employed by the Service, and aided by United States custom inspectors. They worked harmoniously together and did good service, although I do not consider that the patrol was entirely effective. The natural conditions of the river between the two cities and for miles above and below are such that it would take a very large force of well-disciplined men to make it absolutely secure against the possibility of any one crossing who had especial interest in doing so and possessed the necessary courage.

SANITARY WORK OF SERVICE.

We entered into our work with great enthusiasm, and during the first few days we were filled with the hope that our efforts would be crowned with brilliant results, that is, we would be able to wipe out the epidemic in a month or six weeks. In this we were doomed to disappointment. It was soon found that the disease was too widely spread and that the obstacles to be overcome in carrying out the necessary sanitary measures were many and serious, and in some cases insurmountable under existing circumstances. However, while the results of our efforts did not come up to our expectations, they were gratifying and productive of much good, as the sequel will show.

On the 26th of September an office was established in the central part of the city for the transaction of business, and on the following day, September 27, the sanitary corps under my command was given a definite organization. Four mosquito sections had been formed, with an acting assistant surgeon in charge of each, and Passed Assistant Surgeon Von Ezdorf given general supervision over the entire squad. Each séction consisted of about eight men, one of whom was a carpenter and another was designated as foreman and had charge of the material. Each section was supplied with a cart containing all the material necessary for the work, to-wit: sulphur and pyrethrum powder in sufficient quantity, twentyfive pots, twenty-five pans, five-gallon can wood alcohol, roll of paper, shears, knives, bucket of paste, brushes, brooms, wall brushes, mosquito netting, a number of strips of laths, nails, hatchet, saw, ready-made screen door and windows, ladder, five-gallon can kerosene oil.

The

Within a short time the above system was somewhat modified with the object of gaining time and effectiveness. carpenters were separated from the general disinfecting sections and formed, at first, into two and later into three "screening" sections. These were composed each of two or three carpenters, supplied with a wagon carrying tools, lumber, mosquito bars and mosquito netting. The modus operandi was then as follows: Immediately on a case (whether suspicious or positive) being reported to us by the state board of health or by any one having authority to do so, a screening section was at once sent out and the infected house "screened." This "screening" varied according to circumstances. Unnecessary doors and windows were closed tight. One window and a door of the patient's room were left open for ventilation and to admit those caring for him, and both of these fitted with screens. Often the conditions did not admit of this. The shacks or "jacals" of the poorer classes consisted of but one room with innumerable cracks and openings in the walls and rooms. Screening was impracticable here and the patient was placed under a mosquito bar. Towards the end of the epidemic I had a portable mosquito house built, covered with wire gauze and with double doors, which was applicable to such cases. The patient being thus isolated and rendered as safe as possible against propagating the disease by infecting the mosquito, the disinfecting section would come along and disinfect the premises and surrounding houses to kill the insects already infected. It was the duty also of the disinfecting section to pour oil in all cisterns, barrels or other receptacles of stagnant waters found on the premises disinfected.

PROCESS OF DISINFECTION.

The details of the process were as follows: The room or house was made mosquito-tight. To accomplish this all doors and windows were closed. Paper was then cut into strips and pasted over all cracks or openings through which mosquitoes might escape; the chimney was made secure.

In many cases houses were in such bad condition that they had to be almost completely papered over, both inside and out, and large unprotected openings covered entirely, with sheets of paper. In the meantime the pots were being filled with sulphur or pyrethrum, as the case might demand, and placed in position on pans filled with water. These water pans served a double purpose, to prevent danger from fire and for the purpose of collecting mosquitoes, for experience had shown that after disinfection nearly all the dead mosquitoes within the room were found in the pans. The plan used in Havana to facilitate the gathering of the mosquito was em ployed at first, that is, to place a moist piece of paper in front of a window or wherever light might enter, with the object that after disinfection the majority of the dead or stunned insects would be found on this paper. This plan was based on the supposition that the mosquito sought the light and fell on the moist paper and adhered to it. This method was discontinued when experience showed us that what' attracted the mosquito during the process of asphyxiation was the water and not the light, for they were invariably found in the water pans even when these were in dark corners.

The pots and pans being in position, about fifty cubic centimeters of alcohol were poured on the sulphur or pyrethrum, as the case might be, and the contents ignited. Then, without loss of time, the disinfectors would retire, closing the last door of exit and pasting paper over any cracks that might be found in it. When the house admitted of it all rooms except that of the patient were first disinfected, and he was then removed to one of the disinfected rooms duly protected from mosquitoes, so as to permit of the disinfection of the room occupied by him. A great number of the houses or “jacals" consisted of but one apartment, in which case the patient was removed, temporarily, under a tent during the process of disinfection. The latter plan was inapplicable in cold or bad weather, and then it was necessary to wait until circumstances would admit of disinfection, keeping the patient screened in the meantime.

For the purposes of mosquito disinfection sulphur was burned in the proportion of four pounds to the one thousand cubic feet, with four hours' exposure; pyrethrum, six pounds to the one thousand cubic feet and six hours' exposure. On the termination of the disinfection the house was opened and the floors, walls, furniture, etc., carefully swept for the purpose of collecting all asphyxiated mosquitoes and immediately incinerating them. When pyrethrum was used as a disinfectant this operation was done with scrupulous care; when using sulphur it was not so necessary, as the insects were always found dead. As before stated, the great majority of the insects were found in the water pans beneath the pots.

There is no question that sulphur is the best agent for mosquito disinfection. It is certain in its effects and during the short exposure necessary to kill the mosquito little or no harm is done to fabrics or other articles usually injured in this process, when the exposure is of longer duration. Sulphur was our main reliance, although pyrethrum was used where any possibility of damage was to be apprehended. Of the large number of houses disinfected (2,952) there was not a single case of complaint, well founded, of appreciable injury caused by the process of disinfection.

The above described plan was adhered to until the end of the epidemic, with the modification that the duties of oiling cisterns, barrels and receptacles assumed such proportions, and were of such paramount importance, that they were in great part taken away from the disinfecting sections and turned over to an independent section. The former, however, always carried a supply of oil and were ordered to inspect and oil all standing water not previously oiled.

The importance of destroying all breeding places for mos. quitoes was apparent from the beginning of the campaign and the disinfecting sections were duly instructed as to their duties in that respect. But of course these only reached premises and their immediate surroundings that had been reported infected.

It had been arranged that the state and city health authorities would undertake a general sanitary inspection and oiling

of all water containers, but inasmuch as the destruction of breeding places for the mosquito was of the utmost importance and was so closely associated with the work the Service had in hand, I suggested to Health Officer Tabor that I undertake the work. To this he assented very willingly, offering to aid us in every way in his power to carry out our designs. Dr. Tabor's aid was very effective in procuring a large quantity of crude oil and in enforcing a strict quarantine against those who refused to allow us to proceed with our work.

So, October 9, an oiling section was organized and set to work. This section was put in charge of Acting Assistant Surgeon Frick, with a wagon carrying the necessary material. Subsequently it was divided into two sections, one attending to the sprinkling of the streets, pools, ponds and other large bodies of standing water, the other looking after water barrels, cisterns, pails, tin cans and all other water containers found in the neighborhood of houses.

Naturally much opposition arose against the oiling of water barrels, especially among the ignorant classes, who were led to believe that our object was to poison the water. On several occasions this opposition assumed serious and menacing proportions, so much so that the lives of the officers and men engaged in the work were threatened. To obviate this difficulty it was decided to put wooden faucets in the barrels of drinking water, so that the water might be drawn from below, free from oil contamination. The "oiling section" was duly supplied with these faucets, with instructions to apply them to all barrels containing water for drinking purposes. This measure was very effective in allaying irritation and averting trouble with the people. It greatly facilitated the work and made it more effective, although there were always some who objected violently against interference on our part with their water barrels.

Within a short time the "oiling section," under its efficient chief, became so apt in its duties that the entire city could be inspected and oiled in five or six days, so that within that time every water container and other deposits of standing water was inspected and treated, making it impossible for the mosquito larvæ to arrive at maturity. During the first tour of the town 3,500 barrels, without including other containers, were oiled.

I consider this as one of the most important features in the campaign against yellow fever at Laredo, and too much praise can not be given Dr. Frick for the energy and intelligence with which he handled every detail of the work committed to him. The results were so gratifying that when Assistant Surgeon Goldberger arrived in Laredo, November 21, under orders from the Bureau to secure specimens of larvæ of the Stegomyia fasciata, he found it impossible to secure a sufficient number for the purposes contemplated. A thorough inspection of the town, on three or four successive days, yielded only about one hundred mosquito larvæ, half of which were anopheles.

The following table gives a synopsis of the immense amount of work done by the oiling brigade from October 9 to November 30, both dates inclusive. The entire town was gone over six times:

In addition, about 70,000 square feet of standing water were oiled in neighboring arroyos or creeks, and on the streets after rainstorms.

As the epidemic increased the number of disinfecting sections was increased by the addition of two large ones, composed of ten men each, with an experienced foreman and the necessary outfit. It had become evident that the Havana methods of controlling yellow fever were not quite applicable to Laredo, under existing circumstances, and it was determined to undertake a systematic and complete disinfection of the entire city. These two sections were started at the southeast and southwest extremities of the town, working toward

each other and at the same time pushing north. Every house and building was included in this disinfection; schools, public buildings and churches, no matter whether or not they had been previously disinfected. By December 1 two-thirds of the town had been covered by this general disinfection, including its most thickly populated portions. This work was continued after December 1 by Acting Assistant Surgeon Frick and completed under his direction.

From September 26 to November 30, both dates inclusive, 2,952 houses and buildings, containing 10,045 rooms, were disinfected. Repetitions are included in the above figures, a number of houses having been disinfected more than once, a few as many as three or four times.

The following table gives a résumé of the work of disinfection:

It is estimated that there are 2,963 houses in Laredo. This figure was obtained after careful investigation. Of the above number 580 were infected, or 19.54 per cent.; in other words, one house in five. These figures show that the infection was well generalized. The work of screening and disinfection was under the immediate supervision of Passed Assistant Surgeon Von Ezdorf and was admirably directed by him.

Such, then, in brief, was the plan of campaign adopted to stamp out the epidemic. To recapitulate: (a) The isolation of the patient by screening; (b) the fumigation of the infected premises for the purpose of killing infected and other mosquitoes: (c) to prevent the propagation of the Stegomyia fasciata by covering all stagnant water with oil, killing the larvæ and preventing the laying of eggs; (d) the general and systematic disinfection of the entire city.

DIFFICULTIES ENCOUNTERED.

It may be well now to discuss the difficulties encountered in the progress of the work and which interfered materially with its effectiveness. These may be done under four heads: 1. Lack of sufficient authority to carry out necessary sanitary measures. 2. Ignorance of the people. 3. The possibility of the introduction of infected mosquitoes from Nuevo Laredo, across the Rio Grande. 4. Unfavorable weather.

The first two items, being closely associated, will be taken up together.

(1) Lack of sufficient authority to carry out sanitary measures, and (2) ignorance of the people.

When yellow fever was declared to be present in Laredo and the town quarantined a large part of the people, particularly the ignorant class, were filled with the idea that the physicians and the authorities were in a conspiracy against them, and that the main object they had in view was the making of money. They went even further, and it was quite generally believed that the physicians poisoned their patients to get rid of them as soon as possible and in this summary manner end the epidemic. Patients not only refused treatment, but resisted, frequently, to permit the use of the clinical thermometer, thinking that this, too, was poisoned. This was certainly an amazing condition of affairs, and it was difficult to believe that such perversion and crass ignorance could exist within the confines of the Republic. These extravagant opinions were supported by one or two irresponsible sheets printed in Laredo.

Under such circumstances it is not to be wondered at, that all possible means were resorted to to hide cases from the physicians and inspectors. It frequently happened that when a physician reached a house where some one had been reported sick no patient was found, the sick one having been removed to other quarters, or else the house would be found empty and closed, the entire family having moved away.

Patients very ill with yellow fever have been known to get out of bed and hide in a privy or other outbuilding when informed that a physician or inspector was approaching. Moreover, they usually had some member of the family on guard to give the required information. A house-to-house inspection was commenced under the direction of the state health officer

September 29. This was later on supplemented by vol

unteer inspectors named by the mayor. The results were not satisfactory. Finally it became so apparent that cases were being hidden, and that this was one of the prin cipal reasons why the epidemic could not be controlled, that I withdrew the four acting assistant surgeons in charge of disinfecting work, and appointing an additional one, started them on house-to-house inspection on November 9. They worked with good results for several days, when the better class of citizens, becoming interested in the matter, offered their services as inspectors. These were put to work under the direction of a committee consisting of the sheriff, the county clerk, the state health officer, the representative of the Public Health and Marine-Hospital Service and several prominent citizens. The results of this intelligent volunteer inspection force, working in conjunction with and under the direction of the sanitary officers, were excellent. In a little over two weeks, with the aid of favorable weather, the epidemic was entirely under control. Too much praise can not be given these citizens for the disinterested and effective work done by them, and it is to be regretted that their services were not offered at an earlier date.

HOSPITAL.

In organizing the plan of campaign against the epidemic, one of the first things that occurred to the writer was the establishment of a hospital. Without one the entire system appeared faulty and ineffective. This was especially the case in a town, such as Laredo has been described to be, with a very large and ignorant proletariat, living in houses which scarcely merited the name, and under hygienic conditions which must be seen to be believed. Here was a large part of the population unable to care for its sick, and among whom the problem of mosquito disinfection was surrounded with difficulties which were at times insurmountable.

How was a miserable "jacal" consisting of but one room eight or ten feet square and about six or eight feet in height, made up of boards loosely thrown together, or tin cans or old sheets of tin or iron and other inconceivable materials, with cracks and open spaces everywhere, to be effectively disinfected? In many cases the patient had to be removed to the shelter of a tent and the house papered inside and out before disinfection could be attempted. But in a structure such as has been described the removal of the patient, and the very process of making it fit for mosquito disinfection defeated in a measure the object in view, for the movements of the men of the disinfecting gang within a space so reduced would be sufficient to drive out the mosquitoes within the inclosure. The attempt to screen a patient under such circumstances was equally difficult, and naturally was not as effective as could have been wished.

A mosquito-proof hospital, in which such patients could have been removed at once, was, therefore, of the greatest importance. But here again we were confronted with the ignorance of the people and the lack of authority to enforce sanitary measures. After consultation with the mayor and other prominent citizens I was dissuaded from carrying out my intentions respecting the establishment of a hospital. It was impressed on me that the very class of cases I wished to remove to a hospital would absolutely refuse to go, and that there was no authority to force them to do so. My experience with the people soon showed me that this was true and the plan to establish a hospital, while ever present to my mind, was finally abandoned. However, I believe it was an error not to have carried out my original intention, and under similar circumstances, and with my experience at Laredo, I would insist on a hospital, well appointed and well managed, hoping in a short time, by a demonstration of its merits, to overcome the prejudice against it.

The lack of authority to carry out sanitary measures was, as may be seen from what has gone before, the most important obstacle to our success in dominating the epidemic. It interfered with the house-to-house inspection, with the oiling of barrels and cisterns, with the screening and disinfection of houses and premises and prevented the establishment of a yellow fever hospital.

The Laredo epidemic has shown conclusively to my mind that results such as were obtained in Havana in the suppression of yellow fever during the American occupation can not be obtained elsewhere, where the disease is widely spread, without the undisputed authority and the means that were at the command of the Government of Intervention in Cuba. These powers in reality amounted to martial law. In Havana, too, there was no tendency to hide cases, and Spanish emigrants, who furnished the majority of cases, were immediately taken by their friends to a "Quinta de Salud" or private hospital connected with beneficial aid societies, of which there are several in Havana, and in this way promptly came under the observation of the authorities, so that proper precaution could be taken. This simplified matters very much.

I believe that under martial law the Laredo epidemic could have been controlled within three or four weeks after the disease had been officially declared, September 25, even though at that time it had already invaded many parts of the town. When one considers what this would have meant to Laredo in the saving of life, the conservation of commercial and railroad interests and, in addition, the benefits to the surrounding districts, it becomes a serious question whether under such circumstances the establishment of martial law, or something equivalent to it, should not be the very first step to be taken in the suppression of an outbreak of yellow fever or in fact of any of the epidemic diseases.

In most epidemics the hardships endured by the people, the loss of life, the interruption of commerce, causing heavy financial losses, all are greater than in the case of riots or other disturbances of the peace for which ordinarily martial law is imposed. Such being the case, it is not clear why this efficient means of combating an epidemic should not be more strongly recommended, nor why so much opposition should be aroused against it, when it is suggested.

Now let us inquire into the third difficulty which presented itself to our efforts to control the epidemic, that is, the proximity of Nuevo Laredo and the possibility of mosquitoes being carried by the winds across the Rio Grande.

In Nuevo Laredo no practical mosquito disinfection was done until late in the epidemic, when something was attempted in that line, so that the number of infected stegomyia must have been very great. During the summer and fall, and until such time as the northers begin to blow with frequency the prevailing wind is from the southeast and south, that is, directly across the river from Nuevo Laredo toward Laredo. The wind at times blows with considerable force. As already stated, the width of the river is about 1,500 feet and there is a long, narrow island, covered in part with thick brush, situated near the American side. The distance from the Mexican bank of the river to this island is about 900 feet, the width of the island 400 feet, and from it to the American side 200 feet.

Under these circumstances I can readily believe that the stegomyia might easily be carried across the river by the wind.

Knowing that the stegomyia is a house mosquito, and therefore, usually, is in a position to obtain shelter against the wind. I do not consider that they would be carried over in any great numbers, but it is very probable that quite a few were introduced into Laredo, Texas, in that way.

The authorities of Nuevo Laredo were urged to take more effective sanitary measures, and in fact a good deal of work was accomplished under the direction of the active and efficient mayor and health officer, Dr. de la Garza; but for lack of funds it was far from being what it should have been. The Mexican authorities, indeed, had the advantage of power, which we lacked. They were not confronted by the good (?) citizen insisting that "his house was his castle" and that he would shoot the first one who attempted an entrance, but on the other hand they lacked the "sinews of war" to make their power effective.

As has been said, the two Laredos are practically one, and the epidemic could have been handled much more effectively had it been possible to so consider them for epidemic purposes. The necessary arrangements should certainly be made

One thousand and fifty cases of yellow fever were reported up to November 30, when the epidemic was declared over and quarantine against Laredo raised. Only a few isolated cases were reported after that date. These 1,050 cases occurred in 580 houses, the patients being screened and the houses disinfected.

Of the above number of cases 103 died, or 9.80 per cent. This mortality is about the same as that in recent epidemics. While I believe that quite a number of the cases reported as such were not yellow fever, there is no doubt that many cases of mild yellow fever escaped the inspectors and were not reported. These two sets of cases probably balance each other, and the figures given may be considered close to the actual truth.

The following table is of interest as showing the difference in mortality among the Americans and Mexicans, and also emphasizes the difficulty we had to contend with in reaching the latter class:

YELLOW FEVER STATISTICS, LAREDO, TEXAS, FROM SEPTEMBER 25 TO NOVEMBER 30:

Fifty-five Mexicans were discovered dead or in a dying condition.

It is estimated by Dr. Juan F. de la Garza of Nuevo Laredo that there occurred in that town during the epidemic from 2,500 to 3,000 cases of yellow fever. From personal observation and from information obtained from reliable citizens of the place, I am inclined to agree with him.

Estimating the population of Nuevo Laredo at the time of the epidemic at 6,000 persons, we deduce that nearly or fully 50 per cent. of the inhabitants were attacked by the disease.

On the other hand, in Laredo, Texas, with an estimated population of 10,000 during the epidemic, there were only 1,050 cases, or about 10 per cent. of the inhabitants thereof. I consider this an excellent showing and sufficient compensation for the labor, and expense incurred in fighting the epidemic, bearing in mind also that steps had been taken and were subsequently carried out for completing postepidemic disinfection of the city and surrounding districts with the object of preventing infected mosquitoes and a few isolated cases keeping up the disease during the winter months and giving rise to a fresh outbreak in the spring. For, as a result of our efforts, Laredo can not be considered as an immune town, such as I believe Nuevo Laredo to be. In Nuevo Laredo the epidemic had full sway, and all those naturally subject to the disease, I think had it, whereas in Laredo, Texas, as a result of the sanitary measures taken, there still remains a very large majority of the inhabitants who are liable to contract and spread the disease.

The above figures also compare very favorably with those of the yellow fever epidemic of 1899 at Key West, where a total of 1,350 cases were reported and 68 deaths.

I have no way of knowing what the estimated population of Key West may have been during the epidemic, but judge it would not have been over 12,000. It is probable that of those that remained in the city one-half were immunes, through pre

vious epidemics or, on account of their Cuban birth, having been immunized by an attack of the disease in childhood. So that, with very much less available non-immune material in Key West, the number of cases was considerably greater than in Laredo. This shows clearly the controlling influence of mosquito disinfection.

The quarantine against Laredo by the state of Texas was officially raised November 30; a proclamation to that effect being issued by the governor on that date.

DEATH OF SURGEON R. D. MURRAY.

No place appears more appropriate than this to mention the eminent services rendered by our distinguished fellowofficer and esteemed friend, the late Surgeon R. D. Murray, late ranking surgeon of the Public Health and Marine-Hospital Service, and the veteran of many campaigns, both of arms and of sanitation. He came to Laredo under special orders from the Bureau and united himself with us, joining in our labors, assisting us with his counsel and advice. . His special duty was to act as expert diagnostician and ferret out and report cases of yellow fever. He supplemented this by treating a large number of cases, especially of the poorer classes. The number of physicians in Laredo was limited and, at times, insufficient for the calls on them, so that all the officers of the Service were occasionally occupied in the treatment of cases, work which was foreign to their duties, but which had to be done under stress of circumstances.

Dr. Murray did by far the greatest amount of this volunteer work. The effects of his kind treatment of the Mexicans, remaining night after night at their bedsides in the hope of saving some poor and abandoned patient, was most salutary on the minds of these people and was rapidly breaking down their antipathy and suspicion against the American doctors, when destiny called him away from the scene of his labors and through a deplorable runaway accident on November 15, while on his way to visit a case, he met with injuries which caused his death a week later, on November 22. The demonstrations of grief on this occasion from his fellow officers and the people of Laredo were great, indeed, but not more than a fitting tribute to the great-hearted and generous soul that had passed away.

The tragic death of Surgeon Murray will always leave a feeling of sadness in connection with the epidemic of 1903 at Laredo. He died in full armor, in the discharge of his duties as an officer, a gentleman and a physician.

Laredo was our principal field of operations and we were fully occupied therein, but, notwithstanding this, we were obliged at times to devote some of our attention to nearby towns. Of these Minera furnished some interesting data and will be now considered.

MINERA.

Minera is a mining camp situated about twenty-five miles northwest of Laredo and communicating with it by means of the Rio Grande and Eagle Pass Railroad, one mixed train running daily, except Sundays, over this road. It has a population of about 1,100, consisting of miners and their families, almost all Mexicans. The majority live in houses constructed by and belonging to the Rio Grande Coal Co., but quite a number inhabit miserable huts of the worst kind, built by themselves. The camp is situated close to the banks of the Rio Grande and on the opposite side of the river is the Mexican town of Columbia with a population of about 1,500.

Suspicious cases of illness having been reported from Minera, Surgeon R. D. Murray visited the place October 1 and found seven cases and one death from yellow fever. Minera is well isolated and has no rail communication except with Laredo, so that the danger of the disease being carried to other points in Texas was not great, and as the Rio Grande Coal Co. employed a physician to look after the miners, and our time was fully taken up with Laredo, it was deemed sufficient to give the necessary instructions as to screening and disinfection and leave the carrying out of the work to the company's physician. But as the cases of yellow fever continued to increase in number, it was finally decided that we should take hold of the situation and make an effort to control the epidemic.

F. S. Goodman, pharmacist and special disbursing agent of the Public Health and Marine-Hospital Service, was sent to Minera with a disinfecting gang and a complete outfit, with instructions to disinfect every house in the place and to cover all standing water with oil. The mission of Pharmacist Goodman was executed with extraordinary vigor, thoroughness and

success.

The history of the Minera epidemic is extremely interesting and shows conclusively the efficiency of mosquito disinfection in controlling and stamping out an epidemic. Up to October 20 there had occurred in Minera, a town or mining camp of about 1,100 inhabitants, 96 cases and 7 deaths from yellow fever, showing that the disease was generalized. A thorough disinfection of the village done under extreme pressure and within the remarkably short time of something less than three days, was concluded October 21.

On that day two new cases and one death were reported, one case and one death on October 22, and two cases on October 23. From the latter date not a single case occurred until October 30, an interval of more than six days, when one case was reported; then another interval of five days until November 6, when three cases were reported, after which date a few cases appeared from time to time, until the advent of cold weather, aided by the efforts of the officers of the coal company to stem the recrudescence of the disease, following our methods, finally stamped it out.

Considering the incubation period of yellow fever as from five to six days, the above figures show conclusively that the mosquito disinfection of Minera was effective in stamping out the disease.

Whether the second outbreak was due to importation from without or to some infected mosquito that had escaped destruction during the disinfection of the camp, is uncertain, but in any case it is clear that the disease had been practically exterminated and that if reasonable vigilance had been exereised by the officers of the coal company or we had been in a position to devote our attention to the work, the disease would never have been permitted to again obtain any headway. As it is, subsequently to the general disinfection of Minera, on October 21, 36 new cases and 2 deaths occurred up to December 1, without counting the 5 cases and 2 deaths which were reported October 21, 22 and 23, and which it is clear had been infected before the process of disinfection had been concluded. It is, indeed, more probable that the second infection was introduced from without, as the Mexican town of Columbia, on the other side of the Rio Grande, was at that time ravaged with yellow fever, and in spite of the guards maintained along the river by the Service, the state and the coal company itself, it is well known that there was illicit communication between the two villages.

CONCLUSIONS.

1. The results obtained through the efforts to combat the yellow fever epidemic at Laredo go to demonstrate that the mosquito (Stegomyia fasciata), is the only means of transmitting yellow fever and that the efforts to destroy the same were productive of much good, greatly limiting the number of

cases.

2. The measures taken to prevent the reproduction of the Stegomyia fasciata or other mosquito, by oiling all water containers and deposits of stagnant water, were completely successful.

3. It was demonstrated that to control an epidemic of yellow fever which has gained considerable headway (and such is the condition usually met with), it is necessary to have absolute power to enforce sanitary measures until such time as the people are educated up to the importance of such measures.

4. Inasmuch as the Stegomyia fasciata can only become infected by biting the patient during the first three days of the disease, it is of vital importance that cases of fever be reported at the earliest possible moment, so that they may be screened and the mosquito prevented from biting them. Such being the case, an efficient system of inspection is necessary, especially where there is a tendency to hide cases.

5. It is impossible to obtain good results without a mosquitoproof yellow fever hospital.

6. The difficulties of handling an epidemic are increased when such outbreak occurs on the frontier. Arrangements should, therefore, be entered into by treaty with contiguous foreign countries so that, under such circumstances, sanitary measures may be carried out jointly by the countries interested, for mutual protection.

7. Insistent and continued efforts should be made through the public press and other available means to educate the people within the sphere of influence of the Stegomyia fasciata, so that they will learn to protect themselves against the invasion or spread of yellow fever among them by destroying the means for the propagation of said mosquito, and by protecting themselves against the mosquito by efficient screening.

Above all, to eradicate the existing fear in the medical profession, as well as among the laity, of declaring the existence of yellow fever. If the first case presenting the slightest suspicious symptoms of that disease were promptly made public, and the proper modern precautions taken, there would be no danger of the disease spreading. In fact, the public should be taught to acknowledge the existence of yellow fever in their midst with the same equanimity as in the case of measles or scarlatina.

8. The effort to control the epidemic at Minera was decidedly successful and would have been entirely so if we could have given it undivided attention. The results at Minera demonstrate almost as clearly as those in Havana that the mosquito is the only means of conveying yellow fever.

Finally, it is a pleasure to state that our relations with Dr. R. G. Tabor, state health officer of the state of Texas, and his staff, as also with the city and county authorities, were most cordial and happy. This accord was of the greatest importance in obtaining the best possible results from our mutual labors.

As to my personal staff, several of whom I have already mentioned in the body of this report, I have to say that one and all complied faithfully with their duties and to them is due in large part such success as we may have achieved.

SUICIDE; WITH SOME ILLUSTRATIVE CASES.*

JOHN L. DAVIS, M.D.

Medical Director of the Union Central Life Insurance Company. CINCINNATI, OHIO.

The alarming increase of suicide in recent years in this country is sufficient warrant for calling your attention to the subject to-day. The gifted editor of the Chicago Tribune, Mr. Upton, recently contributed some statistics to the Independent illustrating this lamentable fact. He showed that in twelve years there have been over 77,000 suicides recorded in the United States, the number increasing annually from about 3,500 in 1891 to 8,600 in 1903. Doubtless many cases failed to reach public knowledge, and doubtless many others recognized as suicides were officially reported under other causes of death. Had all these been noted properly, without doubt our country would show a loss at this time of fully 10,000 a year from self-destruction.

The Medical News1 of New York says: "There have been 50 per cent. more suicides in Chicago in 1903 than in 1902." The same journal states that in Philadelphia for 1902 the official records showed ratio of 15 deaths per 100,000 of population.2

Great as is this death rate with the population at large, among insured lives unhappily the ratio. is still greater.

*Read at the Fifty-fifth Annual Session of the American Medical Association, in the Section on Practice of Medicine, and approved for publication by the Executive Committee: Drs. J. M. Anders, Frank Jones and W. S. Thayer.

1. March 7. 1903, p. 476.

2. Medical News, New York, Sept. 5, 1903, p. 466.