its destination it may have on board many persons who are thoroughly inoculated with the contagion, though as yet apparently perfectly well.

Fourth.-Another important fact is the rapidity of ocean transit, which must be taken into consideration in estimating the influences of immigration on the importation and dissemination of small-pox. While the incubation period of small-pox is fourteen days, eight or twelve days is the average period of the voyage of the immigrant vessel arriving at New York, where the greater number of immigrants land. Now, it is a well ascertained fact that the emigrants reach the ports of embarkation commonly several days before the sailing of the ship. During this interval the emigrant families take quarters in the low lodging houses about the docks and wharves in which small-pox is now very prevalent. The result is that the unprotected emigrants become infected, and if they immediately embark they may not only reach the port of destination before the incubation period has passed, but may pass the quarantine in apparently perfect health. And, what is still more important, if such infected immigrants immediately on landing take passage on board the immigrant trains, as vast numbers do, they may reach the most distant settlements before the disease finally develops. It is quite plain that under these circumstances no amount of vigilance in merely searching for the sick can prevent the introduction and wide dissemination of small-pox in this country. And this conclusion has tenfold force when applied to the introduction of small-pox from the Dominion of Canada by means of immigrants.

Fifth--It is a noticeable fact that large numbers of immigrants are found, on inspection, to be unvaccinated. This might be inferred from the fact that such a large proportion of the total number are children. Of the 457,257 immigrants arriving in the year 1880, 87,154, or about one-fifth, were under 15 years of age. It is found also that an intense prejudice exists against vaccination on the part of several nationalities. In several instances compulsory measures have been resorted to at the port of New York to compel the vaccination of unprotected persons who have been exposed to the infection. These immigrants have been known to wash their vaccination wounds immediately after the operation, and in some instances they have been detected having another person, as the mother of a child, suck the wound to remove the virus.

The measures at present adopted and relied on to prevent the introduction and spread of small-pox in the United States by immigrants, are evidently inadequate to meet existing conditions. Our health officials are pursuing the methods of prevention in vogue before the era of steam, ocean and land travel. Thus far at the port of arrival the health officer takes cognizance only of vessels having well marked small-pox cases on board, either in transit or on arrival. In this case the vessel is subjected to cleansing and disinfection, and the passengers are vaccinated and allowed to depart, no further care being taken to insure successful disinfection of baggage, nor of the vaccination of the unprotected. The immigrant trains proceed to their destination, scattering their occupants along the way without further sanitary care or inspection. Wherever the immigrant stops he seeks the low lodging-house, and there the

disease that he has carried in his system from the port of embarkation may first develop itself, and establish a focus of infection which may, and often has of late, involved a whole town in disaster. The first knowledge the local health authorities have of the arrival of the pestilence, is its apparently sudden outbreak. It is evident, not only from our past experience, but from the nature of the case, as developed in the preceding recital of facts, that the methods we are now pursuing will not prevent the introduction of small-pox into the United States, nor control, in any proper sense, its spread. There is every indication that the amount of immigration will not be disminished, and that small-pox will become more and more prevalent abroad. To meet this emergency, it is the duty of this Conference to determine upon a practicable plan of concentrated operations adequate to accomplish the purpose in question. In this view, the following scheme is proposed for consideration:

It is evident we can no longer rely simply on quarantine rule, which secures vaccination only of those on board vessels having had small-pox cases during the voyage. The future rule must be that all immigrants shall give satisfactory evidence of being protected against small-pox before being allowed to land. There are two methods of accomplishing this object:

(1.) The restrictions of quarantine may be so applied as to make it obligatory upon steamship owners to cause a medical inspection of all emigrants when they embark, and vaccination of all persons found unprotected. If this plan were carried out in good faith scarcely an immigrant could reach our ports who would develop small-pox. He could only carry the infection in his baggage. But, if proper sanitary care of the baggage was required, that also could be relieved of infection on the voyage. It is doubtful, however, if these measures could be fully carried into effect without Congressional legislation, and it should be a part of the action of this Conference to secure the insertion of such provisions into the bill pending before Congress regulating immigration as will accomplish the results mentioned.

(2.) The second method is the establishment of medical inspections of all steerage passengers at the ports of arrival in the United States, with power to vaccinate all persons found unprotected. This method can be put into operation at once, by adding to the rules regulating quarantine one requiring the inspection and vaccination of all immigrants found unprotected. In localities or ports where local boards make the rules governing quarantine, this rule could. be at once adopted. Where State legislation is necessary to make the rule, which cannot be attained, the National Board of Health could make the rule and render it effective. Or the National Board of Health could make the rule for the several great immigration ports, and the local officers could enforce it. From the following table it appears that the number of immigrant ports is very few, and can be readily brought under a system of efficient inspection:

Through six ports, it appears that the class of immigrants requiring inspection pass into the United States, viz.: New York, Boston, Philadelphia, Baltimore, Detroit, Huron, and San Francisco. To these, perhaps, should be added Passamaquoddy Bay, Maine, and Minnesota. It is evident that a system of inspection and vaccination, such as here proposed, at the first arrival, must be attended with as little detention as possible. Detention of three days for observation of the results of vaccination, would result in the constant collection of from 20,000 to 30,000 persons in the quarantine of New York. Not only would such detention be unadvisable, owing to the hardship which it would create, but as a sanitary measure those vast hordes should be dispersed as rapidly as possible, and aided, rather than hindered, in their efforts to reach their future homes.

To meet the exigency, which requires future inspection of those vaccinated to verify the results, local inspection stations might be established at proper points along the great thoroughfares which the immigrant trains travel, where but a momentary detention would be required to re-inspect the vaccinated, and when necessary to revaccinate. This inspection would be facilitated if a system of ticketing was followed, which might be arranged as follows: Let the port inspector give to every person found to be protected, a white card, having on it his name, age, nationality, date of inspec tion, and destination; to every person requiring vaccination let him give a red card, indorsed like the other, but giving date of vaccina

tion. The immigrants would see that henceforward they must exhibit those cards when called upon. On inspection at a station those having white cards would be no further noticed, while those having red cards would be inspected as to vaccination. The number of inspection ports would not be large, as the routes of immigrant travel are well established. Buffalo, Pittsburgh, Wheeling, Cincinnati, Cleveland, Chicago, St. Louis, Kansas City, and St. Paul, occur as centers through which most of this travel might be intercepted.

(3.) Within the State where the immigrants disperse for settlement there should be organized by the State Board of Health a system of surveillance which would keep them under observation until they reached their final destination. Such a system need not be complicated nor expensive, for the same tickets would be the means of preserving the identity of the individual. State boards of health have also an important duty to perform in securing vaccination. Through their official position they can exert a powerful influence upon the people by advice, and can organize many methods of bringing every community to feel a due sense of its obligation to adopt this measure of prevention.

(4.) Finally, the local health authorities could maintain, as far as necessary, a certain watchfulness over the immigrant family, in order to discover the first evidence of suspicious sickness.

But a more important duty rests upon the local boards, viz, persistent efforts to secure vaccination of every unprotected person within their jurisdiction. At this time, when there is great popular alarm in regard to small-pox, local boards should use their utmost efforts to make vaccination and revaccination (the only real safeguard against small-pox) universal. Vaccination should not only be offered but urged persistently upon those who neglect it, and restrictive measures, as expulsion from the public schools, should be enforced against those who refuse.

THE RESOLUTIONS.

Resolved, 1. That small-pox is very prevalent in European ports at which emigrants embark for the United States, and, owing to the customary delay of the emigrants at these ports, unprotected persons are liable to, and frequently do, become infected with that disease.

2. That vast numbers of emigrants are unprotected against small-pox infection, and contract the disease just before embarking for the voyage.

3. That ocean transit is now so rapid that a person becoming infected with the smallpox poison may, and often does, reach the ports of the United States, and even, by rapid railroad travel, may locate in Western towns before the disease becomes apparent in the individual.

4. That outbreaks of small-pox in many parts of the United States, and the liability to a wide and constant dissemination of the contagious and infectious material of that disease, by means of the immense number of unprotected immigrants who daily land at our ports and immediately proceed to inland districts by railroad, demands the most energetic measures of health authorities to control the spread of this pestilence, and to exterminate it wherever it makes its appearance in any community.

5. That to accomplish this desirable object there should be concert of action among the several sanitary organizations of the country, viz., National, State, and municipal, and each in its own sphere should use its utmost power to stamp out this disease.

6. That, with a view to give practical effect to the objects of this Conference, we recommend

(A.) That Congress incorporate into the law regulating immigration, a provision requiring protection from small-pox by successful vaccination of all immigrants.

(B.) That the National Board of Health be requested to consider (in accordance with an act to prevent the introduction of contagious or infectious diseases into the United States, approved June 2, 1879,) the propriety of making, promulgating and enforcing rules requiring the inspection, at the port of departure, of immigrants into

this country, and the vaccinnation and revaccination of every immigrant who, upon such inspection, is found unprotected from small-pox. Or, failing in any case, or for any cause, to secure such vaccination or revaccination, to prevent such unprotected persons as may have come from or through any infected district, from taking passage on any ship destined for this country during the period of the incubation of the disease until such time shall have elapsed as shall make it certain that they are not carrying the germs of small-pox in their own persons.

(C.) That notification be sent to the various steamship companies bringing immigrants to the United States, that, unless satisfactory evidence of recent vaccination be furnished (by certificate or otherwise) in the case of each immigrant arriving at any port of the United States, such vessels should be quarantined for a sufficient time to secure the development of all undeveloped cases of small-pox, as well as for the discovery, if possible, of concealed existing cases which have developed during the voyage.

(D.) That local health authorities should, as far as practicable, cause a thorough inspection of immigrants at all distributing points, and the detention at such points of all suffering from small-pox, and also the vaccination by the local authorities, if needed, of all immigrants who arrive at their destination.

(E.) That to meet present emergencies the National Board of Health, by virtue of its power to prevent the introduction of contagious and infectious diseases into the United States, and their spread from one State into another, take such measures as will secure the inspection of every immigrant before landing at the ports of the United States, and of the vaccination of all persons not protected.

(F.) That a committee, consisting of one from each State and local board repreented, be appointed, whose duty it shall be to take such measures as may be found necessary to accomplish the objects of these resolutions.

All of which is respectfully submitted.

C. N. HEWITT, Secretary, State Board of Health, Minnesota.
H. P. STRONG, Secretary, State Board of Health, Wisconsin.
HENRY B. BAKER, Secretary, State Board of Health, Michigan.
O. W. WIGHT, Health Commissioner, Milwaukee, Wis.
OSCAR C. DEWOLF, Health Commissioner, Chicago, Ill.

E. LLOYD HOWARD, President, State Board of Health, Maryland.
R. J. FARQUAHARSON, Secretary, State Board of Health, Iowa.
A. H. BRIGGS, Health Officer, Buffalo, N. Y.

THAD. M. STEVENS, Secretary, State Board of Health, Indiana. JAMES A. STEUART, Health Officer, Baltimore, Md.

STEPHEN SMITH, representing State Board of Health, New York. HOSMER A. JOHNSON, National Board of Health.

JOHN H. RAUCH, Secretary, State Board of Health, Illinois,

Chairman.

The report as read was accepted by the Conference, and, on motion, was adopted.

Dr. Hewitt explained that in his speech of the previous day he had not meant to convey the idea that inter-State quarantine was absolutely impracticable; but still held that it could not be enforced by State or local organizations and would require National legislation.

On motion, the members of the committee above named were appointed as the committee called for by the last clause (F) of the sixth resolution.

The Conference then adjourned sine die.

CONCURRENT action to the foregoing was had by the State Boards of Health of New York, Michigan, Iowa and Illinois-the resolutions of the ILLINOIS STATE BOARD OF HEALTH being given in extenso on page xxii of this volume.