DIETETIC MANAGE3IENT.—A most im portant point in the management of yel low fever is the diet. Many a patient. his crisis past and the borders of con valescence reached, has been hurried into an untimely grave by the misplaced kindness of an apparently simple meal. The vellow-fever patient should never be starved; on the contrary, he should be well nourished, but the most scrupu lous care should be exercised in the se lection and administration of his diet. "A little and that often" should be the rule. For the first few days milk with lime-water, given cold; then animal broths, concentrated, but free of fat, should be the regimen. The fever being reduced, soft-boiled eggs, milk-toast, and small bits of the white meat of chicken and tenderest steak may be per mitted. Probably at least ten days or two weeks should elapse before the con valescent, by the easiest stages possible, should resume ordinary diet.
Management of Epidemics.—Before going extensively into details let me explain that there are parts even of the southern portion of the States which are known to practical sanitarians as territory." These are, generally speaking, high and mountain ous sections of the South where experi ence has shown that yellow fever will not naturally spread if introduced. This immunity, while long recognized, has never until quite recently been satis factorily explained. We now have rea son to believe that it is due to the fact that mosquitoes of the genus Stegomyia faseiota do not naturally exist in these localities, or, if introduced in cars, sleep ing-coaches, baggage, or freight, do not there find the conditions necessary to their longevity or propagation. Conse quently, even if actual eases of yellow fever should he introduced into these re gions, or should declare itself in refugees after arrival, there would be no spread of the disease, as there would be no Stegomyiw to become infected.
The geographical distribution of the StPgomyia, while not accurately deter mined. is fairly well known, and it is an
interesting fact that a study of a contour map of the 'United States shows that the territory" corresponds almost completely with the regions beyond the habitat of this particular variety of mosquito.
As examples, St. Louis, Mo.; Atlanta, Ga.; and Huntsville, Ala., may be men tioned as localities where, on account of the elevation, character of the soil, drainage, etc., the disease, though from time to time introduced, has never spread.
The work principally involved in sup pressing the disease is in isolation and disinfection for the destruction of pos sibly infected mosquitoes. If the first case is discovered it is within our power to limit it to the house in which it pre vails, the first effort being to prevent the room and the house itself from becom ing infected. This may be arrived at by carefully screening the case from the bites of mosquitoes, and by fumigations practiced from time to time to destroy such of the insects as may have eluded our vigilance.
If the disease has prevailed for some time, and persons have had free ingress and egress„ it becomes necessary to take those persons and hold them under ob servation a period of ten days to see whether they will develop yellow fever. One can readily imagine, in a district where it has been allowed to run along for some weeks, how difficult it is to trace all the people who have been ex posed to infection. Difficult as it is, this is attempted and frequently with unsuccessful results. An examination is at once begun of surrounding houses and neighboring villages, particularly along the line of a railroad, to see whether the disease may be anywhere co-existent. If the disease prevails in a considerable number of houses, there is no doubt that an excellent plan is to remove the sick to a hospital, though great care must be exercised in moving them, and taking the well to a detention camp, and then disinfecting the vacated premises to destroy mosquitoes.