Quarantine Procedure at The New York Quarantine Station - 1912
Upon the arrival of a non-infected vessel carrying passengers from cholera-infected ports the vessel is boarded, an inspection made, and a most careful history regarding all illness which has occurred during the voyage obtained.
Specimens are obtained from all persons who have been under treatment in the hospital, unless apparent that the ailment could not possibly have any connection with cholera, which are termed "specials." for immediate laboratory examination.
If there has been no sickness among the cabin passengers, and the preliminary examination of the "specials" (which consists in a direct examination of specimens and of the original cultures) proves negative, they are released at once and allowed to land.
By this method every case of illness which has occurred on the voyage is classed as suspicious until proved otherwise.
The procedure before obtaining specimens from the steerage passengers is as follows: Cards are furnished the purser, who is requested to make out one for each passenger according to the manifest, giving the name. age, sex, manifest number, and name of the vessel.
The men and women passengers are then separated, the boys under 12 years of age accompanying their mothers. The hospital or other suitable room is curtained off so that the obtaining of a specimen may be made as private as possible.
The test tubes, with cotton swabs, which have been sterilized, and envelopes are pre pared on shore and taken aboard by the medical officers attached to the laboratory. All being in readiness, the individual passenger presents himself, shows his inspection card, and the special card which has been prepared for him is given him when he enters the room.
The cotton swab, which is moistened by dipping into a sterile tube of peptone solution, is now used in taking the specimen direct from the rectum, and the tube with the swab specimen is placed in the envelope, together with the special card with which the passenger was furnished on entering.
Specimens may be taken by this method from approximately 200 men or 125 women and children in one hour. The envelopes are then brought to the laboratory, where the cards are numbered on being removed from the envelopes with the specimen tubes, and inoculations made into Dunham's peptone media at once, which tubes are given corresponding numbers as those on the cards.
The procedure has been recently modified so that swabs as soon as taken are dropped directly into the peptone tubes, which have been previously numbered, and the corresponding number recorded on the special card of the individual. These original tubes are brought ashore and incubated.
Subcultures are made from the original tubes at the end of six hours, and from these subcultures, six to eight hours old, smears are made, which are stained with carbolfuchsin solution diluted to 10 per cent of the original strength, and examined for vibrio.
Each bacteriologist examines approximately 100 ready-prepared stained specimens in three to four hours. Should a vibrio be found, plates are made on agar, and the colonies studied, and an agglutination test made with specific serum, the macroscopic method being used at 1-200.
This should give an instantaneous reaction if it is cholera. A control with normal serum is always made. All examinations proving negative, the vessel is released. If a carrier is found, the passengers are removed to the detention barracks at Hoffmann Island, where they are segregated into three groups, the carrier being sent to Swinburne Island.
The detains are again examined bacteriologically before the expiration of the five days. The conditions on infected vessels are carefully studied and treated individually.
No particular method of procedure can be given further than that an examination for carriers on the same lines given for non-infected vessels is made of the steerage and crew.
In the experience of practical cholera workers, it seems that this examination could safely be begun 48 hours after the removal of the carrier, as it is believed that the vibrio would make its appearance in the dejecta or lower intestine by that time.
Some objections have been raised to adopting the use of cathartics on board vessels for obtaining stools or dejecta because of the limited toilet accommodations, because of the possible spread of infectious material if present, and because ordinary personal cleanliness might be neglected from frequent action of a cathartic or saline.
More attendants would be required and a careful watch kept over each individual entering the toilet until the specimen is obtained; besides, there might be some delay in obtaining action from the purge.
In favor of the direct method of obtaining specimens it may be said that it is more expeditious in that a specimen can be obtained more rapidly and within a short time after the arrival of the vessel.
It is probably a less satisfactory specimen than that obtained from the stool, yet this can be overcome if the individual is given a purge a day before arrival. An equally good result could be obtained by using the direct swab method immediately after the action of a saline, thereby avoiding the handling of a stool.
Another method is also being tried. A small glass tube open at both ends, containing the swab, has been used for insertion into the rectum in the manner of a speculum, and after introduction the swab passed beyond the tubal end for removal of a specimen.
The result shows a considerably larger amount of material obtained, besides being apparently safer and easier of application. That the direct swab method is efficient has been demonstrated in the results thus far obtained.
Should a vibrio or curved organism be found which in the mixed culture may show on test with specific serum a partial agglutination in a hanging drop, the person is removed into isolation at once pending the further examination of the vibrio.
Thus, if the vibrio on the following day proves to be cholera the contact with the carrier has been shortened and operates further to the advantage of those in detention, shortening their period of observation by about one day, and if it proves negative for cholera, no harm has been done. In general, the practice may be summarized as follows:
Cases of illness occur. ring among the cabin passengers are examined bacteriologically before release of cabin passengers. This practice was applied to all vessels from all European ports this season.
Where a vessel has had a case of cholera aboard, cabin passengers are held until it is determined that no ship infection is present. and that they have not been liable to infection, when they are released at once.
Crews, excepting officers, on infected vessels are examined as a routine measure. Sick members of crews on uninfected vessels are always examined.
All steerage passengers are examined as a routine measure, as required under Department Circular No. 47, July 19, 1911 (vide supra).
In any case where a carrier is found a reexamination is made of all possible contacts, which is initiated before the expiration of five days.
A very important matter in dealing with vessels is the determination of the amount of possible association of one class with another A certain number of vessels carrying immigrants are built especially for the trade.
It is a fairly safe procedure to recognize each class as a unit where infection has occurred among them. This has been recognized in the recent additions to the United States Quarantine Regulations.
Thus, a case of cholera or a carrier found among the firemen or the sailors does not generally affect the steerage, or infection among the steerage does not affect the cabin.
It may be expected that carriers will be found on a vessel upon which a case of cholera has occurred, but it has also been demonstrated that carriers may be found on a vessel arriving with clean history and in good sanitary condition, as occurred on the Duca di Genova.
As stated hereinbefore, vessels carrying - Italian immigrants are required, under the ... laws of Italy, to carry a medical officer of the Italian navy, whose designation is that of Italian royal commissioner. He has no connection with the ship's crew or officers whatever.
His mission is to look after the interests of the immigrants, and to that end he examines into the quantity, quality, and cooking of their food, which he tastes and examines before it is served. He looks after the comforts of the immigrants, cleanliness of their barracks, and the sick who require care and attention.
In the event of any illness developing among any passengers or crew on board the vessel he is informed, and if it is, in his opinion, of an infectious nature, he carries out all preventive measures as to isolation and disinfection.
During the present quarantine season the royal commissioner has, in cases where the diagnosis of cholera was made, or in cases of diarrhea, preserved specimens of the dejecta of such cases, also made cultures from the dejecta or vomit or both, by plating and on agar slants of Dieudonne's media, which he has submitted to the quarantine officer, together with a full history.
In this way cases which have occurred at sea have been confirmed as cases of cholera. In this respect he is of the greatest assistance to the quarantine officer, and if it is found that the measures adopted have been intelligently and effectively carried out, they should be $on weight in the treatment of the vessel.
In addition, during the present quarantine Serrati o o royal commissioner, Dr. M. Serrati, attached to the Italian consulate at New York, has rendered most valuable assistance to the quarantine authorities in obtaining the active interest and cooperation of the officers in his corps and in many other respects in the handling of immigrants subject to examination, which greatly facilitated the work.
"Quarantine Procedure at the New York Quarantine Station," "Operations of the United States Public Health and Marine-Hospital Service," included in the Annual Report of the Surgeon General of the Public Health and Marine-Hospital Service of the United States for the Fiscal Year 1911, Washington: US Government Printing Office, 1912, p. 114-117.