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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 indefi. nitely, 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 practicable 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 wear. ing 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.
The camps for the north and south crews should be at a considerable distance from each other, and the run of trains should be arranged so as to have the crews in camp as little as possible. For passenger trains there need be no delay; for freight trains generally there must be, and their crews go in camp. There is no necessity of doubling these stations if suitable ones be chosen and they be well conducted, but conditions may be such, as on the Illinois Central and Yazoo Valley Railroad this year, where it is advisable. •
These stations must be frequently and carefully inspected, and the same is true of the train inspection work.
Occasions may arise where it is necessary to guard the southern relay camp by a number of guards, as if it were a camp of detention. It must never be allowed to become infected.
A PRECIS OF DETENTION CAMP MANAGEMENT.
By P. A. Surg. J. H. WHITE.
Although instructed to prepare this syllabus of detention camp management simply with a view to yellow fever, the writer has presumed to so arrange it that with slight changes it may also meet the requirements of other diseases.
Of course it would be possible to go more deeply into details in many directions, but it has been shown by the past experience of this service that competent officers do better work when furnished with outline rules rather than minute instructions. The smaller details will suggest themselves when the outline is given. The mind is able to take a comprehensive glance of the whole general plan given in outline, while if it be padded with minutiae this desirable result is in a measure prevented.
To avoid any confusion as to meaning, it may not be amiss to state that this whole article will, in the body thereof, refer entirely to camps for yellow-fever purposes, and that the necessary deviations to meet the requirements of other diseases will be treated in a final chapter.
LOCATION OF CAMPS.
In the selection of a site for a camp of detention, the general points to be considered are: First. A healthful location, as free from malaria as may be available and a situation which has good natural drainage. The avoidance of any possibility of standing water after heavy rains is essential, because such camps are frequently to be occupied by delicate women and children, whose health and comfort are both to be watched over. Second. A site so situated as to be easy of access by rail or steamboat and very preferably the former. Third. One to which good water supply and a good base of food sup. ply is easily accessible. The camp should consist of two distinct portions: (1) main camp and (2) hospital camp. The whole establishment should be, if possible, at a distance of a mile or more from any settlement. The adjunct camp for yellow fever and intermediate hospital purposes should be at least
>ine-fourth mile to leeward or one-half mile to windward of this main camp. The location should be as close to the infected place as clean territory, suitable for the purpose, can be found. It should preferably be upon a line of railway, whose distributing or dividing point outside is a straall place rather than a large city. While this matter of small distributing point is not absolutely essential, it is advantageous, as enabling the easy and careful observation of the distributing point, which point is the one most likely to be attacked in the event of any accidental escape of infection from the camp. Camp Perry, located by P. A. Surg. John Guiteras, United States Marine-Hospital Service, in 1888, on St. Marys River, where it is crossed by the Savannah, Florida and Western Railroad, about half. way between Jacksonville, Fla., and Waycross, Ga., on a slightly rolling sandy plain, which drained itself rapidly into the river, was an ideal location. It also fulfilled the above-mentioned requirement,
Waycross, the distributing point, being only a village of about 3,000 inhabitants.
The site having been selected, the ground should be prepared by such slight ditching as may be necessary to prevent any standing water in case of heavy rains. Much ditching should be avoided on account of malaria. It is always advisable to provide the hospital camp complete before any other work is done, as it often occurs that the very first admissions bring suspected cases to light. Experience has shown that the general outline of establishment used at Camp Perry, subsequently modified by a board of officers (Surgeon Carter and P. A. Surg. Kinyoun), is the most convenient form. It consists of a hollow square, of which the buildings form one side and tents three. Subjoined are ground plans, which are believed to embody all the needed changes from the plans of Drs. Carter and Kinyoun. An alternative, ground plans of which are also submitted, presents itself here, viz: A double camp, its two parts independent, except for a common executive office and kitchen (although not always feasible), presents the advantage that seldom or never will there be any suspicion attached to Camp No. 2, because, as a rule, nearly all sickness has, in our experience, developed within the first four days, and hence would be devoloped in the Camp No. 1. This plan of a double camp would naturally inspire in the people outside more confidence in the safety of camps, and, although not at all a sanitary necessity, may be expedient, for its moral effect alone. Such double camps should be divided, not only by guards, but by a double fence of barbed wire as well. The whole of both camps should be surrounded by a double barbed-wire fence, at least 6 feet in height, each fence to have wires 6 inches apart, from top