While panic and alarm are to be avoided, there is no doubt that it is safer for those who have not been exposed and in the interests of the suppression of the spread of the epidemic, inasmuch as it removes the material on which it may feed, if people will leave. At this time the railroads are taken charge of by the sanitary authorities, and the leaving must be under sanitary regula tions. Those who have not been ex posed to infection may depart when this is absolutely proved. Those concern ing whom there is some doubt may go on through trains to the non-infecti ble territory, where they must report and be kept under observation for a period of ten days. Those who are known to have been exposed must be taken to a detention camp, there to be held ten days until they have demon strated their freedom from infection, when they may be allowed to depart. if a city or village is infected, and its di mensions will allow of a cordon being placed around it, this is done, and no one is allowed to leave except under these conditions. This was done at Brunswick, Georgia, there being guards on land and revenue cutters on the water-front to prevent egress except through the detention camp, twenty-five miles off, where every provision was made for the comfort of the people undergoing detention. When the city is too large to be thus surrounded the outgoing trains are under sanitary sur veillance, and no tickets are allowed to be sold except to persons who have cer tificates that they have been under ob servation for ten days, and arc free from the disease, or unless the ticket is one which leads clear through to non-in fectible territory, and the baggage of all these passengers must be subjected to close scrutiny, and if it is suspected or proved that it harbors mosquitoes, it must be subjected to a process of disin fection sufficient to insure their destruc tion.
Now, Atlanta, as I have said, is in the non-infectible territory, and if yellow fever prevails in New Orleans people who are believed, though not positively known, to be free from infection, are given tickets to Atlanta, and their bag gage disinfected. Now what is to pre vent these people at Atlanta immedi ately taking the south-bound train and returning into the infectible territory where, if the disease should appear, it would be likely to spread? This is man aged through the railroad officials, wha require a certificate from the Marine irospital officer stationed at Atlanta of every person wishing to buy a ticket for a point south—say. Florida—that he has been in Atlanta ten days, and is entirely well, and that the baggage he brought with him from New Orleans has been disinfected. Furthermore, on the trains leaving the infected city there are train inspectors appointed with a view to recognizing quickly any chance cases of the disease and to prevent any persons boarding the train who might leave the city, and try to board it at some outside point, and to see that the passengers go through to the non-infectible This train-inspection service, I have found, is very efficient in checking the spread of the disease. Its details can
hardly be gone into here, and it is suffi cient to say that the inspectors have certain runs and relays, so that those going from an infected territory return into the infected territory, delivering their passengers to those who come from the non-infected territory, who carry them through to the non-infectible ter ritory. At the same time a classification of freight is made, and such as may carry infection (that is, such as may har bor infected mosquitoes) is disinfected before being allowed to leave the in fected city.
It appears certain that neither the handling of nor contact with yellow fever pa-tients nor the performance of necropsies is capable, per se, of convey big the disease to non-immunes. It ap pears probable that general ships' cargoes and the fomites of patients are also not directly infective. It seems to be fairly definitely established that a yellow-fever patient may become a danger by infecting the premises in which he is placed. In such an infected house an interval of about fourteen or twenty-one days obtains before the first secondary cases occur. This prolonged interval is suggestive of a development of the infecting factor in or about some agent or matter in the house, the na ture of which is not yet demonstrated. H. E. Durham and Walter Myers (Brit. Mcd. Jour., Sept. S, 1900).
Before closing this part of the sub ject 1 wish to dwell upon the importance of recognizing the first case. It need not be announced with a flourish of trumpets to alarm the people, but it should be announced to the proper authorities as soon as it is found. The cause of so much panic being produced by yellow fever is the fact that it is so frequently concealed until concealment is no longer possible, by which time there is cause for panic. But if promptly reported there should be no more cause for fear than is caused by a case of small-pox or cholera.
The disease of late years has been so mild that there has been much doubt as to (he nature of the first cases, but these can be determined upon and taken care of. I might say there has been too much written and said about yellow fever. The subject should be made less of by the daily press. The public au thorities should be promptly advised of the appearance of the disease and take prompt charge, and when this is done there need be no more fear or panic than is caused by other diseases.
Disinfection. — Disinfection of cloth ing, bedding, and fabrics or textiles, ex posed during the course of a case of yel low fever, is not necessary in the light of recent investigation and discovery.
The problem lies resolved itself into a campaign against the mosquito (Steep myia fasciata), and efforts should be di rected (a) to the destruction of the in sects about a house where yellow fever prevails, and (b) against their propaga tion in a locality where the disease has manifested itself.