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at Puerto Cortes and Belize. There is little doubt that the infection was 
imported, whether from the interior or from without, and soon made itself 
felt on the non-immune white population, but to what extent, and in what 
severity, and at what date it may have been present among the native 
Spanish and Carib non-immunes, it appears to me to be very difficult to 
say, as the natives are not communicative, and have been in the habit of 
doing without medical advice. 
If Livingston is regarded as the primary focus, the fever appears to have 
spread from it into the interior of Guatemala following the railway line, 
which runs from Barrios to the interior. At Zacapa more especially, 103 miles 
from Puerto Barrios, the fever broke out on June 24th or 25th and was 
particularly virulent; 700 cases of fever are said to have occurred in a 
population of 6,000 inhabitants, and the mortality amongst the infected is 
given as 40%. The inhabitants are mostly Indian-Spanish, and it is evident 
that they must have been largely composed of non-immunes, and therefore 
the probability is that the town had not been visited by previous outbreaks 
as in the case of the coast towns, but that the Stegomyia fasciata was 
breeding there and was ready to receive infection once introduced. It 
is believed, locally, that the infection probably came from Livingston,, as 
there is considerable traffic between this large coast town and Zacapa in the 
interior. 
from Gualan, a town of some 6,000 inhabitants, and further up 
the line than Zacapa and about 138 miles from Barrios, severe sickness was 
reported as early as May,* it was variously styled, and appears to have gone 
sometimes under the name of “Railway Fever,” 128 cases with 77 deaths 
were, it is said, reported on May 22nd. 
If this were Yellow fever it would show that Guatemala was infected as 
early as May, and that the outbreak at Livingston might have been due to 
Gualan. But against this view fever was not announced at Zacapa, a little 
farther down the line, before June 24th, whilst it broke out at Barrios, the 
terminus, on June 4th. As our knowledge of the progress of Yellow fever 
along railway routes shows that intermediate towns often escape, it makes it 
all the more difficult to decide in the absence of accurate knowledge of the 
nature of the outbreak at Gualan, whether Yellow fever was in the interior of 
Guatemala prior to May 22nd, if it were, then Guatemala might have acted 
as a distributing centre to the coast towns. 
It is very remarkable that Puerto Barrios, only 12 miles from Livingston 
on the coast, and the point of departure of the railway to the interior, escaped 
apparent infection. For it will be noticed that not only was there an exceedingly 
severe epidemic up the line at Zacapa and probably at other places, but fever 
was present at Livingston and Belize to the north, and Puerto Cortes to the 
south, its coast and railway communications being thus infected. 
Puerto Barrios is a small village of 250 inhabitants, chiefly Jamaicans 
and Caribs, and within one and a-half hours’ run by sea from Livingston. 
* Reports reached Belize early in the year from deserting Jamaican labourers engaged upon 
the Barrios Railway and from other sources that severe fever, termed “ Railway Fever ” or lebre 
poludismo, was present in the interior. 
