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in our successes, and " The Combined Treat-ment " seems to have narrowed this gap.

In addressing the physician I am speaking tohim of certain types of disease, i.e., some diseasesin which his curative measures are not fullysatisfactory, and others for which he has no formof treatment on which he can rely, in other wordshe is baffled. In these types only am I trying tointerest him, and these, of course are limited in away, which could be explained, were one given theopportunity of actual practice.

I should like to mention the following case,though it has reference to the article of June,1925. Since writing that paper, a woman withright sided paralysis and disturbance of speech,due to a cerebral haemorrhage, I was asked to seeas she was suffering from an inflammation of theright eye. I found an infiltration of the lower partof the cornea associated with a mild iritis. Undertreatment the eye was saved, but with a leucomaand an anterior synechia, a result, which I do notconsider satisfactory, though under the circum-stances, I am aware, many would regard it, as a

good one. This case from my point of view wasa fit and proper one for the employment of "TheCombined Treatment. "My opinion is, that had the treatment been

used, the recovery of the eye would have beenmore complete and the cerebral condition wouldhave shown a greater improvement.To draw attention to the extremes of the ages

of the patients to whom it has been administered,it may be mentioned that I have at the presenttime under "The Combined Treatment," a caseof acute sympathetic ophthalmia in a child, fiveyears of age, which is doing well and will ulti-mately recover with normal vision: and anotherchild, six years old with decided nebulous condi-tion of each cornea, very much impairing vision,the result of old keratitis, which under the treat-ment will become clear, restoring good vision: andalso, I treated successfully, some years ago, a caseof cyclo-iritis after cataract extraction in a man,aged eighty-two years.

G. Herbert Burnham, M.D.(Tor.); F.R.C.S., (Ed.)

Toronto, February 7, 1926.

tflen anb 1BookhTHE STORY OF FIFTY-FOUR YEARS'

QUARANTINE SERVICE FROM1866 TO 1920

BY F. MONTIZAMBERT, C.M.G., I.S.O., M.D.,(EDIN.), F.R.C.S.E., D.C.L.

ForewordPrevious to Confederation the protection of the

public health, and especially that afforded by the quar-antine service, was in the hands of the Governments ofUpper and Lower Canada, and under the authority ofthe Quarantine Act, of 1794, and was directed chieflyto quarantine against the entrance of disease from for-eign countries especially through the ports on the St.Lawrence.

Notwithstanding the operation of this measure, therewere in the first half of the nineteenth century severalsharp outbreaks of cholera in the two provinces (1832-34 and in 1849), and of typhus fever (1845-47). Acentral board of health was established in 1849, andbecause of a further outbreak of cholera in 1866 newand more stringent regulations for the protection ofthe public health were adopted. In this year Dr. Fred-erick Montizambert was appointed medical superinten-dent, at the Grosse Isle quarantine station. Here followsthe interesting story of fifty-four years' continuous ser-vice with the Government of Canada, which he has beengood enough to prepare from notes taken at the time.

JOHN W. S. MCCULLOUGH

Quarantine inspection by the Canadian Gov-ernment of incoming vessels was first estab-lished in 1832, when typhus fever was ragingin Europe, and especially in Ireland. Over100,000 immigrants sailed that year but themortality was very heavy on the long journeya.cross and at the detention station at GrosseIsle. Only a skeleton staff was then kept atthis point thirty miles below Quebec: the staffconsisting of one medical superintendent, Dr.Von Iffland, and a few minor officials. Thechief inspection prior to 1866 was carried outat Quebec. In the year 1847 another recurrencetook place of this very fatal epidemic, and ona small monument on Grosse Isle is the follow-ing inscription "In this secluded spot lie themortal remains of 5,425 persons who, fleeingfrom famine and pestilence in Ireland, foundin America but a grave." The other faces ofthe monument record the deaths of several ofthe medical assistants who also died that yearof the dread disease.In 1866, an epidemic of Asiatic cholera de-

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veloped in several countries in Europe, andthe Canadian Government ordered that all in-coming vessels should be stopped and inspectedat Grosse Isle, excepting the mail steamerswhich were to be inspected at Father Pointwhere they took on their pilot. To further thisinspection Dr. Dechene was appointed to at-tend the hospitals at Grosse Isle under Dr. VonIffland who remained there as medical super-intendent. Dr. Montizambert was given chargeof the inspection of incoming steamers at thisstation, and Dr. Taschereau was directed toinspect the mail steamers at Father Point.During the following winter both Dr.

Dechene and Dr. Taschereau died of tuber-culosis. In the following year Dr. Monti-zambert was stationed at Grosse Isle to act asinispector and medical assistant, under Dr. VonIffland as superintendent, and all incomingvessels were directed to be examined at thatstation before they were allowed to proceedup the river. In 1868 Dr. Von Iffland wassuperannuated on account of his advanced ageand infirmities; Dr. Montizambert succeededhim in his position as superintendent and Dr.Patrick Coote was appointed as his assistant. Inthis year there was a slight recurrence of typhusfever, and Dr. Montizambert unfortunatelycontracted the disease but recovered.

Prior to the year 1886 the only means theinspecting officers at Grosse Isle had for reach-ing vessels in the offing was by rowboat. Inthis year, however, a steam yacht, the Hygiea,wras placed at the station for the purpose of as-sisting the inspection and disinfection of ships,and for landing the sick; and in the followingyear the steamship Challenger was added to theservice to assist the Hygiea which had been over-worked and was suitable for day work only. Sup-plementary quarantine regulations were issuedat the same time embodying the following orders:The medical inspection of every vessel arrivingfrom outside of Canadian ports was to be madeby officers responsible to the Government, andthe evidence of ships' masters and surgeons wasto be taken by these government officers underoath. The hours for the inspection of vesselswas lengthened to include any hour of the dayor night. Heretofore inspections had been madeonly between sunrise and sunset. Vaccinationagainst smallpox of all passengers and seamenwas insisted upon; continued precautions with

regard to the importation of rags from infectedcountries was directed to be taken.

These regulations were adopted on the adviceof Dr. Rouch of Chicago, a United States of-ficer who spent some days at Grosse Isle inOctober, 1885, thoroughly inspected the service,and confirmed all the recommendations of Dr.Montizambert.

In 1889, Dr. Montizambert was appointed asmedical superintendent of the whole St. Law-rence quarantine service, and the inspection ser-vice at Rimouski was plaeed completely underhis charge. The new duties entailed amongothers the necessity for the superintendent togo aboard the mail steamers at Rimouski, andinispect thoroughly all immigrants on theirpassage up. Under arrangements made by Dr.Montizambert, uniformity of administrationand method was brought about in all parts of theservice. Furthermore, although all the mailsteamers were not able to be inspected atRimouski on every passage up the river, theirmedical officers never knew on what incomingvoyage the inspecting officer would come off,and accompany them up the river and thor-oughly investigate the condition of the vessel,and the fact as to whether all the incoming pas-sengers were vaccinated. The necessity forthis procedure was shown by the fact that onone of the early inspections the medical officeron board one of the mail steamers signed underoath a written statement that each of the steer-age passengers on board either showed signsof having been vaccinated within seven years,or of having had the smallpox within thatperiod. A personal examination made by Dr.Montizambert after leaving Rimouski showedthat 198 persons were not protected by vaccin-ation as the law required; of these a large pro-portion were adults who made no pretence ofhaving been re-vaccinated since their infancy.Many had never been vaccinated at all. Dur-ing that season 880 persons were vaccinatedbetween Rimouski and Grosse Isle. The effectof this careful inspection and insistence on vac-cination, very much improved the standard ofservice on board these steamers.In 1890 Dr. Coote, who had been acting as

miedical assis:tant for the past three years, wasreplaced by Dr. F. W. Church who provedhimself peculiarly fitted for the office. In thisyear the American Public Health Association

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which met at Charleston, South Carolina,elected Dr. Montizambert as its president forthe ensuing year, as a tribute to his scientificwork in forwarding the cause of effectivequarantine.In 1892 the spread of Asiatic cholera in

Europe, its great prevalence in Hamburg andAntwerp and its appearance at several portsof Great Britain, again led to the enforcementof special quarantine precautions in the St.Lawrence service. The measures taken werecrowned with complete success. No case ofAsiatic cholera occurred in Canada and underthe Act for the prohibition of the importationof rags from infected countries, there werelanded and burnt at quarantine more than 500bales exported from Hamburg to Canada, andwhich might very possibly have carried muchinfection. During this year Dr. Wyatt John-son, the well known pathologist, visited thestation and tested the quarantine methods,and found that the measures employed wereeffective and in every way satisfactory. Asdisinfection at that time was effected by thefumes of sulphur dioxide, the possibility offire arising as the result of such disinfectionwas realized to be possible, and to preventsuch an accident Dr. Montizambert devised aspecial appliance for cooling the fumes as theypassed through the res'ervoir which proved sat-isfactory, and for the success of which he wascongratulated.In 1893 many important improvements were

made at the quarantine station at Grosse Isle.Three steam chambers suitable for disinfectionwere completed and proved of invaluable ser-vice. The needle and rain shower baths placedin special rooms gave entire satisfaction. Therewas also a very comfortable detention buildingerected for the saloon passengers, capable ofholding 124 occupants with steward, cooks, etc.Two of the existing buildings were fitted withrooms for intermediate passengers with accom-modation for 200. An ample supply of waterwas provided from a 50,000 gallon reservoir.With the consent of the Canadian Government,the United States stationed several of theirmarine hospital medical officers at Grosse Isleto inspect buildings and methods.- After a care-ful examination Dr. Banks, their senior medi-cal officer, reported as follows: "The worknow being done by the Dominion Government

is carried on in a most thorough and scientificmanner, and has left no room for criticism."At the Pan-American congress held this yearin Washington in September, Dr. Montizamberthad the honour to be elected as a memberof the International Executive Committee torepresent Canada.

In this year in his report to the Governmenthe commented as follows: "The sanitary out-look continues to be unfavourable. Asiaticcholera exists in many countries in Europe andin many towns throughout England. Howeverthere has been no spread to Canada."

In 1894 the American Public Health Associa-tion held its twenty-second annual meeting inMontreal, and at the close of the meeting manyof the members were taken on an excursion tovisit the St. Lawrence quarantine stations.The general opinion expressed as the result ofthis visit was one of complete satisfaction atall the methods employed. Previous to this in-spection there had been a tendency among ourneighbours to the south of us, and especiallyamong those in the more western states on theoccurrence of any epidemic in Europe to fearan invasion of the disease by way of Canada, andat times very vexatious inspections and delayswere imposed at the frontier, causing obstruc-tions to trade, travel and traffic. This oppor-tunity of showing so many executive officers ofthe United States health organization the char-acter of our quarantine arrangements was a val-uable one, and proved fruitful of good results byshowing our visitors, how carefully we wereprotecting ourselves and in doing so protectingthem, and that through-passengers arriving bythe St. Lawrence might be as freely and as safelyadmitted to the western states as if they hadarrived by New York or Boston.In the autumn of 1899 Dr. Montizambert was

called to Ottawa by the Honourable SydneyFisher (who was then Minister of the Interiorand had charge of public health affairs) andwas directed to open an office in his depart-nient from whence he could control the require-ments of the cquarantine service both in the St.Lawrence and in British Columbia and also.theleper lazaretto at Tracadie. He was at thesame time given the title of Director Generalof Public Health and Sanitary-Adviser to theDominion Government with tle rank of aDeputy Minister which was afterwards con-

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firmed for life by an Act of Parliament in 1905.In July 1900 smallpox broke out in Dawson

City. Dr. Montizambert at once proceededthere and found that the cases were all isolatedon an island at a distance of two and a halfmiles from the) city, and were doing well. Gen-eral vaccination of the community had beenenforced.

In 1901 the Minister of Militia appointed Dr.Montizambert as one of a medical board ofinspection to investigate the cases of illnessthat had occurred on the steamer Montezumaand to report on the advisability of allowingthat vessel to be used as a transport for Can-adian troops sailing for South Africa. Thisboard of inspection consisted of Colonel Mc-Watters representing the Imperial authorities,Lieut-Col. Tobin representing the Militia De-partment, Dr. Farrell general representative,and Dr. Montizambert as representing the Do-minion Government. The steamer sailed shortlyafter the inspection had taken place and per-mission had been granted.

In 1901 owing to the prevalence of a mildform of smallpox prevalent throughout theUnited States, additional protection was givento all points on the border where, from the lackof efficient health organizations the importa-tion of smallpox into this country was to befeared. During the same year, effective meas-ures were taken through the various schoolboard trustees, 700 in number, to insist uponthe vaccination of every child before it wasadmitted to school. This rule was promptlyand willingly accepted, and requisitions pouredin for over 30,000 tubes of smallpox vaccine.

In 1902 as an epidemic of plague existed inmany ports in Europe and South America pre-cautions were ordered to prevent the embarka-tion of any rats at the ports of departureabroad by means of the placing funnels on allhawsers and the careful guarding of the gang-planks; the same measures to be taken at alllanding ports.

In this same year, owing to the very fre-quent interruptions of telegraphic communica-tion with the St. Lawrence quarantine stations,funds were voted for the installation of theMarconi wireless system. In the past almostevery year floating ice had crushed or brokenthe cable greatly interfering with telegraphic

communication and the requirements of incom-ing vessels.

Changes were made also in the quarantinestation in British Columbia which was greatlyimproved. New bathrooms were installed forfirst class passengers. Houses were erected forthe electrician and for the guards, and a rightof way outside the boundary fence was ac-quired. This allowed the guards to watch andpatrol the quarantine boundary on the pro-montory on which the station was placed.

In 1907 an act was passed respecting leprosy,enabling the Government to have control notonly of the leper lazaretto at Tracadie, N. B.,but also of the lazaretto in British Columbia,and indeed generally throughout the Dominionof Canada. At the Tracadie Leper Lazarettocontinued good results followed the internal ad-ministration of chaulmoogra oil and strychnine,and the use of creolin outwardly. The patientsimproved both in health and spirits, the appal-ling darkness of their former hopeless conditionnow lightened and brightened by gleams of hope.One patient, a man of forty, apparently was socured of all symptoms of the disease that Dr.Montizambert felt justified at his last inspec-tion of the lazaretto in approving of his goinghome, on the condition of his reporting himselffrom time to time for examination. He hadbeen in the institution for five years. Previousto his release all the ulcerations on his bodyand limbs had completely healed, and repeatedmicroscopic examinations of mucus from hismouth, throat and nostrils had for some timefailed to reveal the presence of the leprosybacillus.

In 1908 the occurrence of the bubonic plaguein San Francisco and other places in the Stateo:. California, and in Seattle in the State ofWashington, demanded careful watch to pre-vent its introduction into the Dominion. InJune of that year, Dr. Montizambert inspectedall the Pacific coast stations of Vancouver andVictoria and all the neighbouring harbours.Under Dr. Montizambert's orders it was directedthat all boats from Puget Sound and from theOrient should be breasted out six feet from thepiers to prevent rats jumping on and off. Theywere also to have their mooring lines protectedby metal discs. The gangways were to be asfew as possible and were to be guarded byquartermasters, watch and watch about. Ar-

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rangements were also made for the fumigationof boats running a ferry service to the Sound,and Customs officers were directed to call forthe inspection by medical men of all suspectedvessels. Dr. Montizambert also interviewed themanagers of all the railway lines and steamerlines and arranged for medical inspection atall the important points on the border.In 1909 owing to the time which had elapsed

since the last cases of human plague in San Fran-cisco and in Seattle the special inspection of pas-sengers and crews from those ports was removedin October, but the measures for excluding ratsby breasting vessels from the piers and guardingmooring ropes was maintained in force for sometime.

In 1912 as smallpox was epidemic abroad, casesoccurred on incoming vessels. At Grosse Isle itwas found on five vessels.; at William Head onone vessel; at Halifax on three; and at Louis-burg and Sydney, N. S., on one each. In allcasea the disease was stamped out at the quaran-tine station. The epidemic outbreaks of thisdisease in many of the northern states led to theappointment of temporary inspectors on thefrontier.In this same year the Minister advanced the

unorganized maritime quarantine station at Sum-merside, P. E. I., to the position of a full quar-antine station for the inspection of all incomingvessels. The island had this right for federal quar-antine protection against disease from her sisterprovinces of the Dominion as well as from abroad.In the same year, to meet the increase in the

number of mail steamers coming up the St.Lawrence two additional medical officers wereappointed to meet the incoming mail steamersat Rimouski. By this addition every mailsteamer coming up the St. Lawrence was metby a medical officer and a careful detailed in-spection made of the steamer on its way up theriver.At the outbreak of the Great War in 1914

every precaution against disease was taken beforethe first expeditionary force left its home shore.At the camp at Valcartier in Quebec 27,000 menwere inoculated with anti-typhoid serum. Thesame precautions were taken as far as practicablewith all the later forces.

In 1917 the Department of Militia and Defenseannounced that for the twelve months endingDecember -31st 1916, only 167 cases of typhoid

were reported amongst the 450,000 men of theCanadian Expeditionary Force. This compara-tive freedom is most striking when it is recalledthat during the Boer War one man out of everynine in the British Forces was invalided throughthis disease. The Provincial Board of Healthof Ontario supplied all the typhoid and para-typhoid vaccine used by our entire force; in allnearly 600,000 doses were supplied free of cost.

In 1917 on account of the prevalence of Asiaticcholera in India and China, passengers arrivingfrom those countries at William Head, B. C.,were subjected to bacteriological examinationand were not admitted for entry into theDominion until it had been determined by suchexamination that they were not cholera bacilluscarriers. This was continued for several years;1087 bacteriological examinations were made,-but no cholera carrier was found. In 1920 thisexamination was suspended as the threateneddanger had so far passed that it was deemed tobe unnecessary. Similar action was taken at thesame time by the United States station.

Dr. Montizambert concludes his interestinghistory of the Canadian medical service in 1920as follows: Since my appointment on January16th, 1899, as Sanitary Adviser to the DominionGovernment, I have every year included in myannual reports a synopsis of the progress ofinfectious disease throughout the world duringthe year. I have also given a short account ofwhat has been accomplished during that year inthe way of the advancement of Sanitary Science,and of any new measures for the treatment andcontrol of epidemic disease. This portion of myreport was by Order in Council, October 23, 1917,directed to be discontinued.

During the past year, 1919, at the variousstations of the Atlantic and Pacific coasts, 1450vessels from foreign ports were inspected, and277,910 persons carefully examined. Admissionsto hospital for epidemic disease were 576. In theyear previous to the outbreak of the war the num-ber of persons inspected was 706,769. Of thesethe admissions to the hospital were 1,996. Thecontagious diseases met with this year were thefollowing: bubonic plague, smallpox, influenza,pneumonia, enteric fever, mumps, dysentery,spinal meningitis, and leprosy. The deaths inhospital numbered 55. In every instance thedisease was stamped out in quarantine and didnot spread inland.

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Bubonic plague appeared on board the S. S.Bahama hailing from Capetown, Colombo, Ran-goon and Port Said, in all of which places plaguewas reported to exist and it arrived at GrosseIsle via Liverpool on July 13, 1919. The crewnumbered 93, of whom 50 were East Indians.The captain reported three deaths from influ-enza and pneumonia. There were twenty sick onarrival. The greater number of these were suf-fering from influenza, but* amongst those sickthere were found to be four cases of bubonicplague. This was confirmed by bacteriologicalexamination. Of these one man died, and theother three recovered. A supply of anti-plagueserum obtained monthly from the Lister Insti-tute of Preventive Medicine was promptly sentto the station. The vessel's cargo was removedand her holds were disinfected by sulphur fumes,three pounds to the 1,000 cubic feet of space.The vapour was blown in by strong fans. Thisit was hoped would serve for the destruction ofrats on the vessel as well as for disinfection.

Influenza with all its fatal sequele prevailedas an epidemic during that summer and autumn,and gave rise to many admissions and not a fewdeaths at the quarantine station. With the ar-rival of the first cases early in July, as SanitaryAdviser to the Dominion Government, I recom-mended favorable consideration of the advisa-bility of including this form of influenza amongstthe graver forms of quarantinable diseases to behandled at the quarantine stations. This was atonce sanctioned. The United States PublicHealth Service took similar action later on inSeptember. The virulence of this epidemic ofinfluenza may be estimated by the fact that onone steamer sent from Montreal for quarantinetreatment there were eighty-nine cases out of acrew of 177, and on another sixty-four cases outof a crew of ninety-five. Grateful acknowledge-ments were tendered by the MIinister to the med-ical branch of the Department of Militia whokindly lent to the Grosse Isle quarantine stationthe services of six nurses and twelve orderliesduring the height of this epidemic.

In 1920, Dr. Montizambert was superannu-ated, and our readers will be glad to know thatat this date he is enjoying life quietly in retire-ment at Ottawa, and even at his advanced agehas full control of his mental and physical facul-ties.

THE DEATH OF THE DUKE OFRICHMOND FROM HYDROPHOBIA

IN 1820

In view of the present epidemic of rabies incertain parts of the Provinces of Ontario andQuebec the following account of the death ofH. R. H. Duke of Richmond, Governor Generalof Canada, is of historical and some epidemio-logical interest. It has been received throughthe courtesy of Lieutenant-Colonel E. S. Bernardfrom Dr. J. G. Hayes of Richmond.

There is a very good account of the deathof the Duke of Richmond in "Morgan's Sketchesof Celebrated Canadians, ete," published in1862. It is rather too long to transcribe. Thisbook is somewhat rare but may be had in anygood city library. A shorter account containingthe substantial facts may be had in Gale'sHistoric tales of Old Quebec, published in Quebecin 1923 by George Gale. He says:

"It was on the 29th of June 1819 that theDuke of Richmond arrived in Quebec and as-sumed the duties of Governor. While on a visitto the Ottawa district in the following year, hehad an attack of hydrophobia and died on the28th of August, after a brief illness in a loghut in a hamlet known then as Fallowfield, afew miles from Richmond in Upper Canada.His Grace was bitten on the chin by a youngfox, owned by one of the officers of the house-hold in the Castle of St. Louis some monthspreviously while he was caressing the animaland as stated above, hydrophopia followed. Hisremains were brought to this city and interredwith great pomp and ceremony in the AnglicanCathedral. "Hawkins in his "Pictures of Quebec" 1832,

also makes mention of this death. Also in SirJames Lemoine's "Quebec Past and Present."To Charles Gordon Lennox, fourth Duke ofRichmond, Earl of March and Baron of Sit-trington in the Peerage of England; Duke ofLennox, Earl of Darnley and Baron Methuenin the Peerage of Scotland, and Duke d 'Aubignyin France, the towns of Richmond, P. Q., andLennoxville owe their names which were appliedto these villages shortly after the Duke's death.

It was the self-same Duke who gave the ballin Brussels on the eve of the Battle of Waterloo,commemorated in Lord Byron's poem, "Therewas a sound of revelry by night."

JOHN HAYES, M.D.