to Taylors from Water Valley, and from Taylors to both points. The communication between Taylors and Orwood was by country road, Taylors being the nearest railroad point to Orwood. There is also frequent communication between all these points by driving over country roads, all the towns being close together. Matters of dispute about diagnosis and methods of introduction from one town to another are of little importance. It will be within the truth to say that the undiscovered and concealed cases of yellow fever quite overbalance the errors of diagnosis.

COMMENTS ON CASES AND FOCI.

If we accept the banana theory the interval of time seems hard to surmount. From the time the bananas were taken into Dr. Gray's house to the time of the first probable case of sickness in the house was fifty-one days. The first case of sickness at all suspicious in the house was Mrs. Blanch Wilkins on July 20 (?). I believe she had yellow fever. The next cases were the two Gray children, then Miss Sallie Wilson Gray, and then Dr. Gray-the first fatal case.

Mrs. Blanch Wilkins tells of Dr. Gray being sick with a fever before she was, and that he was sick, "ailing around," several days. That when he got around again he was imprudent and ate too much, and had quite a number of vomiting spells, with fever. He would get up and attend to his business for a little while and then lie down again. While sick with this fever the first day, the doctor told her that he had a sick man down in the "gang" who looked very suspicious, and that if there was any yellow fever around he certainly would say that this man had it. Mrs. Wilkins playfully pretended to be afraid of him, and remarks were made about it several times afterwards. Now, Dr. Gray did visit the shanty cars to see sick negroes as stated by Riley and others. Dr. Gray's books do not show any entry or business transactions with these men; his visits were probably cash transactions.

If Dr. Gray was the first case in the Gray household, and if he partly recovered but died of relapse, which is quite possible, then it would certainly be easy to trace the infection to the cars. If he was not the first case, then our source of infection is certainly aggravating and elusive. If the bananas, why so long in causing trouble? Did the atmospheric conditions retard the growth fifty-one days to a favorable time? That is possible. But if that be true, how are we to account for the infection of young Williams, who was taken sick at the same time as Dr. Gray, dying a day later than the doctor? I have the most positive evidence, written and verbal, that young Williams was not inside the Gray house covering the period under discussion. He was on the veranda of the house for a few minutes only, but never inside, and that was several days before he got sick. Young Williams was, however, in and around the shanty cars a number of times. The cars were sided nearly in front of his father's house. Of course, if Dr. Gray's first attack was not yellow fever, and if there is no mistake that his children and two visitors had the fever before him, then there are only three sources of infection possible for these members of his family, and those are: Fomites by the doctor's person from the shanty cars; by our old friend, the bananas, or from exposure near the shanty cars, which was certainly an infected point. The main line of railroad across a bridge was used as a walk way in going to several houses in the southern part of the village, and was within 10 feet of these cars. If these cars were infected there was every chance for contracting the fever merely in passing. Another question which was investigated was where the hands went when using privy vaults, as that could readily be a source of infection to the whole town. This privy house was dirty and foul smelling. It was near a ravine, about 25 feet from the railroad, about 50 feet from the depot (which proved to be a bad focus), and only a few feet from the nearest shanty car, and the walk way on the railroad most used by people in that part of the place.

NEXT CASES.

The next cases were old Mr. Taylor on August 10 and Mrs. Taylor August 11. Both were in Dr. Gray's house and attended the funeral. Mrs. Taylor attended the funeral of young Williams.

The next positive case was on the 14th, in the family of the section master, who lived near where the shanty cars were sided. His little boy was first sick, and two days later his little girl went down. The girl was seen by Dr. Baird, of Oxford, who made a diagnosis that the case was suspicious, and after her recovery expressed the opinion that it was yellow fever. These cases had been exposed in the Williams house and to the Taylors, but the time for secondary infection in these houses was too short, and Mr. and Mrs. Taylor got sick August 10 and 11, respectively, and young Williams on the 4th, the young man dying on the 10th. These children were exposed to these shanty cars, though never inside.

INTRODUCTION OF FEVER INTO OTHER TOWNS FROM TAYLORS.

The

The fever was introduced into Oxford probably from several sources. exposures to Taylors were many, and if, as is reasonable to believe, that part of the village near the cars was infected, it is in the probabilities that some one of the many passengers to and from Taylors carried the disease to other points during July and August. For the months of July and August the agent's books for the Illinois Central show that there were sold between the points of Taylors, Water Valley, and Oxford 442 tickets. Two hundred and forty-five of these tickets, including round trips, were to persons going to either Oxford or Water Valley from Taylors.

Besides this, many persons drove from one town to another. At Dr. Gray's funeral there were people from all around the adjacent country.

Granting, then, the widest latitude for errors in diagnosis in light and suspicious cases, it is still essentially true that there were many foci in north Mississippi never discovered or reported.

It is uninteresting to go further into the details of the spread to other towns than those shown in Dr. Waldauer's report.

CONCLUSIONS.

I believe George Riley to have been the first case; that he infected the cars, and that the cars and privy house infected the town of Taylor, and that the first case in the Gray house got the fever from exposure to the vicinity of the depot and the shanty cars. Dr. Gray's children were down by the railroad a number of times, and probably every day. This implies that Riley received the infection while in New Orleans in early July. Could infection have been received from New Orleans as early as July? We have no direct proof on that point and I fear that this will be difficult to be obtained; but the fact that a number of towns in Louisiana on roads communicating with New Orleans, other than the Illinois Central system, were infected early-Plaquimine, July 11; Franklin, August 6; Lutcher, August 5 (the first case being in a man recently from New Orleans), etc.-points, I think, to a common source of infection as early as the time in question.

I am informed by Surg. H. R. Carter that when the first cases of fever were recognized at Harveys Canal, just opposite New Orleans, on August 25, they were observed in such numbers (about twenty) as to indicate introduction and an established focus of four or six weeks' standing; even a longer time is probable. Again, knowing that the other towns from which this gang was collected, viz: Coldwater, Jackson, Tenn., Oxford, Holly Springs, and Taylor were free of suspicion or infection; and it being generally acknowledged that yellow fever had

existed in New Orleans for an indefinite period prior to its official announcement, the fact of yellow fever developing in this gang, after the suspicious sickness of Riley from New Orleans, is itself almost enough evidence that it existed there in early July.

It is highly improbable that a bunch of bananas handled as this was and exposed on the veranda over night would retain the infection, even though it had been previously infected. The bananas remaining on the bunch were sound, and the peeling of the bananas remaining intact, there was no further chance for them to act as culture media.

The interval of time from receipt of the bananas to the approximate date of the first case was fifty-one days. The bananas, properly speaking, had never been in New Orleans, only passing through. If the bananas had been ripened by so.ne small fruit vender by putting the bunches under his bed or hanging them in dark closets in his house, the question would have become an interesting one. Of course, it was from this standpoint alone that Drs. Haralson and Gant took it up with such seriousness.

The disease spread along the railroad from a common focus. Railroad people were usually the first ones to take the disease, and they infected the towns.

[Inclosure No. 1.]

Dr. WALDAUER'S REPORT.

Referring to your letter of instructions of October 8, 1898, which is filed herewith and marked Exhibit A, and previous conversation, I have the honor to report as follows:

My investigation led me to believe that yellow fever was introduced into north Mississippi by one George Riley, colored, a member of the construction gang of the Illinois Central Railroad, said gang being in charge of Mr. Snellin, as foreman. Riley joined the gang at Goodman, Miss., on July 7, and for further evidence relating to him you will refer to his deposition in Inclosure No. 2. As to the introduction of the disease into Taylor, Miss., by Mr. Snellin's work gang, which was the next point of infection, you are specially referred to Mr. Snellin's deposition in Inclosure No. 2, and that of Dr. Mathis, also in Inclosure No. 2. Your attention is called to the stenographer's and other evidence gathered from Snellin's work gang, conductors, engineers, and firemen of the Illinois Central Railroad, all of which is attached hereto. This evidence, taken collectively, shows that there was sickness among the men working in Snellin's gang along the road between Taylor, Miss., and Jackson, Tenn., where they broke up September 5.

Much of the evidence was taken down by a stenographer. The other from notes. Many, and especially negroes, gave information reluctantly, fearing that some blame would be laid on them, and it was very hard to get connected stories. My investigation in Kentucky was greatly facilitated by Passed Assistant Surgeon Stimpson. The mortuary records of Oxford and Water Valley are not as complete as they might be, but the most reliable obtainable.

[Inclosure 2.]

SYNOPSIS OF THE SWORN EVIDENCE OF PERSONS EXAMINED BY ACTING ASSISTANT SURGEON WALDAUER AND SUBMITTED WITH HIS REPORT.

George Riley, colored, states as follows: Had been living at Holly Springs. Went to New Orleans in early part of July. Staid only one day. Went to buy a suit of clothes. Bought a second-hand suit from a store on Poydras street, near the market. Came back and joined Snellin's gang July 7 at Goodman, Miss. Was taken sick at Taylor July 10. Had just arrived. Had chill, followed by fever, headache, backache, and severe pain in the eyes, and sick stomach, lasting some time. Was sick eight or nine days, and very weak afterwards. Gained strength slowly. Was attended by Dr. Gray. Several others in the shanty cars got sick after he got well; also Mr. Snellin. These were attended by Dr. Gray and a one-armed man (Dr. Mathis).

Snellin states that George Riley got sick at night, and when he recovered went back to his home.

The examination of the evidence of W. W. Snellin, foreman of gang, Mrs. Snellin, Fred. Snellin, the foreman's son, Elbert Gilmore, John Thomas, John Highmoore, Theodore Thomas, John Hightower, and Sam Stillwater, members of the gang, shows that Riley was taken sick as aforesaid; that he was sick six or eight days; that there was much sickness in this gang (of negroes) after Riley got well, the names of seven men being given as sick at Taylor in the early part of July, a number of them sick enough to go home in convalescence. There had been but little sickness in this gang prior to this time. Of three, it is stated that they had their chills at night; of the others the time is not stated, it not having been asked. Mrs. Snellin and her two children, who had been well, became sick about two and one-half weeks after her husband's return (on account of sickness, from Taylor); they had a single attack each, of some day's duration. She believed the attacks to be malarial. The description of the sickness in the shanty cars is mainly indefinite, but where definite, is like yellow fever, and in none is more than one attack predicated. These men were attended by Dr. Gray, and after he sickened with yellow fever, by Dr. Mathis. The latter saw Mr. Snellin when sick at Taylor and says he had had a chill and had a severe backache and headache. "I should call it a very suspicious case, for, looking backward, Snellin's certainly looked like a yellow fever case." A sick negro whom he saw there gave similar symptoms. Dr. Mathis had not seen yellow fever when he saw Snellin, but had seen and attended it and had it himself before making above statement. It is to be noticed that every case of sickness at Taylor seen by Drs. Haralson, Gant, and Carter the last of August and early part of September, was with one exception yellow fever, and the subsequent history of those who had been sick, with a diagnosis of malarial fever, showed them immune to yellow fever. There were certainly then not many cases of malarial fever among the residents of Taylor in August and September.

YELLOW FEVER PREVALENCE IN OTHER COUNTRIES

YELLOW FEVER IN CUBA.

Cuba has continued to be the great menace of the United States as regards the introduction of yellow fever into this country, for, as I have stated in former reports, it is possible to trace nearly all of the epidemics in this country to the introduction of one or more cases from Cuba, usually from Havana. In that city alone, from the 2d of

July, 1897, until March 31, 1898-since which time, owing to the withdrawal of the United States sanitary inspector from the city during the Spanish-American war, no reports have been received relative to the mortality of the city-562 deaths occurred from yellow fever.

No reports have been received from any of the Cuban cities—with the exception of Santiago after its surrender-since March 31, 1898. From July 1, 1897, to March 31, 1898, there were 1,410 deaths from yellow fever reported from various localities in the island of Cuba, of which the more important were the following cities: Cienfuegos, Havana, Manzanillo, Matanzas, Sagua la Grande, and Santiago.

During the calendar year 1897 the following number of deaths from yellow fever are reported, the figures being confined exclusively to cities:

Deaths from yellow fever in Havana during this same period...

2,583

6.034

Total

The greater number of these deaths occurred among the recruits for the Spanish army, and it is presumable that when reports for the latter half of the fiscal year are available, as regards the prevalence of yellow fever in Cuba during that period, they will show a considerable decrease in the totals, as but comparatively few recruits have been sent from Spain to Cuba during 1898.

JAMAICA-OUTBREAK IN 1897.

On July 10, 1897, a case of yellow fever was discovered at Kingston, Jamaica, and from this time until the end of December cases appeared in the following parishes of the island: Kingston and St. Andrew, St. Thomas, Portland, St. James, Westmoreland, Manchester, and St. Catherine.

According to the statement of cases furnished the United States consul at Kingston by the colonial secretary, there were in all 150 cases and 58 deaths from yellow fever. Of this number-104 cases-40 deaths occurred in the city of Kingston and the parish of St. Andrew. Manchester was the next most severely afflicted parish, having 33 cases, of which one-third had a fatal termination.

Of the cases occurring in the parish of St. Andrew 20 of them occurred at the naval and military stations there.