Copyright
George H. (George Henry) Rohé.

Text-book of hygiene; a comprehensive treatise on the principles and practice of preventive medicine from an American standpoint online

. (page 31 of 39)
Online LibraryGeorge H. (George Henry) RohéText-book of hygiene; a comprehensive treatise on the principles and practice of preventive medicine from an American standpoint → online text (page 31 of 39)
Font size
QR-code for this ebook


receives the same treatment as above. In case the crew are all well, and
there has been no sickness during the passage, but the vessel comes from



SPECIAL MEASURES AGAINST CHOLERA. 389

an infected port, then the treatment of the vessel depends upon the
number of days' passage, the condition of the vessel, the statement of
the captain (which is made under oath) as to whether the crew were
allowed to visit the shore, and the length of time the vessel was in port
discharging the cargo and reloading, and other considerations which
enable us to decide whether any danger need be apprehended in allowing
the vessel to enter. After careful inspection of a vessel from an infected
port, if I find everything neat and clean, I usually allow her to proceed,
provided she has had a passage of ten days or more ; but if she has not
been out for that length of time I detain the vessel, during the summer
season, for observation until the ten days from date of departure have
expired. At the end of this time, if no sickness appear, the vessel is
discharged.

To clean an infected vessel, we begin the first day by fumigating, —
that is, burn about 4 pounds of sulphur for every 1000 cubic feet
of air-space, the hatchways, doors, and windows being closed and
caulked, so as to make the hold, cabin, and forecastle as nearly air-tight
as possible. The sulphur-fumes are allowed to remain in the hold twenty-
four hours, and in the cabin and forecastle about ten hours ; the second
day all beds, pillows, and furniture which cannot be satisfactorily disin-
fected are burned, and all clothing, blankets, curtains, carpets, and cotton
and woolen goods are soaked in a bichloride solution (1 to 2000). The
third day the floors, walls, and ceilings of the cabin and forecastle, and
all furniture, drawers, and chests in them washed with the same solution.
The vessel is now supposed to be clean, and is discharged at once, pro-
vided the average period of incubation for the disease from which the
crew have suffered has elapsed since there was any one sick on board.

SPECIAL MEASURES AGAINST CHOLERA.

Other features of quarantine administration are well ex-
pressed in the following extract from the editorial pages of the
Philadelphia Medical News of October 15, 1887, showing the
measures necessary to extinguish an incipient epidemic of cholera
and to prevent its spread. Such measures are as follow : —

(a) Speedy recognition and isolation of the sick ; their proper
treatment ; absolute and rapid destruction of the infectious agent of the
disease, not only in the dejecta and vomit, but also in clothing, bedding,
and in or upon whatever else it finds a resting-place.

(6) The convalescents should remain isolated from the healthy so
long as their stools possibly contain any of the infecting agent ; before



390 TEXT-BOOK OF HYGIENE.

mingling again with the well they should be immersed in a disinfecting
bath, and afterward be clothed from the skin outward with perfectly
clean vestments, which cannot possibly contain any of the infectious
material.

(c) The dead should be well wrapped in cloth thoroughly- saturated
in a solmtion of corrosive sublimate (1 to 500), and, without delay, cortege,
or lengthy ceremonial, buried near the place of death in a deep grave, re-
mote as possible from water whicli may, under any circumstances, be used
for drinking, washing, culinary or other domestic purposes. (Cremation,
of course, is by far the safest way of disposing of cholera cadavers.)

(d) Those handling the sick or the dead should be careful to dis-
infect their hands and soiled clothing at once, and especially before touch-
ing articles of food, drinking, or culinary vessels.

(e) In the case of maritime quarantine, the well should be disem-
barked and placed under observation in quarters spacious enough to
avoid crowding, and so well appointed and furnished that none will suffer
real hardships.

(f) Once having reached the station, those under observation
should be separated in groups of not more than twelve to twentj^-four,
and the various groups should, under no pretext, intermingle. The quar-
ters for each group should afford stationary lavatories and water-closets
in perfect working condition, adequate to the needs of the individuals
constituting the group, and supplied with proper means of disinfection.
There should be a bed raised above the floor, proper coverings, and a
chair for each member of the group, each person being required to use
only his own bed. There should be a common table of sufficient size to
seat around it all the members of the group, who shoidd be served their
meals from a central kitchen, and with table furniture belonging to the
station and cleaned by the common kitchen scullions.

(g) Drinking-water, free from possible contamination and of the
best quality, should be distributed in the quarters of each group as it is
needed, and in such a manner that it is received in drinking-cups only.
There should be no water-buckets or other large vessels in whicli hand-
kerchiefs, small vestments, children's diapers, etc., can be washed by the
members of any group.

(h) Immediately after being separated into groups in their respec-
tive quarters, every person under observation should be obliged to strip
and get into a bath (a disinfecting one is preferable), and afterward be
clothed with fresh, clean vestments from the skin outward. Every article
of clothing previously worn should be taken awaj*- and properly disin-
fected.

(i) Then all of the personal effects should be at once removed to a



SPECIAL MEASURES AGAINST CHOLERA. 391

separate building, washed (if possible), and thoroughly disinfected, or,
if necessaiy, destroyed. After disinfection they should be temporarily
returned to the members of groups, when occasion requires a further change
of clothing.

(k) Under no circumstances whatever should washing of clothing
by those under observation be permitted. All used clothing should be
first thoroughly disinfected (by boiling, when possible), and then should
be cleansed, the disinfection and washing being done by a sufficiently
trained and absolutely reliable corps of employes supplied with adequate
appliances.

(I) All those under observation should be mustered in their own
quarters, and be subjected to a close medical inspection, while on their'
feet, at least twice every day, in order to discover and isolate, as soon as
possible, new cases which ma} r develop ; and, of course, the clothing and
bedding of these new cases should be treated without delay in the manner
already mentioned. In the meantime, a watch should be set over the
water-closets for the purpose of discovering cases of diarrhoea, and, when
discovered, such cases should be temporarily separated from the rest.
They should receive judicious medical attention at once, and precautions
should be taken as if they were undoubted but mild cases of cholera.

(m) The quarters should be kept thoroughly clean, and every sur-
face upon which infectious material could possibly be deposited, includ-
ing the floors, should be washed with a strong disinfectant twice daily,
and oftener when necessary. Evacuations from the bowels should be
passed into a strong disinfectant ; the hopper of the closet should be
then flushed and finally drenched with a quantity of the same dis-
infectant.

(n) For the proper attention to the sick, there should be two or
more competent and experienced physicians, assisted by a sufficient corps
of intelligent and efficient nurses, with hours of duty so arranged that a
physician, with a sufficient number of nurses, be in constant attendance
in the wards of the hospital.

(o) For the prompt recognition and separation of new cases, their
temporary medical attention, the proper treatment of discovered cases
of diarrhoea or cholerine and of other maladies, and the immediate cor-
rection of every insanitary practice or condition by constant, vigilant, and
intelligent supervision, there should be at least two or more competent
and experienced physicians, with hours of service so arranged that a phy-
sician is on duty night and day among those under observation ; and he
should have, subject to his orders at any and everj^ moment, a sufficient
and efficient corps of nurses and laborers to carry out properly and
promptly his directions.



392 TEXT-BOOK of hygieist:.

(p) In order to prevent the intermingling of the various groups, to
enforce obedience and order, and to make it absolutely impossible for the
quarantined and their personal effects to have any communication with
the exterior, a well-organized and sufficiently large police corps should
patrol the borders of the stations and the buildings day and night.

(q) Any group among whom there have developed no new cases of
cholera or of choleraic diarrhoea, during the preceding eight or ten days,
ma}' be regarded as harmless, and allowed to leave quarantine after each
one is finally immersed in a disinfecting bath and re-clothed with clean
garments from the skin outward, the garments removed being destroyed
or thoroughly disinfected and cleansed, as already indicated.

As yet no reference has been made to the crew, ship, and cargo.
"What has been said of the treatment of those under observation applies
to every one of the ship's inhabitants. The observation, isolation, and
cleansing of the crew and their effects could safely be performed aboard
ship if necessary. The ship should be thoroughly cleansed and disin-
fected, particular attention being given to the quarters of the emigrants
and crew.

AIDS TO QUARANTINE.

In aid of the national quarantines, sanitary inspectors are
appointed by the Marine-Hospital Service at special points of
danger, either in the United States or abroad. Through the
State Department consular notification from foreign ports is
received regularly by mail. or. in emergency, by cable, and the
information thus received, and that received also from home
ports, is communicated, by the Ma line- Hospital Bureau, to all
quarantine authorities and others, by means of a weekly publi-
cation known as the "Abstract of Sanitary Reports."

An important source of information concerning the move-
ments of vessels in every portion of the world is the "Maritime
t Register," published in Xew York. The United States Col-
lectors of Customs are efficient aids, having, by law, the power
of search and detention of vessels, and having exceptional
knowledge of the sanitary condition of the shipping at their
respective ports. The Revenue-Cutter Service, a national coast
patrol, renders efficient aid. and the light-house establishment
and coast survey render valuable assistance in locating and
buoying the anchorages.



INLAND QUARANTINE. 393

Finally, the Marine-Hospital Service, having, besides the
quarantines, the care of the sick of the merchant vessels of the
United States, with 126 physicians stationed at all the larger
and many of the smaller ports, is ready at a moment's notice to
extend indefinitely its quarantine service. To the surgeon-
general of this service, at Washington, are entrusted all national
quarantine matters.

INLAND QUARANTINE.

Under Inland Quarantine will be mentioned The Sanitary
Cordon, Camps of Probation, Railroad Quarantine, Disinfection
Stations, and Inspection Service.

The Sanitary Cordon. — This consists of a line of guards,
military or civil, thrown around a district or locality, either to
protect the same from the surrounding country when infected,
or to protect the surrounding country from the infected district
or locality. When a given locality is infected, and the adjacent
territory is regarded as suspicious, it may be necessary to establish
a double cordon, the first one embracing the whole suspected
territory at its outer edge, the second investing more closely the
well-defined infected locality. After the expiration of a sufficient
time to prove that the area between the cordons is not infected,
or has been cleared of infection, the first cordon may be re-
moved. Hospitals and camps of probation may be necessary
adjuncts to the cordon. The most noted example of the sanitary
cordon is found in the history of the plague epidemic in Russia
in 1878. A colony on the river Volga, called Wetljankaja, with
a population of 1700 inhabitants, became infected with the
Oriental plague, which extended to the neighboring villages. A
military cordon was made to embrace all the infected district.
The inhabitants of the focus of infection, Wetljankaja, were
removed, property appraised for re-imbursement by the govern-
ment, and the village burned. An additional cordon was thrown
around Zarizin, a neighboring commercial city of importance
and terminus of the Russian railway system. The cordons were
maintained several months, and the plague was stamped out.



394 TEXT-ROOK OF HYGIENE.

(See Abstract Sanitary Reports, vol. i [Bulletin's], page 78.)
The sanitary cordon is the customary method of preventing the
spread of epidemic disease in the eastern countries.

In the United States, when yellow fever prevailed in Pen-
sacola in 1882, to the extent of 2200 cases, the navy-yard
reservation, whose boundary-line is within two miles of the city
limit, with a population of about 1500, was successfully guarded
by means of a cordon and non-intercourse.

The following year, 1883, the navy=yard itself was infected,
and a cordon was thrown around it to protect the city of Pen-
sacola, and was maintained for a period of sixty days. This
cordon was under the management of the Surgeon-General of the
Marine -PI ospital Service, aid having been requested of the na-
tional government. The Collector of Customs of Pensacola
was made the agent to execute the orders of the Marine-Hospital
Bureau, and to the president of the local Board of Health was
entrusted the immediate command of the line and guards. The
cordon entirely surrounded the land boundary of the naval
reservation. Its line was four miles in length, one mile of it
through a dense thicket, and was marked by blazed trees and
flags. Forty men were employed as guards, an equal number
being selected from each of the two political parties. Two cap-
tains were appointed, and were obliged to supervise the line
night and day.

The sentinel posts were furnished with tents, and two guards
were allotted to each post, taking alternate watches of four
hours each. A detention or probation camp was established
and placed in charge of a physician, where persons wishing to
leave the reservation were obliged to pass a probationary period
of twenty days. Not more than half a dozen persons were
received in this camp. The government expended about
$20,000 in these restrictive measures, which were entirely suc-
cessful. Not one person got through the cordon line. The
success was due largely to the thorough discipline maintained
by the Collector and the President of the Board of Health.



INLAND QUAKANTINE. 395

Yellow-Fever Cordon in Texas. — In 1882, yellow fever pre-
vailing in Mexico along- the Rio Grande, and in Brownsville,
Texas, a sanitary cordon was established by the Surgeon-General
of the Marine-Hospital Service, on request of the Governor of
the State, extending along the line of the railroad from Corpus
Christi, on the Gulf of Mexico, inland to Laredo, on the Rio
Grande. This line was 180 miles northeast of Brownsville, the
triangular territory thus hemmed in by the cordon on one side,
the Bio Grande on another, and the Gulf on the third, being all
suspected territory, although the fever prevailed in only one
corner of it, viz., in Brownsville. All persons were detained at
least ten days at the cordon before being allowed to pass north-
ward, — a period of probation to insure that no one having the
disease should carry it farther north. As soon as practicable
another cordon was established much nearer to Brownsville,
only 30 miles from it, the line extending from the mouth of the
Sol Colorado, on the Gulf of Mexico, to Santa Maria, on the
Rio Grande. After a time sufficient to prove that .no more
fever prevailed between the two cordons, the first one was
removed. Within the second line, where the fever prevailed,
chiefly in Brownsville, a hospital was established and dispensa-
ries opened for the gratuitous treatment of all applicants.

Upon the Mexican side of the Rio Grande the fever con-
tinued to spread northwardly, and, in order to oppose it, still
another cordon had to be established on the American side of
the river, extending from Santa Maria on the south to Laredo
on the north, a distance of 500 miles. Three hundred guards
well mounted (Texan cow-boys) were employed in this cordon,
and, while the disease was being stamped out in Brownsville,
any further importation from Mexico was thus prevented. In
Mexico the fever continued to spread until the authorities finally
adopted measures similar to the above.

Much violent language has been used concerning the hard-
ships imposed by the sanitary cordon, but in the presence of an
epidemic the authorities who are responsible need to pay more



396 TEXT-BOOK OF HYGIENE.

heed to the efficiency of the cordon than to individual com-
plaints. It should be borne in mind that the sanitary cordon is
not intended to bottle up all the people who are caught within
an infected district. On the contrary, it is intended as a means
of exit to those who will not carry with them contagious disease
to the people beyond.

The cordon, then, imposes simply a period of detention
corresponding to the incubative period of the prevailing disease.
Ample preparation must be made for housing and feeding, in
camps or other quarters, persons awaiting the expiration of the
detention period ; and hospitals must be provided for the treat-
ment of those who develop sickness. Provision must also be
made for the disinfection of suspected baggage.

Camps of Probation. — Camps of probation or detention
should be established with all the precision of arrangement
and regard for site, water, and drainage that pertain to a military
camp. Every effort should be made to make the camp as com-
fortable and cheerful as possible, and to this latter end amuse-
ments and entertainments such as might be suggested by the
campers themselves should be encouraged. Every necessity in
the matter of food, bedding, and the ordinary comforts of life
should be anticipated to prevent any just cause of complaint.
Such a natural division of the inhabitants should be made as
seems desirable at the time, those of equal intelligence and
refinement naturally seeking each other's company. The greatest
concern is to prevent the camp itself from becoming infected.
To this end no baggage should be allowed within the camp
boundary without previous disinfection ; and every refugee
should be examined by a physician before being admitted to the
camp. No one should be received who does not intend to pro-
ceed to an uninfected locality after his probation. In other
words, a camp of probation should not be used as one of
refuge.

The camp must be surrounded by guards to prevent egress
or ingress, excepting through the established .portal. At least



INLAND QUARANTINE. 397

twice or three times in the twenty-four hours all refugees should
be inspected in their quarters, and any case of sickness at once
be isolated and watched until the diagnosis is certain. If the
case is one of the prevailing disease, the patient must be re-
moved immediately to the hospital, which should be at a safe
distance, half a mile or more, from the camp. Before leaving
the camp, each refugee's clothing should be fumigated, and he
should be given a certificate that he has passed the required
period of probation. A clear distinction must be made between
camps of probation and camps of refuge. Camps of refuge are
simply residence camps established to receive the population of
an infected community when it has been determined to depopu-
late the infected district.

Depopulation of a house, a block, a district, or a whole
city, if possible, the people moving into camps, is now recog-
nized as a valuable means of controlling an epidemic ; and
there may be either camps of probation or simply camps of
refuge, or both, according to the requirements of the situation.
Camps of refuge, in connection with depopulation, were sug-
gested by the late Surgeon-General Wood worth, in 1878, and
the measure was practically carried out at Memphis, in 1879,
by the establishment of Camp Mitchell. " But the establish-
ment of a camp to which persons from infected points could go,
be kept under observation a sufficient length of time to demon-
strate they were not infected, have their baggage disinfected,
and be given ' free pratique,' is apparently a new departure in
inland quarantine."

Camp Perry, Fla. — Such was Camp Perry, Florida, de-
scribed by the surgeon in charge, W. H. H. Hutton, in the
Marine-Hospital Service Report for 1889. The site was admir-
ably chosen by Passed- Assistant-Surgeon John Guiteras, upon a
bluff on the south side of St. Mary's River, the dividing line
between Florida and Georgia, about forty miles north of Jack-
sonville, Fla., which city was in the throes of a yellow-fever
epidemic. The camp was opened August 20, 1888. It con-



398 TEXT-BOOK OF HYGIENE.

sisted, in its completed stage, first, of 50 wooden cottages built
elsewhere and transported on cars. Their dimensions were 12
feet by 10, and 10 feet in height, constructed of plain lumber,
with cracks battened, and windows on each side with swinging
shutters. Each held four cots, chairs, and toilet-stand, while
unused clothing was neatly arranged on the rafters above.
Besides the 50 cottages there were a quartermaster and guard-
house, commissary building, dining-room, and kitchen, and
laundry, built of rough lumber; 2 Ducker portable barracks,
each 18 by 35 feet, provided with 12 beds each, and 350 tents,
used principally by the single men, the employes and guards,
and the colored refugees. The camp was laid out and its
military discipline established under the temporary personal
command of Surgeon-General Hamilton. So far as known this
is the first camp of the kind ever established, at least in the
United States. The cottages were arranged in a quadrangle
around a parade-ground two acres in extent, and the tents were
arranged in streets and alleys in the rear of the cottages. The
accommodations were sufficient for 600 people, and extra tents
were on hand so that if required 1000 persons could have been
provided for, or 3000 per month, allowing for only ten days'
detention of each person. Two hundred hospital-tents will
accommodate 1200 people comfortably, according to Surgeon
Hutton, who states that the small A-tents are unsuited for
women and children, but will answer for men or boys. Wire-
mattress cots should be provided. The marine-hospital officer
at Savannah, Ga., was the purchasing agent for the camp, and
promptly forwarded all subsistence supplies on requisition by
mail or telegraph.

Discipline of the Gamp. — On arrival of a train, each pas-
senger was personally examined by a physician!, his health-
certificate scrutinized, and he was made to await the examination
of others. Hand-bags, clothing, and loose wearing-apparel
were left in the baggage-car for disinfection. The refugees were
then marched to the quartermaster's room for registration and



INLAND QUARANTINE.



399



assignment to quarters. On first arrival they were placed in the
southern part of the camp, and in two days, there being no
sickness, were moved forward several cabins, and this progres-
sion was repeated until the time for discharge.

Twelve guards were employed, under the command of a
captain, and were divided into squads of four each. The
schedule was so arranged that each guard was on duty two
hours and off duty four.



A bugler ai


lllOU


need


the


several calls as follows: —


5.30 a.m.,


. Reveille.


6.00 A.M., .








Breakfast, emploj'es.


7.00 A.M., .








Breakfast, guests.


9.00 A.M., .








Surgeon's call and inspection.


12.00 m.,








Dinner, employes.


1.20 p.m.,








Dinner, guests.


4.30 p.m.,








Surgeon's call and inspection.


5.30 p.m.,








Supper, guests.


6.00 p.m.,








. Sapper, employes.


6.30 p.m.,








. Retreat and change of guard.


9.00 p.m.,








. Retiring taps.



The yellow-fever hospital-camp, under the special charge
of Dr. Faget, was located one-half mile from the probation
camp. It consisted of 2 frame buildings, 2 hospital and 12
smaller tents, arranged in a double-crescent shape, the avenue



Online LibraryGeorge H. (George Henry) RohéText-book of hygiene; a comprehensive treatise on the principles and practice of preventive medicine from an American standpoint → online text (page 31 of 39)