96 PREVENTIVE AND REMEDIAL WORK AGAINST MOSQUITOES. 



of the hygienic service of Brazil and created a service for the stamp- 

 ing out of yellow fever. One million six hundred and fifty thousand 

 dollars was appropriated annually for this work. The service estab- 

 lished included 1 medical inspector, 10 sanitary inspectors (physi- 

 cians), 1 administrator, 1 customs inspector, 1 accountant, 70 medical 

 students, 9 subchiefs, 200 overseers, 18 guards of the first class, 18 

 guards of the second class, and 1,000 workmen; and in addition to 

 this personnel, the assistance of the public-health service corps of 

 inspectors was called upon. The city was divided into zones, ac- 

 cording to the density of the population, and the work was divided 

 into two sections: (1) Isolation and sanitation; (2) the policing of the 

 infected districts. Under the first section, yellow-fever patients 

 were removed to the pesthouse, residents were isolated, and houses 

 were disinfected. Under the second, the sanitary police force 

 visited every building in the city, destroyed the early stages of mos- 

 quitoes, and screened standing water where possible. One force 

 worked in buildings, and another in vacant lots, streams, marshy 

 lands, etc. The following paragraphs relative to this work are 

 quoted from an address made before the Latin-American Medical 

 and Sanitary Congress, held in Rio de Janeiro August 1 to 10, 1909, 

 by Dr. Oswaldo Cruz : 



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 treatment (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 mosquitoes, and the house was disinfected in 

 accordance with the system below outlined. 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 windows 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 

 ventilation, 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 pro- 

 portion 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 



