Reprinted from The Sanitarian, April, 1884. 
REVIEW BY THE EDITOR. 
I-THE U.S. MARINE HOSPITAL SERVICE 
AND QUARANTINE. 
The Annual Report of the Marine Hospital Service for 1883, as com- 
pared with previous reports of the same service, is of unusual magnitude; 
chiefly, it appears, by reason of the new duties devolved upon the service, 
in the expenditure of the fund for the prevention of epidemics, to which 135 
pages are devoted. 
Primarily, 40,195 patients are reported upon in the regular service, as 
the number to which relief has been rendered-13,356 in hospitals, and 
26,839 at dispensaries. Days' relief furnished in hospitals, 327,312; trusses, 
46; elastic stockings, 35; peg-legs, 5; knee-caps, 3; glass-eye, 1-at an ex- 
penditure of $469,966 21. This amount includes $35,440.92 expended on 
account of extraordinary alterations and repairs to hospital buildings. 
Receipts from all sources, $426,620.35-tax on seamen for the year, 
$415,945.80. What the number of "seamen" in the merchant marine ser- 
vice, which gives 40,195 patients for treatment; how many and what pro- 
portion of them are women and children in domestic service on board of 
canal boats and ferry boats, from whom this amount of tax has been col- 
lected at $4.80 per capita; and how many more of such seamen there are in 
the marine service, who have refused to pay the tax, are interesting ques- 
tions in this connection, which the report fails to answer. 
Some cases of scurvy are reported with evidence of violation of the law 
which requires lime-juice to be an article of stores, and served under certain 
conditions; but the evidence was deemed insufficient for prosecution. A 
tabulated statement of 121 deaths, with the causes, "on voyages from foreign 
ports to this country, from July 1,1882, to June 30, 1883," from non-conta- 
gious diseases, is given, but as there is no record of the number of persons 
among whom the deaths occurred, by which the death-rate could be com- 
puted, the statement is of no value. Of small-pox treated at the various 
Marine Hospital stations in the United States, there were 141; 78 recovered, 
60 died, the results in 3 not reported. The number of men vaccinated was 2 
1,804. Under the head of Hospital Buildings and Grounds, diagrams of 
the block-plan of the hospital building at Memphis and of the new one pro- 
posed for New Orleans are given, which are excellent. The old-unfinished 
and never occupied-hospital building at New Orleans, appears to be still 
on the hands of the department, and the subject of widely different opinions 
for and against its availability. The worthlessness of this structure, the 
waste of nearly $600,000 of poor " Jack's " money thereon and other similar 
outlays were among the special items of our animadversion, in a review of 
the Report of the Supervising Surgeon-General for the year 1882-(Vol. XI., 
p. 236). Most of the exceptions in our review of the report in regard to 
this and other wastes of the Marine Hospital fund, and the indefiniteness of 
detail in the official report of 1882, apply equally to this for 1883. 
Secondly, in regard to the Quarantine service. This is very elaborate, 
and bears evidence throughout of an effort to show the special fitness and 
adaptation of the Marine Hospital service to its execution. There is a pro- 
fusion of correspondence in regard to the epidemics of yellow fever in 
Brownsville and Point Isabel, Texas, in 1882, and great stress laid upon the 
extensive cordon, and its efficiency in confining people to the infected region. 
But nothing whatever in regard to any measures taken for the removal of 
the people, sick or well, to healthy places, or cleansing the premises. In- 
deed, one particularly notable communication, which displays the policy of 
the cordon system, by the Surgeon-General of the Marine Hospital Service, 
addressed to the State Health Officer of Texas, under date of Sept. 7, 1882, 
and published in the "Preliminary Report of the Yellow Fever Epidemic of 
1882, in the State of Texas," p. 34, is omitted in this final report. It is as 
follows: 
"You are doubtless aware of the two cordons sanitaire in the southwestern por- 
tions of TexasI write for the purpose of suggesting that, as soon as the yellow 
fever has exhausted its material at Brownsville, which it now seems likely to do at 
no distant day, an inspection of the ranches in the space now confined between the 
cordons be made as early as practicable." 
This is the kind of quarantine which the Surgeon-General of the Marine 
Hospital Service is urging upon Congress for the United States in this last 
quarter of the nineteenth century ! He has a chief disciple, it appears, in 
the Governor of Texas, who, following the example of the Marine Hospital 
Service practice in Texas in 1882, is reported as having promulgated the fol- 
lowing orders for the coming summer: 
Galveston, Texas, March 1, 1884. 
A special to the News, from Austin, says: "The Governor yesterday issued a pro- 
clamation establishing a quarantine on the coast of Texas, beginning May 1. It applies 
to vessels from any port south of the twenty-fifth degree of north latitude, unless 
proof that the port from which a vessel arrives is not infected be submitted to the 
Governor's special commission, and an exemption granted. Vessels with clean bills 
of health and no sickness on board will be detained outside for twenty days, and 
other craft for the entire season. At Galveston, however, the cargoes of vessels with 
clean bills of health, and no sickness on board, may be immediately discharged in 
the disinfecting warehouse at the ouarantine station for twentv davs' detention." 3 
Let the reader imagine, if he can, what the effect would be upon com- 
merce, of a national quarantine conducted upon this principle, or if all our 
ports of entry adopted such regulations. Yet this is the system urged in 
the report before us. Its whole spirit is to detain persons on board an in- 
fected ship, or confine them to an infected place until the disease "has ex- 
hausted its material "-until it has spent its force upon all susceptible sub- 
jects-and then proceed with inspection and sanitation! 
Such was once the practice, and for a long period of time; but it was 
before the nature of infectious and contagious diseases was understood. It 
was in vogue, more or less, from its first institution at Venice, early in the 
twelfth to the early part of the present century. Such was the quarantine 
which gave significance to the name-an interdicted commerce-and kept 
persons in " leper houses " or " leper ships " for forty days, with interminable 
renewals, until the disease had exhausted its material with the lives of those 
who were subject to it, while the filthy ships and filthy places continued to 
be the hot-beds for new invasions at every return of the season or new acces- 
sion of subjects. 
Urging the cordon system by precept, and illustrating it by example- 
as practiced in Texas in 1882, and offered for Pensacola, 1883-the Surgeon- 
General of the Marine Hospital Service proceeds to demonstrate to his own 
satisfaction the unwisdom of the National Board of Health in establishing a 
Refuge Station at Ship Island for the prompt treatment of infected vessels 
and merchandise, and the proper care of persons, recommends Chan- 
deleur Islands, because a little nearer New Orleans, but less accessible for 
vessels, with an inferior anchorage ground, and with less protection-a pref- 
erence evidently based upon an erroneous conclusion that the station was 
chosen with reference to New Orleans alone-on "a point repeatedly made 
by the Louisiana State Board of Health," but against the expressed prefer- 
ence of the merchants of New Orleans, whose judgment was thoroughly 
canvassed before the choice of Ship Island was made; and, as appears by 
the report of Captain Thomas W. May, of the Revenue Marine, by order of 
the Secretary of the Treasury to survey the coast and report upon this 
question, in ignorance of the requirements necessary for such a Refuge. The 
following is that officer's report: 
"After a full consideration of all the requirements of a quarantine station 
we have decided to recommend Ship Island, in Mississippi Sound, as the best located 
and only island that possesses these advantages I will also state that there is 
no other island in the vicinity of the passes, within my knowledge, that can be used 
as a quarantine station." * 
But this is only one instance of many, showing the bent of the Surgeon- 
General, without knowledge of the subject which he is ambitious to control. 
* Evidence furnished the Public Health Committee of the House of Representatives, on the charges 
preferred by the Surgeon-General of Marine Hospital Service against the National Board of Health, by 
Dr. Charles Smart, U. S. Army, p. 4. 4 
In advocating a National Quarantine as he would have it, by his direct- 
ion under the Treasury Department, and with a fleet of revenue vessels to 
enforce the cordon, he quotes the report of Dr. Harvey E. Brown, U. S. 
Army, made in 1872, and other subsequent reports and papers in favor of a 
National Service, but adds nothing new. 
Inviting attention to the literature of this subject is, however, the most 
valuable part of the report. More familiarity with it, even in default of any 
practical knowledge whatever fitting him for the exercise of the office which 
he covets, might have prevented the melancholy spectacle of the attempt to 
revive a system of quarantine worthy of the age only when it was instituted, 
by persons wholly ignorant of the nature of epidemic diseases and the 
proper means of their destruction. He might have learned that advanced 
sanitarians and enlightened nations had profited by the progress of cholera 
after its exodus from India in 1831, which was challenged by every govern- 
ment it approached with a revival of just such a quarantine as he advocates; 
that the United States in 1832 followed the example of European nations in 
this regard, aided by a special committee of Congress, and with the same 
futile results; here as in Europe the disease rode over all such attempted 
restraints, defied all such antiquated barriers. In France, where the most 
rigid cordon was found already in force-enacted against yellow fever in 
1822-faith in its efficiency was most violently shaken and soonest followed 
by an enlightened appreciation of the worse than uselessness of efforts to 
restrain epidemic diseases by such means. Under the advice of the Academy 
of Medicine of Paris, a complete reform was decided upon, and on August 
18,1847, many of the restrictions which had proved to be so utterly useless 
for keeping out disease, and burdensome to commerce, were abolished by a 
royal ordinance. In 1849-50, still other reforms were accomplished, and 
the value of internal measures began to be better appreciated. Meanwhile, 
in England, sanitary reform was taking shape under the provisions of the 
New Poor-Law. Medical observers who had watched the relations of filth, 
disease and poverty, were authorized to collect evidence, and this, when 
logically collated, presented an amount of proof altogether irresistible, that 
the causes of diseases, in the main, were physical, removable and prevent- 
able. Hence, in 1839, systematic inquiry was instituted which embraced 
the condition of the laboring population in towns and rural districts, and 
the means of cleanliness and decency everywhere, public and private. Out 
of the information gained by this inquiry, Mr. Edwin Chadwick in 1842 
produced his invaluable " Report of the Sanitary Condition of the Laboring 
Population of Great Britain;" and even to this day, all the subsequent evi- 
dence in the numerous sanitary reports which have since been made in the 
progress of sanitary reform in England and in the United States, may be 
considered as an elaboration of the work of that far-seeing and veteran of 
practical sanitation, Edwin Chadwick, as first published in 1842. Fully 
imbued with the spirit of inquiry into everything in conflict with the public 5 
health, the General Board of Health, instituted by act of Parliament in 
1848, vigorously attacked the quarantine regulations which had proved to 
be so worthless, protesting that protection against pestilential diseases does 
not consist in quarantine regulations alone, but more in internal sanitary 
measures-measures which have for their object the destruction and pre- 
vention of conditions, without which the diseases regarded as quarantinable 
would not exist. The measures instituted at that time, and ever since 
vigorously prosecuted in England; the destruction of all sources of infection 
in town and country ; the improvement of habitations; an abundant supply 
of wholesome food and water; and, if in spite of these precautions, pestilence 
manifests itself in any place, abandonment of the locality with the utmost 
dispatch until the cause of the pestilence is found out and eradicated. 
In its enthusiastic war on the local causes of disease, the General Board 
of Health includes among them quarantines, and in the Report for 1849, by 
resolution declared: "That quarantines, instead of guarding against and 
preventing disease, foster and concentrate it, and place it under condi- 
tions the most favorable that can be devised for its general extension."-No 
one practically familiar with the diseases commonly subjected to quarantine, 
the local conditions under which they commonly prevail, and above all, with 
the special conditions promotive of their continuance on board ship, when 
once introduced, will question the righteousness of this conclusion of the 
General Board of Health of England. With a practical appreciation of the 
conditions involved in this action abroad, the leading sanitarians of the 
United States, at the instance of Dr. Wilson Jewell, of Philadelphia, held 
the Quarantine and Sanitary Conventions of 1857, '58, '59 and '60, in the 
promotion of the same purpose; and at the last of these conventions, held 
in Boston-1860-adopted, as its unanimous sentiment, regulations to abol- 
ish quarantine in this country, with its ancient significance-the cordon sys- 
tem ; and to substitute for it a thorough inspection and cleansing service, to 
begin at the port of departure. 
No vessel to be allowed to depart from any place until she is in a thor- 
oughly healthy condition and outfit, in both materiel and personnel, and pro- 
vided with all necessary regulations, means and instruction for the preser- 
vation of health, at the time of departure and during the voyage; sanitary 
measures on arrival, in detail with special reference to a bill of health from 
the last port of clearance, the health of all persons on board, and the hy- 
gienic condition of the vessel, provisions and cargo, with explicit directions 
for immediate provision for the sick, removal of the well, and thorough clean- 
sing of the vessel, with such detention only as may be necessary for these 
active measures-instead of the hitherto fatal and disease-promoting restric- 
tions-as the only kind of quarantine to be tolerated and relied upon equally 
for the protection of the public health, the promotion of commerce, and the 
exercise of humanity. 
Moreover, the same convention had in contemplation a national system 6 
to perfect and carry out these purposes; but in following up the 
by its committee, which was continued and authorized so to do-a national 
quarantine was found to be impracticable, by reason of an insufficient nufu- 
ber of organized local and State boards of health to support and enforce it. 
Dr. Brown's report in 1872 was in the same direction, was based upon the 
same general knowledge, and still impracticable for the same reason. But 
at the present time there is scarcely a port of any importance on the whole 
water coast of the United States that has not an organized board of health, 
and most of them under the auspices of State boards of health qualified to 
aid in the efficient support of a co-operative national marine health service,' 
under intelligent directions. 
The National Board of Health, created five years ago, was the outcome 
of this progress in local and State sanitation. To reform, unify, and render 
efficient the quarantines of the country, by the institution of active measures, 
such as are here briefly indicated, and which have been practiced in England 
for the last twenty years, were its chief efforts from the outset, and signally 
illustrated in Memphis and New Orleans. In Memphis by the depopula- 
tion and cleaning of the city; in New Orleans by stamping out the disease be- 
fore depopulation became necessary, and by the establishment of a thorough 
inspection and cleansing service of all vessels before departure from the in- 
fected port. This service afforded the first, and thus far the only demon- 
stration of a " quarantine " service in this country alike promotive of health 
and commerce, and the prevention of quarantine at ports of arrival. It was 
conducted on a principle totally diverse from that which has been practiced, 
and is now urged upon Congress and the Treasury Department by Surgeon- 
General Hamilton. The system which he urges has long since been aban- 
doned by all sanitarians, and is advocated and practiced by those persons 
only who have had no practical knowledge in dealing with epidemic diseases 
in their relation to commerce. 7 
Reprinted from The Sanitarian, I&bil, 1884. 
REMARKS BY THE EDITOR. 
II.-THE NATIONAL BOARD OF HEALTH 
BEFORE CONGRESS. 
On another page will be found "A Bill to Protect the Public Health," 
introduced since the one published in March number to "Amend the Act to 
Prevent the Introduction of Infectious and Contagious Diseases," etc. The 
one published in this number has a misleading title. It should be : A bill 
to obstruct commerce by measures promotive of infectious and contagious 
diseases, under the special direction of the Supervising Surgeon-General 
of the Marine Hospital Service-for this is its purport. But under 
the light shed upon the results of the Supervising Surgeon-General's 
service, in the exercise of his temporary functions for the last two years, as 
displayed in his official report, reviewed on other pages of this number; 
and by the reports of evidence before the Committee on Public Health of 
the House of Representatives, in support of House Bill 2,785. Forty-eighth 
Congress, First Session, for the protection of the Public Health, and in 
refutation of charges made against the Board by the Supervising Surgeon- 
General of the Marine Hospital Service, which we have just received, too 
late for such a notice as the importance of the subject demands in this num- 
ber, a further criticism of this bill in behalf of the Supervising Surgeon- 
General is unnecessary. It will suffice for the present to state that the evi- 
dence of the present Supervising Surgeon-General's total unfitness for the 
exercise of the office which he covets is simply overwhelming. 
It is probably quite unknown to our readers that a discussion has been 
going on for some weeks before the Public Health Committee* of the House 
of Representatives as to the merits and demerits of the National Board of 
Health. The reports we have before us contain the several arguments pre- 
sented to the committee, and we are in a position to judge of the nature of 
the controversy. It is in substance this: For some two years the Board has 
found itself obstructed by the opposition of two or three members of the 
lower House of Congress, who were in positions on the Committee on 
Appropriations, to exercise a controlling influence over the appropriations 
for the Board. For a time the origin of this opposition was unknown to 
the Board, but at length a member of the House, Mr. Ellis, of Louisiana, 
who was making charges against the Board, let out the fact that he got the 
data of his speech from Dr. J. B. Hamilton, the head of the Marine Hospital 
Service-one of the branches of the Board itself. At once it became appar- 
ent that all the opposition to the Board had its source in a conspiracy that 
* Hon. Lewis Beach, of New York, Chairman. 8 
for a long time was being secretly organized by the head of the Marine Hos- 
pital Service, Dr. Hamilton, in connection with Dr. Bailhache, an officer of 
that service, detailed to act as a member of the Board, and Assistant Secre- 
tary French, of the Treasury Department. 
When we consider that by the law organizing the National Board, the 
Marine Hospital Service was equally represented in it, with the Army, Navy 
and Department of Justice, and hence was bound in good faith to aid and 
support the Board in its work, the baseness of this treachery becomes ap- 
parent. For four years an officer of the Marine Hospital Service has occu- 
pied a seat in that Board and in its Executive Committee, and has always 
as cordially sustained the work and policy of the Board as any member. 
And yet it appears from Dr. Hamilton's statement that, though he was cogni- 
zant of great errors in management, of expenditure of moneys for corrupt 
purposes, and of numerous defects and delinquencies, he never attempted to 
correct or improve the methods of the Board. On the contrary, while his 
Service, through its representative on the Board, was aiding and co-opera- 
ting in these alleged wrongs, Dr. Hamilton secretly manipulated the records 
of the Board, extracted such statements as he could best employ to prejudice 
the minds of members of Congress, and finally, brought them before the 
Public Health Committee with an amount of self-conceit, personal abuse of 
members of the Board, and general clap-trap which has never been equaled. 
If such stuff as he has issued under the cover of the Treasury Department 
shall have any other effect than that of disgusting the Public Health Commit- 
tee, we despair of any correct health legislation by the present Congress.