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The chief in each district should have charge of all matters in that territory; receive the reports of inspectors, run over the lines himself pretty frequently, and at the same time cooperate, under the direction of his chief, with those in charge of the other districts. He should report direct to the man in charge of all the work, and take orders from him as far as concerns his immediate sphere of action.
OFFICER IN GENERAL CHARGE.
The officer in general charge should outline the work for each district chief, leaving the details very largely to them, but holding them to a strict accountability. He should visit all parts of his territory from time to time, investigate all rumors of the presence of disease, and transmit frequent reports of the work to the Surgeon-General, provided he can find the time. He should keep in close and cordial touch with the local health authorities everywhere, and with the heads of the transportation companies. The former are often a trifle suspicious at first, but tact and judgment usually overcome this very readily. It is often best to request as a favor what one could demand as a rigbt. The people in the smaller Southern towns can usually be reasoned withthey are rather hard to force. The railroad people are generally eager to give every assistance, and their earnest cooperation is most essential. The discipline of a good road is of the greatest help when enlisted on our side. Generally speaking, the larger the corporation and the higher the rank of the official approached the more intelligent will be the assistance secured.
CHIEF OFFICER SHOULD KEEP INFORMED OF ALL WORK. While the details of the work in each district may be left to the man in charge there, the chief should keep himself intimately informed of everything concerning the work in hand. In this work success depends on the execution of details; attention to details is really of rather more importance than excellence of general plan.
TRAIN INSPECTORS AND WHAT THEY SHOULD BE.
The inspectors should always be physicians. They should be furnished with plainly written instructions as to their duties, with formal credentials and badges, and if possible should be sworn in as deputy United States marshals.
MUCH AUTHORITY NEEDED BY INSPECTORS.
It will greatly facilitate the control of the train crews if each in. spector is furnished with a letter from the general superintendent of the road, addressed to all employees of the road, and stating that the inspector is in absolute control of the train. A similar letter from the Pullman authorities should be furnished them, and they should have keys to all cars. They must be instructed that in case they find a case of suspicious illness on their train they will be expected to stay by it and to accompany it to one of the observation camps, mentioned in Section V, Chapter II.
CAMPS OF OBSERVATION.
These camps should be small, consisting of a couple of tents properly equipped with cots, etc., and in charge of two reliable men, and established at several points, the location of which can only be determined on the ground. These camps are for the care of cases of suspicious sickness that may be found on the trains.
IMMUNITY DESIRABLE IN INSPECTORS.
The first tier of inspectors—those under the jurisdiction of the officer inside the infected place—should be immunes. Immunity is desirable but not essential in the others.
SCHEDULES OF INSPECTOR'S DUTIES.
A schedule must be prepared showing what each man's duties are, what train he takes, where he transfers, etc. At the central office it should be possible, by consulting this table, to tell just where each man is at a given time, as the train dispatcher locates his trains from his “train sheet.”
Such a schedule may prove a more difficult job than it looks, for suit. able inspectors can not always be found in sufficient numbers, and those found must sometimes sleep and eat; and, moreover, stations, sidings, State lines, etc., can not be moved at pleasure, so it may be rather a puzzle to fit the men to the runs.
As an illustration of such difficulties and how they are to be met, I give the schedule on the Nashville, Chattanooga and St. Louis Railroad last fall.
The trains were worked out of Nashville into the quarantined territory west of the Tennessee River. Some trains ran all the way into Memphis, some part of the way, and some, after entering the quarantined territory, merged their identity in trains on other roads that entered that territory from other points.
On some of the return runs the men could sleep in the Pullmans; on others they had to work both ways.
Schedule for Nashville, Chattanooga and St. Louis Railroad between Nashville, Memphis, and McKenzie.
7.00 a. m., McKenzie ..
Each inspector to receive a number from 1 to 8 and take his run in accordance with the positions of said number on this shoot. is means first section ; 28 means second section.
DUTIES OF INSPECTORS.
At the beginning it must be explained that the special details of inspection duty will vary very widely on different roads and under different circumstances. In the first place the regulations of the State and local boards will greatly modify the action we must take, and, as a rule, greatly limit our usefulness. I am assuming now that the law under which the work will be done will be as at present.
To KEEP INForMED OF Local REGULATIONs.
The inspectors must keep track of all the changes in the local regulations, or at least the officer in charge must; he must also keep track of the way the local authorities construe the State regulations, and if they propose to be bound by them. Very often they do not.
TO LEARN STATE LINES AND LOCAL GEOGRAPHY.
If the line on which the inspector works runs through more than one State, the inspector must lose no time in learning the location of State lines, otherwise he will have to consult a map or the brakeman before he can answer a passenger's inquiry as to his status, which rather impairs his prestige.
THESE RULES ARE ON BASIS OF NATIONAL QUARANTINE REGULATIONS.
It being understood then that no hard and fast rule can be laid down as to the action under State rules, I will outline how the inspector should work in order to simply carry out the national regulations, and will begin with the case in which the infected territory surrounds the road's terminus, or at least the place where the trains are made up.
INSPECTORS TO BE ON HAND AT DEPARTURE OF EACH TRAIN.
An immune inspector, acting under the orders of the officer in local command, will be on hand before the departure of the train to see that all regulations as to the character of coaches, etc., have been complied with. On boarding the train he will carefully inspect everyone, from the engineer down, for even if all hands are relayed at the end of a few miles it is most important that none of the crew be allowed to sicken, lest they infect the transfer station. The sanitary condition of the cars must be looked into, and if the cars on that run are being disinfected or placarded he must see that the disinfection has been properly certified to and that the placards are in place. Either the inspector bimself or another man detailed for that duty must see that no undis. infected baggage or express matter for infectible terrritory is put on board. He will then proceed to make a careful examination of all the passengers, ascertaining their recent whereabouts and their destina
tions. He will enter the names, etc., on the blank here given:
These forms should be furnished in book form and be used with carbon paper between the sheets, so as to preserve a record after the original has been torn out and given to the next inspector.
TRANSFER OF LISTS AT RELAY STATIONS.
On arrival at the relay station he will assist the inspector stationed there to supervise the exchange of crews. He will then examine the new crew and enter their names on his report.
If the train is a refugee train and runs straight through, his duties will be confined to seeing that no one either leaves or enters the train at the points where stops have to be made for orders or for water and coal. He will keep the doors locked, allow no passing to and fro between cars, and rigidly restrict the intercourse of the crew with the passengers. When the train stops in a town, or has to run very slowly, he will have all the windows kept closed, not to prevent the conveyance of infection, but to limit the chance of communication. Should a case of suspicious sickness occur, he must promptly isolate the patient, and his belongings and companions, and wire the facts to his own chief and to the chief of the inspectors into whose district he is running. The ultimate disposition of the patient depends upon the circumstances of the case. Generally speaking it is better to carry him on into noninfectible territory.
IN CASE OF REFUGEES IN SEPARATE COACHES.
If the run is one upon which the refugees are in separate coaches of a train, doing local work, the inspector must see that there is absolutely no intercourse between the different classes of passengers and that the reserved coaches are kept locked at all times and their windows closed while passing through or stopping at all stations. He will carefully exam. ine all persons boarding the train and require them to present satisfactory evidence as to their recent whereabouts. If possible this should be done before the person is admitted to the train; indeed it ought to be