( '4 ) 
In connection with 
eradication of the 
Stegomyia. 
. 5. Stegomyia survey. 
I 6. Screening of water supply. Oiling. 
I 7. Necessity of screening water supply in vicinity 
wharfs. 
8. Mosquito nets and the screening of houses. 
9. Antimosquito propaganda. 
of 
1. — Early Notification. 
Careful enquiry into the numerous epidemics in the Southern States and in 
the Fruit Ports of Central America this summer proves conclusively that Yellow 
fever had gained a firm foothold before the first cases were notified. 
In Central and Southern American Ports this will prove for a considerable 
time to come a perpetual source of danger, for the inhabitants of these 
districts are likely to be more indifferent to the disease, and therefore to be 
less careful about notification. No doubt this is also the reason why it is laid 
such stress upon in the opening Articles of the Washington Convention of 1905. 
Commercial reasons, it is alleged, may sometimes operate to hold back notification, 
but the lesson of this year shows that the risk of the losses brought about by 
allowing the fever to gain a head is too great. In a modern city swarming 
with the Stegomyia , a concealed case must sooner or later make itself mani- 
fest, and by the time it does so, the total volume of mosquito infection will be 
so great that serious disaster is inevitable. Commercial and civic authorities 
now realise this, so that the danger from suppression of the facts is diminishing. 
More often the loss of time in early notification is due to the fact, either that 
cases of the disease are present amongst the indigenous inhabitants (Central 
and Southern America), or breaks out amongst a particular colony of labourers 
in a town or district, such as amongst the Sicilians and Italians in New Orleans 
this year (1905), who do not readily seek medical advice, and are often exceed- 
ingly suspicious, or that early cases are not recognised. In districts where 
malaria takes a pernicious form, or where Dengue is common, the difficulties 
of diagnosis must be greatly increased, and experience under these circum- 
stances will be of great value. On the other hand, some other epidemic 
may have preceded the Yellow fever, and cases which were in reality yellow fever 
may have been placed to the credit of the former. 
In large cities, as mentioned in the previous chapter, a clue that some- 
thing unusual is happening may be afforded by analysis of the weekly death 
returns. A sudden rise in the number of deaths recorded from malaria in a 
month, at a season of the year when malaria has not occurred in previous 
years, would be a very suspicious element. In small towns, however, such 
indications would probably be too slight to be of practical value in putting a 
community upon its guard. 
Where the practitioners themselves have had the advantage of previous 
experience in the disease there is a greater chance of early notification. But 
I venture to suggest that experience gained of Yellow fever or any other 
disease twenty or fourteen years previously, is not so valuable as experience of the 
disease acquired since our knowledge of the disease has been very greatly 
increased. For this reason I urge that it would be wise for one or morfe of 
the Government Medical Officers of the Colony to be sent, as occasion arises, 
