YELLOW FEVER PROPHYLAXIS IN NEW ORLEANS 5 



residential parts of the City where each house had plenty of space 

 around it and where no refuse was allowed to accumulate. 



No wonder then that a focus like the above of non-immunes 

 should constitute a serious danger to a large community liable to 

 Yellow Fever. The essential factors were at hand to favour an 

 outbreak; the fever started in this district and had gained 

 a firm hold by July 22nd, when it was officially announced. How long 

 It had been present it is difficult to say ; subsequent hunting up of 

 cases of illness would shew that there had been a very considerable 

 number of suspicious cases and deaths, and that these might date 

 from as early as May 13th. One thing certainly is clear, that by 

 July 22nd the infection was not confined to one block, but had already 

 made for itself several foci in the old part of the town. The sub- 

 sequent history of the epidemic shews that the fever centred amongst 

 the Italians, who furnished the largest number of cases and deaths 

 (Map I). In this connection it is noteworthy to record that in 

 the great epidemic of 1853 the chief sufferers appear to have been the 

 Irish and German labouring population, no less than 3,907 deaths 

 being registered amongst them, whilst only 87 deaths were stated to 

 have occurred amongst the natives of New Orleans. 



It will be gathered from these introductory remarks that given 

 the conditions obtaining in New Orleans, it would be very difficult 

 to say when Yellow Fever was introduced, or to lay the blame for the 

 introduction of the disease upon any one place like Belize or Puerto 

 Cortez, through failure of the local medical representatives of the 

 United States to notify the disease at an early enough date. After 

 my stay in New Orleans I had to investigate the outbreak in British 

 Honduras, and subsequently I took the opportunity of visiting Living- 

 stone, Puerto Barrios and Puerto Cortez. I found the same great 

 difficulty in ascertaining with certainty when the disease originated 

 and how it was introduced. Adjacent countries blamed one another. 

 There was little question that, as has been so often the case, the 

 early cases were not recognised and that the outbreak of Yellow 

 Fever was not expected. Upon investigation, I came to the conclusion 

 that great credit was due to the late Dr. Carson, attached to the 

 United States Marine Hospital Service at Belize, for the early and 

 prompt manner in which he acted. Recrimination is of little use : 

 the fact remains that a great Port like New Orleans, with its immense 



