Substitute for Quarantine in the United Kingdom.— The modern practice is to detain or refuse “pratique” to no ship unless there be a communicable form of sickness on board, or there had been such during the voyage. It is the duty of the officers of customs to question the captain as to the existence of any catching disease among the passengers or ship’s company; if there be any evidence or suspicion of communicable infection, the officers of customs report the same to the port sanitary authorities, who have power to deal with the case under the Public Health Act, and according to an order of the Local Government Board first issued in 1873. The medical officer of health proceeds at once to make an inspection, detaining the ship and all on board only until such time as the inspection can be satisfactorily made, the sick removed to hospital, and disinfectants applied. This practice was adopted with success in the case of several arrivals from Baltic and North Sea ports with cholera on board in 1873, no extension of the disease on shore ensuing, and again in 1884 in the case of a troopship arrived at Portsmouth direct from Bombay, and of at least two arrivals (at Liverpool and Cardiff) from Marseilles, with cholera on board. It is also adopted from time to time on account of small-pox cases, and of other catching importations at the discretion of the port sanitary authority.

The last importation of yellow fever into the United Kingdom was at Swansea in September 1865, by a wooden vessel with copper ore from St Jago de Cuba. There had been cases of yellow fever on board during the voyage; but at Swansea (as in many other instances) the infection spread rather from the ship’s hull and the unladed cargo than from the crew or their effects, and some fifteen deaths ensued. If such a case were to occur again, it would be dealt with, like any other communicable disease, by the port sanitary authority under the Public Health Act. The yellow-fever incident of 1865 at Swansea is the last occasion on which the sanction of the Quarantine Acts has been appealed to. The privy council merely directed the board of customs to warn the parties implicated of their liability to prosecution, although no prosecution would be instituted. The Quarantine Acts are still unrepealed, but they may be said to have become practically obsolete during the past twenty years.

Quarantine or its Substitutes in other European Countries. —The principle of inspection, and of isolation of the sick, as stated above for the United Kingdom, was accepted with small reservation by the sanitary conference of Vienna in 1874, and it is now more or less consistently acted upon by all the larger European maritime states except Spain and Portugal. In times of cholera panic, quarantine of the original kind has been imposed against all arrivals from an “infected country” by ports of the Levant and Black Sea, and by several Mediterranean states besides Spain. But it is only in the ports of the Iberian Peninsula that the old quarantine traditions remain in force from year to year; and it is only for them that any special account need be given.

The principal occupation of the quarantine establishment at Lisbon all the year round is λvith arrivals from Brazil, where yellow fever is endemic. The lazaretto of Lisbon, which is probably the largest and in ordinary times the busiest in the world, is situated on a hill opposite the Belem Tower, 4 miles below the city. The present establishment was erected by the Portuguese Government at a cost of over £200,000. It consists of seven perfectly distinct pavilions standing radially in a semicircle with the convexity to the river. It is managed by an inspector who is under the minister of the interior. Public tenders are invited every year, or every two years, for boarding and lodging the passengers according to their classes on board ship (1st, 2d, and 3d), the contract being given to the lowest bidder. The present prices for board and lodging per diem are about 5s. 6d. 1st class, 3s. 2nd class, and Is. 6d. steerage. The establishment is carried on at a loss to the Government. Quarantine is imposed, as a matter of fact, on all ships, passengers, luggage, and cargo coming from the Brazils. The term varies from five days to seven days, according as the Brazilian port is considered infected or suspected. A bill of health is issued to the captain by the Portugese consul at the port of sailing, which usually bears on it that so many deaths from yellow fever had occurred during the previous eight or ten days. If clean bills of health were issued, the quarantine would be raised; and this has happened for short periods at rare intervals. During the winter months (December, January, February), when the cold makes a development of the yellow fever virus at Lisbon improbable, if not impossible, the baggage and cargo only are subject to quarantine, the passengers being allowed to go ashore at once with their hand baggage. Throughout the rest of the year all passengers from the Brazils have to go to the lazaretto and stay there the alloted time, their effects being aired, fumigated, or disinfected. If Lisbon be the port of discharge, the cargo from an infected ship will be landed at the lazaret for purification if so directed. There is a schedule of “susceptible articles,” which includes cotton, hair, hemp, letters, parcels, and other correspondence, hides, fresh meat, wool and linen, skin, feathers, and silk. These articles are fumigated with chlorine; the inside of the ship is washed with chloride of lime or other disinfectant. In the case of a mail steamer on her way to England, the passengers and effects for Lisbon are landed at the quarantine grounds, and the vessel proceeds to her destination (Liverpool or Southampton) “in quarantine,” which means nothing as regards the English ports.

This rigorous routine is a concession to the popular recollection of the terrible epidemic of yellow fever in the hot summer of 1857, when there were 19,000 cases in and around Lisbon, with about 6000 deaths, a large proportion being among the well-to-do. The importation was traced to a tainted ship and cargo from Rio. For many years, no cases of yellow fever have developed among the suspected passengers landed; and in only two or three instances have there been cases among the employés of the establishment who are occupied with the baggage and merchandise. The Lisbon chamber of commerce is now in favour of a modification of the quarantine law, and of regulations in conformity with the prominent facts of experience—namely, that the fever is not started on shore through personal contact, but solely by emanations from a ship’s hull, ballast, cargo, or passengers’ effects, and that high-class iron steamships are not, in the nature of things, under the same suspicion as old wooden sailing vessels.

The quarantine practices of Lisbon are copied faithfully at the Azores, Madeira, and the Cape Verd Islands.

For Spain there are two chief quarantine stations or “foul lazarets,” one for the Atlantic seaboard at Vigo, and another for the Mediterranean coast at Port Mahon, Minorca. Vessels arriving at Spanish ports with foul bills of health (from Havana, &c., in ordinary times, and from various ports in cholera times) must proceed to one or other of these appointed stations to perform their quarantine. A “quarantine of observation,” which is usually for six or three days, and is imposed on vessels with clean bills, may be performed at any port. It is a routine maxim of the Madrid board of health that any country, such as the United Kingdom, which does not practise quarantine, is ipso facto suspected when a foreign epidemic is in any part of Europe to which its vessels trade; and all arrivals from its ports may be subjected to a quarantine of observation. This abstract doctrine, which can hardly be approved by responsible medical authority, was acted on for a short time as recently as 1883 and 1884, when cholera was in Egypt and in Provence.

Next to Spain and Portugal, Turkey and Greece are the countries in Europe where the old quarantine traditions have most vitality, owing doubtless to their nearness to former seats of plague in the Levant. The lazarets at the Piraeus and in the Dardanelles are considerable establishments, mostly used now in times of cholera. Ships bound inwards for Turkish ports take healthguards on board in the Dardanelles. There are many other lazarets at Mediterranean, Adriatic, and Levantine ports, including Malta and Gibraltar, surviving from the days of the plague, whose machinery is furbished up from time to time when cholera breaks out. For the whole of northern Europe, including the Atlantic seaboard of France, quarantine is now practically obsolete; by Holland it was never seriously practised even for the plague, and by the states bordering on the Baltic it was given up about the same time as it fell into disuse in Great Britain. In Norwegian ports subsequent to 1866 there were 3128 arrivals from countries infected with cholera, on board which 25 cases of cholera were found and 29 cases of cholerine; but the malady obtained no footing on shore although quarantine was not enforced. In 1873, when cholera was prevalent in several ports of the Baltic and North Seas, there were 550 arrivals at Norwegian ports from infected countries, among which were 12 cases of cholera; but importation of the epidemic to the shore was prevented simply by inspection and isolation of the sick. In Italian ports, again, 800 vessels were quarantined in 1872, in not one of which was any case of cholera found. The immunity of the United Kingdom in 1873 and 1884, notwithstanding the arrival of ships with cholera on board, and even (in 1873) the unobserved landing of cholera cases, has been mentioned already.

Land Quarantine.— A land quarantine on a frontier is still enforced on account of cholera from time to time in southern Europe, e.g., in 1884 by Italy against France at Ventimiglia and Modena and by Spain against France in the passes of the Pyrenees, and in 1885 by Portugal against Spain. The experiment occasionally succeeds. A “sanitary cordon” is the rigorous isolation (by troops) of a pestilence-stricken place from the country around. It is a survival from the times of the plague, and is of no use in cholera.

Quarantine or its Substitutes in the Western Hemisphere. —Apart from the visitations of cholera now and then, the

chief occasion of quarantine on the American continent and adjacent islands is the endemic existence of yellow fever in Brazilian and West Indian harbours, particularly Havana and Rio de Janeiro (and, since 1853, in Callao and other Peruvian ports). During the yellow-fever season from April to November, the ports of the United States are on the outlook, under the quarantine laws of each State, to detain vessels with yellow fever on board arriving from Gulf ports or from the West Indies and Brazil. In like manner the ports of the River Plate would protect themselves against foul arrivals from Brazil; and some of the Mexican Gulf and West Indian harbours will even practise quarantine against each other according as the fever happens to be epidemic here or there. The practice at New York, Boston, Philadelphia, Baltimore, and other United States ports is to detain only the sick, or those who are reasonably suspected, the lazaret (usually on an island in the harbour) being practically a hospital for sailors, immigrants, and other newly-arrived persons suffering from communicable disease. In some years the cases of yellow fever arriving at New York have been numerous, and an epidemic has now and again arisen among the residents near the lazaret. Experience has shown that the ship’s hull, foul ballast, and the like have been the real sources of infection, cases occurring at New York every year among the labourers on infected ships. It is only occasionally that the unlading of the cargo of a yellow-fever ship into the quarantine barges has been insisted on. The classification of ships according as they carry clean or foul bills of health has been found to be practically unworkable in the United States, a foul bill being a rare thing. The severity of the quarantine is left, accordingly, very much to the discretion of the medical officer of the port. According to the definition of the National Board of Health, quarantine is “the administration employed to determine the presence or absence of the causes of contagious or infectious diseases, and to secure the removal or destruction of such causes and it does not imply detention for any specified time, nor for more time than is necessary for the above purposes. Notwithstanding the creation of a National Board of Health for the Federal Union, quarantine is still an affair of the States acting independently. The detection and isolation of small-pox cases is one of the chief occupations of the quarantine officers at United States ports.

As regards the introduction of cholera into the United States, Billings says :—“The present quarantine systems of the United States are now probably unable to prevent the introduction of this disease, as they have been heretofore. Unless the disease had actually occurred on board ship, very little precaution would be taken, and very few of our ports have the necessary facilities for properly dealing with a large passenger ship having cholera on board, in such a manner as to obtain a reasonable amount of security without causing unreasonable delay, involving unnecessary suffering and danger on the part of those not actually sick” (Trans. Internat. Med. Congress, London, 1881, iv. 416).

In several instances, when cholera has broken out among emigrants in a transatlantic steamship, the vessel has put into Halifax, N. S., where there are facilities for quarantining passengers; and more than once the epidemic, although of the most threatening kind, has gone no farther. New Orleans has proved itself a more likely port of entry for cholera than any of the Atlantic ports.

In the ports of South America and the West Indies the quarantine practice is variable and empirical. Sometimes an absolute cordon has been established, as in the instance of Dominica against Guadeloupe in 1865-66 during the cholera. The smaller and healthier the community the more severe is the quarantine likely to be. In the West Indies, the Bermudas, <fcc., the very remarkable disease of dengue (probably a modern hybrid form) is considered to be an importable infection which quarantine can keep out.

Quarantine in the Red Sea and at Suez.— Cholera having come to Europe in 1865 by a new route, by the pilgrim traffic to Mecca, the conference of Constantinople in 1866 took into consideration the question of a quarantine at the Straits of Bab-el-Mandeb. Since that time such a quarantine has been instituted for pilgrim ships at the island of Xamaran on the Arabian side of the Red Sea, some 200 miles within the straits. Since the severe outbreak of cholera at Mecca in the end of 1881, the quarantine for pilgrim ships at Xamaran has become more stringent. The slight outbreak at Mecca in 1882 is said, without good reason, to have arisen owing to three English steamships with pilgrims having evaded that quarantine. All pilgrim ships whatsoever are required to stop at Xamaran, and the pilgrims from cholera-stricken countries in the East are disembarked and kept under observation in the lazarets on the island for ten or fifteen days.

On the dispersal of the hajj at Mecca, another quarantine is performed by the pilgrims returning by way of Suez, who are usually only a small fraction of the whole assemblage. They are disembarked either at Wejh on the Arabian coast half way between Jeddah and Suez, or at Tor on the Sinaitic side of the Gulf of Suez, sometimes even at both places. After the epidemic at Mecca from September to December 1881, it was not until the 19th February 1882 that the last company of pilgrims was allowed to re-embark at Wejh for Suez, by the authority of an inspecting sanitary commission from Egypt. If no suspicious cases occur, the detention is for fourteen days; but a single case subjects the whole group in which it had appeared to a further term of quarantine. Pilgrims bound for Smyrna, Beyrout, or other ports in the Levant are subjected to another term of quarantine in the lazaret of the port of arrival. Those proceeding landwards to Damascus undergo a quarantine at Moses’ Wells.

The usefulness of this control over the movements of the Mecca pilgrims has been much debated. Regarding the advantages of the quarantine after the breaking up of the hajj there has been a good deal of positive evidence since 1865; but the detention at Xamaran is a much more questionable affair. In a great assemblage at Mecca, such as that of 1881, there are all the conditions for the fresh breeding of a choleraic form of sickness, which shall be communicable to others, just as there have often been (in the commonsense view) the elements of its de novo origin under precisely similar circumstances among a multitude of Hindus at Hurd war, or other religious places of resort in India; and the excessive pains taken to exclude hypothetical cases of the communicable disease coming from India, Java, or other endemic centre are disproportionate so long as there is no assurance that the soil of Mecca is not itself about to become a breeding-place of the poison de novo. On the other hand the dispersal from Mecca is obviously an occasion for sanitary precautions.

For the general traffic from the East a quarantine of observation of twenty-four hours is imposed on arrivals at Suez from time to time when cholera is formally declared to be epidemic in Bombay or other Eastern port. Under such circumstances, ships pass through the canal in quarantine, having their canal pilots either on board the ship “in quarantine,” or, under an older and more cumbrous arrangement, navigating the vessel from a steam-launch. In like manner, the coaling at Port Said is done in quarantine, and the mails and passengers landed at Brindisi under the same restrictions and formalities. The question of a more searching quarantine at Suez for the general Eastern traffic has been much discussed in the French Academy of Medicine, and has been taken up more recently at Berlin; but the weight of opinion (led by Μ. de Lesseps) is against any such interference with the quick despatch of vessels, as at once futile and impracticable. During all the years that the canal has been open, cholera has become epidemic in Europe only once owing to direct importation from the East, namely in 1884, when the vehicle was a transport returned from Saigon; and the circumstances in that case were such that a quarantine at Suez, unless it had included the ship’s hull and the personal effects on board, would have made no real difference. On the other hand, transports with recognized cholera on board have on two or three previous occasions been passed through the canal with all despatch, and no harm done on shore either in the isthmus of Suez or at the port of arrival (Portsmouth, Toulon).

Principles of Quarantine. —Plague, yellow fever, and Asiatic cholera are the three great spreading diseases which have been successively the subject of quarantine restrictions.

For many years plague has ceased to have any practical interest in this connexion; the last occasion of alarm in the Mediterranean ports was the outbreak of 1859, at Benghazi, in Tripoli; and at the present date the sole concern is about the land quarantine along the Turko-Persian and Russo-Persian frontiers. It is for yellow fever and Asiatic cholera, therefore, that the principles of quarantine have chiefly to be discussed, the epidemiological principles being somewhat different in the two cases. But one or two remarks have to be made about the theory of preventing the introduction of other communicable diseases.

In the draft of an international bill of health which was adopted by the international sanitary...