The Interstate Quarantine Law, And its Relation to the Railroads of the United States. Address before the Association of Surgeons of the Southern Railway, Chattanooga, Tenn., June 30, 1897. BY WALTER WYMAN, M.D., LL.D., SURGEON-GENERAL, UNITED STATES MARINE HOSPITAL SERVICE. Reprinted from the "State Board of Health Bulletin," for July 20, 1897. NASHVILLE : Marshall & Bruce Co., Printers. 1897. The Interstate Quarantine Law and Its Relation to the Railroads of the United States. By Walter Wyman. M.D., LL.D., Surgeon-General, United States Marine Hospital Service. [Address before the Association of Surgeons of the South- ern Railway, Chattanooga, Tenn., June 30, 1897.] Mr. President and Gentlemen: It gives me great pleasure to meet with this Association of Surgeons of the great Southern Railway Com- pany, and to discuss with you matters of mutu- al interest which I believe are not generally or thoroughly understood. Happily the relations which the Marine Hospital Service and the rail- ways bear to one another are those of allies. We are allies of one another against a common enemy-contagious disease. This enemy is a destroyer of life, and on that account the Ma- rine Hospital Service has been placed in the field against it. It is at the same time a de- stroyer of commerce, and on that account the railway systems of the United States are inter- ested in its subjugation. Few people realize or know that there are both laws and regulations for preventing the spread of disease from one State into another. Quarantine is ordinarily considered a maritime affair, and fortunately its operations for the most part do relate to ves- sels from foreign lands. The National Govern- ment has made provision to prevent the intro- duction of disease from foreign countries, and the operations of the Marine Hospital Service under national law begin in foreign ports. Re- strictive measures are accordingly enforced on vessels bound to the United States, their cargoes and passengers, before their departure. On ar- rival they are subjected to a system of quaran- tine inspection, and, if necessary, detention and disinfection, which is uniform throughout our whole coast. It is a striking fact that this country breeds no epidemic diseases which may threaten other 2 lands. If all nations possessed the degree of civilization that prevails in the United States, as manifested by the great regard for sanitary conditions, the prompt suppression of conta- gious disease, and by the earnest regard for the sacredness of human life, maritime quaran- tine would be a useless institution; but we are constantly threatened by the filth-born diseases of cholera, smallpox, and the plague from the Orient; from the filth-born disease of yellow fever from South America, Central America, the West Indies, and particularly Cuba and Ha- vana; and by the filth-born and filth-dissemi- nated diseases of cholera and typhus fever from India and the continent of Europe. It requires the utmost diligence and large outlay of money to repel these would-be invaders. Ordinarily we are successful, but we cannot blind ourselves to the fact that maritime quarantine may not al- ways give one hundred per cent of protection, and that epidemic disease may possibly gain ad- mission. To meet the situation which would then confront us, Congress has passed laws looking to the prevention of its further spread. The Constitution of the United States grants to the Congress the right to regulate commerce, both with foreign countries and between the States, and Congress therefore has the right to strip commerce of its disease-bearing prop- erties. Should one of the greater epidemic diseases- such as cholera, yellow fever, smallpox, or plague-obtain a foothold in the United States, there are two laws which throw upon the na- tional quarantine authorities the ultimate re- sponsibility in preventing their spread to ad- joining States. Section 3 of the Act of Con- gress approved February 15, 1893, requires that if in the opinion of the Secretary of the Treas- ury the rules and regulations of the several States and municipalities are not sufficient to prevent the spread of .contagious or infectious diseases from one State into another, additional rules and regulations shall be made by him, which shall be enforced by the State or munici- pal health authorities, if they will undertake tn execute and enforce . them; but if they fail or refuse, the President shall execute and en- force the same, and adopt such measures as in 3 his judgment shall be necessary to prevent the spread of such diseases, and may detail or ap- point officers for that purpose. Practically the same provisions exist in the Act of March 27, 1890; but it is further pro- vided in Sections 2 and 3 of that Act that any officer or agent of the United States at a quar- antine station, or other person employed to aid in preventing the spread of disease, who shall willfully violate the laws of the United States or the regulations of the Secretary of the Treas- ury shall be deemed guilty of a misdemeanor, and be subject to a fine of $300 or imprisonment for not more than one year, or both, in the dis- cretion of the Court; and that any common car- rier or officer, agent or employee of any com- mon carrier, who shall willfully violate such rules and regulations shall be subject to a fine of not more than $500 or imprisonment for not more than two years, or both, in the discretion of the Court. We are now discussing interstate quarantine, and, as the railroads are the chief carriers of commerce between the States, the pertinency of the discussion is obvious. Under the law of February 15, 1893, Section 4, it is the duty of the Surgeon General of the Marine Hospital Serv- ice, under the direction of the Secretary of the Treasury, to perform all the duties in respect of quarantine and quarantine regulations which are provided for by the Act. In accordance with this Act, interstate quarantine regula- tions, therefore, have been prepared in the Bu- reau of the Marine Hospital Service, and have been duly promulgated by the Secretary of the Treasury. Copies of the regulations are in your hands. Another important law, and one which pro- vides the financial means for enforcing these regulations, is included in the sundry civil bill annually passed by Congress making appropri- ations for the ensuing fiscal year. Under the heading, " Prevention of Epidem- ics," the law reads as follows: " PREVENTION OF EPIDEMICS: The Pres- ident of the United States is hereby authorized, in case of threatened or actual epidemic of cholera, yellow fever, smallpox, bubonic plague, or Chinese plague or black death, to use the un- 4 expended balance of the sums previously appro- priated and reappropriated, ... or so much thereof as may be necessary, in aid of State and local Boards, or otherwise in his discretion, in preventing and suppressing the spread of the same; and, in such emergency, in the execution of any quarantine laws which may be then in force." The epidemic fund thus provided for amounts now to about $475,000. The President, in his discretion, has directed that this shall be ex- pended, under the direction of the Secretary of the Treasury, through the Marine Hospital Service, the latter being a bureau of the Treas- ury Department. Before discussing in detail the interstate quarantine regulations, it will be convenient first to explain in a more general way the the- ory and the attitude of the Government, in ac- cordance with which they have been promul- gated-theory and practice which have been adopted and exercised in the past, and which, if necessary, must be utilized again. There is no overweening desire on the part of the Marine Hospital Service to go into any State and to exercise its functions independently of local or State authority. The assistance of the State or local authority, in the first place, is too valuable to be ignored. This attitude was dem- onstrated in 1893, when two cases of cholera were found in Jersey City. Promptly upon in- formation to this effect an officer was placed npon the ground, with instructions to visit the local health authorities and explain to them^ what the General Government, in its care for •other States and municipalities, would demand, nnd to carefully observe that these demands were being complied with. At the same time every assistance possible, in the shape of funds and of skilled professional aid, was offered them. These were accepted, and all precau- tions and all the regulations of the Treasury Department were promptly enforced by the lo- cal authorities; but if they had failed or re- fused, without loss of time the national author- ities would have assumed exclusive control. The same principles, with some extension, were carried out in Brunswick, Ga., in 1893, where the measures taken to prevent the spread 5 of yellow fever in the city of Brunswick itself were in accord with the resolutions of the city authorities; but when it became evident that the suppression of the disease in Brunswick was impossible, then the national authority was utilized in preventing egress from the city, excepting through a camp of detention. In 1895 smallpox threatened the State of Texas and other States, through the return to El Paso of a band of 411 immigrants from Mexico, hav- ing among them 178 cases of smallpox. The lo- cal authorities gladly accepted the aid of the United States Government, and shortly there- after acquiesced in the Government assuming all the responsibility and authority. The great interior States have as much right to protection from disease that has been im- planted on our coast or border as the coast and border States have to protection from abroad; and it is in recognition of this right that these laws and regulations have been promul- gated. It is the practice of the Marine Hospital Serv- ice, wherever epidemic disease may appear, to have an experienced officer immediately upon the ground. Should the disease be yellow fe- ver, every precaution will be taken to prevent its spread in a given locality; but if a locality becomes infected, then every effort is made to prevent its spread into an adjoining State. We come now to the consideration of a prac- tice which has given rise to some discussion, but which has been evolved out of necessity and experience. I refer to the establishment of the cordon and detention camp, and I will add that I know of no other means of preventing the spread of yellow fever. After it has been de- clared epidemic, no person is allowed to leave the locality, except in a prescribed manner. This means that persons wishing to leave the infected district must repair to a detention camp, to be held in observation a sufficient length of time to demonstrate that they are not carriers of the infection. If any other method of dealing with the subject can be suggested, I will be glad to receive the suggestion. In discussing this matter.with the late Dr. Jerome Cochran, a great sanitarian, and expert in yellow fever, he demurred to this procedure. an alternative. He replied he would have each State appoint guards on its own bor- ders for its own protection. To this plan I ob- jected as being but another and a far less effi- cient cordon-one, in fact, which would be wholly inefficient-and no man bearing the re- sponsibility of the situation would dare to em- ploy this loose method of preventing the disease spreading into adjoining States. There would of necessity be too many open avenues, too many unguarded points; the plan would un- doubtedly prove a lamentable failure, and would result in the establishment of shotgun quarantines, now relegated to past history. There is nothing attractive in the cordon and detention camp; yet, hard as this measure seems, it is the lesser of two evils, and its disa- greeable features do not compare with the suf- fering, the hardships, and disaster which would ensue without it. Much depends upon the lo- cation, equipment, and administration of the camp. Two of these camps h^ve been operated by the Marine Hospital Service-the one in 1888, at Camp Perry, Fla.; the other in 1893, at Waynesville, Ga. Since this last date, in view of the unpleasant rumors which have in several seasons reached the Bureau, it has been deemed necessary to have ready a moveable camp, now stored at Waynesville, Ga., ready for shipment, so arranged that within twenty-four hours after the material has been deposited at the se- lected site the camp may be in operation. The equipment and the plans are complete for a camp of from five hundred to one thousand peo- ple. Now the relations of the railroads fb these matters are of great importance. RAILWAY REGULATIONS RELATING TO YELLOW FEVER. In yellow fever outbreaks there is always a time when at the beginning it is merely sus- pected, or the number of cases may be so few and localized that it cannot be called epidemic. At such a time the facts as they exist should be made public, with a view of allowing those who wish to do so an opportunity to leave the neighborhood. Depopulation at this time is to 6 be desired, but under restrictions which are enumerated in the regulations. One of these restrictions relates to the place of destination; and the railroads, therefore, can assist the san- itary authorities in refusing to sell tickets to points other than those designated by the au- thorities, these designated points being in lo- calities whose altitude or degree of longitude may be such that the disease will not be spread therein. Furthermore, certain restrictions relate to the disinfection of baggage of people leaving at this juncture. Article III. (paragraphs 1 and 5) is as fol- lows: " 1. Persons suffering from a quarantinable disease shall be isolated until no longer capable of transmitting the disease to others. Persons exposed to the infection of a quarantinable dis- ease shall be isolated, under observation, for such a period of time as may be necessary to demonstrate their freedom from the disease. All articles pertaining to such persons liable to convey infection shall be disinfected as herein- after prowded. " 5. No common carrier shall accept for transportation any person suffering with a quarantinable disease, nor any infected article of clothing, bedding, or personal property. " The body of any person who has died of a quarantinable disease shall not be transported save in hermetically sealed coffins, and by the order of the State or local health officer." Article IV. (paragraphs 1, 2, 6, and 7) has special bearing upon railroad transportation. I will read the paragraphs: " 1. Localities infected with yellow fever, and localities contiguous thereto, should be depopu- lated as rapidly and as completely as possible, so far as the same can be safely done; persons from noninfected localities, land who have not been exposed to infection, being allowed to leave without detention. Those who have been exposed, or who come from infected localities, shall be required to undergo a period of deten- tion and observation of ten days from the date of last exposure in a camp of probation or other designated place. 7 " Clothing and other articles capable of con- veying infection shall not be transported to noninfected localities without disinfection. " 2. Persons who have been exposed may be permitted to proceed without detention to local- ities incapable of becoming infected, and whose authorities are willing to receive them, and after arrangements have been perfected to the satisfaction of the proper health officer for their detention in said localities for a period of ten days. " 6. As soon as the disease becomes epidemic the railroad trains carrying persons allowed to depart from a city or place infected with yellow fever shall be under medical supervision. " 7. Common carriers from the infected dis- tricts, or believed to be carrying persons and effects capable of conveying infection, shall be subject to a sanitary inspection, and such per- sons and effects shall not be allowed to proceed, except as provided for by paragraph 2." After a cordon has been drawn around an in- fected locality, egress therefrom may be had only on one line of railroad, and that under the surveillance of the sanitary authorities. I wish here to acknowledge the cheerful ac- quiescence heretofore given by the several rail- roads to the regulations imposed, and, more than that, their hearty cooperation and valua- ble assistance. This was demonstrated in 1893, when, in has- tily erecting the camp at Waynesville, Ga., the superintendent of the railroad (Col. Haines), with the great facilities at his command, ren- dered invaluable aid in the establishment of the detention camp. The effect of these measures, however rigor- ous they may seem, is to give confidence in the surrounding country, and to obviate the resort to shotgun quarantines by neighboring cities and towns. To prevent these latter, and to per- mit through railroad traffic without obstruction on roads running near to the infected district, or through communities peopled by refugees, or on a road running through a slightly infected locality, a system of train inspection service is established to prevent persons suspected of be- ing infected, or from suspected localities, from boarding the through trains. A train inspec- 8 9 tion service of this kind was established in 1893, extending from Savannah to the southern bor- der of Georgia. It was under the charge of an experienced surgeon of the Marine Hospital Service, assisted by an assistant surgeon and a corps of fifteen sanitary inspectors. Following are the rules which were enforced by Surgeon Carter to permit the railroads to continue traffic without interruption from local sanitary authorities: " 1. Inspectors will allow none to board a train, unless with a certificate, between Way- cross and Savannah. " 2. If certificate can be examined before boarding, without detention of train, it must be done; and if unsatisfactory, the person pre- senting same will not be allowed to board. " 3. After boarding, the certificate and the person must be carefully examined, and the in- spector assures himself that the passenger is not recently from Jesup or any infected local- ity. " 4. If the passenger is known to be a recent resident of Jesup or any infected locality, or to have been in such place at any time during the past two (2) weeks, he will not be allowed to board, even if he has a certificate. " 5. If, after boarding, either the certificate or the examination of passengers is not satis- factory, the passenger will be turned over to the city authorities at Waycross or Savannah, or at the place where he desires to stop, if be- tween those places, and the facts noted and re- ported. " 6. A record will be kept of the names of all passengers inspected, name of signer of certifi- cate and his rank, date of inspection, date of certificate, and place of boarding train, and where passenger is bound and what disposition is made of him, whether passed or turned over to local authorities; also any other facts worth notice. " 7. Inspectors will aid local quarantine au- thorities in any way in their power consistent with their duties, hnd give them any informa- tion, and obey all local quarantine regulations." So perfect was this service, and such the con- fidence inspired, that through traffic was not 10 impeded, even though the trains passed through the town of Jesup, in which there were some cases of yellow fever. The railroad officials have acknowledged the great benefit to the railway service through these measures. In order that this essay may be complete, I append here, without reading, the rules adopt- ed by the Montgomery Conference for railroad quarantine, said conference being held in Mont- gomery, Ala., March 5-7, 1889: " 1. Quarantine should not be made against any place until it is officially known that yellow fever or other infectious or contagious disease exists at such place. " 2. Only competent physicians should be put in charge of quarantine stations, and only thor- oughly qualified persons should be employed as inspectors on railway trains. " 3. Quarantine stations located on railroads should be established at convenient points, on one or both sides of a town or station, as may be deemed necessary. " 4. If an epidemic of yellow fever or other infectious or contagious disease exist at a town or station, trains carrying passengers or freight should be required to pass through the limits of such towns or stations at a speed of not less than ten miles per hour, without stopping at such towns 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 supervision of the quarantine officer in charge of the sta- tion. " 6. Railway tickets may be sold to persons leaving an infected place to any point willing to receive them. " 7. All baggage from any infected point should be properly disinfected. " 8. As far as practicable, the same rules pro- posed for railroads 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 quaran- tine regulations. The conductors of passenger 11 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 freight 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 any infected place should be properly 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 postmasters to re- ceive and deliver mails at such quarantine sta- tions. " 12. Railroads and express companies may receive for transportation from any infected place, during the time such infection exists, any merchandise or traffic consigned to places willing to receive it. " 13. State authorities should employ compe- tent persons on passenger trains as inspectors of passengers, baggage, and express matter, as additional precaution; but the fact of inspect- ors being on such trains should not relieve trains carrying passengers or express matter or baggage from stopping at quarantine sta- tions for such inspection as the officer in charge may determine to be necessary. " 14. It is recommended that all quaran- tines, as far as practicable, should be uniform in their requirements and operations, which will greatly contribute to the prevention of panics, and tend to allay unnecessary excite- ment and fear on the part of the people. "15. The form of health certificate adopted by the Quarantine Convention, held at Montgom- ery March 5, 1889, should be prepared for health officers to issue to such persons as may be found entitled to receive the same. A copy of this certificate should be printed with these rules and conspicuously posted at railway sta- tions. " 16. It is the desire and intention of health authorities, as far as practicable, to throw ev- ery safeguard around the public health of all localities. Municipal, county, and State au- thorities are expected to cooperate in every pos- sible way with health officers located in towns. 12 villages, and cities, and in charge of quarantine stations, to enable them to prevent the intro- duction or spread of yellow fever or other in- fectious or contagious diseases." RAILWAY REGULATIONS RELATING TO SMALLPOX. There have been other regulations with re- gard to train inspection service-namely, those issued by the Surgeon General of the Marine Hospital Service, October 10, 1885, to prevent the introduction of smallpox into the United States from Canada. They are as follows: " The Act approved April 29, 1878, entitled, 'An Act to prevent the introduction of conta- gious or infectious diseases into the United States,' provides that no vessel or vehicle com- ing from any foreign port or country where any contagious or infectious disease exists, or any vessel or vehicle conveying persons, mer- chandise, or animals affected with any conta- gious disease, shall enter any port of the United States, or pass the boundary line between the United States and any foreign country, except in such manner as may be prescribed under said Act. "Attention is now directed to the prevalence of the contagious and infectious disease of smallpox in Montreal and other places in the Dominion of Canada, and the law referred to is held to apply alike to trains of cars and other vehicles crossing the border, and to vessels en- tering ports on the northern frontier. " Because, therefore, of the danger which at- taches to the transportation of persons and bag- gage and articles of merchandise or animals from the infected districts, the following regu- lations are framed, under the direction of the Secretary of the Treasury, and subject to the approval of the President, for the protection of the health of the people of the United States against the danger referred to: " 1. Until further orders, all vessels arriving from ports in Canada, and trains of cars and other vehicles crossing the border line, must be examined by a medical inspector of the Marine Hospital Service before they will be allowed to 13 enter the United States, unless provision shall have been made by State or municipal quaran- tine laws and regulations for such examination. " 2. All persons arriving from Canada, by rail or otherwise, must be examined by such medi- cal inspector before they will be allowed to en- ter the United States, unless provision has been made for such examination. " 3. All persons coming from infected dis- tricts, not giving satisfactory evidence of pro- tection against smallpox, will be prohibited from proceeding into the United States until after such period as the medical inspector, the local quarantine, or other sanitary officer duly authorized, may direct. " 4. The inspectors will vaccinate all unpro- tected persons who desire or are willing to sub- mit to vaccination free of charge. Any such per- son refusing to be vaccinated shall be prevented from entering the United States. " 5. All baggage, clothing, and other effects, and articles of merchandise, coming from in- feel ed districts, and liable to carry infection, or suspected of being infected, will be subjected to thorough disinfection. " 6. All persons showing evidence of having had smallpox or varioloid, or who exhibit a well defined mark of recent vaccination, may be con- sidered protected; but the wearing apparel and baggage of such protected persons who may come from infected districts, or have been ex- posed to infection, will be subjected to thor- ough disinfection as provided. " 7. Customs officers and United States med- ical inspectors will consult and act in conjunc- tion with authorized State and local health au- thorities so far as may be practicable; and un- necessary detention of trains or other vehicles, persons, animals, baggage, or merchandise will be avoided so far as may be consistent with the prevention of the introduction of diseases dan- gerous to the public health into the United Slates. " 8. Inspectors will make full weekly reports of services performed under this regulation. " 9. As provided in Section 5 of said Act, all quarantine officers or agents acting under any State or municipal system, upon the application 14 of the respective State or municipal authorities, are empowered to enforce the provisions of these regulations, and are hereby authorized to prevent the entrance into the United States of any vessel or vehicle, person, merchandise, or animals prohibited under the Act aforesaid. " 10. In the enforcement of these regulations there shall be no interference with any quaran- tine laws or regulations existing under or to be provided for by any State or municipal author- ity." The following are the special instructions for the guidance of sanitary inspectors, issued by Surgeon H. W. Austin, in charge of the in- spection service on the Canadian frontier from Buffalo, N. Y., to the Atlantic coast during the epidemic above referred to (see Marine Hos- pital Report, 1886): " REGULATIONS FOR SANITARY INSPECTORS. " The following instructions will be observed by the sanitary inspector on the following men- tioned railroads crossing the United States boundary line, viz.: The Grand Trunk Railway, at Rouse's Point, N. Y., and Island Pond, Vt.; the Passumpsic Railroad, at Newport, Vt.; the Central Vermont Railroad, at Highgate Springs or Saint Albans; the Canada Atlantic, at Rouse's Point, N. Y.; and the Southeastern Railway, at Richford, Vt.: "All persons bound for the United States coming from Montreal, or other places in Can- ada where smallpox prevails, must produce sat- isfactory evidence to the inspector that they are protected by a recent vaccination, or submit to this operation before they are allowed to cross the boundary line. " Inspectors will vaccinate all unprotected persons free of charge. " Persons coming from Montreal or suburban villages will be carefully questioned as to their residence, whether smallpox has occurred in their families, or whether they have been in contact with the disease. 15 "Inquiries should also be made relative to their baggage, whether it consists of bedding, household goods, etc., likely to be infected; and if any person or article of baggage is consid- ered by the inspector infected or likely to in- troduce the disease into the country, he or it should not be permitted to cross the line into the United States. " You may consider persons protected who may show evidence of having had the smallpox or varioloid, or who exhibit a well-defined mark of vaccination. Accept as evidence of protec- tion a certificate from any physician in good standing that the person presenting the same has been successfully vaccinated. Should you doubt the validity or authenticity of the certifi- cate, you may refuse any such person present- ing the same the privilege of crossing the bor- der unless he submits to vaccination. Baggage known to have come from any infected district, and believed to be infected, will be thoroughly fumigated with sulphur at Rouse's Point, Saint Albans, Richford, Newport, and Island Pond. " Weekly reports should be made to Surgeon H. W. Austin, United States Marine Hospital Service, Burlington, Vt., of the number of trains inspected, number of persons examined, num- ber of persons vaccinated, number of pieces of baggage fumigated, and any other information relative to services performed, by the inspect- or." RAILWAY REGULATIONS RELATING TO CHOLERA. In 1893, when there was imminent clanger that cholera might be introduced into the sea- board cities of the United States, and carried by immigrants to the interior cities and towns, a carefully formulated plan of railroad medical inspection of immigrants was drawn up; and while it was, fortunately, never necessary to carry out the provisions made at the time, the following regulations, issued in circular form by the Surgeon General, Marine Hospital Serv- ice, will show the scope and general design of the protective and restrictive measures contem- plated: 16 " RAILROAD MEDICAL INSPECTION OF IMMIGRANTS. " Instructions for the Guidance of Medical Offi- cers of the Marine Hospital Service, Sanitary Inspectors, and Others Concerned. " 1. One or more medical inspectors shall ac- company immigrants from the point of depar- ture of each immigrant train, and shall immedi- ately commence making a careful inspection of every passenger-man, woman, and child- upon the train. This inspection shall consist in identifying each passenger with the health card or cards he or she may hold, and satisfying himself as to the health of each person at the time of said inspection. He shall pass through the train once every hour, or oftener if he has reason to believe any person is suffering with diarrhea or other symptoms of cholera. " 2. The railroad companies will be expected to furnish earth closets, which should be used, and the regular closets of the cars are to be locked. These earth closets shall be destroyed before the train reaches its destination, at such points as the railroad officials shall designate. It shall be the duty of the inspector to see that the earth closets are kept clean and frequently disinfected, and the cars properly ventilated and free from all offensive odors and dirt. " 3. He shall, upon the least suspicion of chol- era among the immigrants, have the suspected person or persons immediately removed to the hospital car at the rear of the train, disinfect all ejecta, and take every precaution possible to prevent the spread of the disease among the passengers by thoroughly disinfecting that por- tion of the car occupied by the suspects, the simplest means for this purpose being a solu- tion of bichloride of mercury in the proportion of 1 to 800. " 4. The inspectors will at once notify the conductor of the train upon the first appear- ance of a suspicious case, in order that the hos- pital car may be switched off at the first desig- nated switch, and the health officer of the coun- ty in which said switch is located be immediate- ly notified to take charge of this car. " 5. It is expected that the railroads will fur- 17 nish a ear for hospital purposes, in which the seats can be readily converted into beds suita- ble for the care of the sick. The necessary bedding will be furnished by the United States Marine Hospital Service. " 6. Disinfectants, consisting of packages of bichloride of mercury and an alkali, will be furnished the medical inspector in proper quan- tities for adding to a two-gallon wooden bucket of water; also a quantity of carbolic acid in so- lution and other approved disinfectants. Each hospital car shall be equipped with a dozen two- gallon wooden buckets for holding disinfecting fluids, half a dozen mops, one or more hand force pumps with rose sprinklers, one or more commodes and bedpans, half a dozen eight- ounce hard rubber syringes, half a dozen tum- blers, one dozen rubber sheets, and one dozen feeding cups for administering medicine. There shall also be furnished an oil stove for heating water, and several tin boilers and tin cups. " 7. Medical supplies, etc., consisting of tan- nic acid, hydrarg. chloridum mite, tincture of opium, mustard or mustard papers, chloroform or ether sulph., whisky, brandy, and one or more hyperdomatic syringes; also supply of Squibb's Diarrhea Mixture, for checking loose- ness of the bowels or premonitory diarrhea." In the foregoing pages I have shown the rela- tions of the railroads to the interstate quaran- tine law with regard to three of the greater ep- idemic diseases-yellow fever, smallpox, and cholera. CAR SANITATION. There is another branch of the subject which is of equal importance; I refer to the transmis- sibility of other contagious diseases-such as tuberculosis, diphtheria, scarlet fever, measles, and typhoid fever by railways. This subject has been under investigation for more than a year in the laboratory of the Marine Hospital Service. I will only say at the present time that the results of the investigations thus far made re- lating to the air, the dust, and scrapings from railway coaches are not such as to excite undue alarm; but the investigation is still in progress, 18 and the cooperation of all the railroad compa- nies approached on the matter, as well as the Pullman Palace Car Company, has been cheer- fully given. A thorough and convenient disinfection of a sleeping coach, without injury to fabrics or other material, is a great desideratum, and it is believed that a scientific and harmless method has been discovered through the operations of the laboratory of the Marine Hospital Service. At the present time it is only necessary to refer to the work of the officer in charge of the labo- ratory, Dr. Kinyoun, who has already addressed you on the subject of car sanitation. The results of these labors, it is hoped, will be made known within the coming year. INTERNATIONAL CONFERENCE AT BRUSSELS. Now, gentlemen, before closing, I think it will be of interest to this convention and appro- priate to the occasion to refer to the " Interna- tional Conference Concerning the Hygiene and Sanitary Service on Railways and Vessels," which is to meet in Brussels in September next. This will be the second conference of its kind, the first having been held in Amsterdam in 1895. A few days ago I received, through the De- partment of State, the questions selected by the Committee on Organization to form the sub- jects of reports at the Brussels meeting. The subjects are grouped under three general headings: (A) Organization of the Medical Service; (B) Guarantees of the Efficiency of Employees; (C) Hygienic Requirements and Measures. Following are the questions for dis- cussion under each heading: "(A) ORGANIZATION OF THE MEDICAL SERVICE. " What is the best method of organization of the Railway Medical Service? " The following questions were made the or- der of the day by the Asterdam Congress of 1895, with a view to ascertaining the advan- tages and disadvantages that may result from their settlement: 19 " ' 1. Should the medical service form an in- tegral part of the management, the physicians being considered as agents? " ' 2. Should the medical service be attached to the fund for the relief of the employees, and be simply approved by the management? ' "(B) GUARANTEES OF THE EFFICIENCY OF EMPLOYEES. " 1. Of the influence of predisposition to dis- ease, regard being had to the admission of can- didates, and to the various duties of railway em- ployees. " 2. Reexamination of employees. " 3. Quantitative determination of the ability to distinguish colors. " 4. Defects of hearing in connection with the railway and navigation service. " 5. Concealment: (a) Of defective eyesight; (b) of defective hearing'. "(C) HYGIENIC REQUIREMENTS AND MEASURES. " 1. Methods of preventing the propagation of contagious diseases among passengers and em- ployees on board of railway trains and vessels. " 2. Should employees of railway trains and vessels be allowed to use the intoxicating liq- uors? " 3. Result of the measures taken to prevent the overworking of employees on railways and vessels during the last ten years. " 4. Organization of the relief service in case of accidents." At this conference in Brussels, in response to invitation received through the Belgian minis- ter, the Marine Hospital Service will be repre- sented by the detail of Passed Assistant Surgeon Kinyoun, whose report of the proceedings will appear in one of the publications of the Service, and will be mailed, on application, to the mem- bers of this association. In conclusion, gentlemen, permit me to ex- press my appreciation of the honor conferred upon me by your President in inviting me to address you, and to thank you for your kind at- tention.