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The Advertiser
TUESDAY, JUNE 29, 1897.
MEDICAL INSPECTION V.
QUARANTINE.
NEARLY two years ago, commenting on
the excusable failure of medical officers at
Albany and Adelaide to detect on board
the Cuzco a case of smallpox in its early
stages and strongly modified by vaccina
tion, we ventured to question popular
confidence in the efficacy of quarantine
regulations, and to express the opinion
that- ''the whole policy of quarantine is
open to controversy." In this connection
we quoted at some length from a lecture
by Dr. Collingridge, Health Officer at the
Port of Lonaon, declaring quarantine
to be absolutely useless as a pro
tection against disease, add indeed
in some * respects dangerous; un
trustworthy as a means of keeping out
infection, and at the same time one of the
most serious hindrances to commerce
that could possibly he invented. For
years Great Britain has pronounced in
favor of a rational system of medical in
spection, the detention of the flick, the
disinfection and release of the ship and
all persons in good health ; and this lead,
approved by International Sanitary Con
ferences at Dresden and Paris, has been
steadily .followed by other countries.
We admitted that there is another side
to the question. Owing to its insular
'position and great distance from in
fected centres, Australia is 4 no doubt
favorably' situated to obtain the
maximum of advantage from quaran
tine, though the fast passages now
made from India have seriously increased
the risk of disease slipping through the
barriers intended to prevent its entrance.
Bat the mere suggestion, tentative as it
was, that the question of quarantine
might Have more than the one aide to
which our iong experience has habituated
us, appeared to some critics an offence as
unpardonable as speaking disrespectfully
of the equator. Such is the tyranny
which custom exercises over thought,
tending always to force it along conven
tional ruts. Since 1895 farther proofs
have arisen that our quarantine arrange
ments positively -will not do, and thfctat th?
very least there most be reform, since the
cost and inconvenience they involve to
ships and passengers are out of all pro
portion to their exceedingly small value
aa a sanitary precaution. Thirteen years
ago an Intercolonial Sanitary Conference
held at Sydney approved of the principle
of federal quarantine. The merits of that
system, as ; with provincial
quarantine, are that it would enable the
oolonisa $6 anile in employing Jrighfye
skUtod experts to detect disease! put in
,end"ta-th* conflicts of medical opinion
which are attended by the absurd anomaly
that either atone or more -ports persons
have, been improperly allowed to kbdaad
escape control, or at another port pe?ons
areunneeesaarfly andiaaproperlydetained;
allow ships frithcuMof daeawKm board,
diagnosed in a trustworthy muaua, to
land their (rick at the first port, and after
disinfection proceed on their voyage in
quarantine; and so reduce the period of
exposure to infection of &? passengers,
limit 4he aflmber of ootbreaka, shorten
the tern of detention (as quarantine
would date from the time toe ehip left the
firetportof call), and in those way* reduce
personal inconvenience commercial
loss, a qusrantfMis adhered to, it has
appeared to us tJiit some each rtform ?
urgently necessary, both tat the due pro
<^BCtiata of the public health and in the
"mtfflta^ti? oE sxm£&. ' - *
In dealing with quoMaDM of *hk kind
the lay j^athorities may reasonably look, to
men of light and leading in the wwfi^ij|
pi^essieto f^,,adr^.and Jgnidance.
Aiwfnm-. unlimited trust has been placed
in scientific opinion as to the value of
v&ocinatacm, and, similarly, public confi
dence in the utility . and necessity of
quarantine .laws' is' largely based on the
sanction given to them, etplioitly or im-
P^^i W the ntedioal profession. 21
the policy is even so msch as doubtful,
there could not be a more suitable
subject for discussion by medical
societies, in order that after full consider
ation a right opinion may be arrived
at, and. then that full publicity
may be given to it with the object of
znouldiAff public opinion and harmonising
legislation with the ripest and best
thought. We are therefore gbd to find
from the last issue of the Auetrateuian
Mtdiad Gazette that Dr. Borthwick con
siders the time opportune far the recon
sideration of this subject from the stand
point of first principles, and that -he
recently read a papfr on it before the
South Australian branch of the
British Medical Association. Dr. Borth
wick takes a deep interest in public
hygiene. He is one of ' the most
progressive medical officers of health
we hare, has distinguished himaalf by
securing the establishment in his munici
pality of the system of notification of in
fectious disease, and is aa authority on
bacteriology. The views of such an
expert, formed after careful study, must
command respectful attention, however
much their boldness and novelty may
shock preconceived ideas. Dr. Borth
wick brashes aside all compromise with
what he evidently regards as an obsolete
and unsound principle. We have in these
colonies "limited quarantine," as Ash
burton Thompson calls it, * bnt Dr.
Borthwick points out that full quaran
tine is impossible, and instead of
seeking for relief by federalising the
system, he throws down the gauntlet
to quarantine altogether. He quotes Dr.
Collingridge to show that the system was
abandoned in England because its theory
is no longer tenable; it has never been
found possible to maintain it absolutely,
and consequently a country is snbjected
to a barbarous, unnecessary, and costly
system without even the satisfaction of
knowing that the experiment is com
plete ; where carried out as strictly as
possible it has not arrested the importa
tion of disease; while sanitation and a
rational system of medical inspection have
proved more efficacious and at the same
time less burdensome. And Dr. Borth
wick asks whether the time has not come
to place ourselves in line with English
practice.
Quarantine is objected to because it
promotes the concealment of disease both
at the infected port and on shipboard.
There is always an unorganised conspiracy
to defeat its objects, and it is, as Sir John
Simon describee it, "an elaborate system
|of leakfoaw." It causes enoanoos ?x
pense, harasses trade, endangers the
health of detained persons, fosters a false
feeling of security which leads to the
neglect of effective sanitary measures,
| and after all is futile. Such is the
general indictment against quarantine.
Dr. Borthwick points out that we do not,
even live up to the theory. Proper pro
vision for carrying it out presupposes a
disinfection staff and proper disinfecting
arrangements for ships and oargo ; these
do not exist, the cargo being subjected
merely to a process of fumigation which
passes for disinfection. Another pre
supposition is the existence of a proper
quarantine station with all necessary
accommodation for patients and passra
gets, with a permanent staff, or one ready
to assume duty at once, and with a
proper equipment for disinfection.
Recent events " tend to show that not
one of these conditions existe on Quaran
tine Island." At great length Dr. Borth
wick describes in detail our experience of
quarantine, and shows how leakage has
occurred in two directions—in the failure
to diagnose certain cases of disease, and
in the failure to trace all the passengers
"after landing. The importation of
disease has not been prevented, for there
are no less than four instances on record
of smallpox getting a foothold on the
mainland. The expense to which the
shipping companies are put is heavy,
amounting to £2,000 and £3,000 for each
vessel quarantined. Finally Dz. Bortb
wick considers whether medical inspec
tion would have shown better results, and
finds an affirmative reply. Describing
the system he says :—
"fc^o^i^ftl inspection, as employed in SBngland,
menu that in each port a medical officer oi
.health is engaged -whose doty it is to trait
every ship on which any case of cholera, yellow
fever, or plague is suspected to ertrt, the cu?
pioidn or fact being derived from the master, or
surgeon, or a Customhouse offioer. CoUingridge
contends th?t it should imply visits by the
M.O.H. to every vessel from foreign ports,
wi*b<*T?minntiop of any case of sickuea* (what
ever its nature) on board, and, if from an
infected port, examination of every person
on board as well The system, further,
at once isolates the eick, Allows the
healthy passengers to go free after
taking their names and destaaations, and de
tains the chip only long enough W> pennitof
the necessary disinfection. Therein thus two
lines of defence:—(l) Hedioal inspection at
the part; and, should this fail, (2) the sanitary
crgsoication of the country generally. Tte
health authorities of the district!! to whiah tbe
liberated passengers are boaniaro notified of
the names and addressee, so that e?oh person
can be kept under observation for '??* given
period, if required. In fact, a ship is treated
as if it were a bouM on ebon, and reliance a
pUaad on Httpeetkm, oompaleaiy ootifiaation,
isolation, difemieetiynj >nd genend sanitary
measures. Tbe einonse involvad is little toote
than is necessary &r cuintaismg the general
sanitary^amiaistratian of Uieoonntry, and u
?ore toan aaanterbaloncvd by iba coo-iater
fereaoe with traded CoDingridg? sums up
thus;—"Such a systel?, ?hUe ia no way
interfering with.trade, affords the ntrooat pro
teotion wbieb is pasgiblft or even dasirable; it
is out a novel experiment; far tbore has baen
amjdfi exjmUDea ?<£ it during the last j$
years, in Eaeland, and its valae has bma
sufficiently dtmo&staited to Jaetffj fawre
t^iance ajion it." . ?. . ?
Dr. Borthwick concludes tint the same
catjsee which led to the abandonment of
quarantiai: in England' are bparat ve
iiere; that eaedieftl inspeodon is
proved to be more efficacious than
quarantine; that ' fisallpox .cannot
be exdoded from this colony—
certainly not by -quarantine And
probabl/ not even by medical in
spection, owing to the increftaing speed
of oopan Steamers and lor other reasons,
jftat in order to prevent the disease
bbfcainulg a wideapWd footing, it u
neeeasary to be prepared for the event,
and that the risk is growing, and can
beat be met by the immediate adoptiOE of
thesyEfcomof meaicalinspeotiou, ?
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