( 15 ) 
to study any particular disease affecting the prosperity of the Colony, to some 
place where the particular disease is common. This is one of the chief 
reasons why the medical officers of the Marine Hospital Service are of such 
practical service to the United States. 
Of supreme importance also is the necessity of obtaining a post-mortem 
examination of the first suspicious death. The post-mortem findings are 
characteristic, and do not need microscopic confirmation. 
1 he notification of Y ellow fever is rightly regarded as a very serious matter, 
and a young practitioner will undoubtedly hesitate before he declares. If he 
has notified, and the case does not turn out to be yellow fever as he supposed, 
he regards his diagnostic power as open to criticism, both by other doctors 
and by the patient. If he is dealing with a genuine case, and he hesitates 
till too late, no fumigation is undertaken to kill the infected mosquitoes at the 
outset, and in the meantime contagion is spread to make itself felt some twelve 
days afterwards in the same house or in the vicinity. The situation is 
unquestionably difficult, and it can only be got over by friendly inter-reliance 
amongst the medical men themselves, and by the encouragement given by the 
Senior Medical Officer to his juniors not to hesitate to express their difficulties 
to him nor to think that thereby they suffer in his estimation as careful 
observers 1 I am convinced that this is very necessary, as there is evidence that 
this spirit is not always carried out. The action taken on the initiative of the 
New Orleans Medical Society this year, and also later by Dr. White, in command 
of the Federal Public Health Service in New Orleans, is of oreat interest here, 
for both communications show that those who were best capable of judging, knew 
the difficulties to be encountered in prompt notification and in mistaken diagnosis. 
I reproduce for future guidance the letters in full which were sent to every 
medical man. 
NOTICE TO THE MEDICAL PROFESSION. 
U.S. Public Health and Marine Hospital Service. 
New Orleans, August, 1905. 
Dr 
Dear Doctor, 
Considering the imperative necessity of instituting at the earliest possible moment pro- 
phylactic measures in the case of any person suffering of a fever which may subsequently be shown 
to be yellow fever, you are urgently requested to report to this office not only any case of fever 
which you may be sure is Yellow fever, but also any case you may be unable, even at your first 
visit, to say is not yellow fever. 
We enclose you cards which will facilitate your report of such cases, and will at the same 
time give us your authorization to inspect the said premises, and to do whatever may be necessary 
to prevent the extension of the infection in the house or neighbourhood. 
We give you our assurance that your rights as the attending physician will be fully respected, 
and that our inspectors will make no attempt to examine the patient, or in any manner endeavour 
to influence your diagnosis or treatment of the case. 
We shall await your final determination of the case, but hold ourselves ready to serve you with 
a consultation free of charge to your patient from the enclosed list of gentlemen, who have consented 
at our request to aid this office in the clearing up of any doubtful diagnosis. 
’Reed and Carrol wrote “the chief duty of quarantine officers hereafter will consist in the 
detection of mild or very mild cases of yellow fever. In a series of twelve cases of experimental 
yellow fever produced by the bite of Stegomyia fasciata, we have elsewhere pointed out that four, 
of 33%, were mild or very mild in character, and have indicated the difficulty of making a 
positive diagnosis in such cases.” 
