NECESSITY OF QUARANTINE, 
BY 
S. T. ARMSTRONG, M.D., PR. D., 
Passed Assistant Surgeon, U. S. Marine Hospital Service. Member of the Amer- 
ican Medical Association. American Public Health Association. 
British Medical Association. Societe Francaise 
di Hygiene, etc., etc. 
Read, by request, before the Tennessee State Medical Society, Nashville, 
April, 1887. 
HASSLOOK & AMBROSE, PRINTERS, NASHVILLE. THE NECESSITY OF QUARANTINE.' 
Prefatory to the consideration of this subject, it will, perhaps, be 
well to review the signification of the word quarantine. It is almost 
superflous to say that, like many other words, to-day it does not con- 
vey the old time meaning; the forty days’ detention, hieratical from 
the custom of Lenten purification, pseudo-scientific from the doctrine 
of critical days, is no longer its definition. Our accepted lexicograph- 
ers define it as “ an interdiction of communication to which a ship is 
subjected for a definite period for fear of her bringing infectious dis 
ease.” Consequently, if this restraint occupy even as moderate a 
duration of time as the boarding of a vessel by a health officer, it will 
be an application of the principle of quarantine. 
Ethically, it is a fundamental fact that the State has the right to pro- 
tect the lives and health of its people, a*d inferentially both State and 
National Legislatures regard quarantine as a means of protecting the 
health of the people from infectious disease; as our maratime States 
have enacted such laws, and as early as 1799 Congress passed a law 
empowering United States officers to assist in the enforcement of the 
quarantine and health laws of a State, a provision which is an essen- 
tial feature in the present national quarantine law of 1878. 
It would be presumptions in me to attempt before this audience a 
definition or a catalogue of infectious diseases. Of these, the plague, 
cholera, yellowTever, and small-pox, whose ravages in epidemics have 
cost thousands of lives, are the ones against which quarantine has been 
enforced. 
Whether the idea of quarantine is any thing more than a heritage of 
history may best be judg'ed by a brief reference to the past. Probably 
the earliest suggestion of this principle is in the thirteenth chapter of 
Leviticus, wherein it is directed that the leper “shall dwell alone; 
without the camp shall his habitation be;” and the garments he wore 
“ shall he burnt in the fire.” The Hindoos, Egyptians, Greeks, and 
Romans applied this method of isolating cases, and destroying cloth- 
ing, etc. 
1 Essay read before the Fifty-fourth Annual Meeting of the Tennessee State 
Medical Society, April, 1887, hy S. T. Armstrong, M.D., Ph.D. 2 
In the Christian era the earliest instance of this prophylaxis was in 
1348, in Florence, whereof Baccacio says in reference to the plague 
which had traveled from the Levant: “ In spite of all means that art 
and human foresight could suggest, such as keeping the city clear from 
filth, the exclusion of all suspected persons, . . . the disease 
began to show itself.” 
Hecker quotes Italian authorities that Genoa, which suffered in 1347 
from the plague introduced by ships frpm the Levant, forbade the en- 
trance of suspected ships in 1348. He ascribes to Viscount Bernabo, 
of Reggio, the first regulations regarding persons and goods from in- 
fected places. An examination of these regulations prove them to be 
devoid of ambiguity or prolixity, as the persons were to be killed, and 
the goods destroyed.* [While the punishment may seem severe, 
it is stated that the English law, as late as 1826, made evasion of 
quaarntine a felony, without benefit of clergy.] He also states that 
Venice first had health officers (1348), erected the first lazaretto (1423), 
and established the first board of health (1485) ; a republic, as to day, 
leading the van in progressive works. 
France and Spain soon followed Italy’s example and instituted their 
first quarantines. 
In England, Gloucester in 1348 established a cordon sanitaire 
against Bristol on account of the plague. The king issued quarantine 
proclamations prior to 1604; from that date until 1710 all regulations 
wtere occasional; and in later years various acts, some limited tempo- 
arily, were passed by Parliament. To-day yellow fever should, by 
law, be as stringently quarantined against as in one of our own Gulf 
ports. 
In America, Wm. Penn issued the first law on this subject, for the 
province of Pennsylvania, on October 4, 1700; though it does not ap- 
pear to have been enforced until 1728; and not until 1743 was an act 
passed providing for a quarantine establishment. Massachusetts 
enacted a law in 1701, and in 1736 commenced its quarantine estab- 
lishment. New York passed a law in 1758, and commenced its build- 
ings in 1799. Louisiana first quarantined in 1821, though its subse- 
quent enforcement was fitful; from 1796 to 1886 there were only 
thirty-six years in which quarantine was enforced. 
It is known that the laws of Moses did not exterminate lepers, nor 
the regulations of the Italian cities stop the plague; nor the laws or 
Massachusetts, New York, Pennsylvania, or Louisiana prevent the en~ 
*l)r, F. Imlach, British Medical Journal, September 16, 1882, page 520, 3 
trance of yellow fever or cholera. Is, then, the present adherence to 
quarantine fatuous ? 
To decide this question, to secure an approach to uniformity in 
quarantine and sanitary matters in different countries, International 
Congresses have been held in Paris, Constantinople, Vienna, and 
Rome, the first in 1851 the last in 1885. But the associated countries 
have invariably failed to ratify the conclusions adopted. 
In the United States a Quarantine and Sanitary Convention met in 
Philadelphia in 1857, and elsewhere in three succeeding years, and 
the meetings were attended by representatives from ihe more import- 
ant of the iUlantic States, and even from one interior State, Tennes- 
see, one of whose physicians, the late Dr. Guthrie, found time to un- 
dertake the then arduous duty of attending the last meetings and la- 
boring in the interests of public health. Needless to say that much 
good resulted from these meetings, and this convention found a suc- 
cessor in 1874 in the American Public Health Association. 
A review of the work of these bodies shows every stage of opinion, 
from absolute interdiction of intercourse during the summer months 
to free communication during the entire year. Though the tendency 
of the majority is to the media res of disinfection of vessels and mini- 
mum detention. 
In many cases the same locality has been subject to these pestilences 
several times. Would quarantine have protected them ? To quote 
from the quarantine report of the General Board of Health of Great 
Britain in 1849: “ The real question is whether quarantine can pre- 
vent the extension of epidemic diseases, whatever may be their nature, 
whether contagious or not. If it can, it is valuable beyond price; but 
if it can not, it is a- barbarous incumbrance, interrupting commerce, 
obstructing international intercourse, periling life, ’and wasting—and 
worse than wasting—large sums of public money.” 
Local factors will exist favoring the propagation of a disease, and in cer- 
tain regions plague, cholera, and yellow fever are epidemic. Manifest- 
ly it would be absurd for a country to quarantine against an indige- 
nous disease. Havana would uselessly destroy her commerce to quar- 
antine against yellow fever. 
It is generally accepted that neither small pox, cholera, nor yellow 
fever are indigenous to the United States, and the plague is unknown. 
So, as these diseases are exotic, they must,be introduced either on our 
Atlantic or Pacific seaboard, or on our Canadian or Mexican border; 
and numerous well-attested instances are recored of disease securing 4 
an entrance through our Atlantic and Gulf ports, and across our north 
ern and southern borders. 
In the history of these epidemics in this country it will be found that 
quarantine has been employed from the last century, but to within re- 
cent years it was—and is yet, except in certain parts—a quarantine of 
detention. This history teems with instances of alleged rigorous quar- 
antine which failed to exclude epidemic disease, and againjnstances, 
equally veracious, wherein it was successful. To cite all, or even part 
of these, with their mass of conflicting evidence, would attain a pro- 
lixity as tedious to the compiler as it would be painful to the enforced 
listener. 
Medical and sanitary science of to-day has in the germ theory of 
disease approached a post ergo propter hoc position, which divests a dis- 
cussion of the fallibility of quarantine of the asperity formerly at- 
tendant thereon The researches of Koch have decided the fans et 
origo of cholera; and, while not yet generally accepted by the medical 
world, Doraingas Freire claims to have done the same for yellow fever. 
The vitality of this germinal matter is evidenced in the cholera epi- 
demic of 1873, the disease appearing in interior States on the unpack- 
ing of clothing of immigrants from cholera districts in Europe. To 
many of you the development of yellow fever from opening clothing, 
worn and packed away during an epidemic of that disease, is quite 
familiar. 
But its persistency in vessels surpasses any known duration of via- 
bility in fomites. A reference may be made to the histories of suc- 
cessive contagion in the sanitary histories of the- United States ship 
Gen. Greene in 1800, Enterprise in 1825, and Her Majesty’s ship 
L’Eclaire in 1845, But the following histories, less accessible, are re- 
lated as particularly suggestive: 
Assistant Surgeon A, N. Bell, United States Navy, reported that in 
1847 the United States ship Vixen was on duty in the neighborhood of 
Vera Cruz, and her crew had suffered from yellow fever, which ceased 
during the winter. But it re-appeared in 1848. In order to rid the 
vessel of infection and vermin, everything susceptible of injury was 
taken on deck, the hatches were closed, and steam turned in for three 
hours; after this there was a thorough scraping, whitewashing, and 
painting, and no more fever* In June, 1848, the Mahones, of the 
same fleet, which had previously had yellow fever, was infected ; she 
was steamed out by the Vixen’s engines, and the fever ceased. Both 
vessels remained near Vera Cruz until August, when they returned un- 5 
affected to Norfolk; while the Cumberland and Scorpion, of the same 
squadron, returned to New York at the same time, and both were in- 
fected with yellow fever. [Yellow fever appeared on the United States 
ship Mahaska, at New Orleans, in 1867, and on the United States ship 
Don, at Santa Cruz, in November, 1867, and both vessels were 
steamed out with no subsequent appearance of the fever. Against tins 
method of disinfection contrast the United States ship Marion, at 
Montevideo, in March, 1880, where, on account of yellow fever, for 
sixteen days an average of fifty pans-charged with chlorinated lime and 
sulphuric acid, and frequently renewed, were kept below decks. Yet 
when the hold was afterward broken out two of the men so employed 
were attacked by yellow fever.] 
The United States ship Susquehana arrived at Grey Town, Central 
America, in 1857, from the Mediterranean. A few months after her 
arrival yellow fever appeared on board, and the vessel immediately 
sailed north, leaving nearly one hundred cases at the Royal Naval 
Hospital, Kingston, Jamaica, en route. On arriving at New York 
about one hundred additional cases were sent to the hospital; the ves- 
sel was unloaded, fumigated, whitewashed, ventilated, and almost 
$19,000 expended for ice and salt, which was placed in the hold from 
April to October; and in September the first man sent below decks 
took yellow fever and died. She remained dismantled several winters, 
and when she again returned to the tropics yellow fever re-appeared. 
The United States ship Plymouth incurred yellow fever at Santa 
Cruz, November 4, 1878. On November Bth and 10th, and Decem- 
ber 1, 1878, and January 26 and February 2, 1879, the habited parts 
of the ship were fumigated with sulphur, the vessel having sailed north 
immediately after the first case appeared. Everything was removed 
from the vessel, and at the Boston Navy-yard the ship was freely ex- 
posed from January Bto February 4, 1879, and then repaired. On 
March 15th she sailed for the West Indies, and on the 21st (before 
touching at seaport) a seaman was taken ill with yellow fever, and on, 
the 22nd a second man. The ship immediately returned to the north, 
and subsequent examination showed extensive decay of timbers and a 
foul bilge. 
Several instances of the persistency of germ life may be gathered 
from the history of vessels in the mercantile marine. In the New 
York Herald of November 24, 1885, it was reported that Christian 
Oulby, a fireman on the steamship Alvo, died of yellow fever in New 
York after two days’ illness. In the same paper of September 7, 6 
iBB6, Frank Golden, fireman, on the same vessel, died of yellow 
fever in New York. In each case fhese men were well when inspected 
at the New York quarantine, and had been ten days on the passage 
from Port Limon. The agent of the vessel is reported as having 
stated in reference to the last case that it was the first on record from 
their steamer; yet it has been alleged that every year she loses a fire- 
man from this disease. 
With the introduction of small-pox, like cholera, by emigrants, the 
health records of this country are replete with statistics. In revising 
this paper the morning telegraphic dispatches state that a Chicago 
health inspector found a case of small-pox on April 7 in an Italian la- 
borer who had arrived in Chicago on April Ist from New York. He 
was one of some six hundred immigrants on the steamer Alsatia, 
among whom several cases of small-pox broke out on the passage. 
When it arrived in New York it was quarantined for a day and night, 
when most of the passengers were allowed to land. 
Presumably it would be granted that a vessel, or its contents, may be 
the carriers of infection, and that no other means could exist, except 
the land boundaries before mentioned, for the introduction of con- 
tagious disease in the United States. That these land routes can be 
controlled has been demonstrated by the limitation of an epidemic of 
yellow fever in 1882 on the Texas frontier by the cordon sanitaire es- 
tablished, in connection with the State health authorities, by the 
United States Marine Hospital Service; and on the Canadian frontier 
by the limitation of small-pox in 1885, the sanitary inspection of the 
same Service preventing its introduction into the United States. 
Yellow fever, and probably cholera,* can be exterminated in a ship, 
as has been shown. With immediate vaccination on the appearance of 
small-pox on board, and isolation of the case, disinfection of dis- 
charges, clothing, and quarters, this disease will be stamped out. The 
same measure (except vaccination) may be applied in the case of chol- 
era or yellow fever. 
But, you say, suppose the vessel has not the means of employing 
steam disinfection, or applying these other well-recognized sanitary 
procedures ? 
* Surgeon Abel F. Price, United States Navy, reported that cholera appeared 
on the United States ship Ossipee, while in Nagasaki, Japan, in August, 1885. 
The vessel left that city, put the crew ashore, disinfected the berth deck by 
steam for two hours, and then fumigated with sulphur. The crew returned, after 
being individually disinfected, and no more fatal cases occurred. 7 
In such a case it certainly would not be counselled to permit this 
vessel to go to a wharf, her passengers dispersing, and probably be- 
coming individual centers of epidemic development. Thus only otw 
courses are left, to quarantine or to turn the vessel away from the port. 
1 he latter will not be entertained, so the quarantine becomes neces- 
sary. 
But not a quarantine of detention; for the case of the Susquehana, 
with five months’ detention, and yet yellow fever poison latent in the 
hold, is not the only case of this kind. Nor is the injustice of asso- 
ciating compulsorily the sick and the well taken into account. 
Nor can the quarantine be one of fumigation alone, for this has 
often failed. But thorough fumigation of the vessel under pressure, so 
that the destructive agent employed permeates every part of the 
as is practiced at the Louisiana quarantine; disinfection of all wearing 
apparel; detention of sick passengers, and temporary surveillance of 
others recently exposed, commend themselves as measures least ob- 
structive to commerce, most just to the passengers and the residents of 
their destination, and in accord with our present scientific information. 
And, lastly, I would append the most salient conclusion of the Inter- 
national Sanitary Conference of Rome : “It is the interest of each na- 
tion to assure the salubrity of its seaports. It will often thus avoid 
the invasion of its soil by exotic maladies, and above all will rarely 
transport upon its vessels endemic diseases.” 
[Note. A list of all the cities, with date of appearance of cholera and yellow 
fever has been made, but on account of its hulkiness has been omitted. Also 
the Bibliography, excepting Reports of Quarantine and Sanitary Conventions of 
1858,1859, and 1860, Annual Reports of the United States Marine Hospital Serv. 
ice, Baited States Navy, and the Report of the Cholera Commission of 1873.] HASS LOCK & AMBROSE, 
SPRINTERS PUBLISHERS,I> 
122 CHITECH S'rErEllßT, 
NASHVILLE, “ TENN. 
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