Clothes that have been contaminated with matters thrown off through expectoration and vomit, shall be properly disinfected.

B. Precautionary Measures to be Taken at Schools.

I. The class rooms shall be entirely ventilated by opening the doors and windows during recess hours, and after the pupils leave.

2. The floors shall not be swept, but the dust shall be removed by means of a wet rag or sponge.

3. The class rooms shall be washed weekly, after which they shall be disinfected with a solution of bichloride in the proportion of I per thousand.

4. Care should be taken to see that the children wear clean clothes before entering the class room, and they shall be required to wash their hands after

recesses.

5. Every child with symptoms of whooping cough shall be kept away from the school, and shall only be admitted when it presents a medical certificate showing that the child is not afflicted with said disease, or that three weeks have elapsed since its recovery therefrom.

6. The confirmed cases shall be reported to the principals of the schools, so that they may watch such children as live in houses occupied by those afflicted with the disease.

EXOTIC DISEASES.

II.

We designate by this name such diseases as do not exist in the country, and which have been imported, or may be imported hereafter, such as yellow fever, cholera, the bubonic plague and beri-beri.

As to yellow fever and cholera, we would have nothing to add to what we said in the report presented to the First International Sanitary Convention, which was held in Washington in 1902, but, inasmuch as, since then, there have been adopted provisions of an international character in order to prevent the importation of said diseases, it seems to us that it would be proper to make a brief review of the epidemics of yellow fever and cholera, and also of the appearance and course of the bubonic plague, before we refer to the aforesaid provisions.

Therefore, we shall commence our statement with yellow fever, this having been the first of the exotic diseases which invaded our country, and was epidemically developed at Montevideo.

YELLOW FEVER.

Yellow fever was not known in Uruguay until 1857. Its importation, which occurred in the month of February of said year, was made through some infected vessels which had arrived from Rio de Janeiro, and which probably were not kept in strict isolation, inasmuch as several sailors broke away from the isolation and soon after contracted the disease. From that moment, new cases were more and more frequent, and were spread through different places of the city and mainly in the low grounds of the city near the bay.

The epidemic that was then developed lasted until the month of June, causing about 1,000 deaths.

After many years, yellow fever was again imported from Rio de Janeiro. The epidemics which occurred in 1872 and 1873, the only ones after 1857, did not last so long nor were they of such a malignant character. The first of them broke out in January, and ceased in the month of March, having caused 142 deaths; the second also commenced in the month of January, and disappeared in the month of May after having caused 329 victims.

The fourth and last epidemic, also imported from Brazil, and which occurred in 1878, may be considered as the mildest of all of them and of the shortest duration. Indeed, it only caused 40 deaths, commencing in February and disappearing in May. Subsequently no more cases of yellow fever have been reported, except one that occurred in Montevideo in January, 1903. When the sanitary authorities were advised of the existence of said case, they immediately adopted the proper measures to prevent the spread of the disease.

From this brief review, it will be seen that Uruguay has been free from said disease since 1878, in spite of the fact that there have been great epidemics of yellow fever in Rio de Janeiro, and notwithstanding the yearly increase in the number of infected vessels arriving at the port of Montevideo.

There is no doubt that if strict sanitary vigilance had not been observed on vessels coming from said country, it would have been very difficult to prevent new invasions of the disease during such a long period of time.

Fortunately the danger has continually decreased since the sanitary conditions of Rio de Janeiro commenced to improve, and it is hoped that said danger will entirely disappear if the new processes which have been employed to exterminate yellow fever continue to give equally good results as those secured heretofore.

CHOLERA.

Ten years after the appearance of the first epidemic of yellow fever, cholera broke out, having been imported from Genoa bv a vessel on board of which several cases occurred during the voyage. After completing its quarantine and securing free practique, the first case occurred afnong the passengers who landed in Montevideo from said vessel.

This epidemic commenced in the month of December, 1866, and disappeared in the month of May, 1867, after having caused 128 deaths.

The second epidemic, which was also imported, and of greater importance than the previous one, since it extended to several rural departments, commenced in December, 1867, and disappeared in April, 1868.

It com

The number of deaths caused during that time amounted to 2,955. Another epidemic occurred in 1886, which like the second one, spread to some of the most important cities of the interior of the country. menced in November and disappeared in March, having caused 535 deaths. The fourth and last epidemic broke out in January, 1895, and disappeared in May of the same year, having caused 105 deaths.

In these last two epochs (1886 and 1895), cholera was imported, as it was in the other instances, by persons coming from infected ports.

THE BUBONIC PLAGUE.

Until 1901 there had been no cases of Bubonic plague in Uruguay. The first that occurred was in the second half of January of said year, the victim having been the foreman of one of the custom house warehouses, where a large number of rats had died.

The bacteriological examination which was made, soon demonstrated that the patient had the bubonic plague, the same as the rats found dead. After isolating the patient and adopting the proper precautionary measures, the occurrence of other cases was prevented.

After a period of six months in which good sanitary conditions prevailed, two new cases occurred. The investigations made in order to determine its origin, demonstrated that one of the patients came from a bakery which had just received a shipment of cloth bags from another similar establishment of Asuncion, Paraguay, where there had occurred cases of the bubonic plague, and that the latter had visited the house of the former. As soon as the second epidemic was checked, some time elapsed before new cases of said disease occurred until April, 1902, when it was discovered that in other customhouse warehouses, some dead rats had been found. After it was proved that they were affected with the plague, and the sanitary authorities having learned that there were in said warehouses a lot of coffee bags which had been brought from Rio de Janeiro, it was ordered that said bags should be destroyed by fire, and substituted with new ones.

The four laborers who worked in that operation were taken sick immediately, and two of them died.

Two months later, there occurred another case in the person of a laborer of a mill, but it was impossible to discover the origin of the contagion.

Since that time all the investigations made for the purpose of determining whether the new cases could be attributed to the reimportation of the germs of the bubonic plague, were unsuccessful, because the sanitary authorities were not able to prove that the patient had contracted the disease through having received or handled contaminated articles.

For this reason it was supposed that perhaps the contagion had remained in the rats, having been transmitted by them to persons. Whether this is true or not, the fact is that the bubonic plague has not been epidemically developed in Montevideo, as has happened in other countries, nor has it formed more or less important foci, nor has it extended to other localities. In addition to the above, the only cases discovered have been in one of the infected houses where there had previously been a patient having a complication of pneumonia and the plague.

Therefore, it can be truthfully said, that the bubonic plague in Montevideo has been characterized by its sporadic form, and by the slight mortality it has caused.

The following table shows the number of cases and deaths which occurred from 1901 to 1907:

Cases and Deaths From Bubonic Plague.

In Montevideo, the same as in other cities, it has been noted that the majority of the patients of the bubonic plague were persons employed in custom houses, bakeries, vermicelli factories, mills and domestic fruit deposits where bags with cereals are frequently received, and in which rats some times enter. It has also been observed that the greatest number of cases occur in summer and autumn, that is to say, during the seasons in which the work in the aforesaid establishments is increased, and when the trade in cereals is most active.

In order to complete this statement of data, we will add the provisions relating to the prophylaxis of yellow fever, cholera, and the bubonic plague, calling attention to the fact that said provisions are none other but those agreed upon by the delegates of the Argentine Republic, Brazil, Paraguay, and Uruguay, when they met at Rio de Janeiro for the purpose of studying and discussing the bases of the International Sanitary Convention of 1904.

We transcribe only such provisions as relate to land and maritime prophylaxis, without prejudice to mentioning some others that are especially interesting.

TITLE II.

Concerning Land Prophylaxis.

Art. 15. Whenever the infected locality is situated near the frontiers of the contracting countries, the precautionary sanitary measures shall be applied in accordance with the following principles:

a. The mail between the infected country and those not infected shall not be interfered with, sanitary limits and land quarantine being hereby abolished. b. The high contracting parties reserve the right to limit the places on the frontier through which the transit of passengers and merchandise may be effected.

c. Passengers shall be subjected to medical inspection and the sanitary authorities may prohibit the passage of the suspected patients or convalescents of any of the aforesaid diseases.

d. Passengers shall be under vigilance for the period of time corresponding to that of the incubation of each of the diseases, the importation of which it is sought to prevent.

e. In the case of cholera or the bubonic plague, the clothes in general and all such articles as are susceptible of transmitting the disease, shall be thoroughly disinfected.

In other articles of these rules and regulations it has been prescribed that the sanitary vigilance of first and second class passengers, shall be effected on land, and that of the steerage passengers shall be exercised in their quarters on the ships, under such restrictions as the sanitary authorities may deem advisable. On the other hand, it has been decided not to delay the admission of the mails, subjecting to disinfection only postal parcels.

In addition to the above, such sanitary measures as might be necessary to apply to vessels coming from countries not belonging to the convention, must be in accordance with the provisions contained therein.

From the foregoing, it will be seen that the Convention of Rio de Janeiro has accepted the most liberal of sanitary regimes, omitting the vigilance of first and second class passengers in the lazarettos or on board the vessels, and allowing the admission of the cargo without any restriction. Therefore, it may be said that it differs from other conventions by the fact of having abolished entirely the old sanitary practices which are gradually disappearing, and by having recognized that what was formerly done at lazarettos or on the vessels, can now be done on land without thereby endangering the sanitary condition of the country.

BERI-BERI.

We have little to say concerning this disease, because it is now more than seventeen years since a case has occurred in Montevideo, owing to the fact that the landing in the country and attendance of beri-beri patients in the ordinary hospitals is prohibited.

Before 1889, that is to say when there was no sanitary provision prohibiting the admission of said patients into general hospitals, such patients frequently were admitted and attended, especially at the English Hospital, the greater number of them being patients who landed from Brazilian vessels belonging to the Navy. It was after that time that it was prescribed that such patients should be attended at the lazaretto, and since then all patients of beri-beri arriving at the port must be transferred to said establishment, in accordance with the provisions of the rules and regulations of Maritime Sanitation.

The majority of the cases occurring in the last few years have come from merchant vessels, mainly from certain ports of North America, such as Pensacola, Mobile, etc.

From 1902 to 1906, the number of beri-beri patients arriving at the port of Montevideo and landing at the lazaretto, amounted to 32, as will be seen by the following tables:

Beri-Beri Patients Landed at the Lazaretto of Isla de Flores.

Concerning Sanitary Treatment of Vessels Infected With Beri-Beri.

(Rules and Regulations of Maritime Sanitation.)

Art. 47. Vessels infected with beri-beri shall be subject to the following sanitary treatment:

a. Landing of the patient or patients in the lazaretto for such treatment as may be proper, which shall be applied while the patient is isolated.

b. The disinfection of the clothes of the passengers and crew in the stove provided on board the vessel, in the presence of two officers representing the sanitary authority, or in that of the officers of the lazaretto, according to circumstances.

c. The free practique of the vessel as soon as the disinfection is completed.

MALARIA.

This disease does not exist in Uruguay, and such cases as sometimes occur come from countries where malaria is endemic.

We shall treat granulous conjunctivitis or trachoma in a separate chapter, in order to state that it is a disease which has been observed for a long time in the Orphans and Foundling Asylum of Montevideo, but which at present has not only diminished, but is about to disappear, since the isolation of the patients has been prescribed.

Such cases as oculists have occasion to treat are isolated cases which here-, tofore have not formed foci.

III.

Sanitation of the Port of Montevideo.

In addition to the construction work of the port, carried out so that the harbour of Montevideo may be provided with all the necessary means of easy access and sufficient shelter, in order that vessels may load and unload without encountering the inconveniences and difficulties met with in open ports. Besides other no less important work relating to sanitation have been effected-work commenced in 1903, the greater part of which was completed during the present year.

The object of said work was to avoid the drainage of sewerage into the bay, and to facilitate the drainage of a well populated zone not having a system of sewers. Consequently, in order to obtain this result, it became necessary to construct two great water conduits, and some auxiliary conduits, to receive said sewerage, as well as the waters coming from the new wharves, and a part of the rain water, and convey them to the southern coast of the River Plate. Simultaneously with those works other accessory works have been completed, namely, the cleaning deposits of the water conduits, which have a capacity of 10,000 liters of water each, the emptying chambers, and common emptying conduits, air holes, storm spouts, and ventilating chimneys.

Of the two great water conduits the main conduit is 4,571 meters 67 centimeters, of which 1,362 meters 60 centimeters have been constructed in the form of a tunnel in the rock.

On the south side it empties into Paraguay street, and thence in a northerly direction through Ibicui Street, and General Rendeau Avenue, to Tenientes Street, and thence in an easterly direction through the same street and that of Cuñapini to República Street, where it originates. The following auxiliary water conduits connect with this main water conduit: On the left with that of Orillas del Plata Street, which ends in Florida Street, and with that of Miguelete Street, which extends to Dayman Street. On the right, it connects with that of Miguelete Street, and New York Street. The length of said tributaries is 2,132 meters 12 centimeters.

The secondary water conduit begins where one of the tributaries of the principal water conduit ends, that is to say, in Orillas del Plata, and Florida Streets. From thence it follows to Rampla Street, and then it turns and runs through Piedras Street, and reaches Juan L. Cuestas Street, through which it passes until it empties into the river through Guaraní Street. It has a length of 2,198 meters 48 centimeters, of which only 1,473 meters 48 centimeters have been constructed owing to the fact that the works of the filling of the port have not yet been finished. This is the reason why only one of the drains has been finished, namely, that of Tenientes Street, which connects with the main drain. The cost of said important work was estimated at $1,000,000, of which $692,037.30 has been spent, thus leaving $307,962.70 for the work not yet finished.

Sanitary Works in Rural Departments.

The studies made relating to the sanitation of cities and important towns of the Republic, which it was impossible to undertake until now, have just been started in some departments in conformity with a decree issued by the Government in July of the current year.

In said decree are set forth the reasons which have been borne in mind in order to hasten the preliminary works, as well as the aims of the Government