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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 cases— as would defeat our ends. Burning the certainly infected heavy bedcling (soiled mattresses, etc.) and replacing it by new articles is not only good per se, but does much to make disinfection popular, and hence Iraore 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.
(6) 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.
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.
O. For gaseous disinfection the house must be close or must be made so. For thick fabrics-cotton quilts, mattresses, pillows, beds, etc.gaseous disinfection can not be depended on, if more than their surfaces be infected.
For the disinfection of these articles steam is required, and, indeed, it is advisable to use tbis agent for all fabrics where attainable. Boiling, of course, is equally (absolutely) efficient, as soaking in an effi. cient 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.
ID. The premises outside the houses must be made clear of trash— chips, leaves, pieces of board, etc., rotting wood being believed to be an especially bad nidus of infection. The mere wetting of these things as they lay with bichloride solution is not thorough disinfection, the tiraderside seldom being reached by the solution. It is an injury to wet the leaves of living plants with bichloride of *xercury. It kills the leaves, etc., and after a rain has washed the **ichloride off, these dead leaves are a good nidus (culture nudium) for any infection not destroyed, as on the underside of the leaf. It is raot reasonable to believe that the living leaf would serve such an end. E. The thorough wetting of the cleaned ground, ditches, etc., with bichloride solution or covering it with chloride of lime is doubtless efficient, but unquestionably the disinfection of the outside premises by fire is the method of election. This is best done by the Barber asphalt furnace as used by Farrar in New Orleans in 1897, which is fairly manageable. If this machine is not available, ordinary fires built and continued for a considerable time, as done by the writer at Conquests Camp and at Brunswick, Ga., in 1893, is absolutely efficient but far less manageable and more apt to set neighboring structures afire. The introduction of the asphalt furnace by Farrar is a distinct and valuable addition to our disinfecting armamentarium, and indeed is equivalent to giving a new and most efficient “method,” for it renders quite generally applicable a method which was but rarely used by the crude means used in 1893. By watching the houses to the leeward of the disinfected house one can sometimes form a fairly good idea of the efficiency of the work done about the premises, even if the nonimmunes do not return to those disinfected. * F. Disinfection, when we hope to suppress the fever, must be thorough. Everything must yield to this. The evil we seek to avert is too serious to weigh expense, or convenience, or hardship against it. G. When we no longer hope to suppress the fever and use this measure simply to limit or lessen the rapidity of its spread the extent to which it should be carried out depends, as so many other quarantine measures, on the balance between the good to be attained and the cost, including hardship and inconvenience. In general, the fabrics of the sick room and nurses' room and these rooms themselves should at least be disinfected. This, if done by some method not injurious and little annoying—formaldehyde and steam, and scrubbing the floor with bichloride solution—will not make the second factor large, and will, I believe, in a considerable number of instances prevent the further infection of the household. No one who has examined the lists of the sick by houses, as in post-epidemic disinfection, can fail to be impressed with the fact that yellow fever is to a considerable extent a house disease, even during an epidemic.
MEASURES TO BE TAKEN IN A DISTRICT THREATENED BY
By Surg. H. R. CARTER.
The measures to be taken in the district threatened by the yellow fever epidemic depends to a great degree on wbat is done in the infected district, including its immedi
ate environment. Perfect cordon If a cordon absolutely perfect were around the infected impossible.
district and the arrangements for mail, freight, express, and passengers were also perfect, nothing need be done by places in the threatened district any more than by the country at large with a good maritime system on account of an epidemic in Havana. It seldom or never happens that these conditions exist, and precautions to supplement imperfections in our first guard are requisite. It is well at first to determine on the limits (next to the infected town) of certainly clean territory. The district between this and
the territory adjudged infected, or probably infected (the Neutral zond
so-called “neutral zone”), requires special attention.
Before a cordon is established there is almost invariably an exodus into the country adjacent to an infected town, and after it is established there is especially at first a certain amount of seepage, so to speak, through the cordon, Also the district adjacent to a large town will probably elect to continue some direct communication with it, choosing rather to run a certain risk of infection than to interrupt their trade relations entirely. Unless this action unduly risks other communities, I think it is to be allowed. This communication, too, may be so guarded that the risk is minimal (“daylight communications,” etc.), and yet these districts should not be considered for quarantine purposes as 6 certainly clean."
This region (neutral zone), of possible contamination, yet which we try to keep clean, is to be held as infected so far as communication with clean places is concerned and as clean with regard to that infected district. It should be
subjected to frequent inspection, and it frequently happens
ion from South.
Whetherit be necessary to inspect trains from the North, No"****
to prevent the return of those who have gone North and not stayed long enough, may be a question. I think it is generally unnecessary and generally inefficient. On such trains, however, as have inspectors on them going North
the inspection on the return trip should be done as an added precaution.
There is a section of highland, the southern end of the ...oble
Appalachian mountain system, which projects into the