EIO DE JANEIRO CAMPAIGN 433 



building in the city, destroyed the early stages of mosquitoes, and abolished or 

 screened standing water where possible. One force worked in buildings, and 

 another in vacant lots, streams, marsh lands, etc. The following paragraphs 

 relative to this work are quoted from an address made by Doctor Oswaldo Cruz 

 before the Latin-American Medical and Sanitary Congress held in Eio de 

 Janeiro, August 1 to 10, 1909. 



" Yellow-fever cases were made known to the sanitary inspectors by the 

 reports of medical assistants, of the head of the family in which a case occurred, 

 or by any one to whom the facts of the case were known, in accordance with the 

 requirements of the law. The sanitary service being advised, a competent group 

 of inspectors and authorities were at once dispatched to the locality, having with 

 them a physician. The latter ascertained if the case was one for isolation treat- 

 ment (whether under or over four days after the onset of the disease), and if 

 the case required isolation the same was carried out either in the dwelling house 

 or in the hospital, hospital treatment being resorted to only when the dwelling 

 was unsuited to isolation treatment or when the patient wished it. In such cases 

 the patient was taken to hospital in a vehicle closed against the entrance of mos- 

 quitoes and the house was disinfected in accordance with the system below out- 

 lined. In the case of isolation in the home the physician chose a roomy quarter 

 of the house with door opening into another secluded part of the house and with 

 windows. If there were more than one door, the others were temporarily closed. 

 The patient was kept under a netting enveloping the bed upon which he lay 

 during the time permanent quarters were being arranged. The doors and win- 

 dows of the room to be isolated and of the rest of the house as well were sealed 

 to prevent the exit of mosquitoes existing there, the windows of the isolated 

 room being fitted with wire screens in such a way as not to interfere with ventila- 

 tion, all other openings to the outside or to other parts of the house being sealed 

 with cloth or paper. The only door to be used in the use of the room must be 

 specially fitted with a double door drum, provided with an arrangement which 

 does not permit of both doors being opened at the same time. This apparatus 

 prevents the entrance and exit of mosquitoes, and after the room is thus prepared 

 the door and windows are closed and camomile is burned in the room 3 to 4 hours 

 in the proportion of 10 grams per cubic meter of space. The room is then well 

 ventilated and is ready to receive the patient. The rest of the house is well 

 calked and isolated from the room in which the patient is placed and disinfected 

 with sulphur gas, as below indicated. During this operation a sanitary inspector 

 remains in the room with the patient and stops the entrance of any gas which 

 may possibly find its way through some overlooked crevice. During the prepa- 

 ration for disinfection the sanitary authorities make a thorough inspection and 

 destroy any mosquito larva they find, pick up or destroy any vessels lying about 

 which might serve as a receptacle for mosquito-breeding water and close water 

 boxes against the same danger. The patient remains in isolation for seven days, 

 after which isolation may terminate, if the family so vnshes. The infected 

 district is then treated as above indicated; that is, by disinfection, sanitary 

 policing, and medical supervision. Disinfection is carred on in two ways, one 

 force working from the center toward the outer limits of the district and the 

 other from the boundaries of the district inward. The area of infection being 

 determined over as large an area as possible, these two sections separate, one of 

 which begins immediately with the house in which the case of yellow fever 

 occurred, the other beginning at those houses which might possibly have been in- 

 fected at the greatest possible distance from the case in isolation. The purpose 



