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the greatest commercial advantage in quieting rumors and allowing traffic to go on unimpeded, and if this work be
done as a matter of routine the presence of the inspector Inspection of will cause no alarm or excitement. This inspection of healthy towns.
healthy places may be widely extended in territory having even well-guarded communication with the infected district with the greatest advantage.
In towns of considerable size it is well to have an inni spection of spector of freight and express to see that none is landed Freight.
without proper certificate. It is a check on the work in the infected district.
Towns considered especially threatened by yellow fever Provisional should establish in some safe place a small isolation camp
of both tents and buildings, where an important case
of fever can be removed, if it be right to move him, and · where those presumably exposed to his infection, or rather
suspects, may be isolated. Time and risk of infection will be saved by having this ready.
A place may be so isolated as to be in extreme danger of infection, generally by proximity, from an infected town.
In this case all ingress must be subject to sanitary superP vision and a cordon around the clean town may be required, and practically the same system be adopted as for a be. sieged city. By this method Kenner, La., 11 miles from New Orleans, received no infection in 1897,
Cordon arour healthy towns.
IMIEASURES TO BE TAKEN IN AN INFECTED AND NONINFECTED TOWN.
By P. A. Surg. A. H. GLENNAN.
The experience of this year has tended to confirm my observations made at Key West, Fla., in 1887, where I gained some practical knowledge in the early stages of a yellow-fever outbreak. The first case was discovered in a large boarding house in a populous section of the city. Immediately upon the announcement of the disease these unacclimated boarders scattered to different parts of the city, and owing to defective sanitary and police powers they were kept under a desultory surveillance only. An immediate exodus of other unacclimated people took place, by every available means, to the neighboring keys and the mainland. This is the inevitable tendency in any community upon the announcement of the first cases of yellow fever, and the immediate steps to be taken are, first, the isolation of the sick, guarding the infected premises and contiguous blocks as well, and second, a systematic supervision over all persons and effects leaving such a city or town, with the least amount of hindrance compatible with safety.
ISOLATION OF INFECTED CASES.
In incorporated municipalities, infected premises are generally posted with a yellow flag, and a guard stationed at the front door. This is not sufficient. A cordon of guards—immunes if obtainable—should be established around the infected block and contiguous squares as well.
These guards, when relieved from duty, should not be allowed to go to and return from different parts of the city, but should be maintained at some near central point. A captain of these guards should inspect the day and night watches at irregular times, prevent persons, vehicles, or street cars entering or departing through the lines, see that supplies and necessary articles are delivered at stated times and places, and also to arrest and return persons escaping through the lines. In addition to this, a house-to-house inspection of the infected area should be made once or twice daily by competent physicians, twice daily being preferable, as it tends to reassure the persons in the restricted district. At the same time a systematic inspection and disinfection of premises, yards, and alleyways should be carried out. This double guarding of first foci of infection is comparatively inexpensive and worthy of effort, even if unsuccessful by reason of the disease appearing outside of these lines. A result is obtained in a limited time, and the expense can be rapidly discontinued. In Mobile this year yellow fever was confined for some weeks to twelve or fourteen contiguous blocks, belted by a street-car line only, which route it slowly traveled, although no systematic effort was made to restrict it to this belt. Special stress is to be laid upon the fact that guards should not wander about while off duty. A house guard upon night duty roamed the streets in the daytime, wearing his badge; I afterwards isolated and treated him with a severe case of yellow fever, although he had not entered the infected premises. Interesting points also to be considered, both legal and sanitary, are the removal of the sick, and local depopulation of small infected areas, under proper precautions, to safe points for observation.
The few rudimentary rules laid down in the Report of the National Board of Health for 1879 are not adequate for the present rapid transit of passengers and movement of freight. The object to be attained is to ascertain that no person ill or suspected dangerous is allowed to depart from an infected city or town, and also that passengers are under surveillance while en route to destination.
I attained the first object this year at Mobile by stationing a competent physician at the union depot in that city, who personally examined all would be departing passengers and obtained a signed declaration of their residence, nonexposure to infection, and number of pieces of bag. gage. To this declaration was attached the inspector's certificate of examination of the bearer and disinfection of baggage. By an arrange. ment with the railroad companies box cars were located near by, for disinfection of baggage, railway mail, express packages, and other matter. Ordinary shipping tags were attached marked “Disinfected,” signed, and stamped with the seal of the Marine Hospital Service. This baggage went through to all points without trouble, though I learned that baggage from other points was overhauled along the line.
The second object was attained by placing a competent physician upon each departing train, to examine the passengers en route, who were persons from New Orleans and the infected Gulf coast towns as well; memorandum slips were taken up, completed, certificates checked up and passed on at the next relay, the inspector taking the return train at the most convenient point. In this way a double-check service was instituted, and after I assumed direction of affairs not a single passenger developed yellow fever after leaving Mobile. In one instance a passenger purchased a ticket without first obtaining the certificate of
inspection. He was detected upon the train and returned to the city by the inspector. The incident was not repeated by the ticket offices. In another case a prominent railroad official with his attending physieian departed on passes without certificates and were captured by health authorities in another State and subjected to vexatious delay and disinfection. Pullman sleeping and upholstered cars should be discontinued, except Ipossibly upon through trains for the North. These, together with ordinary cars, should be treated with the steam air blast, disinfected at some central point, and a dated certificate of the fact attached to each car before it is allowed to return. Relays of train crews should be made at not less than five miles from an infected city or town, and another preferably at the State line. It is not necessary to transfer the passengers into new coaches, the experience of this year showing that they are best detained for observation near their point of destination. Train crews, when changed however, should be rigidly kept from mingling, both on freight and passenger trains, as my experience shows that these men, from their environments, offer greater danger along lines of travel than from any other source.
The disinfection of freight and box cars is best performed outside the city limits, with due regard to its classification. Flat cars are not specially a source of danger, but if their external surfaces are required to be treated it is quickly done with a hand force pump, hose, and spray nozzle, from a barrel of bichloride solution swung upon a light wheel truck, which can be moved along the line of the train; this will also answer for disinfecting the interior of empty box cars. The work is more effective, cheaper, and timesaving, than by fumigation, to say nothing of the absurd method of placing a sulphur pot upon the open track beneath a flat car, which I heard of in one or two instances. This may be classed with the exploded theory of refrigerating freight in box cars, as a method of disinfection.
The cars should then be lead sealed and a red label pasted (not tacked) to the outside marked “inspected and disinfected,” dated, and signed.
There is no necessity for transferring freight to new cars at any relay station.
Freight upon steamboats is preferably disinfected before being placed upon board, the vessel and the crew being inspected, and disinfection carried out where necessary. Only classified articles should be accepted; household goods, trunks, etc., rigidly excluded. If passengers are accepted at all upon steamers running to interior points, they should be carefully examined and their baggage disinfected, as in the case of passengers departing by train.
Highways and other outlets from an infected place should be guarded. possibly by the municipal and county officers, although a great amount of good is not to be expected from these city officers in the way of preventing friends and acquaintances from leaving an infected place, while they might be trustworthy in keeping out any threatened danger.
DISINFECTION OF THE MAIL.
Considerable delay and dissatisfaction was caused during the past season by rural communities refusing to accept mail matter from an infected place under any circumstances.
In my opinion, mail bags and mail matter from any infected city or town of considerable size should be disinfected with formaldehyde gas while en route. The mail matter and bags can be scattered and hung upon racks in the mail car, lamps or gas generators used, the car sealed and labeled, and the run made to the next general distributing point, where the matter can be sorted and sent back to points outside of the infected district. This method will effect a great saving of time and an assurance of security.
The wooden paddle, studded with nails to perforate letters, is a slow instrument of torture and delay, besides being ineffective, as it plugs the space between the hole of entrance and exit. If necessary, a hopper should be used, but it can probably be proven that the gas is sufficiently penetrating without these punctures.
While depopulation of an infected city or town is to be encouraged in every way by means of through trains to places not liable to progagate yellow fever and willing to receive the refugees under the supervision as already described, detention camps become necessary as filters of a certain portion of a population who are unable or unwilling to travel considerable distances, but who wish to proceed into the uninfected surrounding country, and would otherwise do so surreptitiously. The construction and arrangement of these camps is well known. They are here mentioned as a medium of communication between infected and noninfected places. There are a few points, however, which have developed in the experience of the past season, to which I wish to invite attention.
A. The location of a camp should be selected to avoid the possibility of being shut in between infected districts, and preferably near State lines. The distance in the transportation of refugees is of little importance as compared with a safe outlet, for there is no benefit in detaining refugees under observation to afterwards pass them into anotherinfected place, even if it is to return to their homes.
B. The expense of wooden buildings can be avoided, dining and kitchen houses can be superseded by medium-sized circus tents, or a