Carson was one of the few port physicians that left a record of his quarantine philosophy and the administrative procedures he used to manage the inspection and treatment of the world’s deadliest diseases. In 1898, Carson explained the way quarantine procedures were carried out in Boston:
“Previous to 1893 there had been no uniformity in the conduct of the various quarantines. Each formulated its own rules, and carried them out in its own manner. Some were extremely efficient; others, the exact reverse. In that year this country was threatened with cholera, as nearly every continental port was infected. The impending danger being so great, the surgeon-general, M. H. S., called a meeting of all the prominent quarantine officers of the country to confer with regard to the best means of preventing, not only cholera, but the other contagious diseases. As a result of this conference, a set of regulations were made, which were to form a basis for all quarantines. Congress at about the same time authorized the sending of medical men to foreign ports to inspect the passengers and cargoes of vessels bound to this country, and also provided that every vessel bound for this country should have a bill of health from the United States consul, making the captain who failed to comply with this regulation liable to a heavy fine. The bill of health is a very important document to the health officers. It states the name, nationality, and rig of the vessel, the number of passengers, if any, number of crew, source and wholesomeness of food and water supply, number and character of cases of diseases that have occurred during the previous voyage, and, furthermore, the number and character of the quarantinable diseases that have occurred at the port of departure for two weeks previous to the time of sailing.”
Carson was intimately involved in the work of inspecting European immigrants and has given one of the finest first hand accounts of the process as follows:
“From June 1 to November 1 all vessels from ports south of Virginia are inspected, this
latter inspection being necessary to guard against the epidemics of yellow fever that occur from time to time along the Southern coast. The hours for boarding are from sunrise to sunset, and all vessels are boarded with as little delay as possible. Immediately after boarding the vessels, papers are examined, for all practical purposes the manifest, crew-list, and bill of health are all that are necessary.
The captain is then questioned as to whether any sickness or deaths have occurred during the voyage; and, if so, the ship's log is examined, to make out, if possible, their character. If the answers are satisfactory, an inspection is then made of all the quarters; and, by the time this is completed, the crew and passengers (if any) are mustered and ready for examination. For the crew, this examination consists merely in a careful scrutiny of each individual and a careful count to see that none are absent. The steerage passengers are then made to pass in single file before the physician with their vaccination ticket in hand. If any do not have these, they are made to stand to one side; and an examination into the cause of the absence is made. If, after the inspection has been made, everything is found to be in good condition, a certificate to that effect is given, so that the vessel may enter at the custom-house.”
In 1898 when Carson served as Port Physician, the quarantinable diseases, according to the United States regulations, were cholera, yellow fever, typhus, small-pox, leprosy, and bubonic plague. In addition to these Carson removed cases of scarlet fever, chicken-pox, typhoid, and measles. Following U.S. quarantine regulations, Carson could a vessel arriving with any one of the latter diseases, unless there is an epidemic, to depart after the removal of the case, as long as the case has been promptly isolated.
Carson left documentation that confirmed when a vessel arrived with cholera on board or from a port infected with this disease it was immediately sent to an anchorage within the quarantine limits. According to Carson, “all the passengers and crew are removed and bathed, and their clothing and hand luggage sterilized.” Soon thereafter they were allowed to enter the houses of detention. Here they were carefully inspected each day, and no communication is allowed between the various houses. If any cases appeared, they were immediately isolated. At the end of twenty-one days from the last possible chance of infection, if they were well, they were released from quarantine.
According to Carson, “This period covers the incubation of the disease; and, while it seems somewhat long and more or less of a hardship, yet, when we consider the severe financial loss which would follow the paralysis of commerce due to an epidemic of cholera, we take a different view of the matter. After removing the crew and passengers, the vessel receives attention.
It is first rendered mechanically clean, or as nearly so as possible. Then every part of the vessel which can by any possible means have become infected is washed with an acidulated solution of mercuric-chloride, 1 to 8oo. On any parts where mercury would have a bad effect a solution of formalin is used. All bedding, carpets, and fabrics of any kind are sterilized with steam at a temperature of 220 degrees Fahrenheit for thirty minutes. The water tanks are emptied, and washed with a 2 per cent solution of potassium permanganate. After everything has been thoroughly dried, all the saloons and quarters are fumigated with formaldehyde for six hours, a pint of the 40 per cent solution being allowed for every one thousand cubic feet.
For yellow fever the treatment of passengers and vessel is the same as for cholera, except that the detention is but for six days. A vessel having small-pox on board would be allowed to depart after disinfection and fumigation, bathing and sterilization of the baggage. Only those who are sick or who cannot show satisfactory evidence of vaccination are detained.”
5. Accessed online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2474756/pdf/jmassbdph00027-0020.pdf