to the willingness of people to take risks for their neighbors and the rarity of sustained carefulness in the laity, I would in general not advise this. Hence, no egress. Still, there may be circumstances in which this may be allowed. It can be made free from danger by intelligent supervision.

PRECAUTIONS TO BE TAKEN BY ATTENDING PHYSICIANS.

The physician, if not immune, must take precautions not to establish a new focus should he develop the fever, regulating his disposition of himself on the hypothesis that he will develop it. He should especially not sleep at any house in which it would be objectionable for him to develop fever. It seems to me best that he should stay on the premises with the patient. In any case he should wear clothing little liable to convey infection-linen or other smooth clothing, or change it if he goes out. I know this is very seldom necessary, but sometimes it is, and if the patient be regularly attended through his illness, and much time spent in his room, there is a slight indeed, but real, risk of conveying infection in this way. These precautions are recommended only when there are very few patients and every real risk, however slight, is to be avoided.

PREMISES CONSTANTLY UNDER GUARD.

Until these premises are released from observation they must be under guard. This has already been stated. These guards should be immune and precautions taken against the conveyance of possible fomites by them. If immunes are unattainable, the guards must be under closer supervision, as they will be exposed to possible infection. They must sleep in the guard camp, be inspected twice daily, and other precautions taken, lest they establish new foci, if they develop fever. They should be, of course, as little exposed to infection as possible, and it is, indeed, generally nominal.

DISINFECTION OF PREMISES.

The premises of the patient and all things in them, including the patient and attendants, must be disinfected as soon as possible on his death or recovery, using the precautions about the disinfectors previously given.

The writer believes (oral communication from Dr. Tarlton, of Patterson, La.) that yellow fever was thus conveyed to Patterson in 1878, and considers it very probable (oral communication of Dr. Folkes, of Biloxi) that it was thus conveyed in one instance to a house near Biloxi, Miss. In both cases the physicians, believed to have conveyed the disease, had been long in the infected rooms (which were badly infected) and in prolonged intimate contact with the sick, his bed, etc., and indeed under the conditions usual with nurses rather than physicians.

Three instances have come to the writer's notice of foci of infection established by guards.

WHEN DOES CONVALESCENT BECOME INNOCUOUS?

At what time during his sickness or convalescence a patient becomes incapable of infecting his premises I do not know, nor can I find any observations or even opinions on this subject, and yet it is a very practical matter for sanitarians.

DISINFECT NEIGHBORING PREMISES.

The premises adjacent to those of the patient which from propinquity, communication, or direction of wind can reasonably be judged to have received infection are also to be disinfected.

DEPOPULATION.

In addition to these means to prevent infection of premises and, failing this, to isolate them, a most valuable adjunct in suppressing yellow fever, existing under the described conditions, is depopulation of the neighborhood and of the presumptive focus. How far this should be done is implied in the paragraph on aerial transmission of infection; but the wider and more completely (within limits) it is done the better from a sanitary standpoint. Reasonable precautions are to be observed lest new foci be established by some of these people who have been already exposed to infection. (See "Disposition of suspects.")

This depopulation, however, is meant to extend well beyond the distance to which fever may be reasonably expected to be aerially transmitted from the focus, the intention being to render the focus as isolated as possible from people. Indeed, a general depopulation of the town, safely done, is of much aid in suppressing the fever. In general, however, it is scarcely advisable.

DISPOSITION OF SUSPECTS.

Now the inmates of the house of the patient (unless immune to yellow fever) should be removed from the house, all clothing, etc., disinfected, and kept under observation, "quarantined," in a place free from infection and so situated that if any of them 'sickens he may not establish a focus of infection dangerous to the community, i. e., either in locality insusceptible to infection as to northern points, Atlanta (Arbita Springs), etc., or so isolated by distance and guards that its infection will do no harm to others (Camp of Detention). Indeed it is not generally difficult to prevent such a place from becoming infected with yellow fever, if one has charge from the beginning of a suitable place, even if fever develops among the suspects.

These people, if in an infectible locality, should be inspected twice daily until the period of incubation has passed, and if one of them sickens, he must be promptly isolated from the remainder (or better, left where he is and the remainder isolated from him) and measures of disinfection taken. If in noninfectible territory all this is unnecessary.

If it be impossible to remove the inmates to a place of safety (it should never be, save by their own will), they must be quarantined in the house. This is bad-bad for them and bad for the communitybecause there is thus risk of prolonging the existence of the fever in the infected house. Their own risk being optional, they must take it for the safety of the community. Here measures previously inculcated to prevent infection of the house are especially necessary.

It is to be noted that if the case be discovered early-time limits not definitely determined-the premises apparently are not yet capable of communicating infections to persons, and the inmates have not, so far, been exposed to chance of infection. This is a reason for their prompt removal, and the statement one so often hears, "I had as well stay, as I have been here days," should never be allowed to weigh with health officers in allowing these people to ignorantly risk their lives.

Those who have been exposed to infection-not inmates of the patient's house-must also be provided for. If possible they should be sent to noninfectible territory or to an isolated place (Camp of Detention) and kept there under observation during the period of incubation of the disease, due care being taken that they are not exposed to any infection, as by fomities carried in, while isolated.

If neither of these methods are practicable, they must be inspected daily or, if possible, twice daily at their own houses, and measures, as before indicated, taken should they become sick.

There is no theoretical reason why these people may not pursue their ordinary avocations while well, as during the stage of incubation the disease is not transmissible, but there is every reason why they should not sleep away from home (fever very generally developing at night), and, unless they be trustworthy, they had best be kept on their own premises. It is to be noted here how rarely people taken from infected premises and placed in camps, or under the conditions of camp life, develop fever. Whether it be the relief from anxiety or the open-air life, the fact remains that the development of fever among suspects in camp is rare. I know of no definite comparative statistics, but the fact has been remarked by all who have had experience and whose attention has been called to it, that development of fever among people in camp is far less common than among an equal number isolated in their own houses.

Measures of this kind are taken for the purpose of preventing further development of the fever-"to stamp it out." They certainly give a fair chance of success if the early cases are reported. Failing this, they will greatly retard its rapidity of spread and will have done good in proportion to the lateness of the season. Indeed, if the season be very late, it may be advisable, in spite of what will be said presently, to continue these measures or a modification of them even after we have no hope of suppressing the fever by their means, for the purpose of lessening the rapidity of spread of the fever, which is then extremely desirable, being indeed equivalent to an earlier frost.

The stringency with which they should be then administered depends on many conditions, mainly the lateness of the season. A balance is to be struck between the good to be gained and the hardship imposed.

HOUSE QUARANTINE OF NO AVAIL IF MANY CASES ARE CONCEALED.

And here let me also say that the measures above outlined for use prior to an epidemic are recommended where practicable-i. e., when the authority or influence of the health officer is sufficient to carry them out. Should the condition be such, however, that the attempted enforcement of these restrictions leads to the successful concealment of cases they must be modified, as successful concealment of cases takes away all chance of suppressing fever.

Our reliance is then placed on preventing the infection of his environment by the patient and preventing ingress. Above all, the first is important and is to be depended on. The presence of the sanitary inspector and of the trained nurse necessary to carry this out are such boons to the patient that we may be sure that no cases will be concealed on account of these measures, if reasonable tact be used.

Indeed, the aim must be in all cases to make the household with the yellow fever a privileged one, so that it will be to its interest if there be a case among them to have it officially known.

To this end physicians and medicines, delicacies for the patient, and even subsistence for his family free, are wise sanitary measures as well as charities.

Remember, if cases are concealed to any considerable extent our chance of suppressing the fever is lost.

MEASURES NECESSARY WHEN THE FEVER CAN NOT BE SUPPRESSED.

The townspeople are always loth to recognize that this condition exists, but when we find cases arising of which we can not trace the source of infection, when we are unable to efficiently carry out the measures here outlined, or when cases are being successfully concealed we may know that the fever will not be suppressed until it has run its course or cold weather supervenes.

* Obviously it is implied that the state of feeling in the community is to be taken into consideration also. Measures which will be readily agreed to and carried out in good faith in one community will excite violent and unconquerable opposition in another.

The observation of the writer is that, in small towns at least, Americans of English descent will willingly bear any reasonable amount of inconvenience and some hardship if convinced that this is necessary to avert a greater calamity from the rest of the community, whether of their own town or neighboring towns, and if convinced of the reasonableness of the measures to be taken will assist in carrying them out. The case of Jesup, Ga., which closely guarded itself, well illustrates this, as does the "house quarantine" in Franklin, Perkinston, and several towns in north Mississippi. It is paralleled by the history of not a few English towns with the plague. The sense of duty to the community seems to be strong.

ILLICIT COMMUNICATION.

An infected town is a source of danger to its neighbors, no matter what means of quarantine are taken. This is because a certain amount of illicit communication from the town to clean territory will be kept up, no matter what rules and regulations are made. The danger is almost exclusively due to those who leave the town for infectible territory. It is in proportion to the number who thus leave directly and to the proportion of infection in the town, hence to their product. Thus, 100 persons leaving when there is 1 per cent of the town infected conveys the same risk as 10 people if 10 per cent of the town be infected. It is our aim, then, to reduce the number who leave directly for infectible territory to a minimum (and, if possible, have none to leave). But to take such risk of leaving as must be taken rather in the beginning of the fever, when there is little infection, than later, when there is much more, we first take measures to prevent these people leaving directly without sanitary supervision-i. e., establish quarantine, and, second, arrange for their leaving under such conditions as will not convey infection to clean territory.

MAKE LEGITIMATE COMMUNICATION EASY, AS BEST PREVENTIVE OF

ILLICIT.

This allowing some means of egress from the infected town should go hand in hand with the prohibition of unsafe egress, not only on the ground of humanity to the townsfolk but because a legitimate means of egress being provided, the number of attempts to pass the lines in other ways-a certain proportion of such will succeed-is enormously lessened, and the providing of a legitimate means of egress, if safe, is an added safeguard, and an important one, against the infection of clean territory.

While it is scarcely necessary to cite instances of this, many can be given; it is self-evident, certainly to all who have had experience of epidemics and seen the imperfection of the best devised prohibitive measures. On the same principle this means of egress should not be made more difficult than is necessary for safety. We wish to encourage its use; to have it, rather than an "underground railroad" selected by those who would leave.

Depopulation, then, which has long been recommended as a valuable means of lessening the horrors of an epidemic in the interest of the infected town, is not less valuable as a protective measure to the surrounding infectible territory.

EARLY DEPOPULATION SAFER THAN LATE DEPOPULATION.

Stress should be laid on early depopulation. There is then not much infection in town, and not only are people who leave escaping risk to themselves by leaving early and lessening the rapidity of the spread of