Report of the Committee 
APPOINTED BY THE NEW ORLEANS MEDICAL AND SURGICAL ASSO- 
CIATION, OCT. 25TH, 1879, ON THE FOLLOWING SUBJECTS, SUB- 
MITTED BY THE EXECUTIVE COMMITTEE OF THE AMERICAN 
PUBLIC HEALTH ASSOCIATION, IO BE READ AND DISCUSSED 
AT THEIR MEETING AT NASHVILLE, TENN., NOV. 18th, 1879. 
Propositions. 
1. How to deal with a city in the yellow-fever zone in order 
to prevent the appearance of a first case. 
2. How to prevent the importation of a first case. 
3. How to deal with a first case and early cases generally 
when, in spite of precautions under first and second headings, 
it has made its appearance. 
4. The duty of local boards of health, or other health authori- 
ties, to report such cases promptly, even though there may be 
some doubt as to the diagnosis. Whether the knowledge that 
such reports would be faithfully made would not have a tend- 
ency to allay apprehensions and give confidence to other com- 
munities while warning them of the importance of making 
preparations for contingencies. 
5. Under what ciicumstauces may it become necessary or 
expedient to remove the unacclimated portion of the population 
from an infected place? How may this be effected for the 
poorer classes of the population, and how should the people 
thus removed be cared for and supported ? 
6. Measures for isolating a dangerously infected place. 
7. Organizations for the relief and treatment of the sick in 
an infected city. 
8. Measures for preventing the spread of the disease from an 
infected place by railroads, including the management of trans- 
fer stations. 
9. Inspection of steamboats at an infected place and at inter- 
mediate stations between the port of departure and their final 
destination. Should stations of observation be established by 
the National Board of Health .' If so, what should be their 
relations to the health authorities of the States within whose 
territoiial limits they may be established. 
10. Results of the co-operation and aid given by the National 
Board of Health to State and municipal boards under the pro- 
visions of the act approved June 2, 1879. What suggestions 
may be made to render tiiis system more efficient ? 2 
1. How to deal with a city in the yellow-fever zone in order 
to prevent the appearance of a first case. 
Answer.-Put such city in the best possible hygienic con- 
ditions. 
a. -Drainage. Proper elevation and grading of the surface 
of the soil. All surface-gutters to be provided with sides and 
bottoms of masonry or chemically prepared wood, to facilitate 
Hushing. All yards to be graded so as to drain into the gut- 
ters. All streets to be properly graded and paved. Banquettes 
carefully constructed. All privy vaults, where existing, should 
be required to be so remodelled as to avoid all possibility of 
siepage. In the construction of new privies, every care should 
be taken to remedy the defects of the present system. 
b. We would suggest, as applicable to most houses already 
built, such practical alterations as would improve their general 
sanitary condition; i. e., elevation of the lots upon which they 
stand to avoid all stagnant water, and such alterations as are 
deemed necessary to improve their ventilation. 
In building new houses, there should be an ordinance enacted 
and rigidly enforced by the proper authorities, requiring a 
specific elevation of the whole lot to be built upon, above the 
level of the street-such ordinance to be complied with before 
the foundations are allowed to be commenced. 
We would suggest thirty indies as the minimum elevation for 
the Hoor above the surface of the lot. 
No tenement houses to be allowed, as in our opinion they are 
always calculated to favor accumulations of filth, and thereby 
the production of disease. 
Sufficient light and proper ventilation are essentials to health, 
also an abundant supply of pure water. 
Where cisterns are used, the gieatest care in their construc- 
tion and management is necessary. 
All accumulations of garbage or tilth to be specially pre- 
vented. 
Extensive excavations or disturbances of soil to be forbidden 
from May to November. 3 
The thorough police of the city by trustworthy and compe- 
tent sanitary inspectors. 
2. How to prevent the importation of a first case. 
Answer.-By a rational quarantine under the direction and 
management of physicians of undoubted capacity and recog- 
nized integrity. 
Require all vessels, at all seasons of the year, to be subjected 
to careful inspection by the quarantine physician and to be sub- 
jected to such detention as he may deem necessary for efficient 
cleansing or disinfection. Establish a quarantine hospital for 
the treatment of infectious or contagious diseases arriving at 
quarantine-and we would advise that suitable facilities be 
provided for the unloading of cargoes and their proper disin- 
fection when judged necessary. 
3. How to deal with a first case and early cases generally 
when, in spite of precautions under first and second headings, 
it has made its appearance. 
Answer.-Every means should be adopted to insure the 
earliest information to the health authorities regarding such 
case or cases. 
Isolate, as far as practicable, the locality where such cases 
have occurred, and delegate to the proper authorities sufficient 
power for a thorough and repeated disinfection of such local- 
ity. All clothing and bedding of patients should be thor- 
oughly disinfected by heat, or destroyed. In case of death, 
immediate private burial to be insisted upon. 
4. The duty of local boards of health, or other health author- 
ities to report such cases promptly, even though there may be 
some doubt as to the diagnosis. Whether the knowledge that 
such reports would be faithfully made, would not have the 
tendency to allay apprehensions and give confidence to other 
communities, while warning them of the importance of making 
preparations for contingencies. 
Answer.-All suspicious cases should be at once reported to 
the proper health authorities, whose duty it should be to investi- 
gate such cases and report them without delay to all other in- 4 
terested communities. We believe this to be the only course 
to pursue to gain confidence and allay useless apprehension. 
5. Under what circumstances may it become necessary or ex- 
pedient to remove the unacclimated portion of the population, 
from an infected place ? How may this be effected by the 
poorer classes of the population, and how should the people 
thus removed be cared for and supported ? 
Answer.-We do uot believe that yellow fever is contagious, 
communicated from body to body-but that the cause, what- 
ever it may be, spreads through the atmosphere, and that a 
certain amount of the poison in this medium is necessary for 
its manifestation. That its spread is not by diffusion, other- 
wise it would grow less and less in intensity; but, that it is 
capable of multiplying in some way, as yet unknown to us, 
thereby increasing the intensity of its infection. That this 
atmospheric infection-tendency while greatly due to, is not 
wholly dependent upon heat and moisture, but that the pres- 
ence of decomposing organic material and the gases arising 
therefrom enter largely as a factor, if not in its production, at 
least in its spread; and that cleanliness of person and sur- 
roundings will go far towards preventing its spread, if not 
securing -its entire eradication. 
The removal of the unacclimated from the place of infection 
is a measure of wisdom, and would save many lives. The 
presence of the disease and its disposition to spread, as man- 
ifested in the successive attacks of several members of the 
same household or adjoining households, should be the signal 
for a general removal of the unacclimated ; for the rapidity of 
its spread, is evidence of its intensity. 
The details of measures for the removal of the poor will be 
suggested and controlled by the circumstances of location and 
surroundings. The governments, national, State, or municipal, 
or all three, aided by private contributions, should furnish 
means for their care. 
6. Measures for isolating a dangerously infected place. 
Answer.-When the disease has progressed to such an extent 
as to render a place dangerously infected, within the meaning 5 
of the term as employed by the National Board of Health, we 
would recommend the removal of all persons liable to infection 
and regulate intercourse so as by all possible means to prevent 
the ingress of unacclimated persons. 
7. Organizations for the relief and treatment of the sick in 
an infected city. 
Answer.-Each infected district should have its own hospital 
centrally located, of sufficient capacity to meet all wants, and 
presided over by a staff of medical men of standing and repu- 
tation in their profession and community. Each hospital 
should have its ambulances easy and comfortable, and every 
patient dependent on charity for its support and medical treat- 
ment, if discovered within the first twelve hours after the inva- 
sion, should be removed to said district hospital. The hospital 
staff should have entire control of the district, and such 
patients as have been sick for twelve or more hours should be 
treated at their place of residence by this staff, and their neces- 
sities should be relieved from the hospital upon the order of the 
attending physician. 
8. Measures for preventing the spread of the disease 
from an infected place by railroads, including the management 
of transfer stations. 
Answer.-We recommend the adoption of such measures by 
the National Board of Health as shall secur e, during the preva 
lence of an epidemic, the abolition on railroad cars of all up- 
holstered articles of furniture, rugs, carpets and such other 
material not washable, as well as all other material capable of 
conveying infection, and the substitution therefor of mattresses, 
chairs, seats, etc., made of wire, cane, wood or other open 
material. That the cars, especially sleeping cars if used, be 
open to free ventilation, as there can be no better puiifier than 
the current of air which passes through cars when in rapid 
motion. Also, that all articles of bedding be thoroughly 
washed in boiling water after leaving point of departure. 
Transfer stations should be under the supervision of compe- 
tent medical officers, subject to the rules and regulations 
of the National Board of Health. 6 
9. Inspection of steamboats at an infected place and 
at intermediate stations between their port of departure and 
their final destination. Should stations of observation be estab- 
lished by the National Board of Health ? If so, what should 
be their relations to the health authorities of the States within 
whose territorial limits they may be established ? 
Answer.-As relates to inspection of steamboats, we recom- 
mend the same regulations in regard to furniture as already men- 
tioned for railroad cars, and the faithful execution of the follow- 
ing rules as already adopted by the National Board, and put 
into use last summer at New Orleans, to-wit: 
" Any decayed wood in the deck or floors should be looked 
for and required to be replaced by sound wood forthwith, or be 
left without covering of any kind and be required to be satur- 
ated daily with a boiling hot solution of copperas-one quart of 
copperas to the pailful of boiling water. All kitchen, pantry 
or other decks or floors subject to frequent wettings and damp- 
ness, should receive a last washing daily from hot copperas 
water. All storerooms or closets should be looked into and 
the stowing away of damp or soiled clothing therein prohibited. 
Water closets and urinals should be scrupulously clean and 
odorless. 
" The hold and keelson of all steamboats and other vessels 
should be examined with special care, and whenever any bilge 
water or offensive odor is present, cleansing should be required 
by pouring in and pumping out water, by use of the syphon 
pipes for carrying steam at as high a heat as possible, under 
the dunnage, and by the use of copperas until all foul odor is 
removed. Merely damp holds and keelsons should be sprinkled 
with copperas to prevent mustiness." 
Stations of observation should be established by the Na- 
tional Board of Health, at certain intervals along routes to be 
provided for by the regulation of the Board, and should be 
provided with ample and comfortable accommodations for tak- 
ing care of such sick as it may be deemed necessary to remove 
from cars cr steamboats. Said statious should be governed by 
the rules and regulations of the National Board of Health. 
In connection with the management of railroads, we would 7 
call attention to the fact that a convention of railroad mana- 
gers has been called to meet at Nashville, Tenn., on November 
19th. We heartily endorse this movement and are convinced 
that it will be productive of much good. 
" The object of this meeting," to quote from their circular, 
" is to secure uniform rules and regulations that will give the 
greatest protection by affording reliable means to arrest the 
spread of infectious or contagious diseases, while at the same 
time providing for the movements of freights and passengers 
with the least inconvenience compatible with safety to the 
public health." 
10. Result of the co-operation and aid given by the National 
Board of Health to State and municipal boards unuer the pro- 
visions of the Act approved June 2, 1879. What suggestions 
may be made to lender this system more efficient ? 
Answer.-In the consideration of this subject, your com- 
mittee do not esteem it incumbent upon it to speak for distant 
communities, and therefore will restrict its observations to the 
State of Louisiana and mainly to the city of New Orleans. 
The subject is natui ally divisible iuto two sections, and the 
results of the co-operatiou and aid furnished by the National 
Board of Health will hist receive attention. 
Its co-operation has been canied out chiefly through its 
medical inspectors and sanitary officers. In localities where 
yellow fever has been an unfamiliar visitor, they have aided in 
distinguishing real from supposed cases, have greatly con- 
tributed by their advice to prevent panic, and in case 
of actual presence of the disease, have directed suita- 
ble means for its repression. Having been selected with 
reference to their fitness for the service these officers 
have also acted as inspectors on railroad trains and 
steamboats, and have superintended the movement of mer- 
chandise, and of travellers and their baggage, and there is 
reason to hope that the failure of yellow lever to spread from 
New' Orleans and Memphis in lb79 may be due to their well 
directed effoits. This view is fortified by the fact of its some- 
what extended spread from the Morgan city focus, where the 8 
above system of co-operation was long delayed by the late dis- 
covery of the outbreak. It may safely be affirmed, that Missis 
sippi city is the only place which has received yellow fever 
infection from New Orleans in 1879, and in this locality the 
rules of the National Board of Health were not enforced, owing 
to the doubts in the first cases. 
Another important result, which is perhaps attiibutable to 
the co-operation of the National Board ot Health, has been the 
establishment of confidence among threatened communities in 
the measures adopted for their protection by that Board, and 
by State and local Boards of Health, the general compliance 
with the rules of the National Board of Health by local health 
authorities, and the moderation of inland qunantine restric- 
tions to such an extent that its inconveniences have notamounted 
to serious hardships, such as occurred last year. Besides this, 
the thorough system of inspection and disinfection of vessels 
by the National Board of Health, meeting as it did the hearty 
approval of those interested in steamboats and shipping inter- 
ests, materially assisted commerce by sooner opening ports 
closed against us. Another result has been the continuance of 
the work inaugurated by the Marine Hospital Service, of gath- 
ering and disseminating intelligence of the appearance and 
progress of infectious diseases, in addition to which cii culars 
have been issued, giving instructions in detail for perform 
ing works of a sanitary character, and forms for carrying 
out the inspection of persons, merchandise, and their car- 
riers on routes of travel. There can be no doubt that 
the bulletin and circulars issued by the National Board of 
Health have greatly contributed to a general awakening to 
the importance of the subject of public hygiene, and that 
tiustworthy intelligence has tended to remove apprehension, 
and obviate interiuption of intercourse. It is desii able that 
the Board should largely extend its system of health reports 
from foreign ports, so that our maritime quarantine restric- 
tions may hereafter be removed or relaxed against localities of 
whose health we are still mainly in ignorance. The pecuniary 
aid from the National Board to State and Municipal Boards 
has been employed in works of local sanitation where means 9 
were wanting to the local authorities, and this has amounted in 
New Orleans to a little more than $3,800, and elsewhere in 
Louisiana to about $2,000 more. It would be difficult to esti- 
mate the immediate results of this sanitary work, for the effect 
of disinfecting agents upon the progress of yellow fever is still 
an open question. The work of cleansing however, has had a 
good moral effect both by inspiring confidence and by the force 
of a good example. With reference to the second head 
of the subject, your committee find so good ground for 
satisfaction in the working of the National Board of Health- 
in other words, they find its success so much greater than they 
had reason to hope, that they would not undertake to suggest 
any changes of magnitude in its functions or powers. It was 
supposed by many that the usefulness of the National Board 
of Health would be proportional to its powers, but the result 
seems not to have justified that opinion. The character and 
reputation of the men selected for this responsible position, 
together with the acknowledged wisdom of the plans and regu- 
lations framed by them, speedily won the public confidence, 
especially in the regions visited by the epidemic of 1878. Their 
regulations have been generally adopted throughout the States 
east of Texas, and the moral influence of the National Board, 
there is good reason to believe, has been more effectual than 
any authority which could have been conferred by the Federal 
government. Having confidence that the Board will hereafter 
rectify whatever defects of administration the operations of the 
first year have brought to their attention, we deem it unneces- 
sary to make any specific suggestions. 
Respectfully submitted, 
D. C. Holliday, M.D. 
J. P. Davidson, M.D. 
S. S. Herrick, M.D. 
Wm. P. Brewer, M.D. 
L. F. Salomon, M.D. 
Representing New Orleans Medical and Surgical Association.