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Full text of "Annual report of the Supervising Surgeon General of the Public Health and Marine-Hospital Service of the United States"



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ANNUAL REPORT OF THE 

Surgeon-General of the Public Health 

and Marine-Hospital Service of 

the United States 



FOR THE FISCAL YEAR 



1909 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1910 



Treasury Department. 

Document No. 2567. 

Public Health and Marine- Hospital Service. 



OPERATIONS 

OF THE 

UNITED STATES PUBLIC HEALTH AND 
MARINE-HOSPITAL SERVICE 

1909 



ooe"te:^ts. 



Page. 

Secretary's letter of transmittal to Congress 9 

Antiplague operations in California 11 

San Francisco '. H 

Work of the federal laboratory 15 

Oakland 17 

Contra Costa County — ground squirrels 18 

Point Rich mond - 19 

Alameda County, exclusive of Oakland 20 

Los Angeles 20 

Attitude of state and local health authorities 21 

Antiplague operations in Seattle, Wash 22 

Scientific research and sanitation 25 

Supervision of viruses, serums, and toxins 27 

Establishments licensed 28 

Antidiphtheric serum 28 

Antitetanic serum 29 

Investigations of vaccine virus 30 

Revised regulations lor the sale and importation of viruses, serums, and 

toxins 34 

Customs regulations regarding importation of viruses, serums, etc 38 

Typhoid fever in the District of Columbia 39 

Typhoid fever at Forest Glen, Md - 43 

Pollution of interstate waters 45 

Pellagra 46 

Investigations in various localities 47 

European pellagra 49 

Etiology of pellagra 49 

Italian preventive measures 51 

Service commission to investigate pellagra 52 

Rabies 52 

Pasteur treatment 53 

Amoebiasis 54 

Source of the infection 54 

Preventive measures - - 55 

Tuberculosis 56 

Colored Anti-Tuberculosis League 56 

Service encouragement 57 

Hookworm disease 58 

Eradication 59 

Health problems on American farms 60 

Racial conditions 60 

Typhoid death rate among negroes 61 

Need of education in sanitation 61 

National leprosy investigation station 62 

Buildings completed 62 

Water supply 63 

Boat landing 65 

Operations of station 66 

Care of lepers in the United States 68 

Second International Conference on Leprosy 68 

United States Pharmacopoaia and National Formulary 70 

Milk and its relation to the public health 73 

The rat and its relation to the jiublic health 74 

Alaska-Yukon-Pacific Exposition 75 

Aid in enforcing i)roper use of the mails ." ^ 76 



6 CONTENTS. 

Scientilic research and sanitation — Continued. Page. 

Special studies at Woods Hole, Mass 76 

Hygienic Laboratory 77 

Buildings and grounds 77 

Personnel 79 

Dangers of the work 79 

School of instruction 79 

Journal Club 80 

Cooperation with other services 80 

Scientific investigations— summary 80 

Division of Pathology and Bacteriology _ _ 80 

Division of Zoology 83 

Division of Pharmacology 65 

Division of Chemistry ' 89 

Bulletins of the Hygienic Laboratory 90 

Advisory Board of the Hygienic Laboratory 93 

State and international relations 95 

Seventh annual conference with state and territorial health officers 95 

International Office of Public Hygiene, Paris 96 

International cooperation for further protection against plague and cholera. 102 

International Sanitary Bureau of American Republics, Washington, D. C. 103 

International Congress on Hygiene and Demography 103 

Sanitation of Guayaquil, Ecuador 104 

Investigation of mild epidemic of jaundice in Texas 105 

Domestic quarantine 107 

Reports from national quarantine stations 107 

Texas-Mexican border quarantine 115 

Supplemental inspection service at New Orleans 116 

Supplemental inspection service at Mobile 117 

New quarantine stations 118 

New Orleans quarantine 118 

Mobile quarantine 119 

South Atlantic quarantine reduced to station of refuge 120 

Insular quarantine 121 

Operations of the service in the Philippines 121 

Operations of the service in Hawaii 130 

Operations of the service in Porto Rico 132 

Foreign quarantine 1 135 

Fruit-port inspection service 135 

Belize, British Honduras 135 

Bocas del Toro, Panama 137 

Bluefields, Nicaragua 138 

Ceiba, Honduras 138 

Livingston and Puerto Barrios, Guatemala 140 

Port Limon, Costa Rica 142 

Puerto Cortez, Honduras 143 

Tela, Honduras 144 

Inspection at other foreign ports 144 

Habana, Cuba 144 

Cienfuegos, Cuba 149 

Matanzas, Cuba 150 

Santiago, Cuba 151 

Veracruz, Mexico 151 

Salina Cruz, Mexico _ 153 

Coatzacoalcos, Mexico 153 

Progreso, Mexico _ 154 

Tampico, Mexico 154 

Bridgetown, Bardados 156 

Castries, St. Lucia — fumigation of vessels for Cuban ports 156 

St. Thomas, Danish West Indies 156 

La Guaira, Venezuela 156 

Callao, Peru 158 

Rio de Janeiro, Brazil - 158 

Guayaquil, Ecuador — quarantine and sanitation 158 

Hongkong, China .■ 166 

Shanghai, China 166 

Amoy, China 166 



CONTENTS. 7 

Foreign quarantine — Continued. 

Inspection at other foreign ports — Continued. Page. 

Yokohama, Japan — quarantine and sanitation in Japan 168 

Kobe, Japan 172 

Nagasaki, Japan 173 

Calcutta, India 173 

Libau, Russia 173 

Methods employed in Chinese and Japanese ports by service officers for 

destruction of rats on vessels 174 

Lectures on quarantine regulations to nevk^ly appointed consular officers. . 177 

Medical inspection of immigrants 178 

Transactions (tabular) at ports in United States, its dependencies, and 

Canada 179 

Excerpts from reports made by service officers 181 

Baltimore, Md 181 

Boston, Mass 181 

Buffalo, N. Y ....].[][" 184 

Brownsville, Tex 185 

Detroit, Mich 186 

Eagle Pass, Tex 186 

El Paso, Tex ...[.WW] 186 

Eastport, Idaho 186 

Montreal, Canada ] 87 

New York (Ellis Island), N. Y .'.'"."."!!! 187 

San Francisco, Cal 189 

Seattle, Wash _ ' 190 

Investigations in state and municipal institutions of immigrants who have 

become public charges 190 

Foreign ports I9I 

Amoy, China 191 

Hongkong, China 191 

Shanghai, China ] ] 191 

Kobe, Japan 191 

Yokohama, Japan I9I 

Naples, Italy, and subports. ] ] ] 192 

Sanitary reports and statistics W 199 

Foreign ' 199 

Domestic .W 199 

Smallpox, statistical " 200 

Plague, statistical. 202 

Yellow fever, statistical. 203 

Cholera, statistical 204 

Service publications 206 

Annual reports ...W... 206 

Weekly public health reports " [ ] 206 

Bulletins of the Hygienic Laboratory ] ] " 206 

Bulletins of the Yellow Fever Institute ] 1 i i 207 

Public Health pamphlets or brochures 207 

Need of larger additions and appropriations " ] " 207 

Marine hospitals and relief ' 209 

Relief to seamen — number treated 209 

Relief stations ...W 209 

Relief on account of fire at Chelsea, Mass "!!!" 209 

Relief to Weather Bureau station, Tatoosh Island, Washington. . . ! ^ ^ I ! ^ 1 210 

Relief to natives of Alaska 210 

Aid to other branches of the Government service: Revenue-Cutter Service] 
Steamboat-Inspection Service, Life-Saving Service, Coast and Geodetic 
Survey, Light-House Service, Immigration Service, Civil Service Com- 
mission, Isthmian Canal Commission 210 

Physical examinations of merchant seamen ] 211 

Physical examinations, Philippine Islands ." 211 

Purveying depot. 211 

Amendments to regulations: 

Officers of Revenue-Cutter Service on leave or retired entitled to cer- 
tain relief 212 

Civilian officers and seamen of naval auxiliaries admitted to treaV- 

"lent 212 



8 CONTENTS. 

Marine hospitals and relief — Continued. Page. 

Increased air space in forecastles of American vessels 213 

Ship's medicine chest 213 

Tuberculosis Sanatorium at Fort Stanton, N. Mex 213 

Personnel 219 

Commissioned and other officers 219 

Special details of officers 219 

Hospital and quarantine attendants ^ 220 

Boards convened 221 

Influence of the corps on medical and public-health activities 222 

Contributions to medical journals, etc 222 

Attendance at medical and sanitary meetings 222 

Resolutions relating to service 224 

Public-health problems 227 

Needs of the service 237 

Financial statement and accounts 239 

Tables, statistical, relating to relief of seamen and physical examinations 243 



LETTER OF TRANSMITTAL. 



Treasury Department, 
Washington^ Decemher 10^ 1909. 
Sir : In accordance with section 9 of the act of Congress approved 
July 1, 1902, entitled "An act to increase the efficiency and change the 
name of the Marine-Hospital Service," I have the honor to transmit 
herewith the Annual Report of the Surgeon-General of the Public 
Health and Marine-Hospital Service of the United States for the 
jSscal year 1909. 

Respectfully, Charles D. Hilles, 

Acting Secretary. 

The Speaker of the House of Representatives. 

9 



ANNUAL REPORT OF THE SURGEON-GENERAL OF 
THE PUBLIC HEALTH AND MARINE-HOSPITAL 
SERVICE. 



Treasury Department, 
Bureau of Public Health and 

Marine-Hospital Service, 
Washington^ I). 6'., November 30, 1909. 
Sir: I h^ive the honor to submit for transmission to Congress, in 
accordance with the act of July 1, 1902, the following report of the 
transactions of the Public Health and Marine-Hospital Service of 
the United States for the fiscal year ended June 30, 1909, this being 
the thirty-eighth annual report of the service in the one hundred and 
eleventh year of its existence, and the eighth annual report under its 
present name. 

Antiplague Operations in San Francisco. 

In previous annual reports it has been shown that plague was an- 
nounced in San Francisco in 1900, and that for four successive years 
the service and the state and local health authorities were engaged in 
its elimination. There were in that period 119 cases and 113 deaths. 
Examination of rats continued for quite a long period after the 
cessation of the disease among human beings, and finally operations 
were brought to a close ; but following the earthquake and fire in San 
Francisco in 1906, cases of plague began to be reported. A fatal case 
of human plague was reported in San Francisco in May, 1907, and 
an active antiplague campaign was begun at once, and has continued 
to the present time. To June 30, 1908, there were in that city 159 
cases of human plague, with 77 deaths. 

No case of human plague occurred in the city and county of San 
Francisco during the fiscal year ended June 30, 1909. A few cases 
of epizootic plague were found among the large numbers of rats 
captured in the city and examined at the plague laboratory, as fol- 
lows : July, 1 rat ; August, 1 rat ; October, 2 rats. The last infected 
rat was found October 23, 1909, in a warehouse near the water front. 
Since that date, although some 60,000 rats have been taken from all 
parts of the city and examined, none has been found infected. 

In view of the tenacious nature of the infection and the fact that 
it may remain practically dormant for long periods of time, it was 
deemed necessary to continue the main features of the campaign until 
all danger of a recrudescence had passed. The original organization 
was maintained until February 1, 1909, when a considerable reduction 
of the force was made and the area under sanitary supervision some- 
what contracted. In February, 1909, the Citizens' Health Com- 

11 



12 PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE. 

mittee, having fulfilled the humane purposes of its organization, dis- 
banded and returned to the subscribers the remaining portion of the 
funds. Surgeon Rupert Blue reports that this action necessitated a 
further cut in the number of laborers employed, and because of this 
reduction it was found necessary to redistrict the city. 

The first, second, third, tenth, eleventh, and twelfth districts, 
occupying practically the entire water front of San Francisco, were 
formed into Sanitary Division No. 1, and the fourth, fifth, sixth, 
ninth, and subtwelfth sanitary districts, of the annual report of 1908, 
were merged into Sanitary Division No. 2. The force was with- 
drawn from the old seventh and eighth districts, commonly known 
as the Sunset and Richmond additions, except when it was necessary 
to investigate rejDorted infractions of the sanitary law or to inspect 
the bodies of persons dying therein. 

The work of the past year has been a continuation of that of the 
preceding year, consisting of the rat-proofing of buildings, trapping, 
poisoning, and the inspection of premises. A thorough inspection of 
the bodies of all persons dying within the city limits has also been 
maintained. Inspections of premises are made frequently, for the 
purpose of maintaining a state of general cleanliness, in respect to the 
collection and disposal of garbage and the finding and reporting of 
cases of infectious and contagious diseases. The plumbing of all 
public and private buildings is inspected, and a large amount of 
repairs and renewals have been secured. 

Whenever a rat-infested place is found, the owner of the premises 
is notified and detailed instructions given him as to the remedy and 
time allowed for the abatement of the nuisance. At the expiration 
of the time, if it is found that he does not intend to comply with the 
sanitary law the case is referred to the board of health for condemna- 
tion jDroceedings. After a hearing, the board, finding sufficient 
grounds for action, condemns the property. If, after a reasonable 
length of time, usually from two to four weeks, the nuisance is not 
abated, the health officer requests the chief of police to vacate the 
premises. In the great majority of cases, however, this is not neces- 
sary, as the owner realizes that these improvements greatly enhance 
the value of his property, and that proper rat -proofing is an invest- 
ment which is not liable to deterioration. Occasionally the owner, 
rather than concrete the full floor area of his building, will invoke 
the aid of the courts and procure an injunction restraining the board 
from further action. The case then enters a long legal phase, regard- 
less of the menace to the health of the communit3\ Insanitary shacks, 
the makeshift abodes of the reconstruction period, have been either 
put in good condition or forced from the city limits. Several failures 
on the part of the representatives of the board of public works to 
correctly interpret and enforce the building laws of the supervisors 
compelled the sanitary inspectors for a time practically to take over 
this part of the city's work also. Maps were prepared, showing the 
progress of new buildings with reference to their compliance with the 
ordinance which required concrete over the entire floor area. 

Notwithstanding the many difficulties encountered and the disas- 
trous delays of court procedure, a large number of permanent im- 
provements have been made and many parts of the cit}'^ have been 
securely fortified against disease. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 13 

The crusade against rats has been systematically conducted with 
success throughout the year. It was found early in the work that 
by the intelligent use of traps and poisons, the rat population could 
be lowered to a safe minimum, yet the species can not be entirely de- 
stroyed by such means. If, however, these measures can be supple- 
mented by an attack upon the habitations and food supply at the 
same time, the number may be reduced almost to a negligible quantity 
in any community. The conclusion has been reached that rat-proof 
construction offers the only solution. In other words, the rat must 
be built out of our cities by the use of concrete, brick, and stone in 
the foundations and side walls of all buildings. Following is a sum- 
mary of these operations: 

DESTRUCTION OF EATS. (SAN FRANCISCO.) 

Poisons placed 4, 781, 135 

Rats trapped • 146, 809 

Rats found dead 9,250 

Rats examined bacteriologically 93, 558 

DESTRUCTION OF RAT REFUGE. 

Yards torn up by owner 708 

Basements torn up by owner 969 

Passageways torn up by owner 770 

Floors torn up by owner 712 

Houses destroyed by owner 108 

Shacks raised 18 inches above the ground 103 

Premises condemned through board of health 846 

Premises in which wood was piled off ground . 2, 326 

Premises in which scrap iron was piled ofC ground 3, 287 

Rat holes stopped up 23,086 

Old sewers stopped up 1,880 

Rat harbors destroyed 29, 404 

DESTRUCTION OF RAT FOOD. 

Premises inspected .367, 925 

Garbage cans installed 13, 8.53 

Chicken yards in city (estimated) i 7,022 

Chicken yards abandoned 2,'171 

Chicken yards concreted (area in square feet, 9,850) 322 

Chickens disposed of 2,516 

Pigeons disposed of 499 

Screens procured 1, 726 

Notices served 15, 346 

Up to October 7, 1908, a bounty of 10 cents per rat was paid by 
the board of health for rats either caught by the trappers or brought 
in by outsiders. The citizens' health fund wag also drawn upon 
and the expenditures charged to this one item amounted to more than 
$12,000. As this measure did not seem to very greatly increase the 
catch, after the wave of excitement was over, it was discontinued. 

In the last eighteen months there has been a remarkable diminution 
of fleas in San Francisco. This disappearance has been noted by 
both residents and nonresidents, but no one has as yet offered a satis- 
factory explanation of the phenomenon. It is believed that general 
cleanliness in house, yard, and cellar, the use of chlorinated lime in 
such places, together with the renovation of stables, has practically 
abated the flea nuisance in San Francisco. Another factor should 
be mentioncnl in this connection. The destruction of the rat and its 
harboring places has, no doubt, contributed largely to the general 



14 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

effect. There are some who maintain that the extermination of the 
rat accounts entirely for the disappearance of the fleas. 

The identification and study of the fleas found on rats, ground 
squirrels {Citellus heecheyi)^ and the other small mammals of this 
vicinity have been carried on in the laboratory. It has been shown 
that the five varieties of rat fleas and the two varieties of squirrel 
fleas, namely, the Hoplopsyllus anomalus and the C eratoj^hyllus 
acutus very readily feed on man under experimental conditions. 
Squirrel fleas have been found infesting the rats of San Francisco. 
This fact is important when considered in relation to the present 
plague situation. There is at this time no plague infection in San 
Francisco, but in the near bay region (Contra Costa County), there 
is a widespread epizootic of plague among the ground squirrels. The 
rats of the city may be reinfected at any time through the medium of 
infected squirrel fleas. 

Although more than 1,200 *men were employed at various times 
in rat destruction, cleansing, disinfecting and laboratory work during 
the epidemic, not one was stricken with the disease. The immunity 
of those engaged in this dangerous occupation was due to the observ- 
ance of routine precautionary measures. Federal employees were 
required to wear gloves and use antiseptic solutions while handling 
rats. A doctor, two nurses, and a morgue attendant contracted the 
disease at the City and County Hospital in the fall of 1907. The 
doctor and one of the nurses recovered. 

INSPECTION OF SICK AND DEAD. ( SAN FRANCISCO.) 

Sick inspected (plague, none) 344 

Dead inspected (plague, none) 5,681 

Necropsies held : 96 

Rats infected with B. pestis (1 taken from Depew warehouse, Third and 
Channel streets, July 25, 1908 ; 1 taken from Depew warehouse, Third 
and Channel streets, August 4, 190S ; 1 taken from California ware- 
house, 631 Second street, October 21, 1908 ; 1 taken from California 
warehouse,. 631 Second street, October 30, 1908) 4 

CLEANING AND DISINFECTION. (SAN FRANCISCO.) 

Vacant lots cleaned and disinfected 5,712 

Streets cleaned and disinfected 101 

Buildings disinfected 4, 572 

Plumbing nuisances abated 2,066 

General nuisances abated 48,299 

Loads of fire debris removed (estimated) 16,060 

Premises cleaned of rubbish 2,302 

Vessels inspected 1, 677 

A movement having for its object the placing of a noninfectible 
zone between the residence section of the city and the water front is 
well under way. Sanitary measures directed toward the permanent 
exclusion of rats from the wharves and first tiers of business blocks 
will be pursued. Property owners have been prevailed upon to 
remedy structural defects and provide rat-impervious floors in the 
grain warehouses and produce stores therein. In addition, the state 
harbor commission has decided to erect only iron and stone piers for 
the accommodation of shipping in future. Three magnificent piers 
of this description have already been completed and are now being 
used by the steamship companies engaged in the oriental trade. 
When closed, these wharves are absolutely rat proof. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



15 



The following tables show the amount and character of the per- 
manent work done in San Francisco. 



Old Premises. 





Concrete work done. 




Number 

con- 
creted. 


Area. 


Basements 


944 
173 
216 
200 
200 


Squarefeet. 
1,888,000 


Floors 


910,717 


Yards 


142, 953 


Passageways 


127,462 


Sidewalks . . 


501,791 







New Premises. 



Basements... 

Floors 

Yards 

Passageways . 
Sidewalks 




2, 565, 370 
324, 430 
59, 879 
123,711 
682,956 



Number of stables condemned and abandoned 645 

Number of stables under construction 47 

Stables rat-proofed by other methods than concreting 379 

Action pending on stables , 62 

Improved health conditions as regards the incidence of typhoid 
fever, variola, and diphtheria are shown in the annual report of the 
local board of health. 

The following statistics are taken from this report : 

Fiscal Year 1907-8. 



Typhoid fever 

Smallpox 

Diphtheria 



Fiscal Year 1908-9. 




Deaths. 



107 
4 



Typhoid fever. 

Smallpox 

Diphtheria 




WORK OF THE FEDERAL LABORATORY. 

The following excerpts are taken from the report of Passed Asst, 
Surg. George W. McCoy, bacteriologist of the San Francisco plague 
laboratory. 

As was the case during the previous year, the great bulk of the 
liiboratory work has consisted in the examination of rodents for 
plague infection. 

Kilts f'Xiimiiml 03, 558 

I{;itH ffdiiul plfiKne infected 4 

(^Iroimd Hfjiiirrels exjunined 3,826 

Ground squirrels found plague Infected 42 



16 PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 

Gophers examined 248 

Rabbits examined 22 

Moles examined 27 

Weasels examined 2 

Total 97, 729 

Since the last plague-infected rat was found, October 23, 1908, over 
60,000 have been examined without finding any case of plague infec- 
tion. 

The ground squirrels examined have nearly all come from Contra 
Costa County during the month of June, 1909. As is shov/n in the 
table, 42 of these animals have been found to be infected. 

The work reported in the last annual report with various biological 
products designed for use as rat exterminators has been continued. 
The results, however, have been rather unsatisfactory. None of the 
preparations that have been examined killed any large percentage of 
the rats to which they were fed. 

A large number of experiments were carried out to determine the 
resistance of rats and other rodents to plague infection. It was 
found that San Francisco rats were only moderately susceptible ; field 
mice were also moderately susceptible ; gophers had a high degree of 
immunity, and ground squirrels were found to be very susceptible. 

Flea determinations have been carried on in the laboratory through- 
out the year. The seasonal prevalence of these parasites is at present 
under investigation, and it is hoped that in due time some definite 
statement may be made on this subject. It was demonstrated that 
all of the common rat fleas would readily bite man under experi- 
mental conditions, as would the squirrel fleas. 

Observations have been made on the subject of rat leprosy, and 
two apparently new points have been brought out in connection with 
this disease. First, that the majority of the cases are rather inti- 
mately associated with the meat industry ; and, second, the very inter- 
esting observation was made that a large percentage of the leprosy 
rats are the subjects of a well-marked nephritis. The tumors of rats 
have been made the subject of considerable study. It has been found 
that they correspond in a general way with the growths found in 
the human species, but on the whole appear to be somewhat less 
malignant. 

Experiments have been conducted with a view to determining how 
long rats would live without water and with certain limited dietaries. 
It was found that if an abundant supply of food was provided the 
rodents would live many days without water. One, indeed, lived 
something over a month. If a mixed diet (without water), such as 
bread and meat, with or without vegetables, is provided the animals 
will remain in perfect health apparently indefinitely. 

A number of physicians have visited the laboratory for the purpose 
of becoming familiar with the lesions of plague in rodents and with 
the elementary features of the bacteriology of the disease. 

Formal demonstrations of plague have been arranged for the 
students of the Medical College of the University of California, for 
the class in hygiene of the Leland Stanford Junior University, for 
the class at Hahnemann College, for the Association of Health Officers 
of the State of California, and for the San Francisco County Medical 
Society. These demonstrations have been well attended, and those 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 17 

for whom they were arranged have stated that they derived great 
benefit from them. 

An exhibit illustrating the various lesions of plague in rodents 
and other points in the j^athology of rodents was prepared for the 
Alaska- Yukon-Pacific Exposition at Seattle. The officers of the serv- 
ice have availed themselves of the facilities offered by the laboratory 
for taking a short course in bacteriology and pathology. 

BANQUET IN CELEBRATION OF SUCCESSFUL PLAGUE CAMPAIGN. 

On March 31, 1909, the citizens' health committee of San Fran- 
cisco, in celebration of the success attending the work of plague eradi- 
cation and in honor of Passed Asst. Surg. Rupert Blue, as representa- 
tive of the service, tendered to him a banquet, which was attended 
by some 300 representative citizens. Doctor Blue was presented with 
a gold watch by the mayor of the city on behalf of the citizens' health 
committee, and each of the federal officers was presented with a medal. 

The campaign had illustrated what can be accomplished by harmo- 
nious cooperation between the national, state, and municipal authori- 
ties, backed up by a patriotic public sentiment, such as had been 
exhibited in San Francisco. 

Antiplague Operations in Oakland, Cal. 

The work in Oakland has been continued as in the past, although 
on a somewhat smaller scale. A laboratory has been maintained and 
a small force of rat catchers has furnished several hundred rodents 
each week for examination. 

The city board of health, through Mayor Mott, succeeded in getting 
a small monthly appropriation from the council. The salaries of 
seven sanitary inspectors were paid from this amount. 

SUMMARY OF OPERATIONS (OAKLAND). 

Sick inspected 170 

Dead inspected 1, 453 

Necropsies held 65 

Cases positive for plague (sickened July 17, 1908) 1 

Premises inspected 32, 095 

Nuisances abated 5, 917 

Garbage cans installed 3,279 

Places rat proofed 53 

Ships inspected 82 

Ships fumigated 26 

I'remises cleaned . 4, 289 

Notices served _' 698 

Hats found dead 1,014 

Rats trapped 24, 875 

Rats identified (J/ws norvegicus, 14,295; Mus niiiiiH, 96; Mus munculus, 

1,133; MuH alexandrinus, 71) 1,5,595 

Ground squirrels caught 18 

Rats exiiniined bncteriologically 16,575 

Rats infected with Ji. pcHtis (1, No. 708 Webster street (Chinatown), 
trapped October .30, 1908; 1, No. 310 Fourth street, between Harrison 

and Webster, trapjied December 1. 1908) 2 

Ground squirrels examined bacteriologically (negative) 18 

Poiwjns placed 401, 350 

18546—10 2 



18 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

On account of the contiguity of Contra Costa County, ^Yhicll is 
badly infected with squirrel plague, it is considered that Oakland 
and the other cities on the eastern shore of the bay should be kept 
under careful sanitary supervision. Special attention should be paid 
to garbage collection and destruction, preferably b}'' incineration. 

The present method, that of hauling the garbage out to sea and 
there discharging it, is to be mentioned only to be condemned. 
During the past year considerable trouble has been experienced from 
this source, as the garbage when discharged at an insufficient dis- 
tance from the shore would be washed onto the beaches, there to 
breed flies and sustain rats. In fact, for a time Bolinas Beach on the 
north and Baker's Beach at San Francisco were temporarily ruined 
in this manner. 

Antiplague Operations in Contra Costa County, Cal. 

Two human deaths from bubonic plague in July, 1908, in Contra 
Costa County emphasized what has long been the opinion of those 
who have studied the problem, the fact that this was an enzootic 
focus for the disease. 

For several years human deaths from plague have been a matter of 
annual occurrence in Contra Costa County, and it has been known that 
for at least the past four years some epizootic has been spreading 
among the ground squirrels of that region. In all probability this dis- 
ease was bubonic plague, but this could not be determined until the 
summer and autumn of 1908, when the investigations following two 
human cases resulted in the discovery of four plague-infected squir- 
rels. Three of these squirrels were shot and one was found dead. All 
were discovered within 4 miles of Baypoint, Cal. One of these 
was found on the ranch where a boy died of bubonic plague in the 
summer of 1908; the others were secured near the coast of Suisun 
Bay. These findings removed the question of squirrel plague from 
the field of theory to that of fact. It remained, however, to prove 
the extent of the infection, and to evolve, if possible, a plan for the 
final eradication of the disease. In April, 1909, Doctor- Blue was 
given an allotment for the beginning of such a campaign. This has 
been carried forward with great vigor under the immediate direction 
of Passed Asst. Surg. W. C. Rucker. The problem has proved a. 
serious one. The infection is found to cover a wide area ; in fact, no 
portion of the county, some 744 square miles, seems to be free from 
the infection. Infected squirrels have also been found in Alameda 
County, to the south. Experiments have been made with the various 
poisonous agents to be used in the destruction of ground squirrels, 
but it has been found impracticable to carry on an eradicati^-e cam- 
paign at the present time, for the reason that the abundance of food 
at tliis time of the year makes the squirrel unwilling to take poisoned 
wheat, and the dry and cracked condition of the ground renders it 
impossible to use the various gaseous agents which give the best 
success in the work. For the present the work consists in securing 
squirrels for the purpose of laboratory examination, in order to deter- 
mine the extent and percentage of the infection. For this purpose 
hunters are stationed in various parts of the county. They shoot on 
an average 2,500 squirrels per week, which are forwarded to the 
service plague laboratory in San Francisco in sealed metal cans. 
Here the carcasses are subjected to careful pathological and bacterio- 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 19 

logical examination. The state board of health and the county board 
of supervisors are cooperating in every way. It is hoped when the 
rainy season approaches a campaign of public education may be 
launched, to the end that every .person living in the county will 
cooperate in the destruction of squirrels. If the agents to be used 
in the destruction of ground squirrels are issued to the ranchers gratis, 
it is believed there will be no difficulty in securing their aid. Without 
this the extermination of the squirrels will be almost impossible with- 
out prohibitive expense. 

This campaign is directed at the eradication of what would other- 
wise be a permanent focus for plagvie in xVmerica, and the constant 
menace not only to San Francisco and the bay cities and the State 
of California, but also to the entire nation. The fact that ground 
squirrels are frequently utilized for food, and are carried into the 
bay cities for eating purposes, doubles the chances of introducing 
plague into the cities. This practice has, in a measure, been stopped 
through the efforts of Doctor Blue and the state board of health, but 
it is impossible to prevent private hunters from shooting and eating 
these animals. Some time will be required to complete the work in 
Contra Costa County. Specimens will also be taken from the various 
contiguous counties with a view to determining whether or not infec- 
tion has spread to them. 

SUMMARY OF OPERATIONS (CONTRA COSTA COUNTY). 

Sick inspected 2 

Dead inspected 56 

Necropsies held 6 

Cases positive for plague (1 sickened July 11, 1908; 1 sickened July 21, 

1908) 2 

Ranches inspected 1, 080 

Ranches poisoned 217 

Ground squirrels received 4, 177 

Ground squirrels examined bacteriologically 3, 826 

Ground squirrels infected with B. pestis 42 

The above figures are for Contra Costa County for the fiscal year 
ended June 30, 1909. Since that date operations have been extended 
so that to November 1, in Contra Costa and other counties, the 
number of ranches inspected has been 4,511 ; squirrels destroyed have 
numbered 44,843, of which number 298 have been found infected. 
It will be necessary to continue this work for an indefinite period 
until all this plague infection has been eliminated. 

Antiplague Operations in Point Eichmond, Cal. 

The intelligent course pursued by the citizens of Point Richmond 
in guarding against infection is an example of what a progressive 
community can do in an emergency. Sanitary inspectors were em- 
ployed and a garbage incinerator installed early in the year. Four 
rat catchers were employed and paid by the Federal Government. 

SUMMARY OF OPERATIONS (POINT RICHMOND). 

Sick inspected (plague, none) 34 

Dead inspected (plague, none) 45 

Premises inspected 18, 207 

XiiiHancos abat(«l 1,031 

Rats found dead 731 

KafH lrai)i)('d 1,365 

Rats (examined bacteriologically 1,082 

Poisons placed 464, 050 



20 public health and marine-hospital service. 

Antiplague Operations in Alameda County, Cal. (Exclusive of 

Oakland. ) 

The work in Alameda County, outside of the city of Oakland, 
consisted in a joint inspection of the dead by federal and state in- 
spectors and the performance of necropsies when a doubt existed as 
to the cause of death in any case. 

Antiquated methods of disposal of garbage and refuse are still 
.employed in the cities of Alameda and Berkeley. In fact, rat destruc- 
tion and other precautionary measures have been entirely neglected. 

SUMMARY OF OPERATIONS. 

Sick inspected (plague, none) 226 

Dead inspected (plague, none) 1,937 

Necropsies held 98 

Antiplague Operations in Los Angeles, Cal. 

As reported by Surgeon S. D. Brooks in August, 1908, a single 
case of bubonic plague occurred in Los Angeles, and shortly after 
one ground squirrel, found dead in the same vicinity, was proven 
to be infected with this disease. 

On September 8, after the positive proofs of the diagnosis were 
obtained, the health department of Los Angeles insisted that the 
mayor and council should recognize the existence of a case of plague 
and authorize means to protect the city. 

Authority Avas given to construct and equip a suitable plague 
laboratory, and an addition of 18 men only was allowed to the force 
of the health department to catch and poison rodents and enforce 
the cleaning of certain sections of the city. At the same time request 
was made by the mayor, seconded by the California state board of 
health, that the Surgeon-General of the Public Health and Marine- 
Hospital Service detail a bacteriologist to carry out the work in the 
proposed plague laboratory. 

With this meager equipment of men the health officer did vigorous 
work. Mice and fleas were found in the house where a boy lay 
sick and were exterminated. The region immediately surrounding 
the house and along the Southern Pacific Company's railroad tracks 
and the railroad warehouses and the meat packing establishments in 
the neighboring section of the city were made the earliest points of 
attack. This section was raided again and again for rodents and to 
enforce temporarily at least as great a degree of cleanliness as was 
possible. The work was extended along the railroad tracks to the 
city limits, where it was taken up by the county health officer, Dr. 
O. K. Stafford. This was the earliest plan of the campaign — to use 
every effort to ascertain if infected ground squirrels, rats, mice, or 
other rodents existed in the section of the city noted and along the 
Southern Pacific Company's tracks as far north in Los Angeles 
County as the mountains. Then the remainder of the city of Los 
Angeles, which embraces 61.40 square miles, was slowly covered. 
The population is now over 300,000. 

In September, 1908, the state board of health appointed Dr. I. E. 
Bancroft (and later his successor. Dr. W. H. Fox, after Doctor Ban- 
croft became an assistant health officer of Los Angeles) to examine 



PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE. 21 

into the cause of all deaths in Los Angeles County and to perform 
necropsies in all suspicious cases. Many necropsies were performed, 
but no case suspicious of plague was found. This special service was 
discontinued May 1, 1909. 

The laboratory of the Medical College of the University of South- 
ern California was used temporarily for the rodent examinations, 
and about September 23, after the arrival of Passed Asst. Surg. A. M. 
Stimson, of the Public Health and Marine-Hospital Service, the spe- 
cially constructed laboratory was available, and the work was carried 
on faithfully by that officer as long as the appropriation by the city 
council was continued — that is, until April 12, 1909 — during which 
time 13,922 animals were examined. Of this number of animals, 
4,722 were ground squirrels, 8,288 were gray rats, 564 were black 
rats, 125 were gambel pocket rats, 96 were mice, 69 were white rats, 
32 were rabbits, 23 were gophers, 2 were skunks, and 1 a wild rat. 

Of the total number of animals examined during the period above 
stated none was found infected with plague. 

Upon this favorable showing, the necessity for the further detail of 
an officer at Los Angeles not being apparent, he was withdrawn 
shortly after April 12, 1909. 

Health Officer Powers realized that he was not exterminating the 
rats nor the ground squirrels in the city, and that it never could be 
done with so small a force of men, nor without an ordinance looking 
to the rat proofing of basements, stables, etc. But all his efforts in 
this direction were unavailing. As time passed and no further cases 
of plague occurred, the opposition to further expenditures increased 
and all possible future dangers to the city were forgotten. 

The total cost to the city of Los Angeles was $10,573.26. 

Following the discovery of the case of plague in Los Angeles, 
measures were instituted for the destruction of rats and ground 
squirrels in the county of Los Angeles adjoining the city, and in the 
cities and towns of Pasadena, South Pasadena, San Pedro, Long 
Beach, Alhambra, Hollywood, Glendale, Banning, Monrovia, Sierra 
Madre, and other places, and also at the Pacific Branch National 
Home for Disabled Volunteer Soldiers. This warfare was pushed 
with considerable vigor at first, and in many places the ground- 
squirrel population seemed to be practically wiped out, but with the 
disappearance of apprehension of a spread of the disease, efforts were 
relaxed or discontinued, and it appears that the rats and squirrels 
are once more numerous. As a rule, no accurate record was kept of 
the number of rodents destroyed. The health officer of the city of 
Pasadena states that the campaign at that point is still on and will 
be continued. In that city and in the county of Los Angeles the war- 
fare seems to have been the most active. 

The use of poisoned grain was found to be the most effective means 
for the destruction of the squirrels. 

Attitude of the State and Local Health Autpiorities. 

The state and local health officials have cooperated to the full ex- 
tent of their appropriations. They were the legal source of authority 
in the prosecution of the campaign and deserve the highest com- 
mendation for delegating such powers to the federal officers. The 
state board of health, through its president and secretary, was par- 



22 PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE, 

ticularly fortunate in securing the passage of a law declaring it the 
duty of all persons to exterminate rats, mice, and ground squirrels 
on i^roperty owned, leased, or occupied by them, and providing a 
penalty for the violation of the same. Reprints of this act have been 
distributed throughout Contra Costa County and in other parts of 
the State liable to become infected. 

In California, as in other States, where the service has been called 
to undertake sanitary problems of great magnitude, the principal 
obstacle to success has been the lack of sanitary laws, both State and 
municipal, which might be brought to bear on the situation. These 
difficulties have been met and overcome in each case. Suitable state 
laws have been enacted and municipal ordinances secured which 
enabled the service to fulfill the humane purposes of its organization. 

Antiplague Operations in Seattle, Wash. 

By way of introduction it may be stated that three verified human 
cases of bubonic plague drew the attention of local, state, and federal 
health authorities to the existence of the disease in Seattle in the 
latter months of 1907. A vigorous sanitary campaign was organized 
by Passed Asst. Surg. L. E. Cofer, of the United States Public Health 
and Marine-Hospital Service, which work, with the exception of the 
fumigation of ships and the bacteriological examination, Avas taken 
over by the municipal department of health on Januar}^ 22, 1908, and 
is now being carried on by the city commissioner of health, J. E. 
Crichton. Passed Asst. Surg. M. W. Glover reports that no human 
cases have occurred since the inauguration of this work. Five plague- 
infected rats were verified from different parts of the cit}^ during the 
fall and early winter. Six cases of rat plague were verified during 
the spring of 1908, five being from within an area of some six blocks 
in length in the business section along the water front and one rat 
from the city garbage dump about a mile to the south. 

DIFFICULTIES OF ANTIPLAGUE WOKE:. 

Seattle is confronted by certain special difficulties in its antiplague 
work. Owing to the newness and rapid growth of the city, the 
cheapness of timber, and the high price of labor, lumber is extensively 
used for building purposes, and even the wholesale business district 
is largely built up with wooden structures. Back of the Avharves are 
the railroad tracks, streets and buildings resting upon piles high in 
the air above the water and a tide-washed shore line covered with 
rubbish. In many of these buildings is carried on a wholesale busi- 
ness in grain, meat, vegetables, and other edible products. Along the 
water front to the south the brush bulkheads harbor countless droves 
of rats, and although this section is less densely built up, yet these 
rats manage to find a subsistence about stables, markets, etc. An 
incinerator, built since the outbreak of plague, has accomplished 
much toward solving the garbage problem. It is, however, inade- 
quate for taking care of the entire accumulation and the city is still 
depositing about 70 tons of garbage per day upon dumps. These 
dumps of course support the usual rat population. Following the 



PUBLIC HEALTI-I AND MAEINE-HOSPITAL SERVICE. 23 

finding of the plague-infected rats in the spring of 1908, a large 
amount of work was done, filling in underneath the streets and build- 
ings of the infected area, thus covering the rubbish. The work was 
very effective in reducing the rat population of the district. 

The routine work carried on by the local health authorities during 
the present year may be summarized under the following heads — 
inspection, poisoning of rats, and trapping of rats. The routine work 
of the officers of the United States Public Health and Marine-Hos- 
pital Service may be summarized under the following heads — 
fumigation of ships, and bacteriological examination of suspected 
material. 

WORK or MUNICIPAL HEALTH DEPARTMENT. 

The municipal department of health and sanitation maintains a 
corps of sanitary inspectors, to each of whom is assigned a district. 
Among other duties the inspector looks after the enforcement of the 
sanitary ordinances relative to keeping premises free of rubbish and 
the j)roper storage and disposal of garbage. As the first essential 
to the reduction of the rat population is the deprivation of the means 
of livelihood in respect to food supply and harborage, this phase of 
the work is regarded of fundamental importance. 

The corps of poisoners is four in number. When responding to 
a complaint of rat infestation the poisoner's first duty is the inspection 
of the premises, as rats alwaj^s mean uncleanly or insanitary conditions. 
If the conditions are found to be particularly bad the case is reported 
to the chief sanitary inspector and taken up from his office. If the 
defects are easily remediable the complainant is instructed as to the 
measures to be employed and as soon as nuisances have been abated 
the poison is placed. The abatement of nuisances and poisoning are 
uniformly effective in the residence districts. In the business sec- 
tion, for reasons above outlined, the measures which would be neces- 
sary to effect a complete and permanent eradication of rats are often 
not practicable. In such cases the poisoning is repeated periodically 
and the case is further taken up by the trappers, who install bait 
and look after the traps and deliver the catch at the laboratory. 

There is a rat bounty of 10 cents, and many rats are procured by 
this means, chiefly from districts where they most abound, notably the 
brush bulkhead and garbage dump areas. The department of health 
also maintains a corps of six trappers who devote their attention for 
the most part to the business section. 

Business men along the water front unanimously testify to the 
radical change for the better in the matter of rat infestation since the 
inauguration of the antirat campaign, and these men are among the 
strongest supporters of the work. 

Though it has been a considerable time since the finding of the 
last plague-infected rat, yet in view of the impossibility of absolute 
certainty as to the eradication of the disease, of the ever present 
danger of a fresh importation of plague from other infected ports, 
and of the economic advantages accruing from the work it is the policy 
of the municipal department of health and sanitation, supported by 
an effective public sentiment, to continue the antirat crusade. 



24 PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 

PRECAUTIONS ON SHIPS. 

In order to prevent the spread of plague by sea-borne commerce, 
all ships were made to breast off from the dock and all lines were 
protected w4th rat guards. Alaskan boats were fumigated monthly, 
intrastate boats were inspected semimonthly for evidences of rats 
and fumigated as often as such evidences were found. Fumigation 
was performed by the burning of sulphur in the holds, galley, store- 
room, forecastle, etc. The dead rats recovered after fumigation were 
taken to the laboratory for bacteriological examination. The fumi- 
gation of ships was carried on under the direction of Passed Asst. 
Surg. M. W. Glover, of the United States Public Health and Marine- 
Hospital Service, until March 13, 1909, when, owing to the length of 
time which had elapsed since the fincling of plague, it was discon- 
tinued by bureau order. From the beginning of the fiscal year to 
the date of the discontinuance of this work 380 vessels were inspected 
and 154 vessels were fumigated. 

The work of the plague laboratory was carried on during the fiscal 
year by Asst. Surg. C. W. Chapin and comprised the examination for 
evidences of plague of rats delivered by the bounty men and city 
trappers, and the investigation of human suspects reported from 
time to time. The human susj^ects occurring in Seattle during the 
year were four in number — three being orientals — and were reported 
on account of sudden death or lack of clinical history. All these 
cases proved negative to examination for plague. During the year 
61,750 rats were delivered at the laboratory and 48,652 were necrop- 
sied. Of these 7 were plague infected. The plague-infected rats 
were delivered at the laboratory on the following dates : July 6, 2 rats ; 
July 9, 4 rats; and September 26, 1 rat. In addition verification was 
completed of 3 rats, 1 delivered on June 23 and 2 delivered on June 
29, 1908. 

The above-mentioned plague-infected rat of June 23 was delivered 
from the woodyarcl premises. Eighth avenue and Madison street. 
This woodyard comprises the greater portion of the block, is located 
some eight blocks up the hill from the infected water-front district, 
and contains, besides the woodyard, a small stable from which the 
infected rat was obtained. As soon as verification was complete the 
stable was ordered vacated, everything movable was removed, the 
building was surrounded by a sheet of galvanized iron to prevent the 
escape of rats, the floors were taken up, and 53 rats killed and found 
deacl, were sent to the laboratory. Altogether 9 rats delivered from 
this stable from June 23 to July 9, inclusive, were found to be plague 
infected. After the removal of the floors and rubbish the ground was 
saturated with a solution of bichloride of mercury. The building 
was left vacant several daj^s, during which time guinea pigs and rats 
from the laboratory were kept caged in the building to test its safety 
These animals remained free from disease. 

The feed used in this stable had been obtained from the Spokane 
Grain Company, a Avholesale house situated in the 1200 block on 
Western avenue within the infected water-front district. It was sup- 
posed that the infection had reached the stable by this route, but the 
examination of rats from these premises yielded only negative results 
until September 26, 1908, when the last plague-infected rat was 
brought from the premises of the Spokane Grain Company. 



SCIENTIFIC RESEARCH AND SANITATION. 

In accordance with legal authority and in response to demands made 
upon it, the bureau, through its Division of Scientific Research and 
various laboratories, has actively engaged during the year in investi- 
gations of contagious and infectious diseases and matters pertaining 
to the public health. The public-health problems for investigation 
have been selected in most instances with the view to rendering the 
results immediately applicable in practical sanitary administration. 
So far as problems are concerned, they are more extensive than can 
be taken up in any one year. There are many questions of a 
public-health character requiring laboratory investigation, and a still 
greater number of unsolved problems in the domain of the sanitary 
sciences which can only be solved by continued research in the 
laboratory and in the field. 

It has been the endeavor to properly equip the several laboratories 
and to maintain them in such a state of efficiency as to facilitate the 
investigations in hand. There have been some additions to the force 
of scientific workers, and as this branch of the service grows it 
becomes more apparent that the success of research work will in 
future depend upon specializing and the development of recognized 
experts in special lines. A wise administrative policy will foster this 
procedure so far as the exigencies of the service will permit, and its 
fulfillment will result in great additional usefulness and credit to 
the public-health service. This policy is now being pursued, 37 
officers having been afforded the facilities of the Hygienic Laboratory 
for purposes of instruction. In addition, officers of the service are 
now devoting special attention to the management of plague and 
yellow-fever outbreaks; the medical inspection of aliens and study 
of the diseases to which they are especially liable ; studies of morbidity 
and mortality statistics; investigations of pellagra, typhoid fever, 
plague, yellow fever, rabies, tuberculosis, hookworm disease, and lep- 
rosy. Through such specializing different officers of the corps have 
become proficient along the several lines, and it is expected that 
officers who enter the service in future will be given this opportunity 
in so far as is possible. 

Investigations begun in previous years have been continued, with 
the result that some of them have been completed, while others are 
still in progress. The reports of these investigations, with full details, 
have been prepared for publication as Hygienic Laboratory bulletins, 
public-liealth papers, and special articles in the public-health reports. 

As in previous years, the service has been represented at the meet- 
ings of the more important scientific and sanitary associations, and 
the officers thus detailed have in most instances contributed articles 
relating to scientific research and practical sanitation. Through 
such association with health authorities and other scientific Avorkers, 
the bureau has kept in touch with the advances made in preventive 
medicine. 



26 PUBLIC HEALTH AND MARTNE-HOSPITAL SEEVICE, 

Upon the request of state and local health authorities, the bureau 
has cooperated with said authorities so far as possible in public- 
health investigations. For this purpose the facilities of the Hygienic 
Laboratory have been utilized. As an instance of this may be men- 
tioned the cooj^eration with the Florida state board of health. Upon 
request of the state health officer of Florida, there have been made 
in the Hygienic Laboratory daily and routine examinations of speci- 
mens upon the diagnosis of such diseases as typhoid fever and 
malaria. In addition, samples of water have been examined and 
reports made thereon. Laboratory assistance of this character can 
be properl}^ rendered, and the association of the service laboratories 
with the health organizations of the country is of mutual advantage 
and should be extended. 

The laboratories now in operation are the Hygienic Laboratory in 
Washington, the leprosy investigation laboratory in Hawaii, and the 
federal plague laboratories in San Francisco and Seattle, as well as 
small clinical laboratories at the Marine Hospital Sanatorium, Fort 
Stanton, N. Mex., and certain of the marine hospitals. At most of 
these stations research work is being carried on. It is expected that 
the laborator}^ in San Francisco will be continued and enlarged, as 
there will be demand for such work in relation to plague among 
rodents for an indefinite period. The leprosy investigation station is 
being devoted to the solution of the special problems of leprosy in 
the Hawaiian Islands, and during these investigations studies will be 
made of allied problems relating to the public health. 

There is necessity for a research laboratory on the Gulf coast for 
the investigation of tropical diseases, including malaria, yellow fever, 
and hookworm disease, and the study of culicides, germicides, and 
agents for the destruction of rodents. A research laboratory should 
also be established in the region of the Great Lakes for the study 
of problems in relation to interstate sanitation, such as the prevention 
of the pollution of streams and the prevention of the transmission 
of typhoid fever, tuberculosis, and other communicable diseases b}'^ 
vessels and trains. It is also desirable that a research laboratory be 
established in New York, in which to investigate the problems arising 
through immigration and in order to utilize the large amount of 
clinical material in the study of communicable diseases. 

These additional laboratories could be established and maintained 
at small cost at the existing marine hospitals, and could be manned 
by officers who have had the course of instruction in the Hygienic 
Laboratory and are specially qualified for such duty. Their admin- 
istration through the Division of Scientific Research would prevent 
duplication and secure cooperation in the scientific study of public- 
health problems affecting all parts of the country. 

The operations of the bureau through the Division of Scientific 
Research and Sanitation, with supplemental work in the laboratories 
and in the field, have included the following: Supervision over the 
manufacture and sale of viruses, serums, toxins, and analogous prod- 
ucts; investigations of vaccine virus; investigation of the reported 
occurrence of apthous fever; investigations of typhoid fever in the 
District of Columbia and Forest Glen, Md. ; investigations of pel- 
lagra and the publication of literature relating thereto; investiga- 
tions of rabies and treatment in the Hygienic Laboratory of persons 
bitten by rabid animals ; studies on tuberculosis and the fostering of 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



27 



colored antituberculosis leagues; investigations of hookworm disease 
and certain problems on American farms; investigations of amoebi- 
asis; investigations of leprosy at the leprosy investigation station, 
and an inquiry into the present status of leprosy in the United States ; 
analyses of drugs, water, and other public-health investigations in the 
Hygienic Laboratory; studies in relation to the pharmacopoeia in 
the Hygienic Laboratory; studies of milk and its relation to the 
public health ; studies of the rat and its relation to the public health ; 
the preparation of an exhibit for the Alaska- Yukon-Pacific Exposi- 
tion; cooperation with other departments of the Government; the 
preparation and publication of scientific and practical public-health 
bulletins; conferences with the advisory board of the Hygienic Lab- 
oratory and state and territorial health authorities; and work in 
relation to international sanitation. 

Viruses, Serums, Toxins, and Analogous Products. 

Administrative supervision has been maintained over the manu- 
facture and sale of viruses, serums, and toxins during the year as 
l^rovided for in the act approved July 1, 1902. Twenty-one estab- 
lishments were licensed by the department during the year, 10 of 
them being foreign. 

Samples of the j^roducts of licensed establishments have been pur- 
chased in the open market from time to time, examined as to purity 
and potency, and with very few exceptions found satisfactory. Where 
lack of purity or loss of potency were detected, immediate steps were 
taken and the faulty conditions responsible corrected. 

The good effects of the above-mentioned law have been previously 
mentioned, and they are shown in the high quality and therapeutic 
efficiency of the biologic products now offered in the market. 

Through inspections close supervision has been had over the various 
establishments, and their products in the main have been satisfac- 
tory. The manufacturers have cheerfully cooperated with the Gov- 
ernment in the enforcement of this law, oftentimes at considerable 
expense. This attitude is coimnendable and necessar}^ for the maxi- 
mum benefits of the law will depend largely upon mutual cooperation 
and confidence. 

The following is a list of the establishments licensed during the 
fiscal year: 

Establishments Licensed. 



No. of 
license. 



Establishment. 



Products. 



Parke, Davis & Co., Detroit, Mich 

n. K. Mulford Co., Philadelphia, Pa 

Dr. n. M. Alexander & Co., Marietta, Pa. 

Fluid Vaccine Co., Milwaukee, Wis 

Cutter Analytic Laboratory, Herkeley, Cal 



Antidiphtheric serum, antitetanic serum, anti- 
streptococcic serum, antigonococcic serum, 
erysipelas and prodigiosus toxines (Coley), 
tuberculins, bacterial vaccines, and vaccine 
virus. 

Antidiphtheric serum, antitetanic scrum, anti- 
streptococcic serum, antipneumonic serum, 
antigonococcic .serum, antidysenteric serum, 
tulierculins, bacterial vaccines, and vaccine 
virus. 

Antidiphtheric serum, antirabic virus, vaccine 
virus, and tuberculins. 

Vaccine virus. 

Antidiplitheric serum, antistreptococcic serum, 
antityphoid serum, .tuberculin, and vaccine 
virus. 



28 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Establishments Licensed — Continued. 



No. of 
license. 



Establishment. 



Products. 



Frederick Stearns & Co., Detroit, Mich... 
Pasteur Institute of Paris, Paris, France. 



Chemische Fahrik auf Actien (vorm. E. 

Schering), Berlin, Germany. 
Health department of the city of New York. . 
W. R. Hubbert Serum Laboratory, Detroit, 

Mich. 
National Vaccine and Antitoxin Institute, 

Washington, D. C. 
Lederle Antitoxin Laboratories, New York 

City. 



Burroughs, Wellcome & Co.. London, Eng- 
land. 



Memorial Institute for Infectious Diseases, 

Chicago, 111. 
Swiss Serum and Vaccine Institute, Berne, 

Switzerland. 



Institut Bacteriologique de Lyon, Lyons, 

France. 
Farbwerke, vormals Meister Lucius & Brun- 

ing, Hoechst-on-Main, Germany. 
Tuberculin Society of St. Petersburg, St. 

Petersburg, Russia. 
Institut de Vaccine Animale, Paris, France. . 

Institut Pasteur de Lille, Lille, France 

Bacteriologisches Institut Lingner, Dresden, 

Germany. 



Antidiphtheric serum, streptolytic serum, pneu- 

molytic serum. 
Antidiphtheric serum, antistreptococcic serum, 

antiplague serum, antidysenteric serum, anti- 

meningococeicserum, and serum antivenimeux. 
Antidiphtheric serum and antistreptococcic 

serum. 
Antidiphtheric serum. 
Do. 

Antidiphtheric serum, antigonococcic vaccine, 
vaccine virus, and normal horse serum. 

Antidiphtheric serum, antitetanic serum, tul)er- 
culins, bacterial vaccines, vaccine virus, anti- 
streptococcic serum, and suspension of lactic 
acid bacilli. 

Antidiphtheric serum, antistreptococcic serum, 
antistaphylococcic serum, antityphoid serum, 
antistreptococcic vaccine, antistaphyloccic vac- 
cine, antigonococcic vaccine, and antityphoid 
vaccine. 

Antidiphtheric serum. 

Antidysenteric serum, antipneumococcic serum, 
antimeningococcic serum, antiplague serum, 
antistreptococcic serum, antieholera vaccine, 
antiplague vaccine, antityphoid vaccine, and 
tul^erculins. 

Antidiphtheric serum and normal goat serum. 

Antidiphtheric serum, antistreptococcic serum, 

antidysenteric serum, and tuberculins. 
Tuberculinum purum. 

Vaccine virus. 
Serum antivenimeux. 
Pyocyanase. 



Antidiphthepjc Serum. 

The standard unit for measuring the strength of antidiphtheric 
serum was promulgated April 1, 1905. The essential facts concern- 
ing the adoption of this standard have been related in previous re- 
ports, and the technical investigations in the Hygienic Laboratory 
necessary in its preparation have been made the subject of a special 
bulletin. 

The standard unit for antidiphtheric serum was prepared and 
sent out from the Hygienic Laboratory at the usual bimonthly pe- 
riods. The use of this standard has now quite replaced in the United 
States that of the serum furnished by the Royal Institute in Frank- 
fort, Germany. 

A large number of samples of antidiphtheric serum and antitoxic 
globulin solutions from licensed manufacturers Avere examined in 
the Hygienic Laboratory during the year, as well as a number of 
samples from establishments desiring to be licensed. Although an 
increased number of samples were examined as compared with 
previous j^^ears, the number of those below^ strength was very few. 
Some manufacturers, in the endeavor to obtain a high potency globu- 
lin solution, have probably increased the total solids to a point which 
hinders the absorption of the solution. 

The secretary of the state board of health of Ohio communicated 
with the bureau March 18, 1909, respecting a complaint made to him 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 29 

of the antitoxin furnished by his board, and forwarded specimens 
of diphtheria antitoxin of the same laboratory number for exami- 
nation in the hygienic laboratory. He also forwarded, on March 
30, replies to inquiries made of physicians throughout the State 
who had used this antitoxin. In all 32 reports, the original com- 
l^laints included, were received. Of these, 28 reported satisfactory 
results from the use of the antitoxin, with no unfavorable symp- 
toms. The physician making the original complaint reported the 
appearance at the point of injection of a dark-blue spot sometimes 
as large as a saucer. A second physician reported some discoloration 
and complaint of pain and swelling. A third reported the appear- 
ance of a small dark-blue spot around the puncture. A fourth re- 
ported considerable SAvelling, with pain on pressure, in two cases. 

In a report of April 6, 1909, the Director of the Hygienic Labora- 
tory stated that a determination of the total solids in* one sample 
of the serum in question was made in the Division of Pharmacology, 
and that the total solids were 21.05 per cent, of which 0.G5 per cent 
w^as nonconsumable ash. He also stated that the total solids in 
normal horse serum are about 9.7 per cent, and that the total solids 
of the sami^le examined were therefore two and one-half times that 
ordinarily found in horse serum. The high percentage of total solids 
noted probably hindered absorption, thereby causing induration at 
the site of inoculation. 

The secretary of the state board of health of Ohio was informed 
of the results of examination of the serums forwarded by him. 

In a letter dated April 9, 1909, all establishments licensed for the 
propagation and sale of diphtheria antitoxin were also informed of 
the presence of high total solids, and that the matter was brought to 
their attention as it seemed advisable to avoid overconcentration of 
diphtheria antitoxin and other serums which may bring about unto- 
ward Local symptoms and loss of therapeutic efficiency. 

On account of the importance of this question in relation to the 
administration of the law of July 1, 1902, correspondence relating 
thereto was forwarded to the Director of the Hygienic Laboratory, 
and in a letter of May 15 his attention was invited to the importance 
of investigating this problem in connection with other examinations 
of serum. 

Antitetanic Serum. 

As a result of the adoption by the department of a standard unit 
for measuring antitetanic serum, this product now being offered for 
sale in interstate traffic by the several establishments is uniform as 
to potency. 

The standard has proved in actual practice to be satisfactory, 
accurate, and permanent. It has been recognized by the Governments 
of Belgium and Brazil, and it is hoped that it will be generally 
adopted, and incorporated in the forthcoming revision of the United 
States Pharmacop(X'ia. The standard tetanus toxin prepared in the 
Hygienic Laboratory is sent out on demand from that institution. 

One of the most important results of the adoption of the official 
standard for the measurement of the strength of antitetanic serum 
will be that physicians, by using a definite number of units for pro- 
phylactic and therapeutic purposes, will gradually collect available 
data as to the number of units necessary for prophylactic use and for 



30 PUBLIC HEALTH AND MAEINE-HOSPITAL SEEVICE. 

use in cases of developed tetanus. There are at present no reliable 
data upon this question, and it is important that physicians in using 
antitetanic serum and reporting cases of tetanus should state the 
number of units administered. 

Investigations of Vaccine Virus. 

In the latter part of November, 1908, there was brought to the 
attention of this bureau by Dr. John R. Mohler, Chief of the Patho- 
logical Division, Bureau of Animal Industry, an account of an out- 
break of foot-and-mouth disease in Pennsylvania and other places. 
He stated that the origin of the outbreak had been traced to Michigan, 
and that there was suspicion that the disease had originated in con 
nection with the manufacture of vaccine virus in the establishment of 
Parke, Davis & Co., Detroit, Mich. 

On account of the susj^ected relationship of the outbreak of foot- 
and-mouth disease to the manufacture of vaccine virus, Surg. M. J. 
Eosenau was ordered, on November 28, 1908, to inspect the establish- 
ment of Parke, Davis & Co., in accordance with the laAV of July 1, 
1902, regulating the manufacture and sale of viruses, serums, ancl 
toxins in interstate traffic and in conformity with the regulations pro- 
mulgated thereunder under date of February 21, 1903. This inspec- 
tion was made in company with Doctor Mohler, and Surgeon Eosenau, 
in his report dated December 22, 1908, stated in effect that the first 
cases of foot-and-mouth disease discovered were brought from the 
stock yards at East Buffalo, N. Y., to two points in Pennsylvania, and 
that the diagnosis was made by the state veterinarian and confirmed 
by the Chief of the Bureau of Animal Industrj^ and his assistants 
November 11, 1908. 

An attempt at this time to trace the origin of the cases was unsatis- 
factory, although it was determined that the infected animals had 
come from Clare, Mich. Subsequently, however, the prevalence of a 
mild type of foot-and-mouth disease was reported on several farms 
in Wayne County, Mich., and among the animals infected were 21 
heifers which had previouslj^ been used by Parke, Davis & Co., of 
Detroit, for the production of vaccine lymph. It was observed b}' 
officers of the Bureau of Animal Industry that these animals were in 
the fourth stage of the disease ; in other words, the lesions were older 
and more nearlj^ healed than those found in any other center where 
the infection had been observed. 

With these facts in mind, and with the knowledge of a previous 
outbreak of foot-and-mouth disease having been attributed to vacci- 
nated cattle in New England, it was necessary to trace the movements 
of the 21 cattle above referred to. 

The investigations showed that these animals were rented by Parke, 
Davis & Co., as was the custom, vaccinated on September 23 ancl 
October 6, and returned to the owners October 16. On this date the 
animals were driven to the Detroit stock yards, watered and fed, and 
then taken to Elm, Mich., and dispersed. The appearance of foot- 
and-mouth disease was observed on October 18 by the purchaser of 
10 of these animals, and by other purchasers about the same time. 

All subsequent foci of infection were directly or indirectly traced 
to the 21 vaccinated animals, while negative results followed the 
investigation of the places whence these cattle came before they were 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 31 

taken to the vaccine establishment in Detroit. The probability of the 
infection of these animals during vaccination was thus indicated, and 
rendered necessary a searching investigation of the method of manu- 
facture and preservation of vaccine virus, including the origin of the 
strains of virus used and the care and disposition of the animals 
used for vaccination purposes. A careful inspection of the biological 
laboratories was therefore made, and on December 1 the records of 
the particular vaccines and cattle used during the months of Septem- 
ber and October were secured. In addition the employees of Parke, 
Davis & Co., directly connected either in a supervisory or minor 
capacity with the production of vaccine virus, were placed under 
oath by Inspector Rosenau, in accordance with the act of Congress 
approved July 1, 1902, and the testimony thus obtained, together 
with records submitted, were made a part of the report of inspection. 
This report contained the following conclusion as to the origin of the 
infection of foot-and-mouth disease under investigation: 

The only conclusion which seemed warranted was that the earliest cases of 
foot-and-mouth disease in the present outbreak occurred in 21 vaccinated 
animals of Parke, Davis & Co., and that the original source of infection was 
traceable to Parke, Davis & Co.'s establishment and to no other point. Whether 
the infection originated in the vaccine virus used upon these calves or whether 
the animals were exposed to the infection by coming in contact with foreign 
material which carried the contagion is now the subject of investigation * * * 
which will be the subject of a supplemental report. 

Upon receipt of the inspector's report it was placed before the 
bureau sanitary board for consideration. This board confirmed the 
recommendations made in the report, to the effect that more space 
should be provided in the pathological department of the above- 
mentioned establishment in order to permit the safe conduct of vac- 
cine and other work ; that refuse, crude materials, and goods of mis- 
cellaneous origin should not be permitted in or about the vaccine 
stables or the animals used for the propagation of vaccine virus; 
that all vaccine virus manufactured by Parke, Davis & Co. since 
October 1, 1908, should under no circumstances enter into interstate 
traffic until the investigations referred to in the inspector's report 
were concluded; that animals used for propagating vaccine virus 
should be under daily veterinary inspection for not less than ten 
days immediately before they are vaccinated ; that an autopsy should 
be made on each vaccinated animal immediately after taking the 
virus, and permanent records kept of the autopsy findings. 

In accordance with these and subsequent recommendations, and in 
accordance with the regulations promulgated under the act of July 1, 
1902, Parke, Davis & Co. were notified of the faulty conditions 
observed in order that they might take steps to correct the same. In 
the meantime their license for the manufacture and sale of vaccine 
virus, which had expired November 22, 1908, had not been renewed, 
and the same was withheld pending the conclusion of investigations 
of their stock vaccines and correction of faults necessary to the safe 
production of vaccine virus. 

In order to determine whether the requirements of the department 
had been complied with, the establishment of the above-mentionecl 
firm was reinspected by Surgeon Rosenau in accordance with orders 
dated February 2, 1909. This inspection included a complete survey 
of the methods, materials, and employees concerned in the propagti- 



32 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

tion, packing, and preparing of vaccine virus for the market. It 
was the opinion of the inspector that the establishment had taken 
and would take necessary steps to improve their methods for the 
propagation of safe vaccine virus. 

In the meantime the laboratory investigations of stock vaccine 
virus secured by Surgeon Rosenau during his first inspection had 
been continued, and on March 5, 1909, he reported that specimens of 
this virus had been shown by Doctor Mohler and himself, together 
and independently, to contain the virus of foot-and-mouth disease. 

During the inspections referred to above, information was received 
that the only vaccine virus used by Parke, Davis & Co., outside of 
their regular strains, was some manufactured by the H. K. Mulford 
Compan}'-, and purchased on the open market for purposes of compara- 
tive tests. Samples of the vaccine virus of this latter firm were there- 
fore secured and examined in the Hygienic Laboratory, and in his re- 
port of March 5, referred to above, the director stated that this vaccine 
was found to contain the virus of foot-and-mouth disease. 

It was recognized that immediate action was necessary, first, to 
prevent the transmission of foot-and-mouth disease to humans 
through the agency of vaccine virus, and second, to prevent the fur- 
ther propagation of contaminated vaccine virus in establishments 
licensed in accordance with the law of July 1, 1902, regulating the 
manufacture and sale of viruses, serums, and toxins. 

The license of the H. K. Mulford Company for the manufacture 
and sale in interstate traffic of vaccine virus was therefore suspended 
March 9, 1909, and the company was advised that any contaminated 
vaccine virus manufactured by them and offered for sale in the open 
market should not be sold for purposes of vaccination, but be with- 
drawn from the market. 

The license of Parke, Davis & Co. had been withheld since Novem- 
ber 22, 1908, and they had been warned against the sale of any vaccine 
virus made by them since October 1, 1908. In addition, all virus 
manufactured by them from May 1, 1908, to February 1, 1909, was 
packed under government seal by the inspector, awaiting absolute 
proof as to its purity. 

In accordance with order dated March- 10, 1909, all licensed estab- 
lishments in the United States were reinspected for the purpose of 
giving information that certain vaccine virus was contaminated with 
foot-and-mouth disease; to determine whether said establishments 
were propagating contaminated vaccine virus; to obtain samples of 
vaccine virus of each strain used for examination; and to give in- 
structions in methods of detecting contamination and its prevention. 

Immediately upon suspension of their license, the H. K. Mulford 
Company discontinued the propagation and sale of vaccine virus. 
They took prompt action, recalling all vaccine virus from jobbers, 
retailers, and health departments by telegram, and at once took steps 
to destroy all virus and infection in their establishment in order to 
make a clean start. 

In his report of inspection made in accordance with instructions 
of March 10, Surgeon Eosenau reported that the propagating barns, 
the laboratories, the ice box, etc., had all been cleansed and disin- 
fected, and that the H. K. Mulford Company proposed building at 
once a quarantine barn in which to keep calves under observation 
during the period of detention preliminary to vaccination. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 33 

In order to determine the thoroughness of withdrawal of presum- 
ably contaminated vaccine virus from the market, letters were ad- 
dressed to officers of the service stationed at twelve cities throughout 
the country instructing them to purchase on the open market original 
packages of vaccine virus. 

All reports received from these officers stated that no vaccine virus 
manufactured b}^ the H. K. Mulford Company was being sold, that 
it had been recalled by that company, and that original j)ackages 
could not be purchased. 

In order to determine the extent of the contamination c^f vaccine 
virus, extensive investigations of samples were undertaken in the 
Hygienic Laboratory. Necessary calves were purchased, and in 
order to take all precautions against the spread of infection, provision 
was made for the erection of pens in which to house them. On ac- 
count of the importance of these investigations, it was deemed advis- 
able to submit them to the advisory board of the Hygienic Labora- 
tory for consultation regarding the methods of conducting them. A 
meeting of this board had previously been called for March 26, 1909. 
During the conference it was stated by the Surgeon-General that as 
every precaution had been taken to prevent the transmission of foot- 
and-mouth disease through contaminated vaccine virus, it was now 
necessary to secure seed virus of absolute purity for purposes of 
propagation; that to this end investigations were being made, that 
they would be continued in the future, and that it was on this point 
particularly that the advice of the board was desired. 

It was the consensus of opinion that routine investigations of vac- 
cine virus should be continued, and that said testing should espe- 
cially have to do with supervision of the use of new strains of virus 
for seed purposes. 

The investigations of stock vaccines from Parke, Davis & Co. and 
The H. K. Mulford Company having been completed, and these 
establishments having been again inspected, it was determined that 
they had complied wi'th the law and regulations regulating the manu- 
facture and sale of vaccine virus, and that all of the presumably con- 
laminated vaccine virus had been destroyed under the supervision 
of the inspectors. The license of the former firm was, therefore, 
renewed April 15, 1909, and the suspension of the license of the latter 
firm was removed on the same date. 

Examinations were also made in the Hygienic Laboratory of the 
vaccine virus propagated by all other licensed establishments. The 
report of these examinations, April 12, 1909, stated that the virus 
tested upon calves in the laboratory for the infection of foot-and- 
mouth disease showed the samples to be free from this infection. 

With the view to effectually controlling the importation and sale 
in interstate traffic of vaccine virus, it was deemed necessary to revise 
;:nd amend the regulations authorized in section 4 of the act approved 
July 1, 1902, entitled "An act to regulate the sale of viruses, serums, 
toxins, and analogous products in the District of Columbia, to regu- 
late interstate ti-affic in said articles, and for other purpose;s." Kevised 
rognlations were therefore prepared and issued May 11, 1909. 

in a letter of June 10, 1909, Dr. Eugene TL Porter, (;ommissioner 
of health of New York, i-eported the occurrence of two cases of 
.tetanus following vaccination in the village of Feekskill, N. Y. He 

18546—40 3 



34 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

stated that upward of 21 children had been vaccinated with one lot 
of lymph during the month of May and early in June, and that on 
account of the untoward results reported the remainder of the vaccine 
used by the physician and the remaining packages of the same lot of 
vaccine in the hands of the local druggist were turned over to the 
department of health June 14 and tests were being made in the state 
antitoxin laboratory of this vaccine for the presence of tetanus 
organisms. Inasmuch, however, as the Treasury Department is 
charged with the supervision of vaccine virus and like products, 
Doctor I^orter reported the existence of the cases above mentioned 
and ojffered to forward specimens of the vaccine in question for 
investigation. 

On account of the importance of determining the origin of infection 
of the above-mentioned cases, and particularly as to whether the 
vaccine virus used had contained tetanus organisms. Passed Asst. 
Surg. John F. Anderson on June 21, 1909, was directed to proceed 
to Albany, N. Y., and other places to investigate the subject. As a 
result of these investigations Doctor Anderson reported that both 
cases of tetanus were in children and in the practice of a physician in 
Peekskill. Both children had been vaccinated from giycerinated 
lymph, the laborator}^ number of which was 19x, and the date of 
expiration June 20, 1909. Between 21 and 25 children had been 
vaccinated with this same virus in May and June, as above stated. 

Doctor Anderson secured all of the remaining shields, intended for 
the protection of vaccination wounds, in the hands of the local drug- 
gist. He also secured some of the vaccine virus of the same labora- 
tory number, and this, together with some of the same furnished by 
the state board of health, was subjected to bacteriological examination 
to determine the presence or absence of tetanus spores. During his 
investigations he inspected the laboratory records of the establishment 
which had manufactured the vaccine virus and found that independ- 
ent tests for the tetanus bacillus had been made by two qualified 
experts and were entirely negative for tetanus spores. All of the 
vaccine virus obtained by Doctor Anderson was subsequently exam- 
ined in the Hygienic Laboratory, also with negative results for 
tetanus spores. In addition a number of the shields were examined 
with negative results. Doctor Anderson, in his final report, made 
August 20, stated that Dr. H. D. Pease, director of the New York 
state laboratories, informed him that all of his results were also nega- 
tive. The investigations made showed conclusively that the cases of 
tetanus reported were not due to the presence of tetanus spores in the 
vaccine virus used. 

Revised Regulations for the Sale and Importation or Viruses, 
Serums, Toxins, and Analogous Products. 

Treasury Department, 

Washington, D. C, May 11, 1909. 
The following regulations have been prepared by the undersigned 
board of officers in accordance with the provisions of section 4 of an 
act of Congress approved July 1, 1902, entitled "An act to regulate 
the sale of viruses, serums, toxins, and analogous products in the 
District of Columbia, to regulate interstate traffic in said articles, 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 35 

and for other purposes;" they are hereby promulgated and will 
supersede the regulations issued February 21, 1903, and amendments 
thereto. 

G. H. TORNEY, 

Surgeon-General^ U. S. Army. 

P. M. RlXEY, 

Surgeon-General^ U. S. Navy. 
Walter Wyman, 
Surgeon-General^ Public Health and Marine-Hospital Service. 
Approved : 

Franklin MacVeagh, 

Secretary of the Treasury. 

Licenses. 

issue of licenses. 

1. Licenses shall be issued, suspended, and revoked by the Secre- 
tary of the Treasury, upon the recommendation of the Surgeon- 
General of the Public Health and Marine-Hospital Service. 

2. Licenses shall be issued only after inspection of establishments 
and examination of the products for which license is desired. 

3. When an establishment shall have been inspected and the prod- 
ucts propagated therein examined in accordance with these regula- 
tions, the report of inspection and laboratory examination shall be 
passed upon by the sanitary board of the Public Health and Marine- 
Hospital Service. The said board shall present its findings to the 
Surgeon-General of the Public Health and Marine-Hospital Service, 
who shall review and forward same, together with his recommenda- 
tions, to the Secretary of the Treasury for action. 

4. The following form of license is prescribed : 

LICENSE. 

, 190 

This is to certify that , of , State of , 

have complied with the terms of "An act to regulate the sale of viruses, serums, 
toxius, aud analogous products iu the District of Columbia, to regulate inter- 
state traffic in said articles, and for other purposes;" that the establishment of 

the said has been duly inspected in accordance with regulations 

made under the terms of the said act, and that the said are 

hereby authorized to engage in the manufacture, barter, and sale of 

for one year from this date, or until reinspection. 

This license is issued in accordance with the regulations prepared under the 
above-mentioned act, and is subject to suspension or revocation when due cause 
therefor is shown. 

[L. s.l 

Secretary of the Treasury. 

5. Licenses shall be good for one year from the date of issue (or 
until reinspection), and will not be reissued without such reinspec- 
tion and laboratory examination; the report of inspection and labo- 
ratory examination to be passed upon by the sanitary board and the 
Surgeon-General of the Public Health and Marine-Hospital Service, 
in accordance with the provisions of paragraph 3. Inspections shall 
be made at least once a year. 



36 PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE. 

INSPECTION OF ESTABLISHMENTS. 

6. The inspection shall be made by an inspector or a board of 
inspectors detailed by the Secretary of the Treasury upon the recom- 
mendation of the Surgeon-General of the Public Health and Marine- 
Hospital Service. 

7. The inspectors shall be commissioned medical officers of the 
Public Health and Marine-Hospital Service or chiefs of Division of 
the Hygienic Laboratory of the same service. 

8. The visit of the inspectors shall be unannounced. 

9. It shall be the duty of the inspectors to call first upon the head 
of the establishment or member of the firm, stating the object of their 
visit. 

10. The inspectors shall examine all portions of the premises, 
appliances, stables, barns, warehouses, records, and the methods 
employed in actual operation. 

11. The inspectors are authorized, when they consider it necessary, 
to interrogate the proprietor, members of the firm, and employees 
of the establishment under oath. 

12. The inspectors shall investigate fully the methods of prepara- 
tion, storing, dispensing, and other details in the manufacture and 
sale of serums, viruses, toxins, and analogous products. 

13. The inspectors shall carefully examine into faulty construc- 
tion or administration of establishments which would tend to impair 
the potency or purity of their products, and shall, if of sufficient 
importance, make special report regarding the same. 

14. It shall be the duty of the inspectors to purchase in open mar- 
ket or, if they deem it advisable, themselves to obtain in the estab- 
lishment samples of the products then manufactured, which samples 
shall be examined by the inspectors for purity and potency or 
forwarded to the Director of the Hygienic Laboratory for such 
examination. 

15. It shall be the duty of the Director of the Hygienic Laboratory 
of the Public Health and Marine-Hospital Service to test samples 
sent him by inspectors for purity and potency, and the result of this 
examination shall be given to the inspectors, who shall give this 
report due weight in making their recommendations. 

EXAMINATIONS OF VIRUSES, SERUMS, TOXINS, ETC. 

16. The terms " virus, serum, toxin, and analogous products " shall 
include the following products and such others as may be designated 
by the Secretary of the Treasury from time to time: Antidiph- 
theric serum or diphtheria antitoxin, antitetanic serum or tetanus 
antitoxin, antistreptococcic serum, antistaphylococcic serum, anti- 
gonococcic serum, antipneumococcic serum or antipneumonic serum, 
antidysenteric serum, antituberculous serum, antipest serum, anti- 
cholera serum, streptolytic and pneumolytic serum, antimeningococ- 
cic serum, antiplague serum, erysipelas and prodigiosus toxins, tuber- 
culins, emulsion tubercle bacilli, suspension of lactic acid bacilli, 
antityphoid serum, bacterial vaccines, normal horse serum, and vac- 
cine virus. 

17. Viruses, serums, toxins, and analogous products j)ropagated in 
licensed establishments and offered for sale in the District of Colum- 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE, 37 

bia, or in interstate traffic, shall be obtained from time to time in the 
open market and examined under the direction of the Surgeon- 
General of the Public Health and Marine-Hospital Service as to 
purity and potency and as to whether said products are properly 
labeled, as requirecl by section 1 of the law. 

18. Viruses, serums, toxins, and analogous products propagated in 
licensed establishments and imported from abroad will be detained 
by customs officers at ports of entrj;', pending examination by officers 
of the Public Health and Marii;ie-Hospital Service as to purity and 
XDotency and as to whether said products are properly labeled as 
required by section 1 of the law. 

19. Samples of the same laboratory numbers shall accompany 
each foreign importation of viruses, serums, toxins, and analogous 
products, and said samples will be forwarded by collectors of customs 
to the Surgeon- General of the Public Health and Marine-Hospital 
Service at Washington for examination. 

20. Viruses, serums, toxins, and analogous products imported 
from foreign countries will be refused entry by collectors of customs 
unless propagated in an establishment holding an unsuspended and 
unrevoked license, or intended for examination precedent to obtain- 
ing a license. 

21. The immunity unit for measuring the strength of diphtheria 
antitoxin shall be that established and distributed by the Public 
Health and Marine-Hospital Service. 

22. The immunity unit for measuring the strength of tetanus anti- 
toxin shall be ten times the least quantity of antitetanic serum neces- 
sary to. save the life of a 350-gram guinea pig for ninety-six hours 
against the official test dose of a standard toxin furnished by the 
Hygienic Laboratory of the Public Health and Marine-Hospital 
Service. 

23. Manufacturers placing on the market serums concentrated by 
Gibson's method or by any other method, or mixed serums made by 
mixing concentrated serum with ordinary antitoxic serum, shall be 
required to so label them. 

24. Preliminary to taking vaccine material from vaccinated ani- 
mals, said animals should be killed or otherwise rendered insensible 
to pain. 

25. As soon as practicable after taking the vaccine virus, a necropsy 
shall be made upon each animal, and permanent records kept of each 
necropsy, in which particular reference shall be made of pathologic 
changes. 

20. All vaccine material from any animal having a communicable 
disease, other than vaccinia, or suspected of having a communicable 
disease, shall be destroyed. 

27. The practice of renting animals for the purpose of propagating 
vaccine virus and returning the animals to the market shall be 
discontinued. 

28. Animals used for propagating vaccine virus must be under 
daily veterinary inspection for not less than seven days imntediately 
before they are vaccinated. Only healthy animals iree from com- 
municable disease shall be used for this purpose. 

20. The propagation and sale in interstate traffic of old-style dry 
" lymph " vaccine points shall be discontinued after January 1, 1910. 



38 PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 

30. Each and every lot of vaccine virus shall be examined to 
determine its freedom from pathogenic micro-organisms, and a 
special examination must be made of each and every lot to determine 
the absence of tetanus; detailed and permanent records of these 
examinations shall be kept by the establishment propagating said 
virus. 

31. Containers, grinding and mixing machines, filling apparatus, 
instruments, etc., that come in contact with vaccine material during 
the process of manufacture and preparation for the market, shall be 
sterilized before use by steam under pressure at a temperature of at 
least 120° C. for not less than thirty minutes, or subjected to dry 
heat at a temperature of at least 160° C. for not less than one hour. 
Materials that will not stand this degree of dry heat shall be steri- 
lized by a process known to be capable of destroying tetanus spores. 

32. Refuse, wastes, excelsior, packing materials such as hay, straw, 
cotton, etc., crude materials and goods of miscellaneous origin and 
unknown history shall not be stored or permitted in or about vacci- 
nation stables or where the animals used for propagating vaccine 
virus are kept. 

SUSPENSION AND KEVOCATION. 

33. Wlien faulty methods of preparation, faulty construction, or 
administration of establishments are observed during inspection, the 
inspector shall bring the same to the attention of the manufacturer, 
and shall forward a report of the conditions found, together with his 
recommendations, to the Surgeon-General. 

34. When impurities or lack of potency of products, or improper 
labeling of same, shall be demonstrated by laboratory examination, 
these facts shall be reported to the Surgeon-General. 

35. Should the faulty conditions discovered during inspection or 
laboratory examination be found upon review by the sanitary board 
and the Surgeon-General to be of sufficient importance, the Surgeon- 
General shall recommend to the Secretary of the Treasury that the 
license of the offending establishment be suspended. If the said 
faulty conditions are not corrected within sixty days after suspen- 
sion, he shall recommend that the said license be revoked. 

36. The facts of suspension and revocation of licenses, with causes 
therefor, may be published in a circular to be issued and signed by the 
Secretary of the Treasury. 

Customs Regulations Regarding Importation or Viruses, Serums, 
Toxins, and Analogous Products. 

It will be observed that paragraphs 18, 19, and 20 of the foregoing 
regulations have for their object the control of the importation of 
viruses, serums, toxins, and analogous products, and these regula- 
tions provide not only for the supervision of products from licensed 
establishments, but the prevention of the importation of products 
from ufllicensed establishments. These provisions were made neces- 
sary in order not only to exclude contaminated and low potency 
viruses, serums, and toxins propagated in licensed establishments, 
but in order to effectually control the importation of seed vaccines 
and other products intended for purposes of propagation in establish- 
ments in this country. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 39 

In order to insure the enforcement of the above provisions, there 
was issued by the Secretary of the Treasury, June 10, 1909, Treasury 
Decision No. 29828, to collectors and other officers of the customs, 
containing the following regulations for their information and 
guidance : 

KEGULATIONS. 

1. Viruses, serums, toxins, and analogous products propagated in 
licensed establishments and imported from abroad shall be detained 
by customs officers at ports of entry pending examination by officers 
of the Public Health and Marine-Hospital Service as to purity and 
potency, and as to whether said products are properly labeled, as 
required by section 1 of the act above referred to. 

2. Samples of the same laboratory numbers shall accompany each 
foreign importation of viruses, serums, toxins, and analogous prod- 
ucts, and said samples shall be forwarded by collectors of customs to 
the Surgeon-General of the Public Health and Marine-Hospital 
Service at Washington for examination. 

3. Viruses, serums, toxins, and analogous products imported from 
foreign countries shall be refused entry by collectors of customs unless 
propagated in an establishment holding an unsuspended and unre- 
voked license, or intended for examination precedent to obtaining a 
license. Collectors and other officers will be advised from time to 
time as to the establishments duly licensed in accordance with said act. 

4. The term " viruses, serums, toxins, and analogous products " 
shall include the following and such other preparations as may be 
designated hj the Secretary of the Treasury from time to time : 

Antidiplitlieric serum, or diphtheria au- Streptolytic and pneumolytic serum. 

titoxin. Antimeningococcic serum. 

Antitetanic serum, or tetanus antitoxin. Erysipelas and prodigiosus toxins. 

Antistreptococcic serum. Tuberculins. 

Antistaphylococcic serum. Emulsion of tubercle bacilli. 

Antigonococeic serum. Suspension of lactic-acid bacilli. 

Antipneumococcic serum, or antipneu- Antityphoid serum. 

monic serum. Bacterial vaccines, 

Antidysenteric serum. Normal horse serum. 

Antituberculous serum. Vaccine virus. 
Antipest serum, or antiplagne sernm. 

Investigations of Typhoid Fever in the District of Columbia. 

In the annual report for 1908, page 50, reference is made to investi- 
gations of typhoid fever which had been carried on by a board of 
officers appointed for that purpose in July, 1906. The personnel of 
the board was increased by the appointment of Passed Asst. Surg. 
J. F. Anderson, Assistant Director of the Hygienic Laboratory. These 
investigations were continued during the year 1908 and the results 
are contained in Hygienic Laboratory Bulletin No. 52. 

The epidemiological studies during the entire investigation were 
made by the same officer in order that the results recorded from year 
to year Avould be comparable. An important featin-e of the work 
during the year 1908 has been an intensive study of 32 city blocks, 
having a population of 5,800, for the purpose of determining the 
extent of typhoid fever and whether the cases were all reported as 
such. A special search was also made for bacillus carriers among this 
portion of the population and the results obtained are set forth in 
the publication mentioned above. 



40 PUBLIC HEALTH AND MARINE-HOSPITAL SEPtVICE. 

The investigations are being continued this year along similar lines 
as during the previous three seasons, except that this year the studies 
will include all cases of typhoid fever occurring between January 1 
and December 31, 1909. Special attention is also being given to the 
diagnosis of cases in order to determine what percentage of those 
reported as typhoid fever is correct. This corroboration is made by 
means of clinical studies as well as the making of Widal tests in the 
Hj'gienic Laboratory and the demonstration of the typhoid bacillus 
in the blood, urine, and feces of typhoid cases. A great many speci- 
mens of blood were examined in the laboratory for the presence of 
the typhoid bacillus with positive results in a certain percentage of 
cases. The laboratory examinations last year also included over 
1,000 samples of feces from 993 supposed healthy persons in the city 
of Washington in an endeavor to determine the percentage of persons 
harboring the typhoid bacillus in their intestinal tracts. The typhoid 
organism was found in three instances, two of which were probably 
bacillus carriers. This proportion would mean approximately GOO 
such typhoid foci in the District of Columbia. These studies will be 
continued during the coming jfiscal year, but with the view to examin- 
ing in the Hygienic Laboratory the discharges from persons who have 
suffered from typhoid fever within the five years previous. It is 
hoped to examine about 1,000 such specimens in order to determine 
the percentage of chronic bacillus carriers and the dangers from 
this source in the District of Columbia. Finally, a special study is 
being made of the raw and filtered Potomac water in its relation to 
the typhoid bacillus. 

It is pertinent here to review the results obtained during the three 
years' study of typhoid fever in the District of Columbia, and their 
bearing on the control of the disease here and elsewhere. The first 
report on the subject is contained in Hygienic Laboratory Bulletin 
No. 35. 

FIRST year's studies. 

The studies during the first year (190G) included a sanitary survey 
of the Potomac watershed; an exhaustive epidemiological stud}^ of 
866 cases of typhoid fever occurring in the District of Columbia 
between June 1 and October 31, 1906; daily chemical and bacteriolog- 
ical examinations of the water supply ; a special study of the pumps, 
wells, and springs in the District and also of bottled waters sold in 
Washington ; an inspection of the dairies and laboratory examinations 
of the milk supply; an inspection of the ice factories; chemical and 
bacteriological examinations of a number of samples of ice, as well as 
the water from which the ice was made; and the making of blood 
cultures, diazo and Widal reactions for practicing physicians in the 
District. The question of shellfish, salads, fruits, and other raw food 
products in relation to the disease was also studied. Further, special 
attention was directed to the communicability of the disease from 
person to person by direct and indirect contact. The relation of 
privies and sewers to wells was also investigated, and the question of 
flies and other insects as carriers of infection received attention. The 
bathing beach and public markets were inspected from time to time, 
and in the division of zoology many specimens of feces were examined 
in order to determine the possible relation of animal parasites to 
typhoid fever. As a result of that year's investigations it was shown 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 41 

that 11.3 per cent of 747 cases were due to infected milk, 7.3 per cent 
to contact, and in addition it was shown that 15 per cent of the 866 
cases were imported. 

Wliile no cases were traced to water from wells, the board realized 
that the shallow wells in the District were a menace to the public 
health, and recommendation was accordingly made to the Commis- 
sioners to close at least those shallow wells that on chemical and 
bacteriological examination showed evidence of pollution, and this 
was done. 

Typhoid fever was regarded by the board as a contagious disease, 
and the importance of isolation and disinfection was emphasized. 
The insanitary conditions surrounding the manufacture and handling 
of ice were pointed out, and it was recommended that this product 
should be under the close sanitary control of the local health author- 
ity. Other recommendations were made looking to the improve- 
ment of the milk supply, the early diagnosis of the disease, and its 
general prophylaxis. 

SECOND year's STUDIES. 

The studies during the second year (1907) included epidemiolog- 
ical investigations of the disease during the typhoid-fever season; 
daily bacteriological examinations of the raw and filtered Potomac 
Eiver water ; and bacteriological and chemical examinations of many 
hundreds of samples of the Washington milk supply; labo-gatory 
tests to assist in the diagnosis of the disease; and examinations of 
speciments in the search for bacillus carriers. 

As a result of its second year's studies, the board concluded that 
much of the typhoid fever in the District of Columbia is imported ; 
that many cases in the District are contracted through contact with 
persons or with articles handled or soiled by persons in the febrile 
stage of the disease ; that infected milk is one of the important known 
factors in the spread of the disease in the District of Columbia ; that 
the filtered Potomac Eiver water during the typhoid season of 1907 
(May to September) was, according to present bacteriological stand- 
ards, of good sanitary quality, and so far as could be ascertained, was 
not responsible for the spread of the infection. 

The board accordingly recommended that all cases of typhoid fever 
and all cases of suspected typhoid fever should be treated as con- 
tagious and dangerous to the community with the view to their isola- 
tion, the placarding of houses, and the prompt disinfection of the dis- 
charges and the patient's bedding; that laboratory facilities should 
be provided free of cost to aid physicians in the early diagnosis of 
typhoid fever, and also to determine when persons who had had the 
disease were no longer a menace to the public health by discharging 
typhoid bacilli; that all milk not certified or inspected should be 
pasteurized under official surveillance, especially during the typhoid- 
fever season; that the enactment of a law prohibiting the handling 
or sale of milk or milk products in any dwelling or any structure so 
situated as to render the contamination of these products especially 
liable; that there should be enacted a law prohibiting the care of a 
case of typhoid fever in any house where food or beverages liable 
to convey the infection are sold or prepared for sale; and that in 
order to furnish a water supply of a satisfactory grade of purity 



42 PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE. 

throughout the year additional storage reservoirs should be con- 
structed, or a coagulant should be used during periods of high 
turbidity. 

THIRD year's STUDIES. 

The third year's studies (1908) included a continuation of the 
epidemiological investigations of the disease during the typhoid-fever 
season ; bacteriological examinations of the raw and filtered Potomac 
River water; an intensive study in a selected district comprising 32 
city blocks and containing 5,300 persons; a special search for bacillus 
carriers among 1,000 healthy persons and a study of the fly abundance 
m relation to the prevalence of typhoid fever in the District of 
Columbia. 

SUMMARY or THREE YEARS' STUDIES. 

As a result of the three years' studies the board has shown that 
typhoid fever has a distinct seasonal prevalence, but that the rate 
during 1908 was lower than for any other year for which there is 
record. They found that practically every case of clinical typhoid 
fever found in Washington was rejDorted to the health officer, which 
is in marked contrast to Koch's findings and investigations in Trier. 
On account of the fact that some cases not typhoid fever are reported 
as such, the board expressed the belief that there should be official 
confirmation of the diagnosis of all cases of typhoid fever and of all 
cases suspected of being typhoid fever, since this would greatly aid 
in the suppression of the disease. 

It was found that the disease was especially prevalent among chil- 
dren, suggesting that milk and contact are responsible for more cases 
than can be definitely traced to these factors. It was shown that 
Washington is a true endemic center, as the majority of cases occurred 
among persons who had not been absent from the city within thirty 
daj^s previous to onset of illness, and some of them had lived in Wash- 
ington all their lives. 

It was found that the majority of the cases occur among persons 
who live in houses of good or fairly good sanitary condition, and that 
there is little difference in the prevalence of the disease in the sewered 
and in the nonsewered districts. No definite relation could be made 
out between the seasonal curve and fly abundance, and no evidence 
was found to support the supposition that day servants frequently 
convey infection to the households of their emplo3^ers. 

The three years' studies jDroved that " contact " is one of the major 
factors in the spread of the disease in Washington at the present 
time. The examinations of excreta from 1,000 healthy persons indi- 
cated that the typhoid bacillus is more commonl}^ distributed among 
persons than actually clinicallj^ recognized cases of the disease would 
suggest. 

It was shown that about 10 per cent of the cases studied during 
the three years were definitely attributed to infected milk, and this 
fact led the board to the conclusion that if all the market milk of 
Washington were pasteurized under official supervision the amount 
of typhoid fever would be materially reduced. • 

It was found that according to the accepted bacteriological stand- 
ards, the filtered Potomac River water during the seasons of 1907 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 43 

and 1908 was of good sanitary quality, and the conclusion was drawn 
that it does not seem probable that such water could have been directly 
responsible for much, if any, of the infection. Attention was drawn 
to the fact, however, that the typhoid fever rate is still comparatively 
liigh for a city with no water-borne infection. In discussing the 
prophylaxis of typhoid fever in the District of Columbia, the board 
concluded that the disinfection of excreta of patients is frequently 
inefficient or neglected, and that there is need of legal control of 
tyiohoid-fever patients and typhoid-bacillus carriers. 

Finally, the board expressed the positive conviction that a vigorous 
campaign against typhoid fever as a contagious disease and the 
adoption of measures that would prevent the spread of the infection 
in milk would eliminate the greater part of typhoid-fever infection 
from the District of Columbia. 

The fourth report of the board will terminate its labors. 

Investigation of Typhoid Fever at Forest Glen, Md. 

During investigations into the origin and prevalence of typhoid 
fever in the District of Columbia the attention of the board was 
brought to an outbreak of the disease at the National Park Seminary, 
Forest Glen, Md. 

In the latter part of March, 1909, several cases of typhoid fever 
reported in the District were found to be cases which had developed 
among the students at this seminary. As the students made frequent 
trips to Washington, there was some question as to whether . the 
infection was contracted at the seminary or in Washington. 

Upon request of the president of the seminary, approved by the 
state board of health, a special investigation w^as undertaken to deter- 
mine the source of infection, with a view to measures to eradicate it. 

Passed Asst. Surg. L. L. Lumsden visited the seminary on April 7, 
The number of persons then at the seminary was about 100, most of 
the 270 students having left about March 30 for the Easter holidays. 
To that date the authorities of the seminary had learned of the devel- 
opment among the students of 7 cases of typhoid fever. Some of 
these cases had developed among the students at the seminary and 
others among those who had gone to their homes in various j^arts of 
the country. Up to April 27 information had been received of about 
20 cases among the persons who at the presumed time of infection 
were living at the seminary. The dates of definite onset of illness of 
the cases extended from March 19 to April 11. 

The results of the investigation left no room for doubt that the 
infection had been contracted at the seminary and not in the District 
of Columbia. The bulk of the evidence pointed to one of two factors 
as being responsible for the outbreak: First, the local water supply; 
and second, bacillus carriers. 

Doctor Lumsden reported that specimens of feces and urine from 
the IG persons concerned in handling the food to which all the persons 
infected had been exposed were obtained and examined in the hygienic 
laboratory, but all were negative for the typhoid bacillus. Further, 
tlie tixplosive character of the outbreak waSj under the excellent con- 
ditions of cleanliness maintained in the kitchen and dining room, 
against the view that the outbreak had been caused by a bacillus car- 
rier. An inspection was made of the dairy farm supplying the sem- 



44 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

inary with milk, but there was no evidence obtainable that the milk 
had transmitted the infection. 

The Avater supply was obtained from two sources. Three bored 
wells, each about 90 feet in depth, supplied most of the water used for 
drinking. Bacteriologic examination of water from these wells 
showed it to be of good sanitary quality. The water used for bathing, 
for washing dishes, and by the girls frequently for brushing their 
teeth and sometimes for drinking was obtained from a creek which 
runs through the seminary grounds and has its source in a spring- 
about half a mile above the intake of the seminary's supply. This 
stream was found by Doctor Lumsden to be highly polluted with 
human excreta. About 100 yards below the spring the sewage from 
a hospital, with about 30 to 40 persons, emptied directly into the 
stream. Besides this, some of the sewage from about 20 residences 
scattered along the Avatershed between the spring and the seminarj^'s 
intake was no doubt washed or drained into the stream. 

The physician in charge of the hospital, who was also physician 
to the seminary, stated that there had been no cases suspected to be 
typhoid fever in the hospital. In one of the houses on the watershed, 
however, there had been a man ill of typhoid fever in February. His 
excreta, after treatment with copper sulphate — probably not suffi- 
cient to thoroughly disinfect them — were thrown out into the yard. 
This yard is on the crest of a hill separating the watershed of the 
stream in question from that of another stream. It could be readily 
seen that some of the excreta from this patient might have been 
washed by the heavy rains and melting snows, which occurred in Feb- 
ruary and the early part of March, down the hill a distance of about 
500 yards to the stream supplying the seminary with water. Bac- 
teriologic examinations of the water from the stream showed it to be 
highly polluted, the colon bacillus being invariably demonstrated in 
quantities of 0.1 c. c. Effort was made to isolate the typhoid bacillus 
from this water, but without success — which fact, under the circum- 
stances, is evidence neither for nor against the organisms having 
been in the water at the time the infection of the persons occurred. 

On March 30, on hearing of the outbreak. Doctor Lumsden had 
advised the seminary authorities to discontinue the use of the water 
from the suspected stream unless it was boiled, and to pasteurize all 
of the milk used in the seminary. After his inspection he made the 
following recommendations : 

1. Immediate discontinuance of use of water from the suspected 
spring unless it could be previously boiled. Running boiling water 
through the distributing pipes to destroy any infection which might 
remain in the pipes. Abandoning the stream as a source of water 
supply and piping the water directly from the spring to the seminary. 

2. Pasteurization of all milk usecl in the seminar3^ 

3. Immediate isolation and thorough disinfection of the excreta 
of all persons becoming ill with symptoms suggesting the possibility 
of typhoid fever. 

4. Examination of samples of urine of persons who had had 
typhoid fever to determine their freedom from infection before per- 
mitting the return of such persons to the seminary. 

5. General recommendations as to the disposal of sewage and 
general sanitary conditions at the seminary. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 45 

6. The extension of the Easter holidays until April 27, so that the 
improvements could be made before the majority of the students 
returned. 

Bacteriologic examinations for bacillus carriers among the cooks 
and helpers of the institution were made in the hygienic laboratory. 
On April 27, when Doctor Lumsden again visited the seminar}^, he 
found that the above recommendations had in a large part been 
carried out. As a result of these steps no further cases occurred, 
and the source of the infection was definitely attributed to the pol- 
luted water supply described above. 

Information having been requested during the progress of this 
investigation, it was stated that conditions had been greatly improved. 
A copy of the report of the investigation was sent to the state board 
of health of Maryland for information and consideration. 

Pollution or Interstate Waters. 

In the annual report for 1908, page 49, reference is made to the 
organization and plan of operations of the Lake Michigan Water 
Commission. The service was represented on this commission by 
Surg. G. B. Young, who served on the committee which had under 
consideration the control of shipping. The commission prepared 
and issued its first report, which contains much valuable information 
bearing on the character of Lake Michigan water. It is becoming 
more and more evident as a result of these and other studies that the 
time is rapidly approaching when legal measures will have to be 
adopted to prevent the further ]Dollution of the water of the Great 
Lakes, which must in future be the source of the potable supply of a 
large population in that section of the country. 

Not alone has the sewage pollution of Lake Michigan attracted 
attention, but Lake Erie is also becoming more and more polluted on 
account of the discharge of sewage of cities and towns located along 
its borders. This has been shown to be especially the case in the east 
end of the lake, and on this account there was organized in November, 
1908, the Niagara Frontier Pure Water Conference, its chairman 
being Mr. W. M. Mills and its secretary Mr. W. H. Hoover. The 
conference represents towns such as Buffalo, Dunkirk, Lockport, 
Tonawancla, and Niagara Falls, drawing their water supplies from 
the Niagara River. The representatives in the conference were ap- 
pointed by the mayors of the various cities, and these representatives 
also represent the boards of trade of those cities. 

The object of this conference is to collect data and excite interest 
regarding the necessity of protecting their water supplies, which 
means the prevention of the further pollution of Lake Erie. The 
conference, however, recognized that the prevention of the pollution 
of these waters is incumbent on the National Government, as the 
problem is not only an interstate but an international one. 

With the view to securing some definite action, a number of the 
members of the conference, in company with the Hon. Peter Porter, 
Member of Congress from the Niagara District, called at the bureau 
January 15, 1909. These gentlemen had previously visited the Presi- 
dent, who referred them to tlu; Surgeon-General. They pointcnl out 
that the Great Lakes must in future be the source of water supply of 



46 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

more than one-fourth of the population of the United States; that 
these lakes are already polluted in certain places; that further pol- 
lution should be stopped, both from the standpoint of the public 
health and from the standpoint of abolishing nuisances. They stated 
that the geographical position of the cities at the outlet of the Great 
Lakes renders them especially liable to the dangers from sewage- 
polluted waters from other States. They reported that a great deal 
of the ice formed during the winter in close proximity to cities such 
as Dunkirk, Erie, and Cleveland, enters the Niagara River, and 
ultimately becomes lodged, thus further polluting the water supplies 
of the cities in the vicinity of the Niagara River. During this meet- 
ing it was explained by the Surgeon-General that this subject had 
received consideration, and that authority had been asked of Congress 
to make investigations of the pollution of interstate streams through 
a bill (No. 18792) which was then awaiting legislative action. The 
passage of this bill would have authorized the employment of a sani- 
tary engineer and other necessary employees, whereby investigations 
of this important problem could have been undertaken. The bill 
Avas passed by the Senate and favorably reported to the House by the 
Committee on Interstate and Foreign Commerce, but failed to become 
a law. It is necessary that some definite action be taken looking not 
alone to the prevention of the pollution of the Great Lakes but other 
interstate streams in the interest of the country and of its interstate 
commerce. While both the legal and sanitary problems involved may 
be difficult, the pollution of interstate waters is a matter for federal 
intervention, and it would appear that it would be easier and cheaper 
to prevent such pollution than for the several States to engage in 
long and costly litigation after it has occurred. 

For a further consideration of this matter, attention is invited to 
the section on water pollution in the brochure on " Public health 
problems of the nation," in the closing pages of this report. 

Investigations of Pellagra. 

In 1908 there was prepared by Passed Asst. Surg. C. H, Lavinder, 
at the request of the bureau, a precis on pellagra. It was expected 
when this article was published that it would be the beginning of a 
very thorough investigation of the disease. Since the distribution of 
this paper much interest has been manifested in pellagi^a in many 
localities, and a relatively large number of cases have been reported 
from time to time. 

In view of the increasing importance of pellagra from a public 
health standpoint. Doctor Lavinder was detailed for duty in the 
Hygienic Laboratory December 15, 1908, for the purpose of making 
special studies as to the cause, methods of transmission, and control of 
the disease. Pellagra has been the subject of most exhaustive study in 
certain parts of Europe, and the problem presents many difficulties, 
but in view of the somewhat different clinical picture presented 
in this country, it was recognized that the disease should receive 
immediate attention. 

In a letter of February IT, 1909, from the Chief of the Bureau of 
Plant Industry, it was stated that the prevalence in southern Europe 
of pellagra is having considerable effect upon the marketing of 
American corn, as the disease is attributed to some injurious property 



PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE. 47 

contained in moldy or so-called " spoiled " corn after it is ground into 
meal. 

The increasing prevalence of the disease in the Gulf States was 
also mentioned, and it was suggested that because of the suspected 
relationship of corn to the disease that the matter should be investi- 
gated jointly by the Bureau of Plant Industr}^ and the Bureau of 
Public Plealth, the Bureau of Plant Industry to undertake the inves- 
tigation of corn with reference to its possible bearing on the develop- 
ment of pellagra, while the investigation of the etiological, clinical, 
epidemiological, pathological, bacteriological, and therapeutic aspects 
of the problem would devolve upon the Bureau of Public Health. 

Cooperation of the character indicated is most beneficial, and the 
Chief of the Bureau of Plant Industry was therefore informed that 
special problems connected with the disease were being undertaken 
from a medical standpoint, and that he would be informed of any 
advances made. 

INVESTIGATIONS IN VAEIOUS LOCALITIES. 

Cases of the disease having been reported at Columbia, S. C, Passed 
Assistant Surgeon Lavinder was detailed April 30, 1909, to proceed to 
that city for the purpose of making special studies, and he was pro- 
vided with necessary laboratory apparatus and materials. An out- 
line of the proposed investigations had been submitted to the advisory 
board of the Hygienic Laboratory on March 26, 1909. In a state- 
ment before that board. Doctor Lavinder referred to the different 
views held regarding the etiology of the disease. He also referred 
to reports indicating that there have been at least 1,200 cases of pel- 
lagra in the United States since 1907, and invited attention to the high 
mortality of the disease in this country and its apparently acute type 
as compared with cases in Europe. 

Having outlined some of the problems to be investigated, particu- 
larly its periodicity in this country and abroad, it was the unanimous 
opinion of the board that investigations to be undertaken should 
begin in South Carolina and other places in this country, and that 
these should be made in order that Doctor Lavinder might be better 
prepared to make comparison with the disease abroad. It was in 
accordance with these views that the above-mentioned detail was 
made. 

In accordance with this decision. Doctor Lavinder was sent to 
Columbia, S. C, April 30, 1909, and established his laboratory at the 
State Hospital for the Insane. This hospital contained a number 
of cases of the disease, and was considered a desirable institution 
in which to pursue investigations. The necessary material in this 
institution had been most courteously placed at the disposal of Doctor 
Lavinder by the South Carolina state board of health through Dr. 
C. F. Williams, the secretary; and the board of regents and superin- 
tendent of the asylum. Dr. J. W. Babcock, had cordially cooperated 
in the arrangement and evinced every desire to lend aid in such an 
investigation. Indeed the State of South Carolina has displayed 
great interest in the pellagra problem from the beginning, and has 
done much to stimulate interest in the grave situation which seemed 
developing in the Southern States. 



48 PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE. 

Doctor Lavinder's studies at Columbia have been clinical, patho- 
logical, and bacteriological, full reports of which are expected to 
appear later in printed form. Briefly he reports that the cases con- 
form in practically all respects to the descriptions of the disease as 
seen in Italy ; that the mortality in institutions is very high, and that 
treatment of asylum cases has not given encouraging results. In his 
laboratory studies of the skin lesions, blood, spinal fluid, and excre- 
tions, his results have not differed from those reported by others. 
Exclusive of such intestinal parasites as hookworms, he has found 
thus far no infecting micro-organism by either microscopical, cul- 
tural, or animal methods. These preliminary investigations have, 
however, afforded him an excellent opportunity to familiarize himself 
with the disease from both the clinical and laboratory sides, and to 
get some idea of the magnitude and importance of the problems 
involved. 

The disease has continued to spread to, or rather to be reported 
from other sections of the country. Early in July the bureau re- 
ceived rej^orts from Nashville, Tenn., through Dr. J. A. Albright, 
secretary of the state board of health, and from Chicago, 111., through 
Dr. W. A. Evans, commissioner of health, stating that pellagra w^as 
thought to exist in the former place in the Baptist Orphans' Home, 
and in the latter at the county asylum at Dunning, 111. Both offi- 
cers requested that some one be sent to confirm the diagnosis and 
give advice. Doctor Lavinder was ordered to these places, and left 
Columbia, S. C, on July 15. He found the disease existent in both 
places, about 15 cases at Nashville and 3 at Dunning. In both places 
it had existed for some time, and at Dunning 9 deaths had occurred 
within the previous year or year and a half. 

Up to this time the disease had been reported from the Southern 
States only, but the corn belt had been watched with suspicion and 
anxiety for some time. It was a matter of much interest therefore 
to find the disease existent also in the North Central States. The 
situation at Nashville was somewhat peculiar and gave rise seriously 
for the first time in this country to the very old question as to the 
communicabilit}^ of the disease. This is a matter, however, which 
has been considered thoroughly many times, and the disease by prac- 
tically all authorities is considered not communicable. 

Some time later, in August, the disease was reported to the bureau 
from the General Hospital for the Insane at Peoria, 111., and request 
was made by the secretary of the state board of health and the super- 
intendent of the asylum, Dr. George A. Zellner, for aid in confirming 
the diagnosis. Doctor Lavinder went to this place on August 13 
and found a large number of w^ell-marked cases in this institution. 
He reported that the disease, while different in some particulars 
from the southern type, nevertheless admitted of easy and positive 
diagnosis, and he commented on the fact that little corn and its 
products entered into the dietary of this institution. 

The above facts serve to give some idea of the extent and preva- 
lence of the disease in the United States. Exclusive of certain early 
sporadic cases, it was reported first in 1907, from the Mount Vernon 
Insane Asylum in Alabama (88 cases). This report was soon fol- 
lowed by similar ones from South Carolina, Georgia^ and North 
Carolina, and later from many other States. In a recent publication 
by the service entitled: "The Prevalence of Pellagra in the United 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 49 

States," by Lavinder, Williams, and Babcock,, existing statistics are 
given, and it is shown, after careful inquiry, that there are records 
of about 1,000 cases scattered in 13 States. Since this date two or 
three other States haA^e reported the disease. 

It is highly probable, from existing evidence, that the disease has 
prevailed in the United States for some years unrecognized, but has 
for some reason become much more frequent and perhaps wide- 
spread within the last two or three years. As to its present prev- 
alence and numbers there are no accurate data on which to base 
statements. Practically all reports of cases thus far have been made 
from insane asylums, and very conservative estimates of the total 
number of cases have increased from 1,000 to 1,500, and to finally 
5,000. It is generally believed by most authorities that about 10 
per cent of the pellagrous show sufficient mental involvement to be 
admitted to insane institutions, and on this basis in this country 
there would be, on a reported 1,000 cases in asylums, a total of 10,000 
cases. At any rate, it is evident that the matter is becoming one of 
great importance; and, if we may judge by the experience of Italy 
and some other countries, it may certainly be questioned whether 
we are not confronted with another public-health problem destined 
perhaps to become of grave national importance. The situation has 
attracted, naturally, a great deal of popular interest, and the lay press 
has given it much attention. 

EUROPEAN PELLAGRA. 

Pellagra is a new disease in the United States, and the American 
medical profession is not all familiar with the subject. It is, how- 
ever, a disease which has been known only too well in southern 
Europe, where for nearly two centuries it has been a burden and a 
tax on the physician, the sanitarian, and the public — a grave problem 
of national and international importance. Appearing first in Spain 
in 1735, it spread in a few years to France, Italy, Roumania, and 
other parts of southern Europe, and is now endemic in several parts 
of the world. Of recent years Roumania and Italy have been the 
greatest sufferers, and it is safe to say that each of these countries 
to-day has not less than 50,000 cases of the disease, about one-tenth 
of which are in insane asylums. 

Professional talent of the highest order, important legislation, and 
large sums of money have been devoted to the solution of this problem, 
yet the disease still remains and advances, afflicting so many indi- 
viduals through both its direct and hereditary influences as to prove 
the gravest menace to the integrity of many large communities. 

ETIOLOGY. 

The etiology of pellagra has received great attention at the hands 
of investigators, and the foreign literature on the subject is vo- 
luminous. The subject still attracts the ablest talents to its solution, 
and tlie literature continues to multiply, but with as yet no entirely 
satisfactory conclusions. There is, however, a very universal and 
profound conviction that the disease is in some definite way con- 
nected with the use of Indian corn, or its products, as an article of 

1854«— 10 i 



50 PUBLIC HEALTH AND MAKTNE-HOSPITAL SERVICE. 

food. This hypothesis is almost as old as the history of the disease 
itself, and has from time to time undergone much development and 
modification. Beginning with the now abandoned ideas that corn 
lacked certain necessary nutritive qualities, or perhaps contained 
certain harmful or toxic substances, it was reserved for Italian ob- 
servers to bring out the view that not in good, sound corn, but in 
damaged or spoiled corn (corn which has undergone a change under 
bacterial influence with production of poisonous substances), must 
the cause of the disease be sought. Lombroso, one of the greatest 
authorities on the subject, after more than twenty-five years of ex- 
perimental work and observation, stated the doctrine that has had 
the most profound effect. Succinctly stated, his hypothesis is that 
pellagra is the effect of an intoxication produced by poisons developed 
in spoiled corn through the action of certain micro-organisms, in them- 
selves harmless to man. These micro-organisms, however, have never 
been satisfactorily identified, and the chemical poisons which they 
are credited with giving rise to have never been successfully and 
satisfactorily isolated and decided. 

While practically all investigators take into consideration the 
harmfulness of si^oiled corn, yet many students and workers have 
dissented' from Lombroso's views. Some have thought the disease an 
auto-intoxication or an intestinal mycosis, while others have regarded 
it as a true infection either by molds or by bacteria. Several specific 
micro-organisms have been described only to be discredited by time 
and the work of other men. The most recent worker in this last 
field is Tizzoni, who has described a micro-organism isolated by him 
from the blood, stools, and organs of acute and chronic pellagrins, as 
well as from spoiled corn. This* micro-organism he has called the 
Streptohacilliis pellagrce. His work is of great interest, but too 
recent to be accepted without further confirmation. 

Perhaps the most important work in the field of a specific infection 
in pellagra is that of Ceni. It is his idea that the disease is due to 
a specific infection by one of two molds, Aspergillus fumigatus and 
A. -flavescens. His hypothesis is a most ingenious one, is supported 
by careful experimental work, and has attracted much attention. In 
the light of his views many obscure points seem at least to be capable 
of a possible, reasonable explanation. The essential points of his 
work and writings may be presented. In his opinion the disease in 
almost all cases is due to a true infection by the Aspergilli mentioned. 
He believes that these molds gain entrance, with food, to the intestinal 
tract, pass through the intestinal wall in the spore state, and localize 
in the lungs, pleurae, pericardium, or pia mater. When localized 
they set up a true diffuse, inflammatory process, and elaborate very 
virulent toxins, which give rise to a characteristic general intoxica- 
tion. Ceni has found several varieties of AspergiUi and Penicillia 
to possess pathogenic power and to be capable of producing character- 
istic toxins, but only the Aspergillus fumigatus and A. flavescens 
seem to have the power of infecting the human organism. All others 
must prove pathogenic by giving rise to absorbable toxins in the 
alimentary tract. The toxins produced by these various molds 
differ in different species and in different varieties of the same species; 
some producing toxins which give rise to depressive phenomena, 
such as general depression, with relaxation and diminution of mus- 
cular tone, while others produce toxins which give rise to exciting 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 51 

symptoms, such as exaggerated reflexes, general tremor, and a spas- 
modic state of the muscidar system. These two classes of symptoms 
are quite commonly observed in different types of pellagra. 

Another important observation is the relation between the produc- 
tion of toxins and the season of the year. The greatest toxicity of 
the Aspergillus fumigatus and A. flavescens^ for example, is said to 
occur in the spring and in the fall and correspond to the " cycle of the 
annual biological evolution " of these molds. And it is at these 
particular seasons that the grave and characteristic phenomena of 
pellagra are most evident in man. Molds isolated from unhj^gienic 
surroundings are found to be more pathogenic and toxic than others ; 
and a fact of importance in the preparation of food by cooking is that 
these molds withstand quite high temperatures without impairment 
of virulence. Finally, as to the point of their relation to corn or its 
products, Ceni does not think corn a necessity for their infection of 
man, but he seems to think that molds grown on corn and eaten with 
the corn on which they grow means greatly increased virulence ; and 
further that corn is probably the very general and usual means of 
their transmission to man. 

As for other etiological views, they may be briefly dismissed. 
There is a small French school of students who deny that the disease 
is a morbid entity. They consider it a " morhus tnisei'iae^'' and re- 
gard it as a syndrome which may occur in many cachectic states, 
particularly if associated with alcoholism. Sambon has made the 
interesting suggestion that the disease may be protozoal in its nature 
and insect borne, adding that the insect which acts as intermediary 
host may live around cornfields. Recently in a brief note. Smith and 
Hedges (Department of Agriculture) have suggested the possible 
connection with diplodia disease of corn. This fungus seems to be 
a soil infection and is difficult to eradicate from fields when once 
started there. It enters the plant by way of the root system and 
passes through stem and cob to the grain. 

To sum up briefly, the belief that there is an etiological relation 
between pellagra and the use of corn as food would seem too universal 
to permit its rejection except in the case of demonstrative, j)roof to 
the contrary. As to the exact nature of this relation there is much 
doubt, and this part of the problem must await further developments 
for its final solution. It would seem safe to say, however, that good, 
sound corn seems from all evidence to be a highly nutritious and very 
valuable cereal; and to counsel its total rejection would not only be 
inadvisable but probably foolish. Corn properly selected, cultivated, 
harvested, stored, milled, and transported, with proper means of 
preparation for food, seems to be innocuous, and the problem then 
may perhaps be resolved simply into proper oversight of methods 
[ipplied to this valuable crop. It must be added, however, that sus- 
picions have been expressed that flour and perhaps other foods may 
be adulterated with corn products. This would require investigation. 

ITALIAN PREVENTIVE MEASURES. 

In Italy, educating the people in proper methods of corn culture 
and preparation of it for food, improving general hygienic condi- 
tions, and inspecting im[)orted grain, are said to be having a bene- 
ficial efl'ect on the occurrence and control of the disease, although 



52 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

pellagra statistics are claimed by some to be exceedingly imtrust- 
worthy. 

The morbid anatomy of the disease is neither constant nor char- 
acteristic. The most essential and important feature is changes in 
the s^Dinal cord: generally degenerations in the lateral columns in 
the cervical and dorsal regions. 

The disease is of an endemic and epidemic nature and -^here once 
introduced is likely to remain for a long period of time. This, 
taken with the general belief in its etiological relation to the use of 
Indian corn has led Governments to institute elaborate organized 
prophylactic measures, involving the enactment of important legisla- 
tion and the expenditure of much money. In the forefront of such 
work has been the Italian Government. Beginning with the estab- 
lishment of a special hospital by Joseph II of Austria in iTS-i, and 
culminating in 1902 in the "Law for the prevention and cure of 
pellagra," many efforts have been made to stay the progress of or 
eradicate the malady. The Italian law of 1902 includes two classes 
or measures — curative and preventive. The curative measures in- 
clude distribution of salt, administration of food at the patients' 
home or at sanitary stations (locande sanitarie), and treatment of 
such cases in special hospitals (pellagrosari), or in insane asylums. 
The prophylactic measures include inspection of imported corn and 
flour, exchange of good for bad corn, drying plants, cheap coopera- 
tive kitchens (cucine economice). improvement of agricultural 
methods, and education of the people. As to the effect of such 
measures the results have not been as good as was anticipated, but 
the administration of the law has not been without criticism. A 
further experience will perhaps be necessary to determine its exact 
influence in controlling the disease. 

^Miile the general conditions in this country are c{uite different 
from those abroad, the whole subject is a matter of grave concern, 
both from public health and economic standpoints, and its earnest 
study is absolutely essential. 

SERVICE COMMISSION TO IN\T:STIGATE PELLAGRA. 

Since the close of the fiscal year a commission to investigate pella- 
gra has been appointed with the approval of the Secretary of the 
Treasury, the personnel of which is as follows: Passed Asst. Surg. 
John F. Anderson (chairman), director of the Hygienic Laboratory; 
Dr. Reid Hunt. Chief Division of Pharmacology. Hygienic Labora- 
tory; Surg. M. J. Rosenau; Passed Asst. Surg. C. H. Lavinder 
(secretary) : Passed Asst. Surg. J. D. Long: Dr. "\Vm. A. ^Yliite, 
Superintendent Government Hospital for the Insane; Dr. Nicolas 
Achuccaro. Government Hospital for the Insane. 

Ix^'ESTIGATIONS OF RaBIES. 

There aj^peared in the annual report for 1908. page 55, an account 
of the investigations of rabies that had been made and those that 
were contemplated. 

As previously stated, the legislative council of the American 
]Medical Association, during a meeting held in Chicago, December 11, 
1907. passed resolutions to the effect that the Public Health and 
Marine-Hospital Service should make investigations of rabies, with 



FFBLIC HEALTH AlSlk MABIKE-HOSPTTAL SERVICE. 53 

the Tiew to its prevention and control. It was determined to ascer- 
tain the geographical distribution of the disease in the United States 
at the present time. The year 1908 was selected, as it was thought 
that de£nite data could be secured. Communications were sent to 
state and territorial health authorities, local health authorities. United 
States Census Bureau, Pasteur institutes, and others who were known 
to be in a position to give definite data. The data received were com- 
piled and prepared for publication as a public-health bulletin. As a 
res-nlt of these studies, it was determined that there were 111 deaths 
froan rabies among human beings during 1908, and it was ascertained 
that there were at" least 53-t infected localities, as shown bv reports of 
rabies among animals. It was shown that the disease prevailed over 
the ^tstern three- fourths of the United States, and that only from the 
Kocky M'" nrains and Pacific coast regions were no cases reported. 
In otiri " : is, 38 States and Territories and the District of Coliun- 
bia were -l±uwn to be Lufected during the year. This widespread 
distribution of rabies indicates the necessity for the adoption of 
measures looking to its prevention. There are now over "20 Pasteur 
institutes in the United States prepared to administer prophylactic 
treatment. 

PASTEITR TREAT^'rE^s'T. 

The Pasteur treatment is also administered at the Hygienic Labora- 
t<">r'v. 13*} ner^ons havino: been given the treatment there during the 
-- "_ . _ -l"- : TAese persons either had been bitten by dogs 

1 "^:: - ' :;.. .-- or had been in intimate contact with rabid 

.- TV- .-Daration of the virus used in these treatments and 
: -- - ~ - ;■ ".lealth authorities has occupied the greater part of 
~ :er. It is gratifying to state that no case of hydro- 
pi^^jl:—-. 1^.-- L-Vei. ped among persons who have been given the treat- 
ment in the Hygienic Laboratory. One patient, however, on the 
ei^ter/:!. " w of treatment developed acute paralysis of the hands 
and i-r-' 7 _^ patient was attended by Passed Asst. Surg. H. M. 
^r _ " •- then in charge of the work, and there has been 

n. _ - rnt, which will end in recovery. Cases of paralysis. 

e_ _ r following the course of the Pasteur treatment, occur 

k. .. _- ;i-::.ll percentage of cases. The cause of this paralysis has 
not been definitely worked out, but some writers attribute it to the 
rabies toxin, while others are inclined to attribute it to anaphylaxis. 
The subject is one for further study, with the view to its solution. 
There are also a number of other problems that demand scientific 
irivestigation. and it is expected that they will be studied in the 
laboratory dnring the coming year. 

During^ the year materials for use in giving the Pasteur treatment 
were sent to the state boards of health of Alabama, Iowa, North 
Carolina, and Sooth Carolina, and in addition to the Canal Zone. 
All of the vims sent from the laboratory was in the form of cords 
pre<»^rved in glycerin, it having been deemed inadvisable to send out 
a- ; ;: the emulsion ready for use. 

Tie investigations of rabies, the preparation of antirabic virus, its 
:i'r'-.r ration in the Hygienic Laboratory and distribution to state 
n- '■■krial health offit^rs is an instance of the usefulness and 

{ atnre of the work that the Hygienic Laboratory is equipped 

t<» carrv oat. 



54 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Investigations of Amcebiasis. 

In a communication of February 26, 1909, Surg. H. W. Austin, 
stationed at San Francisco, reported that during tlie past three years 
occasional cases of amoebic dysentery had been admitted to tlie marine 
hospital at that port, and that the frequency of such cases Avas in- 
creasing. On this account the routine microscopical examination of 
the stools of all patients having intestinal diseases had been prac- 
ticed with the results of finding amoebae in many cases as well as 
other intestinal parasites not commonly found in that locality. 

In view of the importance of having an exact knowledge of the 
origin of the infection with amoebae in its relation to the public 
health, he had an investigation made of all cases of dysentery in 
which amoebae were found present in the stools to determine where 
they contracted the infection. 

Accompanying the above communicatjlon was a report by Passed 
Assistant Surgeon Long, dated February 25, 1909, giving the results 
of the investigations of 20 cases, in all of which motile amoebae had 
been demonstrated in the stools. 

All of the j)atients had been closely questioned as to their move- 
ments, habits, and modes of life in order to determine if possible 
where the infection was obtained. As a result it was found that three 
contracted their infection in Manila, tAvo in Hawaii, two in Central 
America, one in India, one in Tahiti, one in South America, and six 
in San Francisco. 

Evidence was presented to show that the six cases had acquired the 
infection somewhere on the Pacific coast, and most probably in San 
Francisco or vicinity. One of these six cases had lived in San Fran- 
cisco seven years prior to admission to hospital ; one had lived in San 
Francisco six years, had never been in the Tropics, and had had 
symptoms for two years ; one had lived in San Francisco twelve years, 
and had not been in the Tropics nor anyAvhere except Alaska and 
coast ports for seventeen years ; one had lived in San Francisco three 
or four years and had had no symptoms until two months before 
admission to hospital; one had lived in San Francisco six and one- 
half years, and during that time had not been anywhere except to 
coast ports ; and one had never been outside the State of California. 

SOURCE or THE INFECTION. 

The report stated that the probable origin of these cases was not 
surprising in view of the fact that chemical analyses of the potable 
water of that vicinity had demonstrated the fact that the amounts of 
nitrogen present as nitrates and nitrites, chlorine, and organic matter 
(as shoAvn by loss on ignition of total solids) were probably sufficient 
to furnish culture media for amoebae. 

It was also cited that the climate is not cold enough to seriously 
inhibit the groAvth of bacterial life, and hardly any of the water- 
sheds were free from the danger of contamination of human beings. 

Another more important factor is the practice of using human 
excreta for fertilizer on groAving vegetables, as is done in China 
and Japan, many vegetable gardens being under the control of Chinese 
and others whose ideas of hygiene are vague, to say the least. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 55 

Doctor Austin recommended that further investigations be made to 
determine whether in other localities on the Pacific coast amoebic 
dysentery was jDresent, and what preventive measures, if any, should 
be taken. 

Although amoebic dysentry is associated with life in the Tropics, it 
undoubtedly prevails in the North Temperate Zone, as is evidenced 
by the above-mentioned report and other reports of cases from time 
to time. 

In a letter of April 1, 1909, addressed to Surgeon Austin by the 
bureau, it was stated that a review of this subject and further inves- 
tigations should be made, and that Passed Assistant Surgeon Long 
should undertake this duty, the report of the same to be published for 
the benefit of officers of the service and with the view to learning 
something of the geographical distribution of amoebiasis and the 
factors responsible for its propagation. 

The investigations of amoebiasis made at the marine hospital at 
San Francisco during the fiscal year ended June 30, 1909, are a note- 
worthy feature of the work of that station. 

It was found that of a total of 48 cases, including those previously 
referred to, suffering from amoebiasis, 15 had undoubtedly contracted 
the disease on the Pacific coast of the United States. 

PREVENTIVE MEASURES. 

On account of the dangers to the public health from this practice, 
Doctor Austin recommended to the health committee of the San 
Francisco County Medical Society that state legislation be secured 
making it a penal offense to use human excrement in the fertilization 
of vegetables. He addressed, also, a letter to the president of the 
San Francisco board of health, July 22, 1909, inviting attention to the 
dangers of the spread of amoebiasis, and suggesting that supervision 
over the gardens where vegetables are grown might be valuable in 
preventing further spread. 

A meetmg of the board of health was held August 4, 1909, to con- 
sider the matter, and Passed Assistant Surgeon Long was detailed to 
represent the service. His report of the meeting stated in effect that 
the subject of amoebiasis was discussed; that Dr. J. F. Watkins, city 
physician, reported that the sewer from the city jail at Ingleside did 
not connect with the city sewerage system, but emptied into a cess- 
pool which was situated near vegetable gardens, the effluent from the 
cesspool being used to irrigate the vegetables, and that Acting Assist- 
ant Surgeon Wherry, who was present, reported that he had culti- 
vated amfjebffi from lettuce purchased in the open market, which 
organism could not be distinguished morphologically from entomcBba 
histolylica. 

As a result of the meeting, the following measures were decided 
upon : 

1. Amebic dysentery, or amoebiasis, to be declared an infectious 
disease, and all physicians and hospitals notified that cases coming to 
their knowledge must be reported to the board of health. 

2. That a resolution be presented to the board of supervisors 
urgently requesting the extension of the jail sewer to the city sewer, 
and also urging that the construction of Islais Creek sewer bo hastened 
as rapidly as possible. 



66 PUBLIC HEALTH AND MARTNE-PIOSPTTAL SERVICE, 

3. The health officer was directed to prepare an ordinance to pre- 
sent to the board of supervisors, making the use of human excrement 
and sewage for the irrigation or fertilization of vegetables a misde- 
meanor. 

4. That as soon as possible sanitary inspectors be appointed to 
investigate the condition of vegetable gardens. 

5. That samples of vegetables be collected and sent to Acting Assist- 
ant Surgeon Wherry at the plague laboratory, Oakland, to determine 
whether or not amcebfe could be cultivated from them. 

On account of the importance of the prevalence of ama^^iasis on 
the Pacific coast and other parts of the country, it is expected to con- 
tinue investigations of the disease at certain hospitals of the service 
to determine whether amoebae can be found in the stools of patients 
suffering with intestinal and liver diseases, and to record and report 
on the antecedents of all cases of amoebiasis. 

Studies on Tuberculosis. 

During the past few years sjjecial studies have been made upon 
tuberculosis in the Hygienic Laboratory, principally in the Division 
of Pathology and Bacteriology. The thermal death point of the 
tubercle bacillus (60° C. for 20 minutes) has been determined with 
accuracy by the director. He has shown that so far as the viability 
of this organism is concerned, it does not differ widely from other 
nonspore-bearing organisms. The fact that the tubercle bacillus may 
be readily destroyed is important and will be helpful in preventive 
measures. A series of experiments were made by the director and 
assistant director of the laboratory upon the influence of the inges- 
tion of dried tubercle bacilli, the results having been published in one 
of the current medical journals. Studies were also made by the assist- 
ant director on the occurrence of tubercle bacilli in market milk. He 
also made investigations with negative results to determine the 
presence of tubercle bacilli in the circulating blood of tuberculous 
patients. The experiments have been published in Hygienic Labora- 
tory Bulletin 57, together with results of the studies of the director 
on the viability of the tubercle bacillus. 

A number of government employees were examined at the labora- 
tory in accordance with executive order of February 26, 1906, to de- 
termine whether or not they were suffering from tuberculosis. This 
work is a part of the general propaganda against tuberculosis, and 
forms one of the means of safeguarding government employees 
against this disease. 

The service was adequately represented in the Sixth International 
Congress on Tuberculosis at Washington, September 28 to October 5, 
1908, both in the administrative and scientific work and in the 
exhibit. 

The operations of the Tuberculosis Sanatorium at Fort Stanton are 
detailed later in this report. 

COLORED ANTITUBERCULOSIS LEAGUES. 

On request of the president of the Georgia State College for Col- 
ored Youths, Surg. C. P. Wertenbaker was directed by the bureau to 
lecture before a negro farmers' conference at Savannah, Ga., Febru- 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 57 

ary 25, 1909. During the lecture he suggested that as a means of 
preventing tuberculosis among the negroes there should be organized 
a state colored antituberculosis league. As a result such an organiza- 
tion was formed with Prof. R. R. Wright, president of the college, 
as president, and Dr. S. P. Lloyd, of Savannah, Ga., as secretary. 
The jDlan of organization suggested by Doctor Wertenbaker contem- 
plated, in addition to the state league, local leagues in every negro 
church with a vice-president for each county in the State. By this 
means it was thought that any colored person might become a member 
of one of the branch leagues on the payment of a small annual due 
which would entitle him to a certificate of membership containing 
necessary information relative to the cause, prevention, and cure of 
tuberculosis, and the measures necessary to prevent its spread. It was 
expected that the fund formed by the annual dues paid by the mem- 
bers of each church league would be used for the care and treatment 
of members that had tuberculosis or developed it subsequently, and 
that this fund might also be used for disseminating information for 
combating the spread of the disease in a community. 

The proposed plan met with general approval. In a report of 
progress, published in the Public Health Reports for August 6, 1909, 
Doctor Wertenbaker stated that there had been five state leagues 
organized and that great interest was being manifested by the negroes, 
health officers, and others in different parts of the country. 

On account of the importance of the movement in the interest of 
the public health the proposed plan was submitted to the conference 
of state and territorial health officers with the Public Health and 
Marine-Hospital Service June 2, 1909. It was then explained to 
the conference by the Surgeon-General that, while the organization 
was not an official one, the bureau had made every effort to encourage 
its continuance, and the state and territorial health officers were 
requested to give it consideration with the view to lending their 
indorsement and support. As a result of this action, the conference 
of state and provincial boards of health, which met in Washington 
June 4 and 5, 1909, adopted the following resolution : 

Whereas tuberculosis is specially prevalent among the colored people of the 
country, threatening not only their own race with decimation, but constituting 
a serious menace to the whites with whom they come in contact ; and 

Whereas the United States Public Health and Marine-Hospital Service has 
devised the best scheme yet suggested of meeting this problem by tlie organiza- 
tion of state colored antituberculosis leagues, with branch leagues in all colored 
churches : Be it 

Resolved, That the conference indorses the plan of campaign and urges Its 
members within whose jurisdiction it is a practical question to promote as far 
as possible its inauguration and success. 

It is expected, therefore, that the leagues when organized will 
operate in conjunction with the state and local health authorities to 
their mutual benefit. 

SERVICE ENCOURAGEMENT. 

With the view to facilitating the organization of leagues and in 
order to obviate as much as possible the difficulties that arise in 
getting to work in an effective way. Surgeon Wertenbaker prepared 
a practical guide for th(! orgiiuization and operation of such leagues, 
and this was published in the Public Health Reports September 3, 



58 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

1909. In connection with his other work he has, through correspond- 
ence, given all assistance possible to those interested in the movement 
and presented a great many lectures on the subject in different parts 
of the countr3^ 

It is known that tuberculosis is very prevalent among the negroes, 
nearly four times as many of them dying of the disease as white 
people. The suppression of the disease among the colored race has, 
therefore, become a serious problem, and it was recogniizecl that this 
could be accomplished in no better way than through the church, which 
is an organization in which the negro is always interested, and with 
which a majority of them are connected. It was thought that by 
associating antituberculosis work with the church the negro would 
be apprised of not only his religious but his social needs, and that the 
league would become a club that could be presided over by the best 
educated and most intelligent members of the race. The plan of 
having a vice-president for each county provides a convenient and 
useful means of subdividing the work, and should insure greater 
activity throughout the States. 

The affiliation of the antituberculosis movement with the church 
will serve to enlist the clergy in the cause of more improved condi- 
tions of living, and it must be said that in the past this powerful 
agency has not been utilized as it should have been either among 
the white or the negro race. 

The plan provides for the rendering of financial aid by the negroes 
themselves to those of their race who are afliicted with tuberculosis, 
and thus becomes a potent factor in their social and sanitary better- 
ment by teaching them self-reliance and giving them work to do in 
their own interest. 

It is conteinplated that the movement will extend to other States. 
It is organized on broad lines, and can be utilized by health officers 
and others wherever the problem for the suppression of tuberculosis 
among the negroo" presents. Aside from its educational features 
in regard to tuberculosis, the instruction in general sanitation and 
the agitation of the subject must of necessity produce beneficial re- 
sults and an improvement in the conditions under Avhich the negro 
lives. Any improvement in the health conditions among the negroes 
will be beneficial to the country as a whole, and this work should, 
therefore, be fostered in every way possible, not only by the Federal 
Government, but by state and local officials and others interested in 
the cause of general sanitation. 

Hookworm Disease. 

The report on hookworm disease in its relation to child labor, 
which has been prepared at the request of the Secretary of the 
Department of Commerce and Labor, and to which reference was 
made in the annual report for 1908, page 52, has been completed. 
This report was prepared by Dr. Ch. Wardell Stiles, Chief of the 
Division of Zoology, who has had actual experience with the tene- 
ment white class both before and after they enter the mills. As 
shown in the last annual report, his conclusions on the subject of 
child labor in the South are not in harmony with those popularly 
entertained. He is of the opinion that this subject in the South 
involves questions which give to it an aspect quite different from 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 59 

that of child labor in the North, and his conclusions can best be sum- 
marized by his statement that if he had to choose between placing his 
own 10-year-old daughter in the spinning room of a cotton mill and 
placing her on the average small tenant farm of the South he would 
be obliged, in the best interest of the child, to send her to the mill. 
In 1902, when he pointed out the widespread prevalence of hookworm 
disease in the South, Doctor Stiles's views were regarded by some as 
extreme, but to-day it is generally admitted that those views were 
correct, and there are gratifying indications of a popular awakening 
of public sentiment which will eventually lead to an improvement in 
the sanitary conditions. 

During the present fiscal year he has inspected 2G factories in New 
England, including 16 cott/)n mills and 1 knitting mill, but in an 
examination of the 1,437 cotton-mill hands seen he has failed to find 
a single case of that severe type of anaemia (known as " cotton-mill 
anaemia ") which he found in 12.6 per cent of the cotton-mill hands of 
the South. As the New England mills are using cotton from the 
southern cotton mills, and as the mill hands are therefore breathing 
in the same kind of lint as are the southern cotton-mill hands, these 
observations give an additional proof of the error of the popular 
idea that the condition of the latter mill hands is due to the breathing 
in of lint. Such an array of data are now on hand which are not in 
harmony with the lint theory that when all facts are published he 
believes public opinion on this theory will of necessity undergo a 
change. 

ERADICATION. 

The general subject of hookworm disease is deserving of earnest 
attention on the part of the Federal Government, and provision should 
be made whereby the Public Health and Marine-Hospital Service can 
cooperate with state and territorial health authorities in their efforts 
to eradicate the disease and eliminate the excessive morbidity caused 
by it. 

Hookworm disease is due to soil pollution, and in order to awaken 
popular interest in the subject of soil pollution in relation to the 
disease Doctor Stiles, in connection with his other duties, has been 
given details where he could lecture on the subject at the following 
places : Winnipeg, Canada, Asheville, N. C, and Atlanta, Ga. In 
addition, he spent some time under orders in investigations of the 
disease in connection with the Country Life Commission appointed 
by the President. He has also given 25 popular and technical lectures 
on this subject in five States, without any expense to the Government, 
using part of his annual leave for the purpose. 

While the eradication of hookworm disease within a State is pri- 
marily the duty of its sanitary authorities, nevertheless, on account 
of the widespread distribution of the disease and its baneful influence 
on the population of the country as a whole, the Federal Government 
shoidd cooperate with state authorities, and this cooperation should 
include a widespread campaign of education regarding the measures 
necessary to prev(;nt the transmission of hookworm disease and treat- 
ment of the large number of persons aiilicted in different sections of 
the country. 



60 PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 

It is gratifying to note here that since the close of the fiscal year a 
gift of $1,000,000 by Mr. John D. Kockefeller for the purpose of 
eradicating hookworm disease has been announced, and a commission 
has been appointed by him for the management of this fund, Doctor 
Stiles, of this service, being named as one of the members of this 
commission. 

Health Problems on American Farms. 

The commission that was appointed by the President to investigate 
the conditions of life on American farms requested that some assist- 
ance be rendered by the service regarding the insanitary conditions 
in certain areas and the means necessary for their improvement. 
Dr. C. W. Stiles, Chief of the Division of Zoology, of the Hygienic 
Laboratory, was accordingly instructed to render such assistance, and 
in a report prepared by him there is given a brief statement of certain 
health problems on American farms. In this report, which will be 
published, it is stated that health conditions in the open country are 
in need of betterment, and these health problems are classified as of 
national and sectional importance. Among the national problems 
affecting farm life are mentioned the lack of popular education as to 
what good sanitary conditions are ; soil and water pollution, resulting 
particularly in typhoid fever; promiscuous expectoration, resulting 
in tuberculosis; promiscuous indulgence in patent medicines and alco- 
holic drinks; unwholesome, poorly prepared, and monotonous diet; 
lack of proper ventilation and cleanliness; the long hours at work 
and lack of recreation; and lack of care with respect to milk and 
water supplies. Among the questions of sectional importance are 
included the extensive spread of diseases, such as hookworm disease, 
malaria, and typhoid fever; insanitary conditions of life among the 
negroes and certain of the white population in the Appalachian 
region ; and the danger of the introduction and spread of rural exotic 
diseases on account of the arrival of large numbers of foreigners, from 
abroad. 

Life on the farm should be more healthful than in the city, and 
this is true in large sections of the country. On the other hand, there 
are certain areas in which sanitary arrangements are deficient, where 
t3'phoid fever, hookworm disease, and tuberculosis are especially 
prevalent and where the morbidity and mortality rates are excessive. 
There is necessity for the improvement of sanitary conditions in such 
localities, and it is necessary to take into account the conditions under 
which life is led and the association of the races which go to make up 
the general population. 

racial conditions. 

One of the natural results of bringing into close contact two differ- 
ent races is to complicate the sanitary conditions under which they 
live. This may result from the different habits found in the two 
races or from the fact that either race may possess a relative immu- 
nity to one or more diseases to which the other race .(representing 
more or less virgin soil for that disease) may be particularly sus- 
ceptible. In some of the Southern States circumstances of this kind 
exist. From present data it appears that the negro is less susceptible 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 61 

to the effects of malaria, hookworm disease, and Cochin China diar- 
rhea than is the white, but that he is apparently more susceptible to 
tuberculosis. In each race the diseases, becoming established, have 
been attended with serious results according to the respective suscepti- 
bilities. For instance, the insanitary conditions under which the 
negroes live and their great susceptibility to tuberculosis make them 
more or less a menace to the white race living in the same community. 
This may be illustrated by the statistics on typhoid fever. 

TYPHOID DEATH RATE IN THE NEGRO POPULATION. 

The Twelfth Census gives the average negro population for the 
entire country as 11.6 per cent, and the average typhoid-fever death 
rate is 45.5 deaths per 100,000 inhabitants. In his studies Doctor 
Stiles has divided the 50 States and Territories of the United States, 
tabulated in the Twelfth Census (1900), into three groups, as follows: 

(a) Fifteen States which stand above the average (11.6 per cent) 
in negro population, average 34.34 per cent in negro population and 
72.T0 per 100,000 in their typhoid death rate; 

(5) Seventeen States, which have at least 1 per cent but not over 
10 per cent negro population, average 2.48 per cent in negro popula- 
tion and 39.25 per 100,000 in their typhoid death rate. 

(c) Eighteen States, which have less than 1 per cent negro popu- 
lation, average 0.42 per cent in negro population, and 25.51 per 
100,000 in their typhoid death rate. 

This comparison strongly indicates that in our country the typhoid 
fever rate is increased, and in those sections having a large negro 
population. Doctor Stiles has compared the statistics of the white 
and negro with respect to the typhoid fever death rate with the 
following results: 

The typhoid death rate of white males when compared with that 
of negro males is as 37.4 to 75.3. 

The typhoid death rate of white females when compared with that 
of negro females is as 27.4 to 56.3. 

NEED OF EDUCATION IN SANITATION. 

Fortunately sanitary science has already reached the point that 
it will be i^ossible to reduce to a minimum the hygienic handicap 
which existing conditions have brought about. With the excellent 
natural conditions in the Southern States, for instance, a radical 
improvement in the sanitary conditions can be depended upon greatly 
to reduce the death rate. In order to bring about a reduction of the 
death rate, there is demand for education regarding the necessities 
of sanitation. As most of the negroes and many whites are tenants, 
it is the duty of landowners to provide better sanitary accommoda- 
tions for them. Until there is an awakening to the necessity of such 
provision, the people as a whole can not complain if the negro forms 
a reservoir for typhoid fever, hookworm disease, and other infections. 

"WTiat is needed in the country is proper sanitation, better educa- 
tional facilities, find more recreation. It would appear to be a duty 
of the Federal Government to disseminate information as to the 
necessity of these improvements and the means necessary to bring 
them about. 



62 public health and marine-hospital service. 

National Leprosy Investigation Station. 
buildings completed. 

In previous annual reports reference has been made to the measures 
adopted for the establishment of an investigation station for the 
study of leprosy on the island of Molokai. It was shown that al- 
though the establishment of the station was authorized by Congress 
March 3, 1905, the difficulties in erecting the buildings were so 
great as to be almost insurmountable. This was due to the isolated 
location and the dread of leprosy itself. Finally Mr. F. W. Pease, 
inspector of repairs, was sent to the islands with instructions to take 
all steps necessary looking to the erection of the buildings and com- 
pletion of the station. Soon after arrival in Honolulu, October 30, 
1907, he insj^ected the site that had been reserved by the Govern- 
ment, and selected the exact places for the location of the buildings 
to be erected within the reservation, which is situated on the east 
side of the tongue of land or peninsula, midway between the north 
coast of the island of Molokai, and distant about 55 miles north of 
east from Honolulu. Thirty houses occupied by lepers were on the 
site. The leper occupants had to be moved to the territorial leper 
settlement, after which the buildings were demolished and the debris 
burned. Immediately after inspection of the reservation schedules 
and specifications for necessary materials were prepared. Competitive 
proposals for suj^plying these and other necessary materials were in- 
vited by advertisement. The proposals were opened December 18, 
1907, and the lowest accepted. Soon thereafter shipment of the 
materials from Honolulu to Molokai was begun. 

In the employment of labor it was necessary to consider the appli- 
cations of only such laborers as would be easily controlled and sub- 
mit to isolation on the reservation. Furthermore, the laborers were 
required to provide their own subsistence; current rates were paid 
for labor and eight hours constituted a day's work. Upon the arrival 
of the materials at Kalaupapa they were landed and their transporta- 
tion b}^ wagon to the reservation at Kalawao, 3 miles distant from the 
landing, was begun. 

On January 2, 1908, work was commenced on temporary quarters 
for the employees. 

Crushed rock for concrete piers, foundations, and floors was pro- 
vided under accepted proposal from parties having a rock crusher 
at Kalaupapa. Sand was obtained from the beach near Kalaupapa. 

The first permanent building to be erected was the storage build- 
ing, followed by the power house and cold-storage building, the di- 
rector's quarters, the pharmacist's quarters, the administration and 
laboratory buildings, the attendants' quarters, the morgue, the lava- 
tory, the laundry, the hospital, the surgery, and the stable. 

As required by the progress of building operations, competitive pro- 
posals were invited for furnishing additional material. On account 
of the large quantity of lumber required, proposals were invited from 
local firms engaged in the lumber business for supplying lumber by 
vessel from the Pacific coast, with the result that much lower prices 
were obtained. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 63 

As a result of this arrangement a vessel arrived at Kalaupapa in 
May, 1908, and discharged 420,000 feet of lumber and shingles, all of 
which were hauled by team to the reservation. 

The inspector of repairs, who had charge of the building operations, 
increased and diminished the force of workmen as required. He 
states that an ample sewer system has been provided, one line from 
the residence compound and the other from the hospital compound, 
both discharging into the sea at low-water line. 

A complete system of plumbing has been installed in all the build- 
ings, with laundry trays, sinks, water-closets, lavatories, bath tubs, 
shower baths, slop sinks, garden hose outlets, and fire hose stand- 
pipes in the grounds adjacent to the buildings. 

There has been installed an electric lighting system with 30-horse- 
power gasoline engine and direct-current dynamo, supplying 290 
sixteen candlepower lamps. 

A combined ice-making and refrigerating plant has been installed, 
having a capacity of 1 ton of refrigeration, and is capable of produc- 
ing about 1,000 pounds of ice per day. The refrigerating plant is 
operated by a 12-inch diameter water wheel. 

In order to supply the necessary gas for use in the laboratory, sur- 
gery, and elsewhere, a 50-light gas machine was also provided. 

The inspector reports that the exterior of all the buildings has 
been painted and that necessary fences with gates have been built. 
On July 1, 1909, therefore, the station was practically ready for 
occupancy, all the construction work having been completed except 
proper screening of the buildings. 

The hospital will accommodate 15 patients and has ample space for 
necessary nurses. It is also provided with kitchen, dining room, bath- 
rooms, and toilet room. In the attendants' quarters there are 12 
rooms — a dining room, kitchen, laundry, and toilet rooms. The 
stable contains 6 stalls, a feed room, harness room, and wagon space. 
This will accommodate the animals necessary in the transportation 
of materials, which must all be brought from the landing, some dis- 
tance away. 

The buildings are of wood on concrete foundations and of the 
bungalow type, the floor and porch space of all the buildings equaling 
48,000 square feet. The large porch space permits of practically an 
outdoor life and is intended to overcome the inconveniences of pro- 
longed high temperatures and life in the Tropics. 

PROVISION FOR AVATER SUPPLY. 

The pipe line of the water supply for the territorial leper settle- 
ment crosses a corner of the reservation of the leprosy investigation 
station. It was expected that arrangements could be made to obtain 
a sufficient amount of water from this source, and proposals were 
requested from the territorial authorities to furnish the necessary 
water. In returning the proposals, the president of the territorial 
board of health stated that the amount of water available was hardly 
sufficient for the uses of the t(^rritorial leper settlement itself, and 
that it would b(! inipi'ficti(;abh'. to furnish an adequate su])ply also to 
the leprosy investigation station. It was explained by the president 



64 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

of the board, however, that the legislature had made partial provi- 
sion for enlarging the water supply, having appropriated funds 
which had been sufficient to purchase additional water pipe necessary. 
The appropriation was not sufficient to lay the pipe, and the addi- 
tional money necessary could not be secured until the territorial legis- 
lature should meet in 1909. 

"Wliile arrangements were subsequently made with the territorial 
authorities to secure a very small amount of water daily for building 
purposes, it was recognized that it would be impossible to operate the 
lej^rosy investigation station until an adequate supply of water could 
be secured. In anticipation of this need, the inspector of repairs was 
directed on March 7, 1908, to report upon the feasibility of establish- 
ing an independent water supply, and also the cost of extending the 
waterworks of the territorial leper settlement. A report from this 
officer, dated June 9, 1908, showed that the cost of materials and labor 
for providing an independent water supply would be $24,792.60, and 
would require six months to complete the work. He also forwarded 
estimates prepared by the superintendent of public works of Hawaii, 
showing that the extension of the water supply of the territorial leper 
settlement could be completed for a sum not to exceed $4,050, the 
estimated time in which to complete the work being sixty days. This 
latter plan appeared altogether the more advantageous, and the only 
one by which an adequate water supply could be secured without 
delaying for one year the opening of the hospital. Mr. Pease, the 
inspector of repairs, accordingly submitted a letter from the presi- 
dent of the territorial board of health, together with correspondence, 
constituting a proposal to furnish the leprosy investigation station 
with water for all purposes, in perpetuity, in consideration of the 
expenditure of $4,050 on the part of the United States Public Health 
and Marine-Hospital Service for laying the cast-iron pipe, which was 
already on the ground, from the national leprosy investigation station 
to the intake, and also the construction of intake screens and house. 

The correspondence was accordingly referred to the Comptroller of 
the Treasury for a decision as to whether the sum of $4,050 could be 
paid from the appropriation of $100,000 provided for by the act of 
Congress approved March 3, 1905, for the building and equipment 
of the leprosy investigation station. In a decision rendered July 9, 
1908, the Comptroller stated that it was not the intention of Congress 
to have this appropriation expended in the erection of a system of 
waterworks, and especially to expend it in a system belonging to and 
owned by the Hawaiian government. For these reasons he held that 
the department was not authorized to expend the above-mentioned 
appropriation to lay the pipes in question belonging to the Hawaiian 
authorities. The only alternative, therefore, was to submit estimates 
to Congress with the view to securing an appropriation for the pur- 
pose. As a result, an item was included in the act making appro- 
priations for the sundry civil expenses of the Government for the 
fiscal year ending June 30, 1910, in order to enable the Secretary of 
the Treasury to accept the proposal of the proper authorities of the 
Territory of Hawaii, in amount not to exceed $4,500, to make suffi- 
cient extension of the water-supply system of the leper settlement on 
Molokai to provide an adequate water supply also to the leprosy 
investigation station of the United States, provided that the right to 
said adequate water supply would be granted in perpetuity. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 65 

Upon the passage of the act the appropriation of $4,500 became 
immediately available. The proposal of the territorial authorities 
was therefore accepted, and Mr. Pease, the inspector of repairs, was 
directed on May 17, 1909, to certify when the work was satisfactorily 
completed under the direction of the superintendent of public works 
of Hawaii. 

On July 2, 1909, Mr. Pease reported that the necessary extension 
of the water-supply system of the leper settlement had been satis- 
factorily completed at a total expense of $1,390.97. In addition, he 
reported that by extending the line of 8-inch pipe up AVaikolu Valley 
to the new and additional source of supply, a continuous and bounti- 
ful supply of water to the leper settlement as well as to the leprosy 
investigation station had been secured. The pressure of water in 
the 8-inch pipe line opposite the director's quarters when tested was 
97^ pounds. A main supply pipe 4 inches in diameter was installed 
to supply the buildings of the leprosy investigation station, and with 
the pressure stated was sufficient to discharge 480,000 gallons for 
twenty-four hours through a length of 2,000 linear feet of said pipe. 
An adequate supply of water therefore is now available for all pur- 
poses for the use of the station, and it was secured at a very much 
less cost than was anticipated. 

'provision for boat LANDING. 

When the site, 1 mile square, was set aside by the territorial author- 
ities on the island of Molokai to be used in the establishment of a 
leprosy investigation station, it was recognized that provision should 
be made for a landing place. A part of the land set aside therefore 
included the boat landing at Makaluahau and all the land on the 
western exposure of the adjacent hill, as well as the right of way 
oA^er the path leading from the reservation proper around the foot 
of the cliff, and thence along the beach to the boat landing mentioned. 
It was recognized that such provision should be made, because the 
landing j^lace mentioned was very much nearer than the landing 
place at Kalaupapa, and on account of exposure landing at Kalau- 
pajDa was sometimes impossible during rough weather. 

After the construction of the buildings was in progress, it became 
apparent that the landing at Makaluahau should be so improved 
as to admit of landing passengers and supplies there. Until such 
improvement* was made the only nieans of access to the leprosy in- 
vestigation station was through the territorial leper settlement from 
the landing at Kalaupapa. Such landing and communication with 
the leper settlement was objectionable, as both persons and food 
supplies would be brought in contact with lepers, thus causing need- 
less exposure to the disease. 

An item was therefore included in the estimates to Congress, and 
in the act making appropriations for the sundry civil expenses of 
the Government lor the year ended June 80, 1909, an appropriation 
of $1,000 was made for constructing a boat landing for the use of 
the leprosy investigation station. Mr. Pease was thereupon in- 
structed to tsike the necessary steps looking to the completion of 
this work, and in a report of Jtnie 28, 1909, he stated that tlie landing 
had been built at an expenditure of $933.31, including construction 

18546—10 5 



66 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

of the necessary footbridge over Waikolu stream to afford access to 
the hmding. This boat hmding is 112 feet long, and has an average 
width of 12 feet. On account of its more protected location landing 
here will be attended with much less difficulty than the Kalaupapa 
landing of the leper settlement. 

In th(! Annual Report for 11)05, pages 197-207, will be found a full 
description of the site of the leprosy investigation station, together 
with copy of the law authorizing its establishment and correspond- 
ence showing its necessity. 

OPERATIONS OF THE LEPROSY INVESTIGATION STATION. 

On account of the delay in completing the station it was necessary 
to continue the investigations at the temporary laboratory in Hono- 
lulu. In the meantime administrative details were carried on with 
the view to securing the necessary equipment and getting it ready 
for use as soon as the station was ready for occupancy. As above 
stated, the buildings were completed July 1, 1909, but on account 
of the possible danger of transmission of the infection of leprosy 
by means of flies, mosquitoes, and other insects, it was necessary that 
the station be thoroughly screened before leper patients were ad- 
mitted. Bids for necessary screening were taken, but the prices asked 
were deemed excessive, and it was decided to secure new bids from 
manufacturers of Avire cloth in the Eastern States. As a result, the 
screening was purchased at a cost of over $800 less than the original 
bids. 

On July 1, 1909, a part of the personnel of the station took up 
their jDermanent residence there to get the station in final shape for 
the admittance of patients. This force has installed the necessary 
furniture and apparatus, and engaged in clearing the grounds of 
debris, brush, and bowlders. 

While these preparatory steps for the opening of the station have 
been under way the time has been utilized also in carrying on the 
scientific investigations. In the annual reports for 1907 and 1908 
reference was made to provisions for the study of incipient cases as 
a part of the general investigation. This work has been actively 
carried on during the past year, and the results obtained are repre- 
sented in the scientific publications which have been prepared and 
issued and to which reference has previously been made. These 
reports are a forecast of the larger problems which will be investi- 
gated when the station is in complete operation. 

The advantages of the investigations of incipient cases will con- 
tinue to exist even after the main station is opened, as such cases 
present the best opportunity for the study of early methods of diag- 
nosis and means of relief. Such cases are utilized in studies on com- 
plement fixation tests in leprosy ; studies of the pathological anatomy 
of the nasah cavity in leprosj^; in treatment of incipient cases of lep- 
rosy with tuberculin, atoxyol, strychnine, chaulmoogra oil, and cinna- 
mate of soda; in examination of the urinp of lepers for acid-fast 
bacilli; and attempts are being made to grow the lepra bacillus on 
several media. 

On the other hand, experiments on animals and such' other work as 
requires large amounts of leprous material can best be carried on at 
the station on Molokai where the service has full control of the 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 67 

patients under its care. Both lines of investigation are of impor- 
tance, each assists the otlier, and together they form a comprehensive 
plan that should bring about results for which the investigation was 
begun. 

The many problems that leprosy presents have for convenience been 
grouped into two classes : 

The first group includes four important problems, namely : The 
growth of the lepra bacillus on artificial media ; the successful inocu- 
lation of the lower aniinals; the discovery of a substance analogous 
to tuberculin, of use as a remedial or diagnostic agent ; the discovery 
of the usual mechanism whereby the infection spreads from one 
person to another. 

In the second group are included lesser problems that step by step 
acid to our knowledge of the disease, and while not apparently of 
so great immediate importance, yet may indicate the path that leads 
to the solution of the greater problems mentioned. 

The investigations inaugurated have for their primary object the 
solution of the greater problems mentioned, but it is realized that 
scientists in many lands have sought in vain for their solution, and 
years may elapse before success is attained. 

If, however, efforts were thus confined, the station might continue 
its work for years without obtaining results worthy of publication, 
and the greatest utility to the sanitary and scientific world would 
not be subserved. Every effort will therefore be made to throw all 
possible light on different phases of the leprosy problem, and it is 
expected that results will be obtaned from time to time that permit 
of positive opinions and announcements. 

With a well-equipped station and laboratory, an abundance of 
clinical material, and a well-trained corps of scientific workers, it is 
reasonable to expect that interesting and useful knowledge bearing 
on leprosy will be obtained. 

Leprosy hulletins.- — Two brochures, each entitled " Studies upon 
Leprosy," have been issued from the station during the past fiscal 
year. In the first bulletin the author deals with : First, " The present 
status of the leprosy problem in Hawaii ; " second, " The reaction of 
lei^ers to Moro's ' percutaneous' test; " third, "A note upon the pos- 
sibility of the mosquito acting in the transmission of leprosy." From 
these studies it is concluded that the leprosy problem in Hawaii calls 
for more thorough enforcement of the laws of segregation, and that 
the field for the study of leprosy furnished by the Territory of 
Hawaii is unsurpassed, and merits the most painstaking efforts to 
utilize it to the utmost. The percutaneous tuberculin test of Moro 
is shown to be of no value in the differential diagnosis of leprosy and 
tuberculosis. The studies of the mosquito do not permit of a positive 
statement that this'insect functions in the transmission of leprosy, and 
the probabilities are against such mode of transmission. 

The second brochure containing " Studies upon Leprosy " contains 
the results of investigations to determine the utility of the examina- 
tion of the nose and the nasal secretions for the detection of in- 
cipient cases of leprosy. 

The theory has been advanced that the nasal septum is the site of 
the initial h^sion in leprosy, and with the vicAv to determine its correct- 
ness these investigations were made. They included the examina- 
tion of 407 Ilawaiians, and have resulted in tentative conclusions to 



68 PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE. 

the effect that the examination of the nasal septum and the nasal 
secretions is not of dominant value in confirming the diagnosis of 
leprosy in the early , stages of the disease. At the same time, it is 
recognized that when it is not practicable to make a complete exami- 
nation of all individuals of a class suspected of leprosy, the examina- 
tion of the nasal septum and the bacteriologic examination of the 
nasal secretions will prove of value by permitting the recognition of 
a most dangerous type of the disease, and is therefore Avorth while 
even if it does not reveal all cases of the disease in those who come 
under observation. 

Care of Lepers in the United Sta'^tes. 

The great majority of the States and Territories in the continental 
part of the United States require the reporting and segregation of 
cases of leprosy, and classes the disease as dangerous and communi- 
cable. In some communities, however, the policy of reporting and 
segregation does not prevail, ^^^lile there are relatively few cases of 
leprosy in the continental United States, these are located in 13 
States, and there is evidence that they are not all segregated, nor is 
the country afforded the protection which it should have. In some 
States segregation is practiced, but in others there is no isolation or 
segregation, and in New York City, the largest city in the United 
States, with a congestion of population which would furnish good 
opportunities for transmission, segregation is not practiced. . Cases 
of leprosy are reported from time to time by state and territorial 
health authorities, with requests for advice as to their disposition. 
In the absence of national law providing for their care, the state 
authorities can only be advised that the care and segregation of such 
cases must devolve upon the State itself. Many of the States, on the 
other hand, have made no provision for such an exigency, conse- 
quently proper precautions can not be taken to protect the public 
health, and the victim of the disease is also made to suffer through 
lack of such provision. A bill was introduced in the Fifty-eighth 
Congress which contemplated the establishment by the National 
Government of a leprosarium for the segregation of lepers and to 
prevent the spread of leprosy in the United States. 

It is not necessary to review the arguments in favor of that measure, 
but there is still a demand for the authority which the bill provided. 

Second International Conference on Leprosy. 

The Second International Conference on Leprosy was held in 
Bergen, Norway, August 16-19, 1909, and Passed Asst. Surg. Donald 
H. Currie, director of the leprosy investigation station on Molokai, 
was designated as a delegate on behalf of the United States to the 
conference. 

With the view to presenting to the conference the status of leprosy 
in the LTnited States and its possessions at the present time, the bureau 
called for reports from the state and territorial health authorities 
as to the number of cases of leprosy in their jurisdictions and the 
methods of handling them. The data secured was compiled and incor- 
porated in a report which was prepared by Dr. W. E. Brinckerhoff, 
assistant director of the leprosy investigation station, for presentation 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 69 

before the above-mentioned conference. In this report it is shown 
that there are at present 139 cases of leprosy scattered over 13 States 
and the District of Columbia. It was also shown that there are at 
present 764 cases of leprosy in Hawaii, 17 in Porto Rico, 2,330 in the 
Philippine Islands, and 7 in the Canal Zone. The conference was 
also informed of the steps taken in the United States looking to the 
control of leprosy since the first leper conference, in 1897." Refer- 
ence was made to the exhaustive report on the origin and prevalence 
of lejirosy in the United States made by the commission of medical 
officers of the Public Health and Marine-Hospital Service, on Novem- 
ber 30, 1901, in accordance with the act of Congress approved March 
2, 1899. The attention of the conference was invited to the estab- 
lishment of the leprosy investigation station on the island of Molokai 
for the investigation of leprosy, with special reference to the care and 
treatment of lepers in Hawaii. This report also referred to the estab- 
lishment of a leper hospital and enforcement of segregation by the 
State of Massachusetts and the enactment of an adequate leper law 
in Hawaii and the Philippine Islands. 

In addition to matters of an administrative character in respect to 
leprosy, the conference also considered the disease from a scientific 
standpoint, and the following resolutions were adopted : 

EESOLUTIONS ADOPTED BY THE SECOND LEPKOSY CONFERENCE. 



I. The Second Internatioual Scientific Conference on Leprosy confirms in 
eA'ery respect the resolutions adopted by the First International Conference of 
Berlin, 1897. 

Leprosy is a disease which is contagious from person to person, whatever 
may be the method by which this contagion is effected. Every country, in what- 
ever latitude it is situated, is within tlie range of possible infection by leprosy, 
and may, therefore, usefully undertake measures to protect itself. 

II. In view of the success obtained in Germany, Iceland, Norway, and Sweden, 
it is desirable that other countries should isolate lepers. 

III. It is desirable that the children of lepers should be separated from their 
parents as soon as possible, and that they should remain under observation. 

IV. An examination should be made from time to time of those having lived 
with lepers by -a doctor having special knowledge. 

It is desirable that lepers should not engage in certain trades or occupations. 
All leper vagabonds and beggars should be strictly isolated. 



V. All theories on etiology and the mode of propagation of leprosy should be 
carefully examined to ascertain if they accord with our knowledge of the nature 
and biology of the bacillus of leprosy. 

The above resolutions are in harmony with the resolutions adopted 
by the First International Leprosy Conference held in Berlin in 
1897, which are as follows : 

1. In countries in which leprosy forms foci or has a great extension, isola- 
tion is the best means of preventing the spread of the disease. 

2. The system of obligatory notification and of observation and isolation, as 
carried out in Norway, is recommended to all nations with local self-government 
and a sufliclent number of i)liysiciaiiH. 

3. It should be left to the legal authorities, after consultation with the medical 
authorities, to take such measures as are applicable to the special social con- 
ditions of the districts. 

<* I'^or full ror)ort of the First Leper Conference, see Annual Report Marine- 
Hospital Service, 1897. 



70 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

PREVALENCE OF LEPROSY IN VARIOUS COUNTRIES. 

Following the opening of the leprosy conference at Bergen, Norway, 
in August, 11)01), certain official delegates presented their reports on 
the status of leprosy and the measures adopted against it in the 
countries they represented. Such reports were made from the fol- 
lowing countries : Germany, France, Russia, Austria-Hungary, Italy, 
Japan, Belgium, United States of America, and Argentine Republic. 

From the reports, and from other data furnished the delegates by 
the Norwegian Government, it appears that the following enumera- 
tion may be considered as a fairly accurate estimate of the number 
of cases of leprosy in the several countries mentioned. In stucljdng 
such data, however, the fact must be kept in mind that a compara- 
tively large percentage of lepers are not recognized in the early stages 
of the disease, and further that concealment of cases probably exists 
to a. greater or less extent in every country on the globe which adopts 
any measures looking to the isolation of such cases. 

Cases. 

France 24G 

Iceland 200 

Germany 28 

Boumani;! 208 

Servia 3 

Bulgaria 9 

European Turkey 550 

Greece 9 

Crete , 600 

Bussia 1, 372 

Italy 123 

Spain 240 

Palestine - 800 

India 97. 340 

Ceylon ^ 589 

Indo-Cliina 10. 500 

Java 15. 000 

Borneo 68 

Sumatra 896 

Japan 40. 000 

Canada 20 

Cuba - 1.297 

Jamaica 115 

United States of Colombia 4,152 

Argentine Bepublic 12. 000 

Algeria (in twenty-six years) 109 

United States of America : 

Mainland of America 146 

Hawaiian Islands 764 

Porto Bico 17 

Guam 19 

Philippine Islands 2. 330 

Canal Zone 7 

A full report of the Second International Conference on Leprosy 
was published in Public Health Reports September IT, 1909. 

Relations to the Fharmacopceia. 

DIGEST or comments. 

In the annual report for 1908, page G4, I'eference is made to resolu- 
tions adopted by the board of trustees of the United States Pharma- 
copceial Convention calling on the bureau to undertake the publication 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 71 

of a series of bulletins embodying digests of comments on the pharma- 
copoeia. This work was begun in the Division of Pharmacology of 
the Hygienic Laboratory, and the first digest of comments was com- 
piled and published during the fiscal year as Bulletin 49. In begin- 
ning the work it was decided to compile the material chronologically, 
so as to present the available comments in proper sequence. The 
above-mentioned bulletin, therefore, deals with literature of the latter 
half of 1905, representing the period from the publication of the 
Eighth Decennial Revision of the Pharmacopoeia to December 31, 
1905. 

The comments on Bulletin 49 are interesting and suggestive as 
indicative of current opinions regarding the future of this work and 
the development of the Division of Pharmacology. In most foreign 
countries the pharmacopoeia is a government publication, and its 
preiDaration is purely a governmental function. For eighty-five 
years the Pharmacopoeia of the United States of America has been 
by contrast a wholly private enterprise, compiled, developed, and pub- 
lished by members of a voluntary organization and attaining a legal 
status only gradually through the enactment of statutes by the several 
States which recognized its standards. Through recent national leg- 
islation this publication has become the federal standard, and the 
significance and far-reaching effects of this change of status are 
shown by the fact that within a year some revision of the pharma- 
copoeia was made necessary. The problem now to be facecl by the 
Government on the one hand and by the makers of the pharmacopoeia 
on the other is as to what shall be the attitude of each to the other 
with reference to what has been denominated " a sanitary institution 
of the first rank." 

It is altogether consonant with our ideals of a democratic form of 
government that the work already done has been welcomed as evidence 
that the relation of the Federal Government to the pharmacopoeial 
convention is to be that of cooperation without domination. 

The first volume of digests already published has been accepted by 
those interested as an expression of governmental interest in a volume 
of national consequence, and that such interest is second only to the 
legislative action making it the official standard in this country. 

A second digest of comments on the pharmacopoeia has also been 
prepared and submitted for publication as Bulletin 58 of the Hygienic 
Laboratory. This second bidletin covers the literature for the calen- 
dar year ended December 31, 1906. This period was one of unusual 
interest and activity in matters relating to the Pharmacopoeia of the 
United States. The epactment of the Food and Drugs Act, June 30, 
1900, followed by the signing on November 29, 190G, of an agreement 
by the United States and other powers regarding the unification of 
the pharmacopceial formulas for jootent drugs by a diplomatic repre- 
sentative of the Federal Government involves the evolution of an 
independent, more or less local, and purely academic book into a 
recognized legal standard for the development of whieli the Govern- 
ment has incuiTOfl treaty obligations of an international character. 

Since the Pliarmjico])rx'iii of the United Stat(^s nnd the National 
Formnlaiy have become legal standards the nieflicaments to be in- 
corporated must rec(^ive careful study and the collection of disinter- 
(^stcnl information. Tliis is nec(^sHary, inasmuch as not only powerful 
financial interests but the maintenance of tlu; juiblic heaJtli are in- 



72 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

volved. In accordance with the resohition adopted by the American 
Pharmaceutical Association, to which reference Avas made in the 
annual report for 1908, page 65, the second digest of comments that 
has been prepared related also to the National Formulary. In the 
work of compilation it was necessary to have access to as many rep- 
resentative pharmaceutical and chemical periodicals as possible.^ This 
has been difficult to arrange, but through the action of the trustees of 
the pharmaceutical convention and the courtesy of librarians of cer- 
tain colleges access has been had to the more important publications. 
Access has also been had to the reports of state boards of health and 
laboratory reports of some manufacturing establishments. These re- 
ports, in addition to calling attention to the kind of adulteration and 
substitution in vogue, also demonstrate the need for constant watch- 
fulness to insure the purity of therapeutic remedies. 

It becomes more and more evident that the material compiled and 
placed at the dis]30sal of the pharmaceutical convention and others 
interested will be of great value as a source of information for use 
in the correction of standards and the right of the various remedies 
to official recognition. 

INVESTIGATION OF REMEDIES. 

Besides the comj^iling and publication of a series of comments, 
there is also a great deal of important work to be done in relation to 
the remedies to be incorporated in the pharmacopoeia, and the chair- 
man of the revision committee has advocated the carrying on of such 
work in a government proving laboratory. The necessary test for 
the identity and purity of official remedies should be elaborated by 
workers who are free from the stress of commercial self-interest and 
competition, and such work can be carried on in the Hygienic Labora- 
tory, where the methods of making official preparations of official 
drugs and the standardizing of such preparations when so made 
should also be done. 

Much work has been carried on in the Division of Pharmacology 
(Hygienic Laboratory) in relation to therapeutic remedies that has 
tnrown additional light on the strength and value of the prepara- 
tions studied. As a result of this work and in view of the coming 
pharmaceutical convention, the chairman of the committee of revi- 
sion, in a letter of March 27, 1909, requested that some additional 
work be undertaken bearing on the determination of melting points 
and boiling points in the pharmacopceia. He pointed out that the 
melting point and boiling point of the various substances contained 
in the present pharmacopoeia had not all been determined by the 
same method, and that chemists and physicists were not united on 
the best and simplest means of determining these factors. He stated 
that there was necessity for a uniform method for taking the melting 
point and boiling point, and requested that tests be made, and that 
comparative tables be prepared for use in the next revision of the 
pharmacopoeia. It was decided, with the approval of the Secre- 
tary, to undertake this work, and investigations are now in progress 
with the view to the determination of the physical constants of phar- 
macopoeial substances, which include boiling points, melting points, 
and solubilities, 



PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 73 

The results of investigations into the relation of the iodine content 
to the physiologic activity of thyroid preparations, the physiological 
standardization of suprarenal preparations, and such drugs as digi- 
talis, the toxicity of acetanilid mixtures, and the standardization of 
antitetanic serum, which have been published, should be of value 
to members of the pharmacopeial convention. 

Through scientific research, an extensive series of new compounds 
of the choline type have been made in the Hygienic Laboratory and 
studied from a toxicologic standpoint. Some of these are physi- 
ologically very active, and give promise of being of use therapeuti- 
cally, while others are closely related to substances occurring normally 
or abnormally in the body, and may prove of interest in relation to 
health and disease. 

COUNCIL ON PHARMACY AND CHEMISTRY, 

Closely related with the work of the service in connection with the 
United States Pharmacopoeia is its cooperation with the American 
Medical Association of the work of the Council on Pharmacy and 
Chemistry, four of whose members are government officials, two of 
them in the Division of Pharmacology. In addition to the routine 
work carried on in connection with the council with reference to the 
general question of new remedies, it has been shown in the Division 
of Pharmacology that digalen, a preparation of world-wide use, under 
certain conditions, becomes inert. There has also been demonstrated 
the variability of the extremely potent suprarenal preparations. It 
has also been shown that some of the preparations used to increase 
the utilization of food actually contained thyroid having opposite 
actions to those claimed. Many unofficial drugs which have been 
used to a greater or lesser extent, some of them official at one time or 
another, are being studied with a view to determining whether they 
are of sufficient merit to justify therapeutic use. 

Milk and Its Relation to the Public Health. 

In the last annual report reference was made to investigations of 
milk and the incorporation of the results in Hygienic Laboratory 
Bulletin No. 41. The first edition of this bulletin, which was issued 
January, 1908, has proven of great value to health officers and others 
interested in improving milk supplies, as was shown by the enormous 
demand throughout the world for copies. The first edition was long 
since exhausted, and it therefore became necessary to publish a second 
edition. On account of the short time since the first edition appeared 
and the character of some of the data relating to the investigations, 
especially that contained in the statistical table, it was impracticable 
to include corresponding statistics for the year 1908. The limitations 
of the volume have also prevented the inclusion of chapters relating 
to certain milk products, but it is expected that these subjects will be 
given consideration in later publications. Important chapters, how- 
ever, were added in the new edition bearing on the relationship of 
the tuberculous cow to public health; the thermal death point of 
micro-organisms in milk; the relative pro])ortion of bacteria in 
tojj milk and bottom milk, its beaj'ing on infant feeding; and the 
national inspection of milk. This bulletin illustrates several points 



74 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

worthy of mention. It demonfitrates the possibility of the various 
departments of the Government cooperating in public-health mat- 
ters, and sets a precedent for similar work in the future. 

There are many other subjects relating to the public health, such 
as air, water, sewage, disposal of wastes, soil pollution, industrial 
hygiene, disinfectants, the hygiene of habitations, and personal 
hygiene, which could be treated in a similar way and which would 
be of distinct value. 

The Rat and Its Relation to the Public Health. 

On account of the influence of the rat in the transmission of 
plague, this animal must be taken into account more and more in 
the prevention of the introduction of the disease from one country 
to another, and its suppression in endemic areas. 

Rats, like man, are great travelers, and by reason of this fact also 
they give rise to economic as well as public-health problems of great 
moment. Some idea of their danger in transmitting plague may be 
had when it is remembered that 51 countries have been infected with 
the disease since the present pandemic began in Canton, China, in 
1894, and when it is known that at least 14G ships have had plague 
infection aboard during that time. 

Recent outbreaks of plague and investigations made in relation 
thereto have brought out many valuable facts regarding the habits 
of the rat, the parasites that infest him, the diseases from which he 
sulfers, and the measures necessary to his control. The appearance 
of plague in hitherto uninfected centers has also emphasized the lack 
of definite knowledge of this animal on the part of public-health 
officials. It has been shown by the British Plague Commission that 
plague among rats can be readily diagnosed from the gross patho- 
logical appearances by persons having experience, and that this is 
even more reliable than the bacteriologic findings. These facts have 
been confirmed by officers of the Public Health and Marine-Hospital 
Service engaged in antiplague measures, and, in addition, rats have 
been observed to suffer with other diseases, and with the view to 
aiding in the differential diagnoses of the various pathological con- 
ditions studies of the subject have been made. 

On account of these facts the bureau has taken steps to have issued 
a bulletin entitled " The Rat and Its Relation to the Public Health." 
The bulletin will include chapters on " The natural history and habits 
of the rat," " The relation of rats to bubonic plague," " The ecto para- 
sites of the rat," " The ento parasites of the rat," " The rat and its 
relation to trichinosis," " The bacterial diseases of the rat," " Plague 
among rats," " Organic diseases of the rat," " Leprosy-like disease 
of the rat," " Rat fleas in relation to the transmission of plague," 
" Rat extermination," " Practical rat proofing," " The rat as an 
economic factor," " The natural enemies of the rat," " Bacterial 
viruses and their use in rat extermination," " Rats in relation to 
ships and shipping," and " The rat in relation to international sani- 
tation." 

It is expected that the bulletin will be of value to public health 
officials and others engaged in the prevention of diseasej and contain 
data upon which may be based future regulations and measures for 
, the prevention of the transmission of diseases through this agency. 



public health and marine-hospital service, 75 

Alaska- Yukon-Pacific Exposition. 

In a letter of September 22, 1908, the representative of the Treasury 
Department on the United States Government board of managers 
of the Alaska-Yukon-Pacific Exposition requested that an officer 
be designated to cooperate with that office in the preparation and 
assembling of a suitable exhibit of the service as a i)art of the exhibit 
of the Treasury Department, In accordance with this request, Asst. 
Surg, Gen. J, W, Kerr was designated to assemble an exhibit with 
the aid of other officers of the service. 

The floor space set aside for the service exhibit was approximately 
1,500 square feet, and $1,000 was made available for the use of the 
bureau in preparing the exhibit in question. On account of the small 
amount of money available it was necessary to use practically the 
same exhibit as was shown at the Jamestown Exposition, and this 
could be done with advantage, as the materials had never been shown 
in the northwestern States, The part of the original exhibit used 
included the following: 

An operating room with lay figures. 

An operating room and furniture. 

A hospital ward with furniture. 

Clinical records and hospital appliances. 

Laboratory apparatus and an X-ray outfit. 

Models of quarantine stations. 

Models and photographs of the Marine-Hospital Sanatorium at 
Fort Stanton, N. Mex., and 

An exhibit of viruses, serums, and toxins prepared in establish- 
ments licensed under the law of July 1, 1902. 

The additions made to the exhibit included also models and charts 
relating to tuberculosis. Through Passed Asst. Surg. G. W. McCoy 
and Passed Asst. Surg. W. C. Rucker were added educational models 
illustrative of the work done by the Public Health and Marine-Hos- 
j)ital Service in suppressing epidemic diseases. These included a 
model of a house screened against the mosquitoes that carry yellow 
fever and malaria ; the model of a section of an insanitary house 
showing drainpipes and rat-harboring places, and the influence of an 
unhygienic garbage barrel in attracting rats; taxidermal groups of 
the California ground squirrel, which is also a carrier of plague infec- 
tion, and its natural enemies, and pathological specimens showing 
changes in the organs and tissues of rodents due to bubonic plague. 
The exhibit was completed and ready for shipment to Seattle March 
15, 1909. On April 30, 1909, Passed Asst. Surg. M. W. Glover was 
placed in charge of the exhibit. 

It was arranged to have stereopticon lectures given on tuberculosis, 
typhoid fever, hookworm disease, yellow fever, and plague, and the 
necessary slides relating to each of these diseases were prepared and 
forwarded to Doctor Glover to enable him to prepare the lectures 
which he Avas to give. In order to provide for proper demonstration 
of the other parts of the exhibit, including the X-ray machine. Dr. 
J. C. McGuire was appointed by the representative of the Treasury 
Department to assist Doctor Glover in this work. 

In making the appropriation for the government exhibit Congress 
specififjilly provid(Ml that the exhibit in question should inchute an 
exposition of the munifold activities in the preservation of the pub- 



76 PUBLIC HEALTI-I AND MARINE-HOSPITAL SERVICE. 

lie health. The service exhibit was planned with this end in view, 
and the comments made indicate that it has been of great educational 
value. The display illustrating the measures taken in times of epi- 
demics for the suppression of yellow fever and plague was especially 
instructive. The taxiclermal groups, pathological specimens, and 
models of insanitary dwellings were all interesting because of the 
fact that rats and ground squirrels are known to act as carriers of 
plague, and on the Pacific coast as well as elsewhere, great care is 
necessary on the part of the householder to render his dwelling rat- 
proof and otherwise sanitary. 

Public health exhibits are becoming a popular means of disseminat- 
ing sanitary information, but in order that they may fulfill the pur- 
pose for which they are designed, they should embody practical 
ideas, and there should in future be provided sufficient funds and 
time in which to construct them. 

Aid in Enforcing Proper Use of the Mails, etc. 

In accordance with a request received from the Postmaster-General, 
an opinion was given to the effect that the use of the mails should 
also be extended to private laboratories as was the case with national, 
state, and municipal institutions. To this end it Avas recommendecl 
that all pathological tissues, except cholera and plague, be admitted 
to the mails under regulations prescribed by the Post-Office Depart- 
ment. Subsequent opinion on this same subject was given April 5, 
1909, which stated that modified rules governing this subject were 
necessary and reasonable, and stating that the maximum size of 
sputum jars should be 4 drams, and test tubes to be sent in the mails, 
to be of tough glass not over one-half inch in diameter, and not over 
3^ inches in length. 

In addition, opinions have been rendered to the Post-Office De- 
partment regarding the therapeutic value of certain appliances adver- 
tised for the cure of diseased conditions. 

Examinations have also been made of a number of preparations 
advertised as disinfectants, and reports made thereon to the Secretary 
of the Treasury regarding their germicidal properties and adapta- 
bility for use in public buildings. 

Special Studies in Laboratory, Bureau of Fisheries, Woods Hole, 

Mass. 

In a communication of April 21, 1909, Passed Asst. Surg. Joseph 
Goldberger referred to the recent discovery of a case of fatal infec- 
tion of a man in Florida with Sparganum proliferum^ a parasite re- 
ported and described in Hygienic Laboratory Bulletin No. 40, and 
invited attention to the total lack of knowledge of the method of 
transmission of this fatal disease and a suggestion in said bulletin 
that the eating of fish may play a role in its spread. 

The practical importance of the study of this new disease was 
apparent, and also that it should be carried on in a laboratory con- 
taining material and where studies of the cestocles of fi^h, which had 
been begun, could be continued. On account of the advantages 
offered for such studies in the Marine Biological Laboratory of the 
Bureau of Fisheries, at Woods Hole, Mass., the Commissioner of the 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 77 

Bureau of Fisheries was requested to extend the facilities of this lab- 
oratory. This was granted, and Doctor Goldberger was detailed for 
a period of eight weeks, beginning June 25, 1909, at Woods Hole, to 
make investigations of the parasites of fish, to study living specimens, 
and in addition to fix and preserve for later study in the Hygienic 
Laboratory such specimens as he might be able to obtain. A consid- 
erable amount of material was prepared and forwarded to the Hy- 
gienic Laboratory for future studies. 

The Hygienic Laboratory. 

The operations of the Hygienic Laboratory have been continued 
as in previous years, and some new problems have been taken up for 
investigation. This institution, which has been in existence for 
twenty-two years, is established on a solid foundation and has shown 
rapid but substantial development. That there is necessity for the 
maintenance of this laboratory is shown by the demands made upon 
it by Congress and the administrative departments of the Govern- 
ment and state and local health agencies. 

The view that the work of the Hygienic Laboratory should be 
extended is strengthened by the growing demands made upon it. 
Research work in the sanitary sciences is one of the foundations upon 
which all wise sanitary administration must stand, and through this 
means the Federal Government can concern itself with problems of 
interstate sanitation, and in addition cooperate with state and local 
health authorities and improve sanitary administration in different 
j)arts of the country. 

It is neither necessary nor desirable that every community should 
have a complex and expensive laboratory capable of dealing with all 
public-health problems. This would mean much unnecessary dupli- 
cation of work. Small communities can not be expected to carry on 
systematic and extensive work of a research nature, or even handle 
sanitary problems of an unusual or highly specialized nature. 
Through its Hygienic Laboratory, however, the Federal Government 
can cooperate in the solution of such problems, and the dissemination 
of information in relation thereto is thus made available to the 
country as a whole. 

When the present site of the Hygienic Laboratory was selected 
doubts were expressed as to the wisdom of building an institution in 
such an out-of-the-way and unhealthy locality. The neighborhood 
in which the laboratory is situated had long been regarded as an 
unhealthy part of the city. Since that time, however, conditions 
have changed, the malarious flats have been transformed into a beau- 
tiful reservation known as Potomac Park, and the improvements in 
the neighborhood have made it a notable situation in many respects. 
When the contemplated improvements shall have been made it will 
be one of the most conspicuous and inviting reservations in the 
District. 

BnildincjH and grounds. — The crowded condition of the first build- 
ing, which was occupied in 1903, was greatly relieved by the com- 
pletion of the addition to the Hygienic Laboratory in the fiscal year 
covered by this I'eport. Steps were taken to occupy the new addition 
in January, 1909, the furnitiin! having been installed in the new 
rooms as they were completed by the contractor. 



78 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

The Hygienic Laboratory now occupies a building 230 feet long 
containing 41 rooms. It is two stories in height with a basement 
and attic. 

In addition, an animal house of brick and cement for the investi- 
gation of special problems in relation to contagious and infectious 
diseases has been constructed on one corner of the reservation. This 
building is 52 feet long by 25 feet wide, and contains a keeper's 
room besides six rooms for experimental work. The construction 
and equi])ment of this building is specially designed to prevent the 
spread of infection. It is surrounded by a brick and cement wall 
which contains a crematory where all refuse may be burned. 

There are three other buildings upon the reservation; one is a 
wooden structure used for the raising of guinea pigs ; another a stable 
in which the horses, goats, rabbits, and other animals are kept; and 
finally, a shed for wagons and general storage, a room for conducting 
disinfecting experiments with gaseous substances, and a carpenter 
shop. These three structures were built some years ago of very 
cheap material and were intended for temi:>orary use only. They are 
small wooden structures, and because of their close proximity to other 
buildings are a constant source of danger from fire. x\ll three build- 
ings are going to decay, and the roofs, wdiich are of shingle, will soon 
be in need of extensive repair. Such repairs would involve an ex- 
penditure that would not be justified, and the interests of the Gov- 
ernment in efficiency and economy will best be conserved by their 
demolition and the construction of a new brick building of adequate 
size. 

Practically all of the animals used in the laboratory are raised 
there, man}^ of them being required in the examinations of viruses, 
serums, and toxins, in conformity with the law of Julj^ 1, 1902. These 
animals are very susceptible to extremes of temperature, and will 
not breed rapidly unless properly protected from cold. On account 
of the dilapidated condition of the wooden buildings referred to 
it has been exceedingly difficult during the past j^ear to heat them 
and maintain the proper temperature. They are not rat proof, and 
are incapable of thorough disinfection. On this account epidemics 
occurred last sjoring among the laboratoiy animals which resulted 
in the loss of almost half of the stock. This loss from a monetary 
standpoint was considerable, and in addition it caused interruption 
to the experimental work. 

For the above reasons the present frame structures should be de- 
molished and their places taken by a new building constructed of 
brick and cement, so as to render it rat proof and capable of disin- 
fection and proper heating. In view of these facts estimates were 
made and submitted providing for the construction of a stable and 
animal house on the reservation to cost $25,000. 

An estimate for grading and the construction of a retaining wall 
was also made, as such improvement is necessary in order to put the 
grounds of the Hygienic Laboratory in such condition as to make 
them in keeping with the buildings and surrounding properties. The 
grounds at the present time are unsightly, and there is necessity for 
the construction of a retaining w^all on the east boundary of the reser- 
vation to prevent the caving in of the embankment on that side and 
resulting damage to the laboratory building itself. A low retaining 



PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 79 

wall is also necessary for a portion of the western boundary of the 
I'eservation to prevent continued washings on that side. The southern 
IDortion of the reservation has a considerable slope, which is also sub- 
ject to washings that can only be prevented by, proper terracing. 
Such imiDrovements will put the reservation in keeping with the 
adjoining reservation of the Navy Department. 

\Vliile the laboratory now possesses unexcelled facilities for the 
investigation of infectious and contagious diseases and matters per- 
taining to the public health, all the space is occupied and there is 
already overcrowding. An additional wing will soon be required. 

Personnel. — The personnel of the Hygienic Laboratory now con- 
sists of the director and assistant director, 3 chiefs of divisions, 8 
commissioned medical officers, 2 pharmacists, 11 technical assistants, 
an artist, and 28 attendants, making a total of 55. 

This number of workers is barely sufficient to handle the large 
volume of work involving investigations already undertaken. It is 
expected that the laboratory staff will have to be increased to meet 
the demands made upon it. Much of the work in the laboratory is 
of a routine and difficult nature, and its performance often requires 
considerable self-sacrifice, which has been made. The productiveness 
of the laboratory during the past fiscal year is shown in the reports 
£ind publications issued, and which are referred to elsewhere in detail. 

Dangers of the work. — In the last ten years the laboratory has 
experimented much with some of the most virulent infections known 
and has worked with tetanus toxin, diphtheria toxin, and other strong 
poisons in wholesale lots. Fortunately no accidents have taken place. 
Particular record of this fact is made because it has alw^ays been a 
matter of concern to the director, who feels the responsibility for the 
safety of the personnel, as well as the efficiency of the work. 

During the period mentioned two cases of typhoid fever have 
occurred which were in all probabilitv contracted in the laboratory — 
Passed Asst. Surg. G. W. McCoy andAsst. Surg. William Whitfield 
Miller. Both of these officers at the time were working upon a large 
number of specimens of typhoid material. The case of Doctor Miller 
is particularly sad, as it resulted in death, cutting short the jDromise 
of a brilliant career. Doctor Miller had already distinguished him- 
self by his first piece of research work. This consisted in the dis- 
cover}^ of a new parasite {Hepatozoon perniciosum) , the complete life 
cycle of which he unraveled. 

The lahoratory ., a school of instruction for student officers and 
others. — Perhaps one of the most important functions of the Hygienic 
Laboratory is the training of student- officers, health officers, and 
others in the fundamentals of the sanitary sciences. Since its con- 
ception the course of instruction has been greatly broadened and 
made much more practical. It now includes animal parasitology, 
with special reference to the public health; the chemistry of milk, 
water, and the detection of preservatives and adulterants; and phar- 
macology, with particular reference to the pharmacopoeia and drug 
standardization. In cooperation with the city health officer and 
other departments of the Government it coidd of course readily be 
enlarged and widened so as to conform with the requirements and 
objects of the school for health officers proposed in the public-health 
bill now before Congress. 



80 PUBLIC HEALTH AND MAETNE-HOSPITAL SERVICE. 

During the past ten years 37 service officers have either taken this 
course of instruction or have been awarded the facilities of the 
laboratory. 

Journal cluh. — The journal club, which was organized in 1902, 
continued its seminars with few intermissions throughout the fiscal 
year. Attendance upon these meetings is entirely voluntary, but 
there is rarely an absentee. 

The conferences have been stimulating and instructive and the 
officers have presented valuable reviews of the important articles 
which appear in the literature. 

C ooperation with other hranches of the government service. — Again 
this year, as in previous years, Dr. Ch. Wardell Stiles, Chief of the 
Division of Zoology, gave a course of lectures and demonstrations 
upon animal parasitology to the student officers of the army and the 
navy medical schools, and also to various educational associations. 

The director of the laboratory repeated his course of lectures to 
the Naval Medical School upon the subjects of quarantine, antitoxins, 
vaccines, disinfection, immunity, and allied topics ; and further, gave 
a course of lectures upon tropical diseases to the senior students of 
the Georgetown Medical School. 

In other ways the laboratory cooperated with various branches of 
the government service, more particularly the Bureau of Animal 
Industry, Experiment Stations, Bureau of Chemistry, and the Bureau 
of Standards. 

Scienti-ft.c investigations. — The scientific work in the several divi- 
sions of the laboratory during the fiscal j^ear has included the fol- 
lowing: The investigations of viruses, serums, and toxins; prepara- 
tion and distribution of the standard unit for antidiphtheric serum 
and the standard tetanus toxin; investigations of rabies and treat- 
ment of persons bitten by rabid animals; examinations of milk and 
water ; investigations into the origin and prevalence of typhoid fever 
in the District of Columbia; studies of tuberculosis; investigations 
of foot-and-mouth disease; investigations of pellagra; testing of 
antiseptics and germicides; studies of anaphylaxis and immunity; 
examinations of pathological specimens; cooperation with the Inter- 
national Commission of Zoological Nomenclature; cooperation with 
the Bureau of Animal Industry; the preparation of the index cata- 
logue of medical and veterinary zoology ; determinations of zoological 
specimens ; studies of hookworm disease and soil pollution ; investiga- 
tions of pharmaceutical preparations ; research work in relation to 
digitalis; suprarenal preparations; thyroids; acetanilid mixtures and 
choline derivatives; cooperation Avith the Council of Pharmacy and 
Chemistry in the sutdy of new remedies; chemical analyses, and 
chemical research. 

Detailed reference has already been made to the work of the 
Hygienic Laboratory in relation to some of the above-mentioned 
investigations which have been discussed under appropriate headings. 
In addition it is necessary to refer in detail to the work of the several 
divisions. 

DIVISION or PATHOLOGY AND BACTERIOLOGY. 

Exa7ninatio.ns of viruses., serums^ and toxins. — In addition to the 
testing of antidiphtheric serum, antitetanic serum, and vaccine virus a 
number of samples of antistreptococcic, antistaphylococcic, antigono- 



PUBLIC HEALTH AND MAEINE-IIOSPITAL SERVICE. 81 

coccic, antimeningococcic, and antiplague serums were examined in 
the laboratory under instructions from the bureau preliminary to the 
licensing of various firms for these products. As there is no accept- 
able standard at the present time for any of these sera they are only 
examined for purity and freedom from bacteriological or toxic con- 
tamination, amount of preservative, and correct labeling. If further 
results with antidysenteric and antimeningococcic sera should show 
that they are of undoubted therapeutic efficiency, efforts will be made 
in the laboratory to prepare a standard for these sera. The assistant 
director has studied the influence of concentration by the Gibson proc- 
ess upon the presence of tetanus toxin in blood serum. It has long 
been known that the blood serum of animals, during the period of 
incubation of tetanus, contains large amounts of tetanus toxin, and a 
study was undertaken to determine whether this toxin was eliminated 
by the Gibson process or whether it went with the antitoxic fraction. 
It was found that the latter was the case. A preliminary paper upon 
the subject was prepared and permission obtained from the bureau 
for its publication. 

Antiseptics and disinfectants. — During the year a number of dis- 
infectants were examined and reports made thereon. The examina- 
tion of a large number of commercial disinfectants was undertaken 
in the laboratory by Passed Asst. Surg. G. W. McCoy, but on account 
of his detachment from the laboratory for duty in San Francisco 
this work was interrupted. His preliminary experiments showed that 
many of the commercial disinfectants which have a l^rge sale are 
practically useless as disinfectants, and on account of the great public 
health importance of this fact it is hoped that this work may be 
completed during the ensuing fiscal year. 

Examinations of water. — From July 1, 1908, to July 1, 1909, over 
500 samples of city water were examined in connection with the study 
of the prevalence of typhoid fever in the District of Columbia. A 
number of samples of well, spring, and river water were examined 
upon request of the District health officer and various other persons. 

It is intended during the ensuing year to make a study of the 
various organisms that are usually found in Potomac River water 
and to study the symbiosis of the typhoid bacillus with these various 
organisms isolated from the water ; also, in connection with the study 
of typhoid fever in the District of Columbia, various methods will be 
employed in an effort to isolate the typhoid bacillus, from the raw 
water. 

Studies upon anaphylaxis and immunity. — During the year the 
director and assistant director continued their studies upon ana- 
phylaxis and its relation to serum therapy, and the results of their 
studies were embodied in a manuscript for publication in the month 
of April. 

It was found that the various proteins, when dried, could be 
heated to high temperatures without affecting to any appreciable de- 
gree their anaphylactic properties. This bulletin is the fourth one 
submitted by these authors upon the subject of anaphylaxis, a subject 
which has received wide uolico?. 

Examination of paiholof/ical specimens. — A number of patholog- 
ical specimens were submitted to the laboratory by various service 

18546—10 6 



82 PUBLIC HEALTH AND MAEINE-HOSPITAL SEEVICE. 

stations for examination and report. Reference is again made to the 
great importance of officers sending specimens to the laboratory for 
determination, for two reasons: (1) The laboratory is entirely de- 
pendent upon outside sources for its pathological material; and (2) 
the examination of these specimens is of much benefit to the officers 
who are at the laboratory undergoing special instruction. 

Experimental pathology. — Studies in the line of experimental 
l^athology have been crowded into the background by the press of 
work in bacteriology, serum therapy, and allied topics. Pathology, 
from the chemical and experimental side, offers a large field of re- 
search having reference to public health work, and should be given 
more consideration than has heretofore been possible. The director 
recommends that one or two- of the younger officers of the service 
who show an inclination in this direction be permitted to take a 
course of instruction in this subject at Baltimore, Boston, and New 
York for the purpose of carrying on this work in the laboratory. 

Miscellaneous reports and papers. — In addition to the bulletins 
covering research work done in the Division of Pathology and Bac- 
teriology the following shorter articles have been published on work 
done in this division: 

" Further studies upon anaphylaxis," by M. J. Eosenau and John 
F. Anderson. (Journ. Med. Res., July, 1908, p. 37.) 

" Special report — -preliminary note of a new pathogenic hemo- 
gregarine, Ilepatozoon perniciosum, found in white rats in Wash- 
ington, D. C," by William W. Miller. (P. H. R., vol. 23, July 24, 

1908, p. 1070.) 

" What is meant by a disinfectant and how to avoid contamination," 
by John F. Anderson. (Proc. 5th Ann. Confer. Embalmers' Exam. 
Boards, Oct. 2, 1908.) 

" Recent advances in the study of tvphoid fever," by M. J. Rosenau. 
(Proc. Am. Scientific Congr., Santiago, Chile, Dec. 25, 1908.) 

" The viability of the tubercle bacillus," by M. J. Rosenau. (Proc. 
Internal. Cong." Tub., Washington, 1908.) 

" The amount of infection and reasonable sanitary standards," by 
M. J. Rosenau. (Journ. Am. Med. Assn., vol. 52, Jan. 9, 1909, p. 128.) 

" Further studies upon the phenomenon of anaphylaxis," by M. J. 
Rosenau and John F. Anderson. (Journ. Med. Res., Vol. XXI, 

1909, p. 1.) 

" Thermal death points of milk bacteria and other effects of heat 
upon milk," by M. J. Rosenau. (Pediatrics, N. Y., vol. 20, Sept., 
1908.) 

" Report of a case of hydrophobia," by John F. Anderson and 
Joseph Goldberger. (Med. Rec, June, 1909.) 

" The Public Health and Marine-Hospital Service," by M. J. Rose- 
nau. (Med. Rec, Apr. 24, 1909.) 

" Federal control of the manufacture of therapeutic sera," by John 
F. Anderson. (Am. Journ. Pharm., vol. 81, Apr., 1909, p. 181.) 

" The relative proportion of bacteria in top milk and bottom milk 
and its bearing on infant feeding," by John F. Anderson. (Journ. 
Infec. Dis., vol. 6, June 12, 1909, p. 392.) 

"The influence of the ingestion of dead tubercle bacilli upon infec- 
tion," by M. J. Rosenau and John F. Anderson. (Journ. Infec. Dis., 
vol. 6, June 12, 1909, p. 387.) 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 83 

" The prevalence of pellagra in the United States — a statistical 
and geographical note, with bibliography," by C. H. Lavinder, C. F. 
Williams, and J. W. Babcock. (P. H. R., vol. 24, June 18, 1909, 
p. 849.) 

THE DIVISION OF ZOOLOGY. 

The Division of Zoology of the Hygienic Laboratory was estab- 
lished on August 1, 1902, when Dr. Charles Wardell Stiles was ap- 
pointed chief .of the division. At the time of the appointment the 
Hygienic Laboratory was not fully completed and equipped, so that 
the work of the division was carried on in the laboratory of the 
Division of Zoology of the Bureau of Animal Industry of the Depart- 
ment of Agriculture. On June 1, 1903, the division moved to the 
third floor of the Georgetown Medical School, where it remained 
until the completion of its permanent quarters in the Hygienic 
Laboratory in March, 1904. Upon completion of the new extension 
of the laboratory in 1909, the division again moved into its present 
quarters in the central part of the first floor. 

Since the organization of the division its most striking work has 
been in the study of uncinariasis (hookworm disease) in the South 
Atlantic States. Bulletin No. 10 gives the result of the first adequate 
study of this disease in the United States, when a prolonged trip 
was made by the chief of the division through the South in 1902. 
Since then the division has been in constant communication with 
Southern State boards of health and numerous physicians, aiding in 
the spread of the knowledge, cure, and prevention of this disease. 

The presence of intestinal parasites among the insane has been 
determined and reported in Bulletin No. 13. About 4,000 patients 
were examined in various hospitals with interesting results. 

Owing to the large number of specimens of Hymenolepis nana and 
its allied species that were being constantly sent in to the division 
for identification. Bulletin No. 18 was prepared, showing the preva- 
lence of this parasite in the United States. 

The finding of Opisthorchis sinensis and Paragonimus westermanii 
in the Pacific States called the attention of this division to the pos- 
sibility of trematode diseases in the United States. As a result 
Bulletin No. 17 was prepared, being an " Illustrated key to the trema- 
tode diseases in man." 

In 1904 the Chief of the Division of Zoology spent some time in 
Bitter Root Valley making a zoological study of the etiology of the 
"spotted fever" and reported his conclusions in Bulletin No. 20. 
He was unable to substantiate the piroplasma-tick-spermophile theory. 

The confusion resulting from the nomenclatural difficulties is of 
scientific international importance. The chief of this division has 
been secretary of the International Commission on Nomenclature and 
has aided in straightening out many difficulties. In Bulletin No. 
24 the subject of nomenclature according to the international code 
is explained. 

Since the division is continually receiving specimens for determina- 
tion, new undescribed parasites are frequently found. These have 
been reported in various bulletins. Bulletins Nos. 34 and 40 contain 
a collection of new parasites. The 8parganum 'proliferum^ reported 



84 PUBLIC HEALTH AND MAETNE-HOSPITAL SERVICE. 

only once before, is not thoroughly understood and may prove of 
some importance to the southern coast States. 

One of the most important features of the work of this division 
is the publishing of the Index Catalogue of Medical and Veterinary 
Zoology, which work is done in conjunction with the Bureau of 
Animal Industry, Department of Agriculture. The author's cata- 
logue through the letter '' E, " has been completed and the remainder 
is about ready for the press. The Trematodes and trematodes dis- 
eases, iDart of the subject catalogue, ■ was published as Bulletin No. 
37 of this laboratory. At present the cestodes are written and about 
ready for publication and the manuscript of the nematodes is near- 
ing completion. 

The present work of this division consists largely in completing 
several manuscripts. Gne on the subject of child and women labor 
in the southern cotton mills; one on the subject of new Paramphisto- 
midse; one on the subject of ticks, some new forms, and a new and 
more specific method of determination and classification. Work has 
been started on a key to the trematodes. This key will be based on a 
new method. The preliminary work for a paper on the animal para- 
sites of the rat has been completed. 

The routine work of the division consists in indexing for the cata- 
logue of Medical and Veterinary Zoology and the distribution and 
arrangement of cards in that catalogue; of typewriting the manu- 
script of the nematodes; of filing reprints in the division's library; 
of determination of specimens sent into the divison by state boards of 
health, physicians, and others; and the care of the helmenthological 
collection. 

In addition to the medico-zoological studies on child labor, the 
tenant whites, and other duties mentioned elsewhere, the Division of 
Zoology has been making studies in more restricted zoological lines. 
Among tliese may be mentioned : A study of certain North American 
ticks (Ixodoidea), which come into consideration as carriers of dis- 
ease; the anatomy and classification of the amphistome parasites; 
and the possibility of a key (arranged on a card catalogue system) 
to the complex group of the distomes. This latter study is something 
of a departure in methods of determining animals, and the final 
results are not ready for publication, as the system must first be given 
a rigid trial. 

International commission on zoological nomenclature. — Cooperation 
with the international commission on zoological nomenclature has 
been continued through the Hygienic Laboratory, the Chief of the 
Division of Zoology serving as secretary of the commission. A num- 
ber of cases have been submitted during the year for interpretation 
under the code. 

Index catalogue of medical and veterinary zoology. — Through the 
Division of Zoology of the Hygienic Laboratory, cooperation has beeu' 
continued with the Zoological Division of the Bureau of Animal 
Industry in the preparation of an index catalogue of medical and 
veterinary zoology. Of the authors' catalogue, the letters A to Q, 
inclusive, have been published. The letters R and S have been for- 
warded for publication, and the letters T to Z are being prepared for 
the printer. 

Of the subjects, the preliminary draft of the Cestoda and part of 
the Nematoda has been typewritten, but it is planned not to print 
these parts until the authors' catalogue is completed. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 85 

Determination of zoological specimens. — The Division of Zoology 
has continued to make zoological determinations of animal parasites 
for johysicians, boards of health, etc., and a large number of such 
determinations, including many fecal examinations as aid in diag- 
nosis, have been made. 

Public lectures on soil pollution in the South. — In order to awaken 
popular interest on the subject of soil pollution in connection with 
hookworm disease, and without any expense to the Government, the 
chief of the division of zoology has given 25 popular and technical 
lectures on this subject before the following organizations: 

Virginia : 

Charlottesville — 

Four lectures before the University of Virginia. 
Richmond — 

One lecture before the Richmond Academy of Medicine. 
One lecture before the Board of Education of the Methodist 
Episcopal Church, South. 
Hampton — 

One lecture before the Hampton Industrial Institute. 
North Carolina : 
Greensboro — 

One lecture before the State Negro Agricultural College. 
Charlotte — 

One lecture before the North Carolina Medical College. 
Mebane — 

On lecture before Bingham School. 
Raleigh — 

One lecture before the State Agricultural College. 
One lecture before Shaw University (negro). 
One lecture before the Negro Normal School. 
South Carolina: 
Columbia^ 

One lecture before the training school for nurses of the 

Columbia Hospital. 
One lecture in the Cotton Mill Church. 
One lecture before the University of South Carolina. 
Alabama : 
Mobile — 

Three lectures before the Medical Department of the Univer- 
sity of Alabama. 
Louisiana : 

Four lectures before the Medical Department of Tulane Univer- 
sity. 
One lecture before the training school for nurses of the Charity 

Ilospital. 
One lecture before the Negro Medical College of New Orleans. 

DIVISION OF PHARMACOLOGY. 

In response to demands made upon it, and with the approval of 
the Secretary of the Treasury, tlu^n^ has been an extension of the 
work of the Division of I'hai-niacology, and the stall' of the workers 
was correspondingly increased. In the sununer and autumn of 1*J08 



86 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Drs. Motter, Wilbert, Schultz, and Hale were appointed as technical 
assistants, and their duties have related largely to the work in con- 
nection with the pharmacopoeia. Through special arrangement, and 
in accordance with the provision of the Civil Service Commission, 
Dr. C. W. Edmunds, of the University of Michigan, had an ap- 
pointment as special temporary assistant in the summer of 1008, 
and Professor Lovelace, of the University of Alabama, and Pro- 
fessor Hatcher, of Cornell, received similar appointments in the 
summer of 1909. These special temporary aj)pointments have proven 
of much value, not only on account of their providing workers on 
special subjects, but also because of the large amount of work ac- 
complished and the relations they establish between the laboratory 
and some of the leading universities. 

As is shown elsewhere, much work has been devoted to the study 
of pharmacopceial preparations, and the compilation of literature 
relating thereto. This compilation is being edited and published as 
digests of comments on the pharmacopoeia, one volume having al- 
ready been published as Hygienic Laboratory Bulletin 49, and their 
value is fully attested by the medical and pharmaceutical journals 
in this and other countries. This is perhaps the most extensive work 
ever undertaken in connection with any pharmacopoeia, and will 
prove of great value in the revision to be undertaken. 

Research work. — Research work has been done on the following 
subjects: Standardization of digitalis preparations — the various 
methods which have been used for the physiological standardization 
of digitalis were compared and all of the leading preparations on the 
American market tested. The results are published as Bulletin No. 48. 

Analytical methods. — It was found that none of the methods in 
use for determining salicylates are accurate ; much work was done in 
devising a new method. Especial attention was given to methods 
applicable to the salicylates of the pharmacopoeia. Much work was 
also done on the solubilities of compounds in the United States 
Pharmacopoeia, and at present work is in progress on the boiling 
and melting points of these compounds. 

Suprarenal preparations. — The physiological methods for stand- 
ardizing suprarenal preparations were critically examined and modi- 
fied so as to render them more accurate. The toxicity and physiologi- 
cal activity of a number of synthetic compounds of the adrenalin 
series were investigated. Synthetic suprarenin was found to have 
but little more than half the activity of the natural product. The 
manuscript of a bulletin on this subject was submitted in April. 

Thyroid. — Work on commercial preparations of thyroid was con- 
tinued. Especial attention was given to the relation of the iodine 
to the physiological activity; a bulletin (No. 47) on this subject was 
published. 

The investigations on thyroid are the first of sufficient exactness to 
show an unmistakable parallelism between the iodine content of thy- 
roid preparations and their physiological activity. The new method 
which has been devised is based upon the resistance to a definite 
poison, acetonitrile, produced in white mice by feeding appropriate 
amounts of thyroid or preparations of this gland for^ a period of 
about ten days. The degree of the resistance, which is a measure of 
the physiological activity, was found to be proportional to the quan- 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 87 

tity of iodine present as thyroid iodine in the preparation adminis- 
tered. In the case of experiments with other poisons than acetonitrile 
entirely similar results were obtained. With animals other than 
white mice, viz, white rats and guinea pigs, the administration of the 
thyroid produced, instead of a greater resistance to the poisons, an 
increased susceptibility which was proportional to the amount of 
iodine administered in proper thyroid combination. All of the ex- 
periments, therefore, lead to the conclusion that the amount of the 
iodine in combination with the thyroid is a measure of the activity 
of the gland and its determination forms a rapid and satisfactory 
method for the standardization of thyroid preparations. 

Solubilities of pharTnacopceial compounds. — The determinations of 
the solubilities of pharmacopoeial compounds have been carried on in 
the Division of Pharmacology with the object of supplementing and 
correcting the solubility data in the United States Pharmacopceia. 
The solubilities are being determined by Dr. Atherton Seidell, who 
has had much experience in such work, and he has recently compiled 
a handbook entitled " Solubilities of Inorganic and Organic Sub- 
stances," which has been found of much assistance in rendering the 
data appearing in the literature available for correcting the statements 
of the pharmacopoeia, and furthermore for pointing out the particu- 
lar compounds for which the available data is of least reliability. 

The laboratory experiments have been carried on as time could be 
obtained from other lines of investigation. However, the director of 
the laboratory reports that determinations have been so far com- 
pleted and most of them published upon ihQ following compounds: 
Ammonium iodide, ascetanilide, phenacetine, boric acid, camphoric 
acid, benzoic acid, salicylic acid, and the salicylates of ammonium, 
lithium, sodium, phenyl, strontium, bismuth, and quinine. The ben- 
zoates of the pharmacopceia are being studied at the present time. 
The determinations are given for water and ethyl alcohol and mix- 
tures of the two. The results will be brought together in bulletin 
■form when the work upon the several groups, or nearly related 
compounds, is completed. 

Toxicity of acetanilide mixtures. — The reputed antidotal action of 
caffeine and sodium bicarbonate toward acetanilide and antipyrine 
was thoroughly tested experimentally. The results, which have im- 
portant bearings upon the use of these substances in proprietary and 
other headache remedies, were submitted as a bulletin in April. 

Choline derivatives. — A very extensive (nearly 100) series of new 
compounds of the choline type were made and the general laws gov- 
erning their toxicity investigated. Some of these made are very 
active physiologically and give promise of being of use in therapeu- 
tics; others are closely related to substances occurring normally or 
abnormally in the body and may prove of interest in this connection. 

Miscellaneous analyses and reports. — A number of samples of drugs 
were examined and assayed for the purveying depot. Some pills, 
reputed to be of value in treating the opium habit, were examined 
for the International Opium Commission ; they were found to contain 
opium and arsenic. A number of samples of smoking opium, opium 
ash, etc., were assayed for morphine for the chief health officer of the 
Philippines. An exaniin;ilion of a preparation claimed to be a solu- 
tion of mercuric iodide in oil was made; no mercuric iodide was 



88 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

found. A careful comparison of two widely used brands of ether 
was made. A considerable amount of other miscellaneous work was 
done. 

Cooperation with the American medical and American pharmjO^ 
ceutical associations. — Members of the staff have taken an active part 
in the work of these two organizations. Two members, and also 
Doctor Hatcher, who had a temporary appointment for the summer, 
are members of the council on chemistry and pharmacy. Mr. Wilbert 
is a member of the committee of the American Pharmaceutical Asso- 
ciation to revise the National Formulary; he is also secretary of the 
section on scientific papers. The chief of the division was chairman 
of the section on pharmacology and therapeutics; he was also chair- 
man of the committee on the United States Pharmacopoeia and a 
member of the committee on medical research defense; he is also a 
member of the committee of the American Pharmaceutical Associa- 
tion on the UViited States Phaririacopoeia. Doctor Motter is secretary 
of the section on pharmacology and therapeutics and Mr. Wilbert 
vice-chairman. Doctor Motter is secretary of the board of trustees 
of the United States Pharmacopoeial Convention. 

Publications and scientific communications. — The following is a 
complete list of the scientific reports and communications prepared 
during the year : 

" The reaction of the mammalian pupil to adrenalin." (Proc. 
Soc. Exp. Biol, and Med., Oct., 1908.) 

" Studies on thyroid." (Bulletin No. 47.) 

" The physiological standardization of digitalis." (Bulletin No. 
48.) 

" Howell's mercol." (J. A. M. A., 1909, lii, 225.) 

" The detection of mercuric iodide in petrolatum." (_Amer. Chem. 
Soc, Dec, 1908.) 

"A comparative study of biological assay methods for digitalis." 
(Pharmaceutical section, American Chemical Society, Baltimore, 
1908.) 

"Methods for the determination of salicylates." (Seventh Inter- 
national Congress of Applied Chemistry, London, 1909.) 

" The solubilities of the salicylates of the United States Pharma- 
copoeia in aqueous alcohol solutions at 25° C." (Seventh Inter- 
national Congress of Applied Chemistry, London, 1909.) 

" The toxicity of acetanilide mixtures." [In press.] 

" Digests of comments on the United States Pharmacopoeia for 
1905." (Bulletin No. 49.) 

" The effect of certain drugs upon the toxicity of acetanilide and 
antipyrine." [Bulletin in press.] 

" Quantitative studies on adrenalin and related bodies." [Bulletin 
in press.] 

" The relation between the toxicity and chemical constitution of a 
number of choline and analogous compounds." (To appear in the 
Journal of Pharmacology and Experimental Therapeutics.) 

" 'VA'liat the individual physician can do to improve the Materia 
Medica." [In press.] 

" Some problems of pharmacopoeia revision." (Chairman's ad- 
dress, section on pharmacology and therapeutics, American Medical 
Association, June, 1909.) 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 89 

DIVISION OF CHEMISTRY. 

The Division of Chemistry was permanently organized June 20, 
1905, when Dr. Joseph H. Kastle was appointed chief of that divi- 
sion. During the greater part of the time since that date the chemical 
laboratory occupied two rooms in the west end of the first floor of 
the building, with the result that it was considerably cramped for 
space. On April 19, 1909, the division was moved into its new 
quarters in the new addition to the Hygienic Laboratory and at 
present occupies nine rooms in the east end of that building. Dur- 
ing the year expert opinions and reports haye been rendered on the 
following subjects: 

Plans and estimates for the installation of a vacuum and com- 
pressed-air plant for the Hygienic Laboratory. 

Outline of work done in the Division of Chemistry of the Hygienic 
Laboratory from the date of its organization, June 20, 1905, to Sep- 
tember 9, 1908. 

On the possible injurious effect of small quantities of sulphur 
dioxide and sulphites ordinarily present in commercial gelatine, 
with reference to the use of this material in the preparation of cul- 
ture media for bacteriological work. 

Portable ice machines and the preservation of vaccine virus in the 
Tropics. 

On the execretion of drugs and poisonous substances in milk and 
possible dangers to the suckling from intoxication resulting therefrom. 

Publications relating to public water supplies. 

On the humidity of the atmosphere in its relation to disease. 

On the effect of smoke on the mortality in manufacturing centers. 

On the enzymes of milk. 

Milk poisoning. 

Analytical work. — The analytical work of the Division of Chem- 
istry for the past year has included the analyses of 13 samples of 
water, 4 samples of milk, 18 samples of drugs, and 12 samples of 
miscellaneous substances. In connection with the investigation of 
typhoid fever in the District of Columbia, daily turbidity determina- 
tions have been made on the filtered water supplied the city of Wash- 
ington during the months of May, June, July, August, and September, 
1908. 

Laboratory demonstrations covering a period of one week have been 
given during the past year to the officers of the United States Public 
Health and Marine-Hospital Service stationed at the Hygienic Labo- 
ratory, on the subjects of milk and sanitary water analysis. 

Chemir-al reHearcli. — During the past year chemical research has 
been carried on in the following subjects: 

1. Fuchsin S as a permanent standard for the determination of 
nitrites in sanitary water analysis. 

2. On mineral metabolism, especially on the relation of the alkali 
metals, sodium and potassium, to chlorine. 

3. An inquiry into the subject of carbon monoxide poisoning, and 
studies on the oxidation of this substance, with the object of discov- 
ering a suitable antidote therefor. 

4. Cyh(;niicHl tests for blood and pus, and a method whereby 1 part 
of blood at a dilution of 80,000,000 can be recognized. 



90 PUBLIC HEALTH AND MAEINE-HOSPITAL SEKVICE. 

5. A new colorimeter, and studies in colorimetry. 

6. On the decomposition of the leucosulphonic acids of certain of 
the aniline dyes. 

7. The i^reparation and stability of the various modifications of 
sodium sulphite. 

8. A general method for the quantitative estimation of alkaloids. 

Publications and scientific commnnications. — The following publi- 
cations and scientific communications embodying the results of the 
investigations carried on in the Division of Chemistry during the 
past year have been published in the form of laboratory bulletins or 
as special articles in various scientific journals: 

1. " Peroxidase accelerators and their possible significance for bio- 
logical oxidations." (Am. Chem. Jour., 40, No. 3, Sept., 1908, pp. 
251-266.) 

2. " On the use of nitrous acid, nitrites, and aqua regia in the 
determination of the mineral constituents of urine." (Am. Jour, of 
Physiol., Vol. XXII, Sept. 1, 1908, No. IV, pp. 411^22.) 

3. " Tests for pus and blood." (Proc. Soc. Biol. Chem., XCVI- 
XC VII, Dec, 1908.) 

4. " The oxidation of carbon monoxide." (Proc. Soc. Biol. Chem., 
Dec, 1908.) 

5. " Fuchsin S as a permanent standard for the determination of 
nitrites in sanitary water analysis." (Proc. Internat. Cong, of App. 
Chem., Lond., May 27 to June 2, 1909.) 

6. " Chemical tests for blood." (Bull. 52, Hyg. Lab.) [In press.] 

7. "" On the decomposition of the leucosulphonic acids of rosanilin 
hydrochlorid and crystal violet, in aqueous solution." [In press.] 

The following communications, intended for publication as bulle- 
tins of the Hygienic Laboratory or in the American Chemical Jour- 
nal, are m preparation : 

1. " The oxygen-carriers of the living organism." 

2. " Methods of sanitary water analysis." 

3. "A new colorimeter and studies in colorimetry." 

BULLETINS OF THE HYGIENIC LABORATORY. 

The scientific investigations of the service are well represented by 
the bulletins prepared and published during the fiscal year or now in 
press. During the fiscal year the following bulletins were prepared 
and published : 

Bulletin No. 1^7. — " Studies on thyroid." This publication deals 
with the relation of iodine to the physical activity of thyroid prepa- 
rations. Studies were made to determine the phj^siological activity 
of ditferent thyroid preparations by a method which has for its basis 
the effect of thyroid feeding upon the resistance of animals to certain 
poisons. The drugs used were acetonitrile and morphine. Some of 
the experiments made show a close parallelism between the iodine 
content of the thyroid and its physiological activity, as measured by 
its effect in diminishing the resistance of rats to acetonitrile. Other 
experiments showed that thyroid rich in iodine is more active than 
thyroid poor in iodine simplj^ on account of the iodine; in other 
words, that the iodine is the cause and not the result of the activity. 

Bulletin No. 4.8. — " The j^hysiological standardization of digitalis." 
In this bulletin the literature relating to the standardization of digi- 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 91 

talis is reviewed, and it is pointed out that the chemical assay is 
impractical on account of an imperfect chemical knowledge of the 
drug's active constituents. The biological method of assay is the 
more accurate, but there is no uniformity as to the manner in which 
this has been carried out. The authors, in testing these methods, 
state that the lack of absolute uniformity in their results was to be 
expected, as in one case the effect might be upon one organ and in 
another upon an entirely different one. Since an action upon the 
heart corresi3onds to the use of the drug in medicine, this effect should 
be adopted as an end reaction, and frogs are suggested as being the 
most suitable animals. 

A second part of the bulletin deals with the variability of nine dif- 
ferent commercial preparations, which varied in a ratio of 214 to 850, 
while one preparation had a depressant, not a tonic, action upon the 
heart. 

Bulletin No. W. — " Digest of comments on the Pharmacopceia of 
the United States of America." The Federal status given the United 
States Pharmacopoeia by the food and drugs act of June 30, 1906; 
the treaty, entitled an " Agreement between the United States and 
other powers respecting the unification of the pharmacopoeial formu- 
las for potent drugs," of November 29, 1906, and the increasing 
demands of medical and pharmaceutical science, have made necessary 
a more thorough and complete study of medicaments as to their 
identity, purity, strength, and standardization. This bulletin col- 
lates, from the scientific literature of the world data as to pharmaco- 
poeial substances necessarj^ for their intelligent use. Aside from its 
practical value to the medical officers and pharmacists of the service, 
it will afford teachers, and especially the revisers of the pharmaco- 
poeia, material much of which is otherwise inaccessible. In the forth- 
coming convention for the revision of the pharmacopoeia the service 
will, as heretofore, be represented, and will present a standard for 
antitetanic serum, supplementing its earlier contribution to the phar- 
macopoeia on the subject of antidiphtheritic serum. 

Bulletin No. 50. — " Further studies upon the phenomenon of ana- 
phylaxis." Attention is especially given to the intimate nature of 
the factors that make up the phenomenon of anaphylaxis, subordi- 
nating for the time being discussions of the theory of its mechanism 
for its practical application. Special studies were made upon the 
influences of hypnotic substances in preventing anaphylactic shock 
and also upon the effect of heat upon the sensitizing and poisonous 
proteins, etc. 

Bulletin No. 51. — " Chemical tests for blood." The object of this 
bulletin is to give a complete chronological account of those chemical 
tests for blood which depend upon its oxygen-carrying power, to- 
gether Vv'ith the results of considerable experimental work recently 
carried out in the Division of Chemistry of the Hygienic Laboratory 
on the use of phenolphthalin as a reagent for blood, whereby it is 
possible under the most favorable conditions to recognize one part 
of blood at a dilution of 80,000,000. One section of the bulletin 
deals with the nature and general theory of the color tests for blood ; 
another section is devoted to the consideration of substances likely 
to interfere with the test: another to the delicacy of the chemical 
tests for blood ; another to the value of the chemical tests in forensic 
investigations and clinical work. The experimental part of the work 



92 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

includes the preparation and stability of the phenolphthalin reagents 
and their conduct toward blood under a great variety of conditions, 
the delicacy of the phenolphthalin test, quantitative measurements, 
the effect of various animal tissues on the oxidation of phenol- 
phthalin by blood, the absorption of blood piginent by various 
colloidal substances, and the utilization of the phenolphthalin re- 
agent in the examination of pathological fluids and suspected stains 
for blood. The last section of the bulletin consists of a bibliography 
containing 213 references to the original literature of the subject. 

Bulletin No. 52. — " Report No. 3 on the origin and prevalence of 
typhoid fever in the District of Columbia (1908)." This bulletin 
calls attention to the results obtained during the third year of study 
of typhoid fever in the District of Columbia, and comprises an epi- 
demiological investigation of all cases of typhoid fever reported 
from May to November. An intensive study was made of 32 city 
blocks, containing a population of 5,300 persons. Also a special 
search was made for bacillus carriers in this area. Specimens of 
feces were collected from about 1,000 healthy persons and examined 
for the presence of the typhoid bacillus. 

Dr. L. O. Howard made a study of the fly abundance. Particular 
attention was again given to the city water supply, milk, contacts, 
imported cases, etc. The conclusions, found at the end of the volume, 
summarize the status of the problem at the date of publication of 
the bulletin. 

Bulletin No. 53. — " The influence of certain drugs upon the toxicity 
of acetanilide and antipyrine." This bulletin takes up the question 
of antagonism between acetanilide and antipyrine and certain drugs 
commonly found in " headache mixtures." The history of the intro- 
duction of such mixtures into medicine is discussed and this is fol- 
lowed by experimental data. The heart effect was determined for 
frogs and dogs and the general toxicity to the intact animal upon 
guinea pigs and mice. The experiments show that the deleterious 
effect of acetanilide and antipyrine upon the heart is increased by 
caffeine but lessened by sodium bicarbonate. If given to the intact 
animal their toxicity is greater when given with caffeine or the 
opium alkaloids, but somewhat less when given with sodium bicar- 
bonate. The toxicity of acetanilide or antipyrine when adminis- 
tered with the salicylates or bromides is not changed. The toxicity 
of salipyrin, a chemical combination of antipyrine and salicylic 
acid, is shown to be the same as its uncombined constituents. 

Bulletin No. 51^. — " The fixing power of alkaloids on volatile acids 
and its application to the estimation of alkaloids with the aid of 
phenolphthalin or by the Volhard method." This bulletin deals 
with the subject of estimating alkaloids (the active principles of 
drugs). It is shown that all the old methods available for this pur- 
pose are very unsatisfactory. A new method is therefore proposed, 
which is proven experimentally to yield closer results and which is 
also very simple and easily carried out. 

Bulletin No. 55. — " Quantitative pharmacological studies — adrena- 
lin and adrenalin-like bodies." This bulletin deals with the deter- 
mination of the streng-th of adrenalin, a comparatively new and 
valuable organo-therapeutic product now upon the market, but vary- 
ing in the widest possible degree in therapeutic efficiency. A modified 
method of pharmacological assay of adrenalin is presented by the 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 93 

aiitlior, which should be known to pharmacologists engaged in public- 
health work and manufacturing industries. 

Bulletin No. 56. — " Milk and its relation to the public health." 
This is a revision of Bulletin No. 41, relating to milk, which has had 
a wide demand, which is now used as a text-book in many of the col- 
leges of the country, and which is recognized as the leading authority 
on milk in its relation to the public health. The first edition has long 
since been exhausted; there is demand for a revised edition, and the 
manuscript has been prepared by direction of the Secretary of the 
Treasury as a result of the demands. 

THE ADVISORY BOARD OF THE HYGIENIC LABORATORY. 

A meeting of the advisory board of the Hygienic Laboratory was 
held at the bureau March 26, 1909, the following members being pres- 
ent: Maj. Walter D. McCaw, Dr. A. D. Melvin, Dr. Victor C. 
Vaughan, Dr. Wm. H. Welch, Dr. Frank Wesbrook, and Surg. 
M. J. Rosenau. On account of the subjects to be considered, the fol- 
lowing officers were also present: Asst. Surg. Gen. J. W. Kerr, Passed 
Asst. Surg. John F. Anderson, Dr. J. H. Kastle, Passed Asst. Surg. 
C. H. Lavinder, and Passed Asst. Surg. L. L. Lumsden. 

In calling the meeting to order, the Surgeon-General stated that 
there were a number of subjects upon which the advice of the board 
was desired, and that the officers connected with the work to be 
considered were present in order that they might make clear some of 
the subjects under discussion, and benefit from hearing the same. 

The first subject considered was pellagra, to which reference has 
been made elsewhere in this publication. Doctor Lavinder briefly 
reviewed the work already done on the subject, and outlined tentative 
plans for future investigations. In connection with these investiga- 
tions, he mentioned the clinical and bacteriological studies, and stated 
that they could only be carried on where the disease was prevailing, 
as at Columbia, S. C. It was the consensus of opinion of the board 
that the investigations should be made, that Doctor Lavinder should 
be sent at once to study the cases in the South, and later go to Europe 
in order to make comparative studies of the disease in Italy and other 
countries as compared with pellagra in the United States. 

A prepared statement of events in connection with a recent out- 
break of foot-and-mouth disease in the United States was presented 
to the board with the view to obtaining its opinion as to the action 
taken and as to the methods to be adopted in future investigations 
of this subject. This statement set forth the origin of infection, its 
relation to vaccine virus, the steps taken to free vaccine virus of the 
infection, and to recall all presumably infected virus from the market. 
It was also explained that special facilities were being made for 
routine examinations of all vaccine virus sold under government 
license with the special object of determining its freedom from the 
infection of foot-and-mouth disease. 

Proposed regulations were submitted for suggestions as to changes 
or additions, which regulations had been prepared with the special 
view to safeguarding the purity of vaccine virus. The regulations 
as finally issued appear elsewhere in this publication. 

The subject of a second edition of Bidletin No. 41, entitled "Milk 
and Its Relation \a) the Public Health," was also brought to the at- 



94 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

tention of the board. It was explained how the first edition came to 
be published, the demand that it had, and the criticisms that had been 
made of it. At the same time it was stated that if there were any 
criticisms or omissions or additions which the members thought 
should be put in the revision their suggestions would be much ap- 
preciated and used. 

The third season's investigations of typhoid fever in the District of 
Columbia were then outlined by the chairman of the typhoid fever 
board, this board having been appointed by the Surgeon-General July 
2, 1906. The investigations of 1908 had been in line with suggestions 
made by the advisory board and the summary of the season's findings 
were therefore presented. 

It was the consensus of opinion of the advisory board that the in- 
vestigations should be continued and the work proposed was therefore 
discussed in detail. It was believed that the epidemiological studies 
should include all cases reported in the calendar j-ear ; that the collec- 
tion and examination of specimens of blood, feces, and urine from 
about 200 cases of tj^phoid should be reported serially, with the view 
to determining the percentage of cases reported under mistaken diag- 
noses; that there should be collected for examination specimens of 
blood, feces, and urine of about 1,000 persons who had had typhoid 
fever in the District of Columbia during the past five years; that 
further bacteriological studies of Potomac River water should be 
made ; that a special study of the bacteria usually present in the Poto- 
mac River water should be made with the view to determining their 
symbiotic relation to the typhoid bacillus; and that studies be made 
to dedetrmine the viability of the typhoid bacillus under different 
conditions in the District. 



STATE AND INTERNATIONAL RELATIONS. 

SEVENTH ANNUAL CONFERENCE OF STATE AND TERRITORIAL HEALTH 
AUTHORITIES WITH THE PUBLIC HEALTH AND MARINE- HOSPITAL 
SERVICE. 

In accordance with section 7 of the act of Congress approved July 
1, 1902, the seventh annual conference of health authorities with the 
Public Health and Marine-Hospital Service was held at the bureau 
June 2, 1909. Twenty-six States and Territories and the District of 
Columbia were represented by delegates. A number of important 
subjects received attention. The results of investigations into the 
geographical distribution of rabies in the United States during 1908 
were presented to the conference, and it was decided after discussion 
that som^e definite steps should be taken to ascertain the measures 
necessary for the control of the disease. A committee was accord- 
ingly appointed for the purpose, Passed Asst. Surg. John F. Anderson 
being designated as its chairman. 

In view of the Second International Congress Against Leprosy, 
which had been called to meet in Bergen, Norway, August 19-21, 
1909, there were discussed measures taken against leprosy in the 
United States since 1902. Reports had previously been received 
from the state and territorial health authorities upon this subject, 
and the data had been embodied in a report intended for presentation 
at the congress. The purpose of presenting the question of leprosy 
before the conference therefore was to elicit the views of the state 
and territorial health authorities on the question of the segregation 
of lepers as a means of controlling the disease. A committee was 
appointed, consisting of Drs. H. M. Bracken, Joseph Y. Porter, and 
J. N. Hurty, to prepare resolutions relative to the national" care of 
lepers in the United States. 

The investigation and control of typhoid fever was also the subject 
of discussion, and Passed Asst. Surg. L. L. Lumsden, acting chairman 
of the typhoid fever board of the service, presented a review of the 
investigations made in the District of Columbia and the results 
accomplished. 

The movement for the organization of colored antituberculosis 
leagues throughout the United States was brought to the attention of 
the conference, with the object of enlisting the interest of state and 
territorial health authorities. It was explained by the Surgeon- 
General that the movement was not being carried on under official 
auspices, but that the service was doing what it could to foster it, and 
he suggested that it might be utilized by the state and territorial 
authorities as a powerful means of extending the campaign against 
tuberculosis among a class of citizens who are especially prone to the 
disease. 

95 



96 PUBLIC HEALTH AND MAEINE-HOSPTTAL SERVICE. 

The necessity of taking measures against hookworm disease was 
the subject of discussion, and Dr. Ch. Wardell Stiles, Chief of the 
Division of Zoology of the Hygienic Laboratory, outlined his studies 
of hookworm disease in the Southern States, especially in relation to 
the child-laboi- problem, and emphasized the importance of insti- 
tuting measures against the disease as the primary means of uplifting 
certain classes of the white population in the South which he believed 
had been submerged as a result of the ill effects of this intestinal 
parasite. 

The conference was advised of the events in coi^nection with the 
contamination of vaccine virus with foot-and-mouth disease and the 
steps taken to eradicate the infection from licensed establishments, as 
well as to clear this product of all suspicion. 

Finally, the important subject of pellagra received attention, 
and Dr. C. F. Williams, secretary of the state board of health of 
South Carolina, presented the results of a statistical and geographical 
study of the prevalence of this disease in the United States. He pre- 
sented records to show that there were approximately 1,000 cases of 
pellagra scattered in 13 States. It was made apparent in the con- 
ference that it was necessary to secure complete and reliable statistics 
regarding pellagra, as it was becoming a matter of national concern. 
Dr. H. F. Harris, secretary of the state board of health of Georgia, 
who had reported a case of the disease several years previously, stated 
that pellagra had increased in a remarkable manner in the South 
with the last two or three years, and he thought that 15,000 would 
be a very conservative estimate of the number of cases that had 
occurred. 

Great interest was manifested in the work of the conference, and 
the results accomplished are evidence of the good effect of the law 
which authorized them. 

International Ottice or Public Hygiene, Paris. 

In the annual report for 1908, on page 89, there appears an outline 
of the measures taken looking to the organization of an international 
office of public hygiene at Paris, together with a copy of the arrange- 
ment and organic statutes to govern the same, signed at Rome, 
December 9, 1907. In pursuance of this arrangement, the inter- 
national committee provided for therein convened at the ministry of 
foreign affairs in Paris on November 4, 1908. This meeting repre- 
sented the last step taken to organize the above-mentioned office. 
The meeting was composed of one representative from each of the 
contracting powers whose Governments had ratified the arrangement 
signed at Rome. Its duty was to actually create the office, draw up 
its regulations, provide for its expenses, and direct its first opera- 
tions. The representative of the United States at this meeting was 
Passed Asst. Surg. S. B. Grubbs, of the Public Plealth and Marine- 
Hospital Service. 

Officers and committees. — After the details of the office and its 
work had been considered and agreed upon, using the organic statutes 
as a basis, Mr. Jacques de Cazotte, minister plenipotentiary of the 
French diplomatic corps, was chosen director, and Doctor Pottevin, 
for several years the chief sanitary officer of the city of Havre, 
France, was chosen secretary-general of the office. The qualifica- 
tions of these officers will enable them to inaugurate a valuable sys- 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 97 

tern for the collection and diffusion of information regarding the 
graver epidemic diseases. 

The real control of the office of public hygiene, however, lies with 
the permanent international committee, the members of which must 
keep in touch with the office at all times in order that they may 
be able to decide intelligently the questions which will from time to 
time arise. On account of this necessity Surg. H. D. Geddings, 
who had previously been assigned to duty in Europe, was designated 
as the delegate of the United States on the international committee, 
Passed Asst. Surg. S. B. Grubbs having been relieved of this duty 
on account of change of station. 

Expenses. — Twelve countries having ratified the agreement signed 
at Rome, the expenses of the office, apportioned under the financial 
arrangement agreed upon, represented 220 units, of an annual expense 
of 150,000 francs. The United States being in the first category, 
pays 25 units, and the necessary appropriations have been made by 
Congress in accordance with estimates submitted by the Department 
of State. Three thousand dollars have been appropriated for the 
year 1909. 

Operations. — The foundations of the international office of public 
hygiene have been laid as for an institution that is to be permanent. 
In organization it resembles the permanent International Postal 
Bureau and the Bureau of Weights and Measures, but in the field 
of sanitation it is original, being the result of long and preserving 
collaboration by men who believe that the greatest international pub- 
licity in sanitary matters is the first and most important step toward 
perfect sanitary control. The organic statutes authorizes direct com- 
munication with the principal health authorities of the participat- 
ing Governments, and the Bureau of Public Health and Marine- 
Hospital-Service has, therefore, been called upon to furnish from time 
to time all important sanitary facts with respect to the United States 
in order that the committee and officers of the office may accomplish 
the end for which the office was established. The current sanitary 
reports and statistics are therefore being forwarded, the Bureau of 
the Census has been requested to forward reports relating to mor- 
tality and the several state and territorial health authorities have 
been requested to forward reports of sanitary conditions within their 
jurisdictions. 

An outline of the general sanitary organization is being prepared, 
and will be furnished to the international office, together with copies 
of sanitary laws and other data bearing upon the public health. 

As showing the organization of the international office of public 
hygiene, as well as its international committee of control, the follow- 
ing regulations are of value : 

Regulations of the Inteenational Office of Public Hygiene, 
regulation of the inteenational committee. 

Article 1. The committee of the international office of public hygiene meets 
in ordinary session during the course of the month of October of each year. A 
second session may talie place in the month of April. 

The committee may hold at another time of year one or more extraordinary 
session 8 : 

BMrst. By summons of the president of the committee to consider special 
conditions. 

1854f)— 10 7 



98 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Second. On request made to the president by at least one-third of the mem- 
bers of the committee. 

Art. 2. The date of convocation is fixed by the president, who brings it to the 
knowledge of the delegates three weeks at least before the meeting. 

Art. 3. Whenever there is occasion to proceed to the election of the president, 
this shall take place as a rule in the course of the regular October session. 

The vote to this effect shall be by secret ballot, in conformity with article 7 
of the organic statutes. 

In case the president is prevented from performing his functions, his place 
shall be taken by the dean of the delegates, according to age. 

Abt. 4. In case of nomination of a new delegate, his Government shall so 
inform the president of the committee, at the oflfice in Paris. 

This notification is communicated by the president to the other Governments, 
as well as to the director of the oflBice. 

Art. 5. In conformity with article 8 of the statutes, the director shall assist 
at the meetings of the committee and take part in the delibei'ations. 

At each session the secretary-general of the ofiice shall discharge the duties 
of secretary of the committee and keep the minutes of the deliberations. 

Art. 6. The deliberations of the committee shall be accepted on an absolute 
majority of the votes of the delegates present, under the conditions provided 
for by article 6, paragraph 2, of the statutes. 

In case of an equal division of votes, the proposition shall be dropped. 

No action of the committee can be valid if the number of the States repre- 
sented is less than half plus 1. 

Art. 7. In addressing the calls for a meeting of the committee the presi- 
dent shall communicate to the delegates the programme of subjects for discus- 
sion. Every delegate has the right to add to the programme the subjects the 
discussion of which he wishes to suggest, provided the request is made at a 
season acceptable to the president. The committee has always the right to 
discuss at its meetings subjects not included in the programme, provided that 
two-thirds of the members vote that the said subjects are urgent. In the latter 
case the decision which results shall not be carried out until after a new exami- 
nation at the next session. 

Art. 8. It belongs to the committee to fix — 

(a) The detailed plan for the publications of the office conformably with, 
article 10 of the statutes. 

(6) The labor and researches which the office is to undertake. 

(c) The general rules for the accountability of the office. 

Abt. 9. The committee fixes the financial estimate of the office, taking into 
account articles 12 and 14 of the statutes ; it takes cognizance of the financial 
management, a statement of which is submitted to it in closed meeting by the 
director, and approA'es the same after examination, and it receives the report 
which the director presents on the work of the office during the preceding year 
and passes on it after examination. 

Art. 10. The control conferred upon the committee by article 6 of the statutes 
is exercised by the committee itself during its sessions. In the interval of the 
sessions this power is exercised by the president of the committee. 

Art. 11. In the course of the sessions a subcommission of three members 
may be designated for the purpose of examining the accounts of the office in 
closed meeting and preparing the estimates. The subcommission is elected by 
secret ballot. The director may be heard by this subcommission. 

Other subcommissions may be appointed for specific ends; they are elected 
by secret ballot. 

The president forms part of every subcommission. 

Art. 12. The written communications of the committee are signed by the 
president in the name of the committee. 

Art. 13. The expenses of post and telegraph incurred by the president of the 
committee in the exei-cise of his office are at the charge of the official estimate. 

Art. 14. During the sessions each delegate present receives a compensation 
of 100 francs per day, not including days not occupied by meetings of the 
committee or commissions. 

In addition, each delegate is allowed travel expenses calculated by zones 
according to the following division : 

First zone : England, Belgium, France, and Switzerland. 

Second zone : Spain, Italy. 

Third zone : Brazil. United States, Egypt, the Indies, Russia, Servia, Tunis. 

Travel expense is calculated on the basis of: 

250 francs for the first zone. 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 99 

500 francs for the second zone. 

750 francs for the third zone. 

Each delegate may, if the expense of his journey exceeds the proportion 
indicated above, be reimbursed for his expenses on the basis of his tickets going 
from and returning to his accustomed residence. 

The provisions of the present article apply to the expenses of the president 
when he repairs to Paris in execution of article 10. 

Art. 15. In case the committee should judge it advisable to dispense vs^ith the 
services of a director, this measure should be proposed by at least two members 
of the committee during the October session, and becomes final only after a 
delay of six months. 

This decision is valid only if it be taken by the absolute majority of the 
delegates of the states represented in the oflice. 

If the director should resign for any reason, this resignation is effective only 
after a delay of six months. The committee will, however, have the privilege 
of abridging this delay. 

The same provisions apply as concerns the secretary-general. 

EEGULATION RELATIVE TO THE FUND FOR RETIREMENT AND AID OF THE PERSONNEL. 

Article 1. There shall be created a fund for retirement and aid of the per- 
sonnel of the international office of public hygiene. 
Art. 2. The retirement fund shall be obtained : 

(1) By an annual contribution included in the office estimate and amounting 
to the sum of 10 per cent of the total of the salaries allotted to the officials and 
employees of the office. 

(2) By a retention of 5 per cent levied on the remuneration of each official 
or employee. 

In case the interest of the capital thus constituted shall not suffice for the 
payment of the retirements at a given time the necessary surplus for this 
payment shall be included in the annual estimate of the office. 

Art. 3. Every official or employee of the international office of public hygiene 
who, after ten years' of service, shall become in consequence of disease, in- 
firmity, or debility of his physical or mental functions incapable of continuing 
to discharge his functions shall receive a pension calculated on the basis of a 
fourth of his last salary, increased by one-eightieth of the said salary for each 
year in excess of ten years. In any event, this pension shall not be greater 
than one-half of the last salary received ; it shall in no case exceed 6,000 francs. 

Every official or employee numbering ten years' service in the office and hav- 
ing passed his 60th year may request to be retired and to benefit by the pro- 
visions previously referred to even if he should not present the incapacities 
provided for the cessation of duties before the said age is reached. 

Art. 4. In case of the death of an official or employee of the office who has 
had more than ten years of service and who leaves a widow, with or without 
children, the widow shall receive a pension equal to a third if she has no child ; 
if she has one or two children above 18 years of age, to one-half of that which 
the deceased would have received or to which he would have been entitled, 
imder article 3, at the time of his death. This pension shall not in any case 
exceed the sum of 3,000 francs; on the other hand, it shall not be less than 
500 francs. If the deceased leaves no widow, but one or more orphan children 
not having passed their 18th year, there shall be paid into the hands of their 
guardian an annual allotment which shall, for two orphans or more under the 
age indicated, equal the third part of the annual pension which would have been 
accorded to the widow, and for one orphan under 18 years equal to half the 
said pension. In case the orphans are girls the same allotment shall be 
made to them until their marriage, or until the age of 21 years if they remain 
unmarrierl. 

Art. 5. In case an employee not entitled to pension should have his^ services 
discontinue<l, slioukl ret ire, or die. the committee may allow to the said employee, 
his widow, or his family, aid not exceeding the amount of one year's salary of 
the deceased at the time of his discontinuance, dismissal, or death. 

regulation relative to personnel. 

Article 1. The personnel of the office comprises: 

(a) The director and the secretary-general. 

<h) A r-hlef of bureau, a subchief of bureau, translating editors, an account- 
;int, Ji librarian and keeper of the archives, and typists, one of whom shall be a 
stenographer. 



100 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

(c) Watchmen and other subaltern agents. 

Art. 2. The list of personnel enumerated under (6) and (c) of article 1 
shall be fixed according to the necessities of the service within the limits of the 
estimated resources. 

Aet. 3. The salary of the director is fixed at 20,000 francs ; that of the sec- 
retary-general at 12,000 francs. These salaries may be raised, respectively, to 
25,000 and 15,000 francs. 

(a) The salaries of the other oflBcials of the office are determined as follows: 

Francs. 

Bureau chief 6,000 to 8,000 

Subbureau chief 5,000 to 7,000 

Translating editors 4,000 to 7,000 

Accountant 3,000 to 5,000 

Librarian and keeper of archives 3,000 to 5,000 

Stenographer and typist 2,500 to 3,500 

Typist 1,800 to 2,400 

(6) The salary of the watchmen of the bureau and other subaltern agents 
is fixed at 1,500 francs and may be raised to 2,500 francs. 

Art. 4. Independently of their salaries, officials and employees are entitled 
to pensions which are fixed in the provision carrying the creation of a fund for 
retirement and aid under reservation of the provisions inserted under article 13. 

Art. 5. Outside of the fixed list and within the limits of the estimate, persons 
may be attached provisionally, with the authorization of the committee, for 
special work in the bureaus of the office. 

Art. 6. Every official or employee newly appointed to one of the positions 
of the office shall receive only the minimum salary provided for that position. 

In case of change of duty the official or employee shall not receive a salary 
inferior to that which he previously received. 

Art. 7. At the expiration of each period of three years the officials and 
employees enumerated under (6) and (c) of article 1 may receive, up to the 
maximum fixed for the category in which they are placed, an increase of 500 
francs for the bureau chief, subbureau chief, translating editors, accountant, 
and librarian and keeper of archives, and 300 francs for the stenographer and 
typist, typists, and other employees. 

Art. 8. Conformably to the requirements of article 8 of the statutes, the per- 
sonnel enumerated in paragraphs (&) and (c) are nominated by the director. 

Art. 9. The office personnel is selected by direct method after examination by 
the director into the administrative or scientific titles and qualifications of the 
candidates for the several employments. The candidates shall have to prove a 
general acquaintance with the French language. The bureau chief, subbureau 
chief, and translating editors shall have a knowledge of at least one other living 
language ; the language to be determined for each position by the necessities of 
the work of the international office. 

Art. 10. The age limit for candidates for the positions classed under (6) and 
(c) of article 1 is fixed at 40 years. 

Art. 11. The agents and employees contemplated in the preceding article are 
not appointed until after a period of six months. The nominations they have 
received are considered final if at the end of the period they have not been 
discharged. 

Art. 12. Every official and employee is required to devote himself exclusively 
to the exercise of his duties. The combination of a position in the office and any 
employment or profession whatever is forbidden. 

Art. 13. The measures of discipline applicable to the personnel are as follows : 

(1) Reprimand. 

(2) Blame, with note to that efEect on the register, which may entail a 
retardation of advancement. 

(3) Suspension with cessation of salary for a maximum period of two 
mouths. 

(4) Revocation. The official loses all right to a retiring pension, but the 
amount deducted from his salary is restored. 

Art. 14. Every official who is under disciplinary measures will first be per- 
mitted to furnish explanations and to produce evidence in his defense. 

The director shall render account to the committee relative to the disciplinary 
measures which he may be led to apply. 

Art. If). Every commuiiication not authorized by the director or the secretary- 
general in regard to the files of the office or information addressed to the office 
is forbidden under pain of disciplinary measures. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE., 101 

Art. 16. In addition to the public tiolidays, on which it is possible that the 
presence of the personnel may be required at the office, the regular annual 
leaves are determined as follows : 

For officials and agents named under (a) and (&) of article 1: Thirty days. 

For inferior personnel : Fifteen days. 

Officials and agents have the right to take their leave at one time or par- 
tially, and at any time of year. The departure on leave is subordinate to the 
necessities of the office work, and to the authorization of the director. 

Art. 17. Absences for sickness are not included in the number of days al- 
lowed for regular leave. 

Art. 18. Every official who may find himself prevented by sickness from pre- 
senting himself at the office should so inform the director, the secretary-gen- 
eral, or his bureau chief. These reports are brought to the knowledge of the 
director who may, if he judge necessary, delegate a physician to visit the 
patient. 

The absence for sickness shall not be considered justified if such be the 
advice of the official physician. 

Art. 19. In case of sickness the official or employee shall draw his salary 
entire for a period of two months. At the expiration of this period he may be 
kept on the rolls for a further period of two months without pay ; he shall be 
considered discharged if he does not resume service after this last period. 

EEGULATION FOR THE OPERATION OF THE INTERNATIONAL OFFICE OF PUBLIC HYGIENE. 

Article 1. The director has oversight of all the affairs of the international 
office; he transacts all business relating to the civil status of the office. He 
takes all measures for the progress of the service. He signs the bills for ex- 
penses and the correspondence relative to the work of the office and which does 
not by its nature belong to the international committee. Under the control of 
the international committee and between sessions under that of the president of 
the committee, he has the deciding of all cases relating to matter treated by the 
office. 

Art. 2. In case of absence the director is replaced by the secretary-general. 

Art. 3. The secretary-general is charged with the study of questions which 
enter into the duties and authority of the office, as well as the preparation of 
the monthly bulletin. He has the immediate surveillance of the personnel. 

Art. 4. The daily work is divided among the personnel by the secretary- 
general after consultation with the director. 

Art. 5. The chief of bureau has under his orders the accountant, the librarian, 
and the stenographer and typists. He overlooks and combines the work confided 
to them. 

Art. G. The librarian and keeper of records is specially charged with the reg- 
istering of the correspondence on the books of entry and departure, of the 
sealing of letters, the classification and preservation of files, books, reviews, 
journals, and publications, and their entry in the catalogue of the library. 

Art. 7. The director fixes the number of registers of accounts and determines 
the conditions under which they are kept. He periodically verifies these regis- 
ters which are to be kept daily. A report is made of these verifications. 

Art. 8. The accountant balances the current expenses and for this purpose 
receives an advance of .500 francs. As far as the regular keeping of the 
accounts permits, the accountant may be charged with administrative work. 

Art. 9. A list is drawn up of the effects of the office, as well as of the books 
and publications which form part of the library. The furniture and articles 
are listed as they are acquired or on their arrival at the office, and given a 
number. 

This fipplies to books independently of their listing on the catalogue referred 
to in article 6. 

Art. 10. The register of this inventory is kept by the accountant. 

Art. 11. No expense shall be incurred without written authorization or the 
vis«'; of the director, and in the case of the absence of the director, of the sec- 
retary-general. 

Art. 12. The management of the fund for retirement and aid is intrusted to a 
fourifil c-oinj)Osed in ilw, following maniKir: 

'i'he f)rosid('nt f)f the International committee, president. 

The direr-tor of the office. 

The secretary-gen(!ral. 



102 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

A delegate designated by the personnel, referred to in (&) and (c) of article 
1, and elected for three years. 

The funds shall be invested only in govemnient stock of the first order. 
Done at Paris, April 8, 1909. 

International Cooperation for Further Protection Against 
Plague and Cholera. 

The permanent conunittee of the international office of public hj^giene 
considered during the course of its first session that, in pursuance to 
article 4 of the by-laws governing the above-mentioned office, it was 
its duty to consider whether any conditions or facts having a possible 
bearing on the sanitary defense of the Mediterranean countries in 
particular demanded special examination on the part of the office 
with the view to making suggestions to be submitted to the Govern- 
ments which signed the agreement at Rome December 9, 1907. 

As a result, an exchange of views took place at the sixth meeting 
among the members of the international committee regarding the 
provision contained in the second paragraph of article 170 of the 
sanitary convention of Paris and regarding the recently recognized 
necessity of protecting the Mediterranean littoral in particular, and 
Europe in general, against the new dangers of an invasion of cholera 
or plague, owing to the opening up of railroads between Beirut, Kafar, 
and Medina for the transportation of pilgrims from the East and 
destined for Hedjas. It was recognized by the committee that the 
danger of cholera and plague through this route could not have been 
recognized when the Paris convention was concluded, and that that 
convention, which had been specially prepared in view of the intro- 
duction of these diseases by maritime routes, could offer no effective 
defense. Resolutions were therefore adopted citing these facts and 
emphasizing the necessity in the interest of the public health of sup- 
plementing existing international sanitary regulations. Following 
up this action of the committee, its president submitted a copy of the 
resolution to the Department of State, which communication was 
forwarded to the Surgeon-General for an expression of his views 
regarding the matter. 

The Surgeon-General in his reply, invited attention to the rapid 
extension of cholera and plague from their endemic centers and the 
consequent danger of the introduction of these diseases into the Medi- 
terranean countries and other parts of Europe through railroad com- 
munications between Beirut and points east. He further expressed 
the opinion that the question involved might well be the subject of an 
international conference for the consideration of further interna- 
tional sanitary regulations to prevent the spread of cholera and 
plague by the routes mentioned. 

destruction or rats on vessels. 

The Surgeon-General also invited attention to investigations made 
since the adoption of the international sanitary convention of Paris 
December 3, 1903, which investigations have emphasized the impor- 
tance of the rat as an agent in the transmission of plague, and the 
necessity of taking measures for the destruction of rodents on board 
ships for the prevention of the spread of the disease from one country 
to another. He therefore expressed the opinion that the systematic 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 103 

destruction of rodents on ships should also be a subject for the con- 
sideration of the next international sanitary convention with the view 
to the adoption of international sanitary regulations relating thereto. 
This matter was the subject of comment in the annual report of 
this service for 1908, pages 179 and 180. Following this report, cor- 
respondence was conducted by the bureau with its officers in China 
and Japan to learn to what extent disinfection of vessels for the 
destruction of rats is being done regularly on vessels engaged in trade 
with the United States, and the substance of the replies received is 
embodied in a separate chapter in this report, following the chapter 
on foreign quarantine. With regard to vessels arriving at our ports 
on the Atlantic and Gulf seaboard, some information has also been 
received as to occasional disinfection for the destruction of rats at 
convenient times, as well as the disinfection required by the quaran- 
tine regulations. The subject is one that is still under consideration 
with the various steamship companies. 

International Sanitary Bureau of American Republics in 

Washington. 

The service has maintained its interest in the International Sanitary 
Bureau of American Republics in Washington, and through a resolu- 
tion passed by each body the said bureau has been brought into rela- 
tions with the international office of public hygiene in Paris. The 
Washington bureau is the representative of the international sanitary 
conventions of the American Republics, three of these conventions 
having been held, two in Washington, one in Mexico, and the fourth 
about to be held in Costa Rica, beginning December 25, 1909. 

In the " act making appropriations for the diplomatic and consular 
services," approved March 2, 1909, the following is included : 

For the annual share of the United States for the maintenance of the Inter- 
national Sanitary Bureau for the year 1910, $2,830.79. 

International Congress or Hygiene and Demography. 

In 1907 Congress passed the following joint resolution: 

[Public Resolution — No. 16.] 

JOINT resolution Authorizing the President to extend an invitation to the Twelfth 
International Congress of Hygiene and Demography to hold its thirteenth congress 
in the city of Washington. 

Resolved hy the Senate and House of Representatives of the United States of 
America in Congress assembled, That the President of the United States be, 
and he is hereby, authorized and requested to extend an invitation to the 
Twelfth International Congress of Hygiene and Demography, held at Berlin 
in nineteen hundred and seven, to hold its thirteenth congress in the city of 
Washington, District of Columbia, anno Domini nineteen hundred and nine, 
or nineteen hundred and ten. 

Approved, February 26, 1907. 

Referring to the above joint resolution, the following item appears 
in the "Act making appropriations for thfe diplomatic and consular 
service," approved March 2, 1909 : 

To enable the Government of the United States suitably to participate in the 
Tvi'olfth Intfrnational f!ongroKS of Hygiene and Demography, which will be 
held at the city of Washington, D. C, in 1910, in pursuance of the invitation 
extended by the President of the United States, in virtue of the joint resolution 



104 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

of the Congress thereof, approved February 26, 1907, and to meet the expenses 
that will actually and necessarily be incurred by the United States by reason 
of such invitation and meeting, ten thousand dollars, or so much thereof as may 
be required. 

An account of the organization and preparations made for this 
congress will appear in the next annual report. 

The Sanitation of Guayaquil, Ecuador. 

In the annual report for 1908, page 141, reference is made to the 
quarantine and sanitation in Guaj^aquil, Ecuador, and to the fact 
that on March 27, 1908, Passed Asst. Surg. B. J. Lloyd was appointed 
by the President of that Republic as a member of a special technical 
commission to devise and enforce sanitary regulations for the sup- 
pression of plague in Guayaquil. 

In February, 1908, Doctor Lloyd had discovered the existence of 
bubonic plague in Guayaquil. The fact of this discovery and its 
announcement caused much indignation at the time, but plague 
spread so rapidly that the people later became greatly alarmed, and 
at the instance of the President of Ecuador, Doctor Lloyd was ap- 
pointed president and director of the special sanitary commission 
which w^as charged with the duty of combating plague, yellow fever, 
and smallpox, which position he accepted with the consent of the 
Secretary of the Treasury and the approval of the Department of 
State. 

Doctor Lloyd continued his duties as director of health on the 
above-mentioned commission until September 11, 1909, when he re- 
signed, and in a communication of September 8 from the consul- 
general at Guayaquil, it was stated that the Ecuadorian Government 
had appointed Dr. Luis F. Cornejo G., formerly a temporary acting 
assistant surgeon in the Public Health and Marine-Hospital Service, 
to succeed Doctor Lloyd as director of health. 

Failure to provide necessary funds and to enforce the regulations 
of the board of health are the causes which led to the resignation of 
Doctor Lloyd. Public sentiment supports operations against plague, 
but is indifferent with regard to yellow fever. Another officer, 
Passed Asst. Surg. H. B. Parker, has been detailed to succeed Doctor 
Lloyd in the office of the United States consul to inspect vessels leav- 
ing for ports in the United States. 

During the period that Doctor Lloyd was director of health, small- 
pox was eradicated and the number of plague cases rapidly dimin- 
ished until the disease seemingly disappeared, though he w^arned the 
people at the time that the work against plague had virtually hardly 
begun. The work against yellow fever was also pushed vigorously 
until funds failed, and as soon as the effects of antimosquito work 
became apparent, there was a drop of 20 per cent in the mortality of 
this disease over previous years. 

The consul-general, in his communication, states that the net 
results of Doctor Lloyd's work as director of health may be sum- 
marized as follows: 

1. He has established a public health service with definite laws and 
regulations. 

2. Under his administration cases of smallpox were systematically 
isolated and contacts vaccinated — the first instance of the kind in the 



PUBLIC HEALTH AND MARHSTE-HOSPITAL SERVICE. 105 

history of Ecuador. Incidentally, there has not been a death from 
smallpox in Guayaquil for nearly eleven months. Formerly the dis- 
ease was endemic, the mortality ranging from 200 to 500 deaths 
annually. 

3. He seems to have demonstrated that even partially successful 
mosquito work will produce a marked diminution of the death rate. 

4. He leaves behind him clearly mapped out the necessary steps to 
be taken to eradicate yellow fever. 

5. He demonstrated that an effective sanitary corps can be trained 
on the ground. 

6. He has also demonstrated that vital statistics under former con- 
ditions had no practical value, except to determine the actual number 
of deaths. 

7. He has successfully combated plague in the smaller towns 
where measures may be carried out by force when necessary. 

For details connected with the work of Doctor Lloyd in Guayaquil, 
both with regard to quarantine and to sanitation, attention is invited 
to extracts from his report in the chapter on " Foreign quarantine." 

Guayaquil is the worst infected port on the Western Hemisphere. 
For many years it has been recognized as one of the chief foci of 
yellow fever. It has also become infected with plague, and its sani- 
tary condition has been such as to make it a menace to other ports, 
and especially to Panama and the Canal Zone. 

During the year the bureau was visited by representatives of the 
Ecuadorean Government, and plans for sewerage and for furnishing 
a good water supply for the city of Guayaquil were exhibited. It 
was understood that an effort would be made to have these plans exe- 
cuted. So far, however, no information has reached the bureau that 
an attempt of this kind has been made. 

The insanitary condition of Guayaquil is a subject for serious con- 
sideration by all the American Republics with whose ports it has 
commercial relations. 

Investigation of Mild Epidemic Jaundice in Texas. 

The president of the Texas state board of health, Dr. William M. 
Brumby, in a letter dated June 20, 1909, reported to the bureau the 
existence of an epidemic of mild jaundice in the different parts of 
Texas. 

Surg. G. M. Guiteras, of the service, was directed on July 2, 1909, to 
proceed to Austin, Tex., confer with the state health authorities, and 
then visit the localities wherein the disease in question was reported, 
and make an investigation and report of conditions. 

At Corpus Christi, the first town visited, it was learned that the 
first case of "jaundice " appeared in September, 1908, and the last 
case in February, 1909. BetAveen these dates 150 cases of the disease 
were oVjserved. During the months of September, October, and De- 
cember of 1908, the period during which the epidemic i^revailed, there 
was no notable increase in the infant death rate as compared with the 
spring and summer months of the same year. 

The next town visited was Alice, with a population of about 1,500. 
Here between October of 1908 and January of 1909, 50 cases of 
" jaundice " had been reported. 



106 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

From two physicians opinions were given that there was a marked 
connection between the " jaundice " and an influenza epidemic which 
was prevalent at the time. A slow pulse had not been observed in 
this disease. 

A visit was then made to the town of Falfurrias, which is TO miles 
south of Alice, and which has a population of about 2,500. In this 
town between July 11, 1908, and April 20, 1909, between 75 and 100 
cases of " jaundice " were treated. 

Skidmore, a town of about 900 inhabitants, and San Antonio were 
also visited, but no cases of the disease had been reported. 

Doctor Guiteras was of the opinion that from the description of 
the disease prevalent in southern Texas in the fall, winter, and early 
spring of 1908 and 1909, it was possible to exclude both yellow fever 
and Weil's disease for the following reasons: First, the gradual 
onset and mildness of the disease in connection with an intense jaun- 
dice lasting for several weeks. Second, the absence of albuminuria 
and marked gastric disturbance. 

In view of the number of cases observed in Corpus Christi, Alice, 
and Fulfurrias, and the fact that no precautions were taken, had 
the disease been yellow fever it would be quite impossible to under- 
stand why the epidemic disappeared just at the coming of warm 
weather, instead of increasing or even assuming alarming propor- 
tions, which under the circumstances would have been expected. 

Doctor Guiteras was inclined to believe that the disease under con- 
sideration was an epidemic jaundice due to an hepatic choli-bacillary 
infection, probably aided by unknown climatic and telluric influences. 



DOMESTIC QUARANTINE. 

Reports from the National Quarantine Stations. 

During the fiscal year ending June 30, 1909, at the various stations 
of the United States, a total of 8,266 vessels were inspected, and 520 
were disinfected, either for the destruction of mosquitoes as a pre- 
caution against the introduction of yellow fever, or for the destruc- 
tion of rats and other vermin as a precaution against plague. In 
addition 495 vessels were spoken and passed, making a grand total of 
8,761 vessels passing under the observation of the service at the ports 
in the continental United States. 

Following are the summaries of the operations at the various 
quarantine stations : 

Eastfort^ 71/e., quarantine. — Acting Asst. Surg. E. M. Small in 
charge. 

Eight hundred and sixty-nine steamers and 85 sailing vessels were 
inspected. These vessels carried a total of 33,847 passengers and 
23,499 crew. 

Portland., Me.., quarantine. — Surg. J. M. Eager in command. 

One hundred and thirty-seven steamers and 28 sailing vessels were 
inspected and passed. These vessels carried 6,420 crew and 2,784 
passengers. 

Perth Amhoy, N. /., quarantine. — Acting Asst. Surg. Charles W. 
Naulty, jr., in charge. 

Twelve steamers were spoken and passed ; 46 steamers and 4 sailing 
vessels were inspected and passed and 4 steamers were fumigated. 
There were 39 crew on sailing vessels and 1,191 crew on steamers. 
On the steamers were 6 stowaways. 

Reedy Island quarantine. — Post-office address. Port Penn, Del.; 
telegraphic address. Reedy Island, Del. Passed Asst. Surg. W. A. 
Korn in command. 

One thousand one hundred and three vessels were inspected and 
passed, of which 991 were steamers and 112 were sailing vessels. 
Eleven vessels were spoken and passed, and 3 were fumigated. Upon 
the steamers 37,537 crew and 12,833 passengers were inspected. Upon 
the sailing vessels 1,250 crew were inspected. Temperatures were 
taken of the crews of 75 vessels coming from ports suspected of 
yellow-fever infection, and glandular examinations were made of the 
crews of 20 vessels from ports where plague prevailed. 

August 9, 1908, steamship Tlauerford., from Liverpool for Phila-. 
delphia, arrived with 1 case of smallpox. Case removed to island, 
and living quarters and dunnage disinfected. 

Delaware, Breakwater quarantine. — Post-office and telegraphic ad- 
dress, Lewes, Del., Asst. Surg. Edward R. Marshall in command. 

107 



108 PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 

Eighty steamers and 31 sailing vessels were inspected and passed. 
The steamers and sailing vessels carried 3,479 crew and 27 passengers. 

Alexandria^ Va., quarantine. — Acting Asst. Surg. Arthur Snowden 
in charge. 

One steamer and 7 sailing vessels were inspected and passed, with 
a total of 75 crew. 

Cape Charles quarantine. — Post-office and telegraphic address, Fort 
Monroe, Va. Passed Asst. Surg. G. L. Collins in command. 

Nine vessels were spoken and passed, 351 steamers were inspected, 
and 11 steamers were disinfected: 21 sailing vessels were inspected 
and 1 disinfected. On these vessels there were 29,863 crew and 6,439 
passengers, making a total of 36,301 persons inspected. 

Washington, N. C, quarantine. — Acting Asst. Surg. J. C. Rodman 
in charge. 

There were no transactions during the fiscal year. 

Cape Fear quarantine. — Post-office and telegraphic address. South- 
port, N. C, Surg. E. K. Sprague in command. 

Thirty- four vessels (26 steamers and 8 sailing vessels) were in- 
spected and passed, and 3 steamers Avere disinfected. These vessels 
carried a total of 788 crew and 6 passengers. The vessels disinfected 
were from ports of Mexico and Brazil. 

Georgetown, S. C, quarantine. — Acting Asst. Surg. J. William 
Folk in charge. 

Four vessels, with a total of 31 crew, were inspected and passed. 

Charleston, /S. C, quarantine. — Passed Asst. Surg. Baylis H. Earle 
in command. 

Eight sailing vessels and 107 steamers were inspected and passed 
and 1 steamer was disinfected. These vessels carried a total of 3,185 
crew and 197 passengers, among the latter being 2 stowaways. 

Beaufort, S. C, quarantine. — Acting Asst. Surg. Christopher G. 
Hay in charge. 

One vessel was spoken and passed and 3 steamers and 2 sailing ves- 
sels were inspected and passed. Upon the above vessels there was a 
total of 92 crew. 

Port Royal, S. C, quarantine. — Acting Asst. Surg. William P. 
Gibbes in charge. 

There were no transactions during the fiscal year. 

Savannah, Ga., quarantine. — Asst. Surg. Hugh de Valin in com- 
mand. 

Three vessels were boarded and passed, 118 were inspected and 
passed, and 7 were spoken and passed. Two vessels were fumigated 
and held to complete five days from port of departure. These vessels 
carried a total of 3,161 crew and 15 passengers. 

South Atlantic quarantine. — Post-office address, Inverness, Ga. 
Telegraphic address, Darien, Ga. Asst. Surg. W. M. Bryan in com- 
mand. 

Six steamers and 3 sailing vessels were inspected and passed. These 
vessels carried a total of 171 crew. 

Brunswick, Ga., quarantine. — Passed Asst. Surg. E. D. Spratt in 
command. 

Forty-two vessels were spoken and passed, 23 steamers, and 59 sail- 
ing vessels were inspected and passed, and 6 sailing vessels were dis- 
infected. These vessels carried a total of 1,140 crew and 53 pas- 
sengers. 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 109 

Tampa Bay^ Fla.^ quarantine. — Post-office address, Fort De Soto, 
Fla. Telegraphic address, via Palmetto, Fla. Passed Asst. Surg. 
H. McG. Robertson in command. 

Seven vessels were spoken and passed, 90 steamers and 102 sailing 
vessels were inspected and passed, and 37 steamers and 16 sailing 
vessels were disinfected. These vessels carried a total of 560 pas- 
sengers and 4,532 crew. There were no cases of quarantinable dis- 
ease, but 3 cases of illness on board vessels were held under observa- 
tion. 

Cedar Keys., Fla.., quarantine. — Acting Asst. Surg, R. T. Walker 
in charge. 

There were no transactions during the fiscal year. 

Cumberland Sound quarantine. — Post-office and telegraphic ad- 
dress, Fernandina, Fla. Acting Asst. Surg. J. Louis Horsey in 
charge. 

Fifty-nine vessels were spoken and passed, 70 steamers were in- 
spected and passed, and 1 steamer was disinfected ; 26 sailing vessels 
were inspected and passed, and 4 sailing vessels were disinfected. 
Four vessels were fumigated to kill mosquitoes, and 1 was fumigated 
to kill rats. ' On these vessels there were 2,958 crew and 31 passengers. 

St. Johns River quarantine. — Post-office and telegraphic address, 
Mayport, Fla. Acting Asst. Surg. F. J. McKinley in charge. 

Seventy-six vessels were inspected and passed and 1 vessel was 
fumigated. On these vessels there were 48 passengers and a total 
of 898 crew. 

Biscayne Bay quarantine. — Post-office and telegraphic address, 
Miami, Fla. Acting Asst. Surg. James M. Jackson, jr., in charge. 

One hundred and ninety-two vessels were spoken and passed; 35 
steamers and 59 sailing vessels were inspected and passed. These 
vessels carried a total of 2,404 crew and 3,089 passengers. 

Key West, Fla., quarantine. — Acting Asst. Surg. S. D. W. Light 
in charge. 

During the year 253 steamers, carrying a total crew of 11,759 and 
12,423 passengers, and 78 sailing vessels, carrying a total crew of 
606 ancl 264 passengers, were inspected and passed. Eight sailing 
vessels were disinfected and held for observation. 

Knights Key, Fla., quarantine. — Acting Asst. Surg. Joseph Y. 
Porter, jr., reports 182 vessels inspected, on which there were 2,951 
passengers. 

Bocagrande quarantine. — Post-office and telegraphic address. 
South Bocagrande, Fla. Acting Asst. Surg. W. Barnes in charge. 

During the year 25 vessels were spoken and passed, and 3 vessels 
were inspected and passed. 

Penjiacola, Fla., quarantine. — Acting Asst. Surg. R. C. White in 
charge. 

During the year 48 vessels were boarded and passed, 33 vessels 
were spoken and passed, 145 steamers were inspected and passed, 
and 12 steamers were disinfected; 71 sailing vessels were inspected 
and passed and 10 sailing vessels were disinfected. On these vessels 
there were 8,102 crew and 37 passengers, and while no cases of quar- 
antinable disease occurred, 6 cases of malarial fever, remittent, were 
removed to the hospital at the station for observation and treatment. 

St. fJcorqe Sound quurantiru'. — Post-cjffice and h'lographic address. 
Carrabelle, Fla. Acting Asst. Surg. B. B. Blount in charge. 



110 PUBLIC HEALTH AND MAEINE-HOSPITAL SEKVICE. 

Thirty-six vessels, carrying a total of 387 crew, were inspected and 
passed, 3 vessels were fumigated to kill vermin, and 1 vessel was 
remanded to Ship Island quarantine station for fumigation and 
disinfection. 

Mobile, Ala., quarantine. — Passed Asst. Surg. Edward Francis in 
command. 

A total of 675 vessels were inspected and passed, of which 472 were 
steamers and 203 were sailing vessels; 41 vessels were detained in 
quarantine and 45 were disinfected. On these vessels were 12,698 
crew and 476 passengers. Eighteen cases of malarial fever were 
removed from vessels for observation and treatment, but no cases of 
quarantinable disease occurred. 

Pascagoula, Miss., quarantine. — Acting Asst. Surg. B. F. Duke in 
charge. 

Thirteen vessels were spoken and passed, 34 steamers and 77 sail- 
ing vessels were inspected and passed, and 28 sailing vessels were 
disinfected. These vessels carried a total of 2,151 crew and 32 pas- 
sengers. 

Gulf quarantine station. — Post-office and telegraphic address, 
Biloxi, Miss. Passed Asst. Surg. John T. Burkhalter in command. 

The station is located on Ship Island, about 12 miles off the Mis- 
sissippi shore, and separated from the mainland by the Mississippi 
Sound. The quarantine station proper, with its anchorage for in- 
fected and possibly infected vessels, is located on the north shore of 
the island, at about its mid point. The inspection station is at the 
west end of the island, about 4 miles distant from the station proper. 
This latter station is maintained for the inspection of presumably 
noninf ected vessels only. 

The station is available for such ports in Mississippi as Gulfport, 
Pascagoula, Scranton, and Moss Point ; also for infected vessels which 
may be remanded from other Gulf stations. 

A pier about one-half mile long, extending from the shore in front 
of the executive building, constitutes the main approach to the sta- 
tion. A boathouse and ways, for the accommodation of the station 
vessels, is located near the end of this pier. 

The new executive building, assistant's and pharmacist's quarters, 
and attendants' quarters are nearing completion. The two former 
are built on concrete piers and the latter on piling. These buildings 
should be able to weather the hurricanes which prevail during the 
months of August and September. Besides the commanding officer's 
quarters, the station has a j^ellow-fever hospital, a noncontagious 
hospital, and several small buildings. 

For disinfecting vessels the station is equipped with pots and tubs, 
a disinfecting barge containing a bichloride pump, steam chambers, 
and sulphur furnace and fan. Disinfection with formaldehyde gas is 
done by the permanganate of potash and formalin method. The west 
end inspection station consists of a four-room house for quarters, 
placed on piling. This station is operated during the " close season " 
only. 

The transactions were as follows: Vessels boarded and passed — 
steamers 20, sailing vessels 5 ; vessels inspected and passed — steamers 
57, sailing vessels 66 ; vessels fumigated and passed — steamers 7, sail- 
ing vessels 21 ; vessels fumigated and held — steamers 3, sailing vessels 
19. The above vessels carried a total of 3,121 crew and 26 passengers. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



Ill 



Nine cases of malarial fever were detected among the crew and the 
necessary medical attention given aboard ship. 

New Orleans quarantine. — Post-office address, Quarantine, La.; 
telegraphic address, via New Orleans, La. Passed Asst. Surg. R. H. 
von Ezdorf in command. 

Tbansactions at the New Orleans Quarantine Station. 



steam- 
ships. 



Sailing 
vessels. 



Total. 



Inspected and passed 

Inspected and detained for fumigation 

Inspected and held for 5 days 

Inspected and held to complete a period of 5 days from date of fumigation 

at a foreign port 

Inspected and held on account of smallpox infection 

Inspected and held for completion of diagnosis of cases of sickness found on 

arrival 



Inspected and passed from domestic ports 

Spoken and passed 

Boarded and passed 

Vessels fimiigated and disinfected 

Total number of vessels inspected 

Number of crew inspected 

Number of passengers inspected 

Total number persons removed from vessels held in detention. 



700 
136 



51 
3 

18 

55 

31 

1 

195 

971 

33, 671 

7,640 



2 
6 
5 






2 

11 
13 
179 




702 

142 

13 

51 
3 

18 

55 

33 

1 

206 

984 

33,850 

7,640 



Transactions at Lower Inspection Station at Port Eads, Near the Mouth 
OF THE Mississippi River. 



Number of vessels from foreign ports inspected and passed. . 

Number of crew on vessels from foreign ports 

Number of passengers on vessels from foreign ports 

Number of vessels from domestic ports inspected and passed 

Number of crew on vessels from domestic ports 

Number of passengers on vessels from domestic ports 



Steam- 


Sailing 


ships. 


vessels. 


135 


11 


7,714 


181 


1,058 





61 





1,960 





5 






Total. 



196 

7,895 

1,058 

61 

1,960 

5 



A total of 1,241 vessels were inspected at the port of New Orleans 
and at the substation at Port Eads. 

No quarantinable diseases were observed at the station during the 
fiscal year. 

On account of a rise in temperature a number of persons (chiefly 
crew) were removed from vessels to the quarantine hospital for obser- 
vation. The following is a list of diseases treated in the hospital at 
the quarantine station during the fiscal year ended June 30, 1909 : 

Malaria 39 

Typhoid 9 

Tuberculosis 6 

Pleurisy 1 2 

Influenza 1 

General diseases 51 

Temporary elevations of temperature otherwise in good health 3 

Total 111 

The following is a partial list of cases found at the time of the 
inspection of vessels, which cases were diagnosed and the vessels then 
allowed to proceed to New Orleans: 

Typhoid fpvor ...1 g 

Miil;iriii, foniiniif'd niifroscoiiiciilly 19 

Tuberculosis, conhrmed microscopically 6 



112 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Pneumonia 3 

Dysentery 1 

Impetigo contagiosa 1 

General diseases 35 

Total -— 71 

Beginning September 28, 1908, when yellow fever was reported in 
Ceiba, Honduras, to October 6, 1908, when quarantine restrictions 
against that port were removed by order of the bureau, fruit vessels 
from Ceiba were fumigated, and the crew, except the master, first 
mate, and chief engineer, detained in quarantine. The vessels were 
then released and new crews were placed aboard them to New 
Orleans. 

On October 7, 1908, the Brazilian steamship Amazonas arrived 
from Rio de Janeiro via Pernambuco and Barbados. A case of 
smallpox, in the person of the second engineer of this vessel, was 
landed at Pernambuco. The vessel was disinfected at Barbados 
under the supervision of a service representative, and after being 
again thoroughly disinfected at the New Orleans quarantine station, 
and the crew vaccinated, was discharged in free pratique October 9, 
1908. 

On October 13, 1908, the Italian steamship Liguria arrived from 
Genoa. Four cases of varicella and one case of measles were reported 
as having occurred among the immigrant passengers and found to 
be convalescing. The local health authorities at New Orleans were 
informed of this, as is required under the United States Quarantine 
Regulations, paragraph 67. 

On November 4, 1908, the British steamship Castillian Prince 
arrived from Rio de Janeiro via Victoria and Bridgetown, Barbados. 
At Bridgetown a case of smallpox was removed from the vessel. The 
vessel was disinfected and detained four days to complete fourteen 
days from the date of disinfection, which was performed by the 
service representative at Bridgetown. 

On December 30, 1908, the French steamship Gloride arrived from 
Habana, where previous to departure a case of smallpox was removed 
from among some immigrant passengers. The vessel was disinfected 
at Habana before departure under the supervision of the service 
officer stationed there. There were six immigrant passengers on 
board destined for New Orleans, all of whom had been exposed to 
infection. These passengers were detained at quarantine and the 
vessel released, subject to the observation of the sanitary inspection 
service at New Orleans under Surg. J. H. ^Yhite. 

On March 1, 1909, the American steamship Momus from New 
York arrived at the station with a case of scarlet fever. The local 
health authorities at New Orleans were notified of the fact. 

On June 18, 1909, when the steamship Imperator arrived at the 
station, the master of the vessel was advised to have all living quar- 
ters disinfected, watertank washed out and steamed, and all dishes, 
glasses, tableware, etc., boiled, as four cases of typhoid fever had 
been traced to this vessel. Three of these cases had been removed 
on the previous voyage to the quarantine hospital, where the diagnosis 
was made after observation. The fourth case was discovered on 
another vessel in one of the crew who had joined that vessel after 
being discharged from the steamship Imperator. The work of disin- 
fection was done at the New Orleans station. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 113 

In the instances where a case of tuberculosis was discovered among 
the crew of vessels, advice was given as to the sanitary and hygienic 
measures to be followed to avoid the spread of the infection. 

TRANSACTIONS DURING CLOSE QUARANTINE SEASON. 

All vessels entering the river by South Pass between the hours of 
sunrise and sunset are boarded by the medical officer stationed at 
Port Eads. He is instructed to issue pratique to vessels coming direct 
from clean European ports and Porto Rico with good sanitary his- 
tory, after satisfying himself that all persons are well. 

AJl vessels from tropical ports, or such as have any sickness 
aboard, are remanded by him to the New Orleans quarantine station 
for inspection and treatment, when required. 

Vessels arriving between sunset and sunrise proceed to the upper 
quarantine station for inspection. 

The result of the inspection of vessels remanded is telephoned by 
the officer at the substation to the main station, in order that there 
may be no more delay than that necessary to a thorough inspection, 
and that preparations may be made to disinfect such vessels as re- 
quire it. 

The principal shipping passing through to the port of New Orleans 
is from tropical ports. The inspection of these vessels, made at the 
station, consists in the examination of papers, a visual inspection and 
the taking of the temperature of each and every individual on the 
vessel. During close quarantine season all records of temperatures 
taken are kept on file in the office. 

Where the temperature of an individual is found to register 37.8° 
C. or over, and the cause for such a rise in temperature is not ap- 
parent, the individual is immediately removed to the quarantine 
hospital for observation and treatment. 

TRANSACTIONS DURING OPEN QUARANTINE SEASON. 

All vessels except those from plague ports entering the river by 
South Pass between the hours of sunrise and sunset are inspected by 
the medical officer stationed at Port Eads, and pratique issued, pro- 
vided all are found well after a careful visual inspection. All vessels 
arriving at night, and vessels from plague ports or with sickness 
aboard, proceed to this upper quarantine station for inspection. 

The inspection of fruit vessels at night is the same as is done dur- 
ing the close quarantine season, namely, a careful visual inspection 
and the recording of the temperature of each and every person. 

During the entire year the inspection of vessels from plague ports 
consists in a careful examination of papers and the history of the 
vessel, the recording of the temperatures, and a glandular examina- 
tion of all persons. These vessels are also fumigated with sulphur 
dioxide for the purpose of killing rats, and all bedding and soiled 
clothing on board is steamed. 

NIGHT INSPECTIONS. 

Under the state regime all fruit vessels arriving at any hour of the 
night were inspected, for which the medical officers and employees 
received extra compensation. The practice of making night inspec- 

18546—10 8 



114 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

tions at any hour has been continued, but on May 26, 1907, was limited 
to 12 o'clock midnight. No fee nor extra compensation has been 
allowed for such night-inspection work since this station has been 
operated by the service. 

During close quarantine season it has been the practice of the 
medical officer in command to personally make the examination of all 
vessels and persons coming from tropical or suspicious ports. The 
commanding officer and his assistant are on duty between the hours 
of sunrise and midnight, approximately nineteen to twenty hours 
of the day. 

All persons who have been removed from vessels to the quarantine 
hospital are carefully studied and observed, and a clinical record kept 
under the personal supervision of the commanding officer. 

Since the operation of the station under federal supervision no 
quarantinable disease has been observed. 

8an Diego^ Cal.^ quarantine. — Acting Asst. Surg. W. W. McKay 
in charge. 

Forty-four vessels were spoken and passed, 172 steamers and 16 
sailing vessels were inspected and passed, and 1 sailing vessel was 
fumigated. These vessels carried crews aggregating 3,596, and pass- 
engers aggregating 1,412. 

The 44 vessels spoken and passed were either navy vessels from 
Magdalena Bay, Mexico, where they had gone for target practice, or 
coastwise (California coast) vessels that had been spoken for their 
certificate of fumigation from San Francisco. 

San Francisco quarantine. — Post-office and telegraphic address. 
Angel Island, Cal. Passed Asst. Surg. F. E. Trotter in command. 

Seven vessels were spoken and passed, and 108 vessels were boarded 
and passed ; 362 steamers were inspected and passed, and 10 steamers 
were disinfected; 208 sailing vessels were inspected and passed, and 
2 were disinfected. These vessels carried a total of 53,996 crew and 
40,662 passengers. Of these vessels 197 were from plague and cholera - 
infected ports, and 63 were from yellow fever ports. 

Under the heading " Boarded and passed," the steamers have been 
listed under two heads, viz, " Merchant " and " Government." The 
first are the Pacific Coast Steamship Company's vessels from Victoria, 
British Columbia, which are provided with special certificates from 
the service representative at Port Townsend, Wash., and the second 
are, for the most part. United States naval vessels returning to San 
Francisco from target practice at Magdalena Bay, Mexico. 

Occasional requests are received from shipowners for the fumiga- 
tion of their vessels, and these requests have always been met, the 
service furnishing a representative to direct the work. 

The most noteworthy incident of the year has been the discontinu- 
ance of the fumigation of vessels departing from San Francisco. The 
transactions of the service at this station, operated as " Plague-sup- 
pressive measures," between June 30 and October 21, 1908, were as 
follows : 

Vessels fumigated and certified 483 

Vessels certified : 1, Oil 

The work terminated October 21, 1908, and the barge' Disinfector^ 
with the property used, was brought to the station. 



PUBLIC HEALTH AND MABINE-HOSPITAL SERVICE, 115 

Port Townsend^ Wash., quarantine and suhports. — Surg. J. H. 
Oakley in command. 

During the fiscal year ending June 30, 1909, 398 vessels were 
boarded; of these, 254 were steamers, and the remaining 144 sailing 
vessels. Of the total number of vessels boarded 394 were inspected 
and passed, and 41 steamers were detained for disinfection in whole 
or in part, as the circumstances demanded. The 398 vessels carried 
a total of 20,597 passengers, and their crews numbered 20,765. 

Shortly after the close of the fiscal year the new boarding boat for 
this station was delivered. The vessel is 72 feet over all in length 
and 14 feet in beam. The motive power is derived from a starboard 
and port engine of 65 horsepower. The vessel was named after the 
late Passed Asst. Surg. W. M. Wightman. 

At the subport of Port Angeles, Wash., 2 steamers and 6 sailing 
vessels, carrying 152 men in their crews, were inspected and passed 
during the year. 

At the subport of South Bend, Wash., 37 steamers and 2 sailing 
vessels were inspected and passed. These vessels carried 29 passen- 
gers, and their crews were made up of 781 persons. 

Columbia Rioer, Oreg., quarantine and suhports. — Post-office and 
telegraphic address, Astoria, Oreg. Passed Asst. Surg. J. M. Holt in 
command. 

During the year 117 steamers and 68 sailing vessels were inspected 
and passed. These vessels carried 6,023 crew and 4,354 passengers. 

Coos Bay quarantine {substation). — Post-office and telegraphic 
address. North Bend, Oreg. 

Fifty-six steamers and 8 sailing vessels, with 58 crew and 29 pas- 
sengers, were inspected and passed. 

Siuslav) and Umpqna River quarantine (subport). — Three steam- 
ers and 6 sailing vessels, with 75 crew, were inspected and passed 
during the year. 

Yaquina Bay quarantine {substation). — No transactions during 
the year. 

Grays Harbor quarantine {suh station) . — One hundred and twenty- 
seven steamers and 44 sailing vessels, with 876 passengers and 3,141 
crew, were inspected and passed during the year. Nine vessels were 
fumigated during this period. 

TEXAS- MEXICAN BORDER INSPECTION. 

El Paso, Tex. — Acting Asst. Surg. E. Ale-xander reports that dur- 
ing the year 15,113 passengers were inspected. There Avere 168 vac- 
cinations and 17 fumigations of hides and bones; 49 nonimmunes 
from Tampico and Veracruz were held under observation to com- 
plete the period of five days from port of departure. 

Laredo, Tex. — Acting Asst. Surg. H. J. Hamilton reports that 
during the year 743 passenger trains, carrying 49,601 passengers, 
were inspected, 12,433 aliens were inspected and 614 persons were 
vaccinated. The death and embalming certificates, together with 
containers for 6 cadavers, were inspected, and 5 aliens and 6 citizens 
were detained to complete the period of five days from port of 
departure. One case of smallpox was discovered and returned to 
Mexico. 



116 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Eagle Pass, Tex. — Acting Asst. Surg. Lea Hume reports that dur- 
ing the year the transactions were as follows : 

Total number of trains inspected 370 

Total number of persons inspected on trains 14, 298 

Total number of persons inspected on bridge 2,000 

But slight difficulty was found in keeping out contagious diseases 
at Eagle Pass, because of the cooperation of the Mexican health au- 
thorities. When any contagious disease manifests itself on the Mexi- 
can side of the Rio Grande, the medical officer of the service is in- 
formed at once, and he immediately takes steps to prevent the spread 
of the disease by advising and assisting in the necessary quarantine 
work. 

During the fiscal year just ended there were in all 5 sporadic 
smallpox cases in the city of Porfirio Diaz, Mexico (just across the 
E,io Grande from Eagle Pass, Tex. ) . Owing to efficient quarantine, 
vaccination, etc., there was no spread of the contagion. 

Along the line of the Mexican International Railroad, from the city 
of Porfirio Diaz to Torreon, Mexico, there was an epidemic of small- 
pox during the months of February and March. The federal quaran- 
tine officer at Eagle Pass encouraged the Mexican International Rail- 
road officials in their work of free compulsory vaccination and the 
isolating and quarantining of actual cases. Thorough disinfection 
was accomplished in all cases, and furniture, clothing, and old huts 
in which the smallpox cases were confined, were burned immediately 
after recovery from the disease. It was due to these precautions that 
no epidemic occurred on the American side of the river. 

It is the custom of the service officer to inspect all trains from 
Mexico on the railroad bridge over the Rio Grande. This is accom- 
plished by his going every day to the city of Porfirio Diaz, Mexico, 
where the Southern Pacific and Mexican International trains meet. 
Passengers are there transferred from the Mexican train to the 
Southern Pacific. When the Southern Pacific train is ready to leave 
for Texas, the service officer boards it and proceeds with it on the 
bridge, and the train is stopped at a midpoint on the border line 
between the United States and Mexico. Here the actual inspection 
work is done. The quarantine officer inspects each person on the 
train and administers an oath to the effect that the passenger has not 
been in any infected district nor has been exposed to any contagious 
disease. In the event of a susiDicious case, the train is ordered back 
to Mexico, where the conductor of the train is requested to remove 
the suspect and leave him on Mexican soil. This is necessary because 
the service maintains no quarantine camp in Eagle Pass, hence the 
Mexican officials must take charge of the suspect. This procedure is 
carried out with all persons, American citizens included. With the 
Texas authorities the custom is the same. In the event that actual 
disease is discovered in a coach, it is refused entrance until it has 
been thoroughly fumigated. 

Supplemental Inspection Service at New Orleans, La. 

Pursuing the plan described in the annual report of 1908 of main- 
taining a sufficient surveillance over persons arriving at New Orleans 
from the tropical ports which, while considered suspicious, were not 
known to be infected with yellow fever, the bureau continued this 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



117 



service at New Orleans, its usefulness being increased by the coop- 
eration of the state health authorities of Texas and Louisiana. 

The fiscal year just closed shows 38,126 persons under surveillance, 
as against 36,213 last year, and in the local work in New Orleans 
4,682 persons, as against 4,571 last year, these latter being crew and 
passengers remaining in infectible territory to be watched until the 
expiration of the period of incubation. 

Besides this, 30,660 members of regular crews were under observa- 
tion while in port, as against 29,561 last year. 

The greater amount of security given by this work is in some 
measure responsible for a marked improvement in the class of vessels 
now in the tropical trade, no less than 6 large new steamers of mod- 
ern type, 6,000 tons register, having replaced about 12 of the old 
second-rate chartered class. These large vessels carry practically 
all the passenger traffic, and every vessel carries a ship surgeon, who 
is employed or discharged under the direction of either Surg. J. H. 
A^niite, at New Orleans proper, or Passed Asst. Surg. R. H. von 
Ezdorf, at the quarantine station. 

Transactions at the New Orleans Sanitary Inspection Office, Year ending 

June 30, 1909. 



Month. 



^ ft 



ft.s 



a =u 



O) H o 

oSB 

JO O 

3£§i 



3 m a S 



is C5 






a ^ 
03 a 



^ rs a 
3 5 ft,!? 



1908. 

July 

August 

September. 
October... 
November. 
December . 

1909. 
January... 
February.. 

March 

April 

May 

June 

Total... 870 ] 30,660 



2,027 
2,214 
2,379 
2, .582 
2,761 
2,783 



2,152 
1,885 
3,168 
2,396 
3,793 
2,520 



444 
579 
643 
469 
563 
578 



611 
472 
823 
729 
964 
570 



2,482 
2,801 
3,035 
3,063 
3,328 
3,363 



2,763 
2,358 
4,005 
3,140 
4,692 
3,096 



229 
278 
412 
278 
363 
292 



299 
228 
361 
327 
425 
278 



215 
301 
231 
191 
200 
286 



312 
244 
462 
402 
539 
292 



7,445 818 



38, 126 



3,770 



3,675 



2,358 
2,566 
2,863 
2,899 
3,138 
3,082 



2,485 
2,133 
3,562 
2,871 
4,380 
2,808 



342 
360 
497 
329 
381 
301 



333 

249 
408 
490 
595 
294 



102 
74 
72 
39 
14 
7 



34 
20 
33 
148 
162 
10 



35, 145 



4,579 



715 



156 



23 



Supplemental Inspection Service at Mobile, Ala. 

This inspection service, similar to the one maintained at New 
Orleans, is conducted by Acting Asst. Surg. Henry Goldthwaite. All 
the personnel of vessels arriving at Mobile from the Tropics are held 
under observtition after having passed the regular inspection at the 
quarantine station. The transactions for the fiscal year ending June 
30, 1909, are as follows: 

Number of vessels inspected :. 075 

Xnmber of crew inspected ... 12,698 

Nuniber of passengers inspected 476 



118 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Passengers from tropical ports certified to Surgeon Wtiite, New Orleans, 
for observation 35 

Passengers from tropical ports certified from Surgeon White, New 
Orleans, for observation at Mobile 76 

No case of quarantinable disease was found on any vessel during 
the year. 

New Quarantine Stations. 

the new orleans quarantine station. 

As mentioned in previous annual reports of the service, the New 
Orleans quarantine station and its substation Port Eads, and the 
stations at Kigolettes, Atchafalaya, Lake Charles and Lake Borne, 
formerly operated by the State of Louisiana, passed into the charge 
of the Public Health and Marine-Hospital Service on April 1, 1907, 
and have been operated by it continuously since that time. Owing 
to the failure on the part of the State of Louisiana to render a clear 
title to certain of the lands required in connection with the station, 
much litigation has been necessary. 

In the near future, however, all irregularities in the title will be 
removed and the final improvement and equipment of the station will 
be effected. 

This station, formerly operating under the Louisiana state board 
of health, was called the Mississippi River quarantine station, and 
upon its transfer to the United States on April 1, 1907, was named 
the New Orleans quarantine station, under the order of the Surgeon- 
General, Public Health and Marine-Hospital Service, dated March 
25, 1907. 

The New Orleans quarantine station is located on the left bank of 
the Mississippi River about 90 miles below the city of New Orleans. 
An inspection station, considered a part of the main station, is main- 
tained at Port Eads, which is 15 miles below at the mouth of the 
South Pass of the river. 

The quarantine reservation includes a strip of land about 2,000 
acres in extent, having 50 acres frontage on the Mississippi River 
and a depth of about 40 acres. The boundary lines are not clearly 
marked, except where this land is bounded by the river and other 
water courses. There is a short fence built at the upper end of the 
reservation where the land borders on private property. With the 
exception of about 10 acres on which the station is located, all this 
land is subject to overflow during the season of high water. 

The site of the station proper is composed of approximately 10 
acres of made land extending about 1,400 feet on the river front. 
This is protected by a plank revetment, the depth of the land so 
protected is about 300 feet. This land is about 8 ihcheB to 1 foot 
above the river at high water, and the work of filling and raising this 
land is done each year to maintain its level, as each year there is a 
certain amount of settling of this made ground. Canals divide this 
site, from which the silt deposited each year during high river is 
taken for the purpose. 

Buildings. — Commanding officer's quarters, assistant surgeon and 
pharmacist's quarters, executive building and attendants' quarters, 
dormitory, mess hall and kitchen, hospital, wharf and shed for dis- 
infecting apparatus, general storehouse, carpenter and blacksmith 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 119 

shop, boathouse, launch shed. There are several small buildings, 
such as laundry rooms, servants' quarters, chicken houses, and cattle 
shed. 

Floating equipment. — Steam tug Assistance^ steam launch Felicien, 
3 rowboats. 

Wharves. — Main wharf of 400 feet in length, tugboat wharf, small 
freight wharf. 

Disinfecting apparatus. — Three steam disinfecting cylinders with 
superheating coils, Holt pattern. Two sulphur dioxide fumigators, 
Kinyoun-Francis type, one installed on a car on the main wharf 
and the other installed on the tug Assistance. 

Lighting and water supply. — An electric dynamo for lighting up 
the wharf during the night inspection of fruit vessels. Kerosene 
oil lamps are used for lighting all buildings. Rain water is collected 
in cisterns for drinking purposes; also river water, untreated, is 
pumped into cisterns for storage and general use. 

Since the station was acquired by the service a number of repairs 
and small improvements have been made. 

There is a local telephone system. The fire protection comprises 
24 underwriter fire extinguishers and 2 force pumps, hose and reel. 

THE MOBILE QUARANTINE STATION. 

The service assumed charge of the station, situated near the mouth 
of Mobile Bay, on March 18, 1907, and on April 1, 1907, a medical 
officer of the service and a pharmacist were assigned to duty. During 
the fiscal year ended June 30, 1909, many improvements have been 
made to the station. These include repairs to the old hospital and 
old gangway. 

The following new buildings have been constructed : 

Medical officers' quarters, boathouse and attendants' quarters, two 
detention barracks buildings, a building for office, general kitchen and 
dining room, pharmacists' quarters and stores, a building for shop 
and laundry, and two small buildings for oils and paints and gas 
generator. 

The work of the station is conducted by 1 medical officer, 1 phar- 
macist, and 13 attendants. All vessels are boarded in the open bay, 
about three-fourths of a mile offshore, from a launch or yawl boat. 
The boarding of vessels in the winter season, when the northers are 
of frequent occurrence, is sometimes difficult, dangerous, and even 
impossible. The north wind sweeps across 34 miles of Mobile Bay 
and produces a very rough sea at Fort Morgan. During the days 
when the northers are blowing, the launch is unsafe for boarding 
and is sent to Navy Cove, 3 miles distant, where she finds shelter, and 
the boarding is done from a yawl boat. 

All vessels requiring disinfection go alongside the fumigating 
barge Chiprrum., which is anchored about three-fourths of a mile from 
the shore. She swings at one anchor and turns every day with the 
tide. An extra anchor is in reserve, ready to be dropped. On 
account of the swinging with the tide the barge is always in the most 
advantageous position for vessels going alongside for fumigation. 
The barge is equipped with sulphur pots, sulphur furnace, fan, sul- 
phur hose, two steam chambers, bichloride tank, and electric-light 



120 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

plant. She has a boiler which furnishes steam for the chambers, fan, 
electric lights, pumps, and hoists for anchors. 

The barge is equipped with a wireless outfit owned and operated by 
the United Wireless Company. 

Four attendants are stationed on the barge and act as keeper, engi- 
neer, cook, and deckhand, and look after the safety and care of the 
vessel and constitute the fumigating squad, assisted in actual fumiga- 
tion by boatmen stationed ashore. 

The Reduction of the South Atlantic Quarantine to that of a 

Station of Refuge. 

During the fiscal year the personnel and property at the south end 
of Blackbeard Island, on which the South Atlantic quarantine sta- 
tion is located, was reconcentrated at the north end of the island, and 
the station as a whole reduced to that of a station of refuge. 

This was made necessary for purposes of economy, the great dimin- 
ution in the coasting lumber trade on the South Atlantic seaboard 
removing to a great measure the reasons which originally demanded 
a quarantine station on Blackbeard Island, Sapelo Sound, Georgia. 
The station, which will be conducted under a skeleton organization, 
will be always ready for use in the event of an emergency. 



INSULAR QUARANTINE. 

Operations or the Service in the Philippine Islands. 

Passed Asst. Surg. Victor G. Heiser, chief quarantine officer for the 
Philippines, reports on the quarantine transactions for the fiscal year 
ending June 30, 1909, from which the following is abstracted. In 
addition to his detail as chief quarantine officer, Doctor Heiser also 
holds the position of commissioner of health for the insular 
government : 

The United States quarantine laws and regulations were enforced 
by officers of the service at the six ports of entry in the Philippines 
and at two other j)orts at which vessels from foreign ports may receive 
pratique by special arrangement. 

At Manila and Cebu the service has first-class shore disinfecting 
plants, with ample facilities for detaining and housing the different 
classes of passengers and crews as may be necessary. At Iloilo a 
floating disinfecting plant is maintained, with limited accommoda- 
tions for detaining a small number of steerage passengers. At 
Olongapo, Cavite, Zamboanga, Davao, and Jolo inspection stations 
are maintained, and when infected vessels are encountered they are 
remanded to Cebu or Manila. 

From the foregoing it may be seen that the service is in position 
to maintain surveillance over all shipping that enters the Philippines 
from other countries. 

The quarantine during the year has been entirely effective, so far 
as known no quarantinable disease having been introduced. 

The question of the .quarantine inspection of foreign vessels is a 
most important one, especially with regard to plague, because this 
latter disease was only eradicated from the Philippines in 1906, after 
a strenuous effort which lasted over a period of seven years and cost 
many lives and much money. 

In view of the fact that the Philippines are in almost daily com- 
munication Avith near-by plague-infected countries by means of ves- 
sels making the voyage in a few days, only constant vigilance offers 
any hope against the reintroduction of plague. During the past few 
years this danger has been greatly increased on account of the fact 
that the construction of wharves for deep-sea vessels in the near-by 
foreign countries, as well as in the Philippines, is becoming more and 
more common, and this presents a new danger from a health stand- 
point, because the embarkation and disembarkation of plague-infected 
rats is correspondingly increased. 

Personnel. — The chief quarantine officer was absent from August 
to January on an official detail to the International Congress on 
Tuberculosis at Washington, D. C. ; a conference on Chinese immi- 
gration with the Departments of State and of Commerce and Labor; 
a visit to the leper colonies at Molokai and Louisiana ; delegate to 
the Southern Medical Association at Atlanta ; and on detail to Ham- 

121 



122 PUBLIC HEALTH AND MARTNE-HOSPITAL SEKVICE. 

burg for the purpose of making a report upon the fumigation of 
vessels by carbon dioxide gas. 

The roster of officers of the service on duty in the Philippine 
Islands was as follows: Passed Asst. Surg. Victor G. Heiser, chief 
quarantine officer for the Philippine Islands. 

Manila : Passed Asst. Surg. Victor G. Heiser, in command ; Passed 
Asst. Surg. Allan J. McLaughlin (exclusive duty with bureau of 
health), Passed Asst. Surg. R. E. Ebersole, Asst. Surg. J. R. Hurley, 
Pharmacist, and Cashier N. C. Comfort. 

Mariveles : Acting Asst. Surg. William J. Linley. 

Iloilo: Asst. Surg. Robert Olesen. 

Cebu : Passed Asst. Surg. H. G. Ebert. 

Zamboanga : Acting Asst. Surg. H. H. Johnson. 

Jolo : Acting Asst. Surg. W. T. Davidson. 

Olongapo : Acting Asst. Surg. C. F. Ely. 

Cavite : Acting Asst. Surg. H. Butts. 

Davao : Acting Asst. Surg. Max Becher. 

Cholei'a. — While the service was not directly concerned in the chol- 
era epidemic which occurred in the islands during the first half of 
the fiscal year, yet considerable extra work was occasioned it on ac- 
count of the outgoing quarantine measures which had to be imposed 
upon vessels, as well as the cholera-infected vessels that arrived at 
ports of entry from inter-island ports. These may be said to have 
been as effective as could be expected. One case of cholera occurred 
October 11 on the United States army transport Liscum after the 
same had been released on October 10, one day's quarantine detention 
having been undergone at Mariveles. After attempting to take care 
of the case, the vessel finally put in at the Cebu quarantine station 
and was thoroughly disinfected, after which no further cases oc- 
curred. 

Another case occurred on the United States army transport 
Buford, which left Mariveles October 15, after undergoing one day's 
quarantine detention, in a patient who was directly transferred to the 
ship's hospital from the division hospital, Manila, with a certificate 
of an army medical officer that it had not been exposed to infection 
during the preceding five days . The exact date of its detection was 
not learned, but it happened before the vessel's arrival at Nagasaki 
on October 20. 

The steamship Panay left Manila September 26 and arrived at 
Iloilo September 28 without having undergone quarantine detention. 
A case of cholera was found aboard a few hours after arrival. No 
quarantine was imposed upon this vessel originally, because it was 
proceeding from an infected port to another infected port. 

The foregoing shows that it is not advisable to make the quaran- 
tine detention for outgoing vessels less than two days at least, but 
there has been nothing occurring which would change the opinion 
expressed in the annual report of 1906 that a quarantine of five days 
was not necessary as a rule. 

The outgoing United States army transport Sheridan^ which was 
placed in quarantine September 14, developed one case of cholera 
the same day and another on September 16, which was the date upon 
which the complete disinfection was finished. The vessel was held to 
complete five days and no further cases occurred. 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 123 

On January 31 a small sailing vessel, with 8 passengers and crew, 
upon which occurred a case of cholera, was disinfected at Cebu upon 
request of the insular district health officer. 

April 13, while the sailing vessel Lolita^ bound from Escalante to 
Iloilo, was undergoing incoming quarantine detention at Iloilo, a case 
of cholera developed among the crew. The vessel and personnel were 
promptly disinfected and no further cases occurred. 

At Iloilo seven other vessels were disinfected on account of cases 
occurring while the vessels were lying in the harbor, but as all of them 
had been in port from over five days to several weeks, it is evident 
that the infection was contracted in Iloilo, and the disinfections were 
rather in the nature of a courtesy to the local authorities. 

The spread of the cholera during the year, from island to island, 
never took place from ports at which the service has officers nor did it 
enter any such ports. If it were possible to take the same measures at 
all the ports of the islands, the spread of cholera from island to island 
could be prevented with reasonable assurance, but unfortunately this 
is not practicable: First, for want of funds, and second, lack of 
trained officers. 

The results obtained by the service during the past year, however, 
have again shown in a forcible manner that trained officers can pre- 
vent the introduction of cholera into a country and also protect ves- 
sels that are bound from infected territory to United States ports 
against having the disease occur aboard. The detection of cholera 
and its prompt eradication from a transport which is loaded with 
hundreds of soldiers results in the direct saving of many lives and 
protects the United States from the likelihood of invasion, and is a 
sanitary achievement which goes far to show the necessity of modern 
health organization. 

Leprosy. — The Mariveles quarantine station disinfected five ves- 
sels, and the Iloilo station one vessel, on account of the fact that they 
had carried lepers. Five lepers were detected at the quarantine in- 
spection of incoming vessels. 

The Insular Government has been steadily continuing the policy of 
transferring all of the lepers in the Philippines to the island of Culion. 
During the year, 1,318 were sent to that colony, and all of the prov- 
inces, with the exception of Moro and Nueva Ecija, have been gone 
over, and many of them a number of times, and all known lepers 
taken away. Before segregation was commenced it is estimated that 
there were at least 700 new cases each year, and now there are not 
over 300 in the same period, so that this policy is apparently beiilg 
thoroughly vindicated. In other words, in 1906, when segregation 
was begun, there was approximately 1 leper for every 2,000 of the 
entire population of the archipelago, and now it is estimated that 
there is only 1 for every 2,800. The island of Cebu, with its area 
of 1,939 square miles and its dense population of 700,000, had 1 
leper out of every 400 of the population. As was to be expected in an 
island so thoroughly infected, a greater number of incipient cases 
was encountered during the year than on the other islands. 

Considerable success has been had in the treatment of leprosy by 
the X ray and also with crude chaulmoogra oil. 

The work of segregation has been continued without great oppo- 
sition and may be said to be well supported by public opinion. The 



124 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

* 

policy of not permitting nonleprous persons to reside at Culion has 
been strictly adhered to, and in the end such course is for the benefit 
of the patients, for the protection of the public, and the best interests 
of all concerned. 

Plague and rat-proof wharves. — There have been no cases of 
plague in the Philippines since April, 1906, and the interest of the 
service consists in preventing its introduction. This is an undertak- 
ing of no small proportions, because the Philippines are in almost 
daily communication with countries that are plague infected, and 
only a few days' steaming distance from the Philippines. 

The number of wharves suitable for deep-draft ocean vessels that 
are being constructed annually in the ports of the Orient is increasing 
very raj)idly, and in consequence the danger of j^lague-infected 
rats being convej^'ed from port to port and country to country has 
been multiplied many times. To offset this danger the new wharves 
which were recently completed in Manila have been made rat proof, 
in so far as rats gaining access to the shore is concerned. The girders 
under the floors have been rounded and near the shore end a steel 
flashing extends across the entire underside. Upon the wharf proper 
the wharf shed, or superstructure, is built of iron and all openings in 
this are permanently closed with a solid steel partition which extends 
at least a meter above the floor. The driveway has a solid steel lift 
gate, which is operated by an attendant while traffic is going on. A 
good breed of rat-catching cats is kept on the wharf, as well as rat 
traps and funnels on all the lines of all vessels that make fast to the 
wharf. 

In addition to the foregoing, all vessels that ply between the Phil- 
ippines and plague-infected ports are fumigated about every six 
months, or oftener if necessary. At Iloilo and Cebu the wharves are 
parallel with the shore, and owing to their greater length against the 
shore it is not practicable to use the Manila plan, and the measures 
are necessarily confined to fumigation of vessels and the use of tarred 
lines and funnels. 

Smallpox. — This disease was encountered a number of times upon 
incoming vessels. On September 5 the steamer Ghangsha., a passen- 
ger vessel that runs between Japan, China, the Philippines, and 
Australia, was found to have a case on board upon the vessel's arrival 
in Manila. On November 16 the steamer Islas Filipinas was re- 
manded from Zamboanga to Cebu for disinfection on account of 
smallpox. On February 27 the steamer Indrapura had a case among 
her crew which was probably contracted in Japan. May 14 the 
Escalante arrived at Iloilo with a case aboard. On June 9 the 
steamer Magallanes had a case, and upon June 28 a second case oc- 
curred after the vessel returned from a trip. 

All of the foregoing cases occurred in persons who could not show 
a good vaccination mark. 

Smallpox in the Philippines, especially the severe form, is rapidly 
becoming less common, as vaccination becomes more general. In 
Spanish times in Manila alone as many as 260 deaths occurred from 
smallpox during one month, whereas in the past few years, the deaths 
have never exceeded 10, and these occurred mostly in antivaccina- 
tionists. 

Extension of United States quarantine outposts in the Orient. — 
During the month of May the floating disinfecting plant which was 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 125 

used at Cebu before the shore plant was built at that station was 
sold by the service for use at the port of Amoy, China. The effects 
of passengers and crew bound for United States ports are now being 
disinfected at Amoy, when necessary, by a regular officer of the serv- 
ice. This arrangement has expedited matters very much for the ves- 
sels that sail for United States territory and saves them much delay 
and annoyance, which was unavoidable before these better facilities 
were provided. 

Building and equipment. — The Mariveles quarantine station suf- 
fered considerable damage by the typhoon which passed near Manila 
last December. 

The large disinfecting building was unroofed and the structure 
itself was partially blown over. The cabin bath building had the 
porches torn away and considerable other damage was caused. 

Toward the close of the fiscal year authority was granted to draw 
upon the insular government insurance fund for the amount required 
to replace the building. 

The rapid deterioration of structures in a tropical climate by white 
ants, teredos, and dry rot, of which mention was made in the last 
annual report, still continues and causes much work and study to find 
means to overcome it. A large portion of the Mariveles wharf was 
replaced by specially prepared creosoted timber, and another experi- 
ment is now under way of installing reenforced concrete piles and 
decking. If the latter construction can stand without danger the 
thrust strain of large vessels coming alongside, the question of wharf 
construction may be said to have been solved, and thereafter it will 
only be a matter of funds. The cost of concrete construction will be 
about double that of ordinary wood construction, but as it will last 
indefinitely, while wood only lasts from two to three years, it will be 
seen that in the first six-year period even the concrete construction 
would be the most economical. 

Vessels hoarded. — A total of 4,254 incoming vessels were boarded 
and inspected on arrival at the ports of entry in the islands. At 
Manila, 969 were boarded ; at Iloilo, 344 ; at Cebu, 2,793 ; and at the 
other ports, 148. 

Vessels disinfected. — There were disinfected at the several stations 
of the service a total of 68 vessels. Six vessels were disinfected on 
account of smallpox having occurred aboard; 14 were disinfected on 
account of cholera; 6 on account of being employed in transporting 
lepers to the leper colony, and the remainder were disinfected be- 
cause of having been at infected ports, having carried infected 
animals or cargo, or en route to the United States. A large number 
of partial dismfections were constantly necessary of vessels with 
tuberculosis, measles, typhoid fever, or similar diseases having oc- 
curred on board during the voyage, or patients brought to the' larger 
cities for treatment, or for segregation in the leprosarium or con- 
tagious disease hospitals. Vessels in the river and bay have been 
from time to time disinfected at the request of the bureau of health, 
and all vessels transporting cattle have been disinfected when the 
cattle have been found infected by the bureau of agriculture. 

Vaccination. — In order to protect human life and to avoid delays, 
losses, and annoyances to local shipping, the endeavor during the year 
has been to keep all members of crews of interisland vessels as im- 
mune as possible to smallpox. At Manila 785 members of crews were 



126 PUBLIC HEALTH AND MAEINE-HOSPITAL SEEVICE. 

vaccinated, of which number there were 155 known " takes," and 
124 were vaccinated more than twice without " takes." In view of 
the thorough vaccination of the entire population of the localities 
from which crews are secured the number of " takes " from service 
vaccinations diminishes each year. The quadruple-card system, out- 
lined in a previous annual report, has proved very satisfactory and 
is still in use. Virus prepared by the Manila bureau of science is 
used and has been above the average for potency. At the Manila 
station 5,927 vaccinations were performed, divided as to personnel as 
follows : Three thousand six hundred and seventy-one were incoming 
passengers, principally from the China coast ; 297 were smallpox 
contacts on vessels; 785 were passengers bound for the United States; 
283 were crews of foreign vessels; and 891 were crews of interisland 
vessels. Incoming steerage passengers from foreign ports who did 
not show evidence of recent successful vaccination, or from plague- 
infected ports, have also been vaccinated on arrival. This continued 
eifort to admit, if practicable, no unvaccinated persons into the port 
cities, together with the vaccination of the residents, has almost 
entirely eradicated smallpox from these populous centers. During 
April the office force also vaccinated upward of 500 persons, princi- 
pally government employees, who became alarmed because an unvac- 
cinated antivaccinationist died of smallpox. 

Vessels fumigated. — All the vessels engaged in the interisland trade 
were required to undergo fumigation once in every six months. Ves- 
sels in the Hongkong-Manila service are also required to be fumi- 
gated every six months and each time they are dry docked. Vessels 
coming from the coast of China where plague is present and no regu- 
lar officer is stationed are fumigated at frequent intervals at ports in 
the Philippine Islands. During the year 182 vessels were fumigated. 
At Manila 128 vessels were thus treated, at Iloilo 15, and at Cebu 
39. The pot method of burning sulphur has been used almost exclu- 
sively, and for exterminating vermin from vessels that are empty 
has proven very satisfactory. 

Outgoing quarantine. — United States consular bills of health were 
issued to 123 vessels. Said vessels Avere bound for all parts of conti- 
nental United States and also for many ports in the insular posses- 
sions. Of these vessels 12 were disinfected and 15 were fumigated 
throughout prior to loading for America. Of the United States 
army transports bound from the Philippines to New York, Seattle, 
or San Francisco, 13 were partially disinfected and their crews and 
steerage passengers bathed and their effects and baggage disinfected. 
In connection with this outgoing quarantine of vessels destined for 
United States ports, 28,120 pieces of baggage were disinfected, 
26,333 pieces were passed and so labeled after inspection; 497,070 
pieces of cargo were investigated as to source and liability of con- 
veying infection, 495,750 pieces of which were passed and so certified, 
and 1,320 pieces were disinfected. The interisland outgoing quaran- 
tine is considered under another subhead. 

Aid to other services. — (1) Board of marine examiners: The phys- 
ical examinations of all applicants for license as masters, mates, and 
engineers on vessels registered in the Philippine Islands were made 
by the officers of the service. The local law demands a full physical 
examination such as is prescribed for officers in the Revenue-Cutter 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 127 

Service. There were 121 examinations made, of which number 94 
passed and 27 were rejected. 

(2) Immigration: At the ports of entry in the Philippine Islands, 
officers of the service inspected during the year 7,718 arriving aliens. 
Of this number, 22 were certified as having excludable disease, or 
conditions that would affect their ability to earn a living. Of the 
number certified, 17 were deported, 4 landed, and 1 remains in the 
islands awaiting deportation or decision as to residence. 

(3) Light-house service: The service maintained a light on Mari- 
veles Bay for the benefit of navigation, the supplies being furnished 
by the insular government and the work in connection with lighting 
and care of the light was furnished by the quarantine service. Phys- 
ical examinations of employees of the light-house service are made 
when requested. 

(4) Bureau of civil service: Special physical examinations were 
made of civil employees or applicants for certain positions, when so 
requested by the director of civil service. Aid in examination work 
was also given on a number of occasions. 

(5) Weather bureau: Storm signals were displayed at Mariveles 
Bay for the weather bureau. Mariveles Bay being the best refuge in' 
this vicinity during typhoon weather, this station is one of the most 
important in the islands. 

(6) Bureau of agriculture: Owing to the prevalence of cattle dis- 
eases, especially rinderpest and surra, a large number of vessels which 
arrived with infected cattle aboard were disinfected by the service at 
the request of the director of agriculture. 

(7) Bureau of health: The work of the bureau of health and the 
bureau of quarantine service overlaps at times, and the service has 
always been ready and willing to do all in its power to increase the 
efficiency of the specific measures adopted for the sanitary betterment 
of the archipelago. Hides, animal and vegetable food products, and 
their shipment were supervised throughout the year, vessels in the 
river and bay were disinfected on account of disease having occurred 
aboard, and the vessels used to convey lepers from one port to another 
and to the Culion leper colony were disinfected. At Cebu the service 
officer took an active part in the local sanitary work, especially as 
regards quarantinable diseases, vaccination, and general public- 
health work ; and in Manila hundreds of persons were vaccinated at 
the quarantine office. 

(8) Bureau of education: A number of students bound for the 
United States to complete their education, either at government or 
private expense, were examined physically, as were the candidates for 
entrance to West Point. 

(9) Bureau of navigation: Physical examinations were made of 
officers and men to determine their fitness for promotion or for new 
positions in the coast guard service. Cutters and launches were dis- 
infected and crews vaccinated and a general supervision had over 
the sanitary condition of the coast guard fleet. Quarters were fur- 
nished at quarantine stations for repair parties on public work. 

(10) Coast and geodetic survey: Upon request, physical examina- 
tions of officers and men, either as applicants for positions or for 
promotion, were made. 



128 PUBLIC HEALTH AND MARINE-HOSPITAL SEKVICE. 

(11) Bureau of posts: Every possible aid was tendered the postal 
authorities at the different ports and quarantine stations, in order 
that the mail might be dispatched promptly during the ordinary 
routine and during the trying outgoing quarantines on account of 
cholera. At Iloilo for a long time the quarantine launch carried the 
mail ashore from arriving vessels, 

(12) United States Army : A number of transports were disinfected 
on account of having measles or other nonquarantinable diseases on 
board. Lighters and launches were fumigated and disinfected. Ves- 
vels of the interisland transport fleet were fumigated once each six 
months. Quarters at Mariveles were provided for home-going regi- 
ments for periods from five to forty days, and accommodations were 
frequently provided for as many as 1,000 persons. Mapping parties 
of the army were also quartered at the station for considerable periods. 

Immigration. — In the last annual report it was stated that about 
5,000 Chinese persons, many of whom had been residents of the Phil- 
ippines for periods varying up to thirty years or more, were being 
refused transportation in China to the Philippines by the steamship 
companies because of the ruling that all persons who were not citi- 
zens of the United States or expressly covered by the treaty of Paris 
must be regarded as aliens and meet the requirements of the United 
States immigration laws and regulations before they could be ad- 
mitted to United States territory. It was estimated that about 3,000 
were being detained at Amoy alone. It was most difficult for those 
affected by this ruling to understand why they could not return to the 
Philippines. Many of them had large property interests in the islands 
and considered them more as their permanent domicile than they did 
China. At the request of the insular government. Passed Asst. Surg. 
Victor G. Heiser was ordered to Amoy for the purpose of ascertain- 
ing whether some relief could not be extended. He found that many 
of them had undergone treatment and had been cured of the eye dis- 
eases which they thought might prevent their landing in the Philip- 
pines. The steamship companies were notified, and a large number 
soon reached the Philippines and were landed. This relieved the 
tension for the time being, but it was obvious that large numbers 
could not hope to pass the immigrant medical examination. 

On account of the fact that the public health would not be seriously 
menaced by their admission, and since it was believed to be only fair 
and just that persons who had lived in the islands long before Ameri- 
can occupation should be permitted to return, the governor-general 
named Passed Assistant Surgeon Heiser^ who was in Washington 
attending the International Congress on Tuberculosis, to act as his 
representative in bringing this matter to the attention of the State, 
War, and Commerce and Labor departments. 

As a result of this conference, and upon the recommendation of 
the Bureau of Immigration, the War Department on December 21, 
1908, approved and the governor-general put into effect an order 
which exempted Chinese persons who were properly domiciled in the 
Philippines from the requirements of the United States immigration 
laws and regulations. 

The foregoing decision has greatly reduced the work connected 
with the medical inspection of aliens, because the majority of per- 
sons who come into the Philippines, exclusive of the army, are Chinese 
who have a domicile here. 



PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 



129 



Statistics. — The tables of statistics of quarantine transactions cov- 
ering the individual ports of the Philippines, and a tabulated sum- 
mary showing all the work done in the islands, together with the 
financial statement, follow in the order named. 

Summary of Quarantine Transactions, both Incoming and Outgoing, fob 
THE Philippine Islands, Fiscal Year ended June 30, 1909. 



Manila. 



Uoilo. 



Cavite. 



Olon- 
gapo. 



Zambo- 



Jolo. 



Total. 



Vessels inspected 

Vessels detained in quarantine 

Vessels disinfected 

Vessels fumigated to kill vermin . . 

Bills of health issued 

Pieces of baggage disinfected 

Pieces of baggage inspected and 
passed 

Pieces miscellaneous cargo certified 

Cases quarantinable diseases de- 
tected on vessels 

Persons detained in quarantine 

Crew inspected 

Passengers inspected 

Persons vaccinated 

Persons bathed and effects disin- 
fected 



1,275 

143 

50 

128 

1,764 

36, 066 

27, 692 
495, 750 

5 

7,696 

90, 883 

54, 879 

5,927 

14,119 



547 

13 

9 

15 

117 

239 

37 
71, 200 

10 

250 

13, 943 

6,219 

101 

138 



2,793 

100 

9 

39 

135 

1,011 

175 
83, 146 

3 

4,862 

52,134 

18, 570 

132 

350 



,195 
62 



4,361 
2,160 



1,430 
443 



4,763 

256 

68 

182 

2,061 

37,316 

27, 904 
650, 096 

18 

12, 808 

171,946 

82, 333 

6,160 

14, 607 



financial STATEMENT. 

A. — General appropriation Ijureau of quarantine service. 

Balance, former fiscal year appropriations $25, 750. 700 

Appropriation, act 1873, fiscal year 1909 02, 500. 000 

Collections available for expenditure 8, 771. 940 

Total available 97, 022. 640 

Expended during tbe fiscal year 1909 70, 551. 735 

Unexpended balance, June 30, 1909— 26,470.905 

Total 97, 022. 640 

Outstanding obligations (estimated), $17,230,935. 

B. — Appropriation, far public icorks and permanent improvements. 

Balance appropriation, act 1342 .$789.6.30 

Expended during fiscal year 1909 171.420 

Unexpended balance, refunded to Treasury 618. 210 

Total i 789. 630 

Outstanding obligations, none. 

Expenditures, details. 

Com])ensation (if |)ersonn('] $40, 850. 620 

Office and general service expenses 1,815.085 

Launch and barge exjienses 7,994.465 

•Station supiilics and disinfectants 6, .561.025 

llepalrs to buildings and wliarves 12, 264. 165 

New construction and new equipment 1,237.795 

Total expenditures, United States currency - 70, 723. 155 

1S54r;— 10 f) 



130 PUBLIC HEALTH AND MAEINE-HOSPITAL SEKVICE. 

Expenditures hij station. 

Manila : 

General service expenses $17,408,315 

Launch expenses 5, (556. 670 

New station equipment 238. 790 

23, 303. 77;-) 



Mariveles: 

General service expenses and supplies 13,016.500 

Repairs to buildings and wharves 10,689.850 

New construction and equipment 651.190 

25, 2.57. 540 

Hollo : 

General service expenses 3.705.455 

Launch and barge expenses 3,490.815 

7, 205. 270 

Cebu : 

General service expenses 6,207.245 

Launch expenses 6, 019. 965 

Repairs to buildings, wharves, and reservation 1,652.570 

New construction and new equipment 349. 290 

14, 229. 070 

Jolo : 

General service expenses 240. 000 

Zamboanga : 

General service expenses 480.000 

Davao : 

General service expenses _— 7. 500 

Total - 'i'O' '<'23. 155 

Operations of the Service in Hawaii. 

From the report of the chief quarantine officer, Passed Asst. Surg. 
W. C. Hobcly, the following facts are abstracted : 

The work of the service in Hawaii may be described under three 
heads: First, quarantine operations; second, marine-hospital work; 
and, third, plague-preventive measures. 

quarantine operations. 

There has been no outgoing quarantine during the year. 

Orientals detained in quarantine for observation 3 

Europeans detained in quarantine for observation 2 

Baggage disinfected pieces— 1,782 

Persons treated for diseases other than quarantinable 5 

Days treatment furnished above persons 50 

Vessels fumigated with SO- 45 

Vessel disinfected with 1 in 1,000 "bichloride" solution 1 

Aiitopsy 1 

Ci'emation 1 

Number of deaths on station 1--^,,^--. 1 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE, 



131 



Incoming Transactions at Honolulu National Quarantine Station, Fiscal 
Year ended June 30, 1909. 



Month. 



1908 

July 

August 

September 

October 

November , 

December , 

1909, 

January 

February 

March 

April 

May 

June 

Total 



Steam vessels inspected. 



Number. 



Crew. 



Passen- 
gers. 



13,090 
3,660 
8,904 

10, 812 
3,672 
2,390 



4,388 
2,105 
3,571 
4,117 
3,865 
5,565 



3,323 

3,876 
3,872 
3,862 
4,555 
4,234 



3,890 
2,115 
4,042 
3,856 
5,960 
5,375 



66,139 I 48,960 



Sailing vessels inspected. 



Number. 



Crew. 



218 
117 
57 
117 
113 
128 



175 
80 
177 
117 
187 
104 



1,590 



Passen- 
gers. 



Many of these vessels came from ports infected with one or more 
of the following diseases: Plague, cholera, yellow fever, and small- 
pox. There has been no case of infection from any of these diseases 
during the fiscal year.. 



Incoming Transactions at Subport of Hilo, Fiscal Tear ended June 30. 1909. 





Month. 


Steam vessels inspected. 


Sailing vessels inspected. 




Number. 


Crew. 


Passen- 
gers. 


Number. 


Crew. 


Passen- 
gers. 


July 


1908. 




1 

1 
1 
1 

1 
1 


1 
1 
1 






2 
2 

1 
2 


27 
21 


3 


August 


41 


17 




September 




October 


40 
38 
38 

38 
39 


15 
6 
16 

6 
3 


14 
23 






3 


December 




January 


1909. 


2 
2 
1 
3 
1 
1 


27 
26 
9 
54 
14 
11 




February 




March 




April 


38 
40 
39 


4 
8 
15 


4 


May 


1 


June 












Total . . . 


9 


351 90 


17 


226 


11 











Incoming Quarantine Transactions at Subports, Fiscal Year ended June 

30, 1909. 





Steam vessels inspected. 


Sailing vessels inspected. 


Subport. 


Number. 


Crew. 


Passen- 
gers. 


Number. 


Crew. 


Passen- 
gers. 


Mahukona, Hawaii 








10 
9 


95 
176 


2 


Kahului, Maul 


2 
1 


73 
44 




2 


Kihd, Maul 






Lahaina, Maul 




1 
3 


13 
32 




Koloa, Kauai 








3 












Total 


3 


127 




23 


316 


7 


- 







132 PUJiLlC HEALTH AND MAKlNE-iiOSPITAL SERVICE. 

Marine-Hospital Work. 

Summary for fiscal year ended June 30, 1909. 

Patients remaining nnder treatment from previous year 11 

Patients admitted during the year 13J) 

Revenue-cutter seamen treated 

Foreign seamen treated 

Surgical operations 

Deaths 4 

Remaining under treatment at the close of the fiscal year 10 

Outpatient relief: 

Cases treated 455 

Times relief furnished 839 

Foreign seamen treated 

Cases rejected 3 

Physical examinations 10 

Days relief furnished 3,890 

PLAGUE-PREVENTIVE MEASURES. 

This service was asked to cooperate with the board of health in 
an effort to destroy the rats in the city of Honohilu, and thus aid in 
the general work of preventing the recurrence of plague. During 
the year 36,400 rats have been captured, and of this number prac- 
ticall}^ 35,000 have been subjected to bacteriological examination in 
the plague laboratory of the quarantine station. None showed 
plague infection. 

Quarantine in Porto Eico. 

The chief quarantine officer for Porto Rico, Passed Asst. Surg. 
S. B. Grubbs, stationed at San Juan, transmits a report for the fiscal 
year ending June 30, 1909, in substance as follows : 

The operations of the service in Porto Rico include : 

First. The quarantine service both incoming and outgoing. 

Second. The medical relief of American seamen. 

Third. The medical inspection of immigrants. 

Fourth. Physical examinations for various government services. 

The headquarters for the quarantine service are at San Juan, the 
other stations being Ponce, Mayaguez, Fajarclo, Humacao, Arecibo, 
Aguadilla, and Arroyo. The operations at all of these ports are 
under the supervision of the chief quarantine officer to whom the 
various quarantine officers report regularly and confer by mail or 
telegraph on all questions of importance. Frequent inspections are 
also made by the chief quarantine officer. 

The island of Porto Rico, situated in the eastern part of the AVest 
Indies, is naturally in the path of the many vessels in the West 
Indian and South American trade. With its dense population, its 
tropical climate, and imperfect sanitation, it is naturally highly 
infectible territory, especially for yellow fever and plague, and these 
diseases have been constantly present in the neighboring islands and 
mainland of South America. 

The policy of ample protection with the least amount of obstruc- 
tion to commerce has been followed consistently and with success. 
The most alarming danger has been the presence of bubonic plague 
in Venezuela and Trinidad, In the former country the epidemic of 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 133 

1908 had hardly subsided M^hen, on May 21, a new case was reported 
at Caracas, to be followed quickly by several others, practically prov- 
ing that the disease has been constantly present among the rats, and 
that the quarantine measures against these ports were very necessary 
even after a lapse of six months without a human case. 

At present, through the cooperation of the Venezuelan Govern- 
ment and the shipping interests, commerce with Venezuela is being 
carried on with but little delay, and with slight danger. Precautions 
taken at La Guaira and Porto Cabello to prevent rats boarding ves- 
sels, and the fumigation there of vessels when empty, make it possible 
to allow some of the steamers to come to the wharf at San Juan 
under certain restrictions for a few hours, and to reduce the detention 
of passengers to five days from the port of departure. 

The chief quarantine officer, in accordance with orders received 
from the bureau, inspected the cities of Caracas, La Guaira, and Porto 
Cabello, in Venezuela, after the second outbreak of plague in the 
first-named city, and with Acting Asst. Surg. W. H. Kellogg, de- 
tailed at the United States consulate in La Guaira, made arrange- 
ments to minimize as much as possible the danger of rats getting 
aboard vessels at La Guaira and Porto Cabello. 

A number of points in close communication with Porto Rico have 
been infected with yellow fever, notably Barbados, Trinidad, Cuba, 
Curacao (one imported case), and several of the Venezuelan ports, as 
well as the port of Fort de France, and vessels from ports suspected 
of infection" have been fumigated and passengers held five days from 
date of arrival at San Juan, or from the port of departure, depending 
upon circumstances. 

One case of yellow fever was removed from the steamer Julia from 
Santiago de Cuba on July 5, 1908. This case was immediately dis- 
covered on inspection, although the passenger was in the early stages 
of the disease and declared himself in good health. This incident 
showed the care with which the quarantine examination was con- 
ducted. Quarantine was raised on vessels from Cuban ports by 
bureau circular letter of March 22, 1909. 

At all the ports of the island having quarantine officers not only 
are inspections made, but when necessary the ordinary fumigation of 
vessels can be done. 

The plans for the new buildings to be built under the appropria- 
tion made by Congress have been submitted to the bureau, and the 
construction of the buildings will be effected by the Supervising 
Architect. They will add much to the comfort of the personnel of 
the station and of any passengers who may be detained there. The 
force at San Juan consists of 1 commissioned officer, 1 acting assistant 
surgeon, one pharmacist, and 16 attendants. 

During the year the following business was transacted at the ports 
of the ishmd : 

Quarantine service at Han Juan, Porto Rico, durimj the year ending June 

SO, 1909. 

Vessels inspectetl 227 

Vessels held in quarantine 30 

A'eHsels (liKiiiAjctcd , H 

I'assenKers in.spocted 15, 610 

I'iiHHiinfU'.TH detained l 354 

Crew insrier-tMl ^ 14,750 

I'.ills (if iii'Mltli issued 401; 



134 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Relief to American seamen. 

Seamen treated in hospital 88 

Seamen treated as outpatients 141 

Ponce : 

Vessels inspected 154 

Vessels in quarantine 55 

Vessels disinfected 13 

Passengers inspected 9, 803 

Crew inspected 8, 2G7 

Passengers detained in quarantine 118 

Pieces of baggage disinfected 53 

Bills of health issued 332 

Mayaguez : 

Vessels inspected 69 

Vessels held in quarantine 23 

Vessels disinfected '. 3 

Passengers inspected ■ 2, 507 

Crew inspected 3, 148 

Bills of health issued 245 

Immigrants inspected 66 

Fajardo : 

Vessels inspected 2S 

Passengers inspected 80 

Crew inspected 96 

Bills of health issued 33 

Immigrants inspected ., 90 

Aguadilla : 

Vessels inspected 18 

Vessels held in quarantine 5 

Passengers inspected 433 

Crew inspected 833 

Bills of health issued 92 

Arecibo : 

Vessels inspected 19 

Vessels held in quarantine 3 

Passengers inspected 174 

Crew inspected 659 

Bills of health issued 25 

Arroyo : 

Vessels inspected 1 

Crew inspected 10 

Bills of health issued 99 

Humacao : 

Vessels inspected 1 

Crew inspected 26 

Bills of health issued 62 



FOREIGN QUARANTINE. 

The duties of officers of the Public Heahh and Marine-Hospital 
Service detailed at foreign ports are as follows: 

First: The investigation into the previous whereabouts and the 
past and present sanitary history of all vessels destined for ports in 
the United States, its possessions and dependencies. 

Second : The inspection of vessels, crews^ and passengers, and the 
certification of freight. 

Third : The fumigation of ships to kill rats and mosquitoes, or the 
disinfection of ships when necessary. 

Fourth : The observation, if necessary, under detention, of intend- 
ing passengers for ports in the United States and its dependencies. 

Fifth : Weekly reports of transactions. 

Sixth : Weekly reports as to the health and sanitary conditions of 
the foreign port, and when possible of the country contiguous thereto. 

Seventh : The certification, in conjunction with the United States 
consular officers of the bills of health issued, said certification to be 
made just prior to the departure of the ship and to cover all require- 
ments provided for by the United States quarantine regulations. 

Fruit Port> Inspection Service. 

Acting assistant surgeons were detailed in accordance with custom 
to enforce at certain foreign fruit ports the quarantine regulations 
relating to fruit vessels, which permit the entry of such vessels to 
ports in the United States without detention at quarantine stations. 

The reports from the officers at the several stations follow : 

BELIZE, BRITISH HONDURAS. 

Acting Asst. Surg. C. L. Mengis reports as follows : 

Season of 1908 (July 1 to October 31). Forty-four steamers and 9 
sailing vessels were inspected, and 7 steamers were fumigated. There 
were 1,34.5 crew and 394 passengers on steamers, and 58 crew on 
sailing vessels. During this period health conditions were reported 
as good. 

Season of 1909 (April 1 to June 30). Twenty-eight steamers and 7 
sailing vessels were inspected, and 1 steamer fumigated. There were 
SCO crew and 358 passengers on these vessels. The passengers ex- 
amined prior to their departure from the port of Belize for American 
ports numbennl 121, and those examined in transit numbered 233. 

Doctor Mengis reports the health conditions of Belize during the 
fiscal year to have been excellent. 

There were a few cases of smallpox at Stann Creek, a small Carib 
settlemc^nt 30 miles from Belize, but conditions were handled so care- 
fully that the disease was soon eradicated and confined to that locality. 

135 



136 PUBLIC HEALTH AND MARIN E-HOSPITAL SERVICJE. 

All of the cisterns in the town of Belize are screened and are in- 
spected by two officers detailed for the purpose, and with few excep- 
tions there are no breeding places for the Stegoinyia calopus. The 
streets are kept free from trash or rubbish and the sanitary condition 
of the town is uniformly good. 

All quarantine matters in Belize are regulated and governed by the 
quarantine ordinance of 1907. The governor in council has the power 
to declare any port or place infected, and at the close of the last fiscal 
year the following places had been so declared : The island of Cuba ; 
the island of Trinidad; Colon and the Isthmus of Panama; the 
Atlantic coast of Honduras; the Bay Islands and Ruatan; the At- 
lantic coast of Guatemala; I3razil; the ports of Veracruz and Pro- 
greso ; Ascension Bay and the coast of Mexico. 

All vessels are boarded by the health officer of the port, and the 
passengers and crew examined ; those coming from infected places 
are kept under medical surveillance for six days from date of ar- 
rival. The water receptacles of the smaller boats are examined and 
if mosquito larvae are found the barrels are emptied and water sup- 
plied free at the hospital. All such vessels are fumigated with 2 
per cent sulphur dioxide gas. 

In cases where vessels bring bad bills of health or have infected or 
suspected cases on board, the passengers are detained at the observa- 
tion station situated at the extreme end of Newtown Barracks, about 
a mile from town, for the required number of days, the suspicious 
case or cases being removed to the isolation hospital at Moho Caye, 
about 3 miles from town. 

In order to be in a better position to deal with disinfection and 
fumigation, two Clayton's disinfectors have been imported into Belize 
and are now ready for service. The one for use at sea is installed 
upon a large lighter and is worked by a motor. This is knoAvn as 
Type C, the cost of which was $5,000. This machine is highly effect- 
ive in its germicidal and vermin destroying properties. The smaller 
disinfector is known as " Type M," a hand machine especially suitable 
for use in houses. 

Weekly reports are received from the British consuls in all the 
neighboring republics. 

The River Hondo, the boundary line between Honduras and Mexico, 
is patrolled by a motor boat under a customs officer, both for revenue 
and quarantine purposes. The customs officer keeps the medical 
authorities informed as to the existence of diseases prevalent. All 
the Cayes to the north of the colony are under the supervision of such 
an officer. 

General sanitary improvemsnts and precautions. — Every district is 
under a competent medical officer wdio sends a weekly report as to the 
sanitary condition of hi-; district, the prevailing diseases and general 
conditions. 

During recent years extensive antimalarial measures have been car- 
ried out in Belize and the principal towns in the colony, such meas- 
ures including the cutting down of bushes, attention to drains, and the 
filling in of clitcli,es and swamps. 

The people are being educated by lectures on tropical hygiene, as 
to sanitary matters in general, and the j)recautions to be taken against 
infection from the various tropical diseases. 



PUBLIC HEALTH AND MAlllNE-HOSPtTAL fSERVICE. 137 

Steps have been taken for the destruction of rats, " ratin " being 
used in the government public buildings. 

The removal of garbage from houses and streets is effected daily 
by the use of city carts. The streets are well paved and are arranged 
so that they drain rapidly. 

The general health conditions for the last three years have been 
good. The authorities have successfully coped with epidemics of 
dengue, influenza, and quickly stamped out smallpox in the Stann 
Creek district. 

BOCAS DEL TORO, PANAMA. 

Acting Asst. Surg. Paul Osterhout reports as follows : 

Season of 1908 (July 1 to October 31). Sixty-nine vessels, with 
1,941 crew and 79 passengers, were inspected. 

No infectious or contagious diseases appeared in this port during 
the year. 

The general health conditions of the town and the surrounding 
territory have been good. 

The work of grading the town, which was given out by the Pan- 
ama National Government in the form of a contract, is nearing com- 
pletion. No attempt has been made to provide a water system, and 
the people continue to use tanks and barrels. 

The Isthmian Canal Commission continues to maintain a sanitary 
corps at this post. Under these conditions all tanks and barrels are 
screened, breeding places for mosquitoes destroyed, and cans, bottles, 
and general garbage gathered and burned. 

Season of 1909 (April 1 to June 30). Sixty-five vessels, with 2,060 
crew and 184 passengers, were inspected. Health conditions in the 
port remained satisfactory. 

The last case of yellow fever to occur at Bocas del Toro, which 
originated there, died February 21, 1906. No other quarantinable 
diseases have appeared since that date. 

For about three years i^rior to April 1, 1909, the Isthmian Canal 
Commission had charge of the sanitation of the port and supervised 
the maritime quarantine. Since that date the maritime quarantine 
and sanitation have been turned over to the Panama Government and 
are under the direction of the Panama Government medical officer for 
the port. There is an agreement between the Isthmian Canal Com- 
mission and the Panama Government (by treaty or otherwise) by 
Avhich the Isthmian Canal Commission can enforce quarantine regu- 
lations in any port of the Republic to their satisfaction, and since 
their withdrawal from the port they have given additional power to 
the Panama medical officer to enforce maritime quarantine regula- 
tions. 

All vessels on arrival are boarded by this officer and a close inspec- 
tion carried out. 

The contract for raising the grade of Bocas del Toro, which was 
made by the l^anama National Government about three years ago, is 
nearly completed, and it is now possible to traverse very nearly all 
parts of the town with carts and horses. The garbage of the town is 
gathered up daily and disposed of by burning. Mosquito eradica- 
tion is now going on, bnt owing to lack of material for covei'ing l)ar- 
rels and tanks the Avork is delayed. 



138 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

There is no doubt that the conditions haA'e been greatly improved 
in the past three years, and the (Tovernment appears to he sincere in 
its endeavors to comply with whatever measures are deemed proper 
for a better sanitary condition of the port. 

BLUEFIELDS, NICARAGUA. 

Acting Asst. Surg. T. B. L. Layton reports as follows: 

Season of 1908 (July 1 to October 31). Twenty-three steamers, 
with 167 passengers and 485 crcAv, were inspected and their tempera- 
tures taken. 

Season of 1909 (April 1 to June 30). Eighteen steamships, with 
330 crew and 08 passengers, were inspected and their tempera- 
tures taken, and for this period there were no quarantinable diseases 
reported. 

At present there are no fixed regulations pertaining to maritime 
quarantine at Bluefields or elsewhere on the coast of Nicaragua, nor 
have any fixed rules existed during the past five years. 

The port physicians board and inspect the personnel and passen- 
gers of all fruit steamers coming from the United States. This in- 
sj^ection is compulsory and has been insisted upon by the local gov- 
ernors, past and present. 

It has been stated that should an infected vessel arrive it would be 
sent to sea, there being no quarantine facilities in the port. 

CEIBA, HONDURAS. 

Acting Asst. Surg. Allen J. Jumel reports as follows: 

Season of 1908 (July 1 to October 31). Seventy-four vessels, with 
1,727 crew and 53 passengers, were inspected. Twenty-three vessels 
were fumigated. 

Season of 1909 (April 1 to June 30). Fifty-five steamers, with 
1,233 crew and 86 passengers were inspected. Seven sailing vessels, 
with 42' crew, were inspected. Health conditions during this period 
remained satisfactory. 

In compliance with bureau instructions to this effect, Acting As- 
sistant Surgeon Jumel made a report upon the maritime and sani- 
tary advances at Ceiba, Honduras, during the past three years, and 
from this report the following facts are or interest : 

The local maritime quarantine at Ceiba, Honduras, is under the 
immediate supervision of Dr. Emilio Reina, a competent graduate of 
the Guatemala School of Medicine, who is assisted in his work by 
the commandante's secretary and an officer detailed from the local 
aduana. 

In general all vessels are boarded during the daytime and are not 
officially entered until released by the port physician. No actual in- 
spection of the crews and passengers is made, but the vessel's certifi- 
cates and other official papers are closely examined as to number and 
personnel of both crews and passengers. On steamers the captain's 
verbal report is courteously accepted as to the general health condi- 
tions prevailing on board. This, however, is not the case when 
smaller vessels from neighboring republics are boarded. These ves- 
sels are subjected to an actual inspection, which, although cursory in 
character, is sufficient to meet local requirements. Small vessels ar- 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 139 

riving with bad bills of health are not permitted to enter, and a simi- 
lar regulation prohibits the entry of all infected vessels. This is not 
an unreasonable rule, in view of the fact that no provision has been 
made for the local care, isolation, and detention of persons suffering 
with quarantinable disease, although excellent facilities exist where 
an isolation hospital could be readily established. Local quarantine 
laws are practically good, but their application depends upon the 
sense of duty and integrity of the medical officer of the port. 

Local sanitary advances were given their initial impetus by the 
visit to this port in 1907 of Acting Asst. Surg. John N. Thomas, who 
directed the resident service officer to insist upon such sanitary 
measures as were then considered to be essential. The sanitary ad- 
vances effected by the service officer in 1907 were further augmented 
by the submission in 1908, by verbal request of the alcalde, of a brief 
synopsis of such sanitary improvements as were then urgently needed. 
All suggestions offered by the service officer in 1908 for local sanitary 
advancement were practical and easy of application, and the majority 
of them were acted upon by the municipal officers. The intelligent 
acceptance of suggestions for local improvement may be justly con- 
sidered as an early sanitary advance, for without the intelligent ap- 
plication of new ideas no sanitary progress could have been effected. 

The most prominent sanitary advance made in Ceiba during the 
past three years was the official acknowledgment of the mosquito 
theory, and the measures adopted for mosquito destruction during the 
summer of 1907. All large water containers were ordered effectually 
screened, water barrels and other receptacles capable of breeding or 
becoming the breeding places of mosquitoes were destroyed, and ex- 
isting defects in local drainage were remedied with a view to the 
prevention of surface-pool formation. By request of the service officer 
during the quarantine season of 1908, frequent inspections to maintain 
these improvements were regularly practiced until the revolutionary 
attack on Ceiba in July of the same year, after which all sanitary 
matters were neglected. This neglect continued until June, 1909, 
when upon the appointment of a new commandante, activity along 
sanitary lines was efficiently resumed. The destruction of small water 
containers left the poorer inhabitants without an adequate water 
supply, and to remedy this evil artesian wells were driven. These 
wells were then and are now situated in close proximity to numerous 
old-fashioned water closets, and they eventually became contami- 
nated, so that in time what was originally intended as a sanitary 
improvement became a menace to the general health. In 1909 amoebic 
dysentery made its appearance and is still present. 

Road construction, the building of concrete sidewalks with appro- 
priate culverts and drains, and the grading of old thoroughfares, 
started during 1907, have been added to from time to time, so that at 
present the business section of Ceiba presents a cleanly appearance 
and the drainage, although not perfect, is very good. 

During the year 1908, the local board of health began the impor- 
tant work of cutting the grass in the streets and on the sidewalks, and 
the prnning of dense shrubbery twice monthly. They also ordered 
the r(!nioval of all old tin cans and empty bottles from yards and be- 
neath all houses. 'J'his was discontinued in July, 1908, on account of 
the revolution, but was resumed in June, 1909, and is now an active 
feature of the local scheme for sanitary advancement, 



140 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

The daily removal of garbage from the city limits was begun in 
1907 in a haphazard manner; in 1908 the removal of garbage was 
done in a systematic manner, and from July, 1908, to June, 1909, it 
Avas allowed to remain on the streets and sidewalks indefinitely, so 
that it became a menace to the public health. Since June, 1909, all 
garbage has been regularly removed from the city limits daily. 

The oiling of cesspools with crude oil, which was begun in 1907, 
has continued in a desultory fashion up to the present time. Insuf- 
ficient oil is used for this purpose, as a rule. However, since June, 
1909, the authorities have been more liberal in the quantity of oil 
used and in their attention given this important work. In August, 
1908, all cesspools were ordered deepened to a uniform depth of 7 
feet, and this did much toward contaminating the well-water supply. 

In 1907 the municipality permitted the local fruit companies to 
build conjointly a hospital for the care, isolation, and detention of 
sick sailors. 

The prompt recognition of the necessity for public vaccination to 
prevent smallpox infection during the early part of the jesii- 1909 
may be mentioned as an educational advance in local sanitary require- 
ments. Formerly it was the custom to wait until the port became 
infected before resorting to needed prophylactic measures. 

One of the most important sanitary advances made during the last 
three years is the maintenance of all improvements by frequent 
municipal inspection. The present governor of Ceiba, the Hon. M. 
Rivas, has done much toward improving the sanitation of the port. 

Formerly it was the custom for residents and local officials to 
deride resident service officers whenever yellow fever infection visited 
the port, but in 1908 their attitude changed, and official orders for a 
house-to-house inspection were issued, to determine the existence of 
further cases. 

LIVINGSTON AND PLTERTO BARRIOS, GUATEMALA. 

Acting Asst. Surg. L. A. Wailes reports as f oIIoavs : 
Season of 1908 (July 1 to October 31). One hundred vessels, with 
a total of 636 passengers, were inspected. 

Acting Asst. Surg. R. P. Ames reports as follows : 
Season of 1909 (April 1 to June 30). Thirty-four vessels, with 
1,161 crew and 762 passengers, were inspected. 

Since the completion of the dock of the Guatemala Railway at 
Puerto Barrios all traffic has been removed from Livingston to that 
port. Puerto Barrios is the only port in Guatemala on the Atlanti'3 
side, whence ships clear and passengers embark for United States 
ports. 

On passengers coming from the interior, the medical examinations 
are made at Guatemala City by Dr. Juan Padilla, a prominent and 
well-known physician, and for this examination a small fee is charged. 
Passengers holding certificates from Doctor Padilla must make a 
direct trip from Guatemala to Barrios in order to obtain the personal 
passenger certificate, issued by the service officer; otherwise passen- 
gers would be subject to a stay of three days, under observation, as 
required by regulations, at Barrios. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 141 

Vessels bound for the Gulf ports of the United States carry in 
addition to the consular bill of health and special certificate a record 
of temperature variations. The papers issued contain the names of 
all persons on board, an entry of the temperature of each passenger 
being placed opposite each name, together with the hour when taken. 
The inspections are made on lines similar to those in vogue at the 
United States quarantine stations. 

Livingston. — Situated on a high bluff at the mouth of the Rio 
Dulce. Population estimated at 2,400. The drainage is natural. 
The water supply is derived from rain water stored in tanks and 
various receptacles, all unscreened. Stegomyim calopus are present. 
Yellow fever has been present at Livingston at various times, the 
last epidemic having occurred in 1905. Vessels anchor in the open 
sea about 1 mile from shore. No passengers embark from the port. 
Ships get their final clearance from Barrios, some 15 miles across the 
bay. 

Puerto Barrios. — A small swampy town or settlement situated on 
the Gulf of Amatigue. Terminus of the Guatemala Railway. Popu- 
lation estimated at 350, consisting mostly of the office force and col- 
ored laborers in the employ of the United Fruit Company and rail- 
way. These laborers have either resided in Puerto Barrios or at 
other places in the hot belt on the coast, which probably accounts for 
Barrios having escaped the yellow fever epidemic of 1905. 

Water supply : Piped from a well about a half mile away ; quality 
good, but quantity inadequate. The rain water is stored in cisterns 
and other receptacles, only a few of which are properly screened. 
Stegormyim calopus are present, mostly in the central part of the 
town. Recurrent cases of malaria and dysentery are the prevailing 
diseases. Early in March Passed Asst. Surg. R. H. von Ezdorf made 
inspections covering Barrios, the fincas of the United Fruit Company 
at Virginia, the adjacent points on the line of the railway and Zacapa. 
Certain recommendations were made by him which have been partly 
carried out. Vessels discharge and load cargo at the railway dock 
at Barrios day and night. The dock projects into the bay 1,083 feet, 
is made of heavy creosoted timber, and is mosquito proof. 

Virginia farms. — These farms are the property of the United Fruit 
Company. They extend from a point about 20 miles from Barrios 
along the line of the railway in the direction of Guatemala City for 
a distance of about thirty-odd miles. The population is about 4,000, 
including women and children. Malaria and dysentery are the pre- 
vailing diseases throughout the farms. A small modern and well- 
equipped hospital has been erected at a central location, 
z' Early in the year a few cases of smallpox occurred. The sick were 
isolated. The Ijuildings used were destroyed by fire. Contacts Avere 
quarantined and everyone vaccinated. The disease was promptly 
checked. 

Zacapa. — This town is 102 miles distant from Barrios. The Avater 
supply is piped from a distance and is stored in various unscreened 
receptacles about the houses. Th.Q tS teg o'myia calopus is present. This 
town was visited by an epidemic of yellow fever m 1905, 



142 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

PORT LIMON, COSTA RICA. 

Acting Asst. Surg. D. W. Goodman reports as follows : 

Season of 1908 (July 1 to October 31). One hundred and nine 
steamers, with 6,140 crew and 3,578 passengers, were inspected and 
temperatures of crew and passengers taken. 

There has been no evidence of any case even suspicious of yellow 
fever during the season either in Port Limon or vicinity. 

At the request of the quarantine authorities on the Isthmus of 
Panama 30 bills of health for ships leaving this port for Panamanian 
ports have been viseed, and 287 certificates were issued to residents 
of San Jose, Cartago, or Limon bound for Colon. 

Season of 1909 (April 1 to June 30). Ninety-seven steamships, 
with 5,492 crew and 1,427 transit and 1,205 direct passengers, have 
been inspected. Of these steamers, 52 were fruit vessels bound for 
ports in the United States south of the southern boundary of Mary- 
land, and were made to conform to the special quarantine regulations 
provided for vessels from the fruit ports. No quarantinable diseases 
v/ere reported during this period. 

Doctor Goodman also reports that the sanitary conditions of the 
port have been good for the past two years. The policing of the 
streets and the removal of garbage are duties now performed by an 
organized sanitary squad. 

For several years the quarantine officers of the Canal Zone, sat- 
isfied of the freedom from yellow fever of Port Limon and San Jose, 
but being suspicious of the towns in the interior of Costa Rica, have 
required all passengers embarking for Colon to bring certificates 
from the medical officer of the Public Health and Marine-Hospital 
Service stationed at Port Limon to the effect that they had remained 
under observation five days in Port Limon or San Jose. In May of 
this year this requirement was withdrawn. Passengers from La 
Guaira and Caracas are quarantined upon arrival at Port Limon by 
the local authorities to complete five days from those ports. 

Acting Asst. Surg. William H. Harris, who relieved Acting Asst. 
Surg. Goodman on August 10, 1909, the latter being obliged to re- 
sign his position on account of ill health, reports as follows on the 
sanitary advances in the Republic of Costa Rica during the past 
three years : 

At Port Limon very radical sanitary changes occurred about ten 
years ago, and transformed the port completely. The water supply 
was changed four years ago from the Puta River to the Banana 
River. The water is pure and is piped a distance of 10 miles. 

The sewage sj^stem constructed ten 5^ears ago has been connected to 
1,200 additional dwellings in the past four years. There are remain- 
ing only about 50 houses with ground closets, and these will soon be 
forced to make sewer connections or pay a fine. A large reservoir of 
50 cubic meters capacity has been erected to add additional water 
supply for flushing purposes. This rendered it possible for dwell- 
ings previously inaccessible to the sewer system to be connected with 
it. Six thousand feet of sewer pipe have been laid for these addi- 
tional connections and submains along the various streets. 



PJBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 143 

Within the city limits 5,700 square feet of swampy districts have 
been filled in. Drains have been cut in adjacent swamps, which now 
render this ground practicall}^ dry. These improvements, together 
with the fact that care is taken by the local authorities to remove all 
receptacles capable of collecting water, or to use petroleum where 
necessary, has diminished greatly the number of mosquitoes present. 
There are strikingly few mosquitoes to be found, but in their number 
there are some of the Anopheles and Stegomyia species. 

One criticism concerning the sewage disposal must be made. The 
outlet pipes into the Carribean Sea open upon a shelf or table of coral 
rock where the water is quite shallow, and at certain times of the 
tide the rock is almost dry. An extension of these pipes for a dis- 
tance of about 150 yards would convey the sewage into a good cur- 
rent and into deep water. 

MARITIME QUARANTINE IN COSTA RICA. 

Maritime quarantine interests are focused on two ports, Limon on 
the eastern or Atlantic coast and Punta Arenas on the western or 
Pacific coast. 

A statement concerning the quarantine of the local government for 
Port Limon will be equally applicable to Punta Arenas, as the two 
have identical regulations. 

The diseases quarantined against are bubonic plague, yellow fever, 
. smallpox, and cholera. Other diseases, such as scarlet fever and 
whooping cough, are also quarantined when actuallj^ occurring on 
board of vessels. 

Trachoma cases are not rejected, although it is reported that there 
is much of it in Costa Rica. 

There have been no epidemics of any disease in the Costa E,ican 
ports during the last three years. 

Yellow fever, at one time endemic, has only appeared in the past 
five years in the form of two sporadic cases. 

There has been a change in regard to the period of time of quaran- 
tine for this disease from five to ten days. This change was based 
upon the last epidemic at St. Nazarre, propagated from a case im- 
ported from Martinique which developed ten clays after departure. 

Persons landing at Port Limon must have been successfully vac- 
cinated within the past three years or must submit themselves to 
vaccination before landing. 

PUERTO CORTEZ, HONDURAS. 

Acting Asst. Surg. R. P. Ames reports as follows : 
Season of 1908 (July 1 to October 31). One hundred and twenty- 
five vessels, with 2,974 crew and 229 passengers, were inspected and 
temperatures taken. 

Acting Asst. Surg. L. A. Wailes reports as follows: 
Season of 1909 (April 1 to June 30). Sixty-two vessels, with 98 
passengers, were inspected and temperatui'cs taken. Health condi- 
tions at this port during this period were fair. 



144 PUBLIC HEALTH AND MARINE-HOSPITAL SEllVICE. 

TELA, HONDURAS. 

Acting Asst. Surg. C. K. Roe reports as follows: 

Season of 1908 (July 1 to October 31). Twentj^-five steamers, 
with 782 crew, were inspected and temperatures taken. 

Season of 1909 (April 1 to June 30). Thirty-one vessels, wdth .587 
crew, were inspected. Health conditions during these periods were 
reported satisfactory. Doctor Roe praises the health authorities for 
their willingness to carry out the suggestions made by him for the 
improvement of sanitary conditions. He states that the town of 
Tela Avill compare favorably with the "majority of places of a similar 
size in the United States. 

INSPECTION AT OTHER FOREIGN PORTS. 

In addition to the medical officers detailed to the several fruit ports 
above mentioned, officers were also detailed to the offices of United 
States consuls, in accordance with the act of Congress approved Feb- 
ruary 15, 1893, in the following-named ports, for the purpose of 
enforcing the Treasury regulations provided for such ports, and 
signing the bills of health in conjunction with the consuls. 

At certain of the ports, viz, Bridgetown, Castries, La Guaira, and 
St. Thomas, officers were detailed not only to certify as to the health 
conditions of vessels leaving these ports for the United States, but 
also to perform the necessary disinfection of said vessels when their 
original port of departure was an infected or suspected port. By 
fumigating said vessels, either for the destruction of mosquitoes or 
the destruction of rats, and giving a certificate with regard to such 
disinfection, the time consumed by the passage of the vessel from the 
above-named ports to the quarantine stations in the United States 
was accredited to the vessel as a deduction from the time which 
might otherwise be demanded for detention at the United States 
quarantine station. 

At a number of the other ports named below, particular!}^ those in 
China and Japan and Naples, the officers, in addition to their quar- 
antine inspection, made inspection of immigrants with reference to 
contagious or infectious diseases which might debar them from 
admission on arrival in the United States. These inspections were 
made in accordance with requests from the immigration service and 
the steamship companies, the officers exercising no positive right of 
exclusion, but informing the steamship companies and others of 
those who would be subject to rejection at the port of arrival under 
the immigration regulations. 

Following are extracts from the reports made to the bureau by the 
officers stationed at the ports named : 

HABANA, CUBA. 

The following is an extract from the report of Passed Asst. Surg. 
J. W. Amesse for the fiscal year ending June 30, 1909 : 

The sanitary history of this period in Cuba was signalized by the 
final extinction of yellow fever throughout the Republic and the 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE, 145 

transfer of the health department from American to Cuban author- 
ity at the close of the second intervention, January 28, 1909. 

The year opened inauspiciously. After an apparent freedom from 
epidemic fever and the appearance of but three cases at Santiago de 
Cuba in three months, the disease was found July 8 to exist at the 
mining camp of Daiquiri, a few miles from that city. 

An expert sent by the national sanitary department reported 10 
convalescent cases of yellow fever, which had been diagnosed by the 
local health officer as malaria, and expressed the opinion that the dis- 
ease had been continuously present in Daiquiri for at least three 
months. Twenty cases were subsequently reported from this camp, 
but the epidemic was effectually eradicated by August 1. 

This outbreak alone fully justified the close surveillance of pas- 
senger traffic begun by the service on April 6, 1908. The subsequent 
introduction of yellow fever (July 5) into San Juan, P. R., by the 
Cuban steamer Jidia^ sailing out of Santiago de Cuba, supplied addi- 
tional evidence of the need of such restrictive measures. 

The fortunate interception of this case from the Daiquiri mines by 
Acting Asst. Surg. P. del Valle, Public Health and Marine-PIospital 
Service, at San Juan, forestalled a possible epidemic among the non- 
immunes of Porto Rico. 

On August 22, a further focus was found at Firmeza, near Santi- 
ago, and, August 27, one at Antilla, a town on the north coast. On 
September 7 a case was discovered in the city of Habana, which had 
remained free of infection from January 31, 1908. The patient was 
a Spanish boy about 20 years of age, without occupation, and living 
at a very insanitary lodging house near the passenger landing, known 
as the " Machina." The history of the case showed that he passed 
the first four days of his illness without medical care, finally enter- 
ing Las Animas Hospital on September 11, where he died five days 
later. The clinical course and necropsy findings were characteristic. 

Investigation showed that this nonimmune had resided in Habana 
continuously for at least a year, and furnished conclusive evidence 
that one or more cases of yellow fever had gone unrecognized — ^had 
infected various Stegomyia?, which later inoculated the above patient. 

The infection could not be satisfactorily traced, but it is probable it 
was brought from Daiquiri. The sanitary department was fully 
alive to the situation, and proceeded with commendable activity. All 
nonimmunes within a radius of six blocks were registered and exam- 
ined twice a day for six days; several hundred vagrants from the 
water front were rounded up by the police and sent to Triscornia 
quarantine for a similar period, while all buildings in the suspected 
area were thoroughly fumigated with sulphur. Through this vigi- 
lance the invasion was confined to one case and the quarantine im- 
posed by the United States against Habana was raised after eighteen 
days. 

Later, in December, two further cases of yellow fever were reported 
from the town of San LuLs, in Oriente Province, both patients en- 
tering the Civil Hospital at Santiago, where one died on December 31, 
and the other was discharged, recovered, January 13, 1909, The 
original focus in this invasion also baffled the diligent search made 
by American sanifjiriaiis through Oriente Province. 

1854G— 10 10 



146 PUBLIC HEALTH AND MARTNE-HOSPITAL SERVICE. 

From this outbreak to the close of the fiscal year no other cases 
have been reported, and the disease may fairly be considered extermi- 
nated, in view of continued hot weather, with great humidity, and 
the known influence these factors have in the development of latent 
foci. 

History of the epidemic 1905-1909. 

A revicAV of this last visitation of yellow fever furnishes an inter- 
esting study for sanitarians. Its origin has thus far defied detection 
and it is very probable will never be known. Some authorities believe 
infection was carried by a mild case from New Orleans, where the 
disease existed in 1905 in epidemic form. Others think it was con- 
veyed from Veracruz. 

At any rate, its progress in Habana was so insidious that by Octo- 
ber 17, 1905, when the first case was officially reported, it was evident 
that yellow fever had been present for some weeks. 

Invasions during this period were either unattended medically or 
Avrongly diagnosed, as is usual with epidemics of this disease every- 
where. 

Once announced and a medical dragnet installed by the sanitary 
department, cases were reported from various quarters of the city, 41 
being treated in November and 26 in December. 

The following table summarizes statistics for the entire period. 

It will be noted that the epidemic was suppressed in this city after 
three months, the cool weather of the winter season aiding materially 
in reducing the number of Stegomyia\ In the fall of 1906, it was 
again introduced and 61 persons were infected, 8 fatally .^ 

In the rural districts, however, where ambulant cases conveyed the 
infection sometimes great distances, it resisted the most determined 
efforts of the authorities for three years. In 1906 its stronghold was 
in Matanzas Province, in 1907 in Santa Clara Province, and in 
1908 in Oriente, where it was finally exterminated. 

The mortality rate of 32| per cent registered in this epidemic must 
not be interpreted as an indication of special virulence. 

In the provinces numerous mild cases of fever were unquestionably 
not reported to the health officer and grave cases only being recorded, 
the death rate was correspondingly raised. In addition, atypical cases 
carelessly studied or not studied at all by rural practitioners, with 
whom a positive diagnosis rests solely on the phenomenon of black 
vomit, aided in the perpetuation of the disease. 

Dr. M. G. Lebreclo, subdirector of Las Animas Hospital, and a 
recognized authority on yellow fever, has frequently expressed the 
opinion that in this climate, where sudden weather changes are un- 
common, and among Spanish laborers whose habits are remarkably 
abstemious, yellow fever does not result fatally in more than 10 per 
cent of the cases. 

Anything in excess of this indicates hidden infection. 

In view of the fact that the last epidemic at Laredo, Tex., had a 
mortality of 10 per cent, and the 1905 invasion of Louisiana and 
Mississippi a rate almost as low, we may fairly assume that instead 
of 403 cases there were actually about 1,200 cases in Cuba since 1905. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 
Review of Yellow Fever Epidemic in Cuba, 1905 to 1909. 



147 





t 
ca 

3 

a 

1-5 


ea 
3 


i 


ft 

< 




June. 
July. 


So 

3 

-=1 




a; 
.Q 
o 
o 
O 


6 




.CI 

s 




O 




1 


i 




1 
ft 




5 


i 


1 
ft 


1 
o 


1 




s 
ft 


i 


i 


1 


ft 


1 
O 

3 

24 
3 


J3 
1 

2 
3 
1 


1 

41 
23 


J3 
"ca 

Oi 

11 
2 


i 



26 
3 
1 


i 
ft 


City of Habana: 
1905 


1 


11 


1906 


5 


2 


1 

















4 


1 ;... 




4 
1 





7 
2 
1 


2- 

1 


n 


1907 

















1908 


2 









i 



















Habana Province: 
1905 






1 












1 

1 












1 
1 
5 




2 

1 


i' 

1 




1906 
































2 
8 


1 
4 


4 
12 


2 
6 





1907 










1 









3 


1 


2 





1 





4 


1 


1 


1908 


2 


1 








Matanzas: 
1905 










































5 


n 


1906 

1907 


1 








1 












2 
2 


1 





'6' 


1 

4 




1 


2 


2 


1 
4 


1 
3 


h' 


2' 


3 

4 


3 

4 








1908 






















Santa Clara: 
1905 . .. 


















































1906 
































1 
31 


1 

7 


8 
8 


5 
3 


9 
14 


4 
4 


1 
5 





1907 . 




























35 


9 


4 


1908 


7 


4 


6 


1 






















Camaguey: 
1905 










































1906 








^ 










































1907... . 






































1 


1 


2 


1 






1908 








































Orients: 
1905 


















































1906 . 


















































1907 














































1 

2 


1 


1908 . 


2 


1 


1 









1 


1 


1 





3 


1 


20 


3 


2 


1 





1 










' 1 



















Summary. 



1906. 
1907. 
1908. 



Total- 



Cases. 



110 
167 
50 



Deaths. 



Death 
rate. 



Gran':! total. 



Per cent. 
31.67 
30 

34.72 
30 



Measures to freoent the introduction of yellow fever into the United 
States^ fiscal year 1909. 

To ^iiard against both the knoAvn and unknown foci in the rural 
districts and yet effect no hardship to the city of Habana, which re- 
mained free of fever until September, 1908, was a sanitary problem 
of moment. 

The solution made at the opening of the close quarantine season in 
April, 1908, wherein Habana and surburban toAvns were named as 
detention centers for passengers about to embark for southern ports, 
proved fairly safe and was continued throughout the heated term. 



148 PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE. 

On arrival from the suspected country localities prospective pas- 
^^engers were registered at the office of the service and re<|uired to 
report twice daily thereafter for six days. The necessity for frequent 
inspection was occasioned by the ease with which quite distant points 
can be reached from Habana and return be effected the same day. 

At the conclusion of the detention period passengers free of quar- 
antinable disease were given certificates which admitted them to 
southern ports. 

Persons boimd for New York were allowed to proceed without 
delay, those en route for points north of the southern boundary of 
Maryland carrying certificates from this office to that effect. The 
quarantine officer at New York was thus able to clear vessels promptly 
and to ascertain readily what portion of the personnel was bound for 
jooints in infectible territory. 

As rapidly as sanitary conditions in the interior returned to normal, 
quarantine from the districts involved was removed. 

On August 5 it was lifted from the provinces of Habana, Matanzas, 
Pinar del Rio, and the Isle of Pines. 

On September 10 restrictions were withdrawn from the provinces 
of Santa Clara and Camaguey, leaving only Oriente under surveil- 
lance. It was fianally removed from this province on October 20. 

Ciihan quaTantine against Mexico. 

To guard against the reintroduction of yelloAV fever fiom Mexican 
ports, rigid quarantine has been maintained by the Pepublic since 
September, 1908. The sanitary department was thus able to inter- 
cept cases as follows: From Merida, September 28, per steamer 
Merida, a fatal case in the person of an American citizen. On Octo- 
ber 19 a second case was apprehended on the steamer Monterey^ 
from Veracruz, and another on June 18, also from Veracruz, the 
latter case appearing more than four months after yellow fever was 
said to be exterminated. 

The quarantine also twice developed the presence of smallpox on 
vessels en route from Veracruz during this period. 

All nonimmune passengers from these ports are detained for six 
days at Triscornia quarantine, on the north shore of Habana Harbor. 
Those showing a rise of temperature are immediately transferred in 
screened launch and ambulance to Las Animas Hosi^ital, 

Tuberculosis in Cuba. 

Relieved again of its ancient and most calamitous plague, Cuba 
has turned her attention toward the control of an endemic affection 
which exacts an annual tribute in human life as appalling as it is 
unnecessary. Tuberculosis answers for 1 death in 5, and its man- 
agement constitutes the most important hygienic problem presented to 
the sanitary department. 

An antituberculosis campaign was carefully planned during the 
closing months of the provisional government, which is being faith- 
fully carried out by the new administration. 

A modern sanitorium for incipient cases has been established at 
Arroyo Naranjo, a particularly salubrious point near this city, and 
in Habana a free dispensary is conducted, to which is attached a 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



149 



corps of visiting nurses under the direction of trained supervisors 
from the United States. 

Popular education, as well as immediate relief, is aimed at. 

The result of six months' efl'ort is already apparent in the death 
rate, and the outlook for a very considerable amelioration of condi- 
tions is bright. 

Operations of the service. 

Aside from the general surveillance of ships and their personnel, 
the following transactions were reported in the weekly summaries 
during the fiscal year : 

Bills of health issued 1. 113 

Vessels inspected 891 

Passengers inspected 4.3, .539 

Members of crew inspected 52, 562 

Vessels fumigated S3 

Immune certificates for Canal Zone 270 

Health certificates issued S, 000 

In addition, medical treatment was furnished to 31 seamen ill 
aboard American vessels, and the medical officer in command served 
as United States pension examiner for the district embraced by the 
local consulate. 

Special inspections were made during the year at Nuevitas and 
Caibarien, Cuba. 

Mortality report of Haljana. 

The following represents the numl^er of deaths monthly in this 
city for the fiscal year: 



1908 

July 

August 

September 

October 

November 

December 




Month. 



1909 

January 

February 

March 

April 

May 

June 

Total deaths... 



Deaths. 



506 
529 
534 

498 
568 
537 



Poijiilntion of Ilahnna, ''.\'^,(iOO ; mortality rate, 19. SO per 1,000. 

fSerr/lee personnel. — At the beginning of the fiscal year there weiv 
on duty at Habana, Cuba, Passed Asst. Surg. J. W. Amesse, in com- 
mand. Acting Asst. Surg. Pedro Villoldo, and R. M. Colmore, and 
three attendants. 

The only changes made during the year were the discontinuance 
of Doctor Colmore's services at the close of the quarantine season, 
the appointment of Acting Asst. Surg. Charles A. Noiret as traveling 
sanitary inspector on June 7, 1909, and the substitution of Attendant 
T. liiicsga for 1.,. Villegas, resigued. 



CIENFUEGOS, CUBA. 

'i lie following is from tlie report of Acting x\sst. Surg. J. R. 
Suarez. During the months of July, August, niid for th(i first fifteen 
diiys of Sep(('nil)('r this station was in charge of Acting Asst. Surg. 



150 



PUBLIC HEALTH AND MAMNE-HOSPITAL SERVICE. 



P. Villoldo, who was sent from Habana on account of the serious 
iHness of Actmg Asst. Surg. C. J. Marsillan. 

STATEMENT OP INSPECTION SERVICE AND FUMIGATION OF VESSM-8. 



Month. 



1908 

July 

August 

September 

October , 

November 

December 

1909- 

January 

February , 

March . ." 

April 

May 

June 

Total , 



Vessels 
inspected. 



196 



Vessels 
inspected 

and fu- 
migated. 



34 



Bills of 
health 
issued. 



200 



Crews — 



In- 
spected. 



170 
340 
380 
374 
566 
426 



484 
720 
748 
717 
431 
527 



5,883 



Landed. 



Passen- 
gers. 



All vessels destined for ports in the United States south of the 
southern boundary of Maryland, until November 21, 1908, were fumi- 
gated for the purpose of killing mosquitoes. This fumigation was 
done just prior to the departure of the vessel, the vessel being placed 
in the open bay, away from the wharves, to prevent a reintroduction 
of mosquitoes. 

During the dry season the city has been free from mosquitoes, but 
since the rainy season has begun these insects have appeared in many 
parts of the city. The local health authorities have begun the sys- 
tematic oiling of all possible breeding places. The sanitary condi- 
tion of the city has been satisfactory on the whole. 



MATANZAS, CUBA. 

Acting Asst. Surg. E. F. Nunez reports as follows : 
No yellow fever has been reported either in the city or in the Prov- 
ince during the fiscal year ended June 30, 1909, nor has any vessel 
arrived with a quarantinable disease on board during the said period. 
Prior to November 10, 1908, while yellow fever still prevailed else- 
where in the island, all vessels leaving for ports south of the southern 
boundary of Maryland were fumigated, and crews and passengers 
inspected and certified in accordance with the service regulations. 
Since then, in view of the improved conditions existing, quarantine 
restrictions have been abolished against outgoing vessels and their 
personnel originating from any Cuban port ; this in compliance with 
directions from the bureau. 

lu those cases where a vessel arrived from an infected port without 
having been fumigated hj an officer of the service at the port of de- 
parture, this operation was performed whenever such a vessel left 
Matanzas for the United States direct, particularly for its southern 
ports. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 151 

The Cuban quarantine service at Matanzas has been conducted with 
efficiency during the year, the same officer, Dr. Felix Garcia, being in 
charge since the withdrawal of the first American intervention, in 
1902. 

Dr. Juan Guiteras, well known as a sanitarian and yellow-fever 
expert, formerly of the service, was promoted during the year to 
the position of director of sanitation for Cuba. 

During the year 213 bills of health were issued for United States 
ports, 5,884 members of crew and 679 passengers inspected and 
passed, 18 vessels fumigated and certified, and 17 health and acclima- 
tion certificates issued to passengers bound for the United States, 
mostly by way of Habana. There were no transactions during this 
period either for the Canal Zone or for the Republic of Panama. 

SANTIAGO DE CUBA. 

Acting Asst. Surg. Richard Wilson, on duty at this port, reports in 
part as follows for the fiscal year 1909 : 

Bills of health were issued to 269 vessels bound for the United 
States and its dependencies ; 163 vessels were inspected and 21 fumi- 
gated. On these vessels there were 10,924 crew and 5,878 passengers. 

The number of certificates of immunity to yellow fever issued dur- 
ing the year was 35. Twenty-one vessels were fumigated to destroy 
mosquitoes. 

VERACRUZ, MEXICO. 

Acting Asst. Surg. C. S. Carter reports the following transactions : 
Bills of health issued, 76 ; sailing vessels inspected, 3 ; steam vessels 
inspected, 24; sailing vessels fumigated, 3; steam vessels fumigated, 
46 ; passengers inspected, sailing vessels, 2 ; passengers inspected, steam 
vessels, 1,833; number of crew inspected, sailing vessels, 47; number 
of crew inspected, steam vessels, 3,300; total number passengers and 
crews, 5,182 ; number of crew removed on account of sickness, 3. 

During the period from November 1, 1908, to February 13, 1909, 
there were 13 cases of yellow fever with 6 deaths. Since February 
13 no cases of yellow fever have been reported. One case of yellow 
fever was reported as having been removed from the passenger 
steamer Fuerst Bismarck at Habana, which vessel sailed from Vera- 
cruz on June 16 last, after having been at Puerto, Mexico, and Tam- 
pico, taking on passengers at both places. The patient came from 
I'uebla and registered at the Hotel Buena Vista, at Veracruz, where 
he remained for six days before embarking on said steamer. The 
reports of the inspector of the superior board of health of Veracruz 
show that thei-e has been no sickness in the hotel during the last 
two years, and that the man had been in good health while he stayed 
there. There have been no other cases of sickness, either before or 
after this man left the hotel, nor in any of the buildings in the same 
block; nor, in fact, in any of the adjoining blocks. Although the 
entire water front was diligently searched and every means exhausted 
by the local sanitary authorities to locate the source of the infection, 
nothing definite relative; then^to was ever determined. 

Siiiallpcjx was reported prevalent throughout the country surround- 
ing the city of Veracruz. 



152 PUBLIC HEALtfT AND MAEtXE-HOSPITAL SERVICE. 

While the city of Veracruz was believed to be reasonablj^ safe so 
far as yellow fever was concerned, there was always some doubt as 
to the freedom of certain localities in the country surrounding from 
mild or unrecognized cases of this disease ; therefore temperatures 
Avere taken of all passengers and crews going to southern ports in the 
United States, also of intermediate and steerage passengers going 
north by the Ward Line steamers. 

During the months of April and May, although the death rate was 
high, it compared favorably with that of the preceding two years, 
and for June the death rate was the lowest for the last. ten years, 
being only 117. Tuberculosis was the cause of most of the deaths 
during the last three months of the year. 

The antimosquito work was carried on during the last three months 
of the fiscal j^ear with fair regularity. A house-to-house inspection 
was inaugurated, and the removal of any fever cases to the hospital 
for observation and the isolation of all contagious diseases was the 
rule. All cases of sickness reported by the inspectors were investi- 
gated. Houses wherein sickness occurred were fumigated, and 
mosquito breeding jjlaces were either obliterated or treated with 
petroleum. 

The inspection of the city was carried out in the following manner : 
The city was divided into districts, with each district under the 
supervision of a medical inspector. Under him a chief inspector or 
foreman was placed in charge of a squad of men. The chief inspector 
was directly responsible to the phj^sician in charge for the condition 
of the district. This squad was composed of oilers, ditchers, and 
disinfectors. If an inmate of a house was reported sick, he was at 
once reported to the physician in charge of the district, who imme- 
diately visited the patient. If a case of fever was discovered, and 
the temperature was above 100° F., the patient was removed to the 
observation ward either at the hospital of San Sebastian, the 
Woman's Hospital, or the Hospital cle Salubridad. The observa- 
tion wards in these hospitals are very comfortable, and are thor- 
oughly screened and clean. Each house in every district is inspected 
at least three times a week as a routine measure, and, if necessary, 
every day. Each inmate of a building must be seen or accounted for 
by the inspector, and his book must tally exactly with that of the in- 
spector of the preceding day, and the "patios" (back yards) must 
be free and clean of all trash. In the tenement-house district, knoAvn 
as the washerwoman's district, all water, trash, and other waste 
matter is removed. All such refuse is hauled out of the city, loaded 
upon barges and towed out to sea. Owing to the very dry season, 
the city water supply has been hardly adequate to the needs of the 
people, causing special trouble with Avater-closet comiections. 

Owing to the hot, dry season (only two heavy rains in about eight 
months) there were very few mosquitoes in Veracruz. After a 
diligent search of the vessels that cleared from Veracruz for United 
States ports, mosquitoes were found on but three. These vessels dis- 
charged cargo alongside of what is known as the railroad pier, and 
the mosquitoes were of the Culex variety. Very few Stegomyise were 
observed in the city. 

There are very few screened houses in Veracruz at present, but 
screens for beds, or mosquito bars, are g-enerally used. It would be 
almost impossible to enforce the regulation compelling the screening 



PUBLIC HEALTH AND MAEIKE-HOSPITAL SERVICE. 153 

of houses on account of there being so many people who are not 
financially able to purchase the required material. 

There has been very little sickness reported aboard vessels while in 
the harbor at Veracruz. One case was removed from the steamship 
Merida^ and two from the steamship City of Mexico; all three were 
malaria — one of them of the ha^maturic variety. This small amount 
of sickness on vessels in the harbor was attributed to the fact that 
every morning all crews were required to report to the steward, and 
in the event of illness of a member of the crew the doctor employed 
by the ship was immediately notified. Where the illness was of a 
serious nature the doctor removed the patent from the ship until he 
had recovered. 

Cuba maintains a six-day quarantine against Veracruz, and has a 
medical officer stationed there who inspects and fumigates vessels for 
Cuban ports. 

SALINA CRUZ, MEXICO. 

Acting Asst. Surg. Alfredo E. Gochicoa reports as follows: 
For the fiscal year ended June 30, 1909, 39 vessels bound for ports 
in the United States and its insular possessions were inspected and 
fumigated. The fumigation of vessels leaving Salina Cruz for ports 
in Hawaii is regularly performed for the destruction of mosquitoes. 
A great many vessels ply between Honolulu and Salina Cruz, bring- 
ing sugar and taking away general cargo. The general cargo comes 
via Coatzacoalcos and the National Tehauntepec Kailway. This rail- 
way joasses through several places on the Isthmus of Tehauntepec 
in which yellow fever is liable to be present either in a mild form or 
in a form escaping observation. The peons or laborers who handle 
this cargo at Salina Cruz are drawn for the most part from the 
interior of the isthmus, and they have in the past been the supposed 
means of bringing j^ellow fever into Salina Cruz. The infection of 
Stegomyise in Salina Cruz from any source would constitute an easy 
means of infection for Hawaii, in which Territory mosquitoes of the 
variety above mentioned abound. A vessel from which a cargo of 
sugar has just been removed would naturally attract many mos- 
quitoes, and that this is the case an inspection of conditions at Salina 
Cruz has shoAvn. So in order to remove the possibility of transport- 
ing an infected mosquito to Hawaii, which as a whole is extremely 
vulnerable to yellow-fever infection, every vessel leaving Salina Cruz 
for that place is fumigated. The sanitary condition of the port has 
been excellent throughout the year. 

COATZACOALCOS, MEXICO. 

Acting Asst. Surg. W. K. P. Thompson reports as follows: 
During the fiscal year ended June 30, 1909, 76 vessels, with a total 
of 4,779 crew and 150 passengers, were inspected. Fourteen vessels 
were fumigated for the purpose of destroying rats and mosquitoes. 
This port, owing to the drainage or reclamation of marsh lands dur- 
ing the past three or four years, together with the installation of a 
new sewerage and water system, has become very much improved 
from a general sanitaiy standpoint. 'Ilie ])()rt, however, as in the case 
of Salina ('niz, is always siib)(!ct to infection from yellow fever from 



154 PUBLIC HEALTH AND MARINE-LTOSPITAL SERVICE. 

the small settlements or towns in the interior of the Isthmus of 
Tehauntepec. 

PROGRESO, MEXICO. 

Acting Asst. Surg. J. F. Harrison reports as follows: 

Season of 1908 (July 1 to October 31, 1908). Twelve vessels were 
spoken and passed, 62 steamers were inspected and passed, 28 steamers 
were disinfected and passed, 3 sailing vessels inspected and passed, 
and 3 sailing vessels were disinfected ; 3,351 crew and 523 passengers 
were inspected. 

Season of 1909 (April 1 to June 30, 1909). Nineteen vessels were 
inspected and fumigated, and a total of 226 passengers and crew in- 
spected. 

In compliance with a general order issued to the service officers 
stationed at the Mexican and Central American Gulf ports to report 
upon the sanitary advances made in the last three years at said ports. 
Acting Assistant Surgeon Harrison states that few, if any, changes 
have occurred at Progreso even in the past six years. 

Maritime quarantine at Progreso is under the direction of a med- 
ical officer appointed by the superior board of health of Mexico. All 
vessels arriving or departing must be "' passed " before being granted 
" entry " or " clearance." All arriving vessels are detained at a safe 
distance from shore until inspected and passed. If found infected, 
they are disinfected and subjected to further detention, all quarantin- 
able cases having been removed to the lazaretto ashore. Outgoing 
passengers are all examined before being permitted to board outbound 
vessels. 

TAMPICO, MEXICO. 

Acting Asst. Surg. Le Roy Stowe reports as follows : 

Season of 1909 (April 1 to June 30, 1909). Fifty-nine vessels were 
inspected and passed, 1,798 crew and 124 passengers inspected, and 
11 vessels fumigated. No cases of quarantinable disease occurred 
during this period. 

During the past year a new quarantine station has been completed 
at the port of Tampico. This building is situated on the north bank 
of the river, just within the harbor entrance. The station has not 
been equipped with a wharf. There is one hospital ward with a 
capacity of 8 beds. 

Thus far there have been no cases of contagious diseases removed 
from vessels to the station. 

In the city of Tampico proper, which is situated 6 miles from the 
mouth of the Panuco River, a well-equipped city hospital is main- 
tained. This building now has a capacity of 100 beds, and the aver- 
age number of patients treated is 80. A well-equipped bacterio- 
logical laboratory is also maintained. 

There is an isolation hospital located in the suburbs of the city at 
a safe distance from the residences. It has a capacity of 30 beds. 
During the past three years this hospital has remained empty, not a 
single case of j'^ellow fever or smallpox having occurred.' 

In the extension of the water and sewage systems and in the filling 
in of the low-lying areas about the city excellent work has been done 
during the past three j^ears. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 155 

The following statistics covering the period June 30, 1908, to June 
30, 1909, will indicate the nature and progress of this work : 

Cubic meters of filling 231,000 

Meters of sewer piping laid 3,400 

Meters of water piping laid 5, 300 

At the present rate of progress it is estimated that two more years 
will yet be required to complete the water and sewage systems and to 
fill in the low-lying areas to secure proper drainage. 

An additional contract has recently been let for the paving with 
asphalt of the streets intersecting 100 squares of the city's area. 

Tampico derives her water from a point on the Tamesi River 20 
kilometers distant. It is pumped to a reservoir to settle, and is car- 
ried thence to the city. The water now furnished is clear and whole- 
some, typhoid fever i3eing of rare occurrence. 

Sewage is pij^ed about 1 mile below the business center of the city 
and emptied into the Panuco Eiver. Except when the tide is at flood, 
the strong current of the river carries this sewage promptly to sea. 

Garbage is collected regularly and removed to a hillside beyond 
the city limits. At intervals, when sufficiently dry, much of this 
material is burned. 

Dona Cecilia, Arbol Grande, Talleres, and La Barra are small vil- 
lages along the railway between Tampico and the Gulf. As yet they 
have no water or sewage systems. The railroad company furnishes 
these districts with a limited supjoly of water from their private line 
of piping. During the summer season, however, many residents 
catch rain water in barrels for household use, and as these barrels are 
neither screened nor oiled, they furnish abundant breeding places for 
mosquitoes. 

The area lying between Tampico 9.nd the Gulf is poorly drained, 
especially along the right of way of the railroad. 

Pools of stagnant water are numerous, and no effort has been made 
thus far to drain these districts nor to oil the pools. 

Tampico therefore has mosquitoes in abundance, mostly anopholes 
and culex. Stegomyise are present, but are relatively few in number. 

With the onset of the rainy season in May mosquitoes make their 
appearance in numbers and breed uninterruptedly until the dry 
season sets in during the winter months. 

If the further advance is made of draining the districts mentioned, 
and oiling such breeding places for mosquitoes as can not be drained, 
Tampico will be made as sanitary a port as any that can be found on 
the Gulf coast. 

With a population of 20.000 inhabitants, the average number of 
deaths per month from all causes is 45. 

The American population of Tampico, conservatively estimated, is 
about 500. 

Out of this number there has been only 1 death during the past 
three months, this being a case of death by violence. 

During the month of May, 1909, smallpox prevailed rather widely 
in the district adjacent to the Intercoastal Canal between Tampico 
and Tiixpan. At the present time Hie (•()n<liti()ii of this district has 
rnarkeflly imprr)ved and is no longer considered a menace to tlie 
health of the port. 



156 PUBLIC HEALTH AND MARINE-HOSPTTAL SERVICE. 

BRIDGETOWN, BARBADOS. 

Acting Asst. Surg. E. H. Urquhart reports as follows : 
Season of 1908 (July 1 to October 31) : 

Number of bills of liealth issued 162 

Number of passengers and crews examined 81,489 

Number of vessels fumigated 35 

Season of 1909 (February 22 to June 30) : 

Number of bills of health issued 133 

Number of person examined 0,468 

Number of vessels fumigated 24 

The last case of yellow fever occurred in this port on March 19. 
The port of Bridgetown is reported to be in excellent sanitary 
condition. 

CASTRIES, ST. LUCIA. 

Acting Asst. Surg. A. J. Maylie reports as follows : 
Season of 1908 (July 31 to October 31, 1908). One hundred and 
thirty-eight vessels were inspected and 92 fumigated. These vessels 
carried a total of 4,400 crew and 116 passengers. During this period 
the sanitary condition of the island was reported to be good. 

Season of 1909 (April 6 to June 30, 1909). Thirty-five vessels were 
inspected and 21 fumigated. These vessels carried a total of 107 
crew and 98 passengers. No quarantinable diseases prevailed during 
this period either in the port or in the vicinit}^ thereof. 

Fumigation of vessels for Cuban ports. 

Upon the request of the Munson Line of steamships, made through 
the bureau, the sanitary authorities in Cuba gave their consent to 
waive the disinfection upon arrival at Cuban ports of the vessels of 
the Munson Line leaving the port of Castries, St. Lucia, when such 
vessels carried a certificate of disinfection from the service officer sta- 
tioned at that port. Accordingly orders Avere issued to Acting Asst. 
Surg. A. G. Maylie, at Castries, St. Lucia, to fumigate and certify 
steamers of the Munson Line destined to Cuban ports upon the re- 
quest of the captains of these vessels. 

ST. THOMAS, DANISH WEST INDIES. 

Acting Asst. Surg. W. F. Wild reports as follows : 

Season of 1908 (July 1 to November 2). Sixty-eight vessels were 

inspected and 1 fumigated. 

Season of 1909 (March 31 to June 30, 1909). Forty-five vessels 

were inspected. Good health conditions prevailed at this port during 

both periods. 

LA GUAIRA, VENEZUELA. 

On account of the existence of bubonic plague in the cities of 
Caracas and La Guaira, Venezuela, during and including the time 
between the months of March and June of 1908, and on account of 
the belief, based upon previous experience under similar conditions, 
that there Avould be a recrudescence of the disease this summer, the 



PUBLIC HEALTPI AND MARINE-HOSPITAL SERVICE. 157 

Secretary of the Treasury addressed a letter to the Department of 
State setting forth the necessity from a sanitary standpoint of at- 
taching a medical officer of the Public Health and Marine-Hospital 
Service to the American consulate at La Guaira for the purpose of 
cooperating with the consular officer in carrying out the provisions 
of the act of Congress approved February 15, 1903. 

As a result of negotiations, during the latter part of December, 

1908, the consent of the Venezuelan Government was obtained for 
the detail of this medical officer, which had been objected to by a 
previous (Castro) administration. 

Accordingly Acting Asst. Surg. W. H. Kellogg was assigned to 
duty in the office of the American consul at La Guaira by and with 
executive and departmental approval. 

Acting Assistant Surgeon Kellogg assumed his duties on June 15, 

1909. In the meanwhile, as was predicted, plague again appeared 
in Caracas, 13 cases with 5 deaths occurring between May 20 and 
June 17 of the fiscal year. The placing of a service officer in La 
Guaira at such an opportune time was productive of much good. 
Doctor Kellogg Avas accompanied to Venezuela by Passed Assistant 
Surgeon Grubbs, who joined him Avhile en route from San Juan, 
P. R. Together they proceeded to Caracas and called upon the 
American minister there, who arranged meetings with the minister 
of the interior, the minister of foreign affairs, and the chief of 
the hygienic commission. These officials were anxious to inaugurate 
an antiplague campaign and gave the officers of the service their 
earnest cooperation. 

After a conference with the American minister the cities of Cara- 
cas, La Guaira, and Puerto Cabello were inspected. 

Acting Assistant Surgeon Kellogg was equipped by the bureau 
with a bacteriological outfit for the diagnosis of cases of either 
human or rodent plague. His duties therefore have been twofold, 
including the inspection and certification of vessels and their per- 
sonnels, and the conduct of a bacteriological laboratory. 

The transactions for the fiscal year were as follows: 

Inspection and certiflcaiion of vessels. 

Steamships ins])ectecl and health bills issnecl 27 

Sailing vessels inspected and health bills issued 1 

Total 2S 

Ships fumigated " 

Baggage inspected and passed, pieces 13S 

Baggage disinfected, pieces IS 

Total 156 

Laboratory transactions. 
Rats : 

Examined bacteriologically 72 

Plague 

Identified : 

MiiH dccumanuH 4."> 

MtiH alcvandrinus 2(5 

MuH raitus 3 

Total 72 



158 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Fleas identified (from 25 rats) : 

Pulox chcopis 120 

Pulox irriiaiin 1 

Ctenocephalus canis 1 

Total 122 

CALLAO, PERU. 

Acting Asst. Surg. J. L. Castro-Gutierrez reports for Callao, Peru, 
for the fiscal year ended June 30, 1909, as follows : 

One hundred and fifty-six vessels disinfected, 118 fumigated, 8,152 
crew, 3,779 cabin passengers, and 2,757 steerage passengers were in- 
spected; 2,200 persons received health certificates; 882 persons re- 
ceived vaccination certificates; 339 pieces of baggage were inspected 
and passed, and 2,556 pieces disinfected. 

RIO DE JANEIRO, BRAZIL. 

Acting Asst. Surg. W. J. S. Stewart. 

An abstract from the weekly reports of this station shows that 
172 vessels were inspected and issued bills of health, 1,505 cabin pas- 
sengers were inspected, and 22 new crew shipped at Rio. The gross 
number of crews on vessels is not given, for the reason that the said 
crews were not shipped at Rio de Janeiro. 

GUAYAQUIL, ECUADOR. 

[See also page 104.] 

Passed Asst. Surg. B. J. Lloyd reports as follows : 

During the fiscal year bills of health were issued to 94 vessels, 90 
of Avhich were fumigated to kill rats or mosquitoes, or both. The 
usual inspection of vessels and personnel was maintained; immune 
certificates were furnished only to such persons as embarked for Pe- 
ruvian ports, no quarantine being maintained by ports south on 
account of plague. 

During the year a change in the schedule of the steamship com- 
panies provided for steamers direct from Guayaquil to the Canal 
Zone and return. As these vessels anchor some distance down the 
river and outside of the j^ellow-fever infected zone, passengers are 
allowed to go on board under supervision, two days in advance of 
sailing day, and thus complete their period of quarantine (six days) 
before reaching Ancon. This is a very important provision for those 
in transit across the Isthmus, for the reason that a difference of one 
day in quarantine will frequently make a difference of a week on the 
Canal Zone waiting for a steamer. 

Passed Asst. Surg. William M. Wightman died on May 16, a 
victim of yellow fever. His detail was temporarily filled by Tem- 
porary Acting Asst. Surg. Carlos A. Miiio. 

General conditions. 

Guayaquil is a city of about 80,000 population, spread out on low 
ground between the Guayas River and an extension of the Bay of 
Guayaquil, being about 5 kilometers long by from 1 to 2-| kilometers 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 159 

wide. The houses are generally of wood, or at least if not built of 
ordinary lumber, are made of bamboo, with double hollow walls 
throughout, the walls being covered with a layer of "quincha" to 
reduce the dangers from fire. The majority of these houses contain 
dark and badly ventilated rooms; in the better class of dwellings 
these rooms being occupied by servants. Many houses are built 
directly on the ground, but in the lower sections of the town there are 
many huts that are raised some 8 or 10 feet; and, though they are 
otherwise in miserable condition, these latter are usually well lighted 
and ventilated, and it is exceedingly rare that cases of plague are 
found in them. A few of the better streets are paved and sewered. 
Water is brought from a very good source, but the main pipe is too 
small to feed the extensive network of city mains. For this reason 
the storage tanks are never full and the supply of water is so deficient 
that the city mains are filled only twice during the twenty-four hours, 
and two hours later they are generally empty. On account of the 
fact that water is discharged through the pipes only during certain 
hours, each family must arrange for storing on the premises sufficient 
water to last during the rest of the day. Practically all houses have 
either storage tanks or barrels — generally the latter — each tank or 
barrel being a continuous breeding place for Stegomyife unless cov- 
ered or otherwise treated. As many as 17 breeding places have been 
found in one house. 

There are two seasons in Guayaquil, the wet and the dry, miscalled 
" winter " and " summer," respectively. The wet season begins about 
December 15 and lasts until about May 1. During this time, and es- 
pecially during February, March, and April, the city is converted 
into one large marsh, the unpaved streets being practically impassa- 
ble. As soon as the rains cease the yards and streets dry very quickly. 
From May until November the weather is cool, dry, and pleasant, the 
temperature ranging from 17° C. at night to 25° to 28° at midday, 
while from November to May it is hot and disagreeable, and after the 
1st of January exceedingly wet. The annual cleath rate varies from 
25 to 30 per thousand m July and August to from 90 to 100 per 
thousand in February and March, the yearly average being about 60, 
but varying greatly in successive years. 

Bvhonic plague. 

This disease appeared in Guayaquil in February, 1908, spreading 
rapidly all over the city and causing during the first five months of 
its existence about 350 deaths in Guayaquil and about 30 deaths in 
Huigra. Later plague made its appearance in Babahoyo, Milagro, 
Tolte, Daule, Nisag, Alausi, and in adjacent plantations. 

Prior to February. 1908, and for some time after, a rigid quarantine 
was maintained against plague-infected ports; this has been dis- 
continued and only such vessels as are actually infected or which 
have docked in infected ports without having been subsequently 
treated are fumigated on arrival. There is no detention of per- 
sonnel. 

As soon as plague was known to exist in Guayaquil, traffic between 
this and other Ecuadorian ports was suspended and commerce was 
paralyze<l : for a few days train service on the railroad was inter- 
rupted. This condition was soon remedied by the establishment of 



160 PUBLIC HEALTH AND MARTNE-HOyPlTAL SiiRVICE. 

the outgoing fumigation of river and coast vessels. This is still con- 
tinued, over 1,200 fumigations being recorded for the year. 

Organization. — With the consent of the bureau and Secretary of 
the Treasury and the a]:>proval of the State Department, Passed 
Assistant Surgeon Lloyd was authorized (March, liJOS) to accept the 
proffered direction of sanitary measures in Guayaquil. Existing sani- 
tary statutes being insufficient, an executive decree was given creat- 
ing the special sanitary commission, which w^as latter replaced by 
the i^ublic health service, created by act of Congress in October, 1008, 
for the purpose of absorbing or replacing all other health organiza- 
tions, and Doctor Lloyd was appointed acting director. 

The duties of the public health service are to combat epidemic dis- 
eases throughout the entire Republic and to administer national, in- 
terprovincial, and interurban quarantines. Authority was gxanted 
by the decree creating the service to promulgate and enforce sanitary 
and quarantine regulations. In December, 1908, a code of sanitary 
regulations was formulated ; the regulations w'ere approved in April 
and published in June, and their legality was immediately disputed 
by the municipality of Guayaquil; on again being referred to the 
Federal Government the municipality has been overruled, and an 
attempt will be made to enforce them. 

Briefly, these regulations embody the following measures : 

(1) Isolation of persons suffering from smallpox, varioloid, 
plague, or yellow fever. 

(2) The reporting of actual or suspected cases of such diseases. 

(3) Compulsory vaccination against smallpox. 

(4) Prohibition of breeding places of mosquitoes in water con- 
tainers in houses and yards. 

(5) Prohibiting the issuance of false death certificates. 

(6) Making obligatory the installation of water-closets in houses 
facing on streets where there is a public sewer. 

(7) The correction of defects in houses unfit for human habitation 
or in bad sanitary condition. 

(8) Making obligatory, the use of antipest serum in the treatment 
of bubonic plague. 

(9) Establishing penalties for persons who maintain their prem- 
ises in bad sanitary condition. 

(10) Sundry general measures. 

It is further provided that these regulations or such modifications 
of them as may Idc necessary may be applied to any city or community 
in the republic six days after being published in such locality. 

C amj^aign against smallpox. 

This disease has long been endemic in Guayaquil, causing from 150 
to 400 deaths annually. For many years vaccination has been prac- 
ticed, but never systematically; there exists a belief on the part of 
many that those who have been exposed to smallpox should not be vac- 
cinated. Previous to the month of July of last 3^ear no attempt at 
isolation had ever been made. "Wlien work against smallpox was 
begun there existed about 30 cases, representing half as many foci, 
but by November 1 the disease hacl been exterminated. In April a 
doubtful case occurred and the usual precautions were taken ; in 
June two mild cases were found and promptly isolated, all contacts 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 161 

being vaccinated; these have been discharged and no further cases 
have developed. 

In Quito preparations are bein^ made to handle smallpox in the 
same way ; in other places vaccination is being enforced ; more or less 
severe epidemics have occurred in Manglar Alto and in the Canton 
of Santa Elena. 

Measures against hubonic flague. 

The victims of this disease gradually diminished in number until 
November, and during the month of October there was only one 
case and no death. At one time the lazaretto was completely empty 
and no case was known to exist. The same was true of smallpox and 
yellow fever. In the face of congratulatory telegrams and public 
clamor that the city of Guayaquil should be declared free from quar- 
antinable disease, Doctor Lloyd was forced to warn the people that 
with regard to plague and yellow fever, at least, appearances were 
deceptive, and that both these diseases would reappear in a short 
time. The condition lasted just five days when plague slowly began 
to develop, the cases gradually increasing in number until April. 
Yellow fever did not develop as rapidly as plague until later, but by 
the middle of March was fairly epidemic. It seems now clearly 
established that for Guayaquil, at least, the plague season corre- 
sponds to the hot, wet (winter) season. The same is true of yellow 
fever, though cases of both diseases occur throughout the year, and 
jDlague may assume epidemic proportions at any time. 

The use of antipest serum. — Doctor Lloyd does not advise the use 
of antipest serum as a prophylactic unless there are symptoms; as a 
curative it is invaluable; he advises from 40 to 80 c. c. to be given 
at one injection; the temperature is frequently a valuable guide as 
to when the dose should be repeated; from 400 to 600 c. c. are fre- 
quently required before the case can be considered to be out of danger. 

Pregnant women treated early do not usually abort or miscarry. 
One woman was delivered of a living child, almost full term, which 
showed no manifestations of the disease and lived (temperature not 
taken). Apparently hopeless cases sometimes recover; a boy sent to 
the morgue, reported to have died suddenly (cause unknown), was 
found to be living; he was suffering from plague; recovered. 

Destroying the infecting agency in houses where human cases or dead 
rats have occurred. — One-story huts which can be unroofed need no 
further treatment ; if they are of adobe the interior may be burned 
over without material damage, and the floor, if of dirt and straw, or 
dirt alone, may be lightly saturated with kerosene and burned super- 
ficially ; body clothing, beds, blankets, etc., may be spread out in the 
sun (if climate is favorable) and turned occasionally. So far these 
measures have proven very effective in Indian villages, where living 
conditions beggar description. In cities, plague-infected houses 
should be treated according to the condition of the house and its sur- 
roundings; if old, badly constructed, and a menace to the vicinity, 
every effort should be made to have the house torn down. The fact 
that a case of plague has occurred in a house is strong presumptive 
evidence that the house does not meet modern sanitary requirements, 

1854eJ— 10 11 



162 PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 

unless infection can be clearly traced to some other source. Fumiga- 
tion and disinfection of houses unfit for human habitation without 
obliging the owner to correct sanitary defects is money thrown away. 
The procedure in plague-infected houses at Guayaquil is: (1) To re- 
move sick; (2) remove occupants, preferably disinfecting their 
effects, but if infection is already widespread this may be omitted; 
pyrethrum powder may be given such people to sprinkle in their 
clothing; (3) sprinkle good quality pyrethrum powder in every ac- 
cessible part of the building, especially in dark corners, cracks, under 
floors, and wherever dust collects; (4) if funds are plentiful and in- 
fection not too general, surround the entire block with a rat-proof 
iron fence with the idea of limiting the infection to the block and 
thereby exterminating it ; if there are sewers or drains other than 
iron pipes leading from the block, which can not be temporarily closed 
against rats, such a fence will be of little use; (5) take up ground 
floors in infected houses, tear out the inner walls, if walls are double, 
do the same with double ceilings, and rip open dark and badly venti- 
lated rooms; (6) sweep up and burn (after half an hour) the pyre- 
thrum mentioned in 2, together with all rubbish, especially such as is 
found under floors or in the runways of rats, rats' nests, etc.; (7) 
fumigate with sulphur, but do not attach too much importance to this 
measure nor to washing with antiseptic solutions; this may even be 
omitted; (8) leave the house unoccupied for fifteen days, exposing it 
daily to sun and air, leaving nothing that a rat can eat; (9) make a 
memorandum of what is necessary in order to put the house in condi- 
tion for human habitation, pass this to the owner, informing him that 
the house can not be reoccupied until these improvements are made. 
Campaign against rats. — The present outlook is that the only way 
to get rid of rats permanently is to huild them out of existence. Until 
this is done the usual temporary measures may be applied. The 
necessity of keeping house and premises free from anything a rat 
can eat (except, of course, in receptacles out of their reach) can not 
be too strongly emphasized. If this is not clone, poisons, traps, and 
viruses give very poor results. 

YelJoio fever. 

This disease has been endemic in Guayaquil for many years. No 
reliable statistics are obtainable, but few" nonimmunes who remain 
here for any length of time escape. Few people realize the extent of 
its ravages. The average resident immune manifests a profound in- 
difference to its presence. The worst season is from November to 
May, February, March, and April being the worst months. From 
May until November the cases are few in number on account of the 
cool weather, although the Stegomyia? breeds throughout the year. 
The conditions under which the mosquitoes breed are given in the 
following order: From May to December: (1) Barrels; (2) bath 
tanks; (3) small containers, such as earthenware jars (4 to 5 gallons 
or more) and similar receptacles; (4) storage tanks; (5) street wells 
and wells under houses or in yards; (6) water-closet tanks. 

There are practically no other breeding places during this season. 
From December 16 to May 1 other breeding places must be dealt with, 
such as small pools in the yards and underneath the houses; accidental 



PUBLIC HEALTH AND MAEINE-HOSPITAL SEKVICE. 163 

containers, as bits of broken bottle, cans, flowerpots, certain plants, 
street pools, and gutters. It is very unusual to find Stegomyise breed- 
ing in the streets in Guayaquil, but they breed in small pools in the 
yards during the rainy season. 

Because the funds authorized for sanitary work were wholly inade- 
quate for the fumigation of all houses in the city or even all those 
in infected blocks, it was decided that the work against yellow fever 
should consist of the following measures (in addition to the isolation 
of cases) : (a) Fumigation of infected houses; (5) covering of con- 
tainers; (c) oiling; (^d) ditching. 

Ditching, as practiced in Guayaquil, does not play an important 
part in mosquito work. It is practiced every year merely to remove 
the excess of water, and the ditches are allowed to fill up during the 
dry season ; no amount of ditching would remove the water from the 
3'ards during the rainy season in their present condition, as they are 
not infrequently lower than the level of the ditch. 

Oiling is an important item of expense. Doctor Lloyd estimates 
that at least 30,000 gallons of crude petroleum are required for each 
of the months of January, February, March, and April ; 20 inspectors, 
with 4 laborers each, are required to distribute the oil. 

Fumigation of infected houses. — When cases of yellow fever occur 
in the houses of the poorer classes this presents no difficulty. Among 
the wealthier classes fumigation is eagerly sought in cases of plague, 
but not infrequently permission is roundly denied in cases of yellow 
fever. 

Co vering containers. — It has already been explained that the water 
supjDly of Guayaquil is deficient, necessitating the use of deposit tanks 
for bathing and other purposes. The average tank is a wooden struc- 
ture, zinc lined and sometimes enameled, varying greatly in size. 
There are about 3,000 such in the city, practically all of which have 
been covered, the cost averaging about $9 gold each, including labor 
and repairs. Every variety of cover was tried before satisfactory 
results were obtained. It was found that many tanks were old and a 
few blows with a hammer or the mere cleaning of such a tank was 
sufficient to start it to leaking. Such tanks required to be repaired 
before they could be covered, and for this work plumbers were em- 
ployed. The round float which mechanically closes the intake would 
nearly always come in contact with the cover and prevent the action 
of the stopcock and the room would be flooded. This difficulty was 
met in most instances by turning the float upside down when it would 
not rise high enough to touch the cover. Provision had to be made 
for cleaning the tank and for repairing valves if they should subse- 
(juently get out of order, and for this reason covers were made with 
movable windows of wire netting, placed over the float and fastened 
to the main part of the cover with screws. The cover itself generally 
consisted of a wooden frame made to fit tongue-and-groove fashion 
over the tank wall and also screwed on. The frame was filled in with 
a kind of tarred burlap of a good finish, the window only being of 
wire netting. This gives better results than the use of wire netting 
alone and is much cheaper, prevents dust from falling into the water, 
and lasts well. Practically all of these covers are now in good 
condition. 



164 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Barrels. — Practically all houses in Guayaquil, including the better 
class of houses, have their water barrels, which are placed under the 
municipal key (spigot). In many cases these keys are placed so low 
that in order to raise the barrel to a height sufficient to enable water, 
to be drawn with a spigot the municipal key would require to be 
spliced and raised. Covers were made of wood with windows of 
wire netting, and so long as they remained nailed on were satisfactory, 
except that not infrequently cockroaches would breed underneath 
such covers in large quantities and die in the barrel. Movable covers 
are useless. Not infrequently mosquitoes will lay their eggs on the 
damp wire netting and these or the recently hatched larvse will drop 
into the barrel the next time the water is turned on. At first covers 
were not interfered with, but as soon as it became generally known 
that no fine would be imposed ior removing covers they were 
l^romptly knocked off by the users of the barrels, and no amount of 
urging could induce the authorities to interfere. The only recourse 
left was to try larvae-destroying fish. The so-called " million " fish 
(a small and very prolific minnow ( ?) ) was imported from Barbados 
and hatcheries established. In the meantime two native fishes were 
tried. One of these would persist in jumping out of the barrels, 
though if persistently watched and replaced during the first day they 
would generally remain. The other remains indefinitely and thrives 
on such food as may chance to be present. These fish being much 
larger than the " million " fish, were objected to because they were 
supposed to " foul " the water, though plenty of similar fish exist in 
the deposits and in the stream from which the water is taken and no 
difference could be detected in the water. They are voracious larvae 
destroyers. After experimenting with the " million " fish it was 
found that they reproduce with almost incredible rapidity in this 
climate, and even breed in water that is decidedly brackish. They 
are so small that the question of fouling the water is never raised. 
As an experiment from 2 to 10 fish were placed in each of about 250 
barrels and other containers. Six weeks later an inspection revealed 
the fact that from about three-fourths of these containers they had 
disappeared. In some cases the barrels had become dry at some time 
through carelessness ; in others they had been taken out by children ; 
in still others they were found in the parlor in glass receptacles 
being kept for ornamental purposes. In about one- fourth of the 
barrels they were thriving and breeding. Barrels which were under 
immediate supervision, as in the lazarettos, those owned by inspectors 
and laborers, etc., were easily kept free from larvae by these fish, and 
instead of having to replace fish that were lost it was not infrequently 
necessary to remove the excess of young. AAHien bred too rapidly in 
small containers the young are frequently eaten by the adults. The 
" million " fish is too small to eat the larger larvae, and it not infre- 
quently happens that they will not free a barrel from larvae until all 
the older ones that existed at the time the fish are put into the barrel 
are hatched out. Regulations were secured imposing fines on such 
persons as were found to have mosquito larvae in containers on their 
premises or in their houses, and the use of these fish on a large scale 
w^as contemplated when funds failed and the regulations were dis- 
puted by the local authorities, and although enough fish exist at 
present to supply every container in Guayaquil no use is being made 
of them. 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 



165 



statistics of transactions. 

Bills of health issued 94 

Vessels fumigated 90 

Sulphur consumed (about) tons 18 

Passengers inspected 3, 050 

Crew inspected 5, 685 

Baggage inspected (pieces) 4,240 

Baggage disinfected (pieces) 816 

Immune certificates given 106 

The following is taken from Doctor Lloyd's annual report to the 
Ecuadorian Government : 

From the following figures it might be deduced that there has been much 
more yellow fever during the present season than during the same period for 
last year, but even were this the case it would be a sufficient reason for making 
the work more efficient. When it is remembered that formerly there occurred 
some 500 deaths annually of persons who were never seen by a physician and 
no diagnosis made, it will readily be understood that these statistics may be 
in part misleading. The fact must also be borne in mind that mosquito work 
was suspended in part in January and altogether in March, and has not yet 
been resumed. 

Yellow Fever. 



Month. 



1908. 



Deaths. 



Deaths. 



January . . 
February . 

March 

April 



Unknown. 
Unknown. 
Unknown. 
Unknown. 
Unknown. 



12 
38 
114 
69 
50 



Total. 



163 



Total suspension of yellow fever work in March, 1909. 
General Mortality — Same Period. 



1908. 


1909. 


Months. 


Deaths. 


Months. 


Deaths. 


January 


311 
386 
604 
503 
354 




256 


February 




303 


March 


March 

April 


417 


April 


386 


May 




349 




Total . 




Total 


2,158 


1,711 









Difference, 447. 

During the same period for 1908 and 1909 there were 314 and 88 deaths from 
plague, respectively; of smallpo.x, 64 persons died in 1908 and none in 1909. 
Deducting these deaths, there still remains a difference of 157 for 1908 over 
1909, and yet the statistics for yellow fever are much higher in the latter year. 
This increase is apparent, not real. 

From tlie 1st of .January, 1908, to the 1st of October of the same year there 
were 111 deaths from smallpox in (iuayaquil ; during the last eight months there 
Lave been no deaths from smallijox." 



'Mt is now nearly one year since tliere has been a death from smallpox; sev- 
eral tiiiu-H the infection has been reintroduced, but each time has been promptly 
controlled. 



166 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

HONGKONG, CHINA. 



Acting Asst. Surg. J. S. Hough in charge. 

During the fiscal year ended June 30, 1909, 457 vessels were in- 
spected and bills of health granted. 

SHANGHAI, CHINA. 

On September 29, 1908, owing to the reappearance of plague and 
cholera in the Shanghai consular district. Dr. S. A. Kansom was ap- 
pointed an acting assistant surgeon in the service and reassigned to 
duty in the office of the American consul at Shanghai. 

His report therefore, covers the period from September 29, 1908, 
to June 30, 1909 — about nine months. 

Transactions. 

Vessels spoken and passed 42 

Steamers inspected and passed 62 

Steamers disinfected 16 

Number of crew on steamers 14,666 

Number of passengers on steamers 9, 183 

All vessels taking bills of health from this port to ports in the 
United States, with the exception of those under the head of " Spoken 
and passed " are inspected by the service officer as near as possible to 
the hour of sailing. This inspection consists of an examination of 
the entire personnel, of the inspection of the living quarters, and of 
a search through the ship's papers, manifests, and " boat notes " to 
see that the regulations governing cargo have been complied with. 
Manifests are certified for the information of the quarantine officer 
at the port of arrival of the vessel. 

In the case of vessels bound direct for ports in the United States 
or in the Philippines, the crew and steerage passengers are bathed 
and their effects disinfected by steam immediately before the depar- 
ture of the ship, and the living quarters are rendered mechanically 
clean and disinfected when necessary. 

AMOY, CHINA. 

Upon the request of the Department of State and in accordance 
with the act of Congress approved February 15, 1893, Passed Asst. 
Surg. A. D. Foster was detailed to serve in the office of the United 
States consul at Amoy, China. He assumed his duties on March 5, 
1909, from which time to the close of the fiscal year ended June 30, 
1909, the following report is made to include all transactions : 

Twelve bills of health were issued to vessels, all of which were 
bound for Philippine ports. Seven hundred and forty-eight crew, 
439 cabin, and 1,208 steerage passengers were inspected. Thirty-one 
aliens were rejected for causes as noted, viz, trachoma, 25 ; f avus, 3 ; 
scabies, 2; leprosy, 1. Six thousand and eighteen pieces of freight 
were certified, of which 6,013 pieces were shipped to ports in the Phil- 
ippine Islands and 5 pieces to United States ports. 

Owing to the prevalence of smallpox in this port all passengers who 
did not show evidence of having been recently successfully vaccinated 
were vaccinated a few days prior to sailing. Before issuing the bill 



1>UBLIC HEALTH AND MABINE-HOSPITAL SERVICE. 167 

of health the crew and all passengers are inspected on board at the 
hour of sailing. 

On January 8, 1909, a letter was received by the American consul 
in Amoy from the insular collector of customs at Manila stating that 
Chinese domiciled in the Philippine Islands visiting China are, when 
returning to the Philippine Islands, no longer to be debarred under 
the provisions of the act of Congress of February 20, 1907. 

Accordingly the examination of passengers for diseases or dis- 
abilities which would exclude them from the Philippines under the 
immigration law is limited to those Chinese going to the Philippines 
for the first time and who belong to the privileged classes, viz, 
merchants, travelers, students, wives, and minor children of Chinese 
merchants domiciled in the Philippine Islands. For this reason the 
percentage of rejections at this port is low. 

At the request of the American consul applicants for extension 
certificates are examined and an opinion rendered as to their physical 
condition by the medical officer of the service. Chinese who depart 
for China from the Philippines to return are given a " return cer- 
tificate," good for one year, and may be granted an extension certifi- 
cate by the American consul on account of sickness or other disability. 

The following quarantinable diseases were present during the fiscal 
year in Amoy : Plague, leprosy, smallpox, and cholera. 

Plague first appeared in the month of March, and with the advent 
of hot weather the number of c^ses steadily increased until at the 
end of the fiscal year it was considered epidemic. 

It is impossible to estimate the number of cases of leprosy in Amoy. 
No attempt is made to segregate lepers. They are frequently ob- 
served on the streets and in the dispensaries of the mission hospitals. 

Smallpox is quite prevalent during the greater part of the year, 
but in the summer months the number of cases diminishes consid- 
erably. Vaccination is extensively practiced by the Chinese in Amoy. 
Large quantities of Japanese vaccine, which is put up in capillary 
glass tubes, are imported from Japan and Formosa. The practice of 
inoculation into the nose with virus from smallpox patients is still 
carried out by some of the Chinese. 

About the middle of June information was furnished by a Chinese 
physician in the Amoy hospital that cholera had appeared in the city, 
and also in Kang Thau, a village on Amoy Island, about 4 miles 
distant. 

In order to obtain information as to the prevalence of cholera, 
plague, and smallpox in the vicinity of Amoy, forms printed in both 
the Chinese and English languages were sent to physicians practicing 
in the Province, and they were requested to fill them out and return 
them by mail to the service officer at the end of each month. 

The disinfecting barge which was recently purchased by repre- 
sentatives of one of the steamship companies for bathing and disin- 
fection of clothing and baggage of steerage passengers embarking for 
the Philippines is now ready for use. 

The sanitary condition of Amoy is exceedingly bad, owing largely 
to the lack of a sewer system and to an insufficient water supply. 
Kain and waste water is carried away by means of gutters beneath 
the flagstones of the streets. During the rainy period the gutters 
overflow, leaving the stre(>ts covered with filth. Tlu^ city is dependent 
on wells for its water supply. They are readily exposed to contami- 



168 



PXJBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



nation, owing to the fact that they are uncovered, and in the majority 
of cases are level with the surface of the ground. 

YOKOHAMA, JAPAN QUARANTINE AND SANITATION IN JAPAN. 

Passed Asst. Surg. Hugh S. Gumming reports, in part, as follows 
for the fiscal year ended June 30, 1909 : 

Steam vessels inspected and granted bills of health 224 

Sailing vessels inspected and granted bills of health . 11 

United States war vessels granted bills of health without inspection 28 

Total number of bills of health granted during the year 263 

Destinations and Number of Above Vessels, with Numbers of Personnel. 



Port. 



Vessels. 


Saloon 
passen- 
gers. 


Steerage 

passen- 

ger^. 


57 

50 

8 

26 

58 

2 

2 

2 

1 

13 
1 
1 
1 
2 


3,236 

794 

53 

1 

932 


8,929 

4,064 

145 


3,062 


2 


























10 


772 



Crew. 



San Francisco, Cal., and Honolulu, Hawaii 

Seattle, Wash 

Tacoma, Wash 

New York, N. Y., via , 

Manila, P. I., via 

Cebu, P. I 

Boston, Mass., and New York, N. Y , 

Port Arthur, Tex 

Honolulu, Hawaii, only 

Portland, Greg 

Gavlota, Cal 

Cavite, P. I 

Port Townsend, Wash 

South American ports via Honolulu 



397 
499 

554 

303 

709 

186 

72 

110 

30 

746 

48 

52 

42 

243 



Recapitulation . 





Vessels. 


Saloon 
passen- 
gers. 


Steerage 
passen- 
gers. 


Crew. 




224 
28 
11 


5,033 

77 
5 


16,972 


24,991 




15,069 






226 








Total 


263 


5,115 


16,972 


40,286 







Number of persons required to hathe and undergo special inspection. 

Passengers for the United States or Hawaii or Manila — 1, 234 

Passengers for British Columbia on vessels for United States 290 

Members of crews 390 

Total bathed and examined 1,914 

Pieces of baggage disinfected under supervision 4,030 

Vessels fumigated or disinfected, etc., in whole or partly 30 

Quarantinable disease detected at time of final inspection 1 

The continued spread of bubonic plague over both hemispheres 
shows the absolute necessity of continued vigilance. One of the most 
important methods of combating its advance is undoubtedly the 
periodical fumigation of vessels trading in infected ports; in fact, 
this would seem to be the most important method, except the im- 
practicable one of preventing the invasion of vessel or cargo by rats. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 169 

Therefore, the service has continued to fumigate all vessels at Yoko- 
hama desiring bills of health if the vessels are empty and there is a 
history of possible infection. Yokohama is the terminal and starting 
port of many cargo lines trading between that port and New York 
via any port in Asia where cargo offers. Such vessels are almost 
invariably fumigated there, but the treatment of the crew is deferred 
until the port is reached, at which the crew is discharged and a new 
crew enlisted. Unfortunately Singapore, where there is no medical 
officer, is the usual port for the discharge and enlistment of Lascar 
crews. 

There are two lines of mail steamers which ply between Yokohama 
and the ports in Australia via Japan and China ports, Hongkong 
and Manila. By suggestion of the chief quarantnie officer of the 
Philippines a certificate of fumigation from the British health officer 
at Brisbane is accepted in lieu of fumigation of one of the line, the 
North German Lloyd, and the vessels of the other are fumigated at 
Yokohama every trip. 

The vessels of the Nippon Yusen Kaisha running to Seattle and 
Manila and those of the North German Lloyd to Manila all lie at the 
customs docks at Yokohama, and as there are many vessels constantly 
at the same wharf from plague-infected ports, the steamers for 
American ports are compelled to use rat guards. The wisdom of this 
routine is shown by the enormous number of rats, some infected, 
which have been killed by the local health authorities at Yokohama, 
upon some of the other vessels since they instituted quarantine against 
Shanghai. 

The policy of bathing and disinfecting the effects of persons trav- 
eling steerage upon vessels bound for American ports, whether the 
individual is to disembark at Victoria or other ports before the ves- 
sel reaches her American destination is continued, whether this imme- 
diate vicinity be infected with quarantinable disease or not. 

Cargo is inspected or handled by having all consular invoices sub- 
mitted to the service officer before final clearance in the consulate, and 
by initialing, for convenience of the loaders, all shipping notes. For 
the convenience of the quarantine officers at the home ports, manifests 
are also signed just before the vessels sail. Doubtful cargo is person- 
ally inspected and a close watch kept upon godowns. 

Sanitary conditions in Yokohama. 

The official census of December 31, 1908, shows a population of 
892,870 living in 78,138 houses, with total deaths during the year of 
3,28G males, 2,793 females, total 6,079; and total births during the 
year of 4.132 males, 3,976 females, total 8,108. 

The population according to the census of 1907 was 378,884 living 
in 74,572 houses, an increase of 15,986, the registered births having 
been 8,201 and the deaths 5,411, while for the year 1906 the census 
showed a population 29,022 less than 1907. 

The death rate for the past year shows per mille 15.46, as against 
14.28 for 1907, 11.12 for 1906, and 12.7 for 1905. As will be shown 
below, this increase was not due to reportable diseases, which were 
only about 60 per cent of those of the j)r-eceding year, and it was 
probably due to'gen(U'al diseases whose nioi-tality and incidence were 
increased by poverty and its inevitable results due to the bad indus- 



170 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



trial and economic conditions which, here as elsewhere, prevailed. 
Here in Japan, as elsewhere, the agricultural classes have not suf- 
fered, to which may be attributed the decrease in percentage of in- 
crease of population. 

Keportable Diseases Have Occurred as Follows, Year ended June 30, 1909. 





Cases. 


Deaths. 


Remarks. 


Cholera 


4 
22 
293 
151 
21 
115 


4 
16 
70 
35 

6 
22 


All in the first half year (June to January). 


Plague. . . . 


A.11 in the second half year. 


Typhoid fever 


228 cases, 54 deaths first half; 65 cases, 16 deaths second half. 
75 cases, 17 deaths first half; 76 cases, 18 deaths second half. 


Scarlet fever 

Dysentery 


15 cases, 4 deaths first half; 6 cases, 6 deaths second half. 
99 cases, 18 deaths first half; 16 cases, 4 deaths second half. 






Total 


606 


103 





Against a total of 1,027 cases and 338 deaths during the year ended 
June 30, 1908, of which 413 cases and 142 deaths were from smallpox. 

Cholera. — Four cases occurred last summer and were probably 
sporadic. 

Typhoid fever showed an increase of about 46 per cent. 

Diphtheria showed a decrease of 25 per cent. 

Scarlet feiier showed an increase of 1 case. 

Dysentery showed an increase of 9 per cent. 

Smallpox. — One (doubtful) case occurred, as against 424 reported 
last fiscal year. 

Bubonic plague. — Every j^ear about the month of January plague- 
infected rats, although few in number, generally begin to be reported, 
and increase until after the "rice rains " are over, in July. Two rats 
were reported November 4 and 17, and no others until February, 
when one was picked up in the street in the center of the city. Since 
this time they have been found at frequent intervals. 

April 30 an umbrella mender was attacked with plague, but the in- 
fection was apparently traced to rice from Formosa which arrived 
on the FukxLoha Maru, upon unloading which steamer, after fumiga- 
tion, some infected rats were found. Repeated outbreaks of plague 
were traced to imported rice, and the fumigation of all vessels from 
Rangoon and Saigon was continued, and of those vessels from For- 
mosa fumigation was begun before unloading. In addition to this, a 
municipal order was issued to disinfect all of the 3,000 houses where 
rice, strawj gunny bags, rags, etc., are kept, and to forbid the removal 
of those articles from the infected districts until after disinfection. 
Up to the present time there have been 26 cases of plague reported in 
various districts. The city assembly has voted to grant a bonus of 50 
sen to the owner of each female cat which litters, and to continue the 
purchase of rats in addition to the use of arsenic phosphorus and 
other poisons and the use of traps. 

Leprosy. — The practical segregation of lepers has been started, for 
they are no longer noticed in the foreign settlement as formerly. 

Rinderpest and rabies have both appeared in epidemic form in 
Yokohama and elsewhere throughout the Japanese Empire. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 
Sanitary Conditions Thboughout the Empiee. 



171 



Reportable diseases occurring throughout the Empire, exclusive of the island 
of Taiwan (Formosa), during the year ended December 31, 1908. 



Cholera 

Dysentery 

Typhoid fever 
Smallpox 



Cases. 



652 
32, 721 
24,494 
18,067 



Deaths. 



401 
7,843 
5,331 
5,837 



Scarlet fever 
Diphtheria . 
Plague 



Cases. Deaths. 



860 

17,790 

347 



128 

4,971 

280 



Cholera. — There is some doubt as to the nature of the four cases in 
Yokohama, but the disease reached Moji-Shimonoseki as usual first 
early in July, almost certainly from China, and 300 of the total cases 
were in those prefectures (Yamakuchi-Fukuoka). Later it occurred 
at Kure naval station, on Shikoku Island, and in November there 
were 22 cases in Tokyo. Several cases occurred on an English steamer 
from India, via China ports and Moji, after her arrival at quarantine 
here. 

Dysentery. — A terrible epidemic, with 7,468 cases and 2,143 deaths, 
occurred in Kagawa Ken, on Shikoku. The widespread and fatal 
epidemic is shown by the annexed detailed statistics of this and other 
diseases. 

Typhoid fever. — The water supply of Yokohama is reported to be 
exceiDtionally good, and that of the other large cities as good as that 
of many of the cities in the United States, and the occurrence of the 
disease is attributable to the use of human excrement and the eating 
of raw vegetables and shellfish which have been fattened in canals 
which run through cities and are contaminated with filth. 

Smallpox. — The severe epidemic with 18,067 cases and 5,837 deaths 
was a continuation of the epidemic mention of which was made in 
the last annual report. Rigid vaccination rules have this year been 
enforced and there has been in consequence almost the total disap- 
pearance of the disease. 

Scarlet fever caused only 128 deaths, of which 94 were in Tokyo, 
Osaka, and Kyoto. The disease is of recent importation and is mild 
in form. 

Diphtheria is extremely common all over Japan, and despite the 
enlightened action of the Imperial Government in furnishing prac- 
tically free antitoxin and the widespread knowledge of its useful- 
ness, the official statistics show a rather heavy mortality of 27.9 per 
cent. 

Bubonic plague. — Of the 347 cases and 280 deaths it is not unfair 
to say that nearly every case could be traced directly or indirectly to 
Kobe and Osaka. 

The most interesting events related to plague are the elaborate 
studies made by Doctor Kitasato and his assistants of the outbreak 
of pest on Yura Island, near Kobe, especially in regard to the rela- 
tive incidence and importance of varieties of fleas with regard to 
pest. 

An incident of quarantine interest was the occurrence of plague 
lipon the st(!amship iHukuali'mui Mam aftei- a voyage of several weeks 
from Peru. She had carried from Kobe many emigrants without 



172 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

illness having been detected upon either voyage until after arrival at 
Kobe. 

Despairing of the destruction of rats and eradication of pest by 
present methods, the authorities have attempted to take advantage of 
the suggestions made by Koch and Kitasato in regard to the use of 
cats, and official suggestion is made for householders to keep cats, and 
there has been an attempt to introduce good ratting breeds from 
India. 

Pest having repeatedly been traced to cotton and rice imported 
from India and Cochin China, and both of these products being abso- 
lutely essential to the well being and industrial progress of the 
Empire, cargoes of these products are now fumigated with CO gas 
before discharge. 

The attention of the bureau has been invited to the opening of the 
new coaling port of Miike, to which port it is stated the United 
States army transports will in the future go for coal in place of 
Nagasaki. 

KOBE, JAPAN. 

Acting Asst. Surg. C. P. Knight reports in part as follows on the 
transactions at this station during the fiscal year ending June 30, 
1909 : 

Vessels inspected and passed 228 

Vessels disinfected 17 

Passengers inspected 19, 338 

Crew inspected 23, 031 

Packages of freight viseed 2,092,147 

Pieces of freight inspected and disinfected 1,845 

Cases of quarantinable diseases inspected 5 

The sanitary condition of the city during the fiscal year is reported 
to be fair. Among the prevailing diseases were cases of measles, 
typhoid fever, diphtheria, and a few cases of plague. Fortunately 
plague has not been found in the vicinity of the water front of Kobe 
or in the shipping districts, it being mostly confined to the old part 
of the town among the poor classes. 

The godowns and lighters where cargo is stored are all in a good 
sanitary condition, and are practically kept clear of rats. 

The number of rats examined during the year was 743,851, of which 
2,349 were found plague infected. Of the number caught along the 
water front none were found to be plague infected, according to the 
report of the Japanese officials. A thorough house cleaning of the 
whole city has been performed three times, since January, 1909, with 
a view of destroying rats. The city government pays 2^ cents apiece 
for these rodents, thereby encouraging the poorer classes to rid their 
neighborhood of them. The sewage system of the city as a whole is 
very poor, being the open-drain system. A most unhygienic practice 
among the natives is to scoop the filthy water from the sewers and 
sprinkle it upon the streets, thereby transmitting disease by the germ- 
laden dust. 

The water supply of Kobe is good. It comes direct from the hills, 
where there is no contaminating drainage, and is then purified 
through excellent filters. A chemical and bacteriological examination 
is made daily by the health authorities of the city. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



173 



The official report of infectious diseases during the year is as 
follows : 



Cholera 

Typhoid fever 

Dysentery 

Diphtheria . . . 



Cases. 


Deaths. 


None. 


None. 


159 


32 


133 


20 


93 


28 



Smallpox. . . 
Scarlet fever 
Plague 



Cases. 



Deaths. 



It is worthy of note that no cholera has appeared in Kobe this year. 



NAGASAKI, JAPAN. 

Acting Asst. Surg. Thomas J. Thompson reports for the fiscal 
year ending June 30, 1909, as follows : 

Total number of vessels inspected 120 

Total number of passengers examined 29, 482 

Total number of crew examined 22, 114 

In September, 1908, cholera appeared at several points in this con- 
sular district of Nagasaki, but it did not gain a footing in Nagasaki. 
One or two ships arrived with cholera on board, or having had it on 
the voyage. These were effectively treated at quarantine, so that it 
did not spread. There were no deaths from the disease. 

CALCUTTA, INDIA. 

Acting Asst. Surg. A. Smith Allen reports : During the fiscal year 
73 vessels were inspected, with 4,003 crew, and the personal effects 
of the members of such crew were disinfected in accordance with the 
quarantine regulations. 

LIBAU, RUSSIA. 

Owing to the prevalence and spread of Asiatic cholera in Russia, 
and the danger of the importation of this disease through immigrants 
arriving in the United States, a medical officer of the service, Acting 
Asst. Surg. C. M. De Forest, was assigned to duty in the office of 
the American consul at Libau, Russia, on September 26, 1908. This 
officer assumed his duties on October 12, 1908, from which date to 
the end of the fiscal year the transactions were as follows : 

Number emigrants examined 14, 790 

Number emigrants sailed 11,716 

Number held back 3,074 

Number held for trachoma and favus 2,934 

Number held back by representative of the Public Health and Marine- 

• Hospital Service 140 

I* == 

Diseases certified to : 

Measles 24 

Scarlet fever 2 

Chicken pox 9 

Diphtheria 9 

Leprosy . 1 

Smallpox, 1; exposed to smallpox, 56 57 

Fevers and suspected cases 38 

Total 140 

Total baggage disinfected from (X-toI)er 12, lOOS, until August 24, in09__ 2,868 
Crew and oflicerB examined from October 12, 1908, until August 24, 1909- 1, 623 



174 PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 

Libau is a city of 100,000 inhabitants, situated directly upon, the 
water front of the Baltic Sea. The water supply of the city is taken 
from about 300 artesian wells. These are situated in various parts 
of the city and the water is pumped by hand. There exists no system 
of water pipes or hydrants. Therefore it is reasonable to suppose 
that no epidemic of cholera can occur in Libau, although there may 
occur a few imported cases. 

Emigrants are examined up until the evening of the sixth day pre- 
ceding the sailing of the vessel, but none are examined after that 
time. They are held in Libau for five full days prior to their de- 
parture. Each single person or family is given a card by the repre- 
sentative of the service, containing the name and age of each member 
of the family, and the printed card states that they are free from 
evidence of quarantinable disease. This card is dated and stamped. 
Then upon the day of sailing all passengers are again examined and 
the card above mentioned is again stamped with a date stamp marked 
" Second inspection." All cases having no quarantine card, those 
having cards which are not stamped, and all cases of illness and sus- 
pectecl cases are not allowed to board the ship and are held over until 
the next boat, two weeks later. 

All passengers, cabin and steerage, are, as far as the time for quar- 
antine is concerned, treated alike. No evidence except that of a per- 
sonal examination of the passenger is accepted. 

The officers and crew of every ship are examined every day for five 
days prior to sailing, and no new man for the crew is shipped at 
Libau unless he has been there for more than two weeks. 

Personal inspection of the ship is made on the day of sailing. 

Inspection of all baggage is made and all eatables, such as bread, 
herring, cucumbers, fruit, etc., and all drinkables are removed, and 
all the large baggage — not hand baggage — is thoroughly disinfected 
by the use of formaldehyde gas. The disinfection is carried out by 
a sanitary official of the city of Libau. 

During the last three months a new building has been erected for 
the disinfection of the baggage. 

Within the last three months three new emigrant houses have been 
leased by the steamship company and have been remodeled and made 
clean and in good sanitary condition. Each is capable of housing 
from 100 to 250 emigrants. Not more than 20 people are allowed to 
sleep in a room. The number is regulated by the sanitary police, who 
measure the rooms and allow each person about 500 cubic feet of air 
space. The number allowed for each room is posted upon the door 
of each room. 

In the event quarantinable disease appears in an}'' one of the emi- 
grant houses nobody from that house is allowed to sail until all have 
undergone the period of incubation of the disease. Libau is the only 
port in Russia from which emigrants sail direct to the United States. 

Methods Employed in Chinese and Japanese Ports by the Service 
Officers for the Prevention and Destruction of Eats on Ves- 
sels Destined to United States Ports. 

[See chapter on International cooperation against plague, etc., p. 102.] 

Honghong^ China. — All vessels on the regular routes between Hong- 
kong and the United States ports are required to undergo, while 
empty, sulphur fumigation every six months. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 175 

All vessels " dry docking " in Hongkong are fumigated after leav- 
ing the dock. 

All " occasional " or " tramp " vessels calling at Hongkong from 
any port in China must be fumigated before a bill of health is granted. 

During the past year many of the vessels have been disinfected at 
San Francisco, and when this was done, and a certificate from the 
medical officer of the service produced, the fumigation was waived at 
Hongkong. 

The Nippon Yusen Kaisha, a Japanese line plying regularly be- 
tween Hongkong and Seattle, require their vessels to be fumigated 
on every trip, i. e., about once in three months. This is the company's 
regulation, but the service officer is often required to supervise it. 

There are three steamship lines running vessels from Japan to Aus- 
tralia via Hongkong and Manila, and these vessels are fumigated 
each trip, either in Japan or Australia, as is required by the Aus- 
tralian Government. 

One line of vessels — the Arthur Holt Steamship Company — plies 
between England and Seattle via Malay Straits and China and Japan. 
All of these vessels are fumigated when empty in Liverpool, and 
always have a certificate of disinfection from the United States consul. 

"V\^en the systematic fumigation was started about four years ago 
great numbers of rats were killed on every vessel. Now, however, the 
number found on the regular steamships is very small, showing that 
the fumigation is effective. 

Very few of the vessels go alongside the wharf in Hongkong. 

Shanghai^ China. — Vessels bound for American ports are not al- 
lowed to go alongside the wharves when loading, with the single 
exception of the French line around the world from Havre to San 
Francisco, and the exception is made^ in this case only because of the 
fact that these vessels carry very heavy structural iron cargo for 
Shanghai and the interior and it would be difficult if not impossible 
to lighter it. These vessels place rat guards on all their lines, as is 
required of all vessels taking bills of health from Shanghai for the 
United States, and adopt the other precautions previously reported. 

A close supervision is kept over vessels bound for the United States. 
It not infrequently happens that no rat guards are found on the lines 
to lighters alongside the vessels, and in such cases the attention of 
the agents is drawn to the fact and a note of the omission is made on 
the bills of health. The lighters are fully as dangerous as the 
wharves, as during the time they are not in use or are undergoing the 
process of loading they often lie at docks where infected rats have 
been found, and the lighters themselves are not infrequently infested 
with rats. Their periodic fumigation has been suggested. 

Cargo in which rats might make nests is inspected. 

Loading in Shanghai is done as far as possible by daylight. 

Yokohama^ Japan. — (1) Trade with the Pacific coast of America 
direct or via Hawaii : The trade is conducted, with few exceptions, in 
vessels of the various mail lines, the port of origin of which is Hong- 
kong, in which port the vessels of such lines, i. e., Pacific Mail, Toyo 
Kisen Kaisha, to San Francisco via Hawaii, Nippon Yusen Kaisha, 
Great Northern, Bank, and other lines to Puget Sound, lie empty, or 
while unloading and cleaning for an average period of ten days. Upon 
arrival at Yokohama these vessels have taken on cargo at Hongkong, 
Amoy, or Keelung (during the tea season only), Shanghai, Nagasaki, 



176 PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE. 

Kobe, Yokkaichi, Shimidzu (during tea season only), and Yokohama, 
which is the last port of call and at which these vessels lie for about 
two days. 

All vessels, except those of the Nippon Yusen Kaisha, lie out in the 
open bay at Yokohama, and these vessels are compelled to use rat 
guards while at the dock, and have a light on the gangway at night 
if one be used. Excejjtions to origin in Hongkong are («) vessels of 
the Alfred Holt (blue funnel) Line from Liverpool via Suez, Co- 
lombo, the Straits Settlements, China, and Japan ports for Seattle 
and Victoria. These vessels bear a certificate on the original bill 
from Liverpool or Glasgow, showing fumigation while empty, and 
consular statements on the supplemental bills as to use of rat guards 
in Singapore and Port Said; (6) vessels of the Chargeurs Reunis, 
which follow a similar course, and bear fumigation certificates from 
Havre, and which, after leaving Yokohama, sail for Hawaii or Seattle 
direct; and (c) an occasional oil steamer. 

All of the above vessels are more or less completely loaded upon 
arrival, and it is impracticable to fumigate them at Yokohama. All 
are or should be fumigated at port of departure. 

(2) Vessels having Yokohama as their port of departure include: 
(a) A large number of freight vessels trading between Yokohama and 
New York and touching at any port of Japan, China, the Straits Set- 
tlements, Malabar or Coromandel coasts of India and Africa, including 
Manila or Cebu during the sugar and hemp seasons. These vessels 
are empty at Yokohama and are invariably fumigated by the service 
officer unless they have just been treated at Manila or have not stopped 
at infected ports. Their crews are usually Lascars shipped at Singa- 
pore on their way to America, or else Chinese shipped from Hong- 
kong. They are bathed and disinfected at Yokohama, Shanghai, 
Kobe, or Hongkong. (6) The mail steamships of the North German 
Lloyd, Nippon Yusen Kaisha, and China Navigation Company (blue 
funnel), plying between Yokohama and Australia via Manila, carry 
physicians. The Japanese vessels are fumigated at Yokohama, but 
the British and German steamers, under agreement with the chief 
quarantine officer for the Philippine Islands, are not so treated if 
carrying a certificate of fumigation at Melbourne or Hongkong, (c) 
Vessels of the Pacific Mail, Toyo Kisen Kaisha, and Great Northern 
lines stopping at Yokohama en route from Pacific coast ports to 
Manila are simply inspected and not fumigated. 

Nagasaki^ Japan. — There being no wharves or docks at the port of 
Nagasaki, vessels are moored in the stream and are loaded and coaled 
from small open lighters, the bottom boards of which are movable. 
Measures for rat destruction are actively enforced, and a reward is 
given for every rat delivered. 

Kobe., Japan. — Vessels taking out an original bill of health at Kobe 
port are fumigated with SO2 for twenty-four hours, using 3 pounds 
of sulphur to the 1,000 cubic feet in order to destroy the rats in the 
holds. When a vessel comes into port empty it is fumigated within 
a reasonable length of time afterwards. 

The periodical fumigation of vessels at Kobe is practicable always, 
except when the vessels are laden with cargo. 

Amoy., China. — Owing to the fact that there are no docks at Amoy 
vessels are obliged to make fast to buoys in the stream which sepa- 
rates Amoy Island from the island of Kulangsu. The width of the 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 177 

stream between the two islands is about 700 yards and ocean-going 
vessels anchor well out for the reason that small river craft occupy 
the anchorage near the shore. 

Vessels take on cargo only during the daytime. The cargo is con- 
veyed by means of small lighters which make fast to the vessel. Rat 
guards are not placed on the lines. There is no opportunity in this 
port for rats to gain entrance to vessels by means of lighters. 

There is almost no steamship traffic between Amoy and United 
States ports. During the past eighteen months but two vessels have 
been granted bills of health at Amoy for United States ports. The 
trade is principally with the ports of the Philippine Islands. About 
5,000 Chinese laborers leave Amoy each year for the Philippine 
Islands. 

Periodical disinfection for the purpose of eradicating rats from ves- 
sels has been carried out upon their arrival at the quarantine station 
at Mariveles near Manila, P. I., but in the future vessels will be dis- 
infected by the service officer at Amoy prior to departure. A dis- 
infecting barge containing a sulphur furnace, two steam chambers, 
and facilities for bathing steerage passengers has been purchased by 
representatives of one of the steamship companies at Amoy for use 
in connection with the Philippine Island traffic. 

Lectures on Quarantine Principles and Eegulations to Newly 
Appointed Consular Officers. 

It has been the custom for the Department of State to require 
every new class of consular officers to attend a special course of in- 
struction, during which lectures are given on various conditions with 
which they are likely to be confronted while on duty in their pros- 
pective stations in foreign countries. These lectures include the dis- 
cussion and explanation of the various regulations with which a con- 
sular officer must be familiar. 

By the terms of the act approved February 15, 1893, every vessel 
clearing at a foreign port for a port in the United States is required 
to obtain a bill of health from the United States consular officer. In 
the rendering of such a bill of health it is essential that the consular 
officer be not only familiar with the United States quarantine regu- 
lations, but that he should have a general idea of sanitary matters, to 
enable him to know how to watch for and suspect infection in the 
port or place wherein he is stationed. 

' To fulfill these requirements a request was made of the bureau 
last year for the detail of a medical officer to contribute a discourse 
on the United States quarantine regulations and their practical appli- 
cation at foreign ports. 

This lecture was said to have been favorably received, and on July 
22 of this year the request for a similar lecture was made, there being 
a new class of consular officers attending the regular course. 

The bureau was pleased to comply with this request, because the 
public-health work performed jointly by the consular corps and the 
service is growing daily in importance, as well as in volume, and the 
reports mad(! by consular officers and the good account to which 
they are turned by the service are matters of constant comment. Too 
much can not be done to make more perfect the joint operations, the 
value of which is so generally recognized. 

18546—10 12 



MEDICAL INSPECTION OF IMMIGRANTS. 

During the fiscal jenr ending June 30, 1909, 966,124 immigrants 
were examined by medical officers of the service to determine their 
physical fitness for entrance at ports in the United States and its 
dependencies, Porto Rico and Hawaii. Fourteen commissioned offi- 
cers and 50 acting assistant surgeons were assigned to this duty exclu- 
sively, and a large number of officers, primarily engaged in other 
service duty, examined aliens whenever presented to them. During 
the fiscal year 14,536 aliens were certified for physical reasons. The 
officers of the service stationed at the consulates for quarantine duty 
in Italy, Japan, and China also inspected departing aliens at the 
request of the Department of Commerce and Labor, this work at some 
ports exceeding in volume and difficulty the quarantine function. 

As in previous years the function of the officers at foreign ports is 
advisory to the transportation companies, and the number of unde- 
sirable emigrants reported to have been refused on the advice of these 
officers bears testimony to the value of the work. 

The following table furnishes a summary of the transactions at the 
several ports in the United States and in its dependencies and in 
Canada : 
178 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



179 



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20, 610 

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1,199 

3,449 

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3,391 

4,745 

1,061 

1,895 

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2,173 

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733, 207 

810 

16,257 

7,718 

7,589 

349 

3,319 

3,943 

9,047 

157 

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PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



181 



Excerpts from Reports Made by Service Officers Detailed for 
THE Medical Inspection of Immigrants. 

BALTIMORE, MD. 

Passed Asst. Surg. J. W. Schereschewsky, through the medical 
officer m command, reports that for the two months prior to the 
end of the fiscal year all cases of eye diseases with clinical symptoms 
suspicious of trachoma have been examined for the presence of the 
organism described by Greef in the Deutsche Medizinische Wochen- 
schrift of March 25, 1909. This organism was detected in all cases 
which subsequently proved to be trachoma, but other inflammatory 
conditions of the conjunctiva gave negative results on examination. 

The presence of this organism is therefore of value in making an 
early diagnosis of trachoma in acute cases, and its detection may be 
regarded as confirmatory of the diagnosis. The ease, however, with 
which it disappears under treatment from the surface of the con- 
junctiva and also the fact that its detection is at all times by no 
means easy of accomplishment renders its presence an aid rather than 
a sine qua non to the diagnosis of trachoma. 

BOSTON, MASS. 

Acting Asst, Surg. M. V. Safford, through the medical officer in 
command, reports the following : 

During the past fiscal year 396 ships arrived at Boston bringing 
passengers liable to medical examination. The aliens thus arriving 
constituted about 80 per cent of the total passengers. Aboard ship 
they were mixed with citizens of the United States, as indicated in 
the following table: 





United 

States 

citizens. 


Aliens. 


Total. 


First cabin 


4,612 

3,409 

3,235 

28 


1,259 

8,763 

38,065 

47 


5,871 




12, 172 


Steerage 


41, 300 




75 







Out of the total, therefore, of 48,132 alien passengers arriving at 
Boston, 2,018 were found on medical examination to be diseased or 
defective and disabled to such an extent at least as to raise a question 
as to their capacity for future self-support. 

Increafiinci tendency of aliens to travel second cabin. — Of the aliens 
thus certified as defective, 1,312 were found in the steerage and 700 
in the so-called " second cabin." Proportionately, therefore, about 3^ 
per cent of the alien steerage and about 8 per cent of the alien second 
cabin were found to require medical certification for conditions suffi- 
ciently serious to call for consideration in determining the alien's 
admissibility. In this connection it may be noted that whereas in 
1900 (lie aliens arriving in the second (;abin at Boston were only 10 
per cent of tlic total ali(;n passengers, for the past year the propor- 
tion reached 18 per cent. 



182 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

There is of course a normal tendency to increase in second-cabin 
travel, but as is indicated by the large proportion of defectives now 
found in the second cabin, this increase is made up to a considerable 
extent of people of the steerage type who would normally travel 
steerage but who are led to pay approximately the difference between 
$37 and $45, or possibly less, for a second-cabin passage, because in 
so doing they are not subject to the sanitary regulations imposed on 
steerage passengers originating in districts where serious epidemic 
diseases are prevailing, and because if diseased or crippled they find 
less difficulty in securing acceptance for passage by the steamship 
companies. Then, too, they believe they will find it easier to land as 
second-cabin passengers upon their arrival. From the point of view 
of the medical examination it must be admitted that this belief is not 
groundless. It is becoming more and more difficult to make a proper 
examination of the type of aliens now arriving in the second cabin, 
on shipboard in crowded quarters, and mingled with naturalized citi- 
zens, as is now the usual practice. Wliatever conditions may have 
once existed for treating aliens traveling in the second cabin dif- 
ferently from those traveling in the steerage such conditions no longer 
exist. 

With passage rates as at present every alien passenger pajdng less 
than $60 for his ocean passage should be removed from shipboard and 
examined in the same manner as the steerage passengers. The price 
under which an alien might be regarded as a steerage passenger is 
set at $60 not because diseased aliens of the steerage type will find the 
cost of $60 iDrohibitive, but because such an arbitrary standard will 
insure the proper examination of those who are now paying less and 
enable the giving of the needed attention to the increasing number 
of diseased aliens who are already paying more and coming " first- 
class " to aVoid the second-cabin examination. 

As to the character of the diseased persons certified during the 
year, it is to be noted that the steady diminution in the number of 
those, for the bringing of which $100 penalties were provided by law 
in 1903, is still continuing. Improvements in methods of examining 
and handling prospective passengers at foreign ports of embarkation, 
and the practice of the steamship lines running to this port in re- 
fusing passage to persons presenting any inflammatory condition of 
the eyelids whatever to avoid the possibility of taking a case which 
later might prove to be trachoma has had the gratifying result of 
reducing to an insignificant figure the number of acute inflamma- 
tory eye affections of a nontrachomatous nature which it was formerly 
found necessar}^ to send to hospital for treatment on arrival. 

It is unfortunate, however, that all rejections for eye conditions 
at European ports should have come to be commonly referred to as 
rejected for trachoma, since this practice has tended to prejudice the 
prospective passenger's subsequent consideration for passage, given 
rise to a regular sj^stem of extorting money from emigrants under 
pretense of necessity for medical treatment of their eyes, and enabled 
steamship companies to work up the semblance of a grievance when a 
prospective passenger, refused by one line on account of what was 
merely a transitory inflammation of the eyes, has afterwards been 
accepted for passage by another line and successfully landed here. 
As for all practical purposes any inflammatory condition of the eyes 
may be regarded as contagious and a menace to the health of other 



PUBLIC HEALTH AND MAEINE-HOSPITAL SEKVICE. 183 

• 

persons in crowded quarters aboard ship, it would greatly help every- 
body concerned if the embarkation of cases of inflamed eyes from 
any cause were specifically prohibited by regulation as a sanitary 
measure just as, for example, cases of measles now are, and inde- 
pendently of the attitude of the Government with respect to tra- 
choma. It is to be observed that under the department ruling, that 
stowaways were not subject to examination with reference to their 
admissibility they have not been certified during the year even if 
found diseased, and diseased aliens of this class are therefore not 
included in our records. 

Hosjntal cases. — During the year 120 arriving aliens were sent to 
the various hospitals in Boston, and in addition nearly 600 aliens 
were treated for less serious ailments or held for observation for 
varying j^eriods at the station itself. The patients and their rela- 
tives and friends are such a nuisance to the ordinary hospital that 
there is an increasing disinclination on the part of local institutions 
to accept cases for treatment, and when accepted there is a tend- 
ency to try to get rid of them before they are ready to be discharged. 
To provide suitable care for all cases during the year, it has been 
found necessary to have recourse to eight different institutions, in- 
cluding the state hospital at Tewksbury, located about 24 miles from 
Boston. The number of aliens arriving in need of hospital treat- 
ment during the year is practically about one-half the average for 
the preceding four years. The decrease is due chiefly to a noteworthy 
diminution in cases of measles and other acute eruptive diseases, and 
also in part to a falling off from the usual number of pneumonia 
cases originating on shipboard. 

Detention station. — The total number of aliens brought to the de- 
tention station at long wharf in Boston during the year, including 
those arrested as being in the United States in violation of law, was 
3.910. The health of the inmates of the station has been remark- 
ably good, notwithstanding the fact that a greater proportion than 
ever before have been detained for periods exceeding six weeks. A 
new record has also been made, in that no case of contagious disease 
has developed at the station which can be attributed to infection in 
the station itself. 

Inspection vwrk. — It has been the practice, as in the past, to con- 
duct the examination of arriving aliens, including the medical inspec- 
tion, on shipboard or in the accommodations provided for the pur- 
pose at the five wharf terminals about the harbor used by the princi- 
pal trans- Atlantic lines. Aliens remaining detained after the pri- 
mary inspection and one board of special inquiry hearing are brought 
to the detention station at long wharf in the city proper. 

Destruction of terminal. — In July, 1908, the Cunard Line terminal 
at East Boston was destroyed by lire, and during the remainder of 
the year it was necessary to make the medical inspection of steerage 
passengers arriving by that line on shipboard or in improvised quar- 
ters in an old freight shed. Under those conditions the proper ex- 
amination of passengers arriving by Cunard ships during the year 
was attended with unusual difficulties. A new railroad and wharf 
terminal at the site of the old pier is now practically completed. In 
it is provided, for the purpose of the immigration examination of 
steerage passengers, a well-lighted hall with over 80,000 square feet 
of floor space fully e^iuipped for this examination and including 



184 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

provision for the medical examination, which, so far as completeness 
and convenience of facilities for making such examination is con- 
cerned, is probably in advance of anything that has hitherto been 
designed for work of this character. Adjoining this new Cimard 
pier work has already begun also on a similar wharf terminal for 
the use of the larger passenger ships of the International Mercantile 
Marine, represented here by the White Star, Red Star, and Leyland 
lines. The result of these projects, already under way, will be to con- 
centrate at East Boston in the future almost the entire trans- Atlantic 
passenger business of the port. The work of examining arriving 
passengers will also be further facilitated by the location of the new 
immigration station at Jeffries Point, in the same vicinity. The pur- 
chase by the Government of land at this site is now practically 
assured, and the construction of the station may be expected to be 
begun early in the coming year. Wliile it is proposed to arrange 
the new station so that arriving passengers may be transferred there 
by water for examination as at Ellis Island, the present practice of 
examining at the dock where suitable facilities may be provided will 
undoubtedly be continued. 

Commissioner Billings, Deputy Commissioner Hurley, and all 
other members of the immigration force are to be praised for their 
uniform courtesy and assistance to the service officers on duty at 
Boston. 

BUFFALO, N. Y. ' 

From the report of Acting Asst. Surg. W. L. Savage, made through 
the medical officer in charge at Buffalo, the following is taken : 

The immigration office at the port of Buffalo, N. Y., is located in 
the United States custom-house at Black Rock, on the Niagara River, 
at the American end of the international bridge. 

Up to 1901 the immigration work at Buffalo, N. Y., was carried on 
in a perfunctory manner, and its offices were located in the Federal 
Building in the city of Buffalo. There was little or no attention paid 
to immigrants coming to the United States, and only occasionally 
was the Public Health and Marine-Hospital Service called upon to 
examine aliens. Such as were examined were detained by the cus- 
toms officers and the immigration service notified. The chief work of 
the service at the port of Buffalo prior to 1901 was the looking up of 
violations of the laws governing alien contract labor. 

During the year of the Pan-American Exposition at Buffalo the 
work assumed a new and more extensive form, and the immigrants 
coming to the United States were subjected to a rigid examination, 
both physically and mentally. At this time an extra inspector was 
placed at Black Rock, and the office removed from the Federal Build- 
ing to its present location on the banks of the Niagara River, and an 
officer of the Public Health and Marine-Hospital Service was placed 
in charge of the medical examination of all immigrants seeking admis- 
sion to the United States. 

At first the work was light. It was not long, however, before the 
increase of work necessitated the assignment of another immigrant 
inspector to duty there. The flow of immigration to this country at 
Black Rock from and through Canada has increased to such an 
extent during the past eight years that the immigration office force 



PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 185 

now numbers 14 persons. Notwithstanding this increase in immigra- 
tion work there has been no increase in the number of Public Health 
and Marine-Hospital Service officers detailed to examine the incoming 
immigrants, the one on duty being obliged to hold himself in readi- 
ness at all times, both day and night, to report at the immigration 
office for the examination of aliens, independent of the regular daily 
office hours. 

Passenger traffic between Canada and the United States has more 
than tripled itself during the last five or six years, and the number 
of passenger trains arriving daily has so increased that at the present 
time there are no less than twenty-three daily, independent of excur- 
sion and race trains. Added to this are twenty-four dummies daily, 
across the international bridge, from 6 a. m. to 12 p. m. The immi- 
gration service has care also of the international ferry, which runs 
between Fort Erie, Canada, and Ferry street, Buffalo, N, Y. It runs 
every twenty minutes. The steamers plying between Crystal Beach, 
Canada, and Main street, Buffalo, N. Y., also fall under their inspec- 
tion. 

To this has been added the examination and deportation of aliens 
who have become public charges in any of the local hospitals, county 
hospitals, and poorhouses for physical or mental conditions existing 
prior or subsequent to their arrival in the United States. Alien 
insane cases are also examined and reported. In all cases their phys- 
ical and mental condition has to be certified to by the officer of the 
Public Health and Marine-Hospital Service in charge of that work. 

The care and examination of Chinamen smuggled into this country 
and later caught by the Chinese inspectors, as well as the examination 
of those who have a legal right to return to the United States, after a 
visit to China, also falls to the medical examiner. 

The abolition of the " white slave " traffic has of late occupied the 
attention of the Department of Commerce and Labor, and special 
immigrant inspectors have been appointed to investigate the existing 
conditions. The victims of this traffic when arrested are confined in 
the county jail where they are held either as witnesses or for deporta- 
tion. Their care also falls to the medical examiner. 

BROWNSVILLE, TEX. 

Acting Asst. Surg. G. D. Fairbanks reports that the number of 
aliens entering at Brownsville, Tex., has greatly increased over that 
of last year. 

The noted increase is due to the extraordinary development which 
is going on by which ample work is provided for large numbers of 
laborers, and the outlook at present is for its continuation, partic- 
ularly in view of the international railroad bridge, which is now 
being constructed across the Rio Grande at Brownsville. This bridge 
will also probably change the character of immigrants arriving and 
increase the number of aliens other than Mexican. 

The section of Mexico adjoining Brownsville seems to be partic- 
ularly infected with trachoma, but it is also noticed that people from 
the ranches and the interior, outside of the cities and towns, are seldom 
seen with the disease. Another very prevalent affection of the eyes is 
pterygium, which is noticed in extraordinary degree. 



186 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

DETROIT, MICH. 



Acting Asst. Surg. A. H. Wise reports, through the medical officer 
in command, that during the past year the class of aliens arriving at 
this port has changed decidedly. Aliens, principally Bulgarians com- 
ing from southeastern Europe and Asia Minor, generally after a short 
stay of from one to twelve months in Canada, were frequently en- 
countered during the first few months of the fiscal year. Yet, in spite 
of the fact that the number of monthly inspections has grown greater, 
this class of immigrant has, in a great measure, ceased to come, the 
great majority being English-speaking peoples. Possibly this ac- 
counts for the marked decrease in the number of certifications of 
trachoma, for since January the trachoma cases have averaged only 
3 per month, while previous to that time they averaged 14 per month. 

EAGLE PASS, TEX. 

From the report of Acting Asst, Surg. Lea Hume it appears that 
the principal diseases for which aliens are certified at Eagle Pass, 
Tex., are those of the first and fourth class. Trachoma is the cause 
for the largest number of rejections, and is found principally among 
Syrians wdio land in Mexico from Marseille. Mexicans are seldom 
found suffering from trachoma. 

EL PASO, TEX. 

Acting Asst. Surg. J. W. Tappan reports that alien immigration, 
other than Mexican laborers, has decreased at El Paso during the 
j)ast two years. Whether this is due to the recently instituted inspec- 
tion of immigrants by the Mexican authorities (who are now exclud- 
ing diseases likely to affect the alien's ability to earn a living) or to 
the general depression in immigration, it is hard to determine. 

During the year a tour of inspection of the immigrant stations 
along the Texas-Mexican and Arizona-Mexican borders was made 
by Acting Assistant Surgeon Tappan, at the request of the Commis- 
sioner-General of Immigration, through the bureau. The medical 
inspection of arriving aliens w^as found much improved over previ- 
ous years and trachoma, favus, and tuberculosis in arriving aliens 
were found to be on the decrease. Medical officers were instructed 
in the methods which prevail at Ellis Island for the medical inspec- 
tion of aliens and arrangements w^ere made at each station to render 
the inspection as nearly uniform for the whole border as possible. 
In this effort valuable assistance from the supervising inspector of 
immigration for the border was received, without Avhose active coop- 
eration in medical affairs the good results already accomj)lished could 
not have been attained. 

EASTPORT, IDAHO. 

Acting Asst. Surg. N. L. Slamberg reports that the immigration 
at Eastport, Idaho, has been steadily increasing, more than double 
the number of immigrants presenting themselves for examination dur- 
ing the later months of the year than was the case during the first 
months. 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 187 

A certain proportion of the immigrants were found to be persons 
who had more or less recently undergone a medical examination at 
some Canadian jDort of entry, and the great majority consisted of 
strong j^oung men and women in search of work. While the limited 
number presenting themselves daily allowed time for a more thor- 
ough examination than would be possible where hundreds had to be 
examined at one time, the percentage of certifications was not large. 

Besides the regular work at the office, trips of inspection have been 
made from time to time down the Spokane and International Rail- 
road, with a view of observing those passengers who board the train 
shortly after its entrance into the United States. For persons 
familiar with the country it would be quite feasible to cross the 
boundary line at a point remote from the immigration station, and 
while so far no suspicious cases have been observed, it is believed 
that the fact of the small stations being even occasionally watched, 
will, to some extent, serve the purpose of preventing illegal immi- 
gration. 

MONTREAL, CANADA. 

From the report of Passed Asst. Surg. E. H. MuUan, the following 
is taken : The Public Health and Marine-Hospital Service assumed 
charge of the medical inspection of immigrants bound for the United 
States, at Montreal, on September 30, 1908. Since that date the pas- 
sengers who are presented for medical inspection are examined at 
the immigration office by the service officer daily. 

For every case inspected the service officer signs a blank form, 
certifying that the alien is either free from the disease or that he is 
afflicted with a certain condition. All deformities and diseases are 
noted on these forms. To the certificates bearing the words tra- 
choma or pulmonary tuberculosis, the words " a dangerous, contagious 
disease," are added. Certificates of other serious conditions contain 
the name of the disease or deformity, immediately after which are 
inserted the words " affecting ability to earn a living." Minor de- 
fects which do not hinder the alien in earning his livelihood are 
simply mentioned on the same blank certificate form, after which the 
word " Record " is written. 

The list of records comprises principally slight deformities, preg- 
nancy, skin diseases, and visual defects. 

The board of special inquiry gives great weight to the certificates 
bearing the words " affecting ability to earn a living," issued by this 
office. The medical officer is frequently called before the board of 
special inquiry to supplement the certificates with statements which 
tend to show the degree of seriousness of the maladies certified to. 

NEW YORK (eI-LIS ISLAND IMMIGRATION STATION). 

Surg. George W. Stoner, chief medical officer, reports the following : 
Seven hundred and thirty-three thousand two hundred and sixty- 
seven aliens were examined upon arrival, including 133,350 cabin 
and 500,017 steerage ])ass('ng<M's. 

In addition to the above there were 135,181 cabin and 34,639 steer- 
age pass(!ngers, who, upon further examination by the immigrant 
inspectors, proved to be citizens of the United States. 



188 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Nine thousand one hundred and twenty-one aliens were certified 
for physical or mental defects, as per tabulated statement herewith, 
including 1,286 classified as dangerous contagious or loathsome con- 
tagious, viz, trachoma, 1,083; favus, 67; tinea tonsurans, 49; tuber- 
culosis, 44; syphilis, 8; gonorrhea, 22, and chancroids or ulcer, 13 
and 261 mentally diseased or defective, viz, insane, 94; idiots, 7 
epilepsy, 14; imbecile, 44; feeble-minded, 95; mentally retarded, 3 
and mental instability, 4. 

Eight thousand three hundred and twenty-two arriving immigrant 
aliens were admitted to hospitals as follows : 

Immigrant Hospital, Ellis Island, N. Y G, 186 

Health Department Hospital, New York City, N. Y 1,166 

St. Mary's Hospital. Hoboken, N. J 750 

Long Island College Hospital, Brooklyn, N. Y 96 

St. Vincent's Hospital, New York City, N. Y 73 

Columbus Hospital, New York City, N. Y 51 



Total 8, 322 

One hundred and sixty-one aliens were on hand at the difl'erent 
hospitals at the beginning of the fiscal year, making a grand total 
of 8,483, including 3,940 men, 2,117 women, and 2,426 children, fur- 
nished hospital care and treatment. 

Forty-one men, 10 women, and 116 children, total 167, died in hos- 
pital during the year. 

Fourteen children (8 male and 6 female) were born. 

Of the number admitted to hospitals of the New York City health 
department and St. Mary's Hospital, Hoboken, N. J., 1,241 were 
suffering from acute contagious disease, including: Measles, 831; 
scarlet fever, 132; chicken pox, 126; erysipelas, 64; diphtheria, 37; 
mumps, 26 ; cerebro-spinal fever, 10 ; whooping cough, 9 ; and small- 
pox, 6. 

The number of aliens admitted to immigrant hospital include the 
94 certified insane on arrival and 8 whose mental condition had not 
been definitely determined at the date of this report, June 30, but 
who have since been certified insane. 

The immigrant hospital admissions also include 218 warrant 
(landed) cases returned to Ellis Island for deportation, and among 
these there were 98 insane, making a total of 200 insane aliens fur- 
nished temporary hospital care and treatment during the fiscal year. 
(See tabulated statement.) 

The new Contagious Disease Hospital, Ellis Island, N. Y., and the 
new wing to the immigrant (general) hospital not being ready for 
the reception of patients July 1, 1909, contracts with the New York 
City health department hospital and St. Marv's Hospital, Hoboken, 
N. J., for the care and treatment of arriving alien immigrants suffer- 
ing from acute contagious diseases are being continued ; also the con- 
tracts with the Long Island College Hospital, Brooklyn, N. Y., 
St. Vincent's Hospital, and Columbus Hospital, New York City, for 
care and treatment for such arriving aliens as may be sent to them. 

Summary of Jiospital transactions, fiscal year ending June 30, 1909. 

Patients in hospital at beginning of year 161 

Patients admitted to hospital during year 8, 322 

Total treated (men, 3,940; women, 2,117; male children, 1,279; female 

children, 1,147) 8,483 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



189 



Births (male, 8; female, 6) 14 

Deaths (men, 41; women, 10; male children, 70; female children, 46) __ 167 

Pay patients treated during the year 8,028 

Free patients treated during the year 455 

Days treatment for pay patients 93,343 

Days treatment for free patients 6, 550 

Total days treatment for hospital cases 99, 893 

Daily average number of patients in hospital 273 

Patients in hospital at end of year 279 



Hospital. 


From 
pre- 
vious 
year. 


Ad- 
mitted 
during 

year. 


Total 
treated. 


Recov- 
ered. 


Im- 
proved. 


Not im- 
proved. 


Died. 


Re- 
main- 
ing at 
end of 
year. 


Days 

treat- 
ment. 


Immigrant 


91 
36 
30 


6,186 

1,166 

750 

96 

73 

51 


6,277 

1,202 

780 

96 

75 

53 


2,828 

1,050 

661 

74 

56 

47 


1,414 

7 

4 
3 
2 


1,860 
1 
16 
3 
9 
2 


32 
80 
37 
13 
5 


143 

71 

60 

2 

1 

2 


53,721 




35,076 


St. Mary's 


17,568 




1,525 


St. Vincent's 


2 


1,126 




877 






Total 


161 


8,322 


8,483 


4,716 


1,430 


1,891 


167 


279 


109,893 







SAN FRANCISCO, CAL. 

The statistical report for San Francisco, given elsewhere, shows 
7,785 immigrants examined, but this number does not give adequate 
information as to the number actually examined at the station. 
Passed Asst. Surg. W. W. King reports that there were examined, 
besides the number given above, 2,733 passengers, mostly Chinese, 
who were landed as American citizens, being natives, sons of natives, 
etc. Of this number 384 were certified for various causes. There 
were also 8,556 alien members of ships' crews examined, making a 
grand total of 19,074. Reexaminations, examinations for age, and 
other purposes are not included in this total. 

Immigrants who are certified as suffering from trachoma are gen- 
erally brought by the Commissioner of Immigration before a medical 
board of inquiry, in accordance with paragraph 811 of the Service 
Regulations. During the year 420 immigrants were examined by 
this board and the diagnosis was confirmed in all cases but one. 

The rulings of the circuit courts of appeals that aliens having 
become domiciled in the United States and returning from visits 
abroad could not be deported for medical cause on their return became 
operative during this fiscal year. Thus many Chinese returning to 
the United States have been landed, whereas formerly they would 
have been deported. It has resulted in an increase in the number 
landed and a corresponding decrease in the number deported. 

The examination of Chinese applicants as to their age has grown 
to be an important feature of the work of the medical examiner at 
San PVancisco, owing to the time required to make the numerous trips 
to the Pacific Mail dock or the detention shed for this purpose. 
During the year there were 194 such examinations made, necessitating 
probably one-third that many trips for this particular duty. 

Other visits have been made to the various hospitals where there 
Avere immigrants who had been permitted to land for hospital treat- 
ment. Also to the Alameda County jail, Oakland, to examine aliens 
under arrest who complained of being ill and in need of I'emoval to 
a hospital. 



190 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

SEATTLE, WASH. 

Passed Asst. Surg. M. W. Glover reports that at Seattle the arriv- 
ing aliens have decreased in number from one-half to one-fourth since 
June of last year, that being synchronous with the time the Japanese 
Government enforced the rule of giving passports only to others 
than the labor class. At the present time the average number arriv- 
ing on any one steamer is about 50. The great majority are Japa- 
nese, East Indians and Europeans making up about 10 per cent of the 
total. 

As a class the aliens are a clean, orderly set, appearing for medical 
inspection in new clothes and clean faces. In fact, the medical in- 
sx^ection at times is delayed for the many last touches to the toilet. 

Almost without exception no loathsome or contagious skin diseases 
are observed. Frail physique is a rarity, the immigrant class being 
recruited, apparently, from an unmixed blood and not far distant 
from the soil. Only one case of alcoholism was noted, and the evi- 
dence of more moderate drinking is gratifyingly absent. Trachoma 
is the most prevalent of all diseases. This is only in a subacute form, 
and is increased in severity by the wind and sun of the passage and, 
perha]3s, the close contact in quarters of the vessel. All cases of 
inflamed lids are held for further medical examination, a certificate 
not being issued for a week or ten days after arriving. Some mild 
form of treatment is instituted meanwhile, such as zinc solution in 
the morning and silver solution at night; in the meantime the en- 
deavor is made to place the alien under the best hygienic surround- 
ings in the detention house. 

In most cases of arriving aliens, when a case has been certified, a 
request for hospital treatment is made, and in two or three months 
the condition has cleared up and the alien admitted. 

Quite a number of cases of trachoma among " arrest " cases coming 
from across the border from Canada have been found. These have 
in not a few instances been released by department orders. This I 
find is due to the fact that the Canadian authorities have refused 
readmission to the arrests, they not having been long enough in 
Canada to secure citizenship. 

A total of 30 new eye cases have been held for further medical 
observation for a period of from three to ten clays, in which, by 
simple application, the membrane cleared up and a suspicious case 
of trachoma resolved itself into a noninfectious conjunctivitis. 

The Medical Inspection or Immigrants Who Have Become Public 
Charges in Various State or Municipal Institutions. 

New Yorh^ N. Y. — The medical officer reports that state or local 
medical certificates in the cases of 493 alien immigrants who had 
become public charges in various state or municipal institutions or 
dependent upon private charity were referred to his office by the Com- 
missioner of Immigration with request for examination and certificate 
by medical officers of the service; accordingly visits were made to 
the various institutions and certificates in each case were rendered 
for the information of the commissioner. 

During the last two months of the fiscal year there were not so 
many public charge cases examined by medical officers of the service 
as formerly. The reason is that the procedure in such cases has been 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 191 

changed, so that the data which is now supplied by the state and 
municipal officers is in most cases in such form as to afford sufficient 
evidence to justify the department in taking action. 

Philadelphia, Pa. — Investigation was made of 391 aliens who had 
become public charges in various state or municipal institutions, said 
investigations resulting in the deportation of 39 aliens. 

Eighteen cases of insanity were certified as due to causes existing 
prior to landing. This does not mean that these people were insane 
at the time of arrival, nor could it be foreseen that they would be- 
come so at that time, but that they were victims of the influence of 
change of environment operating on a defective heredity. 

Boston, Mass. — During the fiscal year 392 cases were referred to 
the Boston office for action, 278 from institutions in Massachusetts, 
and 114 from other States. 

San Francisco, Cal. — Fortj'^-two visits were made to hospitals, 
hotels, and jails for the purpose of inspecting aliens who had become 
public charges from causes either prior or subsequent to landing. 

All of these visits were within the corporate limits of San Francisco 
and Oakland. 

Chicago, III. — Investigation was made of 93 aliens, of which num- 
ber 82 were recommended for deportation. The inspection of these 
93 aliens involved the making of 79 trips, aggregating 3,000 miles 
of travel. Among the cities visited were Springfield, Jacksonville, 
and Elgin, 111., Gary and Logansport, Ind., and Mendota and 
Wauwatosa, Wis. 

Baltimore, Md. — The medical officer reports that few requests are 
made by the commissioner of immigration at Baltimore for the exam- 
ination of aliens who have been found to be public charges in the 
various city and state institutions. 

This is owing to the fact that only about 10 per cent of the aliens 
arriving at the port of Baltimore remain in the State, and also per- 
haps to the somewhat superior physical average of those who actually 
do remain. Only 9 aliens were reported during the year as public 
charges by the various institutions of this State and city. Of this 
number 6 were certified. 

New Orleans, La. — Six aliens were examined during the year at 
public institutions, with the result that 3 were certified. 

Foreign Ports. 

China — Amoy. — Asst. Surg. A. D. Foster reports the inspection of 
1,208 steerage passengers destined for Philippine ports, of which 31 
were rejected, 25 for trachoma. 

Tlorujkonq. — Acting Asst. Surg. J. Spencer Hough reports that 
during the fiscal year 8,678 aliens destined for the Pacific coast of the 
United States and Honolulu were inspected, of whom 2,353 were 
advised to be rejected. 

ShangJiai. — Acting Asst. Surg. S. A. Ransom reports the inspection 
of 49 immigrants, of which number 49 were advised to be rejected, 
4 for trachoma. 

Japan — Kohe. — Acting Asst. Surg. C. P. Knight reports 2,718 aliens 
inspected, of which 917 were recommended for i-ejection. 

Yokoharaa. — Pass(Hl Asst. Surg. Hugh S. Ciunming reports the 
inspection of 1,748 aliens, of whom 05 were rejected, of which number 
61 were for trachoma. 



192 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



NAPLES, ITALY, AND SUBPORTS MESSINA, PALERMO, AND GENOA. 

Asst. Surg. E,. A. C. Wollenberg reports the following transactions 
for the fiscal year ended June 30, 1909 : 

Statistics of Aliens Examined at Naples, Messina, Palermo, and Genoa. 



Months. 



Number of emigrants. 



Naples. Messina. Palermo. Genoa 



1908, 

July 

August 

September 

October 

November 

December 

1909, 

January 

February 

March 

April 

May 

June 

Total 



1,989 
5,269 
4,031 
6,873 
7,116 
5,987 



13,996 
21,565 
40,865 
32, 278 
26, 385 
12, 784 



176, 158 



52 



257 
215 
714 
524 
657 
977 



1,296 
2,487 
4,758 
4,185 
1,852 
1,002 



18, 924 



1,259 



2,979 
1,531 



Rejections Recommended. 



Months. 



1908. 

July 

August 

September 

October 

November 

December 

1909. 

January , 

February 

March 

April 

May 

June. 

Total 



Tra- 
choma. 



100 
124 
172 
241 
270 
209 



459 
526 
995 
949 
794 
386 



5,225 



Favus. 



Suspected Suspected 
trachoma, favus 



24 
86 
89 
100 
95 
31 



466 



76 
122 
166 
112 



270 
324 
705 
554 
490 
282 



3,223 



Measles. 



Small- 
pox. 



Other 
causes. 



88 
135 
316 
310 
278 
135 



1,442 



Total. 



170 
212 
271 
436 
480 
379 



849 
1,078 
2,117 
1,928 
1,667 

841 



10, 428 



During the past year there has been a notable increase in number 
of emigrants inspected at Naples by the service, as is shown from the 
following table : 





Number of 
emigrants 
inspected. 


Number of 
emigrants 
embarked. 


Baggage- 


Rejections 


Year. 


Disin- 
fected. 


Passed. 


recom- 
mended. 


1907-8 


121,897 
211,424 


114,673 
200,996 


141,653 
238,365 


38,879 
41, 139 


7,224 


1908-9 


10,428 







The following officers of the service were stationed in Italy during 
the past year : 

Naples. — Asst. Surg. R. A. C. Wollenberg, Acting Asst. Surg. 
Enrico Buonocore, Acting Asst. Surg. Frederico Reale, Clerk R. D. 



St. Leger. 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 193 

Palermo. — Acting Asst, Surg. Ignazio Di Bartolo. 

Messina. — Acting Asst. Surg. Sebastiano Tornatola. 

The services of Doctor Tornatola were discontinued on February 
1, 1909, on account of the destruction of the city of Messina by the 
earthquake of December 28, 1908, when it ceased to be a port of 
emigration. 

Methods. 

At Naples all physicians employed by the steamship companies 
for the vaccination of emigrants perform this work under the super- 
vision of the service. 

There are, further, under service direction, eight " inspectors," who 
are engaged in the inspection, disinfection, and labeling of steerage 
baggage, the stamping of labels and inspection cards, and the ex- 
amination of cards in conjunction with a supplemental medical 
inspection held on the ship's gangway. 

The examination of emigrants and the inspection and disinfection 
of baggage is done as heretofore. During the year 41,139 pieces of 
baggage were inspected, and 238,365 pieces were disinfected and 
labeled accordingly. The building for the disinfection of baggage 
is large and well kept. It is divided into two parts — the " clean " 
and the " unclean " sides, and is furnished with two pressure steam 
disinfecting chambers and a room for formaldehyde and sulphur 
disinfection. The effects of the emigrants are brought for disin- 
fection usually on the morning of the sailing of the vessel. All 
baggage from the Levant, from smallpox-infected Italian provinces, 
and all that which is soiled or worn is subjected to thorough disin- 
fection. New or clean articles from noninfected Italian provinces 
are passed. Immediately following these operations proper labels 
are affixed, and all pieces are taken to the wharf, a short distance 
away, and deposited to await the owners, or else immediately placed 
on board. 

On the morning of departure, or on the previous day, the emigrants 
are vaccinated in rooms furnished by the steamship companies. At 
hours fixed by the chief inspector of emigration the emigrants ap- 
pear at the " capitaneria " to receive the necessary inspection. The 
" capitaneria " is a building for customs, emigration, and other officers. 
In a large, fairly well-lighted and ventilated room, the emigrants 
are placed in line, and are inspected by the service officers in the pres- 
ence of the Italian emigration commission. This commission consists 
of an emigration officer, a port medical officer, a royal commissioner, 
and certain police officials. 

The service inspection is intended to conform to the requirements 
of the United States immigration laws and regulations and also 
with the United States quarantine laws and regulations. Each line 
of emigrants is examined by two service officers; one examines for 
diseases of the eye, especially trachoma, while the other searches for 
favus and such other diseases and conditions as might be causes for 
rejection upon arrival in the United States. Emigrants recom- 
mended for rejection have their tickets and inspection cards taken up, 
and are turned back to the emigration, port, or steamship officials. If 
the cause of rejection is apparently of a temporary nature they are 
advised that they may again present themselves for examination. 
18540—10 13 



194 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

No one is ever denied an examination. Minor ailments and de- 
formities are always pointed out, and aliens presenting such dis- 
abilities are transported, if at all, at the risk of the steamship com- 
panies. Following the medical inspection the cards are stamped 
with the service seal. 

Passports, which are required to be in possession of all emigrants, 
are then examined by the police. After the passports are inspected 
the emigrants enter the wharf, gather their belongings, and prepare 
to board the ship. They receive, however, another inspection at 
the gangway. At this point the eyes and scalp are reexamined by a 
physician in the company's employ, and inspection cards are viseed, 
as before stated. This gangway examination is a valuable protection 
against fraudulent embarkation and against evasion of the regular 
inspection. 

Deceptions. 

Notwithstanding all efforts directed against clandestine embarka- 
tions, such cases still occur from time to time. 

Ships from Naples carry a notoriously large number of stowaways. 
There appear occasionally citizens of the United States with American 
passports giving the names of persons to whom thej^ are issued and 
the words " accompanied by two minor children," as the case may be. 
These passports may be, and undoubtedly have been, used illegally, as 
alien children afflicted with disease may be substituted here and be 
carried into the United States under such protection. This might be 
remedied by inscribing on the passport the name and description of 
each accompanying person. Smuggling diseased persons aboard is 
conducted by an organized band, it is said. With confederates em- 
ployed on the ships the swindlers ply their business more or less 
freely outside the regular inspection hours. They extort a consider- 
able sum of money from gullible emigrants. If the latter be suc- 
cessfully embarked they finally find themselves deported from Amer- 
ica and returned to Italy after a great loss of time and funds, besides 
being a danger to other passengers, and causing a loss to the steam- 
ship companies in the way of fines and return passage. One ruse is 
to smuggle a diseased person on board, then to pass a sound person 
through the line of examination, who afterwards leaves the ship, 
having turned the cards over to the hidden owner, who appears as a 
regularly listed passenger after the ship clears; or, after boarding 
in the same manner, the emigrant may be handed a card stamped 
with a forged service seal. 

The erection of a proper emigration building like that at Ham- 
burg, for instance, would obviate most of this trouble. This could be 
done by the steamship companies, and with such great emigration as 
there is from the port of Naples it is an urgent necessity. Kecom- 
mendations along this line have not met w^ith much support for the 
reason that steamship companies will not cooperate. 

No cases have been observed where diseased aliens have been 
embarked by accredited steamship officials for the purpose of de- 
frauding the United States Government. 

Further methods. 

After the earthquake at Messina there was a temporary change 
in the place of examination, due to the fact that all available space 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 195 

in the " capitaneria " was occupied by supplies being forwarded to 
the stricken districts. For several weeks the examination was done 
on the wharf alongside the shii^, and the work went along without 
trouble or confusion. A considerable number of refugees were ex- 
amined in the consulate, at the request of the consul, preliminary 
to their embarkation to the United States. 

Emigrants from Palermo who sail by way of Naples are inspected 
on board at their arrival. 

Vessels for the United States requiring supplemental bills of 
health from Naples receive such inspection and certification as may 
be necessary. 

Daily visits, involving the inspection of 3,577 persons, were made 
to boarding-houses wherein were held for observation all emigrants 
coming from foreign countries and districts where quarantinable 
diseases prevailed. The period of observation usually extended from 
two to three days, or what, with the time en route to Naples, would 
complete a quarantine period determined by the United States quar- 
antine regulations. The temperature of each individual was regu- 
larly taken. No quarantinable disease was discovered. However, 
20 persons were isolated on account of fever and intestinal disturb- 
ances and 14 for whooping cough. Two hundred and eighty-nine 
cases of trachoma, 2 cases of favus, 2 cases of tuberculosis, and sev- 
eral deformed persons were found and informed that their embarka- 
tion would be prohibited. Forty- four smallpox contacts and 3 plague 
contacts were held under observation for the required length of time. 

These visits were conducted chieflj^ by Doctor Buonocore. This 
service was most highly appreciated by the local health office at 
Naples, and was the subject of much favorable comment. Copies of 
weekly sanitary reports and other sanitary information of interest 
kindly furnished from various consulates, such as those at Constanti- 
nople, Damascus, Smyrna, Samsoun, Trebizond, Athens, Odessa, and 
Alexandria, were of great assistance to the service officers at Naples 
in the execution of this important work. 

On December 9, 1908, it was recommended to Mr. J. A. Smith, 
consul-general at Genoa, that emigrants from that port be vaccinated. 
There had been some smallpox in Genoa, and a rather violent epidemic 
had been reported in the province of Ferrara. The recommendation 
was promptly acted upon. Four visits were made during the year to 
Genoa by the officers at Naples for the purpose of examining emi- 
grants sailing directly from Genoa to the United States. The exami- 
nations were conducted in a manner similar to that in vogue at Najoles. 
The vaccination of emigrants was regularly and properly clone. 
Baggage from southern Italy was disinfected at Naples prior to ship- 
ment by steamer to Genoa. The necessary disinfection of baggage 
from northern Italy was done in steam chambers aboard ships, as no 
apparatus was at hand on the Avharf. All possible assistance and 
courtesy was rendered by the consul-general, port officials, and steam- 
ship company officers, by whom the work seemed to be much appre- 
ciated. 

Smallpox in Naples, introduced from Marseille June 13, 1908, con- 
tinued as a mild epidemic throughout the whole year, with a total 
number of 732 cases and 112 d(!aths. Of those attacked the oldest was 
aged 04 years, the youngest 13 days. Six cases were discovered among 
emigrants at the examination prior to embarkation, and were sent 



196 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

to the Cotiigno Plospital for contagious diseases. All contacts were 
lield under our observation for two weeks, but no further cases 
appeared. Several cases of smallpox were found at the Palermo 
examinations. 

Paragraph 34, Quarantine Regulations, referring to crews, was 
complied with for the greater portion of the year. 

Sanitary conditions. 

The general sanitary condition of Naples during the fiscal year 
was fair. It was considerably improved in June by the abolishing 
of the time-honored custom of driving cows and goats about the 
streets at all hours, to be milked at the customers' doors. Narrow 
streets and sidewalks have often been made almost impassable by the 
manure deposited by these itinerant animals. Though this method of 
milk distribution insured a fresh supply, the quality was seldom good. 
Eegistered milk animals to the number of 2,291 cows and 2,768 goats 
are now permitted on the streets only during the two hours from 7 
until 9 a. m. The city health department of Naples now conducts a 
strict supervision over all dairies and stables. The spread of in- 
fectious disease by milk seems, hoAvever, to be of rare occurrence, the 
latter being customarily boiled before consumption. 

Restraint of emigration. 

Italian emigration for the United States reached its maximum in 
March. The decline commenced earlier than in past years, when the 
spring rush usually continued until June. The cause of the sharp 
decline in May may be partly attributed to the restraining efforts of 
the Italian commission of emigration. The following circular letter, 
which caused much comment, was widely distributed throughout the 
country districts and was undoubtedly effective. 

[Translation.] 

Commission of Emigration, 

April 10, 1909. 

During the first three months of this year more than 100,000 Italians emi- 
grated to the United States. This number is much larger than any other for 
the past years. 

From the American Confederation each day news arrives that there is a 
considerable excess of worljmen over those wanted; therefore a good number 
of those who are already there find themselves without occupation and in bad 
circumstances. Work in general will be taken up again only when a good 
many serious questions are straightened, among which the customs tariff is 
the most important. 

It is in their most vital interest that the commission of emigration dissuade 
our emigrants fi-om leaving in a great number for the United States, where 
they would only make the condition worse for those already gone, and at the 
same time would expose themselves to a great loss. 

The commission of emigration trusts to have in this work of advertisement 
the truest and sincerest cooperation of all the authorities, newspapers, of all 
social parties, and of everyone who is interested in our emigration. 

Sent to: The provincial and communal authorities, the institutions of pro- 
tection for emigrants, and the newspapers. 

Emigration — Statistical. 

From time to time letters, pamphlets, and news articles are pub- 
lished throughout the Kingdom concerning foreign, economic, and 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



197 



industrial conditions for the benefit of emigrants, tlie Government 
being most solicitous as to their welfare. 

The total emigration for the United States includes the number 
leaving by northern European ports and those leaving from the 
Italian ports of Naples, Genoa, Messina, and Palermo. The director- 
general of statistics publishes interesting information concerning 
the movement for the calendar years 1907 and 1908 : 

Total Number Passports Issued. 



United States 

Canada 

Central America . 

Brazil 

Argentine 

Uruguay 





1907. 


1908. 


For European countries and Mediterranean regions 


288,744 
415,901 


248, 101 




238,573 






Passports for Transoceanic Countries. 



298, 124 

10,436 

2,122 

21,298 

78,493 

1,650 



131,501 

5,988 

723 

15,558 

80,699 

1,874 



There was a diminution of Italian emigration for the European 
States of Germany, Switzerland, Austria, and France to the number 
of 35,467. 

Diminution of total emigration was noted during 1908, especially 
from Abruzzo and Molise, Campania, Basilicata, Calabria, and 
Sicily. 

Emigration from Venetia, Lombardy, Piedmont, Emilia, Tuscany, 
and Umbria was mostly for European States. Emigration from 
Marches, Liguria, Latium, southern Italy, and Sardinia was for 
transoceanic countries. 



Emigration hy sex and age for 1908. 

Per cent. 

Male emigrants 82. 7 

Males under 15 years 7. 

Of the total number of male emigrants only 1S.7 per cent were accompanied 
by families. 

Emigration dg occupation for lOOH. 

Ordinary laborers 139, 488 

Farm laborers 138,969 

.Skilled laborers 107, 348 

Leprosy is present in Italy chiefly in Apulia and Sicily. Perhaps 
the greater number of cases have been imported from Brazil by re- 
turning emigrants. There are no laws in force concerning the disease. 



198 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



The following table, compiled from the monthly sanitary bulletins 
of the bureau of health, gives the total number of cases of the diseases 
reported in Italy for the year 1908 : 





Smallpox. 


Typhus. 


Malaria. 


Pellagra. 


Anthrax. 




625 
539 
396 
407 
477 
309 
397 
417 
167 
169 
204 
310 








1 


1 

1 





5,518 
4,245 
4,996 
5,665 
8,766 
13,250 
28,699 
35,321 
30,618 
20, 313 
10,043 
5,428 


198 
142 
241 
289 
463 
447 
368 
247 
125 
134 
98 
76 


1.37 




116 




104 




93 


May 


126 




338 


July 


466 




643 




710 




442 




213 




180 






Total 


4,317 


3 


172,862 


2,828 


3,568 







Population of Italy, census of 1901, 32,475,253. 



SANITARY REPORTS AND STATISTICS. 

Foreign. 

Through the Division of Sanitary Reports and Statistics the bureau 
has kept informed in regard to : (1) The existence and prevalence of 
the quarantinable diseases — cholera, leprosy, plague, smallpox, typhus 
fever, and yellow fever — throughout the world; (2) the nature and 
scope of the sanitary measures taken by foreign countries to prevent 
the introduction of or to eradicate these diseases, and the results of 
their application; (3) the unusual virulence or prevalence of disease 
which might in any way have a bearing on the public health of the 
United States; (4) the nature and effect of general public-health 
measures adopted by other countries. 

This information is obtained through the International Sanitary 
Bureau of American Republics at Washington, the International 
Office of Public Hygiene at Paris, the officers of the Public Health 
and Marine-HospitalService, the American consuls, and from health 
officers and sanitary officials. The information thus acquired, Avith 
the exception of that of a confidential nature, is published weekly in 
the Public Health Reports in a form convenient for reference. The 
matter as published shows where throughout the world dangerous 
contagious diseases are present. It shows the course of epidemics. 
If they are spreading, it indicates the involvement of new territory ; 
if subsiding, the places where they no longer exist. The effect of 
sanitary measures is likewise made apparent. This makes the reports 
of special value to all officers, federal and local, connected with mari- 
time quarantines, and, in fact, a necessity for the proper and efficient 
execution of their duties. 

Domestic. 

In the United States cognizance has been taken of sanitary condi- 
tions, needs, and progress, with special attention to matters which, 
being interstate in nature and national in scope, could not be under- 
taken by local health authorities. Special attention has been given to 
the diseases directly or indirectly contagious. Morbidity statistics 
showing their distribution and prevalence have been carefully com- 
piled. Special consideration has been given to the public-health prob- 
lems created by the local or general prevalence of tuberculosis, typhoid 
fever, pellagra, hookworm disease, and plague. Information in re- 
gard to these subjects, as well as the other matters referred to, has 
been published from time to time in the Public Health Reports for 
distribution to health officers in the localities most interested. 

"^I'he statistics gathered and published by the bureau relating to the 
United States are those pertaining to any special epidemic disease 
tliat niay be prevailing, such as smallpox, and the number of cases 
and deaths from tuberculosis, typhoid fever, scarlet fever, diphtheria, 

199 



200 PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE, 

measles, and whooping cough. Recently there have been added to 
this list statistics of cases and deaths of pellagra, hookworm disease, 
leprosy, rabies, and tetanus. 

Heretofore this information has been obtained from some 284 
cities, all having a population greater than 10,000, but latel}' requests 
and blank forms have been sent to some 6,500 additional cities, towns, 
and counties, reports from which are now being received. These 
statistics are gathered for the most part weekly, and are published 
in the Public Health Reports. Some cities and towns, however, can 
not give weekly statistics, and in these cases monthly reports are 
received and published. 

By these means information as to the prevalence of disease is com- 
municated to health officers throughout the United States each week. 
The same plan is adopted with regard to information from foreign 
countries and our insular possessions, exce]Dting that the tables con- 
taining statistics from foreign cities do not include the five addi- 
tional diseases which have been added to the domestic list. 

Additional information concerning diseases particularly prevalent, 
or of a special interest, such as smallpox or rabies, is received through 
a press clipping bureau, with the practical end in view of mailing 
to the health authorities of the places indicated by the clippings the 
bureau pamphlets relating to these special diseases. 

A summary of the statistics, both domestic and foreign, relating 
to four of the principal epidemic diseases is, in accordance with the 
custom, submitted herewith. 

Smallpox in the United States — Statistical, 

In the United States, 42 States, 1 Territory, and the District of 
Columbia reported 24,657 cases of smallpox, with 75 deaths, being 
6,543 cases and 6 deaths less than reported for the fiscal year 1908. 

During the fiscal year 1902 there were reported 55,857 cases, with 
1,852 deaths. Since then the number of cases and deaths has grad- 
ually diminished. 

The number of cases reported in 1909 was therefore a little less 
than half of that of 1902, whereas the number of deaths was approx- 
imately one-twenty-fifth as great. The marked decrease in the mor- 
tality of the disease is of the greatest interest and importance. It 
means that while there are many cases of smallpox occurring at 
present in various parts of the United States, but few are fatal. 
The disease has assumed a very mild form, less serious in its results 
than many of the commoner diseases which usually attract little 
attention. 

The conclusion must not be drawn, however, that the disease has 
lost its importance from a public health standpoint, for at times in 
isolated outbreaks it takes on a virulent form with a high death rate, 
meriting all the dread with which communities have been accustomed 
to look upon it. The cause of this occasional change from a mild to 
a highly fatal disease is not known, nor can it be foretold whether the 
general mild type existing at present may not at some time change 
to the more usual fatal form. 

Since the end of the fiscal year, that is, from July 1 to November 
30, 1909, only 5,499 cases have been reported, and of these but 27 
were fatal. This shows further improvement. 



PtTBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 201 

The States reporting the greatest number of cases of smallpox were 
Minnesota, Kansas, Ohio, Illinois, Indiana, Wisconsin, Utah, North 
Carolina, Iowa, and Michigan. 

The cities reporting the greatest number of cases were, in Minne- 
sota, St. Paul, Duluth, and Minneapolis ; in Kansas, Pittsburg, Kan- 
sas City, Parsons, Topeka, and Wichita ; in Iowa, Dubuque, Council 
Bluffs, and Cedar Rapids ; in Ohio, Cincinnati, Plain City, and Hills- 
boro; in Illinois, Cairo, Peoria, Danville, Browning, and Murphj^s- 
boro; in Wisconsin, Milwaukee, La Crosse, Manitowoc, and Sheboy- 
gan ; in Utah, Salt Lake City ; in Michigan, Saginaw, Battle Creek, 
and Lansing; in Montana, Bozeman and Butte; in California, San 
Francisco, Sacramento, and Stockton; in Texas, San Antonio, Fort 
AA^orth, and Encinal; in Colorado, Denver; in Georgia, Atlanta and 
Macon; in New York, Middleburg, Broome, Amsterdam, and Cort- 
land; in Missouri, Kirksville, St. Louis, St. Joseph, and Kansas City; 
in Washington, Spokane, Tacoma, and Seattle ; in Louisiana, New Or- 
leans ; in South Carolina, Yorkville and vicinity ; in Alabama, Hunts- 
ville and Mobile ; in Arkansas, Allbrook and Little Rock ; in Tennes- 
see, Memphis, Nashville, and Knoxville; in Nebraska, Lincoln and 
South Omaha ; and in Vermont, Lithia, Brattleboro, and East Dover. 

From October to May there was an outbreak in Maine, along the 
Canadian border, the greatest prevalence being at Van Buren; and 
in the latter half of the fiscal year an outbreak in New Jersey, the 
principal cities visited being Perth Amboy, Camden, and New 
Brunswick. 

In Porto Rico 8 cases were reported at Mayaguez, and in the Phil- 
ippine Islands 285 cases, with 88 deaths at Manila. 

Smallpox in Foreign Countries — Statistical. 

In Cuba there were 10 cases reported, of which 8 were from 
vessels. 

In Canada the principal cities reporting cases of smallpox were 
Halifax, 136 cases; Toronto, 26 cases, with 2 deaths; Kingston, 47 
cases; and Victoria, 28 cases. 

The greatest prevalence in Mexico was at Mexico City, where 655 
deaths, and at Monterey, where 89 deaths, were reported. 

In Guatemala from December to May it was epidemic at Guate- 
mala City, where 606 cases with 200 deaths were reported. 

The disease was present in Salvador, at Santa Ana, and Santiago. 

In South America a large number of cases was reported from 
Brazil. Rio de Janeiro, with a population of 811,443, reported 13,364 
cases with 6,010 deaths. Pernambuco, with a population of 210,000, 
reported 507 deaths, and Bahia, with a population of 265,000, re- 
ported 1.330 cases with 91 deaths. (The difference in the mortality 
rate of this disease in Rio de Janeiro, with its 13,364 cases and 6,010 
deaths, and that in the United States, Avith its 24,657 cases and 75 
deaths, is very marked, the disease showing in one place great viru- 
lence and in the other a form exceedingly mild.) 

Id Argentina there were 546 cases reported in Buenos Aires Prov- 
ince and 9 deaths in the city of Buenos Aires. In Ecuador there were 
51 d(!aths at Guayaquil. In Peru the cities reporting the greatest 
number of cases were Lima and Callao. 



202 PUBLIC HEALTH AND MAKTNE-HOSPITAL SERVICE. 

In Europe, the larger cities reporting cases were Bristol, Christi- 
ania, Paris, Naples, St. Petersburg, Moscow, Odessa, Belgrade, and 
Constantinople. 

In Asia, the cities reporting the greatest number of cases were, in 
India, Bombay, Calcutta, and Kangoon; in China, Honglvong, Tien- 
tsin, and Shanghai; in Japan, Tokyo and Osaka; in Siberia, Vladi- 
vostok; in Manchuria, Dalny; in Indo-China, Cholen and Saigon; 
in Ceylon, Colombo; in Java, Batavia; in Turkey in Asia, Bagdad 
and Smyrna; in Arabia, Aden; in Persia, Hamadan, Kermanshah, 
and Teheran; and in Africa, Algiers, Bona, Cairo, Alexandria, Suez, 
and Tripoli. 

Plague in the United States — Statistical. 

During the fiscal year 1909 California was the only State in which 
plague was reported. There was a fatal case in Oaldand, 1 in Con- 
cord, and 1 in the Prenois Valley, Contra Costa County, during 
July, and 1 case in Los Angeles in August, 1908. In San Fran- 
cisco no case of human plague was reported, but the disease was 
found in rats, the last case of rodent plague being recorded October 
23, 1908. Plague was also found in rodents in Seattle, Oakland, 
and in Contra Costa County. In Seattle the last infected rat was 
found September 26, 1908, and in Oakland December 1, 1908. 

During the year 42 plague-infected ground squirrels Avere found in 
Contra Costa County, the last being found June 30, 1909. The squir- 
rels came from widely distributed points, and revealed the important 
fact that these rodents, living on the ranches and in the hills and 
valleys, were harboring the bacillus of plague, and that measures were 
needed to prevent the reintroduction of the disease into the cities. 
Between July 1 and September 10, 1909, 178 more infected squirrels 
were found in Contra Costa County and 19 in Alameda County. 

Plague in Other Countries. 
• 

India. — As usual, plague has been epidemic to a much greater ex- 
tent in India than in any other country. A marked change for the 
better is, however, apparent. In the fiscal year 1907 there were 
1,022,275 cases of this disease reported in India; in 1908 the number 
had dropped to 730,729, and in 1909 there were only 168,408 cases. 
The deaths show a corresponding decrease from 860,556 in 1907 to 
133,626 in 1909. It may be concluded either that plague in India 
is losing its virulence or that the sanitary measures being carried on 
are becoming effective. 

South America. — Plague continues to prevail in Venezuela, Ecua- 
dor, Peru, Chile, Uruguay, and Brazil. In Venezuela a larger num- 
ber of cases and deaths were reported than last year ; in Ecuador 
some improvement has been noted; in Peru the condition remains 
about the same, 1,192 cases with 560 deaths having been reported ; in 
Uruguay 2 cases were reported in May ; in Brazil cases still occur, 
but to no very great extent; in Argentina, where the disease was 
present in 1908, no cases were reported in 1909. In the South Ameri- 
can countries the disease has prevailed mainly at the seaports, the 
infection having undoubtedly been introduced by vessels coming 
from infected localities. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 203 

Wef^t Indies. — Trinidad reported 3 deaths from plague in 1908, and 
18 cases with 14 deaths in 1909. This is the nearest encroachment of 
the disease on the United States from the south up to the present 
time. It, however, is a constant reminder of the danger from this 
direction and the need of watchfulness. 

Europe. — Cases of plague occurred on vessels arriving at Trieste, 
at Liverpool, and at the quarantine station at Doel, in Belgium. A 
case also occurred at the laboratory at Elstree, near London. There 
was also a case at Libau, in Russia, but the disease did not spread. 

Asia. — Plague was present in various places in Turkey and in the 
Bahrein Islands in the Persian Gulf. In China the greatest preva- 
lence was at Hongkong. In Japan outbreaks occurred on the islands 
of Formosa and Awaji. Kobe, Osaka, and Yokohama also had cases. 

Afi'ica. — Cases of plague occurred in Egypt, the British Gold 
Coast, British East Africa, and German East Africa. The disease 
was also present in Zanzibar and at Mauritius. 

Azores. — Outbreaks of plague occurred at Fayal and Terceira. 

Australia. — Cases of plague were reported at Adelaide, Brisbane, 
Sydney, and Newcastle. 

Yellow Fever — Statistical. 

There was no yellow fever in the United States. 

In Cuba during the fiscal year there were in Habana 5 cases with 
3 deaths, 3 cases being from vessels from Mexican ports and 1 case 
from a vessel from Buenos Aires by way of West Indian ports. In 
Oriente Province there were 24 cases with 6 deaths; the greatest 
outbreak being at Daiquiri, from June to August, when there were 
20 cases with 4 deaths; at Firmeza there was 1 case in August; a 
case removed from Antilla to Santiago in August was fatal. In 
December 2 other cases, 1 fatal, were removed from San Luis to 
Santiago. 

In Porto Rico at San Juan there was 1 case in July from a vessel 
from West Indian ports. 

In the West Indies in the Barbados from the outbreak in Decem- 
ber to June 24, there were 86 cases with 36 deaths; of this number 
11 cases were reported at Bridgetown, where there had been a fatal 
case in October. The other cases occurred in the parishes. The 
greatest prevalence was in the parish of St. Joseph. In March a 
case occurred in Speightstown. In Curasao there were 2 cases with 1 
death; in Martinique at Fort de France, 78 cases with 19 deaths; in 
St. Vincent Island, 3 cases with 2 deaths ; in Trinidad, Port of Spain, 
a fatal case in January and 1 also fatal in April. 

In Mexico there were at Merida 61 cases with 28 deaths, and at 
Veracruz 47 cases with 24 deaths; at Maxcanu, 7 cases with 4 deaths. 
During the first half of the fiscal year there was at Acapulco 1 fatal 
case from a vessel; at Campeche there were 2 fatal cases; Frontera, 
1 case; Laguna del Carmen, 2 cases; Lagima de Terminos, 8 cases 
with 2 deaths, 4 cases being from a vessel from Venezuela; Tierra 
Bhinca, 1 case; Znmpich, 1 case. In the second half of the fiscal year 
there were in vicinity of Merichi, at San Bernardo plantation, 8 
cas(!S with 4 deaths; at Sodzil plantation, 7 cases with 5 deaths, and 
at 'I'ifiil 1 case. 

In Iloiidiii'as at Cciba (licrc was 1 case in Sojjtcnibci'. 



204 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

In South America, at Rio de Janeiro, there were 3 fatal cases from 
June to August, and 1 case in April; in Bahia there were 217 cases 
with 90 deaths, 3 cases being from a vessel; at Para, 136 deaths; 
Manaos, 60 deaths; Pernambuco, 11 deaths. In Colombia, at Carta- 
gena, there was 1 fatal case in January. In Ecuador, at Guayaquil, 
there were 180 deaths. In Dutch Guiana there were at Paramaribo 
32 cases with 8 deaths in the first half of the fiscal year. 

In Europe the only occurrence of yellow fever was in France, at 
St. Nazaire, in September and October, where there were 11 cases 
with 6 deaths from a vessel from West Indian ports ; and June, 1909, 
in Portugal at Lisbon, where 2 cases were quarantined from a vessel 
from Para. 

Cholera — Statistical. 

In the Philippine Islands, at Manila, there were 981 cases of 
cholera, with 647 deaths, and in the provinces 23,094 cases and 14,364 
deaths. The greatest prevalence in the provinces was in Iloilo, with 
5,715 cases and 3,381 deaths, and in Capiz, Ilocos Sur, Negros Occi- 
dental, and Pangasinan, each having over 2,000 cases. Three cases 
were reported on vessels, 2 cases with 1 death in September from 
Manila ; 1 case in April from Iloilo. 

In Austria at Ostrowo there were 77 cases and 39 deaths, and at 
Tarnopol 1 fatal case. 

In all Russia there were 31,436 cases, with 14,837 deaths. In St. 
Petersburg there were 10,359 cases, with 4,019 deaths, from Septem- 
ber to May. In other localities the greatest number of cases was in 
Ekaterinislav, 1,114 cases with 540 deaths; Kooban, 1,834 cases with 
975 deaths; Rostov, 1,174 cases with 531 deaths; Saratov, 1,682 cases 
with 936 deaths, and Nijni Novgorod, 755 cases with 330 deaths. In 
the Astrakhan government district there were 1 ,722 cases with 13,045 
deaths; Samara government district, 1,183 cases with 542 deaths; and 
in the Don territory, 3,035 cases with 1,451 deaths. In Russia, in 
Asia, there were at Baku 227 cases with 120 deaths; at Tiflis 168 cases 
with 81 deaths; at Tomsk 414 cases with 236 deaths. The disease 
was present in the Transcaspian district in September. 

In Persia, at Teheran, there was a fatal case in July, and the disease 
was epidemic at Tabriz from October to December, when 1,003 cases 
with 500 deaths were reported. 

In India the cities reported the greatest number of deaths in the 
order mentioned: Calcutta, 1,626; Madras, 1,160; Bombay, 435; Ran- 
goon, 163, and Negapatam, 111. In Calcutta there were 2 deaths 
among the shipping. 

In China 55 deaths were reported from Hongkong. From July 
to August cholera was epidemic in Hankau, there being 10,790 cases 
with 1,397 deaths. During the same period there were 200 deaths 
at Hanyang and 100 cases in the military camp at Wuchang. The 
disease was present at Shanghai, Kulangsu, Ichang, and Swatow. 

In Japan cholera was present in the first half only of the fiscal year, 
when 448 cases with 129 deaths were reported. The greatest preva- 
lence was at Moji, 159 cases with 79 deaths; in Yura, Awaji Island, 
90 cases with 6 deaths ; Tsushima Island, 70 cases ; at Tokyo, 16 cases 
with 5 deaths. There were cases at Nagasaki, Yokohama, Ikishima, 
Kokoora, Kuchinotsu, Kure, Obama, Sasebo, Tokushima, Wakamatsu, 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 205 

and in Chiba, Ehime, Fukuoka, Kanagawa, and Yamaguchi kens. 
Cholera was reported on vessels at Kuchinotsu, Nagasaki, and Yoko- 
hama. 

In Korea in the first half of the fiscal year there were 33 cases with 
2 deaths, and at Fusan 2 cases. Cholera was present on Nakanoshima 
Island in October. 

In Indo-China there were 334 cases with 239 deaths reported from 
Cholen, Saigon, and Bien Hoa. In Ceylon, at Colombo, 51 cases with 
35 deaths. In Siam, at Bangkok, 2 cases with 1 death. At Bassein 
cholera was present in May. In the Straits Settlements, at Singa- 
pore, there were 196 deaths. There was a case at Petalung in Sep- 
tember, and 1 case was reported from a vessel at Penang in February. 



SERVICE PUBLICATIONS. 

The service publications may be described under five heads: (1) 
Annual reports; (2) Weekly Public ITealtli Reports; (3) bulletins of 
the Hygienic Laboratory; (4) bulletins of the Yellow Fever Insti- 
tute; (5) public health pamphlets or brochures. 

Annual reports. — The laws authorizing the publication of these 
reports are as follows. Act approved July 1, 1902, section 9 : 

It shall be the duty of the Surgeon-Geueral to transmit annually to the 
Secretary of the Treasury, for transmission to Congress, a full and complete 
report of the transactions of said service, including a detailed statement of 
receipts and disbursements. 

Joint resolution approved February 24, 1905, section 2, provides: 

That there shall be printed each year 4,000 copies of the annual report of 
the Surgeon-General of the Public Health and Marine-Hospital Service, bound 
in cloth, to be distributed by the Surgeon-Geueral. 

Weekly Public Health Reports. — These reports are published under 
authority of section 4 of the act of Congress approved February 15, 
1893, quoted in part as follows : 

The Secretary of the Treasury * * * shall prepare, publish, and trans- 
mit * * * weekly abstracts of the consular sanitary reports and other 
pertinent information received by him. * * *. 

The Weekly Public Health Reports, containing the above informa- 
tion, are published in an edition at present of 3,700 copies. These 
reports are arranged in two parts, the first relating to the United 
States, and the second to our insular possessions and foreign coun- 
tries. In the first part are published articles or contributions of 
special present importance, which are frequently reprinted as sepa- 
rates, the latter being distributed in larger numbers than the full pub- 
lication; reports of sanitary operations; statistical reports of mor- 
bidity and mortality in the States and cities of the United States; 
special tables giving weekly reports of the greater epidemic diseases, 
such as smallpox and plague, and special tables giving the weekly 
record of cases and deaths of the principal contagious or infectious 
diseases in the cities of the United States having a population of 
more than 10,000, there being included in this table the populations 
of said cities according to the last census. 

In the second part are published articles or contributions and 
statistical tables similar to the above relating to the cities and terri- 
tories in foreign countries and in our insular possessions. 

Bulletins of the Hygienic Laboratory. — Section 1 of the joint reso- 
lution of Congress approved February 24, 1905, provides : 

That there shall be printed each year the bulletins of the Hygienic Labora- 
tory, not exceeding ten in number in any one year, * * * j^ g^ch editions, 
not exceeding 5,000 copies in any one year, as the interests of the Government 
and the public may require, subject to the discretion of the Secretary of the 
Treasury. 
206 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 207 

These bulletins have been described in the portion of this report 
relating to the Hygienic Laboratory. The total number of bulletins 
issued by the Laboratory to the present time is 57. 

The demands for Bulletin No. 41, " Milk and Its Relation to the 
Public Health," quickly exhausted the first edition, and a new revised 
edition has been published as Bulletin No. 56. 

Bulletins of the Yellow Fever Institute. — Section 1 of the joint 
resolution of Congress approved February 24, 1905, provides: 

That there sliall be printed each year the bulletins * * * of the Yellow 
Fever Institute of the Public Health and Marine-Hospital Service of the United 
States, not exceeding five in number in any one year, in such editions, not ex- 
ceeding 5,000 copies in any one year, as the interests of the Government and the 
public may require and in the discretion of the Secretary of the Treasury. 

One bulletin, entitled " The Prophylaxis of Yellow Fever," was 
issued in February of this year, being Bulletin No. 17 of the Yellow 
Fever Institute. 

Public health pamphlets or brochures. — These pamphlets or bro- 
chures are published under authority of section 4 of the act of Congress 
approved February 15, 1893, as quoted in the foregoing, and also in 
the acts making appropriations for the sundry civil expenses of the 
Government for public printing and binding " for the Treasury 
Department." Following is a list of the brochures published during 
the fiscal year and the editions of each : 

Edition. 

Trachoma, its Character and Effects 5, 000 

Pellagra, A Precis 3,000 

Prevalence of Pellagra in the United States 3, 500 

Precis Upon the Diagnosis and Management of Outbreaks of Smallpox, 

Diphtheria, and Scarlet Fever . 3,000 

Precis Upon the Diagnosis and Pi'evention of Smallpox 3, 000 

Plan of Organization for Suppression of Smallpox in Communities not 

Provided with an Organized Board of Health 3, 000 

Prophylactic Value of Vaccination 3,000 

Colored Antituberculosis League — Plan of Organization 3,000 

The Present Status of Leprosy 3, 500 

f2 500 
Studies on Leprosy (two pamphlets) 1 4' 000 

Notes on Rat Leprosy 1,000 

The Present Pandemic of Plague 3, 500 

Plague Investigations in India 1, 000 

California Ground Squirrels 5,000 

Campaign Against Ground Squirrels in Contra Costa County, California. 1, 000 
Experimental Investigations of Biting of Man by Fleas from Rats and 

Squirrels 2,000 

Dengue Fever as Observed in Brownsville, Texas, in 1907 1, 000 

Prevention and Destruction of Mosquitoes 2, 500 

Danger and Prevention of Tetanus from Fourth of July Wounds 1,000 

Transactions of the Sixth Annual Conference of State Boards of Health 

with the Public Health and Marine-Hospital Service 750 

Itegulations for the Sale of Viruses, Serums, Toxins, and Analogous 

Products 1,000 

Official Catalogue of Publications of the Service 6, 000 

Since the close of the fiscal year new editions of a number of the 
above have been issued. 

NEED OF LARGER EDITIONS AND APPROPRIATION. 

The importance of the foregoing publications is indicated by their 
titles, and I would respectfully invite attention to the limited editions 
of each and their inacfequacy when the great purpose for which they 



208 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

are published is considered, viz, the spread of information concerning 
sanitary and health matters. 

In the present and future development of this service it seems evi- 
dent that a far wider distribution of information of the above char- 
acter is necessary in order that the service may properly perform its 
function as the public health service of the United States, and I 
have respectfully to urge a larger appropriation for the annual print- 
ing of the service publications. This is an obligation of the General 
Government, the propriety of which can not be questioned. 

According to the present arrangement, the ex]Dense of printing the 
public health publications is met from the general appropriation for 
printing and binding for the Treasury Department, which during the 
last fiscal year was $365,000. I am informed that of this amount 
the expenditures for the service publications was $25,537.88. 

TVliile acknowledging the necessity of economy in printing, it 
seems obvious that this economy should be exercised toward useless 
and wasteful printing, and it also seems obvious that the amount 
spent last year for service publications, $25,537.88, can not provide 
for all the printing that should with good reason be done for the 
spreading of information relating to the public health. 

I have, therefore, to recommend that the amount necessary for the 
above-named purpose be separately estimated for and asked of Con- 
gress, either as a special item or as a specified allotment from the 
general appropriation for printing of the Treasury Department. 

Some of the printing required by the bureau for its bulletins during 
the last fiscal year was necessarily postponed to the ensuing year 
because of the exhaustion of the general appropriation. I believe a 
fair estimate of the amount required for the printing of the next 
fiscal year on account of service publications would be $50,000. 



MARINE HOSPITALS AND RELIEF. 
Relief to Seamen. 

During the fiscal year 53,074 seamen were treated at the various 
stations of the service. Of these 14,204 were treated in hospital and 
38,870 were treated as outpatients. The number of days' hospital 
relief furnished seamen was 449,262. 

Eight hundred and seventy-nine seamen from foreign vessels were 
treated. The number of days' hospital relief furnished these seamen 
w^as 12,305. 

Relief Stations. 

The service operated 21 hospitals, all of which are owned by the 
Government, and maintained 126 other stations, including 2 discon- 
tinued during the year, where hospital and dispensary relief were 
furnished. 

On account of the small amount of relief work done the station at 
St. Michael, Alaska, was closed, and that at Sitka, Alaska, was also 
discontinued when the department abolished the customs oJERce at 
that port. 

The marine hospital under construction at Buffalo, N. Y., is ap- 
proaching completion, and it is expected to occupy it during the early 
part of the next fiscal year. 

Considerable progress has also been made in the construction of 
the marine hospital at Pittsburg, Pa., appropriated for by acts of 
Congress approved March 31, 1902, and March 3, 1903. 

Plans have been drawn for the reconstruction of the marine hos- 
pital at New York, in accordance with appropriation made by 
Congress for that purpose. 

Relief to Sufferers from the Great Fire in Chelsea, Mass. 

During the year relief was continued at the Marine Hospital at 
Chelsea to certain accident, emergency, and maternity cases, under 
authority of act of Congress approved May 23, 1908, accommodations 
for which in the city of Chelsea were destroyed by fire in April, 1908. 
The following statement shows ,the number of cases treated on this 
account : 



Influenza '- 1 

Enteric fever S 

Erysipelas 1 

Syphilis, secondary 1 

VjWwwwa gluteal muscles 1 

Meningitis 1 

Opium poisoning 1 

Effects poison 1 

Foreign body in hand 1 



Rheumatism 2 

Rheumatic fever 1 

Carcinoma oesophagus T 

Debility 2 

Ana'uiia 1 

Ef)il('psy 1 

Vertigo 1 

Hemorrhage brain 1 

Spinal hemorrhage. 1 



1854G— 10 14 209 



210 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



Bronchitis 

Pneumonia 

Pneumotborax 

Pleurisy 

Tubercle costal cartilage 

Tubercle lung 

Colic 

Appendicitis 

Intestinal obstruction 

Indigestion 

Hernia 

Sacro-iliac disease 

Brigbt's disease-' 

Nephritis, acute 

Cystitis 

Gallstones 

Retention urine 

Exhaustion 

Burns 

Inflammation connective tissue 

Synovitis I^nee 

Caries, ribs 

Necrosis tibia 

Necrosis phalanx foot 

Rupture internal lateral ligament- 
Contusions 

General contusions 

Contusion : 

Shoulder 

Back 

Hips 



Contusion — Continued. 

Knee 1 

Ankle 2 

Foot 1 

Multiple injuries • 2 

Concussion brain 2 

Fracture : 

Skull 5 

Nose 1 

Javp 1 

Clavicle 3 

Malleolus 1 

Ribs 2 

Humerus 2 

Femur 6 

Tibia and fibula 11 

Ankle -__: 1 

Toe 1 

Gunshot wounds 1 

Wound : 

Scalp 9 

Face 5 

Radial artery 1 

Hand 5 

Leg 1 

Foot 2 

Ankle _._ 1 

Amputation arm 2 

Total 148 



The number of days during which these patients were treated was 
2,696. 

Diphtheria at Tatoosh Island, Wash. 

On August 15, 1908, a telegram was received from the Chief of 
the Weather Bureau, reporting that the Weather Bureau observer 
on Tatoosh Island, Wash., his wife, child, and assistant, were sick 
with diphtheria, and that one of the children had already died, and 
asking for assistance from this service, as no medical attention could 
be procured on the island. 

A telegram was sent at once to the medical officer in command of 
the marine hospital at Port Townsend, directing him to proceed im- 
mediately to that place with a supply of antitoxin and render what 
assistance he could; all expenses to be paid by the Weather Bureau. 

Doctor Stimpson immediately sent a physician, nurses, and sup- 
plies to Tatoosh Island, and then under orders proceeded there him- 
self, and assumed charge of the care of the sick until all had 
recovered. 

Reuef to Natives of Alaska. 

One hundred and fifty-three natives were treated by officers de- 
tailed aboard revenue cutters sailing in Alaskan waters. The number 
of times outpatient relief was furnished these natives was 245. 

Aid to Other Branches of the Government. 



Revenue-Gutter Service. — One thousand four hundred and thirty- 
seven men were physically examined, of whom 197 were rejected. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 211 

Mention of special assistance to this service in the nature of duty 
on special boards on United States revenue cutters, etc., will be found 
under other heads. 

Steamboat- Inspection Service. — One thousand and seventy-one 
pilots were examined as to visual capacity, of whom 44 were rejected. 

Life-Saving Service, — One thousand nine hundred and seventeen 
keepers and surf men were physically examined, and 62 rejected. 

Three hundred and ninety-nine papers referred to the Surgeon- 
General by the General Superintendent of the Life-Saving Service 
were acted upon by direction of the Surgeon-General. These paj)ers 
called for an expression of opinion upon the medical evidence of 
disability submitted for claims for benefits under the act of May 4, 
1882, and upon the physical fitness of .candidates for enlistment an4 
reenlistment. 

Coast and Geodetic Survey. — One hundred and fourteen employees 
and applicants for appointment were examined, and 31 were rejected. 

Light-House Service. — Ninety-one applicants for enlistment were 
examined, and 1 was rejected. 

Immigration Service. — One hundred and forty-three persons con- 
nected with this service were physically examined, and 1 was rejected. 

Civil Service Commission. — One hundred and thirty-two appli- 
cants for appointment were physically examined, and 15 rejected. 

Isthmian Canal Commission. — Seven employees and applicants for 
appointment were physically examined, and none rejected. 

In addition to the above, upon the request of the heads of the re- 
spective departments, phjT^sical examinations were made at different 
places in the country, of three clerks under the Post-Office Depart- 
ment, with a view to determining whether they Avere afflicted with 
tuberculosis, and of three employees of the Department of Commerce 
and Labor, with a view to determining their physical and mental 
condition. 

PHYSICAL EXAMINATION OF MERCHANT SEAMEN. 

Physical examinations were made of 364 American merchant sea- 
men, of whom 31 were rejected, and 36 foreign seamen, of whom 7 
were rejected. 

PHYSICAL EXAMINATIONS, PHILIPPINE ISLANDS. 

In the Philippines 121 examinations were made of seamen and per- 
sons connected with the civil service, and in the United States 
physical examinations were made of 68 applicants to serve in the 
islands. Of the latter 6 were rejected. 

Purveying Depot. 

The following statistics show the transactions of the purveying 
depot during the fiscal year : 

SUPPLIES PURCHASED. 

Dry goods $15, 689. 99 

DruKS and chfrnicals 12.04.^.11 

Sur^if-jjl iiistniiMOiits and appliances 7, 8.'i7. 88 

rhurmacal implomeiits, etc 4,758.02 



212 PUBLIC HEALTH AND MAKINE-HOSPITAL SEEVICE. 

Beds and bedding $4,160.13 

Alcohol, wines, etc 2,985.10 

Rubber goods 1,683.84 

Books and journals 1,389.35 

Flags 665. 75 

Packing boxes and sawdust 424.65 

Bacteriological supplies 309. 25 

Total 52, 547. 07 

Cr. 

By bills paid direct from funds: 

Quarantine service $1, 511. 63 

Maintenance 1,386.97 

Bureau (books and journals)- 373.65 

Care of seamen^ etc. (journals) 255.70 

Epidemic fund 149.45 

Hygienic laboratory 80. 28 

— 3, 757. 68 

Total ,—1 48, 789. 39 

By amounts reimbursed from other appropriations for 
supplies issued from stock : 
Quarantine service $2, 693. 63 

Leprosy investigation station 635. 05 

Revenue-Cutter Service 247. 08 

Treasury Department 213.32 

Epidemic fund 65.81 

3, 854. 98 

Net expenditures chargeable to appropriations for purvey- 
ing depot (in amount $45,000) 44,934.50 

Salaries $6, 040. 00 

Rent 3, 250. 00 

Operating expenses 366.48 

9, 656. 48 

Total net expenditures 54,590.98 

Number of requisitions filled 359 

Number of packages shipped 2, 535 

Total weight of supplies shipped pounds__ 259,992 

Amendments to Kegulations. 

Officers of Revenue-Cutter Service^ on leave or retired^ entitled to 
certain relief. — Under date of March 23, 1909, an amendment to the 
regulations was made authorizing relief by the service to officers of 
the Eevenue-Cutter Service on leave, on sick leave or retired, at 
marine hospitals owned by the Government and dispensaries con- 
ducted by the service, provided no bills for such relief are. incurred. 

Civilian officers and seamen of naval auxiliaries admitted to treat- 
ment. — Upon request of the Surgeon-General of the Navy, approved 
by the Secretary of the Navy, the regulations were amended so that 
civilian officers and seamen employed on board naval auxiliaries 
could be treated, upon the written request of their commanding offi- 
cers, as patients of the Public Health and Marine-Hospital Service 
at first, second, and third-class stations, at rates to be fixed by the 
department each year. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 213 

INCREASED AIR SPACE IN FORECASTLES OP AMERICAN VESSELS. 

On May 18 a communication was addressed to the Commissioner of 
Navigation requesting an expression of opinion regarding the neces- 
sity'' for increasing the size of forecastles and providing more air 
space for each seaman than is now allowed under the navigation laws 
of the United States, and on June 12 the commissioner replied stat- 
ing that he expected to consider the matter in his annual report for 
1909. 

PROPOSED AMENDMENT TO LAW RELATING TO SHIP's MEDICINE CHEST. 

The law requiring American vessels to carry a medicine chest 
should be amended to provide that the chest shall include such arti- 
cles as may be prescribed by the Surgeon-General of the Public 
Health and Marine-Hospital Service, and that the same shall be in- 
spected once each year by an officer of the service. 

The law now requires that vessels shall carry a medicine chest, but 
does not specify what should be in it. At the same time a " Hand- 
book of the ship's medicine chest " has been published by the service 
and distributed to masters of vessels, which contains instructions for 
first aid to the injured and other pertinent information for the mas- 
ters of merchant vessels, and there should be a provision of law re- 
quiring that a ship's medicine chest should contain articles corre- 
sponding with the demands made by this book. 

Tuberculosis Sanatorium at Fort Stanton, N. Mex. 

Passed Asst. Surg. H. S. Mathewson, in charge, reports as follows 
regarding the transactions of the sanatorium for the fiscal year 
ended June 30, 1909 : 

During the year under review the maximum number of patients 
rose to 265 and it was necessary to suspend transfers for a short time. 
The sanatorium as planned accommodates comfortably 250 patients 
and it does not seem wise to attempt to far exceed that number with 
the existing dining room and kitchen equipment. 

The tent village was added to during the winter and now numbers 
81 tents and 16 tent houses, furnishing outdoor sleeping accommoda- 
tions for 194 tuberculous patients or attendants. Several months 
ago one tent was removed from its frame and a permanent rubberoid 
roof was erected in its place, canvas curtains being placed on the 
sides and ends of the structure. This tent house has given excellent 
service and is considered far superior to a canvas-covered house. 
Tents require constant repairs and after every rain or wind storm 
complaints are frequent of leakage during tne night, damage to 
flies, etc. The life of a canvas tent does not exceed two years and 
the expense for renewals is a constant item. The station records 
show that since the sanatorium was established 356 tents and 426 
tent flies have been furnished, and it is believed that supplying the 
tents with a permanent roof will effect a considerable economy. 

During the year the dairy herd were tested with tuberculin supplied 
by the Department of Agriculture and found free from tuberculosis. 
This herd is increasing in number and an enlargement of the dairy 
corral is needed for its proper accommodation. 



214 PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 

Owing to the isolation of this station the question of providing 
mental diversion and amusement for the patients is of great impor- 
tance. Recommendation has been made that building No. 30 be con- 
verted into an amusement hall and equipped with box-ball alley, 
shuffleboard, and pool tables. The general assembly hall, on the 
second floor of building No. 9, is utilized at present for the giving of 
entertainments and a fund is being raised on the station to add to its 
equipment a moving-picture apparatus, but this hall does not supply 
the need indicated above. 

As to the professional work of the sanatorium, the statistical matter 
herewith submitted speaks for itself. It is believed that the results 
obtained compare favorably with results obtained in other institu- 
tions treating all classes of consumptives. From time to time encour- 
agement is given by reports of continued good health and ability to 
work enjoyed by former patients several years after their discharge 
from the sanatorium. 

In the scientific study of tuberculosis certain investigations are in 
progress in the laboratory of the station which, it is hoped, will prove 
of value in the settlement of questions still in dispute. 

STATISTICS (fort STANTON SANATORIUM). 

Patients under treatment July 1, 1908 194 

Patients admitted during the year 205 

399 

Patients under treatment July 1, 1909 211 

Patients discharged during the year ^ 188 

399 

Ages of patients treated during the year: 

Under 25 years . 71 

Between 25 and 34 years 136 

Between 35 and 44 years 103 

Between 45 and 54 years 54 

Over 54 years 23 

Nontubercular (lungs) 12 

399 

Heredity in patients treated during tlie year : 

History of tuberculosis in parents 90 

No history of tuberculosis in parents 259 

History of tuberculosis in parents doubtful 38 

Nontubercular (lungs) 12 

399 

Stage of disease of patients admitted : 

Incipient 27 

Moderately advanced 70 

Far advanced 100 

Nontubercular (lungs) ; ^J 7 

No examination 1 

205 



PUBLIC HEALTH AKD MARIKE-HOSPITAL SERVICE. 



215 



Ge'jeral conditiou on arrival : 

Good 46 

Fairly good 20 

Fair -. TO 

Poor 60 

Extremely poor 1 

No examinatiou 1 

Nontubercular (lungs) 7 

205 

Tubercle bacilli in spntnin : 

Were found in 167 

Were not found in 29 

No examination 2 

Nontubercular (lungs) 7 

205 

Record of pulmonary hemorrhages of patients admitted : 

Before arrival only 50 

After arrival only ^ 

Both before and after arrival 14 

• Neither before nor after 88 

Streaked sputum 41 

No examination 1 

Nontubercular (lungs) 7 

205 

Greatest number of patients under treatment at one time during the year__ 265 

Condition of 188 patients at time of discharge : 

Cured 1 

Apparently cured 25 

Arrested 37 

Improved 41 

Unimproved 9 

Died 67 

Discharged cases nontubercular (lungs) : 

Cured 1 

Apparently cured 1 

Improved 4 

Unimproved 1 

Died -- 1 

118 
DuEATioN OF Stay and Character or Cases. 



Character of case. 


Longest stay. 


Shortest stay. 


Average stay. 


Cured *. 


Yrs. mos. dys. 

6 6 IG 
3 5 2 

7 9 5 
G 2 8 
1 5 29 
7 7 10 


Yrs. mos. dys. 
6 6 16 
3 22 
1 19 
1 19 
1 15 
3 


Yrs. mos. dys. 
G 6 16 




11 11 




1 2 




1 2 2 




G 22 


Death 


1 3 5 







DocH not Include 8 nontubercular (lungs) cases. 



216 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 



List A. — Patients Discharged who were Under Treatment at Beginning of 

Fiscal Year. 





Cured. 


Appar- 
ently 
cured. 


Arrested. 


Im- 
proved. 


Unim- 
proved. 


Died. 


Total. 


Incipient 




1 


5 
7 
2 


2 
11 
11 



8 
9 



1 
2 



9 
33 


7 




36 


Far advanced 


58 






Cases discharged 


1 


14 


24 


17 


3 


42 


101 



List B. — Patients Discharged who were Admitted during the Year. 



Cured. 



Appar- 
ently 
cured. 



Arrested.' 



Im- 
proved. 



Unim- 
proved. 



Died. 



Incipient 

Moderately advanced. . 
Far advanced 



Cases discharged. 



25 



79 



Does not include 8 nontubercular (lungs) cases. 

Patients under treatment July 1, 1908 

Patients discharged during the year from these. 



194 
101 



Patients remaining under treatment from these. 



93 



Patients admitted during the year 

Patients discharged during the year from these. 



205 

79 



Patients remaining under treatment from these 

Nontubercular (lungs) cases discharged 

Length of time under treatment at sanatorium of the 188 discharged cases ; 

Over two years 

Between one and two years 

Between six- and twelve months 

Between three and six months 

Under three months 

Nontubercular (lungs) 



126 



30 
40 
40 
44 
26 



188 

Of the patients discharged during the year, 8 were under treatment for less 
than thirty days, one of which was nontubercular (lungs) : Result in all 8 
cases death. 

Cause of death of 67 patients dying during the year : 

Tuberculosis 59 

Other causes 8 

67 

During the year there were under treatment, in addition to the 
above, tuberculous officers and employees, as follows : 

Under treatment July 1, 1908 14 

Admitted during the year 9 

23 

Remaining under treatment June 30, 1909 12 

Discharged during the year__ 11 

23 



PUBLIC HEALTH AND MARINE-HOSPlTAL SERVICE. 21 7 

Condition of tuberculous employees at time of discharge: 

Cured 

Apparently cured 5 

Arrested 3 

Impi'oved 2 

Unimproved 

Died (appendicitis — tuberculosis arrested) 1 

11 

Number of physical examinations made during the year 1,253 

LABORATORY FORT STANTON. 

The routine work in the laboratory during the fiscal year com- 
prises the following: 

Examinations of sputum 2, 460 

Examinations of urine 1,607 

Blood examinations for tubercle bacilli 27 

Blood examinations in which tubercle bacilli were found 3 

Blood examinations for malarial parasite 2 

Feces examined for tubercle bacilli 17 

Cows tested with tuberculin 76 

Cows found infected 

Stools and urine examined for typhoid bacilli 25 

Pathological specimens prepared for microscopical examination 155 

Mice inoculated with sputum to determine presence of pneumococcus 118 

. PRODUCTS OF THE STATION. 

During the year the dairy produced 37,468 gallons of milk, and a 
small amount of butter, i. e., 292 pounds. 

During the first seven months of the year the station was supplied 
with beef from the station range, 134 head being slaughtered, fur- 
nishing 59,465 pounds of beef. The number of cattle in the beef 
herd is 1,654. 

The station still breeds all horses necessary for station use, the herd 
at present numbering 71 head. These horses, however, are small, and 
the station should be supplied with a few large mares for breeding- 
purposes. 

During the year 160 hogs were slaughtered, supplying the station 
with 12,559 pounds of pork and 75 pounds of lard. 

The poultry yard supplied 603 dozen eggs and 978 pounds of 
dressed chicken. 

The total yield of alfalfa for the season of 1908 was 215 tons. 
Corn fodder and oat hay were raised to the amount of 72 tons. 

The garden was operated successfully during the year, the station 
being supplied with fresh vegetables from it. 

CERTAIN CASES NOT SENT TO FORT STANTON. 

The experience of the medical officer in command shows that cer- 
tain classes of patients are not benefited at Fort Stanton. It will 
be recalled that Fort Stanton has an elevation of more than 6,000 
feet. The transfer of such patients therefore from the marine hos- 
pitals to Fort Stanton has been discontinued, and special arrange- 



218 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

ments will be made for their treatment in tents on the reservations 
connected with the several hospitals. The classes of patients above 
alluded to are as follows: 

(1) Patients whose pulse remains above 100 and temperature 
remains above normal after a few Aveeks treatment in hospital. 

(2) Cases of tuberculosis complicated by asthma. 

(3) Cases of tuberculosis comiDlicated by uncompensated valvular 
disease of the heart. 

(4) Tuberculosis complicated by chronic alcoholism. 

(5) Chronic fibroid cases. 



PERSONNEL. 

Commissioned and Other Officers. 

The commissioned medical officers at the beginning of the fiscal 
year, July 1, 1908, numbered 128, as follows: The Surgeon-General, 
5 assistant surgeon-generals, 29 surgeons, 62 passed assistant sur- 
geons, and 31 assistant surgeons. 

At the close of the fiscal year, June 30, 1909, though numbers in 
several grades were changed, the total number was the same as at 
the beginning of the year, viz, 128, consisting of the Surgeon-General, 
5 assistant surgeon-generals, 35 surgeons, 66 passed assistant sur- 
geons, and 21 assistant surgeons. 

The changes during the year were as follows: Five passed assist- 
ant surgeons promoted to the grade of surgeon, 13 assistant sur- 
geons promoted to the grade of passed assistant surgeon, 4 candi- 
dates passed the examination and were commissioned as assistant 
surgeons. Death removed from the corps 1 surgeon, 1 passed assist- 
ant surgeon, and 1 assistant surgeon. One passed assistant surgeon 
resigned. On account of physical disability, 1 surgeon and 1 passed 
assistant surgeon continued on " waiting orders." 

Casualties. — Surg. Alexander C. Smith died at Pittsburg, Pa., 
January 15, 1909, from injuries received in an accident. Passed 
Asst. Surg. William M. Wightman died May 16, 1909, at Guayaquil, 
Ecuador, of yellow fever contracted in line of duty. Asst. Surg. 
William W. Miller died November 24, 1908, at Washington, D. C, of 
typhoid fever contracted during his investigations into the cause of 
the prevalence of this disease in Washington. 

Assignments. — Among other assignments of commissioned medical 
officers during the fiscal year were the following: Fourteen were 
assigned to exclusive immigration duty, their services being supple- 
mented by employment of acting assistant surgeons; 6 to the quaran- 
tine service of the Philippine Islands; 7 to vessels of the Kevenue- 
Cutter Service ; 23 to the quarantine stations in the continental United 
States, Porto Rico, and the Hawaiian Islands; 6 to duty in foreign 
countries to prevent the introduction into the United States of 
epidemic disease. 

Special details. — Three commissioned medical officers continued on 
detail duty with the Isthmian Canal Commission, serving, respec- 
tively, as follows : Surg. H. R. Carter as director of hospitals. Canal 
Zone; Surg. J. C. Perry, as chief quarantine officer and in charge of 
the quarantine at Panama ; and Passed Asst. Surg. Claude C. Pierce 
as quarantine officer at Colon. 

Passed Asst. Surg. V. G. Heiser, in addition to his duties as chief 
quarantine officer, has been continued as director of health of the 
Philippine Islands, and Passed Asst. Surg. A. J.' McLaughlin as 

assistant director of health. 

219 



220 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



Passed Asst. Surg. B. J. Lloyd, under the act of Congress ap- 
proved February 15, 1893, has been continued for duty at Guayaquil, 
Ecuador. 

Personnel Hygienic Laboratory. — At the close of the fiscal year, 
there were on duty in the Hygienic Laboratory, in addition to the 
director, assistant director, and 3 chiefs of divisions, 7 passed assist- 
ant surgeons, 2 assistant pharmacologists, 2 pharmacists, 1 artist, 8 
technical assistants, and 28 attendants. 

Sanitary inspectors. — At the beginning of the fiscal year 3 sani- 
tary inspectors were on duty. One resigned and the designation of 
another was changed to that of quarantine inspector. 

Acting assistant surgeons. — At the beginning of the fiscal year there 
were 281 acting assistant surgeons on duty; 272 were appointed, 6 
died, 268 were separated from the service by limitation of appoint- 
ment, resignations, and removals, leaving on duty at the close of the 
fiscal year 279 such officers. 

Medical inspectors. — Two female inspectors served during the en- 
tire year for the inspection of women passengers — 1 at Honolulu, 
Hawaii, and 1 at San Francisco quarantine station. 

Internes. — At the beginning of the fiscal year there were 12 in- 
ternes on duty at the various marine-hospital stations; 15 were ap- 
pointed and 17 separated from the service by reason of resignation, 
leaving 10 on duty at the close of the fiscal year. 

Pharmacists. — At the beginning of the fiscal year there were on 
duty 48 pharmacists, divided as follows: Pharmacists of the first 
class, 16; second class, 20; third class, 12. One pharmacist of the 
first class, 2 of the second class, and 4 of the third class resigned; 3 
appointments and 1 reinstatement as pharmacists of the third class, 
1 promotion of the second class and 3 of the third class were made, 
leaving at the close of the fiscal year 45 pharmacists on duty, as fol- 
lows: Pharmacists of the first class, 16; second class, 20; third 
class, 9. 

pilots and marine engineers. — At the beginning of the fiscal year 
there were on duty 14 pilots and 22 engineers ; 1 pilot resigned and 3 
were appointed; 5 marine engineers were separated from the service 
and 4 were appointed. The number on duty at the close of the fiscal 
year was as follows : Pilots, 16 ; marine engineers, 21. 

Hospital and Quarantine Attendants. 

At the beginning of the fiscal year 1,184 attendants were employed 
at the various marine hospitals, quarantine stations, and on epidemic 
duty, including 74 such employees on duty in the Philippine Islands, 
and at the close of the fiscal year there were 978 so. employed, as 
follows : 



Branch of service in which employed. 


In service 

July 1, 

1908. 


Appointed 
during 
year. 


Separated 

from 

service. 


In service 

June 30, 

1909. 


Marine-Hospital Service 


441 
298 
445 


601 
223 

508 


■ 593 
162 

783 


449 


Quarantine (including Porto Rico and Hawaii) 

Epidemic ... 


359 
170 






Total ■ 


1,184 

74 


1,332 
22 


1,538 
22 


978 


Philippine Islands 


74 







PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 221 



RECAPITULATION. 



Medical inspectors 2 

Internes 10 

Pharmacists 45 

Pilots 16 

Marine engineers 21 

Attendants 978 

Laborers 9 



Commissioned medical officers— 128 
Chiefs of divisions, Hygienic 

Laboratory 3 

Assistant pharmacologists 2 

Artist 1 

Technical assistants 8 

Sanitary inspector 1 

Quarantine inspector 1 

Acting assistant surgeons 279 Total 1,504 

Boards Convened. 

Seventy-three boards were convened at different times and at 
various stations throughout the United States for the physical exami- 
nation of officers of the Revenue-Cutter Service and applicants for 
entrance therein. Three boards were convened for the examination 
of passed assistant surgeons to determine their fitness for promotion 
to the grade of surgeon, and five for assistant surgeons to determine 
their fitness for j^romotion to the grade of passed assistant surgeon. 
Seven for the physical examination of detained aliens ; three for the 
examination of pharmacists, to determine their fitness for promotion 
to a higher grade; four for examination of applicants for entrance 
as assistant surgeons ; and one for a special physical examination of a 
surfman of the Life-Saving Service. 

The bureau sanitary board has been convened in 25 sessions to pass 
upon reports of inspections of establishments engaged in the manu- 
facture of vaccines, serums, toxins, etc., prior to recommending a 
•license ; and to pass upon advertised remedies and appliances to deter- 
mine if said advertisements should be excluded from the mails. 



INFLUENCE OF THE CORPS IN MEDICAL AND PUBLIC- 
HEALTH ACTIVITIES. 

A feature of the service worthy of comment is the intimate relation 
maintained by the medical corps with the great body of the medical 
profession of which they are a part, and their active participation 
in associations to advance scientific knowledge and sanitary reforms. 

This is in keeping with the repeatedly avowed policy of the bureau. 
Encouragement is given to officers to attend medical societies, to 
write for the medical journals, and to assist lay movements in the 
interest of public health. These officers, members of the medical 
profession of the United States, are its representatives in our civil 
government, and the effort has been to impress upon the profession 
that the corps is not a body separate and apart, but rather is a part 
of itself. 

No medical corps can retain its vigor and efficiency independent of 
the thought and experience of the great army of coworkers in the 
profession. 

There is likewise an obligation on the part of the corps to give to 
the profession and to the public the benefit of its experience and 
investigations — results obtained in its special line of study under ^ 
special opportunity of observation and facilities for scientific re- 
search. 

Aside from the subjects treated in the bulletins and brochures pub- 
lished officially by the bureau, there are facts of real interest de- 
veloped in service work which may not be chronicled among official 
transactions, but which are worthy of publication in the medical or 
lay press. As showing the influence of the corps upon medical and 
sanitary science in this auxiliary form, it may be stated that 128 
articles of the above character have been contributed by 54 officers 
during the period covered by this report. These do not include a 
large number of unpublished addresses and lectures. 

In the healthy interchange of thought and inspiration between the 
corps and other members of the medical profession, no medium is so 
valuable as the association meetings where professional men are 
brought closely together. The value of these meetings lies not only 
in the formal discussion of the subjects on the program, but in the 
information obtained through informal conversation upon special 
topics of mutual interest. These meetings are very profitable. 

Following is a list of meetings attended by officers of the service 
during the period covered by this report, and at which they presented 
formal papers and took active part in the discussions. In nearly 
every instance the attendance has been by special and even urgent 
request of the officfers of the association. The exceptions are the meet- 
ings of those societies of which the service officers are regular members. 

International Congress on Tuberculosis, Washington, September 
21-October 3, 1908. 
222 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 223 

International Conference on Tuberculosis, Stockholm, July 8-10, 
1909. 

International Tuberculosis Exhibition, Philadelphia, March 12, 
1909. 

International Bureau of Public Hygiene, Paris, November 4, 1908. 

International Congress of Applied Chemistry (Seventh), London, 
May 27-June 2, 1909. 

International Fisheries Congress, Washington, September 22-26, 
1908. 

International Commission for the Revision of the International 
Classification of Diseases and Causes of Death, Paris, July 1-3, 1909. 

International Congress on Alcoholism (Twelfth), London, July 
18-24, 1909. 

International Congress Against Leprosy (Second), Bergen, Nor- 
way, August 16-19, 1909. 

International Medical Congress (Sixteenth), Budapest, August 
29-September 4, 1909. 

Pan-American Medical Congress (Fifth), Guatemala, August 6- 
10, 1908. 

Conference of State and Provincial Boards of Health, Washington, 
June 4-5, 1909. 

American Medical Association, Atlantic City, June 8-11, 1909. 

American Public Health Association, Winnipeg, Canada, August 
25-26, 1908, and Richmond, Va., October 19-21, 1909. 

Legislative Council, American Medical Association, Washington, 
January 18, 1909. 

Council of Medical Education, American Medical Association, 
Chicago, April 5, 1909. 

Council of Pharmacy and Chemistry, American Medical Associa- 
tion, Chicago, November 12-13, 1909. 

Lake Michigan Water Commission, meetings at Chicago, Grand 
Rapids, and Indiana Harbor. 

Committee on Revision of Nomenclature of Diseases, Washing- 
ton, October 22, 1909. 

National Association for Study and Prevention of Tuberculosis, 
Washington, May 13-15, 1909. 

Association of Militarv Surgeons, Atlanta, Ga., October 13-16, 
1908; Washington, D. C.,"' October 5-8, 1909. 

American Pharmaceutical Association, Hot Springs, Ark., Sep- 
tember 7-12, 1908 ; Los Angeles, Cal., August 16-21, 1909. 

Southern Commercial Congress, Washington, December 7, 1908. 

American Academy for Advancement of Science, Baltimore, De- 
comber 31, 1908. 

Medical Society of the Missouri Valley, St. Joseph, Mo., March 18, 
1909. 

American Academy of Political and Social Science, Philadelphia, 
April 16, 1909. 

American Association of Pathologists and Bacteriologists, Boston, 
April 8, 1909. 

Association of Medical Milk Commissioners, Atlantic City, June 7, 
1909. 

Southern Medical Association, Atlanta, November 10-12, 1908. 

Seaboard Medical Association, Washington, N. C, December 1-3, 
1'908. 



224 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE, 

American Physiological Society and the American Society of Bio- 
logical Chemistry, Baltimore, December 28, 1908. 

Society of American Bacteriologists, Detroit, December 30, 1908. 

American Chemical Society, Detroit, June 29-July 2, 1909. 

American Society of Tropical Medicine, Washington, April 10, 
1909. 

Arkansas State Medical Society, Pine Bluff, May 21, 1909. 

Idaho State Medical Association, Boise, October 8-9, 1908. 

Minnesota State Sanitary Association, Winona, October 12, 1909, 

Minnesota State Medical Society, Winona, October 13, 1909, 

Conference of Sanitary Officers of State of New York, Eochester, 
November 10-12, 1909. 

North Carolina State Medical Society, Asheville, June 15, 1909. 

North Carolina Convention of Mayors, Charlotte, November 17-18, 
1908. 

Ohio State Medical Association, Cincinnati, May 5-7, 1909. 

South Carolina State Medical Association, Summerville, April 20, 
1909. 

Virginia State Medical Society, Eichmond, October 22, 1908; 
Eoanoke, October 5-8, 1909. 

Virginia State Conference on Charities and Corrections, Lvnch- 
burg, May 19, 1909. 

Washington State Medical Association, Walla Walla, September 
9-11, 1909. 

Washington, Oregon, and Idaho, Medical Association of, Seattle. 
July 20-23, 1909. 

Association for Prevention of Tuberculosis, Washington, Decem- 
ber 4, 1908. 

Columbia University, New York, March 15, 1909 (lecture). 

Atlanta School of Medicine, Atlanta, Ga., April 26, 1909. 

Philadelphia Maritime Exchange, Quarantine Conference, June 
25-26, 1909. 

Political Economy Club, Baltimore, November 8, 1909. 

Chicago Medical Society, Chicago, November 24, 1909. 

Cleveland Academy of Medicine, Cleveland, November 19, 1909. 

At a number of the foregoing meetings resolutions were passed 
relating to the service, some of which are mentioned below. 

American Public Health Association, August 25-28, 1908 : 

Resolved hy the American PuNic Health Association, That it heartily recom- 
mends to the American Congress the passage of such legislation as is intended 
to enlarge the scope and increase the efficiency of the Public Health and 
Marine-Hospital Service. To this end the association believes the powers of 
the service should be increased ; that provisions shall be made for the retire- 
ment under pay of the members of the service; and that the salaries of the 
said members should be made commensurate with the medical services of the 
army. 

The secretary shall send a copy of this resolution to the chairman of the 
House Committee on Interstate and Foreign Commerce and to the correspond- 
ing committee in the Senate. 

Idaho State Medical Association, October 8-9, 1908 : 

Resolved by the Idaho State Medical Association. That it .heartily recom- 
mends to the Congress of the United States the passage of such legislation as 
is intended to increase the public health duties and the efficiency of the Public 
Health and Marine-Hospital Service of the United States. To this end this 
association believes the powers of the service should be increased ; that provi- 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 225 

sions should be made for the retirement under pay of the commissioned officers 
of the service ; and that the salaries of the said officers should be made commen- 
surate with the Medical Corps of the Army. 

Be it further resolved, That this association advocates the formation of a 
national department of public health, to be developed from the Public Health 
and Marine-Hospital Service. That the secretary shall send a copy of this 
resolution to the chairman of the Senate Committee on National Quarantine, 
the House Committee on Interstate and Foreign Commerce, and to the United 
States Senators and Representatives in Congress from the State of Idaho. 

Legislative Council of the American Medical Association, January 
18, 1909 : 

At this meeting two bills (S. 6101 and S. 6102) relating to the service were 
considered. The council unanimously resolved to indorse the personnel bill and 
also the public health bill with the addition of an amendment in effect that, in 
addition to investigating the methods of propagation and spread of various dis- 
eases enumerated in the bill, the Public Health and Marine-Hospital Service 
should enforce means for the prevention of the same. A second amendment to 
the public health bill provided that the President should be empowered to 
transfer the various existing health agencies now in the Government within the 
period of one year to a single department. 

Conference of State and Provincial Boards of Health, June 4-5, 
1909: 

I. 

Whereas tuberculosis is specially prevalent among the colored people of the 
country, threatening not only their own race with decimation if not final exter- 
mination, but constituting a serious menace to the whites with whom they come 
in contact; and 

Whereas the United States Public Health and Marine-Hospital Service has 
devised the best scheme yet suggested of meeting this problem by the organiza- 
tion of state colored antituberculosis leagues, with branch leagues in all the 
colored churches : Therefore be it 

Resolved, That the conference indorses the plan of campaign, and urges its 
members within whose jurisdictions it is a practical question to promote as far 
as possible its inauguration and success. 

II. 

Whereas in the opinion of the National Conference of State and Provincial 
Boards of Health of North America the work of the United States Public 
Health and Marine-Hospital Service has been and is increasingly of very great 
value to the cause of public health and should in consequence be fostered and 
encouraged : Therefore be it 

Resolved, That the association respectfully recommends to the United States 
Senate and House of Representatives the enactment of legislation enlarging the 
powers and increasing the duties of the Public Health and Marine-Hospital 
Service, and for the improvement of the status of the personnel so that they 
will be put on a parity as to compensation, retirement, and other allowances 
with other medical services of the Government, and that it indorses Senate bills 
531 and 1908, respectively, covering the legislation desired. 

III. 

Resolved, That the Congress of the United States be, and is hereby, peti- 
tioned to establish within the limits of the continental United States a hospital 
for the care and treatment of patients suffering from leprosy, and for the study 
of that disease, under the control of the Public Health and Marine-Hospital 
Service, and further, if it lies within the power of Congress to do so, that pro- 
vision be made for the reception, care, and treatment in said hospital, either 
at their own e.\pens(! or at the (!Xi)cns(; of th(! several States, of patients who 
are now, or may heicaflcr, from lime to time come under the care of such 
States and who may either apply voluntarily for treatment in said hospital or 
be sent there for that purpose pursuant to state law. 

18546-10 15 



226 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

IV. 

That it is the sense of this conference that each member of the conference be 
requested to send to the Surgeon-General of the Public Health and Marine- 
Hospital Service a complete compilation of the laws of their respective States 
at the earliest opportunity, and that the Surgeon-General be requested to have 
them printed; and further, that the secretary be instructed to communicate 
with the Surgeon-General and cooperate with him in every possible way in 
compiling this document. 

In the following pages I have discussed some of the problems with 
regard to public health. Though prepared for presentation before 
the College of Physicians and Surgeons of New York, the discussion 
was intended for wider presentation and relates to principles and 
lines of activity with regard to the public health necessary to be con- 
sidered in the administration of the service. 



• PUBLIC HEALTH PROBLEMS. 

In considering public health problems of the nation it is obvious 
that two kinds of problems must be considered — the sanitary and the 
legal. Of the two the legal problems are the least settled. Our scien- 
tific knowledge of disease and the methods of prevention are far in 
advance of legal provision and executive administration. 

It will be interesting and useful at the outset to consider the public 
health problems of the past, for when we reflect that many of them 
are past problems it gives courage in the solution of those at present 
pending. 

It is but a comparatively short time since smallpox, typhus fever, 
cholera, yellow fever, plague, and leprosy were problems of a scientific 
as well as legal character. AAHien the last epidemic of cholera visited 
this country, in 1878, its true nature was unknown. The true char- 
acter of yellow fever was also unknown until 1898, and the same may 
be said of plague until 1894. These diseases for centuries baffled the 
wisdom of men, inspired terror, which naturally accompanied igno- 
rance concerning them, and gave rise to innumerable investigations, 
theories, and procedures which were of no avail. One has but to 
examine the literature regarding plague to be impressed with the hor- 
rors which it entailed from the fourteenth to the eighteenth centuries, 
inclusive. Hecker calculates that one-fourth the population of 
Europe, or 25,000,000 persons, died in all of the epidemics in the four- 
teenth century. The literature on this subject is appalling in extent. 
A mere enumeration of titles, with authors, covers 40 pages royal 
quarto size of the Index Catalogue of the Library of the Surgeon- 
General's Office of the United States Army. But now we feel the 
power of mastery over these great epidemic diseases. Their mystery 
has been solved, and so has the problem of their extermination. 

The quarantine problems connected with these diseases, meaning 
the legal measures necessary to prevent their introduction arid spread, 
have also been solved, and this pari passu with our knowledge of the 
diseases to be prevented. 

The quarantine of to-day is not deserving of the same name as the 
first quarantine which was imposed at Venice in 1403 against the 
bubonic plague. Vessels were simply held at a remote distance from 
shore and the disease thereon allowed to run itself out. Quarantine 
to-day means the isolation of the sick, the detention under observa- 
tion of those exposed during a period equal to the incubative period 
of the disease, and the sanitation of the ship. With the removal of 
infected or suspected persons and material the ship may be disin- 
fected and released, suffering thus scarcely any detention at all. In 
the old colonial days each colony had its quarantine regulations, and 
after the formation of (he TJnion quarantine was left to the care of 
the state governments and by the latter to county governments or to 
municipalities. 

227 



228 PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 

The first national quarantine law in the United States was passed 
in 1878, but, aside from bestowing power to aid state governments, it 
had little effect. Until 1893 each State had its own individual re- 
quirements. Different cities in the same State had different require- 
ments. One city, in order to divert trade from its neighboring rivals, 
would be less exacting than the latter. Before the civil war conven- 
tions were frequently held of the quarantine officers of our Atlantic 
seaboard, with a view to establishing harmony of action, but they 
failed, and it was not until 1893 that a national quarantine law was 
passed by Congress authorizing national regulations for all quaran- 
tine, uniform in character and, if not enforced by the States, to be 
enforced by the National Government. Kelief from the previous 
quarantine evils immediately followed, and in 1906 an additional 
quarantine act was passed, under which the Federal Government has 
obtained control of the stations and of the administration of nearly 
all the quarantine in the United States. 

Another problem practically solved or being solved is that con- 
nected with immigration. Until the passage of the immigration law 
of 1891 there was no adequate hindrance to the influx of immigrants 
afflicted with disease other than those which were quarantinable. 
Our cities and towns were receiving immigrants afflicted with loath- 
some contagious diseases, particularly favus and trachoma, but under 
laws and regulations this invasion has been practically stopped, and 
many other diseases of like nature are regularly excluded. 

Now, while the foregoing public-health problems have been practi- 
cally solved, new public-health problems have come into the fore- 
ground, or at least are brought forward for more pressing considera- 
tion. This is due to the growth of the country. Diseases which were 
formerly not considered necessary for public recognition and action 
now call very loudly for it. But before considering these diseases 
and the sanitary problems connected therewith, let us study briefly 
the legal status, or the measures affecting them provided by law. In 
so doing it will be convenient to comment, first, on the relations of our 
nation to other nations in matters of public health, and afterwards 
upon the relation of the National Government to the States. 

International Relations. 

With regard to immigration, it has been repeatedly urged and in- 
cluded in bills introduced in Congress that the most effective method 
of barring immigrants afflicted with loathsome or contagious diseases 
would be to place medical officers in the foreign ports of departure. 
But foreign governments have objected to this, and at present it 
seems impracticable. Indirectly, at some foreign ports, however, the 
desired end is brought about through the quarantine act of February 
15, 1893, which authorizes the President to detail medical officers in 
the offices of the United States consuls to enforce the Treasury regula- 
tions upon vessels leaving for the United States to prevent bringing 
to this country persons or merchandise infected with quarantinable 
disease. Officers are thus stationed now at Libau, Naples, and Cal- 
cutta ; and in China, Japan, South America, Central America, Cuba, 
and other islands in the West Indies, and at any foreign port where 
contagious disease is rife officers are promptly sent. These officers at 
many ports, by request of the steamship companies and the Immigra- 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 229 

lion Bureau, examine emigrants and advise the steamship companies 
as to those whom they should not bring. The steamship companies 
are thus protected from infringement of the law and the imposition 
of the consequent penalty. 

But our international relations with regard to the public health 
have recently been extended beyond the mere question of quarantine 
and immigrants, and it is noteworthy that the Congress of the United 
States has recently signified its interest in these matters by three 
appropriations in the " act making appropriations for the diplomatic 
and consular service," approved March 2, 1909. 

The appropriations are as follows : 

INTERNATIONAL OFFICE OF PUBLIC HEALTH ( PARIS). 

For the payment of the quota of the United States for the year 1909 toward 
the support of the International Office of Public Health, created by the inter- 
national arrangement signed at Rome, December 9, 1907, in pursuance of article 
181 of the International Sanitary Convention, signed at Paris on December 3, 
1903, three thousand dollars. 

INTERNATIONAL SANITARY BUREAU. 

(This means the International Sanitary Bureau of the American 
Republics, located at Washington.) 

For the annual share of the United States for the maintenance of the Inter- 
national Sanitary Bureau for the year 1910, $2,830.79. 

INTERNATIONAL CONGRESS OF HYGIENE AND DEMOGRAPHY. 

To enable the Government of the United States suitably to participate in the 
Twelfth International Congress of Hygiene and Demography, which will be 
held at the city of Washington, D. C, in 1910, in pursuance of the invitation 
extended by the President of the United States, in virtue of the joint resolution 
of the Congress thereof, approved February 26, 1907, and to meet the exiienses 
that will actually and necessarily be incurred by the United States by reason of 
such invitation and meeting, ten thousand dollars, or so much thereof as may 
be required. 

The Congress of Hygiene and Demography, just referred to, is a 
voluntary organization; that is, it has no official relations with the 
nations from v/hich the delegates come. Delegates, however, are 
officially appointed to represent the several governments, but no 
powers are delegated to them. 

The other two organizations mentioned above are strictly official, 
and treaties or conventions establishing them have been ratified by 
the Senate of the United States, as well as by the other governments 
represented therein. 

The International Sanitary Bureau of American Republics at 
Washington was founded by the International Conference of Ameri- 
can States held in the City of Mexico in 1901. That conference 
also called for international sanitary conventions, which are now 
held every two years. Two have been held in Washington, and a 
third, a little more than a year ago, in the City of Mexico. The 
next one is to bo held in Costa Rica beginning December 2.5, 1909. 
The objo/'t of the conventions is to freely discuss all matters relating 
to th(! public health, and pai*ti(;ularly those which ali'ect the Ameri- 
can R(;|>ijblics, and the obje(;t of the International Sanitary Bureau 
is to encourage the executi(jn of the resolutions or agreements de- 



230 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

cided upon by the conventions. The convention held in "Washington 
in 1905 drew up a treaty with regard to the quarantine treatment 
of cholera, plague, and yellow fever, which Avas signed ad referen- 
dum by the official delegates, and has since been confirmed by practi- 
cally all of the American Kepublics. At the meeting in Mexico City 
in December, 1907, action was taken which has brought the Inter- 
national Sanitary Bureau at Washington into relations with the 
International Office of Public Health at Paris. 

The International Office of Public Health at Paris was formally 
inaugurated November 10, 1908. It is the outgrowth of inter- 
national sanitary conferences at Rome, Venice, and Paris, with 
regard to the bubonic plague. The following Governments are 
represented: Belgium, Brazil, British India, Egypt, France, Great 
Britain, Holland, Italy, Portugal, Roumania, Russia, Spain, Switzer- 
land, and the United States. 

Each of these Governments has agreed to pay its pro rata of the 
expenses necessary to maintain the international office. Article IV of 
the organic statutes states as follows : 

Tlie principal object of the office is to collect and bring to the knowledge of 
the participating States facts and documents of a general character interesting 
to public health, especially as concerns infectious diseases — notably cholera, 
plague, and yellow fever- — as well as the measures taken to combat these 
diseases. 

It is believed that the full exchange of ideas that will take place at 
the semiannual gathering of the governing committee, composed as it 
is of men of the highest authority and influence, will have a beneficial 
effect upon the march of international sanitation, and that as a central 
clearing house of sanitary information the bureau will become of the 
highest importance, both in the quarantine and the internal sanitary 
administration of the various countries of the world. 

It will thus be seen that these international sanitary bodies, strictly 
official in character, may reasonably be expected to have a stimulating 
effect, and possibly a still more aggressive effect upon sanitary re- 
forms in the several nations. 

How to make the international sanitary agreements and organiza- 
tions have a practical bearing upon the sanitary conditions, even 
local conditions, is one of the great problems under consideration to- 
day. Whether an affirmative solution is possible is a question, but 
there is reason to believe that affirmative results can be obtained. In 
any event the effort is a worthy one, and the effect can only be good. 

With regard to the American Republics, the matter has gone so 
far as to be included in resolutions adopted at the Third International 
Conference of American States, which met at Rio de Janeiro in July, 
1906. That conference recommended to the countries represented 
the following, viz: 

The adoption of measures tending to obtain the sanitation of the cities, and 
especially of the ports, and to attain as far as possible to a better knowledge 
of the greater observance of hygienic and sanitary principles. 

The conference further directed that the respective delegates to 
the next International Sanitary Convention be instructed to solve 
the question of " practical means of rendering effective " the above 
recommendation. 

The action of the conference was the result of instructions given by 
Secretary Root to the American delegates, and which were included 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 231 

in a letter written by myself by invitation of Secretary Root, sug- 
gesting considerations regarding hygiene and sanitation and quar- 
antine which might appear worthy of being brought before the Rio 
conference. The argument was that quarantine and quarantinable 
diseases heretofore considered at international sanitary conventions 
should now be put to one side as no longer requiring international 
consideration; and international deliberations should now take up 
matters of hygiene and sanitation, even though it is admitted that 
the activity of the National Government in local sanitation is more 
difficult in some Republics than in others. It was argued that while 
unhygienic conditions are local, they give rise to diseases which 
spread from one country to another, and then become the care of 
the national governments, and that the latter should therefore find 
some means of exercising effective influence with regard to local 
conditions. 

It was further argued that this influence should be exerted first 
upon seaport cities and towns, since these are the connecting points 
between nations. 

This problem is still before the International Sanitary Conven- 
tions of the American Republics and the International Sanitary 
Bureau. 

Relation or Nations to States. 

Having thus discussed international relations, we must now con- 
sider the relation of the nation to the States in public-health matters. 
In the earlier days of the Republic legal problems of this nature 
seldom arose, if we except the quarantine question, but since, as 
before stated, diseases that were not' formerly considered necessary 
for public recognition now call very loudly for it, so legal questions 
relating thereto involving new examinations and decisions are now 
before us. In other words, sanitary and legal problems are con- 
stantly changing and new questions are arising for determination. 

In attempting to determine what is the proper relation of the 
nation to the state in the matter of public health, it is necessary to 
have as clear an understanding as possible of our ultimate object or 
what ends we are striving to attain. These may be broadly enumer- 
ated as follows: (1) To diminish the death rate; (2) to extend the 
period of life; (3) to decrease physical suffering; (4) to increase 
physical and mental stamina. 

To attain these ends requires a warfare upon disease, particularly 
disease of a communicable nature. The greater epidemic diseases, 
viz, cholera, yellow fever, smallpox, typhus fever, and plague, are 
not here considered, for they can be successfully fought with our 
present scientific knowledge and lawful regulations. But other dis- 
eases do require consideration, both as to their character and the best 
legal arrangements for combating them. Among the more important 
requiring immediate attention are the following: Tuberculosis, ty- 
phoid fever, malaria, measles, pneumonia, scarlet fever, hookworm 
disease, pellagra, cancer, and insanity. And the topics to be consid- 
ered in connection with their eradication are as follows: vital sta- 
tistics (the bookkeeping of public health), water pollution, milk 
supply and pure food, sanitation and hygiene, mental hygiene, scien- 
tific investigation, and publication. 



232 PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 

Now, in the struggle to eliminate these diseases and in providing 
means relating to the topics just mentioned, how much shall devolve 
upon the States, how much shall be imposed upon the General Gov- 
ernment ? And here arises the old question as to the police powers of 
the States and the restrictions imposed upon the National Govern- 
ment by the Constitution. There is evidently a growing sentiment 
that the National Government should do far more than it is now 
doing toward the protection of the public health, and there is like- 
wise a strong feeling that too much is expected of the National Gov- 
ernment, and that there is a tendency to allow or to call upon the 
Federal Government for service which is properly imposed on the 
States themselves and a willingness to surrender even state rights for 
the sake of financial assistance. There is danger of an extreme view 
in each case, and it appears to me that as regards the public health 
the limitations of the Constitution are the very limitations that the 
best policy would dictate. I do not admit that the limitations of the 
Constitution are as narrow as is claimed by some strict construction- 
ists. Much may be done under the Constitution that at first blush 
seems impossible, and modern conditions of life make it imperative 
that the National Government should assume its responsibilities in 
"sanitary matters affecting more than one State or Territory, On the 
other hand, measures evidently beyond the powers granted by the 
Constitution to the Federal Government would be unwise measures, 
weakening, as they would, the independence and self-reliance of States 
and municipalities, which would lead to a weakening of our national 
character. 

In his address at Gettysburg, June 1, 1908, Senator Knox, of 
Pennsylvania, now Secretary of State, in commenting on the dangers 
of peace, states as follows: 

Sometimes a portion of the people, strong by reason of their numbers or by 
reason of their zeal and activity, and interested in the accomplishment of laud- 
able aims, become impatient and restive under the checks and balances and 
boundaries which control and harmonize our system, and may therefore oppose 
what they want through the methods they propose. Recently this tendency 
seems to me to have threatened seriously to disturb the just relations between 
the state and federal governments. Impatient of the difficulties and delays 
which may attend the action of separate States in the accomplishment of their 
objects, some of the people have seemed to feel that by an assumption of federal 
power or by ignoring state power their aims could be speedily and fully 
obtained. 

But the genius of our Constitution, the supreme equity of our form of gov- 
ernment, the balance wheel of our system, is that each of the dual governments 
shall keep within its own sphere, untrammeled and uncontrolled by the other. 

The Hon. James A. Tawney, chairman of the Committee on Ap- 
propriations, House of Eepresentatives, in his memorial address on 
the battlefield of Gettysburg, May 30, 1907, states as follows : 

In the early part of the nineteenth century there was fear and danger that 
the union of the States was as a rope of sand and would fall apart. To-day 
there is more reason to fear that the several States and the local self-govern- 
ment which they represent will, for all practical purposes, disappear from our 
politics as distinct entities and be swallowed up in an all-embracing federal 
power. The States not only seem inclined to allow, but in many instances are 
anxious voluntarily to surrender to the Federal Government the discharge of 
duties and the exercise of powers and privileges reserved to them by the Con- 
stitution, especially when the exercise of those powers involves the expenditure 
of money. They are also to-day either soliciting or acquiescing in a degree of 
federal supervision over their domestic affairs that less than half a century ago 
would have led to revolution had the Federal Government attempted to force 
such supervision upon them. 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 233 

Furthermore, Mr. Tawney, on March 4 of the present year, com- 
menting on the greatly increased expenditures of the General Govern- 
ment, declared as follows: 

An analysis of our expenditures during the past decade proves conclusively 
that the primary cause for this increase is a tendency on the part of our people 
toward militarism and in favor of the exercise by the Federal Government of 
rights and functions belonging exclusively to the States. 

These thoughts expressed by well-known leaders in our public life 
must be given due weight in considering the relation of the National 
Government to the States in matters of public health. 

THE CONSTITUTION. 

It would be a sad reflection, however, that under our form of 
government as much could not be done for the public health by the 
national and state governments as ought to be done to bring about 
the necessary results. It has sometimes been asserted that in these 
matters the autocratic governments of the Old World have an advan- 
tage over the self-governing republics, but further study of the sub- 
ject will show that their advantages are not superior. As stated 
before, it is believed that the Constitution does permit national legis- 
lation of the necessary scope and character. 

The principal laws on the national statute books which have a 
bearing on public health are based upon, or are carefully in accord 
with, that clause of the Constitution which gives the right to Con- 
gress to regulate commerce between the States. There is another 
clause of the Constitution which, as will be seen presently, may have 
an important bearing on national health legislation, particularly with 
reference to the pollution of interstate waters. I refer to the clause 
empowering the federal courts to settle controversies between the 
States. 

It has also been claimed that under the " general-welfare " clause 
of the Constitution certain beneficent institutions can be organized 
and maintained by the National Government, but a strict construc- 
tionist will inform you that the United States Government can only 
legislate in accordance with powers expressly delegated by the Con- 
stitution and that the " general-welfare " clause of the Constitution 
applies as a qualifying clause to the specified prerogatives — that the 
latter are only granted when necessary to the general welfare. Still 
others will declare that nevertheless the " general-welfare " clause has 
a meaning which can not be ignored and whose influence has been felt 
in legislation. 

WATER POLLUTION. 

Recurring now to the specified diseases hereinbefore mentioned as 
furnishing problems for the national as well as state governments, 
viz, tuberculosis, typhoid fever, malaria, pneumonia, measles, scarlet 
fever, pellagra, hookworm disease, cancer, and insanity, and their 
corresponding topics, vital statisticSj water pollution, milk supply 
and pure food, sanitation and hygiene, mental hygiene, scientific 
investigation, and publication, it would be intei'OHting to discuss 
each of them; but it must suf!i(;(! at })r(!S(uit to coiniri(!nt at length 
on only one, viz, water pollution, which presents probably greater 



234 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

difficulties, both of a sanitary and legal character, than the others. 
I shall not attempt to make an exhaustive statement as to the pollu- 
tion of the water supplies of the United States, nor to give statistics 
showing the tremendous economic loss, as well as the loss of human 
life, caused by such pollution. To do so would require a special article 
dealing with this subject alone. In general, it may be said that the 
legal problem involved is more difficult of solution than the sanitary 
one, although to provide measures which will prevent the pollution 
of streams, whether by diverting the sewage of cities from the streams 
or requiring a purification of sewage before being emptied into a 
stream, andto insure purity of drinking water, implies sanitary study 
and research and questions of engineering of the most profound char- 
acter. But the legal problem involved, so far as national action is 
concerned, is now engaging the careful thought of men eminent in 
the legal as well as the medical profession. Among those who are at 
present giving most earnest attention to this subject is the Hon. 
George Shiras, 3d, former Representative in Congress and son of 
Justice Shiras, formerly of the Supreme Court of the United States, 
and himself a lawyer of distinction. By request he has furnished me 
with the following statements bearing on this subject. 

The right of a government to regulate and control the extent and character 
of water pollution is a primary one, and may in the United States be divided 
into two general classes: 

First. Local waters, or those lying wholly within the confines of a single State 

Second. Interstate waters, or those traversing or lying within the territory of 
two or more States. 

In the first division the sanitary jurisdiction. over local waters is limited to 
the state courts, and all remedial or corrective legislation is vested solely in 
the lawmaking body of the State. 

In the second division, however, the jurisdiction over interst€ite waters may 
be a concurrent one of the State and Federal Governments, or at times when 
the conflicting interests of the States in such common waters requires the inter- 
vention of a final arbitrator, the Federal Government becomes supreme in its 
determination of what constitutes an unreasonable and unnecessary pollution 
of waters common to two or more States. 

On the part of many it has been frequently asked upon what legal grounds 
the National Government is able to prevent the pollution of interstate waters. 
And yet the answer seems a simple one. In the year 1901 a bill was filed in 
the United States Supreme Court by the State of Missouri against the State of 
Illinois (vol. 180, U. S. Rep., p. 208) alleging that the construction and subse- 
quent use of the Chicago Drainage Canal would so pollute the waters of the 
Mississippi River as to seriously impair the health of the citizens of St. Louis 
and adjacent communities within said State. To this bill a demurrer was filed, 
admitting that even if these allegations were true, there existed no jurisdiction 
in the Federal Government to prevent such pollution ; the position being taken, 
in effect, that it was no concern of the Federal Government to what extent such 
interstate waters were polluted or the effect thereof upon the health of the citi- 
zens of the United States. Just how this vital question was met by the Supreme 
Court and how far-reaching the decision was it is only necessary to quote a few 
lines from the opinion of the court : 

"An inspection of the bill discloses that the nature of the injury complained 
of is such that an adequate remedy can only be found in this court at the suit 
of the State of Missouri. It must surely be conceded that if the health and 
comfort of the inhabitants of a State are threatened, the State is the proper 
party to represent and defend them. If Missouri were an independent and sov- 
ereign State, all must admit that she could seek a remedy by negotiation, and, 
that failing, by force. Diplomatic powers and the right to make war having 
been surrendered to the General Government, it was to be expected that upon 
the latter would be devolved the duty of providing a remedy, and that remedy, 
we think, is found in the constitutional provision we are considering. The 
allegations of the bill plainly present such a case. The health and comfort 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 235 

of the large communities inhabiting those parts of the State situated on the 
Mississippi River are not alone concerned, but contagious and typhoidal diseases 
introduced into the river communities may spread themselves throughout the 
territory of the State. Moreover, substantial impairment of the health and 
prosperity of the towns and cities of the States situated on the Mississippi 
River, including its commercial metropolis, would injuriously affect the entire 
State. * * * The bill in this case does not assail the drainage canal as an 
unlawful structure, nor aim to prevent its use as a waterway. What is sought 
is relief against the pouring of sewage and filth through it by artificial arrange- 
ments into the Mississippi River, to the detriment of the State of Missouri and 
her inhabitants ; and the acts are not merely those that have been done, or which 
when done cease to operate, but acts contemplated as continually repeated from 
day to day. The relief prayed for is against not merely the creation of a 
nuisance, but against its maintenance. Our conclusion, therefore, is that the 
demurrers filed by the respective defendants can not be sustained." 

The effect, therefore, of this decision is plain, viz, that in any case where 
the pollution of waters common to two or more States is threatened, or where 
such nuisance is in actual existence, the Federal Government is in a position 
to pass upon the questions of law and fact and determine the respecti\'e equities 
of the States in such joint waters. And in this connection it matters not that 
the particular bill referred to was dismissed without prejudice, because, in the 
opinion of the court, the evidence submitted failed to justify the facts alleged 
in the bills. 

Precisely the same rule was laid down in a more recent case of the State of 
Kansas against the State of Colorado (U. S. Rep., vol. 206, p. 66, 1907) (see 
also U. S. Rep., vol. 185, p. 125, 1901), where it was held that an unreasonable 
use and diversion of the Arkansas River for irrigation purposes by the defend- 
ant was subject to control or restriction by injunctive process in the Supreme 
Court of the United States, while in the later case of the Tennessee Copper 
Company it was decided by the same court that the unreasonable pollution of 
the atmosphere by the citizens of one State which resulted in the material 
injury of the property and health of the citizens of another State was a sufii- 
cient ground for a federal jurisdiction in granting adequate relief in the case 
stated. 

It would therefore seem to follow whenever the federal judiciary decide, as a 
matter of law, that the commission of a certain act by a State, or the citizens 
thereof, constitutes an impairment of the existing rights of an adjacent State, 
it comes clearly within the scope of the constitutional provision empowering the 
federal courts " to settle controversies between the States ; " and, logically, it 
would seem to follow that thereupon there was imposed on Congress the duty of 
enforcing, by appropriate legislation, the equitable rights of the States in accord- 
ance with the principles enunciated by the judicial branch of the Federal Gov- 
ernment ; or otherwise no controversy between the States over water pollution 
would ever be settled, in a judicial sense, if the federal courts would have to 
continue to sit as a nisi prius tribunal passing continually upon mere questions 
of fact and not upon any of the primary questions of law which might be sup- 
posed to be involved in the determination of what constitutes the " settlement 
of controversies between the States." 

Therefore when the United States Supreme Court decided that one State may 
not unreasonably deprive a co-State of its equitable interest in waters common 
to each, then and thereupon it becomes the duty of Congress to put such prohibi- 
tions or restrictions upon the statute books, so that under the administrative 
activities of the Government they may be so enforced as to prevent the erection 
and mainlenance of nuisances decided to be in violation of the lawful rights of 
the injured State. 

For years this principle has been followed in the prevention or abatement of 
nuisances affecting navigation upon interstate streams. Although it may be ad- 
mitted that Congress predicates its alleged jurisdiction over such navigable 
waters by reason of the power " to regulate commerce among the States," it is 
nevertheless true that the power to prevent the citizens of one State from doing 
an act niireiLsonably interfering with the navigable rights of the citizens of 
anotber State was based upon many decisions of tlie Supreme Court that navi- 
gablf,' iiiterslale wjiters were Hul)je('t to any and all federal legislation necessary 
to de)eniiiri<! ;uu] niiiitilain the riglits of tlie Stjites in these joint waters. When 
we reiiictiii)cr tliat Ihc; word " iiiivigiiiion " is not even mentioned in the Federal 
Const iliition and that t)ie many acts of Congress jmssed in reference to commerce 
upon Interstate waters have really been based upon the necessity of determining 



236 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

in advance the conflicting rights of the citizens of different States in such waters, 
it should be realized that the time has now come when, by precisely similar regu- 
lations. Congress should exercise its sanitary control over such waters, since in 
many respects the objects sought to be attained are of infinitely greater impor- 
tance to the health and general welfare of the citizens of the United States than 
the commercial value of any of these interstate waters. 

In other words, when any acts of commission or omission, whether relating to 
navigation, irrigation, the potability or other domestic uses of interstate waters, 
have been judicially declared to constitute public nuisances per se, and the only 
questions left open for settlement thereafter are those based upon the existence or 
nonexistence of certain facts, and on which the existence of a particular nuisance 
depends, it surely ought to be conceded that Congress has the power, by appro- 
priate legislation, of regulating and determining in advance what are reasonable 
uses and what are unreasonable uses of waters owned jointly by two or more 
.States, with the right of any aggrieved party to be heard in the courts upon the 
reasonableness of such federal regulations. Otherwise, if Congress has no such 
power, we are in the ridiculous plight of only being able to control in a hap- 
hazard way the pollution of interstate streams by long and expensive litigation, 
in which litigation the trial judges can have no sanitary knowledge or technical 
experience and in which in most cases the individuals, tlie municipalities, or the 
States affected by the adverse decision of the court might have avoided the 
expenditure of great sums of money and useless litigation if they had known, 
or might have known, in advance just what their legal rights were in and over 
such common waters. 

When therefore the Supreme Court of the United States decides that the pollu- 
tion of interstate waters is a matter for federal intervention, such an established 
jurisdiction must include the right of Congress to legislate in accordance there- 
with. 

Public Health Organizations. 

Before closing, a word should be said in regard to the public-health 
organizations of the country, national, state, and municipal, but time 
does not permit of their full description. It may be said, generally, 
that the National Government, aside from its quarantine regulations, 
its regulations regarding the manufacture of vaccines, toxins, and 
antitoxins, and those relating to pure food, is engaged chiefly in inves- 
tigation and dissemination of information and in bringing about co- 
oj^eration between its own organization and those of the States. The 
state health organizations are yearly increasing in power and effi- 
ciency and many municipalities are working out through proper 
ordinances and effective administration their health problems. 

National law requires a conference to be called each year by the 
Surgeon-General of the Public Health and Marine-Hospital Service 
between said service and the representatives of all the state boards 
of health. Six annual conferences have been held. Other confer- 
ences, as occasion may require, are also provided by law between the 
national health service and all or a part of the state health organiza- 
tions. The effect of these conferences is an exchange of information, 
a spirit of cooperation, and the determination of vexed sanitary 
questions. Their deliberations pertain particularly to administrative 
measures. 

In the strictly scientific work of the Plygienic LaboratorA^ the serv- 
ice has by law the advice of its advisory board, nine in number, com- 
posed of scientists eminent in laborator}^ work, both of other depart- 
ments of the Government and of endowed institutions. The Public 
Health Bureau at Washington has six divisions through which the 
operations of the service, properly classified, are conducted by trained 
medical officers under the direction of the Surgeon-General. 



public health and maeine-hospital service. 237 

The Public Health Movement. 

Finally, in reviewing this subject, the thought is suggested that in 
our progressing public health movement we are simply participating 
in a stage of the evolution of the human being. It would seem that 
the public health movement, or the status of the public health ques- 
tion, runs joarallel with the other great movements connected with 
the advancement of civilization. It played a subsidiary part in the 
earliest days when men's energies were chiefly engaged in advancing 
their temporal welfare or struggling for personal liberty, but at the 
present time it has relatively a much more significant status. 

As shown before, the grosser problems such as the management of 
the great epidemics, are practically solved: The problems of the 
ordinary domestic communicable diseases are noAv solved so far as 
the diseases themselves are concerned, and the legal problems con- 
nected therewith are being solved; and we are actually in another 
stage of health preservation, signified by sanitation and hygiene, the 
maintaining of health, and the building up of health. We are just 
approaching a stage which might be considered that of mental 
hygiene, which will be followed by one relating more particularly to 
the improvement of the average intellect, the building up of charac- 
ter, and a further development of the moral and the spiritual. 

All these developmental stages are bringing nearer together the 
different nations of the earth. They tend at least to what some ideal- 
ists are advocating, a confederation of the world. Surely, in sanitary 
and in public health matters, the world is one great family, and this 
fact becomes more pronounced with the agitation arfd consideration 
of each of the advanced stages of the public health question. 



NEEDS OF THE SERVICE. 

The most pressing need of the service at the present moment is the 
enlargement of its facilities for furnishing information by distribu- 
tion of its reports and other publications. Requests for these are 
being constantly received which can not be complied with. This 
matter has been fully set forth in the foregoing pages (207 and 208). 

Other necessities of the service are duly set forth in the bills 
referred to in the last annual report^ — one relating to increase of func- 
tion, the other to the personnel. Both of these bills (S. 6102 and 
S. 6101, 60th Cong.) were passed by the Senate, and with some 
amendments were reported favorably by the committee of the House 
of Representatives, but were not brought to a vote in the House, and 
failed, therefore, of enactment into law. 

The financial statement and the usual statistical tables relating 
to the professional care of seamen and physical examinations are 
appended. 

I have the honor to remain, respectfully, 

Walter Wyman, 

Burgeon-General. 

Hon. Fkankljn MacVkagh, 

tSecrctary of the Treasury. 



APPENDIX. 



FINANCIAL STATEMENT. 

Receipts and Expenditures, Public Health and Marine- 
Hospital Service, for the Fiscal Year ended June 30, 1909. 

Public Health and Marine-Hospital Service, 1909. 



Appropria- 
tions and 
repay- 
ments. 



Expendi- 
tures. 



Balances 
June .30, 



Less esti- 
mated out- 
standings. 



Pay and commutation commissioned oflBcers and 

pharmacists 

Pay other employees 

Freight and traveling expenses: 

Appropriation 

Repayments 

Fuel, light, and water 

Furniture and repairs 

Purveying depot purchases: 

Appropriation 

Repayments 

Rent, purveying depot 

Maintaining hygienic laboratory 

Equipment hygienic laboratory 

Maintenance marine hospitals: 

Appropriation 

Repayments 

Care of seamen and other purposes: 

Appropriation 

Repayments 

Bureau, books 

Stairways, Chicago 

Total: 

Appropriations 81 , 299. 750. 00 

• Repayments 17,712. .59 



?.325,000.00 
390, 000. 00 

35,000.00 

127. 75 

80,000.00 

9,000.00 

45,000.00 
3,869.18 
3,250.00 
15,000.00 
10,000.00 

235,000.00 
13,111.37 

140, 000. 00 

604. 29 

500. 00 

a 12, 000. 00 



.8277,561.44 
352,975.98 



S47, 438. 56 
37,024.02 



26,244.58 

72, 768. 26 

7,610.23 



8,883.17 
7,231.74 
1,389.77 



48, 117. 99 
3,250.00 

13, 720. 46 
9, 966. 25 



1,279.54 
.33. 75 



235, 505. 87 



12,605.50 



116,408.45 
419. 52 



24, 195. 84 



■:1,317,462.,59 



1,164,549.03 



140,913.56 



S827. 79 
100. 00 



4,206.79 



1,194.31 



604.09 



1, 109. 38 



2,313.57 



63.79 
68.12 



10,487.84 



o Transferred to Supervising Architect. 
For expenditures by stations, see Statistical Table II. 



Quarantine Service, 1909. 

Amount of appropriations $420, 000. 00 

Repayments, subsistence furnished, etc 935. 46 



Total 420, 935. 46 

Expenditures 399, 784. 03 



Balance June 30, 1909 21, 151. 43 

Less outstanding liabilities, estimated 2, 837. 77 

239 



240 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Expenditures by stations. 



Name of station. 



Alexandria, Va 

Beaufort, S. C 

Biscayne Bay 

Bocagrande 

Brunswick 

Cape Charles 

Cape Fear 

Cedar Keys 

Charleston, S. C 

Columbia River 

Coos Bay, Oreg 

Cumberland Sound . . . 
Delaware Breakwater. 

Eureka 

Florence, Oreg 

Georgetown, S. C 

Gulf 

Hawaii 

Key West 

Miscellaneous 

Mobile 

Newbern, N. C 

New Orleans 

Newport, Oreg 

Pensacola 

Perth Amboy, N.J... 

Port Harford, Cal 

Port Inglis 

Portland, Me 

Porto Rico 

Port Royal, S. C 

Port Townsend 

Punta Rassa 

Reedy Island 

St. Georges Sound 

St. Johns River 

San Diego L 

San Franoisco 

San Pedro. ; 

Santa Barbara 

Savannah 

South Atlantic 

Tampa Bay 

Washington, N. C 



Total 274, 102. 91 



Pay and al- 
lowances, 
officers and 
employees. 



$130. 00 
1,500.00 
1,529.07 
3,111.07 
3,4.37.21 
9,037.00 
0,920.01 

728. 00 
5, 492. .50 
9, 913. 33 

200.00 
3,000.00 
4,468.00 
1,178.50 

200.00 

1,200.00 

11,837.01 

29,878.30 

4,080.00 



11,024.00 

200.00 

29, 378. S3 

200.00 

8,482.50 

1,596.00 

350. 00 

310. 00 

7, 854. 52 

22,982.19 

1,500.00 

14,710.10 

300. 00 

16, 382. 43 

3,200.00 

1,980.00 

6,472.00 

24,151.93 

205. 00 

290.00 

10,511.05 

0,041.77 

6, 881. 67 

645.00 



Subsistence 
and mis- 
cellaneous. 



Medical and 
hospital 
supplies. 



$17. 22 

100. 01 

2.56 

.567. 40 

1,282.93 

5, 426. 61 

2,021.10 



1,380.74 
5, 503. 20 
99.10 
98.38 
2, 373. 69 
1,406.08 



311. 93 

5,931.44 

9, 083. 65 

678. 92 

579. 61 

7, 710. 27 



9,065.62 



3,001.58 

1,041.79 

2.19 

2.88 

1,993.55 

5, 927. 56 

131. 12 

1,893.25 



11,391.95 

507. 91 

583. 93 

3,591.63 

25, 722. 82 

182. 50 

22 

6,944^40 

3,204.56 

3, 163. 07 



122,987.49 



$9.70 
24.57 

58.45 
168. 25 



122. 10 

1..50 

10. 20 

24.07 

2.35 



225. 57 
127. 21 



2.75 
286. 95 



248.25 
'i47.'63 



12.79 
175. 98 



300. 71 
45. 65 
4.25 



423.34 



79.31 

17.36 

146. 19 



2, 693. 63 



Total. 



S147. 22 

1,600.01 

1,532.23 

3,688.83 

4, 744. 71 

14, 522. 12 

9, 11.5. 36 

728.00 

6, 873. 24 

15, 538. 63 

300.60 

3, 708. 58 

6,805.76 

2, .580. 93 

200.00 

1,511.93 

17, 994. 02 

39, 089. 16 

4, 758. 92 

582. 36 

19,021.22 

200.09 

38, 092. 70 

200.00 

11.631.11 

2,637.79 

352. 19 

312. 88 

9, 860. 86 

29, 085. 73 

1,631.12 

16, 632. 51 

300. 00 

28,081.09 

3,753.56 

2, 568. 18 

10,063.63 

50,298.09 

387. 56 

290.22 

17, 535. 36 

9,323.69 

10, 190. 93 

645. 00 



399, 784. 03 



Preventing the Spread op Epidemic Diseases. 

Balance July 1, 1908 |711, 007. 58 

Amount appropriated by Congress 750, 000. 00 

Total 1, 461, 007. 58 

Expenditures: 

Foreign medical service, salaries and miscellaneous, 
China, Japan, Italy, etc.. Central and South America, 
and West Indies $55, 858. 73 

Panama and Canal Zone, salaries, etc 10, 394. 44 

Habana, Cuba (including outlying district), salaries, 
subsistence, supplies, and miscellaneous 22, 009. 79 

Mexico, salaries, supplies, etc 7, 044. 26 

Sanitary inspection in United States, salaries, traveling 
expenses, and miscellaneous 12, 677. 96 

Plague suppressive measures, Pacific coast 337, 403. 13 

Yellow fever, maintenance of detention camps, pre- 
caution against outbreak, salaries, medical and hos- 
pital supplies, disinfectants, etc 31, 783. 52 

Texas border inspection, salaries and miscellaneous 5, 821. 88 

482, 993. 71 

Balance June 30, 1909 978, 013. 87 

Less outstanding liabilities, estimated 39, 000. 00 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 241 

National Quarantine and Sanitation. 

Balance July 1, 1908 , $368, 666. 68 

Repayments, subsistence furnished 92. 00 

Total 368, 758. 68 

Expenditures for salaries, supplies, improvements, and mis- 
cellaneous: 

Mobile, Ala $35, 841. 96 

NewOrleans, La 6,662.95 

Rigolets, La 225.00 

Atchafalaya, La 125. 00 

Calcasieu, La 125. 00 

Miscellaneous 34. 69 

43, 014. 60 

Balance June 30, 1909 325,744.08 

Less outstanding liabilities, estimated 7, 689. 29 

Salaries, Office of Surgeon-General, Public Health and Marine-Hospital 

Service, 1909. 

Amount of appropriation $39, 780. 00 

Expenditures 39, 392. 71 

Balance June 30, 1909 387. 29 

Maintenance Leprosy Hospital, Hawaii, 1909. 

Balance July 1, 1908, reappropriated $28, 25.8. 53 

Additional appropriation 20, 000. 00 

Total 48, 258. 53 

Expenditures 24, 442. 67 

Balance June 30, 1909 ; 23, 815. 86 

Lees outstanding liabilities, estimated 12, 000. 00 

Leprosy Hospital, Hawaii, Buildings and Equipment. 

Balance July 1, 1908 " $57, 709. 07 

Expended July 1, 1908, to June 30, 1909 33,142.94 

Balance June 30, 1909 24, 566. 13 

Leprosy Investigation Station, Hawaii, 1909-10. 

Amount appropriated, act March 4, 1909 $5, 500. 00 

Expended July 1, 1908, to June 30, 1909 2, 390. 44 

Balance June 30, 1909 3, 109. 56 

Appropriations, Marine Hospitals. 

Chicago, ni., act March 3, 1905: 

Balance July 1, 1908 $1, 132. 98 

Expended July 1, 1908, to June 30, 1909 688. 00 

Balance June 30, 1909 444. 98 

Baltimore, Md., act March 4, 1907: 

Balarif.'O July 1, 1908 114. 80 

Expended July 1, 1908, to June 30, 1909 113. 31 

Balance June 30, 1909 1. 49 

18546—10 16 



242 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Boston, Mass., act March 4, 1907: 

Balance July 1, 1908 - $5, 996. 76 

Expended July 1, 1908, to June 30, 1909 5, 810. 83 

Balance June 30, 1909 185. 93 

Cleveland, Ohio, act March 4, 1907: 

Balance July 1, 1908 3, 000. 00 

Expended July 1, 1908, to June 30, 1909 2, 278. 05 

Balance June 30, 1909 721. 95 

Key West, Fla., act March 4, 1907: 

Balance July 1, 1908 50. 65 

Balance June 30, 1909 50. 65 

New Orleans, La., act March 4, 1907: 

Balance July 1, 1908 24. 30 

Balance June 30, 1909 24. 30 

New York (Stapleton), N. Y., act May 27, 1908: 

Amount appropriated 100, 000. 00 

Amount transferred to Supervising Architect 100, 000. 00 

Appropriations, Quarantine Stations. 

Reedy Island: 

Amount appropriated, act May 27, 1908 800. 00 

Expended July 1, 1908, to June 30, 1909 800.00 

Gulf: 

Balance July 1, 1908, act March 4, 1907 5, 925. 00 

Expended July 1, 1908, to June 30, 1909 916. 62 

Balance June 30, 1909 5, 008. 38 

San Francisco: 

Balance July 1, 1908, act March 3, 1905 395.17 

Expended July 1, 1908, to June 30, 1909 -. 9.22 

Balance June 30, 1909 385. 95 

Balance July 1, 1908, act June 30, 1906 7,365.41 

Expended July 1, 1908, to June 30, 1909 1,471.15 

Balance June 30, 1909 5,894.26 

Amount appropriated, act May 27. 1908 10, 000. 00 

Expended July 1, 1908, to June 30, 1909 9,819.25 

Balance June 30, 1909 180. 75 

Port Townsend : 

Balance July 1, 1908, act March 3, 1905 940.00 

Balance June 30, 1909 940. 00 

Savannah : 

Balance Julv 1, 1908, act March 4, 1907 1. 40 

Balance June 30, 1909 1.40 

Balance July 1, 1908, act March 4, 1907 2,612.00 

Expended July 1, 1908, to June 30, 1909 1,301.31 

Balance June 30, 1909 1, 310. 6 9 

San Diego: 

Balance July 1, 1908, act March 4, 1907 , 5.00 

Balance June 30, 1909 5. 00 

Delaware Breakwater: 

Balance July 1, 1908, act March 4, 1907 857. 00 

Balance June 30, 1909... 857. 00 

Honolulu: 

Balance July 1, 1908, act March 4, 1907 390. 52 

Balance June 30, 1909 390. 52 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



243 



Relief of owners tug Juno: 

Amount appropriated, act March 4, 1909 $376 50 

Expended July 1, 1908, to June 30, 1909 376. 50 

Balances of Appropriations made prior to July 1, 1904. 

Reedy Island quarantine station, April 28, 1904 $75. 01 

San Francisco quarantine station, June 6, 1900 4, 777. 06 

Port Townsend quarantine station : . 

Balance July 1, 1908, act March 3, 1901 39, 914. 67 

Expended July 1, 1908, to June 30, 1909 $18,825.63 

Outstanding liabilities 87. 00 

18, 912. 63 

Balance June 30, 1909 21, 002. 04 

Savannah quarantine station: 

June 6, 1900 112 20 

April 28, 1904 325. 00 

Key West, Mullet Key, quarantine station, June 6, 1900 19, 996. 83 

South Atlantic quarantine station, June 28, 1902 2, 795. 60 

Bocagrande quarantine station, June 28, 1902 500. 00 

San Diego quarantine station: 

Balance July 1, 1908, act March 3, 1903 6, 000. 00 

Expended July 1, 1908, to June 30, 1909 5,25L58 

Balance June 30, 1909 748. 42 

Accounts. 

VOUCHERS passed FOR PAYMENT AND SETTLEMENT. 

The records of the bureau show that 18,480 vouchers were passed during the year. 
Of this number, 16,128 were sent to the disbursing clerk for payment, 1,082 were 
transmitted to the Auditor for the Treasury Department for examination and set- 
tlement, and 1,270 were examined and referred to the auditor, they having previ- 
ously been paid by special disbursing agents of the service. 

STATISTICAL TABLES. 



Table I. 



-Comparative Table op Number of Patients Annually Treated- 
1868 TO 1909. 



Fiscal year. 


Number of 
sick and 
disabled 
seamen 

furnished 
relief. 


Fiscal year. 


Number of 
sick and 
disabled 
seamen 

furnished 
relief. 


Prior to reorganization: 

1808 


11,535 
11,350 
10,500 

14,250 
13, 150 
13,529 
14.350 
15,009 
10,808 
15, 175 
18,223 
20, 922 
24,8(30 
32, 013 
3(i, 184 
40, 195 
44,701 
41,714 
43,822 
45,314 
48,203 


After reorganization— Continued. 
1889. 


49 518 


18fi9 


1890 


50 671 


1870 


1891. 


52,992 
53,010 


After reorganization: 


1892 


1871 


1893. 


53,317 
52,803 
52 643 


1872 


1894. . 


1873 


1895. 


1874 


189G 


53,804 

54 477 


1875 


1897. 


187fi 


1898. . 


52, 709 


1877 


1899 


55 489 


1878 


1900 


50, 355 


1879 


1901. 


58 381 


1880 


1902 


50, 310 


1881 


1903 


.58, 573 


1882 


1904 


58, 550 


188:} 


1905. . .. 


57,013 


1884 


1900 


54,303 


1885 


1907 


55, 129 


\m\ 


1908 


54,. 301 


1887 


1909 


63,704 


1888 









244 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 



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-H (M -rtt CO 00 Ttl t^ 

t^ c-» o r^ 00 lo tp 

CM rH CM 




cs o) a; o <u 



246 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



COOrHrHCOOSO>o6oi»Q'-HOi'-H 
OlCOOiMOiiOCCCMCOOOCOt^ 

I-T' ,-h' o" .-h I o t4 "i^ 



0>OQO>OlCQiO»OOsOiiOO CO 

« -j: ■ ^ ^ :o io 05 '^i:; 






O CO (M Oi C^ »^ (M 



Or----HOC0OiCh-»-IO 
ot^r-'-'co OCT. lOOi 

!M TT lO O CD W 00 O 

'-t* Tp com" 



Q 



-;„ "ca t^ Td C C3 

1^ 2 '-^"■S^ S 



:2;2oS; 






■ - ^.2.a.^ 



M r^ o ^Ho 

CO T-H (M »0 



»oi-teooooCT)0' 
"^ ao(M CO i-H -^ ' 



3 ftx P<ca o 






3^ 



OlOOlOOCOCCMOOiOrOOiCO 



oo»o»or^cDi^coh-oooo 



TtiCOCOO(N05»OlO<Nt^ 

c-JOOJi-Hoo t>-or^o 









(M01»0(MC33DO>OOOOCO'-H0'-H 
■^iQi— IOOOOtHIO'-H'^COO'— <0 



r- CO i^ c^J CO 'X; .— I -j^ r^ tN »o 



r-t.-H,-tOOOiCQCOOiC 






■-Hcocot^cocoo'^ai 

OilMiCOOKMOO'— I 
OSi-Ht--COr-l.— It-HCMCO 






ag^&S§ 

o) 2 o ij'"^ 



i-H o 00 ^H (M 00 C 



.2 M 

P c3 



»O(NlOCOO500Q0COC 
(N T-H coco y-tc 



oir~ooOT)it^'^oco(M 

CO »-H "* CO t^ lO CO 



H 3 a a ft 



&H 3 Si a I 



C^liOOCO'MOOOO'^CO 
lO-— I C/JCO ^ rH i-H 



5 000 ^ »o ^ CO r^ 



a^5^ 



40 i-H CO CO »-H tH Oi 



OOOOiOOCOi— H0"^cD-^ 






3^ g fl ' 



CO r^ 10 (M ■^ 00 io 
r^ CO Tt< 00 -t* CM CO 



10 -^ 0(N i-H 



00CTl-^h--^(M7-lTt<O— <i 



CN C0 05C0O 



oococr>cioioooo^-io 



T-H t^CD (N O -^ 



> 



^ <:_;,-. 

000 0'>| -zi 

^^^fe^at: 

OJ OJ <U QJ CJ O O 



gf>^ 



o:z; • . c3 




^-^ I- > 



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: ~ -^^ a t: t: 1 

.. ..jOOOOOOi 

1 1ll Ph Ph Ph P4 P^ Ph P^ 1: 



C3J3 O'' 

S"C)«Ph' 

g|3W§a«-§'^'5 
j3 o g eio"G— a a a a 



PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 



247 



U^-ioocO"*Oic^o»or 



■^ CO o t-^ <:i; as CO -1"' "^ t-- o 

iCCO'— '»— lOO'^i-HirsCOO- 



CJCDCnOOCOCOO^ir^C'l'^CT) r— I'—ICOCO'MOiCO'— " 



»0OC000OCD0S00(NC0i-<O 

'^(NOOiiC'-HTtiasOOCOiMO 

O»-HO0ilOiO06>-HC0CCI-^i-H 

'-icoco'MaicO'-Hi-<cO'— I 

COCOOO'-HioOOICOfM 



CO 



r*(N »c ocCt 



.-HOOiT-iioeNOio 

lO W CO CVI Oi C<» '^ 



Th rH t- 



»-l l^ Ol QO rH i-H O 

CO Oi CO c^ t^ 



C-lOiOOCOCOioiOiO 
00 C^ COOOi— I CO 



t^o COOl 



rH (N -^ OS "-I i-l 00 
i-H 00 CN Ol CO 



OOQOiOOOCOOOCO 

r-ioOi-HiooQiOiO 
oT i-TirT'^ 



coco t^ '^ 



-rjl ^ ,-< '^ (M <0 
(M CO CO i-l<M CO 



CO CO-n» C7i 



lO CO i-H rH CO CO 



w-^-^t^t^ooc^co 



CS-^CS.COtCCO'-'CO 
■^ CO lO CI 



lOCO <»-HCOCO 



• tr^OiOl ■ .-i 



1* tfO CI O CO CO t 
<0 f-H O «0 Ci C-l 
CO ?l 00 'O 



1— ' cs coo 



COOCO(Ni-HiHOO»OCOi-lrHiOCO 
CO O •-( CI CI CO 



^^-^^c 






:— o' 






CO M oj Vj «/ CO «/ % «j ; 



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a.S 



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c o S r 2 



.2 a &•= j; a a ' 



248 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



Table III. — Summary of Physical Examinations made by Officers of the 
Public Health and Marine-Hospital Service during the Fiscal Year 
ended June 30, 1909, exclusive of alien immigrants. 



Summary of examinations and re- 
jections. 






i 

•s 




a oJ 

w 

3 


6 

Cm 

c3t3 




> 

CO 

m 

4 
3 


i 

a 



> 

CO 

c 

_o . 
be 

B 

a 


a 


•-.2 
m a 

'> 



i • 

*^ a 

I'i 

B 


1 

HI 

a 
p. 

i 




5,380 

4,985 

395 


1,071 

1,027 

44 


304 

333 

31 


1,437 

1,240 
197 


1,917 

1,855 

62 


114 
83 
31 


91 
90 

1 


36 
29 

7 


143 

142 

1 


132 
117 
15 


7 
7 


OS 


Number passed 


f)? 


Number rejected 


6 






Causes of rejection (disease, disa- 
bility, etc.). 

Abscess coccyx 


1 
1 
1 
4 
1 
5 
2 
1 
1 
1 
1 
1 
1 
1 

27 
1 
3 
1 
1 

10 

93 
2 
2 
1 
1 
1 
1 
2 
6 
4 
3 
4 
7 
3 
1 

17 

6 
2 
2 

7 
12 

18 

11 
8 








1 
















Acne 








1 














Albuminuria 






1 
2 
















Alcoholism 






1 




1 












Asthma 






1 










Bronchitis 




1 


2 
1 


1 


1 












Cachexia 












1 


Cancer lip 






1 
1 
















Cancer liver. . 






















Cataract 








1 














Catarrh 






1 
















Cerebral congestion 












1 










Cerebral hemorrhage 






1 
















Cicatrices 


-i9- 


1 


















Color blindness 


8 


















Conjunctivitis 


1 
















Curvature spine 






3 
















Cyst thigh 








1 














Defective hearing 








1 

1 

10 














Defective teeth. . . 






7 
38 
2 


1 

1 








1 
3 






Defective vision 


24 


16 










1 


Deformity 










Deformity of chest 






1 


1 














Deviation septum nose 






1 














Diabetis 






1 
















Enlargement inguinal ring 






1 
1 
2 
















Enlarged testicle 






















Enlarged tonsils 






















Fever 




1 












4 






Flat foot 


2 


"'""3' 

4 

1 


2 








Fracture elbow 


















Gastritis 






















General debility 




3 


2 
3 

1 
13 

1 
1 

1 
4 
10 

1 










1 






Gleet •. 














Goiter 






















Gonorrhea 






3 


4 














Heart: 

Abnormal action of 
















1 


Hypertrophy of 













1 








Mitral insufficiency 


...... 


1 
2 
















Mitral regurgitation 


















Valvular disease of 


2 
















Weakness of 




















Heat stroke 






















Hernia 




1 


11 


3 


3 










Hip joint, disease of 








1 










1 
3 


...... 


1 
1 












Hypertrophy of tonsils 


















Incontinence urine 


















Inflammation, ear 






1 
2 
1 
1 
1 
1 
















Inflammation, lymph glands groin . 




1 


















Influenza 








































Itch 






















Laryngitis 






















Locomotor ataxia 








1 














Malaria . . 






















Myopia 






4 


...... 

1 


1 












Nephritis 


















Nervous weakness 






















Paralysis 






















Paraphimosis 






1 
2 
8 
















Phimosis 






















Piles 






3 
















Pleurisy 




















Pneumonia 




1 


















Poor physique 


5 


2 


i 






:::::::::::: 





PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



249 



Table III. — Summary op Physical Examinations made by Officers of the 
Public Health and Marine-Hospital Service during the Fiscal Year 
ended June 30, 1909, exclusive of alien immigrants — Continued. 



Summary of examinations and re- 
jections. 


3 

o 


1 


i 

1 


> 


> 

a 6 
m 

k 

2 


o 

Oca 

03 o 

o 

O 


CO 

3 


S 

a 

03 

1 

s 

o 


> 

02 

a 
o . 


o 
O 

fc.a 


'3 
«d 

la o 

ag 


§ 

l-H 

.3 
p. 

1 


Causes of rejection {disease, disa- 
bility j eic.)— Continued. 


4 
5 
1 
1 
1 
1 

14 
1 
1 
1 

10 
1 
1 
3 
2 
5 
1 

19 
9 
1 
1 
1 




1 


4 


3 






























1 








1 
























1 






















1 




















1 
10 




















2 




1 
1 








1 


















Tonsillitis 
















1 












1 
5 
























1 
1 








3 




1 






















1 
2 






















1 
2 
5 


































































1 
4 




















14 
5 
1 


■""4" 












1 














































1 






















1 







































Table IV.- 



-Tabular Statement op Diseases and Injuries Treated during 
THE Year ended June 30, 1909. 





Number of cases. 


Disease. 


2S^ 

£ g 

.2^1 

Sxi p. 


(I. 

X) 03 

l.i 

< 


£ 

o 

a) 


13 


2 
0. 

a 


•a 


T3 

p 


.2^.- 

tr--g 

g c3 >. 

CO «, w 

a 05 


.2 

'Si 

s ft 


|3i 
-•as, 




1,040 

508 

1 


13,164 

5,260 

9 

1 

16 

35 


7,638 

2,872 
9 

""is" 

34 


4,618 

1,996 

1 
1 
2 


429 
161 


446 
223 


1,073 
516 


38,870 

14,569 

4 
109 
9 
4 
1 
1 
1 
1 
662 
3 

23 
3 
5 
9 

32 
5 

11 

(15 
3 

1,510 
88 


53,074 


General diseases . 


20,337 




14 










110 




2 






1 


27 




1 




39 


Rubella 








1 


Scarlet fever 




8 


5 


1 




1 


1 


9 






1 


















1 




6 
1 
2 
5 


220 


178 


38 

1 
5 


2 


3 


5 


888 




4 




32 
15 
2 
13 

398 

3 

1 

85 

9 

915 

IHS 

1 

.'iS 

1 

3 


29 
20 

9' 

.308 

3 

1 

49 

5 

780 
167 








57 










23 




1 

4 
45 




1 




7 






22 




50 


3 


52 


40 


480 




8 














12 


Dytfentery 


!) 


35 
3 

HO 
13 




2 


4 
1 

22 
"7 


155 


Beriberi 


12 


Malarial fever: 

Intermittent 


14 
9 


13 

7 

1 
1 


4 
3 


2,439 


ftemlttent 


285 




1 




1 


32 

1 
2 


5 
1 




1 


12 
3 
3 


51 




4 


Septicemia 














250 



PUBLIC HEALTH AND' MARINE-HOSPITAL SERVICE. 



Table IV. — Tabular Statement op Diseases and Injuries Treated during 
THE Year ended June 30, 1909 — Continued. 





Number of cases. 


Disease. 




H 

li 
< 


"6 

> 
o 


2 

1 


> 

2 
ft 
S 




73 

5 


■5—0 


'•3 
■^ >> 

<^ 13 

03 

is 


-1 


Tetanus 




1 

615 

40 
579 

11 
714 

75 

9 

8 
1 
9 
9 

9 
4 
4 
5 
1 
3 

1 

194 

117 

635 

1 

16 

2 

7 

1 

39 

42 








1 

116 






1 


Tubercle 


240 

5 
45 

1 
38 

2 


49 
2 

"'366' 

58 

4 

7 
1 
4 
5 

5 
2 
4 
4 

1 
2 

1 

158 

70 

395 

3' 

3 
3 
1 

29 

7 


374 

42 

559 

8 

315 

11 

5 


64 


252 

1 
45 

2 
58 

7 


177 

3,287 

42 

4,389 

339 

44 
12 


1,018 


Syphilis: 

Primary . 


222 


Secondary 


15 
2 
13 

1 


5 


3,911 


Tertiary 


54 


Gonorrhea . 


5,141 


Diseases dependent on animal par- 
asites 


416 


Diseases dependent on vegetable 
parasites 


53 


Effects of animal poisons: 






1 




20 


Pellagra 








1 


Effects of vegetable poisons 




4 
4 

3 
1 






1 


44 
5 

18 
11 
3 


53 










14 


Effects of the presence of foreign 
bodies 








1 


27 






1 




15 


Effects of heat 








7 


Effects of cold 




1 








6 














1 






1 








5 

2 

224 

45 

2,433 

8 

3 

37 

9 


8 


Effects of excessive exertions and 










3 




4 
4 
55 


33 
42 
245 

1 
6 


3 

3 

12 


2 
"■3' 


2 

6 

35 


422 


Rhenmatin fp.vp.r 


166 


Rheumatism 


3,123 


Gout 


9 


Osteoarthritis 




1 




^ 6 


19 


Cyst 


1 


40 




3 




1 




16 






1 


New growth, nonmalignant 

New growth, malignant 


2 
8 


7 
12 


1 

8 


1 
16 


3 

7 


118 

28 

1 

35 

1 


159 
78 




1 






10 
1 
3 

19 
1 
1 
5 

68 

1 

6 

5,652 


3 
2 


5 
1 

1 
14 


2 






45 


Idiopathic anaemia 


1 


1 




3 




3 


Diabetes mellitus 


1 


1 
1 


4 


1 


34 
4 
1 
8 
461 
9 
3 
19,341 


54 




5 










1 


i' 

6 


1 




2 
3 


4 
26 


2 
30 




15 


Debility 


5 


4 

1 


532 




10 






6 
3,243 






9 


Local diseases 


412 


1,953 


247 


198 


423 


25,405 






Diseases of the Nervous System. 
Of the nerves — 
Inflammation- 


114 

3 
5 


332 

34 
4 

8 
2 

3 
5 
29 

5 
4 


89 

17 

1 

2 
2 

2 
3 

1 


164 

15 
3 

2 
1 


41 


29 


123 

5 
2 

1 


1,044 

52 
5 

2 
2 

1 
2 
18 

6 

1 
2 


1,490 
89 


Multiple neuritis 

Of the spinal cord and mem- 
branes- 
Cord— 
Inflammation- 
Diffuse 


2 
1 


1 
2 


14 

10 




1 

1 
6 
16 

3 


6 


Degeneration— 




1 

'""i" 
5 


1 
4 
19 

3 


5 


Of lateral columns 

Of posterior columns . . . 
Of lateral and posterior 


2 
20 


2 
4 


13 
63 

14 


Of the brain and its mem- 
branes- 
Membranes- 
Inflammation— 


2 


2 




5 


Of pia mater and arach- 


1 


1 






3 


Hemorrhage 


2 






2 




2 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 



251 



Table IV. 



-Tabular Statement of Diseases and Injuries Treated during 
THE Year ended June 30, 1909 — Continued. 











Number of eases. 








Disease. 


a.t;.2 




■6 



13 


l-H 




ft 

s 




•6 

5 


•ill 
p 


■gg 

a ft 




Diseases op the Neevous Sys- 
tem — Continued. 
Of the brain and its mem branes— 
Continued. 
Brain— 
















3 

W 

3 


3 




1 

2 


6 
9 

2 

5 

3 
39 


i" 

3 


2 
7 
1 

1 


3 


...... 


2 
2 


7 




30 




5 


Functional nervous disorders 
with other diseases of unde- 
termined nature- 




3 


1 




5 


Paralysis— 


4 

16 

1 


4 
19 


3 
9 
1 

15 
4 
2 
2 

13 
9 


IC 




25 
1 
5 
4 
1 
2 


2 


9 


64 








9 
12 
3 
2 
2 
1 
1 
15 


1 

2 

1 

i" 


2 
3 

2 


"""i 


1 
8 


24 


Incomplete paralysis 


4 


2C 










4 












1£ 














IC 






1 
13 








] 










1 


29 
31 


44 










3] 






8 
2 
1 
1 

66 
2 

20 


6 

2 
1 


1 


1 






8 










189 


191 














] 








1 
6 






2 
398 

4 
180 
21 

4 
9 
1 






2 


32 
5' 


27 
2 
13 




3 


46f 




( 




1 


1 




2 


20 




2 


Mental diseases- 


10 

4 

26 


3 

6 

11 

1 

3 

3 

161 

42 

12 

17 

7 

1 

1 

4 

19 

1 

2 

30 

1 

4 


3 
1 








10 

4 

28 


1' 




4 
4 


1 
1 
1 

1 
3 
13 

2 


"""4' 


If 




3i 




] 


General paralysis of the in- 


3 
4 

8 

3 


'""69" 

26 
7 
3 
1 

1 


4 

1 
77 

17 
4 

14 
5 




1 
3 
10 


1 
1 

512 

90 
242 

21 
3 

11 
3 
3 
2 






i 




68 


Conjunctivitis— 


13 






1 


25 










3 










1 


1 










1 








1 
2 

1 
1 












"""ii" 


2 
4 








Ulceration of cornea 






3 


2 












1 

13 
...... 


1 

18 

1 
2 












2 






1 


29 
2 
2 
1 

1 
11 
1 


6 


















1 






1 


1 

2 
2 
1 






Atrophy and degeneration of 


2 
5 

1 
1 












I^enticular cataract 


2 


2 


1 




2 


1 












1 








Ambiyoiiia— 










8 
5 
2 
1 


























1 

1 
1 
2 

1 


i' 


1 


























1 
2 




















4 
2 










1 




Obstruction olnasal duct 















252 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 



Table IV.- 



-Tabular Statement op Diseases and Injuries Treated during 
THE Year ended June 30, 1909 — Continued. 











Number of cases. 










Disease. 


"■" o 2 
tcii •^, 

.- C3 3 

n.t:.2 
111 


-§.5 


> 

i 


■d 
B 


> 


ft 

s 


"7^ 


■d 
5 


a 
c 

g 


- 

ftO) 

So 

J3 


■5 

Is 

CSP. 


Total treated in 
hospital and 
dispensary. 


Diseases of the Eye— Continued. 
Blepharitis marginalis 




2 
2 
1 


2" 


2 








17 
37 
10 

2 

2 
300 

40 
3 
13 

106 

22 
85 

1 

9 

2. 

2 

8 

9 


19 


Sty.. . . 










39 






1 








11 












2 


CEdPina eyelid 




.- 1. . . . 












2 


Diseases of the Ear 


6 


^ 87 

4 
1 
2 

• 3 

2 
58 
12 

2 


45 
3 

i' 

3 

1 
24 
12 


44 

1 
1 

1 


3 


1 




393 


Inflammation of the external 
meatus— 
Acute 




44 


Chronic 










4 












15 


Accumulation in external me- 
atus of wax or epidermis 










109 


Inflammation of the middle 
ear— 
Nonsuppurative 




1 
37 








24 


Suppurative 


6 


2 


1 




149 






13 


Perforation of membrana tym- 




1 


1 






11 


Anchylosis of ossicles 








2 


















2 


Tinnitus 
















8 


Deafness 




1 

1 
1 

18 
6 


i" 

9 

2 


1 
1 








10 












1 














1 


Diseases of the Nose 


2 

1 


9 

4 


1 




1 
1 


629 
' 544 

3 

1 

2 
10 

3 

66 

391 
4 

2 

16 
178 

1 

7 
1 
6 
3 


649 


Inflammation of soft parts 

Inflammation of framework- 


551 






3 


Caries 
















1 


Diseases of septum- 




1 
4 

4 

3 

344 


1 
3 

3 
53 










3 






1 

1 

3 

208 








14 


Inflammation of the accessory 


1 


1 






8 


Inflammation of the naso-phar- 
ynx . . . 






69 


Diseases of the Circulatory 
System 


22 


16 


39 


50 


757 


Pericarditis . . . 


4 






2 

30 

143 

1 

10 
16 

2 
10 

1 

I 

16 
4 

10 
14 

2 

1 

11 

64 

2 

716 

1 


3' 

i" 

....... 

1 
e" 

40 

2 

391 


1 

27 
93 

1 

5 

7 
2 

7' 

1 

2 
2 
12 
2 

9 
10 

1 

1 

4 

21 


.....^. 


1 

2 

28 




4 


Valvular disease — 
Aortic 


2 
13 


3 

25 


48 


Mitral 


334 




2 


Degeneration of heart- 
Fatty 






2 
1 




3 

7 


17 






17 








8 


Dilatation of heart .. 






1 


2 


13 






1 


Disordered action of the heart- 










1 


3 

6 
21 
22 

4 
4 

1 


6 










8 






2 
2 

...... 


1 


1 


37 






26 


Degeneration of arteries— 

Arterio-capillary fibrosis 


2 

1 


2 

1 


1 
3 


16 
19 


Obstruction of arteries- 


3 








1 


Phlebitis 










1 
. 3 


4 

99 

9 

2,516 

7 

74 


15 




4 


4 




167 






11 


Diseases of the Respiratory Sys- 
tem 


23 


245 

1 


29 


44 


30 


3,255 




8 


Tracheitis 








74 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



253 



Table IV. — Tabular Statement op Diseases and Injuries Treated during 
THE Year ended June 30, 1909 — Continued. 





Number of cases. 


Disease. 


Remain i n g i n 
hospital from 
previous year. 


^4 

1.1 


> 
o 


'6 

> 


U4 

S 


-d 

? 

2 

a 



73 

5 


a °3 


-5 
ts P. 


d-d 
— a 

*-•- S 

-&» 
J 0.2 


Diseases of the Respiratory 
System— Continued. 
Inflammation of mucous mem- 
brane of larynx— 


1 


20 


7 


14 








78 
40 
3 

1,849 

209 

84 

38 

4 
7 
2 


99 


Catarrhal, chronic 








40 


















3 


Bronchitis — 


8 
4 

4 


272 
60 
52 
3 

5 

138 

12 

,1 

2 
4 
3 

124 
10 
2 
1 
6 
1,460 


185 
7 
16 
3 

2 

80 

4 

82 
4 
1 


85 
42 
32 


8 

7 
1 


2 


2 
6 
5 


2,120 
273 






140 


Congestion of lung 


41 


Hemorrhage of lung— 




2 
17 

7 

1 

1 

2 
1 

29 
6 






1 
7 
1 


9 




1 


2 


33 


146 


Broncho-pneumonia 


14 


Chronic interstitial inflamma- 








1 


Phthisis— 


3 

2 


3 

4 
2 

2 




1 


10 
6 
2 

102 
5 


15 




12 


Tubercular 






5 


Pleurisy- 




4 


7 


226 


Chronic 




15 








1 
1 
1 

45 




2 


Dilatation bronchi 








""""69" 


2 
3 

6,505 
7 
6 
60 
18 
4 
7 
114 
7 

6 
43 

17 

28 
9 
5 

92 
4 
1 
4 

14 
226 

405 
15 
12 
8 
7 
2 

ISl 
2 
3 
1 
4 
2 


3 






"'999' 


5 
337 


""78" 


9 


DiSE asesof the Digestive System . 
Inflammation of the lips 


68 


8,033 

7 


Ulceration of the lips 




1 

4 
1 


3" 


1 

1 
1 








7 


Inflammation of the mouth 










64 


Ulceration of the mouth 










19 


Inflammation of the dental pulp. 










4 


Suppuration of the dental pulp. 
















7 


Caries of dentine and cementum . 




5 


4 


1 








119 


Necrosis of cementum 










7 


Inflammation of dental perios- 




2 
10 

1 
2 
1 


2 
8 

i" 










8 


Abscess of dental periosteum. . . 




1 

1 
1 
1 


1 






53 


Inflammation of gums and 
alveoli 








18 












30 


Ulceration of gums and alveoli.. 










10 












5 


Toothache 
















92 


Necrosis alveoli 




2 




1 


1 






6 


Malposition teeth 








1 


Inflammation of the tongue 
















4 


Ulceration of the tongue 




3 
10 

121 
29 
7 
1 
1 
1 

17 

2 


1 

8 

110 
24 
6 
1 
1 
1 

11 
2 


i' 

12 
5 
1 


2 






17 


Sore throat 




1 
1 


1 


236 


Inflammation of tonsils- 


3 


529 


Suppuration 


44 


Ilypertrophy of tonsils 










19 


Elongated uvula 










9 


Inflammation of salivary glands. 












8 


Salivation 












3 


Ind'imination of the pharynx— 
C;atarrhal 




5 






1 


198 


Granular 








4 














3 


Fistula, inte.stines 




4 


3 


1 








5 


Ulceration of pharynx 










4 


Strifrtiirc-, r('/;tiiin 




4 

177 


04 


1 
3 

73 


...... 

fi 


1 
1 

3 


2 


6 


Htriftturn, </;sophagus . . . 




s 


Inflammation of the stomach — 
Caturrhal 


7 


H 


536 
9 

16 


720 


M(;n]l;ranoij.s or peiHoular.. . 


9 


Ulceration of the .stomach— 
SuiKirficial 


I 


4 

1 


2 


3 








21 


Perforating 




1 




1 



254 



PUBLIC HEALTH AND MAEIKE-HOSPITAL SERVICE. 



Table IV. — Tabular Statement of Diseases and Injuries Treated during 
THE Year ended June 30, 1909 — Continued. 





Number of cases. 


Disease. 


Remaining in 
hospital from 
previous year. 


til 

4) 

< 


> 
o 

s 


2 
ft 
B 


■d 


ft 

a 

1 


-2 
5 


tf.-S 


■w >. 

03 t- 

C3 

|g 
^ft 

Eh 


•- a 
p. 


Diseases of the Digestive Sys- 
tem— Continued . 
Hemorrhage of the stomach 




3 
3 

102 

8 


3 

"'""83' 
1 
1 
5 










5 

4 

1,387 

8 

6 

24 

39 


s 


Dilatation of the stomach 


1 
3 


3 

17 






1 
4 


8 




1 




1 492 


Pyrosis 


9 


Vomiting 












7 






3 








32 


Loss of appetite 










39 


Stricture, pilorus 




51 

118 

11 

9 

3 

2 

5 

238 

3 

4 

45 

8 

118 

2 

4 








1 

3 
1 
1 




1 


Inflammation of the intestines — 
Enteritis . ... 


5 

7 


34 

83 

3 

6 

2 

4 

181 

i' 

41 

4 

98 

2 


13 

25 
4 
4 
1 
1 
1 

27 
1 
1 
3 
3 

20 
1 
3 


4 
7 
1 
1 


2 
9 
2 


55 

53 

13 

45 

6 

5 

7 

507 

1 

31 

1,263 

46- 

460 

4 

6 

11 

5 

9 

38 

1 


111 


Typhlitis 


178 




24 




2 


56 


Ulceration of the intestines 






9 


Hemorrhage, intestines 




1 






7 










12 


Hernia . ** ... 


10 


22 


3 

2 


15 
2' 


755 


Obstruction of the intestines 


4 


Intestinal dyspepsia 




35 


Constipation 


1 
1 

4 


2 




1 309 


Colic 


1 
2 
1 


1 
2 


55 


Diarrhea 


582 




6 


Inflammation of the rectum 


1 
1 


11 


Periproctitis 


1 






12 




26 
4 
46 
2 
1 
33 
41 
44 
2 
7 

2 

2 

22 

26 

1 


16 
1 

27 
2 


8 
2 
16 




2 

1 
- 4 


31 


Fissure of the anus 








13 


Fistula in ano 


6 


5 




90 


Prolapse of the rectum 


3 


Fistula, gall bladder 






1 
1 
3 
3 






1 


Piles, internal 


2 
1 
3 


18 
28 
34 


13 
10 
10 




3 

1 


180 
82 
32 
21 
35 

1 


215 




124 




79 


Pruritus ani . ... 


2 


3 


23 


Inflammation of the liver, acute. 

Inflammation of the liver, acute 

suppuration 


1 


1 
----- 


2 

1 

1 

11 
2 


2 
1 
1 
5 


43 
3 


Inflammation of the liver, acute 


1 


1 

6 
2 
1 




3 


Inflammation of the liver, 
, chronic 


i' 


12 

146 

2 

9 
33 

15 
6 

14 
2 
1 


34 






172 






3 


Hypertrophy of the liver 










9 






18 

18 
2 
1 
3 
1 
1 
1 


10 

7 


7 
6 






1 
2 


51 


Inflammation of hepatic ducts 
and gall I^ladder . 


3 


3 

1 


3 
1 


36 


Calculi 


8 








1 


15 


Inflammation of theperitona3um 
Dropsy 


1 

2 




3 
1 
1 
1 


1 


6 




2 




4 




1 


Perforation, intestines 














1 




1 
28 






1 

7 






1 


Diseases of the Lymphatic Sys- 
tem 


428 


309 


116 




24 


348 

8 

106 

213 

8 

13 


804 


Atrophy of spleen 


8 


Inflammation of lymph glands. . 
Suppuration 


24 
4 


6 

404 
4 

13 
1 

4 
4 

1 

1 
206 
24 


23 

274 

1 

11 


7 

106 

2 

1 








136 


5 
1 




23 


621 




12 


Inflammation of lymphatics- 
Suppuration 






1 


26 






1 




1 


Diseases of the Thyeoid Body 




""'49' 
5 


4 
4 

1 

1 

121 

15 






6 
6 

1 

1 

540 

18 


10 












10 


Diseases of the Suprarenal Cap- 
sules 










2 












2 


Diseases of the Urinary System. 
Acute nephritis 


16 
3 


8 


27 
3 


17 
4 


762 
45 



PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE. 



255 



Table IV.- 



-Tarular Statement op Diseases and Injuries Treated during 
THE Year ended June 30, 1909 — Continued. 





Number of cases. 


Disease. 


1^ 6 !s 
set; t» 
"■a 3 

a o s 
^^ ft 


k 

-a .a 


> 
O 

o 


o 

a 

h- 1 


> 
2 
ft 

a 

o 


•d 

5 


TO «j m 


5ft 




Diseases of the Urinary Sys- 
tem— Continued. 
Brighit's disease — 


6 
2 


86 
7 
1 
1 
8 

4 


4 


59 
5 


3 
1 
1 


19 

1 


7 
2 


112 

28 

1 


204 


Granular iiidney 


37 




2 






1 
2 

1- 








1 






4 

i' 


1 


2 
1 


1 


5 

i" 

2 
1 
9 
3 
3 
8 
19 
6 

209 
19 
28 

1 
40 

6 
21 

2,078 

93 

32 

5 

245 
1 
8 
3 


13 


Abscess — 

Oflcidney 




4 




1 


2 














2 






2 
4 
2 
2 
3 


1 
2 
2 

} 


I 








3 












13 












5 






1 
2 








5 












11 












19 


















6 


Inflammation of bladder- 




43 

8 
3 

2 
4 
1 

1 

860 
1 


25 
1 

2 

i" 

545 


15 
6 
5 
2 
2 
1 






3 


25? 






1 
1 




27 




4 


1 




35 




3 


Irritability of bladder 










44 












7 












22 


Diseases of the Generative Sys- 


64 


304 
1 


26 


8 


41 


3,002 




94 


Gleet 










32 






2 

108 
2 
3 

7 


1 
51 

2 

4 


1 

SO 

1 








7 


Stricture of urethra— 


9 


7 


3 


6 

1 
1 
3 


362 




3 










11 


Urethral fistula 


2 
1 


2 
1 
1 

1 
1 






12 








1 




2 

1 
1 


1 










2 


Inflammation of the prostate — 










3 

8 

3 
32 

9 
32 

8 

28 
14 

266 
11 

884 


4 












9 












3 


Hypertrophy of the prostate 


3 


1 
61 
9 

4 


6 

2 
48 
8 

2 


10 


2 


3 




53 
11 




4 


12 
2 


3 

1 




2 


97 




17 


Inflammation of the penis — 
Of the glans 








32 












14 




4 


83 
5 

269 

1 


49 

4 

160 

1 


32 

1 

123 


1 




5 


3.53 




16 


Soft chancre 


31 


2 




15 


1,184 
1 














9 

5 

3 
14 

3 
104 
34 

137 

9 

22 

4 

21 
14 


9 






3 


2 


1 








5 












5 


Inflammation of the spermatic 




3 

10 


3 

10 










6 


Hydr(x;cleof thespormaticcord . 
Ua;inat<x;ele of tne spermatic 


1 


6 


1 






31 






3 






.53 
38 

122 
3 

;io 

3 


44 
29 

07 
■■■■-■ 

2 


4 
7 

29 
3 

1 


3 
1 

2 




2 
1 


157 


IJydrfXj'iieoftunicavaKinalis 

Inflitinmation of the testicle — 
Acute orchitis 


1 

7 


73 
266 




12 


Epididymitis 


1 


3 


1 


1 


63 




7 












21 


















14 


Congenllaliy hidden penis 




i 








i 




1 



256 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



Table IV.-Tabular Statement of Diseases and Injuries Treated mrpTMr^ 
THE Year ended June 30, 1909-Continuefl. '''''^'''=" ^^^«^n« 



Disease. 



Diseases of the Generative 
System— Continued . 
Inflammation of the ovary 
Inflammation of tlie fallopian 

tube __ 

Displacements and distortions 

of the uterus 

Amenorrhcea 

Dysmenorrhoea ' 

Diseases of the Organs of Loco- 
motion 

Inflammation of the bones—' 

Osteitis 

Periostitis 

Caries 

Necrosis 

Inflammation of joints— 

Acute synovitis 

Chronic synovitis 

Suppuration 

Ankylosis 

Dislocation of articular'c'artiiage 

Loose body in joint 

Atrophy muscles 

Necrosis rib "" 

Dislocation spine 

Inflammation spine 

Caries of the spine 

Necrosis of the spine ] 

Psoas, lumbar and other "al> 

scGsses 

Posterior curvature" "of " spine" ' 

angular 

Lateral curvature of spine 

Anterior curvature of spine 

Inflammation of muscles 

Suppuration of muscles. 

Myalgia 

Lumbai,'o... 

StiUncck 

Inflammation of fasciaj. 
Contracture of fasci se . . 
Inflammation of tendons 
Adhesion of tendons 
Contraction of tendons. 
Inflammation of sheaths of ten- 
dons 

Thecal abscess 

Ganglion '_'_ 

Inflammation of burs^'— 

Acute 

Chronic 

Abscess of bursa " 

Bunion 

Flat foot .'."."."."."."."." 

Diseases of the Connective Tis- 
sue 

Inflammation 

Abscess 

Gangrene 

(Edema 

Obesity 

Diseases of the Skin.. 

Erythema [[ 

Urticaria 

Prickly heat j 

Eczema t 

Impetigo 

Pityriasis rubra 

Prurigro ,... | 



Number of cases. 



'^ o ^ 

w)4s Si, 

— ca 3 
d.ti <= 

<^ eft J^ 

aXi ft 



S '^ 



165 

A 

4 
13 

18 
7 



110 



103 
1 



- 03 C 



1 
6 

6 
4 
2 

11 
2 
6 
1 
5 

324 

138 

180 

3 

3 



422 
5 

24 



.... 



4 
1 
3 

234 
90 

140 
3 
1 



286 

4 

23 



131 
1 
1 

"'is 



3 
5 
2 

1,291 

9 
15 

5 
10 

63 
14 
1 
5 
4 
2 



9 
6 
367 
659 
1 
1 
2 
7 



31 

2 

5 

12 

24 

841 

324 

505 

7 

4 

1 

2,339 

20 

90 

39 

445 

18 

5 

11 I 



•^ a 

q; w 52 
■" g <u 

^ M. Q, 



115 
29 
1 
9 
6 
2 
1 
1 
1 
1 
1 
1 



2 

3 

1 

10 

8 

375 

771 

2 

5 

3 

7 

1 

9 



42 
4 
11 
13 
29 

1,179 

465 

696 

10 

7 

1 

2,782 

25 

114 

39 

492 

22 

5 

13 



PUBLIC HEALTH AND MARINE-HOSPITAL SEEVICE. 



257 



Table IV.- 



-Tabular Statement op Diseases and Injuries Treated during 
THE Year ended June 30, 1909 — Continued. 





Number of cases. 


Disease. 


Remaining in 
hospital from 
previous year. 




■6 
> 


i 
> 
s 
p. 
a 


1 

P. 

a 


tt) 

s 




la Q 


PI -a 
-" a . 


Diseases of the Skin— Cont'd. 




1 

6 
10 
8 
1 
6 


1 

4 
10 
5 
1 

1 










3 

44 
97 
39 

19 

99 

18 

5 

4 

2 

1 

4 

507 

583 

86 

74 

48 

27 


4 




1 


3 








51 










107 






1 


1 




1 


47 






20 






4 






1 


105 










18 














.. 1 


5 
















4 














1 


2 


















1 


Chilblain 




2 

170 

67 

30 

9 

16 

3 

1 

7 


"'"'98' 

66 

20 

7 

14 
3 
1 
6 


2 
74 
9 
9 
2 
2 
1 








6 


Ulcer 


16 
2 


2 
1 


1 


11 

3 
1 


693 


Boil 


652 




116 


Whitlow 








83 












64 




1 








31 


Cheloid 








1 


Wen 




1 








9 

7 
27 
1 
3 
4 

4,960 

192 

138 
9 

is' 

4 
12 
10 


16 












7 






1 
1 
1 
1 

2,252 

108 

67 
15 
2 
1 

2 
18 
2 
1 

"2,ui' 




1 








28 










1 


2 






1 

1,523 

70 

44 

11 

1 

2 
9 
1 
1 
1 
1,453 








4 


Rhinoscleroma 




1 
669 

29 

18 
2 








5 




120 

8 

3 
2 


21 

3 


25 

5 

4 
1 


134 

9 
4 

i' 


7,332 


General Injxjeies 


308 


Effects of heat- 
Burns and scalds 


208 


Heat strolie 


26 


Sunstroke 


2 


Effects of cold 




1 






16 


Effects of chemical irritants 
and corrosives 










6 


Multiple injury 


2 


7 
1 






4 


32 








12 


Exhaustion 










1 


Shock 


1 

112 










4 

4,768 

2 

i' 

13 
71 
3 


5 


Local Injuries 


640 


18 


20 


125 


r.024 


Contusion of nerves 


2 


Wound of nerves 




1 
1 
2 
9 
2 
1 
2 










1 


1 


Contusion of internal viscera . . . 




i' 

6 
2 
1 
2 


1 

1 
3 






2 


Contusion of muscles 










15 


Strain of muscles 










80 


Rupture of muscles 










5 


Wound of muscle 












1 


Strain of tendons 












3 
6 
5 
14 
73 
30 
191 
15 

14 


5 


Rupture of tendons 












6 


Wound of tendons 


: 












5 


Contusion of skin 




4 
3 
2 
67 
5 


2 

■■■■-■ 
3 


2 
3 

2 

22 

2 








18 


Abrasion of skin 










76 


Wound of skin 










32 


Bum or scald of skin 


7 






5 


265 


Frostbite 






20 


Effects on the skin of irritants or 
corrosives 










14 


Contusion of mucous membrane. 





1 


1 










1 


Abrasion of mucous membrane. . 










3 

10 

2 

14 

181 

3 

2 


3 


Burn or scald of mucous mem- 
brane 




4 


2 


2 








14 


Effects on the mucous mem- 
brane of irritants or corrosives. 










2 


Contu.sion of scalp 




9 

93 

2 

9 


7 

64 

1 

3 


1 

26 

1 

1 






1 
6 


23 


Wound of scalp 


3 






277 


Contu.sion of skull 






5 


Fracture of tiie vault of skull . . . 


i 




4 


2 


12 



I8r)4f;— 10- 



-17 



258 



PUBLIC HEALTH AND MAEINE-HOSPITAL SERVICE. 



Table IV. — Tabular Statement of Diseases and Injuries Treated during 
THE Year ended June 30, 1909 — Continued. 



Disease. 



Local Injuries — Continued. 

Fracture of the base of skull 

Wound of skull 

Concussion of brain 

Contusion of face 

Wound of face and mouth 

Foreign bodies in the nose, an- 
trum, or other cavities 

Fracture of facial bones 

Dislocation of nasal cartilages. . . 

Contusion of eyelid 

Wound of eyelid 

Wound of conjunctiva 

Contusion of eyeball 

Foreign bodies in the conjunc- 
tiva or cornea 

Foreign bodies in the eyeball . . . 

Wound of eyeball 

Contusion of pinna 

Wound of pinna 

Rupture of membrana tympani. 

Foreign body in external 
meatus 

Contusion of neck 

Wound of neck 

Foreign body in the food pas- 
sages 

Gunshot wound 

Contusion of chest 

Dislocation of costal cartilages. . . 

Fracture of ribs 

Wound of parietes of chest 

Penetrating wound of pleura or 
lung 

Contusion of back 

Sprain of back 

Wound of back 

Fracture of spine 

Concussion of cord 

Contusion of abdomen 

Wound of parietes of abdomen. . 

Contusion of the pelvis 

Contusion of the perinseum, 
scrotum, or penis 

Wound of the male urethra, 
periniBimi, scrotum, testis, or 
penis 

Rupture of urethra 

Foreign body in the rectum 

Fracture or dislocation of pelvic 
bones 

Fracture spine, with displace- 
ment 

Contusion of testicle 

Contusion of upper extremities . 

Sprain of shoulder 

Sprain of elbow 

Sprain of wrist 

Sprain of hand 

Sprain of thumb 

Sprain of fingers 

Wound of upper extremities 

Wound of joint, upper extremi- 
ties 

Fracture of clavicle 

Fracture of scapula 

Fracture of humerus 

Fracture of bones of forearm- 
Radius 

Ulna 

Both bones 



Number of cases. 



fl.t;.2 



<1 



24 



100 

1 
9 
1 
10 



S°2 



c3 Pi 



5 

367 

78 

9 

128 

14 

19 

8 

1,377 



2 
56 
140 

7 
14 

1 

18 
16 

2 
10 

123 
5 
3 
3 
13 
2 

4- 

i 
10 

4 
3 
140 
3 
70 
2 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



259 



Table IV.- 



-Tabular Statement of Diseases and Injuries Treated 
THE Year ended June 30, 1909 — Continued. 





Number of cases. 


Disease. 


Remaining in 
hospital from 
previous year. 


ll 

< 




1 

1 


■d 

1 

1 
o 


5 


Mr- la 

■SftO 
■^ M s 




•SI. 


Local Injuhies— Continued. 

Fracture of carpus, metacarpus, 


2 


28 
6 

27 
4 

1 

3 

1 


13 
3 

17 
3 

1 

2 


15 
3 

11 
1 






2 


54 
3 

13 
3 

1 

1 


84 








9 




1 
1 








41 








1 


8 


Dislocation of phalanges of 






2 


Dislocation of phalanges of fin- 






1 






4 






1 




1 














9 
347 
27 
25 
174 
11 


9 


Contusion of lower extremities. . 


7 
3 
1 

4 

1 


216 
6 
14 

139 
8 
2 

302 

6 

26 
1 

7 
26 
26 
75 

5 
16 

4 
1 


162 
6 
12 
96 
4 
1 
236 

3 
10 

i 

19 
15 

53 

3 
10 
4 
1 


53 
2 
3 

37 
5 
1 

58 

3 
9 

1 
3 
4 
8 
20 

3 
6 


3 




5 
1 


570 
36 








40 


Sprain of ankle . . .... 






10 


317 








20 


Internal derangement of joints. . 








2 


Wound of lower extremities 

Wound of joint, lower e.xtremi- 
ties 


12 


1 


2 


17 


425 

9 

4 


739 
15 




4 
1 
1 
3 
1 
10 

1 
3 
1 






11 


34 


Fracture of cervix femoris 


1 




2 






1 
5 
4 
11 


2 
6 
9 

4 

3 
4 
1 


10 


Fracture of tibia . . 


1 




35 




36 


Fracture of tibia and fibula 

Fracture of bones of foot— 

Of the tarsus 




1 


89 
9 


Of the metatarsus . . . 


1 




2 

1 


23 


Of the phalanges of the toes. 


6 


Dislocation of patella 








1 


Dislocation of tibia 












2 


2 


Dislocation of foot 




2 

1 
3 


1 

1 
1 








1 


2 


2 


Dislocation of metatarsus and 
phalanges 










3 


Amputation, toes 


1 


2 




1 




4 











Table V. 



-Comparative Exhibit — Ratio op Deaths prom Specific Causes, 
1900-1909. 





Gen- 






















Deaths from— 


eral 
aver- 
age. 


1900. 


1901. 


1902. 


1903. 


1904. 


1905. 


1906. 


1907. 


1908. 


1909. 


General diseases 

Diseases of the— 

Nervous system 

Circulatory system . 
Respiratory system. 
Digestive system... 
Genito-urinary sys- 
tem 


48.32 

5.98 
10. 76 
12.08 

6.94 

6.84 
6.68 
2.39 


44.02 

3.62 
9.71 
15. 12 
9.70 

9.03 
6.32 
2.48 


45.60 

8.78 
n.87 
13.53 

6.65 

5.70 
5.22 
2.61 


44.01 

7.29 
12. 23 
13.54 

7.55 

4.94 
7.55 
2.86 


48.06 

5.36 
10.72 
11.64 

7.39 

6.65 
6.47 
3.71 


49.49 

5.30 
8.76 
14.66 
7.33 

6.72 
6.09 
2.65 


53.46 

6.32 
11.88 
8.81 
4.79 

5.74 
7.09 
1.91 


51.52 

4.87 
11.16 
9.13 
5.88 

6.09 
9.13 
2.22 


52.17 

6.72 
10.47 
11.06 

5.34 

5.54 
7.12 
1.58 


44.92 

5.06 
12.06 
13.42 

4.67 

10.13 
7.20 
2.54 


50.00 

6.51 
8.74 
9.87 
10.08 

7.85 


Injuries . 


5 61 


From all other causes. . . 


1.34 



260 



PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 



Table VI. — Nativities of Patients Treated in Hospital During the Fiscal 
Year Ended June 30, 1909. 



Country. 



Total 

Alaska 

Australia 

Austria 

Belgium 

Canada 

Cape Verde Islands 

Chile 

Chiina 

Cuba 

Denmark 

England 

Finland 

France 

Germany 

Greece 

Hawaii 

Ireland 




6 
37 

137 
30 

401 

85 

27 

22 

4 

238 

483 

356 
70 

946 
78 
31 

716 



Country. 



Number. 



Italy I 58 

Japan ! 33 

Mexico ' 11 

Netherlands 45 

Newfoundland 80 

Norway 1,023 

Philippines 16 

Porto Rico - 26 

Portugal 80 

Russia 119 

Scotland 198 

Spain 185 

Sweden 741 

Switzerland 24 

Turkey 14 

United States 7. 578 

Wales 22 

West Indies 120 

Other countries 164 



Table VII. — Surgical Operations, Fiscal Year 1909. 



Operations. 




Total number of operations. 

TxjMORs: Excision of 



Adenoma, breast 
Angioma, arm . . . 

Carcinoma 

Cystic tumor 

EpitheUoma 

Fibroma 

Hsemangioma 

Keloid 

Lipoma 

Papilloma 

Sarcoma 

Gumma 



Cysts: Excision of. 



Sebaceous 

Dermoid... 

Cyst of epididjrmis . 



FoEEiGN Bodies: Removal of. 



From — 

Connective tissue. 

Cornea 

Foot 

Heel 

Rectum 

Hand 



Abscesses: Incision and drainage. 



Connective tissue of — 

Axilla 

Back 

Buttock 

Chest 

Dental periosteum . 
Elbow, tubercular . 

Face 

Hip 

Ischio-rectal fossa. . 

Lumbar region 

Lower extremity . . 

Neck 

Parasternal 

Penis 



1,568 



42 



26 




146 



Operations. 



Abscesses— Continued. 

Connective tissue of — Continued. 

Perineum 

Perirectal 

Perirenal 

Peritonsilar 

Periurethral 

Psoas 

Scrotum : 

Upper extremity 

Bursa 

Cowper's gland 

Liver 

Muscle 

Parotid gland 

Prostate 

Testicle 

Blood Vessels 

Arteries — ligation of 

Veins — for varix— 

Phlebotomy 

Phlebectomy 

Schede's operation 

Nekves: Suture after injury— musculo- 
spiral 

Lymphatic Glands 

Incision and drainage of — 

Axillary 

Inguinal 

Submaxillary 

Suprapubic 

Enucleation of— 

Axillary 

Cervical 

Inguinal 

Excision for Hodgkin's disease — cervi- 
cal 

Sken and Subcut.ineous Tissue 

Incision and drainage for — 

Inflammation 

Cellulitis 

Curretting ulcers 



Num- 
ber of 
cases. 



1 
164 



2 

105 

1 

1 

1 

8 
45 

1 

85 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 261 

Table VII. — Surgical Operations, Fiscal Year 1909 — Continued. 



Operations. 



Skin AND subcutaneous tissue— Cont'd 
Excision of — 

Ulcers 

Scar tissue 

Blastomycosis 

Operations for onychia 

Skin-grafting for— 

Chronic ulcer 

Deformity of penis 

Suture and dressing for woimd of— 

Body 

Face 

Lower extremity 

Scalp 

Upper extremity 

Tbachea: Tracheotomy 



Bones. 



Simple fracture- 
Reduction, splints, or extension- 

Acromion process 

Base of skull 

Clavicle 

Femur 

Fibula (Pott's) 

Humerus 

Maxilla, inferior 

Metacarpal 

Metatarsal 

Nasal 

Radius (Colles) 

Radius and ulnar 

Ribs 

Tibia 

Tibia and fibula 

Ulna 

Bone exposed and wired— 

Clavicle 

Femur 

Maxilla, inferior 

Patella 

Tibia and fibula 

Compound fracture — 

Reduction, wiring, splints— 

Humerus 

Nasal 

Patella 

Radius and ulna 

Rib ; ; 

Tibia and fibula 

Ulna ; . 

Nonunion — 

Wiring and splints- 
Femur 

Radius 

Tibia 

Ulna ;;;;;; 

Refractured and reset for deformity- 
Tibia and fibula 

Resection or currettage of portion of 
bone for disease, necrosis, or injury- 
Femur 

Foot ;;;;; 

Frontal bone 

Maxilla, inferior 

Metatarsal 

Os caleis 

Phalanges ' 

Radius 

Ribs '.y.'.'.'.'.'.'.'.' 

Sternum 

Tibia 

Ulna ■ ■■ 



K 



xploratory osteotomy— Tibia— gim- 
Hnot 



Incision and drainage— 
Absf;css pcrio.steum- 

Tlbia 

Ulna 



Num- 
ber of 
cases. 



Operations. 



Joints. 



Reduction of dislocation — 

Elbow 

Phalanges " 

Semilunar cartilage 

Shoulder 

Arthrotomy — 

Elbow 

Knee 

Shoulder .._, 

Arthrectomy, for — 

Tuberculosis of hip 

Tuberculosis of knee 

Halux valgus 

Arthrotomy and removal of semilunar 
cartilage 



Num- 
ber of 
eases. 



Muscles, Tendons, and Fascia. 



Tenorrhaphy 

Lengthening tendons- 
Flexors of hand 

Flexors of foot 

Flexors of fingers 

Incisions of fascia for Dupuytren's 
contracture 



Amputations. 



For disease or injury of- 

Fingers 

Foot 

Leg 

Thigh 

Toes 

Shoulder 

Forearm 



Skull. 



Trephining 

Opening mastoid cells 

Opening frontal sinus 

Opening maxillary sinus. 
Explqj-atory craniotomy. 
Curretting necrosed bone. 
Fracture 



Spine and Spinal Cord. 



Laminectomy 

Correction of kyphosis 

Lumbar puncture for diagnosis. 



Face, Nasal CAVArtES, and Mouth . 



Excision of— 

Lacrymal sac 

Nasal septum 

Nasal pollypi. . . . 

Portion of auricle . 

Ranula 

Tonsils 

Uvula 

Extraction of teeth . . . 



Eye. 



Extraction of lens 

Suture wound, eyeball 

Enucleation of eyeball for— 

Injury 

Glaucoma 

Syphililis keratitis 

Openil ion for ectropion 

Excision of plerygiMni 

Iridotomy 

Aspiration subconjunctival cyst. 



27 



262 PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 

Table VII. — Surgical Operations, Fiscal Year 1909 — Continued. 



Operations. 



Thorax 

Thoracentesis 

Resection of rib 

Abdomen 

Paracentesis abdominalis 

Excision post-operative scar 

Abdominal section for — 

Appendectomy, closure 

Appendectomy, drainage 

Appendicostomy 

Volvulus 

Epiplopexy (Talma) 

Enterorrhophy for— 

Gunshot wound, intestine . . . 

Stab wound, intestines 

Typhoid perforation 

Cholecystotoray 

Choledochotomy 

Gastro jejunostomy 

Freeing adhesions 

Drainage 

Exploration 

Closing fistula 

Gastrostomy 

Herniotomy— 
Inguinal — 

Bassini 

Halsted 

Ferguson 

Andrews 

Rectus transplantation 

Strangulated inguinal 

Femoral 

Post-operative 

Umbilical 

Ventral 

Rectum and Anus 

Operations for — 
Hemorrhoids — 
Internal- 
Clamp and cautery 

Ligature and excision 

External- 
Clamp and cautery 

Ligature and excision 

Incision and packing 

Whitehead method 

Mixed — 

Clamp and cautery 

Ligature and excision 

Stricture of rectum— dilatation. . . 
Ulcer of rectum— resection portion 

rectum 

Anal fissure — incision 

Fistulo in ano — 

Incision : 

Excision 

Bladder 

External perineal urethrotomy 

Dilatation for retention 

Urethra 

Operations for — 
Stricture — 

Gradual dilatation 



Num- 
ber of 
cases. 



311 



152 
10 
12 
1 
1 
7 
2 
3 
3 
4 



122 



Operations. 



Urethra— Continued. 

Operations for— Continued. 
Stricture— Continued. 

Internal urethrotomy 

External urethrotomy 

Suprapubic cystostomy 

Perineal section 

Rupture or abscess— perineal sec- 
tion , 

Urinary fistula — perineal section. 

Male Organs of Generation 

Operations on penis- 
Circumcision for — 

Phimosis 

Herpes preputialis 

Primary syphilis 

Soft chancre 

Dorsal incision for — phimosis or 

soft chancre 

Amputation for — 

Malignant disease 

Gangrene (partial) 

Cauterization for — ulcer 

Incision and drainage for — ab- 
scess 

Plastic operation for — malforma- 
tion 

Operations for varicocele — 

Phlebotomy 

Phlebectomy 

Operations for hydrocele — 

Excision of sac 

Tapping 

Incision 

Castration 

Operations on spermatic <;ord — ex- 
cision 

Operations on scrotum — 
Excision of— 

Cyst 

Epididymis 

Operations on testicle — 
Castration for— 

Cyst 

Tuberculosis 

Undescended testicle 

Incision and drainage, for — abscess 
Partial resection, for — tuberculosis 
Operations on prostate- 
Incision and drainage— for abscess 
Dilation for — hypertrophy 

Female Organs of Generation: 

Salpingectomy 

Carbuncles: Incision and drainage 

Gunshot Wounds of: 

Finger 

Abdomen 

Toe 

Tibia 

Spinal cord 

Operations for Gangrene: 
Amputation of— 

Finger 

Arm 

Foot 

Operation for Hematocele 



Num- 
ber of 
cases. 



INDEX 



A. 

Page. 

Accounts 243 

Acetanilide and antipyrine (Bulletin) 92 

Acting assistant surgeons 220 

Advisory board of the Hygienic Laboratory 93 

Africa, plague in 203 

Aid to other branches of the Government 210 

Air space in forecastles 213 

Alameda County, Cal., antiplague operations 20 

Alaska, relief to natives of 210 

Alaska- Yukon-Pacific Exposition, exhibit at 75 

Alexandria, Va. , quarantine, transactions at 108 

Amendments to regulations 212 

American Medical Association 224 

Cooperation with council on pharmacy and chemistry 73 

Legislative council of 225 

American Republics, International Sanitary Bureau of 103 

Amesse, Passed Asst. Surg. J. W., report of service transactions in Cuba 144—151 

Amoebiasis, investigations of 54—56 

Amoy, China: 

Floating disinfecting plant at 125 

Medical inspection of immigrants at 191 

Methods employed against rats by service officer 175 

Report of service officer at 166 

Anaphylaxis, further studies upon (Bulletin) 81, 91 

Anderson, Passed Asst. Surg. John F.: 

Article on disinfectants 82 

Federal control of manufacture of therapeutic sera, article on 82 

Further studies upon anaphylaxis, paper on 82 

Investigation of reported tetanus following vaccination 34 

Proportion of bacteria in milk, article on 82 

Annual reports 206 

Antidiphtheric serum 28 

Antiseptics and disinfectants 81 

Antitetanic serum 29 

Recognition of standard unit by Belgium and Brazil 29 

Appropriation for printing, need of larger 207 

Appropriations (.see also Financial statement) : 

Lei^rosy-investigation station, Hawaii 241 

Marine hospitals 241 

Preventing spread of epidemic diseases 240 

Quarantine service 239 

Quarantine stations 242 

Surgeon-General's office 241 

Asia, plague in 203 

Assignments of officers 219 

Attendants, hosjjital and quarantine 220 

Australia, plague in 203 

Azores, plague in 203 

B. 

Bacillus carrions in the District of Columbia 40 

Baltimore, Md., medical inspection of immigrants at 181 

IJanquet in celebration of Huccessful plague campaign 17 

Beaufort, S. C, Quarantine, transactions at 108 

Belgium, recognition of serum unit by 29 

263 



264 INDEX. 

Page. 

Belize, British Honduras, report of service officer at 135 

Bergen, Norway, leprosy conference at 68-70 

Biscayne Bay Quarantine, transactions at 109 

Blackbeard Island 120 

Blue, Surg. Rupert, antiplague operations in California. {See Plague.) 

Bluefields, Nicaragua, report of service officer at 138 

Boards convened 221 

Bocagrande Quarantine, transactions at 109 

Bocas del Toro, Panama, report of service officer at 137 

Boston, Mass., medical inspection of immigrants at 184 

Brazil: 

Recognition of serum unit by 29 

Smallpox in 201 

Bridgetown, Barbados, report of service officer at 156 

Brinckerhoff, Dr. W. R., report on leprosy 68 

British plague commission 74 

Brochures 207 

Brooks, S. D., Surg., antiplague operations in Los Angeles 20 

Brownsville, Tex., medical inspection of immigrants at 185 

Brunswick, Ga. , Quarantine, transactions at 108 

Bubonic plague. (See Plague.) 

Buffalo, medical inspection of immigrants at 184 

Bulletins of the Hygienic Laboratory (see also Hygienic Laboratory) 206 

Bulletins of the Yellow Fever Institute 207 

Bulletins on leprosy 67 

C. 

Calcutta, India, report of service officer at 173 

California, plague in. (See Plague.) 

Callao, Peru, report of service officer at 158 

Cape Charles Quarantine, transactions at 108 

Cape Fear Quarantine, transactions at 108 

Castries, St. Lucia, report of service officer at 156 

Casualties _. 219 

Cedar Keys, Fla., Quarantine, transactions at 109 

Ceiba, Honduras, report of service officer at 138 

Charleston, S. C, Quarantine, transactions at 108 

Chelsea, Mass. , relief to sufferers from fire at 209 

Chemical Tests for Blood (Bulletin). 91 

Chemistry, work of division of, in Hygienic Laboratory 89 

Child labor, relation of hookworm disease to 58 

China: 

Cholera in 204 

Medical inspection of immigrants in 191 

Methods employed by service officers against rats 174 

Reports of service officers at ports in 166 

Chipman, fumigating barge 119 

Cholera: 

Austria 204 

China 204 

India 204 

International cooperation for protection against 102 

Japan ^ 171, 204 

Korea 205 

Other countries 205 

Persia 204 

Philippine Islands 204 

Russia 173, 204 

Russian Asia 204 

Statistical 204 

Yokohama, Japan 170 

Cienf uegos, Cuba, report of service officer at 149 

Civil Service Commission, physical examinations for 211 

Coast and Geodetic Survey, physical examinations for 211 



INDEX. 265 

Page. 

Coatzacoalcos, Mexico, report of service officer at 153 

Colored antituberculosis league 56-58 

Discussed at annual conference with state health, authorities 95 

Columbia, S. C, pellagra investigations at 47 

Columbia River Quarantine, Oreg., and eubports, transactions at 115 

Commission to investigate pellagra 52 

Conference of state and provincial boards of health 225 

Conference with state and territorial health authorities 95 

Constitution, public health powers under 233 

Consular officers, lectures to newly appointed 177 

Consumption. {See Tuberculosis.) 

Contra Costa County, Cal., plague in {see also Plague) 18 

Coos Bay, Oreg., quarantine transactions at 115 

Costa Rica, maritime quarantine in 143 

Cotton-mill employees, hookworm disease among 58-60 

Council of pharmacy and chemistry, cooperation with 73 

Cuba: 

Extension of yellow fever in 144 

History of yellow fever epidemic in 145-148 

Operations of service in 144-151 

Quarantine against Mexico 148 

Tuberculosis in 148 

Yellow fever in 203 

Cumberland Sound Quarantine, transactions at 109 

Currie, D. H., Passed Asst. Surg., delegate to leprosy conference 68 

Customs regulations regarding importation of viruses, etc 38 

D. 

Delaware Breakwater Quarantine, transactions at 107 

Detroit, Mich., medical inspection of immigrants at 186 

Digitalis, physiological standardization of (Bulletin) 90 

Diphtheria in Japan 171 

Disinfectants 81 

District of Columbia, investigations of typhoid fever in 39^3 

Domestic quarantine 107-120 

Drugs. {See Pharmacopceia.) 

Dysentery, amoebic, investigations of 54-56 

E. 

Eagle Pass, Tex.: 

Medical inspection of immigrants at 186 

Quarantine transactions at 116 

Eastport, Idaho, medical inspection of immigrants at 186 

Eastport, Me., quarantine transactions at 107 

Ellis Island, medical inspection of immigrants at 187-189 

El Paso, Tex.: 

Medical inspection of immigrants at 186 

Quarantine at ; 115 

Europe : 

Pellagra in : 49-52 

Plague in 203 

Exhibit at Alaska- Yukon-Pacific Exposition 75 

Expenditures. {See also Financial statement.) 

Marine-hospitals and relief stations 244 

Quarantine stations 240 

F. 

Farms, health problems on 60 

Financial statement 239 

Flies, relation to cause of typhoid 42, 92 

Foot-and-mouth disease: 

DiscuHHcd at annual conference with state health authoritioH 96 

New regulations tf) y)revcnt ;'.4-39 

Relationship to infected vaccine vims 30-34 

ForecaHtloB, increased air space in 213 



266 INDEX. 

Page. 

Foreign countries, smallpox in 201 

Foreign ports, quarantine transactions at 135-177 

Foreign quarantine {see also Quarantine, foreign) 135-177 

Forest Glen, Md., typhoid fever at 43-45 

Fort Stanton, N. Mex., tuberculosis sanatorium 213-218 

Beef herd 217 

Dairy herd 213, 217 

Laboratory at 217 

Products of the station 217 

Statistics 214-217 

Fruit-port inspection service 135-144 

G. 

Geddings, H. D., Surg., representative of United States at International OflBce 

Public Hygiene 97 

Georgetown, S. C, Quarantine, transactions at 108 

Goldberger, Jos., Passed Asst. Sm-g., studies at Woods Hole, Mass 76 

Grays Harbor Quarantine 115 

Great Lakes, pollution of 45 

Grubbs, S. B., Passed Asst. Surg.: 

Representative of United States at International OflSce Public Hygiene.. . 96 

' Service operations in Porto Rico 132-134 

Guayaquil, Ecuador: 

Sanitation of 104, 158-165 

Yellow fever in 162-165 

Guiteras, G. M., Surg., investigation of jaundice in Texas 105 

Gulf Quarantine, transactions at 110 

H. 

Habana, Cuba: 

Mortality, report of 149 

Report of service officer at 144-150 

Yellow fever in 203 

Haverford, S. S., smallpox on board of : 107 

Hawaii: 

Operations of service in 130-132 

Plague preventive measures in 132 

Health problems on American farms 60 

Heiser, Victor G., Passed Asst. Surg., report of quarantine transactions in 

Philippines 121-130 

Hilo, Hawaii, transactions at 131 

Hobdy, W. C, Passed Asst. Surg., operations of service in Hawaii 130 

Honduras, yellow fever in 203 

Hongkong, China: 

Medical inspection of immigrants at. .' 191 

Methods employed against rats by service officer 174 

Report of service officer at 166 

Honolulu : 

Leprosy investigations at 66 

Operations of service at 130-132 

Hookworm disease - - 58-60 

Discussed at annual conference with state health authorities 96 

Rockefeller fund and commission 60 

Soil pollution in the South 85 

Hospitals of the service. {See Marine hospitals and relief.) 

Howard, Dr. L. O., study of fly abundance in Washington City 92 

Hydrophobia, report of a case of 82 

Hygiene and Demography, International Congress of 103, 229 

Hygienic Laboratory {see also Scientific research) : 

Advisory board 93 

Anaphylaxis and immunity 81 

Antiseptics and disinfectants 81 

Buildings and grounds 77 

Bulletins of 206 

Bulletins Nos. 47-56 90-93 



INDEX. 267 

Page. 
Hygienic Laboratory — Continued. 

Bulletin No. 57 56 

Cooperation with other services 80 

Dangers of the work 79 

Division of chemistry 89 

Division of pathology and bacteriology 80 -83 

Division of pharmacology 85-88 

Division of zoology 83-85 

Examination of pathological specimens 81 

Expansion of, desirable 77 

Experimental pathology 82 

Foot-and-mouth disease investigations 30-34 

Investigations of vaccine virus m connection with foot-and-mouth disease. 30-34 

Journal Club 80 

Operations of 77, 94 

Personnel of 79, 220 

Rabies, treatment of 53 

School of instruction for student officers 79 

Scientific investigations 80 

Water examinations 81 

I. 

Idaho State Medical Association, resolution adopted by 224 

Immigration : 

Italian emigration restricted 196 

Philippine Islands 127, 128 

Immigration Service, physical examinations for 211 

Immigrants, medical inspection of 178-198 

Examination of immigi'ants who have become public charges 190 

Female inspectors 220 

Increasing tendency to travel second cabin 181 

Methods employed at Naples 193 

Table showing number inspected at domestic ports 179-180 

India: 

Cholera in 204 

Plague in 202 

Influence of the corps in medical and public health activities 222-226 

Insane, intestinal parasites among 83 

Insular quarantine {See also Quarantine, insular) 121-134 

International Conference on Leprosy 68-70 

International Congress of Hygiene and Demography 103 

International cooperation for protection against plague and cholera 102 

International Office of Public Hygiene, Paris 96-102, 229 

Expenses of 97 

Officers and committees 96 

Operations of : 97 

Regulations of 97 

International relations 95-106, 228 

International Sanitary Bureau of American Republics 103, 229 

Internes 220 

Interstate waters, pollution of 45, 233-236 

Investigations of vaccine virus 30-34 

Isthmian Canal Commission, physical examinations for 211 

Italy: 

Medical inspection of aliens leaving 192-198 

Pellagra in 49,51 

J. 
Japan: 

Cholera in 204 

Methods employed by service officers against rats 174 

Sanitary conditions throughout empire 171 

Jaundice, investigation of epidemic in Texas 105 

Journal Club of Hygienic Laboratory 80 



268 INDEX. 



K. 



Pags. 

Kastle, Dr. Jos. H., work in division of chemistry 89 

Key West Quarantine, transactions at 109 

Knights Key (Fla.) Quarantine, transactions at 109 

Knox, Hon. P. C, quotation from 232 

Kobe, Japan: 

Methods employed against rats by service officer 175 

Report of service officer at 172 

Medical inspection of immigrants at 191 

L. 

Laboratories of the service, enumeration of 26 

Laboratories, need of additional 26 

Laboratory, Hygienic. {See Hygienic Laboratory.) 

Laboratory operated in connection with plague work in San Francisco. 15 

La Guaira, Venezuela, report of service officer at ' 156-157 

Lake Michigan water commission 45 

Laredo, Tex., quarantine transactions at 115 

Lavinder, C. H., Passed Asst. Surg.: 

Article on prevalence of pellagra in the United States : 83 

Investigations of pellagra 46-52 

Lectures on quarantine to consular officers 177 

Legislation desired 238 

Lepers. {See also Leprosy.) 

Care of, in United States 68 

Leprosy: 

Bulletins on 67 

Discussed at annual conference with state health authorities 95 

Investigation laboratory in Hawaii 26 

Prevalence in various countries 69, 70 

Second international conference at Bergen 68-70 

Yokohama, Japan 170 

Leprosy investigation station, Hawaii: 

Appropriation for ^ 241 

Boat landing 65 

Buildings completed 62 

Operations of station 66 

Water supply 63 

Libau, Russia, report of service officer at : 173 

Life-Saving Service, physical examinations and other aid to 211 

Light-House Service, physical examinations for 211 

Livingston, Guatemala, report of service officer at 140, 141 

Lloyd, B. J., Passed Asst. Surg.: 

Report of service transactions and sanitary condition of Guayaquil, Ecua- 
dor 158-165 

Sanitation of Guayaquil, Ecuador 104 

Louisiana, quarantine station acquired from 118 

Lumsden, L. L., Passed Asst. Surg. , typhoid fever investigations 43 

M. 

Mails, aid in enforcing proper use of 76 

Manila. {See Philippine Islands.) 

Marine hospitals, appropriations for 241 

Marine hospitals and relief -09-218 

Mariveles Quarantine Station 125 

Maryland, typhoid fever at Forest Glen 43-45 

Matanzas, Cuba, report of service officer at 150 

Mathewson, H. S., Passed Asst. Suj-g., report of Fort Stanton Sanatorium 213-218 

Medical inspection of immigrants _ 178-191 

Medical societies, attendance of service officers at meetings of 222 

Merchant seamen. {See Seamen.) 

Mexican-Texas border inspection 115 

Mexico, yellow fever in 203 

Milk and Its Relation to the Public Health (Bulletin) 73, 93 

Milk a cause of typhoid 42 



INDEX. 269 



Miller, Wm. W., Asst. Siirg.: 

Death of - - 219 

Special report on a hepatozoon perniciosum 82 

Work in hygienic laboratory 79 

Mobile, Ala. , Quarantine, transactions at 110 

Mobile, Ala., supplemental inspection service at ]17 

Mobile Quarantine Station taken in charge by service 119 

Mohler, Dr. John R., investigations of foot-and-mouth disease 30 

Molokai, leprosy investigation station on '. 62 

Montreal, Canada, medical inspection of immigrants'at 187 

Mulford, H. K., Co., manufacture of vaccine by 32 

N. 
Nagasaki, Japan: 

Methods employed against rats by service officers 175 

Report of service officer at 173 

Naples, Italy: 

Sanitary conditions in 196 

Medical insipection of aliens 192-198 

National formulary. (-See Pharmacopoeia.) 

National quarantine stations, reports from 107 

Nativities of patients treated, table of 260 

Naval auxiliaries, officers and seamen of, admitted to treatment 212 

Needs of the service 238 

Negroes: 

Susceptibility to disease 60-61 

Typhoid fever among 61 

New Orleans, La., supplemental inspection service at 116-117 

New Orleans Quarantine: 

Night inspections 113 

Transactions at Ill 

New quarantine stations 118 

New Orleans sanitary inspection office, transactions at 117 

New York (Ellis Island), medical inspection of immigrants at 187-189 

New York City, care of lepers in 68 

Niagara Frontier Pure Water Conference 45 

Niagara River, pollution of 46 

O. 

Oakland, Cal., plague in (see also Plague) 17 

Officers {see also Personnel), attendance at meetings of medical and sanitary 

associations 222-226 

Ohio state board of health, examination of antitoxin for 28 

Operations, surgical, table 260-262 

P. 

Paris, International Office of Public Hygiene at 96-102 

Parke, Davis & Co., vaccine manufactured by 30 

Pascagoula, Miss., Quarantine, transactions at 110 

Pasteur treatment of rabies • 53 

Pathology, experimental 82 

Pathology and bacteriology, work of division of 80-83 

Peaae, F. W., inspector of repairs, work on leprosy investigation station 62-68 

Pellagra : 

Considered by advisory board of Hygienic Laboratory 93 

Discussed at annual conference with state health authorities 96 

Prevalence in the United States, article on 83 

Pellagra, in vestigations of 46-52 

European pellagra 49-52 

Italian preventive measures 51 

Servif:o f.'ommisHion appointed 52 

Pensacola, Fla., Quarantine, traTiHactionH at 109 

Personnel of the service 219-221 

Perth Amboy, N. J., Quarantine, transactions at 107 



270 INDEX. 

Page. 

Pharmacists 220 

Pharmacological studies (Bulletin) 92 

Pharmacology, work of division of, in Hygienic Laboratory 70-73, 85-88 

Pharmacopoeia: 

Digest of comments 70, 73, 91 

Investigation of remedies 72 

Relations to 70 

Philippine Islands: 

Bureau of health 127 

Cholera in 122 

Immigration 127, 128 

Leprosy in 123 

Operations of the service in ] 21-130 

Physical examinations 211 

Smallpox in... 124 

Physical examinations: 

For other services 210-211 

Merchant seamen 211 

Philippine Islands 211 

Table of 248 

Pilots and marine engineers 220 

Plague : 

Africa 203 

Alameda County, Cal 20 

Asia.... 203 

Australia 203 

Azores 203 

California state and local authorities, assistance from 21 

Contra Costa County, Cal — 18 

Destruction of rats on vessels 102 

Europe 203 

Foreign countries 202 

Guayaquil, Ecuador 159, 161 

Hawaii 132 

India - 202 

International cooperation for protection against 102 

Japan 171 

Los Angeles, Cal 20 

Methods employed against rats in Chinese and Japanese ports 174 

Oakland, Cal ' 17 

Philippine Islands 124 

Point Richmond, Cal 19 

Rat bulletin 74 

San Francisco, Cal 11 

Cleaning and disinfection 14 

Banquet in celebration of successful campaign • 17 

Rat destruction 12-13 

Work of federal laboratory 15 

Seattle, Wash.— 

Difficulties of antiplague work 22 

Precautions on ships 24 

Work of municipal health department 23 

South America 202 

United States 202 

West Indies 203 

Yokohama, Japan 170 

Point Richmond, Cal., antiplague operations 19 

Pollution of interstate waters 45 

Portland, Me. , Quarantine, transactions at. 107 

Port Angeles, Wash . , Quarantine, transactions at 115 

Port Eads, La., transactions at inspection station Ill 

Port Limon, Costa Rica, report of service officer at 142-143 

Port Royal, S. C, Quarantine, transactions at 108 

Port Townsend, Wash., and subports, transactions at 115 



INDEX. 271 

Page. 
Porto Rico: 

Operations of service in -. 132-134 

Yellow fever in 203 

Post-Office Department, aid rendered to 76 

Printing, need of larger appropriation for 207 

Progreso, Mexico, report of service officer at 154 

Public health activities, influence of the corps on 222-226 

Public health associations, meetings of 222-226 

Public health movement, the 237 

Public health organizations 236 

Public health pamphlets or brochures 207 

Public health problems 227-237 

Public health reports 199,206 

Public Hygiene, International Office of 96-102 

Publications of the service 206-208 

Puerto Barrios, Guatemala, report of service officer at 140, 141 

Puerto Cortez, Honduras, report of service officer at 143 

Purveying depot 211 



Quarantine, lectures on, to newly appointed consular officers 177 

Quarantine service, financial statement 239 

Quarantine: 
Domestic — 

• New quarantine stations 118 

Reports from national quarantine stations 107-120 

Foreign _ 135-177 

Fruit port inspection service 135-144 

Inspection at other foreign ports 144-177 

Insular 121-134 

Hawaii 130-132 

Philippine Islands 121-130 

Porto Rico 132-134 

R. 

Rabies: 

Discussed at annual conference with state health authorities 95 

Investigations of 52-53 

Rats {see also Plague) : 

Destruction of, in San Francisco 12-13 

Destruction of, on vessels 102 

Methods employed in Chinese and Japanese ports for destruction of 174 

Relation to the Public Health (Bulletin) 74 

Reedy Island Quarantine, transactions at 107 

Regulations, amendments to 212 

Regulations for sale and importation of viruses, serums, etc., revised 34-39 

Relief stations of the service '. 209 

Table of operations 244 

Remedies, investigation of 72 

Research and sanitation 25-106 

Resolutions adopted by Second International Conference on Leprosy 69 

Resolutions adopted relating to the service " 224-226 

Revenue-Cutter Service: 

Aid to 210, 211 

Officers on leave or retired entitled to certain relief 212 

Rio de Janeiro, Brazil, report of service officer at 158 

Rosenau, M. J., Surg.: 

Further studios upon anaphylaxis, paper on 82 

Investigations of vaccine virus in connection with foot-and-mouth disease. 30 

Recent advances in the study of typhoid fever, paper on 82 

The viability of the tubercle bacillus, paper on 82 

Thermal death points of milk bacteria, article on 82 

Roumania, pellagra in 49 

Rusaia, cholera in 204 



272 INDEX. 

S. Page. 

Salina Cruz, Mexico, report of service officer at 153 

San Diego Quarantine, transactions at 114 

San Francisco: 

Amcebiasis in marine hospital at 54 

Medical inspection of immigrants at 189 

Plague in. {See Plague.) 

Work of plague laboratory 15, 26 

San Francisco Quarantine, transactions at 114 

San Juan, P. R., service operations at 132-134 

Sanatorium for consumptives. {See Fort Stanton.) 

Sanitary inspectors 220 

Sanitary reports and statistics 199-205 

Sanitation and scientific research 25-106 

Santiago de Cuba, report of service officer at 151 

Savannah, Ga., Quarantine, transactions at 108 

Scientific research and sanitation 25-106 

Seamen: 

Physical examinations of 211 

Relief furnished to 209-218 

Statistics of disease and injury 243-262 

Seattle, Wash.: 

Antiplague work in 22-24 

Exposition at, service exhibit 75 

Medical inspection of immigrants at 190 

Plague laboratory in 26 

Serum: 

Antidiphtheric 28 

Antitetanic 29 

Serums, viruses, etc.: 

Supervision of 27 

Revised regulations for sale and importation 34-39 

Service: 

Needs of the 238 

Resolutions relating to ^. 224-226 

Publications 206-208 

Shanghai, China: 

Medical inspection of immigrants at 191 

Methods employed against rats by service officer 175 

Report of service officer at 166 

Ship Island Quarantine, transactions at 110 

Ship's medicine chest 213 

Shiras, Hon. George, opinion as to federal power over pollution of interstate 

waters 234-236 

Siuslaw and Umpqua River Quarantine 115 

Smallpox: 

Foreign countries 201 

Guayaquil, Ecuador 160 

Japan 171 

United States 200 

Smith, Alexander C, Surg., death of 219 

Soil pollution in the South 85 

South America: 

Plague in 202 

Yellow fever in 204 

South Atlantic Quarantine : 

Reduced to a station of refuge 120 

Transactions at 108 

South Bend, Wash., quarantine transactions at 115 

Sparganum j>roliferum, studies of 76 

Special details of officers 219 

St. George Sound Quarantine, transactions at 109 

St. Johns River Quarantine, transactions at ■ 109 

St. Thomas, Danish West Indies, report of service officer at 156 

State and international relations 95-106 

State medical associations, meetings of 223-225 

Stations for relief of seamen - 209 



INDEX. 273 

Page. 

Stations of the service, table of operations 244 

Statistical tables '. 243-262 

Statistics: 

Foreign, how obtained 199 

Fort Stanton Sanatorium 2]4r-217 

Sanitary reports and ] 99-205 

Steamboat Inspection Service, physical examinations for 21 1 

Stiles, Dr. Ch. Wardell: 

Health problems on American farms 63 

Hookworm investigations 58-60 

Lectures on soil pollution in the South 85 

Work of division of zoology 83-85 

Surgical operations, table of 2G0-262 

T. 

Tables, statistical 243-262 

Tampa Bay, Fla., Quarantine, transactions at 109 

Tampico, Mexico, report of service officer at 154 

Tatoosh Island, Wash., diphtheria at 210 

Tawney, Hon. J. A., quotation from 232 

Tela, Honduras, report of service officer at 144 

Tent houses , 213 

Tetanus following vaccination 33 

Texas, epidemic of jaundice in 105 

Texas-Mexican border inspection 115 

Thyroid, studies on (bulletin) 90 

Ticks, study of 84 

Toxins. {See Viruses.) 
Tuberculosis : 

Colored antituberculosis leagues 56-58 

Fort Stanton Sanatorium, report of 21.3-218 

Sixth International Congress at Washington 56 

Studies on 56 

Typhoid fever: 

Death rate in negro population 61 

District of Columbia — 

Considered by advisory board of Hygienic Laboratory 94 

Investigations in 39^3 

Origin and prevalence of (bulletin) 92 

Forest Glen, Md., investigations at 43-45 

Japan 171 

Pollution interstate waters 45, 233-236 

Recent advances in the study of 82 

Water examinations 81 

TJ. 
United States: 

No yellow fever in 203 

Plague in 202 

Smallpox in 200 

V. 

v accine establishments licensed 27 

Vaccine virus, investigations of, in connection with foot-and-mouth disease. . . 30-34 

Vera < "ruz, Mexico, report of service officer at 1 51 

Vessels of merchant marine, increased air space in forecastles 213 

Virginia farms, Guatemala 141 

Viruses, serums, and toxins: 

( "uHtoms rffgulations regarding importation 38 

Examination of, in Hygienic Laboratory 80 

Revised regulations for sale and importation 34-39 

Sii7>ervision of 27 

W. 

\\ anhington, I). <'., typhoid fever in :'>!) 13 

Washington. N. ('., Quarantine, transactions al lOS 

18516—10 18 



274 INDEX. 

Page. 

Water examinations in Hygienic Laboratory 81 

Water pollution 233-236 

Weather Bureau, aid to observer on Tatoosh Island 210 

Wertenbaker, ('. P., Surg., work in connection with colored antituberculosis 

league 56-58 

West Indies: 

Plague in 203 

Yellow fever in 203 

White slave traffic 185 

Wightman, Wm. M. , Passed Asst. Surg., death of 219 

Woods Hole, Mass., special studies at 76 

Y. 

Yaquina Bay quarantine 115 

Yellow fever : 

Cuba 203 

Europe - 204 

Guayaquil, Ecuador 162-165 

History of epidemic in Cuba 145-148 

Honduras 203 

Mexico 203 

Porto Rico 203 

South America 204 

Statistical 203 

West Indies 203 

Yellow Fever Institute, bulletins of 207 

Yokohama, Japan: 

Medical inspection of immigrants at , . 191 

Methods employed against rats by service officer 175 

Report of service officer at. 168-172 

Sanitary conditions in 169 

Young, G. B., Surg., work on Lake Michigan Water Commission 45 

Z. 

Zacapa, Guatemala 141 

Zoological Nomenclature, International Commission on 84 

Zoological specimens, determination of 85 

Zoology, Index Catalogue of 84 

Work of Division of 83-85 

o 



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