« السابقةمتابعة »
REGULATION OF TRAFFIC TO, FROM, AND THROUGH YELLOW
By P. A. Surg. J. H. WHITE.
A.-TRAFFIC FROM ONE CLEAN PLACE TO ANOTHER THROUGH AN
(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 tbrough a large city, offering opportunity for entry to and exit from them. Special watch must also be kept against tramps boarding traius 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 poiuts 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 INorth.-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 nominfectible 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.
(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 fol. lows:
(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 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 origi. nating 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 observa. tion, 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 par. ticular 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. a, 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 towu 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 physicians 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 dis. infected on departure. Indeed, if there be any reasonable doubt of