garding the sanitary condition of passengers, cargo, crew and ship, should be everywhere carried on in the same way. The period of detention may reasonably vary with port and season, but the inspection should be always the same.

Carelessness in making such inspections is a crime and should be so considered. Efficiency depends upon the honesty, faithfulness and patriotism of the inspector. No.man should be selected for this great responsibility who does not combine with the necessary technical knowledge these three characteristics.

The following, revised from an article by the writer,' gives an account of the details of quarantine management:

A quarantine station usually consists in a hospital for the sick (lazaretto, so named from the isolation of St. Lazarus on account of leprosy, mal de Saint Lazare); a boat, usually a steam vessel, to carry the boarding officer and supplies for the station, if there be any sick found on board the vessel coming into port, a separate boat or the ship's boat should take them to the lazaretto; and quarters for attendants. On arrival of a vessel at the quarantine, she is boarded by an inspecting officer, her bill of health examined, the crew and passengers mustered, the vessel itself inspected in every part to determine whether it be clean or foul. At this day, the bill of health is not accepted as prima facie evidence of the sanitary condition of the vessel, but is only corroborative. Even if it be stated thereon that the port from which the vessel last sailed was free from infectious disease, the inspector trusts to his own inspection of the vessel and examination of the persons on board and the cargo, together with his knowledge of the sanitary condition of the port of departure to determine whether or not the vessel should be detained in quarantine. If, however, the vessel is from an infected port, and the period of incubation of the disease has not elapsed, the vessel is detained in quarantine until the expiration of that time, whether there be sickness on board or not. If there be found contagious sickness, the sick are removed to the hospital, the bedding and other articles in their state-rooms or berths removed and destroyed, and the place thoroughly fumigated with the fumes of burning sulphur. In case the vessel is discovered to be foul and in an unsanitary condition, whether there is sickness on board or not, the vessel is detained in quarantine for the purpose of cleansing and fumigation, the cargo is removed to a warehouse, or to open lighters, the bilge water pumped out and all parts of the vessel fumigated. The hold of an infected vessel should be thoroughly washed out before fumigation with solution of the sulphate of copper. The sulphate of iron is cheaper and nearly as efficacious. Corrosive sublimate solution may also be employed. Whenever necessary, the wood-work should be repainted.

For the treatment of the cargo as well as the vessel much yet remains to bring the practice to a level with the advanced state of collateral sciences. As shown by Dr. Joseph Holt of New Orleans, we are still pursuing the practice of a past age in the lack of improved machinery. An invention has recently come into use for the disinfection of rags which makes it possible to disinfect them in a bale. The fumes of burning sulphur, are driven into the bale through hollow, perforated screws. Superheated steam may also be used, and is in fact easier of application.

1

Cyclopædia of Political Science, Political Economy and Political History of the United States, edited by John S. Lalor, Chicago, 1883.

B. By land.-Land quarantine is that form of quarantine which has furnished the opponents of the system with their most effective arguments. If rigorously carried out, it is denounced as cruel and barbarous; if loosely enforced, it is certainly ineffective. The weight of medical opinion at this day is theoretically against land quarantines,' but practically almost every country establishes an inspection system on its frontier as soon as the introduction of an epidemic is threatened. In the United States "shotgun" quarantines always follow the failure of a State or the Government to establish a proper quarantine, and as one of the elements of land quarantine, and as well as a means of allaying excitement and preventing panic, cordons sanitaire are very useful, as was proved during the yellow fever epidemic of 1882 in Texas. Sparsely settled countries show the usefulness of the cordon sanitaire to its best advantage; indeed the system is considered impracticable if not impossible to carry out where large cities are concerned. This, however, is fallacious; the land quarantine is difficult to carry out, but not by any means impossible. A land quarantine is simply medical inspection of travelers, their baggage, the vehicles of transportation and the freight carried thereon, and the cordon sanitaire simply the local police. This duty may be effectively performed by troops or by carefully picked men from civil life. The plan followed in Russia as a means of stamping out the plague will appear from the following account:

"The Oriental plague made its appearance in the district above Astrakhan, in Russia, about the middle of November, 1878. It prevailed along the river Volga, and upon its islands. The center of the malady was in the village of Wetljankaja, with a population of some seventeen hundred inhabitants. The Governor of Astrakhan telegraphed to the Minister of the Interior the report of the medical supervisor of the Cossack forces in the district of Astrakhan, Dr. Depner. A few cases had appeared in the previous year, but the disease had not become epidemic until November, 1878. From the 27th of November to the 9th of December, out of one. hundred sick in Wetljankaja forty-three died; and in less than a month two hundred and seventy-three persons died of the dis

1 The following may prove of interest in this connection:

On the 1st of July, 1884, the Minister of Commerce appointed the following named persons to serve as a cholera commission to consider the measures best adapted to restrain the ravages of the epidemic at that time existing at Toulon and Marseilles. The commission was composed of MM. Brouardel, chairman, Pasteur, Peter, Proust, Legouest, Rochard, Gallard, Vallin, and Nicolas, director of internal commerce. The commission presented its report to the Academy of Medicine, in order to obtain the approval of that body, before submitting it to the Minister of Commerce. The conclusions of this report, which were adopted by the Academy, were as follows:1

1. Land quarantines, whatever be the form under which they are established, are impracticable in France. 2. The methods of disinfection imposed upon travelers and their baggage in the railway stations are inefficacious and illusory. 3. Posts of medical surveillance might be established in the larger stations along the lines of railway in order to render assistance to those attacked with cholera, and to isolate them from the other travelers. 4. The efficacious measures of preservation are those which each one ought to take for himself and his house.

The duty of the municipal authorities is to see that the instructions in regard to isolation of the sick, to disinfection of linen, clothes, apartments, etc., are rigorously enforced, and that the precautions of private and general hygiene are executed in all their rigor.-E. C. W.

2

⚫ Brouardel; Épidémie du Choléra à Toulon et à Marseilles, Paris. J. B. Baillière et Fils, 1884.

ease. It then spread from Wetljankaja to the surrounding villages, and was declared epidemic. Dr. Koch and six army surgeons became victims to the epidemic, the priest died, the Cossacks who attended the sick or removed the dead died; almost all died who in any way came in contact with the sick or dead.' Dr. Depner then arrived at the conclusion that the only means for suppressing the disease was quarantining; and on the 11th of December, Dr. Depner, with Colonel Preibanow, instituted measures. He could not prosecute further observations, however, for he himself fell sick with the plague. These facts being telegraphed to the Emperor of Russia, the Imperial Committee of Ministers was convened, and the following rules were adopted, which received the imperial sanction: "1. (a.) The inhabitants of the colony of Wetljankaja shall be transferred and distributed as shall seem best after a careful examination of the local requirements, the limit of the quarantine not to be overstepped.

"(b.) The appraisement of the movable and immovable property destroyed by fire, as likewise the fixing of the indemnities to be paid to the owners, shall be reserved for a special commission, under the presidency of the Governor of Astrakhan, with the participation of members of the Cossack administration and the Ministry of the Finances, the Ministry of the Domains, and the Ministry of the Interior, according to regulations which shall be prepared on the spot by the aforesaid commission.

"(c.) This commission shall be charged with the execution of all the measures that may be necessary for the destruction by fire of the colony of Wetljankaja, as likewise of all measures necessary to supply the population transferred from that colony with food, underclothing, and warm garments; to provide for the treatment of the sick, etc.

"2. That the acting Minister of the Interior may be authorized to extend the measures referred to concerning the colony of Wetljankaja to other villages, as well as to isolated buildings everywhere, to such extent as shall be deemed indispensable.

3. That three regiments of Cossacks may be immediately placed at the disposal of the civil administration for the quarantine service.

"4. That all outlays necessary for the execution of the measures above referred to, and to meet the expenses of all measures that may be required by the present epidemic, may be charged to the account of the imperial treasury.

It was the unanimous conclusion that "the plan of burning the colony of Wetljankaja (the center of the infection) is proposed after a thorough examination of the question, and from a conviction of the indispensable necessity of so radical a measure for the extirpation of the disease in the locality where it first appeared-the committee having subsequently heard the opinion of the physicians present, both with regard to the measure in question, and in general in relation to the means which have been shown by science and experience to be best adapted to put a stop to an epidemic, and to prevent it from spreading."

In addition to the irregular troops mentioned above, bodies of infantry were placed at the disposal of the civil establishments, and unlimited credit was opened to meet all expenses from the treasury. His Majesty the Emperor sent a special commissioner plenipotentiary. A commission was appointed to act in the matter, composed of medical specialists, whose duty it was to study the subject of the progress of the epidemic, and the proper means of stamping it out, and purifying the localities then infected or those likely to become so; and in view of the impression produced in foreign countries by the reports of the plague, they should furnish to this government reliable information concerning the epidemic, and the measures adopted against it; and the instructions were carried out as above outlined, under the direction of Aide-de-Camp General Count Loris-Melikoff, who was sent to the infected locality with the rights and privileges of a temporary governor-general. On the arrival of Count Loris-Melikoff, in March, 1879, an international sanitary council was held, composed of the most distinguished sanitarians of Europe, Professors Hirsch, Besiadetsky, Cabiadis, Petrisco and Eichwald. By the advice of the International Council, a general sanitary cordon was established all round the province of Astrakhan, with the object of protecting Russia and neighboring countries of the empire, and Professor Eichwald advised that the sanitary cordon should be maintained around the infected region until the 2d of May. These measures were entirely successful, and the plague did not spread to any other place outside of the originally infected district, nor has it reappeared.

In the United States a land quarantine was established under my direction for the prevention of the spread of yellow fever in Texas in the summer of 1882.

A serious epidemic of yellow fever broke out in Bagdad, Tampico, and Matamoros, Mexico, and soon spread to Brownsville, in the State of Texas. There were in a short time, out of a city of some 5,000 inhabitants, between five and six hundred persons sick of yellow fever. A general panic prevailed throughout southwestern Texas, and refugees were leaving that part of the State in great numbers, as it was believed the infection would rapidly and certainly extend to the surrounding country. Under these circumstances, an appropriation of $100,000 having been placed at the disposal of the Treasury Department to prevent the spread of epidemics, by the President, the Governor of the State of Texas applied to the Secretary of the Treasury for assistance from the general government; and, as the exact

area of the infected region was undetermined, at my suggestion a cordon was immediately established from Corpus Christi, on the Gulf, to Laredo, on the Rio Grande, along the line of the Texas and Mexican Railway. No person was allowed to pass this cordon until after ten days' detention at some one of the quarantine stations (represented by flags upon the accompanying map), that length of time being considered necessary to determine whether or not the particular person would be attacked with yellow fever. Baggage was not allowed to cross the line upon any pretext. A hospital was established in the city of Brownsville, a dispensary opened, and experienced

physicians and nurses sent there, who were constantly employed in the treatment of the poor, and all persons unable to pay were treated and cared for at the public expense. These physicians also aided the health authorities of the city in carrying out sanitary measures, including the fumigation of houses.

As soon as practicable after opening the hospital, an inner protective cordon was established, thirty miles from Brownsville, the original cordon having been one hundred and eighty miles distant. Perfect liberty was allowed to the inhabitants of the infected city to leave at any time, and they were encouraged to scatter in camps; but they were not allowed to