R K P O R T 
TO THE 
op Health- 
OF THE - 
STATE OF LOUISIANA, 
ON THE 
SANITARY CONDITION OF THE 
I§L/\]SfD Op 
- BY 
I.I'CIKN F. SALOMON, II. D. 
With Resolutions adopted at a Meeting held 
Wednesday,-April 1st, IBB5, 
NEW ORLEANS: 
L. GRAHAM Ac. SON, PRINTERS, 101 GRAVIER ST. BEPOBT 
— TO THE — 
Board of Health of the State of Louisiana 
Sanitary Condition of the Island of Jamaica, 
— UPON THE — 
To the President and Meebers of the 
Board of Health of the State of Louisiana. 
Gentlemen—Pursuant to a request of your honorable body I 
made a visit to the Island of Jamaica for the purpose of inquiring 
into its sanitary condition, with a view to the removal of quaran- 
tine restrictions against said island, should the facts, after thor- 
ough investigation, warrant such action on the part of this 
Board. 
Perhaps it may be excusable, for the information of those not 
acquainted with the exact location and extent of Jamaica, to en- 
ter somewhat into these particulars: Jamaica is situated in the 
Caribbean Sea, between the 17th and 19th degrees of latitude 
and the 76th and 78th degrees of longitude west, about ninety 
miles south of Cuba and 1170 miles from the mouth of the Mis- 
sissippi river. The island is 144 miles in length and its greatest 
width is forty-nine miles, covering a total of 4193 square miles. 
It is almost entirely mountainous. Beginning from the west end 
the land gradually rises, until near the eastern end of the island 
the highest point is reached, the Blue Mountain peak, 7360 feet 
above the level of the sea. There is a small area of swamps 
where malarial fevers of a mild type are found. 
I arrived in Kingston, the capital of the island, on March 3, 
1885, and immediatety upon my arrival and the object of my 
visit becoming known, every courtesy was shown me and every 
facility offered for the obtaining of the information I sought. 2 
I am indebted to the Governor, Sir Henry Norman, K. C. B., 
C. I. E. ; to Hon. H. J. Kemble, Gustos of Kingston; to the As- 
sist it Colonial Secretary, Mr. James Allwood ; to the Director 
of Public Gardens and Plantations, Mr. D. Morris, M. A., F. 
L. S. ; to Dr. Chas. B. Mosse, Senior Medical Officer of the Is- 
land Medical Department; Dr. D. P. Rosse, Director of the 
General Hospital, Kingston; Mr. E. A. Foster, Secretary of the 
Central Board of Health, and to the physicians of Kingston,'as 
well as to Dr. J. Pringle and Dr. F. A. Sinclair, of Anotta Bay; 
Dr. C. A. Mosely, of Port Antonio, and Dr. V. Mullen, of Port 
Maria, for valuable assistance and information. 
For the purpose of making as complete an investigation as my 
limited time would permit, I remained in Kingston five days, and 
then proceeded overland to the principal ports on the northern 
side of the island, being altogether eleven days pursuing my in- 
quiries and observations. 
To facilitate the object of this report and render it as brief and 
concise as possible consistent with the subject matter, I shall first 
enter into the sanitary condition of the island in general and then 
direct your attention to the individual ports where export trade is 
carried on. The population of the island according to the census 
of 1SS1 is 580,804, of whom 14,132 are white, 444,486 black and 
the remainder composed of mulattoes, coolies and Chinese. The 
principal diseases are ague, syphilis and rheumatism. Although 
malarial fevers of the intermittent and remittent type are preva- 
lent in the low marshy districts, they are of a very benign charac- 
ter, as shown by the following figures found in the report of the 
Island Medical Department for 18S4: Of 1955 cases treated 
there were eight deaths, a remarkably low mortality, especially 
when we take into consideration the habits and mode of living of 
those among whom this disease is most prevalent, the blacks, who 
for the most part live in poorly constructed bamboo huts, and are 
but poorly fed at best and among whom syphilis is common. 
The island is divided into forty-four districts, under the control 
of what is known as the Island Medical Department, of which 
Dr. Chas. B. Mosse is the efficient head or senior medical officer. 
In each district is a hospital (in charge of a medical officer of this 
department) for. the treatment of all persons unable to employ a 3 
physician. Each officer is required to report to the Senior Med- 
ical Officer at stated intervals, so that from the records of Dr. 
Mosse’s office and his published repoits an accurate estimate can 
be easily arrived at of the prevailing diseases, mortality, etc. 
Twelve years ago this service was established by the government, 
and it is only since its establishment that any records of vital sta- 
tistics have been kept. These records have all been placed at 
my disposal for examination, as well as the individual records of 
public hospitals, and of the Central Board of Health. 
This latter (the Central Board of Health) has control of the 
sanitary affairs and quarantine of the entire island, and in the 
city of Kingston there is a Quarantine Board, charged with the 
enforcement of quarantine laws. 
But as we have to do in this report only with yellow fever and 
the sanitary condition of the seaport towns, I shall not enter into 
further details of the excellent medical and sanitary supervision 
of the whole island. 
As far as shown by the records, and from information ob- 
tained privately from practicing physicians, Jamaica is singularly 
free from yellow fever. During the past year, that is to say from 
October i, 1883, to September 30, i8Sq, not a sing’e case was 
treated in any of the hospitals. Since the latter date four cases 
have been treated in the public hospital at Kingston, but of these 
I shall treat more fully when considering Kingston individually. 
The report of the Registrar-General shows the number of 
deaths on the island from yellow fever for the four years ending 
September 30, 1883, as follows: 
October 1, 1880, to September 30, 1881, 8; October 1, iS8r, 
to September 30, 1SS2, 4; October 1, 18S3, to September 30, 
1883, 2; October 1, 18S3, to September 30, 1884, o. 
Eleven of these fourteen cases died at Kingston, where cases 
are sometimes admitted into the general hospital from vessels 
which have put in there. 
Whenever an isolated or sporadic case of. yellow fever has oc- 
curred, said to have originated on the island, it has never been 
known to give rise to other cases through contagion or infection, 
a fact which, coupled with the very peculiar clinical history of 
said cases (of which mention will be made later) is worthy of 
note. The mean annual death-rate of Jamaica is high, about 29 4 
per thousand ; but this is accounted for by the fact that a very 
large proportion of the deaths is among children under five years of 
age. For instance, in 1883, 41.5 out of every 100 deaths occur- 
red among children under five years, and in 1882, 38.5. This 
large mortality in children under five years is attributed to want 
of proper care, caused by the fact that so large a proportion of 
the children born on the island are illegimate, about sixty per 
■cent, being born out of wedlock. As a natural result these chil- 
dren are badly cared for, and too often die victims of diseases 
caused from neglect. 
Kingston being the capital and principal seaport of the island, 
it is there that our particular attention should be directed in con- 
sidering this question of the removal of quarantine, and minute 
■details of this city from a sanitary point of view will not be out of 
place. 
Approaching Kingston by sea, the first point of observation is 
Port Royal, situated upon the extremity of a spit of land at the 
■entrance to the harbor and six miles from Kingston. It is now 
nothing more than a naval station. Opposite Port Royal and 
two miles or more across the entrance to the harbor and six miles 
from Kingston is Green Bay, where the quarantine station is lo- 
cated. The quarantine grounds are marked off by buoys and are 
over a mile from the channel. The Lazaretto is situated upon a 
bluff fifty or sixty feet above sea level, and protected in the rear 
by impenetrable brush and undergrowth which cover the hillside, 
so that isolation is complete. 
Having passed between these two points we next arrive at 
Kingston, a city of 38,566 inhabitants, according to the census of 
1S81, of whom 4999 are white. These figures embrace the sub- 
urbs as well as the town of Kingston proper. 
The mean annual temperature of Kingston is about 80, the va- 
riations between maximum and minimum averaging about 15 
degrees. The average rainfall is about 30 inches annually. Dur- 
ing the day the heat is tempered by a strong sea breeze, generally 
blowing from the south-east. 
Kingston is a town of the customary tropical type—low houses 
and narrow streets. The streets are all either paved or macada- 
mized, and, owing to the natural declivity, the drainage is per- 
Kingston. 5 
feet, the waste water running in clear streams down the streets 
into the sea. No refuse matter of any kind is found upon the 
streets. The law's are very stringent upon this point, and any 
infringement is soon punished. All garbage and household re- 
fuse is carted awray to some distance outside of the city limits, and 
there deposited in pits and covered with quicklime. After it has 
become sufficiently dried it is burned. While earth closets are 
used by many of the inhabitants, the prevailing style of latrines is 
similar to our own—vaults dug in the ground. These undergo 
systematic and periodical inspection by the health commissioner, 
and are ordered emptied whenever found necessary, so that 
although the city, owing to its narrow streets and peculiar archi- 
tecture, is not very attractive to the eye, it is essentially a clean 
city. Added to this, the w'ater supply is most excellent, the 
water being obtained from the mountain streams and conducted 
through aqueducts to reservoirs, and from there through filtering 
tanks, before being delivered through iron pipes to the city. 
These sanitary precautions render Kingston singularly free from 
“ filth diseases,” as the records clearly show. 
Mortality. 
The mortality in Kingston, in view of the foregoing facts, ap- 
pears to be very high, the annual death rate for 1884 being 28 
per thousand. But when we consider the fact that there are a 
number of public institutions to which people come and are sent 
from all portions of the island, including a large general hospital, 
we are brought to see how these factors go to swell the death 
rate. As an example we may take the month of February, 1885. 
Of 113 deaths during that month 17 died in the public hospital, 8 
in the lunatic asylum and 16 in the destitute home. Added to 
this, 37 of the deaths wrere among children under five years of age 
and 20 above 65. On looking over the records I found that the 
principal diseases treated in hospitals are malarial fevers and “ in- 
fantile diseases.” 
Yellow Fever in Kingston. 
That yellow fever is a rare disease in Kingston is shown by the 
records of the Public Hospital, where, through the kindness of 
Dr. D. P. Rosse, I was permitted to see every patient then un- 6 
dergoing treatment and to examine the records. These records 
for the past six years show that there were treated in the hospital 
eighteen cases of the disease in question. Of these fourteen 
were cases which had occurred upon vessels and removed to hos- 
pital for treatment, and four were cases said to have originated on 
the island. It is a noteworthy fact that although these cases oc- 
curred singly and at intervals extending over a period of more 
than six years, in no instance was the disease communicated to 
any other individual. That this is due in great measure to the 
excellent sanitary condition not only of the hospital but of the 
entire city is very probable. 
Of the four cases originating in Kingston or its environment 
the following brief history of the last case will serve as a 
type. 
A traveling musician who came to the Island had given a per- 
formance in Spanish Town, fifteen miles from Kingston, in the 
interior. After indulging freely in rum he started to walk back 
to Kingston during the night. To do this he was compelled to 
cross a marsh. Before arriving in Kingston, and after exposure 
to the rays of the sun, he was taken with a fever while on the 
road. lie was brought to the Hospital on November 26, and died 
the next day of black vomit. This is about the history of all cases 
originating on the island. Exposure to miasm and a tropical sun, 
coupled with too free indulgence in rum, followed by a fever and 
death. Comment is unnecessary. While isolated cases giving 
the above history have occasionally occurred from time to time, 
there has not been in the recollection of the oldest practising 
physicians,’ nor do the records show anything like an epidemic 
visitation of the disease, and this, notwithstanding the, fact that 
there is estimated to be about 3000 foreign British offi- 
cials and others, who are fit subjects for the disease. In 1S72 
there were at one time five cases, all giving a previous history of 
rum-drinking and reckless exposure. This is the greatest num- 
ber of cases that has occurred at any one 'time for many 
years. 
While in Kingston I visi ed all the public institutions, with a 
view of obtaining some idea of the prevalence of disease. As an 
example of what I observed I may state that in the penitentiary 7 
which contained 370 prisoners I found two sick, one with dysen- 
tery and-one with intermittent fever. 
The remarkable purity of the atmosphere of Kingston and its 
freedom from septic influences can not be better shown than by 
the results of surgical operations in the public hospital. Septi- 
caemia is a thing unknown is this hospital. In 1883, out of 236 
operations, there, were ten deaths. These operations were, many 
of them', what are known as capital operations, such as high am- 
putations, laparatomies, ovariotomies, etc., with a mortality of 
4.32 per hundred ; in 1882 the mortality after operations was 1.93 
per centum, and in I8S4, 2.50. 
Before leaving Kingston I was invited to meet the Central 
Board of Health, and accordingly did so on March 6th. A free in- 
terchange of views was had between the members of said board 
and myself, I questioning freely so that I might obtain all in- 
formation possible. A fulFexposition of the sanitary and quar- 
antine arrangements, was given to me, and I learned that every 
effort is being made to improve the sanitary condition of the 
island. Its quarantine laws, and the rules and regulations gov- 
erning the quarantine administration, are stringent and well en- 
forced; bo vessel from an infected or suspected port is allowed 
to' enter any port of the island before undergoing inspection, ne- 
cessary detention and observation, and, when demanded, thor- 
ough cleansing and disinfection. I submit for your information 
a plan of the quarantine grounds at the entrance to Kingston har- 
bor, and also copies of the quarantine laws, and rules governing 
the action of the quarantine officer. Every port in the island has 
its quarantine inspector, and should any vessel arrive with infec- 
tious or contagious disease on board she is sent to the quarantine 
station nearest the port where she arrives, there to await the ac- 
tion of the Central Board of Health and Quarantine Board, who 
are immediately informed of the facts. 
At My rdqueist the Central Board of Health adopted, unani- 
mously, the following resolution, I, in turn, pledging the Louisi- 
ana State Board of Health, to reciprocate in the same manner. I 
would'i therefore, suggest that this Board adopt suitable resolu- 
tions to that end. The resolution reads as follows, an official 
certified copy of which I herewith submit: 8 
“ Resolved, That this Board do furnish to the Board of Health 
of the State of Louisiana, in the Southern States of America, 
monthly reports of the sanitary condition of this island and do 
keep such Board at all times advised as to any cases of yellow fe- 
ver or other contagious or infectious disease of an epidemic char- 
acter, or any abnormal state of the public health as it may arise ; 
and that the said Board of the State of Louisiana be requested, 
through Dr. Lueien F. Salomon, to reciprocate the like informa- 
tion to this Board.” 
Every parish in the island has its local Board of Health under 
direction of the central Board, and any case of contagious or in- 
fectious disease occurring on the island is immediately reported 
to the central Board, so that it is kept thoroughly informed as to 
the sanitary condition of the whole island. 
I learned from the records of this Board that in addition to the 
cases reported above, in 1868 and 1869 there were thirty-odd cases 
of yellow fever among the shipping in the harbor, but, although 
some of these cases were treated in the public hospital, there was. 
no spread of the disease to the inhabitants of Kingston. 
Leaving Kingston I proceeded to the principal ports on the 
North side of the island, and while no cases of yellow fever have 
ever occurred any where on this side of the island within the re- 
collection of the resident physicians, and no record for twelve 
years past shows the existence of any case, I learned that about 
thirty years ago there were six or seven cases at Montego Bay, 
and in 1871 there were several cases on a vessel lying in quaran- 
tine at Port Antonio. There are no records of any case having 
originated on this side of the island, and we may consider it free 
from the disease. 
Port Antonio, Annotta Bay, Port Maria, St. Ann’s Bay and 
Montego Bay, are the principal ports on the North side, and as 
it is principally with the three first named ports that commercial 
relations exist or may in future exist with New Orleans, through 
the development of the fruit trade, a brief resumt of the most 
prominent diseases may not be uninteresting. 
At port Antonio I found, undergoing treatment in the hospital,, 
many cases of intermittent fever and ulcers of the leg. The re. 
cord shows that in 1884 there were treated 109 cases of intermit- 9 
tent fever with no deaths, and five cases of remittent fever with 
two deaths. No record of yellow fever was found. 
At Annotta Bay I found about the same condition of affairs, 
malarial fever of the intermittent type being the prevailing disease 
in the hospital. In 1884 there were treated here 212 cases with 
no deaths. 
Port Maria shows the same record ; 120 cases of malarial fever 
with two deaths. 
The apparently large number of cases occurring in the public 
hospitals of these small towns is readily accounted for when we 
bear in mind the fact that these hospitals are the refuge for the 
sick from large districts extending to from fifteen to twenty miles 
in area. 
To recapitulate, it was found that yellow fever does not exist in 
Jamaica to an extent that would make commercial intercourse a 
source of danger. An isolated case has occasionally occurred 
upon the south side of the island, but in no instance did it extend 
beyond the first cases. Of the cases originating upon the island 
during the past six years there was in 1879 one case in Kingston, 
in 1880 one case in Kingston, in 1881 none, in 1882 two cases in 
the persons of sailors at the Sailors’ Home in Kingston, in 1883 
none, and in 1884 one in November at Spanish Town. So far 
in 1S85 there has been none. 
That there is no reason for maintaining quarantine restrictions 
against Jamaica, in view of the foregoing facts and the pledge 
received from the Central Board of Health, is my opinion, based 
upon the results of my investigation ; and in recommending to 
the Board of Health of the State of Louisiana the removal of said 
restrictions, I can not do better than introduce in this report a 
quotation from the last annual report of the senior medical officer 
of the island medical service, Dr. Chas. B. Mosse. He says: 
“ Should the immunity experienced from the yellow fever dur- 
ing the year be continued in future, the disease will happily cease 
to find a place in the medical archives cf the colony. If the fact 
of the exemption from this disease which has obtained for many 
years past w.re more widely known, and the climate of the island 
in relation thereto were better understood, the unreasonable preju- 
dice which is occasionally manifested on this point would cease 
to exist, and our commercial relations with other countries—nota- 10 
bly the Southern States of America—would no longer be hamp- 
ered by quarantine restrictions dictated by groundless fears, based 
presumably upon the sanitary history of the past, and which are 
even now kept alive by the erroneous assumption that because a 
neighboring island is unhappily yearly visited by the disease, 
therefore a risk would be encountered by New Orleans and other 
Southern ports if unrestricted admission were granted to vessels 
with clean bills of health from Jamaica.” 
From m}r observations and the information obtained I am in 
accord with the opinion of Dr. Mose, for with its excellent 
“ Island Medical Service,” its good water supply, its well direct- 
ed and efficient quarantine and sanitary laws, I believe that yellow 
fever will in future fail to obtain a foothold on the island, and 
that its sanitary condition will continue to improve at the same 
rate that it has done in the past twelve years. 
In conclusion, I may add that the danger to us lies not at all 
in the present sanitary condition of Jamaica, but in its possible 
condition through communication with infected ports. But with 
well administered quarantine laws under the supervision of the 
authorities of the island and the pledge received from the Cen- 
tral Board of Health to enforce all viligance in this regard, such 
danger is reduced to a minimum, and the probability of the in- 
troduction of yellow fever into the island very small. 
All of which is respectfully submitted. 
435 Carondelet street. 
April i, 1885. 
Lucien F. Salomon, M. D., 
The foregoing report was presented at a regular meeting of the 
Board of Health of the State of Louisiana held on Wednesday, 
April ist, 1SS5, after which the following resolutions were unani- 
mously adopted : 
I. 
Resolved, That the Board of Health of the State of Louisiana 
cordially reciprocates the action of the Central Board of Health 
of Jamaica, and will keep said Boaad of Jamaica informed as to 
the sanitary condition of New Orleans at all times, as well as 
ansmit, immediately, information of the occurrence of yellow fever or cholera should such make their appearance; also that 
the weekly bulletins of mortality in the city of New Orleans be 
regularly forwarded to said Central Board of Health by the Sec- 
retary of this Board. 
11 
Resolved, That in view of the facts reported by Dr. Lu- 
cien F. Salomon in regard to the sanitary condition of 
the Island of Jamaica, said island shall be withdrawn from 
the list of places against which a ten days quarantine 
is annually imposed ; but, that all vessels arriving from the ports of 
Jamaica be subjected to such inspection, cleansing, disinfection 
and detention as this Board may at any time direct, or as occasion 
may deman:l. 
[A true copy from the minu'es.] 
S. S. HERRICK, M, D., 
Secretary. 
II.