time the stand- 
ard solution of chloride of lime, or a strong solution of 
chloride of zinc. Decks and some of the thicker and more 
exposed wooden floors are holy-stoned frequently, chloride of 
lime being used in the process. 
The bilges and bilge-spaces are cleaned and sponged out 
every week, and treated twice a week alternately with solutions 
of bichloride of mercury and chloride of lime. 
The hold is also whitewashed weekly. 
The engine-room is kept clean, and the bilge underneath is 
cleaned every week, and treated by disinfectants, while every 123 
two days clean sea water is run through the bilge-spaces and 
pumped out. 
As far as practicable the officers and crews of these vessels, 
are composed of acclimated persons, who are prohibited from 
going ashore, or visiting vessels in the harbor, without a special 
permit from the sanitary inspector, and they are individually 
examined before the vessel leaves the harbor for a port in the 
United States. 
Not one of them has ever been found in the least suffering 
from any infectious disease now over four years. In the light 
of what is known of practical disinfection, and the prevention 
of a vessel becoming invaded by infective disease, it is difficult 
to see how much more could be done, as the methods above 
mentioned comprise about all that is regarded as most useful 
in modern maritine sanitation. To enable the sanitary in- 
spector at Havana to be one of the agents in enforcing these 
restrictions, they must not only be required by the port au- 
thorities at the vessels destination, but desired by the agents, 
the owners, and those interested in her welfare. Such has 
been the case in regard to some steamers, and such restrictions 
have enabled them to continue in active service, without one of 
their crew or one of their passengers ever suffering from in- 
fectious disease, or any reasonable suspicion, or proof that they 
have in any instance conveyed the specific morbific cause of 
yellow fever. 
It is not pretended that the foregoing restrictive methods 
can, are, or need be carried out in the harbor of Havana for the 
security of all ports in the United States, and particularly in 
winter. 
The authorities in Havana, are probably, as in most other 
ports, very sensitive to and jealous of any approach to or as- 
sumption of jurisdiction. 
We have no treaty with Spain, by virtue of which an 
United States sanitary inspector is invested with any par- 
ticular authority. He can, however, do very much t6 assist in 
preventing the introduction of infectious diseases into the 
United States by ships, because of the maratime and sanitary 124 
regulations of the ports of entry, and of the moral support 
afforded by the consul general of the United States, and the 
still more important assistance of the authorities in Washing- 
ton ; and in case of danger, he can sound the note of warning. 
The bill of health which all vessels should and are expected 
to carry is the consular bill of health, and is made out and 
signed by the sanitary inspector as well as by the consul. Such 
information is given in the document as will assist the health 
authorities at the port of entrance, in forming an opinion of 
the sanitary status of the vessel and port from which she sails, 
and will aid in determining what treatment she should receive. 
It comprises the sanitary history of the ship; her sanitary 
condition ; what her exposures have been in the harbor from 
which she proceeds; what has happend to her there; what 
measures have been taken, if any, to improve her sanitary 
state; sanitary condition of cargo, if she carries any, and when 
she has ballast, what kind, and where taken in; sanitary condi- 
tion of crew and passengers—stating whether they have had 
sickness or not; the existence in the port of infectious diseases 
as yellow fever, asiatic cholera, plague, small pox, or typhus 
fever; how many cases, and how many weekly deaths from 
them, &c.; and all pertinent information which may assist the 
health authorities at the port of destination. 
To enable the inspector to state intelligently as to the truth 
of what he certifies, it is clear that he must visit and inspect 
the vessel and examine the crew. Captains, agents and owners 
now understand this, and ask him to go aboard and do what- 
ever is necessary, that they may be provided with the bill of 
health. When the inspector is invited aboard it is apparent 
there can be no well founded complaint of assumption of juris- 
diction, however foreign the vessel may be. 
He then inspects the vessel in all parts, hold, bilge, the 
dunnage ballast, water-closets, forecastle, cabin, &c., and in- 
dicates what should be done. 
In some instances he is asked what can be done to make the 
vessel more acceptable to the health authorities at the port of 
destination. 125 
There are quite a number of lines which are not only willing 
but anxious to do everything reasonable within their power to 
prevent yellow fever getting aboard, or if there is danger of its 
being aboard in fomites to disinfect and destroy the infectious 
agent at once. 
Such lines as Ward’s, Morgan’s, Plant’s and Alexander’s, are 
excellent examples. They not only keep their vessels away 
from wharves and dangerous places, but are willing to cleanse 
and to use disinfectants in their vessel, cargo, ballast, bilge, &c. 
Others are indifferent to exposure, sacrifice comparative 
safety to convenience, lay during the very dangerous season of 
the year at wharves, with their ship’s company going any and 
every where they please, and say, “Oh, we will take our 
chancesand that class of captains are ever ready to deny that 
they have had or have now any sickness aboard. 
The key to the sanitary condition of the port of Havana in 
relation to infectious diseases lies largely in the hospitals, pub- 
lic and private, of which there are eight or ten. 
Here the inspector is very vigilant, and here he will usually 
encounter the sick from vessels and can learn what ships they 
are from, &c. Frequent visits are made to these institutions. 
From what has been stated in this paper, it would seem that 
vessels going to the United States from the port of Havana 
can, for the convenience of bills of health, be classified into 
four different classes: 
The first class, or “good,” would include those vessels which 
remain in the open bay, keep their crews aboard, and, in short, 
observe rigidly all the methods of modern maritime sanitation. 
In them the sanitary history, condition, cargo, crew and pas- 
sengers are all marked good. Sailing vessels would take nei- 
ther cargo, ballast or passengers from Havana. It is believed 
that the most of such vessels could enter ports in the United 
States at any season without imperilling the health of these 
ports. 
Second class, or “fair,” includes such vessels as do not go to 
wharves, neither are they particular about the use of disin- 
fectants or extreme cleanliness. These may go to wharves 126 
during winter months, in which case they disinfect and cleanse 
thoroughly. 
Third class, which are indicated by “fair only,” or “a little 
suspicious,” are those vessels which go to wharves but have not 
had yellow fever aboard in consequence. Fair only, or a little 
suspicious, are intended to be synonymous terms. 
Fourth class—“suspicious,” sometimes “evidently infected,” 
are those which go to wharves in the dangerous season which 
are known or believed to be infected—or those vessels which, 
although in the open bay, have become surrounded by infected 
vessels from the wharf, and in consequence have had yellow 
fever occur among their crew; and in which little has been 
done to remedy their insanitary condition. 
There is every reason to believe that many vessels, at wharves,’ 
become infected in fact, particularly Spanish vessels, which do 
not reveal their dangerous condition by any sickness existing or 
having occurred aboard, as their entire crews have immunity 
from yellow fever by having had it before. Other vessels on 
entering the harbor immediately discharge all unacclimated 
persons, and ship new ones only the moment they desire to 
leave. In such cases there can be no tell-tale incident to betray 
their actual condition in regard to infection. 
It is found that the statements of the officers and crew of 
the average sailing vessel are so unreliable that the sanitary his- 
tory must depend to a great extent upon the vigilance and port 
experience of the inspector himself. Captains have frequently 
declared, that they had had no sickness, when the inspector 
knew and had seen some of their men sick in hospital with 
yellow fever, and again confronted them aboard convalescent, 
but still yellow as oranges. 
Instances like the following used to occur much oftener than 
at present: 
A Spanish steamer, bound for New Orleans, applied a few 
years ago for the consular bill of health, presenting that of the 
local board, in which it was stated that all were well aboard and 
that there was no disease of an infectious or epidemic character 
in the harbor. I knew that the steamer had been discharging 127 
three or four days at an infected wharf, and on going aboard 
to inspect crew and vessel, I found the chief engineer and two 
men down with yellow fever. The engineer’s case was a rapid 
and malignant one, for he was already vomiting black and won- 
dering what it was, and why he felt so weak in so short a time. 
The sick were all sent ashore and the engineer died the next 
day. Here was a vessel about to start for Hew Orleans, with 
a dean bill of health from the Cuban or local board of health, 
while three of her crew were actually sick and dying of yellow 
fever aboard. 
The unreliable character of bills of health, issuing from local 
boards of health in some foreign ports, subject to all the influ- 
ences of social, political and commercial surroundings, which 
consider only the supposed interest of their own place, is well 
shown in such an instance as.has just been narrated. It also shows 
that that instrument, to be of protective sanitary value, should be 
made out by one who not only keeps himself aucourant with the 
prevailing diseases, and particularly any of an infective charac- 
ter, but also with the sanitary condition of the port and the vessels 
therein. He also should be one whose interests and sympathies 
are with the people of the port of destination, who has a natu- 
ral and loyal desire to assist in protecting them from the intro- 
duction of infectious and contagious diseases, and who can be 
held responsible to those who appointed him and to the country 
which he serves. In the faithful execution of his mission, he 
often has many disagreeable duties. Where is the sanitarian 
or quarantine official who at times is not criticised most un- 
justly and unmercifully, and calumniated without sense or rea- 
son? Every captain wants what he calls a dean bill of health, 
no matter how infected the city and wharves and his vessel 
may be. The sickness may have occurred aboard, and which 
may have resulted in death from yellow fever in hospital or 
elsewhere, he calls a bad cold, or the result of the bad care the 
sailor took of himself, &c., or anything to disguise the facts. 
The sanitary inspector frankly, in the consul’s bill of health, 
tells whether in his opinion the sanitary condition of the port, 
and vessel particularly, is good—fair—a little suspicious—or 128 
suspicious and infected, and thus a hint is given to the authori- 
ties at the port of arrival. Notwithstanding the principal 
sources of danger to legitimate shipping, and therefore to ports 
to which they are bound, are sufficiently indicated for all prac- 
tical purposes. Standing as I do as a kind of sanitary lookout, 
I cannot close this paper, already perhaps tiresome in detail, 
without referring to a constant source of peril from the intro- 
duction of yellow fever into the States of the South, and 
particularly Florida, infinitely greater than all others put to- 
gether. I refer to that kind of illicit intercourse which is car- 
ried on between the ports of Cuba, principally Havana and 
Florida, by a class of light-draught, fast-sailing vessels which 
sail from there in quite large numbers. These have for their 
ostensible and legitimate business, fishing, and they are called 
viveros or fisHfng smacks, and while they do quite a fair busi- 
ness in that way, they often do a more paying one in an illegiti- 
mate manner by smuggling different articles into the country 
on whose coasts they hover for both of the above purposes. 
No dirtier or worse smelling vessels probably leave the port 
of Havana; their inside condition and atmosphere being emi- 
nently favorable for the reception and growth of such disease 
germs as thrive under the influence of heat, moisture and filth. 
Laying, as many of them do while here (and that for a long 
time frequently), at wharves notoriously dangerous, with an 
under deposit of sewage and foecal pollutions, and doubtless in- 
fection, every opportunity is given the cause of yellow fever 
to get aboard, and render the little craft a vile storehouse of 
infectious disease. Moreover, there is reason to believe that 
young men recently arrived from Spain, and totally unaccli- 
mated, are at times shipped as some of the crew. 
The articles which this class of vessels can smuggle into 
Florida and Mexico to the greatest advantage are cigars, 
aguardiente or rum, gin, wine, fruit, etc. The inducement to 
smuggle aguardiente and rum is very great, as the spirit which 
costs only twenty-five or thirty cents a gallon in Havana, pays 
a duty of two dollars a gallon in the United States. 
The method of doing these two branches of business, viz s 129 
fishing and smuggling, is an open secret at Havana, and the 
fishing fraternity, when they have a little confidence in the 
person to whom they are talking, say very frankly that it is 
not a difficult thing at all to smuggle their stuffs into Florida 
or Mexico, and there is but*little danger in it. 
These vessels clear, or rather leave port, with a simple permit 
to go out and fish on the high s,eas or along the coast. Being 
small of size and resembling coasters they go out at any time 
(usually at night), but no one knows when or where bound. 
Once outside of the Moro Castle, some of them may go and 
fish in the waters up about Cardenas and Sagna, others to the 
banks of Yucatan, while a large number will try to better their 
fortunes in the waters and inlets of Florida. Some of those 
for Florida may transfer their goods to Confederates among 
that line of keys which terminates at the Tortugas, while 
others will go farther up and hover around the coast of the 
main land, all the way from Pnnta Rossa, Charlotte Harbor, 
up past Tampa, and even on beyond Cedar Keys. 
Here they are on the alert, waiting a favorable opportunity 
to dispose of what they have, either to confederates, or make 
an unlawful incursion into some of the many inlets, bayous and 
passes on that coast. Once inside, they communicate with the 
people or settlements they may know, interchange visits and 
commodities, friends sleep aboard, articles are carried ashore, 
and it is feared infective disease brought in with them from 
Havana. 
I am credibly informed of these methods, and that many 
outside of fishing and smuggling circles know of them. Cap- 
tarns of steamers running along the coast from Charlotte 
Harbor to Tampa, etc., tell me that they often see about day- 
break this class of vessels which they know to be Spanish, 
coming out of the inlets, bayous and passes. They have no 
business there except to smuggle. If this smuggling was 
limited to articles of commerce it would be bad enough, but 
when terrible infective disease is smuggled into the midst of an 
unsuspecting people in this manner it is in the highest degree 
culpable. 130 
Florida, with an extent of sea-coast greater than that of any 
other State bordering on the Atlantic or Gulf, is more exposed 
by\hese smugglers than any other State in the Union. 
A condition of things has increased this illegal business very 
much within the last few years. Several years ago Spain put 
so high a duty on the importation of live fish from the States 
that the many fishing smacks, which up to that time had been 
doing a nice paying live fish business from Key West and 
other places of Florida, were obliged to suspend business. A 
large portion of those little vessels were then sold to live fish 
merchants in Havana, and since then there have been not far 
from fifty of these light-draught, fast-sailing vessels going out 
of the harbor of Havana. Being nearly all built in the United 
States, in American waters they are taken for American vessels 
till they are made to show their papers. 
During that period, or the last five years, a large and rapidly 
increasing population has appeared in Florida, and particularly 
on the Gulf coast, which requires the very articles to be found 
in Havana. 
It is well known that where there is a demand for an article, 
the article is very sure to be obtained in some way, either by 
fair or foul means. 
Finally, I would say, that in view of the facts stated, and as 
a result of my personal observations as sanitary inspector at 
Havana, I am decidedly of the opinion that one or more lines 
of steamers to Florida ports, under proper sanitary supervision, 
and all the restrictions mentioned in the first part of this paper, 
whereby danger of their conveying disease is reduced to a 
minimum, will do much to suppress this illegal traffic by trans- 
porting the articles required. 
The danger of introducing infectious disease by such steamers 
is so small, that it cannot for one moment be compared to that 
infinitely greater one by the smuggling by vessels referred to. APPENDIX X. 
“THE QUARANTINE OF THE FUTURE” 
BY 
W. C. VANBIBBER, M. D., 
of Baltimore, Md. 
I desire to enlist your interest in the design of an estab- 
lishment for the promotion of health and the suppression 
of disease. I can not doubt that similar ideas may have 
occurred to many of you; but as I have given the matter 
much and careful consideration, and have thoughtfully 
weighed all the points that presented themselves to my 
mind, I have the temerity to suppose that the design I 
shall suggest will probably be more complete in detail than 
any that has been proposed. At least, I am safe in saying 
that no such system has yet been put into operation in this 
country, even in those localities where something of the 
sort is most urgently demanded. I will call my design, for 
the present, a system of quarantine, as its first object is to 
prevent the introduction and spread of communicable dis- 
ease ; but I energetically protest against my views suffering 
prejudice by reason of the repellent associations which are 
too often—and often too justly—connected with that name. 
As the hospital of to-day is something very different from 
the “lazaretto” or lepers’ house of the middle ages, so the 
quarantine of the future must be something different from 
the inefficient, and at best unattractive, quarantine of to-day. 
I will call it the “State Bureau of Health and Quarantine,” 
and look forward to a system which will be not only scien- 
tific and effectual, but attractive ; so that those for whom ifc 
is provided, whether for personal treatment or for public 132 
safety, will rather be lured to it than repelled ; and the sick 
gladly avail themselves of its beneficent arrangements. I 
look forward to an establishment worthy of the State which 
founds it, and a pride to her citizens. If- such a result be 
desirable—which I think will hardly be questioned—and if 
the design which I shall broach promises to realize such a 
result—of which you must be the judges—may I not appeal 
to my professional brethren to come forward as pioneers in 
this movement; to give the light of their experience and 
wisdom in perfecting what may be left imperfect, and the 
weight of their influence in disseminating enlightened ideas, 
and combatting old prejudices? It lies with them to ex- 
plain to the public what a well-equipped and scientific quar- 
antine system ought to be, and may be; and how 
thoroughly physicians, if their exertions are sup- 
ported by wise laws and seconded by public 
opinion, can now cope with those communicable 
diseases which are so often, and have been so recently, 
causes of wide-spread suffering and of the wildest terror. 
There is an old saying that “afflictions are often blessings 
in disguise.” Though in no case, perhaps, is the disguise 
thicker and harder to penetrate, than in that of a great ep- 
idemic, yet even here it lies with us to make the proverb 
good, if the effective epidemic leads us to devise means 
against its recurrence. Certainly it is a discredit to our 
civilization, to our humanity, and almost a reproach to the 
noble profession to which we have devoted our lives, that 
such diseases should paralyze whole communities, and drive 
them into paroxysms of frantic terror. Eecent advances 
which have been made in the study of the quarantined dis- 
eases, will permit some things to be done now with safety, 
which were not formerly allowed. 
Formerly, if a community proposed to place a quarantine 
establishment in an accessible, convenient and desirable 
situation, such opposition would be made, and such influ- 
ences brought to bear, that the site would have to be aban- 
doned, and the buildings, necessarily located in some un- 133 
attractiye, inconvenient and perhaps unhealthy place— 
turned out into the wilderness like the scape-goat, and pur- 
sued even there by the fears and aversion of the whole 
community. All this is, or should be, a by-gone state of 
things. In the city in which I live—Baltimore—when 
more than sixteen years ago, the late John Hopkins 
bought thirteen acres of land within the city limits and 
proposed to build thereon a public hospital, there arose 
strong opposition on the ground of prejudice and the dread 
of spreading disease ; but now that the noble foundation, 
which bears his name is erected, none of this feeling exists. 
Our people are logical, and it did not take long for the 
objectors to see that the function of a hospital is to extin- 
guish disease, not to spread it ; and that communicable dis- 
eases are far less dangerous to the community when con- 
fined under the immediate control and supervision of a 
corps of physicians and nurses, who may be able to steril- 
ize the germs emanating from infected patients, than if 
these latter were allowed to scatter themselves throughout 
the community, and become FOCI of infection at many 
points. The fact is, it is only necessary for the people to 
understand how different, the well appointed scientific hos- 
pital of the present day, is from the traditional hospital of 
the past, and their views and prejudices would undergo a 
radical change. Let me state what I think would be the 
public feeling here, where we now are, if such a question 
should arise. Should the State of Alabama propose to 
erect a quarantine establishment in the city of Montgom- 
ery, and set about securing land for the purpose, opposi- 
tion might at first be raised by adjacent property-holders ; 
but it would subside as soon as it was known what the hos- 
pital was going to be. A properly built and appointed hos- 
pital is an embellishment to the city that contains it. Its 
buildings are imposing, its grounds are spacious, ornamen- 
tal and well kept, and have the beauty and advantages of a 
public park. The establishment becomes one of the at- 
tractions of the city, and neighboring property is enhanced 134 
in value. Those of you who have seen the Johns Hopkins 
hospital, to which Baltimoreans always take guests from 
abroad, as one of the chief attractions of the city, can bear 
out what I say. Now if proper ideas can be disseminated 
on this matter, if the people can be convinced that a quar- 
antine can be made safe, efficacious and at the same time 
attractive, that it will effectually prevent not only the 
spreading of disease, but the spreading of panic, such a 
quarantine will certainly enlist in its favor the whole body 
of public sentiment. But to attain this desirable end, the 
community must be enlightened as to the results which 
have followed the study of quarantined diseases, and the 
use of sterilizing agents in combatting them, of which we 
have learned much of great value from Dr. Wilkinson’s pa- 
per. 
The diseases now quarantined in this country—I need 
not speak of such rare and exceptional cases as Asiatic-lep- 
rosy—are three; small-pox, cholera, and yellow fever. 
What physician is there who has any dread of small-pox in 
his own person, or for his immediate family or his obedi- 
ent patients ? The physicians and people of England have 
nearly convinced the world that the spread of cholera may 
be checked by sanitary measures ; and if that disease spreads 
through a community, it is the fault of the people. I say 
this on the authority of one who is with us now, Surgeon 
George H. Sternberg of the U. S. Army. It only remains, 
then, to speak of yellow fever. 
Less careful and less advanced people than we are, living 
near our own coasts, bring this disease to us. It comes 
from Hayti, Cuba and Mexico. 
We know many of its ways and peculiarities. It has nev- 
er yet gained a permanent abode in our country. I say this 
on the authority of Dr. Cochran and Dr. Wall, as also of 
other physicians in New Orleans, though I admit that Sur- 
geon General Guiteras, U. S. M. H. S., from some recent 
investigations in Key West, is not so sure on this point. 
Be this as it may, it is the clear and urgent duty of us 135 
Americans to prevent the introduction or the domestication 
of this pest-germ on our soil if we can. The several states 
and the Federal Government are alike interested in this 
matter. The germ has been most frequently brought into 
Louisiana, Texas, Alabama, Georgia, and the two 
Carolinas. But it has also been brought into Vir- 
ginia, Maryland, Pennsylvania and New York; conse- 
quently all the states in the Union have a common interest 
in excluding this germ and this disease. This convention has 
assembled here to consider this subject. How do you pro- 
pose to advise those governments to make this attempt ? 
It is not without preparation that I appear before you, 
gentlemen, and give my humble advice in this important 
and much debated matter. With the knowledge, and all 
the facilities now at hand, an establishment may be erected 
which will in time become the centre of study, for informa- 
tion and of authority upon these points; and as soon as 
built and equipped, will be a school, an asylum for patients, 
a place for isolation and for controlling communicable 
diseases by subduing the germ. The drawing shows the 
plan of such an establishment designed with the view of 
fulfilling these purposes. I will explain it more in detail 
later. It consists, as you perceive, of four buildings, kept 
well apart; a separate hospital for each of the quarantined 
diseases, and a building for the administration. These four 
buildings are connected with all parts of the State by rail- 
roads and telegraphs, and with each other by railways, tele- 
graphs, telephones, and electrical transits. It is intended 
that the spacious grounds shall be laid out as a park; por- 
tions being reserved for the exercise and recreation of con- 
valescents, and other portions for those persons who come 
from an infected locality ; but exhibit no symptoms of the 
disease; and who, of course, are most likely to be impatient 
under detention. Quarters should be provided for these in 
the main building, and every practicable arrangement made 
to render their sojourn as pleasant as possible. The whole 
establishment should be located in as attractive and heal- 136 
ful site as possible; and given as much the air of a summer 
health resort, as may be consistent with the purposes for 
which it is destined. 
The main building would be the place at which all infor- 
mation should be centered, and from which all authority 
should emanate. Here would be the headquarters of the 
medical staff; and here the knowledge acquired at the bed- 
side would bear its fruits. Here should be kept models and 
designs for building; here should be exhibited the highest 
standard of cleanliness; here should be formulated the 
sanitary rules. Each subsidiary department should be 
complete in itself. The small-pox department should un- 
dertake to keep on hand thoroughly reliable vaccine virus, 
and distribute it throughout the state. The working of 
such an establishment would be something like this : on the 
appearance of quarantinable disease any where, or the 
landing of passengers from an infected locality, the staff 
would be immediately communicated with. At once officers 
would be dispatched to remove the infected or suspicious 
persons, to investigate the circumstances thoroughly, and 
take all necessary measures. The very presence of these 
officers, and the knowledge that the matter was being 
promptly and efficiently dealt with, would quiet alarm. If 
I may use a trivial comparison, it would resemble the in- 
troduction of the modern fire department in to a great city. 
I can remember when Baltimore, New York and Philadel- 
phia were protected only by volunteer fire companies with 
hand apparatus; these firemen were brave and devoted 
men; but there was no proper organization, no discipline, 
no efficient appliances. They worked at random, and there- 
fore at a great disadvantage. Any one who chose might 
offer his advice or his services, and this well meant zeal was 
often a hindrance rather than a help. The consequence was 
that a large fire spread alarm over the city. Now that we 
have a thoroughly organized department, with experienced 
chiefs, improved apparatus, and thorough drill, the fire 
alarm scarcely causes a ripple of excitemet. Every one 137 
knows that whatever can be done, will be done, and that 
the whole business is in the hands most competent to 
manage it. The practical advantages of such a system as 
I have described may be summed up as follows: 1. It 
would prevent panics. For nothing could be more necessary 
to a community than the knowledge that there was such a 
body of men, at all times ready to meet the first appearance 
of disease, and thoroughly provided with the means to cope 
with it. 2. It would give the greatest facility for preventing 
the outbreak of an epidemic, and subduing the germ if it 
made its appearance. 3. It would give the best possible 
facility for the recovery of patients attacked, by combining 
the most effective medical treatment with the most perfect 
possible sanitation. 4. It would be a headquarters for all 
movements in the direction of hygiene and sanitation, whether 
these should take the form of warning, or instruction to the 
people, suggestions to medical practioners or recommendations 
for legislation. 5. Each of these establishments would be in 
communication with other similar establishments in this coun- 
try or the world, that whatever advance was made, or knowl- 
edge acquired at the one, would at once inure to the benefit of 
all. Thus each would possess at once the highest possible au- 
thority ; and would be a school at which medical practioners 
could learn the latest results of science in every branch that 
came within its scope. Such an establishment should be built 
upon a large domain; and this domain might at the same time 
serve for other useful public purposes. Here might be medi- 
cal or other scientific colleges and museums; a vaccine virus 
farm, an agricultural college. The domain, if near a city, 
might be a suburban park. 
So far as I can judge there is more knowledge now exist- 
ing among the medical officers of the United States concerning 
this branch of public necessity, than can be found elsewhere. 
Any one who doubts this need only visit the war, navy and 
hospital department in Washington, where he can judge for 
himself. I am not thoroughly acquainted with what has been 
done by other governments in the way of collecting informa- 138 
tion bearing on that branch of the public safety which relates 
to communicable diseases, but from conversations with our 
officers, I have reason to think that, in unapplied knowledge, 
at least, we are in the advance. It is therefore eminently fitting 
that the federal government should utilize these collected 
treasures of knowledge, and show the work—the needed quaran 
tine of the future. It seems to me that this might best be done- 
in'Florida ; a state perhaps more dependent at present on her 
sister states, than the others, and important as a winter resort 
and refuge for the inhabitants of more vigorous climates. If 
by means of such a system, Florida was always and certainly 
safe for visitors when the northern cold began to be trying to 
persons of delicate health, or sufferers from pulmonary affec- 
tions, the advantage and the blessing would be incalculable. I 
believe that this matter could be so presented to congress as to 
enlist the favorable consideration of that body; but in this 
matter I can only offer suggestions, leaving choice of steps to 
the judgment of others. I will now explain the details of the 
drawing. 
Note—in this drawing the architect has also shown 
how a healthy house may be built in a warm climate, standing 
upon piers, with a clear story above, and a garden roof. I am 
aware of an objection that may be raised to my plan. It may 
be said that if it succeeds—if communicable diseases be 
stamped out or reduced to minimum, our staff of trained 
physicians and assistants will have nothing to do. We can not 
scatter them to the four winds and put the buildings in charge 
of care-takers, and hope to find every man at his post again 
if disease should break out. I answer that I would make the 
institution the permanent centre of hygiene for the whole state. 
Now hygiene and sanitation never rest; they are always furn- 
ishing new occasions for deliberation, investigation and action. 
Sudden outbreaks of typhoid fever, of diphtheria, of the more 
malignant types of zymotic disease, can often be traced to local 
or preventable causes. 
In such cases as these—and they are constantly occurring— 
our staff would be called upon. Many other cases will occur 139 
to yon, which I need not suggest. I think that in denominat- 
ing the institution a state bureau of health and hygiene, I meet 
the objection fully. Besides preventing panics, and giving 
eveiy possible chance for subduing and curing the disease, this 
advanced and elevated treatment of it, will have a tendency to 
change or reduce its management from a rough and pestiferous 
detention, to an enlightened and agreeable attendance upon 
the laws of the treatment and prevention of disease. 
This change, I think, is due alike to the unfortunate patients 
themselves, as well as it is the best policy for the public. 
From conversation with some' of our statesmen, it is my belief, 
that congress could be interested in this national matter, but I 
must leave the rest, my brethern, with you, to take what action 
you may wish, to bring about this desired result. 
Note.—The plan for the buildings has been omitted. APPENDIX XI. 
A PLEA FOR YELLOW FEYER INOCULATION AS 
A PROPHYLACTIC MEASURE, 
BY 
DR. J. McF. GASTON, 
of Atlanta. 
As germane to the object of this Conference for the preven- 
tion of yellow fever, it seems proper to consider the claims of 
a prophylactic measure which, if it effects anything, is to be 
regarded as the most radical means of preventing the access of 
yellow fever. I refer to inoculation with the attenuated virus 
of yellow fever. It is known to me that there are distinguished 
gentlemen present who differ from my view of this measure, 
yet I trust they may aid in the elucidation of this subject. 
I would state that previous to the past six years, my resi- 
dence in Brazil for a long period, enables me to act under- 
in this matter, and my only interest is for the 
general good. 
From Dr. Sternberg’s instructive and interesting description 
of the observations made by himself and others, it is inferred 
that the germs or bacteria presented by Freire, Carmona, Gibier, 
Finlay and others, are not to be regarded as identified uni- 
formly in connection with yellow fever, so that the yellow 
fever bacillus has yet to be discovered. It is most probable 
that the views of Dr, Yaughan in regard to certain diseases be- 
ing developed by ptomaines after the death of bacteria in the 
different structures, may be the key to explain the phenomena 
of yellow fever. All are aware that in the case of hydatids, 141 
the chief element of disorder is their death, and hence it would 
seem that the most philosophic investigation after the pro- 
gressive changes in yellow fever have resulted fatally, should 
not detect living bacteria in the structures of the body, but 
that they should be sought in the fluids or secretions of the 
subject of yellow fever in its early stages. 
Independent altogether of the recognition of a special ba- 
cillus of yellow fever, there is a practical question of prime 
importance in regard to the feasibility of protection by any 
process of inoculation or vaccination, such as proves effectual 
against the small pox. 
When Jenner introduced vaccination nearly a century ago, 
the presumption against his process was stronger than that 
which exists at the present day against yellow fever inocula- 
tion, and it was necessary to determine by actual demonstra- 
tion that the modified impression produced by vaccination 
really gave immunity from any serious effects of variola. 
This is the course which must be pursued with respect to 
inoculation against yellow fever. 
Facts are stubborn things, and, as in medicine we use many 
remedies emperically without having any rational explanation 
of their modus ojoerandi, we are called upon to test the pro- 
phylactic virtues of yellow fever inoculation without having a 
truly scientific clue to its efficacy. 
If it appears that inoculation in any form or with any sub- 
stance, be it a bacillus or not, prevents or modifies the pro- 
gress of yellow fever in human beings, we are warranted in 
resorting to it to secure our people against the ravages of this 
disease. 
It is claimed that such a process has been employed with 
satisfactory results in Rio de Janeiro by Dr Domingo Freire, 
and the results have been tabulated, giving the names and 
location of those inoculated, reaching above seven thousand in- 
dividuals, subject to the scrutiny of interested observers. The 
deaths among all those subjected to this process have not ex- 
ceeded one to the thousand, while the percentage of deaths 
among those attacked with yellow fever in the same localities 142 
has far exceeded this proportion, being one in one hundred. 
Under such circumstances we must either disprove the sta- 
tistics or accept the results as conclusive in favor of inocula- 
tion by the attenuated virus of yellow fever. 
A thorough examination of the data by a competent com- 
mission of practical observers prepared to discriminate between 
the true and the false, is the only available mode of testing 
this matter, and while scientific investigation should prove 
many points of great interest, there are elements of common 
sense requisite to reach correct conclusions by the members of 
this commission. 
In view of the fact that inoculation with the attenuated 
virus of yellow fever has been used as a prophylactic measure, 
and in consideration of the action taken by the American 
Health Association and the American Medical Association 
recommending the appointment of three commissioners for the 
investigation of this subject, while the United States Govern- 
ment only authorized one commissioner to visit Brazil and 
Mexico in furtherance of this proposition, it is the sense of 
this Convention that the object intended by the said Associa- 
tion has not been satisfactorily met or complied with. 
Furthermore, it is worthy of note that favorable action was 
taken by the International Medical Congress, in recommend- 
ing the investigation of yellow fever inoculation ; and in con- 
sideration of these facts— 
Be it resolved, That inoculation with the attenuated virus of yellow 
fever for the modification or prevention of this disease, calls for thorough 
examination, and that the statistics should receive careful and dis- 
criminating investigation by practical observers for the verification of 
the data presented. 
Be it jurther resolved, That this Convention acquiesces in the recom- 
mendation of the above named associations that three commissioners 
be appointed by the United States Government for a full investigation 
of the claims of the prophylactic virtues of inoculation against yellow 
fever. APPENDIX XII. 
SPECTKOSCOPIC EXAMINATION OF BLACK 
VOMIT, 
BY 
Dr. GEO. T. KEMP, 
Of Hoagland Laboratory. 
Brooklyn, R. Y., March 4, 1889. 
My Dear Doctor: After jour departure, I opened the bottles 
containing the black vomit collected by you last June. The 
vomit was much decomposed, but in spite of this decomposition 
the masses of partly decolorized red blood corpuscles could still 
be made out. A spectroscopical examination proved the exist- 
ence of blood pigment beyond a shadow of doubt! The reac- 
tion of the vomit was strongly alkaline from fermentation, and 
the vomit, untouched by any chemical reagent, gave the spec- 
trum of alkaline hcematin. Boiling this with acetic acid gave 
the spectrum of acid hcematin, and treating the vomit with 
Stokes’ fluid and ammonia gave the characteristic beautiful 
bands of JEEsemochromogen, (Stokes’ Reduced Hsematin). 
These are the characteristic spectra wrhich one would expect to 
obtain from decomposed blood, and prove, beyond all question, 
the presence of blood pigment in the vomit. 
These obsevations agree with those of Dantec, except in one 
point, viz: that he found the pigment in the condition of hsema- 
globin or methsemaglobin. There is not the slightest contra- 
diction here, for he examined the vomit fresh, while the speci- 
mens at my disposal had undergone alkaline decomposition, and 
this process should change the haemaglobun or methsemaglobin 144 
found by him, into the alkaline lisematin found by me. Our 
observations, therefore, are entirely in accord. I only exam- 
ined the specimens taken from the stomach/ the specimens of 
dark colored material from the intestine, I shall examine later.