the disease in the town, but the chance of infection of outside places from any mishap which may occur is less than if it should happen later.

CLASSES WHO MAY LEAVE.

All who have been certainly not exposed to infection, which we would be able to say of few later, should go without let or hindrance. The others may go (1) directly to points incapable of receiving the infection of yellow fever, generally northern points-high altitudesto remain there indefinitely, or for a time to cover their incubation; (2) to points capable of receiving such infection but through a camp of detention.

By a "camp of detention" is meant any place at which these persons stay unexposed to any infection a sufficient time to cover their period of incubation. No infected article going within.

PEOPLE LEAVING FOR NONINFECTIBLE TERRITORY-POINTS NORTH.

(1) How to get these people through infectible territory to their destination without infecting it is a problem of "traffic," and will be there considered. Before these people are allowed to go north we must be assured that they will remain there to cover the period of incubation of yellow fever, say ten days, or indefinitely, i. e., after frost.

TREATMENT OF BAGGAGE.

Disinfection of baggage is not necessary for such people. If, however, they will return after a time to points South, their baggage must be disinfected on departure. Indeed, if there be any reasonable doubt of their not returning, the burden of proof being on them, disinfection of baggage must be done.

The methods by which the train inspector, on whom this work falls, assures himself (1) that a passenger intends and will stay North indefi initely, and (2) that he will stay ten days and not double back, must be worked out for each particular epidemic, and to a certain extent to each particular road and case. A good man will err by over suspicion and hard rulings.

TRAIN INSPECTIONS.

A person leaving New Orleans in 1897 took an affidavit-the stub of which was preserved by the train inspector-that he "would not return to any place quarantined against New Orleans" or that he would not return to quarantining place "for ten days." In the latter case his baggage was disinfected and a certificate of disinfection given him giving the date of his departure from New Orleans, and of course the same date of disinfection and the number and kind of pieces disinfected. A label of thin paper was then pasted on each piece of baggage. The certificate of date of leaving New Orleans had a personal description, and the baggage label was made of thin paper so it could

not well be detached and used over again. It had the name and date on it, and was signed.

It seems best to disinfect all baggage going to remain at points like Atlanta, Charlotte, Nashville, etc., which are great distributing points for railroad travel south, and the only baggage ever sent to any such places undisinfected in 1897 was that of some schoolgirls going to Nashville to a seminary the latter part of October. Indeed, Atlanta required this to save herself from quarantine by the coast cities.

There seems no reason why baggage going north through these places should be disinfected, any more than Havana baggage going by the Ward Line to the same points. Indeed, there is good sanitary reasons for not doing so. Every obstruction, however slight, put in the way of people leaving an infected town to some extent prevents their leaving and to a disproportionate extent induces them to put off leaving if they do leave. We want them to leave early. Again, as before said, no quarantine is perfect, and in proportion as a safe and legitimate way of exit is obstructed the illegitimate ways are sought, which is (especially if sought after the town is well infected) dangerous in the extreme to the territory we seek to protect.

Unless we have been in an epidemic on the inside we fail to realize what slight obstructions prevent people leaving an infected town by the ways provided and induce them, for the purpose of avoiding moderate inconvenience, to take sanitary risks for others which are simply appalling. The rule which should obtain, then, would be to "require everything which is necessary for safety and nothing which is not necessary," throwing, of course, the doubt in favor of stringency.

Arrangements should be made with sanitary inspectors at places to which most of these people go to return South again-Atlanta, Nashville, St. Louis, etc.-so that they can keep some supervision of them and see that they do not leave for the South until their ten days are past. It would not be difficult to arrange for a pretty fair supervision. It will require to be supplemented by a train inspection south from some of these places. This latter has always been put on.

(2) Persons leaving for infectible territory through a detention camp. The method of conducting detention camps in detail will not be described. They require much pains and care in their management. I would again call attention to the sanitary protection they afford to the quarantining places as well as advantage to the infected town by letting its people escape. By providing a safe and allowed means by which people who can not go North can leave the infected town, the effort to evade quarantine restrictions is lessened and the seepage, so to speak, through the cordon is minimized. It is extremely difficult to prevent people evading quarantine who have friends willing to receive them outside, and these are the very people who will go through a camp.

For the same reasons as given for not disinfecting through baggage, the camp should be made as pleasant as possible, and impose no restric10918-23

tions which are not necessary to prevent the conveyance of infection. The writer holds that it should be known that it will not be held open indefinitely, but be closed after a limited time, so that those intending to avail themselves of it should not unduly put off coming to it. The earlier the people come to camp the less fever will develop among them; and while the development of fever at a camp is to be expected, yet it is to be averted as much as possible. It is surprising how little does develop.

WORK IN THE TOWN.

It is no part of this paper to describe the "relief measures" to be taken in the town for the care of the sick, relief of pecuniary distress, etc., only such as appertain to purely hygienic "quarantine" work. They have, consequently, not been considered. They are not the less important.

A modification of the measures of disinfection and isolation heretofore outlined may be of use in lessening the rapidity of spread of the fever even when we no longer hope to suppress it, and I quote from the latter part of a paper read by title at the Mobile Conference, on “House quarantine."

House quarantine during an epidemic.-Here, it seems to me, no elaborate or specially restrictive measures are advisable. Certainly in large towns, and with the epidemic well under way, none are practicable. To attempt too much is to fail and do less than if less were attempted.

The aim should be

(1) To prevent infection of sick premises and to keep the other inmates from developing fever from such infection as we fail to prevent. (2) To prevent unnecessary ingress of people in the sick room, or premises.

(3) To prevent conveyance of infection from sick premises to outsiders. (4) To destroy, as far as possible, the focus (presumably) thus estab lished.

Of these, the first, second, and the fourth are now the most important. (1) The removal of unnecessary fabrics from the sick room, cleanliness, aeration and destruction or disinfection of the discharges are about all that can be done to prevent infection of premises. The isolation of the inmates from the sick room should be advised and the advantage of sleeping in the upper story remembered.

(2) The means which will prevent ingress varies with the respect for the law and the good sense of the community. In some places, as at Montgomery, Ala., an official prohibition and placarding is sufficient, and when this is not it is doubted if the measures which would be are advisable. In general, simply designating the houses and prohibiting entrance is all that to me seems advisable.

(3) Perfection here would be change of clothing, disinfection of hair,

etc., on the part of those leaving the house. Free egress would then be harmless. This can not, in general, be enforced, but the change of clothing should be recommended and ordered and will be followed to a considerable extent, and to that extent do good. There is less risk in even free unconditional egress than is generally believed.

(4) The premises should be disinfected with as much thoroughness as will not lead to such obstructive measures-concealment of casesas would defeat our ends. Burning the certainly infected heavy bedding (soiled mattresses, etc.) and replacing it by new articles is not only good per se, but does much to make disinfection popular, and hence more general and efficient.

It was found last year that the disinfection of the person-required in some towns of all in the house-was more objected to than everything else and, save for the patient, I would not require this and would be satisfied with soap and water for him.

If an epidemic begins early in the season it may well be a question whether even the method here outlined, which works little inconvenience and no hardship, is worth attempting. An epidemic of yellow fever well scattered in a town will be apt to go through it.

The propositions presented for adoption in the above-quoted paper are also reproduced here for adoption.

(1) House quarantine may be an efficient means of suppressing the spread of yellow fever in a city.

(2) It may also be an efficient means of retarding its spread.

If used for the first purpose there being but few cases of yellow fever in the city,

(a) The nonimmune inmates of the patient's house should, if they remain in the city, be moved from that house immediately and kept under observation in an isolated place free from infection.

(b) The patient if not in a suitable place, and it be safe to move him, should be moved to one, and the premises disinfected.

(c) The premises the patient occupies should be under guard, prohibiting ingress and egress of persons, save as absolutely necessary and under sanitary supervision.

(d) Every possible precaution must be taken to prevent infection of his environment by the patient.

(e) Guards must be under sanitary surveillance.

(f) The premises of the patient should be thoroughly disinfected on death or recovery of the patient.

(g) That if the conditions be such that successful concealment of cases be caused by the measures adopted they must be so modified as to avoid this and such restrictions removed and privileges added as may be required.

If used for the second purpose, during an epidemic,

(a) Such precautions as are not too onerous should still be taken to prevent infection of premises of patient and inmates of his home.

(b) Ingress into the infected premises should be discouraged and unnecessary ingress forbidden.

(c) Egress from the infected premises should be freely allowed, with such precautions, as change of clothing, etc., as can be enforced.

(d) The premises should be disinfected on death or recovery of the patient.

(e) These measures are advisable in proportion to the lateness of the

season.

DISINFECTION.

It seems better to put these few points on disinfection of premises by themselves. They really belong on page 73, "Premises," but to insert them there would, I think, break the continuity of the sketch. It is not proposed to give a description of the process, only to call attention to a few points not always noted.

A. The owner must be insured against any loss from disinfection. We must do no injury, or pay for what we do. If this be not done, it may lead to concealment of cases of fever or else to concealment of fabrics especially valued, which thus escape disinfection.

B. Unless the disinfector be experienced, it is well to do as much burning,* wetting and soaking in antiseptic solutions as possible, using gaseous disinfectants as adjuvants.

So.

C. For gaseous disinfection the house must be close or must be made For thick fabrics-cotton quilts, mattresses, pillows, beds, etc.gaseous disinfection can not be depended on, if more than their sur faces be infected.

For the disinfection of these articles steam is required, and, indeed, it is advisable to use this agent for all fabrics where attainable. Boiling, of course, is equally (absolutely) efficient, as soaking in an efficient germicidal solution. The writer would state that his observation leads him to have full faith in the use of sulphur dioxide if properly used; also, it has been his experience that this agent very rarely is properly used outside maritime quarantine stations. He has full faith, also, in the efficiency of the aeration of fabrics.

Prolonged exposure to sun and air, reasonably dry air, will disinfect any ordinary fabric from yellow fever as completely as burning, and if the choice be between gaseous disinfection as usually applied and aeration he would, by all odds, prefer the aeration. Of course the location of the premises is frequently such that aeration of infected fabrics is not possible. The house should be kept open, well ventilated, and dry after disinfection.

*Not a few cases of development of fever has been ascribed to burning infected articles. Whether the current of air caused by the fire carries the agent of infection through the heat, etc., may be a question. If the surface of the pile be pretty thoroughly wetted with coal oil and this fired first, it would seem impossible that infection would be thus spread. The writer has no personal cognizance of any spread from burning infected articles.