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number of large wall tents lined together, with central larger tent for kitchen purposes, etc.
Light, portable disinfection rooms in sections can form a part of the camp equipage and be rapidly erected for the purposes intended.
C. The present heavy tent floors, in two sections, should be cut through into quarter pieces for less expensive handling and quicker transportatiou.
D. In addition to the mattresses furnished a quantity of bedticks should be provided, which can be filled with hay or straw at the camp location, and afterwards destroyed. This is a good idea, suggested to me by Steward Peck of this service.
If these equipments are organized in sections, heavy and bulky material dispensed with where possible, the establishment of a camp will be numbered in days instead of weeks. As soon as they have accomplished their purpose and ceased to be useful they are also more rapidly shifted, in sections, to other fields of usefulness.
MEASURES AT NONINFECTED PLACES.
The second part of your instructions, to state what precautions should be taken at uninfected places having communication with places which are infected, is complex and difficult. This is due to the fact that in several of the States (Florida excepted) individual counties, villages, and settlements are a law unto themselves as regards sanitary matters. Probate judges, mayors, and self-constituted village authori. ties proclaim a quarantine against the world. Trains are not allowed to pass through their territories under any regulations or at any rate of speed. The roads are tied up. Advantage is taken of the situation to twist commerce for selfish interests. To my knowledge the stock of liquors and provisions became exhausted in one of these places, and an offer was made to raise the quarantine for two days, obtain a fresh liquid supply, and close it down again. Over all this situation the State boards of health have only advisory powers, and their advice is often received with derision.
I have observed, however, that where a strict total nonintercourse was proclaimed the object has been signally defeated in time by the entrance of the disease. In some cases where mail was absolutely refused from an infected place it was sent to St. Louis and other points under cover for remailing.
Certain general procedures, however, may be outlined, following somewhat the rules laid down for departures from an infected city or town.
First. An inspection station should be located not less than 5 miles outside of the corporate limits, where passengers and baggage considered safe can be transferred and admitted upon a local train, other passengers and train crews being excluded, and to pass through at a speed of not less than 10 miles an hour.
Second. A camp of detention is of greater benefit near points of destination than if located just outside an infected district. Diversity of routes and mingling with other travelers are avoided after undergoing the period of observation, and greater confidence is given the pratique.
Third. The municipal police and county officers, in a noninfected place, display greater zeal in keeping out irregular communication by road and water ways or other means of entrance by circumvention.
Fourth. Mail matter should be received from the first distributing point of the postal service to the northward or outside the infected district with a general authoritative certificate of safety.
Fifth. Freight, express matter, and rolling stock if not already certified to as "inspected and disinfected," should be treated at the relay station outside the city limits before being admitted.
If a proper surveillance is maintained over the arrivals and the steps taken in a suspicious case, as indicated in the first measures for premises in an infected place, a greater degree of safety will be secured than if total nonintercourse is proclaimed.
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 Disposition of
first case. 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 teni 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. 2. Should more than one case occur, or many foci be When more
tban one case discovered, a cordon should be established around the town occurs. 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. 3. The railroads issuing from, and the boats plying on the Supervision of
railroads. 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 camps. such a time as to insure their freedom from infection. Medical inspectors should be placed on each train, so that
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 bound.
ary 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 shonld 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.
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 steainers 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. Regulations of 5. Freight for shipment should be divided into two grand freight
of 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 were accepted by the entire South. .
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 Amito City.
It is barely possible, not probable, that first-class mail Disinfection of
inails. 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.
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.
gees to the in.
MEASURES NECESSARY AT A HEALTHY LOCALITY TO
PREVENT THE INTRODUCTION OF THE DISEASE.
No person from an infected territory should be allowed Restrictions
relative to perto enter a poninfected 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 incar 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.