154 QUARANTINE ment at Lisbon all the year round is with arrivals from Brazil, where yellow fever is endemic. The lazaretto of Lisbon, which is probably the largest and in ordinary times the busiest in the world, is situated on a hill opposite the Belem Tower, 4 miles below the city. The present establishment was erected by the Portuguese Government at a cost of over .200,000. It consists of seven perfectly distinct pavilions standing radially in a semicircle with the convexity to the river. It is managed by an inspector who is under the minister of the interior. Public tenders are invited every year, or every two years, for boarding and lodging the passengers according to their classes on board ship (1st, 2d, and 3d), the contract being given to the lowest bidder. The present prices for board and lodging per diem are about 5s. 6d. 1st class, 3s. 2nd class, and Is. 6d. steerage. The establishment is carried on at a loss to the Government. Quarantine is imposed, as a matter of fact, on all ships, passengers, luggage, and cargo coming from the Brazils. The term varies from five days to seven days, according as the Brazilian port is considered infected or suspected. A bill of health is issued to the captain by the Portugese consul at the port of sailing, which usually bears on it that so many deaths from yellow fever had occurred during the previous eight or ten days. If clean bills of health were issued, the quarantine would be raised ; and this has happened for short periods at rare intervals. During the winter months (December, January, February), when the cold makes a development of the yellow fever virus at Lisbon improbable, if not impossible, the baggage and cargo only are subject to quarantine, the passengers being allowed to go ashore at once with their hand baggage. Throughout the rest of the year all passengers from the Brazils have to go to the lazaretto and stay there the alloted time, their effects being aired, fumigated, or disinfected. If Lisbon be the port of discharge, the cargo from an infected ship will be landed at the lazaret for purification if so directed. There is a schedule of " susceptible articles," which includes cotton, hair, hemp, letters, parcels, and other correspond- ence, hides, fresh meat, wool and linen, skin, feathers, and silk. These articles are fumigated with chlorine ; the in- side of the ship is washed with chloride of lime or other disinfectant. In the case of a mail steamer on her way to England, the passengers and effects for Lisbon are landed at the quarantine grounds, and the vessel proceeds to her destination (Liverpool or Southampton) " in quaran- tine," which means nothing as regards the English ports. This rigorous routine is a concession to the popular recollection of the terrible epidemic of yellow fever in the hot summer of 1857, when there were 19,000 cases in and around Lisbon, with about 6000 deaths, a large proportion being among the well-to-do. The importation was traced to a tainted ship and cargo from Kio. For many years, no cases of yellow fever have developed among the suspected passengers landed ; and in only two or three instances have there been cases among the employe's of the establishment who are occupied with the baggage and merchandise. The Lisbon chamber of commerce is now in favour of a modification of the quarantine law, and of regulations in conformity with the prominent facts of experience namely, that the fever is not started on shore through personal contact, but solely by emanations from a ship's hull, ballast, cargo, or passengers' effects, and that high-class iron steamships are not, in the nature of things, under the same suspicion as old wooden sailing vessels. The quarantine practices of Lisbon are copied faithfully at the Azores, Madeira, and the Cape Verd Islands. For Spain there are two chief quarantine stations or "foul lazarets," one for the Atlantic seaboard at Vigo, and another for the Mediterranean coast at Port Mahon, Minorca. Vessels arriving at Spanish ports with foul bills of health (from Havana, &c., in ordinary times, and from various ports in cholera times) must proceed to one or other of these appointed stations to perform their quaran- tine. A " quarantine of observation," which is usually for six or three days, and is imposed on vessels with clean bills, may be performed at any port. It is a routine maxim of the Madrid board of health that any country, such as the United Kingdom, which does not practise quarantine, is ipso facto suspected when a foreign epidemic is in any part of Europe to which its vessels trade ; and all arrivals from its ports may be subjected to a quaran- tine of observation. This abstract doctrine, which can hardly be approved by responsible medical authority, was acted on for a short time as recently as 1883 and 1884, when cholera was in Egypt and in Provence. Next to Spain and Portugal, Turkey and Greece are the countries in Europe where the old quarantine traditions have most vitality, owing doubtless to their nearness to former seats of plague in the Levant. The lazarets at the Piraeus and in the Dardanelles are considerable establishments, mostly used now in times of cholera. Ships bound inwards for Turkish ports take health- guards on board in the Dardanelles. There are many other lazarets at Mediterranean, Adriatic, and Levantine ports, including Malta and Gibraltar, surviving from the days of the plague, whose machinery is furbished up from time to time when cholera breaks out. 1 For the whole of northern Europe, including the Atlantic seaboard of France, quarantine is now practically obsolete; by Holland it was never seriously practised even for the plague, and by the states bordering on the Baltic it was given up about the same time as it fell into disuse in Great Britain. 2 In Norwegian ports subsequent to 1866 there were 3128 arrivals from countries infected with cholera, on board which 25 cases of cholera were found and 29 cases of cholerine ; but the malady obtained no footing on shore although quarantine was not enforced. In 1873, when cholera was prevalent in several ports of the Baltic and North Seas, there were 550 arrivals at Norwegian ports from infected countries, among which were 12 cases of cholera ; but importation of the epidemic to the shore was prevented simply by inspection and isolation of the sick. In Italian ports, again, 800 vessels were quaran- tined in 1872, in not one of which was any case of cholera found. The immunity of the United Kingdom in 1873 and 1884, notwithstanding the arrival of ships with cholera on board, and even (in 1873) the unobserved land- ing of cholera cases, has been mentioned already. Land Quarantine. A land quarantine on a frontier is still enforced on account of cholera from time to time in southern Europe, e.g., in 1884 by Italy against France at Ventimiglia and Modena and by Spain against France in the passes of the Pyrenees, and in 1885 by Portugal against Spain. The experiment occasionally succeeds. A "sanitary cordon " is the rigorous isolation (by troops) of a pestilence- stricken place from the country around. It is a survival from the times of the plague, and is of no use in cholera. Quarantine or its Substitutes in the Western Hemisphere. Apart from the visitations of cholera now and then, the 1 Sir William Pym, the superintendent-general of quarantine, who visited most of them officially in 1844, narrates a case at Messina which illustrates the abuses that these establishments might be put to : " it is only very lately that the board of health at Messina placed a vessel (the 'Rapid') from England under quarantine, because a report had appeared in the papers of a fever having prevailed at Glasgow, and subjected her to a charge of about 3 per cent, upon the value of her cargo for quarantine fees " (Correspondence respecting the Quarantine Laws, Parl. Paper, 1846, p. 16). 2 The lazaret for all the Baltic states was on the Swedish island of Kanso at the entrance of the C'attegat opposite Gothenburg.
