11 



be stated succinctly as follows : To prevent the infection of Stegomyia 

 mosquitoes by properly protecting all persons ill with yellow feyer 

 during the first three days of the illness; to protect the well from the 

 bite of the mosquito; and, as a corollary to the above, the destruction 

 of all mosquitoes and their means of propagation. Given the requi- 

 site personnel, sufficient funds, and the necessary authority to enforce 

 measures to this effect and there would be little danger of the disease 

 spreading. These desiderata, however, are usually wanting or only 

 imperfectly supplied. - The practical adaptation of the above propo- 

 sitions may be considered under the following heads : 



1. Detection of cases or inspection. 



2. Yellow fever hospital. 



3. Martial law. 



4. Detention camp. 



5. Protection against the bite of the mosquito ; screening, etc. 



6. Extermination of mosquitoes, including oiling, fumigation and 

 the screening or destruction, of water containers. 



The details of the two, latter are so well known and, in fact, so 

 simple that it seems unnecessary to take up the reader's time with a 

 discussion of them. Kelative to the first three, which I consider of 

 great importance and which, in a way, form the tripod on which the 

 others rest, it is well to say a few words. 



1. Detection of cases or inspection. 



In order to put in force efficient prophylactic measures it is abso- 

 lutely necessary that all cases be reported immediately. For reasons 

 before stated this is difficult, and to those already given we may add 

 that during an epidemic many cases of fever do not call a phy-' 

 sician at all. To surmount these obstacles, as well as the difficulty of 

 definitely recognizing the disease in its early stages, all cases of 

 pyrexia in which the reason of the abnormal temperature is not 

 manifest should be treated prophylactically during the first three 

 days as though they were yellow fever, or until a positive diagnosis 

 to the contrary is made. For the purpose of reaching- all cases of 

 fever a thorough inspection is required. Every dwelling in the in- 

 fected area must be inspected daily, or, better, twice a day, by com- 

 petent inspectors, persons capable of reading the clinical thermometer. 

 All cases of pyrexia discovered by the inspectors should be imme- 

 diately reported to the officers in charge of the screening and fumi- 

 gating parties for proper action. The patient having been protected 

 against the bite of the mosquito by screening and his dwelling and 

 the surrounding houses fumigated for the purpose of destroying any 

 possibly infected mosquitoes, the question of diagnosis may safely 

 be left to be determined later. Whenever possible the patient should 

 be removed to the hospital. 



