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New Orleans.—The accompanying map of the chief shipping routes in the
Gulf of Mexico and the Carabean Sea indicates the present importance of New
Orleans in connexion with the spread of yellow fever, an importance which will
doubtless be increased when the markets of the western coast of South America
are brought into direct shipping communication with those of Louisiana and
neighbouring States by way of the Panama Canal. The city is exposed to infec-
tion from both the seaward and landward sides, and as regards the latter danger
it is believed by responsible local officials that the chain of defence is unavoidably
weak. Railway communication between the city and Central America is advanc-
ing rapidly, and even at present passengers from suspected places in Mexico can
arrive in New Orleans within the incubation period of yellow fever. The city lies
on the ßoth degree of north latitude and its climate is such that yellow fever can
be epidemic during only the hotter months of the year; the average monthly
temperature in winter and spring does not rise above 55° and much lower tempe-
ratures than that are ofter recorded. This fortunate circumstance was in the
past the only check upon the severe epidemics of yellow fever from which during
the first half of the 19th century the city suffered every year. The beginning of
a reduction in the frequency of those epidemics dates from 1859, and must be
attributed during the early years to the absence of participation in foreign com-
merce as a result of the great civil war, and later to the gradual substitution of a
rigid system of maritime quarantine and of a strict observance of the quarantine
laws for the quite ineffective and almost entirely unobserved systems of earlier
years. But the evolution of an effective quarantine system was of slow growth,
and it was not until the early eighties that comparatively adequate arrangements
were established. These arrangements, in addition to ensuring almost complete
freedom from the risk of entry of yellow fever patients, included rules for the
fumigation of ships by sulphur, and although the difficulties of carrying out the
latter measure in the case of fruit vessels subsequently necessitated modifications
which may have permitted the entry of infected mosquitoes, their general efficacy
is shown by the following figures«
Since 1900 the only year in which a death from yellow fever has
been recorded was 1905, when an epidemic which is said to have caused
3,403 cases and 437 deaths occurred. That epidemic afforded the first
opportunity in a large American city of carrying out measures based
upon the knowledge that the disease is spread by stegomyia mosquitoes, and in
consequence has been much written about. Its present interest is chiefly that
it brought to light the exceedingly primitive and dangerous condition of the city,
and provided a much needed stimulus to sanitary effort and progress. Since its
occurrence improvement has been more or less continuous, but the problem is
very complex, and at the time of my visit in April 1912 it appeared to me that
its difficulties had been by no means entirely overcome.
The accompanying map which shows the general anangement and boun-
daries of the city, and the position of districts occupied chiefly by tenement
houses, conveys some idea of the magnitude of the task with which the sanitary
authorities have to deal. The municipality as a whole covers an area of 196
square miles, of which the " city proper, " containing about 80,000 houses,
covers 36 square miles« In general the site has been reclaimed from swamps
and flooded areas which were three or four feet below the level of the lakes and
river by which the city is almost surrounded ; and on the outskirts of what is
called the " built up section" or " improved area " of the city, swamps, marshes,
canals and low jungle are still the chief features of the landscape. The popula-
tion of the city proper is estimated to be about 380,000, of whom perhaps
100,000 are negroes. The remainder includes large numbers of French,
Spaniards and Italians, and it has been said of the Italians, as well as of the
negro inhabitants that they do not participate in the civic life of the community,
but live in a manner which violates every sanitary rule. Among a population of
this kind conditions are favourable for the concealment of disease, and any inter-
ference for sanitary purposes is usually much resented. The 1905 epidemic of
yellow fever began near the wharves in the tenement districts where these people
live, and for the reasons just given it is not surprising that it progressed for
some time before its presence became known to the authorities, and that during
its continuance it was necessary to seek the assistance of Italian physicians,