New York 66 66 66 North Carolina 66 Pennsylvania 66 66 66 Texas Brooklyn home for consumptives, St Joseph's hospital, New York Montefiore sanitarium, Bedford. 92 beds. 350 beds. 15 beds. 30 beds. 75 beds. 40 beds. 40 beds. The legislature of New York has also appointed a commission to consider and report on the same subject, and a similar movement is on foot in Michigan. Sir Richard Douglas Powell says of this excellent class of establishments: Their usefulness, however, in my judgment extends far beyond the immediate purpose for which they are proposed. Lessons in self-management are learned by those who sojourn for a time in such sanatoria; habits of self-discipline and attention to hygienic laws are acquired which are of much importance to those afflicted with consumption, and which have a favorable influence on prophylaxis; and these persons when they pass again into the general community become centres of instruction in domestic hygiene. Disinfection. The methods employed for disinfection, after the occurrence of infectious diseases, in the United States, have been very much the same as those in use in the different countries of Europe, specially since the very important investigations of Prof Koch, upon the value of the different substances used for disinfection, were made public. Apparatus for steam disinfection has been introduced in the largest cities for the disinfection of movable material, and similar apparatus is in use in connection with many public institutions, isolation hospitals, and also at the different quarantine stations in sea-port cities. Within the past three years or more the use of formaldehyde, by means of various forms of apparatus, has very largely superseded the use of sulphurous acid for the disinfection of closed apartments. Vaccination. Laws relating to vaccination were first enacted during the first decade of the century, and have been followed by various amendments and limitations from that time till the present. One of the most efficient laws relating to this subject, is that which exists in many of the states, requiring that unvaccinated children shall not be admitted to the public schools.1 While there are compulsory laws in some states, it can not be said with truth that such laws are thoroughly enforced, to the extent of securing the vaccination of the entire population over 2 years of age, as is done, for example, throughout the German empire. The vaccinated portion of the inhabitants of the United States may be estimated at not far from 90% of the whole, and the re-vaccinated portion at probably 50%. But this unvaccinated contingent of 10% (usually composed of children under 5) and the larger percentage of adults who have only submitted to primary vaccination, always affords an opportunity for a rapid spread of an epidemic. The production of vaccine lymph, as well as that of antitoxins, in the United States, is, unfortunately, largely in the hands of private parties, but the tendency in the past 10 years has been very decidedly in the direction of improvement, and antiseptic methods have been introduced, together with new appliances intended to secure the production of a pure and reliable lymph. Glycerinated lymph is largely taking the place of the older forms, and humanized lymph is now but little used. 1) See Wood's reference handbook. v. 7. p. 554. QUARANTINE The measures existing in the United States for preventing the introduction of infectious diseases from other countries into the United States, through its principal sea-ports, are provided chiefly by laws enacted by those states which are on the sea-coast, and by certain statutes of the general government which confer authority for inspection on the marine hospital service, a department of the United States treasury (act of February 15, 1893). By this act the chief official of this department is required to examine the quarantine regulations of state and municipal boards of health, and to cooperate with these authorities in preventing the introduction of disease from abroad, as well as from one state to another (act of March 27, 1890). United States officers in foreign ports are also required to publish regulations for securing the best sanitary condition of vessels, cargoes, passengers and crews departing for the United States. The topics which are treated in the United States quarantine regulations are: The inspection of vessels with the passengers and crews. Diseases quarantinable. These are cholera, yellow fever, small-pox, typhus fever and leprosy1. Requirements at quarantine. Nature of infected vessels; disinfection of vessels and cargoes, and of personal effects of crew and passengers; detention of passengers, and measures to be taken on the Mexican and Canadian frontiers. It is worthy of note, with reference to Asiatic cholera, that notwithstanding its frequent prevalence in transatlantic countries, it has never gained a foothold in the United States since 1873, while, previous to that date, outbreaks had usually followed every great European epidemic. The first instance on record of the enforcement of marine quarantine in the United States, was the detention of a vessel which arrived at Philadelphia, from England, in April 1728. 1) To these may now be added bubonic plague. This ship, the Dorothy, was ordered not to come "nearer than one mile to any of the towns or ports of this province; that the master or owners do not presume to land any goods, passengers, or sailors at Philadelphia without license, under penalty," provided in an act of 1700. The sheriff was required to provide a convenient place, at a distance, for the reception of persons still sick on board, that proper care be taken for their recovery.1 The maintenance of an efficient quarantine is relatively more important in the United States, as compared with other countries, in proportion to the preponderance of the factor of immigration. The necessity, also, of maintaining such quarantine more stringently at the present day than was required in earlier years, is due to a decided change in the quality of the immigration. The total number of immigrants into the United States from 1820 to 1895, inclusive, was 18,480,951, and this number constituted nearly one third of the total increase of the population during the same period. Gen. F. A. Walker in commenting on this subject, in 1896, said: Fifty, even 30 years ago, there was a rightful presumption regarding the average immigrant, that he was among the most enterprising, thrifty, alert, adventurous, and courageous of the community from which he came. It required no small energy, prudence, forethought, and pains to conduct the inquiries relating to his migration, to accumulate the necessary means and to find his way across the Atlantic. To-day the presumption is completely reversed. . . . So much have the rates of railroad fares and ocean passage been reduced, that it is now among the least thrifty and prosperous members of any European community that the emigration agent finds his best recruiting grounds.2 In the 10 years 1841-50, fully 65% of the European immigrants coming to the United States were natives of Great 1) Proceedings of third national quarantine and sanitary convention held at New York city, April 1859. p. 280. 2) Atlantic Monthly, June 1896. |