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Flying the Quarantine flag

THE FORGOTTEN OF ELLIS ISLAND
Deaths in Quarantine, 1909-1911

 

A Word to Ship Captains About Quarantine

An Open Letter to Ship Captains (continued)

by L.E. Cofer, Assistant Surgeon General
Public Health Bulletin No. 55, July, 1912
Part 3 of 3


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Yellow Fever

The next disease to take up is yellow fever, or yellow jack. A person catches yellow fever from a mosquito bite. Not from any mosquito which happens along, but from a special kind, a striped black and white fellow called the stegomyia calopus. In order that this mosquito may carry yellow jack he must bite a person who is suffering from yellow fever during the first three days of his illness, but after the mosquito bites the sick man, 12 days must go by before this mosquito can give the disease to another person by biting him, but after 12 days and just so long as the mosquito lives, and he may live 154 days, he can spread yellow jack by biting people. The yellow fever mosquito is found nearly everywhere, but especially between 38º north and 38º south latitude. It breeds and lives in houses, on vessels, in water pools, cuspidors, gutters, or in very damp places; for instance, in the keelsons of a vessel.

The eggs are laid on the surface of the water, or on the sides of the containers (tin cans, or other similar things) just above the water line. From the time the eggs are laid until the mosquitoes are hatched out is only about 9 days, and immediately after the birth of the female she is impregnated and 3 or 4 days after this she is ready to lay eggs. As stated above, after the mosquito is hatched out it may live as long as 154 days. The male yellow-fever mosquito does not bite but lives on vegetable and fruit juices. The female, however, must have a feed of blood before laying her eggs. If the female is disturbed while making her blood meal, for example, by being brushed off by the hand, she will fly away only to return to finish her meal. In this way, one female mosquito infected with yellow fever may try several persons in turn in order to finish her blood meal, and thereby may infect several members of a ship's company and produce several cases of yellow fever.

Yellow fever is not carried by such things as clothes, and therefore no attention need be paid to such articles save to rid them of mosquitoes. The yellow-fever mosquito will bite at any time during the 24 hours. The idea formerly prevailed that these mosquitoes did not bite in the daytime, and therefore shore liberty was frequently allowed to crews in yellow-fever ports during the day. This, however, is now known to be a dangerous practice for captains of vessels.

Yellow fever is also called yellow jack, sailor's fever, and black vomit.

A person bitten by a yellow-fever mosquito sickens in from 24 hours to 6 days after the bite, and the disease may be divided into three stages. In the first stage, the patient has at first a headache, no appetite, feels exhausted, and perhaps has a chill. This is followed by a high fever with pains in the head, limbs, and back. The attack usually begins at night or in the early morning hours. The patient's pulse is rapid, his face is flushed, his eyes are bright, and there is a desire to vomit. The patient then becomes very restless, is anxious, tosses about in his bunk, and is very weak. There is a peculiar odor about him also. This first stage lasts from about 30 hours to 3 or 4 days, and during the latter part of this time his body becomes slightly yellow. The patient may be "out of his head."

The next stage, the second stage, is the one in which the fever goes down and all the bad symptoms above described may suddenly stop and the patient begin to get well, but more frequently in from a few hours to 4 days the patient runs into what is known as the third stage, in which all the bad symptoms described in the first stage come back, but the patient is very much sicker, and his body becomes yellow, even sometimes becomes of a deep mahogany color, and the vomiting of black material commences. His pulse is then very weak, the surface of the body is cold, the patient breathes in jerks, and while his mind remains clear, he may die in this stage from simply being "worn out."

Should a physician be called in the first stage of the disease he will note that as the temperature rises the pulse beats faster at first but later beats very much slower. He will also notice that the urine is very small in amount, very highly colored, and contains albumen.

When the captain of a vessel finds anyone on board suffering from a disease answering the description above given, particularly if said disease occurs in connection with any locality known to be yellow-fever infected, or else thought to be so, the action which the captain should take immediately is as follows:

First. Protect the patient from mosquitoes by the use of a mosquito net, or in the absence of one of these, by carefully screening with fine netting the stateroom or cabin in which he is being treated. This is because in the first three days of yellow fever, mosquitoes become infected by biting patients suffering from the disease.

Second. Muster all hands and kill every mosquito on the ship. Burn 21/2 pounds sulphur, by pot-and-pan method already described, for each 1,000 cubic feet of space, and let the gas remain for two hours. If there is no sulphur on board and it can not be bought, burn ordinary insect powder, 4 pounds to every 1,000 cubic feet of space, for two hours, but when either insect powder or sulphur are used the mosquitoes should be swept up and destroyed as soon as possible, otherwise many of them may come to life. Before attempting to kill mosquitoes all closet doors and drawers should be opened, and all clothes taken out into the sun or light.

After fumigating the vessel in the manner above described, sprinkle a small quantity of kerosene oil on the surface of all water containers which are not kept closed. It is particularly necessary that the water in the bilges of the vessel and also the water in the bottom of the lifeboats should be treated with kerosene oil, and this oiling process must be frequently repeated for the reason that as soon as the vessel enters port a new crop of mosquitoes will come aboard. It is necessary that a continuous warfare be waged against these insects. No mosquitoes—no yellow fever.

Smallpox

Every captain knows what this disease looks like, so there is no need to waste time describing it. Every captain knows that his ship will be quarantined if he has a case of smallpox on board. But not every captain knows that by having his crew vaccinated and by refusing to ship new crew men until they are vaccinated he can protect himself against censure from his owners for exposing his vessel to quarantine from smallpox. A captain can get his crew vaccinated in any American port free of charge by applying to the marine-hospital surgeon in the customhouse. In a foreign port the United States consul can arrange for the crew to be vaccinated at a very small cost, and what does a few dollars amount to when spent to protect a ship's crew from smallpox, and the shipowners from the expense of quarantine.

Ship Fever or Jail Fever

Think of people having fevers known as "ship fever" and "jail fever," and yet this disease occurs on ships and is called typhus fever, and, worse yet, it is carried by lice. Now, a great many people in this world have at one time or another gotten lousy-doctors frequently get lousy by examining or operating upon lousy patients. There is just one thing to say, and that is that as soon as a person finds he has lice on him he should drop everything and proceed to get rid of them. Captains of vessels should pass the word regularly as to whether any of the crew have lice on them. If this be the case the man should apply kerosene oil to the parts of his body infected and should follow this up by frequent washings with soap until all the nits on the body hairs have been removed. Then everything which can be burned should be burned, and whatever is too good to burn should be boiled. The bunks should be swabbed well with kerosene oil, and, if possible, the crews' quarters should be scrubbed down and painted.

When a sailor catches typhus or ship fever he is taken sick in from a few hours to two weeks after the lice bite him. He gets sick suddenly, has a chill, and pains all over him, with a high fever, weak-ness, dizziness, and quivering all over. After the fifth day and up to the seventh day a nasty-looking measly skin disease appears. The skin looks splotchy, and the patient gives off a foul odor. The sickness is very catching, lasts two weeks, and kills many people. It has been known to kill nearly half those having the disease. No lice—no typhus.

Cholera

Every ship captain has heard of cholera, many ship captains have seen people die of it, but no ship captain will willingly let the disease get amongst his passengers and crew if he can help it, but many ship captains may not know just how they can help it or just how they can not.

Pure food, pure water, and cleanliness-no cholera; which means that in a cholera-infected port a captain should keep his crew on board, allow them to eat only food that is served steaming hot, allow them to drink only water that has been boiled, and not to allow any crew man to sit at table without washing his hands. In addition to this a strict guard should be kept against purchasing articles of food or bottled water from bum boats. A ship captain never knows when he is trading out of a cholera-infected port whether or not he has a "cholera carrier" on board.

A cholera carrier is a person who, although he has the cholera, is not sick himself, but he can give cholera to other persons, and the other persons if they catch the cholera from the "cholera carrier" may die of it in a few days. For this reason the ship latrines must be kept clean, all flies and insects must be killed, the food supplies must be kept carefully screened against flies, and every one, especially the cooks and waiters, must be made to wash their hands frequently. Captains of vessels trading in cholera ports should cut out the following warning and paste it up in every room or compartment in the vessel.

WARNING-HOW TO GUARD AGAINST CHOLERA

Cholera CAN BE INTRODUCED INTO THE SYSTEM ONLY THROUGH THE MOUTH. It is caused by microbes too minute to be seen except with a microscope. These microbes are readily killed by heat, and the disease may therefore be successfully fought by the proper use of fire and hot water, which are at the disposal of everyone.

To avoid cholera and prevent its spread, observe the following precautions:

  1. Boil all drinking water and place it while hot in covered vessels. Do not dip up the water when needed, but POUR it into drinking cups; otherwise cholera germs may get into the water from the hands.
  2. Do not touch drinking water or food with the hands unless they have just been washed in water that has been boiled.
  3. Eat only cooked food. Avoid all raw fruits and vegetables. Fruits may be made comparatively safe by dipping them a few seconds into boiling water.
  4. Flies may carry cholera germs on their feet from human excreta to food; therefore to protect it from flies, cover all food immediately after it is cooked.
  5. Boil all water used for diluting milk.
  6. Cook all meats and fish thoroughly so as to heat the same throughout.
  7. Keep kitchen and table dishes thoroughly clean and scald them before using.
  8. Keep the place in which you live and everything pertaining to it clean.
  9. Water closets can be made safe by flushing with fire hose and then with a 5% solution of carbolic acid. When this can not be done dejecta may be buried or thoroughly covered with earth.
  10. Isolate all the sick.
  11. Filth or vomit and the dejecta of the sick should be promptly cleaned, up with boiling water and buried.
  12. Clothes and bedding used by sick persons must be boiled.

Now, captains, ask your owners to back you up in fitting out your ship so at any time you can kill your rats, mosquitoes, and, if there are any on board, your lice.

  1. Burn up all your rubbish, including old ropes and unused timber, cans, paint buckets, etc.
  2. Put your doors and ports in good repair so they can be closed easily and be made tight.
  3. Put your crew to work making canvas hatch and ventilator coverings.
  4. Put half-inch wire mesh plugs in the spaces left between all pipes and the sides of the bulkhead openings through which the pipes pass.
  5. Protect ice boxes and provision lockers from rats by using half-inch wire mesh freely, and raise the lockers from the decks, mounting them upon short legs.
  6. Look after the sheathing in the vessel's hold. Do away with as much of the temporary sheathing as possible, and see that all rat holes in the permanent sheathing are covered up by patches of half-inch wire mesh.

Remember that much of the time required in fumigating a vessel is taken up not in burning the sulphur or pumping in whatever gas is to be used, but in making the holds, cabins, and other compartments of the ship air tight, so that the fumigating gas will get at the rats and mosquitoes.

Lend a hand, captain, to this quarantine business. There's money in it for your owners in the long run.

Source: A Word to Ship Captains About Quarantine: An Open Letter to Ship Captains, by L.E. Cofer, Assistant Surgeon General, Chief, Division of Foreign and Insular Quarantine of the Bureau of the Public Health and Marine-Hospital Service. Treasury Department, Public Health and Marine-Hospital Service of the United States; Public Health Bulletin No. 55, July 1912 [Washington: Government Printing Office, 1912].

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