Annual report of the Supervising Surgeon-General of the Marine Hospital Service of the United States (Volume 1889) online

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Treasury Department. Marine-Hospital Service.



A:^n^UAL REPORT



OF THE



SUPERVISING SURGEON-GENERAL



OF THE



MARINE-HOSPITAL SERVICE OF THE UNITED STATES



FOR THE



FISCAL YE^Il 1889.



WASHINGTON :

GOVERNMENT PRINTINQ OFFICE.

1889.



Treasury Department,

Docun)ent No. r245.
Marine- Hospital Service.



OPERATIONS



•OF THE



UNITED STATES MARINE-HOSPITAL SERVICE.



18 8 9.



CONTENTS.



Report to the Secretary 9-128

Receipts and expenditures 129-132

The public health 9

The field of the central bureau 9,10

Resolutions of Florida legislature 16, 17

Diagnosis of yellow fever 17-22

Treatment of yellow fever 22-49

Camp Perry 49-52

United States inspection service 52-60

Yellow fever in Tampa, Plant City, and Palmetto 60-76

Yellow fever at Feruandina 76-85

Yellow fever at Gainesville 85-95

Yellow fever at Macclenny 96-99

Observationt on chagres fever 100-103

Quarantine appliances 103

The hygienic laboratory 104, 105

Purveying division 105, 106

Organization of the bureau 106-109

Changes in the Medical Corps 109

National quarantines 109-114

Post epidemic disinfection 114-116

Marine hospitals 116-120

Relief furnished 120-128

Financial statement 129-132

Report on the prevention of yellow fever by inoculation 133-239

Selected cases from hospital practice i... 241-285

Report of surgical operations 286-292

Report of fatal cases with necropsies 295-410

Statistical tables 413-470

7



IlEI>0]RT.



Treasury Department,

Marine-Hospital Bureau,
Washington^ September 1, 1889.
Sir : I have the honor to make the following report of the operations
of the Marine-Hospital Service of the United States for the fiscal year
ended June 30, 18.9, being the ninetieth year of the Service and its six-
teenth annual report.

THE PUBLIC HEALTH.

ITo general epidemic has visited the country since the disappearance
of the yellow fever at Jacksonville and various points in Florida. The
active measures of disinfection practiced have doubtless contributed more
to that result than any one factor. The subsequent establishment of a
State board of health in Florida, with full power ; its rapid organization
and great vigilance, is an important gain to the national defenses
against disease. Under our system of government, it is to the proper
equipment and support of the State boards that we must look for the
greatest advances in raising the standard of the ijublic health within
their territories. 'So central bureau or department can be large enough
to undertake the general municipal sanitary work of the several States,
and if there were no constitutional objections, in practice it would be
an unwieldy and cumbersome machine.

THE FIELD OF THE CENTRAL BUREAU.

The Central Bureau, properly equipped, supported by liberal appro-
priations and empowered by law, can effectually guard against the
introduction of contagious diseases from abroad, by means of informa-
tion from consulates and the proper administration of the quarantines.
The Bureau can effectively aid the State boards on the occasion of
special epidemics, by sending skilled inspectors ; the management of
inland quarantines ; the settlement of the varied and never-ending ques-
tions requiring a well-equipped laboratory and trained expert knowl-

9



10 MARINE -HOSPITAL SERVICE.

edge for their elucidation, and the dissemination of the information ob-
tained from all sources.

The work is thus outlined in a few words, but the labor involved is
vast, and the results can but dimly be foreseen. The venerable Profes-
sor Davis, himself a pioneer in American State Medicine, said at the
last meeting of the American Medical Association that this Bureau has
now become " a health department in all but in name,"* and the ac-
complished secretary of the Tennessee Board of Health, in his address
as chairman of the section on State Medicine, said : t

There is now at Washington nearly all the provision or machinery of a health de-
partment worthy this mighty people, which yet does not satisfy the puhlic demand,
for want of enlargement and co-ordination. A Service nearly a century old, estab-
lished originally as an act of charity to a heedless class, and supported by a tax upon
that class, has, by a singularly interesting process of evolution, expanded into a
Bureau with four exceedingly important drawers. The care of the United States
Marine Hospitals, once its sole function and the cause of its creation, is now only one
ot its duties, a great charity though it be, with a chain of splendid buildings per-
fectly equii^ped and ably managed. All honor to him who conceived the idea of
elevating this service from the low estate into which partisan administration had
reduced it. All honor to those who have changed it from sinecure posts for party
reward to scientific positions for genuine merit.

Last year, iu pursuance with an earnest request from the American Medical Asso-
ciation, Congress greatly enlarged the ability of this Service to take charge of the
maritime quarantine, so that now this, one of the chief functions of a National Health
Bureau, is by common consent placed iu its hands, with funds and powers amply
sufficient for most efficient work. Surely this addendum far outweighs in impor-
tance and esteem its moderate hospital work.

Curiously enough, last year also a threatened epidemic of yellow fever brought a
demand upon the ceutral Government for assistance which could not be refused, in-
asmuch as a contingent fund for just such purposes had been placed to the order of
the President, who could find no other channel through which to extend relief than
this same old seaman's friend. Thus interstate quarantine and aid fell under its
wing. And though this may be a temporary work, yet when occasion does occur for
its performance, in magnitude and importance it dwarfs even maritime quarantine.

A fourth drawer in this nondescript Bureau is the direction of investigations throw-
ing light upon the causes and prevention of diseases, which has been committed to
its charge iu more than one instance by act of Congress during the few years jnst
passed.

Thus it would seem that the United States Marine-Hospital Service has altogether
outgrown its name. It should be styled the United States Public Health Service,
while retaining essentially its present organization. Maritime quarantine, interstate
quarantine and aid, and scientific researches, with its original work, should consti-
tute four separate sub-departments with ample funds and full clerical force. The
head of the whole should be, as now, a Supervising Surgeon-General. This is better
than a Bureau with a political appointee at itg head. The term Service is significant
and it is popular.

THE QUARANTINE CONFERENCE AT MONTGOMERY.

The event of the most importance in the administration of quarantine
matters was the Quarantine Conference held iu Montgomery, Ala., pur-

• Jowrnal American Medical Association, July, 1889.

+ Dr. .T. Berrien Li ndsley. Journal AmcricaB Medical Association, July 13, 1889.



MARINE-HOSPITAL SERVICE. 11

suant to a joint resolution of the general assembly of Alabama. The
following circular, by the accomplished State health officer, Dr. Jerome
Cochran, explains fully its object and purposes :

Quarantiiie Conference. — Circular letter.

This circular letter is specially addressed to the health authorities of the several
States most directly interested iu the protection of the South against invasion of
yellow fever. Copies of it will also be sent to the governors of the several States
referred to, and to the mayors of some of the more important cities, for their informa-
tion and with a view of enlisting intelligent interest in the undertaking herein
explained.

Under a joiat resolution of our general assembly the governor of the State of Ala-
bama has issued to the governors of the States of Texas, Florida, Louisiana, Missis-
sippi, South Carolina, North Carolina, Georgia, Tennessee, Kentucky, and Illinois
invitations to appoint delegates to a Quarantine Conference to be held in the city of
Montgomery, beginning on Tuesdaj', the 5th of March next, and to continue for such
number of days as the business in hand may render necessary.

About two weeks ago Dr. C. P. Wilkinson, president of the board of health of the
State of Louisiana, addressed a circular letter to the health authorities of these same
States, suggesting a similar conference to be held in the city of Jacksonville, Fla, I
have been in correspondence with Dr. Wilkinson, and the assemblage of the proposed
conference in Montgomery meets with his approval.

The object of the conference can not be easily overrated. It is to formulate, in a
way that will command the confidence of the general public and of the civil and
sanitary authorities of the States concerned, and, in the light of our latest experience
and information, the principles and regulations which should govern our Southern
quarantines, and at the same time to arrange such plans for harmony and concert of
action as may seem practicable and desirable.

It is earnestly desired that all of the States included in the invitation shall be rep-
resented in the conference by full delegations of such of their citizens as are best fitted
to discuss the theoretical and practical problems involved in the rational administra-
tion of quarantine in the South. The occasion ought to be made a very memorable
one.

The conference proper will be composed exclusively of the duly accredited dele-
gates of the States ; but other persous interested in quarantine matters will be heart-
ily welcomed to seats on the floor, and to take such part in the discussions as under
the circumstances may seem expedient.

To facilitate the work of the conference, experts believed to be specially qualified
will be requested to formulate in advance for discussion, a series of propositions cover-
ing the subjects of maritime quarantine, railroad quarantine, municipal quarantine,
depopulation of infected towns, refugee camps, panics, stampedes, disinfection, health
certificates, etc.

We desire the assistance and co-operation of all who have had experience in the
management of quarantines, and of all who have studied the progress of epidemics of
yellow fever. Suggestions through the mails will be thankfully received.

All persons receiving this circular letter will confer a favor by acknowledging its
reception, and notifying us what themselves and the communities they represent can
be depended on to contribute to the success of the conference.

Address all communications to

Jekome Cochrax, M. D.,

State Health Officer.

Montgomery, Ala., Januari/ 10, 1889.



12 MARINE- HOSPITAL SERVICE.

The conference was called to order ]\[arcb 5, 1889, by Dr. Cochran,
State bealtli officer, and Dr. C. P. Wilkinson, president of the State
board of health of Louisiana, was elected president.

In regard to notification of diseases, the conference agreed to the fol-
lowing resolution, and on motion the Marine-IIospital Service was in-
cluded in the scheme of inter-state notification :

Resolved, That tbia convention urge upon all health authorities of States represented
in it the importance of strict compliance with the agreement of interstate notifica-
tion adopted by the national conference of State boards of health, and the sanitary
council of the Mississippi Valley, in regard to all commimicahle diseases, and espe-
cially in regard to yellow fever.

The question of the depopulation of a place on the appearance of yel-
low fever was fidly considered, and, on motion of Dr. Seelye, the follow-
ing was adopted as the sense of the conference :

Eesolved, In the beginning of an outbreak of yellow fever there is no need of depop-
ulation at all, except of infected houses or iufect*'d districts; but if people who
are able to afford the expense desire to leave they should do so quietly and delib-
erately, and no obstacles should be placed iu their way ; and those who leave
healthy districts of the city or town should go wherever they please, without let or
hindrance.

Persons living iu infected houses or infected districts should be eucouraged to leave,
but should be allowed to leave only under such restrictions as will afford reasonable
guarantees of safety to the communities in which they find asylum ; and they should
be sent only to such communities as are willing to receive them.

In the depopulation of infected houses or of special infected districts, the in-
habitants should be removed into camps of probation, or into vacant houses iu
the adjacent country. After teu days' detention, if they remain well, and under
proper regulations, such as disinfection of baggage, they should be considered
free from danger, and allowed to go freely into any community willing to receive
them.

The following resolution was also adopted in regard to the national
quarantine stations now managed by the Service as refuge stations
on the Atlantic and Gulf coasts :

The refuge stations as at jiresent operated on the sea-coast of the United States
are, in the opinion of this body, of iufiuite service, and we would recommend their
continuance and full equipment for all requirements.

A motion was made to substitute resolutions favoring the enactment
of a law providing the appointment of a health commissioner, but, on
motion, it was tabled.

Inland quarantines.

The following resolutions were adopted :

A well-digested quarantine formula, making and promulgating the necessary rules
and regulations for enforcing the same, should be prepared, ready to be put iu force,
when necessary to do so, at all points where it is necessary to put quarantine iu
force. These rules should be published for general information, to enable all persons
to comply with the same, and displayed by placard in every depot.

At quarantine stations accommodations should be provided for caring for such



MARINE-HOSPITAL SERVICE 13

persons, if any, as may be detained or are not permitted to pass through such sta-
tions, while in transit, until they can be disposed of.

Only competent physicians, who have had experience with contagious and infec-
tious diseases, should be made inspectors at quarantine stations, whose duty it shall
be to inspect and examine the condition of passengerSj baggage, and express matter.
All inspectors should have the power to administer oaths, and to remove from the
trains and detain at quarantine stations such passengers, baggage, or express mat-
ter, etc., as may be found necessary to prevent the introduction or spread of in-
fectious diseases of any kind.

The following in regard to method of the practice of quarantine was
passed :

Resolved, That this conference indorse the Holt quarantine and disinfection sys-
tem, as at present operated at New Orleans, La., as the best one known for the pre-
vention of the introduction of yellow fever into the ports of the United States, and
recommend its uniform adoption.

The following topic was discussed under the head of

Isolation.

Topic 6. — On the occurrence of a case of yellow fever, what immediate
measures of isolation are desirable ?

Upon motion of Dr. Cochran, the following resolutions were adopted
as the answer to topic 6 :

Eesolved, (1) When one case or a few cases of yellow fever occur in any community,
it does not follow of necessity that the disease must spread and become epidemic.
On the contrary, the experience of many countries through long periods of time shows
conclusively that in the majority of such instances, and without the observance of
any special means of prophylaxis, the disease fails to spread.

(2) When one case or a few cases of yellow fever occur in any community, in the
light of our present knowletlge of the habits and modes of propagation of the disease,
it is generally possible, by the employment of the proper prophylactic measures, to
prevent the development of an epidemic.

(3) The golden rule for the prevention of yellow fever is non-intercourse — isolation —
the keeping of the well away from the sick, away from infected things, and, very es-
pecially, away from infected localities.

(4) In the enforcement of this golden rule of non -intercourse, two problems present
themselves for solution, (a) To keep the people generally from coming into the in-
fected houses and the infected localities; and (&) to keep doctors and nurses and
other attendants, and the well members of sick families, from visiting and mingling
with people outside of the iufected houses and localities. The solution of the first of
these problems is comparatively easy. The solution of the second is sufficiently diffi-
cult. But it is possible to solve them both.

(5) In the densely settled sections of cities guards may be useful for the enforcement
of non-intercourse. They are much less needed in sparsely settled towns. In villages
and country neighborhoods, as a rule, they are not needed at all. In all cases every
intelligent family should be able to take care of itself ; should be able to keep all of
its members away from infected houses and localities, and to guard its own premises
from invasion by dangerous persons and things.

(6) Non-intercourse may be practiced in the very center of an infected district with
considerable probability of escaping the fever. Cloistered convents and prisons in



14 MARINE-HOSPITAL SERVICE.

infected cities, with yellow fever raging all around tbeui, usually escape invasions;
and there are numerous instances on record in which private families in the midst of
epidemics have passed the ordeal safely by the vigorous enforcement of non-inter-
course.

General disinfection.

In regard to general disinfection the following resolution, intro-
duced by Dr. T. Grange Simons, of South Carolina, and Dr. Thomas
F. Wood, of North Carolina, was adopted as the sense of the confer-
ence :

Eesolved, That this conference recommend that all approved methods of disinfection
by means of personal and municipal cleaulii ess, by ventilation, fumigation, chemical
affusion, destruction by fire of all infected or suspected things used during an epi-
demic of yellow fever and until the danger of its spread shall have passed, and that
all fomites should be disinfected after the recovery of the sick.

We recommend as a basis of disinfection the processes as set forth by the commit-
tee on disinfectants of the American Public Health Association.



Miscellaneous resolutions adopted by the conference.

Dr. Wilkinson introduced the following resolution, which was unani-
mously adojited as the sense of the conference :

Resolved, That the Secretary of the Treasury of the United States is hereby requested
to increase the revenue patrol service on the coast of Florida to such extent as may
be necessary to prevent smuggling.

The following resolutions, introduced by Drs. Wood, Foster, and
Hamilton, were adopted :

By Dr. Wood, of North Carolina : Whereas it appears by the report which Dr.
Burgess has made tjthis conference that sanitary inspection of vessels where yellow
fever is endemic is of vital importance ; therefore be it

Resolved, That this conference approves the i^lan of having medical inspectors at-
tached to those consulates where yellow fever and cholera are endemic, with a view
of securing for our protection definite information as to the exact sanitary condition
and the presence or absence of contagions diseases in such consular district, and
that Congress be urged to make the necessary appropriations to carry this plan into
effect.

By Dr. Foster, of Georgia: Resolvid, That the United States Government is hereby
requested, if compatible with international and constitutional law, to enter into
negotiations with Spain with a view of investing the United States sanitary inspect-
ors at Spanish ports with such legal jurisdiction as maj- be necessary for the enforce-
ment of such rules and requirements as are provided.

By Dr. Hamilton: Resolvid, That this conference is of opinion that it is a duty
devolving on all nations to take measures to eradicate any plague centers from
their territory, and that the existence of such plague centers is a menace to all other
nations, and that our State Department be requested to take measures through
proper diplomatic channels for the conveyance of this opinion to the governments
deemed obnoxious to the opinion as herein expressed.*

* This resolution was also adopted at the last meeting of the American Medical
Association, held at Newport.



MARINE-HOSPITAL SERVICE. 15

Eeturn of refugees.

In answer to the question of when refugees may safely return to their
homes after the existence of yellow fever in a place, on motion of Dr.
Hier, of Mississippi, the following was adopted :

After the occurrence of ice.

After the occurrence of three killing frosts.

After the occurrence of no cases of fever for the period of two weeks, and after
thorough disinfection and ventilation of all localities infected and bedding and sucli
other articles as are capable of conveying germs.

Rules for railroad quarantine.

The rules for the government of railroad quarantines, as drawn up
by the special committee appointed for that purpose, are here sub-
joined.

The committee was composed of J. 0. Clark, J. B. Baird, J. R. Porter,
E. S. Starkweather, William Bailey, H. B. Horlbeck, J. E. Black, E.
Eutherfoid, E. F. G-ray, O. E. Early, and 0. M. Smith.

RULES PREPARED BY THE COMMITTEE.

1. Quarantine should not be made against any place until it is officially known
that yellow fever or other infectious or contagious disease exists at such place.

2. Only competent physicians should be put in charge of quarantine stations, and
only thoroughly qualified persons should be employed as inspectors on railway
trains.

3. Quarantine stations located on railroads should be established at convenient
points, on one or both sides of a town or station, as may be deemed necessary.

4. If an epidemic of yellow fever or other infectious or contagious disease exist at
a town or station, trains carrying passengers or freights should be required to pass
through the limits of such towns or stations at a speed of not less 10 miles per hour,
without stopping at such towns or stations, but should stop at the quarantine
station.

5. Passengers to or from such infected point should only be received or delivered
at the quarantins station, under the supervision of the quarantine officer in charge
of the station.

6. Railway tickets may be sold to persons leaving an infected place to any point

willing to receive them.

7. All baggage from any infected point should be properly disinfected,

8. As far as practicable, the same rules proposed for railroads should be applied to
vessels of every kind, stage coaches, or other means of travel.

9. The passage of railroad trains through any point on the line of road, whether
infected or not, should not be prohibited by any quarantine regulations. The con-
ductors of passenger trains should close the windows and ventilators and lock the
doors of cars passing through any place where a train is not permitted to stop.

10. All freight to any infected place should be delivered either at the quarantine
station or the nearest railway station to such infected point, where it can be properly
cared for.

11. All mail matter from any infected place should be properly disinfected by the
United States Government ; and mail matter intended for infected points should be
put off the trains at the quarantine stations. The United States Government should
instruct postmasters to receive and deliver mails at such quarantine stations.



16 MARINE-HOSPITAL SERVICE.

12. Railroads and express companies may receive for transportation from any in-
fected place, during the time such infection exists, any merchandise or traffic con-
signed to places vrilliug to receive it.

13. State authorities should employ competent persons on passenger trains as in-
spectors of passengers, baggage, and express matter, as additional precaution ; but the
fact of inspectors being on such trains should not relieve trains carrying passengers
or express matter or baggage from stopping at quarantine stations for such inspec-
tion as the officer in charge may determine to be necessary.

14. It is recommended that all quarantines, as far as practicable, should be uni-