CHAPTER XIX. QUARANTINE. QUARANTINE applies to the detention of ships with cases of infectious diseases on board to the ports in which they are found, to the detention of persons in infected localities, and to the detention of the occupants of a house in which there is a case of infectious disease. The first is commonly spoken of as maritime quarantine, the detention of persons in infected localities as inland quarantine, and the last as house quarantine. Maritime Quarantine.—Maritime quarantine consists of the detention of the infected ship, the isolation of the sick in a special hospital at the quarantine station, the disinfection of the ship and its cargo as well as the clothing and bedding of the well, the detention of all well persons in barracks until after the period of incubation of the particular disease has elapsed and all danger of dissemination has been eliminated. The period of detention, the mode of disinfection, as well as all the other prophylactic measures employed, will depend entirely upon the character of the disease, its period of incubation, and the nature of the ship's cargo. The disinfecting agents commonly employed are superheated steam and formaldehyd. The following States still maintain quarantine stations: Massachusetts, New York, Pennsylvania, Maryland, and Texas. In all the other States having sea, lake, or gulf ports the quarantine regulations are in charge of the Public Health Service of the United States. The United States maintains quarantine stations at the following points: East Port and Portland, Me.; Provi 438 dence, R. I.; Perth Amboy, N. J.; Reedy Island and Delaware Breakwater, Del.; Alexandria and Cape Charles, Va.; Washington, Newbern, and Cape Fear, N. C.; Charleston, Georgetown, Beaufort, and Port Royal, S. C.; Savannah and Brunswick, Ga.; Cumberland Sound, St. John's River, Biscayne Bay, Key West, Punta Rossa, Bocogrande, Tampa Bay, St. Andrew, St. Joseph, Port Inglis, Cedar Keys, St. George's Sound, and Pensacola, Fla.; Fort Morgan, Ala.; Gulf and Pascogoula, Miss.; New Orleans, La.; Laredo, Eagle Pass, and El Paso, Tex.; San Diego, San Pedro, Redondo, Santa Barbara, Port Harford, Monterey, San Francisco, Fort Bragg, and Eureka, Cal.; Columbia River, Florence, Newport, Coos Bay, Ore.; Port Townsend and Port Angles, Wash. Inland Quarantine.-Inland quarantine is employed in times of epidemics confined to certain localities of the country. In the United States this form of quarantine has been frequently applied to localities infected with yellow fever. The prevention of all communication with the locality is sometimes enforced by means of a line of guards surrounding the locality, and hence is frequently spoken of as "shotgun" quarantine. Where important railroad centers are involved in an infected area, this form of quarantine is commonly known as railroad quarantine, and all intercourse with the infected area by rail is stopped. All merchandise and mail coming from the infected area are disinfected whenever traffic is not completely at a standstill. The extension of inland quarantine to interstate commerce and traffic is known as interstate quarantine, and becomes necessary where large areas are infected and there is danger of general dissemination of the infectious. disease. The establishment of definite interstate quarantine regulations by the U. S. Treasury department obviates in large part the confusion which frequently existed during an epidemic of yellow fever, because of the conflicting, and in many instances ridiculous, quar antine regulations formulated by State, county, and municipal authorities. Isolation or House Quarantine. The infectious diseases against which house quarantine is usually employed are small-pox, scarlet fever, diphtheria, cerebrospinal meningitis, cholera, typhus and typhoid fevers, yellow fever, relapsing fever, and leprosy. Plague is now also included in this category. The patient suffering from any of these infectious diseases should be isolated from the rest of the family, preferably in a room on an upper floor of the house. All persons residing in the house are prohibited from attending any school whatsoever, as well as from going to any other places of public assembly. No one is allowed to enter the house during the course of the disease except those in direct charge of the patient, and no one is permitted to visit the sick-room except the physicians and attendants. The house is placarded by the local health authorities with a placard indicating the nature of the disease and the danger of communicating the disease to others. The placard is not removed by the health authorities until after the patient has either recovered or died, and the premises have been thoroughly disinfected. Value of Disinfection and Isolation.—It is impossible to give definite information with regard to the value of disinfection alone, because at the present time it is almost always practised along with isolation. The value of these measures in such a disease as small-pox is well known. In other diseases they are no doubt of equal value. The only figures obtainable which bear directly upon this point are contained in the reports of the State Board of Health of Michigan. In the report for the year 1898 are given some comparative observations made during a number of outbreaks of diphtheria and scarlet fever in that State during the eleven years from 1887 to and including 1898. In some of these outbreaks isolation and disinfection were enforced, in others they were TABLE 1.-Diphtheria.-Exhibiting for the eleven years, 1887-97, the Number of Reported Outbreaks, Cases, and Deaths; also for this eleven-year period the average number of cases and deaths, per outbreak, in all outbreaks in which isolation or disinfection was doubtful; in which both isolation and disinfection were neglected; in which both isolation and disinfection were enforced; and also the number of cases and deaths indicated to have been prevented by isolation and disinfection. Isolation and disinfection, Isolation and disinfection Isolation and disinfection Indicated saving of cases or both, not mentioned, or both neglected. and lives by isolation statements doubtful. and disinfection. All outbreaks. both enforced. Years. Out Out breaks. Cases. Deaths. breaks. Cases. Deaths. breaks. Cases. Deaths. Out Cases. Deaths. 1887 1888 398 2,321 311 1,529 1889 376 561 202 732 190 60 822 195 79 198 3,132 733 58 ΙΟΙ 31 3,292 416 41 478 108 63 98 14 2,398 570 71 902 169 46 70 15 2,862 426 366 1,777 389 79 944 194 70 1892 157 525 3,485 740 323 1893 536 3,133 746 303 1894 2,341 456 52 1,681 362 957 147 105 74 1,020 282 65 159 45 420 2,262 404 202 986 174 56 738 122 81 176 1895 388 2,292 425 178 1,102 209 45 610 1896 119 70 146 405 2,460 432 153 925 165 64 794 142 69 164 1897 464 2,838 497 165 916 137 100 1,366 252 93 225 46 ANN WAN W 33 3,392 666 24 37 3,274 512 28 1,599 351 34,784 7,103 TABLE. II.-Scarlet Fever.-Exhibiting for the eleven years, and for each of the eleven years, 1887-97, the Number of Reported Out breaks, Cases, and Deaths; also for this eleven-year period the average number of cases and deaths, per outbreak, in all outbreaks; in those outbreaks in which isolation or disinfection or both were doubtful; isolation and disinfection both neglected; isolation and disinfection both enforced; and also the number of cases and deaths indicated as having been prevented by isolation and disinfection. 1887 299 1,882 141 190 340 1,838 112 225 955 74 61 417 1,822 123 284 1,455 477 3,054 115 302 1,711 1,200 93 35 32 61 72 1,208 48 52 67 94 1,137 42 II 2,229 176 I 2,718 66 1891 602 4,936 193 380 3,012 91 141 1,704 66 42 107 I 2,342 90 1892 622 5,240 306 377 2,944 188 ΠΟ 1,621 59 97 1893 667 5,219 327 387 3,197 204 124 1,511 157 1894 662 4,349 175 378 2,366 93 104 1,348 42 187 9 4,231 1895 555 2,905 85 275 1,259 42 82 1,139 27 92 162 4,798 98 1896 389 1897 336 1,534 42 1,531 635,310 1,671 488 3,210 152 148 485 15 80 681 16 78 153 1,776 36 52 130 654 21 63 427 17 59 127 5 747 39 Average cases and deaths, per outbreak, for II yrs. 1887-97. 6.58 0.31 5.25 0.31 12.40 0.50 2.24 0.10 |