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Appendix C

Table of Contents

APPENDIX C

Circular No. 5: Yellow Fever Prevention and Control

NOTE.-The first directive for the prevention and control of yellow fever, based upon the findings of the Walter Reed Yellow Fever Commission, was issued as Circular No. 5 by command of Major General Leonard Wood (1860-1927), Governor General of Cuba (Dec. 1899-May 1902), at Havana, Cuba, on 27 April 1901. The text of this document was reproduced in the Annual Report of The Surgeon General of the U.S. Army for the fiscal year ended June 30, 1901. The following are excerpts from that report (various places on pp. 144-146).

REPORT OF MAJ. V. HAVARD, SURGEON, UNITED STATES ARMY,
CHIEF SURGEON, DEPARTMENT OF CUBA, July 22, 1901:

I have the honor to submit the following report of the operations of this office for the fiscal year ending June 30, 1901:

In the summer of 1900, on the recommendation of the Surgeon-General, a board of medical officers consisting of Maj. Walter Reed, United States Army, and Contract Surgeons Carroll, Agramonte, and Lazear, United States Army, was convened in Havana for the investigation of tropical diseases. The result of its experiments, as already well known, was one of the most brilliant medical discoveries of the age, namely, the mode of transmission of yellow fever, and, as a natural consequence, a complete revolution in the methods adopted to prevent and combat this disease. The doctrine of the transmission of yellow fever by the bite of mosquitoes having been proved by incontrovertible experiments on nonimmunes and fomites proved to be harmless, the following circular having received the sanction of the Surgeon-General, was published.

Circular, No. 5} HEADQUARTERS DEPARTMENT OF CUBA,
Habana, April 27, 1901

Upon the recommendation of the chief surgeon of the department, the following instructions are published and will be strictly enforced at all military posts in this department.

The recent experiments made in Habana by the Medical Department of the Army having proved that yellow fever, like malarial

 


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fever, is conveyed chiefly, and probably exclusively, by the bite of infected mosquitoes, important changes in the measures used for the prevention and treatment of this disease have become necessary.

1. In order to prevent the breeding of mosquitoes and protect officers and men against their bites, the provisions of General Orders, No. 6, Department of Cuba, December 21, 1900, shall be carefully carried out, especially during the summer and fall.

2. So far as yellow fever is concerned, infection of a room or building simply means that it contains infected mosquitoes; that is, mosquitoes which have fed on yellow fever patients. Disinfection, therefore, means the employment of measures aimed at the destruction of these mosquitoes. The most effective of these measures is fumigation, either with sulphur, formaldehyde, or insect powder. The fumes of sulphur are the quickest and most effective insecticide, but are otherwise objectionable. Formaldehyde gas is quite effective if the infected rooms are kept closed and sealed for two or three hours. The smoke of insect powder has also been proved very useful; it readily stupifies mosquitoes, which drop to the floor and can then be easily destroyed.

The washing of walls, floors, ceilings, and furniture with disinfectants is unnecessary.

3. As it has been demonstrated that yellow fever can not be conveyed by fomites, such as bedding, clothing, effects, and baggage, they need not be subjected to any special disinfection. Care should be taken, however, not to remove them from the infected rooms until after formaldehyde fumigation, so that they may not harbor infected mosquitoes.

Medical officers taking care of yellow fever patients need not be isolated; they can attend to other patients and associate with non-immunes with perfect safety to the garrison. Nurses and attendants taking care of yellow fever patients shall remain isolated, so as to avoid any possible danger of their conveying mosquitoes from patient to non-immunes.

4. The infection of mosquitoes is most likely to occur during the first two or three days of the disease. Ambulant cases-that is, patients not ill enough to take to their beds and remaining unsuspected and unprotected-are probably those most responsible for the spread of the disease. It is therefore essential that all fever cases should be at once isolated and so protected that no mosquitoes can possibly get access to them until the nature of the fever is positively determined.

Each post shall have a "reception ward" for the admission of all fever cases, and an "isolation ward" for the treatment of cases which prove to be yellow fever. Each ward shall be made mosquito-proof by wire netting over doors and windows, a ceiling of wire

 


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netting at a height of 7 feet above the floor, and mosquito bars over the beds. There should be no place in it where mosquitoes can seek refuge, not readily accessible to the nurse. Both wards can be in the same building, provided they are separated by a mosquito-tight partition.

5. All persons coming from an infected locality to a post shall be kept under careful observation until the completion of five days from the time of possible infection, either in a special detention camp or in their own quarters; in either case their temperature should be taken twice a day during this period of observation so that those who develop yellow fever may be placed under treatment at the very inception of the disease.

6. Malarial fever, like yellow fever, is communicated by mosquito bites and therefore is just as much of an infectious disease and requires the same measures of protection against mosquitoes. On the assumption that mosquitoes remain in the vicinity of their breeding places, or never travel far, the prevalence of malarial fever at a post would indicate want of proper care and diligence on the part of the surgeon and commanding officer in complying with General Orders, No. 6, Department of Cuba, 1900.

7. Surgeons are again reminded of the absolute necessity in all fever cases to keep from the very beginning a complete chart of pulse and temperature, since such a chart is their best guide to a correct diagnosis and the proper treatment.

By command of Major-General Wood:

H. L. Scott, Adjutant-General.