the volume of actual inspection was much reduced thereby, and also that it did away with much unnecessary disinfection which was already being done, while insuring disinfection of articles needing it.)

In railroad work, of course, having no customs manifest as an absolute check upon the honest description of goods, we must inspect everything before shipment, but will avoid countless inquiries.

Express matter should be governed by same rules as ordinary freight.

Household goods should be debarred shipment to points South unless it be possible to disinfect perfectly (generally not the case in the great press of an epidemic).

(2) Empty freight cars going South.-These should be swept clean, and if going only a short distance, I would advise an interior surface disinfection with 1-1000 HgCl2, which I did at Avondale, La., and in which manner an energetic crew with proper appliances can treat 200 cars per day at a cost of 25 cents per car.

Subsequently all ventilating windows to be left open until destination is reached, be it long or short.

Flat cars need no disinfection except such as ordinary sweeping clean will give.

(3) Passengers from infected to Southern points.-Passengers originating in infected towns and bound South should invariably (unless well-proved immunes) go into a camp of detention for at least eight days before being allowed to proceed. They should be under observation, if practicable, while en route to camp and before embarkation. Observation on embarkation has, in my own experience, discovered a few cases of yellow fever, and to that extent relieved the camp of some cases by their being returned to their homes or to hospitals.

No health certificates to nonimmunes should under any condition issue from any infected point, and all officers should be forbidden to give any certificate of nonexposure to infection to any person resident in a city or town resting under even a faint suspicion, for the reason that, while theoretically correct, my experience goes to show that one can not definitely determine nonexposure.

(4) Mails for points South.-Letters pure and simple need no disinfection. Newspapers, if originating in a very badly infected quarter, should have the usual manner of steam disinfection; otherwise not disinfected at all.

Parcels should be debarred absolutely as possible carriers of disease and involving an amount of labor to disinfect beyond the good derived from same.

If disinfection must be done, it can be and should be done in town of origin, because disinfection in town of origin economizes officers and avoids the possible infection of another point, i. e., the mail camp.

Puncture of mail should be made with a knife, which should make slits the nail punctures close up-or, better, have properly punctured envelopes on sale.

COMMUNICATION WITH AN INFECTED TOWN.

By Surg. H. R. Carter.

It must be noted that an infected town is a source of danger to its neighbors, whether communication be allowed with it or not, because a certain amount of illicit and unwatched communication will occur, especially if the season be prolonged, no matter what is allowed. In my experience the rigid nonintercourse rule was, if to be kept up for considerable periods, less safe than carefully regulated commerce. I mean as a general rule. The object then is to formulate general rules under which commerce through and from infected places can be carried on first with the greatest safety to other communities, and second, with the least inconvenience. The measures to be taken to some extent vary from a sanitary standpoint with the degree of infection of the place and from a commercial one with the interests involved and the way these interests are involved. The problem, even considering only the risk of conveying infection, which naturally is the first consideration, is of extreme intricacy, and only a general outline to be varied in particular cases can be given here.

A.-RAILROAD TRAFFIC THROUGH AN INFECTED TOWN.

(1) Freight.-Freight traffic in sealed cars passing through such a town needs no regulation; it is safe.

(2) Empties.-The same is true of empty freight cars, but care should be taken to see that they do not contain tramps, etc. Neither freight nor empties should stop-i. e., stay in the town.

(3) Passengers.-Can pass through such a town by adopting the most obvious precautions-not stopping in town, not communicating with it in any way. Closing the cars is in general unnecessary, but is easy to do and is an added safeguard.

(4) Train crews are under the same general rules as passengers. Under some conditions they may require relay. The traffic through such a town must be under the supervision of a sanitary inspector. (5) Mail cars. To be handled like passenger coaches.

B.-RAILROAD TRAFFIC FROM AN INFECTED TOWN.

Through traffic, i. e., to points incapable of receiving yellow-fever infection, to be designated hereafter as points north, the places capable of receiving infection being designated as points south.

(1) Freight.-Freight of any usual kind in sealed cars can go without hindrance through to destination.

Freight cars which are ventilated passing to points north were, however, disinfected (bichloride 1-500) at New Orleans to pass through Southern territory, and I believe this to be advisable.

(2) Empties.-Cars, clean, need no disinfection. Box cars, clean and dry and closed, are incapable of conveying infection. If open, the same is, I believe, true, especially if not parked open in a specially infected place. They must be carefully inspected for tramps.

(3) Mail.-Is under the same rule as other freight, modified by the location of distributing points. Parcels other than mercantile sample packages shall be barred. It is an easy problem. Railroad mail is also to be attended to.

(4) Passengers.-Traffic to points north can be allowed by preventing all chance of such passengers conveying infection en route, either by themselves leaving the train, returning to points south, or by fomites; mainly their clothing.

Now, as a rule people travel in clean clothes and are well when they start. The risk from the clothes which they have on, while it exists, is not great. The risk from a case of yellow fever developing en route is practically nil if ordinary precautions be taken, as it takes some days-three is probably the minimum-for such a case to infect his environment. Besides, experience has shown that such cases seldom

occur.

This traffic should be on a special train, which should not carry other passengers. A sanitary inspector must accompany this train beyond the quarantined territory, under whose absolute sanitary charge the train is, and who will prevent communication by persons or possible fomites with this territory, and carry out other sanitary regulations. It is best that these men, especially the first relay of them, be physi cians and immunes. The coaches which carry these passengers must be disinfected before they come South again. Unless they stand some time in the infected town, which they should not, there is no need to disinfect them there.

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.

Disinfection of baggage is not necessary for the latter. 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 indefinitely, 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 oversuspicion and hard rulings.

Train inspectors must inspect return trains returning to the infected town for those passengers returning to points South. Train inspectors must be properly relayed and the first tier of them ought to be immune. If they sleep in clean territory, they must be.

C.-LOCAL TRAFFIC, I. E., TRAFFIC TO POINTS CAPABLE OF BECOMING

INFECTED BY YELLOW FEVER, I. E., POINTS SOUTH.

(1) Freight. This traffic must be limited to such articles as will not convey infection, whether by nature, as railroad iron; by origin and history, as original packages in smooth metal containers, put up in clean locality or by disinfection.

(It will be further limited by what will be received.)

The division of freights promulgated by the Marine-Hospital Service this year in New Orleans, and adopted with slight modification by many State and municipal boards, is not a bad one. It was decidedly incomplete, however, and does not contain all that it could contain, either in the class requiring no disinfection or in that shipable with disinfection. Still, it contained nothing that was not strictly safe if shipped under its provisions and was found practicable and smooth in its operation. A better one can be devised after consultation with merchants, railroad men, and health officers, but it is rather an extensive job.

Express matter must be counted as freight. It is infinitely more troublesome.

Empties. Under the same rules as in B. Box cars should be opened, not closed. If going a short distance, they may be disinfected; it is very little trouble. If a considerable one this is unnecessary. The chance of conveying infection for even a short way by a clean, dry, empty box car is minimal, if it exists.

The time they stay in the town and the locality in which parked, if parked, is to be considered.

Mail.-In general, mail can be disinfected as well in town as at a station outside of the infected district. There may possibly be occasions, however, when the latter method is preferable. I never saw one, but can conceive of them.

Newspapers have little chance to become infected, but if they do

might retain and convey it. If in large amount steam is the only prac ticable method.

Packages are best not allowed in the mail.

Letters do not require disinfection; the Havana mail has never been and is not now disinfected.

On the chance of envelopes containing fomites it may be judged best to disinfect letter mail, but most of such can be discovered in the necessary handling, and I believe the added safety does not compensate for the inconvenience.

The best way is to have properly perforated envelopes on sale, as at Brunswick, Ga., and to refuse all not in such envelopes, and use formaldehyde for the disinfecting agent. The ordinary punctured envelope, however, does unquestionably admit gas to its interior, and its use is efficient, though bungling. Steam is not applicable to letters. Railroad mail must be disinfected just as any other.

Passenger traffic.-Direct passenger traffic from an infected town to points capable of receiving infection must not be allowed. Those certainly immune may go to such territory without detention after disinfection of baggage. Personal disinfection, unless in very special cases, as of those recently attending the sick or disinfecting goods or premises, is unnecessary.

The others must pass a period sufficient to cover the period of incubation of yellow fever, not exposed to any infection during this period, before being allowed to enter this territory. This is the theory of the detention camp. The details of the camp are not to be considered here.

People who have gone to points North to spend their period of incubation are in the same position as those who have been through a detention camp. The baggage of these people must be disinfected before leaving, and it is best to count the period of detention from arrival at their Northern destination, as there is a possibility (although extremely slight) of contracting fever from possible fomites on the train, just as that in camp counts from disinfection of personal wearing apparel.

Relays. All train crews, freight and passenger, in traffic from an infected town, must be changed so as not to go into clean territory. This should be done at a place as isolated as possible, a siding rather than a station, and certainly not in a town.

Every man, mail agent, expressman, and train butcher (news agent) must make this relay, unless we know that he is going North not to return to points South, in which case he is like a through passenger.

None of the merchandise of the train, butcher, unless disinfected papers be excepted, must pass the relay. No possible fomites must pass the relay to the crew bound North, and as little communication as possible, save what is necessary for the run of the train, is allowed. The relay must be under the supervision of a sanitary officer or officers (two are generally required), whose position is one of great responsibility.