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1 
Quarantine Regulations.
NATIONAL
d|Mrfliti« mi ^mdmt
ASSOCIATION.
REPORT OF COMMITTEE
EXTERNAL  HYGIENE.
I860.
v\ Gen/',,

      NEW YORK :
EDMUND JONES & CO., PRINTER
     X o. 28 John street.
/££0 

/?L#+2? 11,0-1+ 
QUARANTINE  REGULATIONS.
   REPORT OF THE  COMMITTEE OX EXTERNAL HYGIENE.


   At the Third National Quarantine and Sanitary Associa-
 tion, held in New York, April, 1>>59, the following Resolu-
 tions were adopted, and the undersigned were appointed
 a Committee in accordance therewith :
   Resolved,  That the operations  of quarantine should not
 be confined to the warm months  of the year;  inasmuch as
 a vessel, arriving in midwinter, with small-pox or typhus
 on board, is as legitimate a subject for quarantine as one
 arriving in midsummer.
   Resolved,  That the adoption, by the commercial nations,
 of a sound and well-digested  code of marine hygiene,  and
 of the necessary measures  for  insuring its strict enforce-
 ment, would tend greatly to alleviate the evils of the pre-
 sent svstem of quarantine, and  promote the  comfort of
 passengers and crew.
   Resolved,  That this Convention appoint a Committee to
 consider and  report in what manner the foregoing resolu-
 tions may be most effectually carried out.
   Resolved,  That the Committee  report, at the next meet-
 ing  of  this  Convention (in  Boston,  June 14th, I860),
 specific  recommendations of principles and  measures of
 quarantine,  as severally applicable to yellow fever, cholera,
tvphus fiever and small-pox, having reference  also to  the
variations which different localities require.
I
l 
4
   The Committee, to  whom  the  above resolutions were
referred, have taken much pains to obtain all  the informa-
tion possible on  the subjects to which they relate; and
they are under lasting obligations to the Honorable Lewis
W. Cass, Secretary of State,  and to the Honorable John
Appleton, Assistant Secretary of State, for  the procure-
ment of printed  copies  of the  quarantine regulations  of
the principal commercial nations;  also to the Health Offi-
cers of the chief seaports of the United  States, for the
health regulations and ordinances which have been, or are
now, in use in our own country.  From these  and some
other resources, the Committee mi External Hygiene have
had abundant means for appreciating the Quarantine Re-
gulations of different nations and places, and of comparing
them together in  such a manner  as to promise a fair pros-
pect of presenting a code of marine hygiene applicable  to
all the varying circumstances of commerce.
  The strongest  evidence of human progress  is the con-
quest of science  over error and superstition.   When,  in
1831, the cholera left India for a tour of Europe, after hav-
ing traveled over  the continent of Asia,  every government
it approached essayed to put a stop to  its progress by the
powers of  quarantine.   Equally vain were the like forces
on the continent  of America.  The  cholera rode over all
quarantine  restraints—bid defiance to all such  antiquated
barriers.  About  this same  period of time, Chervin, the
great  student of  yellow fever, was battling against the
quarantine  ordinances of France, as worse than useless for
the protection of  the French frontiers against this disease ;
and the triumph of cholera over the quarantine which was
to keep out yellow fever, was regarded  by Chervin as a
strong argument in favor of his view's against quarantine__ 
o
for the abrogation of the odious ordinance of  L&j-J.   Confi-
dence in quarantine regulations for the prevention of plague
was also forfeited in a great degree by frequent recurrences
of that disease in  places the most rigidly guarded, whilst
other places, exempt from stringent quarantine regulations,
were  free from this much-dreaded  disease.
  The conquest of Algeria by the French placed the govern-
ment of that country under the necessity of reducing, from
time to time, the burdens of quarantine which had been pre-
viously imposed, even when the States of Barbary were free
from the plague.  These reforms, however, were strenuously
opposed, particularly by the sanitary authorities of Marseilles,
who had been for a longtime accustomed to exercise the most
arbitrary powers in this regard ; also by the Health authori-
ties of Italy, who went so far as to accuse  France of open-
ing the port of Marseilles to the plague.
   In  spite of these oppositions, however, reform steadily
advanced.  Two  Commissions confided to M.  de  Segur
Dupeyron,  the Inspector of  quarantine,  who, though a
coniagionist, clearly displayed in his  reports the vices and
incoherences of the system; a collection of the published
opinions  of many men distinguished  in  science,  by  M.
Aubert-Roche; the exemption experienced by the French
mail-boats; and,  finally,  the remarkable report  of the
Academy of Medicine, of Paris, upon the plague and quar-
antines—all  concurred  in  the propriety  of a complete
reform.
   On the Ibth of August, lt>47, a  royal ordinance of France
declared  the  first  recognition of truths  based  upon the
opinions  of medical men, that many of the restrictions of
quarantine were  unnecessarily burdensome, and therefore
abolished. Still other reforms were established by decrees, 
6
on the 10th of August, 1849, and on the 10th of Decem-
ber,  1850.   But it was not enough  for the eminent  sani-
tarians of France to have accomplished a reform in their
own country, and for their own commercial ports;  this was
only a beginning of the work.   They proposed to show
that it was to the interest of the commerce of other nations
to accept the reforms which they had effected for France.
And Dupeyron suggested to the Ministers of Commerce
the idea of a Sanitary Congress, formed  by delegates from
the  divers powers  having seaports  on the Mediterranean.
The Government adopted his opinion, but—on attempting
negotiations—failed in accomplishing its intended purpose.

   In 1850, M. Melier, member of the consulting committee
on public hygiene, renewed the  proposition of Dupeyron,
and with  more success.  Melier submitted a programme,
which was agreed to by all the governments interested ; and
a convention was formed by delegates  from  France, Eng-
land, Austria, Spain, the Two Sicilies, the Roman States,
Greece, Portugal, Russia, Sardinia, Tuscany, and  Turkey.
This convention soon after met in Paris, and, after long dis-
cussion, proposed an international code of quarantine laws,
which has since been ratified  by the  nations represented ;
and this code is now observed in all  the ports of the Medi-
terranean.  Meanwhile, the sanitary reform, which  began
in England about twenty years  ago, under the provisions
of the "New Poor Law," attacked  no  less vigorously the
ancient  fallacies of quarantine, which had been in vogue
in that country since the Great Plague of 1666.   The Gen-
eral Board of Health, instituted by an Act of Parliament in
1848, persisted  in repeated efforts against the quarantine
regulations, for  plague, cholera, and yellow fever—diseases
alike in essence, modified by climate or other circumstances 
7
of locality, and subject to the same  means  of control__
protesting that  protection from  pestilential disease  does
not consist in quarantine  regulations, but in internal sani-
tary measures, that is to say, in measures which have for
their object  the  suppression and  prevention of conditions
without which the diseases regarded as quarantinable would
not exist.  The industry, the boldness, and the enthusiasm
of Chadwick, of Guy, of Southwood Smith, of Duncan, of
Ferrier,  of Currie, of Toynbee, of Milroy, and others  of
like stamp, astounded the United Kingdom, and astonished
the world by reports which  implied accessory murder of
thousands of human beings, by the very authorities whose
office it should be to protect them.
   The measures proposed by the General Board of Health
were  the destruction of fomites—all sources of infection in
town and country ; sanitary improvement of habitations;
a full supply of wholesome water and wholesome food—
extending to the personnel and materiel of commerce—and,
finally, if, in spite of these precautions, pestilence manifests
itself in  any place, abandonment  of the locality until the
cause of the pestilence is found out and eradicated.  These
theories, though for a long  time silently believed in by
many physicians of eminence, were now for the first  time
openly proclaimed,  and pressed upon the authorities as the
only safeguards  against the recurrence  of appalling epi-
demics.  And when the first International Sanitary Conven-
tion met in Paris, in  1850, the delegates from France had
already a well-matured programme as a basis of discussion ;
—the chief feature of the Convention was the abrogation
of useless quarantine restrictions, and the  inculcation  of
municipal hygiene in their stead.
   However lamentable the devastations of cholera, since its 
9
exodus from India, in 1831, it is to our better acquaintance
with the habitudes of this disease that the commercial world
is indebted for the progress already made, in the removal of
pernicious influences to health, and restrictions burdensome
to commerce and navigation.  Quarantine reform has been a
prominent feature in the sanitary improvement of Europe for
nearly thirty years, and it is with chagrin that your commit-
tee on external hygiene, after diligent  investigation,  finds
that the quarantine regulations of the United States are
nearly identical with the most odious restrictions of Europe
thirty years ago.  They are, in effect, the same laws as those
imposed by England, in colonial  times, for the protection
of America  from " plague or other malignant distempers,"
and in  several of the  States  it yet remains an indictable
offense, with a large penalty, for any  person to come into
the State from any place infected with contagious disease.
The quarantine laws still presume that certain diseases are
communicable from the sick to the well, under all circum-
stances, and that such diseases are capable of  being trans-
mitted  to new  and distant  localities, independent  of all
conditions.   They also presume that the germs of  all dis-
eases,  regarded by quarantine officials  as contagious or
infectious, may lie dormant in the systems of persons who
are apparently well, but who may afterwards sicken, and
then become the  radiating  centres  of infection.   Based
upon these conclusions, the time and duration of Quarantine
pretend to  depend upon the real or suspected presence of
the apprehended  disease, in the personnel of any vessel
during the vovage and at the time of arrival, the  kind of
cargo, and whether there has been any  communication with
other vessels, persons, or things, during the voyage.  These
 requirements, however, are of short duration, and usually
 limited to the warm season of the year.  This rfsvme is a 
9
fair  representation of the Quarantine regulations of the
United States, while there are no exceptions to the incon-
gruities herein stated.
   It has been justly remarked by McCulloch,  in his Com-
mercial Dictionaiy,  that  "the complaints  of  quarantine
grievances and  oppressions  are almost wholly occasioned
by want  of  proper facilities for  its performance."   But,
while we may properly  admit the truth  of this  assertion,
as applicable especially to the view which commercial men
must naturally take of this  subject, we think it  must ap-
pear to scientific observers that the defective  facilities to
which McCulloch has referred are mainly owing to the pre-
vailing indefiniteness of opinions and official practices  re-
lating to  quarantine, and to febrile infections.   As medical
men, therefore, your Committee  frankly acknowledge that
the  medical  profession, and  quarantine officers  themselves,
are  partly responsible for the defects of our external sani-
tary defenses.
   Before enumerating the points which  we  believe to be
essential  to  the provision and perfection of the external
sanitary system  of maritime  cities and  large commercial
towns, your Connnittee  would  briefly  note  the special
 defects and  wants  that are acknowledged to exist in all, or
 at least most, of the ports in the civilized world.

 I. THE  DEFECTS  THAT  RELATE  TO   THE  SICK, AM)  TO
      SANITARY PROTECTION.

 II.  THE  DEFICIENCIES  THAT  RELATE   TO   COMMERCIAL
      TRANSACTIONS AND  PUBLIC  CONVENIENCE.
   Under  the Jirst  head  are  included :   1st.  Hospitals—
 their  location, construction, and  fitness ; the  facilities for 
10
the reception, distribution, and care of the patients.   2d.
The construction and  management  of  docks and  ware-
houses for quarantine purposes, with reference to sanitary
protection.
   Under the second head we enumerate :  1st. The need-
less  delay  of vessels.  2d. The unnecessary  detention  of
cargoes.   3d.  The damage of such cargoes and vessels  at
Quarantine.  4th. The inconvenience and expense of light-
erage.   5th. Loss of time and the use of vessels.
   As all  these points under the second head are connected
with the  genera] question of quarantine docks and ware-
houses—their location, capacity, and special adaptation—it
is  manifestly right and eminently proper that the  interests
and requirements of commerce should be provided for, and
made perfectly consistent and harmonious with all the con-
ditions and provisions which are necessary for the protec-
tion of the public health. These points include the grounds
upon which objections are made respecting deficient facili-
ties as  well as burdensome restrictions of quarantine estab-
lishments.  We propose  to make a fair and full  state-
ment of  the points, without attempting  their discussion.
But we feel warranted  in  making the  following general
statement,  involving all  these points incidentally, and  at
the same  time affirming what is  conceded to be necessary
to  the arrangement of a quarantine establishment.
                   I.—THE SICK.

  Humanity and public policy alike demand that, wherever
there is a  quarantine establishment, or wherever and when-
ever there is any detention of vessels and the  sick, in  the 
11
nature of quarantine, there, in the immediate vicinity of the
quarantine anchorage,  should  be provided  ample facili-
ties for the proper care  of all such cases of disease as may
not,  with  safety  to  the public and to the patients,  be
removed to more suitable places.
  The nature and extent of hospital provisions required at
any quarantine  station  must be  in  no  small measure de-
pendent upon the nature and extent of hospitals, and the
internal sanitary arrangements of the city or place requir-
ing a quarantine establishment.
  For the welfare of the sick it is required that the  loca-
tion of the hospitals should be within a convenient distance
of the  quarantine station, and  that the facilities  of access
to them from  the quarantine anchorage be  such  as to
secure the greatest safety to the sick, and the least danger
to the public; and lastly, such location, distribution, and
special management of  the sick, as shall prevent the general
contamination of the hospital in which they may  be placed
for treatment, and also  preclude liability to any dangerous
exposure  to subsequent infection, or to any other unhealthy
influences.
   Both the public safety  and the welfare of  the sick in
hospitals  require that effectual provisions be  made for the
immediate and thorough disinfection of all baggage and
personal clothing liable to infection.
 II.—QUARANTINE DOCKS AND WAREHOUSES.

  If it is admitted that the security of the public health
against certain diseases demands the protracted detention 
12
or exclusion of vessels or cargoes that are liable to convey
and propagate those diseases, then it may justly be claimed
that the interests of commerce require special  docks and
warehouses for that  class of quarantined vessels and car-
goes,  while experience has  fully demonstrated  the great
importance of such  special  facilities, no less  for public
safety than for commercial convenience.
   To illustrate the nature and extent of the deficiencies of
quarantine establishments, we would  refer to  the  state-
ments on this  subject as embodied in the Report on Ex-
ternal  Hygiene,  adopted  by this Convention last year.*
We would also mention  the testimony given on the  same
subject,  particularly as  regards  deficient provisions for
the sick, by the. British Quarantine Commissioners, in their
First Report.f   And  in regard to  the testimony  respecting
those special  deficiencies that embarrass  commerce  and
incommode the public, it is painfully evident that the judi-
cious author  of  the  Commercial  Dictionary speaks truly
when he asserts,  that were the proper facilities afforded to
enable merchants  and others to comply with quarantine
and all needed external  health regulations, " the burdens
it (quarantine) imposes  would   be  comparatively  light,
and we do not know that  many  more important  services
could be rendered to the country than by constructing a
proper quarantine esrablislnnent."  Continuing his remarks
on this subject, Mr. McCulloch states, "there is  not on the
Thames  a  lazaretto, where a ship from a suspected  place
may discharge her cargo and  refit,  so that it is detained,
frequently at an enormous expense, during the  whole pe-
riod of quarantine."
  ° See Report of Convention, 185U, pp. 821, 322 el seq.
  t See First Report of the Quarantine Commissioners to the General Board
of Health of Great Britain, pp. 78-7C. 
13
  This  statement, which  applies  to ports that  less than
almost any other large maritime cities require such special
external sanitary provisions, has been strongly corroborated
l>y the testimony of  boards of trade and chambers of com-
merce in the principal ports of both America and  Europe.

  As respects  medical and  official testimony, generally, we
find none more decided than that adopted by this Conven-
tion  at  its last session, in answer to the question, "What
reforms are required to make quarantines more  efficient
and  less burdensome?"  In  that  report it is  stated, that
" we must be prepared to denounce, as  worse than useless,
every system  of quarantine which, either  from incorrect-
ness of the  principles upon which it is founded, or from the
careless and inefficient manner in which it  is executed, as
inadequate to  guard the community against the  introduc-
tion  of disease from abroad."

  The Quarantine Commissioners  of Great Britain, in their
first  report  to the  General  Board of Health, in 1848, con-
cisely sum irp the deficiencies and objections of British quar-
antines, by stating, that ''the Quarantine establishments of
this and every  other country, of which we have information,
are wholly insufficient, even on the  assumption on which
they have  hitherto been maintained, to prevent the intro-
duction and spread of disease."

  " That these establishments are of a character calculated
to inflict on passengers extreme and unnecessary  inconve-
nience,  and to subject such  of them  as  may be sick to
increased suffering and danger, while  they maintain false
securities in relation to the means of preventing the spread
of disease."
  With such  testimony, and  with the  various quarantine 
14
codes of civilized nations before your committee, and from
the results of their own personal observations—strongly cor-
roborating such statements—they feel that the task imposed
upon them by the resolutions of the last Convention pos-
sesses such a degree of practical importance, and involves
such a variety of questions and interests, that " the specific
recommendations of principles  and measures of Quaran-
tine," called for in this report, need to be very carefully con-
sidered and clearly stated.

  Having been directed to report to the fourth meeting of
this Convention " specific recommendations of principles
and measures of  quarantine, as severally applicable to yel-
low  fever, cholera, typhus fever, and small-pox, having
reference, also, to the variations which different localities
require," this  Committee will  now endeavor to  comply
with the direction, in accordance with the  design  of the
resolutions. 
      SPECIFIC  MKAS1 RFS  OF  QUARANTINE,

SEVERALLY APPLICABLE TO YELLOW FEVER, CHOLERA, TYPHUS,
       AND SMALL-POX, WITH THE VARIATIONS WHICH
              DIFFERENT LOCALITIES REQUIRE.


   As the specific measures of an efficient system  of exter-
nal sanitary police, to guard against the several diseases
here enumerated, will, in particular cases, relate to persons,
clothing, cargoes, or vessels, the special provisions required
may be included under the following heads:

i.--quarantine  hospitals,  and  the  proper  (are  of
       the Sick.

ii.--quarantine  warehouses   and   docks,  and  the
       proper disposal and care of  infected  things.

   First.— (Quarantine Hospitals,  and the Care of the Sick.—
It must  be admitted that the welfare  of the sick and the
interests of the  public health require  that  the  sick with
pestilent diseases  should receive medical attendance and
hospital care immediately upon their arrival at quarantine,
or at  the first place of detention of vessels by quarantine
authority.   Ample  provisions, therefore, should  be  made
for the immediate  and proper  care of the sick at every
quarantine station.
   The extent  and variety of such hospital provisions, re-
quired for  particular quarantine stations, will manifestly
depend upon the number of patients liable to be received,
and the variety of infectious maladies to be treated. 
16
  Distribution of the Sick.—It is plain that no two or more
of the pestilent maladies enumerated in this report  should
ever be introduced together into  the same ward, and, if pos-
sible, they ought to be treated in separate buildings.

  While facts do not warrant the conclusion that any disease
is necessarily and inevitably infectious or contagious under all
circumstances, it is so true of small-pox and of typhus that
they do certainly spread by personal contact, limited infec-
tion of apartments, and also by personal ywwVr.s—it is mani-
festly the duty of the sanitary authority to insure the entire
seclusion  of each of those maladies.  As regards both yel-
low fever and cholera, it will be generally  admitted that it
is  due to  public quietude, even if it is not known  to be
absolutely necessary for public safety, that persons arriving
at quarantine with either of those maladies should be pro-
vided for in secluded hospitals.   But it is safe to recommend
that the local sanitary authority of any city or port should
decide whether special hospitals be established for the sick
arriving at quarantine, or whether the special hospitals, es-
tablished  for the seclusion of cases of those diseases occur-
ring in such city or port, be also used for the same classes
of patients arriving from  abroad.   One hospital establish-
ment for typhus fever, and one  small-pox lazaretto, may, in
certain  places, be so located and  furnished  as to answer
well  for  the  sick  from abroad,  and also  promote  the
efficiency and economy of both the external and internal
sanitary  police.

  It is probable  that the proper distribution of the sick
may sometimes be best secured by such a combination of
the hospital arrangements of the external  and the internal
sanitary systems  of particular  places.  Proper distribution 
17
and  the  safe seclusion of the  sick  with pestilent  diseases
should be secured in every quarantine  establishment.

  Location of Quarantine Hospitals.—First, they should be
so convenient, and so  situated, with reference to the quar-
antine anchorage and the quarantine warehouses and docks,
as to offer the  best  possible facilities for the immediate
medical  care of the  sick arriving, and of the laborers or
other persons becoming ill at the quarantine  station.

   Character and Construction of (luarantine Hospitals.—First,
they should  be  so located as to enjoy a pure and  dry air ;
and, consequently, should be sufficiently  remote from the
warehouses and infected vessels to be safe from any danger
from that quarter, nor should they be landlocked by eleva-
tions around them, or too much sheltered from the wind-
ward.
   Whether erected on the shores, or  floating, the number
of separate hospitals  should be  sufficient to give at least
one  for each of the diseases that are to be provided for at
any  one  period;  and the hospitals should be so arranged as
to secure—

   1st. Perfect cleanliness.
   2d.  Ample space for patients.
   3d.  Complete and controllable ventilation.
   4th. The best facilities for the reception and care  of the
sick.
   5th. The  requisite means for cleansing and disinfecting
bedding  and clothing.
   There can be no better test of the good management of
hospitals for pestilent diseases than that the hospital wards 
18
be so free from contamination that they do not become  in-
fected places.  To preserve a typhus-fever or a small-pox
ward from infectious contamination, and, consequently, to
secure the welfare of its inmates, it is indispensably neces-
sary that the air-space be much greater than has usually been
provided in our hospitals.  In the wards for cholera and for
yellow fever, the welfare of the sick, if not the safety of
attendants, requires a liberal and constant supply of  fresh
air.
  To attain such a degree of sanitary security in quaran-
tine or fever hospitals,  it is necessary that ample space  be
allotted to the sick.  Not less than two thousand five  hun-
dred  cubic feet  of air-space should be allotted  to  each
patient, unless the facilities for insuring the constant supply
of fresh air from without, by  means of arrangements for
plenum ventilation, be  of an unusual character.   But it is
not the design of this report to  enter upon any  details  of
hospital construction.
  The main objects of  reference to this subject  have  been
attained in the foregoing remarks, on the proper distribu-
tion and care of the sick at  quarantine.  But we need to
add in this place a few  suggestions upon an indispensably
important branch of service, connected with the manage-
ment of hospitals, particularly  those pertaining to a  qua-
rantine establishment.  We refer to  the best  means for the
cleansing and disinfection of clothing, etc., from hospital wards,
or from infected vessels.
  There cannot be a more highly important regulation  in
any hospital than that which secures the immediate cleans-
ing of every utensil  or article of personal and hospital cloth-
ing, as soon as soiled; and in the arrangement of  a quaran-
tine establishment, none is more essential than that which 
19
provides for the immediate and thorough disinfection of all
articles of clothing, bedding, etc., both from infected vessels
and hospital wards.   It is not only desirable but necessary,
that every quarantine establishment should be provided with
ample means for effecting such purification and disinfection,
as a grand measure of sanitary protection against all per-
sonal and common fomites of pestilent diseases.
   Notwithstanding the general  impression regarding  the
uncertainty of the ordinary chemical disinfectants,  so called,
it will not be denied that all articles of clothing may,  and
certainly ought to be, completely disinfected and thoroughly
cleansed  by some speedy and  effectual  process, at every
quarantine establishment.
   By referring to the able report that was adopted by the
Convention last year, on disinfectants, it will be  seen that
for the disinfection of apartments  or things  contaminated
with the infectious cause of pestilent diseases, free venti-
lation must be the main reliance; and it is truly stated  in
that  report, that " a disinfectant for the yellow fever is a desider-
 atum."  Nearly as much  may  be said  of other  specific
 febrile infections.  In the present state of our knowledge
 respecting the essential nature of these infections, and their
 relations to physiological and atmospheric chemistry, it is
 not to be expected that positive chemical disinfectants will
 be successfully applied ; but this Committee would  ven-
 ture to recommend that, for the disinfection  of all fomites
 and  apartments  contaminated with  yellow fever or any
 other febrile poison, full  experiment be made  with  high
 steam or  with dry heat above 200 degrees Fahrenheit,
 as a common mode of disinfection  and purification, when-
 ever, and to whatever such heat may  be safely  applied.
 As this recommendation is based upon  obvious  principles 
20
 and facts which will be set forth in a special communica-
 tion on this subject, by a member of this Committee, they
 will extend their suggestions on this subject only  to  the
 practical application of heat as a disinfectant in the execu-
 tive managment of quarantine  hospitals, workhouses, and
 infected vessels.
   The Committee recommend, that in  connection with every Quar-
 antine establishment, at the warehouses as veil as at the hospitals,
 properly constructed steam-generators  and steam chambers or vats,
 be provided for  the disinfection if all personal, hospital,  and
 ship's clotlnng and bedding, together  n-ith such  other goods or
 things as may properly be subjected to high steam heat.
   It is also  recommended that experiment  be  made  to
 test the utility of steam as a disinfectant  in vessels  con-
 taminated with yellow fever or  any  other  febrile  poison
 that is not readily destroyed or dissipated by other agencies.

   It is also recommended that at every  Quarantine  estab-
 lishment it shall be an  established  rule that all  articles  of
 clothing, bedding, or dunnage on board of vessels suspected
 of being contaminated  with yellow fever  or  cholera,  and
 liable to propagate the same, shall be subjected to high
 steam  or dry heat for the purpose  of disinfection; and that
 this duty be attended to as soon as  convenient  after the
 arrival of the infected  vessel or things,  ;  and  especially,
 that, without such process having  been performed, no  ar-
ticle or thing whatsoever  shall  be thrown overboard  or
 otherwise disposed of, except by rapid incineration  or  by
being securely sunken under the water.

  It is  also  recommended that in  every quarantine
hospital it be an established rule,  that all articles of per-
sonal   clothing, bedding,  and  every absorbant  material 
21
pertaining  to  the furniture and  utensils of the wards, or
the care of the sick or the  dead, be removed to the steam-
vats as soon as they become soiled  or  contaminated ;  and
it is further recommended  that, in  addition to means for
ventilation, provision  be made for the application of high,
dry, or steam heat in the wards where pestilential infection
is liable to be perpetuated.
  In the case of fomites of small pox and of typhus fever,
the same rule is recommended to all sanitary authorities,
connected either with the  internal or the  external police
of cities.
  The foregoing  suggestions  and recommendations  em-
brace the most important  measures, which are of essential
importance in  the  executive1  management of quarantine
hospitals ;  and all specific  regulations that the Committee
would recommend on this subject may be concisely sum-
med up under the heads of—

   1. Ample air-space, and effectual ventilation.
  2. Proper supply and control of sun-light  in the wards.
  3. Such a construction   and  material for hospital wards
        as  not to favor the retention and perpetuation of
        febrile poisons and the emanations from the sick.
  4. Means  for immediate  and  safe  disinfection  of  all
       clothing, bedding, etc.
  -5. Facilities for the reception of the  sick, and  for  the
        removal and burial of the dead without the obser-
        vation  of the  patients in the wards.
  G. A resident medical officer, who shall have control of
        the internal  management and  police  of the hos-
        pitals. 
22
Location, Construction, and  the  Executive Manage-
     ment of Quarantine Docks and Warehouses.

   In a former part of this  Report reference has already
been made  to the  universal defect of all modern quaran-
tine establishments, viz.: the absence of suitable docks and
warehouses  for  infected vessels  and  cargoes.  This is a
subject of such vast importance to commerce, and of such
vital interest to  the public health, that  the  Committee
would deem it their duty to present the full argument  in
favor of the  recommendation they desire clearly to express
in the declarations of the proposed code.   But, happily for
the  brevity  of  this Report, as  well  as for  the complete
statement of its various questions connected with the sub-
ject, a special report on  wet docks and quarantine ware-
houses is to be presented to the Convention.   On this
subject, therefore, the  Committee need only to enunciate
the following general statements :

   1. Ample and  safe warehouse facilities, and  convenient
and safe dockage for infected vessels and their cargoes are
indespensible requisites  for every  quarantine establish-
ment where yellow fever, cholera or the plague are liable
to be perpetuated by exotic fomites.

   2. Though not indispensably necessary to  enable the
Sanitary authorities to guard against the introduction of
typhus or small-pox, such  special quarantine docks and
warehouses  might often be of great service.
   3. At any port where a considerable number of vessels
with their cargoes  is  liable to protracted detention  at
quarantine, wet  docks and  capacious warehouses, exclu-
sively devoted to quarantine purposes, are recommended ; 
23
and  it is further recommended, that, in  all cases where a
vessel is reasonably suspected of being infected with yel-
low  fever, it  shall not, even  after discharging cargo,  be
permitted by the health officer, or the local council, to ap-
proach  nearer to the city than  the quarantine docks,  or
warehouses ; until thoroughly disinfected.

   4. For the general  security of the public  health of all
cities in maritime communication, no less than for the con-
venience and benefit of commerce, it is recommended that
a  dry dock, or a marine railway, be constructed in  con-
nection with the quarantine docks and warehouses, for the
purpose of enabling merchants to overhaul and repair their
vessels, and to enable  the sanitary authorities  to make such
inspections  as  they may  deem expedient in  connection
with such  repairs.

   5. The quarantine  docks, warehouses, and  anchorage,
should be located at a sufficient distance from  any populous
neighborhood  to insure seclusion,  and be free from any
liability of communicating the infection of any disease  to
any persons not  employed at the quarantine establishment.
To this end, it is recommended  that  the  docks, ware-
houses,  and anchorage be located at least two miles from
any populous neighborhood, however rural, and, when prac-
ticable, at a much greater distance from  cities or large
towns.
   6. The warehouses should be "so constructed as to se-
cure the best natural ventilation, and to that should be
added  appliances and power  to  afford to  each store-loft
and  apartment the most complete provisions for artificial
ventilation and disinfection."  It is  further recommended
that  at every quarantine  establishment  there  should be 
24
 constructed,  in  connection  with the warehouse or ware-
 houses,  an apartment,  or chambers, with  suitable  appli-
 ances for special  disinfection, by high steam,  dry heat,
 refrigeration,  chemical disinfection, and forced ventilation;
 and that facilities  be supplied for the speedy and safe de-
 livery and shipment of goods that have been subjected to
 such disinfecting processes.
   7th. It is recommended that the executive management
 and control of quarantine warehouses  and docks, and  the
 goods and persons therein, be under a competent scientific
 officer, who shall be approved by the health officer of  the
 port, and the  local sanitary council.

   As the special regulations which the committee  would
 recommend respecting the unlading,  detention, and pratic
 of cargoes, will be stated in the declarations of the code
 submitted, we will not extend our suggestions on this sub-
ject.
   It will be observed that this report assumes, without ar-
 gument or any narration of reasons or opinions, that both
yellow fever  and cholera are diseases  capable of  being
transmitted and propagated  from place to place beyond
their indigenous habitats.
  In the case  of yellow fever, having satisfactory evidence
that such transmission is effected generally,  if not always,
by means of inanimate fomites, the committee have no oc-
casion to renew the discussion of questions  which were so
fully entered upon by the Convention last year.   But it will
be  observed that the suggestions and  recommendations
contained in this  report, so far as they  relate to the sick
with yellow fever, contemplate such care and seclusion as to
answer the demands of those among us who still believe 
25
in the personal connnunicability of that  scourge of the
tropics, while providing for  the  simply humane interests
of the sick.
   In respect to  Asiatic cholera, the report coincides with
the high authority of the most reliable  commissioners and
committees that have specially investigated the history and
progress of that fearful malady.  With the conclusions of
Doctors Baly and Gull, as expressed in the able report of
the British  Royal College of Physicians, your  committee
believe that  " human  intercourse is certainly only one
cause of the propagation of  the  disease,"  and  that  "the
propagation of the disease by human intercourse does not
prove1 its contagious nature ;" all of which  may be affirmed
with  equal truth of the propagation of yellow fever.   But
" the  possibility that cholera  is occasionally communicated
by a  virus produced  in, and emanating from the sick," is
admitted.
   As regards the utility of quarantine  restrictions against
cholera, it  may safely  be stated, in the language  of the
 Royal  College  of  Physicians, that " quarantine has un-
doubtedly often failed  of its object, partly from its  being
evaded  by the  crews  of infected  ships, partly,  perhaps,
from  the  ships being  placed so near  to  habitations on
shore, that the imperfect air of the ships would be carried
 to them by atmospheric currents ;  and, in some cases, pro-
 bably, because  clothes, still  containing infectious matter,
 were conveyed on shore during or subsequent to the period
 of quarantine.*''
   This report also adopts the conclusion of the able docu-
 ment from which the preceding paragraphs  have  been
 quoted, that " it cannot be doubted that ships are more or
 less fitted to convey the disease, or its cause, from port to
               1 
2 IS
port, in proportion  to  their want  of cleanliness, defective
ventilation, and overcrowded state, and that  if these evils,
of which  the  two former  are  so  flagrant in the smaller
trading vessels, and the two latter in ships carrying passen-
gers, could be removed, the danger of the importation of
cholera would be greatly lessened."  The language of this
most recent and reliable  authority on this subject so fully
expresses the views of your committee, that we beg per-
mission to  quote the following, as  the best that can  be
given on this point in our report:
   t; While, therefore, it is much to be desired, on general
grounds, that measures should be adopted for  inculcating
and enforcing attention to cleanliness and free ventilation,
in the whole mercantile marine, the special application of
measures  of this kind to ships coming from ports where
cholera prevails, as far as may be  practicable,  is impera-
tively  called for.  A close inspection of all such vessels
should be  made on their coming into  port,  and it would
not be unreasonable to require that there should be brought
with each ship coming from  an infected port  an official
certificate of its having been inspected, and found cleanly
and not over-crowded, and the crew healthy at  the time of
its sailing."
   "On the arrival of ships having persons ill  of cholera
on board,  or having had deaths from  that disease during
the voyage, more active measures must be adopted ;  1, and
the best that have been recommended seem to  be, the re-
removal of the sick to a hospital ship, moored at a distance
from the other shipping in the harbor,  or to a special hos-
pital in an isolated and airy situation on shore;  2, permission
to the rest of the crew to land after exchanging their dress
for fresh clothes provided from  the shore; 3, the thorough 
■27
exposure of articles of dress and baggage to the air and
disinfecting agents before they are removed from the ship
(or from Quarantine warehouses); and, 4, the use of disin-
fecting agents in  every part of it,  but  especially in the
parts occupied by the crew and  their baggage."
   In the foregoing concise statement is embodied all that
need be said  on this subject of quarantine for  cholera,
though there is stronger ground for quarantine restrictions
against that disease in America than can exist on the Eastern
continent.
   As  regards  typhus fever and  small  pox, this Report
recommends that all  specific directions or regulations for
the management of both the sick  and the vessels in which
they arrive  be committed  to the discretion of the  local
sanitary authorities ;  yet the Committee, desiring to fulfill
the  commission intrusted  to them,  feel  it  incumbent on
them to report as follows regarding the quarantine regula-
tions demanded by those diseases :
   It is well known that typhus fever and smallpox are
diseases that prevail most frequently in  cold weather, and
that persons laboring under these maladies, and also infected
goods, are not subjected to  quarantine.   It has  been well
observed that  a ship arriving with  typhus fever or small
pox at midwinter is as legitimately a  subject for quarantine
restrictions as one with yellow fever on board arriving in
midsummer.   Nor will it be denied that the danger of con-
tageon in  small pox and from infection in ship fever is far
more to be dreaded than any danger  from persons sick with
yellow fever at any season.  While  the fomitc* of yellow
fever—existing independent of  persons—-though active
only during hot weather, are much  less subject to control
than the fomites of typhus fever and small pox. 
2S
  Should a single doubt linger in the mind of any one on
this question, let  it be remembered  that the foul atmos-
phere of a ship at sea is oftentimes produced during cold
weather  or in cold latitudes, by overcrowding, and by the
exclusion of pure air, impoverished diet, and want of proper
attention to cleanliness.   Such  a condition of things has
repeatedly happened,  and disease has been introduced into
our ports by the arrival of emigrant,  and other vessels, in
midwinter, after a protracted voyage,  or, where the ship's
company consisted of  a squalid, filthy, half-fed, and intem-
perate collection of  passengers, at  the same time the
vessel laboring under  a leaky hold, and having a perishable
cargo on board. 
(ODE  OF MARINE  HYGIENE.
                    DECLARATIONS.
  J.  Every  organized  government has the right of pro-
tecting itself against the introduction of infectious diseases,
and of putting any country, place, or thing in quarantine
which  would  introduce  infectious  diseases;  provided,
however, that no sanitary measure shall go so far as to ex-
clude or drive  from  port  a vessel, whatever  may be
her condition.
  2. The only diseases at present known, against the in-
troduction of which general  quarantine regulations should
be enforced,  are  plague,  yellow fever, and cholera.  Tn
addition to  these, however, all ports have the right of pro-
viding against a ship having typhus fever on board, and of
applying  prophylactic measures against small-pox.   And,
as regards plague, the European Congress at Paris had the
right to settle the question   for the nations there  repre-
sented ; and that inasmuch as they and the other nations of
the eastern  continent have reason to subject the plague to
quarantine  restrictions, the States of America yield impli-
cit obedience to that convention.
   3.  All quarantine  regulations, of  any place whatever,
should bear with equal force against the toleration or  propa-
gation of disease as against its introduction  ; and authority
to prevent the introduction of disease in any place  should
be equally applicable against its exportation.
   4. All quarantinable  diseases are chiefly introduced and
propagated by the materiel of commerce;  and it is there- 
30
fore against it that quarantine  restrictions should be insti-
tuted, and not against the personnel.—Excepting, however,
persons with no evidence of vaccination, and known to have
been  exposed to small-pox;  such  persons  shall be vac-
cinated as  soon as  practicable,  and detained  until  the
vaccinia shall have  taken effect; otherwise, they may be
detained fourteen days from  the  time  of  the  known
exposure.
  5. The application of quarantine regulations shall be
regulated by the  official declaration of the constituted
sanitary authority at the port of departure where the malady
exists.  The cessation of these  measures  shall  be  deter-
mined by a like  declaration that the malady has ceased—
after, however, the expiration of  a  fixed  delay  of thirty
days for the plague, fifteen days for yellow  fever, and ten
days for cholera.
  6. It is  obligatory on all  vessels  to  have a bill of
health ; this shall consist of  two kinds only, a clean  bill
and a gross bill, the first for the attested absence of disease,
and the second for the attested presence of  disease.   The
bill shall state the hygienic state of the vessel; and a vessel
in a bad condition, even with a clean bill of health, shall be
regarded as a vessel having a gross bill, and  shall be  sub-
mitted to the same regime.

  7. The plague, yellow fever, and cholera being the  only
maladies that entail general measures, and place in  quar-
antine those places whence they proceed, the restrictions
enforced against these diseases  shall  not  be applied to any
other suspected or diseased vessel.

  S. The power of applying the general  principles  of this
code,  and of acceding to its provisions,  are  expressly re- 
31
served to those nations3 and governments who consent to
accept the obligations it imposes;  and all the administra-
tive measures proceeding  from it  shall be determined by
international sanitary regulations, or by a convention of the
representatives of the governments which have adopted it.
  9.  This code shall continue in force and vigor among the
governments adopting it for five years, and it shall be the
duty  of any party wishing to withdraw from its observance,
at the end of that time, to officially declare his intention six
months before the term expires ; if there be no such notice,
the code shall be regarded as in force one year longer, and
thus it shall continue year after year with all the govern-
ments accepting it,  until  after due  notice—six months
before withdrawal.
               PROVISIONS   IN  DETAIL-

         1.--MEASCKKS KKLATIM! TO  DEPARTIKK.

   10. Measures relating to departure comprise observation,
inspection, and the ascertaining of the sanitary state of the
place and vicinity ;  the examination and ascertaining of
the hygienic state of the vessel which is about leaving, of
its cargo and provisions, of the health of  the  crew, and if
there art1 any passengers, of their health also ; and lastly,
of the bill of health, and all relating thereto.   These obser-
vations, inspections, and examinations shall  be confined to
the authorities hereinafter designated.
   11. All vessels, before lading, must be visited by a dele-
gate of the sanitary authority,  who  shall be  a  doctor of
medicine, and  submit  to  hygienic  measures, if deemed 
32
necessary.   The vessel shall be visited in all her parts, and
her hygienic state ascertained.   The authority shall inquire
into the state of the provisions and beverages, in particular
of the potable water and the means  of  preserving it;  he
shall also inquire into the state of the crew, and in geneial
into every thing relating to the maintenance of health on
board.  If any person has been shipped, having  a  trans-
missible disease, such person shall be forthwith discarded.
  12. Charges shall not be made until after the visit, and
the accomplishment of the measures judged  indispensable
by  the sanitary authority.
  13. Captains and masters shall furnish to the  sanitaiv
authority all the information and all the evidence, to the
best of  their knowledge, demanded of them.  If the sani-
tary authority judges necessary, and does not believe him-
self sufficiently informed by the captain oi* other persons
in charge, he can proceed to a new  visit, after  the  lading
of the ship, in order to assure himself if all the  prescribed
hygienic measures have been observed.
   14. These various visits  shall be  made without  delav,
and in such  a manner as to  avoid unnecessary  loss to the
ship.
  15. Vessels  carrying a foreign flag shall be  visited bv
the sanitary authority, with the consul or consular agent of
the nation to which  the vessel  belongs.
  10. The  number  of passengers embarking  on sailing
vessels or steamers, the arrangement  of their accommoda-
tions, and the quantity of provisions on board for the pro-
bable length of voyage shall be  determined by particular
regulations  of the  different  governments  adopting  this
code.   But in no case should the number of individuals  to 
33
lie accommodated on board any vessel, or in any apartment
provided for the accommodation of crew or passengers,
exceed in ratio one individual to every four hundred  cubic
feet of air space, together with provision for effectual ven-
tilation in all weathers.
   1.7.  Passenger vessels  of  whatever size, and all vessels
carrying sixty persons, or  a  smaller  number,  including
crew,  shall furnish themselves with  the necessary  medi-
cines and apparatus for the treatment of the most ordinary
diseases and accidents likely to happen on board.  And it
shall be the duty  of the sanitary  administration of each
government to make out a catalogue  of the medicines and
apparatus, and detailed instructions for their use on  board
all vessels of this class.
   IS. All sea-going passenger vessels, and all vessels hav-
 ing a larger number of persons on board than named in the
 last preceding article, shall carry a doctor of medicine, ap-
 proved of by  the  sanitary authority.
   19. Bills of health shall not hereafter be delivered until
 after the fulfillment of the regulationsJiereiii specified.
   20. Vessels of the navy and revenue vessels shall  not be
 subject to the preceding regulations.
   21. In ordinary times, fishing-vessels, pilot-boats,  vessels
 in the coasting trade, of the same country, and canal boats,
 need not carry a bill of health; the sanitary regulations of
 this  class  of vessels  shall  be determined by  the local
 authorities.
    22.  No vessel shall have  more than one bill of health.
    23. Bills of health shall  be delivered in the name of the
 local government by the sanitary authority, vised  by the 
34
 consuls or commercial agents,  and be  of credit  in the
 ports of all governments adopting this code.
   24.  The bill  of health shall  contain  the name of the
 vessel, the name of the captain, or master, and the results
 of the examinations, relating to the tonnage, merchandise,
 crew, and passengers;  it shall state the exact sanitary con-
 dition  of  the place, the hygienic state  of the  ship,  and
 whether there are  any  sick on board.  In short, the  bill
 shall contain all the information  that can enlighten  the
 sanitary authority  of the port of destination, to give him
 as exact an idea as possible  of the  public health  at  the
 place of departure and environs ;  of the state of the ship,
 her cargo, the health of the  crew  and passengers.  The
 environs are those  places in habitual communication with
the port of departure, and possessing the same sanitary
relations.   The bill of health for all parties adopting this
code shall  conform to the annexed model : 

       BILL OF HEALTH.


 Same of vessel.........
 Nature of vr.-.-H........
 Hag..................
 Tonnage.................
 (tllllS....................
 Port of Registry.........
 Destination..............
 Name of Captain.........
 Name of Physician.......
 Ktpiipage.—All complete.
Passengers..............
I'argo...................
 Hygienic state of Ship. . .
Hygienic state of Equipage,
  Cordage, Sails, etc.....
Hygienic state of Passen
  gors..................
Kood, Provisions, etc.....
Water..................
Disease on Hoard........
sanitary state of place and
  environs,.............
  and that............. .


      IVlivered        th     «H
IS    At       o'clock.

p
c/a




W
H-t
Wi
        SANITARY  REGULATIONS.

    1! II;  li    O l*1    1 I  1<)  A T^ Til  .
                     Port oi'___    ______
of the  Health Department  in          certify that  the vessel, hepdnafti
nanicd, left this port in  the  following condition, namely :
Name  of vessel.........                    |i  Hygienic state of Hie Ship
Nature of the vessel.....
Flag....................
Tonnage ................
Guns...................
Port of Registry.........
Destination.............                       Hygienic Mate of Pass-n
Name of Captain.........                         !i''i's...................
Name of Physician......
Equipage.—All compl. . .  .
Passengers.  ............
Cargo.................
Disease on Hoard........                       Wat;
Hygienic state of Kquipage
  Corda'.'e. Sails, etc......
Pood. Provisions. < t<
    We  nlso certify Hint  the Sanitary -!at" of the place and environs
the
   In testimony of which w »  have delivered the picscut Hill of H'alth. at
IS    at    o'clock.

      (Signed.)
W
A
i  r
[SKA I..]
m 
30
  25. Whenever there prevails at the place of departure,
or in its environs, one of the three maladies reputed to be
importable  or  transmissible—and   when  the   sanitary
authority  shall have declared its existence, tin1 bill  shall
give the date of the declaration.  It shall give the date of
the cessation of the same when the  cessation  shall  have
been established.

  20. In  conformity to the  provisions of Article 0,  the
Bill of Health must be either Clean or Gross.  The sanitary
authority  shall always pronounce upon the existence or
nonexistence of disease at the port of departure.  Doubt-
ful  cases shall be interpreted in the most prudent  sense—
and the bill shall be gross.  In regard  to passengers, for
those whose health may be suspected, the sanitary author-
ity  may demand  the  certificate of a  doctor  of medicine,
known to him to be of good standing, and if any proposed
passenger is thus found to be in a condition  compromising
the health of the ship or of persons on  board, he shall,
upon  the direction  of the sanitary authority, be prohibited.

  27. Bills  of Health  can  only be  considered  as valid
when they  have been  delivered  within the  forty-eight
hours last preceding departure. If the departure is delayed
beyond this period, the bill must be vis^d by the authority
delivering it,  stating whatever change may have taken
place.

  23. The existence  of  transmissible  or importable  dis-
ease in the quarantine establishment of an}- place shall not
alone be  considered cause   sufficient for  a gross  bill of
health. 
                           37

     IT.--SANITARV  MEASURES DURING THE VOYAGE.

  21). All vessels at sea shall be kept in a good state of
ventilation and cleanliness.   And to this end it shall be the
duty of the sanitary authority at the port of departure, to
see  that every vessel is provided with the necessary means,
and that captains  and masters are sufficiently  conversant
with the use of those means, for the purposes indicated.

  30. Captains and masters shall conform to the  instruc-
tions  of  the sanitary  authority ;  otherwise, on arriving,
they shall  be considered as having a gross bill  of health,
and be treated accordingly.

  3 I. Physicians  attached  to  sea-going  vessels shall be
considered  as the agents of the sanitary authority, and it
shall be their special mission to watch the health of the
crew  and passengers, to see that the  rules of hygiene are
observed, and, on  the arrival of the  vessel, to give an ac-
count of the circumstances  of the voyage.  They  must
also keep an exact record of all circumstances of interest
to the public health, meteorological observations, etc., and
note with particular care the history  and treatment  of all
the diseases and accidents that  occur.

  32. In vessels carrying no physician, it shall be the duty
of the master, or  captain, to fulfill, as far as practicable,
the obligations  of the last preceding article.

  33. All captains or masters touching at or conimunicat-
i,,o- with  a  port,  shall have  their bills of health visid by
the sanitary authority ;  or in default of such authority, by
the delegated officer of the local police.
  34. It  is forbidden to the sanitary authority at the port 
3S
where a vessel touches, or holds communication, to retain
the bill of health given at the port of departure.
  35. In cases of death at sea from a disease of a suspect-
ed character, the wearing apparel and bedding which have
been used by the  deceased in  the course of his sickness,
shall be burnt if the ship is at anchor;  if en route, thrown
into the sea, with the necessary precaution  that they shall
not float.   Other articles belonging to  the  deceased  shall
be immediately aired or otherwise purified.
         111.--SANITARY  MEASURES ON  ARRIVAL.

  30. All vessels on arrival shall submit to an examination
and questioning.  The examination  and questioning shall
be made by the  sanitary  authority delegated for that pur-
pose ; and the result shall be recorded upon a  special re-
gister.
  37. All vessels, furnished  with a clean  bill  of health,
which have had during the voyage no disease or communi-
cation of a suspected nature, and which present a satisfac-
tory  hygiene  condition,  shall be admitted  to free pratic
immediately after examination.
  38. There being  no  evidence that any disease was ever
introduced  into a community by persons  who had been
quite healthy  during the voyage, and were so  on arrival,
such persons  should not be  detained under the apprehen-
sion that  disease may be dormant  in  their systems.  All
well persons  shall  be  allowed free  pratic, excepting only
the  temporary delay provided in Article 4 for  small-pox,
immediately after arrival. 
39
  39. Whenever there are sick on board, they shall be re-
moved as promptly as possible from the vessel to clean and
airy rooms on shore, or to a floating hospital moored in a
healthy situation.   The detention  of  such  persons  in  an
infected ship is obviously most objectionable, and  should
be allowed under no circumstances whatever.

  40. The experience  of quarantine shows  that  the fears
of pestilential disease  being introduced by the  ordinary
cargoes of dry and  imperishable  goods is groundless, and
that with the temporary exceptions hereinafter provided,
such cargoes shall be admitted to free  pratic immediately
after examination.  Neverf heless there are numerous articles
of commerce which should not be landed except under
special restrictions,  and apart from all populous  neigh-
borhoods.
  41. The application of sanitary measures to merchandise
shall be arranged in  three classes :  1. Merchandise to  be
submitted to an obligatory quarantine  and to purification ;
2. Merchandise subject to an optional  quarantine ;  and 3.
Merchandise exempt from quarantine.
  The 1st class comprises clothing, bedding, personal bag-
gage  and dunnage,  rags, paper, paper-rags, hides,  skins,
feathers,  hair, and all other remains of animals, woolens, and
silks.
  The 2d class comprehends cotton, linen, and hemp.
  The 3d class comprehends all  merchandise not enume-
rated in the other two classes.

  42. With a gross bill and  existing quarantinable disease
on board, or if there has been any such disease  on  board
within the ten days last preceding, merchandise of the first 
40
class shall always be landed  at  the quarantine warehouse
or other place provided, distant at least two miles from all
populous neighborhoods, and there submitted to the neces-
sary measures for purification.   Merchandise of the second
class  may be  admitted  to  free pratic  immediately, or
transferred to the warehouse, according to circumstances, at
the option  of the  sanitary authority,  with  due  regard to
the sanitaiy regulations of the port.   Merchandise  of the
third  class shall be declared free, and admitted without
unnecessary delay.
   43. In all cases  of a gross bill, letters  and papers shall
be submitted  to the  usual purifications ; but  articles of
merchandise, or other things not subject to purifying meas-
ures, in an envelope officially sealed, shall immediately be
admitted to  free  pratic, whatever may be  the  bill of
health.   And if the envelope is  of  a substance  considered
;is optional, its admission shall be equally optional.
   44. Afoul ship is much more to  be  dreaded, as a vehicle
of introducing disease, than anything she has  on board;
and vessels in a filthy, unwholesome  state, whether there
has been sickness on board or not, should not be allowed to
enter a crowded port, or to lie along-side  a wharf or other
ships, until they have been broken out, duly cleansed and
ventilated.
   45. If a vessel,  though furnished   with  a  clean  bill of
health, and having had during the voyage no  case of sick-
ness,  yet be found in a bad or infected state, or in a condi-
tion which the sanitary authority judges  compromising to
the public health, the  vessel and  cargo  shall be detained
until  the  cargo has been considered by the authority ; his
decision,  however, shall  be  rendered within twenty-four
hours. 
41
   46. If in the judgment of the sanitary authority the vessel
requires it, he may order the following hygienic measures :
Baths  and other bodily care for the personnel, washing or
other disinfecting  means  for  clothing ;  displacement of
merchandise  on board, or a complete breaking  out;  sub-
jection to high steam, incineration, or submersion at a dis-
tance, in the sea, of infected articles; the destruction of
tainted or spoiled food or beverages ;  the complete ejection
of water ; thorough  cleansing of the hold, and  the disin-
fection of the well; in short, the complete  airing and venti-
lation  of the vessel in all her parts, by the use of force
pumps, steam, fumigation, washing,  rubbing, or scraping,
and  finally  sending  to  an  isolated anchorage ground.
Whenever these divers operations are  deemed  necessary,
they shall be executed in the more or less complete isolation
of the vessel, according to circumstances, but always before
admission to free pratic.

   47. All vessels having no bill of health, which, by reason
of the place from whence they came,  could not obtain one,
or in case of accidental loss of bill, shall submit  to restric-
tions according to circumstances, depending upon the judg-
ment of the sanitary authority, in conformity, with the pro-
visions herein established.

   48. All bills showing evidence of erasure or  alteration
shall be  considered null, and shalF incur the conditions of
the last preceding  article, without prejudice to the  pro-
ceedings which  may be instituted against the  authors of
the alterations.
   49. A doubtful case, reported in an unsatisfactory man-
ner,  shall always be interpreted in the most prudent sense.
The vessel shall be provisionally detained.
              6 
42
   50.  Admission  to  free pratic shall  be preceded  by as
many visits to  the vessel as the  sanitaiy authority may
judge necessary.
   51.  No vessel can be put in quarantine, without a stated
decision of the  sanitaiy authority.   The  captain or mas-
ter of the vessel shall be informed immediately after of this
decision.
   ■Y2.  A vessel shall have the right, except when they have
plague, yellow fever, or cholera onboard, of putting to sea,
in preference to being quarantined; and in the exercise of
this right, if the vessel has not arrived at the port of desti-
nation, the bill  of health  shall be returned ; the sanitary
authority,  however,  shall  mention upon such  bill  the
length and circumstances of the detention, also the condi-
tion of the vessel on re-putting to sea.  But before the ex-
ercise of this right, the sanitaiy authority must assure him-
self that the sick  will  be taken care of for the remainder
of the voyage; and take charge  of such of the sick  as
prefer to remain.

   53. Besides the specific measures in the foregoing regu-
lations, the sanitaiy authority of each country or port has
the right, according to Article 1st,  in the presence of im-
mediate  danger, to take the responsibility of applying such
additional measures as may  be deemed indispensable for
the protection of public health.

   54. Notwithstanding  the preceding regulations,  when-
ever the sanitaiy state is positively healthy, vessels going
from one port to another in the same country can, in virtue
of the  particular sanitary regulations of  each country, be
freed from sanitary examinations.   And, in ordinary times,
by virtue of declarations exchanged between the contract- 
43
ing nations, all vessels, proceeding or intending to proceed
from one of two countries to the  ports of the other, may
also be free from examination.
            IV.--EXECUTIVE  ARRANGEM KM S.

  55. Every  seaport  town  requiring  the  obligations of
quarantine, should have a quarantine hosjntal for sick per-
sons,  warehouses for infected goods, with the necessary
docks, and a  designated anchorage ground  for  infected
vessels ;  these several parts of the  establishment  shall be
at such a distance  and direction  from each other, and all
populous neighborhoods, infections and iufectable places,
as to endanger the life of no one.
  50. ()n the arrival of infected vessels at the quarantine
establishment, all well persons  shall  be  admitted to free
pratic as soon as  possibly consistent with the foregoing
regulations, sick peisons shall be  immediately transferred
to the  quarantine hospital,  or to  hospital ships, and the
vessel unladen as soon  as practicable.  All  merchandise
shall  be placed  in  capacious and perfectly  secure ware-
houses, and there freely  exposed  to the air, and moved
from time to time to insure its perfect ventilation.

  57. Merchandise coming from different vessels and places
in quarantine, at different times, shall be kept  separate,
and placed  as much as possible in different warehouses.

  58. Merchandise of the first class (Art. 41) shall be sub-
mitted to  such  measures of  purification as the  sanitary
authority shall judge  necessary.  No  putrified  animal or 
44
vegetable  substances,  or substances  likely  to  putrify,
shall be admitted into the warehouses.  All such substances
shall be rendered innoxious or destroyed.
   59. The clothes and dunnage of passengers contaminated
with the infection of different diseases shall be exposed to
ventilation in different places.
   60. Each Quarantine  establishment  shall  have one or
more warehouses specially appropriated to the reception of
purified  merchandise  to  which  all merchandise  may be
removed so  soon as it  shall be deemed by  the  sanitary
authority admissible to pratic.
   61. Letters or dispatches  shall be  so  purified that the
writing may not be  affected.   Consuls and representatives
of foreign  countries have the right  to  be present at the
opening  and purification of letter-bags,  or   other  mail
packages  addressed  to them  or designed for their country.
Postmasters shall have the same right as consuls and foreign
representatives.
   62. All governments and places adopting this code shall
as soon  as  practicable provide the necessary  arrangments
and appurtenances for fulfilling the obligations it imposes.
   63. In case of the arrival of infected vessels at a port not
provided with a  quarantine establishment, vessels or hulks
may be appropriated to the service of the sick, and also for
the reception of merchandise; but in such cases they shall
be disposed in such a manner as will permit the separation
of the sick  and assure the best conditions of hygiene__es-
pecially ventilation.  But under no circumstances whatever
shall sick persons be kept in proximity with infected goods.
Well persons shall have their liberties as soon  as practica-
ble, consistent with  the  preceding regulations;  and  all 
45
other measures essential for the protection of public health,
shall be instituted according to the exegencies of the case
provided they are not inconsistent with the tenor and spirit
of these regulations.
              V.--SANITARY  AUTHORITIES.

  64. Sanitary authorities shall be established upon a uni-
form basis by the countries or governments adopting this
code, and shall be composed:  First, of a responsible agent
of the government, who shall be a doctor of medicine ; and,
Second, of a local Sanitary Council or Board of Health.


  In addition to the above  report, presuming it to  be
adopted, your Committee beg leave to offer the  follow-
ing resolutions :
  1. Resolved, That this  report be referred back to the
Committee, with directions  to negotiate with our National
Government  or Department of State, to secure, by conven-
tion or otherwise, the national and international adoption
of this code.
  2. Resolved, That a committee of one from  each State
represented  in this Convention be designated by the dele-
gates of the several  States, and appointed by the Chairman
of the Convention, with power to confer with the Govern-
ments  of their  respective  States  for  the adoption of this
code.
  3. Resolved, That the  local sanitary authorities of the
several  States and  municipalities in the United States be 
46
furnished  with a copy of this report,  and that they are
hereby respectfully requested to carry into effect all  its
specific recommendations, and the general provisions of the
code, without waiting for their national and international
adoption.

        Respectfully submitted,
                         A. N. BELL, Chairman ;
                         ELISHA HARRIS,
                         WILSON JEWELL. 
 
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