*•"•■ AV5 JJttANTINE SYSTEM ESSENTIAL TO THE SAFETY OF OUR PEOPLE. REPORT OF THE SPECIAL COMMITTEE, OF THE NEW YORK BOARD OF TRAP TRANSPORTATION, ON QUARANTINE 3^4? *3 ADpPl'SD, JANUARY 6tk, 1893. With the Correspondence, WA N568r 1893 63020180R NLM 0513070E 1 NATIONAL LIBRARY OF MEDICINE ARMY MEDICAL LIBRARY FOUNDED 1836 WASHINGTON, D.C NLM051307021 ; J HJEFOUT OF THE SPECIAL COMMITTEE, OP THE NEW YORK BOARD OF TRADE AND TRANSPORTATION, ON QUARANTINE. ADOPTED, JANUARY 6th, 1893. With the Correspondence. USLVr 1 873 RESOLUTIONS A.DOPTED BY THE NEW YORK BOARD OF TRADE AND TRANSPORTATION AT THE SPECIAL MEETING HELD FRIDAY, JANUARY 6th, 1893. Resolved, That the Report of the Special Committee on Quaran- tine be approved, and the recommendations therein contained adopted. Resolved, That the Committee be continued with power to print the report and correspondence, and circulate it to members of Con- gress and such other persons as in their judgment will best promote the establishment of a National System of Quarantine in the United States, with uniform regulations at all ports. EEPOET. New York, January 6, 1893. To the New York Board of Trade and Transportation: At the October meeting of this Board the undersigned Special Committee was appointed pursuant to the following resolution, viz.: Resolved, That the question of the establishment of a national quaran- tine be referred to a Special Committee of five members to report at the next meeting by resolution, bill or otherwise, their conclusions in the matter. The question thus presented for investigation and consideration is : do the safety and welfare of the people of this Country, and the interests of commerce demand the establishment of a uniform system of quarantine in the United States, under the management of the Federal Government ? This question is not a new one, but renewed interest attaches to it by reason of the experiences of the past year and the dread of the threatened invasion of cholera during the coming Spring and Summer. The obligation of government to protect the people, by the best means it can command, from the ravages of pestilential and infectious diseases is fully recognized by all enlightened nations, and no apparent conflict between a national and a state system should be allowed to interfere with a proper discharge of the duties which such obligations and the exigencies of the times demand. Eliminating from the question the consideration of all local and political interests, the Committee has sought information from every available source that would throw light upon the subject and disclose the true condition of the defenses of the country as a whole, as they now exist, against the threatened invasion of cholera 6 and other epidemics and infectious diseases. The Committee ha* not investigated the existing administration of quarantine at this- port and presents to you no testimony relating thereto, or criticism thereon. New York is but one point in the line that needs defense 'r it is immaterial, from the point of view of this investigation, whether New York can be protected under the state system as- fully as under a national system, if other points are left weak and defenseless. The question concerns the country as a whole and every part thereof. In the public discussion of quarantine the subject of immigra- tion has been somewhat involved with it, to the confusion of both questions. The very consideration of quarantine implies the con- tinuance, within safe regulations, of international commerce and the migration of the world's population. The more perfect we make- file system of quarantine under scientific regulations, with ample facilities to enforce them, the less will be the restrictions and the burdens upon commerce. The purpose of quarantine is to elimi- nate the elements of danger, and to confine the restrictions within those limits. In corroboration of this position we quote from the report of the International Quarantine Inspection Commission, after a thorough examination of the quarantine establishments of the St. Lawrence and Atlantic coast, in September last: " A quarantine of exclusion should not be necessary at a port properly equipped, and it is not to the credit of a countay like ours that we are forced to resort to it. With preparation, safety can be had with little interference with commerce and traveV The general question of immigration, and whether it has the same value for our country as in past decades, is foreign to the subject, and care should be taken that under the pretense and cover of quarantine laws the opponents to immigration, as such, be not permitted to effect their purpose contrary to the will of the majority of the people in the several states. What classes of immigrants shall be admitted to this country is one question; what system of quarantine and sanitary inspection of vessels, cargoes and passengers shall be adopted is another question, and it is the opinion of this Committee that the best results will be attained by separating the two subjects in legisla- tion. I i 7 The first step taken by the Committee was the preparation of a circular, which is submitted as appendix A to this report. This circular, with a personal letter, the Committee sent to the Governors of all the states ; to the Mayors of the principal cities on the Atlantic and Pacific seaboards and on the Great Lakes, and those of the larger interior cities, seventy in all; to the principal officers of the U. S. Marine Hospital Service, and Surgeons of the Army ; to the Boards of Health of all the states, and the officers thereof individually; to the Boards of Health of the principal cities, and to a selected number of other persons who were sup- posed to have had practical experience with sanitary affairs in the United States and Canada, or who by reason of special knowledge upon the subject were able to give valuable opinions. To this circular the Committee has received 67 replies. Of these 44 recommend the adoption of a national quarantine system, 5 are opposed to a national system, 5 are doubtful, and 13 express no opinion. As these letters were received, the Committee, learning that the newspapers were willing to publish them, fur- nished duplicate copies which were reproduced from day to day in the columns of both the morning and afternoon papers, in many cases in full. By this liberal and public-spirited policy the papers have laid before the country many valuable contributions to the literature and information of the subject. To make an analysis of these communications, or to print ex- tracts from them, would so largely detract from their value and importance, the Committee deem it essential, if the greatest good is to be derived from the inquiry, that they be put in permanent form. Those favoring a national quarantine are therefore sub- mitted as appendix B to this report. The communications which oppose a national quarantine are few, and, although contrary to the conclusions the Committee has reached, are submitted in appendix C as probably embracing the strongest arguments which can be urged in support of that side. Several letters received which expressed no decided preference are nevertheless interesting and instructive and are submitted in appendix D. Enabled as we are to place before you these intelligent opinions, with the data they contain, of scientists, physicians and experts in 8 sanitary affairs, it is not 'necessary for this Committee to discuss the question in detail. The findings of the Committee are : First. That quarantine in times of danger is of equal concern to the entire country—to the people of the interior states as well as those on the seaboards—and it is not just to the latter to throw the whole expense and responsibility of the defenses upon them ; nor is it just to the former to deprive them of a voice as to the method and degree of protection along the seaboards. Second. That the line of defense to be effective must be fortified at all points where the invasion of disease is threatened or possible, and it is not wise or safe to trust the defenses to chance, or to a quarantine system exhibiting varying degrees of efficiency or de- ficiency, as now existing under the separate regulations of the several states and of local authorities. Third. That the testimony presented shows quarantines main- tained by the national government to be more uniformly efficient than those maintained by the State and local authorities, and that the means employed and apparatus necessary and available are superior, and usually such as are approved and meet the require- ments of sanitary science. Fourth. That State and local quarantines are largely, if not wholly, supported by fees and taxes levied upon ships, immigrants or commerce ; that states and local authorities are reluctant, ex- cept in the presence of imminent danger and then often unable, to provide, in addition to these imposts, the means necessary to render quarantine efficient ; that many points are wholly un- covered and open to invasion. Fifth. That State and local quarantines, as at present main- tained, are unequal and often unjust burdens upon commerce, and their regulations, imposts and fees lacking uniformity are disad- vantageous. That no power exists short of Congress to maintain and perfect uniformly safe defenses against the invasion of disease and thereby adequately protect all the states and the people of the entire country. The conclusion of your committee, therefore, is that it is essential to the safety of our people and the protection 9 OF THEIR LIVES THAT A NATIONAL QUARANTINE SYSTEM BE ESTAB- LISHED in the United States at the earliest possible day. We believe that to be effective the system adopted must be national, and that any systems maintained at ports of entry, under state or local control should not be allowed to conflict with or hinder the national system. Respectfully submitted, OSCAR S. STRAUS, AMBROSE SNOW, E. H. COLE, E. S. A. de LIMA, JEREMIAH FITZPATRICK, Special Committee. 10 Appendix A. Rooms of the New York Board of Tradb and Transportation, 55 Liberty Street, New York, December 5, 1892. A Special Committee of the New York Board of Trade and Transporta- tion has been appointed, pursuant to resolution, and is seeking informa- tion, data and opinions touching quarantine, and the advantages, if any, of establishing a uniform system in the United States, under the manage- ment of the general government ; the intention being, if the weight of opinion and evidence favor the proposition, to prepare suggestions for Congressional Legislation on the subject. The members of the Committee are : Chairman, Hon. OSCAR S. STRAUS, (Ex. U. S. Minister to Turkey), of L. Straus & Sons, Importers of China, Glass, etc. Mr. JEREMIAH FITZPATRICK, of J. Fitzpatrick & Co., Importers and Manufacturers of Plate Glass, Looking Glass, etc. Mr. EDWARD H. COLE, of The Eaton, Cole & Burnham Co., Well Machinery and Brass Goods. Mr. ELIAS S. A. DE LIMA, of D. A. De Lima & Co., Foreign Commission Merchants. Mr. AMBROSE SNOW, of Snow & Burgess, Shipping and Commission Merchants. The Committee have adopted the following line of inquiry, and invito euch suggestions and opinions thereon as they may be willing to make public, from experts and professional men having practical experience of sanitary affairs and from others having opinions on the subject: 1st. Quarantine administration in foreign countries as furnishing pre- cedents for the United States. 2d. The present status of quarantine in the United States : A. National. B. State. 3d. The existing system of quarantine administration in the United States: A. Cost. B. Restrictions imposed on commerce and travel; C. Security afforded. 4th. A national^ quarantine : A. Would it lessen the existing imposts upon commerce? B. Would restrictions on commerce and travel be less injurious ? C. Would it afford increased security to the country ? Persons writing the Committee are requested to affix to their names their professional or special titles, if any, and to address their communications to Hon. Oscar S. Straus, Chairman, 55 Liberty Street, New York, N. Y. Respectfully, etc., DARWIN R. JAMES, Secretarj. II Appendix B. COMMUNICATIONS WHICH FAVOR A NATIONAL QUARANTINE, RECEIVED BY THE COMMITTEE IN RESPONSE TO CIRCULAR SUBMITTED IN APPENDIX A. State of Rhode Island, ] Executive Department, State House, }■ Providence, R. I., Dec. 19, 1892. J Darwin R. James, Esq., Secretary New York Board of Trade and Trans- portation, New York City. Dear Sir:—Your favor of the 6th inst., addressed to ex-Gov. Herbert W. Ladd, has been referred to me. I believe that the National Government should guard our entire border* against infectious diseases. In our State the Governor has power, when- ever he shall deem it advisable for the preservation of public health, and the prevention of the spread of infectious diseases, to place under quaran- tine the whole or any portion of the State. I recognize that a central authority with rules and regulations uniform, covering all ports and ways of entry, may in times of danger prove a better safeguard than the precau- tions taken by each State separately. Yours, very truly, D. RUSSELL BROWN, Governor. State of Florida, Executive Department, | Tallahassee, Dec. 10, 1892. j Darwin R. James, Esq., Secretary New York Board of Trade and Trans- portation, 55 Liberty Street, New York City. Dear Sir:—Your favor of the 6th inst., enclosing your circular and requesting an expression of my views on the subject of the management of quarantine by the general government, was duly received. In my opinion it would be better for the general government to have the management and bear the expense of marine quarantine, whereby a uni- form system throughout the United States may be enforced, with all the modern appliances and the benefits of advanced science, and abundant means to provide for and maintain the same, which some of the most exposed states do not possess. Notwithstanding the fact that we have in Florida an able, efficient and active State Board of Health, which, since its organization, has accom- plished a great deal of good and prevented the introduction of epidemic disease, I realize that with a seacoast of 1,300 miles, reaching almost into the tropics, and within a stone's throw of those localities where yellow 12 fever exists the year round, it is scarcely practicable for the State to bear the expense of providing all the means which are necessary to make our quarantine regulations and safeguards against the introduction of disease as effective as desirable. While our own interest prompts us to bear the burden of this quaran- tine, we feel also that on account of our extensive seacoast and peculiarly exposed situation, the protection is by no means confined to this State, but the whole southern country, and, in fact, the United States get the benefit of it; and the burden is unfairly disproportionate to Florida with a comparatively sparse population and small wealth, to protect not only herself, but a very large proportion of the United States. I mention the condition of our State as an additional argument why, in my opinion, it would be better that marine quarantine should be under the control and at the expense of the United States. I do not wish to be understood, however, that I should favor the control of such quarantine by the United States to such an extent as to ignore State authority. While for the reasons stated the expense, general man- agement and control should be by the United States, such authority should also recognize and work in harmony with the State organizations, which should control interior quarantine and the management of epi- demics. The enforcement of the rules and regulations of the United States should not prevent State authorities from enforcing more rigid and restrictive regulations, within reason, as they should see proper. The above views are hastily written as they occur to me without time for such elaboration and thought as so important a matter deserves. Very truly yours, F. P. FLEMING, Governor. Treasury Department, ] Office of the Supervising Surgeon-General ! Marine-Hospital Service, Washington, D. C, Dec. 7, 1892. J Hon. Oscar S. Straus, Chairman Special Committee of the New York Board of Trade and Transportation, 55 Liberty Street, New York, N Y. Sir .—I am in receipt of a circular signed by Darwin R. James, Secre- tary, requesting suggestions and opinions upon certain topics relating to quarantine. Replying seriatim, I have to state: (1.) "Regarding quarantine administration in foreign countries as furnishing precedents for the United States." Foreign quarantine administration can furnish but little aid to the United States in the way of suggestion or example, the conditions being with regard to the United States so distinct from those pertaining to other countries that the quarantine system of this government must be sui generis. The English system, which has some good features has its 13 foundation in the fact that the English government is practically scattered all over the world, and, while the English system of sanitation commands our admiration, it is unreasonable to suppose that quarantine measures adapted to a country so small as England itself would be effective in a country of such great magnitude, with such a length of seacoast, and covering so many degrees of latitude and longitude as the United States. (2.) " Concerning the present status of quarantine in the United States: A. National; B. State." For many years the theory of quarantine in the United States has been that it is a police function of the State. No national legislation has been enacted curtailing the powers of the United States in this matter, but national legislation looking to national control has been of a conservative character and directly in sympathy with the doctrine of States Rights ; yet, the power of the national government, partly expressed and partly implied, as seen in the national quarantine Act of 1878, is very great; and in accordance with a recent decision of the Solicitor-General, approved by the Attorney-General of the United States, the quarantine power of the general government is far-reaching and effective, its limitations being due chiefly to want of specific legislation in the matter of establishment of quarantine stations and plants, with appropriations therefor; and to the want of clearly expressed power to enforce a sanitary condition of vessels, cargo, crew and passengers at ports of departure. As regards State quarantines, they are, in some instances efficient and in others defective ; and this disparity has occasioned a weakness in the quarantine defence established by them. For example, for a number of years the health officer at the port of New York demanded consular certi- ficates of disinfection of rags from Marseilles, France. Vessels laden with rags without such certificate being quarantined at New York then pro- ceeded to a port in New Jersey, where no such restrictions existed, and the rags were entered. The futility of this demand on the part of the health officer in New York being thus demonstrated he ceased to make it; and although the rag dealers at Marseilles had.erected warehouses for disinfection, and were perfectly willing to undertake the work, knowing that certificates would not be absolutely required they abandoned the disinfection. (3.) "The existing system of quarantine in the United States :—A., Cost; B., restrictions imposed on commerce and travel; C, security afforded." With regard to cost, I have to state that there are no fees charged at the national quarantine stations. I will remark, parenthetically, that there are eight of these stations : three on the Atlantic Coast, two in the Gulf of Mexico and three on the Pacific Coast. The local quarantines, however, have a system of fees which impose quite a tax upon tonnage. Moreover, it is believed that at some local stations quarantine restrictions are im- posed upon commerce under the disguise of a protection to the public health, but in reality for the sake of the fees. As to security afforded (C), the insecurity of this double system finds 14 an illustration in the statements just made regarding the importation of rags. (4.) With regard to a national quarantine, I believe it would decidedly lessen existing imposts upon commerce. By announcing beforehand and having posted in the offices of the United States Consuls abroad the rules and regulations which must be complied with by every vessel entering a port of the United States, the rules and regulations of each port being distinctively printed, and by the appointment of medical officers abroad in conjunction with the consulates to ensure compliance with these rules before the vessel sails, I believe the restrictions on commerce and travel would be less injurious. A national quarantine administration should be, and would necessarily be an impartial one, allowing no undue laxity at one port for the sake of diverting trade from a more exacting one, and imposing no unnecessary restrictions at any port. National quarantine administration should be administered both with a profound regard for public health and a clear insight into the demands of commerce, with a full appreciation of its im- portance, and the necessity of stripping it of every unnecessary incum- brance. I enclose for your information copies of the National Quarantine Laws, and a copy of the opinion of the Solicitor-General regarding the Presi- dent's power in quarantine matters. I will be pleased to answer any inquiry that may suggest itself to you, as I have taken a deep and active interest in this subject of quarantine for a number of years. Respectfully yours, WALTER WYMAN, Supervising Surgeon-General, M. H. S. Washington, D. C, Dec. 6, 1892. Hon. Oscar S. Straus, Chairman of Committee on Quarantine, New York Board of Trade and Transportation : Sir :—I have the honor to acknowledge the receipt of a letter from Mr. Darwin R. James, Secretary of the New York Board of Trade, saying that the Committee on Quarantine desires an expression of my views on the subject of a national quarantine, and enclosing a printed circular giving the line of inquiry adopted by the Committee. In reply I would say that, in my opinion, a system of national quaran- tine, or maritime sanitary inspection, can be organized and enforced in such a manner as to afford greater security to the country against such diseases as cholera, yellow fever, typhus, and small-pox than it now possesses, and at the same time to cause less unnecessary and injurious restrictions upon traffic and travel than result from the present state and municipal systems. Such a national system, properly equipped and organized, would cost more than the present system, because it would have larger and better plants, and better paid officials, but the cost being 15 defrayed from the national treasury would be much more fairly distrib- uted among the people benefited than it can be on the present plan. The direct imposts upon commerce would be lessened. One great difficulty in the way of establishing a proper system of national quarantine lies in the claim of the individual states to the right, under their police powers, to establish quarantine systems of their own, independent of the national system, and to refuse to recognize the certifi- cates of the national authorities as to freedom from infection of persons, baggage, and goods of all kinds. Some of the states would not desire to exercise this right, but the officials of some of the states will probably desire to keep this power, and the emoluments connected with it, in their own hands ; they may be willing to have the United States pay the expenses of properly equipped inspecting stations, but will wish to manage these themselves, and they will often be able to induce the legislative and executive authorities of their state to adopt their views and support them in their claims. But, while those engaged in commerce would no doubt willingly submit to delays and restrictions which are definite and uniform, it is a different hing when there is a local quarantine behind or within the general one, which stops boats and trains and treats them in a manner different from that employed by the national authority. Commerce then avoids the obstructed paths as far as possible, and if the local restriction cannot be removed it will seek to destroy the general one. This difficulty should not be ignored or glossed over, but squarely faced and provided for in any proposed legislation on the subject. Very respectfully, JOHN S. BILLINGS, Surgeon, U. S. Army. Norfolk, Va., Dec. 14, 1892. Hon. Oscar S. Straus, Chairman, Board of Trade and Transportation: Dear Sir .—Relative to the enclosed circular, which I return, I would say that to adequately discuss the first subject would require a long paper. The second, as I understand it, is rather a question for lawyers. For the last two repetition can be avoided by taking them together, and beginning at the end I will assume that maritime quarantine against ex- otic diseases is meant. (4 C.) A national quarantine would afford increased security to the country. No sanitarian doubts this, I believe no thinking man does. I have cer- tainly never heard it denied. Under the existing system a seaport or State with, say, a perfect sys- tem of quarantine, keeping out all infection from abroad, has absolutely no protection against such exotic disease introduced at some other place where the quarantine is defective. I leave out of consideration its protec- 16 tion against its neighbors by land quarantines, which are exceedingly obstructive to commerce, and very difficult to render efficacious. Now the quarantine administration in the United States is at present of all grades of efficiency, from the almost worthless to the efficient, and the measure of protection to the country is no greater than that afforded by the least efficient, taking into consideration the chances of introduction of infection to the different ports. So well is this understood in the South, with its perennial menace of yellow fever, that Louisiana, with a well equipped quarantine, laid the greatest stress on the smaller Gulf ports which have less efficient apparatus, sending all of their infected ves- sels to the United States Refuge Station at Chandeleur for treatment. Knowing that to protect the Mississippi never so well, the way by the les- ser Gulf ports was open. Similarly Savannah feels towards the smaller and less careful South Atlantic ports. A well administered national quarantine would give uniform efficiency with no weak point. Again, the key to prevention of introduction of cholera and such like diseases from Europe, especially in passenger vessels, is inspection and dis- infection abroad. Let good men, known to be efficient and trustworthy, stationed at the principal suspected ports abroad, inspect the passengers and disinfect their baggage, when necessary, efficiently, not as has usu- ally been done ; and if this work be done rightly, the vessels of this class requiring quarantine detention on this side will be exceedingly rare. This measure, to my mind, goes far to solve the problem of maximum safety with a minimum obstruction to commerce and cost to the vessel. There need be no detention to such a vessel on this side, and if the work of in- spection and disinfection be finished on her arrival in a foreign port, no detention there either. This work abroad can only be done by the national authorities, and has indeed been already begun by them. I submit, too, that the work done by national quarantine would be more efficacious from being free from local politics ; the same reason would les- sen its cost. (4 B.) With a national quarantine restrictions on commerce and travel would be less than at present. Vessels would have one set of conditions to fulfill; these would be known and not liable to change, and hence could be more easily met by the vessel. At present there are different rules for almost every American port, and for some of them more than one set. For instance, this Fall vessels after receiving clearance at the United States station at Delaware Breakwater, and the Pennsylvania State station, have been refused entrance to Philadelphia until a certain longer quarantine was performed ; and so vessels that were satisfactory to the United States officials at Cape Charles have been stopped at the Baltimore quarantine. For the same reason, different rules at different ports, many Southern ports quarantine against vessels which have been admitted to entrance at 17 other United States ports. An American bark, the Sanchez, was this Fall refused entrance at Savannah with a cargo of coal from Baltimore, and had to return in cargo to Baltimore. There are many similar instances to my knowledge. With a national system there would be a cessation of the panicky local quarantine of towns and states in the interior against seaboard cities, as was the case last Fall. Whether rightly or wrongly, in many of the western and southern states there was no confidence whatever manifested in the certificate of the New York, Philadelphia or Baltimore health author- ities, while those of the Federal officials, where they could be obtained, were received without question. You can readily see what an advantage this cessation of stoppage, inspection and detention of railroad trains would be to travel and commerce. The treatment of vessels and passengers abroad would be no less advan- tageous to commerce than to sanitation. It would practically do away with any detention on this side of vessels from ports where practised. (4 A.) A national quarantine would greatly lessen the existing imposts upon commerce, and indeed remove such as are due to quarantine fees. (1) It would cost less to administer than the present system, because, (a) not a few ports have both a State and municipal quarantine, both of which are supported by imposts on commerce; (b) in some places, like the entrances to Chesapeake and Delaware Bays and Sapelo Sound, one United States station can do the work for two or three states and a number of municipalities, thus lessening the force required; (c) from what I have seen of some of the principal quarantine stations, I can assert positively that they could be conducted under United States control at an expense of from 25 per cent, to 60 per cent, less than the fees collected. The extra cost of the plants necessary to make some of these stations efficient could in a few years be paid for out of the excess of the present fees over the cost of this administration. (2) No part of the expense of administering a national quarantine would fall on the vessel; they are borne by the whole country protected by it, as indeed seems right. The present system throws all of the cost of its administration on the vessel. The fees now paid for inspection are not generally large, but the charges for disinfection, where disinfection is practised, are considerable and are a serious tax on the vessel. Very respectfully, H. R. CARTER, M. D., Surgeon U. S. M. H. S. Mayor's Office, } Chicago, 111., Dec. 15, 1892. j Darwin R. James, Esq., Secretary New York Board of Trade and Trans- portation, 55 Liberty Street, New York City. Dear Sir :—Your favor of the 7th instant was duly received. IS Categorical answers to the questions propounded do not seem to be the readiest or most satisfactory way of furnishing the information sought for, if for no other reason than that the term " quarantine "is so inexact and is understood in so many widely-varying senses in the various countries and even by different writers in the same country. "Quarantine" originally meant a forty days detention of a vessel sus- pected of having an infectious or contagious disease on board, or one arriving from an infected port ; and during which period intercourse with the shore was forbidden and passengers and crew, infected and healthy alike, were confined together in violation of every sanitary requirement or precaution. Such a system or quarantine is still in vogue, the period of detention only varying, as witness some European countries, the Spanish West Indies, Mexico, South America, and even the United States in a modified degree. The lower in the scale of civilization and of maritime commercial importance, the less informed as to the resources of modern sanitary science, and, consequently, the more readily a prey to unreason- ing panic, the greater the reliance on the arbitrary time-detention quaran- tine. Contrast with this the English system which has been tested for more than twenty years and found adequate to the protection of the United Kingdom, notwithstanding that it is peculiarly exposed by reason of its vast and wide-spread commercial relations, and that during the past sea- son Asiatic cholera was introduced through a score or more of its ports. In that country the antiquated Quarantine Acts, although still unre- pealed, are a dead-letter and have not been enforced in any instance since 1865. The modern system is fully indicated in the following resolutions of the Illinois State Board of Health. These resolutions were offered by the Secretary of the Board soon after the promulgation of the twenty-day quarantine in this country, but were not published because of the unfor- tunate occurrences in New York harbor and a reluctance to add to the existing complications by what could only be construed as an adverse criticism of the administration at that port. As unanimously adopted by the Board the resolutions are as follows : '' Resolved, That the first principle of modern maritime sanitation, 'quarantine,' so-called, in dealing with an infected vessel or vehicle, or one concerning which there exists reasonable suspicion of infection, demands the immediate removal therefrom, first, of every individual, passengers and crew; and, second, of all material capable of being the nest of infection and contagion, and the immediate enforcement of proper measures of medical inspection, sanitary treatment, disinfection, etc. " Resolved, That no sanitary authority, national, state, or municipal, is justified in enforcing a quarantine of detention until it has secured provision for the decent and proper care of those detained, such care in- volving the removal of the sick to isolation hospitals and the comfortable shelter and subsistence of those detained during the incubation period, with competent medical oversight during such period. " Resolved, That under no circumstances is an arbitrary period of detention justifiable ; but the duration of detention, as to persons, should be determined by the period of incubation of the particular disease to be 19 guarded against; and, as to things, by the time required for the disinfec- tion of material and for the cleansing of the vessel or vehicle so that it may be safely and promptly returned to its proper employment." As to the present status of quarantine in the United States the national system is imperfect for want of adequate and definite legislation. State quarantines are costly, conflicting, capricious and wholly unreliable. They are costly in that they often impose unnecessary and vexatious re- strictions upon travel and traffic. They are conflicting because they are the outcome of varying degrees of civilization and intelligence. They are capricious because too often the response to popular clamor accented by popular superstition and popular fear. They are unreliable because all experience, foreign and domestic, proves the futility of quarantines of exclusion and sanitary cordons between states and communities on. the same continent. A national quarantine—or rather a national sanitary service—would impose the minimum of interference with commerce while securing the maximum of protection to the public health. Let Congress enact that no immigrant shall enter the United States except through certain specified ports of entry on the sea-board and frontier, at which ports suitable sani- tary depots shall be established and maintained under the control of the national government. Then let the administration of such depots see to it that no immigrant pass the sea-board or frontier into the interior ex- cept through the portals of a bath-house, nor his personal effects and be- longings except through the wash-tub and disinfecting chamber—and this if for no other reason than that the conditions of the steerage are con- ductive neither to cleanliness nor health. If from a healthy port, on a healthy vessel and himself healthy, the detention of the immigrant for such purposes of purification would be a matter of a few hours only; if communicable diseases existed or were suspected the period of detention would vary according to the character of the disease, and he would be properly treated and cared for if sick in hospital under conditions most favorable for his speedy recovery. But under no circumstances should any immigrant or his belongings be allowed access to the interior until he and his had first been rendered incapable of carrying and spreading the exotic diseases and pestilences. This would render State quarantines unnecessary, since it is the in- fected immigrant who furnishes the sole cause for their being. I am aware that these utterances may sound dogmatic—that they may be characterized as ex cathedra. But they are believed to be based upon the views and judgment of the best sanitary authorities both in this country and in Europe; and they are further fortified by personal experi- ence in the most practical character during the past twenty years. Yours very truly, HEMPSTEAD WASHBURN, Mayor. City of Memphis, Office of the President, Memphis, Tenn., Dec 15, 1892. Hon. Oscar S. Straus, Chairman, No. 55 Liberty Street, New York, N. Y. Dear Sir .-—Replying to questions of your circular letter of thej5th inst. I will state: 1. I know too little of quarantine administrations in foreign countries to offer any suggestions or comment. 2. (A.) There is no regular national quarantine maintained in the United States. (B.) Some of the local (State or City) quarantines are very good, for example, New York, New Orleans, Charleston and possibly others; some local quarantines are known to be inefficient. 3. There is no one defined system of quarantine in the United States;. the quarantines at present are local. (A.) Do not know the cost. (B.) Do not know to what extent restrictions are imposed on commerce and travel. (C.) Security afforded is not satisfactory. 4. (B.) In my opinion it would, and at the same time increase confi- dence. I am now and have been during ten years of official service as President of the Memphis Board of Health, and a greater part of that time member of the Tennessee State Board of Health, an advocate of a national system of maritime quarantine ; also, when occasion arises for it, of international quarantine along the Canadian and Mexican borders. I also believe that interstate quarantine and sanitary inspectors can be more efficiently maintained, with less inconvenience to commerce and travel, by national authority than by the several states or cities directly affected. To be brief, I respectfully submit that a uniform system of national maritime quarantine should be maintained the whole year round and should be extended to an international and interstate quarantine or sani- tary inspection service whenever occasion demands. I think that experience teaches that this can only be done satisfactorily by a national service. State and local health authorities should co-operate with this national health organization whenever called on to do so. If this could be done it would not only be more efficient in times of real danger, but would prevent panic and useless restrictions and inconvenience to commerce and travel. To discuss the subject beyond the simple expression of opinion would go beyond the proper limits of reply to your questions. Respecfully yours, G. B. THORNTON, M. D., Ex-President Memphis Board of Health, ex-member Tennessee State Board of Health, member of American Public Health Association, etc' ROOMS OK The New York Board of Trade and Transportation. New York, January nth, 1893. At the annual meeting of the New York Board of Trade and Transportation, held this day, the following resolutions were unanimously adopted: The Sherman Silver Law. Resolved, That, in the opinion of the New York Board of Trade and Transportation, the immediate suspension of the Sherman Silver Law is essential to the continued welfare and prosperity of the business interests of the country. Amendment of Inter-State Commerce Law. Whereas, A bill has been introduced in Congress, by Senator Cullom, proposing certain amendments to the Inter-State Commerce Law, the most important of which is to permit pooling arrangements between railroads, subject to the approval of the Inter-State Commerce Commission; and Whereas, Great inequalities in rates are now experienced under the workings of the Inter-State Commerce Law, which were not experienced before the enactment of that law and pooling was in force between Eastern trunk lines, Resolved, That, in the judgment of the New York Board of Trade and Transportation, it is expedient to try the experiment of permitting pooling arrangements, subject to the approval of the Inter-State Commerce Commission, as proposed in the amendments to the Inter-State Commerce Act introduced by Senator Cullom. Favoring survey for Deep Water Canal and construction of Niagara Ship Canal. Whereas, A bill has been introduced in Congress by Mr. Bentley, of New York, providing for a survey to determine the most practicable and economical route for a deep water canal between the great lakes and the seaboard, Resolved, That this Board favors the enactment of said bill, and earnestly urgfiis its speedy consideration by Congress. I Resolved, That, in the opinion of this-Board, Lakes Erie and Ontario ©fight-ttriie aDnnected by an adequate ship canal entirely within the territory of this country. {A true copy.) ,, -. AMBROSE SNOW, President. [seal.J DARWIN R. JAMES, Secretary. 3461 H 21 The above views and expressions of Dr. Thornton are approved and endorsed by our municipal authorities. W. L. CLAPP, President City of Memphis. Town of Beaufort, Intendant's Office, I Beaufort, S. C, Dec. 16, 1892. j Hon. Oscar S. Straus, Chairman New York, N Y. Dear Sir:—I have the honor to reply to the circular letter of the New York Board of Trade and Transportation, of December 5, 1892, in refer- ence to quarantine regulations, and to say that I referred the same to Dr. H. M. Stuart, who is Chairman and in charge of the quarantine regulations of the Port Royal and St. Helena Bars, and inclose his reply.* I cannot indorse his conclusions in full. 1. " As to quarantine administration in foreign countries. "—I am not conversant with such regulations. 2. "The United States Quarantine. (A.) National."—I believe a United States Government supervision would be more generally efficient, and command greater respect and authority. 3. "The existing system in the United States."—(B.) Should be restricted by the United States Government without imposing upon com- merce or travel. (C.) A more general security would be afforded. 4. "National Quarantine."—(A.) Should increase the restriction upon commerce in proportion to the necessity of a strict quarantine. (C.) The recent epidemic in New York harbor, the first city in the Union, has shown the insufficiency of the State or city quarantine to protect the country, and a more active and efficient system should be inaugurated by the general government for the security of the country. Very respectfully, G. HOLMES, Intendant (or Mayor), Beaufort, S. C. Mayor's Office, I Austin, Texas, Dec. 12, 1892. j Hon. Oscar S. Straus: Sir:—Your printed circular asking my views on the subject of quaran- tine is at hand. My views ought not to have much weight, as we are located so far from the seaboard and in such a healthy location that I have never given the subject much attention, but I would think that the United States Government could better attend to all quarantine matters than to divide the duties up among local states and cities. Yours, &c, john Mcdonald, Mayor. * See Dr. Stnart's letter in Appendix " C." •)•) Mayor's Office, / Oswego, N. Y., Dec. 27, 1892. j Darwin R. James, Secretary, New York City. Dear Sir :—Your circular in relation to quarantine at hand. I should favor a uniform system in the United States under the management of the general government. In my estimation the Board of Health officers of New York made a splendid record last fall. We had carload after car- load of emigrants passing through our city and no trace of contagious diseases have made themselves apparent yet. Pay good salaries to com- petent men and the cost will be reduced to a minimum. It occurs to me that a national quarantine would afford the best security to the country. Yours truly, W. D. 'ALLEN. Mayor. Mayor's Office, ) Covington, Ky., Dec. 10, 1892. f Hon. Oscar S. Straus, Chairman Special Committee, New York Board of Trade and Transportation. Dear Sir:—I have received one of the circulars sent out by your Com- mittee. Though by no means counting myself an expert in such matters, I shall submit in a plain, common sense way such thoughts as suggest themselves to my mind in regard to quarantine. In the first as well as in the last place, I would say that the general government should be empowered and intrusted with the whole thing if we want to make it effectual and satisfactory. If left to the different states and municipalities, with their varying laws and more or less dif- ferent ideas about quarantine, there will be constant conflicts and dis- satisfaction arising between such states and municipalities, and we will be left in a state of uncertainty all the time. Uncertainty has a tendency to create distrust, depress business, paralyze trade and commerce and create panics. If, however, the government has control, with ample means at its command and power to enforce; with one head to direct and with fixed rules to govern, it would give confidence to merchants and shippers, and commerce and trade would go on with some degree of cer- tainty. There would then be no danger when shippers sent goods or merchandise of any kind of their being stopped at some State line or by the corporation of some municipality, and at all our seaports shippers would know just what to depend upon. Then in a way of protection to ourselves it would be for the best. Many places are without the money, and some may be without the disposition, to organize a quarantine. In such cases we may need to be protected against ourselves. Government control would add tone and effect to the whole system and the people would rest in the idea of security. It would to a good degree remove that sense of fear and anxiety that is apt to seize hold of many of us in time of an epidemic, especially when it comes sud- 23 denly upon us and we find our houses not in order. At such times excite- ment and madness takes the place of reason and good judgment in our rush to do something, we know not what, and in that state, if anything is done, it is as apt to be the wrong thing as the right. So, look at it from any point I may, the thing that suggests itself to my mind as of first importance is that the general government should have control. I know that the plan may meet with objections. We all seem to be so constituted that any restraint placed upon us is galling, and in our great desire to buy and sell and get gain our minds are absorbed to such an extent that we care not if all mankind perish so we ourselves prosper. But if we will stand, ourselves, aside for a short while and let reason and patriotism take the place of selfishness and greed and consider that we are to some extent at least our brother's keeper, we can but ar- rive at the conclusion that the above plan would be the best for the en- tire country, both for its safety, convenience and general prosperity, as well as doing the greatest amount of good for a smaller amount of money than with any other system. Respectfully, JAMES T. THOMAS, Mayor of the City of Covington, Ky. The Pan-American Medical Congress, j New York, Dec. 18, 1892. J Hon. Oscar S. Straus, Chairman Special Committee, New York Board of Trade and Transportation, City. Dear Sir:—Ln response to your circular-letter of the 5th inst. I have the honor to state : 1st. That my personal experience with the quarantine administration of foreign countries has not impressed me with their efficacy ; and the pub- lished reports of the pharaphernaHa of various foreign seaports sustain the theory that, as a rule, they are not in keeping with modern ideas of sanitary administration. (2d A.) The present quarantine system of the government is in the hands of the Marine-Hospital Service. The medical officers of this service are selected by competitive examination in professional and literary subjects as are the medical officers of the army and navy. They are required to be in the prime of early manhood (21 to 30), and political influence is without weight in their appointment or tenure of office. They are assigned to duty in various portions of this country, and their stations are changed every four years at most. This ensures familiarity with the various diseases of the different sections of our country; and while increasing professional skill in treating disease also secures that familiarity with government methods that makes the medical officer on duty at Port Townsend, Wash., conduct the details of his hospital as does the medical officer on duty at Key West, Fla. These officers are likely to, and do, 24 serve as quarantine officers at the stations that are under national control, so that the quarantine station at Dry Tortugas is conducted on the same scientific principles as that at Chandaleur Island or at San Francisco. (2 B.) There are only two state quarantines in the United States that are conducted on scientific principles, viz.: Charleston* S. C., and New- Orleans, La. The system in the former city is copied after that in the latter city, originally inaugurated by my friend, Dr. Joseph Holt. But the excellent system he inaugurated, and that has been adopted by the government, is administered by other hands than Dr. Holt's, for the vicissitudes of party politics have relegated him to the background. And the political aspect of local quarantine is so pre-eminent a feature of its administration, that no sanitarian, who is not an office-holder, or would-be office-holder, believes in other than a national administration of quarantine. I might here remark, parenthetically, that no better illustfation of this view can be had than that of Dr. Holt's present position as contrasted with that he formerly held. To-day your committee has a letter from him urging a national quarantine, while but a few brief years back he opposed that idea as vigorously as his successors do now. 3d. Quarantine administration in the United States is either by the Marine Hospital Service at a few ports, or by local authorities at many. As Surgeon-General Wyman has informed you, the Marine Hospital Service imposes no quarantine tax. Regarding the local quarantine tax we may cite from the reports of the Health Officer of the Port of New York for 1890 and 1891: Total receipts (1890)............................... .^34 140.27 (1891)............................... 34,661.96 These are the only official figures that can be obtained because until the Legislature of the State of New York passed a law compelling the pub- lication of receipts and expenditures by the Health Officer these matters could only be surmised. This tax, of course, is directly on commerce, but this is not all that New York has to bear. The following table exhibits the appropriations by the Legislature from 1864: ^ear- Amount. 1864......................#50,000 1865 ....................... 45,000 1866..................... 75 000 1867...................... 75)000 1868....................... 56,012 1869..................... 57,000 1870 .................... 55,000 lg71.....................102,400 1872...................... 124,744 1873...................... 94,000 1874...................... 59,000 1§75....................... 54,000 1876...................... 10,000 1877.................... 10,000 *-ear' Amount. 1878.....................$30,000 1879....................... 20,807 1880..................... 25^00 1881...................... 45,000 1882....................... i7;50o 1883...................... none 1884................... M27 1885...................... 27,500 llll...................... 10,000 iyyu ..................... 63,270 As 78 per cent, of the immigration into the United States is ria the port 25 of New York, it may be seen that the commerce of that city, and New York State, is being heavily taxed to protect the people of the United States; for it is the immigration that is a source of danger, imported merchandise being innocuous. I will quote a letter published in the New York Times for October 29th as authority for the statement that at Key West, Fla., $33,000 had been exacted for quarantine service in 1891, and this year it was expected that the income would be $80,000. If commerce can stand this extortion for alleged services, the sanitarian has no cause to complain on that score. (3 C.) But on the ground of security afforded he has much reason for complaint, because a community may be lulled into a false sense of security by reason of the existence of what is supposod to be a protection, .but in reality the system does not protect. Men are appointed to office who are unable to distinguish between a hemorrhagic malarial fever and yellow fever, or who can not distinguish between a typhus eruption and that of itch; no standard is fixed for an appointee except that of political influ- ence. Rare instances have occurred in which the best qualified man has been appointed to the vacancy of health officer of a port. But sanitary science is no more a matter of intuition, or of general familiarity with medical men, than is any other specialty in medicine. It is not considered profitable, and there are very few medical colleges in this country in which the subject is taught; not one of the medical colleges in New York City, be it said to their discredit, has a chair in sanitary and state medicine. It may, therefore, be seen that with most physicians the essentials of public health are matters that slowly penetrate their interests; and the appointment of an average physician in charge of a quarantine establish- ment is a sort of adult and professional kindergarten training. Aside from the cities of Charleston, New Orleans, Savannah and San Francisco (where there are Marine Hospital Quarantines), there is not the least security afforded to the people of this country that exotic epidemic diseases will be excluded by properly equipped quarantine establishments. 4th. A national quarantine would be desirable and could be easily obtained by Congress passing a law slightly extending the present author- ity of the Marine-Hospital Service in the matter, and by prohibiting any state, municipality, or locality imposing any tax on commerce for quarantine services ; this could be done at a very slight expense to the country. Ex- hibit A, herewith, is a list showing the various stations of the medical officers of that service. It may be noted that these are at all of the important mar- itime and inland ports of this country. No officer of that service receives any extra compensation for quarantine service, and there is always one or more on hand at each of these ports. An epidemic disease exists in some foreign country; that service has its fixed and tried plan already in exist- ence to prevent the introduction of that disease. If the officer in charge of the New York quarantine is overworked, men from various parts of the country can be ordered there to duty; and not one, but a dozen, or a score, or two score, if necessary. The individual officer is but a factor; 2(i he dies in fighting the disease, another man in this small army of physi- cians is ready to step forward and take his place, carry out the same proce- dure, and interpose the same protection to his fellow-countrymen. It is not an experiment with green hands that is being carried on, as was lamentably witnessed here during the past Summer, but it is a definite and well organized plan of campaign conducted by officers that have had experience in all parts of the country and with the various diseases. It would lessen the existing imposts upon commerce, for no fees are exacted for the professional services rendered; there would be fewer re- strictions on commerce because Congress would equip the various sta- tions so that an infected vessel could be speedily disposed of; and it would afford the security to the country that a well-organized army does in case of war. Instead of a guerilla campaign here and there on our sea- board there would be a definite system for the entire country. I am not sure that my professional brethren of the Marine Hospital Service would be pleased at this increased responsibility imposed upon them. But as this service is now intimately associated with the sanitation of our own mercantile marine, as it has charge of the medical inspection of immigrants, as it has charge of the existing national quarantines, it seems better to extend its scope than to inaugurate another bureau that would be beset by the political doctor hungry for a place, that would be the refuge of the party partisan, that would have a staff changing quadrannually, and that would be no better than existing local quarantines. There is not a reputable medical society in the country that will in- dorse our present local quarantines, nor is there a medical society in this city that will not condemn the existing New York quarantine system. A bill has been introduced in Congress giving the Marine Hospital Ser- vice the duties I have referred to, and as it is the only national medical service fitted to undertake the duties it is to be hoped that your Com- mittee will feel justified in indorsing it. The question is one that is absolutely alien to party politics, and the cry that it is otherwise is coming from those that hope to profit by the continuation of the present condemnable system. And it may be seen that those that are advocating national control are not impelled by self- interest. In general it may be said that the inefficiency of the present system has been demonstrated, so it would be better to resort to another method that offers a definite plan and organization. Very respectfully, S. T. ARMSTRONG, M. D., Chairman Section in Public Health of the New York Academy of Medicine; also English-Speaking Secretary, New York City, The Pan-American Medical Congress; Section in Marine Hygiene and Quarantine, etc., etc. 27 Exhibit A. At the following places medical officers or acting assistant surgeons of the United States Marine Hospital Service are stationed, and it may be seen that every important sea or inland port, at which immigrants might enter, is thus guarded Albany, N. Y., Alexandria, Va., Apalachicola, Fla., Ashland, Wis., Ashtabula, O., Astoria, Ore., Baltimore, Md., Bangor, Me., Bath, Me., Belfast, Me., Bismarck, N. Dak., Boston, Mass., Bridgeport, Conn., Brownsville, Tex., Brunswick, Ga., Buffalo, N. Y., Burlington, la., Burlington, Vt., Cairo, 111., Cedar Keys, Fla., Charleston, S. C, Chattanooga, Tenn., Chicago, 111., Cincinnati, O., Cleveland, O., Corpus Christi, Tex., Crisfield, Md., Darien, Ga., Detroit, Mich., Dubuque, la., Duluth, Minn., East Saginaw, Mich., Edenton, N. C, Elizabeth City, N. C, Ellsworth, Me., Erie, Pa., Escanaba, Mich., Eureka, Cal., New Orleans, Dec. 8, 1892. Messrs. Darwin R. James, Secretary, and Members of the Special Committee of the New York Board of Trade and Transportation; Gentlemen .—I am this moment in receipt of your favor of the 5th inst., requesting an expression of my views concerning quarantine. To make a categorical reply in the order of statement of your inquiries I have the honor to submit the following : 1st. Quarantine administration in foreign countries is so crude and un- scientific as to furnish no precedent worthy of acceptance for the United Evansville, Ind., Fairport Harbor, O., Fernandina, Fla., Fredericksburg, Va., Gallipolis, O., Galveston, Tex., Georgetown, D. C, Georgetown, S. C, Gloucester, Mass., Grand Haven, Mich., Green Bay, Wis., Hartford, Conn., Jacksonville, Fla., Keokuk, la., Key West, Fla., La'Crosse, Wis., Lewes, Del., Little Rock, Ark., Louisville, Ky., Ludington, Mich., Machias, Me., Manistee, Mich., Marquette, Mich., Marshfield, Ore., Memphis, Tenn., Michigan City, Ind., Milwaukee, Wis., Mobile, Ala., Nashville, Tenn., New Bedford. Mass., New Berne, N. C., New Haven, Conn., New London, Conn., New Orleans, La., Newport, Ark., Newport, R. I., New York, N. Y., Norfolk, Va., Ogdensburg, N. Y., Oswego, N. Y., Pensacola, Fla., Philadelphia, Pa., Pittsburgh, Pa., Plymouth, Mass., Port Huron, Mich., Portland, Me., Portland, Ore., Portsmouth, N. H, Port Townsend, Wash., Providence, R. I., Richmond, Va., Rockland, Me., Rome, Ga., St. Louis, Mo., St. Paul, Minn., San Diego, Cal., Sandusky, O., San Francisco, Cal., Sault Ste. Marie, Mich., Savannah, Ga., Seattle, Wash., Shreveport, La., Sitka, Alaska., Solomons, Md., Tacoma, Wash., Tappahanock, Va., Toledo, O., Tuckerton, N. J., Vicksburg, Miss., Vineyard Haven, Mass., Wheeling, W. Va., Wilmington, Cal., Wilmington, Del., Wilmington, N. C. 28 States. The first departure from the gross methods of quarantine en- forcement generally prevailing in Europe and America, was the invention of the modern " System of Maritime Sanitation " in 1884, and its estab- lishment in the lower Mississippi River for the protection of New Orleans and the Mississippi Valley, of which I have the honor of being the origi- nator, inventor and founder. Concerning this system I have the honor to transmit a treatise entitled : "An Epitomized Review of the Principles and Practice of Maritime Sanitation," respectfully referring you to page 17, under caption " Quarantine and Commerce," and to page 86, " Opion- ions Abroad and at Home," and also page 37, "The Quarantine Methods of Louisiana—Maritime Sanitation," continuing to page58, and illustrations. 2nd. The present status of quarantine in the United States, with the exception of New Orleans and the few ports which have adopted the modern system above mentioned, is fully set forth in the pamphlet enti- tled "Pestilential Foreign Invasion as a question of States'Rights and the Constitution—The Failure of the Maritime States Demands a Common Defense," an address delivered by me before the Tri-State Medical Society of Georgia, Alabama and Tennessee at Chattanooga, October 26, by special invitation. Please see pages 10 to 16. 3rd. The existing quarantines in the United States, as a whole, are dis- jointed and utterly without system in method of application, period of detention, cost of equipment, schedule of charges, restrictions imposed on commerce and travel, and security offered. Each is independent and imposes its restrictions upon commerce according to local fancy and the varying necessities for revenue for the maintenance of fat salaries, often- times extending to the payment of the officers and employees of a State Board of Health concerned with internal local sanitary affairs. Under the present status the quarantines offer most desirable and sometimes rich positions in the distribution of local political favors—all of the bills being footed by fees, dues and fines levied on shipping; usually without any return whatever in efficient sanitary treatment. These stations being, with few exceptions, unprovided with scientific and adequate apparatus, the charges are necessarily for hypothetical services never rendered, a mere legal fiction to secure a fee. That pestilence filters through these go-as- you-please state quarantines is not at all strange, but reasonably to be expected; and furthermore, as long as this vital trust is in state hands there is no remedy for the present status. 4th. "A national quarantine: A. Would it lessen the existing imposts upon commerce ? B. Would restrictions upon commerce and travel be less injurious ? C. Would it afford increased security to the country ? " Under a properly organized Bureau of Health, established in the United States Treasury Department, having its limits clearly defined while granted plenary powers within its normal field of action, properly safe-guarded in strictly Federal functions, at no point in frictional con- tact with the internal police powers of the states, and non-partisan under such a national organization, the reply to each of these inquiries is un- equivocally, yes ! 29 Having been requested to formulate the substance of a bill embodying my views on the subject of a national sanitary system, quarantine, inter- national and inter-state, being its principle element, because the most important, I had the honor to submit the plan of a complete national sys- tem, modeled in organic construction upon the plan of our Federal Con- stitution and Government, creating a Bureau of Health containing a National Sanitary Council with plenary power, legislative, judicial and executive in those specific duties and responsibilities, concerning which a limited body of seven specialists, selected on account of high scientific attainment and technical ability, would certainly be a better judge than the framer of a bill in Congress—whose members do not profess to be skilled physicians or sanitary scientists. Without much enumeration of detail, the bill introduced December 2d, by Mr. Isidor Rayner, of Mary- land, completely covers the entire field of national health affairs in each and all of its departments so far as these are manifestly related to the protection of commerce and the general welfare. I have written asking Mr. Rayner to send to each of you gentlemen of the special committee a copy of his bill. Please accept, with my sincere regard, the beforementioned published treatise and address I have this day mailed. They, together with the bill, contain, in my opinion, a complete reply to each of your inquiries. With profound respect, I remain, gentlemen, Yours very truly, JOSEPH HOYT, M.D., Former President Louisiana State Board of Health. Washington, D. C, Nov. 15, 1892. Hon. Oscar S. Straus, Chairman Committee on Quarantine, New York Board of Trade and Transportation : My Dear Sir:—Your letter of the 14th inst. is just received. In reply my reasons for favoring a national quarantine are as follows : 1. Quarantine regulations are, as you well known, intimately connected with the subject of immigration. The national government has as- sumed the entire charge of the regulation of immigration, in compliance with a public demand now fully sustained by public sentiment, and I be- lieve the same sentiment now requires the national government to take full charge of the subject of quarantine along our entire sea-board. 2. Quarantine is an incident of foreign commerce which embraces not only the transportation of freights, but also of passengers. This is text law. See "Story on the Constitution," sec. 1,074-1,077. It is one of those governmental powers which may be exercised by states until as- sumed by the national government. Then the authority of the latter over the subject becomes exclusive. 3. The national government having full authority over ships and over immigration, the control of quarantine by the states has become incap- 30 able of beneficial administration, as it involves an embarrassing inter- mingling of state and national authority. This was illustrated glaringly in the events of last August and September in New York. 4. In consequence of the great flow of immigration toward this country, quarantine regulations involve important international relationships and give rise to incidents which the national government alone can deal with under the provisions of the Constitution of the United States. 5. The separate administration of the subject of external quarantine by different states would inevitably leave loopholes in the scheme and defeat the end aimed at, whereas a single system of quarantine under a central authority at Washington, connected with every important point by tele- graph, would maintain an effective quarantine of the whole coast. 6. The wonderfully successful administration of the subject of quaran- tine by the national government, where its present powers in that direc- tion have been exercised, fully vindicate the propriety of entrusting the whole subject to the United States Marine Hospital Service—the office en- trusted with this vitally important public function. 7. The fact that cholera exists in France and Germany at this late day in the season furnishes ground to apprehend that the disease may be brought over next year by immigrants, and suggests the wisdom of national regulations touching both immigration and quarantine under the provisions of law which should be enacted by Congress during its ap- jxroaching session. I am glad to know that the New York Board of Trade and Transporta- tion has so earnestly taken up this important question. I shall at any time be glad to serve you in this direction. In the hope that you may find the foregoing hastily prepared statement of some service, I am, Sir, Verv truly yours, JOSEPH NIMMO, Jr. The Pan-American Medical Congress, / Cincinnati, Dec. 20, 1892. f Darwin R. James, Esq., Secretary New York Board of Trade and Transpor- tation, New York City. Dear Mr. James:—The question of national and international quarantine is one to which I have given considerable attention in connection with the development of the Pan-American Medical Congress. You may know that the International American Conference, popularly known as the Pan-American Congress, held some years since in Washington, endeavored to formulate a code of international quarantine regulations. In this they failed for several reasons, chief among which wag the fact that the quar- antine service in the United States was so indefinite that no body, not even the central government, was in position to bind himself or itself to the consummation of any definite plan. The result is that the quarantine 31 service in the Western Hemisphere is in a very disorganized state and interferes seriously with the commercial relations between this and the other countries on this side of the Atlantic. It must be said, however, to the credit of our neighboring states, or countries, that I believe in no single instance is the quarantine regulation under other control than that of the national or central government. In the United States, however, the matter is in a still more disorganized state. With the United States Marine Hospital Service in charge of cer- tain features of our quarantine service, and with the states arrogating to themselves certain privileges of regulation, and certain municipalities still other features of regulation, I do not know what we would do in the management of an epidemic. / am thoroughly impressed that we are spending more money for quarantine service than any other country in the world; that we are interfering more effectively with our commerce than any other country in the world, and that we are receiving less protection in return than any other country in the world. With a national quarantine made clear and definite, with no possible misunder- standing as to authority, regulations could be imposed that would not amount to an embargo upon commerce, and that would give us increased security for the reason that it would result in concert of action and in responsible centralization of authority. The full agitation of this question will comprise one of the leading features of the Pan-American Medical Congress, one of the sections, namely, that of Marine Hygiene and Quarantine, under the Presidency of Dr. Walter Wyman, being devoted to the subject. Very sincerely yours, CHARLES A. L. REED, Secretary-General of the Pan-American Medical Congress. New York, Dec. 26, 1892. To the Secretary of the New York Board of Trade and Transportation : Sir:—in reply to your letter and circular relative to the '' quarantine administration in foreign countries as furnishing precedents for the United States," I beg to state that I am able to speak with precision of the system of quarantine in France, as I have passed a great deal of time in that country, and being in Paris a great part of last Summer, was more or less in communication with the health authorities, general and local. I con- sider that the French system demonstrates the great value of a properly organized national quarantine. Quarantine is administered throughout France in accordance with a law passed in 1876. The provisions of this law are carried out under the direction and advice of a body entitled the Comite Consultatif d'Hygiene Publique de France. The functions of this body are not to make any new laws, but to see that existing laws are executed, and to act as an advisory body to the Ministry of the Interior, in regard to such measures as seem to this council well or badly employed. This body is charged with the investigation and study of all questions referred to it by the Ministry of the Interior, especially those which con- cern the marine sanitary police, quarantines and their service and the necessary measures to take for the prevention and combatting epidemics. This committee acts also, I may add, as an advisory body in all other questions of public health, lodgings, water, food, the sale of medicines, etc. Practically it constitutes the real quarantine, as its councils, I may say, are almost invariably followed. This committee is composed of 34 members. Twelve of these are members ex-officio, and are as follows: The Dean of the Faculty of Medi- cine of Paris; the Perpetual Secretary of the Academy of Medicine; Inspector-General of Sanitary Service; Director of Public Charities and Hygiene; the President of the Committee on Health of the Army; the Inspector of the Service of the Health of the Navy; the Director-General of the Customs; the Director of Public Charities of Paris; the Director of Commerce of the Interior; the Inspector-General of Veterinary Col- leges; the Inspecting Architect of Thermal and Sanitary Buildings. The others are appointed by the Minister of the Interior, and are at present composed of seven professors in the Faculty of Medicine of Paris, of whom one is a senator. The other members comprise the Inspector of the School of Mines; the Director of the School of Pharmacy; the Inspector of Benevolent Institutions; the Secretary-General of the Supe- rior Council of Public Assistance; the Director of Statistics of Paris; a professor in the Institute of Agriculture; the Chief of the Laboratory of Toxicology, two or three hospital physicians and, Pasteur, member of the Academy of Medicine and of the Institute of France. The executive power of this body is delegated to a committee of three, composed at this moment of Brouardel, Dean of the Faculty of Medicine, Member of the Institute and of the Academy of Medicine ; Proust, Inspector General of the Sanitary Service of France, perhaps the best known writer upon cholera in France, and who was twice sent to the East to study the disease; and Monod, Director of Public Charities and Hygiene. The members of the Council sign a bulletin attesting their presence, and a member receives for each meeting he attends fifteen francs. Certainly not a sufficient sum to enable him to squander much of the public money! It is interesting to note the composition of this body. Perhaps, except that of Pasteur, the names of the medical members are not well known here, but are well known in the medical world. The others cover by their official positions everything on sea and land connected with sanita- tion. Now as to the results of the labors and influences of this body. I have myself witnessed some of these. I was in Paris much of the time in Julv, 33 August and September, 1884, while the cholera was raging fiercely in Tou- lon, Toulouse and Marseilles. Though the latter city is only thirteen hours from Paris, and the communication very extensive, not a single case of cholera occurred in Paris till early in November, when there were a few cases, the first case being brought from Fecamp, a small seaport in Nor- mandy, about three hours from Paris. The quarantine regulations were admirable. Every traveler from Spain or the south of France was obliged, on his arrival, to report within a certain number of hours to the authori- ties, stating from what locality he had come, his address in Paris, and the condition of his health. If fae formality were neglected imprisonment followed very promptly. In addition travelers from certain localities were subjected to thorough fumigation at the stations. This year the Executive Committee of the Council made at least two visits to Havre while the epidemic was at its height, and, in co-operation with the municipal authorities, enforced such orders and such a process of cleaning that the epidemic was stamped out, considering its violence, in a reasonable time. The first case appeared August 2nd and the last towards October 4th. Last Summer this committee established an effective quarantine between the Austrian and the German frontiers and France; travelers entering France from these countries being subjected to careful inspection, and, in needed cases, detention. Their soiled clothing was taken from them, fumigated, washed, ironed and sent in a few hours to the traveler's destination, and this at the simple cost of carriage. It may be asked if the French national quarantine be so efficacious, how could the cholera have been introduced so easily from Hamburg into Havre, as is usually supposed it was ? I am glad to be able to contradict this belief. The first case of cholera occurred at Havre August 2nd; the first in-Hamburg August 11th, and between August 2nd and August 11th it had become quite prevalent at Havre. It is true that there were a large number of deaths from cholera in Paris this Summer, the week ending September 8th there being 177 deaths and the week ending September 15th, 148 deaths, these occurring in the city, irrespective of the suburbs, but I believe it was sporadic or cholera nostras and was not brought in. It commenced towards the middle of June in a very mild form, and long before its appearance in Havre or Hamburg. It did not, however, assume a severe form till the last week in August. Outside of Paris and Havre I have not been able to find records of more than thirty or forty deaths from the disease in all France. As to the question of a national quarantine: " Whether it would afford increased security to the country?" I would answer : If properly managed it should. The outposts and ports of the country should be subjected to surveil- lance by the government with the same care that they are watched to pre- vent the entrance of contraband goods. The sanitary cordon should be as strict as was the military cordon between the Union and Confederate outposts during our war. But it is not possible for one man without suf- 34 ficient resources to cope with such a formidable condition of things as was suddenly developed here last Summer. It is not to the point whether he could have done more. There was, however, conflict of authority; unsuccess in simple questions of trans- portation, which any shipping merchant or railroad man could have solved at once; there were panic and confusion. Neither government nor state did well; people were subjected to hardships and privations such as belong to war and siege. The same regulations and laws proceeding from one central source, the national government, should apply to every port in the country. Harmony of action could then prevail in the whole length and breadth of the land, from the temperate to the torrid zone. The senseless panio which led a town in Texas to quarantine goods purchased in New York, and to subject vessels to long quarantine at Havana and Malaga long after the disappearance of the cholera here would not be likely to recur. At the same time, although national quarantine is best, it would not be desirable if it were placed within the power of the Secretary of the Treasury to retain without cause for several days vessels from a non-in- fected port and with a clean bill of health, as was recently done this month in the case of La Bretagne, and early in November in the case of another vessel of the French line. A national quarantine which did not know how to manage healthy ships from healthy ports would be of no advantage, at least, to commerce. I do not believe in state quarantine, but I believe less in a mixture of it with national quarantine. I cannot see but that a national quarantine, somewhat on the plan of that of France, should fulfill every purpose. Very respectfully yours, H. B. MILLARD, M. D., Foreign Corresponding Member of the Academy of Medicine of Paris, Fellow of the Academy of Medicine of New York, and of the American Academy of Medicine, etc. New York, Dec. 21, 1892. Hon. OscarS. Straus, Chairman, etc., No. 55 Liberty Street, New York City. Dear Sir:—Referring to the circular issued on behalf of the Special Committee of the New York Board of Trade and Transportation, under date of December 5th, 1892, asking answers to certain questions, I would say that I feel in no way qualified to answer any of the questions as an expert. * * The only one of your questions which I can answer categorically with a "yes" or "no" is the question whether a national quarantine would " afford increased security to the country." Aa to this I have no sort of 35 question. The hap-hazard and conflicting provisions of the statutes of our various states furnish loop-holes without number through which disease can enter the country. We have twenty-two or twenty-three sea- board states and some twelve or thirteen border states through which quarantinable diseases may come. It is absurd to suppose that each one of these states has an effective system of quarantine. I regard it as the imperative duty of Congress to exercise its power to pass a quarantine law which shall represent the highest and best system anywhere to be found in the statute books of any one or more of our states. The machinery which the federal government has at hand for effective quarantine would, of itself, be a sufficient reason for imposing this duty upon the federal govern- ment. The surgical force of the Army and Navy can readily be utilized for the professional service necessary for the quarantine system, and this medical force has the great advantage of being as far removed from polit- ical influence and as independent of political patronage as any body of men in the public service can possibly be. The revenue marine force and the marine corps of the Navy furnish a ready and useful police force with which to carry out the regulations of a national quarantine system. Very sincerely yours, W. B. HORNBLOWER. Provincial Board of Health, ) Toronto, Ont., Dec. 16, 1892. j Hon. Oscar S. Straus, Chairman, Board of Trade and Transportation, No. 55 Liberty Street, New York, N. Y. Dear Sir:—Replying to the request contained in your circular of December 5th, it gives me pleasure to remark regarding the various points on which information is asked : 1. Quarantine in Canada is by the Constitution relegated to the federal government, which is thus enabled to apply a uniform system of regula- tions, both on the Atlantic and Pacific coasts. Mexico, similarly, has its federal laws executed under federal control. There can be no question as to the wisdom of this procedure, since one central authority relatively free from local influences is enabled to legis- late for the general public interest, rather than with a view to the tem- porary advantages of any locality. Further, it becomes possible for con- joint action to be promptly taken for common safety on the part of the several federal governments of the continent. 2. The evils resulting from divided authority are well known to those who have watched the varied operations of different ports in the matter of disinfecting appliances and their manner of treating infected ships and cargoes. It is to be regretted that the absence of national legislation has given to the United States a partial federal service, which was never properly organized, and which has not, except at a few stations, exhibited that ap- 3(5 preciation of the work to be done or the requirements therefor which the public interest might fairly demand of it. 3. Regarding the existing port quarantine in the United States, one can only say that the old idea of a quarantine for revenue is subversive of the very intention for which such services have been established, and almost always has resulted in inefficiency, the temptation on the part of officers to discriminate against different lines for personal reasons, to which might be added other evils all affecting trade and commerce without advan- tages commensurate therewith. In Canada quarantine belongs to the federal governments, and all costs of the working of the station are paid by the government, and no fees charged upon the shipping companies or passengers. 4. The last answer is a reply to 4th A., while B. may be answered by saying that were laws uniform and effective in their extent and execution, the confidence resulting from this would serve in the greatest degree pos- sible to prevent injury through panic and local discriminating inspections against some of our seaports. 5. There would seem to be no doubt but that any uniform, comprehen- sive and modern system carried out independently, without local favor or regard to particular interests, would result in an increased feeling of, as well as actual, security to the country. Trusting these opinions may not prove wholly valueless, I have the honor to be, your obedient servant, PETER H. BRYCE, Secretary Provincial Board of Health of Ontario. Office California State Board of Health, | Sacramento, Dec. 26, 1892. ' j Hon. Oscar S. Straus, Chairman Special Committee of New York Board of Trade and Transportation, No. 55 Liberty Street, New York City. Sir:—In reply to questions one to four, propounded in a circular relat- ing to quarantine accompanying a letter signed by Secretary Darwin R. James, I will say that the first question might properly be passed by without discussion, inasmuch as the establishment of any kind of quaran- tine has for its only object the protection of the people of the United States and those who act in conjunction with them. The studv of quaran- tine administration in foreign countries will be instructive, but it should not be prosecuted with a view merely of finding precedents for our future action on this continent. It would be well to divest ourselves at once of any leaning or dependence on other countries, and to adopt a course best suited to our present and future necessities. I would, however, call your attention to Dr. Shakespeare's very compre- hensive and voluminous report to the President on this subject with special reference to Asiatic cholera. ' The present status of quarantine in the United States is mixed being 37 partly National and partly State. Each is distinctly separate and different in function, but identical in purpose and interest. Under the present system there must of necessity be a want of uniformity of administration, with weakness at points in the line of defense. Such uniformity of administration as would bring all defensible points to a parallel degree of efficiency cannot be too strongly urged; but this cannot be put into successful operation while it is possible for the State and National authori- ties to conflict. The national quarantine administration is under the management of the general government, through the Treasury Department, which dele- gates it to the Marine Hospital Service. Its efficiency has so far been unquestioned, and it has everywhere met the full expectations of the public where it has been invested with means and authority to act. It has the positive advantage of mobility, which the state authorities cannot possess. Any want of suitability of local administration may be corrected by a change of station, which is impossible in state and municipal affairs. The cost of the Marine Hospital Service may be ascertained in the United States Treasurer's report. The restrictions to be imposed on commerce and travel would, it is hoped, be increased rather than diminished under a national administra- tion, inasmuch as security to ourselves is the prime object of quarantine. But the asperities of such restriction might and should be reduced so as to bear as lightly as possible by the establishment of suitable refuge stations, the separation of the sick from the well, and the detention of suspects in isolated but commodious quarters. But the restrictions on commerce and travel should cover a wide range. It should, under certain conditions, to be determined by competent authority, be absolute. A total suspension of commerce and travel for a time would prove less injurious to commerce itself than the presence of an Asiatic pestilence for the same period. Add to the injuries of commerce the injuries to national prosperity produced by an unsettled and panicky condition of the public mind, and' the financial results are appalling and far reaching in their ultimate effects. A national quarantine system under the control of the general govern- ment would undoubtedly lessen the existing imposts on commerce, and also modify advantageously the restrictions on commerce and travel. It would most certainly afford increased security to the whole country. There would be the decided advantage of uniformity of administration under the central authority of the government. Such deviations as were found necessary at the point of action could be provided for. But the laws under which the restrictions are applied would be known at home and abroad, and all requirements would be weighed and anticipated. Duplicity and want of good faith are less likely to be found in an officer of the general government than in the state and municipal appointee, whose brief official tenure is obtained through political influence, which hampers him with a sense of personal obligations that he cannot evade 38 without ingratitude. Add to this the multiple and heterogeneous duties of a health officer in one of the large cities, and it need not seem unrea- sonable that the great mass of people remote from the seaboard view the situation with alarm and apprehension. For it must be generally under- stood that a careless, inefficient, or corrupt State or municipal administra- tion of quarantine at any point along the borders may endanger all. There can be no doubt but that the government officer placed at his station, and invested with authority to perform specific functions, will have the confidence and moral support of the people of the interior ; while the State and municipal officer, no matter how capable and high minded he may be, cannot have equal confidence and support. There must also be considered the moral aspect of the question, the question of right. The interior claims by right that our national defenses shall be made sufficient. If a foreign enemy were to invade our shores or borders, no one questions the right of all the states to repel the invaders. How much greater is their right to demand that our shores and borders shall be guarded against an invasion that is terrible and loathsome. This is not a question that admits of sentimental considerations. The authority of the general government may be applied to all matters of a national system of maritime and interstate quarantine, without trend- ing upon the right and prerogatives of states to manage their own local affairs. But a State or municipality has no greater moral right to use its powers in such a way that other states shall suffer, than has the indi- vidual. There inheres in the national government a police power for national purposes, in the State Government for State purposes, and where delegated to county, city, or town, for local purposes. There are times when the vigorous exercise of this police power must be invoked for the protection of society. This power, which is the essence of all social order, may not be evaded or relinquished. The citizen of an interior State has the same right to invoke the general police power of the national govern- ment for protection against an invasion of cholera, as he has to call upon his local health officer to abate a local nuisance. Will a rich, intelligent, and powerful country continue to jeopardize its prosperity by a trustful faith in the ability of any local government to act for the whole people ? Is it just to impose upon the local government the enormous cost of such quarantine ? With a full knowledge of the power of local pobtics and meretricious influences, is it wise to leave our defenses entirely or even partially in such hands ? It would seem wiser to invoke the authority of the United States, backed by its treasury, and to inaugurate a uniform system of national maritime and interstate quarantine. That such a sys- tem would afford increased security, cannot be successfully contradicted. That it would have the confidence of the people there can be no doubt. The matter of commerce might be so adjusted that only such lines as are least capable of carrying infected germs shall be transported during seasons of danger, but there should be scope in the laws for a total and absolute inhibition of all commerce, if the exigency for such an extreme measure shall arise. 39 I believe that the placing of capable and trustworthy medical inspec- tors at all infected foreign ports would be of first importance. Their authority should be superior to officers of customs and shipping agents, who should not be permitted to issue clearance papers until after a full compliance with the requirements of the medical inspector. A report by cable would vouch for the condition of vessel, crew, passengers, and cargo, when leaving port. An absolute inhibition of travel and commerce with any port that re- fused to comply with imposed conditions would narrow the quarantine service to practical proportions. Very respectfully, J. R. LANE, M. D., Secretary California State Board of Health. San Diego, Cal., Dec. 15, 1892. Darwin R. James, Esq., Secretary New York Board of Trade and Trans- portation : Dear Sir:—In reply to your note and circular, just received, I would state that, from my observations, both among our quarantine stations and those of foreign governments that I have visited, that our extensive coast and border exposure imperatively demands that our system should be strictly and solely under government control. 1st. With the uncertainty of tenure of office under state appointments, and outside of a regularly organized corps entirely unconnected with any political influence or preferment, it is next to impossible to keep an efficient service as regards its personnel, to say nothing of its material and other appointments. 2nd. An independent state quarantine lacks all the benefits of that neces- sary action and concert of movement between the different stations that times of danger demand. Such a service would be further depending on the doubtful assistance that it alone could command through courtesy from the State Department at Washington, the local representatives of the Treasury Department, and from our Consular officers abroad. 3rd. In a national quarantine system all these forces naturally co-operate, and from its personnel and command of material the government (na- tional) can concentrate the required particular, executive and professional talents at any given point to meet any particular or special emergency. Such a reserve of ability cannot of necessity be kept by one State, except at an unnecesaary and onerous expense. 4th. Quarantine service, to be effective, must have at its command a body of trained and devoted men throughout—from boatmen and infirmarians to boarding officers and medical attendants, or station chiefs. Such a corps can only be trained by time and application. The most excellent training in a few individuals, or even in the chief, with a few undisciplined or deficient cannot, by any means, be called a reliable force. To make a 40 reliable and effective service, there must be the feeling of steady employ- ment, some incentive to perfection, an esprit de corps, and a singleness of purpose. Feeling that one may be transferred to a position on a garbage scow, and that he is only in his present position until a change of adminis- tration, is hardly an incentive tending to produce that esprit de corps and devotion so essentially required with a display of more than usual intelli- gence and moral courage that should animate all the employes of the quarantine service. 5th. In the matter of expense, the national government can maintain an effective quarantine station in readiness for all emergencies at less than one-half what an inefficient station would cost a single state. With the national government the efficiency of the service would be the sole con- sideration. That can readily be seen at the perfection at the San Fran- cisco, New Orleans or Charleston stations, whilst the amount paid out by the State of New York for its quarantine, and the helpless and inefficient nature of its appointments, as shown in the late trial, are sufficient com- mentaries upon the inability of a state government to properly manage such things. Dr. Jenkins labored well and creditably with such material and with such appointments as he had at hand. 6th. A well trained, co-operative quarantine force—which needs to under- stand its offices and duties equally as well as a Coast Survey corps—cer- tainly offers the greatest protection to the nation as well as to its single states. Such a service would also from its greater official precision offer the least interference to either trade or commerce. The magnificent stations above mentioned as existing by national effort have in no way acted detrimentally to their respective ports. In San Francisco the P. and O. Steamer Company have well co-operated with the station, finding in the national stations something upon which they can rely and de- pend. These companies have erected at their own expense structures that will accommodate a thousand or more passengers; these structures were built at the station and are under control of the government officers. The instability of State actions, and the shifting and change of officers liable to happen under State control, would make such co-operation on the part of steamship companies with quarantines under state governments imper- fect. Neither would steamship companies—when bhndly injuring them- selves—undertake to trifle with the national government. From all these considerations I would without hesitation pronounce in favor of a national quarantine, whether in regard to efficiency, state or national safety, less interference with travel or commerce, or in view of financial economy. Yours very truly, JP. C. REMONDINO, M.D., Member of the California State Board of Health, and San Diego City Board Health. 41 Board of Health and Bureau of Vital Statistics ) of the State of Washington. > Olympia, Dec. 20, 1892. ) Hon. Oscar S. Straus : Dear Sir:—(2 A.) National. A failure because of too much "States' Rights." So long as the national authorities attempt to carry out a sys- tem of national quarantine with less authority than the individual states it must prove a failure. (B.) Also a failure for want of harmonious and united action. This could not take place unless the state board delegated their powers to some central committee, which would in effect be national quarantine without the authority and prestige a national board should have. It is also a failure because the negligence of one State might set at naught the most vigorous efforts of all the others; and some—as Oregon— may have no state authorities whatever for sanitary purposes. (3 A.) The present cost is too great. 1st. At seaboard where there are two and sometimes three sets of officers to maintain : federal, state and municipal. 2d. The needless trouble and expense of one State quaran- tining against the others. The cost is vastly increased in this State at least—The Marine Hospital Service maintains one officer, the local board of Puget Sound collection district keeps another, the latter charging the vessels for his services, which are the proper duties of the former officer. (B.) Restrictions at present too great in consequence of inter-state quar- antine. No particular harm would arise for a year in prohibiting immi- gration. (0.) Security afforded varies from the greatest to absolutely nothing, depending on efficiency of local boards and the authority with which they are invested. (4 A.) Yes; particularly at points where local officers are allowed to collect fees. (B.) YES. (C.) Most assuredly. Yours, G. S. ARMSTRONG, M.D., L.R.C.P. Lond, Secretary Washington State Board of Health. Ohio State Board of Health, \ Columbus, O., Dec. 24, 1892. j Hon. Oscar S. Straus, Chairman, New York: Dear Sir: — In reply to the communication of Secretary Darwin R. James; I am not sufficiently familiar with the quarantine methods of foreign countries to express an opinion as to their respective merits or demerits. It is my opinion, however, that this country will have to be as essentially American in this particular territory as we are in the various other departments of our national affairs. As is generally recognized by physicians, no two cases of the same disease, in different individuals, require the same treatment in detail, so, I believe that the quarantine regulations should be adapted to national peculiarities. 42 Our present national quarantine is incomplete, and consequently cannot be effective. Thoroughly organized and generally applied, and properly fostered by the government, we would have as good, if not better, protection than any foreign country. From the fact that each State has different sanitary and quarantine regulations, and is firmly impressed with the idea its system is the best, resulting in conflict with each other on important questions at critical and dangerous times, it cannot be consistently claimed that the state quaran- tine has a status. Uniformity of rules and regulations concerning questions of common interest would seem to be necessary for their efficiency. The recent engagement with cholera, and the results, together with the subsequent revelations of the methods used, plainly indicate the great necessity for a change. That the conflict between local and national authorities is, in great measure, responsible for the introduction of the dread disease into your city cannot be successfully disproved. That there can be such a conflict, and the safety of the whole country jeopardized, is sufficient argument in favor of placing the control and responsibility in the national government. No one State should be required to bear the responsibility and expense of protecting the entire country. Nor should local interests be allowed to influence the adminis- tration of sanitary regulations to the possible detriment of the general welfare of the entire country, or any part of it. There would certainly be less interference with the commercial interests and travel by the systematic enforcement of the necessary quarantine rules than results from the erratic application of empirical edicts based upon assumed knowledge. It can not be doubted that the constant operation of wholesome sanitary laws would give better protection to the country than the spasmodic attempts to prevent disease under the press of imminent danger of an outbreak. "In time of health prepare for sick- ness " should be paramount to the duty of preparing for war during time of peace. Preventable diseases cost the country many times more than war both in lives and money, the cause being in constant operation. We have become accustomed to the ravages of disease, and are inclined to attribute it to the "inscrutable ways of Providence," when the same might be frequently averted by the intelligent use of means in our pos- session. Let us by all means systematically organize against our common enemy, and, by so doing, add to the health and life of the country, as well as its material wealth. Very respectfully, THOS. C. HOOVER, M.D., Professor Surgery Starling Medical College, Member Ohio State Board of Health. 43 Michigan State Board of Health, ) Office of the Secretary, > Lansing, Mich., Dec. 17, 1892. j Hon. Oscar S. Straus, Chairman Special Committee on Quarantine, New York Board of Trade and Transportation: Dear Sir:—This communication is in response to a circular letter from Darwin R. James, Secretary, dated New York, December 5, 1892, and it is addressed to you by request of that circular. The subject is here considered in the order outlined in the printed circular. 1. Quarantine administration in foreign countries does not supply very useful precedents for the United States, for the reason that this country is situated and circumstanced so differently from the foreign countries. While most foreign countries, inhabited by the most highly civilized peoples, are in close relation with neighboring countries, and the travel from one to another is a question of a very brief time, this country is separated from them by a wide ocean, and the travel from many of them to this country involves several days, thus supplying time for the develop- ment of some diseases, and, by the addition of a short additional time, for the development of most of the dangerous communicable diseases which may be restricted by quarantine. From this it results that if proper provision is made, such measures may be taken, at ports of embarkation, on shipboard, and at ports of arrival, as will greatly promote the safety in this country from the introduction of disease from foreign countries. On the other hand, few, if any, foreign countries are subjected to such a continuous and immense tide of immigration as is pouring into the United States, so that what may be disregarded in foreign countries is an element of great danger to this country. It should be distinctly under- stood that there is no foreign country, from which immigrants come to the United States, which is ever free from dangerous communicable dis- eases liable to be brought to this country. I regard this as a very im- portant fact, too frequently overlooked by quarantine officers. 2. The present status of quarantine in the United States :— (A.) National quarantine is, as yet, fragmentary, having been built up only in those parts of the coast line where state quarantine officials had not already assumed control. At those stations where the United States has entered upon quarantine work there is apparent a tendency toward modern appliances, of a type in advance of most of the State quaran- tine plants. (B.) State quarantines are good, bad and indifferent, according to whether one refers to one State or to others. The quarantine work at New Orleans was for many years a cause of complaint by the interior states. For several years the " Sanitary Council of the Mississippi Val- ley," composed of delegates from the State Boards of Health, tributary to that Valley, used to meet and use its influence toward improved quaran- tine at New Orleans. Kentucky and Tennessee were especially active in 44 that direction. Now, the quarantine work at New Orleans is believed to be as good as at any port in the world, perhaps better than at any other port. At Charleston, S. C, there is now a good quarantine plant in the charge of a very capable officer. At other cities improvements are being made. At New York the appliances for disinfection of ships, baggage and persons are still antiquated, crude and inadequate. The State provision for the care of persons while under observation has been, until recently, almost none, and now is not sufficient; New York being the port at which a large proportion of the immigrants enter this country. Large numbers of immigrants enter the United States by way of the St. Lawrence River and the Dominion of Canada in Summer, and by way of Portland, Maine, and other ports on the Atlantic seaboard in Winter. No proper quarantine with reference to such immigrants has ever yet been provided by any State, or by the United States, except for brief periods of time during a threatened epidemic of some unusal disease. No proper provision has ever been made to prevent the introduction of disease into the United States from Mexico. The difficulties in the way of this being accomplished by a single State, dealing with a general government like that of Mexico, was set forth by the State Health Officer of Texas at the recent meeting of the American Public Health Associa- tion. That association passed a resolution favoring the placing of quar- antine duties in the hands of officials representing the general govern- ment of the United States. On the Pacific coast, as well as on the Atlantic coast, and on the exten- sive land borders of the United States, are many localities where disease is liable to enter, and where no proper provision is made, or is likely to be soon made, by the localities or by the states in which they are situated; and this for many reasons, one being the general fact that the danger is no greater to the border locality than to many other localities interior thereto, and to the border locality alone the danger does not seem to war- rant the entire expense or trouble of the quarantine. Yet the danger to the whole country is abundantly sufficient to warrant the quarantine. Not infrequently, if local quarantines were established, it would be easy for infected persons and things to enter at some neighboring locality. If the quarantine were a national one that could easily be provided against. 3. (A) At New York the cost of quarantine, levied upon commerce, has been great. Probably the protection to the country has been worth much more than its cost. But it is reported that not all the money col- lected of commerce for quarantine purposes has been used in quarantine work. (B.) Restrictions on commerce and travel have been greater, at such ports as New York, than would be necessary if the quarantine plant, ap- pliances and systems of work were in accordance with the views of lead- ing sanitarians in this country, familiar with modern quarantine systems and requirements. 45 (C.) The security afforded by such quarantine as that at New York has not compared favorably with that at New Orleans. It must be under- stood, however, that the work is very much greater as well as much more complicated at New York, because at New Orleans there is, as a rule, only about one disease—yellow fever—to be excluded, while at New York there are many dangerous diseases which should be constantly guarded against. 4. (A.) Whether or not national control of quarantine would lessen ex- isting imports upon commerce would depend upon the course taken. If a complete quarantine system were adopted, with modern establishments throughout the coast and borders of this country, and the entire expense were taxed upon commerce and travel, it would seem certain that, at least at first, the imposts upon commerce and travel would be increased. But is not protection from foreign disease a proper duty to be performed by the general government, at the general expense of the people of the country ? The danger is general. The need for commerce is general. In case of the introduction and spread of disease, the disturbance of busi- ness is general. Surely it seems that there is no more general need than for safety from communicable disease which tends to spread through all classes of citizens, and to disturb all classes of business and all occupa- tions. It should be understood that in this country we have no cholera, yellow fever, typhus fever nor small-pox unless it is brought to us from some other country. It should be understood that we do not make or generate any specific disease ; that if we could stop the great stream of disease which has so long been pouring into this country with the immense flood of immigration, the restriction of all of those diseases which now cause the most of the deaths would be comparatively easy. This refers to con- sumption, diphtheria, scarlet fever, typhoid fever, measles, and all the diseases which are now most common. (B.) If the views of leading sanitarians in the United States, concerning what should constitute modern quarantine, were embodied in a national quarantine, the restrictions on commerce and travel would be less than now. If national quarantine were to be put in the control of a political party, I should not venture to predict the result. It might not differ much from what now exists. However, national quarantine should, even then, supply more general protection than is now afforded by local quar- antines, and with less burdensome restrictions on commerce and travel. (C.) National control of quarantine, if managed by sanitarians, would unquestionably afford greatly increased security to this country—to the life and health, and prosperity of all classes of our people. The greatest avoidable taxes upon our people to-day are the immense losses through diseases which sanitarians know how to restrict and prevent. National quarantine is an important part, but it is only a part of the sanitary work which the United States Government should perform for 46 the welfare of the whole people. Surely the life and health of the people of this country are the highest interests which the general government can guard. There should be a National Public Health Commission, consisting of seven of the leading practical sanitarians in this country, appointed by the President and Senate of the United States, and charged with the duty of establishing and maintaining a National Health Service for the United States. This commission should select an expert sanitarian especially qualified for the work, and such person should be elected Chief of the United States Quarantine Service. He should be the chief execu- tive officer of that service, and should not be subject to removal except for cause. But the general rules for the maintenance of quarantine should be subjects for consideration by the Commission. The Commission should collect information on, and be familiar with, all branches of sanitary science and public health work. The terms of office of members of the Commission should be at least six years, and the terms of not more than two should expire at the same time, so that the Commission should be permanent and non-partisan. On this subject permit me to ask your attention to a copy of the Report of the Committee on National Health Legislation, adopted at the recent meeting of the American Public Health Association, in Mexico. (The Association is really the North American Public Health Association, its membership including sanitarians in the United States, Dominion of Canada, and the Republic of Mexico.) A copy of the Report is as follows: REPORT OE STANDING COMMITTEE ON NATIONAL HEALTH LEGISLATION. City of Mexico, Nov. 30, 1892. To the American Public Health Association : Your Committee on National Health Legislation respectfully reports that it has given to this subject a careful and long-continued study and discussion, and now offers a brief outline of its conclusions' with respect to the public health service of the United States. It is well known to this Association that, while many of the states in the United States, and Provinces in Canada, have excellent State Boards and Provincial Boards of Health, and the Republic of Mexico has a well- organized Federal Board of Health, the United States Federal Govern- ment has, as vet, no public health service worthy of such a great country. Only a few of the several divisions of work which should be performed by a great nation for the safety of life and health among its people have been provided for. Its public health service should include several divisions, such as : 1. For the collection and compilation of mortality statistics, sickness statistics, and meteorological statistics, and for the utilization of all such statistics in gaming accurate knowledge of the causes of mortality, the causes of diseases and the progress made from time to time in the pre- vention of each important disease through the measures adopted 2 For bacteriological and other laboratory investigations, such as those to learn methods for the production of immunity, and into the causes of diseases of mankind, similar to those which have already been so success- fully made by the United States Government, into the causes of diseases of animals and plants, and such as have been legally provided for bv the Republic of Mexico relative to the diseases of man, and such as 'have 47 C'elded such brilliant and valuable results in Germany through the boratory work of Prof. Koch, and in France by the work of Pasteur, and in England by the Local (General) Government Board. 3. For a system of interstate aid in protection from the spread of dangerous diseases, which system shall be based upon the well-known principles of sanitary science, being a system of inspection, isolation of infected persons and things, and final disinfection. 4. For a National Quarantine Service which shall do what no local quarantine can do so well—utilize the information obtained in every foreign country by the United States Diplomatic and Consular Service, utilize the knowledge gained by all the several divisions of the National Health Service, and systematize the quarantine service, so that instead of being, as now, exceedingly weak and inefficient in many places, it shall be uniformly effective. The National Public Health Service should be organized under a responsible head, into a Bureau or a Department of Public Health, with divisions such as have been named; and each division should have for its chief officer an expert in that special branch of sanitation. The chief sanitary officer of the government should be chosen by a commission of sanitary experts, and should not be subject to removal so long as he faith- fully and properly discharges his duties. He should annually submit to the head of said Department, or to the President of the United States, for transmission to Congress, estimates for the expenses necessary to sustain Eroperly the Health Department during the ensuing year. His duties, owever, as the chief sanitary officer of a great nation need not be here specified. Such a permanent National Commission of sanitarians as has been referred to should be provided for by Congress, and should not con- sist of ex-officio members, but of the leading sanitarians of the country, appointed because of their experience in practical sanitary work. Your Committee believes, also, that it will be well for the United States government to provide for the organized assistance of the Health Depart- ments of the several states, by authorizing the President to call a meet- ing in Washington, of delegates, one from each State Board of Health, once in each year, or whenever general co-operation or conference is deemed advisable. (Signed.) H. P. WALCOTT, Chairman. J. D. PLUNKET, IRVING A. WATSON, HENRY/ B. BAKER. The foregoing report was adopted by the American Public Health Association, at its recent meeting in the City of Mexico. The circular, to which this is a response, asks for titles of those who express their views. Accordingly I give those of the members of the committee above—H. P. Walcott, M.D., is President of the Massachusetts State Board of Health, and ex-President of the American Public Health Association; J. D. Plunkett, M.D., is President of the Tennessee State Board of Health, and member of the Executive Committee American Public Health Association; Irving A. Watson, M.D., is Secretary of the New Hampshire State Board of Health, and Secretary of the American Public Health Association; Henry B. Baker. M.D., is Secretary of the Michigan State Board of Health, ex-President of the American Public Health Association, and Treasurer of the International Conference of State Boards of Health. Drs. Watson and Baker are members of the International 48 Quarantine Inspection Commission, which recently visited and inspected the the quarantines from Quebec to Delaware Breakwater. The under- signed has been Secretary of the Michigan State Board of Health smce 1873. Very respectfully, HENRY B. BAKER. , Secretary Michigan State Board of Health. Ann Arbor, Mich., Dec. 9, 1892. Hon. Oscar S. Straus, Chairman of Special Committee of New York Board of Trade and Transportation. Dear Sir:—I have been requested by Mr. Darwin R. James, your Secre- tary!, to give you my views on the best means of protecting our country against the importation of infectious diseases, and especially against Asiatic cholera. I suppose you wish me to state how, in my opinion, this protec- tion can be most certainly obtained with a minimum interference with travel and traffic. In attempting to comply with this request want of time will necessitate my answering you in the form of dogmatic statements, all of which will, I think, be conceded and any of which I could undertake to fortify in case they should be questioned. The term " quarantine " should not be used. Our increased knowledge of the causes of the infectious diseases renders prolonged detention, such as was formerly practiced, wholly unnecessary. We should speak of "sanitary inspection," the inspectors having the authority to temporarily detain both persons and their personal effects and to disinfect the same. The disinfection of the mails ; of textures from the manufacturer, of silk, woolen, linen, and cotton from the looms; of articles made of wood, glass or metal; of china, pottery and earthenware of all kinds; of chemicals and medicines; of instruments, tools and manufactured articles of all kinds, directly from the manufacturers, do not need disinfection even when they come from an infected place. Consequently there is no need of the detention of these articles unless they be on an infected vessel. The importation of rags, raw wool and other fibres from infected places should be prohibited, or these articles should be disinfected before being baled on the other side of the Atlantic. With these exceptions attention should be given exclusively to immi- grants and travelers and their personal effects, wearing apparel, &c. In regard to immigration, I think that the policy should be not to absolutely prohibit, but to carefully select those who are admitted. This selection should be made principally upon a basis of health. It should be done by a competent medical man and at the port of embarkation. First class passengers (travelers in the ordinary sense, those coming to this country either on business or pleasure, or American citizens returning home) have never brought cholera to this country. They have brought small-pox, but this would probably be prevented by the practical plan which I shall propose. 49 The inspection of immigrants and travelers should be carried out wholly by the United States Government. It is not just to require New York or Michigan to bear the burden of this service in which all the states are interested. The plan proposed would avoid conflict of authority. It would secure uniformity in methods. The service would be in the hands of those trained in the work and its efficiency would be enhanced. proposed plan. 1. Congress should modify and extend the laws restricting immigration. On this point I would like to offer the following suggestions: (a) That the insane, idiotic, tuberculous, syphilitic, leprous, and all of those who have been convicted of crime (other than a political one) should be absolutely prohibited from coming, (ft) That all who are sixteen years old or older and who cannot read their native language be absolutely forbidden com- ing, (c) That all who are over seventy years of age and all those who, on account of physical deformity or injury, are unable to do the labor necessary to support the average laboring man, should be prohibited from coming, unless: (1) such person can show that he or she has in hand the necessary means of self-support; or (2) such person must give evidence that other members of the family are able and willing to provide for his or her support. 2. It should name certain cities along the Atlantic, the Canadian border, the Gulf of Mexico, and possibly along the Mexican border, as "places for the inspection of immigrants," and all immigrants should en- ter through one of these places. 3. Congress should make appropriations for fitting " the places' for the inspection of immigrants " with disinfecting apparatus, infectious disease hospitals and places for the temporary detention of suspects. 4. The work of inspection should be entrusted to the Marine Hospital Service. 5 Details from the Marine Hospital Service should be sent to each im- portant port of Europe from which vessels sail to this country. The duty of these men should be to inspect the immigrants in accordance with such rules as Congress may adopt. (A.) No immigrant should be allowed to embark for this country unless such immigrant has been for five days im- mediately preceding embarkation under the inspection of this officer. (B ) If disinfection be thought necessary by this officer he should see that it is properly done, but the cost of this should be borne either by the immigrant or by the steamship company. (6 ) Every vessel bringing immigrants to this country should carry, as one of its officers, a medical man detailed from the Marine Hospital Ser- vice and it should be the duty of such detail to look after the health of immigrants during the voyage and to give a minute report of the same on arriving at the port of entry. (7.) The expenses arising from 5 and 6 should be borne by the steam- ^S~A- f OA5 50 ship companies, and should be levied by a tax upon the company for each immigrant brought. 8. The duties of officers in charge of the "ports of inspection" on this side are evident, and need not be stated here. If some such plan as this should be adopted, neither travel nor traffic would be materially delayed; prolonged detention would be avoided and the best guarantee of protection from the introduction of cholera or other infectious disease, that can be made, would be given. The cost of main- taining this system would be less than that which results from the pro- longed detention of large numbers as happened last year. There are many point s in this hastily written communication which need elaboration and probably some which need modification, but if I have made any worthy suggestions I shall be amply repaid for the time which I have devoted to it. Respectfully, VICTOR C. VAUGHN, Professor of Hygiene and Dean of the Medical Depart- ment in Michigan University, and member of the Michigan State Board of Health. Michigan State Board of Health, | Greenville, Dec. 9, 1892. j Hon. Oscar S. Straus: Dear Sir:—I do not feel qualified to give an opinion upon the first, second, and third inquiries contained in your circular of December 5th, 1892. I am decidedly in favor of a national quarantine system. A matter of such vital importance to the people of the entire country should be con- trolled by the general government. This is necessary to avoid conflict between local, state and national authorities, and to secure a uniform system throughout the country; to reduce to the minimum the imposts and restrictions upon commerce and travel, and to afford increased security to the country. Very truly, JNO. AVERY, M.D., President Michigan State Board of Health. (Member elect of 53d Congress.) Michigan State Board of Health, I Grand Rapids, Mich., Dec. 12,1892. j Hon. Oscar Straus, Chairman: Dear Sir:—Immigration and commerce are not individual entities, to be considered as a man's dress or house furnishing, pertaining to himself alone, but as belonging to all citizens of the nation. The responsibilities must, therefore, be carried by all, even as we all expect to profit thereby. 51 The intent of quarantine is to restrict the introduction of disease and death into the midst of a community. It is far easier to do it before it .enters, than to combat it when spread in a number of localities. There- fore the danger is not local entirely at the port of entry. The authority for quarantine should, therefore, come from the general government that it may be respected and obeyed by all. Experience has proven that disease germs may be destroyed almost'instantly, and that the restrictions of travel and commerce need not be onerous to protect all. For efficient service, however, several requisites are necessary. Compe- tent officers in charge at the several stations, whose term of "office shall not be limited by years, nor by the caprice of any one, but under similar regulations to that of the Army or Navy. The location of quarantine stations should be determined by an inde- pendent commission, to the end that as few plants may be maintained as will secure efficient service to every port and line of travel. That each station be provided with the approved apparatus for disinfecting ships and cargoes as well as passengers, immigrants and their belongings. Also with hospital and other accommodations for the detention and care of sick and suspects. With the details of the service governed by the same intent as the .above suggestions, I feel sure that an affirmative answer can be given to the three questions asked in the fourth section of the circular dated De- cember 5, 1892. Very respectfully, ARTHUR HAZLEWOOD, M. D., Member of the State Board of Health of Michigan. Chicago, Dec. 29, 1892. Darwin R. James, Esq., Secretary New York Board of Trade and Trans- portation, New York City. Sir:—Yours of the 6th inst. awaited me upon my return from Mexico, where I was attending the meeting of the American Public Health As- sociation. I herewith enclose an address of mine, delivered at St. Louis in 1884, entitled " Practical Recommendations for the Exclusion and Prevention of Asiatic Cholera ;" also my paper printed a year later—" Coast Defenses Against Asiatic Cholera." In these will be found answers to your queries which time and my experience at Camp Low and in New York Harbor last September and October has not modified. Very respectfully, JOHN H. RAUCH. Ex-Secretary Illinois State Board of Health. Note.__Dr. Rauch, in the address and paper referred to by him, strongly advocates the regulation and control of quarantine by the na- tional government. 52 Office of | Health Department, r Milwaukee, J)ec. 19, 1892. ) Hon. Oscar S. Straus, Chairman, etc., New York City, N. Y. Dear Sir .—I am the recipient of a circular and letter from a special committee on quarantine of the New York Board of Trade and Transpor- tion, requesting me to give an expression of my views on the subject referred to. In reply I desire to say that, as a first step in the solution of this prob- lem, I am most heartily in favor of the passage of a bill now before Con- gress, which provides for the creating of the office of a Secretary of Public Health in the Cabinet of the President. Your Committee is undoubtedly familiar with the arguments in favor of this measure, which have been so ably set forth by the Committee of the American Medical Association. I believe that this is the true solution of the quarantine question, and that it can only be satisfactorily settled by such a measure. It would seem that the time has come in the history of our country when it is for the best national interest to create such an office, and to my mind it seems as necessary to create and maintain an office of Secretary of Public Health in the Cabinet of our President as it is to maintain the office of Secretary of War, Secretary of the Navy, or Secretary of Agriculture. By having a Cabinet officer serving in that capacity there would be a national dignity given to any effort on the part of this country in establishing quarantine at foreign ports in times of danger of epidemics, which I believe should certainly be done, that would be respected by all foreign powers. Such an officer would be able to work in harmony with foreign sanitary authorities to the best possible advantage. While the same laws applicable to commercial interests in different countries may differ, and rightly so, for the interests of all concerned, the laws controlling epidemics of contagious diseases should be the same in Hamburg, New York or Milwaukee; in other words, the steps taken to protect human life from these scourges should be the same in all parts of the world. Hence, laws relating to these matters should differ very materially from those govern- ing the commercial relations of different people. Such being the case I see no danger of any clashing of authority on sanitary and quarantine questions, either international or interstate, provided a proper head can be given to such work, and a uniform order be maintained. With a national head all of the state and municipal boards of health would have something to look to and be guided by. I am most decidedly opposed to placing national quarantine powers in the hands of a board of health which is a part of another department, as, for instance, under the Secretaryship of the Treasury; a matter so import- ant as that of sanitation and quarantine should have a head of its own as much as any other department of government, and I believe it would be an act of profound wisdom and economy on the part of our government to estabbsh the same. The pubbc health and freedom from epidemics 53 are matters of the greatest importance to our country, for as we preserve human Hfe and guard our people against epidemics we lay the first corner stone for the foundation of commercial success and national prosperity. Yours very respectfully, U. O. B. WINGATE, M. D., Commissioner of Health of Milwaukee and Member of the Wisconsin State Board of Health. Des Moines, Iowa, Dec. 8, 1892. Hon. Oscar S. Straus, Chairman, etc., New York. Sir:—In answer to a letter received from Darwin R. James, Secretary, dated December 5, 1892, would say that I am not prepared to answer your questions. Our State Board of Health has just made provision for quarantine against cholera and small-pox, by appointing inspectors on the borders of the State and requiring trains or steamboats having on board the above named diseases to telegraph to the inspector, that he may meet the.affected before they enter the State, etc. The plan has not been tried yet, and I cannot speak of it from experience. (4 C.) Yes. I favor some such bill as introduced in Congress, Decem- ber 6, by Mr. Rayner, which provides for a national quarantine, a bureau of health consisting of an executive commission and advisory council, etc. Very respectfully, yours, E. H. CARTER, M.D., Member of Iowa State Board of Health. State University of Iowa, ] Medical Department, Y Iowa City, la., Jan. 5, 1893. ) Hon. Oscar S. Straus, New York. Dear Sir:—I am in receipt of a circular letter asking opinions in regard to a quarantine being imposed by the national government. Having given some thought to this question I am well satisfied that quarantine can be more effectually established by the national government than by the separate states. The laws, as I am informed, being somewhat at variance would not or could not be so effectually enforced as by the general government. Hoping you may succeed in so laudable an undertaking, I am, truly yours, J. C. SHRADER, A.M., M.D., Professor of Obstetrics and Gynecology, and Member of State Board of Health of Iowa. 54 St. Louis, Dec. 20, 1892. Darwin R. James, Esq., Secretary New York Board of Trade and Trans- portation : Dear Sir:—Replying to yours of December 6 I will say that I am un- qualifiedly in favor of a national quarantine service, embracing all the seaboard states, and federal maritime jurisdiction in the interior (lakes and waterways). Typhus, small-pox, cholera and yellow fever have more than once passed the local quarantine stations on the Atlantic and Gulf coasts. Their ancient methods of "sulphur pot" and "carbolic drench," long detention and unjust charges, paralyze commerce and maintain an open highroad for pestilence. The federal power is under the same obligation, legal and moral, to undertake the protection of the country from the insidious invasion of unseen pestilence from abroad as of that of a foreign army, and it would certainly not expect any single State to perform that duty in the latter regard. An invasion of pestilence involves the interests of all the states, and all should therefore assist in defense. A national quarantine so organized as to be absolutely non-political and non-partisan, operated as far as possible by local officers, (whose zeal would be intensified by their local interest), but conducted, and its varied branches co-ordinated by a central authority, with full power to utilize every expedient suggested by science and experience, will, in my opinion, do all that is possible to pro- tect the whole country, with the minimum of injury to commercial in- terests. Appointments and removals of national quarantine officers should be uninfluenced by any political or partisan consideration, nor should they be made at the instance of the self-constituted "Medical Hierarchy," who would dictate all legislation and appointment in medical matters. Ability and personal probity should alone determine questions of appoint- ment ; neglect of duty or dishonesty should be the only grounds of re- moval. RespectfuUy, &c, ALBERT MERRELL, M.D., Member Missouri State Board of Health, State Board of Health of Kentucky, ) Elkton, Ky., Dec. 17, 1892. \ Hon. Oscar S. Straus, Chairman Committee on Quarantine, New York. Dear Sir:—In reply to your circular of December 5th ult. I would say : 1. State quarantine as a protective measure against epidemics of cholera or yellow fever is inefficient, unsatisfactory, vexatious and well nigh use- less. 2. Quarantine should be entirely under the control of the national government. Should be rigid, and rigidly enforced. Then it would af- ford great security. 55 3. Coast quarantine rigidly enforced against all districts affected with cholera or yellow fever affords the best and surest means of protection to the states. 4. Immigration from infected districts should be absolutely prohibited. 5. Commerce between the United States and countries infected with either cholera or yellow fever should be placed under very strict restric- tions. 6. Importation of rags or clothing should be positively forbidden from all infected countries. Respectfully, JOHN O. McREYNOLDS, M. D., Member of State Board of Health of Kentucky. Office of State Board of Health, I Olathe, Kan., Dec. 29, 1892. j Darwin R. James, Esq., Secretary of New York Board of Trade and Transportation, New York. Dear Sir:—Some time since I received a letter from you, and circular, requesting my views on the subject matter enclosed. In answer will state that I regret being obliged to have delayed. In reply to question 1, " Quarantine administration in foreign countries as furnishing precedents for the United States," will say that it is a fact beyond controversy that it has and is done by other nations. In answer to question 2 I will state that the present status of quarantine in the United States is such that one is bable to conflict with the other. In answer to question 3: (A.) Cost would depend entirely, in [my judg- ment, on the severity of the system inaugurated, as well as in answer to question (B.) A rigid state of quarantine would increase the cost, hence there would be a greater restriction imposed on commerce and travel. In answer to (C.) "Would the amount of security afforded, if properly car- ried out, remunerate the loss ?" That would be a matter to be tested. In reply to question 4: I am in favor of a national quarantine that can be thoroughly carried out, in all the ports, without fear or favor by the United States for this reason : If the City of New York or the State of New York imposes a severe or unnecessarily severe quarantine, the quar- antine of Savannah or New Orleans might be much milder, and they could say to the world or to foreign countries, "You can pass our ports with less inspection and with less Hability of detention and loss than you can the port of New York." In an instance of that kind it might divert traffic and open the way to competition for business which would make a quarantine in one port useless, because it would allow the entrance of disease through another. (A.) It would undoubtedly lessen the existing imposts upon commerce in proportion to the severity or necessity of the case. I believe that restrictions on travel and commerce would be less 56 injurious under a national than a state system. (C.) "Would it afford increased security to the country ? " I believe it would. Notwithstanding the fact that many eminent men denounce quarantine methods as useless, it is true that if the nation had the power to enforce sanitary improvements in all our sea-port cities, in my opinion that would afford the best results. And I beHeve that the nation should have some authority in those matters, to compel, if it were possible, any city, that through its unsani- tary condition stands as a menace to the whole nation, to improve their sanitary condition. And we must bear in mind that the experience of England is in favor of medical inspection and sanitary improvement. Respectfully yours, R. A. WILLIAMS, M.D., Member Kansas State Board of Health. Office of Board of Health, ) Little Rock, Ark., Dec. 13, 1892. ) Hon. Oscar S. Straus, Chairman : Dear Sir:—Answering questions of your committee respecting quaran- tine regulations, addressed to our Honorable Mayor, I beg leave to offer my opinions for what they may be worth. My only knowledge of quarantine administration in foreign countries being from general reading, and, of course, very inexact, can only say that the countries which best guard against contagious diseases seem to be those governed by a national quarantine set of laws, and would serve as a precedent to the United States for such national quarantine laws, with power to suspend both travel and shipment of merchandise when necessary. Our present system of mixed State and national quarantine laws is susceptible of conflicts arising and interfering with best control of such diseases, and increasing the costs. The present system throws the protection of lives of citizens on each State, and compels them to maintain additional quarantine precautions, or leave such citizens unprotected. As at each State line additional examinations, detentions and fumiga- tions may be enforced, of persons as well as merchandise, then national laws, with one effective and authoritative release, would impose less restriction and less cost on both travel and commerce with an equal degree of security. National quarantine would lessen existing imposts on commerce; the restrictions on travel and commerce would be less injurious, and it would afford increased security to the country at large. Very respectfully, PUTNAM DICKINSON, M.D., Secretary Board of Health. 57 Ashevtlle, N. C., Dec. 27, *892. Hon. Oscar S. Straus, Chairman, New York. Dear Sir:—Answering the circular of the Special Committee of the Board of Trade of New York, I regret that I have not of late kept suf- ficiently well up on the matters referred to to be able to answer at length and intelbgently the separate questions at issue. I have had experience of several years in the government service, and from my observations at home and abroad I am decidedly in favor of a national quarantine for the country—such as a National Board at Washington, acting in harmony with State boards. The United States Marine Hospital Service, with en- larged powers in this direction, or a separate National Health Board at Washington, under the Treasury Department, might be worth considering. Yours truly, S. WESTRAY BATTLE, Past Assistant Surgeon, U. S. Navy, and Member North Carolina State Board of Health. Health Department, ) Baltimore, Md., Dec. 14, 1892 j Hon. Oscar S. Straus, Chairman: Sir:—Replying to the letter of New York Board of Trade and Trans- portation asking four questions on quarantine matters and observing the numbers given : As to first question, the conditions of population and government are so different from ours that I fail to see any advantage in comparing. As to second question, the movement of last Autum has shown such dif- ferences of opinion in neighboring cities as to force the observing citizen to desire a strong, impartial national quarantine system, with officers so appointed as to be clear of obligations to influential persons or classes. As to third question, the same recent experience denoted make-shift ar- rangements special to each port and hardly liable to being classed. As to fourth question, I would advocate a national quarantine regard- ing only demand (C.) and believing that it would afford the security which should be the object of the whole system. In view of the only one certainty that we have, which is, that were the oceans impassible we would have no foreign diseases, I would recommend such measures as would come nearest accomplishing this condition, while we conformed to the demands of modern civilization. With respect, J. CRAWFORD NEILSON, C.E., Member Maryland Board of Health. State Board of Health, I Philadelphia, Pa., Dec. 21, 1892. j Hon. Oscar S. Straus, Chairman Committee on Quarantine, New York Board of Trade and Transportation : Dear Sir:__Your circular of December 5 would have received earlier at- tention but for my absence from home. 58 The subject of your inquiry is a large one. Of its extreme importance there can be no question. I would say in reply to your several inquiries: 1. As regards "quarantine administration in foreign countries as fur- nishing precedents for the United States," that the circumstances of those countries differ so widely from our own that it is almost an impossibility to establish a comparison between them looking to uniformity of admin- istration. The immense immigration into this country, without a pre- cedent in the history of modern times, and the character of a very con- siderable proportion of the immigrants of recent years, represents a danger to the United States infinitely greater than that which threatens any other country on the globe from the introduction of contagious dis- ease from abroad. To give a ay thing like an intelligent answer to this question would require a more careful study of the quarantine depart- ments of the nations of Europe than I have yet been able to make. I may say, however, that the argument which has been made in favor of laxity or discontinuance of quarantine at the sea-board and the establishment of rigid internal sanitary regulations, a policy founded upon the experi- ence of Great Britain, seems to me to be an extremely fallacious one. Where Great Britian receives one dangerous immigrant we probably re- ceive five hundred, and it can not have escaped your notice that during the recent danger from Asiatic cholera Great Britain was very careful to send the dangerous ships on to the United States, without allowing immi- grants to land on her shores. 2 As to "the present status of quarantine in the United States." (A.)' The national quarantine in the hands of the United States Marine Hospital Service is constantly increasing in efficiency of administration and com- pleteness of equipment. Its regulations are uniform for the entire country. The system of notification through the Consular agents in for- eign ports enables it to receive early intelligence of dangerous conditions abroad, and it has made use of this intelligence to good purpose during the past year. There is of course room for question whether the health of this great nation is not a matter of sufficient importance to entitle the country to a special department entirely devoted to this subject instead of simply to an appendage of a department having entirely different duties and responsibibties. (B.) State quarantine still remains in a very unsatis- factory condition. Some stations are well equipped, others poorly equipped, and still others are entirely without equipment. The regula- tions at each station are different from those of every other station. It is a matter of great difficulty to induce municipal and state legislatures to devote sufficient sums for the proper equipment and maintenance of quarantine stations. Many of the stations are so situated that they do not afford protection to the entire country, leaving loop holes through wrhich contagion may enter. 3. With regard to "the existing system of quarantine administration in the United States:—(A.) Its cost." The question of expense in this matter is one which appears to me to be entitled to very little consider- 59 ation. I have no hesitation in saying that at least ten times the amount at present expended, both by state and national quarantine services, could be advantageously devoted to this important purpose, and this would be a most insignificant figure as compared with the amounts spent both by the national government and state governments in fostering the art destructive of life and property. (B.) The restrictions imposed on commerce and travel are unnecessarilly great, exactly in proportion to the want of proper equipment of stations. We are obliged to supple- ment by long detention the inefficiency of our scientific sanitation. (C.) The same facts diminish the security which we have a right to demand, and further create a sense of insecurity which is in itself a calamity. 4. In view of the preceding statements I would reiterate here what I have always maintained in any public utterance upon the subject, that a national quarantine liberally supplied with every appliance that modern science can suggest would (A.) very greatly lessen the existing imposts upon commerce; (B.) that the restrictions on commerce and travel would be diminished and periods of detention would be lessened, and even in the matter of fees the impositions would probably be less serious than with the present disjointed system. (C.) Every port of entry, large or small, rich or poor, having precisely the same facilities afforded for dis- infection, classification of passengers and segregation of the sick, and equal and equitable fees being everywhere imposed, quarantine would be administered not in the interest of any particular state or region, but of the entire country remote from, as well as contiguous to, the sea-board, and I entertain no doubt that the security of the country would be vastly increased. I may mention that I have maintained this view on these subjects in a paper read before the National Conference of State Boards of Health in 1888, entitled "Should the national government assume control of quarantine at all points of entry?" and in a paper read before the Section on State Medicine of the American Medical Association in the same year, entitled "Should not the national government defend our ports against the national enemy, contagious disease;" also in a report of inspection of the Quarantine Stations of the Middle Atlantic Coast, made to the National Conference of State Boards of Health. I take the bberty of enclosing a paper recently read by me before the Philadelphia County Medical Society bearing upon this subject, and will send the others referred to if I can find copies of them, Yours very truly, BENJ. LEE, M.D., Secretary of the State Board of Health of Pennsylvania. State Board of Health, | Pittsburgh, Pa., Dec. 15, 1892. ) Hon Oscar S. Straus, Chairman Committee on Quarantine, New York Board of Trade and Transportation : Dear Si)---In accordance with the request of Darwin R. James, Esq., 60 Secretary of the New York Board of Trade, etc., I have the honor to sub- mit to the Committee the following observations and suggestions relating to the subject of your inquiry. 1. My observation of quarantine administration in foreign countries, (ex- tending over most of the countries of Europe and Northern Africa), would lead me to question their superiority over pin* own, with the single excep- tion of the advantages secured by uniform administration under strong general governments. In most countries of Europe, notably England, quarantine supervision is weak and inadequate, only rising to an occasion such as a serious cholera outbreak offers. 2. The present status of quarantine administration in the United States is far from satisfactory, because of a lack of uniformity which must inevit- ably obtain where authority is divided up among municipal governments. 3. This system (or want of system) existing in the United States leads (A.) to increased cost, an assertion easily substantiated; (B.) increased interference and restrictions to travel, each representative of a separate government having to be satisfied; and (C.) making strong probability of less security in the end owing to misunderstandings where authority is divided. 4. All of which leads me to declare unequivocally in favor of a quaran- tine under national administration. Leaving to others the discussion of the effects upon imposts and commerce, it would seem to me plainly and broadly within the province of national government to deal with a pro- cedure so distinctly international. Quarantine regulations and questions arising therefrom must inevitably provoke negotiations between foreign powers and the home government, and nothing short of the diplomatic and consular service will suffice for such international deabngs. It seems almost absurd to ask foreign governments to open negotiations with this or that municipality. There are questions of health, sanitation and even quarantine which may arise between states and which may well occupy the attention of state authorities, but any experience I may have in connection with the Health Department of this State only confirms my belief in the necessity for adequate quarantine regulations under national authority. The quarantine laws of the United States should be administered by the government of the United States. Finally—there should be prohibitory regulations against trade and immi- gration, in toto, from districts permanently pestilential, as for example where cholera has its habitat. We legislate against the Chinese—better legislate against pestilence. I have the honor to be, very respectfully yours, j. h. McClelland, m.d., Member of the State Board of Health of Pennsylvania, Member of the American Public Health Asso- ciation, etc. 61 Connecticut State Board of Health, ) ™ -r^ -^ T Bridgeport, Conn., Dec. 17, 1892. j Mr. D. R. James: Dear Sir:—On returning from the meeting of the American Public Health Association, I find your note with printed circular. Inasmuch as I had just read the report of the committee on quarantine any views which I might express would be of no service to the committee. However, I am pleased to be fully in accord with the expressions of that report. Not living in a town where much is made of the quarantine question, I cannot speak from experience, but this one point is in favor of a national quarantine—vessels coming here are generally entered in the port of New York. There may be no conflict between the authorities of the States of New York and Connecticut, but a quarantine under national control would tend to prevent any such. A national quarantine guarding the entrances to Long Island Sound would protect better all the ports of the included waters, at less cost, with less delay perhaps. This is but a small point, but yet it is a thought. I am thankful for the position the committee has taken. Sincerely, yours, N. E. WORDIN, M.D., Member Connecticut State Board of Health. Connecticut State Board of Health, ) Meriden, Conn., Dec. 16, 1892. f Hon. O. S. Straus, Chairman: Dear Sir:—In answer to the questions proposed I beg to favor national to state quarantine for the greater security it would afford, the less cost of one than many dupHcate organizations, with various conflicting and uncertain regulations, the removal of interstate jealousy and irritation, with the consequent savage and brutal shot-gun policy liable to arise between states. Yours very truly, G. H. WILSON, M.D., Connecticut Board of Health. State Board of Health, 1 Rutland, Vt., Dec. 12, 1892. J Hon. Oscar S. Straus, Chairman, etc.: Sir:—Replying to circular letter signed by Darwin R. James, Secretary, my opinions, as far as I should feel warranted in expressing them, would be as follows : Second enquiry: "Present status of quarantine in United States. (A.) National." If such a quarantine can be literally enforced there is little doubt it would prove sufficient to keep out cholera or any other disease. The only national quarantine I know of is that created by the President's twenty-day order. But it is an unnecessary and unreasonable limit to 62 place on a ship load of immigrants who have been free from exposure dur- ing the voyage, i. e., if they and their effects are thoroughly disinfected previous to landing. So it is bkely to prove a needless hardship to both immigrants and steamship companies. " (B.) State." Local quarantine is varied in its methods and efficiency. Good authorities seem to think the only really efficient modern quarantine in this country is at New Orleans. There is little doubt that the present status of state quarantine is as varied as the characters of the inhabitants or the climates of the different states, and that it is as a rule inefficient •and behind the times. Third enquiry: " Existing system of quarantine administration in the United States. (C.) Security afforded." The country is exposed to cholera from abroad only. It must find its way via sea-ports or land routes. These spots are protected by various kinds of quarantine rules and methods—some good, possibly one or two the best, most bad. The whole country is exposed through the weakest spot. Unless then the President's twenty-day order can be construed as a part of the "existing system," the security afforded by that system fails to be any security at all. Fourth enquiry: "A National Quarantine. (C.) Would it afford in- creased security to the country ?" It is my opinion that this is the only kind of quarantine than can be relied upon for any kind of security. Our vast borders, sea-coast, and land must be under the protection of one depart- ment or head, and the cordon sanitaire must be maintained with all the efficiency of a standing army, and be equipped and managed by sani- tarians according to modern methods. It would undoubtedly "afford increased security to the country." I am glad to give my opinions as far as I have had opportunity to form them, but, as you will observe, I have not answered some of the questions asked. They are such as I have had very little opportunity to form mature opinions on, and they would be of no value if expressed. I do hope that your Board, however, will find it possible to aid sani- tarians generally in securing for our country a thorough, uniform system of quarantine administration controlled by central authority. I am, Very respectfully, yours, C. S. CAVERLY, M.D., President Vermont State Board of Health. Concord, N. H., Dec. 22, 1892. Hon. Darwin R. James, Secretary: Dear Sir:—On my return from the City of Mexico, where I have been in attendance upon a meeting of the American Public Health Association, I found your circular letter on my table. Without discussing your circular in full I will simply say: It has been found necessary to have some form of quarantine, and from a humane as well as from a business view the restrictions should be as slight as is necessary for complete safety. 63 That a uniform method, adopted and imposed by national officials, would occasion less friction than to attempt the same through more than forty state organizations, does not to me seem to admit of argument. Then again the quarantine relations of our country with another is a subject for federal control, and reciprocal hygienic treaties should be exacted at the same time social and commercial relations are made. It is not business-like to leave a state or a city to deal with foreign countries, and such habits certainly do not impress our foreign friends with enthusiasm or with ideas of our being a progressive people. A few years since duties were imposed and a passport demanded at every state bne in Mexico. It was considered absurd and ridiculous by all intelligent people, yet it was no more absurd than the views of many of our pobticians upon the question of quarantine. However, it is so late and so much has been written upon this subject, I will not go into further detail. Yours truly, G. P. CONN, M.D., President of State Board of Health of New Hampshire. State Board of Health, ) Portland, Maine, Dec. 14, 1892. j Hon. Oscar S. Straus, Chairman : Dear Sir:—I have delayed reply, hoping to furnish you with an expres- sion of the State Board, rather than that of an individual, but a meeting is postponed by the absence of members in Mexico. It would be difficult to answer separately under your four headings without repetition; the subjects seem to me interlaced. 1. My opinion is that foreign precedents are simply educational. 2, 3 and 4, Call for opinions practically upon the value of a national quarantine administration, as compared with a state or local administra- tion, the latter being the conditions for all the ports of the State of Maine. Can there be any doubt that a national administration would insure, as a rule, greater intelbgence, and above all, the great merit of uniform practice?' Local boards are rarely selected for their special knowledge on quarantine subjects, and vary greatly in ability and energy. The appro- priation necessary to equip and operate a quarantine station is very diffi- cult to obtain and maintain as a preventive measure. Equitis: The citizens of Portland and other seaboard towns seriously object to having the burden placed upon them of providing ways and means of cleansing and disinfecting immigrants and baggage booked for western states, which is the case practically of all immigrants arriving at Portland Unless there is uniformity of rules the steamship lines seek the port of least restriction. Already the Allan and the Dominion lines 64 of steamers, not bking Portland's careful supervision, have planned to land their immigrants at HaHfax, and deliver them to the western states over the Canadian railroads. The West should not be left to the hap-hazard that citizens of ports that are simply used by immigrants en route will provide and maintain effective quarantine regulations, especially where, in many cases, their own risks are very small. I am safe in stating that the State Board of Health of Maine favors and urges the establishment of a national quarantine system. I believe the cost and restrictions would be less and equitably borne, and the security greater. The restrictions would be uniform and well-known, and the cost could be discounted. Respectfully, E. C. JORDAN, President State Board of Health. Brunswick, Me., Dec. 12, 1892. Hon. Oscar S. Straus: Dear Sir:—In response to your circular I would state that I am not familiar enough with the matter to say anything on the first three topics. On the fourth, "A National Quarantine," my opinion is that by it the existing imposts upon commerce would not probably be lessened, as most ports have but Uttle in the way of quarantine at present. But that con- dition of things will not probably last long, and it behooves the general government to anticipate the action of the states and establish uniform quarantine regulations, which, besides being more effective, will be far less burdensome than the different plans which the states will doubtless enter upon. In my judgment, then, the government cannot act too quickly in the matter. Very truly yours, FRANKLIN C. ROBINSON, Professor of Chemistry, Bowdoin College, and Mem- ber of Maine State Board of Health. 65 Appendix C. State of North Carolina, ] Executive Department, > Raleigh, Dec. 16, 1892. ) Darwin R. James, Esq., Secretary New York Board of Trade and Trans- portation, No. 55 Liberty Street, New York. Dear Sir:—I wrote you in response to your letter of December 6th that I had referred the same to the Secretary of the State Board of Health. I have the honor to enclose you herewith his reply, which I endorse. Very respectfully yours, THOS. M. HOLT, Governor. North Carolina Board of Health, ) Raleigh, N. C, Dec. 14, 1891. j His Excellency Thomas M. Holt, Governor of North Carolina: Sir:—In response to your request for my views upon the circular letter of the New York Board of Trade and Transportation in relation to "es- tabbshing a uniform system of quarantine in the United States under the management of the general government," I would respectfully submit the following brief general statement of them : In the first place you will please understand that the opinions ex- pressed axe personal and not as representing the State Board of Health, since that body has never considered this question. Like every other question it has two sides. Considered solely from the standpoint of the pubbc health of the wdiole country, / think it not un- likely that a uniform system, of quarantine under the control of the general government, irit'h its immense resources, would be more effective than the methods now in use and, considering the service rendered, more economical, on the well-established principle that the same work can be done more cheaply by wholesale than by piece-meal. But is it necessary? I think not. The in- stinct of self-preservation, both as to bfe and trade, on the part of the dif- ferent states and sea-ports may, I believe, be depended upon to insure quarantine protection, to all intents and purposes, as effective as is prac- ticable. The very fact that the service is local—that the officials belong to the community most exposed and are immediately responsible to their friends and neighbors, would probably make them more alert and careful than they might be if they were strangers from a distance. If all officials were entirely conscientious there need be no fear on this score, but the ordinary principles of human nature obtain among public servants as well as private individuals. One objection to the establishment of a national system is the deadening effect upon local effort in matters of health generally that the assumption by the general government of the functions that should be performed by the various states and municipanties themselves would probably have— the latter thus becoming parasites after a fashion, would in proportion to their dependence upon a stronger power become the more enfeebled. Ao-ain, in times of special clanger, I am confident that the State and 66 municipal health authorities would cordially co-operate, not only with one another, but with those of the United States as well, and the same practical result would be obtained with fewer drawbacks. Finally, you and I, in common with a large majority of our people, firmly believe that in the centralization of power in the general govern- ment bes the greatest danger to our free institutions, and, therefore, as good citizens (and the citizen is not lost in the health officer), we must be thoroughly convinced of the necessity before resigning any of our rights and privileges as states and municipalities. Such a necessity does not, in the matter we are discussing, in my opinion, exist, and, therefore, looking at it from every point of view, and taking everything into consideration, I am convinced that a uniform system (of quarantine) under the control of the general government is not advisable. With great respect, your obedient servant, Rich. H. Lewis, M.D., Sec'y N. C. Board of Health. Pensacola, Fla., Dec. 12, 1892. Hon. Oscar S. Straus, Chairman, 55 Liberty Street, New York City. Sir:—Your communication of the 5th inst. at hand. In answer to first inquiry, "Quarantine administration in foreign countries as furnishing precedents for the United States," I would say that I do not know of any foreign country the size of ours, furnishing such varieties of climate and diversities of business interests likely to be affected by quarantine, where a uniform system is in practical operation, and, of course, no comparison can be made unless similar conditions existed in both cases. We are probably too close to tropical neighbors Avho do not thoroughly appreciate the benefits of sanitation to secure us in adopting the enhghtened quarantine system of Great Britain; and, we are, on the other hand, too jealous of our business interests to permit of our accepting the exclusive non-intercourse system of Spain. The liberal quarantine pobcy of England might be adapted to the needs of New York or Massachusetts, but put in operation in Florida or Louisiana it might be as disastrous to the public health of these states as would the rigor- ous policy of Spain be to the commerce of our northern states. This proposition will remain true, not only until we have ourselves arrived at a higher state of sanitary perfection, but until science removes the dan- gerous sources of infection to the south of us. No one foreign country could furnish us with a safe precedent for our guidance in matters of pubbc health. 2. "The present status of quarantine in the United States: A, National; B, State." In my opinion the rivalry existing between these constituted authorities has been productive of great good to the country, and has succeeded in increasing the security on the one hand, by the application of scientific methods, and on the other materially lightened the burden on commerce by shortening the days of detention to a few hours of inspec- tion and cleansing. I am sure that the condition of both our national and state quarantine systems is improving each year, and I believe it to be a matter of only a short time when it will be little less than perfect. 67 3. "The existing system of quarantine administration in the United States: A. Cost. B. Restrictions imposed on commerce and travel. C. Security afforded." (A.) Under the national system of quarantine, as it now exists, the entire cost of maintaining the different stations is borne by the general govern- ment; or, in other words, by taxation levied upon our people. In this connection it might be interesting to know that in his recent report the Secretary of the Treasury says : "At smaller seaports, where local quar- antine provision is insufficient, and where cholera-infected vessels might seek entrance to avoid the greater restrictions at larger ports, the authori- ties have been invited by circular to apply for such aid from the Marine Hospital Bureau as may be required for their defence." I should bke to ask if this does not appear as a general invitation to aU foreign commercial powers to send their vessels to our shores, preferably to the smaller ports, when they are in need of sanitary repairs, as such work will be done gratis ? What magnificent generosity, but how appalling to the mind of the already overburdened American taxpayer. On the other hand, the different states of the seaboard collect the revenues for the support of their quarantine stations by charges upon commerce (generally foreign), thus rebeving us of all expense in the matter. The justification for this plan, if it needs one, seems to my mind to lie in the fact that those who are instrumental in the importation of epidemic diseases should bear the burden of the cost of their ignorance or carelessness, as the case may be, and no tax shoidd be collected from those who are merely the victims of the criminal stupidity or negbgence of others. That this expense upon the shipping interests is not unjust I bebeve to be true; nor do I think that in many instances it is in excess of the benefits derived by the owners of vessels which are in need of being placed in a sanitary condition. (B.) The restrictions upon commerce and travel are being reduced to a minimum, and under improved methods of rapid disinfection and cleans- ing, they will shortly be removed altogether. In support of the truth of this statement I will cite you the fact that under an enbghtened system of quarantine this State has carried on safely and uninterruptedly for the past three (3) years its commercial relations with the neighboring Island •of Cuba, whereas before that time our quarantine laws, while interdicting commerce, were yet unable to prevent the introduction of yellow fever. If so much has been accomplished in such a short space of time, what may we not hope for in the very near future ? (C.) The security afforded has been greatly increased of late years, and is, no doubt, due to the same causes which have operated to remove the restrictions on commerce and travel, that is, instead of detention, scientific sanitary measures have been substituted. 4 " A National quarantine : A. Would it lessen the existing imposts upon commerce? B. Would restrictions on commerce and travel be less injurious? C. Would it afford increased security to the country ?" (A.) Possibly it would, but by placing a tax upon those who are in no 68 wise responsible for the conditions necessitating the resort to quarantine measures, and this I would consider unjust. (B.) No. I can see no reason why the principles of quarantine ex- ecuted by the intelbgent hands of the state or community, whose health and prosperity are both at stake, should not be more successful than when operated by an official at a distance who may be totally ignorant of the conditions and requirements of such state or community. (C.) No. There is nothing in all the history of quarantine to justify the opinion that health matters are safer in the hands of the general govern- ment than in those of communities directly, or bkely to be affected. In substantiation of this statement it is only necessary to recall the fact that very recently the health authorities of a commonwealth of this Union suc- ceeded in averting an epidemic of the terrible disease which had baffled the best efforts of the compact and centralized powers of Russia and Ger- many. When the citizen knows that much depends upon his individual efforts toward sanitation, and that he has a voice in the practical opera- tion of all systems devised to prevent diseases, he becomes a most zealous and intelbgent factor ; but let him understand that the general govern- ment has charge of all matters of pubbc health, and he at once loses his in- terest and looks only to that government for protection and safety. Sanitation and not quarantine should be the aim of the modern scientist, and in order to attain this end it is absolutely necessary to have the hearty co-operation of every individual in every community in the country. This cannot be done by the supervention of the general gov- ernment, and I bebeve the attempt at such interference would result only in a disastrous failure. Very truly yours, WARREN E. ANDERSON, M.D., Member Florida State Board of Health. State Board of Health of Maryland, ] Secretary's Office, > Baltimore, Dec. 9, 1892. ) To the Hon. Oscar S. Straus, New York Board of Trade and Transporta- tion, New York City. Dear Sir:—In deference to the request of your Board that I should give my opinion concerning the quarantine regulations necessary for the pro. tection of this country against the importation of infectious diseases, I have the honor to submit the following as embodying my views on the subject. These views, I am well aware, will not be endorsed by many sanitarians and physicians on the American Continent, but my conclusions have been formed on what I consider a sound "basis of facts," and, I must bebeve, will in the end prove to be correct. The influence which the law of quarantine is supposed to have in the protection of the pubbc health, the bearing of that law on some of our strongest prejudices, and the assumption that it contains the various pre- 69 cautions which have been long deemed our safeguards against the intro- duction of epidemic diseases, from whatever part of the world the danger may be apprehended, render every suggestion that may affect it a matter at once of general interest and pecubar debcacy. There is no subject on which such vague notions have prevailed, none respecting which men's minds have been so completely and so generally mystified, as that relating to the system and utibty of quarantine laws. On the one hand care is to be taken that in the attempt to rebeve com- merce from burthens and inconveniences which press upon it, and to afford it the greatest freedom of which it is susceptible, we do not expose the country to the most formidable risk. On the other hand, that neither ancient prejudices nor an excess of anxiety to avert possible danger should induce the introduction or continuance of restrictions inessential to their object, and should thus deny to trade any of those facilities which, con- sistently with every prudential regard for considerations of protection and safety, it may be permitted to enjoy. The argument against our present system of quarantine is based upon a multiplicity of testimony which seems perfectly unanswerable, and, therefore, it appears wonderful that any doubt should remain upon any mind acquainted with the facts in regard to the spread of disease. It is doubtful whether in the whole history of legislation there exists an instance of such stupendous folly as that of supporting, at a great expense, a quar- antine estabbshment whereby commerce is subjected to innumerable inconveniences for the sole purpose of jjreventing the introduction of epi- demic or infectious diseases, which can be controlled much more certainly by other means. From the date of the earbest historical records, the opinions of men have been divided on the subject of the causes and origin of pestilential diseases, and modern scientists and physicians, unable to account for the spread of pestilence on the principle of extraordinary seasons, and dis- daining to admit that such diseases can arise, de novo, from putridity of the air, or pollution of the water, have resorted to invisible animalculse concealed in bales of goods or old clothes transported from foreign coun- tries, and let loose at certain periods to scourge mankind and desolate the world. The great Sydenham ascribed pestilence to occult qualities in the air, and explained the peculiar symptoms of diseases by the influence of an epidemic constitution of the air. His "occult qualities" have been ridiculed by later physicians, but so far as his theory, in this respect, has been neglected, the science of medicine has degenerated, and the cause of humanity has suffered. One of the most important, as well as most difficult branches of medical science, is to ascertain the effect of the reign- ing constitution of the air on prevaibng diseases, and to apply that knowl- edge to the arrest and cure of those diseases. In opposition to the theory that cholera is never bred or propagated in America but always imported from abroad, it is very probable that the disease may and generally does, originate in the country where it exists 70 as an epidemic. The common opinion of the propagation of pestilential diseases solely by infection, or the deadly germ diffusing itself through the air has had a most calamitous effect on medicine and human happi- ness. It has prevented the researches of modern scientists and physi- cians who might have been able, by diligence and a comprehensive view of the subject, to trace pestilence to its real causes, and to suggest the true means of avoiding the terrible scourge of Asiatic cholera. Where the disease has once existed there the seed is planted forever, and, bke the grain of wheat that lies dormant for centuries in a mummy, it loses none of its latent vitality, but will, under favorable conditions of soil, moisture and temperature, sprout and bring forth its kind; and the disease will ap- pear first where the original or secondary causes are the most powerful, in spite of the most rigid non-intercourse measures that can be instituted. The quarantine theory errs in demanding the exclusion of the germ of the disease, at the expense of neglecting all other sanitary precautions. Such restrictive measures, mejudice, are utterly useless and always injur- ious, not only to commerce but to communities as well, inducing a con- dition of the pubbc mind which readily results in a disgraceful panic such as was witnessed last Fall at Fire Island and in the Harbor of New York. Cholera is to be dealt with on the same general principle as all other diseases, and this is that every sanitary defect might be sought out and as far as possible remedied. The cause of cholera—what governs its distribution and relative incidence in different places—is still as inscrut- able as when the disease first appeared in Jessore in 1817, but it is well known that when this cause or combination of causes is present it is fav- ored by filth, over-crowding and every other condition adverse to health. The practical work to be done is to remedy these conditions, and this can- not be accomplished by oppressive quarantines. Quarantine, as practised by our government, consists in subjecting per- sons to a seclusion, and merchandise to a purification of twenty days. The reason why twenty days have been fixed on as the period necessary and sufficient to exterminate infection, in all its known and unknown states, no one has ever pretended to assign. Let us look at the system in relation to merchandise. The argument against a national quarantine as applicable to merchandise is short and unanswerable. As the germ of cholera is, according to Dr. Koch, killed by drying, and as it cannot be conveyed by currents of air, except when dry, but bttle or no import- ance is attached by scientists to the influence of the atmosphere in con- taminating merchandise. The only way, therefore, in which goods can be contagioned is by being handled, or by coming in contact by some means or other with those affected with the disease. But people sick with cholera cannot labor in the fields to gather the raw material; they cannot labor in the various processes by which the.raw material is manu- factured; they cannot labor in the warehouses, at the docks, or on board ship in order to pack and store these goods. It is not then particularly easy to see how merchandise can become impregnated with the infectious matter or germs of the disease. 71 Our government has gone so far as to require all vessels coming from an infected port to perforin quarantine for twenty days, but releases all other vessels coming with clear bills of health, though bills of health can afford no criterion whatever of the state of merchandise Avith respect to its freedom from contamination, even were that phantom a real existence. Bills of health are documents from Consuls to ships sailing from places subject to their consular jurisdiction, certifying the state of the health of these places in reference to pestilential diseases at the time of the departure of the vessel. A foul bill declares the presence, and a clean bill the absence of pestilence in the sea-port from which a vessel departs at the period of her saibng. Now, suppose two ships to load with clean cargoes in a period of health; one sails a day before the other. In the mean time a single case of pestilential disease occurs in the port; this obliges the detained ship, although she may have had no communication with the shore, other than to receive her bill of health, to sail with a foul bill. On their arrival in the United States, one ship is immediately released ; the other is obbged to perform quarantine for twenty days. Again, two ships load with foul cargoes during pestilence ; one sails before the plague has ceased ; she must carry a foul bill. The other waits a certain time, when she is entitled to a clean bill. The ship with a foul bill will be obliged to undergo quarantine; that with a clean bill will discharge her cargo at once ; but it is obvious that the danger in each case is equal, and were the danger real, the ship with a clean bill must of necessity con- vey infection to the market in which her goods are sold. Once more, a ship loads with a foul cargo during an epidemic; she waits a certain num- ber of days after its termination and sails with a clean bill. Another ship loads with a clean cargo after the epidemic has ceased; she is detained a few hours, and a case of the plague is reported to have happened in the port; she has no communication with the shore, yet she is obbged to sail with a foul bill. In this case also an infected cargo is covered with a clean biU, and a clean cargo is accompanied with a foul bill. It is certain, therefore, that were infection capable of being conveyed by goods, the cargo of ships with foul bills would often be without the slightest danger, while the cargoes of ships with clean bills would frequently be extremely perilous. From these facts it is clear that our system of quarantine cannot be supported by bills of health, the last prop on which it stands. We cannot stop to detail the expense of the quarantine system, nor the opera- tion of the sanitary code of which it is a part, on commerce in general; nor the mischievous influence and power which it gives to despotic government officials—a power which has been recently exercised in a most arbitrary fashion towards the City of Baltimore. The measures which have been substituted for quarantine against infec- tious diseases by the English government consist in a " system of medical inspections, " which differ from "quarantine" in the following essential respects: 1. It affects only such ships as have been ascertained to be, or as there is reasonable ground to suspect of being, infected with pestilential 72 disease. No ship is deemed infected unless there has been actual occur- rence of the disease on board in the course of the voyage. 2. It provides for the detention of the vessel only so long as is necessary for the require- ments of a medical inspection, for deabng with the sick, if any, in the manner it prescribes, and for carrying out the process of disinfection. 3. It subjects the healthy on board to detention only for such length of time as admits of their state of health being determined by medical examination. The relative advantages of the system of medical inspection and of quar- antine, as against cholera in the ports of Europe, underwent the most thorough discussion at the International Sanitary Conference which was held in Vienna in 1874. A large majority of the delegates, including those from every State of the first rank except France, declared in favor of the former system. The majority, while adhering to quarantine, agreed to a system which would considerably diminish its stringency as heretofore practised. The Engbsh government assumes no control over quarantine stations beyond instructing the proper officers (usually the collectors of the several ports) in the event of the arrival of a vessel from a port in which there was cholera, small-pox, typhus fever, or in which any disease whatever was extensively prevalent, forthwith to report the same to the local authorities in order that they may take such measures as they may see fit for the protection of the public health within their jurisdiction. The sanitary authority of every district exercises sanitary jurisdiction over all posts and shipping in its district, except where from topographical circum- stances it has been found necessary to create a special port sanitary authority. The Public Health Act of 1875 (Sees. 287-293) empowers the Local Government Board to create such an authority and to assign to it such powers, rights, duties, etc., provided for by the Act, and exercised by sanitary authorities in general, as may be necessary. This would seem to be quite sufficient, and far more in keeping with the spirit and traditions of our government than the arbitrary and unseemly interference with the commercial interests of the country, through the grasping instrumentabty of the United States Marine Hospital Service. A theoretically perfect quarantine, which it should be impossible to break on any point, and which must, of course, include the full period of incubation of the particular disease quarantined against, would doubtless, if practicable, afford a certain higher degree of security against the introduction of disease than can be attained by mere inspection on arrival as to the actual existence of disease. But where are the condi- tions for a perfect quarantine to be found, and at what cost would the experiment be carried on ? On these points we cannot do better than quote the observations of Mr. Simon, the late distinguished Medical Officer of the Local Government Board of England. "A quarantine which is ineffective," says Mr. Simon, "is a mere irrational derangement of commerce; and a quarantine of the kind which insures success is more easily imagined than reabzed. Only in proportion as a community lives. 73 apart from the great highways and emporia of commerce, or is ready and able to treat its commerce as a subordinate pobtical interest, only in such proportion can quarantine be made effectual for protecting it. In propor- tion as these circumstances are reversed, it becomes impossible to reduce to practice the paper plausibibties of quarantine. The conditions which have to be fulfilled are conditions of national seclusion." Very respectfully, C. W. CHANCELLOR, M.D., Secretary Maryland State Board of Health, Baltimore, Md. Beaufort, S. C, Dec. 14, 1892. His Honor Geo. Holmes, Mayor of the Town of Beaufort: Sir:—The circular letter of the New York Board of Trade and Trans- portation, referred by you to me, has been carefully considered, and'I beg to make the following statements : 1. This country cannot be influenced by the way foreign countries ad- minister their quarantine. For instance, England does not detain vessels from the "fossi of endomicily " of yellow fever. We are obliged to, and until this was done yellow fever often prevailed, during the fall, along the Carobna, Georgia and Florida coasts. In old times it was called "stranger's fever." Since the establishment of the State Board of Health of South Carobna it is impossible for diseases of this class to get into the State. 2. National quarantine should aid the State authorities in the adminis- tration of quarantine, but never interfere, as General Hamilton attempted to do in New York last Summer with the efficient quarantine officer of the port of New York, Dr. Jenkins. I am satisfied with the quarantine laws of South Carobna. AH of our ports have excellent quarantine officers, and since 1882 the system has been working admirably. 3. If all of the states adopt a system of quarantine similar to that of South Carobna, we could not do better. Government quarantine would be expensive. There would be no difference in "restrictions imposed upon commerce," if there is any change or "security afforded." 4. I am opposed to the control of the quarantine by the national government, as pobtics is bound to creep in, and the only class of men who desire the change are the Marine Hospital surgeons, under the leader- ship of ex-Supervising Surgeon-General Hamilton. It is a question for the states to decide. lam, Very respectfully, H. M. STUART, M.D., Chairman Board of Health. *See Mayor Holmes' letter in appendix 74 Loudonville, O., Dec. 22, 1892. Hon. Oscar S. Straus, Chairman, &c: Sir .-—After an absence of three weeks from home, to-day I find your circular-letter of the 5th inst. on my table. While a prompt answer might have been of bttle value, one so long delayed may be of no utility; how- ever, I hope to avoid the charge of neglect or want of courtesy even at this late day. I have not traveled abroad sufficiently to have an opinion of quarantine regulations in foreign countries, but the kind of immigrants that reach our ports render social circumstances such that we could scarcely gather precedents that would safely guide in the solution of the quarantine problem. National quarantine in the United States is yet crude, periodical and spasmodic, besides being generally tainted with pobtics. It is emotional, unstable, and, to a great extent, unreliable, because it has not the force of matured system that comes from time, and fixed rules that work abke from year to year, whether state medicine is everywhere enjoying sun- shine, or our ports are menaced by the clouds of disease and social danger. State quarantine, it is true, in most respects, partakes somewhat of the character of national quarantine, but it is not so cumbrous and unwieldy, and in some of the states has already shown efficient organization and power to grasp the situation and act with a promptness deserving much praise ; going far to establish it as a fact that State quarantine is the line on which our efforts in that respect should be carried out. Quarantine as carried out heretofore by the general government of the United States has been crude, embryonic and expensive. Indeed, of necessity and as a matter of course, it is costly, inasmuch as it is either latent or in a state of ebullition. When latent it is of no value, and con- sequently dear at any cost, and when called forth by alarm and set to boibng it has to be suddenly reconstructed de novo to meet the approach of some menacing danger. The whole system then must be like a mushroom, the growth of a day, and the entire organization has to be created out of chaos ; and, of course, such quarantine must be expensive. At such times, and on such occa- sions, it is scarcely possible to get the right man for the right place, and many who are called in such emergencies to act possess but bttle quali- fication for the office, further than to draw the salary. Under such ad- ministration quarantine becomes very expensive and, worse still, often imposes heavy burdens on commerce and travel. The restrictions though not always unreasonable generally appear so, because they are not always placed with wisdom, and the whole thing is a surprise that no one is prepared to meet, because entirely out of the ordi- nary manner of things. Under these circumstances and with these conditions the maximum of annoyance, inconvenience and expense is inflicted and only the minimum of security afforded. A national system of quarantine should be made as 75 near perfect as possible, and once so framed it should, like the laws of the Medes and Persians, never change. Then all men might know and under- stand it and would be able to provide for it accordingly. Then when once fully understood, and every man knew and expected just what he might meet as the inevitable, and provided accordingly, there is no plausible reason why it should not lessen the existing imposts upon commerce. With this fixedness of things—a law made alike for all—to govern and protect all alike, the restrictions on commerce and travel would be bghter and, indeed, less injurious to aU. And better still it would afford in- creased security to the country and greatly promote the general welfare of mankind. I will only add that while many are in favor of a national quarantine, which, if properly constructed and judiciously carried out would greatly benefit our country and conduce to the welfare of men in general, it is nevertheless my opinion and, on account of many reasons that I could adduce, evident to me that a perfect system of quarantine carried out through State legislation and State authority is the measure most to be desired, and which, through simpbcity of construction, freedom from compbcations and conflict of authorities, as well as ease in execution, will eventually commend itself to the wisdom of those who have this matter in hand, and in the greatest possible manner conduce to the welfare of man- kind. Your obedient servant, ANDREW J. SCOTT, AM., M.D. 76 Appendix D. State of Nebraska, ) Executive Department, f Lincoln, Dec. 12, 1892. ) Hon. Darwin R. James, Secretary Board of Trade and Transportation, New York, N. Y. Dear Sir:—In response to yours of the 6th inst., enclosing printed circular relating to national quarantine, would say, that I think in the protection of the pubbc health there cannot be too rigid a quarantine enforced during the coming year. The Worlds' Fair at Chicago may be somewhat damaged thereby, and in making the quarantine regulations this should be kept in view. It is a matter well understood that infection of contagious diseases is conveyed from foreign ports mainly by steerage passengers. An act which would exclude this class of immigration for one year might serve the desired end. I do not think there is any neces- sity for restrictions upon commerce, as I do not bebeve the germs of disease are transmitted in that way to any appreciable extent. Very respectfully, JAMES E. BOYD, Governor. City of Nashville, ) Office of the Mayor, Dec. 9, 1892. j Hon. Oscar S. Straus, Chairman, No. 55 Liberty Street, New York, N. Y. My Dear Sir:—The letter of Darwin R. James, Secretary, has been re- ceived, contents noted and for reply to inquiries therein made would say that I represent an inland city, and consequently am not as well informed upon the subject nor in a position to make any suggestions that would be of value to you. I, however, have been impressed with the good effects the quarantine laws of late years have brought about. These, doubtless, could be fur- ther improved, and I reply merely to inform you that my people are ready and willing to co-operate in any movement by legislative enact- ment to forward and secure further safeguards in this direction. Yours very respectfully, GEO. B. GUILD, Mayor of Nashville, Tenn. The State Board of Health, ) Montgomery, Ala., Dec. 9, 1892. j Hon. Oscar S. Straus, New York: Dear Sir:—I have your circular of the 5th. The subject of quarantine 77 is a very large one ; the more you know about it the larger it is seen to be, and I am too busy to discuss it with any thoroughness. I will endeavor, however, to give brief answers to your several questions. 1. The administration of quarantine in foreign countries with chmatic and commercial conditions similar to ours may be usefully studied in framing plans for the quarantine of United States ports. 2. In many respects the quarantines of the United States—the maritime quarantines, I mean—are, I bebeve, superior to those of other countries at this time. I am best acquainted with our Gulf quarantines, but the quar- antines of the Atlantic and Pacific coasts are projected along the same bnes. Our Gulf quarantines are partly under the control of the United States and partly under the control of the states, the two sets of authorities acting for the most part in concert. At the several ports there are quaran- tines of observation, deabng with all vessels not known to be infected; while infected ships are sent to the government stations, or refuge sta- tions, as we call them. But the City of New Orleans keeps up a complete system of quarantine of its own. The Gulf States are continually in danger of invasion by yellow fever, hence we must always keep on the lookout, and I think our quarantine defenses are superior to any others, either of this country or of Europe. This co-operative system works well with us, and I should regret to see it subjected to any radical change. It grew out of a recommendation made by myself to the National Board of Health in 1879, and I am natur- ally partial to it. The objections to administration of all maritime quarantines come chiefly from the large cities—such as New Orleans, New York, Philadelphia, etc. It is easy to see why. The management of these quarantines involve the expenditure of large sums of money. Considerations of local commercial advantages have also had considerable influence. The quarantine of New York is made important by the vast currents of travel and traffic that pass through it. On the other hand it is made comparatively easy, except in cholera years, for reasons easily indicated. New York is not in much danger of yellow fever. Typhus fever has ceased to be common m European ports. SmaU-pox is no longer dreaded anywhere. The manage- ment of the New York quarantine during the time when cholera was re- cently thundering at her gates was simply barbarous, and showed that proper and adequate preparation had not been made. 3 I am not prepared to discuss the cost of existing quarantines. I only know in a general way that it is frequently two or three times as much as it would be under competent expert administration. The restrictions imposed on commerce and travel have been very greatly diminished of late years, pari ^ with our increased knowledge of the methods by which migrating epidemics are disseminated. But these restrictions are still sometimes more stringent than is necessary Ships and cargoes Should not be detained at all, except such as need disinfection, and these 7S only long enough to have disinfection properly done. By present im- proved methods disinfection can be done very rapidly. Passengers should not be detained beyond the time necessary after last exposure for the incubation of the disease to be guarded against: In yellow fever and cholera I believe the period of incubation does not exceed five days. As I have already indicated, the security afforded by our Gulf quarantines is very great. 4. I believe that a national quarantine would lessen the existing imposts upon commerce. Whether it would afford increased security to the coun- try would depend on how it was administered. I want to say in addition, although the point is not covered by your questions, that in my judgment the local management of epidemic diseases, the quarantine of infected houses and persons, is quite as impor- tant, and perhaps more so, than the outer quarantine lines intended to prevent invasion. I am perfectly satisfied that cases of cholera, or of yel- low fever, can be so managed as to prevent further infection. Very truly. JEROME COCHRAN, M.D., State Health Officer Alabama. 18 Montague St., | Charleston, S. C, Jan. 2, 1893. j Hon. Oscar S. Straus, Chairman Committee New York Board of Trade, etc. Dear Sir:—Pardon the delay in answering your circular requesting "in- formation and opinions touching quarantine." In reply I would say to Query No. 1: As to foreign quarantine, I have no information from per- sonal observation that would be useful. Query No. 2: "The present state of quarantine in United States. A. National." The Marine Hospital system has had control since the des- truction of the National Board of Health. I never was in favor of the transfer of power as I thought the National Board of Health should have been maintained, and its powers increased and its usefulness developed with greater powers and larger experiences, especiaUy in matters of mari- time quarantine. The Marine Hospital system has defects, and I do not think at Brownsville, Tex., nor in Florida, during the yeUow fever epi- demics, that this department showed any great executive skill in managing the epidemic, nor in conducting the refuge camps. The disinfecting stations were crude, and the methods employed inefficient; nor have the several quarantine refuge stations been equipped since with any facibty from government. I do not think there is a single station equipped as well as it should be to render it effective for maritime sanitation, or with steam cylinders and tanks for chemical effusion to render merchandise and vessels clean. (I think the Cape Charles station has a steam tug equip- ped). Nor is any other station that I have any information of supplied with the Holt plant for sanitation. Nor do I regard the service rendered at such stations as properly conducted, as vessels sent from the ports of 79 South Carolina have been carelessly attended to and not considered safe to return to our ports according to the regulations of the State Board of Health. Nor have these national quarantine refuge stations suitable ware- houses to store cargoes so as to properly disinfect and fumigate vessels. Nor can any number of passengers or immigrants be properly provided for ; that is, to take care of the sick and isolate the well during a term of probation or period of detention to prevent the spread of infectious diseases. (B.) State quarantine methods defective; some few, especially New Or- leans, La., and Charleston, S. O, have properly constructed stations with modern apparatuses for properly cleaning a vessel and disinfecting her cargo, clothing of crew; but no facilities exist for stowing away cargo, or for providing for large numbers of immigrants or passengers. Query 3. Costs to the State of South Carolina by legislative provision about §5,000 or 86,000; from fees about double this amount. Restrictions upon commerce and travel great during the Summer months; virtually non-intercourse with tropical ports as the restrictions are so exacting. Security from this method has been all that could be desired, and as no infected vessel is allowed to enter port she must go to Sapelo national quarantine station. Query 4. A national quarantine. I approach this subject with some de- gree of doubt, and have my individual views. The seaboard states and towns now bear the expense and burden of keeping the interior states and towns free from disease. This is burdensome, but it has to be borne to keep themselves and their communities safe from disease. A national quarantine, with properly equipped stations for dealing with infected vessels and immigrants at places remote from bnes of travel, would be a national blessing, and is a fit measure for national expenditure. These places or national quarantine refuge stations should be under control of experts, and fully equipped and maintained by the national government. The control of the ports and also of interstate quarantine measures should remain under control of the State authorities. If they are not able to con- duct or maintain these systems the national government should assist. In both of these measures partisan or political influences should be elim- inated; such influences have and do still prevail, and destroy confidence and security that should exist. (A.) A properly conducted quarantine, with the general government taking charge of the outposts, would necessarily lessen the expenses of maintaining the quarantine at the ports, and a reduction of fees would result. (B ) With increased facibties afforded by better equipped stations to deal with infected vessels, and all immigrants provided with proper camps of detention for observation or treatment, the period of probation having passed or the disease treated, or the healthy passengers disinfected after a short'term of detention, restraints could be made less burdensome and security afforded to the whole country. A national quarantine can be 80 made a national blessing or a national curse as those who control it act. Pardon the length of my reply, but I have given you a candid opinion, and I claim some experience in epidemic diseases, and in quarantine matters also. Respectfully yours, T. GRANGE SIMONS, M.D., Chairman Quarantine Committee State Board of Health of South Carolina. State of West Virginia, j Office of Secretary of State Board of Health, .- Martlnsburg, Dec. 26, 1892. ) Hon. Oscar S. Straus, Chairman, etc., New York, A". Y. Dear Sir:—In response to the request of the "committee on quarantine," I submit the following opinions as to the utility of national quarantine, and the relative value of national as compared to state supervision of quarantine matters. 1. I am disposed to doubt that the experience of foreign countries can be of much use in affording precedents for our action. The results follow from such entirely different causes and the surroundings, both in the nature of the governments and the geographical concbtions are so widely different as to vitiate the results of their experiences. 2. The cholera scare of the past Fall was of greatest value in disclosing many points of weakness and possible friction in the existing quarantine regulations. The continual jarring between the national and the state boards and officers, having charge of these preventive and restrictive measures, showed only too clearly how inefficient was the co-operation, and how unscientific the feeling existing between these co-ordinates. It is greatly to be hoped that the weaknesses disclosed can be remedied so effectually that the country may be spared the scourge, and sanitary officers the disgrace of furthering the spread of the disease which they were constitued to combat. 3. The present system of quarantine in the United States seems to me to afford the most sobd basis upon which to build up a system, which, with the improvement of methods and the growth of experience, shall become more and more effective. The bifurcation of functions betweeu the national and State boards throws a double safeguard around the people, and, if an intelbgent and sympathetic co-operation can be secured between these two, the perfection of quarantine methods is resolved into a simple question of time. The cost of quarantine has not yet reached an extravagant figure, nor have the restrictions upon travel and commerce been at all burdensome in the State of West Virginia. We found it possi- ble to secure the co-operation of the railroads, and, by careful regulation, to impose the minimum of hardship on the public. As to the securitv afforded by our quarantines, both state and national, there is, of course, 81 unbmited room for improvement, but it is certainly impossible to negate the good done, and the prospect opened by the past actions and successes of quarantines. 4. I am decidedly opposed to any system which seeks to merge State in national surveiUance. That the national government should exert itself to the utmost to prevent the landing of infected persons and baggage is of course apparent, but I do not bebeve that the central power could es- tabbsh any system which would supply the place of the co-operating State Boards. Our country is so wide in extent that national quarantine would inevitably become locabzed along the coast and in great centres of trade and travel, while the local Board of Health machinery, abeady existing in many of our states, in connection with and guided by the State Boards, renders it practically possible to carry on an intelligent quaran- tine almost in the homes of individuals. Among the powers reserved by the states, and not delegated to the general government, none seems to require the local accommodation of State action as much as the regulation of matters pertaining to the pubbc health. In all such questions wisdom seems to dictate that the smaller units will be more sensible of the threatened dangers and more prompt and generous in their efforts to meet them. Finally L would say that, in my opinion, the best results are to be obtained from a national coast quarantine supplemented and aided by State quaran- tine in each individual State. By a careful discrimination of functions it ought to be possible to secure hearty co-operation between the State and national officers, and to secure the maximum efficiency of the best known scientific methods of quarantine. Hoping that your labors may meet with great success, I remain Faithfully Yours, N. D. BAKER, M.D., Secretary State Board of Health. 82 In addition to the foregoing, letters were received from the fol- lowing gentlemen, acknowledging the communication of the com- mittee and stating that the same had been received, referred for answer or otherwise disposed of: Hon. Wilbam Potter, U. S. Minister, Rome, Italy. George F. Lincoln, U. S. Consul, Antwerp. W. R. Estes, U. S. Consul, Hamburg. Governor R. P. Flower, Albany, N. Y. Governor Robert Pattison, Harrisburg, Pa. Governor Wilbam E. Russell, Boston, Mass. Governor Henry H. Markham, Sacramento, Cal. Mayor Charles F. Bishop, Buffalo, N. Y. Mayor Darius H. Ingraham, Portland, Me. Mayor Thomas F. Gilroy, New York, N. Y. H. B. Hohlwech, M.D., Health Officer, Charleston, S. C. Joseph F. Edwards, M.D., Philadelphia, Pa. WA N568r 1893 63020180R NLM 0513070E 1 NATIONAL LIBRARY OF MEDICINE NLM051307021