MEASURES TO BE ADOPTED TO PREVENT THE PROPAGATION OF YELLOW FEVER FROM AN INFECTED TO A NONINFECTED LOCALITY.

By Asst. Surg. SEATON NORMAN.

I. The patient should be isolated immediately and no intercourse allowed with healthy individuals. The persons exposed should be removed, if practicable, to a different house, or if the weather permits, to a tent provided for the purpose, and should be kept under observation for ten days. As soon as the patient recovers or dies, the mattresses, pillows, comforts, and blankets should be destroyed by fire or be thoroughly disinfected. The house and premises should then be subjected to thorough chemical disinfection and the apartments exposed to sunlight and free currents of air for several days.

The attending physician and nurse should, if possible, be immunes.

Disposition of first case.

more

than one case

occurs.

2. Should more than one case occur, or many foci be When discovered, a cordon should be established around the town or village to control the egress or ingress of the people.

The advisability of depopulation will depend upon the size of the town or village, the density of the population, and the number exposed. Where a case has occurred, for instance, in an army post or in a crowded community, an immediate exodus and the subsequent detention of sus pects will be the best method of exterminating the disease. In cities a cordon would not be considered practicable, and regulations governing the transportation of passengers, baggage, express, freight, and mails must be adopted.

railroads.

3. The railroads issuing from, and the boats plying on the Supervision of river from, an infected port should be under the strictest medical supervision. On the line of each railroad leading from the city there should be established, if practicable, a probation camp at a safe and convenient distance, where persons Detention desiring to leave the infected locality may be detained for such a time as to insure their freedom from infection. Medical inspectors should be placed on each train, so that

camps.

northern exit.

should any passenger develop symptoms of suspicious fever he may be isolated until a station is reached where he may leave the train. The isolation hospital of the probation camp would be the proper refuge for such a passenger. Unrestricted Persons whose destination is north of the southern boundary of Maryland and who do not intend to return within ten days to a point quarantined against the infected territory, may be allowed to proceed. Arrangements should be made for the changing of train crews and railway-mail clerks at stations distant not less than 15 miles from the infected place. Changes should also be required at a point along the route 40 or 50 miles beyond the station where Railroad in first change is made. Railway inspectors should accompany trains for at least 100 miles beyond any infected place.

spection.

Regulations of shipment of freight.

The crews and passengers of steamboats should be inspected immediately before their departure, and if the trips are of less than five days' duration, this inspection should be repeated on their return. Only two cases, I think, developed on the various steamers leaving New Orleans during the fall of 1897, and in both instances the vessels were immediately and thoroughly disinfected.

4. The express companies handled very little matter during the late epidemic, forwarding only such articles as required no disinfection.

5. Freight for shipment should be divided into two grand classes: That requiring no disinfection and that capable of disinfection. A specified list of both classes should be placed in the hands of the freight agents of the various railroads.

During the past epidemic in the South such a classification was made by Surg. H. R. Carter, United States Marine Hospital Service, and his assistants' certificates accepted by the entire South.

were

NOTE.-Free and uninterrupted daylight communication by rail and boat continued between New Orleans and Covington, La., during the past fall. Covington is a small summer resort, situated on Lake Pontchartrain, directly north of New Orleans, about two hours' journey from New Orleans, and no case of yellow fever was reported there during the late epidemic. If a case did occur there, the conditions favorable to its dissemination did not exist. A similar instance of the capriciousness of yellow fever is recorded by Dr. John P. Wall in the Annual Report of the Marine-Hospital Service, 1889, where uninterrupted communication existed between Seffner, Fla., and Tampa, Fla. Although a few persons in the incubative stage at the time of departure from Tampa developed the disease in Seffner, only 12 miles distant, the infection did not spread.

Intercourse also existed between Covington and Amite City, La., on the Illinois Central Railroad, although the latter place observed strict quarantine against New Orleans. As far as I know no yellow fever occurred in Amite City.

mails.

It is barely possible, not probable, that first-class mail Disinfection of matter may convey infection; old and soiled newspapers, coming from an infected house, would undoubtedly be a source of danger.

While it may be considered that the disinfection of mails is generally a useless labor and expense, clamor and fears of the public may render it necessary.

In the late epidemic in New Orleans, letters and singlewrapper newspapers were submitted to formaldehyde gas in a closed chamber specially constructed for the purpose, while newspapers were disinfected in a steam chamber designed by the service. Supplementary disinfection was also instituted at points farther north on the Louisville and Nashville and Illinois Central railroads.

gees to the in

Refugees should not be permitted to return to the Return of refu infected territory until after the second frost or until the fected district. place has been pronounced by the constituted authorities

as free from fever.

MEASURES NECESSARY AT A HEALTHY LOCALITY TO
PREVENT THE INTRODUCTION OF THE DISEASE.

relative to per

No person from an infected territory should be allowed Restrictions to enter a noninfected place unless he has complied with sons. regulations relative to a probation of ten days' supervision and in addition to having his effects amply disinfected by the most approved methods. This rule should not apply to immunes, who should be allowed to proceed, provided their baggage and other effects have been subjected to thorough disinfection. Places north of the southern boundary of Maryland incur but a minimum risk in receiving refugees, and cities like Atlanta, which are elevated high above the sea level, may receive individuals from the infected district with comparative freedom from danger.

In the districts where it is known by experience that the disease if introduced will spread, absolute nonintercourse, if possible, should be observed. Even in such territory, communication, under the proper safeguards (such as detention at probation camps, disinfection of effects, etc.), may be permitted with safety.

10918-24

REGULATION OF TRAFFIC TO, FROM, AND THROUGH YELLOW

FEVER-INFECTED TOWNS.

By P. A. Surg. J. H. WHITE.

A.-TRAFFIC FROM ONE CLEAN PLACE TO ANOTHER THROUGH AN INFECTED TOWN.

(1) Freight. In sealed cars, freight should pass without let or hindrance, but cars should not be allowed to remain in the infected town overnight.

(2) Empties.-Empty cars (box) should be passed through sealed, but not allowed stoppage. Flat cars can not become infected, or if so, simple cleaning would remove it, and hence it is a matter of indifference whether they stop or pass directly through.

(3) Passengers and train crews.-Passenger trains should be allowed passage through an infected town in daytime and under observation of inspectors, who should prevent any stoppage or any possible communication between any person on the train, crew or passenger, and any other person in the town. Especial care is needed where trains move slowly through a large city, offering opportunity for entry to and exit from them. Special watch must also be kept against tramps boarding trains under these conditions, and, indeed, under any other. Crews may require relay in case of a large city.

(4) Mails.-Through mails need no interference.

B.-TRAFFIC FROM INFECTED POINTS TO NONINFECTIBLE POINTS.

(1) Disinfection of baggage and freight.-To points North may be generally assumed to be unnecessary, provided ample assurance is obtained that such will not be returned South. Baggage, if there be any reason to doubt its remaining North, should be disinfected with the same care as that for points South. The freight charges would almost certainly bar any returning of merchandise (new). Household goods (old) should be watched more carefully and should be disinfected even if going North, unless late in autumn.

Express matter under same conditions as freight.

(2) Empty cars going North.—If going through without stop and left open as freely as possible (end windows as well as doors) to first relay

station and then doors closed, no reason for disinfecting, as the aeration so obtained is most thorough and fully as efficient as need be.

All cars, however, should be very thoroughly swept before starting. The latter is all that is needed for flat cars.

(3) Passengers and train crews originating in an infected town and bound North.-Such should from the beginning be under observation, and continue so until they reach a point beyond the infectible zone.

Each road should provide a relay for its train crews near to, but outside, the infected area, where crews should change and the train continue its journey with a crew beyond suspicion.

It would be very advisable when possible to have the relay who take the train in hand in clean country to be (at least the conductor and brakeman) immunes. Of course, this may be impossible.

A sanitary inspector (a doctor) should be constantly on each passenger train and be cognizant of the destination and state of health of each person on the train; should assure himself that they reach that destination, and be aware of their health status when they leave his observation there.

On the return trip, he should be empowered to forbid anyone starting who can not prove his recent whereabouts, and so avoid the doubling back of persons recently out of the infected place and trying to reach noninfected but infectible localities.

(4) Mails going North, i. e., into noninfectible territory.-Letter mails for points North need no disinfection; neither do newspapers.

Parcels will hardly need it, but in view of possible return South would best be either barred or disinfected; this may be modified by location of distributing points South. Railroad mails should have same supervision as other mail.

C.

(1) Baggage and freight to points South, i. e., to infectible territory from infected points.-All disinfection of these things may and should be done at point of origin, for same reasons given for mail matter, viz: Economizing officers and avoiding possible infection of the camp or other point selected outside for disinfection.

Of course, disinfection outside might be and probably is more certain, but the difficulty and expense incident to the creation and operation of an outside plant would be enormous, and in many cases impossible to overcome.

All merchandise should be classified in four separate groups, as follows:

(a) Such as may be shipped without any obstruction.

(b) Such as requires.investigation and may or may not require disinfection.

(c) Such as must be always disinfected.

(d) Such as is absolutely barred shipment.

(I adopted such a classification in Hamburg in 1893, and found that