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Columbia  (Hnttiem'tp 
intiifCtfpofllrttJgork 

COLLEGE  OF 

PHYSICIANS  AND  SURGEONS 

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ANNUAL  REPORT 


OF   THK 


SURGEON-GENERAL 


OF  THE 


PUBLIC  HEALTH  A\'I)  MARIXE-HOSPITAL 
SEK\1CE  OP  THE  LiNTTED  STATES 


FOR   THE 


FISCAL     YKAR     1904. 


WASHINGTON: 

GOVERNMENT    PRINTING    OFFICH  = 
1904. 


Treasi'ry  Department, 

Ddcuinent  X(i.  21^78. 

Public  Health  and  Marlne-IIosjntal  Serrice. 


OPERATIONS 


UNITED  STATES  PUBLIC  HEALTH  AND 
MARINE-HOSPITAL  SERVICE. 


I 


904 


C  O  N  T  F  N  T  S  . 


Page. 

Secretary's  letter  of  transmittal  to  Congress ]'A 

Report  to  the  Secretary — summary  of  operations 15 

Division  of  personnel  and  accounts '6',] 

Personnel: 

Connnissioned  officers — promotions,  appointments,  resignations,  and 

casualties 35 

Chief  of  division  of  pharmacology,  Hygienic  Laboratory 36 

Advisory  board  for  Hygienic  Laboratory 36 

Noncommissioned  officers — sanitary  inspectors,  acting  assistant  surg- 
eons, medical  inspectors,  internes,  pharmacists,  pilots,  and  marine 

engineers 36 

Hospital  attendants 37 

Boards  convened 37 

Details  of  officers  to  represent  the  Service  at  meetings  of  medical  and 

public  health  associations - 38 

Accounts: 

Vouchers  passed  for  payment  and  settlement 39 

Financial  statement 39 

Administrative  details — circular  letters 41 

Division  of  marine  hospitals  and  relief 43 

Relief  of  seamen 45 

Relief  stations 45 

Inspection  of  stations 45 

INIonthly  statement  of  expenditures 45 

Aid  to  other  branches  of  the  Government  service:  Revenue-Cutter  Serv- 
ice, Steamboat-Inspection  Service,  Life-Saving  Service,  Light-House 
Service,  Civil  Service  Commission,  Isthmian  Canal  Commission,.  Immi- 
gration Service 46 

Physical  examinations  of  merchant  seamen 46 

Examination  of  drugs 46 

Sanatorium  for  consumptive  seamen.  Fort  Stanton,  N.  Mex.   (report  of 

medical  officer  in  command ) 47 

Report  of  operations  bacteriological  laboratory,  Fort  Stanton  Sanatorium 

(Asst.  Surg.  J.  W.  Trask). 56 

Purveying  depot  at  New  York  (report  of  medical  purveyor) 62 

New  hospitals :  Pittsburg,  Pa. ;  Savannah,  Ga 64 

Repairs  and  improvements  made  to  buildings  and  grounds,  inchiding  work 

under  contract  and  repairs  to  heating  ai)paratus  of  marine  hospitals 65 

Division  of  sanitary  reports  and  statistics 69 

Cholera 71 

Yellow  fever 73 

Plague 75 

United  States  (California) 75 

Foreign  and  insular , 76 

Smallpox 80 

United  States 80 

Foreign  and  insular 97 

Division  of  foreign  and  insular  quarantine  (embracing  medical  inspection  of 

immigrants )  103 

Cuba 105 

No  yellow  fever 105 

Personal  health  certificates  at  Habana 105 

7 


8  CONTENTS. 

Division  of  foreign  and  insular  quarantine — Continued.  Page. 
Cuba — Continued . 

Reports  of  transactions: 

Habana 105 

Matanzas 107 

Nu.evitas 109 

Santiago 109 

Cienf  uegos 113 

Porto  Rico 114 

Title  to  Mirafiores  Island  declared  good 114 

ObserAations  on  leprosy  in  Porto  Rico 114 

Reports  of  transactions: 

San  Juan  and  subports 116 

Ponce 118 

Mexico 118 

Detail  of  officers,  season  of  1903 118 

Rei>ort3  of  transactions: 

Veracruz 118 

Tampico 119 

Progreso 119 

Season  of  1904 120 

Reports  of  transactions: 

Veracruz 120 

Tampico ~. 122 

Progreso 123 

Central  and  South  America 123 

Fruit-p(jrt  inspection  service 123 

Letter  of  instructions 124 

Reports  of  transactions: 

Port  Limon 1 25 

Puerto  Cortez 127 

Livingston 128 

Bocas  del  Toro 1 29 

Ceiba 130 

Bluefields 132 

Belize 133 

Panama 134 

Details  medical  officers  to  protect  Canal  Zone 134 

Republic  of  Panama  requests  assistance  of  Service  officers  on  duty  at 

foreign  ports 1154 

Bills  of  health  fur  Panama  to  be  signed  by  Ser\-ice  officers  at  foreign 

ports 135 

Recommendation  that  incoming  quarantine  be  placed  in  hands  of 

Service 137 

Assistant  Surgeon  Pierce  appointed  health  officer  at  port  of  Panama. .  141 

Detail  of  Surg.  H.  R.  Carter 142 

Surgeon  Perry  and  Assistant  Surgeon  Pierce  report  to  Canal  Com- 
mission   142 

Reports  of  transactions: 

Colon 143 

.  Panama 144 

Ecuador: 

Report  of  transactions  at  Guayaquil 145 

Peru: 

Report  of  transactions  at  Callao 146 

Brazil : 

Officer  detailed  to  Rio  de  Janeiro 147 

Report  of  transactions  at  Rio 147 

Hawaii 152 

Report  of  transactions  at  Honolulu  and  subports 153 

Philippine  Islands 155 

Transfer  of  Mariveles  quarantine 155 

Vessels  from  L'nited  States  to  Philippines  not  required  to  carry  bills  of 

health  (decision  of  solicitor) 158 

Commutation  for  quarters  allowed  officers  of  the  .Ser^nce 159 

Ins-tructions  sent  to  officers  serving  in  Orient  to  cooperate  with  chief 

quarantine  officer  of  Philippines 161 

Military  services  of  Asst.  Surg.  M.  K.  Gwyn 162 

Manila  and  subports 163 


CONTENTS.  9 

Division  of  foreign  and  insular  quarantine — Continued.  Page. 

Japan 185 

Reports  of  transactions: 

Yokohama 185 

Na<rasaki 185 

Kobe 186 

China 186 

Reports  of  transactions: 

Hongkong 186 

Shanghai 188 

India  (detail  of  oflicers  at  Calcutta  and  Bombay) 192 

i\Ie<licai  inspection  of  immigrants 193 

Question  of  stripjiing  aliens  for  detecting  venereal  diseases 193 

Officers  at  ports  in  China  and  Japan  directed  to  examine  aliens 195 

Reports  of  transactions: 

United  States 197 

Porto  Rico 212 

Hawaii 213 

Philippines 213 

Canada 216 

Italy  ( Naples  and  Palermo ) 217 

Japan  (  Yokohama ) 219 

(Kobe) 220 

China  ( Hongkong ) 220 

Division  of  domestic  quarantine 223 

Plague  in  San  Francisco 225 

Statement  of  conditions 225 

Resolutions  adoj^ted  regarding 226 

Report  of  Passe<l  Assistant  Surgeon  Blue 227 

List  of  plague  cases 230 

Yellow  fever 230 

Correspondence 231' 

Report  of  Surgeon  Guiteras 303 

Report  of  Passed  Assistant  Surgeon  Richardson 320 

Smallpox  in  the  United  States 326 

The  national  quarantine  stations 328 

Annual  reports  from  stations 329 

Portland 329 

Eastport 330 

Ree<ly  Island 330 

Delaware  Breakwater 331 

Alexandria 333 

Cape  Charles 333 

Cape  Fear 334 

Newbern 335 

Washington,  X.  C 335 

Savannah 335 

South  Atlantic 337 

Bnmswick 338 

Tampa  Bay 339 

Cumberland  Sound 340 

St.  Johns  inspection  station 340 

Kev  West 341 

Boca  Grande 343 

Cedar  Kevs 343 

St.  Georire  Sound 343 

Santa  Rosa 344 

Biscayne  Bay 345 

Pascagoula 345 

Gulf 345 

San  Diego 346 

Los  Angeles , 348 

San  Francisco 349 

Eureka 350 

Columbia  River 350 

Hoquiam 352 


10  CONTENTS. 

Division  of  domestic  quarantine — Continued.  Page. 
The  national  quarantine  stations — Continued. 
Annual  reports  from  stations — Continued. 

Port  Townsend 353 

Seattle 354 

South  Bend 354 

Port  Angeles 355 

Sitka 355 

Texas-Mexican  Border  Quarantine 355 

Laredo 35G 

El  Paso 356 

Conclusion 356 

Division  of  scientific  research  and  sanitation 357 

Transactions  of  the  division 359 

Yellow-fever  institute 359 

Etiology  of  yellow  fever 359 

Collection  and  identification  of  mosquitoes 360 

Mosquito  destruction 361 

First  antimosquito  convention 361 

Cooperation  with  State  and  lociil  boards  of  health 361 

Spotted  fever 362 

Second  General  International  Sanitary  Convention  of  American  Republics.  363 
Second  Annual  Confei'ence  of  State  Health  Officers  with  the  Public  Health 

and  Marine-Hospital  Service 363 

Aid  to  management  of  the  Louisiana  Purchase  Exposition 365 

National  Association  for  the  Study  and  Prevention  of  Tuberculosis 365 

Porto  Eican  Aufemia  Commission,  preliminary  report 366 

International  Sanitary  Conference  at  Paris 370 

Inspection  of  manufacture  of  vaccines,  serums,  etc 371 

Hygienic  Laboratory,  report  of  the  director 373 

Opening  of  new  laboratory  building 373 

Improvements  needed 373 

Laboratory  course  for  student  oflicers 374 

Laboratory  bulletins 374 

Standard  for  dipbtheria  antitoxin 375 

Examination  of  vaccines 376 

Car  sanitation 377 

Pathologic  specimens  examined 378 

Suspected  cases  of  plague  at  quarantines 379 

Examination  of  drugs  and  chemicals 379 

Exhibit  for  St.  Louis  Exposition 379 

Disinfectants  and  germicides 379 

Yellow  fever 380 

Malarial  fevers 380 

Dengue 381 

Hooikworm  disease 381 

Tuberculosis - .  381 

Typhoid  bacillus  in  drinking  water  (report  of  Passed  Assistant  Sur- 
geons Perry  and  Anderson) 381 

Chloride  of  zinc  and  chloride  of  lime  as  disinfectants  (report  of  Assist- 
ant Surgeon  McClintic ) 386 

Division  of  zoology,  report  of  chief  of 394 

Division  of  pharmacology,  report  of  chief  of 397 

Ye'llow  fever,  abstract  of  report  of  French  commission 399 

Sanitation  of  railway  coaches  and  Pullman  cars 403 

Reports  of  officers  detailed  to  represent  the  Service  at  meetings  of  medical 

and  public  health  associations 404 

Mosquito  extermination  convention  (report  of  Passed  Asst.  Surg.  J.  C. 

Perry) 404 

Association  of  American  Bacteriologists  (report  of  Passed  Asst.  Surg. 

M.  J.  Rosenau) 405 

American  Rontgen  Ray  Association  (report  of  Surg.  Fairfax  Irwin)..  405 
National  Association  for  the  Prevention  and  Study  of  Tuberculosis 

( report  of  Passed  Assistant  Surgeon  Rosenau) 408 

American  Medical  Association,  Atlantic  City,  N.  J..: 

Remarks  by  the  Surgeon-General 408 

Report  of  Asst.  Surg.  Gen.  G.  T.  Vaughan 411 

Report  of  Asst.  Surg.  Gen.  H.  D.  Geddiugs 412 


CONTENTS.  1  1 

])i\  isioii  of  scientific  research  and  sanitation — Continned.  I'liKc 
Reports  of  ollicers  detailed  to  represent  the  Service  at  meetings  of  niccUcal 
and  pnl>lic  lieaUh  associations — Continned. 

American  Medical  Association,  AtlantU;  City,  N.  J. — Continned. 

Remarks  hy  Asst.  Snrjjf.  (<en.  li.  1).  (ieddings 412 

Report  of  Snrg.  V.  M.  Carrington 415 

Report  of  Tassed  Asst.  Hurg.  M.  J.  Koseiian 415 

Mississi|)pi  State  Medical  Association  (report  of  Dr.  Charles  Wardell 

Stiles) 41(3 

Eleventh  International   Congress  of  Hygiene  and  Demography  (re- 
port of  Passed  Asst.  Snrg.  J .  M.  Eager) 417 

Texas  State  Medical  Association   (report  of  Surg.  H.  R.  Carter  and 

his  address  before  the  association ) 4135 

Cerebro  spinal  meningitis  in  Hartford,  Conn,  (report  of  Passed  Asst.  Surg. 

J.  E.  Anderson 443 

Insanitary  dwellings  and  the  rehousing  problem  in  foreign  cities 444 

Miscellaneous  division  (including contributed  articles  and  necroi)sy  reports)..  447 

Transactions  of  the  division 449 

Contributed  articles: 

Chronic  pancreatitis  with  induration.    By  Asst.  Surg.  L.  P.  H.  Bahren- 

burg 451 

Leprosy  in  Sulu  Archipelago.     By  Asst.  Surg.  J.  W.  Amesse 455 

Sanitary  improvements  at  Naples.     By  Passed  Asst.  Surg.  J.  M.  Eager.  458 
Catheter  in  l)ladder;  removal  through  perineum.    Reported  by  Passed 

Asst.  Surg.  J.  A.  Nydegger 463 

Reports  of  fatal  cases,  with  necropsies 464 

Necropsies  of  plague  cases 545 

Statistical  tables 575 

Index 641 


LETrER  OF  TRANSMirrAL 


Treasury  Department, 

Washi7i(/tov^  D.  61,  Decemher  5^  lOOlf.. 
Sir:  In  accordance  with  section  9  of  the  act  of  Congress  approved 
Jul\'  1,  1902,  entitled  "An  act  to  increase  the  efficiency  and  change 
the  name  of  the  Marine-Hospital  Service,"  I  have  the  honor  to  trans- 
mit the  annual  report  of  the  Surgeon-General  of  the  Public  Health 
and  Marine-Hospital  Service  for  the  fiscal  year  190*. 
Respectfulh', 

Leslie  M.  Shaw, 

Secretai'y. 
The  Speaker  of  the  House  of  Representatives. 

13 


■ 


ANNUAL  REPORT 


SURGEON-GENERAL,   PUBLIC    HEALTH   AND 
MARLNE-HOSPITAL  SER\^ICE. 


REPORT  TO  THE  SECRETARY. 


Treasury  Department, 

Bureau  of  Public  Health  and 

Marine-Hospital  Service, 
Washington^  D.  6',  September  17^  190 J4.. 
Hon.  Leslie  M.  Shaw, 

Secretary  of  tit  e  Treasury. 
Sir:  I  have  the  honor  to  submii:;,  for  transmission  to  Congress,  in 
accordance  with  the  act  of  July  1,  1902,  the  following  report  of  trans- 
actions of  the  Public  Health  and  Marine-Hospital  Service  of  the 
United  States  for  the  fiscal  year  ended  June  30,  1904,  the  same  being 
the  thirty-third  annual  report  of  the  Service,  in  the  one  hundred  and 
sixth  year  of  its  existence,  and  the  third  annual  report  under  its  new 
name. 

The  operations  of  the  Service  have  been  conducted  under  the  act 
above  referred  to,  and  Service  regulations  in  accordance  therewith 
promulgated  by  the  President  August  12,  1903,  which  supersede  the 
regulations  of  November  29,  1902. 

PERSONNEL. 

COMMISSIONED   CORPS. 

At  the  close  of  the  fiscal  year  the  commissioned  corps  of  the  Service 
consisted  of  118  officers,  as  follows:  The  Surgeon-General,  6  assistant 
surgeons-general,  25  surgeons.  36  passed  assistant  surgeons,  and  50 
assistant  surgeons.  Four  candidates  passed  a  successful  examination 
for  admission  to  the  corps  and  were  commissioned  assistant  surgeons. 

CASUALTIES. 

Among  the  casualties  enumerated  in  the  report  from  the  division 
of  personnel  and  accounts  should  be  specially  noticed  the  sad  death 
of  Surg.  Iv.  D.  Murra}',  due  to  an  accident  while  engaged  in  the  sup- 
pression of  yellow  fever  at  Laredo,  Tex.     The  details  are  mentioned 

15 


16  PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE. 

in  the  report  of  Surgeon  Guiteras  on  pp.  31-1:-315  of  this  report. 
8urg-eon  Murra3''s  skill  and  devotion  through  thirt}'  3'ear8  of  service 
in  the  suppression  of  epidemic  diseases,  particular!}-  yellow  fever, 
were  so  marked  as  to  give  him  a  national  reputation  and  to  make  his 
loss  a  public  misfortune. 

ACTING   ASSISTANT  SURGEONS. 

At  the  close  of  the  fiscal  3-ear  there  were  194  acting  assistant  sur- 
geons, including  8  appointed  for  duty  at  fruit  ports  of  Central  and 
South  America  whose  services  will  be  terminated  at  the  close  of  the 
quarantine  season. 

PHARMACISTS. 

At  the  close  of  the  fiscal  year  there  were  49  pharmacists,  as  follows: 
Pharmacists  of  the  first  class,  16;  of  the  second  class,  25;  of  the  third 
class,  8. 

ATTENDANTS. 

At  the  beginning  of  the  fiscal  year  there  were  577  hospital  attendants 
at  the  marine  hospitals,  quarantine  stations,  and  on  epidemic  dut}^ 
The  number  at  the  close  of  the  fiscal  vear  was  643. 


During  the  fiscal  year  41  boards  of  medical  officers  were  convened 
for  the  physical  examination  of  officers  of  and  applicants  for  entrance 
into  the  Ke  venue -Cutter  Service. 

EXPENDITURES. 

« 

SERVICE   FUND. 

The  balance  of  the  appropriation  for  the  maintenance  of  the  Public 
Health  and  Marine-Hospital  Service  at  the  beginning  of  the  fiscal  year 
was  $486,638;  the  receipts  from  all  sources,  tonnage  tax,  repayments, 
care  of  foreign  seamen,  and  reimbursements  from  the  Immigration 
Service,  etc.,  were  $937,257.61.  The  expenditures  for  the  same  period 
were  $1,168,252.36,  leaving  a  balance  on  hand  at  the  end  of  the  fiscal 
year  of  $255,643.25.  These  expenditures  included  improvements  and 
repairs  to  marine  hospitals,  heating  apparatus,  furniture,  and  fuel, 
light,  and  water,  these  items  being  no  longer  included  by  Congress  m 
annual  appropriations. 

EPIDEMIC    FUND. 

The  amount  available  of  the  appropriation  for  preventing  the  spread 
of  epidemic  disease  at  the  beginning  of  the  fiscal  year  was  $489,051.99; 
the  expenditure  was  $211,461.82,  leaving  a  balance  June  30,  1904,  of 

$277,590.17. 

QUARANTINE    FUND. 

The  amount  of  the  appropriation  was  $325,000.  There  were  repay- 
ments for  the  care  of  foreign  seamen,  etc.,  of  $1,605.88.  Congress 
also  made  a  deficiency  appropriation  of  $9,500  for  "quarantine  serv- 
ice, 1904,  repairs  to  floating  property."  When  all  of  the  accounts  are 
adjusted,  a  small  balance  of  these  appropriations  will  remain. 


PUBLIC    HKALTH    AND    MARINE-HOSPITAL    SERVICE.  17 

^MARINE    HOSPITALS   AND    RELIEF. 

The  relief  statistics;  for  the  year  arc  as  follows: 

Total  number  of  patients 58, 550 

NuiuIht  of  patients  treated  in  hospital 14,  803 

^■unllH•r  of  patients  treated  in  dispensary 44,  253 

Total  ninnher  of  days'  relief  in  hospital 415,  292 

])e(Tease  in  total  iuind>er  of  patients  as  eonipared  with  last  year 17 

Increase  in  nundR'r  of  hospital  patients  over  previous  year 738 

Increase  in  number  of  days'  relief 31,  il03 

The  Service  controls  and  operates  22  hospitals,  all  of  which  are 
owned  by  the  Government. 

In  addition  to  the  marine  hospitals  there  are  122  relief  stations 
where  seamen  receive  hospital  and  dispensary  treatment.  A  relief 
station  was  established  during  the  yeav  at  Ketchikan,  Alaska. 

NEW    HOSPITALS. 

Pittsburg,  Pa. — As  authorized  by  act  of  Cong-ress  approved  March 
3,  1903,  the  Secretary  of  War,  on  "^the  Tth  of  May,  19(14,  transferred 
to  the  custody  and  control  of  the  Treasury  Department  a  portion  of 
the  United  States  arsenal  grounds,  Pittsburg,  Pa.,  5  acres  in  extent, 
to  be  used  as  a  site  for  the  proposed  marine  hospital. 

Buffalo,  N.  Y. — A  site  for  the  marine  hospital  was  purchased  during 
the  3^'ear  at  a  cost  of  $22,000.  The  site  is  3  acres  in  extent  and  is  sit* 
iiated  on  Main  street,  3i  miles  from  the  city  hall. 

SaTannah,  Ga. — Contract  has  been  let  for  the  construction  of  the 
new  hospital  for  $96,170,  the  building  to  be  completed  August  15, 1905. 

SANATORIUM    FOR   CONSUMPTIVES,   FORT   STANTON,   N.   MEX. 

The  number  of  patients  cared  for  in  this  institution  continues  to 
increase.  Three  hundred  and  eighty-six  patients  have  been  treated 
during  the  year,  exceeding  the  number  for  the  previous  3^ear  by  112. 

Number  of  patents  treated 386 

Number  discharged,  cured 16 

Number  discharged,  disease  arrested 9 

Number  discharged,  improved 87 

Number  discharged,  not  improved 19 

Number  discharged,  nontubercular,  recovered 1 

Died 62 

Kemaining  under  treatment 192 

PURVEYING    DEPOT,   NEW    YORK,   N.   T. 

During  the  year  718  requisitions  were  filled,  and  supplies  furnished 
to  the  marine  hospitals  and  quarantine  stations  in  the  United  States 
and  its  dependencies.  Supplies  were  also  purchased  for  the  Immigra- 
tion Service  and  for  the  vessels  of  the  Revenue-Cutter  Service  and  the 
Coast  and  Geodetic  Survey.  Provision  has  been  made  for  an  examina- 
tion of  drugs  by  the  Hygienic  Laboratory  in  order  to  determine  the 
purity  of  those  purchased  for  issue. 
8629—04 2 


18  PUBLIC    HEALTH    AND    MARIJSE-HOSPITAL    SERVICE. 


Ain    TO    OXnEK   SERVICES. 


Aid  was  extended  to  other  branches  of  the  Government,  in  the  mat- 
ter of  physical  examinations,  as  follows: 


Ser\'ice. 

Examined. 

Rejected. 

Revenue-Cutter  Service 

728 

1,812 

1,161 

53 

12 

1,405 

2 

128 

Steamboat-Inspection  Service; 

126 

37 

Coast  and  Geodetic  Survev 

6 

Light-House  Service 

3 

Civil  Service  Commission 

89 

Isthmian  Canal  Commission 

0 

Total 

5,173 

389 

Physical  examinations  were  also  made  of  604  American  merchant 
seamen,  of  whom  88  were  rejected;  and  of  6  foreign  seamen,  of  whom 
3  were  rejected. 

MEDICAL   INSPECTION    OF   IMMIGRANTS. 

During  the  fiscal  year  840,714  immigrants  were  inspected  by  ofii- 
cers  of  the  Service  to  determine  their  physical  fitness  for  admission, 
as  prescril)ed  b\'  the  immigration  laws.  At  all  ports  of  the  United 
States  wliere  aliens  seek  admission  ofiicers  have  been  detailed  in 
accordance  with  the  law,  and  on  request  of  the  Immigration  Service, 
for  the  purpose  of  making  these  examinations.  The  details  of  officers 
for  a  like  purpose  at  Naples,  Italv,  and  Quebec,  Canada,  have  been 
continued,  and  additional  officers  have  been  stationed  at  Vancouver 
and  Victoria,  British  Columbia,  for  the  same  purpose  by  special 
request  of  the  Immigration  Bureau. 

By  request  of  the  honorable  Secretary  of  Commerce  and  Labor, 
and  with  j^our  approval,  all  the  officers  on  dut}"  in  Japanese  and  Chi- 
nese ports  were  directed  to  make  medical  inspection  of  aliens  embark- 
ing for  the  United  States  at  said  ports,  and  to  certify  upon  each 
immigration  manifest  that  those  whose  names  are  inscribed  on  the 
manifest  are  free  from  loathsome  or  dangerous  contagious  disease. 
In  the  event  of  the  detection  of  a  would-be  immigrant  with  a  pro- 
hibitive disease  the  ofificers  were  instructed  to  notify  the  steamship 
companies  accordingl}^,  it  being  well  understood  that  such  immigrants, 
if  carried,  would  subject  the  steamship  companies  to  penalties  on 
arrival  in  the  United  States.  This  proAnsion  has  been  executed  with- 
out friction  and  with  great  Ijenefit  both  to  the  Immigration  Service 
and  to  the  steamship  companies,  statistics  which  will  doubtless  be  pub- 
lished b}"  the  Commissioner-General  of  Immigration  showing  that  a 
large  number  of  immigrants  have  been  prevented  from  leaving  for 
the  United  States  who  would  have  been  rejected  on  arrival,  and  would 
have  caused  an  infliction  of  penalty  upon  the  steamship  companies. 
The  steamship  companies  themselves  made  request  for  this  arrangement. 

The  officers  in  Japanese  and  Chinese  ports  were  further  directed  to 
make  a  descriptive  list  of  aliens  recommended  for  rejection  copies  of 
list  to  be  sent  immediately  to  the  medical  officer  at  the  port  of  arrival, 
to  the  Commissioner-General  of  Immigration  and  to  the  Public  Health 
and  Marine-Hospital  Bureau. 


I'lJHLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  19 


ko  iiiTiint^emont  for  iininif^rimts  leaving  Europojin  ports  for  tho, 
tic  i)orts  of  tho  rnitod  Stutos  is  dosirahlc  hut  as   yet   has   not 


A  lik( 
Athmtic  i)oi ,     ^ 

hecn  oll'octod  save  at  tlie  poi't  of  Naj)h\s,  where  tlie  inspection  ])y  an 
otticcr  of  tliis  Service  is  made  hy  recpiest  of  the  Italian  Government. 


SMAIXI'OX. 

The  report  of  the  division  of  sanitary  reports  and  statistics  shovvs 
that  (hirin*;-  the  six  months  ended  December  81,  liKKi,  smallpox  was 
reported  from  85  States,  with  a  total  of  18,789  cases  and  ()()(5  deaths, 
Dnrini;-  the  six  months  ended  flune  80,  1904,  smallpox  was  reported 
from  87  States  and  Territories,  with  a  total  of  11,8(J7  cases  and  512 
deaths.  Total  for  the  year,  25,10()  cases  and  1,118  deaths.  Total  for 
the  previous  fiscal  year,  1908,  42,590  cases  and  1,()42  deaths. 

This  is  a  o-reat  decrease  since  last  year,  and  would  indicate  that  the 
disease  had  reached  the  highwater  mark  in  1902  and  will  continue  to 
decrease  in  the  future. 

This  decrease  may  be  due,  in  part  at  least,  to  fewer  mistakes  in 
diagnosis.  Within  the  past  year  the  Bureau  certainly  has  received 
fewer  requests  for  expert  diagnosticians  and  fewer  communications 
than  formerly,  showing  that  the  writers  confused  the  disease  with 
other  maladies.  It  is  believed,  too,  that  there  is  greater  confidence  in 
vaccination  and  that  the  vaccine  itself  has  been  so  improved  by  the 
manufacturers  as  to  remove  in  a  great  measure  such  prejudice  as  has 
existed  against  it.  The  fact  that  all  of  the  manufacturers  of  vaccine 
are  now  required  b}-  law  to  have  their  establishments  licensed  after  a 
rigid  examination  b}^  Government  authority  is  a  good  reason  for  the 
growth  of  confidence  in  the  purity  and  potency  of  vaccine. 

The  Service  has  continued  to  transmit  its  pamphlets  upon  protection 
against  smallpox,  has  rendered  aid  when  requested,  but  has  also  con- 
tinued in  the  policy  which  was  announced  in  the  annual  report  for 
1898,  leaving  to  the  States  themselves  the  suppression  of  the  disease 
therein,  believing  that  a  disease  so  easily  conquerable  should  be  left  to 
the  management  of  State  and  municipal  authorities.  The  result  has 
been  a  strengthening  of  the  medical  authorities  of  the  States  and  cities, 
both  by  the  enactment  of  necessary  State  and  municipal  laws  and 
thi'ough  the  administrative  activity  required  of  State  and  municipal 
ofiicers. 

The  aid  rendered  to  the  State  health  authorities  of  Maine  in  the 
exclusion  and  suppression  of  smallpox  at  the  Canadian  border  was 
continued  throughout  the  jem\  The  oflacers  engaged  in  the  work 
report  a  total  of  93  families  under  observation,  3,753  persons  inspected, 
1,736  persons  vaccinated,  206  cases  of  smallpox  treated,  and  111  dwell- 
ings and  20  schoolhouses  disinfected. 

LEPROSY. 

In  the  annual  report  of  1902  reference  was  made  to  the  report  of 
the  commission  of  medical  ofiicers  of  this  Service  appointed  by  law 
to  investigate  the  origin  and  prevalence  of  leprosy  in  the  United 
States  and  report  upon  measures  necessary  for  the  prevention  of  its 
spread.  The  commission  recommended  at  least  one  leprosarium  in 
the  United  States  where  lepers  found  in  the  se\  eral  States  could  be 
segregated,  and  a  bill  was  prepared,  but  owing  to  the  consideration  of 


20  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

the  matter  of  leprosy  in  the  Hawaiian  Islands  and  sucrgestions  which 
were  made  of  sending  there  all  lepers  from  the  United  States,  it  was 
deemed  inadvisable  to  present  a  measure  to  Congress  without  further 
consideration  of  this  feature  of  the  subject. 

I  have  to  recommend  the  establishment  of  a  leprosarium  in  the  con- 
tinental United  States.  It  is  believed  that  the  necessar}"  site  can  be 
found  on  Government  land,  and  it  is  proposed  to  submit  for  3'our 
approval  a  bill  containing  necessary  provisions.  In  the  meantime  the 
health  authorities  of  the  HaAvaiian  Islands  have  signified  their  earnest 
desire  that  this  Service  should  make  use  of  the  opportunity  presented 
by  the  leper  settlement  on  Molokai  for  a  scientific  inquir}'  into  the  best 
methods  for  the  care  and  treatment  of  lepers.  The  leprosy  germ 
{Bacnius  leprosi)  has  been  isolated,  but  it  is  believed  that  much  may 
be  accomplished  by  a  thorough  inquiry  into  the  methods  of  cure,  and 
it  is  suggested  that  in  any  legislation  regarding  lepros}"  there  be 
included  a  provision  for  the  detail  of  specially  qualified  oflBcers  in 
Hawaii  for  this  purpose. 

PLAGUE. 

Plague,  which  has  existed  in  San  Francisco  since  March  6,  1900, 
though  reported  occasionally  during  the  fiscal  year,  has  steadih'  dimin- 
ished. During  the  twelve  months  ending  June  30,  1904,  there  were 
24  cases  and  23  deaths,  but  no  case  has  been  reported  since  Februar^^ 
last. 

The  cooperation  of  the  State  and  municipal  authorities  of  California 
and  San  Francisco  with  the  Public  Health  and  Marine-Hospital  Serv- 
ice for  the  purpose  of  eradicating  plague  infection  in  the  Chinese  dis- 
trict of  San  Francisco  has  been  eflective  and  the  work  has  been  steadih' 
carried  on  under  the  direction  of  Service  oflicers.  The  fact  that  no 
case  of  plague  has  been  reported  in  Chinatown  since  February  19  indi- 
cates the  thoroughness  with  which  the  work  has  been  done  and  justifies 
the  methods  adopted  for  the  extermination  of  this  infection.  Doubt- 
less due  to  improved  sanitary  conditions,  the  mortality  from  all  dis- 
eases in  Chinatown  (with  an  average  population  of  13,000)  was  reduced 
from  31.70  per  1,000  for  the  fiscal  year  1903  to  27.23  per  1,000  for  the 
fiscal  year  1904. 

The  prevalence  of  plague  on  the  west  coast  of  South  America,  in 
Peru  and  Chile,  and  also  in  Uruguay,  Paraguay,  and  Brazil,  on  the 
east  coast,  indicates  the  danger  which  now  menaces  and  will  in  all 
probaliility  continue  to  menace  the  United  States  in  the  immediate 
future  from  these  our  southern  neighbors.  The  special  measures 
which  have  already  been  taken  to  protect  the  Isthmian  Canal  Zone 
from  this  insidious  disease  are  narrated  elsewhere.  They  include  the 
detail  of  ofiicers  in  foreign  ports  and  special  quarantine  measures  at 
Panama  and  Colon. 

There  is  encouragement,  however,  in  the  fact  that  we  have  for  this 
disease  both  preventive  inoculations  and  a  curative  serum,  that  it  can 
be  recognized  with  scientific  accuracy,  and  that  there  is  cooperation 
on  the  part  of  the  different  nations  toward  its  extinction.  The  sanitary 
conference  held  in  Paris,  an  account  of  which  is  contained  in  another 
part  of  this  report,  was  productive  of  practical  regulations  and  agree- 
ments, which  will  undoubtedly  prove  of  great  value  in  consideration  of 
this  world-wide  danger. 

The  disease,  too,  is  better  understood  as  to  mode  of  transmission. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  21 

iiud  at  the  Paris  conference  the  opinion  .seemed  to  prevail  that  pla«^ue 
has  l)eeii  deprived  in  larc^o  measure  of  its  traditional  terrors  and  that 
persons  atHicted  with  the  bubonic  (the  ordinary)  form  of  tlie  dis(>iise 
are  not  per  se  dunjiferous.  hut  are  dant^erous  us  reoards  the  possibility 
of  their  infectinj^  their  surioundinijfs.  The  continued  prevalence  of 
the  disea^'^  and  its  great  mortality  in  India,  wheie  it  caused  neiirly 
1,0<K>,000  deaths  during  the  last  fiscal  year,  remain  as  a  source  of 
anxiety  to  all  other  nations  despite  the  fact  that  the  disease  is. so  largely 
restricted  to  the  nati\  e  po})ulation.  As  shown  by  the  report  of  the 
division  of  sanitary  report  and  statistics,  there  were,  from  May,  1903, 
to  May,  1904,  913.784  deaths  from  this  disease  in  India,  an  increase  of 
more  than  250. (»00  over  the  num})er  of  deaths  occurring  during  about 
the  .same  period  of  the  previous  year. 

It  should  ])e  remarked,  however,  that  the  British  Government,  which 
for  a  time  lessened  its  protective  measures  on  account  of  ditticulties 
with  the  native  population,  religious  scruples,  etc..  have  again  begun 
more  active  measures,  prosecuted  in  a  manner  to  avoid  exciting  the 
opposition  heretofore  encountered. 

YELLOW    FEVEK. 

During  the  year  just  ended  nearly  all  the  cases  of  yellow  fever 
occurred  near  the  Mexican  border.  In  Laredo,  Tex.,  from  September 
24,  19(13.  to  March  IS,  1904.  there  were  reported  1,014  cases,  with 
107  deaths:  in  Minera  up  to  November  28,  1903,  137  cases,  with  11 
deaths;  in  San  Antonio  from  October  21  to  November  28,  1903,  43 
ca.ses  and  16  deaths.  Other  places  in  Texas  in  which  yellow  fever 
was  reported  present  were  Cannel.  Castroville,  Hondo,  and  Dewitt 
Countv. 

In  the  annual  report  for  1903  special  attention  was  invited  to  the 
prevalence  of  yellow  fever  in  Mexican  ports  and  the  location  of 
Service  officers  at  El  Paso.  Eagle  Pass,  and  Laredo.  Tex.,  in  aid  of  the 
Texas  State  quarantine  authorities.  The  disease,  which  subsequently 
assumed  epidemic  proportions  along  the  Mexican  side  of  the  Rio 
Grande,  had  existed  unannounced  for  a  consideraVjle  period,  and  to  this 
fact  and  the  low  fordable  condition  of  the  Rio  Grande,  the  epidemic 
upon  the  Texas  side  of  the  river  can  probably  be  attributed. 

The  fever  was  not  reported  officially  until  the  third  week  in  Sep- 
tember, and  when  the  officers  of  the  Public  Health  and  ^larine- 
Hospital  Service  detailed  for  the  suppression  of  the  disease  arrived 
in  Laredo,  September  2.5.  thev  were  confronted  by  a  very  serious  prob- 
lem. Cases  of  yellow  fever  were  reported  in  rapid  succession  from 
widely  separated  points,  this  probablv  being  the  period  of  the  third 
mosquito  cycle  of  infection,  showing  that  the  disease  had  already 
obtained  a  firm  foothold  and  was  widely  dis.seminated  among  a  popu- 
lation almost  entirely  nonimmune.  There  were  an  al)undance  of  dego- 
hiy^,  thousands  of  unscreened  water  tanks  and  other  breeding  places, 
and  an  entire  lack  of  police  or  other  authority  to  enforce  sanitarv 
measures.  In  spite  of  these  discouraging  conditions  some  remarkable 
results  were  accomplished.  In  Nuevo  Laredo.  Mexico,  where  very 
little  antimosquito  work  was  done,  50  per  cent  of  the  population  con- 
tracted the  disease.  In  Laredo.  Tex.,  directly  across  the  river,  where 
after  October  1  fever  ca.ses  were  screened,  water  tanks,  etc.,  oiled, 
and  infected  premises  disinfected  to  kill  mosquitoes,  1,050  cases  devel- 


22  PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE. 

oped  in  a  population  of  10,000,  constituting  only  al>out  10  pev  cent  of 
the  population.  The  practical  results  obtained  by  drainage,  mosquito 
destruction,  prompt  screening  of  all  fever  patients,  and  screening  of 
water  containers  show  that  this  disease  can  be  controlled  In'  measures 
directed  exclusively  toward  the  mos(juito.  So  thoroughly  was  the 
work  of  destroying  mosquitoes,  and  especially  the  work  of  oiling  con- 
tainers and  other  breeding  places  performed,  that  an  officer  of  the 
Service  detailed  in  Novem))er  to  study  infected  yellow-fever  mos- 
quitoes could  not  find  in  Laredo,  after  diligent  search,  enough  dcgo- 
my;t  in  the  adult,  larval,  or  pupal  stages  to  cai-ry  on  his  work. 

In  January  I  visited  ^Mexico  and  conferred  with  the  Mexican  authori- 
ties for  the  purpose  of  considering  measures  for  the  eradication  of 
3'ellow  fever  in  both  Republics.  As  a  result  of  this  conference  an 
agreement  was  reached  and  a  vigorous  prosecution  was  at  once  begun 
of  a  practically  identical  plan  of  campaign  upon  both  sides  of  the  Rio 
Grande. 

The  plan,  as  outlined,  may  be  found  in  the  report  of  the  division  of 
domestic  quaranti  ne. 

With  regard  to  the  elimination  of  this  disease  from  the  Western 
Hemisphere,  which  has  been  the  subject  of  hopeful  comment  in  previ- 
ous annual  reports,  it  would  appear  that  the  clearance  of  yellow  fever 
from  the  island  of  Cuba,  the  sanitary  work  which  has  been  done  in 
ports  of  the  United  States  with  special  reference  to  it,  and  the^dmirable 
measures  which  have  been  taken  by  the  Mexican  (jovernment  to  the 
same  end,  are  having  a  marked  effect.  South  and  Central  American 
republics  are  giving  evidence  of  attention  to  the  same  matter,  and  in 
like  maimer,  and  it  is  not  too  much  to  hope  that  through  the  coopera- 
tion of  the  different  American  republics,  brought  about  largely  through 
the  international  sanitary  conventions,  the  end  may  in  reasonable  time 
be  achieved. 

The  fact  that  the  disease  is  conveved  in  but  one  manner  (viz:  by  the 
mosquito)  gives  force  and  focus  to  the  work  of  elimination.  The  ulti- 
mate cause,  however,  remains  as  yet  undetermined.  The  results  of  the 
investigations  of  working  party  Ko.  1  of  the  Yellow  Fever  Institute  of 
the  Public  Health  and  ]\iarine-Hospital  Service  gave  everv  promise  of 
the  determination  of  the  etiology.  ])ut  subsequent  investigations  by 
working  part}'  No.  '1  of  the  same  institute  at  Veracruz  failed  to  confirm 
all  the  findings  of  working  party  No.  1,  leaving  the  cause  still  undeter- 
mined; but  as  to  the  method  of  transmission  through  the  mosquito  there 
can  be  no  doubt.the  tindingsof  the  army  commission  inCuba having  t)een 
amply  confirmed  both  by  scientific  investigations  of  the  Yellow  Fever 
Institute  of  this  Service,  by  the  practical  results  of  preventive  measures 
based  upon  those  findings,  and  also  by  the  commission  appointed  under 
the  auspices  of  the  Pasteur  Institute  of  Paris,  whose  labors  and  conclu- 
sions were  conducted  and  reached  in  the  city  of  Rio  de  Janeiro. 

THE    NATIONAL    QUAUANTIXE    SERVICE. 

The  work  of  conducting  national  quarantine  for  the  exclusion  of 
epidemic  diseases  has  l^een  carried  on  during  the  3'ear  at  the  iO  national 
inspection  and  disinfection  stations  located  upon  the  Atlantic,  Gulf, 
anti  Pacific  coasts  of  the  United  States.  A  total  number  of  7,021  ves- 
sels were  inspected  and  323  vessels  disinfected  before  entiy,  with  the 
least  possible  dela}-  to  commercial  interests. 


PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE.  23 

Aid  was  extended  to  the  health  authorities  of  the  State  of  Maine 
u\Hm  tlie  Canadian  border  in  the  exclusion  and  suppression  of  small- 
pox, reports  fioni  otiieers  detailed  for  this  work  showintr  a  totul  of  l»3 
families  utuler  observation,  3,753  persons  inspected,  1.73G  persons 
vaccinated,  2(h;  cases  of  smallpox  treated,  and  111  dwellings  and  2<) 
schoolhouses  disinfected. 

The  Service  has  maintained  the  usual  land  quarantine  stations  along 
the  Texas-Mexican  border  in  aid  of  and  in  cooperation  with  the  State 
health  authorities  of  Texas,  at  El  Paso,  Eagle  Pass,  and  Laredo. 

The  national  quarantine  procedures  in  the  suppression  of  yellow 
fever  at  Laredo  and  of  the  plague  at  San  Erancisco  will  be  found  in 
other  portions  of  this  leport. 

The  national  quarantine  laws  and  regulations  have  also  been  enforced 
through  Service  officers  stationed  at  the  ports  of  Porto  Kico,  Hawaii, 
and  the  Philippines.  Necessary  improvements  at  the  quarantine  sta- 
tion on  Miratiores  Island,  Porto  Rico,  will  be  made  as  soon  as  the  title 
has  been  declared  clear,  out  of  the  appropriation  of  '^'23.5^^0  made  for 
the  purpose  by  the  Eifty-eighth  Congress.  Attention  is  specially 
invited  to  the  effective  administration  of  quarantine  in  all  three  of 
these  insular  possessions.  The  report  of  the  chief  quarantine  officer 
of  the  Philippines  is  of  particular  interest.  It  illustrates  clearly  how 
the  great  epidemic  diseases  may  be  suppressed  and  excluded  in  the 
presence  of  untoward  conditions  by  scientific  methods  accompanied  by 
administrative  skill  and  energy. 

The  details  of  officers  stationed  in  the  offices  of  the  United  States 
consuls  at  Yokohama.  Nagasaki,  and  Kobe.  Japan,  and  Hongkong  and 
Shanghai.  China,  have  been  continued. 

On  account  of  the  continued  epidemic  of  plague  in  Bomba}'  and 
Calcutta,  India,  officers  have  been  detailed  for  special  duty  in  the  offices 
of  the  United  States  consuls  at  those  ports.  Officers  have  been  on  duty 
also  at  the  following  foreign  ports:  In  Cuba  at  the  ports  of  Habana. 
Matanzas,  Nuevitas.  Santiago,  and  Cienfue^os  to  exercise  supervision 
over  outgoing-  vessels  bound  for  the  United  States,  its  insular  posses- 
sions or  dependencies;  at  Vera  Cruz.  Tampico.  and  Progreso.  Mexico, 
for  the  disinfection  of  vessels  at  those  ports  bound  for  the  United 
States,  insuring  their  freedom  from  infection  and  thus  preventing 
imdue  detention  at  the  United  States  ports:  at  7  fruit  ports  in  Central 
and  South  America,  for  the  enforcement  of  the  Treasury  Kegulations 
on  vessels  engaged  in  the  fruit  trade,  for  the  purpose  of  preventing 
their  detention  at  quarantine  in  the  L^nited  States  which  detention 
would  result  in  the  destruction  of  their  perishable  cargoes;  in  the 
offices  of  the  L'nited  States  consuls  in  the  ports  of  Colon  and  Panama 
to  sign  bills  of  health  of  vessels  leaving  those  ports  for  United  States 
ports,  and  at  the  same  time  to  transmit  all  available  information  con- 
cerning health  conditions  there  in  accordance  with  section  2  of  the  act 
of  Congress  approved  Eebruary  15,  1893;  and,  tiually,  in  the  offices 
of  the  United  States  consuls  at  La  Guaira,  Venezuela;  Callao,  Peru, 
and  Guayaquil,  Ecuador,  to  inspect  and  sign  bills  of  health  of  vessels 
bound  for  ports  not  only  in  the  L^nited  States  but  by  request  of  the 
Panama  Government  of  vessels  bound  for  ports  in  that  Republic. 

I  deem  it  my  duty  to  invite  attention  to  the  somewhat  anomalous 
condition  as  regards  authority  for  quarantine  work  on  the  Mexican 
border.  At  the  three  principal  crossings  from  ^lexico  into  the  United 
States  quarantine  inspection  stations  are  established  by  the  State  of 


24  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Texas,  which,  under  the  present  hiw,  the  State  has  a  legal  right  to  do. 
Under  the  national  quarantine  law  this  Service  has  a  right  of  surveil- 
lance over  these  stations  and  is  also  required  to  give  aid,  so  far  as 
may  be  necessary,  to  the  State  quarantine  authorities.  Under  these 
two  provisions  of  national  law,  officers  of  the  Public  Health  and 
Marine-Hospital  Service  have  also  been  stationed  at  the  three  principal 
crossings.  The  State,  having  but  a  small  appropriation  available,  has 
gladly  accepted  the  assistance  of  the  Service,  which  has  established 
detention  camps  and  otherwise  provided  quarantine  protection  at  these 
points. 

With  the  exercise  of  great  care  and  tact  there  has  been  no  friction 
between  the  two  sets  of  officeivs,  nor  between  the  Bureau  and  the  State 
health  authorities  of  Texas,  but  in  the  exercise  of  its  rights  the  State 
has  occasionally  placed  restrictions  upon  travel  which  have  seemed 
excessive  and  which  the  Bureau  could  not  consent  to  assist  in  enforcing, 
though  requested  to  do  so. 

The  officers  and  employees,  the  necessary  equipments,  and  the  prin- 
cipal expenditures  necessary  for  maintaining  the  quarantines,  have 
been  borne  by  the  United  States,  the  State  maintaining  principally  its 
physicians  at  the  stations,  who,  it  must  be  stated,  have  sedulously  ond 
faithfully  performed  their  duties,  accepting  the  help  of  the  Service, 
the  situation  thus  offering  none  of  the  conditions  mentioned  in  the  act 
of  Congress  approved  February  15, 1893,  under  which  the  Government 
may  demand  and  enforce  exclusive  control. 

The  control,  however,  of  a  land  quarantine  between  two  Picighbor- 
ing  republics  presents  problems  diii'erent  from  those  arising  at  mari- 
time quarantine  stations,  and  in  the  solution  of  these  problems  the 
neighboring  republic  must  be  taken  into  account,  and  great  tact  and 
diplomacy  is  necessary  to  secure  the  friendly  cooperation  of  its 
authorities  in  preventing  the  invasion  of  the  United  States  by  the 
disease  which  threatens. 

Certain  well-detined  practical  measures  can  be  best  enforced  in  the 
neighboring  republic,  and  embarrassment  can  readil}"  result  if  when 
efforts  to  this  end  are  being  made  by  the  national  authorities  and  in  a 
manner  to  avoid  offense  the  State  authority  precipitateh^  adopts  meas- 
ures looking  only  to  its  own  protection,  such  as  total  exclusion  of  pas- 
senger traffic,  or  exclusion  with  provisos  which  can  not  be  looked  upon 
with  acquiescence  by  the  authorities  of  the  neighboring  republic. 

In  the  minds  of  the  Mexican  authorities,  therefore,  during  the  past 
year  there  must  have  been  some  confusion,  as  they  were  obliged  to  deal 
both  with  the  United  States  and  the  State  of  Texas,  and  in  fact  pro- 
tests against  the  action  of  the  State  have  been  received  from  the 
superior  board  of  health  of  Mexico  at  the  Bureau. 

With  regard  to  maritime  quarantine  in  the  United  States  proper, 
the  administration  of  the  1:0  stations  belonging  to  the  Service  has  been 
conducted  with  facility  and  with  a  diminished  restraint  upon  commerce. 
The  administration  of  the  stations  which  have  been  turned  over  to  the 
National  Government  by  the  action  of  States  or  nmnicipalities,  such 
as  Savannah,  Ga.,  the  17  quarantine  stations  of  Florida,  the  quarantine 
service  in  North  Carolina,  and  Maine  and  New  Jersey  has  been  of  a 
character  evidently  satisfactory  both  to  the  State  and  local  authorities 
and  to  the  conmiercial  interests.  The  dealings  of  the  Bureau  with 
these  stations  have  certainl}^  been  more  easy  and  more  effective  than 
when  the}^  were  under  State  or  municipal  control.     In  fact,  it  would 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE.  25 

easily  mid  to  the  fiicility  tnid  cll'ecti\(Mic.ss  oi'  the  natioiial  (jiuimiitiiie 
law  if  all  the  (|iianintiiie  stations  of  the  Lhiited  States  were  op(>rated 
by  the  National  (Jovenmient.  There  has  been  no  fault  found  with 
the  ctfeetive  administration  of  the  stations  which  are  now  operated  by 
the  State  and  local  authorities,  and  I  am  pleased  to  say  there  is  Ji  fra- 
ternal spirit  of  hearty  cooperation,  yet  the  Bureau  contimies  to  receiyc 
mnnl)ers  of  su^nestions  looking- toward  making-  the  (juarantini^  seryice 
of  the  United  States  entirely  national,  and  since  the  law  passed  oidy 
two  years  ai^'o  authorized  the  health  authorities  of  the  States  to  call  a 
conference  at  any  time  with  regard  to  quarantine  matters  it  would 
seem  that  if  proyision  were  made  for  the  retention  in  the  Seryice  and 
and  with  their  present  emoluments  of  efficient  local  or  State  (piaran- 
tine  officers,  thus  gi\'int»-  them  the  benefit  of  attachment  to  a  Seryice 
which  is  devoid  of  politics  and  has  an  assured  tenure  of  office,  much  of 
the  opposition  to  makino-  all  quarantine  national  would  be  remoyed. 

The  facilities  possessed  by  this  Seryice  foi*  the  manag'ement  of  the 
(luarantine  stations  of  the  country  and  the  administration  of  the  cpiar- 
antine  laws  are  illustrated  in  the  reports  of  the  two  quarantine  divisions 
of  the  Bureau.  The  officer  in  charge  of  one  of  these  divisions  has 
complete  control  of  all  the  maritime  quarantine  stations  in  the  United 
States  proper,  to  which  he  gives  his  almost  exclusive  attention,  the 
exceptions  being  the  rare  occasions  when  there  may  be  an  epidemic  in 
the  United  States.  This  dlyision  (domestic  quarantine)  is  always  pre- 
sided over  by  an  officer  who  has  had  practical  experience  himself  and 
who  has  what  might  be  practically  termed  a  ""iDoard  of  quarantine 
commissioners  "  in  the  sanitary  board  of  the  Bureau  composed  of  five 
officers,  to  which  board  are  frequently  referred  questions  of  moment 
wdiich  are  promptly  and  satisfactorily  settled  in  accordance  with  the 
most  recent  scientitic  developments  regarding  epidemic  diseases.  The 
quarantine  regulations  prepared  by  this  board,  with  one  or  two  special 
members  added  thereto,  have  demonstrated  their  value  from  a  practi- 
cal and  scientific  standpoint  in  their  administration,  and  their  value  has 
been  furthermore  shown  by  the  adoption  of  their  principles  and  even 
details  by  State  authorities,  and  in  one  or  two  instances  by  foreign 
authorities.  The  findings  of  the  International  Plague  Conference  in 
Paris  last  3' ear  are  in  accordance  with  the  quarantine  regulations  of 
the  United  States  and  during  a  recent  quarantine  convention  of  the 
authorities  of  the  British  West  Indies,  in  the  Barbados,  the  domestic 
quarantine  regulations  of  the  United  States  were  adopted,  and  have 
been  published  in  the  report  of  the  conference. 

The  Bureau  is  constantly  training  men  specially  for  the  administra- 
tion of  quarantine  stations  by  a  course  of  special  instruction  in  the 
Hygienic  Laboratory  and  in  practical  work  at  the  stations  themselves 
under  superior  officers,  so  that  material  is  constantly  on  hand  in  the 
event  of  an  officer  detailed  to  a  quarantine  station  showing  a  Avant  of 
adaptal)ility  or  whose  health  might  require  his  relief  for  substitution 
by  other  officers  of  experience  and  special  training. 

The  control  of  quarantine  by  this  Service  in  Porto  Rico,  Hawaii,  and 
the  Philippines  has  been  made  comparativeh'  easy  because  of  these 
stations  belonging  to  a  broad  system  in  w-hich  the  work  of  an  officer  at 
one  port  is  recognized  and  accredited  by  the  officers  at  the  other  ports, 
orshouldfailureof  cooperation  appear  any  where  the  Bureauis  promptly 
informed  and  any  diflerencc  readil}'  settled. 


26  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

ISTHMIAN    CANAL   ZONE. 

As  shown  in  the  report  of  the  division  of  foreign  and  insular  quar- 
antine, as  soon  as  it  was  evident  that  the  United  States  was  to  come 
into  possession  of  the  Isthmian  Canal  Zone,  realizing  that  pending 
completion  of  transactions  there  should  be  official  cognizance  of 
health  conditions  both  there  and  in  neighboring  South  American  and 
Centi'al  American  ports,  with  your  appi'oval  and  })y  order  of  the  Presi- 
dent officers  Avcre  detailed  in  the  offices  of  the  L'nited  States  consuls  at 
Panama  and  Colon,  and  reports  of  these  officers  published  in  the  Pul)- 
lic  Health  Reports  gave  much  desired  information.  At  the  same  tinu! 
officers  were  detailed  to  the  United  States  consulates  in  Callao,  Pei'u, 
and  Guayaquil,  Ecuador,  two  ports  from  which  there  was  especial 
danger — from  Y)lague  in  the  one  and  yellow  fever  in  the  other. 

Soon  after,  through  the  accredited  minister  of  Panama  to  the  United 
States,  request  was  made  that  the  officers  in  these  said  ports  (Calhio 
and  Guayaquil)  should  exercise  the  same  surveillanc^e  over  vessels 
bound  for  Panama  as  o\er  vessels  bound  for  United  States  ports,  a 
re([uest  gladlv  acciuicsced  in  for  the  sake  of  protection  to  the  Panama 
Canal  Zone. 

Subse(iuently,  the  Government  of  Panama  turned  over  the  adminis- 
tration of  their  local  ((uarantine  at  Panama  t(^  the  regularly  ccnn- 
missioned  officer  of  this  Service  there  stationed.  Eventually  the 
administration  of  all  matters  relating  to  sanitation  as  w^ell  as  quaran- 
tine was  assumed  by  the  Isthmian  Canal  Commission,  and  recjuests 
have  been  made  upon  this  Bureau  for  the  detail  of  certain  officers,  four 
in  number,  particularly  for  quarantine  administration.  The  senior  of 
these  officers  has  been  made  chief  of  the  quarantine,  under  the  chief 
sanitary  officer  of  the  Canal  Zone,  who  is  himself  an  appointee  of  the 
Isthmian  Canal  Commission.  Officers  of  this  Service  reported  by 
request  to  the  chairman  of  the  Isthmian  Canal  Conunission,  who  in 
turn  directed  them  to  report  to  the  chief  sanitary  officer. 

On  account  of  the  prevalence  of  plague  in  Peru  and  yellow  fever  in 
Ecuadoi'  prom})t  action  with  regard  to  quarantine  was  absolutelv  neces- 
sary, and  the  Service,  with  your  consent,  has  practically  given  all  these 
officers  to  the  Isthmian  Canal  Commission.  It  is  to  be  hoped,  how- 
ever, that  this  arrangement  may  be  considered  but  temporary,  and 
that  th(;  Commission  itself  will  desire  that  the  maritime  quarantine  l)e 
conducted  by  this  Service,  as  it  is  in  our  other  possessions.  There  is 
mm-h  dependence  by  the  authorities  of  the  Canal  Zone  upon  the  work 
of  the  officers  of  this  Service  in  Chile,  Peru,  Ecuadoi-,  and  V^enezuela, 
as  well  as  various  West  Indian  and  Central  American  ports,  and  it 
would  maintain  the  harmony  of  the  whole  maritime  fpiarantine  service 
if  some  arrangement  were  made  similar  to  that  now  existing  in  the 
Philippines  and  in  Porto  Rico  and  Hawaii. 

It  should  be  remai'ked  that  under  the  Spooner  law  the  salaries  of 
the  officers  detailed  I)y  the  Bureau  and  given  over  to  the  Isthmian 
Canal  Commission  are  still  paid  by  the  Service. 

SCIENTIFIC    KKSEARCH    AND   SANITATION. 

In  the  report  from  the  division  of  scientific  research  and  sanitation 
will  be  found  many  items  of  great  interest,  to  some  of  which  refer- 
ence has  alreadv  been  made.     This  section  of  the  report  deals  with 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  27 

tlic  various  couvcMilions  whirh  havo  hoen  lu'lcl  duriiio-  the  year  in  wiiicli 
tlio  ScM'vice  has  partiripjitcd,  and  <;i\e.s  account  of  the  sp(M-ial  investi- 
gations made  intotheeau.se  of  outbreaks  of  tyi^lioid  and  spotted  fever; 
the  sanitation  of  railway  coaches  and  Pulhiian  cars;  incjuiry  into 
insanitary  dwellings  and  tlie  I'ehousinu-  prohK'ui  in  foreign  cities;  the 
First  Anti-Mos(|uito  (\)n\-ention;  the  National  Association  for  the 
Prevention  of  Tul'M-culosis;  Tiu^  Porto  Rican  Anemia  Commission; 
the  enfoi'cement  of  the  law  regulating  the  sale  of  vaccine,  serums,  and 
antitoxins;  and  the  opei'ations  of  the  Yellow  P\>ver  Institute. 

All  matters  of  scientific  import  iinolving  sanitary  problems  ;ire 
referred  to  this  division,  which  is  rapidly  growing  in  impoitance  and 
usefulness,  and  which  also  has  administrative  charge  of  tne  Hygienic 
Lal)oratory. 

HYGIENIC    LABORATORY. 

The  report  of  the  director  gives  in  detail  an  account  of  the  research 
and  other  scientific  labors  conducted  in  the  La])oratory,  among  which 
were  the  examination  of  vaccines  and  serums  under  the  provisions  of 
an  act  aj)pr()ved  Jul}"  1,  liK)2;  experiments  on  car  sanitation;  exami- 
nation of  pathologic  specimens  from  various  stations  of  the  Service; 
examination  of  cases  of  suspected  plague  at  quarantine  stations; 
examination  of  drugs  and  chemicals  for  the  purveying  depot  of  the 
Service  at  New  York;  preparation  of  a  considerable  portion  of  the 
Service  exhibit  at  the  Louisiana  Purchase  Exhibition;  the  investiga- 
tion of  various  diseases,  as  3'ellow  fever,  the  malarial  fevers,  hook 
worm  disease,  tul)erculosis,  etc.;  the  testing  of  microscopes  and 
microscopic  lenses,  etc. 

Tyj>hol(J  fever  and  drin]t:ing  toater. — The  assistance  of  the  Service 
having  been  invoked  to  investigate  an  outbreak  of  typhoid  fever  at 
Lexington,  Va.,  the  water  supply  was  investigated,  and  a  bacillus 
similar  in  morpholog}'  and  reaction  to  the  B.  tj'phosus  was  isolated 
from  the  water. 

Invedigat'ion  of  disinfecting  agents. — Several  investigations  of  the 
germicidal  efficiency  of  various  commercial  compounds  were  conducted 
for  various  bureaus  of  the  Treasury  Department,  and  in  addition  an 
extensive  research  was  made  into  the  germicidal  efi'ects  of  chloride  of 
lime  and  chloride  of  zinc. 

Division  of  zoology. — The  following  subjects  were  investigated  in 
this  division:  Spotted  fever  in  Montana,  hook-worm  disease  in  various 
parts  of  the  United  States,  the  intestinal  parasites  of  Pennsylvania 
miners,  the  intestinal  parasites  of  insane  patients  in  governmental  and 
State  institutions,  the  dwarf  tapeworm  {IT.  nana),  and  the  trematode 
parasites  of  man. 

Division  of 2)}iarmacology . — The  following  subjects  were  investigated 
in  this  division:  Experiments  with  nitriles,  experiments  with  alcohols, 
experiments  with  quinine  derivatives,  and  the  examination  of  drugs 
and  chemicals  for  determination  of  their  phaimacopeial  purity  and 
potency. 

AW'  building. — It  will  be  recalled  that  the  new  laboratory  was  pro- 
vided by  act  oi'  Congress  approved  March  3,  11H)1,  with  an  appropria- 
tion of  $35,000,  the  functions  of  the  laboratory  being  declared  to  be 
''  for  the  investigation  of  infectious  and  contagious  diseases  and  matters 
relating  to  the  public  health."  Five  acres  of  the  reservation  occupic^d 
by  the  Naval  Museum  of  Hygiene,  old  Naval  Observatory  grounds, 


28  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

was  also  made  available.  The  new  building-  was  completed  and  the 
ke3's  turned  ov^er  to  the  Bureau  on  July  21,  1903.  The  building  was 
occupied  for  laboratory  purposes  on  March  10, 1904.  The  cost  of  the 
building  was  approximately  $35,000.  The  cost  of  equipment  was  in 
the  neighl^orhood  of  i^l8,000. 

Since  the  building  was  appropriated  for  another  act  of  Congress 
(July  1,  1902)  provided  for  the  enlargement  of  its  functions  by  the 
addition  of  an  advisory  board  and  three  new  divisions,  namely,  those 
of  zoology,  pharmacology^  and  chemistry.  An  appropriation  for  an 
additional  building  was  included  in  the  Treasury  Department  estimates 
for  the  present  fiscal  ,year,  but  was  not  granted.  The  need  for  addi- 
tional room  has  become  acute  to  meet  present  pressing  necessities. 
Ultimately  there  will  doubtless  be  needed  a  building  for  each  one  of 
the  four  divisions  of  the  laboratory,  namely,  the  three  just  mentioned 
and  the  division  of  bacteriology  and  patholog}',  but  it  is  proposed  to 
ask  of  Congress  appropriations  for  these  buildings  only  as  their  neces- 
sities become  manifest.  One  new  building  should  be  provided  for  at 
once. 

Bidletliis. — Four  l)ulletins  have  been  issued  during  the  year  and 
others  are  in  course  of  preparation. 

STANDARD    UNIT   FOR    DIPHTHERIA   ANTITOXIN. 

In  the  laboratory  examination  of  diphtheria  antitoxin  for  purit}^  the 
product  can  be  satisfactorily  tested  by  ordinary  culture  tests  and 
animal  inoculations,  but  in  determining  the  potency  the  want  has  long 
been  felt  of  a  standard  unit.  There  has  been  no  such  unit  produced  here- 
tofore in  the  United  States,  and  the  American  Medical  Association 
and  the  American  Pharmaceutical  Association  have  both  passed  resolu- 
tions I'equesting  the  Service  to  prepare  a  standard  antitoxic  unit  for 
diphtheria  antitoxin.  In  this  request  the  manufacturers  of  the  prod- 
uct have  also  united. 

The  director  of  the  Hygienic  Laboratory  has  therefore  been  directed 
to  prepare  such  a  unit,  and  the  work  is  progressing  rapidly,  and  it  is 
hoped  that  it  will  be  ready  for  issue  within  a  few  months.  Manufac- 
turers have  up  to  this  time  been  employing  Ehrlich's  method  and 
Ehrlich's  standard  toxin  for  standardizing  their  products,  but  owing  to 
the  necessity  of  importing  the  standard  toxin  and  the  time  necessarily 
consumed  in  the  importation,  the  results  have  been  only  fairly  accu- 
rate, and  variations  in  technic  have  still  further  impaired  the  accuracy 
of  the  determinations.  The  errors  have  been  slight,  it  is  true,  but  it 
is  felt  that  in  a  matter  of  such  moment  the  determinations  should  be 
as  nearly  absolutely  accurate  as  it  is  possible  to  render  them. 

OFFICIAL    SANITARY    CONFERENCES. 

During  the  fiscal  year  the  transactions  of  the  first  annual  conference 
of  the  Service  with  State  health  authorities  were  published.  The 
second  annual  conference  was  held  ,June  3,  190-1,  22  States  and  Terri- 
tories being  represented.  Resolutions  were  passed  expressing  confi- 
dence in  the  present  measures  in  force  with  regard  to  plague  in  China- 
town, San  Francisco,  and  congratulating  the  national.  State,  and 
municipal  authorities  on  their  harmonious  action.  Committees  were 
appointed  from  the  State  health  officers  upon  ten  subjects  relating  to 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  29 

epiflomiolooy  and  sanitary  sc-ionco.  To  these  connnittoos  will  he  siil)- 
initttMl  the  several  matters  atteetinjjf  the  puhlic  health  which,  in  the 
opinion  of  the  Bureau,  should  reeeive  their  consideration. 

Tiie  relations  of  the  Service  with  the  State  boards  is  now  nioi-o 
intimate  and  cordial  than  ever,  and  it  should  ])e  the  policy  of  the 
Department  and  Bureau  to  eno-age  their  activities  in  the  manner  a])ove 
suggested  whenever  possible  to  the  advantaj^cof  both  the  State  boards 
and  the  Service.  It  is  evident  that  at  times  Avhen  lar<jfe  matters  of 
serious  import  have  been  confided  to  some  of  these  committees  it  would 
])e  advisable  occasionally  to  sunnnon  them  to  Washinj^ton  for  consul- 
tation. The  conunittees  are  not  laro-o  in  mem])ership,  there  being  onh' 
from  three  to  live  on  each  committee,  and  it  is  believed  that  Congress 
should  authorize  the  payment  of  their  traveling  expenses  when  con- 
sultation with  them  is  desired  b}^  the  Bureau. 

International  Sanitary  Conference  of  Par! s^  1903. — This  conference 
aimed  to  consolidate  existing  conventions  and  to  bring  them  into 
accord  with  the  present  scientilic  knowledge  of  plague  and  cholera,  but 
more  especially  plague.  An  officer  of  the  Service  was  detailed  to 
represent  the  United  States  at  this  conference  in  conjunction  with 
officers  from  the  medical  departments  of  the  Army  and  the  Navy. 

The  delegates  from  the  United  States,  having  no  plenar}'  powers, 
signed  the  convention  ad  referendum  only. 

The  convention  was  translated  and  reviewed  in  the  Bureau  and 
transmitted  to  yourself  with  my  recommendation  for  its  adoption  with 
certain  reservations,  being  finalh'  transmitted  by  the  Department  of 
State  to  the  United  States  Senate,  where  it  failed  of  ratitication,  owing 
to  the  lateness  of  its  presentation.  Little  doubt  is  felt,  however,  that 
it  will  be  ratified  during  the  approaching  session  of  Congress. 

Sanitary  Coivtntion  of  Anierican  Hepahlics  i)OHtponed.  —  The  date 
for  holding  the  Second  General  International  Sanitary  Convention  of 
the  American  Republics  was  set  b}'  the  first  convention  at  March  1.5, 
1904,  and  the  place  fixed  upon  was  Santiago  de  Chile.  Owing  to  the 
inability  of  the  representatives  of  the  national  health  services  of  the 
United  States  and  presumably  ^Mexico  to  attend,  on  account  of  the  work 
necessar}"  to  prevent  the  recurrence  of  yellow  fever  in  ]\Iexico  and  Texas 
as  well  as  the  apparent  difficulties  in  the  waj"  of  other  republics  sending 
representatives,  it  Avas  decided,  after  correspondence  with  the  pros- 
pective hosts  at  Santiago  de  Chile  and  other  countries  interested,  to 
postpone  the  next  convention  until  April,  190.5.  It  is  hoped  to  obtain 
at  that  time  a  full  representation,  especially  of  the  Central  and  South 
American  republics  particularly  interested  in  sanitation  and  the  elimi- 
nation of  yellow  fever,  and  to  further  advan(?e  upon  the  lines  laid  down 
by  the  convention,  held  in  Washington,  December  2-5,  1902,  toward 
an  international  agreement  looking  to  thp  removal  of  quarantine 
restrictions  upon  shipping  by  the  eradication  of  disease-producing 
conditions  which  now  obtain  in  certain  ports. 

CONCLUSION. 

A  review  of  the  transactions  of  the  Public  Health  and  Marine-Hos- 
pital Service,  as  recounted  in  the  foregoing  and  succeeding  pages,  will 
show  that  the  Service  has  fairly  entered  upon  its  functions  as  the 
national  health  organization.  The  various  duties,  scientific  and  admin- 
istrative, outside  of  Washington  find  their  ready  and  capable  agents 


30  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

in  the  well  organized,  disciplined,  and  trained  officers,  commissioned 
medical  officers,  a  corps  of  efi'ective  acting  assistants,  and  phar- 
macists. The  variety  of  the  dnties  connected  with  the  Service,  so  far 
from  embarrassing",  is  a  source  of  strength,  the  experience  of  the 
officers  of  one  bi-anch  making  them  all  the  more  valuable  for  duty  in 
other  branches  of  the  Service.  The  administrative  Bureau  at  Wash- 
ington, organized  as  it  is  under  the  law  of  1902,  has  been  made  effect- 
ive not  only  through  the  regulations  of  the  general  Service,  ])nt  b}^ 
special  Bureau  ordinances  recently  consolidated  in  a  Bureau  manual, 
with  Department  approval,  clearly  defining  the  duties  of  each  assist- 
ant surgeon-general  and  providing  a  S3"stem  of  coordination  in  admin- 
istration, so  that  the  Bureau  in  its  seven  divisons  practically  works 
as  a  unit. 

These  results  have  been  attained  gradually  through  the- school  of 
experience  and  special  stud3\  The  perfection  of  the  Bureau  organi- 
zation since  the  passage  of  the  law  of  1902  has  been  necessarily  ante- 
cedent to  greater  activity  in  connection  with  the  State  boards  of  health 
and  the  committees  which  have  been  appointed  from  among  them,  and 
it  is  hoped  that  the  full  working  of  the  national  health  organization, 
in  which  is  now  included  b}^  law  the  association  of  State  authorities, 
will  be  rapidly  developed. 

It  should  be  considered  that  the  Service  occupies  a  position  involving 
a  responsible  trust,  a  position  given  it  by  Congress  and  recognized  by 
the  State  boards  of  health.  It  is,  therefore,  expected  to  inaugurate 
and  to  conduct  measures  for  the  benefit  of  the  public  health  to  the 
extent  and  with  the  energ}'  that  have  been  demanded  of  the  National 
Government  in  times  past  by  the  more  thoughtful  sanitarians  and  the 
medical  profession  of  the  United  States.  Moreover,  as  will  be  seen  in 
this  report,  it  has  close  international  relations  in  health  matters,  and 
the  stinudating  effect  of  one  nation's  activit}^  upon  that  of  others  is 
being  rapidly  demonstrated.  It  is  believed  that  much  may  be  accom- 
plished through  these  relations. 

It  should  be  liorne  in  mind  that  the  object  of  our  own  and  other 
national  organizations  is  not  merely  the  exclusion  and  suppression  of 
the  great  epidemic  diseases.  The  contents  of  this  report  show  that 
the  terror  inspired  by  these — a  dread  born  of  ignorance — has  given 
way  to  a  feeling  of  confidence  justified  by  knowledge  and  successful 
contest.  Greater  attention  is  now  directed  to  what  have  been  termed 
the  lesser  epidemic  diseases,  which  arc  in  reality  more  fatal  and  bring- 
far  greater  distress.  In  the  advancement  of  civilization  the  elimina- 
tion of  these  more  familiar  diseases  will  be  an  important  factor,  and 
the  measures  to  accomplish  it  will  not  be  quarantine,  detention  camps, 
and  sanitary  guards,  but  insistence  upon  sanitary  dwellings,  in  which 
shall  be  abundance  of  air  and  sunlight,  pure  water,  and  safe  disposal 
of  all  wastes.  In  the  development  of  these  measures  new  problems, 
both  legal  and  material,  will  confront  the  Service,  and  it  is  hoped 
both  the  Administration  and  Congress  will  give  such  aid  as  may  be 
wisely  given  in  the  pursuance  of  its  policies.  Its  organization  is 
believed  to  be  comprehensive  and  effective,  but  much  remains  to  be 
done  for  the  improvement  of  its  several  branches. 

1  have  already  alluded  to  the  Hygienic  Laboratory,  of  which  so 
much  is  expected  and  which  may  be  developed  into  a  hygienic  institute 
second  to  none.     Its  development  should   be  gradual,  but  the  new 


rUHLIC    HEALTH    AND    MARINE-HOSI'ITAL    SEKVIOK.  31 

lmildin<i'  rp(niostcd  of  the  liist  (Vinjifres.s  and  iio'ain  to  l)o  uskod   for  is 
essential  to  meet  the  retiuireineiits  at  the  j)reseMt  time. 

The  liureau  force  i-e(|uires  the  addition  of  one  chM'k  in  the  dishms- 
in<4"  olliee  as  a  substitute  for  the  ])hai"ma('ist  now  serving-  under  (h'tail 
from  the  «;eneral  Service.  The  Bureau  re<|uires  also  the  services  of  a 
law  clerk,  on(^  well  ^•ersed  in  constitutional  law  and  in  the  laws  of  the 
several  States  rtdatino-  to  medical  and  sanitary  matters.  His  services 
would  be  invaluable  in  the  development  of  a  policy  of  uniformit}'  or 
coordination  in  municipal,  State,  and  national  leoisJation  and  in  decnd- 
ino-  problems  arising-  in  the  Bureau  in  the  administration  of  present 
laws  and  in  the  f  ramino-  of  desired  legislation. 

During  the  past  year  I  invited  your  attention  to  the  restiictions 
under  existing  law  upon  the  editions  of  the  Service  publications,  and 
with  your  api)roval  a  joint  resolution  was  prepared,  which  was  passed 
1)V  the  Senate,  enabling  the  Department  to  publish  in  suflicient  num- 
ber the  reports  and  bulletins  of  the  Service.  The  joint  resolution  has 
been  referred  to  the  House  of  Representatives,  and  it  is  confidently 
hoped  that  it  will  be  enacted  into  law,  thus  enabling  a  wider  distri))u- 
tioii  of  the  information  collected  by  the  Buieau.  the  demand  for  which 
by  those  interested  in  furthering  the  cause  of  public  health  is  so  greatly 
in  excess  of  the  supply. 

I  have  the  honor  to  remain,  respectfully, 

Walter  Wyman, 
•    Siti'geon-  General. 


DIMSION  OF  PERSONNEL  AND  ACCOUNTS. 


8629—04 3  33 


REPORT  OF  THE  DIVISION  OF  PERSONNEL  AND  ACCOUNTS. 

By  11.  D.  GKDDixtis, 

Assistant  Surgeon-General,  Public  Health  and  Marine-Hospital  Service,  in  temporanj 

charge. 

Sir:  I  have  the  honor  to  transmit  herewith  tlu>  following-  report  of 
the  division  of  personnel  and  accounts  for  the  fiscal  year  ended  June 
30,  1904:     . 

Personnel. 

commissioned  officers. 

At  the  beginning-  of  the  tiscal  xqwy  July  1,  1903,  the  commissioned 
corps,   including-   the  Surgeon-General,  consisted  of  109  otiicers,  as 

follows: 

• 

Surgeon-General 1 

Assistant  surgeons-general 6 

Surgeons 24 

Passed  assistant  surgeons 27 

Assistant  surgeons 51 

Surg.  R.  D.  Murray  died  November  22,  1903,  and  P.  A.  Surgs. 
H.  D.  Geddings,  C.  P.  Wertenbaker,  and  J.  C.  Perry  were  promoted 
to  the  grade  of  surgeon. 

Eleven  assistant  surgeons,  M.  J.  White,  L.  D.  Fricks,  V.  G.  Heiser, 
W.  C.  Hobdy,  W.  C.  Billings,  J.  W.  Kerr,  D.  E.  Robinson,  G.  M. 
Corput,  T.  F.  Richardson,  W.  W.  King,  and  C.  Ramus,  were  pro- 
moted to  the  grade  of  passed  assistant  surgeon. 

Asst.  Surg.  C.  E.  Decker  died  October  21,  1903;  Asst.  Surg.  H.  C. 
Russell  died  March  2,  1901,  and  one  assistant  surgeon  was  dismissed 
from  the  Service  by  Department  letter  of  June  16,  1903. 

As  a  result  of  the  examination  held  l)y  a  board  of  commissioned 
medical  officers  convened  to  meet  in  Washington  June  15,  1903,  nine 
candidates  passed  a  successful  examination  and  w^ere  commissioned 
assistant  surgeons  in  this  Service. 

Four  candidates  were  successful  in  passing  an  examination  before 
the  board  of  commissioned  medical  officers  convened  to  meet  in  AVash- 
ington,  D.  C,  April  1,  1901,  and  all  have  been  commissioned  assistant 
surgeons  in  this  Service. 

The  corps  at  the  close  of  the  fiscal  3'ear,  June  30,  1904,  consists  of 
118  officers,  as  follows: 

Surgeon-General 1 

Assistant  surgeons-general - 6 

Surgeons 25 

Passed  assistant  surgeons 36 

Assistant  surgeons 50 

35 


»< 


36  PUBLIC    HEALTH    AND    MARINE-H08PITAL    SEKVICE. 

PHARMACOLOGIST   AND   ADVISORY    BOARD,    HYGIENIC   LABORATORY. 

In  accordance  with  the  provision.s  of  an  act  of  Congress  approved 
Jul}'  1, 1902,  entitled  "An  act  to  increase  the  efficiency  and  change  the 
name  of  the  United  States  Marine-Hospital  Service,"  Dr.  Reid  Hunt 
was,  on  March  1,  1904,  appointed  chief  of  the  division  of  pharmacol- 
ogy. Hygienic  Laboratoiy,  and  entered  upon  duty. 

The  term  of  service,  one  year  from  Juh^  1,  1902,  of  Prof.  Frank  F. 
Wesbrook,  of  the  University  of  jMinnesota,  as  a  member  of  the  advis- 
oiT  board  of  the  Hygienic  Laboratory  having  expired  by  limitation, 
he  was,  on  August  11,  1903,  reappointed  for  a  period  of  five  years  from 
July  1,  1903. 

NONCOMMISSIONED   OFFICERS. 

Sanitary  insjyectors. — Two  sanitary  inspectors  served  during   the- 
entire  fiscal  year,  namel}',  J.  Y.  Porter  at  Key  West,  Fla.,  and  R.  I.   ' 
Bowie  at  Nagasaki,  Japan, 

Acting  assidant  surgeons. — At  tlie  beginning  of  the  fiscal  year  there 
were  1T9  acting  assistant  surgeons  on  dut}';  57  were  appointed.  3  died, 
and  39  were  separated  from  the  Service  b}'  limitation  of  appointment 
and  resignation,  leaving  on  duty  at  the  close  of  the  fiscal  year  194 
such  officers. 

Medical  inspectoi'S. — Two  medical  inspectors  served  during  the  entire 
year,  namely,  E.  F.  Smith  at  Honolulu,  Hawaii,  and  J.  McDonald  at 
San  Francisco  quarantine.  One  was  appointed  temporarily  at  Hono- 
lulu during  the  illness  of  E.  F.  »Smith,  her  services  being  discontinued 
without  prejudice  October  9,  1903. 

Internes. — At  the  beginning  of  the  fiscal  vear  there  were  10  internes 
on  duty  at  the  various  marine-hospital  stations;  14  were  appointed 
and  13  separated  from  the  Service  by  reason  of  resignation,  leaving 
11  on  dut}-  at  the  close  of  the  fiscal  year.  j 

Pharmacists. — At  the  beginning  of  the  fiscal  year  there  were  on  duty  I 
46  pharmacists,  divided  as  follows: 

Pharmacists  of  the  first  class 16 

Pharmacists  of  the  second  class _ 22 

Pharmacists  of  the  third  class 8 

Four  pharmacists  of  the  third  class  were  promoted  to  the  grade  of 
pharmacist  of  the  second  class;  1  pharmacist  of  the  second  class  was 
transferred  to  the  Immigration  Service;  5  appointments  were  made  to 
the  position  of  pharmacist  of  the  third  class;  2  resigned,  and  1  was 
reinstated,  leaving  the  number  at  the  close  of  the  fiscal  3^ear  49,  divided 
as  follows: 

Pharmacists  of  the  first  class Ifi 

Pharmacists   of  the  second  class 25 

Pharmacists  of  the  third  class 8 

Pilots  and  marine  engineers. — At  the  beginning  of  the  fiscal  year 
there  were  on  duty  11  pilots  and  21  marine  engineers.  During  the 
year  2  pilots  were  separated  from  the  Service  b}'  resignation  and  5 
were  appointed.  One  marine  engineer  was  discharged  for  cause,  7 
resigned,  and  10  were  appointed,  leaving  the  total  number  on  duty  at 
the  close  of  the  j^ear  as  follows: 

Pilots 14 

Marine  engineers 23 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


37 


irospitftl  attendants. — At  the  ])eo'innliio-  of  t]i(^  fiscal  year  577  lios- 
pital  attendants  Avere  employed  in  the  various  marine  hospitals,  quar- 
antine stations,  and  on  (epidemic  dut}',  not  including  <)!>  such  employees 
on  duty  in  the  Philippine  Islands. 

During  the  year  l.2(U)  were  ai)pointed,  1,200  were  separated  from 
the  Service  by  reason  of  limitation  of  appointment,  resignation,  deser- 
tion, and  dismissal,  leaving  at  the  close  of  the  3'^ear  643,  as  shown  by 
the  following  table: 


Branch  of  Service  in  whiel 

employed. 

In  Service 

July  1, 

1903. 

Appointed 

during 

year. 

Separated 

from 

Service. 

In  Service 

June  30, 

1904. 

Marine-Hospital  Service 

342 
199 
36 

762 
213 
291 

683 

269 
248 

421 

Quarantine 

143 

79 

Total 

577 

1,266 

1,200 

643 

69 

74 

s. 

60 

The  quarantine  tal)le  includes  17  attendants  employed  in  the  Terri- 
tory of  Hawaii  and  20  in  the  island  of  Porto  Rico. 

The  epidemic  table  includes  1  attendant  at  Matanzas  and  9  employed 
on  the  disinfecting  steamer  Sanator  at  Habana. 

RECAPITL^LATION. 

Commissioned  medical  officers 118 

Chiefs  of  divisions,  Hygienic  Laboratory 2 

Sanitary  inspectors 2 

Acting  assistant  surgeons 19-4 

Medical  inspectors 2 

Pharmacists 49 

Pilots 14 

Marine  engineers 23 

Attendants 643 

Total -'. 1,047 


BOARDS   COJ^VENED. 

Forty-one  boards  were  convened  at  different  times  and  at  various 
stations  throughout  the  United  States  for  the  phj^sical  examination 
of  officers  of  the  Revenue-Cutter  Service  and  applicants  for  entrance 
thereto. 

One  board  was  convened  for  the  examination  of  passed  assistant  sur- 
geons to  determine  their,  fitness  for  promotion  to  the  grade  of  surgeon. 

Nine  boards  were  convened  for  the  examination  of  assistant  surgeons 
to  determine  their  fitness  for  promotion  to  the  grade  of  passed  assistant 
surgeon. 

Four  boards  were  convened  at  different  stations  for  the  examinations 
of  pharmacists  of  the  third  class  to  determine  their  fitness  for  promo- 
tion to  the  grade  of  pharmacist  of  the  second  class. 

Juh^  8,  1903,  a  board  was  convened  at  Washington,  D.  C,  for  the 
purpose  of  considering  the  preparation  of  plans  for  inspection  of  vac- 
cine farms  and  antitoxin  establishments. 

July  27, 1903,  a  board  was  convened  to  consider  the  request  of  Asst. 
Surg.  C.  E.  Decker  to  be  placed  on  waiting  orders  on  account  of  phys- 


38  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVI(;E. 

ieal  disability,  as  a  result  of  which  he  was  placed  on  waiting  orders 
from  August  1,  1903. 

August  24, 1903,  a  board  was  convened  to  meet  at  Washington,  D.  C, 
for  the  purpose  of  considering  the  question  of  correcting  certain  errors 
and  amending  other  matters  in  regard  to  the  uniform  regulations. 

January  7,  19()4,  board  was  convened  to  meet  at  Washington,  D.  C, 
for  the  purpose  of  considering  the  revision  of  medical  books  on  con- 
tract and  preparation  of  list  of  professional  books,  etc. 

March  27, 1901,  a  board  was  convened  to  meet  at  Washington,  D.  C, 
to  consider  the  construction  or  purchase  of  boarding  steamers  for  the 
quarantine  stations  at  San  Francisco,  Cal.,  and  Port  Townsend,  Wash. ; 
also  to  consider  the  type  of  launch  for  boarding  or  inspection  of  ves- 
sels at  Key  West  quarantine  and  at  Habana,  Cuba;  also  to  consider 
the  feasibility  of  repairing  the  hull  of  the  launch  Spray  at  Delaware 
Breakwater  quarantine,  and  placing  new  motive  power  therein. 

April  -1,  1904,  a  board  was  convened  to  meet  at  Washington,  D.  C, 
for  examination  of  candidates  for  admission  as  assistant  surgeon. 

A  board  was  convened  to  meet  at  Washington,  D.  C,  for  the  pur- 
pose of  making  inquiry  into  unbecoming  conduct  of  an  otficer  and, 
upon  recommendation  of  this  board,  a  l)oard  of  investigation  was  sub- 
sequently convened  and  the  findings  of  the  said  board  were  laid  before 
the  Secretary  and  received  his  approval. 

OFFICERS   DETAILED  TO  REPRESENT  SERVICE  AT  MEETINGS  OF  MEDICAL 
AND   PUBLIC    HEALTH   ASSOCIATIONS. 

Asst.  Surg.  Gen.  G.  T.  Vaughan:  Meeting  of  American  Medical 
Association  at  Atlantic  City,  N.  J.,  June  7-10,  1901:. 

Asst.  Surg.  Gen.  II.  D.  Geddings:  Meeting  of  International  Sani- 
tar}^  Conference,  Paris,  France,  October  10,  1904.  Upon  adjournment 
to  proceed  to  Berlin  and  Frankfort,  Germany,  and  London,  England; 
meeting  of  American  Medical  Association  at  Atlantic  City  June  7-10, 
1904.  _  .  . 

Surg.  Preston  H.  Bailhache:  Meeting  of  American  Public  Health- 
Association,  Washington,  I).  C,  October  20,  1903. 

Surg.  H.  R.  Carter:  Conference  of  quarantine  officers  at  New  Orleans, 
La.,  March  14,  1904. 

Surg.  P.  M.  Carrington:  Meeting  of  American  Medical  Association' 
at  Atlantic  City,  N.  J.,  June  7-10,  1904. 

Surg.  J.  C.  Perry:  Convention  to  Consider  the  Question  Involved 
in  Mosquito  Extermination  at  New  York,  N.  Y.,  December  1(5,  1903. 

Passed  Asst.  Surg.  M.  -I.  Rosenau:  Meeting  of  the  Society  of 
American  Bacteriologists  at  Philadelphia,  Pa.,  December  29-30,  1903; 
meeting  of  tul)erculosis  committee.  College  of  Ph3'sicians,  Philadel- 
phia, Pa.,  March  28, 1904;  meeting  International  Association  for  Study 
and  Prevention  of  Tuberculosis  at  Atlantic  Cit}^  N.  J.,  June  6,  1904; 
meeting  of  American  Medical  Association,  Atlantic  City,  N.  J. ,  June 
7-10,  1904. 

Passed  Asst.  Surg.  J.  M.  Eager:  Meeting  of  International  Congress 
of  Hygiene  and  Demography  at  Brussels,  Belgium,  September  3-8, 
1903. 

Asst.  Surg.  T.  F.  Richardson:  Conference  of  State  health  officers 
and  count}'  health  officers  of  Texas  at  Austin,  Tex.,  March  31,  1904. 


PITBLIO    HEALTH    AND    MAKINE-HOSPITAL    SERVICE.  39 

Asst.  Suro-.  J.  W.  Amesso:  Moctint;-  of  Washiii<jft<)ii  State  Medical 
Association,  July  12-14,  IDO-t. 

Dr.  Cli.  WarcU^ll  Stiles:  Meetino-  of  Medical  Association  of  Missis- 
sippi at  Jackson,  ]\Iis.s.,  April  20,  1JM)-1. 

Accounts. 

vouchers  passed  for  payment  and  sp3ttlement. 

The  records  of  the  Bureau  show  that  19,391  vouchers  were  passed 
during  the  year.  Of  this  number  17,7()L  were  sent  to  the  special  dis- 
bursing agent  for  payment,  830  were  transmitted  to  the  Auditor  for 
the  Treasury  for  examination  and  settlement,  and  800  were  examined 
and  referred  to  the  Auditor,  they  having  previously  been  paid  by 
special  disbursing  agents  of  the  Service. 

FINANCIAL  STATEMENT — RECEIPTS  AND  EXPENDITURES,  PUBLIC  HEALTH 
AND  MARINE-HOSPITAL  SERVICE,  FOR  THE  FISCAL  YEAR  ENDED  JUNE 
30,  1904. 

The  balance  of  the  Public  Health  and  Marine-Hospital  fund  available 
at  the  commencement  of  the  fiscal  vear  was  $486,638,  and  the  receipts 
from  all  sources  $937,257.61.     The  expenditures  were  $1,168,252.36. 

Summary  Public  IfeuUJi  and  Marine-Hosjntal  fund. 

Balance,  July  1,  1903 . I486, 638. 00 

Receipts,  tonnage  tax 825,  911.  41 

Repayments,  care  foreign  seamen,  medical  and  hospital  supplies,  immi- 
gration service,  etc Ill,  346.  20 

Total '. - 1,  423,  895.  61 

Expenditures: 

Maintenance  of  stations $853,  759.  31 

Salaries,  Surgeon-General's  office 39,  540.  00 

Fuel,  lights,  and  water 70, 550.  95 

Repairs  to  jjublic  buildings 62,  .346.  32 

Furniture  and  repairs 4,  233. 41 

Heating  apparatus 5,  342. 52 

Purveying  depot 132, 479.  85 

1,168,252.36 


Balance,  July  1,  1904 255,643.25 

Preventing  the  spread  of  epidemic  diseases. 

Balance  July  1,  1903 $489, 051.  99 

Expenditures  July  1,  1903,  to  June  30,  1904: 

Foreign  medical  service,  salaries  and  miscellaneous, 
China,  Japan,  Italy,  etc.,  and  Central  America $43, 176.63 

Habana,  Cuba  (including  outlying  district),  salaries, 
subsistence,  supplies,  and  miscellaneous 32,  838. 08 

Sanitary  inspection  in  United  States,  salaries,  travel 
expenses,  and  miscellaneous 55,  815. 14 

Yellow  fever,  maintenance  of  detention  camps,  precau- 
tion against  outbreak,  salaries,  medical  and  hospital 
supplies,  disinfectants,  etc 18,  205.  93 

Mexico,  salaries,  supplies,  etc 13, 073.  52 

Nome,  Juneau,  Sitka,  Alaska,  medical  supplies,  vaccine, 
salaries,  etc. ,  smallpox  inspections 2,  300. 13 

Texas  border  inspection,  account  smallpox,  salaries,  and 

miscellaneous 46,  052.  39 

211,461.82 


Balance  June  30,  1904 277,  590. 17 


40  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Appropriations,  quarantine  stations. 

Chesapeake  Bay  Quarantine  Station,  act  March  3,  1893: 

Balance  July  1,  1903 $6, 935. 00 

Balance  June  30,  1904 6,  935.  00 

Gulf  Quarantine  Station,  act  March  3,  1899: 

Balance  July  1 ,  1903 824. 56 

Balance  June  30,  1904 824. 56 

South  Atlantic  Quarantine  Station,  act  June  4,  1897: 

Balance  July  1,  1903 453.02 

Balance  June  30,  1904 453. 02 

Savannah  (Ga. )  Quarantine  Station,  act  June  6,  1900: 

Balance  July  1,  1903 282.  20 

Balance  June  30,  1904 282.  20 

Reedy  Island  Quarantine  Station,  act  March  3,  1901: 

Balance  July  1,  1 903 867. 95 

Balance  June  30,  1904 867. 95 

Port  Townsend  Quarantine  Station,  act  March  3,  1901: 

Balance  July  1 ,  1903 39, 976.  30 

Balance  June  30,  1904 39, 976.  30 

South  Atlantic  Quarantine  Station,  act  June  28,  1902: 

Balance  Jul v  1 ,  1903 - 3, 329. 60 

Balance  June  30,  1904 3,329.60 

Mayport,  Fla.,  act  June  28,  1902: 

Balance  July  1,  1903 : 1,500.00 

Balance  June  30,  1904 1, 500. 00 

Miami,  Fla.,  act  June  28,  1902: 

Balance  July  1,  1903 6,  747.  76 

Expended  July  1,  1903,  to  June  30,  1904 6, 519. 17 

Balance  June  30,  1904 228.  59 

Boca  Grande,  Fla.,  act  June  28,  1902:' 

Balance  July  1,  1903 500.  00 

Balance  June  30,  1904 500.  00 

Pensacola,  Fla.,  act  June  28,  1902: 

Balance  July  1,  1903 4,530.61 

Expended  July  1,  1903,  to  June  30,  1904 358.  49 

Balance  June  30,  1904 4,172.12 

San  Diego,  Cal.,  act  June  28,  1902: 

Balance  July  1,  1903 7, 498.  55 

Expended  July  1,  1903,  to  June  30,  1904 7,  480.  00 

Balance  June  30,  1904 18.  55 

Pensacola,  Fla.,  act  March  3,  1903: 

Balance  July  1 ,  1 903 14, 000.  00 

Expended  July  1,  1903,  to  June  30,  1904 1,210.90 

Balance  June  30,  1904 12,  789.  10 

San  Diego,  Cal.,  act  March  3,  1903: 

Balance  July  1,  1903  (amount  of  appropriation) 6, 000.  00 

Balance  June  30,  -1904  ( amount  of  appropriation ) 6,  000.  00 

Honolulu,  Hawaii,  act  March  3,  1903: 

July  1,  1908,  appropriation 80,  000.  00 

Transferred  to  Supervising  Architect 80, 000.  00 


PUBLIC    HEALTH    AND    MARTNK-HOSI'ITAL    SKRVKIK. 


41 


Stdliiiinit  of  ((jiprti]>ri<tlioiis,  <jiiar<iiitliic  Herrirr,  JWJ,}. 

Amount  of  appropriation |i825, 000. 00 

Repayment  care  foreign  seamen,  etc; 1,  fiOi).  'Mi 

Total  available 326,  009.  m 

KxpenditurcH  July  1,  1908,  to  June  :«),  1904 324,092.39 

Balancte,  June  30,  1904 2,  510.  97 

Deficiency  ap})ropriaikm:  Jicpairs  fofioathiyprupertij,  qnaranl'me  service,  1904. 

Amount  of  appropriation $9,  500. 00 

Expended 9,  053.  51 

Balance  June  30,  1904 446. 49 


Name  of  station. 


Reedy  Island,  Del 

Delaware  Breakwater,  Del 

Cape  Charles,  ya 

Cape  Fear,  N.  C 

South  Atlantic 

Brunswick,  Ga 

Gulf,  Miss 

Tampa  Bay,  Fla 

San  Diego,  Cal 

San  Francisco,  Cal 

Port  Townsend,  Wash 

Columbia  River,  Oreg 

Savannah,  Ga 

Key  West,  Fla 

Hawaii,  H.I 

Cumberland  Sound 

St.  John's  River,  Fla 

Biscayne  Bay,  Fla 

Boca  Grande,  Fla 

Cedar  Keys,  Fla 

St.  Georges  Sound.  Fla 

Santa  Rosa,  Fla 

Porto  Rico 

Miscellaneous 

Total 


Maintenance 
of  stations, 
salaries,  sub- 
sistence, sup- 
plies ana  mis- 
cellaneous. 


257. 6t; 
600. 98 
098. 81 

197. 30 
034.34 
857.70 
249. 44 
690. 37 
626. 33 
917.  88 
665. 52 

180. 31 
582. 35 
131. 79 
139. 64 
665. 00 
075. 72 
856. 64 
384. 81 
723. 00 
280. 02 
527. 27 
655. 06 
247. 94 


309, 545. 88 


Medical 
and  hospi- 
talsupphes. 


81, 737. 65 
647. 24 
952. 48 
933. 15 
212. 33 
571.34 

1,656.14 
592. 65 
54. 11 

1,051.90 
251. 33 
600. 74 

1,060.67 
6.00 

1,67.6.85 


71. 50 
19.19 


1,199.91 

1,084.77 

366. 96 


14, 646. 51 


Total. 


»25, 995. 31 

13, 248. 22 

18,051.29 

9, 130. 45 

12, 246. 67 

6, 429. 04 

23, 905. 58 

7, 283. 02 

8, 580. 44 

43, 969. 78 

17,916.85 

13, 681. 05 

15, 643. 02 

5, 138. 39 

38, 716. 49 

4, 666. 00 

2, 075. 72 

5, 928. 14 

3, 404. 00 

723. 00 

3, 280. 02 

12,727.18 

28, 739. 83 

2,614.90 


324, 092. 39 


Administrative  Details — Circular  Letters. 

Circular  Letter  Relative  to  Reinstatement  op  Employees. 


Treasury  Department, 
Bureau  op  Public  Health  and  Marine-Hospital  Service, 

Washington,  August  13,  1903. 
To  commissioned  medical  officers  and  acting  assistant  surgeons: 

Your  attention  is  called  to  the  following  instructions  from  the  Secretary  of  the 
Treasury,  under  date  of  July  25  and  July  28,  1903,  respectively,  relative  to  submit- 
ting recommendations  for  reinstatement  of  employees  in  this  Service  and  to  making 
recommendations  in  each  case  for  probationary  appointments: 

"  Hereafter  in  forwarding  requests  for  reinstatement  in  the  United  States  Public 
Health  and  Marine-Hospital  Service  you  will  give  the  legal  residence,  date  and  cause 
of  separation,  position  occupied  by,  and  rate  of  compensation  paid  to  the  person 
seeking  reinstatement,  and  also  military  or  naval  record,  if  any." 

"Hereafter  it  will  be  necessary  for  the  medical  officers  in  command  to  make  rec- 
ommendation in  each  case  for  the  prolmtionary  ajipointment  of  a  person  serving 
under  temporary  appointment  and  whose  name  is  placed  on  the  eligible  list  if  it  is 
desired  to  continue  such  per^n  in  the  sei'vice." 
Respectfully, 

Walter  Wvma.n,  Surgeon- General. 


42  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Circular  Letter  Relative  to  Transmitong  Semiannual  List  of  Attendants. 

Treasury  Department, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

WasJilnr/ton,  December  1,  1903. 

To  commimoned  medical  officers  and  acting  amstaid  surgeonji, 

Public  Health  and  Marine-Hospital  Service: 
Referring  to  paragraph  704  of  the  regulations  of  this  Service,  relative  to  transmit- 
ting semiannual  list  of  attendants  at  your  station,  their  duties  and  compensation, 
you  are  hereby  directed  to  forward  said  report  to  this  Bureau  in  duplicate. 

The  report  required  from  custodians  by  paragraph  556  of  the  regulations  should 
also  be  forwarded  to  the  Bureau  in  duplicate. 

Walter  Wvmax,  Surgeon-General. 

With  this  .summary  of  the  operations  of  the  Division  of  Personnel 
and  Accounts,  1  remain, 
Respectfully, 

H.  D.  Geddings, 
As8ista7it  Surgeon-  General  in  Temporary  Charge. 
The  Surgeon-General. 


DIVISION  OF  MARINE  HOSPITALS  AND  RELIEF. 


43 


REPORT  OF  DIVISION  OF  MARINE  HOSPITALS  AND  RELIEF. 

By  L.  I>.  Williams, 
Assidant  Surgeon- General,  I'ublic  Ileallh  and  Marine- Hospital  Service,  in  charge. 

Sir:  I  have  the  honor  to  submit  the  following  report  of  the  opera- 
tions of  the  division  of  marine  hospitals  and  relief  for  the  fiscal  year 
ended  June  30,  1904: 

RELIEF   OF   SEAMEN. 

During-  the  j^ear  58,550  seamen  were  treated  at  the  various  relief 
stations  of  the  Service.  Of  these,  14,303  were  treated  in  hospital,  and 
44,253  M^ere  treated  as  out-patients.  Four  hundred  and  fifteen  thou- 
sand two  hundred  and  ninety-two  days  relief  in  hospital  were  fur- 
nished. The  excess  in  number  of  da^^s  relief  over  the  previous  year 
was  31,903. 

RELIEF   STATIONS. 

During"  the  year  the  Service  controlled  and  operated  22  hospitals, 
all  of  which  are  owned  by  the  Government.  The  transfer  of  equip- 
ment from  Dutch  Harbor,  Alaska,  to  Nome,  Alaska,  has  been  com- 
pleted, and  the  hospital  at  the  latter  port  is  in  full  operation,  the 
buildings  assigned  to  the  Service  having  been  recently  repaired. 

INSPECTION    OF   STATIONS. 

The  following  relief  stations  -were  inspected  during  the  year  and 
appropriate  action  on  the  inspection  reports  taken  b}^  the  Bureau: 
Yicksburg,  Miss.;  Baltimore  and  Solomons,  Md.;  Brunswick  and 
Savannah,  Ga. ;  Mobile,  Ala.;  Fernandina,  Jacksonville,  Port  Tampa, 
Pensacola,  and  Key  West,  Fla. ;  Vineyard  Haven,  Gloucester,  Boston, 
and  New  Bedford,  Mass.;  Detroit,  Mich.;  Manitowoc,  Wis.;  Phila- 
delphia, Pa.;  Purveying  Depot,  New  York,  N.  Y. ;  New  Haven  and 
New  London,  Gonn.;  Newport  and  Providence,  P.  I.;  Portsmouth, 
N.  H. ;  Bath  and  Boothbay  Harbor,  Me. ;  Norfolk,  Fredericksburg, 
Richmond,  and  Newport  News,  Va. ;  Washington,  Elizabeth  City, 
Beaufort,  Newbern,  and  Wilmington,  N.  C. ;  Georgetown  and  Charles- 
ton, S.  C;  Wheeling,  W.  Va.;  Gallipolis  and  Cincinnati,  Ohio;  Louis- 
ville and  Paducah,  Ky.;  Evansville,  Ind. ;  Cairo,  111.;  St.  Louis,  Mo. ; 
Memphis,  Tenn. ;  New  Orleans,  La. 

MONTHLY   STATEMENT   OF   EXPENDITURES. 

The  monthly  statement  of  expenditures  (Form  1956)  received  from 
all  the  relief  stations  of  the  Service  during  the  year  were  duly  exam- 
ined and  filed  for  reference. 

45 


46  PUBLIC    HEALTH    AISTD    MARINE-HOSPITAL    SERVICE. 

AID   TO    OTHER   BRANCHES   OF   THE    GOVERNMENT. 

Remnue- Cutter  jSermce. — Seven  hundred  and  twenty-eight  appli- 
cants for  enlistment  were  examined,  of  whom  128  w^ere  rejected. 

Steamhoat- Inspection  Service. — One  thousand  eight  himdred  and 
twelve  pilots  were  examined  as  to  visual  capacity  and  126  rejected. 

Life- Saving  Service. — One  thousand  one  hundred  and  sixty-one 
surfmen  were  examined  and  37  rejected. 

Light- ILnise  Service. — Twelve  applicants  for  enlistment  were  exam- 
ined and  3  rejected. 

Civil  Service  Coimnissioii. — One  thousand  four  hundred  and  three 
applicants  for  appointment  physically  examined  and  89  rejected. 

Idhmian  Canal  Commission. — Two  employees  physically  examined 
and  none  rejected. 

finmigration.  Service. — Two  employees  physicallj^  examined  and 
none  rejected. 

PHYSICAL   EXAMINATIONS   OF   MERCHANT   SEAMEN. 

Physical  examinations  were  made  of  604  American  merchant  sea- 
men, of  whom  88  were  rejected,  and  of  6  foreign  seamen,  of  whom  3 
were  rejected. 

EXAMINATIONS   OF   DRUGS. 

The  following  orders  were  issued  during  the  year: 

Thkasury  Department, 
Bureau  ot"  Public  Health  and  Marine-Hospital  Service, 

Washington,  April  1,  1904- 
Sir:  You  are  liereby  directed,  in  so  far  as  the  facilities  at  your  disposal  will  per- 
mit, to  make  an  examination  as  to  the  purity  and  potency  of  suiih  drugs,  pharmaceu- 
tical prejiarations,  etc.,  as  may  from  time  to  time  be  forwarded  to  you  for  that  purpose 
from  the  Bureau  or  the  Medical  Purveyor  of  the  Service.  Reports  of  the  findings  in 
each  case  should  be  forwarded  to  the  i)urveyor  through  the  Bureau. 
Respectfully, 

Walter  Wyman,  Surgeon-General. 
Director  Hygienic  Laboratory, 

Public  Health  and  Marine-Hospital  Service, 

Washington,  D.  C. 


Treasury  Department, 
Bureau  of  Public  Health  and  Marink-Hospital  Service, 

Washington,  April  1,  1904- 
Sir:  Copy  of  a  communication  of  even  date  addressed  to  the  Director  of  the 
Hygienic  Laboratory,  relative  to  examination  of  drugs,  etc.,  is  inclosed  herewith  for 
your  information,  and  you  are  directed  to  forward  to  the  laboratory  for  examination 
any  drug  or  preparation  thereof  which  you  have  reason  to  believe  fails  to  conform 
to  the  standard  of  the  United  States  Pharmacopreia  or  tbe  contract  requirements. 

As  the  divisions  of  the  laboratory  in  which  this  examination  would  be  made  are 
not  yet  thoroughly  organized,  you  are  directed  to  correspond  with  the  Director  of  the 
laboratory,  and  ascertain  the  extent  to  which  this  work  can  be  undertaken  at  the 
present  time. 

Respectfully,  Walter  Wyman,  Surgeon-General. 

Medical  Purveyor, 

Public  Health  and  Marine-Hospital  Service, 

378  Washington  street,  New  York,  N.  Y. 


PUIJLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  47 

SANATORIUM    FOR   CONSUMITIVE    SEAMEN,  FORT   STANTON,   N.  MEX. 

Report  of  Sunj .  P.  M.  Cai'rington,  in  coihiikhuI. 

United  States  Public  Health  and  Makine-IIosi'ital  Sukvkk, 

Office  of  Medical  Officer  in  Command, 

Fort  Sldutov,  N.  Mex.,  Am/nd  a;,  1904. 
Sir:  I  have  the  honor  to  report  hk  follows  regarding  the  transactions  of  tiiis  station 
for  the  fiscal  year  ended  June  oO,  1904: 

Statislica. 

Patients  under  treatment  July  1 ,  1903 150 

Patients  admitted  during  the  year 23fi 

Patients  under  treatment  June  30,  1904 192 

Patients  discharged  during  the  year 194 

Ages  of  patients  treate<l  duifng  the  year: 

Under  25  years 56 

Between  25  and  34  years 1 34 

Between  35  ami  44  years 117 

Between  45  and  54  years 61 

Over  54  years 18 

386 

Heredity  in  patients  admitted  during  the  year: 

History  of  tuberculosis  in  parents 105 

No  history  of  tuberculosis  in  parents 281 

Stage  of  disease  (first  stage  meaning  -where  no  consolidation  nor  excavation  can 
be  discovered;  second  stage  meaning  considerable  involvement  and  consolida- 
tion without  excavation;  third  stage  with  excavation): 

First  stage 34 

Second  and  third  stages 200 

Nontuliercular '. 2 

Area  of  involvement  as  shown  l)y  physical  examinations: 

Right  lung  only 20 

Left  lung  only 15 

Both  lungs 346 

Doubtful  diagnosis  of  tuberculosis 5 

386 

General  condition  at  arrival  "good,"  meaning  well  nourished  and  without  grave 

complications;  "bad,"  meaning  rather  poorly  nourished  or  with  complica- 
tions not  necessarily  fatal;  "very  bad"  meaning  much  emaciated  or  with 
grave  complications  such  as  organic  heart  disease,  chronic  nephritis,  or  ad- 
vanced laryngeal  involvement) : 

Good 83 

Bad 159 

Very  bad j 144 

386 

Tubercle  bacilli: 

Were  not  present  in  the  sputum  of 26 

Were  present  in  the  sputum  of 360 

Record  of  patients  who  had  pulmonary  hemorrhages: 

Before  arrival  only 107 

After  arrival  only 15 

Both  before  and  after  arrival 28 

The  greatest  number  of  patients  under  treatment  at  one  time  during  the  year 

was  208. 

Condition  of  194  patients  at  time  of  discharge: 

Apparently  cured 15 

Arrested 9 

Improved 87 

Unimproved 19 

Died 62 

Two  patients,  non-tubercular,  admitted  and  discharged  cured 2 

194 


48 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Duration  of  stay  and  character  of  cases. 


Chariicter  of  case. 

Longest  stay. 

Shortest  stay. 

Average  stay. 

Years. 

Months. 

Days. 

Years. 

Months. 

Days. 

Years. 

Months. 

Days. 

2 
1 
3 
3 
2 

7 
5 

4 
15 
21 
14 
16 

5 
2 

18 
18 
9 
2 
4 

1 

17 

11 

7 
8 
5 

12 

12 

7 
9 

11 

Died        .          

10 

i 

I  have  divided  the  patients  into  two  classes:  List  A,  which  consists  of  patients 
who  were  under  treatment  at  the  beginning  of  the  fiscal  year;  twid  List  B,  which 
consists  of  patients  who  were  admitted  during  the  year. 

List  A. — Patients  under  treatment  at  beginnir^  of  fiscal  year. 


Cases  discharged , 

First  stage 

Second  and  third  stages  . 


Cured. 


Ar- 
rested. 


Im- 
proved. 


Unim- 
proved. 


Died. 


Total. 


Patients  under  treal ment  July  1, 1903 1.50 

Remaining  under  treatment  June  30, 1904 68 

Discharged  during  the  year 92 

List  B. — Patients  admitted  during  year. 


Nontu- 
bercular 
(cured). 

Cured. 

Ar- 
rested. 

Im- 
proved. 

Unim- 
proved. 

Died. 

Total. 

2 

1 
1 

4 
4 

1 

46 
8 
37 

10 
2 
8 

39 
3^ 

102 

First  stage 

16 

84 

Admitted  during  the  year 236 

Discharged  during  the  year 102 

Remaining  at  end  of  year 134 

Complications. 


Syphilis 50 

Cardiac  valvular  disease 39 

Functional  disease  of  heart 17 

Nephritis 7 

Rheumatism 1 

Anaemia 1 

Diabetes 2 

H  yd  ro pericardium  1 

Hydrocele 2 

Appendicitis 1 

Rupture  of  tympanic  membrane 1 

Hjematoma  testicle 1 

Deafness 4 

Pleurisy  with  effusion 8 

Fracture  of  ribs 1 

Hydropneumothorax 1 

Gastritis 3 

Necrosis  of  lower  jaw 2 

Chronic  diarrhea 3 

Polyuria 9 


Fistula  in  ano 2 

Renal  calculi , 1 

Keratitis 1 

Cataract 1 

Nasal  polypi 4 

Occlusion  of  nares 2 

Occlusion  of  lachrymal  duct 2 

Lateral  spinal  curvature 1 

Lumbago 1 

Hemorrhoids 36 

Varicocele ^ 13 

Adenitis 16 

Hernia 13 

Varicose  veins  of  leg 5 

Hepatitis  and  ascites 1 

Acute  mania 2 

Incontinence  of  urine 1 

Epilepsy 1 

Otitis  media 2 

Effusion  of  knee  joint 2 


^Nephritis. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


49 


Complications — Continued. 


Aneurism 

Peritonitis 

Ununited  fracture  inferior  maxilla . . . 

Pyopneuniothorax 

Pneumothorax 

Cystitis 

Epididymitis 

Asthma 

Organs  other 

Larynx 4 

Testicles 

Knee  joint 

Ribs 

Trachea, 

Q'sophagus 

Meninges  brain 

Fistula  in  ano 


Eczema 

Necrosis  of  rib 

Biliary  calculi 

Iritis 

Atony  of  bladder 

Stricture 

Perirectal  al)sces8 2 

Partial  paralysis 1 

lan  lungs  affected. 

Intestines 25 

Hip  joint 2 

V^ertebra; 1 

Tarsal  bones 1 

Pharynx 2 

Peritoneum 2 

Ischiorectal  abscess 1 

Lymph  glands 2 


Length  of  time  binder  treatment  at  sanatorium. 

Over  two  years 9 

Between  one  and  two  years 27 

Between  six  and  twelve  months 45 

Between  three  and  six  months 47 

Under  three  months '. 66 

Total 194 

Of  the  194  patients  discharged  during  the  year  24  were  under  treatment  for  less 
than  thirty  days.     The  results  in  these  cases  were  as  follows: 

Improved 4 

Unimproved 5 

Died 15 


Total 


24 


During  the  year  we  have  had  under  treatment,  in  addition  to  the  above,  consump- 
tive officers  and  emplovees  as  follows: 

Under  treatment  July  1,  1903 10 

Admitted  during  the  year 11 

Total 21 

Still  under  treatment  June  30,  1904 11 

Left  during  the  year 10 

Condition  of  those  leaving  at  time  of  discharge: 

Apparently  cured 2 

Improved : .   „ 7 

Unimproved 1 

Our  results  are  very  conservatively  stated,  and  under  any  usual  nomenclature 
would  show  a  much  larger  proportion  of  cured  cases.  Several  months  ago,  noting  the 
large  number  of  patients  discharged  without  physical  or  other  signs  of  disease,  or 
only  with  signs  indicating  healed  lesions,  but  who  had  been  under  treatment  only 
from  three  to  six  months,  and  were  for  this  reason  recorded  as  "improved"  cases,  I 
adopted  the  plan  of  calling  such  cases  "arrested,"  and  the  "improved"  cases  herein 
recorded  include  a  great  many  which  might  properly  be  recorded  a.s  "arrested" 
cases. 

It  is  to  be  hoped  that  the  efforts  which  are  being  made  to  devise  a  uniform  system 
of  nomenclature  for  tuberculosis  will  be  successful,  and  that  the  various  terms 
employed  will  thereafter  always  mean  the  same  thing  wherever  and  by  whomsoever 
used.  I  wish  to  renew  the  recommendation  contained  in  my  report  of  1903,  that 
some  law  be  secured  or  regulation  adopted  which  will  give  greater  control  over 
patients  and  enable  us  to  retain  them  under  treatment  for  a  sufficient  period  to  insure 
recovery  or  demonstrate  their  incurability. 

8629—04 4 


50 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


During  the  fiscal  year  under  consideration  tlie  rainfall  has  been  greatly  less  than 
during  any  year  in  the  life  of  the  sanatorium,  and  notwithstanding  the  comparatively 
small  number  of  cured  cases  reported  this  year,  our  patients  have  undoubtedly  done 
better,  as  a  rule,  than  heretofore.  While  we  have  a  considerable  percentage  of  deaths, 
this  is  not  remarkable  when  the  character  of  cases  admitted  is  taken  into  consideration. 

TREATMENT. 

The  treatment  has  been,  in  the  main,  as  heretofore,  hygienic,  dietary,  and  sympto- 
matic. I  have  experimented  with  the  bacillary  treatment  introduced  by  Doctor 
Maher,  of  Connecticut,  and,  while  his  treatment  has  undoubtedly  been  of  benefit 
in  a.  certain  proportion  of  cases,  the  observations  have  not  been  sufficiently  prolonged 
to  warrant  an  opinion  at  this  time  of  its  value. 

The  daily  breathing  exercises  have  been  continued  and  have  proven  of  undoubted 
value,  and  the  drill  has  also  promoted  good  discipline. 

Nose  and  throat  clinic. — The  nose  and  throat  clinic,  which  was  for  a  time  necessarily 
suspended,  owing  to  shortage  in  medical  officers,  was  resumed  November  16,  since 
which  date  the  following  cases  have  been  treated: 


Disease. 


Rhinitis: 

Acute 

Chronic 

Hypertrophic,  rhinitis 

Rhinitis  chronic  and  pharyngitis  clironic. 

Empyema  of  the  frontal  sinus 

Perforation  of  septum  nasi  (tuberculous). 

Epistaxis ,. 

Pliaryngitis: 

Simple  acute 

Simple  chronic 

Subacute 

Atrophic  or  sicca 

Follicular  or  granular 

Tonsilitis,  follicular 

Uvulitis 

Stomatitis 


Disease. 


Laryngitis: 

Acute 

Chronic 

Tuberculosis  of  larynx 

Tuberculosis  of  larynx  and  pharyngitis 

sicca 

Syphilis: 

Secondary  of  pharyn  x 

Ulceration  of  septum,  nasi 

Otitis: 

Media  suppurative,  acute 

Media  suppurative,  chronic 

Media  suppurative,  chronic  and  ec- 
zema of  both  auricles  (mois>t) 

Media,  catarrhal 

Perichonditis,  auriculae 

Cerumen,  impacted 


Cases. 


Operations. 


Disease. 

Cases. 

Disease. 

Cases. 

Removal  of  spur  from  septum,  nasi 

Removal  posterior  end  of  middle  turbi- 

5 

1 
5 

T 
1 

Paracentesis  auricula 

2 

Removal  anterior  end  of  middle  turbinate. 

Hajiek's  operation  for  deflected  septum. . 

1 

Several  cases  of  laryngitis  included  in  the  report  of  nose  and  throat  work  were 
treated  by  applications  of  bacillus  X  of  Maher  with  marked  benefit. 


REPAIRS   TO   BUILDINGS,   ETC. 

This  being  in  the  natural  course  of  events  the  last  annual  report  of  the  operations 
of  this  sanatorium  which  I  shall  render,  it  seems  appropriate  to  give  a  brief  resume 
of  the  work  under  this  head  which  has  been  accomplished  during  my  detail.  Wlien 
I  assumed  command  of  the  station  in  January,  1901,  very  little  in  the  way  of  repairs 
had  been  accomplished  except  interior  repairs  to  building  No.  1,  commanding  offi- 
cer's quarters,  minor  repairs  to  building  No.  2,  passed  assistant  surgeon's  quarters, 
and  certain  essential  repairs  to  the  hospital  building. 

During  the  past  three  and  a  half  years  nearly  all  the  buildings  have  been  reshingled, 
and  No.  4  has  been  overhauled  and  repaired  for  occupancy  by  convalescent  patients. 
Building  No.  5  has  been  converted  into  a  power  plant  and  steam  laundry.  In  this 
building  we  have  placed  an  ice  plant,  with  cold  storage  rooms  and  dairy  facilities 
and  an  additional  boiler  which  furnishes  steam  heat  for  buildings  Nos.  4,  5,  and  7. 
In  this  building  also  has  been  placed  a  dynamo,  which  supplies  light  to  all  buildings 
and  the  corrals  and  a  considerable  portion  of  the  grounds. 

Building  No.  6  has  been  converted  into  a  modern  kitchen  and  dining  room,  with 
subsistence  storeroom,  bakery,  and  attendant's  quarters. 


PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    RERVICE.  51 

Buildinjij  No.  7,  which  in  January,  1001,  consisU'd  of  bare  Htoiu!  wailw  left  aftt-r  tiie 
building  was  dostroyod  l)V  lire  during  the  army  (Hrnpancy,  haw  been  rebuilt,  and  in 
now  oiTupied  as  an  executive  building  and  laborat(iry. 

Building  No.  9  has  been  remodeled  and  the  first  iloor  contaiuH  the  post-office,  two 
storerooms,  and  a  commodious  tol)accoand  barl)er  shop,  while  the  upper  floor  ha.H 
been  convirted  into  a  light  and  airy  hall,  which  is  used  for  reading  room  and  chapel, 
with  book  and  t)ther  necessary  rooms  adjoining. 

Buildings  Nos.  10  and  11,  which  were  in  utter  dilai)idation,  have  been  converted 
into  well-lighted  and  ventilated  dormitories,  and  are  now  occupied  by  and)ulant  con- 
sumptives. No.  11  containing  also  a  modern  and  well  e(iuipped  operating  room  with 
dressing  room  and  surgical  ward. 

No.  13  has  been  entirely  done  over,  and  is  so  arranged  that  it  may  be  used  for 
either  single  men  or  families.  It  is  now  occupied  by  two  assistant  surgeons,  several 
patients  who  are  commis.sioned  oflicers  of  other  services  and  beneficiaries  of  this 
Service,  and  employi'cs  detailed  in  the  office.  These,  except  one  commissioned 
otlicer  who  has  a  family,  constitute  the  "bachelor  officers'  mess." 

All  these  buildings  have  been  supplied  with  modern  plundnng,  and  on  buildings 
Nos.  1,  2,  3,  and  the  hosj)ital  commodious  and  artistic  i)orc,hes  have  been  erected. 

The  corrals  have  been  completely  done  over;  a  sufficient  nund)er  of  stalls  and  feed 
rooms  were  erected  in  the  horse  corral;  hay  sheds  and  milking  sheds  with  cement 
floors  have  been  elected  in  the  cow  corral.  The  corrals  are  also  lighted  by  electric- 
ity and  dangerous  oil  lanterns  dispensed  with. 

An  electric  motor  has  been  installed  and  is  used  for  pumping  water.  In  connec- 
tion with  the  electric  light  plant  over  1,000  lights  and  an  electric  fire  alarm  system 
have  been  installed. 

The  expenses  of  repairs  to  buildings  since  I  assumed  command  of  the  station, 
including  contracts,  material,  labor,  and  salary  of  architect,  have  been  $134,525.86. 

WATER   SUPPLY. 

During  the  year  just  ended  the  question  of  water  supply  has  been  most  perplexing, 
and  the  scarcity  of  water  has  been  a  source  of  constant  anxiety.  The  failure  of  the 
rains  during  the  summer  of  1903,  and  the  almost  total  absence  of  snow  in  the  moun- 
tains during  the  past  winter,  deprived  us  of  our  former  supply  of  water  from  the 
Rio  Bonito.  The  old  army  wells  became  almost  dry  and  practically  our  only  source 
of  supply  has  been  some  little  springs  which  rise  in  the  bed  of  the  Rio  Bonito  about 
1  mile  west  of  the  buildings.  The  water  from  these  springs  has  been  carried  through 
a  ditch  to  the  old  sutler's  store,  used  in  the  early  days  of  the  sanatorium  as  a  chicken 
yard,  and  thence  by  means  of  a  flume  across  the  river  to  a  wooden  tank  at  the  army 
well;  thence  it  has  been  jjumped  to  small  reservoir  on  little  round-top  hill.  With 
great  economy  this  has  been  sufficient  to  supply  our  urgent  domestic  needs,  but  we 
liave  been  unable  to  store  any  water,  and  night  after  night  we  have  gone  to  bed 
with  less  than  5,000  gallons  of  water  in  the  reservoir,  a  condition,  which  especially 
during  the  windy  season,  has  given  rise  to  the  gravest  apprehensions,  for,  had  a  fire 
occurred  at  this  time,  we  would  have  been  absolutely  helpless.  On  more  than  one 
occasion  it  has  been  a  question  of  going  without  coffee  or  dispensing  with  the  morn- 
ing ablutions.  The  uncertainty  of  the  water  supply  and  its  inadequacy  led  to  a 
recommendation  for  boring  anew  well.  This  recommendation  was  approved  by  the 
Bureau;  the  well  has  been  bored,  cased,  and  the  pump  is  now  being  placed.  A  par- 
tial test  showed  that  this  well  should  furnish  not  less  than  40,000  gallons  of  water 
daily,  running  the  pump  both  night  and  day.  Additional  wells  for  irrigating  the 
garden  and  alfalfa  fields  should  be  bored,  and  it  is  probable  that  in  boring  such 
wells,  water  will  be  developed  sufficiently  near  the  surface  to  permit  pumping  by 
means  of  windmills.  Earth  reservoirs  may  be  constructed  at  small  cost  and  water 
stored  for  irrigating  purposes.  Such  reservoirs  can  also  be  used  as  fish  ponds,  and 
thus  add  to  our  dietary  an  important  article  of  food,  which  we  are  at  present  unable 
to  use  by  reason  of  our  distance  from  sources  of  supply. 

MILK   SUPPLY. 

The  shortage  of  milk  referred  to  in  my  report  of  1903  is  less  than  heretofore.  Dur- 
ing the  fiscal  year  1903  we  produced  19, 120  gallons  of  milk.  During  the  fiscal  year 
ended  June  30,  1904,  we  produced  and  used  24,053  gallons  of  milk  and  a  small  quan- 
tity of  butter.  The  increase  in  the  milk  supply  has  been  accomplished  by  reason  of 
the  addition  to  our  herd,  by  natural  increase,  of  a  number  of  cows  and  in  the  natural 
order  of  events  the  number  of  milk  cows  will  continue  to  increase,  and  it  is  only  a 
matter  for  a  short  time  when,  without  any  additional  purchases,  we  will  be  able  to 
produce  all  the  milk  we  can  consume. 


52  PUBLIC    HEALTH    AND   MARINE-HOSPITAL   SERVICE. 

A  purchase  of  milk  goats  has  been  authorized  by  the  Bureau  in  order  to  add  to  the 
milk  supply  and  give  occupation  to  the  patients  willing  to  undertake  their  care. 
There  has  been  some  difficulty  in  securing  goats  of  the  right  kind,  but  negotiations 
are  now  under  way  and  within  a  few  weeks  the  experiment  will  be  begun. 

RANGE   OP   REEF   CATTLE. 

Our  beef  herd  continues  our  most  promising  investment.  The  number  reported 
on  hand  on  my  report  of  1903  was  369.  The  property  return  for  the  same  period 
showed  401.  This  difference  is  accounted  for  by  the  transfer  on  the  property  return 
of  a  number  of  Jersey  steers  from  the  dairy  to  the  range  herd  and  by  probable  error 
in  count  of  a  few  head. 

The  present  record  of  our  cattle  is  as  follows:  We  have  branded  this  season  149 
calves;  46  head  of  cattle  have  been  killed  for  beef,  and  10  head  have  died.  We  have 
remaining  474  head.  There  are  also  110  head  of  cattle  in  the  dairy  herd.  A  portion 
of  these  110  have  heretofore  been  reported  as  having  been  transferred  to  the  beef 
herd.  By  a  recent  authority  granted  by  the  Bureau  all  cattle  are  now  entered  on 
the  property  return  as  "Cattle."  This  total  of  584,  therefore,  includes  all  range 
stock  and  dairy  stock,  consisting  of  bulls,  cows,  2-year  olds,  yearlings,  and  calves. 

The  46  head  of  cattle  killed  dressed  17,563  pounds,  worth  at  contract  price 
$1,229.31. 

The  original  investment  of  beef  cattle,  including  the  bulls  recently  purchased,  was 
approximately  $6,800,  and  although  the  herd  has  not  grown  sufficiently  large  to 
entirely  supply  us  with  beef,  yet  in  the  past  two  years  w^e  have  killed  and  used  beef 
equal  in  value  to  almost  one-third  of  the  original  investment. 

The  progress  of  our  cattle  investment  may  be  better  shown  by  the  following  state- 
ment: 

Original  investment $6,  800.  00 

Value  of  beef  consumed 2, 192.  48 

Net  investment 4,  607.  52 

Present  value  of  the  herd: 

9  bulls  ( 3  station  raised) ,  at  $75 675.  00 

3  bulls,  thoroughbred 1, 000.  00 

462  head  of  cows  and  young  stuff  at  an  average  valuation  of  $25 11, 550.  00 

Total 13,225.00 

Net  investment 4,  607.  52 

Showing  an  actual  profit  in  three  years  of 8,  617.  48 

From  this  sum  should  be  subtracted  salary  of  one  cowboy  for  three  years  and  salt 
fed  to  range  cattle,  but  even  after  subtracting  these  items,  amounting  to  approxi- 
mately $1,200,  there  remains  a  net  profit  of  over  $7,400,  which  is  a  most  excellent 
showing,  and  our  herd  of  cattle  is  generally  conceded  by  cattlemen  in  this  vicinity  to 
be  as  fine  as  any  in  the  Territory,  if  not  the  very  finest. 

HORSES. 

Our  experiment  in  horse  raising,  begun  three  years  ago,  has  been  most  successful. 
We  now  have  18  colts,  7  of  which  -will  be  3  years  old  in  the  spring  of  1905. 

HOGS,  POULTRY,   ETC. 

We  have  no  difficulty  in  raising  all  the  hogs  we  can  feed.  During  the  present 
year  we  have  killed  a  number  of  hogs  which  have  dressed  11,602  pounds  and  fur- 
nished 1,140  pounds  of  lard.  These  products  at  the  contract  prices  were  worth 
$756.80. 

Belgian  bares,  while  considered  a  delicacy  by  a  great  many  people,  were  not  pop- 
ular w'ith  our  patients,  and,  as  the  expense  of  raising  them  was  considerable,  I  killed 
and  served  those  on  hand,  amounting  to  325  pounds. 

Our  poultry  yard  has  furnished  425  pounds  of  dressed  chickens,  75  pounds  of 
dressed  turkey,  and  610  dozen  eggs.  Our  flock  of  chickens  now  number  555;  365  of 
which  have  been  raised  in  the  past  three  months. 

The  flock  of  pigeons  numbers  over  100,  and  we  have  a  constant  supply  of  squabs 
for  use  at  the  hospital. 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    8ERVICE.  53 


I'AKM    AND    (iAKDE.V. 


Tlio  fiiriu  and  i^ardeii  work,  owinj;  to  tho  extreme  scarcity  of  water,  lias  been  niofit 
disappointintr,  hut  the  )oun<j  orchard  of  fruit  trees  has  not  <»nly  been  kept  alive,  hut 
is  growing  and  a  portion  of  tlie  <jrehard  slioidd  bear  fruit  next  year. 


The  new  library  and  reading  room,  recently  occupied,  is  a  very  valuable  means  of 
entertainment  for  the  patients.  The  hooka  have  been  neatly  numlxired,  classified, 
arranged,  and  catalogued,  and  a  system -of  cards  provided,  so  that  the  i)atients  may 
receive  books  and  at  the  same  time  the  librarian  may  keep  a  projjer  account  of  them. 

SA  NAT<  nUVM    A  D.M  I  NISTK  ATIOX. 

The  growth  of  the  sanatorium  has  rended  it  necessary  to  sy.stematize  the  work, 
assigning  to  each  ofHcer  his  portion,  which  1  have  done  in  the  following  order: 

Assignment  of  medical  officers  and  schedule  of  daily  duties. 

The  commanding  officer  will  assume  charge  of  the  entire  sick  call,  assisted  by 
Acting  Assistant  Surgeon  O'Reilly. 

Assistant  Surgeon  Trask  is  detailed  in  charge  of  the  laboratory,  including  the  rou- 
tine and  special  work.  He  will  also  have  supervision  over  necropsies  and  all  other 
pathological  work. 

Assistant  Surgeon  Ebert  is  detailed  in  charge  of  the  physical  examination  room, 
and  will  have  charge  of  all  clinical  records  of  every  description. 

Acting  Assistant  Surgeon  Laws  is  detailed  to  assist  Assistant  Surgeon  Ebert  in  the 
physical  examination  room  during  the  forenoon,  and  in  the  afternoon  as  assistant  in 
the  pathological  work  of  the  laboratory. 

Acting  Assistant  Surgeon  O'Reilly  will  act  as  assistant  to  the  commanding  officer 
at  morning  sick  call,  and  will  review  the  medical  journals,  marking  articles  of  inter- 
est for  the  commanding  officer. 

Acting  Assistant  Surgeon  Walker  is  detailed  in  charge  of  the  nose  and  throat  clinic, 
and  will  receive  and  treat  such  cases  as  may  be  referred  to  him  by  any  of  the  officers 
making  sick  call;  he  is  also  detailed  as  attending  surgeon  to  the  attendants  and  other 
employees,  and  will  have  charge  of  the  surgical  clinic. 

Acting  Assistant  Surgeons  Laws,  O'Reilly,  and  Walker  will  alternate  month  about 
in  making  evening  sick  call,  the  object  of  the  evening  sick  call  being  to  meet  sucii 
emergencies  as  may  arise  after  morning  sick  call  is  made  and  which  could  not,  with- 
out prejudice  to  the  patient,  remain  unattended  until  the  following  morning. 

OFFICER  OF  THE  DAY. 

The  junior  medical  officers  will  serve  successively  as  officers  of  the  day,  and  will 
be  on  duty  as  such  for  twenty-four  hours,  beginning  at  6  o'clock  a.  m.  It  will  be 
the  duty  of  the  officer  of  the  day  to  make  inspection  of  all  wards,  tents,  and  rooms 
occupied  by  patients  between  8  and  9  o'clock  a.  m.,  and  at  10.30  a.  m.  he  will  report 
the  result  of  such  inspection  verbally  to  the  commanding  officer.  It  will  also  be  the 
duty  of  the  officer  of  the  day  to  see  arriving  patients,  assign  them  to  beds,  and  see 
that  they  are  otherwise  properly  cared  for,  and  to  answer  emergency  calls. 

The  officer  of  the  day  will  also  make  a  general  round  of  inspection,  between  the 
hours  of  9  a.  m.  and  midnight,  with  the  object  of  ascertaining  whether  or  not  good 
order  is  prevailing;  this  round  will  extend  from  the  vicinity  of  the  hospital  to  the 
corrals,  and  the  officer  of  the  day  will  exercise  his  judgement  about  entering  build- 
ings. The  tent  village  should  always  ])e  included  in  this  inspection.  In  case  of  neces- 
sity, the  commanding  officer  may  be  called  at  any  hour  to  receive  report  concerning 
any  matter  which,  in  the  opinion  of  the  inspecting  officer,  may  require  immediate 
attention,  and  a  verbal  report  may  be  made  the  following  morning  of  matters  not 
especially  urgent,  but  still  requiring  attention. 

The  officer  of  the  day  will  not  be  excused  from  duty,  and  will  not  ahsent  himself 
from  the  occupied  portion  of  the  reservation  during  his  twenty-four  hours  of  duty; 
he  should  remain  in  easy  call,  and  when  not  in  the  executive  building  should  indi- 
cate on  the  office  bulletin  board  where  he  may  be  found. 

OFFICE   HOURS. 

Medical  officers,  pharmacists,  and  office  assistants  will  report  at  the  office  of  the 
commanding  officer  at  8.30  a.  m  and  1.30  p.  m.     This  order,  however,  shall  not  pre- 


54  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SEEVICE. 

vent  the  officer  of  the  day  completing;  liis  inspection  in  the  proper  manner,  even 
though  to  do  fio  may  prevent  him  rei)orting  before  9  a.  m. 

All  affected  by  this  order  will  be  expected  to  remain  at  their  posts  of  duty,  unless 
excused,  from  8.30  a.  m.  until  noon,  and  from  1.30  p.  m.  until  the  day's  business  is 
completed. 

Office  hours  on  Sunday  from  8.30  a.  m.  until  noon  only. 

OFFICIAL  DAILY  SCHEDULE. 

Surgeon  Carrington. — 8.30  a.  m.,  office;  8.40  a.  m.,  hospital  sick  call;  9.30  a.  m., 
ambulant  sick  call.  From  10.30  until  noon  the  commanding  officer  may  be  found 
in  his  office  to  receive  necessary  reports  and  attend  to  the  requests  of  patients  and 
others;  he  will  also  be  in  his  office  from  1.30  j).  m.  to  the  close  of  business. 

Assistant  Surgeon  Trask. — 8.30  a.  m.,  at  office,  and  then  to  laboratory  room  until 
12  o'clock  noon,  and  from  1.30  p.  m.  until  the  close  of  business  also  in  the  laboratory. 

Assistant  Surgeon  Ehert. — 8.30  a.  m.,  office,  then  to  examination  room  until  noon. 
From  1.30  p.  m.  until  the  clo.se  of  business  in  examination  room  working  on  records. 

Acting  Assistant  Surgeon  Laws. — 8.30  a.  m.,  office,  then  to  examination  room  until 
noon.     At  1.30  p.  m.  in  the  laboratory  until  excused  by  Assistant  Surgeon  Trask. 

Acliyig  Assistant  Surgeon  0' Eeilly. — 8.30  a.  m.,  office,  then  to  accompany  the  com- 
manding officer  on  sick  call.  At  1.30  p.  m.,  at  office,  for  going  over  medical  journals 
and  such  other  work  as  may  be  verbally  assigned  to  him. 

Acting  Assista7it  Surgeon  Walker. — 8.30  a,  m.,  office  until  9  a.  m.,  seeing  employees 
who  may  have  been  reported  sick  by  the  pharmacists.  From  9  to  12  o'clock  at  the 
nose  and  throat  clinic.  From  1.30  p.  m.  until  completion  of  the  work  at  the  surgical 
operating  room. 

Pharmacists. — Must  also  report  at  the  office  at  8.30  a.  m.  and  afterwards  will  pro- 
ceed to  their  usual  duties. 

NECROPSIES. 

As  a  rule  necropsies  will  be  held  at  1.30  p.  m.,  immediately  after  ofl&cers  have 
made  their  afternoon  report,  and  on  necropsy  days  all  other  work  after  noon  will  be 
omitted,  except  in  cases  of  emergency. 

All  officers  will  be  expected  to  be  present  at  necropsies,  but  the  officer  in  charge 
of  the  surgical  clinic  will  complete  his  surgical  dressings  before  reporting  at  the 
necropsy  room. 

NOTES. 

The  officer  in  charge  of  the  surgical  clinic  will  send  to  the  laboratory  specimens 
from  cases  under  his  care  and  of  which  it  is  desired  to  have  an  examination  made. 
He  will  consult  the  officer  in  charge  of  the  laboratory  as  to  the  character  of  such 
specimens. 

Inspection  and  muster  will  be  held  on  Saturdays  at  7  a.  m. 

The  officer  of  the  day  may  call,  or  cause  to  be  called,  any  other  officer  in  case 
assistance  is  needed,  and  any  officer  so  called  shall  respond  promptly. 

Nothing  in  this  order  shall  be  construed  as  authorizing  discontinuance  of  work 
prior  to  4  p.  m. 

This  order,  essentiallj^  is  still  in  force,  although  some  of  the  officers  mentioned 
therein  are  no  longer  on  duty  here,  and  it  has  proven  very  satisfactory  in  operation. 

In  order  to  keep  a  check  on  the  patients  the  head  nurse  and  the  night  watchman 
each  have  a  roll  book,  showing  the  Imilding  and  bed  occupied  by  each  patient.  Roll 
is  called  at  morning  sick  call,  after  which  absentees  are  looked  up  and  accounted  for, 
and  the  night  watchman  again  makes  roll  call  by  bedside  visitation  at  9  p.  m.  The 
double  daily  inspection  by  the  officer  of  the  day  has  had  a  most  beneficial  effect. 

Our  records  have  been  greatly  improved  during  the  past  three  years,  and  we  keep 
a  number  which  are  not  required  by  the  Regulations,  but  which  greatly  facilitate  our 
work  and  its  tabulation.  I  inclose  a  specimen  of  the  clinical  chart  at  present  in  use. 
A  careful  record  is  kept  of  all  work  done  in  the  laboratory,  nose  and  throat  clinic 
and  examination  rooms,  and  the  officers  in  charge  of  these  divisions  of  work  make 
daily,  monthly,  and  other  periodical  reports  to  me  of  their  work. 

L,\BORATORY. 

During  the  last  ten  months  of  the  fiscal  year  the  following  work  was  done  in  the 
laboratory : 

Sputum  examinations 1, 112 

Urine  examinations 540 

Quantitative  examinations  for  sugar  in  urine 5 


PUBLIC    HEALTH    AND    MAlUNE-HOSi'lTAL    SJiKVICE.  55 

Hemoglobin  estimations  aecording  to  Fleischel 124 

White  blood  »-ell  eounta i;i 

Red  blood  evil  counts 2 

Examinations  of  blood  for  tiie  piasniodinni  malaria! 2 

Quantitative  and  (inalitativo  gastric  jnico  analysis I 

Feces  examinations 8 

Microscoi)ic  examinations  of  exudates,  transudates,  and  pus 9 

Necropsies 52 

Nt)t  all  tlie  necropsies  have  been  written  up  to  date,  for  the  reason  that  we  have 
been  unable  with  the  force  at  our  disposal  to  work  continuously  at  them. 

Besides  the  foregoing  routine  laboratory  wori<,  consideraljle  other  work  has  been 
carried  on,  as  follows:  Kxi)eriments  to  establisii  the  (condition  of  our  hospital  and 
dormitories  with  refereiu'e  to  tlu'ir  possible  infection  witli  tubercle  bacilli;  the 
administration  of  the  tuberculin  test  to  our  dairy  herd  of  (10  milk  cows;  work  done 
to  ascertain  morphological,  cultural,  and  jjathological  character  of  the  bacillus  X  of 
Maher;  also  the  examination  of  milk  from  our  different  dairy  cows  to  establish  the 
absolute  and  relative  value  of  their  yield. 

A  full  and  detailed  report  of  the  work  done  in  the  laboratory,  prepared 'by  the 
officer  in  charge,  is  submitted  as  an  exhibit  with  this  rei>oi-t. 

DtTRABILITV    OF   CURE. 

Being  myself  a  beneficiary  of  this  sanatorium,  its  conduct,  operations,  and  aims 
have  become  very  dear  to  me,  and  when  I  begin  to  talk  or  write  of  it  it  is  very 
difiicult  for  me  to  limit  my  remarks  to  proper  proportions. 

There  is  one  question  of  paramount  importiiiice  to  the  individual  consumptive — 
namely,  the  durability  of  cure.  We  are  nnfortuiuitely  not  able  to  secure  the  subse- 
quent histories  of  a  good  many  of  our  patients.  I  do,  however,  receive  an  occasional 
letter  from  patients,  who  have  been  away  from  the  sanatorium  for  a  few  months, 
and  I  recently  received  one  from  a  patient  discharged  over  threi^  years  ago,  which  is 
of  so  much  interest  as  bearing  on  this  question  of  the  durability  of  the  cure,  as  to 
warrant,  I  think,  an  extract  from  it  being  included  in  this  report. 

[Copy  of  letter  from  Capt.  John  S.  Simmons,  discharged  March  31,  1901.] 

Office  op  Steamer  John  S.  Simmons, 

Paducah,  Ky.,  July  4,  1904. 
My  Dear  Sir:  *  *  *  i  have  never  had  any  trouble  with  mj'  lungs  since  1  left 
Stanton,  and  have  taken  the  best  of  care  of  myself,  but  have  worked  very  hard,  as  this 
business  [operating  towing  boats,  Tennessee  and  Cumberland  rivers]  requires.  I  do 
not  weigh  as  much  by  aliout  ten  or  twelve  pounds.  This  valley  is  a  very  hard 
climate  to  live  in,  as  it  is  malarial,  and  I  am  touched  with  it  all  the  time  here.  I 
would  like  to  locate  in  a  healthier  climate,  but  my  business  is  all  here,  and  it  is 
impossible  to  leave  it  long  at  a  time.  I  have  a  large  capital  invested  in  my  two  plants, 
and  you  can  see  that  I  am  a  very  busy  man. 

I  can  only  think  that  Stanton  did  me  a  great  deal  of  good  and  that  I  received  all 
the  attention  and  courtesies  that  were  due  me  at  that  institution,  and  I  shall  not 
live  long  enough  to  ever  forget  the  kind  treatment  I  received  at  the  hands  of  the 
persons  in  charge  of  the  fort.at  the  time  of  my  stay  at  that  place. 
Very  truly,  yours, 

John  S.  Simmons. 
Dr.  P.  M.  Carrington, 

Fort  Stanton,  N".  Mex. 

recommendations  and  conclusion. 

For  the  consideration  of  tlie  Bureau  and  in  furtherance  of  the  industrial  idea  for 
sanatoria  in  general  and  this  sanatorium  in  i)articular,  I  wish  to  suggest  that  shops 
be  established  for  the  manufacture  and  repair  of  articles  of  furniture,  etc.,  for  the 
use  of  the  sanatorium  and  for  sale  or  barter  under  the  proposed  law  relating  to  the 
subject.  We  have  a  variable  number  of  patients,  who  are  comjjetent  to  do  cabinet 
work  in  its  several  branches.  If  the  commanding  officer  might  be  granted  authority 
to  em])loy  such  patients  in  accordance  with  their  physical  and  technical  ability,  in  a 
shop  organized  to  do  cabinet  and  repair  Mork,  paying  them  by  the  piece  or  job, 
many  articles  of  furniture  now  purchased  by  the  Purveyor  and  shipped  from  New 
York  at  considerable  expense  could  be  manufactured  at  the  station,  and  all  of  our 


56  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

repair  work  could  be  done  in  such  a  shop.  Surphis  articles  thus  made  might  be 
disposed  of  by  sale  or  barter  in  accordance  with  the  law  which  it  is  proposed  to  ask 
Congress  to  pass.  The  advantage  of  such  a  shop,  operated  on  such  a  basis,  will  he 
primarily  to  give  employment  to  convalescent  patients,  and  the  sale  and  barter  of 
articles  thus  manufactured  may  operate  to  reduce  very  materially  the  running 
expenses  of  the  sanatorium. 

Ill  any  regulations  made  under  such  a  law  authority  should  be  granted  the  com- 
manding officer  to  use  the  moneys  and  materials  accruing  from  the  sale  or  barter  of 
the  products  of  the  shop  to  purchase  materials  for  additional  articles  to  be  manufac- 
tured or  otherwise  at  his  discretion,  due  care  being  had  to  matters  of  accountability 
for  funds,  and  provisions  being  made  to  pay  the  piece  wages  of  patients  employed 
out  of  moneys  so  received. 

Such  a  law  should  also  permit  the  sale  or  barter  of  surplus  and  useless  products, 
such  as  hogs  and  other  live  stock.  Such  sale  and  barter,  so  far  from  being  opposed 
by  the  citizens  of  the  vicinity,  will  be  eagerly  welcomed  by  them  and  will  afford 
them  a  ready  market  for  their  products,  as  well  as  one  in  which  they  may  procure 
in  exchange  for  their  products  better  grades  of  stock  than  they  could  otherwise 
afford  to  own. 

The  industrial  shop  suggested  above  has  in  it  a  great  many  possibilities  which  will 
develop  according  to  circumstances  and  the  exigencies  of  the  station,  and  I  believe 
the  idea  is  well  worthy  of  your  careful  consideration. 
Respectfully, 

P.  M.  Caerington,  Surgeon,  in  Command. 

The  Surgeon-General. 

[Inclosure.] 

Report  of  Laboratory,  Fort  Stanton,  by  Assist.  Surg.  J.  W.  Trask. 

United  States  Public  Health 
AND  Marine-Hospital  Service, 
Fort  Stanton,  S.  Me.r.,  July  1,  1904. 

Sir:  I  have  the  honor  to  make  the  following  report  of  work  done  in  this  laboratory 
during  the  ten  months  from  September  1,  1903,  to  June  30,  1904,  in  which  I  have 
been  in  charge  of  the  work: 

When  first  assigned  to  the  laboratory  I  was  the  only  one  working  in  it,  and  even 
then  not  all  of  my  time  was  devoted  to  it,  inasnmch  as  sick  call  and  surgical  dressings 
for  a  while  constituted  part  of  my  assignment.  The  laboratory  at  this  time  under- 
took to  prepare  stained  specimens  from  the  various  organs  and  tissues  of  each  body 
brought  to  necropsy,  and  with  but  one  or  two  exceptions,  such  as  in  cases  where 
relatives  claimed  the  body  for  burial,  a  necropsy  has  been  held  on  all  patients  who 
died  at  this  sanatorium  during  the  past  ten  months.  It  was  then  found  that  the  work 
was  more  than  one  man  could  do,  an<l  an  assistant,  an  undergraduate  medical  student, 
was  placed  in  the  laboratorv  to  make  routine  urine  and  sputum  examinations,  which 
by  this  time  constituted  a  considerable  amount  of  work,  inasnmch  as  we  had  nearly 
200  patients  whose  sputum  and  urine  were  regularly  examined  every  three  months, 
and  in  cases  where  tubercle  bacilli  were  ab.sent,  few,  or  hard  to  find,  and  these  form 
a  considerable  percentage  of  the  whole.  Repeated  examinations  on  successive  days 
were  made,  and  besides  this,  patients  are  continually  being  admitted  and  discharged, 
and  in  both  of  these  cases  the  urine  and  sputa  are  examined.  Later,  a  riiedical  officer, 
Acting  Assistant  Surgeon  Markoe,  was  detailed  to  assist  in  the  sputum  and  urine 
examinations.  In  the  meantime  the  laboratory  had  been  carrying  on  special  experi- 
mental and  research  work,  and  another  medical  officer,  Acting  Assistant  Surgeon 
Laws,  was  detailed  to  assist  in  the  preparation  of  tissues  anfl  stained  specimens  from 
necropsies.  These  three  assistants  spent  only  a  part  of  their  time  in  the  laboratory, 
on  an  average  not  over  two  hours  a  day;  the  remainder  of  their  time  was  occupied 
with  other  work. 

Besides  the  routine  laboratory  work  considerable  other  work  has  been  carried  on, 
as  follows:  Experiments  to  establish  the  condition  of  our  hospital  and  dormitories 
with  reference  to  their  )0ssible  infection  with  tubercle  bacilli;  the  administration  of 
the  tuberculin  test  to  our  dairy  herd  of  60  milk  cows;  work  done  to  ascertain  mor- 
phological, cultural,  and  pathological  characteristics  of  the  l)acillus  X  of  Maher;  also 
the  examination  of  milk  from  our  different  breeds  of  dairy  cows  to  establish  the 
absolute  and  relative  value  of  their  yield. 


PUBLIC    HEALTH    AND    MARINK-HOSI'ITAL    SKKVKK.  57 

Report  No.  1. 

Fort  Stanton-,  X.  Mi;\.,  .lniiHiinj  J^,  JHO/,. 
Sir:  I  have  the  honor  to  fiuliiiiit  thi'  followiii'j  report  of  special  \v<»rk  done  in 
laboratory  "t<>  ostahhsli  the  condition  of  our  liospital  and  other  donnitories,  with 
reference  to  their  j)OS8ible  infection  with  tnljercle  bacilli:" 

The  following  work  was  done  in  compliance  with  the  lirst  request  of  the  following 
instructions: 

United  States  Public  Health  and  ^Iakink-IIospital  Service, 

Office  of  Medical  Officer  in  Command, 

Fort  S((mton,  N.  Me.r.,  September  7,  J90.L 
Sir:  I  desire  to  have  you  take  up  as  f'oon  a^^  practicable  experiments  to  establish 
the  condition  of  our  hospital  and  other  dormitories  with  reference  to  their  possible 
infection  with  tubercle  bacilli. 

The  resources  of  the  laboratory,  now  in  your  charge,  and  including  such  a  number 
of  rabbits  and  guinea  pigs  as  may  be  necessary,  are  at  your  disposal  for  this  purpose. 
Individual  cages  for  the  animals  to  be  used  in  the  experiment  are  l)eing  ma<le  in 
order  to  avoid  the  error  of  having  them  confounded  with  other  animals. 

Upon  the  completion  of  these  experiments  you  should  render  a  report  in  detail, 
together  with  your  conclusions. 

Respectfully,  P.  M.  Carrinotox, 

Surgeon  in  Command. 
Asst.  Surg.  J.  W.  Trask, 

Fort  Sta)ito)t,  N.  Mex. 

The  experiments  to  ascertain  whether  or  not  our  hospital  was  infected  with  tuber- 
cle bacilli  were  begun  on  September  14,  1903. 

September  14,  1903,  test  tubes  and  petri  dishes  were  washed  clean;  the  test  tubes 
were  plugged  with  cotton  and  with  the  petri  dishes  sterilized  with  dry  heat  for  one 
and  one-half  hours  in  the  oven  of  a  common  kitchen  range.  (We  have  no  dry-heat 
oven  in  tlie  laboratory. ) 

September  15,  1903,  pieces  of  wood,  3  inches  long  by  one-fourth  inch  wide,  by 
one-sixteenth  inch  thick,  were  placed  in  the  covered  petri  dish  and  sterilized  in  dry- 
heat  oven  until  they  were  charred  brown. 

September  16,  1903,  made  a  salt  solution  of  6  parts  sodium  chloride  and  1,000  parts 
of  distilled  water  and  boiled  it  in  flask  for  one-half  hour;  then  poured  the  salt 
solution  into  the  sterilized  test  tubes  to  a  depth  of  3  inches  and  again  sterilized  tubes 
with  salt  solution  for  one  hour  in  Arnold's  steam  sterilizer.  They  were  then 
removed  and  allowed  to  cool.  Then  took  to  the  hospital  a  copper  basin  and  alco- 
hol lamp,  the  test  tubes  with  salt  solution,  and  wood  splinters  in  petri  dish  in  which 
they  had  been  sterilized.  Sterilized  a  pair  of  artery  forceps  in  boiling  water  by 
means  of  alcohol  burner  and  copper  basin.  Then,  with  sterile  forceps,  grasped  sterile 
splinter  of  wood,  moistened  wood  in  boiling  water,  then  let  it  cool  for  few  seconds, 
and  with  moist  end  of  splinter  dug  dirt  out  of  cracks  and  corners,  then  dropped  the 
splinter  along  with  the  collected  dust  and  dirt,  which  amounted  to  a  mass  larger 
than  a  marble,  into  a  test  tube  containing  the  sterile  salt  solution.  Then  replaced 
cotton  plug  in  tube  and  sterilized  the  mouth  of  tube  with  flame.  This  procedure 
was  gone  through  with  in  each  separate  room  in  which  dust  was  collected.  The 
artery  forceps  were  boiled  between  each  operation.  The  amount  of  dust  collected 
each  time  was  sufficient  to  make  the  salt  solution  look  muddy. 

The  test  tubes  were  numV)ered  from  1  up. 

Test  tube  No.  1  contained  dirt  from  the  southwest  and  northwest  (corners  of  the 
floor  of  the  hospital  ward  and  from  a  crack  in  the  center  of  the  room. 

Test  tube  No.  2  contained  dirt  from  corners  of  floor  and  Ijaseboard  of  hospital  toilet 
room,  in  which  the  closets  are  located. 

Te.st  tube  No.  3  contained  dirt  from  corner  and  cracks  in  floor  of  room  No.  7, 
occupied  by  negro  patients. 

The  above  tubes  were  shaken  well  and  allowed  to  stand  for  two  hours.  They  were 
again  shaken  and  the  salt  solution  and  dirt  in  suspension  poured  into  a  sterile 
petri  dish,  each  tube  into  a  separate  dish.  Antitoxine  syringes  of  5  c.  c.  capacity 
and  needles  were  sterilized  in  boiling  water  and  allowed  to  cool.  Th(  solution  and 
suspended  dirt  were  then  drawn  from  e^ich  dish  separately  into  the  sterile  syringes, 
and  guinea  pigs  were  inoculated  both  hypodermatically  and  intraperitoneally  with 
the  solution,  one  pig  hypodermatically  "and  one  pig  inti-aperitoneally  with  each 
solution.  The  technique  was  as  follows:  The  pigs  were  held  by  an  assistant;  hair 
over  part  of  left  side  of  abdomen  was  cut  close  with  scissors,  the  clipped  area  and 


58  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

surrounding  hair  was  soaked  with  bichloride  of  mercury,  1:700;  syringe  needle  was 
then  passed  through  the  skin  to  inoculate  hypodermatically  and  through  the  entire 
abdominal  wall  in  inoculating  intraperitoneally. 

The  pigs  were  numbered  from  1  up  and  when  inoculated  were  placed  in  hutches 
also  numbered  from  1  up.  Each  hutch  was  marked  with  a  card  upon  which  were 
recorded  the  numbers  of  the  pigs  in  it  and  also  when,  with  what,  and  how  much 
they  had  been  inoculated.  It  also  gave  a  description  of  the  markings  and  colors  of 
the  pigs.  In  each  hutch  were  put  only  the  two  which  had  been  inoculated  with  the 
same  tube  of  salt  solution. 

The  pigs  were  used  as  follows: 

Pig  No.  1. — Large  brown  boar  was  inoculated  subcutaneously  with  2  c.  c.  of  con- 
tents of  tube  No.  1  and  placed  in  hutch  No.  1  September  16,  1903. 

Pig  No.  2. — Black  boar  with  brown  spots  was  inoculated  intraperitoneally  with 
2  c.  c.  of  contents  of  tube  No.  1  and  placed  in  hutch  No.  1  September  16,  1903. 

Pig  No.  3. — Black  boar  with  white  face  was  inoculated  subcutaneously  with  2  c.  c. 
of  contents  of  tube  No.  2  and  placed  in  hutch  No.  2  September  16,  1903. 

Pig  No.  4- — Black  boar  with  brown  spots  was  inoculated  intraperitoneally  with 
2  c.  c.  of  contents  of  tube  No.  2  and  placed  in  hutch  No.  2  September  16,  1903. 

Pig  No.  5. — Black  boar  was  inoculated  subcutaneously  with  2  c.  c.  of  contents  of 
tube  No.  3  and  placed  in  hutch  No.  3  on  September  16,  1903. 

Pig  No.  6. — Black  boar  with  brown  spots  was  inoculated  intraperitoneally  with  2 
c.  c.  of  contents  of  tube  No.  3  and  placed  in  hutch  No.  3  Sejitember  16,  1903. 

On  September  18,  1903,  the  head  nurse  at  the  hospital  swept  the  wards  and  halls 
with  a  broom.  (Schnauder  is  a  robust,  German,  uninfected  nurse,  apparently  in  per- 
fect health. )  He  then  blew  his  nose  into  a  clean  piece  of  toilet  paper  and  brought 
it  to  the  laboratory  in  a  clean  paper  filler,  such  as  is  used  here  in  the  hand  sputum 
cups.  The  jiaper  with  discharge  from  nose  was  soaked  and  agitated  in  0.6  per  cent 
salt  solution  and  was  treated  otherwise  with  the  same  care  and  technique  as  was  used 
with  the  collections  from  the  hospital  floors.  It  was  injected  into  guinea  pigs  as 
follows: 

Pig  No.  7. — Brown,  black,  and  white  boar  was  inoculated  subcutaneously  with  2J 
c.  c.  of  mixed  salt  solution  and  secretion  from  nurse's  nose  and  placed  in  hutch 
No.  4  September  19,  1903. 

Pig  No.  8. — Black  and  brown  sow  was  inoculated  intraperitoneally  with  2  c.  c.  of 
mixed  salt  solution  and  secretion  from  nurse's  nose  and  placed  in  hutch  No.  4  Sep- 
tember 19, 1903. 

November  12,  1903. — In  order  to  ascertain  the  presence  or  absence  of  infection  of 
the  spray  room,  where  many  cases  have  their  nares,  pharynges,  and  larynges  treated 
daily,  and  where  there  is  necessarily  much  coughing,  sneezing,  and  spraying,  scrap- 
ings were  made  with  a  sterilized  potato  knife  from  the  floor.  The  surface  of  the 
boards  was  scraped  and  what  small  amount  of  dirt  had  collected  in  the  cracks  was 
dug  out  from  the  area  of  the  floor  which  is  directly  in  front  of  where  the  patients 
sit  and  which,  therefore,  would  be  most  apt  to  be  infected.  The  collection  thus 
made  by  scrapings  was  treated  in  exactly  the  same  way  as  had  been  that  collected 
from  the  floors  at  the  hospital,  and  was  injected  into  guinea  pigs  as  follows: 

Pig  No.  11. — Brown  and  black  sow  was  inoculated  subcutaneously  with  3  c.  c.  of 
salt  solution  and  scrapings  from  spray  room  floor  and  placed  in  hutch  No.  6  on 
November  12,  1903. 

Pig  No.  12. — Cream-colored  boar  was  inoculated  intraperitoneally  wdth  3  c.  c.  of 
salt  solution  and  scrapings  from  spray  room  floor  and  put  in  hutch  No.  6  on  Novem- 
ber 12,  1903. 

NECROPSY  REPORT  OF  INOCULATED  PIGS. 

Pig  No.  1. — Killed  with  chloroform  January  13,  1904;  was  well  nourished;  body 
heat  present;  liver  of  rather  dark  color;  spleen  slightly  pale;  splenic  follicles  showed 
distinctly;  kidneys  normal;  lymph  glands  not  enlarged ;  heart  filled  with  fluid  blood; 
mac-oscopically  no  signs  of  disease  were  found;  spleen  was  hardened  in  alcohol,  ancl 
sections  made  from  it  showed  neither  tubercles  nor  tubercle  bacilli. 

Pig  No.  2. — Well  nourished;  body  heat  present;  killed  with  chloroform  January 
13,1904;  liver  dark  in  color;  spleen  pale,  but  follicles  easily  seen;  kidneys  apparently 
normal;  lymph  glands  not  enlarged;  heart  filled  with  red  clots;  no  macroscopical 
signs  of  disease;  sections  made  from  spleen  showed  neither  tubercles  nor  tubercle 
bacilli. 

Pig  No.  3. — Well  nourished;  body  heat  absent;  rigor  mortis  present;  died  Decem- 
ber 8,  1903;  no  tubercles  nor  suspicious  areas  found  anywhere  in  body;  smears  made 
from  spleen  and  liver  were  entirely  negative,  and  sections  made  from  spleen  showed 
neither  tubercles  nor  tubercle  bacilli. 


PUBLIC    HEALTH    AND    MAKINK-HOSPITAL    SKKVICE.  59 

Pl(/  No.  4- — l>ie<l  Doceinltcr  S,  liKW;  was  well  nourished;  alxlouiinal  orgauH  and 
Ill-art  vesselw  f^huwtnl  passive  (•oii<;c'stinii;  licart  lilicd  with  red  clots;  spleen  sinearH 
were  negative  as  wert^  also  sections  made  from  the  same  (jrgan. 

Pig  No.  5. — Well  noinished;  died  I)ecend)er  S,  l!)()o;  omentum  and  mesentery  rich 
in  fat;  vessels  of  intestines  injei-ted;  lieart  lille(l  with  red  clot;  smears  made  from 
spleen  were  negativi^,  as  were  also  sections  niadi'  from  same  organ. 

P'kj  No.  6. — kille<l  with  chloroform  .lanuary  i;{,  1904;  well  nourished;  body  heat 
present;  lymphatic  glands  not  enlarged;  liver  reddish  brown  in  color;  spleen  some- 
what pale;  follicles  visible,  heart  tilled  with  red  dots;  no  tubcn-le  nor  suspicious 
areas  found  anywhere;  sections  made  from  si)leen  showed  neither  tubercles  nor 
tubercle  l)aiilli. 

i'/V/  No.  7. — Killed  with  chloroform  January  L3,  1904;  body  heat  present;  well 
nourished;  lymph  glands  not  enlarged;  liver  reddish  brown;  spleen  slightly  pale; 
follicles  of  spleen  visible;  heart  tilled  with  fluid  blood;  no  tubercles  nor  suspicious 
areas  were  found  anywhere;  sections  made  from  spleen  were  negative. 

Pig  No.  8. — Died  January  3,  ]!H)4;  well  nourished;  congestion  of  small  intestines; 
passive  congestion  of  heart  vessels;  heart  tilled  with  semiliquid  blood  and  (Uirrant- 
jelly  clots;  no  tubercles  nor  suspit-ious  areas  found  anywhere;  sections  of  s[)leen 
showed  neither  tubercles  nor  tubercle  bacilli. 

Pig  No.  11. — Killed  with  chloroform  January  13,  1904;  well  nourished;  lymph 
glands  not  enlarged;  heart  tilled  with  dark  fluid  blood;  no  pathological  lesions  found; 
sections  made  from  spleen  showed  neither  tubercles  nor  tubercle  bacilli. 

Pig.  No.  12. — Killed  with  chloroform  January  1.3,  1904;  well  nourished;  lymph 
glands  not  enlarged;  right  kidney  contained  many  small  urinary  cysts,  but  was  other- 
wise apparently  normal;  no  pathological  lesions  other  than  the  urinary  cysts  were 
found  anywhere  in  the  body,  and  sections  made  from  spleen  showed  neither  tuber- 
cles nor  tubercle  bacilli. 

Of  the  10  pigs  inoculated,  3  died  during  the  night  of  December  8,  1903,  and  one 
during  the  night  of  January  3,  1904.  Both  of  these  nights  were  very  cold,  and  inas- 
much as  they  died  on  the  same  nights  as  other  pigs  which  had  never  been  inocu- 
lated, and  inasmuch  as  those  which  had  been  inoculated  w'ere  all  well  nourished  and 
apparently  in  good  health  up  to  the  evening  they  died,  and  since  no  pathological 
lesions  nor  cause  of  death  could  be  found  post  mortem,  there  seems  no  other  expla- 
nation to  be  given,  and,  in  my  judgment,  none  needed  other  than  that  they  died  from 
the  effects  of  cold. 

Of  the  4  that  died  because  of  cold,  3  had  been  inoculated  two  monthsand  twenty- 
one  days,  and  1  three  months  and  fifteen  days  previously.  Of  the  6  which  were 
killed  by  chloroform  anaesthesia  3  had  been  inoculated  three  months  and  twenty- 
eight  days,  1  three  months  and  twenty-five  days,  and  2  two  months  and  one  day 
previously.  The  interval  between  the  time  of  their  inoculation  and  death  was  in 
each  case  sufficient  to  have  at  least  produced  advanced  tuberculosis,  if  not  emaciation 
and  death,  had  there  been  present  tubercle  bacilli  in  the  material  with  which  they 
were  inoculated. 

The  10  pigs  were  at  time  of  necropsy  without  exception  well  nourished.  Not  one 
of  them  showed  the  least  suspicion  of  a  tuberculous  lesion  macroscopically,  nor  did 
sections  of  the  spleens  show  any  lesions  microscopically. 

As  a  check  upon  the  technique,  and  to  make  the  experiments  as  complete  and 
thorough  as  possible,  I  used  2  guinea  pigs  as  a  control.  I  took  sputum  belonging  to 
a  patient  and  examined  stained  specimens  of  it  to  make  sure  of  its  containing  tubercle 
bacilli.  They  were  present  in  considerable  numbers.  I  then  took  some  of  the  sputum 
and  agitated  it  in  0.6  per  cent  salt  solution  and  on  November  10, 1903,  inoculated  the 
two  controls  with  it,  using  in  every  detail  the  same  methods  and  syringes  as  were 
used  with  the  other  pigs. 

Control  A  was  inoculated  subcutaneously  with  1\  c.  c.  of  the  mixture  of  salt  solu- 
tion and  sputum  and  was  put  in  hutch  No.  5. 

Oontrol  B  was  inoculated  intraperitoneally  with  1\  c.  c.  of  the  mixture  of  salt 
solution  and  sputum,  and  as  previously  stated  the  same  technique  was  used  as  had 
been  employed  with  the  other  pigs.     Control  B  was  placed  in  hutch  No.  5. 

Control  B  died  during  the  night  of  December  15,  1903,  and  the  necropsy  held  the 
next  morning  showed  emaciation;  testicles  soft;  lymph  glands  of  anterior  medias- 
tium  enlarged,  and  in  section  they  were  found  firm  and  containing  yellowish  nodules 
w^hich  composed  the  greater  part  of  the  gland;  heart  filled  wjth  currant-jelly  clots; 
lungs  congested  and  edematous;  liver  enlarged  and  mottled  greenish  yellow  and  red- 
dish brown,  and  on  section  contained  many  greenish-yellow  nodules;  spleen  many 
times  enlarged  and  mottled  reddish  brown  and  white,  and  on  section  the  white 
mottling  of  the  surface  was  found  due  to  large  whitish  nodules  throughout  the 
spleen;  omentum  was  matted  and  thickened,  adherent  to  itself  in  many  places,  and 


60  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

contained  many  pin-head  tubercles;  mesenteric  and  retroperitoneal  lymph  glands 
enlarged  and  on  section  resembled  those  of  the  anterior  mediastium;  parietal  jieri- 
tonemn  contained  thickened  yellowish  patches;  smears  made  from  the  spleen  con- 
tained tubercle  l^acilli  in  considerable  numbers;  sections  made  from  spleen  showed 
the  presence  of  tuberculous  tubercles  and  of  tubercle  ])acilli. 

Control  A  was  killed  by  chloroform  on  January  13, 1904.  Necropsy  showed  emacia- 
tion marked.  There  was  a  softened  caseated  nodule  which  was  just  about  to  break 
at  the  point  of  inoculation.  Spreads  were  made  from  the  broken-down  matter  which 
escaped  from  the  nodule  when  punctured,  and  when  stained  were  found  to  contain 
tubercle  bacilli.  Mesenteric  and  inguinal  glands  were  enlarged  and  some  of  them 
softened.  Spleen  was  much  enlarged  and  tilled  with  Avhite  nodules.  Liver  con- 
tained many  pearh^  nodules  scattered  throughout.  Sections  made  from  spleen 
showed  tuberculous  tubercles  and  tubercle  bacilli. 

It  is  seen  from  the  above  that  the  two  controls  inoculated  with  known  cultures  of 
tubercle  bacilli  became  rapidly  tuberculous;  that  contT-ol  B  lived  but  one  month  and 
five  days  and  was  found  to  have  extensive  general  tuberculosis,  and  that  control  A, 
killed  two  months  and  three  days  after  inoculation,  Avas  found  in  the  same  condition. 

CONCLUSIONS. 

In  a  room  or  building  occupied  by  consumptives  the  part  most  apt  to  become 
infected  is  the  floor,  next  to  this  the  baseboards,  and  then  the  side  walls  for  a  dis- 
tance of  2  or  3  feet  from  the  Hoor.  This  is  so  because  the  greater  amount  of  the 
scattering  of  bacilli  is  done  by  spraying  when  the  patient  talks  or  coughs. 

The  organisms  leave  the  mouth  in  minute  droplets  of  saliva  and  sputum,  which, 
because  of  their  weight,  gravitate  to  the  floor.  Of  course  when  these  droplets  dry 
they  may,  or  rather  the  bacilli  which  were  in  them  may,  be  stirred  up  in  the  dust 
and  find  lodgement  on  any  and  all  dust-collecting  surfaces  and  in  spider  webs.  And 
on  the  floor  the  greatest  infection  will  be  found  in  the  cracks  and  corners  where  dust 
and  dirt  collects  and  remains  undisturbed  for  days,  weeks,  and  ])erhaps  months. 
The  material  collected  for  inocculation  was  from  rooms  occupied  continually  by  con- 
sumptives in  the  last  stages  or  from  lavatories  and  the  spray  room  daily  used  by 
them.  It  was  removed  from  cracks  and  corners  of  floor,  and  in  each  case  a  consid- 
erable amount  was  scraped  up  and  inserted  in  each  tube  of  salt  solution.  The  amount 
was  such  that  had  it  been  infected  it  was  enough  to  guarantee  a  sufficient  dose. 

Since  all  the  pigs  thus  inoculated  were  healthy  up  to  the  time  of  their  death,  and 
none  of  them  either  ante  or  post  mortem  showed  any  sign,  symptom,  or  pathological 
lesion  of  tuberculosis,  the  only  conclu.sion  that  can  be  drawn  is  that  no  living  tubercle 
bacilli  were  present  in  the  dirt  removed  from  the  hospital  rooms  and  spray  room; 
and  since  this  dirt  was  taken  from  the  parts  of  the  rooms  most  exposed  and  liable  to 
infection,  it  can  further  be  concluded  that  no  part  of  the  above  rooms  contained  living 
tubercle  bacilli. 

Therefore  it  can  be  said  that  the  measures  employed  in  the  rooms  tested  are  ade- 
quate to  prevent  infecting  of  floors  and  l)asel;)oards. 

The  measures  used  at  the  hospital  are  a  weekly  mopping  of  the  floors  with  kero- 
sene oil.  In  the  si)ray  room  the  floor  is  mopped  weekly  with  bichloride  of  mercury 
solution  1:1000  and  the  room  disinfected  by  formaldehyde  gas  as  generated  by  a 
Kuhn  generator. 

Lest  the  question  might  be  asked  as  to  how  long  after  the  mopping  with  kerosene 
or  bichloride  of  mercury  was  the  material  collected  for  inoculation,  I  will  state  that 
the  scrapings  were  made  five  and  six  days  after  the  moppings,  that  is,  just  before  it 
was  time  for  the  next  application  of  kerosene  or  bichloride. 

TUBERCULIN    TKST    OF    .JERSEY    llEKD. 

In  testing  out  the  cattle  with  tuberculin  the  routine  advised  by  the  Agricultural 
Department,  Bureau  of  Animal  Industry,  was  followed.  The  temperature  of  each 
cow  was  taken  per  rectum  at  8  a.  m.,  10  a.  m.,  12  noon,  2  p.  m.,  6  p.  m.,  and  at  10 
p.  m.  Immediately  after  the  last  temperature  2  c.  c.  of  tuberculin  were  injected 
subcutaneously  just  back  of  the  right  shoulder.  Then  on  the  following  day  the  tem- 
perature was  again  taken  per  rectum  at  8  a.  m.,  10  a.  m.,  12  noon,  2  p.  m.,  4  p.  m., 
and  6  p.  m.  Sixty  cows  were  thus  tested.  One  of  the  cows  reacted.  Her  maximum 
temperature  before  injection  was  38.4°  C.  and  after  injection  40.1°  C.  Eight  days 
later  she  was  again  tested  and  her  maximum  temperature  before  injection  was  38.6°  ('. 
and  after  39.6°  C.  Thus  the  rise  in  temperature  was  1.7°  C.  after  the  first  test  and 
1°  C.  after  the  second.  This  cow  was  killed  and  a  necropsy  held,  but  no  lesions  were 
found  macroscopically.     Her  remains  were  burned. 


PUBLIC    HEALTH    AND    MAKINK-II()81'ITAL    SEKVIOK. 


()] 


H.VCILI.US    X    OK    MAHKK. 

Considt'i-ahli'  (iiuc  w;ih  spent  in  studying  the  BacilluH  X  of  Mahcr.  Sevonty-nine 
l)ationts  were  later  inoculated  with  it  at  their  own  request,  and  in  all  102  ino(!ulation8 
wi're  made.  J>ut  inasuuuh  as  this  work  is  not  as  yet  completed  a  detailed  report  will 
be  made  later. 

J.  W.  Thask, 
AHsiskmf  Sunjcon,  Public  IFcalth  and  Marine-JIoxpildl.  Service, 

In  Charge  of  Laburalory. 

P.  M.  Cakrinc.ton, 

Medical  Officer  in  Command,  Fort  Stanton,  N.  Mux. 

•    Report  of  Milk  PIkaminatioxs. 

Fort  Stanton,  N.  Me.\.,  .Jnbj  1,  1004. 

Sir:  In  accordance  with  your  verbal  request  made  about  ten  days  ago,  asking  that 
an  examination  of  the  milk  from  the  different  ])reeds  of  milk  cows  l)e  made  to  ascer- 
tain their  relative  worth  as  a  food,  and  especially  to  determine  whether  or  not  there 
is  any  difference  in  the  size  of  the  fat  globules  in  the  milk  from  the  various  breeds,  I 
have  the  honor  to  report  that  I  have  examined  10  specimens,  that  there  was  no 
appreciable  difference  in  the  size  of  the  fat  globules  in  the  milk  from  cows  of  different 
breeds.  The  fat  globules  varied  in  each  specimen  from  1  to  8  micromillimeters  in 
diameter,  the  greatest  numl)er  measuring  2  to  3.  There  were  a  great  numl)er  of 
bacteria  in  eacli  sample,  which  would  indicate  that  the  milk  had  not  been  i)roperly 
cooled  after  milking.  The  Jersey  cows  were  the  only  ones  which  produced  what  is 
considered  a  proper  percentage  of  cream.  Both  the  Holsteins  and  half-breeds  (Here- 
ford and  Jersey)  fell  considerably  l^elow  the  normal  in  cream  ]>roduction.  Seven  of 
the  10  specimens  of  whole  milk  examined  fell  below  1.029  in  specific  gravity,  which 
is  considered  the  minimum  for  good  milk.  There  were  10  specimens  examined,  4 
Jerseys,  4  Holstein,  and  2  half-breed  (Hereford  and  Jerseys). 

The  following  are  the  specific  gravities: 

THE  WHOLE  MILK. 


Jersey. 

Holstein. 

Half-breed. 

1.02842 
1.02755 
1.02813 
1.02784 

1.02987 
1.02958 
1.02871 
1. 02842 

1.029 
1.02697 

SKIMMED  MILK. 


1.02958 
1.03117 

1.03016 
1. 03074 

L 02987 

The  cream  percentages  were 


Jersey. 

Holstein. 

Half-breed. 

Per  cent. 
9.0 
13.3 
10.77 

Per  cent. 
8.0 
7.2 

Per  cent. 
8.3 

Respectfully,  J.  W.  Trask, 

Assistant  Surgeon, 
Public  Health  and  Marine- Hospital  Service, 

In  Charge  of  Laboratory. 
Medical  Officer  in  Command, 

Fort  Stanton,  N.  Mex. 


62  PUBLIC   HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

PURVEYING   DEPOT   AT   NEW    YORK. 

{Report  of  medico  I,  jnirveyor.) 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Purveyor, 
S78  Washington  street,  Neiv  York,  N.  Y.,  August  10,  1904. 

Sir:  I  have  the  honor  to  transmit  herewith  report  of  the  operations  of  this  station 
for  the  fiscal  year  ended  June  30,  190-4. 

The  routine  work  of  the  depot  has  heen  conducted  on  similar  lines  as  heretofore, 
with  such  changes  from  time  to  time  as  suggested  themselves  to  facilitate  the  details 
dependent  on  the  issuing  and  receiving  of  supplies  and  the  proper  accounting  of  the 
same. 

The  work  pertaining  to  the  records  kept  at  the  depot  has  been  greatly  augmented, 
with  as  yet  no  additional  assistance,  and  which  before  long  will  require  the  detail  of 
one  more  pharmacist  for  duty  at  the  depot.  The  work  referred  to  is  that  covered  by 
Bureau  letter  of  August  22,  1903,  directing  that  an  account  be  opened  with  each 
station  of  the  Service,  showing  the  total  cost  of  supplies  issued,  as  well  as  the  cost  of 
the  individual  classes  as  mentioned  in  the  letter  al)ove  referred  to.  This  work  in 
connection  with  the  accounts  kept  with  other  services  for  supplies  issued  has  been  a 
severe  tax,  and  has  been  met  only  by  the  devoting  of  considerable  time  outside  of 
office  hours  to  this  particular  feature  of  the  office  work. 

The  examination  of  supplies  is  now  receiving  more  attention  than  heretofore, 
especially  pharmacopoeial  products  and  other  pharmaceutical  preparations. 

By  Bureau  order  samples  of  the  character  above  noted  are  now  submitted  to  the 
director  of  the  Hygienic  Laboratory  for  examination  as  to  their  purity  and  potency. 
The  examinations  thus  far  conducted  have  revealed  results  that  can  not  fail  to  be  of 
great  benefit  to  the  Service  in  determining  the  character  of  supplies  offered,  and  at 
the  same  time  enabling  the  Service  to  secure  drugs  and  their  various  pharmacopaMal 
preparations  of  a  constant  and  standard  purity. 

The  personnel  of  the  station  as  to  numbers  remains  the  same  as  during  the  previous 
fiscal  year,  one  resignation  having  occurred  during  the  year. 

The  depot  has  filled  requisitions  to  the  number  of  718,  including,  besides  stations 
of  this  Service,  the  Immigration  Service,  Coast  and  Geodetic  Survey,  government  of 
the  Philippines,  storekeeper  Treasury  Department,  as  well  as  the  quarantine  and 
epidemic  services,  which  are  under  the  immediate  supervision  of  this  Service. 

The  financial  statement  follows: 

Total  cost  of  supplies  for  which  orders  were  placed  during  the  fiscal 
year,  inclusive  of  fuel  and  packing  material  (|l,103.88),  which  are  not 

accounted  for  under  the  head  of  operating  expenses  of  the  depot $112, 953.  55 

Medical  supplies $19,118.09 

Drv  goods,  etc 19, 523.  29 

Hospital  stores -  -  -  18,  658.  85 

Surgical  dressings,    instruments,   appliances,   and  hospital 

furniture 13,503.82 

Station  equipment 8, 695. 89 

Microscopical,  bacteriological,  and  optical  apparatus 6,  744.  52 

Disinfecting  apparatus  and  disinfectants 3, 266.  69 

Medical  books  and  journals 3, 231. 92 

Kitchen  utensils 2,  722. 10 

Pharmaceutical  appliances,  etc 2, 644.  54 

Fire  hose  and  apparatus 2, 189. 33 

Beds,  bedding,  etc 2,050.86 

Rubber  goods 1, 313. 59 

Vials..-. 1,194.27 

Wines  and  liquors 1, 066.  29 

Paints  and  brushes 865.  08 

Toilet  and  wrapping  paper 759. 81 

Carpets 753.06 

Packing  materials,  etc 748. 80 

Flags.:. 748.68 

Lumber -- 718.40 

Chemical  glassware,  etc -  497.  65 

Purveying  depot  equipment 496. 57 

Band  instruments 407.  73 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE.  63 

Photographic  and  X-ray  apparatuH $388. 58 

KiK'l 355. 08 

(^llic'ial  seal  j)re8ses,  stamps,  etc 290. 06 

Operatiiifi  expenses $8, 592.  89 

Total 121, 546.  44 

Cr. 

By  amounts  included  in  above  statement  authorized   by 

special  department  ajiproval,  payments  being  made  from 

the  several  ai)in-oi)riations  other  than  that  of  Public  Health 

and  Marine-liospital  Service: 

Quarantine  fund $2, 300.  78 

Immigration  Service 1, 056. 83 

Epidemic  fund 356.  70 

Government  of  the  Philippines 338. 25 

Coast  and  Geodetic  Survey L3. 53 

$4, 066. 09 

117, 480. 35 
By  amounts  due  for  reimbursements  for  supplies  issued  dur- 
ing the  year  to  other  services: 

Quarantine  Service 14, 546.  46 

Immigration  Service 6, 075.  77 

Epidemic  Service 3, 934. 93 

Philippine  government 1,  241. 57 

Coast  and  Geodetic  Survey 549.  31 

Storekeeper  Treasury  Department 95. 14 

26, 443. 18 

Net  expenditures  chargeable  to  Public  Health  and  Marine-Hos- 
pital Service  91,037.17 

Salaries 16,  876.  00 

Commutation 600.  00 

Total  net  expense 108,  513. 17 

From  the  foregoing  it  will  be  observed  that  the  total  net  amount  chargeable  to  the 
Public  Health  and  Marine-Hospital  Service  for  the  vear  exceeds  that  of  the  fiscal 
year  1903  by  $15,663.31. 

This  difference  can  be  accounted  for  by  the  natural  increase  in  the  growth  of  the 
Service,  and  to  the  work  being  carried  on  in  connection  with  sanitation  and  original 
research  in  various  parts  of  the  Tropics,  for  which  work  microscopic  outfits  have  been 
furnished  during  the  past  year. 

The  cost  of  the  various  classes  of  supplies  issued  to  stations  of  the  Sersnce  during 
the  year  is  as  follows: 

Stations  of  the  first  class $71,082.26 

Stations  of  the  second,  third,  and  fourth  classes 11,  653. 93 

Quarantine  stations 16,  997.  41 

Epidemic  service 3,  989.  44 

Grand  total 103,723.04 

Number  of  requisitions  filled 718 

Number  of  packages  used  in  packing 8, 015 

Total  weight  of  supplies  shipped pounds. .         719, 431 

Respectfully, 

Henry  W.  Sawtelle, 
Surgeon  and  Medical  Purveyor. 

The  Surgeon-General. 


64  I'UBLTC    HEALTH    AND    MAEINE-HOSPITAL    SERVICE. 

NEW   HOSPITALS. 

Pittsburg,  Pa. — -Transfer  of  nUe  from  War  Department. 

[Letter.] 

War  Department, 

WasUjigton,  May  7,  WOlf,. 
Sir:  Referring  to  the  request  contained  in  your  letter  of  May  23, 
hist,  and  to  subsequent  correspondence  on  the  subject,  I  transmit  here- 
with an  instrument,  executed  this  date,  transferring  to  the  custody  and 
control  of  the  Treasury  Department,  for  a  marine-hospital  site,  5  acres 
of  ground  of  the  arsenal  grounds,  situated  in  the  city  of  Pittsburg, 
Pa. ,  and  described  in  said  instrument. 

Very  respectfully,  Wm.  H.  Taft, 

Secretary  of  War. 
The  Secretary  of  the  Treasury. 

[Inclosure.] 

Whereas,  by  an  act  of  Congress  approved  March  3,  1903,  entitled  "An  act  making 
appropriations  for  sundry  civil  expenses  of  the  Government  for  the  fiscal  year  ending 
June  30,  1904,  and  for  other  purposes,"  it  is  provided,  inter  alia: 

"That  the  Secretary  of  War  be,  and  he  is  hereby  authorized,  in  his  discretion, 
upon  the  application  of  the  Secretary  of  the  Treasury,  to  transfer  to  the  custody  and 
control  of  the  Treasury  Department,  as  a  marine-hospital  site,  so  much  of  the  United 
States  arsenal  grounds  in  the  city  of  Pittsburg,  Pennsylvania,  as  may  be  required  for 
that  purpose,  not  exceeding  five  acres  in  extent,  fronting  on  Pennsylvania  (Penn) 
avenue.  Thirty -ninth,  and  Fortieth  streets." 

And  whereas  the  f^ecretary  of  the  Treasury  has  applied  for  the  transfer  to  the  cus- 
tody and  control  of  the  Treasury  Department,  for  a  marine-hospital  site,  of  the  follow- 
ing described  parcel  of  land,  viz : 

All  that  part  of  the  United  States  arsenal  grounds  situated  in  the  city  of  Pittsburg, 
Pa.,  bounded  as  follows: 

Beginning  at  the  point  where  the  northerly  side  of  Penn  avenue  meets  the  west- 
erly side  of  Fortieth  street,  and  running  thence  northwesterly  along  the  westerly 
side  of  Fortieth  street  593  feet  to  a  stake;  thence  southwesterly  at  right  angles  to 
Fortieth  street  500  feet  to  the  easterly  side  of  Thirty-ninth  street;  thence  southeast- 
erly along  the  easterly  side  of  Thirty-ninth  street  275  feet  to  the  northerly  side  of 
Penn  avenue;  thence"  easterly  along  the  northerly  side  of  Penn  avenue  592  feet  to 
the  place  of  beginning,  containing  not  to  exceed  5  acres,  together  with  any  rights 
the  United  States  may  have  in  the  portions  of  said  streets  and  avenue  adjacent  to 
the  said  parcel. 

Now,  therefore,  this  is  to  certify  that  under  authority  of  said  act  of  Congress  the 
Secretary  of  War  hereby  transfers  the  said  parcel  of  land  as  described  above  to  the 
custody  "and  control  of  the  Treasury  Department  for  a  marine-hospital  site,  as  speci- 
fied in  said  act  of  Congress. 

Witness  my  hand  this  7th  day  of  May,  1904. 

[seal.]  Wm.  H.  Taft, 

Secretary  of  War. 

Savannah,,  Ga. —  Completion  ef  plans  and  letting  of  contract. — ^The 
building  plans  for  this  hospital  nave  been  completed  in  the  office  of 
the  Supervising  Architect  of  the  Treasury  Department,  and  the  build- 
ing contract  was  awarded  June  3,  1904,  in  the  sum  of  $96,170.  Under 
the  terms  of  the  contract  the  building  is  to  be  completed  by  August  1, 
1905.  Buildings  for  officers'  quarters,  laundry,  and  stable  are  not 
included.  An  additional  appropriation  will  be  necessary  for  the  erec- 
tion of  these  buildings. 


iniBLiC    HEALTH    AND    MAKINE-HOSI'ITAL    SKRVICK.  C)!") 

UKI'AIHS  AND  IMPROVEMENTS  MADE  TO  BUILDIN(;S  AND  (;U<)LNDS, 
lN('LUDIN(i  WORK  UNDER  CONTRACT  AND  RIM'AIRS  TO  HEATIN(; 
APPARATUS   OF   MARINE    HOSPITALS. 

2Iann<'  Hoi<pital  at  B(dtiiii<)r<\  Md.  {iiwcUd  1S87). — As.st.  Surjr.  C. 
AV.  Willo,  in  tcinporarv  coininantl,  reports  the  following  r(;pairs  and 
iinproN'einents: 

The  addition  to  exeontive  hnildiiij^  for  space  for  an  opcratiuff  room  was  compli'ted 
NovemhtT  4,  1903.  Ceilings  of  two  roonw  in  surgeon's  (luartens  were  rei)laHtere(i  and 
repairs  made  to  plastering  in  other  buildings  at  a  cost  of  $82.  A  large  portion  of  the 
wood  floors  of  the  galleries  of  the  three  ward  buildings  was  renewed  and  various 
repairs  made  to  buildings  at  a  cost  of  $577.86  for  materials.  The  kitchen  range  was 
repaired  at  a  cost  of  $27.25.  INIinor  repairs  were  made  to  heating  apparatus  at  a  cost 
of  $172.50. 

IL)sj)i!(d  at  Boston^  JIa.<t,s.  {erected  1800). — Surg-.  R.  ^I.  Woodward, 
in  command,  reports  the  following  repairs  and  improvements: 

Repairs  to  roof,  cupola,  and  dormers  of  main  building  and  8  new  doors  in  out- 
buildings, $1,087;  painting  exterior  iron  and  woodwork  of  main  building,  $1,049; 
repairs  to  plastering  in  assistant  surgeon's  quarters,  $16;  repairs  to  chiiiiiiey  and 
down  spouts,  main  building,  and  replacing  spire  on  laundry  Ijuilding,  $110;  wire 
fence  and  gates  inclosing  reservation,  $2,095,  and  minor  repairs  to  buildings  made  at 
a  cost  of  $701.74  for  materials. 

Hospital  at  Cairo,  III.  {erected  1885). — Surg.  G.  M.  Guiteras,  in 
command,  reports  the  following  repairs  and  improvements: 

New  lockers  for  patients'  clothing,  $120;  galvanized  iron  gutters  for  all  buildings 
except  upper  portion  of  surgeon's  quarters,  $441;  window  and  door  screens  to  wards 
and  repairs  to  screens  of  the  other  buildings,  $435;  new  kitchen  range  and  steam 
table,  $383;  window  awnings  for  executive  building  and  surgeon's  quarters,  $223; 
chimney  tops  of  all  buildings  rebuilt,  $106;  wood  fence  on  Tenth  street  repaired, 
$171.65;  repairs  to  porch  roof  of  surgeon's  quarters,  $109.75;  lowering  window  sills 
of  first  story,  surgeon's  quarters,  $479;  repairs  to  plumbing,  $85;  and  various  minor 
repairs  and  repair  material,  lumber,  paints,  etc.,  at  a  cost  of  $558.23. 

IIo8p''*al  at  Chicago.,  III.  {erected  1873). — Surg.  Charles  E.  Banks,  in 
command,  reports  the  following  repairs  and  improvements: 

Painting  metal  I'oof,  $310;  repairs  to  front  steps  of  hospital,  $325;  interior  telephone 
system  installed,  $347;  laundry  tubs,  surgeon's  and  assistant  surgeon's  quarters,  $103; 
thirty  shade  trees  planted,  $115;  two  windows  installed  in  basement  stairway,  $60; 
repointing  mortar  joints  of  brick  walls  of  power  house,  $771;  repair  of  tile  roof  of 
power  house,  $55;  repair  of  plaster  in  power  house  and  cement  ceiling  second  story 
porch  of  hospital  building,  $220. 

A  new  dumb  waiter  from  hospital  kitchen  in  basement  to  third  story  was  installed 
and  repairs  made  to  old  freight  elevator,  by  the  Supervising  Architect,  at  a  cost  of 
$1,160.  From  the  balance  of  the  appropriations  for  the  building,  minor  repairs  to 
heating  apjjaratus  were  made  at  a  cost  of  $117.63  for  material. 

Ilosjntal  at  Cincinnati.^  Ohio  {ei^ected  18811). — Surg.  G.  M.  Ma- 
gruder,  in  command,  reports  the  following  repairs  and  improvements: 

New  coal  bin,  stall  floors,  door  to  pharmacist's  quarters,  repairs  to  gutters  and 
lumber  for  minor  repairs,  $541.46;  painting  material  for  exterior  of  wards,  executive 
building,  surgeon's,  quarters,  stable,  and  outpatient  building,  $166.87;  two  lavatories 
installed,  $110;  repairs  to  laundry  machinery,  water  heater,  plumbing,  and  miscel- 
laneous minor  repairs,  $243.48;  repairs  to  heating  apparatus,  $34.92. 

Hospital  at  Cleveland.,  Ohio  {erected  185'2). — Passed  Asst.  Surg.  H.  S. 
Mathewson,  in  command,  reports  the  following  repairs  and  improve- 
ments: 

Porcelain  sinks  in  surgical  dressing  room,  laboratory,  and  bathrooms,  $365;  repairs 
to  main  stairway,  $85;  electric  bell  and  call  system  installed,  $148;  crushed  stone  for 
driveways,  $83.25;  and  miscellaneous  minor  repairs,  $191.33;  repairs  to  and  supplies 
for  heating  apparatus,  $308.56. 

8629—04 5 


66  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

lloapital  at  Detriot^  Mich,  {erected  1S57). — Surg.  H.  W.  Austin,  in 
command,  reports  the  following  repairs  and  improvements: 

Re])airs  to  plumbing,  $505.25;  painting  and  repairs  to  hosi)ital  building,  $1,727.75; 
miscellaneous  repairs,  $77.32;  repairs  to  heating  ai)paratus,  $2,305.75. 

JIosj>{tal  at  EvansviUe.,  Ind.  {erected  1891). — Passed  Asst.  Surg. 
B.  W.  Brown,  in  command,  reports  the  following  repairs  and  improve- 
ments: ♦ 

The  painting  of  all  the  buildings,  inside  and  outside,  has  been  completed,  $322.20 
having  l)een  expended  for  material  during  the  year.  Cement  floors  for  two  rooms 
and  hall  in  basement  of  executive  building  and  for  one  room  in  basement  of  sur- 
geon's quarters,  $160;  roadways  and  walks  repaired,  $118;  new  water  heaters  for 
executive  building  and  northward,  $110.15;  new  washing  machine  for  laundry,  $402; 
miscellaneous  repair  material,  $282.70;  repairs  to  heating  apparatus,  $360.96. 

Marine- Hospital  Sanatorirdji.  Fort  Stanton.,  li.  Mex.  {estahlished 
1900). — Surg.  P.  M.  Carrington,  in  command,  reports  the  following 
repairs  and  improvements: 

The  general  repairs  and  improvements  to  buildings  Nos.  1,  2,  3,  9,  13,  and  14  and 
the  corrals  and  the  installation  of  an  electric-lighting  system  have  been  completed. 
Electric  motor  for  pmnping  j)lant  installed,  $1,257.27;  3  sputum  crematories,  $336.22; 
2  road  scrapers  purchased,  $75;  lumber,  painting  material,  glass,  plumbing  material, 
hardware,  and  electrical  supplies  and  miscellaneous  repairs,  $2,649.08;  repairs  to 
boilers,  heating  stoves,  new  stoves,  and  heaters,  $443.17.  Proposal  has  been  accepted 
for  boring  a  well  500  feet  deeji,  including  casing,  pump  barrel,  and  rod;  estimated 
cost,  $3,081,  and  the  work  is  now  in  progress. 

Hospital  at  Key  West.,  Fla.  {erected  181/)). — Passed  Asst.  Surg.  C.  H. 
Gardner,  in  command,  reports  the  following  repairs  and  improvements: 

Painting  roof  and  exterior  woodwork  of  main  building  and  three  outbuildings, 
$399.55;  plumbing  fixtures  for  pharmacist's  quarters,  $218.55;  new  range  for  hospital 
kitchen,  $148;  window  and  door  screens,  $126.80;  new  plumbing  for  surgeon's  quar- 
ters, $128;  lumber  and  hardware,  shop  and  fuel  house,  $140.66;  paints,  oils,  etc., 
$109.65,  and  miscellaneous  minor  repairs,  $569.70. 

Hospital  at  Louisville.,  Ky.  {erected  185%). — Passed  Asst,  Surg.  G.  B. 
Youtig-,  in  command,  reports  the  following  repairs  and  improvements: 

New  macadam  roadway  at  Portland  avenue  entrance,  $125;  new  down  spouting 
for  hospittfl  l)uil(ling,  $51,  and  new  cornice  gutters,  $134;  door  to  stable,  $75;  disin- 
fecting chamber  installed,  $233;  81  trees  planted,  $49.75;  repairs  to  cupola,  $:36;  gas 
fitting  and  repairs,  $49.95;  piping  and  hydrants  for  hose,  $25.50;  painting  material, 
lumber,  glass,  pipe  and  fittings,  and  miscellaneous  repair  material,  $675.52.  Contract 
has  been  made  for  renovation  of  the  plumbing  and  toilet  rooms  for  patients  and 
attendants,  $5,114;  the  work  to  be  completed  November  18,  1904. 

Hoxpitid  at  Memphis.,  Tenn.  {erected  1885). — Surg.  Eugene  Wasdin, 
in  command,  reports  the  following  repairs  and  improvements: 

Second  story  to  porch,  front  of  executive  building,  $267;  repairs  to  plastering,  $88; 
extension  of  gas-lighting  system  to  entrance  gates,  $31.12;  repair  material  and  tools 
for  minor  repairs  to  buildings,  heating  apparatus,  plumbing,  and  stoves,  $204.07. 

Hospital  at  MohiJe^  Ala.  {erected  181^3).— Snvg.  J.  H.  White,  in 
command,  reports  the  following  repairs  and  improvements: 

Eepairs  to  hospital  roof,  $28.60;  new  window  screens,  $55.95;  repairs  to  porches  at 
ends  of  building,  $1.35;  ventilating  pipe  from  hospital  kitchen,  $48;  repairs  to  plaster 
ceilings  and  new  cement  wainscot  in  halls,  $196;  painting  material  for  outbuildings, 
$306.90;  repairs  to  plumbing,  $16.75,  and  whitewashing  main  building,  $9. 

Hospital  at  New  Orleans,  La.  {erected  1885). — Surg.  C.  P.  Werten- 
baker,  in  command,  reports  the  following  repairs  and  improvements: 

Repairs  to  assistant  surgeon's  quarters  (old  plantation  building),  $1,083.07;  new 
sewer  pump,  $361.50;  protecting  water  intake  pipe  in  river,  $312,55;  repairs  to  en- 


rUBLlC    HEALTH    AND    MAKINK-HOSI'ITAL    SKKVICK.  07 

ginos  and  pumps,  $ir)0.15;  to  electric  li^rlit  jilant,  $lt)8.Sti;  to  sewer  outlet,  $1.S2.()0; 
paintin;:  tii;ilerial,  lumber,  and  minor  repairs,  S,S!)6.(W;  repairs  to  heating  apparatus, 
tools,  new  stoves,  anil  radiatxjrs,  $500.ll.'{. 

Hospital  at  Neio  Y(n'X\  K  Y.  {erected  i<§5-).— Surg.  P.  II.  Builhache, 
ill  command,  reports  the  following  repairs  and  improvements: 

Sliorinj:  and  Vjracing  floors  of  the  old  huildinj,'  known  as  the  whitt;  liouse,  $110; 
repairs  to  roof,  j^Mitters,  and  spouts,  $41;  rejjuirs  to  laundry  building,  $2!t.Kr);  re|)airH 
to  roofs,  gutters,  and  spouts  of  main  liuilding,  $85.40;  repair  material  for  miscella- 
neous re])airs  to  buildings  and  plumbing,  $796.28;  repairs  to  heating  apparatus, 
stoves,  etc.,  $.384.68. 

Marhu- Hospital  office  and  out-patient  huilding^  Philadelphia^  Pa. 
{erected  1S77 ;  extension,  1901). — Surg.  Fairfax  Irwin,  in  command, 
reports  that  repairs  were  made  to  a  window,  at  a  cost  of  !i>13.75. 

Hi^spifal  <d  Portland,  2L .  {erected  1859).— ^wvg.  W.  P.  Mcintosh, 
in  command,  reports  the  following  repairs  and  improvements: 

New  washing  machine  for  laundry,  $482.50;  repairs  to  electric-lighting  plant, 
$171.03;  painting  material,  lumber  and  hardware,  and  minor  repairs,  $566.83;  mate- 
rial and  repairs  to  heating  apparatus,  $78.34. 

Hospital  at  Port  Tovmsevd.,  TI«.S'A.  {erected-  1895). — Passed  Asst. 
Surg.  M.  H.  Foster,  in  command,  reports  the  following  repairs  and 
improvements: 

Galvanized-iron  ventilating  ducts  installed  in  attics,  $537.50;  concrete  floors  in 
areas  around  building,  $275,  and  material  for  miscellaneous  minor  repairs,  $313.74; 
repairs  to  heating  apparatus,  $2.30. 

Hospital  at  San  Francisco.,  Cal.  {erected  1875). — Passed  Asst.  Surg, 
W.  G.  Stimpson,  in  command,  reports  the  following  repairs  and  im- 
provements: 

^lacadam  road  to  fuel-oil  tank,  $.340;  drain  at  back  of  wards  A,  B,  and  C,  $285; 
material  for  and  miscellaneous  minor  repairs,  $473.14. 

Hospital  at  St.  Louis.,  J/o.  {errected  1885). — Surg.  James  ]M.  Gas- 
.sawav,  in  command,  reports  the  following  repairs  and  improvements: 

New  floor  for  front  porch  of  executive  building  and  remodeling  entrance  doors, 
$117.50;  new  mangle  for  laundry,  $335;  repairs  to  water  heaters  in  center  and  south 
wards  and  in  executive  building,  $261;  miscellaneous  repairs  to  plumbing  and  foun- 
tain basin,  $98.05;  painting  material,  $217.55;  lumber  and  hardware,  $619.89;  for 
miscellaneous  minor  repairs  to  buildings,  $146.23;  repairs  to  heating  apparatus, 
$112.63. 

Hosjjital  at  Vineyard  Haven.,  Mass.  {erected  1895). — Surg.  D.  A.  Car- 
michael,  in  command,  reports  the  following  repairs  and  improveiuents: 
Miscellaneous  repairs  to  buildings,  $178.69;  repairs  to  heating  apparatus,  $48. 

Hospital  at  Wihnington,  K.  C.  {ei^ected  1859). — Surg.  John  Godfrey, 
in  command,  reports  the  following  repairs  and  improvements: 

Terra-cotta  pipe  in  old  drainage  ditches  and  earth  filling  of  ditches,  $571.25;  paint- 
ing roofs  of  buildings,  $141.29;  painting  material,  $326.05;  and  miscellaneous  repairs 
and  material,  $103.82. 

Hospital  at  Cape  Nome.,  Alaska. — Acting  Asst.  Surg.  A.  L.  Derb}'- 
shire  in  charge. 

The  old  hospital  building  and  second  story  of  telegraph  building  upon  the  Govern- 
ment reservation  were  assigned  to  the  Public  Health  and  Marine-Hospital  Service, 
and  necessary  repairs  to  the  buildings  to  adapt  them  for  use  were  made,  at  a  cost  of 
$2,500. 


68  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Hygienic   Lahoratory,    Wa.sJihxjton^    IJ.    V.  {erected  190J). — Passed 
Asst.  Surg'.  M.  J.  Rosenau,  director,  reports  the  following: 

The  building  was  formally  occupied  by  the  Lalioratory  on  March  16,  1904.  The 
painting  of  the  interior  of  the  building  was  completed,  gas  and  electric  fixtures, 
special  plumbing  fixtures,  tables,  partitions,  instrument  and  book  cases,  refrigerating 
plant,  library  and  office  furniture,  fire-alarm  system  and  extinguishing  apparatus, 
rubber  matting  and  stair  treads  installed,  the  disinfecting  shed,  animal  house,  and 
incinerator  moved  and  reconstructed,  all  at  a  cost  of  §13,114.65. 

Respectfully  submitted. 

L.  L.  Williams, 
Assistant  Surgeon-  General. 
The  Surgeon-General, 

[Note. — ^The  statistical  tallies  whicli  form  a  part  of  the  report  of  the  division  of 
marine  hosjiitals  and  relief  will  be  found  at  the  end  of  this  volume.] 


DIVISION  OF  SANITARY  REPORTS  AND 
STATISTICS. 


69 


REPORT  OF  DIVISION  OF  SANITARY  REPORTS  AND  STATISTICS. 

By  CJEOK(iE    T.    VAl'dllAN, 

Asmfaiit  Surgeon-General ,  Pulilic  Ifnillli  uml  Min-ini-IfoKjilldl  Scrrlre,  in  clnirge. 

Sir:  I  have  the  honor  to  su})mit  the  followiiij*-  report  of  transac- 
tions of  the  division  of  sanitary  reports  and  statistics  for  tlie  iiscal 
ypar  ended  Juno  30,  1904: 

CHOLERA. 

There  has  been  a  j^reat  diminution  in  the  prevalence  of  this  disease 
as  compared  with  the  past  fiscal  year,  when  it  was  reported  present  in 
twelve  countries  with,  in  round  numbers,  165,000  deaths.  During  the 
year  just  ended  it  was  reported  present  in  only  seven  countries — allin 
the  Eastern  Hemisphere — with,  in  round  mnnbers,  2(),000  deaths,  as 
follows: 


AFGHANISTAN. 


In  December,  1903,  cholera  was  reported  present  in  Plerat;  no 
particulars. 

CHINA. 

During  the  year  less  than  800  deaths  were  reported  from  China— 
chiefly  from  Amov  and  Shanghai — as  compai-ed  with  55,000  deaths  for 
the  year  before.  Other  cities  affected  were  Hankau,  Hongkong, 
Shanghai,  and  Tientsin.  One  case  of  cholera  occurred  at  Shanghai  in 
October,  1903,  on  the  steamship  Olivelxiul'.  Three  cases  and  1  death 
occurred  at  Tientsin.  The  disease  was  said  to  have  been  imported  by 
the  steamship  Shenking. 

INDIA. 

The  decrease  of  cholera  in  India  continues,  only  1,089  deaths  having 
been  reported  for  the  year  just  ended,  compared  with  2,355  deaths  for 
the  year  before. 

JAPAN. 

From  August  11, 1903,  to  November  30, 1903, 94  deaths  were  reported 
from  Japan  from  two  places,  viz,  Kobe  and  Nagasaki,  as  compared 
with  4,750  deaths  from  19  places  during  the  previous  year. 

PHILIPPINE    ISLANDS. 

From  May  2, 1903,  to  May  2, 1904,  there  were  reported  from  Manila 
and  the  provinces  21,214  deaths  from  cholera,  a  small  numl)er  com- 
pared with  the  report  of  the  preceding  year,  which  gave  6(5, 771  deaths. 

STRAITS   SETTLEMENTS. 

From  May  16  to  December  19,  1903,  310  deaths  from  cholera  were 
reported  from  Singapore — showing  here  also  a  decided  falling  off — 895 
deaths  having  been  reported  for  the  preceding  year. 

71 


72 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Cholera  has  continued  to  prevail  to  a  considerable  extent  in  Turkey. 
In  Syria,  from  August  8  to  November  2,  1903,  there  were  reported 
1,542  deaths.  The  disease  occurred  in  other  vilayets,  as  follows: 
Bagdad,  Bassorah,  and  Diarbekir.  Most  of  the  cases  occurred  between 
August  1  and  December  31,  1903. 

Below  is  given  a  table  of  cholera  in  two  sections  (1)  from  June  27 
to  December  25,  1903,  and  (2)  from  December  26,  1903,  to  June  24, 
1904: 


Cholera  as  reported  to  the  Surgeon  General,  Public  Health  and  Marine-Hospital  Service. 

JUNE  27,  1903,  TO  DECEMBER  25,  1903. 

[Reports  received  by  the  Surgeon-General,  Public  Health  and  Marine-Hospital  Service,  from  United 
States  consuls  through  the  Department  of  State  and  from  other  sources.] 


Place. 

Date. 

Cases. 

Deaths. 

Remarks. 

China: 

July  19- Aug.  1 

650 
2 
4 
90 

1 

19 
320 

1 

Sept.  5-Sept.  19 

June  &-0ct.  31 

Aug.  1-Oct.  10 

4 
9 

Tientsin 

Sept.  5-Sept.  19 

May  20- Aug.  22 

3 

Br.  ss.  Olivebank. 
Imported  via  ss.  Shenking. 

India: 

Calcutta                 

May  22-Nov.  14 

Chefoo 

Sept.  .'V-Sept.  12 

i 

1 

June  6-Oct.  9 

21 

1 
92 

670 

Japan: 

Kobe 

Sept.  27-Oct.  3 

Aug.  11-Nov.  20 

May  2-Oct.  24 

1C9 
761 

Nagasaki 

Philippine  Islands: 

do 

25,629         19.142 

Straits  Settlements: 

May  16-Nov.  7 

298 

Turkey: 

Arghani-Maaden 

Oct.  C 

2 

Oct.  8 

Oct.  6 

4 

Oct.  8..          

Present. 

Syria 

Aug.  8-Nov.  2 

5,760 

1,542 

DECEMBER  2t;,  1903,  TO  JUNE  24,  1904. 


Afghanistan: 

Herat Dec.  12 

China: 

Shanghai Dec.  18 

India:  { 

Bombay Dec.9-Mdr.26  . 

(Jalcutta Nov.  15-May  21 

Karachi Feb.  22-M!ir.  27 

Madras Nov.  14-May  6  . 

Japan: 

Nagasaki |  Nov.21-30 

Philippine  Islands:  < 

Manila '  Oct.  31-May  2 . . 

Provinces |  Oct.  31-Mar.  12 . 

Straits  Settlements:  I 

Singapore 1  Nov.8-Dec.  19  . 

Turkey: 

Bagdad — 

Bagdad ,  Mar 


Hitt. 
Kerbela . . 
Mossul  . . . 
Musseieb . 
Bassorah — 
Basra 


Dec. 
Dec. 
Dec. 
Dec. 


8-Apr.  6... 

13-15 

12-Jan.l2. 
21-Jan.4.. 
17-Jan.4.. 


reb.6-Apr.10. 


8 

660 

2 

59 


48 
1,354 


28 

4 

463 

1 

35 


Present. 

On  Br.  ss.  Olivebank. 


1  (k-ath  on  ss.  Coptic. 


PUBLIC    HEALTH    AND    MARIN K-llOSl'ITAL    SKKVICE. 


78 


YELLOW    FKVKU. 


I'Nri'lOl)    STATICS. 


During  the  year  just  ended  nearl}-  all  the  cases  of  yellow  fever 
occurred  near  the  Alexiean  border.  In  Laredo  from  Se})tenil)i'r  24, 
1903,  to  March  IS,  11104,  there  were  reported  1,014  cases  with  107 
deaths;  in  Minera,  up  to  November  28,  1908,  137  cases  with  11  deaths; 
in  San  Antonio  from  October  21  to  Noveml)er  28,  1903,  43  cases  and 
16  deaths.  Other  places  in  Texas  at  which  yellow  fever  was  reported 
])resent  were  Cannel,  Castroville,  Ilonilo,  and  Dewitt  County.  One 
iatid  case  was  imported  to  Anoel  Island  Quarantine  in  8epteml)er  on 
the  steamship  (hlon  from  Panama  via  Acapulco. 

Cases  were  brought  to  Gulf  Quarantine  as  follows:  In  July  1  fatal 
case  on  steamship  Mount  Verno/i.  from  Limon;  in  September  1  fatal 
case  on  schooner  ILni'ieUa  J.  Powell  from  Veracruz,  and  in  Novem- 
ber 2  cases  on  steamship  Celaeno  from  Tampico. 

Yellow  ferer  in  the  United  Slate.i,  as  reported  to  the  iSurgeon-deneral,  PuhUf  Jfe(d.lh  and 

Marine-Hosp'ttid  Service. 

JULY  3,  1903,  TO  DECEMBER  25,  1903. 


Place. 

Date. 

Cases. 

Deaths. 

Remarks. 

California. 

Angel  Island 

Sept.lO-Sept.ll... 
July  3-July5 

Sept.l 

1 
1 

1 

2 

28 

1 

1 

1,008 

137 

43 

5 

1 
1 

1 

Case  on    ss.   Colon    from 

Mississippi: 

Gulf  Quarantine,  Ship  Island... 

Panama;   port   of    call, 
Acapulco. 

Case  on  .ss.  Mount  Vernon, 
from  Llnion;  discovered 
at   Mobile.     Vessel    re- 
mande<l  toCiulf  Quaran- 
tine, Hliip  Island. 

Nov.  21 

etta.I.  Powell,  from  Vera 
Cruz. 

Texas: 

To  Nov.  26 

Oct.  21 

1 

from  Tampico,  Mexico. 
Mining  camp. 

Hondo 

Oct.  19 

Laredo 

Sept.  24-Dee.  21 ... 

ToNov.28 

Oct.21-Nov.28.... 

Oct.26-Nov.4 

lo- 
ll 

16 
1 

M  i  ni  ng  (ram p  near  Laredo. 
1  case  at  Fort  Sam  Hou.s- 

San  Antonio 

Dewitt  County 

ton. 

DECEMBER  20,  1903,  TO  .JUNE  24,  1904. 


Te.xas: 
Larod( 


Dec.  26-Mar.  18 


1     case     imported     from 
Minera. 


FOREIGN    AND    INSULAR. 


During  the  same  period,  as  was  said  last  year,  no  case  was  reported 
from  Cuba  as  having  originated  there.  From  July  7  to  November  14, 
1903,  7  cases  and  2  deaths  occurred  at  Habana;  February  6  to  13, 19()4, 
6  deaths  in  the  vicinity  of  Niquero;  and  April  9, 1904, 1  ca.se  at  Sagua — 
all  having  been  imported  on  vessels  coming  from  Mexico  or  South 
America. 


74 


PITHLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Yellow  fever  wa.s  reported  in  tlic  foUowino-  countries:  Africa — On 
the  Ivory  Coast,  CI  rand  Bassani.  Brazil — Pernanibuco  and  Kio  de 
Janeiro.  Colombia — Barranquilla,  Carta«>ena,  and  Banania.  Costa 
Kica — Alajuela,  Linion,  Matina,  San  Jose,  and  Zent.  Ecuador — Guaya- 
quil. Jamaica — Kingston  and  Port  Royal.  Mexico — At  31  places. 
Venezuela — Seven  places.  It  occurred  in  nine  countries  in  all,  4,300 
cases  with  1,519  deaths,  as  compared  with  1,.537  deaths  last  year,  the 
degree  of  prevalence  appearing  to  be  the  same.  It  will  not  do  to 
estimate  mortality  on  these  figures,  as  in  many  instances  only  deaths 
are  reported  and  the  number  of  cases  remains  unknown. 

For  the  3'ear  just  ended  by  far  the  greatest  number  of  cases  and 
deaths  from  yellow  fever  were  reported  from  Mexico,  viz,  3,087  cases 
with  1,303  deaths. 

See  table  on  yellow  fever,  in  two  sections. 

Yelluiii  fever  as  reported  to  the  Sitrffeon- General,  Public  Health  and  Marine- Hospital 

Service. 

JUNE  27,  1903,  TO  DECEMBER  25,  1903. 

[Reports  received  by  the  Surgeon-General,  Public  Health  and  Marine-Hospital  Service,  from  United 
States  consuls  through  the  Department  of  State  and  from  other  sources.] 


I'lace. 


Brazil: 

I'tTnambuco  . . 

Rio  de  Janeiro. 
Colombia: 

Panama 

Costa  Rica: 

Limon 

Matina 

San  Jose 

Zent 

Cuba: 

Habana  


Ecuador: 

Guayaquil 

Jamaica: 

Port  Royal 

Mexico: 

Altamira 

Cardenas 

Citas  

Ciudad  Victoria. 

Coatzacoalcos  .. . 

Dofia  Cecilia 

El  Higo 

Linares 

Merida 

Mexico 

Monclova 

Monterev 

Motul 

Motzoroiigo 

Nnevo  Laredo... 

Orizaba 


Progreso 

Qiiinlana  Roo . . 

Rcata 

Salina  Cruz 

San  Luis  Potosi. 
Tampico 


Cases.     Deaths. 


Junel6-June30. 
May  17-Nov.  15. 

June  8-Sept.  28. 

June  11-Oet.  29. 

Aug.  20 

do 

do 


July  7-Xov.  14... 


1 

148 


Tamuin Aug.  15 

Tehuantepec Aug.  9-Nov.  28. 


May  2-Nov.  28. 

Oct.   ll-Nov.21..  5 


July  18 

July  10 

Aug.  23-Oct.  24.. 

Oct.  4-Dec.  6 

Julyl9-Dec.5 

July  11-Nov.  4... 

Aug.  15 

To  Dec.  5 

Jan.  1-Dec.  5 

Aug.  10-Oct.  4... 
Nov.  17-Nov.  25.. 

Nov.  7 

Sept.  6-.Sept.26.. 

July  20 

Sept.  15-N0V.28.. 
Mayl7-July6.... 


2,011 
214 


6 

500 

1 


Tan.  1-Nov.  7  ... 

Sept.  26 

Nov.  26 

Aug.  9-Nov.  28.. 

JulySl 

Junel3-Nov.  28. 


366 
85 
3 
4 


One  case  on  ss.  Westgate. 
Imported. 


One  from  Ward  Line  ss.  Vigi- 
lancia,  from  Progreso;  1  from 
Sp.  s^.  .\lfonso  XIII;  1  on 
Am.  s-i.  Monterey,  from  Pro- 
greso; 2  on  Ger.  ss.  Prinz  Adal- 
bert, fr.im  Veracruz  and  Tam- 
pico, and  2  casts  and  1  death 
from  ss.  Paloma,  from  Guanta, 
Venezuela. 


Sporadic. 
Present. 

Three  cases  imported. 
Present. 


Do. 

Eleven  casosimported  from  Vera- 
cruz. 


Present. 

One  on  American  schooner  Al- 

verda  S.  Elzey. 
Present. 


PUBLir    HEALTH    AND    MARINK-H<  >S1»ITAL    SERVK'K 


<  .) 


Yellow   fever  us  reported  to  the  Siirgeon-fieiieral,    I'uhiie   Ilenllli  and   Miiriut-IIoxiiilnt 

Service — C'ontinue<l. 

JUNE  27.  1903,  TO  DECEMBER  !»,  1903— Coiiliiiiioil. 


Place. 


l)HtO. 


Casvs.     Deaths. 


M«  xifo — Continued. 

Tenin Aug.  27 

Tierni  Blanca Jiilv20 

Valladoliil  Aug.  tf-Sept.  2il. . 

Veracruz June  13-Dei'.  12. 


Victoria Aur.  10 

Zongolica To  July  11 

Venezuela: 

Barquesimeto July  31-Oct.  21 

Cagua Sept.  1 1  I're.sent. 

Caraea.>i Sept.  15 1 

Manicaibo lulv  5-Oct.  21 2  2 

Puerto  Cabell o Sept.  20-Sept.  2t; 1 

Tocuvo Julv  31-Oct.  16 Do. 


Present. 
Do. 

One  from  Br.  .lis.  Trader,  proba- 
bly infected  on  .shore.  (Jne  on 
Br.  .S.S.  Ka.>>.sala.  probably  in- 
fected on  shore. 


DECEMBER  26,  1903,  TO  JUNE  24,  1904. 


Dec.  12 


.•Vfrica: 

I  vory  Coast,  Grand  Ba><';am 
Brazil: 

Rio  de  Janeiro 

Colombia: 

Barranquilla , 

Cartagena Nov.  23-Mar, 

Costa  Rica: 

Alajuela Apr.  1 9-24. . . . 

Limon May  28-June 

Cuba: 

Vicinity  of  Niquero Feb.  6-13 


Nov.  23-Mav  1... 


Mar.  28-.\pr.  17 
20 


Sagna Apr.9. 


Ecuador: 

Guyaquil Dee.6-May  2-t... 

Jamaica: 

Kingston Dec.  27-Jafi.  9 . . . 

Mexico: 

Ciudad  Victoria Dec.  6-19 

Coatzacoalcos May  11-May  28  . 

Merida Dec. 6-June  17.. 

Progreso Apr.  2S-May  5. . . 

Salina  Cruz .\pr.  3-June  4 . . . 

Talleres Ma v  11 

Tampico May  14-28 

Tehuantepec Dec.  6-June  11 . . 

Veracruz Dec.  13-June  11 . 

Panama: 

Panama Jan. 4 -June  5  ... 

Venezuela: 

La  Guaira Jan.  2-9 

Maracaibo Oct.  25- Feb.  14  . . 


Present. 


From  the  Nor.  bk.  Eugen  from 
Cardiff  and  La  Guiara.  wrecked 
on  .south  coa.st  of  Cuba. 

From  Br.  s,s.  Wildercroft  from 
Veracruz. 

Two  eases  on  a  British  bk.  from 
Newcastle. 


One  case  imported  from  Boca  de 
Rio.  One  case  on  ss.  Vigilan- 
cia  from  Progreso. 


PLAGUE. 

This  disease  is  .still  prevalent  in  the  Eastern  Hemisphere,  and  still 
slays  its  hundreds  of  thousands  in  India.  It  also  shows  evidence  of 
extending  its  invasion  of  the  Western  Hemisphere,  having  been 
reported  present  in  Argentina,  Bolivia,  Brazil,  Chile,  Mexico,  and 
Peru. 

UNITED   ST.\TES. 

Below  two  tables  are  given.  No  1  includes  the  calendar  j'ear  1903 
with  17  cases  and  17  deaths,  and  No.  2  the  six  months  ended  June  30, 
1904,  with  9  cases  and  8  deaths. 


76 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Plague  in  the  United  States,  (is  reported  to  the  Surgeon- (leneral,  Public  Health  and  Mar'ntt 

Hospital  Service. 

DECEMBER  27,  1902,  TO  DECEMBER  25,  1903. 


I 


Place. 


California: 

San  Francisco 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 

Do 


Number 

since 

March,  1900. 


93 
94 
95 
96 
97 
98 
99 
100 
101 
102 
103 
104 
105 
106 
107 
108 
109 
110 


Number 

since 

March, 1903. 


Dec.  11 
Mar.  l(j 
June  5 
July  15 
July  19 
July  20 
July  29 
Aug.  9 
Aug.  21 
Sept.  13 


Oct. 
Oct.  20 
Oct.  23 
Oct.  24 
Oct.  29 
Nov.  4 
Nov. 


Nov.  12 


Deaths. 


Remarks 


DECEMBER  26,  1903,  TO  JUNE  24,  1904. 


Place. 

Num- 
ber 

since 

March, 

1900. 

Num- 
ber 

since 
January 
1,  1904. 

Re- 
ported. 

Died. 

Bacterio- 
logically 

eon- 
firmed. 

Remarks. 

California: 

Ill 
112 
113 
114 
116 
116 
117 
118 
119 

1 

2 
3 

4 

7 
8 
9 

Jan.    10 
Jan.    12 
Jan.    13 
Feb.     7 
Feb.     9 
Feb.  12 
Feb.   15 
Feb.  17 
Mar.    1 

Jan.    10 
Jan.    11 
Jan.    13 

Jan.   25 
Jan.    27 
Jan.   22 
Feb.   17 
Feb.  27 
Feb.  24 
....do... 
Mar.     8 
Mar.  12 

Do 

Do 

Do                     

Recovered. 

Do 

Feb.     8 
Feb.  12 
Feb.   14 
Feb.   19 
Feb.  29 

Do 

Do           

Do 

Summary:  Calendar  vear,  1900,  22  cases,  22  deaths;  1901,  30  cases, 
25  deaths;  "1902,  41  cases,  41  deaths;  1903,  17  cases,  17  deaths. 


FOREIGN    AND    INSULAR. 


For  the  year  just  ended  plague  was  reported  present  in  27  countries 
as  compared  with  20  countries  the  previous  year.  Only  6  cases  were 
reported  in  Mexico,  at  Bagio  and  Sequeros,  while  in  the  previous 
year  there  was  an  epidemic  at  Mazatlan.  The  disease  increased  con- 
siderably in  the  Philippine  Islands,  in  Cebu  and  Manila,  but  no  cases 
have  been  reported  since  May  7, 1904.  Plague  seems  to  have  increased 
in  China,  but  the  overwhelming  majority  of  cases  and  deaths  occurred 
in  India,  where  during  the  period  from  May,  1903,  to  May,  1904, 
nearly  1,000,000  (913,784)  deaths  were  reported  from  plague.  During 
about  the  same  period  of  the  preceding  year  there  were  reported 
658,259  deaths. 

The  countries  reporting  plague  were:  Africa — Cape  of  Good  Hope, 
Natal,  and  the  Transvaal.  Arabia — Aden.  Argentina — Tucuraan. 
Australia — Queensland,  West  Australia,  and  New  South  Wales. 
Bolivia — I^a  Paz.  Brazil — Seven  places.  Chile — Six  places.  China — 
Twelve  places.      Egypt — Twenty -three    districts   and    places.      For- 


riTBLIC    HEALTH    AND    MARTNE-HOSPTTAL    SERVICE. 


77 


mosji-  In  s(>von  phioes,  (|uito  extensively.  Iliiwaiiaii  Isliinds  At  llilo 
iind  Honolulu.  India- (uMUM-ally  over  the  counliy.  Italv — Lieata,  I 
fatal  ease,  riapan — A  few  (;ases  and  deaths  in  Na<^asaki,  Yokohama, 
and  Shid/uoka  Ken.  Mauritius.  INIexico  — A  few  cases  at  Baj^io  and 
Setiueros.  New  Caledonia — Eio-hty-eioht  eases  and  71  deaths.  New 
Zealand — Two  eases  and  1  death  at  Auckland.  Persia — Twentv  dcniths' 
at  Kernianschah.  Peru — At  Areiiuijja,  Parranca,  C'allao,  C'hosica, 
Lima,  Matacuna,  Mollendo,  Pacasmayo,  Payta,  vicinity  of  San  J^^dro. 
Philippine  Islands — Cebu  and  Manila.  Russia — Kronstadt,  1  fatal  case 
in  laboratory,  Jaiuuuy,  1904.  Straits  Settlements — Singapore.  Tur- 
key— Smyrna,  2  deaths. 

See  plague  table  for  the  year  in  two  sections  below. 

Plague  ((.s  repijrtcd  to  the  Surgeon-General,  Pnhlic  Heattlh  ami  Murine- Hoxp'dal,  Service 

JUNE  27,  1903,  TO  DECKMBKK  ^F,,  1908. 

[Reports  received  by  the  Surgeon-deneral  Public  Health  and  Marine-Hospital  Service,  from  United 
States  consuls  through  the  Department  of  State,  and  from  otlier  sources. 


Place. 


Date. 


Cases.     Deaths. 


Remarlis. 


Africa: 

Cape  of  Good  Hope  (Port 
Elizabeth,  East  London, 
King  Williams  Town, 
and  Queenstown  in- 
cluded). 

Natal  (Durban  and  Pieter- 
maritsburg  included). 
Australia: 

Queensland,  Brisbane 

Bundaberg  .. 
Townsville... 

Western  Australia,  Free- 
mantle,  Perth. 

New  South  Wales,  Sydney. 
Bolivia: 

La  Paz 

Brazil: 

Para 

Pernambuco 

Rio  de  Janeiro 

Sergipe  

Chile: 

Concepcion,  vicinity  of 

Iquique ". 

Pisagua 

Valparaiso 

China: 

Amoy 

Canton 

Fuchau 

Heuiig  Shan 

Honam 

Hongkong 

Niuchwang 

Sgun  Tak 

Yeung  Kong  

Egypt: 

Alexandria 

Beni  Mazar 

Damiette 

Port  Said 

Tantah  

District  of  Embabek 

District  Galiab 

District  Magaghii 

District  Minieh 

District  Samalut 

District  Tukh 

France: 

Marseille 

Formosa 

Germany: 

Berlin 


May2-0ct.  24. 


Apr.  18-July  25  .. 


May  9-Sept.  12 . . . 
May  1(3-Juue  13.. 

Sept.  4 

JunelO-Oct.  13.. 


Junel3-July  11. 
Aug.  13 


Nov.  1-Nov.  7  . . , 
Ocl.l7-Oct.31  .. 
May  24-Nov.  15  . 
Sept.  30 


July  11 

May  15-Sept.  30 . 

July  11 

To  Aug.  24 , 


May  10-Aug.  1 . . 

JNIay  12 

July  15 

May  12 

....".do 

Jan.l-Nov.13  .. 
Sept.  1-Oct.  3  . . . 

May  12 

do 


1,420 
465 


May  19-Nov.  13  . 
June  6-June  19  . 
June]3-0ct.  1  .. 
May  23- Aug.  7  . . 
June20-Jurv9.. 
May  30- June  6. . 

do 

May  23-June6.. 

do 

May  23-Nov.  13  . 
May  30-June  27. 


To  Sept.  15 

Jan.  1-Sept.  30  . . 


124 
3 
26 
22 
7 
1 
1 
3 
1 


10 
915 


June  5-June  18  . . 


1 

6 

221 


414 


4 
4 

5 

750 


Present. 

Prevailing. 
Present. 
Do. 


Estimated. 
Increasing. 
Becoming  epidemic. 

Do. 
Increasing. 


Increasing. 
Do. 


Nurse    of    case    previously    re- 
ported. 


78 


PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 


Plague  (in  reported  to  the  Surgeon- General,  Public  Health  and  Marine- Hospital 
Service — Continued. 

JUNE  27,  1903,  TO  DECEMBER  25,  1903— Continued. 


Place. 


Date. 


Hawaiian  Islands: 

Hilo i  Sept.  1.5 

Honolulu June  24-Sept.  12 

India: 
Bombay     Presidency    :i  ii  d 
Sind — 

Northern  Division May  2-Oct.  31 . . . 

Central  Division do 

Southern  Division do 

Sind do 

political  charges do 

Madra-;  Presidency do 

Bengal — 

Calcutta do 

Presidency do 

Burdwan do 

Bhagalpur do 

Patna do 

Chota  Nagpur Sept.  'iO-Oct.  31 . . . 

United  Provinces — 

Allahabad May  2-Oct.  31 . . . 

Benares do 

Fyzabad do 

Gorakhpur do 

Meerut do 

Lucknow do 

Agra do 

Rohilkhand June  6-Oct.  31  . . 

P^injab —  I 

Jullunder I  May  2-Oct.  31 . . . 

Lahore do 

Rawalpindi do 

Multan do 

Delhi do 

Burma — 

Rangoon do 

Central  Provinces — 

Nerbudda do 

Nagpur do 

Jubbulpore do 

Chhattisgarh Sept.  26-Oct.  31. . 

A.s.sam Mav  16-Oct.31.  . 

Coorg June  6-Oct.  31  . . 

Mysore  State May  2-Oct.  31 . . . 

Hyderabad do 

Berar do 

Rajputana do 

Central  India do 

Kashmir do 

N.  W.  F.  Province May  16-Oct.  31 . . 


Grand  total 

Italy,  LicAta Sept.  14-Sept.  20. . 

Japan: 

Nagasaki ,  May  21-.\ug.  18  . . 


Deaths. 


35, 


Shidzuoka  Ken July  11 

Yokohama Jan.  1-Nov.  21 


Mauritius May  21-Nov.  12  . 

Mexico; 

Bagio Aug.  17 

Sequeros Aug.  18 

New  Caledonia Julv  26-Aug.  13  . . 

Peru:  ' 

Arequipa Aug.  13 

Mollendo do 

Paca-smayo do 

Philippine  Islands: 

Cebu  .Sept.  1-Sept.  30. . . 

Manila Apr.  11-Oct.  24  . . . 

Turkey:  , 

Smyrna Sept.  29 

Straits  Settlements:  I 

Singapore June  14-Aug.  1. . . 


143 

74 

20 

,637 

194 

,274 
736 

458 


,076 
,684 
535 
,819 
36 
64 
,004 
,624 


13, 


254,712 
1 


11 
128 


6,231 

26, 771 

39, 791 

614 

25, 168 

9,509 

358 

138 

70 

17 

1,311 

151 

1,111 
4.54 
376 
436 
502 
429 
118 
3 

11,  %6 
13,  719 
11,924 
678 
6,660 


1,7.58 

2,649 

364 

1,645 

9 

27 

7,009 

7, 357 

1,633 

283 

11,991 

431 

2 


193,663 
1 


117 

1 

20 


Remarks. 


Two  ca-ses  and  1  death  on  Rus- 
sian war  vessel  Otvazny,  from 
Shanghai. 

One  case  on  Japanese  ss.  Kaga 
Maru.  from  Seattle.  Ports  of 
call,  Hiogo  and  Hongkong. 


Present. 
Do. 
Do. 


PUCLIC    HEALTH    A2iD    MAKINE-UUSITI'AL    SERVICE. 


7y 


Plague  us  reported  to  the  Surgeon-Genentl,  J'uhlic  Iltullh  ami  J/arliu-IIusjiltal 
.Service — Continued . 

DECEMBER  26.  1903,  TO  JUNE  24,  1904. 


Place. 


Date. 


Cases. 


Deaths. 


Remarks. 


.\nibia: 

.\deii 

.Argentina: 

Tuciiman 

Australia: 

Brisbane 

Cairns 

S.vdney 

Brazil: 

Niitheroy 

Para 

Pernambuco 

Piiidaniuiihangrtbu 

Porte  Alegere 

Riode  Janeiro 

British  South  Africa: 

Cape  Colony  (East  London, 
King  Williams  Town, 
Port  Elizabeth,  Uiten- 
hage). 

Katal  (Pietermaritzburg).. 

Transvaal  (Johannesburg, 
Pretoria  i . 
Chile: 

Antofagasta 

Iquique 

Santiago 

Valparaiso 

China : 

Amoy 

Canton  

Fubleau 

Hongkong 

.Sunui 

Tientsin 

Egypt: 

Abu  Homos 

Alexandria 

Assiout 

Baliana  district 

Beni  Mazar 

Bibeh  district 

Chibin-el-Kom 

Dechneh  

Girgeh  district 

Kuesna 

Minieh  district 

Nag-Hamadi  district 

Port  Said 

Samallut  district 

Sohag  

Suez 


May  Iry-M. 
May7 


Feb.  12-Apr.  30. 
Feb.  ;t;-Mar.  22 
Mar.  10-Apr.  26 


Apr.  15 

Nov.  1-Feb.  22  . 
Nov.  16-Jan.  l.i. 

Jan.  15 

Jan.  1-Feb.  2».. 
Nov.  16-May  1 . 


Nov.  15-May  1 


Nov.  29-Dec.  5  . 
Mar.20-Mav5. 


To  May  2 . 

Apr.  9 

Apr.  10.... 
June  8 


June  4 

May  26 

Apr.  15 

Nov.  8^Dec.  12  . 

Apr.  15 , 

Nov.  29-Dec.  5 


Tahtah  district . 

Zagazig 

Formosa 


Apr. 
Nov. 
Mar. 
Mar. 
Mar. 
Mar. 
Apr. 
Mar. 
Mar. 
Mar. 
Nov. 
Mar. 
Mar. 
Mar. 
Mar. 
Feb. 


9-16 

21-Mav  14. 
19-26  .'..... 
13-Mav  14. 
19-Apr.  28. 
26-Mav  14. 
10-Mav  14. 
19-MaV  14. 
13-Mav  14. 
19-Apr.  2.. 
21- Feb.  3. . 
13- Apr.  23. 
18-Mav7.. 
13-Mav  14 . 
i:J-26 ."..... 
21- Apr.  2  . . 


Ensuiko 

Hozan 

Kagi  

Kelung 

Taihoku 

Tainan 

Toroku  

Hawaii: 

Hilo 

Honolulu 

India: 

Bombav  Presidencv 
Sind. 

Madras  Presidency 

Bengal " 

United  Provinces 

Punjab 

Central  Provinces  (includ 
ing  Berar) .  I 

Burma 

Coorg 

Mysore  State  . . 


and 


Mar.  l:i-Mav  14.. 
Apr.  22-Mav  7... 
To  Dee.  15.  1903.. 

Jan.  l-Mar.  6 

Mar.  1-Mavl4  ... 
Apr.  17-Mav  14.. 
Mar.  1-Mavl4... 
Mar.  1-Apr.  SO... 
Mar.  1-Mavl4... 

do 

Mar.  31-Mav  14 . . 


Mar.  4 

Jan.  10-June  ID.. 


50 
232 


1 
16 

1 
75 

4 
11 
13 
20  I 
37  I 

3  ' 

7 
41 

3 
156 

1 

3 


34 

1 

869 

225 

781 


1.043 

■1 

28 

976 

11 


Nov.  l.T-May 


.do 16,301 

.do 66,116 

.do 129,374 

.do 307,312 

.do 52,  .831 


Feb.  14-Mav  7  . . .  1 
Nov.  15-MaV7...  18 
do 14,918 


135 
19 


20 


28 

1 
702 
145 
440 

3 
678 

3 

24 

772 

3 

5 
3 


240,123  !  162,993 


Present. 


Several  cases. 


Present. 
Do. 
Do. 

Do. 
Do. 


12,673 

59, 456 

120,  .543 

244,  111 

44,214 

1 
10 
11,374  I 


One  from  Br.  ss.  Knight  of  the 
Thistle,  from  Bombay,  and  1 
from  Br.  transport  Plaissy, 
from  Bombay. 


Imported. 


80 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Plague  as  reported  to  the  Surgeon- General,  Fuhltc  Health  and  Marine-Hospital 
Service — Continued. 

DECEMBER  26,  1903,  TO  JUNE  24,  1904— Continued. 


Place. 

Date. 

Cases.     Deaths. 

Remarks. 

India— Continued. 

Hyderabad  State 

Nov.  15-May  7... 
do 

22, 952 
29, 232 
13, 549 
10, 517 
52 
29 

18,946 

26, 123 

11, 670 

7,823 

48 

18 

Central  India 

Rajputana 

do 

do 

N.  W.  F.  Provinces.     . 

Nov.21-Mav7... 
Nov.  29-May  7  . . . 

Six  cases  imported. 

Baluchi.stan 

Grand  total 

903, 325 

720,003 

Nov.22-Dec.5  ... 
Nov.l3-Apr.7  ... 

Apr.  29  .      ... 

Japan: 

Yokohama 

2 
535 

2 

2 
317 

1 

5 

New  Zealand: 

Peru: 

Baranco 

Apr.  14 

Callao 

Feb.24-Apr.24... 
Apr.  14 

6 

3 

2 
60 

One  case  on  ss.  Limarl  Apr.  21. 

Cho.sica 

Lima 

Mar.  25-May  14  . . 

Apr.  14 

May  30 

l.iO 
2 

Pavta 

San  Pedro  vicinity 

Persia: 

Kermanschah 

Febi  20-26 

Mar.31-Apr.ll  .. 

Jan.]-Mar.31.... 
Nov.  15-May  7  ... 

Jan.  14-20 

Feb.28-Apr.2.... 

Dec.  1-6 

io 7" 

20 

5 :        5 

47  1              38 

:            1 

1 

I             a 

Philippine  Islands: 
Cebu 

Manila 

Russia : 

Kronsttult  . .            

At  plague  laboratory. 

Straits  Scttlrments: 

Turkey: 

1 

S1VLA.LLPOX. 


UNITED   STATES. 


During  the  six  months  ended  December  31,  1903,  smallpox  was 
reported  from  35  States  with  a  total  of  13.739  cases  and  606  deaths. 
Dui-ing  the  six  months  ended  June  30,  1904,  smallpox  was  reported 
from  37  States  and  Territories  with  a  total  of  11,367  cases  and  512 
deaths.  Total  for  the  year,  25,106  cases  and  1,118  deaths.  This  is  a 
great  decrease  since  last  year,  and  parth'  fulfills  the  statement  made 
in  my  last  report  that  the  disease  had  reached  the  high-water  mark 
in  1!»()2,  and  would  continue  to  decrease  from  that  time  until  it  prac- 
tically disappears. 

A  short  table  follows,  which  shows  the  stead}^  increase  of  the  disease 
to  the  maximum  point  and  then  the  decrease  during  the  last  two  years. 

During  the  six  years  from  July  1,  1898,  to  June  30,  1904,  there 
were  reported  189,389  cases  of  smallpox  with  6,745  deaths,  a  mortality 
of  3.56. 


Julv  1, 1898-Junc  30, 1899 
Julv  1, 1899-June  30, 1900 
July  1, 1900-Junc  30, 1901 
July  1, 1901-June  30, 1902 
July  1, 1902-June  30, 1903 
July  1, 1903-June  30, 1904 

Total 


Cases. 


Deaths. 


12,277 
15, 053 
38,506 
55, 857 
42,590 
25, 106 

709 

735 

689 

1,852 

1,642 

1,118 

189, 389 

6,745 

PUBLIC    HEALTH    AND    MARINE-IK >SIMT A L    SERVICE. 


HI 


Below  is  o-ivon  t\u\  tal)lc  in  two  sections  for  tlic  liscul  3our  ended 
June  30,  11>0-1:,  showinjj,-  the  occurrence  of  the  disease  l)y  States,  coun- 
ties, etc.: 

JSmaUpox  in  the    United  Slates  as  reported  to  the  Saryeon-G'cneral,  J'ahlic  Ifci/lli  and 

Marine-Hospital  Service. 

JUNE  27,  1903,  TO  DECEMBER  25,  1903. 


Place. 


Alabamii: 
Mobile 


Total  for  State 

Californiii: 

Fresno 

Los  Angeles 

Oakland 

Sacramento 

San  Francisco. .. 


Total  for  State  , 


Colorado: 

Adams  County 

Archuleta  (bounty 

Boulder  Coiuity 

Chaffee  County 

(;heyenne  County 

Clear  C^reek  County 

Delta  County 

Denver     County     (Denver 
eluded). 

El  Paso  County 

Fremont  County 

Garfield  County 

Gilpin  County / 

Jefferson  County 

Kit  Car.son  County 

Lake  County 

LarimiT  County 

Las  Animas  County 

Lincoln  County 

Logan  County 

Mesa  County 

Morgan  County 

Otero  County 

Ouray  County 

Park  County 

Pueblo  County 

Rio  Grande  County 

Routt  Comity 

San  Miguel  County 

Summit  County 

Teller  County 

Washington  County 

Weld  County 

Yuma  County 


Total  for  State  , 


Florida: 

Alachua  County,  Gainesville 

Baker  County,  Sanderson 

Duval  County,  .fackson ville 

Escambia  County,  Pensacola 

Holmes  County,  Ponce  de  Leon . . 
Leon  County,  Tallahassee  and 
Crestview. 

Levy  County,  Ottercreek 

Polk  County,  Kathleen 

De  Soto  Cotinty,  Punta  Gorda 


Total  for  State 


Georgia: 
Atlanta 


Total  for  State 


Date. 


June20-Nov.27. 


June  1-June  30 . 
July  12-N0V.21. 
Aug.  1-Oct.  31 . . . 
Aug.  2-Aug.  23 . . 
June  14-Dec.(!.. 


Apr.l-May31... 
do 

Apr.  1-Nov.  30  . . 
Apr.l-Sept.30.. 
June  1-June  30 . 
Apr.  1-June  30.. 
June  1-Julv31.. 
Apr.  1-Nov.  30  . , 


do 

Apr.  1-Sept.30  ., 
Apr.  1-July  31  ., 

do 

Apr.  1-Sept.30.. 
Apr.  1-Nov.  30  .. 
June  1-Nov.  30.. 
Apr.l-Aug.31  .. 
Apr.  1-May  31  . . 
Apr.  1-Oct.30... 
Apr.  1-May  31  .. 
July  1-Nov.  30.. 
Apr.  1-May  31  .. 

do , 

July  1-July  31  .. 
June  1-June  30. 
Apr.  1-July  31  . 
Nov.  1-Nov.  30  . . 
Apr.  1-June  30.. 
July  1-Aug.  31  .. 
Apr.  1-July  31  .. 
Apr.  1- Aug.  31  .. 
Apr.l-Julv  31  .. 
Apr.  1-Nov.  ;30  .. 
Apr.  1-July  31  . . 


June  13-Oct. 

do 

do 

do 

do 

do 


-do. 
.do. 
.do. 


June  2r)-Julv  8.. 


Cases. 


Deaths. 


M 
1 

88 
33 

3 
12 

2 
28-1 

20 
41 
2 
l.'i 

-nl 
■IV 
21 
3.5 

8 
1 

13 
1 
14 
2 
1 

10 
39 
82 
18 
3 
12 
20 
115 
25 


1,015 


Remarks 


8629—04- 


82 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Smallpox  in  the   United  Slulcx  us  reported  to  the  Hargeon-deneral,  Public  Health  and 
Marine-  Hospita  I  Ser  v  ire — Conti  n  ued . 

JUNE  27,  1903,  TO  DECEMBER  25,  1903— Continued. 


Place. 

Date. 

Cases. 

Death.s. 

Remarks. 

Illinois: 

Nov.  1-Nov.  30  . . . 
do......  . 

2 
5 
11 

50 

6 

287 

2 
10 
10 

25 

1 

16 
3 
10 

35 

6 
117 

10 

5 

3 
25 

12 

Christian  County  (Millersville, 

Assumption) . 
Clark  Countv  (Casey  Township, 

Moriah,  Westfield). 

do 

do 

do. 

2 

1 
lu 

Cook  Countv  (Chicago,  Lemont, 

Orland). 
Cumberland  County  (Hazeldell). 

June28-Dec.ll.. 

Nov.l-Nov.30... 
do 

Grundy     County    (South    Wil- 
mington). 

Lawrence  County  (Russellville,^ 
Russel      Township,       Allison 
Township). 

do 

1 
1 

do 

do 

do 

2 

do 

Marion  County   (Haines  Town- 
ship, Harris  Township). 

McLean  County  (BloominKt:)n, 
Hey  worth,  Shirley). 

Randolph  Countv  (Coultervillei. 

St.     Clair    County     (Belleville, 
Freebnrg,      Lenzburg,      Mill- 
stadt.  New  Athens). 

Vermilion     County    (Danville, 
Rankin). 

Washiiigtun  County  (I'lum  Hill 
T()wnslii[i). 

do 

1 

2 

1 
15 

1 

do 

do 

June  13-Dec.  12.. 

Julyll-Nov.30.. 
Nov.  l-Nov.30... 
do 

Will  County   (Lockpnrt,   .loliet, 

Du  Page  Township  1. 
Williamson  County  (Gninville, 

Marion). 

.do 

2 
1 

.....do 

651 

40 

June  1-June  30  .. 
June  l-Nov.30... 
May  l-Nov.30  ... 
June  1-June  30.. 
Mayl-0ct.31.... 
May  1-June  30... 
May  l-Nov.30  ... 
May  1-June  30... 
do 

Indiana: 

1 

17 

21 

1 

8 

18 

8 

44 

9 

111 

2 

14 

59 

1 

21 

8 

28 

31 

2 

8 

18 

17 

12 

46 

7 

1 

1 

5 

11 

22 

1 
1 

30 
6 
6 

13 
-       12 



Blackford  County 

1 

May  l-Nov.30  ... 

Oct.  1-Nov.  30 

May  l-Nov.30  ... 
do 

2 
2 

June  l-.June  30  .. 
May  1-June  30... 
May  1-Nov.  30  . . . 
May  1-June  :-i0... 
Oct.  1-Nov.  30.... 
.lune  1-June  30 .. 

May  l-0ct.31 

May  1-Nov. 30  ... 
do 

Deknlb  Countv  

Floyd  County 

Ful ti )!!  County 

Gibson  County 

Mavl-Oct.31.... 
Mav  1-Nov.  -60  ... 
Mayl-Mav31.... 
Oct.l-Oct.31  .... 
Nov.  1-Nov. 30  ... 
June  1-June  30  .. 
Mav]-June30... 
May  1-Nov. 30  ... 

Mavl-Mav31.... 
'do 

Greene  County 

Hamilton  County 

1 

Hendricks  County 

Howard    County    (Kokomo  in- 
cluded). 

Huntington  County 

.lackson  County 

Jasper  County 

Jennings  County 

Johnson  County  

Knox  County 

Lake  County 

do 

i 

May  l-Nf)V.  30  . . . 
Mavl-Mav31.... 
May  1-June 30.  .. 
June  1-Nov.  30... 

I 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE. 


H8 


Smallpox  in  the   United  States  as  reported  to  the  Stin/eon-(ieniral,   Public  IletUlli  anil 
Marine- Hospital  Si^rvice — Continued. 

JUNE  27, 1903,  TO  DECEMBER  25,  1903— Continued. 


Place. 


Date. 


(Ehvood    m- 
( Indianapolis 


Intliana— Continued. 
IjilHirte  County.. 
Lawrence  County 
Madi.son   County 

eluded). 
Marion    County 

included). 

Marshall  County 

Martin  County 

Miami  County 

Monroe  Coun'  y 

Montgomery  County 

Morgan  Coiinty 

Newton  County 

Noble  County 

Orange  County 

Owen  County 

Parke  County 

Perry  County 

Pike  County 

Posey  County 

Pula.<ki  Couiity 

Putnam  County 

Riplev  County 

St.  Josepli  County  (South  Bend 

included). 

Scott  Count V 

Shelby  County 

Spencer  County 

Starke  County 

Sullivan  County 

Tippecanoe  County 

Tipton  County . . . ." 

Vanderburg  County 

Vermilion  County 

Vigo  County ." 

Wabash  County 

Warren  County 

Warrick  Comity 

Wavne  County 

Wells  County 

White  County 

Whitley  County 

Places  not  meiitioned 


May  1-Oct.  31  . . . 
Mav  1-June  30  . . 
May  1-Oct.  31... 

do 


Oct.  l-Nov.30... 
Mavl-Nov.30.. 
Mav  1-June  30. . 
Mavl-Nov.30.. 

.....'do 

do 

Mavl-Mav31.. 
Mav  1-June  30.. 
Mavl-Nov.30.. 
Mavl-May  31  .. 
Mrtvl-Nov.  30.. 
Mav  1-Oct.  31... 
Nov.  1-Nov.  30.. 
Mavl-Mav31  .. 
Mav  1-June  30.. 
Get.  1-Oct.  31... 
June  1-June  30  . 
July  ig-Sept.  12. 


Total  for  State I    1.488 


May  1- 
Oct.  1- 
May  1- 
June  1 
Mav  1- 
May  1- 
Jurie  1 
Mav  1 
Mav  1 
Mav  1 
Nov.  1 
Mav  1- 

....."do 
May  1- 
Jurie  1 

do 

May  1- 
June  1 


■June  30.. 
Nov.  30  . . 
■May  31... 
-June  30 . 
Oct.  31... 
■Nov.  30.. 
-June  30. 
Oct.  31... 
June  30.. 
Nov.  30.. 
-Nov.  30. . 
Nov.  30 . . 


June  30. 
-Nov.  30 


Nov.  30.. 
-June  30  . 


Cases. 


Iowa: 

Dubuque  County  (Cascade) 

Hamilton  County  ( Webster  City) 

Harrison  County  (Cass  Town- 
ship). 

Jasper  County  (Des  Moines 
Township  and  Vandalia). 

Marion  County  (Perry  Town- 
ship). 

Polk  County  (Des  Moines) June  1-July  4 

Wapello  County  (Ottumwa) July  1-Aug.  31... 


Aug.  1-Aug.31.. 
do 

Sept.  1-Sept.  30 . 

Aug.l-Aug.  31.. 
do 


Total  for  State  . 


Kentucky: 
Louisville. 


Total  for  State  . 


Oct.  1-Nov.  10  . . 


Louisiana:  j 

Baton  Rouge Oct.  25-Dec.  r> 

New  Orleans June  l-Dec.  12. . . 

Total  for  State 


16 
106 

6 

10 

47 

174 

1 
11 
56 

2 

5 
16 
16 


Deaths. 


5    . 

10  '. 


83 


Maine: 

Aroostook    County     (including     July  4-Nov.  30... 

Grand  Isle,  Fort  Kent,  Mada- 

waska    To%5mship,    and    Van 

Buren) . 

Bangor To  Nov.  10 

Beaver I  Aug.  28 


Remark.*). 


One  case  from  Pitt.sburg. 


Reported. 


1     Six  cases  imported. 


84 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Smallpox  in  the   United  States  as  reported  to  the  Surgeon- General,  Public  Health  and 
Marine-Hospital  Service — Continued. 

JUNE  27,  1903,  TO  DECEMBER  25, 1903— Continued. 


Place. 


Date. 


Deaths. 


Remarks. 


Maine— Continued. 

Belfast Sept.  19 

Brewer Sept.  17-Nov.  4 . . . 

Camden Oct.  29 

Oldtown Sept.  26-Nov.  26. . 

Orono Oct.  29-Nov.  26. . . 


Total  for  State . 

Maryland: 

Baltimore 

Cumberland 


Total  for  State . 


June28-Oet.l7  . 
Mavl-Oct.31... 


Maiv«achusetts: 

Boston Oct.  25-Dec.  5  . . 

Cambridge 1  Sept.  27-Oct.  3. . 

Fall  River June  20-Sept.  26 

Haverhill Kov.  1-Dec.  9  . . 

Lawrence •  Nov.  8-Nov.  21 


Lowell 

New  Bedford 

North  Adams 

Taunton 

Vinevard  Haven 


Total  for  State . 


Michigan: 

Detroit 

Flint 

Grand  Rapids 

Hillsdale 

Marquette 

Port  Huron 

Iosco  County  (Sherman  Town- 
ship). 

Marquette  County  (Wells  Town- 
ship). 

Total  for  State 


Minnesota: 

Aitkin  County 

Beltrami  County 

Benton  County 

Big  Stone  County 

Brown  County 

Carver  County 

Cass  County 

Chisago  County 

Clay  County 

Columbia  County 

Crow  Wing  County  ... 

Douglas  County 

Fillmore  County 

Freeborn  County 

Goodhue  County 

Grant  County 

Hennepin  County 

Houston  County 

Hubbard  County 

Isanti  County 

Jackson  County 

Kandiyohi  County 

Lac  qui  Parle  County. 

Lincoln  County 

McLeod  County 

Meeker  County 

Morrison  County 

Nobles  County 

Norman  Countv 

Ottertail  County 

Pine  County 

Pipestone  Countv 

Polk  County 

Ramsey  County 


Nov.  22-Nov.  28 
July  l-Oct.24.. 
Dec.6-Dec.l2.. 
June20-Oct.3.. 
Sept.  21 


June  16-Dec.  12 . 
Junel3-Dec.l2. 
June  13-Aug.  22. 
Oct.  l-0ct.31  ... 
Aug.'23-Aug.29. 
June  13-Dec.  12. 
Sept.l-Sept.30.. 

Aug.  l-.A-Ug.  31 . . 


Nov.  2-Nov.  9  . . . 
Nov.l7-Dec.l4.. 
June  15-Julv  13. 
Dec.8-Dec.l4... 
Aug.3-Aug.21.. 
June  1.5-NOV.23. 
June30-Nov.23. 
Nov.  17-Nov.  23  . 
Julv  1-Julv27.. 
July  6-July  13.. 
June  1.5-Nov.  23. 
Julv6-Dec.6  ... 
Sept.7-Sept.l4.. 
Julv  21-Julv  27  . 
Oct.20-Oct.26... 
June  l-T-Julv  20. 
Junel.5-Nov.30. 
June30-Julv6.. 
Julv  21-Julv  27  . 
June  15-NOV.23. 
June  l-i-July  13. 
June  15-Dec.  6.. 
June  22-.Iune  29 
Julv  13-Aug.  3.. 
June  22-.\ug.  10. 
June  15-.\ug.  3.. 
June  15-Dec.  14 . 

do 

June  22-June  29 
Oct.20-Nov.  30.. 
June  15-.\ug.  3.. 
June30-Julv6.. 
Aug.24-.N'ov.2.. 
June  15-Dee.7.. 


1  . 
4  . 
1  . 
9  . 
1  '. 


Imported. 
Present. 


On   sch.  Orozimbo,   from 
Calais,  Me. 


,  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  85 

Smallpox  in  the   United  States  an   reporl^^d   to  the  Surgeon-Cemral,    I'lihlic  Ifrallli  anil 
Marine-IIostpital  Service — Continued. 

JUNE  27.  1903,  TO  DECEMBER  25,  190;?— Coiitiiuu<l. 


Place. 


Date. 


Cases. 


Deaths. 


Remarks. 


Minnesota— Continued. 

Redwood  County 

Rfuville  County 

St.  Lo\iis  County 

Scott  County 

Sherburne  County 

Sibley  County 

Stearns  County 

Steele  County! 

Stevens  County 

Swift  Count V 

Todd  County 

Waseca  County 

■Washington  County 

Wilkin  County 

Winona  County 

Wright  County  

Yellow  Medicine  County 

Kandiyohi  (Jounty,  not  previou.s- 
ly  reported. 

Do 


Oct. l»-Oct.  19  ... 
June  30-I)ec.  7... 
June22-Nov.  9... 
July  6-July  13... 
June  15-June  22  . 
June3(>-July  C... 
June  1,^-Dec.l4.. 
Julv6-Julv  13... 
Sept.l4-Oct.2G  .. 
Julv  6-.\ug.  10... 
JulV  la-Nov.H.. 
July  21-Aug.31.. 
Dec.8-Dec.  1-}.... 
Aug.  18-Oct.2(!... 
Julv6-July  13... 
July6-Oct.26.... 
June  15-Aug.  31  . 


Pine  County,  not  previously  re- 
ported. 

Stearns  County,  not  previously 
reported. 

Todd  County,  not  previously  re- 
ported. 

Waseca  County,  not  previously 
reported. 

Other  parts  of  the  State  not  pre- 
viouslv  reported. 
Total  for  State 


Mississippi: 
Moss  Point. 
Natchez 


Total  for  State . 


Missouri: 
St.  Louis 


Total  for  State . 


Montana: 
Helena. 


Total  for  State 


Aug.,  Sept.,  and 
Oct. 


Aug.  28 

Julv4-Dec.l3. 


June  16-Dec.  5 . 


June  1-June  30  .. 


Nebraska:  j 

Omaha I  Aug.  2-Aug.  31  . . 

South  Omaha June  1-JuIy  1... 

Total  for  State ..i 


New  Hampshire:  ! 

Manchester June  13-Dec.  12  . . 

Nashua j  June  13-June  20  . 

Total  for  State 


New  Jersey:  | 

Bordentown i  June  6-June  27  . 

Camden July  5-Dee.l9  .. 

Hoboken Aug.  17-Aug.  23 . 


Jersey  City, 
Trenton. 


Total  for  State  . 


Oct.  19-Oct.  2-5 
June20-June27 


New  York: 

Buffalo Nov.  9 

Elmira June  13-June  20 

New  York  ■  July  4-Dec.  12.. 


Niagara  Falls . 
Rochester. 


Total  for  State . 


Sept.6-Oct.10 
July  15-July  21 . 


2 

31 

8 

1 

1 

9 

168 

1 

8 

13 

21 

3 

1 

2 

2 

7 

10 

21 

32 

9 

40 


2  '<... 

49    

51    

39    

39    

1    

1        

3      

6    

9    

,=)0          

1    

51  1 

24 
21 

1    i... 

5 
3 

1   ' 

1  :     :  : 

29 


86 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Smallpox  in  the   United  States  as  reported   to  the  Sun/eon-Genero!,   Public  Health  and 
Marine- Hospital  Service — Con ti n ued . 

JUNE  27,  1903,  TO  DECEMBER  25,  1903— Continued. 


Place. 


North  Carolina: 

Alamance  County 

Ashe  County 

Bertie  County 

Buncombe  County 

Burke  County 

Cabarrus  County 

Caswell  County 

Catawba  County 

Chatham  County 

Cleveland  County 

Columbus  County 

David.son  County 

Davie  County 

Durham  County 

Forsyth  County 

Gaston  County 

Graham  County 

Guilford  County 

Harnett  County 

Henderson  County  . . . 

IredeU  County 

McDowell  County 

Madison  County 

Mecklenburg  County  . 

Moore  County 

New  Hanover  County 

Pender  County 

Person  County 

Polk  County 

Randolph  County 

Rockingham  County  . 

Rowan  County 

Rutherford  County  . . . 

Stanly  County 

Surry  County 

Wake  County 

Warren  County 

Wayne  County 

Wilkes  County 

Wilson  County 

Yadkin  County 


Total  for  State . 


North  Dakota: 

Benson  County 

Billings  County 

Bottineau  County 

Cass  County 

Cavalier  County 

Grand  Forks  County. 

Griggs  County 

Morton  County 

Nelson  County , 

Ramsey  County 

Ransom  County 

Richland  County 

Sargent  County 

Stark  County , 

Towner  County 

Traill  County 

Walsh  County 


Total  for  State . 


Ohio: 

Allen  County 

Ashtabula  County 

Auglaize  County 

Belmont  County 

Brown  County 

Butler  County  (Hamilton  in- 
cluded). 

Champaign  County 

Clark  County 

Clermont  County 

Columbiana  County  (East  Liver- 
pool included). 


Date. 


Aug.l-0ct.31.. 
July  1-July  31  . 
July  1-Aug.  31  . 
Mav  1-Oct.  31 . . 
May  1- Aug.  31  . 
Aug.  1-Aug.  31  . 
Oct.l-Oct.31  .. 
July  l-.Aug.31  . 
May  1-May  31  . 
May  1-Aug.  31  . 
Aug.  1-Aug.  31. 
Oct.l-Oct.  31  .. 
May  1-Oct.  31 . . 
May  1-Aug.  31  . 
Mav  1-Oct.  31 . . 
July  1-Aug.  31 . 
Mav  1-Mav  31  . 

do...." 

Oct.  1-Oct.  31  .. 
May  1-May  31  . 
Aug.  1-Aug.  31  . 
May  1-May  31  . 
Aug.  1-Oct.  31.. 
May  1-May  31  . 

do 

May  1-July  31  . 
July  1-July  31  . 
Oct.  1-Oct.  31  .. 
Julv  1-Aug.  31 . 
July  1-July  :il  . 
July  1-Aug.  31 . 
Oct.  1-Oct.  31  .. 
May  1-July  31  . 
July  1-Julv  31  . 
May  1-Oct.  31.. 

do 

May  1-May  31  . 
Oct.  1-Oct.  31  .. 
May  1-May  31  . 
May  1-Oct.  31.. 
July  1-July  31 . 


July  1-Aug.  31 

do 

do 

Oct.  1-Oct.  31  . 
May  1-Aug.  31 
July  1-Oct.  31. 
May  1-Aug.  31 

do 

July  1-Aug.  31 

do 

Oct.  1-Oct.  31  . 
July  1-Aug.  31 

do 

May  1-July  31 
Oct.  1-Oct.  31  . 
May  1-Oct.  31 . 
July  1-Aug.  31 


May  10-Aug. 

do 

do 

do 

do 

do 


.do. 
.do. 
.do. 
.do, 


Deaths. 


463 


139 


Remarks. 


PUBLIC    HKALTH    AND    MAKINIMIOSPTTAL    SKRVKK. 


87 


Smallpox   in  the    United   Stati'i^  ax  ri'iioiitd  to  tin:  Siinjcoii-d'iiii ml,  I'uhlir   llinllh   mul 
Mannc-JIuKj>il<il  Service — ('(jiitimicd. 

JUNE  27,  1903,  TO  DECKMBKR  Jf),  litoa-Coiiliiiiied. 


Place. 


Ohio — Continued. 

Crawford  County 

C^uyiUiuK'ii  Couiity  (Cleveland 
incluiled). 

Deliance  County 

Delaware  County 

Erie  (bounty 

Fairlielil  County 

Fayette  County 

Franklin  County  (Columbu.**  in- 
cluded) . 

Gallia  County 

Geauga  County 

Greene  County i do 

Guernsey  County ' do 


Date. 


Mnv  lO-Aup.S.. 
May  10-Nov.'_'l  ., 

Mav  lO-Aufi.  s  .. 
....do 


Hauiiltou  County  (Cincinnati 
included). 

Hancock  County 

Harrison  County 

Henry  County  .". 

Jackson  County 

Jeflerson  County 

Lawrence  County 

Logan  County ....   

Lorain  County  (Lorain  in- 
cluded). 

Luca.s  County  (Toledo  in- 
cluded). 

Mahoning  County  (Youngstown 
included). 

Marion  County 

Meigs  County 

Miami  County 

Monroe  County 

Montgomery  County  (Dayton 
included). 

Morrow  County 

Maskingum  County  (Zanesville 
included). 

Paulding  County 

Pickaway  County 

Preble  County  . .". 

Ross  County 

Scioto  County 

Seneca  County 

Stark  County" 

Summit  County 

Trumbull  County  (Warren  in- 
cluded). 

Tuscarawas  County 

Van  Wert  County .' 

Warren  County  ." 

Washington  County 

Wyandot  County . .". 


Total  for  State  . 


Pennsylvania: 

Allegheny  County  (Allegheny, 
Pittsburg,  and  McKecsport 
included). 

Armstrong  County , 

Beaver  County  . . .'. , 

Berks  County  (Reading) 

Blair  County  (Altoona  in- 
cluded). 

Butler  County  (Butler  included) 

Cambria  County  (Johnstown 
included).  I 

Cameron  County May  1-May  31 .. 

Carbon  Couniv June  1-June30  . 

Center  County I  May  1-May  31 . . 


May  10-Dec.  US.. 

May  lO-Aug.8.. 
do 


do 

do 

do 

do 

do 

May  10-()ct.3. 


May  10-Sept. .'.... 

May  10-Dec.  12... 

May  10-Nov.  21  . . 

do 

do ... 

Mav  10-Nov.  14  . . 
May  10-Dec.  12... 

MavlO-Aug.8... 
...."do 


do 

do 

do 

do 

do 

do 

do 

do 

Mav  10-Nov.  2.. 


.do. 
.do. 
.do. 
.do. 
.do. 


June  13-Dec.  12 


June  l-.\ug.  31.. 
June  1-Sei>t.30  . 
Nov.2-l-Dec.  14  . 
May  1-Dec.  12... 

Mavl-Sept.30.. 
Mav  1-Dec.  12  .. 


Clarion  County 
Clearfield  County 
Clinton  County  . . , 
Columbia  County 
Crawford  County 
Delaware  Countv 
Elk  County 


do 

Mav  1-Sept.  30. . 
Julv  1-Ju!v31  .. 
Aug.  1-Sept.  30  . 
Mayl-Julv31  .. 
May  1-Sept.  30  . 
May  1-May  31 . . 


fJiuses. 

Deaths. 

Remarks. 

2 

1« 
G 

1 

25 

18 
1 
1 

1 

27 
15 

3 

1 

10 

2 

140 
18 

5 

1 

43 

7 

18 

101 

4 

11 

(i 

49 
72 

2 

1 

2 

12 
2 

2 

74 
1 

1 

49 

1 

1 

30 

9 

3 

34 

12 

G 

29 

9 

G 
30 
^9. 

3' 

1,042 


C 
20 

4 
20 

31 

98 

5 

5 

27 

2 

167 

1 

5 

11 

28 

3 


38 


207  !  Eight  cases  imported. 


Two  cases  imported. 


88 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Smallpox  in  the   United  Slates  as  repoHed  to  the  Surgeon- General,    Puhlic  Health  and 
Marine- Hospital  Service — Continued. 

JUNE  27,  1903,  TO  DECEMBER  25,  1903— Continued. 


Place. 


Penn.sylvania — Continued. 

Erie  County  (Erie  and  Franklin 
included). 

Fayette  County 

Fore.st  County 

] ndiana  County 

.Jefferson  County 

Lackawanna  County  (Scranton, 
Carbondale,  and  Dunmore  in- 
cluded). 

Lancaster  County 

Luzerne  County '. 

Lycoming  County 

McKean  County  '. 

Mercer  County 

Montgomery  County  (Norris- 
town  included). 

Northampton  County 

Perry  County 

Philadelphia  County 

Pike  County ! 

Potter  County 

Schuylkill  Co"unty 

Sullivan  County ." 

Susquehanna  County 

Tioga  County 

Venango  County 

Warren  County 

Wa.«hington  County 

Wayne  County " 

We.stmoreland  County 

Wyoming  County 


Date. 


Cases. 


Total  for  State  . 


Rhode  Island: 
Providence 


May  1-Dec.  12.. 

Mavl-Sept.,30.. 
I  Mav  1-Aug.  31.. 
I  Mavl-July  31.. 

July  1-July31  .. 

June  7-Dec.  7... 


Aug.  1-Aug.  31  . 
May  1-May  31  .. 
May  1-July  31  .. 
June  1-June30  . 
May  1-Sept.  30.. 
May  1-Dee.  12.. 

May  1-May  31  . . 
May  1-Aug.  31.. 
June  20-Dee.  19. 
June  1-June  30 . 
Junel-July  31.. 
May  1-July  31  . . 
Aug.  1-Aug  31  .. 
June  1-July  31.. 
May  1-June30.. 
June  1-July  31.. 
May  1-May  31  .. 
May  1-Sept.  30. . 
June  1-Julv31.. 
May  1-Sept.  .30.. 
Aug.  1-Aug.  31  . 


Nov.  1-Nov.  7  . . 


Total  for  State. 


South  Carolina: 

Charleston I  June  20-Nov.  14 

Greenville June  20-Sept.  19 


Total  for  State  , 


Tennessee: 

Anderson  County |  Mar.  15-Sept.  l.i 

Blount  County ' do 

Bradley  County do 

Campbell  Couiity do ! ! 

Carroll  Cotmty.." do '.'. 

Carter  County do 

Cheatham  County do .'. 

Chester  County  .." do ...... 

Claiborne  County do !! 

Cocke  County..." do 

Coffee  County do 

Crockett  County do 

Cumberland  County do 


Davidson  County  (.Vashville  in- 
eluded). 

Franklin  County 

Gibson  County 

Giles  County , 

Hamblen  County 

Hamilton  County  (Chattanooga 
included). 

Hancock  County 

Hardeman  County 

Hardin  County. . .' 

Hawkins  County 

Haywood  County 

Henderson  County 

Henry  County  . . .'. 

Houston  County 

Humphreys  County 

Jackson  County 

James  County.". 


.do. 

.do. 
.do. 
-do. 
.do. 
.do. 

.do. 
.do. 
.do. 
.do. 
.do. 
.do. 
-do. 
.do. 
.do. 
.do. 
.do. 


19 
40 

810 

2 

24 

28 

10 

128 

8 

2 

2 

18 

8 

19 

3 


Deaths. 


2,887 


35 


13 
4 
10 
31 

783 

12 
11 

1 
16 
17 

9 
40 

3 
12 
15 
13 


2 
2 

170 


Remarks. 


PUIU.IC    HEALTH     AM)    M  AKIN  K-H<  )Sl'n  A  I,    SKKVHK. 


89 


Smalli>OJ-  i)i  llif   I'liiliil   Sfulis  (tn   reported   to  thr  Siir;/eou-(,'ei>rr<i/,    I'lil.lic  /frtillli  mul 
Miiri)i(-Ilospiliil  Scrricv — Continueil. 

JINE  -11.  ly03,  TO  DECKMBKK  Jo,  190:i— Conlinuu<l. 


Place. 


Tennessee — Continued. 

.k'fterson  County Mar.  15-Sept.  lo. . 

Knox  County  (Kiioxville) rto 

McMinn  County lio 

Madison  County do 

Marion  County do 

Marshall  County do 

Manry  County do 

Monroe  County do 

Montgomery  County do 

Morgan  County do 

Obion  County do 

Rhea  County do 

Roane  County do 

Robertson  County do 

Rutherford  County do 

Scott  County do 

Shelbv    County    (Memphis    in-  i  Mar.  l.VDec.  12.. 
eluded).  I 

Smith  County Mar.  1.5-Sept.  15. 

Stewart  Couiity do 

Sullivan  County do 

Sumner  County do 

Union  County do 

Warren  County do 

White  County do 

Williamson  County do 


Total  for  State  . 


Texa.s:  , 

San  Antonio July  1-Xov.  30.. 


Total  for  State  , 


Utah: 

Ogden .\ug.  1-Xov.  30. . . 

Salt  Lake  City June  6-Nov.  2s. . . 

Total  for  State 


Virginia: 

Lvnehburg Aug.  1-Aug.31. 

Pocahonta-s ,  Aug.  29 


Total  for  State  , 


Washington: 

Adams  County 

Clark  County 

Columbia  County 

Cowlitz  County 

Douglas  County 

Island  County 

King  County  (Seattle  incduded) .'. 

Kitsap  County 

Klickitat  County 

Lewis  County 

Lincoln  County 

Okanogan  County 

Pierce  (bounty  (Tacoma  included; 

Skagit  County 

Snohomish  County 

Spokane   County   (Spokane  in- 
cluded). 

Stevens  County 

Thurston  County 

Walla  Walla  County 

Whatcom  County 

Whitman  County 

Yakima  County 


Aug.  1 
June  1 
June  1 
July  1 
June  1 
Aug.  1 
Junel 
June  1 
Oct.  1- 
Sept.  1 
Oct.l- 
Junel 

do 

Sept.l- 
June  1 
Junel- 


-Nov.  30... 
-Xov.30... 
-Aug.  31... 
-Aug.  31... 
-Oct.  31... 
-Sept.  30 . . 
-Nov.  30... 
-June  30.. 
Nov.  30... 
-Sept.  30 . . 
Nov.  30.... 
Aug.  31... 


Nov.  30... 
-Sept.  30.. 
Nov.  30... 


Total  for  State 


Sept.  1-Oct.  31 

Julvl-Julv31... 
June  l-0ct.31  ... 
Julv  l-Nov.30... 
July  l-Oct.31.... 
July  1- Aug.  31 ... 


West  Virginia: 

Jefferson  Countv '  Obt.l-Oct.  15  .. 

Wheeling " 1  Mar.  1-Sept.  30 . 

Total  for  State 


86 


Remarks. 


36 


Two  cases  imported. 


5     3  cases  imported. 


65 


90 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Smallpox  in  the  United  SUitcs  rt.s   reported  to  the  Surgeon-General,  Public   Health  and 
Marine- Hospital  Service — Continued. 

JUNE  27,  1903,  TO  DECEMBER  25,  1903— Continued. 


Place. 

Date. 

Cases. 

Deaths. 

Remarks. 

Wisconsin: 

40  counties,  87  iihuos 

39  countie.s,  90  placLS 

31  counties,  ,50  pliices 

32  counties,  53  yiliiees 

Feb.l-Feb.28.... 
Mar.l-Mar.31  ... 
Apr.l-Apr.30.... 
Mayl-May  31  ... 
June  1-June  30 . . 

495 
412 
194 
2.59 
238 

3 
4 
1 
3 

Julvl-Julyll...l          15 
July  12-July  31..!         50 
Aug.  1-Aug.  31 . . .          24 
Sept.  1-Sept.30...           15 

7  counties,  10  pliues 

1 

Oct.  4-Dec.  12 

30 

Total  for  State                     

1,732                12 

13,739                606 

DECEMBER  26,  1903,  TO  JUNE  24,  1904. 


Alaska: 

Hoonah . . 
Juneau  .. 
Killisnoo 


Total  for  Territory , 


Arkan.sas: 

Fort  Smith. 
Little  Rock 


Total  for  State 

California: 

Berkeley 

Escondido 

Fresno 

Los  Angeles 

Oakland  

Sacramento 

San  Francisco... 


Total  for  State 


Colorado: 

Bent  County 

Boulder  County 

Chaffee  County 

Conejos  County 

Denver  County  ( Denver) 

Douglas  County 

Eagle  County 

El      Paso      County     (Colorado 
Springs  included). 

Gilpin  County 

Huerfano  County 

Kit  Carson  County 

Lake  County 

La  Plata  County 

Larimer  County 

Las  Animas  County 

Mesa  County 

Otero  Cou,nty 

Pitkin  County 

Pueblo  County 

Rio  Grande  County 

Koutt  County 

Washington  County 

Weld  County 

Yuma  County 


Mayl7 

May  15-June4.. 
Mavl? , 


Dec.  13-Feb.  20 . 
Apr.  1-May  31.. 


Jan.  1-Feb.  29.. 

Feb.  23 

Dee.  1-31 

Dec.  27-May  28  . 

Jan.  1-31 

Apr.  1-30 

Dec.  7-June5... 


Feb.  1-29 

Dec.  1-Apr.  30 . 
Feb.  l-Apr.  30 . 
Jan.  1-Feb.  29.. 
Dec.  1-Mar.  31. 
Mar.  1-Mar.  31. 
Mar.  1-Apr.  30. 
Dec.  1-Feb.  29  . 


Total  for  State . 


Delaware; 

Wilmington. 


Total  for  State 


Apr.  1- 
Dec.  1- 
Dec.  1- 
Dec.  1- 
Apr.  1- 
Dec.  1- 
Dec.  1- 
Dec.  1 
Jan.  1- 
Dec.  1- 
Feb.  1 
Dec.  1 
Jan  1- 
Dec.  1- 
Dec.  1 
Dec.  1- 


30 

Mar.  31 . 
Apr.  30.. 
•Feb.  29 . 

-30 

■Apr  30. 
Jan.  31.. 

■31 

Mar.  31 . 
Jan.  31.. 
■Apr.  30. 

■31 

Feb.  29  . 
■Jan.  31  . 
■Apr.  30 . 
■31 


Feb.  21-June  18. 


35 


4 
31 

8 

37 

44 

1 

6 

37 

1 

2 

24 

3 

1 

lOG 

4 

1 

47 

2 

11 

11 

14 

3 

134 

1 


PUBLIC    HEALTn    AND    M ARINK-HOSI'ITAL    SERVICE. 


91 


■^  I  nail  pox  in   thr    Inilal  St<ttiti  ax  nixirted  to  the  Snr<i<<ni-(lnnr<il,    I'lilil'ic    Ilndtli   mid 
Marini-  Ilospilnl  Scrrirr — C(  in t  i  mu'(  I . 

DECEMBER  JO,  1903,  TO  JINK  21,  I'.tOJ— Coiiliiiuud. 


Place. 

Date. 

Cases. 

Deaths. 

Remarks. 

Mistrict  of  Columbia: 

Jan.  10-Junei... 

:             1 

.S4    ' 

54 

Nov.  1-Jan.  16... 
Nov.  1-Dec.  31... 
Nov.l-Junell... 
Nov.  1-Dec.  31... 
Nov   1-Dec.  31... 
Jan.2-1G 

Florida: 

Esi'iinibia  County  ( I'ensacola  i . . . 
Dade  County  (Fort  Lauderdale). 

Duval  County  (.laeksonville) 

Leon  County  (Tallaliassee) 

Polk  County  (Bartow) 

11  I 
1   1 

42  i 

•2  1 

1 

88 

1 

Total  for  State                

l^-^l 

Jan.  14 

lieorgia: 

•} 

Feb.  12 

7 

May  15-June  11.. 

13 

Total  for  State 

15 

7 

Dec.l3-Mar.  31.. 

Jan.  1-Feb.  5 

Dec.  20-June  18.. 
Dec.  13-June4... 
Mavl-May  31... 
Jan.l-Dec.31,iy03 

Jan.  10-16 

Mar.  6-26 

Mar.  1-31 

F^eb.26-Mar.  3... 

Illinois: 

Belleville 

29 
13 

101 

53 

22 

3 

1 

10 
3 

2 

Cairo 

Chicago 

1 

East  St.  Louis 

1 

Total  for  State 

242 

4 

Dec.l3-Jan.  20... 

Apr.  17-23 

Mar.  27-May  14.. 

Indiana: 

22 

1 

16 

South  Bend 

1 

Total  for  State    

39 

1 

Jan.  23-Apr.30... 
Dec.27-June  11.. 
May  1-May  31... 

Iowa: 

8 
5 

1 

■ 

1 

Keokuk 

Total  for  State             

14 

1 

Mar.1-28 

Mar.l3-Junell.. 
Oct.l-Apr.30.... 
Mar.  22-28 

Kentucky: 

16 

25 

66 

6 

Covingtc  )n 

Louisville — 

16 

Total  for  State 

113 

16 

Dec.l3-June  11.. 

Louisiana: 

119 

5 

40  imported. 

Total  for  State                       

119 

5 

Dec.  31 

Maine: 

Present. 

Dec.  13-19 

Mar.  18 

i 

2 
1 

1 

Dec.  19 

Dec.  31 

Do. 

Feb.  7-18 

10 
2 

13 

23 
8 

67 
1 
2 
9 

June  3 

May  17-June3... 

Mayl6-26 

May  31 

Dec.  1-Apr.  9  . . . . 
Jan.  28 

Milford 

Oldtown 

To  Dec.  24 

92 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Smallpox  in  the   United  Slates  o.s  reported  to  the  Surgeon- Genera  I,    Piihlic  Health  and 
Marine- Hospital  Service — Continued. 

DECEMBER  26,  1903,  TO  JUNE  24,  1904— Continued. 


Place. 


Maine — Continued. 

Orono 

Smithfield , 

Stacyville 

Van  Buren 


Total  for  State . 

Maryland: 

Baltimore 

Cumberland 


Total  for  State  . 


Massachusetts: 
Brockton... 
Fall  River  . 
Haverhill .. 
Lawrence . . 
Lowell 


Total  for  State  , 


Michigan: 

Detroit 

Flint 

Grand  Rapids 

Port  Huron 

Bay  County 

Lapeer  County 

Muskegon 

Osceola  County  . . . 
St.  Jo.seph  County 

Total  for  State  . . 


Minnesota: 

Aitkin  County 

Anoka  County , 

Becker  County , 

Beltrami  County , 

Benton  County , 

Blue  Earth  County 

Cass  County 

Chippewa  County 

Chi.sago  County 

Clay  County 

Cottonwood  County  . , 
Crow  Wing  County  ... 

Dakota  County 

Dodge  County 

Douglas  County 

Fillmore  County 

Freeborn  County 

Grant  County 

Goodhue  County 

Hennepin  Counj^y 

Houston  County 

Hubbard  County 

Isanti  County 

Itaska  ('ounty 

Jack.son  County 

Kanabec  County 

Kandiyohi  County 

Kittson  County 

Lac  qui  Parle  County. 

Lake  County 

Lesueur  County 

Lyon  County 

Meeker  County 

Millelacs  County 

Morri.son  County 

Mower  County 

Murray  County 

Norman  County 

Ottertail  County 

Pine  County 

Pipestone  County 

Polk  County 


Date. 


Dec.  19-Jan.22. 

Jan.  21 

do 

Jan.  1-31 


Jan.  17-June  18 . 
Feb.  1-Mar.31... 


Dec.  20-26 

Dec.  20-Mar.  19. 

Dec.  20-26 

Jan.  10-16 

Mar.  13- Apr.  2.. 


Dec.  13-June  11 . 
Dec.l3-Feb.6... 
Jan.2-June  11  .. 

Dec.  16-23 

Feb.1-29 

....do 

Mar.  1-31  

....do 

....do 


Feb.  9-29 

Apr.  5-May  9.. 
Mar.  1-May  16. 

Jan.  5-May  30 

May3-9 

Apr.26-May  9... 
Jan.26-Apr.  11.. 
Feb.9-Apr.  18... 
Jan.  12-Apr.  4... 
Dec.22-June  13. 

Feb.  2-15 

Jan.5-June  13  .. 

Feb.  2-8 

Mar.  15- Apr.  18  . 
Jan.26-June  13  . 

Mar.  1-7 

Apr.  5-11 

Mar.22-Apr.  18... 

Jan.  5-May  30 

Dec.22-June  13.. 
May  24-Juiie  6... 
Jan.l9-June  6  ... 
Dec.22-May  23... 
Dec.l5-June6... 

Jan.  5-11 

May  24-30 

Dec.l5-June  13.. 

Apr.  5-18 

Apr.26-Junel3.. 

May  24-30 

Apr.  5-May  30 

May  16-23 

Feb.  16-June  13.. 
Feb.  16-Mav  30. . . 
Dee.  15-May  30.. 

Feb.  2-8 

May  24-June  13 
Feb.  2-Junel3. 
Dec.  15-June  6. 
Feb.  2-May  16  . 
Mar.  15-June  13 
Jan.  5- Apr.  18  . 


Cases.     Deaths. 


Remarks. 


6 
2 

53 

52 

1 

2 

14 

26 

13 

29 

2 

6 

2 

13 

57 

2 

1 

7 

11 

207 

2 

16 

36 

24 

1 

1 

98 

5 

6 

5 

9 

1 

6 

8 

31 

1 

4 

18 

157 

9 

25 

6 


PUBLIC    HKALTH     AND    MAKINK-HOSl'ITAL    SKRVK'E. 


93 


SmalljMX  in  tlte   rDllnl   Stoteti  us    rcjiortcd  to  llic  Sitnji'(j>i-<i<iiir<il,   I'uhUc  Jleatth  and 
Mdrine-IIoKpitul  Service — Contiinu'd. 

DKCKiMHER  '20,  1903,  TO  JUNE  24,  1904— Con limicd. 


Plai-e. 


Date. 


Cases. 


Deaths. 


Remarks. 


Minnesota— CoiitiiHii'd. 

Popi-  (.'ounty 

Ramsey  County 

Redwood  County 

Renville  County 

Riee  County 

Roseau  County 

St.  Louis  County 

Scott  County 

Sherburne  County 

Sibley  County 

Stearns  County 

Steele  County 

Stevens  County 

Swift  County 

Todd  County 

Wabasha  County 

Wadena  County 

Washington  County 

Wilkin  County 

Winona  County 

Wright  County. 

Yellow  Medicine  County 

Cases  not  previously  reported 
in  Hennepin  County. 

Cases  not  previously  reported 
in  Kandiyohi  County. 

Old  cases  not  reported  previ- 
ously in  Stearns  County. 

Total  for  State 


Mar.  15-May  16.. 
Dec.  29-May  28  .. 
•Ian.  19-Jinu'  tl... 
Jan.  l".i-.\pr.  is  .. 
Jan.  19-Mav  30  .. 

Jan.  12-18 

Jan.l2-May  9 

Mar.  15-May  16.. 

May3-16 

Feb.  9-15 

Dec.  15-June  13.. 

Jan.  5-18 

Mar.  15-Mav9... 
Jau.26-Mayl6... 
Dec.  15-June  13.. 
Jan.26-Apr.  18... 
Jan.l2-Apr.  25... 
Dee.  2.i-May  30.. 
Jan.  5-Apr.  25  ... 
Apr.  26-June  6... 
Mar.  1-June  13  .. 
May  16-23 


Missouri: 
St.  Louis  . 


Dee.  20-June  11.. 


Total  for  State  , 


Montana: 
Butte  .. 
Helena. 


Jan.l-Feb.  29... 
Jan.  1-31 


Total  for  State 


Nebraska: 
Omaha . 


Dec.  20-June  11 . 


Total  for  State 


New  Hampshire; 
Manchester  . 
Nashua 


Dec.  13-June  17 , 
Jan.  3-23 


Total  for  State  . 


New  Jersey: 

Camden 

Jersey  City . 

Newark 

Plainfield . . 
Trenton 


Dec  27-Apr.30.. 

Mar.  21-27 

Feb.  1-6 

Jan.  17-23 

Dec.  27- Apr.  23.. 


5 
•12 

0 

9 
10 
10 
13 
17 

2 

i 

237 
2 
3 

29 

158 

27 

3 

23 

18 

10 

16 

1 

11 

13 

11 


1,652 


19 


Total  for  State  . 

New  York: 

BufTalo 

Elmira 

New  York 

Niagara  Falls 

Saratoga  Springs. 

Total  for  State  . 


Dec.  20-June  4  . . 

Feb.  7-13 

Dec.  20-June  11. 
Feb.  14-Apr.  12. . 
Dec.  1-31 


North  Carolina: 

Alamance  County. 
Anson  County  .... 

Bladen  County 

Buncombe  County 
Cabarrus  County.". 
Chowan  County. . . 


Jan.  1-31. 

do... 

do... 

do... 

do... 

do... 


Imported. 
Do. 


94 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Sriialljiux  in  the  United  Stales  <ik  re/xiHed  to  the  Sur<jeon-G'eiier(d,  Public  Health  and 
Marine-Hospital  Service — Continued . 

DECEMBER  26,  1903,  TO  JUNE  24, 1904— Continued. 


Place. 


North  Carolina — Continued. 

Cleveland  County 

Cumberland  County 

Davidson  County 

Davie  County 

Durham  County 

Edgecombe  County 

Forsyth  County 

Gaston  County 

Guilford  County 

Harnett  County 

Henderson  County 

Iredell  County 

Jafkson  County 

Johnston  County 

Macon  County 

Madison  County 

Mecklenburg  County  (t:harlotte 
included). 

New  Hanover  County  (Wilming- 
ton included). 

Orange  County 

Perquimans  County 

Pitt  County 

Richmond  County 

Robeson  County 

Rockingham  County 

Scotland  County 

Stanly  County 

Union  County 

Vance  County 

W^ke  County 

Wayne  County 

Wi I kcs  County 

Wilson  County 

Vancey  County 


Total  for  State  , 


North  Dakota: 

Barnes  County 

Cass  (.'ounty . ." 

(;avalier  County 

Eddy  County 

Emmons  County 

Foster  County , 

Grand  Forks  County, 

Griggs  County , 

McHenry  County 

McLean  County 

Ransom  County 

Richland  County 

Rolette  County 

Stark  County 

Stutsman  County 

Towner  County  '. 

Traill  County 

Walsh  Coun  ty 

Ward  County 

Wells  County 

Williams  County 


Total  for  State 


Oliio: 

Allen  County 

Ashland  County 

Ashtabula  County 

Athens  County 

Auglaize  County 

Belmont  County 

Butler  County 

Carroll  County 

Champaign  County . . . 

Clark  County 

Clermont  County 

Columbiana  County  . 

Coshocton  County 

Crawford  County 


Date. 


Jan 


.1-31 

do , 

do 

do 

do 

do 

do 

do 

do 

do 

do 

do 

do 

do 

do 

do 

.  l-Apr.3U. 


Jan 

Jan.  1-Mar.  s 

Jan 


Cases. 


.  1-31 . 
.do... 
-do... 
.do... 
.do... 
.do... 
-do... 
.do... 
.do... 
.do... 
.do... 
.do... 
.do... 
.do... 
-do... 


Dec.  1- 
Nov.l 
Dec.  1- 
Dec.  1- 
Feb.  1- 
Apr.  1 
Nov.l 
Dec.  1 
Feb.  1 
Jan.l- 
Nov.  1 
Feb.l 
Nov.l 
Feb.l 
Dec.  1- 
Nov.  1 
Dec.l- 
Dec.  1- 
Dec.  1- 
Nov.  1 
Dec.  1- 


•Apr.30.. 
-Apr.  30  . 
•Apr.  30.. 

•31 

-29 

-30 

-Dec.  31  . 

31 

■Apr.  30.. 
Feb.  29.. 
■Apr.  30  . 
Mar.  31  . 
-Apr.  30  . 
Apr.  30.. 
•Apr.  30.. 
-Mar.  31 . 
•Apr.  30.. 
Mar.  31 . . 
Apr.  30.. 
-Feb.  29  . 
Mar.  31.. 


Aug.8-Apr.9  .. 
Jan.l-Apr.  9... 
Aug.  8-Apr.  9  . . 

do 

do 

......do 

Aug.  8-May  14  . 
Aug.8-Apr.9  .. 

do 

Jan.l-Apr.  9... 

do 

Aug.8-Apr.9  .. 

do 

Aug.  8-May  28. 


30 
1 

12 
112 
40 
25 
30 
34 
19 
4 
1 
60 
66 
85 


Deaths. 


Remarks. 


Present. 
Do. 


Do. 


I 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


95 


Smallpox  in  the   I  ■ailed  StutrH  (ts  irporlol  to  tlic  Surgeon- General,  I'uhiic  Ileallh  and 
Marine- Hospital  Service — Continued. 

DECEMBKK  26,  1903,  TO  JUNE  24,  1901— Continued. 


Place. 


Oliio — Continiiod. 

('iiyalidKii  County 

Diiikc  County , 

Dcliiuiirc  County 

Kne  County 

Fairliclil  County 

Franklin  County 

Gallia  ('ounty , 

(TruiMK'  County , 

Guernsey  County 

llaiuilion  County 

Hancock  County 

Hardin  County 

Harrison  County 

Hocking  County 

Holnu's  County 

.lackson  Comity , 

•letVcrson  County 

Knox  County 

Lake  County 

Lnwroncc  County 

Licking  County 

Lorain  County 

Lucas  County 

Madison  t'ounty 

Mahoning  County  . . . 

Marion  C^ounty 

Miami  Comity 

Montgomery  County. 

Morgan  County 

Morrow  County 

Muskingum  County.. 

Noble  County , 

Ottawa  County 

Paulding  County  . ... 

Perry  County 

Pickaway  County 

Portage  County 

Preble  County 

Putnam  County 

Richland  Couiity 

Ros.s  County 

Scioto  County 

Seneca  County 

Stark  County 

Summit  County. 


Date. 


Trumbull  County 1 do  . 

Tuskarawas  County 

Union  County 

Van  Wert  County 

Vinton  County. ." 

Washington  County 

Wayne  County 

Williams  County 

Wood  County 

Wyandot  County 


Aug.8-May27. 
Aug.8-Dec  2t)  . 

do 

Aug.  8-Apr.  9  .. 

do 

do 

do 

Jan.  l-Apr. 9  ... 
Aug.  8-A{>r.  9  .. 
Aug.  8-Junc  17. 
Aug.  8-Apr.9  .. 
Jan.  1-Apr.  9... 
Aug.8-Apr.9  .. 
Jan.l-Apr.  9... 

do 

Aug.8-Apr.  9  .. 

do 

Aug.  8-Dcc.  26  . 

do 

Aug.8-Apr.  9  .. 

do 

do 

Aug.S-Juue  11. 
Jan.  1-Apr.  9  . . . 
Aug.  8-Apr.  9  .. 

do 

do 

Aug.8-JuiielS. 
Jan.  1-Apr.  9.. . 
Aug.  8-Apr.  9  .. 
Aug.  8-May  7  .. 
Jan.l-Apr.  9... 
Aug.  8-Apr.  9  .. 
Aug.  8-Dec  26  . 
Aug.  8-Apr.  9  .. 
Jan.l-Apr.  9... 
Aug.  8-Apr.  9  .. 
Jan.l-Apr.  9. .. 
Aug.  8-Apr.  9  .. 

do 

Jan.l-Apr. 9. .. 
Aug.  8-Apr.  9  .. 
Aug.  8-Dec.  26  . 
Aug.  8-Apr.  9  . . 
do 


Total  for  State 


Pennsylvania: 

Allegheny  County 


Beaver  County 

Berks  County 

Blair  County 

Bradford  County. . 

Bucks  County 

Butler  County 

Cambria  County . . 
Clearfield  County. 
Columbia  County. 


.do 

do 

Jan.l-Apr.  9... 
Aug.  8-.\pr.  9  . . 

do 

do 

Jan.l-Apr.  9... 
Aug.  8-Dec.  26  . 
Aug.  8-Apr.  9  . . 


Dec.l3-June  11. 


Dec.  1 
Dec.  1 
Dec.l 
Dec.  1-, 

do 

Feb.  1- 
Dec.  1- 
Dec.  1-, 
do 


Jan.  31.. 
■Mar.  4  .. 
June  18. 
Jan.  31.. 


Apr.  30.. 
June  4.. 
Jan.  31.. 


-30 

Jan.  31. 


Center  County ! do  . 

Chester  County do  . 

Crawford  County Apr.  17 

Cumberland  County Dec.  1- 

Dauphin  County do 

Delaware  County do 

Erie  County Dec.  1-Apr.  2 . . 

Fayette  County Dec.  1-Jan.  31 . 


Cases. 


r>.i 
I 

13 
17 

9 
171 
71 

1 

132 

21.') 

31 

1 
26 
81 
44 
31 
CO 

1 

1 

242 

49 

4 
14 

1 

239 

258 

32 

239 

2 

9 
35 

4 
15 

2 
71 

1 

6 

4 
45 
27 

4 
20 

1 
144 
41 
44 
35 
30 
12 
13 
76 

9 
30 
31 
18 


3,  292 


111 
28 


Deaths. 


Remarks. 


Thirteen    cases  imported 
at  Pittsburg. 


Five  ca.ses  imported. 
Two  cases  imported. 


96 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Smallpux  in  tJte   Uiiiled  Slates  as  reported  to  the  Suryeon-Uetieral,  Public  Health  and 
Marine-Hospital  Service — Continued. 

DECEMBER  26,  1903,  TO  JUNE  24,  1904— Continued. 


Place. 


Date. 


Cases. 


Pennsylvania — Continued. 

Greene  County 

Indiana  County 

.Jefferson  County 

Lackawanna  County 

Lancaster  County 

Lebanon  County  

Lehigh  County 

Luzerne  County 

Lycoming  County 

Monroe  County 

Montgomory  County 

Northampton  County 

Northumberland  County 

Perry  County 

Philadelphia  County 

Schuylkill  County 

Somerset  County 

Susquehanna  Comity 

Warren  County 

Washington  County 

Wayne  County 

Westmoreland  Countv. . . 


Dec.l-Jan.31 .... 

do , 

do , 

Dec.l-Mar.31..., 

Dec.  1-Jaii.31 

do 

Dec.  l-Apr.23.... 
Dec.  1-Jan.31  .... 

.Tan.3-Apr.  23 

Dec.  1-Jan.31 

Dec.l-Mavl4.... 
Dec.  1-Jaii.31.... 

do 

do 

Dec.  20-Junel8.. 

Dec.l-Jan.31 

do 

do 

Jan.  l-Jan.31 

Dec.  1-Jan.31.... 

do 

do 


10 
8 

12 
1 

11 

120 

4 

16 


Deaths. 


Total  for  State  . 


South  Carolina: 
Charleston . . 
Georgetown. 
Greenville .. 


Dec.20-June4.. 

Mar.27 

Feb.21-June4.. 


Total  for  State  . 


Tennes-sce: 
Memphis., 
Nashville  . 


Dec.  13-June  11..'        433 
Dec.  27-Junc  18  . .         1-56 


Total  for  State  . 


Texas: 

San  Antonio  . 


Dec.l-MavSl.... 


Total  for  State 

Utah: 

Ogden  

Salt  Lake  Citv  .. 


Jan.l-Mar.31.... 
Dcc.27-Mav2S... 


Total  for  State . 

Virginia: 

Dunvilk- 

Pocahontas 


Feb.  7-13 

Jan.l-May  31.. 


Total  for  State . 


Wa.shington: 

.\dams  County 

Chchalis  County 

Chelan  County." 

Clallam  County 

Clarke  County 

Columbia  County 

Franklin  County 

Jefferson  County  (Port  Town- 
send). 

King  County  (.Seattle  included) , 

Kittitas  County 

Klickitat  County 

Lewis  County 

Lincoln  County 

Mason  County 

Pacific  County 

Pierce  County  (Tacoma  in- 
cluded). 

Skagit  County 

Spokane  County  (Spokane  in- 
cluded.) 

Thurston  Countv 


Dec.  l-Apr.  30. 

Dec.  1-31 

Mar.  1-Apr.  30 

Mar.  1-31 

Feb.  1-29 

Jan.l-:^1 

Mar.  1-31 

Apr.l2 


Dec.  1-Apr.  13. 

Dec.1-31 

Dec.  1-Apr.  30. 

Feb.  1-29 

Dec.  1-Apr.  30. 

Mar.  1-31 

Jan.l-Feb.29. 
Feb.  1-June  6 . 


Feb.  1-29 

Dec.  1-Apr.  30. 


5S9 


9 
23.5 

1 

3 
1 

921 
16 

225 

9 

2 

10 
18 

3 

92 

43 

2.130 

282 

49 
1 

4 

42 

I 

I 


Three  imported. 


3  

19  

22  

2  

23       5 

25  !      5 

6'  

3  i 

Feb.  1-29. 


PUBLIC    HEALTH    AND    MAlilNK-HOSPlTAL    HERVICK. 


1)7 


jSlmall])o.r   i»  the    United  Stales  ax  irporled  to  the  Suryeon-fJenerul,  I'ublic  HeaUh  ami 
Marine-IIosfpital  Service — Continued. 

DECEMBER  26,  1903,  TO  JUNE  24,  1904— Continued. 


riacc. 

Dato. 

Cases. 

Deaths. 

RcmarlcH. 

Wnshinston— Continued. 

Wallawnllii  County 

ncc.l-.Ian.31  .... 

l)ec.l-Fcb.29 

I)ec.l-Mar.31.... 
Jan.  1-Apr.  30 

9 

18 

4 

10 

Total  for  State 

186                  3 

Apr.4-Mayl3 

West  Virginia: 

20  I                1 

Total  for  State 

20                   1 

Dec.l3-Junell.. 

Wisconsin: 

206 

Total  for  State 

206 

11, 367 

512 

FOREIGN    AND    INSULAR. 


During  the  year  ended  June  30,  1904,  smallpox  was  reported  in  39 
countries  and  islands  outside  of  the  United  States,  as  may  be  seen  in 
the  two  tables  given  below — one  for  each  half  year.  The  deaths  from 
smallpox  amount  to  5,266,  of  which  4,452  occurred  in  nine  countries 
as  follows:  Brazil,  1,525;  Turkey,  892;  India,  580;  Russia,  436;  France, 
320;  Mexico,  229;  Great  Britain,  185;  Belgium,  147,  and  Spain,  138. 

It  is  interesting  to  note  that  only  one  of  these  CK)untries,  Brazil, 
reported  as  many  deaths  from  smallpox  as  the  United  States,  namely, 
1,525,  as  compared  with  1,118. 

Smallpox  as  reported  to  the  Surgeon-General,  Public  Health  and  Marine-Hospital  Service. 

JUNE  27,  1903,  TO  DECEMBER  25,  1903. 

[Reports  received  by  the  Surgeon-General,  Public  Health  and  Marine-Hospital  Service,  from  United 
States  consuls  through  the  Department  of  State  and  from  other  sources.] 


Place. 


Da,te. 


Cases.     Deaths. 


Remark.s. 


Argentina: 

Buenos  Ayres.. 
Austria-Hungary: 

Prague 

Belgium: 

Antwerp 

Brussels 

Ghent 

Liege 

Brazil: 

Pernambueo  .. 

Rio  de  Janeiro. 
British  Guiana: 

Demerara 


Canada: 

British  Columbia,  Vancou- 
ver. 

Cape  Breton,  Sydney 

Manitoba,  Winnipeg 

New  Brunswick,  Lans- 
downe. 

Ontario 

Quebec 

Canary  Islands; 

Las  Palmas 


May  1-Sept.  30., 
Mav  31-Nov.  28  . 


do 

June  6-Nov.  14.. 
Mavl6-Julv4.. 
May  23-Sept.  5. . 


June3-Oct.31  .. 
May  17-Nov.  15  . 


Aug.  29-Sept.  26. 


Aug.  1-Aug.  31 . . 


Oct.8 

July  12-Nov.  14 . 
Aug.28 


May  1-Oct.  31... 
Sept.28-Oct.3... 

May  16-June  13. 


114 
33 


613 


114 
1 


14 

44 

7 

3 

123 

425 


Feb.  10-Sept.  26,  1,475  cases,  6 
deaths. 


Imported. 


8629—04- 


98 


rUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Smallpox  as  reported  to  the  Surgeon- General,  Public  Health  and  Marme-HospUal 

Service — Continued. 

JUNE  27,  1903,  TO  DECEMBER  25,  1903— Continued. 


Place. 

Date. 

Cases. 

Deaths. 

Remarks. 

Chile: 

May  1-Oct.  31 

96 

5 
6 

15 
11 

1 

China: 

May  2-Oct.  3 

Mav  9-Aug.  15  . . . 

16 

Colombia: 

Aug.  10-Nov.  29  . . 

June9-Sept.l5... 

Sept.3-Sept.l7... 
Sept.  9 

65 

2 

1 

1 

Costa  Rica: 

On  ss.  Altai,  from  Savanilla. 

Cuba: 

Sept.  30 

On    a   steamer    from    Trujillo 

Ecuador: 

Julv5-Nov.2S... 

5 

Honduras. 

Apr.  1-Aug.  31  . . . 
Nov.  l.T-Nov.  21 . . 

8 

France: 

1 

127 

15 

8 

1 

May  1-Nov.  30  . . . 

Paris 

Aug.  2-NOV.28... 
Aug.  l-0ct.31 

25 

Germany: 

Aug.  1 

1 
13 

60 
172 
3 
28 
46 
15 
1 

99 

145 

1 

204 

188 

75 

111 

32 

15 

2 

4 

1 

5 

1 

3 

On  88.  Bremen. 

Kehl 

Mayl-May31.... 

June  6-Dec.  5  — 
June6-Oct.24  ... 
June6-Oct.3  .... 

May  2-June6 

Juiie  6-Sept.  5 

June6-Sept.l2... 
Julv  4-Julv  11 . . . 
Sept.  19-Dec. 4  ... 
June6-Oct.24.... 

Oct.4-Oct.l0 

June6-Oct.24.... 
Junel4-Nov.28.. 
June  6-NOV.28... 

Great  Britain  and  Ireland: 

Birmingham 

Bradford 

2 
9 

Cardiff 

Dublin 

8 

Glasgow 

10 
5 

Leith 

Liverpool 

25 

London  

Manchester 

6 
8 
1 

Nottingham 

May23-Nov.28.. 
May  31-Oct.24... 
June  14-Dec.  5... 
Aug.9-Oct.24.... 
June6-Aug.  15... 
Junel4-Aug.22.. 

Oct.  4-Oct.  10.... 

Sept.l-Sept.30... 

Mayl9-Nov.24... 

Sheffield 

Southampton 

South  Shields  . .     . 

From  ss.  St.  Paul  from  New  York. 

Sunderland 

West  Hartlepool 

Greece: 

Athens 

1 

Hawaiian  Islands: 

2 

194 
13 

India: 

Bombay 

Calcutta 

Mav  3-Sept.  12... 

Mav  25- June  7... 
Mav  23-June  19.. 

4 

2 
17 

Italy: 

Aug  21-Dec.  3 

June  1-June  30 . . 
Oct.l8-Nov.21... 
Mav  24-Mav  30  . . 

1 
3 

1 
1 

Japan: 

Kobe 

Nagasaki 

May  23-June  30. . 
June  11-June  20 . 
Jan.l-Sept.l9  ... 

Sept.28-Nov.7... 
Oct.4-Nov.l4.... 
Oct.  4 

5 

1 
2 

98 
10 

Java: 

Batavia 

Malta 

27 
2 

Present. 

Mexico: 

June  20-June  27  . 

Oct.ll-Oct.24  ... 

June  7-Nov.  29.'. . 

1  Dec.  10 

1 

3 

161 

1 

1 ioi" 

4- 

2 

!              19 

Merida 

Monclova 

Tampico 

Veracruz 

Julvl2-Nov.23.. 

Julyll-Sept.5... 

July  25-Nov.  14  . . 

Aug.  1-Sept.  30 . . . 
Apr.  11-Oct.  24  . . . 

5 

23 

i:> 
77 

1  One  case  from  vessel  from  Tarn 

Netherlands: 

Amsterdam 

Philippine  Islands: 

Cebu 

Manila 

pico. 

PUBLIC    HEALTH    AND    MAKINE-UUSITI'AL    SEliVICE. 


99 


Smallpo.r  as  reported  to  the  Surgeon- Gene  ml,  J'lihlic  Jleo/tlt  atid  Murine-IIoHpital 

Service — Conti  nued . 

JUNE  27,  1903,  TO  DECEMBER  26,  1903— Continued. 


Place. 


Porto  Rico: 

Sun  Juan 

Kiissiti: 

Moscow 

Odessa 

KiRiv 

St.  I'etor.sburK  . 

Warsaw    

Spain: 

Barcelona 

("adiz 

("orunna 

Straits  Si'ttlcments: 

Singapore 

Switzerland: 

Geneva 

Zurich 

Turkey: 

Constantinople 

Smyrna 

Uruguay: 

Montevideo  ... 
Venezuela: 

Barquisimeto.. 

Bolivar 

Caracas 

El  Coro 

San  Felipe 

La  Pascua 

Maturin 

I'uerto  Cabello 

Qtiibor 

Tocuyo 

Yaritagua 


Date. 


Sept. 9-Oct.  31  ... 

Mav23-Nov.21  .. 
July  26-NOV.21  .. 
Apr.  1-Jun(!  30... 
Mav31-Nov.21  .. 
May  16-N0V.21  .. 


July  22-NOV.7  ... 
May  1-May  31  ... 
Nov.  22-Nov.  28  . . 


July  12-Aug.22.. 

Aug.  16-Aug.22.. 
June  6-June  13  .. 

June  14-NOV.29.. 
May  25-Nov.  22  . . 


Cases. 


Junol-Sept.5  . 

June  1-Julv  31. 

Oct.5 "..... 

Aug.  28 

Aug.  10 

Oct.  14 

Aug.l 

Aug.17 

Aug.  28 

June  1-July  31. 

Oct.  16 

Sept.  22 


Deaths. 


134 
606 


Remarks. 


On  board  ss.  Grangeworth. 


Present. 

Do. 
Smallpox  prevalent. 
Present. 

Do. 

Do. 

Do. 
Smallpox  prevalent. 
Present. 
Smallpox  prevalent. 

Do. 


DECEMBER  26,  1903,  TO  JUNE  24,  1904. 


Africa: 

Cape  Tovi'n 

Green  and  Sea  Point 

Argentina: 

Buenos  Ayre.s 

Austria-Hungary: 

Prague 

Trieste 

Belgium: 

Antwerp 

Brussels 

Liege 

Brazil: 

Bahia 

Campininhas 

Pernambuco 

Rio  de  Janeiro 

British  Guiana: 

Demerara 

Canada: 

British  Columbia  (Tower 
Hill  and  Vancouver). 

Manitoba  (Winnipeg) 

New  Brunsvvick(McAdam 
Newcastle). 

Nova  Scotia  (Sydney) 

Ontario 

Quebec  

Chile: 

Antofagasta 

Santiago 

China: 

Hongkong 

Shanghai 

Tientsin 

Colombia: 

Barranquilla 

Cuba: 

Habana  


Dec.l-Mar.l.'S.... 
Nov.29-Dec.  5 


Oct.  1-Mar.  31 . 


Nov.29-May  28  .. 
Nov.  22-Mar.  5  . . . 

Jan.ll-Mav  14... 
Jan.  31-Mav  14. . . 
Jan.lO-Mar.  19... 


Feb.13-Apr.23... 
Feb.l6-Apr.l7... 
Nov.  1-Apr.  15  . . . 
Nov.  16-May  1 . . . 

Nov.  1-Dec.  26  . . . 

Dec.  1-May  31 

Mar. 27-June  4... 
Jan.  9-21 


Apr.l0-May21  . 
Dec.  1-Jan.31... 
Feb.7-Mar.l9  .. 

Nov.  1-Dec.  31  .. 
Feb.l 


Dec.27-Mar.26... 
Nov.  15- May  7  ... 


Jan.31-Feb.6.. 
Dec.  1-May  28  . 
June  5 


4 

"i,"i24' 

73 

22 

11 


73 
116 
14 


239 
1 


269 
698 


4 
167 


Epidemic. 


One  case  on  ss.  Shimosa  from 
Yokohama. 


On  ss.  La  Navarre  from  St.  Na- 
zaire. 


100 


PUBLIC    HEALTH    AND    MAEINE-HOSPITAL    SERVICE. 


Smallpox  as  reported  to  Ihe  Surgeon-General,  Public  Health  and  Marine- IlospUal 

Service — Continued. 


DECEMBER  26,  1903,  TO  JUNE  24,  1904— Continued. 


Place. 

Date. 

Cases. 

Deaths. 

Remarks. 

Jan.l-Mar.31 

Feb.7-Mayl4 

16 

France: 

5 
103 

Dec.  1-Apr.30 

Jan.  1-31 

2 

472 

1 

Nov.  29-June  4... 

Feb.8-Mayl 

Feb.  1-29 

56 
1 

4 

Germany: 

Apr.  23-29 

Jan.l-Dec.  31 

4 

On  ss.  Wittikind, 

2 

May23-29 

Dec.6-June4 

Nov. 22- June  4... 

May  8-June  4 

Mar.l.S-May21.. 
Mar.  13-June  4... 
Dec.  13-June  4... 
Dec.5-Junel0... 
Jan.  17-June  4 ... 
Dec.27-May21... 
Jan.lO-May  14... 
Dec.  13-June  4 . . . 

Nov. 29-June  4... 
Mar.27-June4... 

Dec.  5-June  4 

Nov. 29-June  4... 
Dec.27-May21... 

Dec.27-Apr.9 

Jan.3-May  21 

Jan.3-Feb.6 

Feb.  4 

1 

9 
17 
8 
7 
9 
139 
887 
63 
26 
26 
16 

298 
64 
142 
217 
37 
7 
58 
17 

1 

Great  Britain: 

1 

Bradford 

Cardiff 

1 

11 

63 
2 

Hull 

Leith 

2 
1 

3 

6 
4 
10 

1 
1 
2 
2 

Three  cases  1  death  from  ss.  In- 

dore  from  Baltimore. 

SheflBeld 

Southampton  . .          

Sunderland 

Hawaii: 

From  U.  S.  a.  t.  Logan. 

India: 

Bombay 

Nov.  25-Mav  24  . . 

320 
25 
26 

8 

Dec.27-May21... 

Karachi 

Dec.21-May22... 
Dec.4-May  12 

118 

Italy: 

Catania 

Leghorn 

Apr.  11-17 

Dec.  12-18        

1 

1 

Milan 

Jan.l-Feb.29.... 
Jan.lO-May  14... 

Feb  23        .     ... 

6 
9 

15 
3 
3 

Palermo 

Japan: 

Amakusa 

Apr.  3-16 

Feb.  15 

From  Ger.  ss.  Batavia  from  Vlad- 

Mogi  

Apr.  9 

ivostok. 
Present. 

Fukuoka  Ken 

To  May  9 

Feb.ll-May20... 

Apr.  9 

45 
576 

Nagasaki  Ken 

99 

One  case  from  Br.  ss.  Kwang 

Sasebo 

Ping  from  Tsin-hvran-tao. 
Present. 

Jan.l-Dec.31,1903 
Feb  1-27 

2 
3 

174 
25 

Do 

Java: 

Batavia 

Nov.15-Apr.23.. 
Dec.  6- Apr.  2 

Mar.  9 

42 
5 

Mexico: 

Do. 

do 

8 

118 

1 

Mexico 

Dec.  28-June  5 . . . 
Jan. 9  

67 

Porfirio  Diaz 

Jan.ll-Mayl4... 

15 

m 

8 
1 
3 

2 
14 

Torreon .' 

Feb.24-May28... 
Dec.  19-June  4  . . . 

Dec.20-May21... 
Dec.6-May28.... 

144 

8 

40 
16 

One  case  ss.  Prince  August  Wil 

Netherlands: 

Amsterdam 

helm  from  Havre.    One  case 
imported. 

Rotterdam 

Philippine  Islands: 

Cebu 

Jan.l-Mar.31 

Nov.  15-May  7  . . . 

Dec.l-Mar.8  — 

6 
31 

9 

Manila 

Porto  Rico: 

San  Juan 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


101 


SmalljM.r  <is  reported  to  the  Surgeon- General,  Public  ffealth  mid  Marine- Hospital 

Service — Continued . 


DECEMBER  26,  1903,  TO  JUNE  '24,  1904— Continued. 


Place. 

Date. 

Cases. 

Deaths. 

Remsirks. 

Russia: 

Moscow 

Nov.  22-May  28  . . 
Nov.  29-May  28  . . 
do 

148 

32 

407 

62 

6 

73 

101 

97 

Nov.  8-May  7 

Spain: 

Jan.  10-May  20... 

To  Dec.  15 

Dec.9-Apr.J 

Fcb.21-Apr.  16... 

35,000 
51 

15 
3 
2 

Straits  Settlement^: 

Turkey: 

Alexandretta 

Mar.  6-May  21 . . . 
Apr.  .5-30 

17 

Beirut 

Jan.  18-May  29... 

99 
51 

3 

Nov.  23-May  1  . . . 

Uruguay: 

Sept.6-Feb.29... 

12 

Respectfully  submitted. 


To  the  Surgeon-General. 


George  Tully  Vaughan, 

Assistant  Surgeon- General. 


DIVISION  OF  FOREIGN  AND  INSULAR 
QUARANTINE. 

(EMBRACING   MEDICAL    INSPECTION    OF    IMMIGRANTS.) 


103 


REPORT  OF  THE  DIVISION  OF  FOREIGN  AND  INSULAR  QUARAN- 
TINE (EMBRACING  MEDICAL  INSPECTION  OF  IMMIGRANTS). 

By  W.  J.  Pettus, 
Assistant  Surgeon  General,  Public  Health  and  Marine- Hospital  Service,  in  charge. 

Sir:  1  have  the  honor  to  submit  the  following  report  of  the  trans- 
actions of  the  division  of  foreign  and  insular  quarantine  and  immigra- 
tion for  the  fiscal  year  ended  June  30,  1904: 

Cuba. 

no  yellow  fever. 

As  during  the  preceding  year,  not  a  single  case  of  yellow  fever  has 
been  reported  as  originating  on  the  island  during  the  fiscal  j^ear, 
though  eight  cases  were  removed  from  vessels  coming  from  Mexican 
and  South  American  ports,  and  sent  to  Las  Animas  hospital  for 
treatment. 

PERSONAL   HEALTH    CERTIFICATES   TO    BE    GIVEN*  AT    HABANA   ONLY   ON 
REQUEST   OF    STEAMSHIP   COMPANY. 

Referring  to  the  correspondence  between  this  Bureau  and  Acting 
Assistant  Surgeon  Echemendia  at  Habana,  Cuba,  relative  to  the  issu- 
ance of  health  certificates  to  passengers  from  ports  infected  with  yel- 
low fever  via  Cuban  ports  to  Gulf  ports  of  the  United  States,  in  Public 
Health  Report  of  April  29,  1904,  page  798,  it  was  found  to  be  \qtj 
detrimental  to  the  interests  of  the  steamship  lines  ph'ing  between 
Habana  and  the  Gulf  ports,  since  passengers  for  other  southern  ports 
were  not  required  to  have  these  certificates.  For  these  reasons,  and 
on  account  of  the  very  excellent  Cuban  quarantine  regulations, 
explained  in  the  correspondence  above  referred  to,  the  following  tele- 
gram was  sent  to  the  medical  officer  at  Habana: 

Washington,  May  21,  1904- 
Acting  Asst.  Surg.  D.  M.  Echemendia, 

Habana,  Cuba: 
Cease  gi\'ing  personal  health  certificates,  unless  specially  requested,  for  each  indi- 
vidual case  by  steamship  company. 

Wyman. 

HABANA. 

Report  of  Acting  Asst.  Surg.  D.  M.  Echemendia,  in  Temporary  Charge. 

PcBLic  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Habana,  Cuba,  July  11,  1904. 
Sir:  I  have  the  honor  to  submit  the  following  report  of  the  transactions  at  this 
port  for  the  fiscal  year  ended  June  30,  1904: 

The  work  of  the  Service  continues  under  the  same  rules  as  last  year,  and  it  has 
been  conducted  without  any  variation,  except  that  the  certificates  and  inspection  of 

105 


106  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

the  baggage  for  Florida  were  discontinued,  and  no  restriction  whatever  remains  for 
the  traffic  between  jxirts  of  Cuba  and  those  of  the  Uniterl  States,  only  the  inspection 
of  vessels,  passengers,  and  crew. 

Asst.  Surg.  F.  E.  Trotter,  who  was  in  temporary  command  since  the  past  year,  was 
relieved  on  the  2d  of  January  l>y  Passed  Asst.  Surg.  Jose{)h  B.  Greene,  who  was  in 
charge  twenty-three  days  only,  as  he  had  to  leave  on  account  of  liis  ill  health,  and  I 
have  been  in  temporary  charge  ever  since. 

The  steamship  Sanatnr,  which  was  recently  repaired,  is  now  in  good  condition  to 
do  service  in  the  harbor  for  some  years,  but  she  is  not  in  condition  for  sea  voyages. 

On  tlie  Lst  of  February  the  Cuban  quarantine  service  was  transferred  from  the 
department  of  government  to  the  department  of  finance. 

The  quarantine  service  of  Cuba  was  originally  placed  under  the  department  of 
finance  by  General  Wood  l)y  military  order  No.  122,  dated  April  2,  1902.  A  few 
weeks  after  the  withdrawal  of  the  American  force  from  Cuba  the  quarantine  service 
was  taken  from  the  department  of  finance  and  placed  under  the  department  of  gov- 
ernment and  the  service  merged  into  the  superior  sanitary  1  )oard  as  a  dependent.  The 
affairs  of  quarantine  continued  to  be  achninistered  through  the  chief  sanitary  officer, 
Dr.  Charles  J.  Finlay,  until  the  1st  of  Fe))ruary,  when  the  Cuban  Congress  placed  an 
amendment  to  the  appropriation  bill,  declaring  that  the  military  order  No.  122  was 
still  in  force,  and  returned  the  quarantine  service  to  the  department  of  finance, 
thereby  making  it  indeiiendent  of  the  superior  sanitary  board. 

The  service  is  now  reorganized,  with  Dr.  Hugo  R(jl)erts  as  chief  quarantine  officer 
of  the  island  of  Culia.  He  has  been  quarantine  officer  since  August,  having  filled 
his  position  very  satisfactorily. 

Dr.  Felix  Giralt,  who  was  previously  acting  assistant  surgeon  in  the  United  States 
Public  Health  and  Marine-Hospital  Service,  is  now  local  chief  quarantine  officer  of 
this  port,  having  been  appointed  by  General  Wood  ever  since  the  l^eginning  of  the 
organization.  He  is  considered  thoroughly  reliable  in  the  fulfillment  of  his  duties, 
and  adheres  to  the  rules  of  the  United  States  Public  Health  and  Marine-Hospital 
Service,  being  very  strict  and  energetic.  He  is  assisted  by  Doctors  Milanc^s,  Domin- 
guez,  and  Ponce  de  T^eon,  officers  who  have  been  in  the  Service  for  some  time  and 
have  given  proof  of  tlieir  efficiency. 

Our  relations  with  the  Cuban  quarantine  officers  are  of  the  most  cordial  nature; 
they  give  us  information  f)n  anything  pertaining  to  sanitary  matters. 

I  inclose  herewith  list  of  vessels  arrived  at  quarantine  with  yellow  fever  on  board, 
together  with  the  mortuary  report  and  report  of  vessels  inspected. 
Respectfully, 

D.  M.  ECHEMENDIA, 

Acting  Assistant  Surgeon  in  temporary  charge. 
The  Surgeon-General. 


[Inelosures.] 

VESSELS    ARRIVED    WITH     (lUARANTINABLE    DISEASE    ON    BOARD    AND   THOSE    DISINFECTED 

BY    THE   SERVICE. 

J%dy  3,  J 903. — American  steamship  Matanzas  from  Tampico  arrived  on  June  30 
with  1  case  of  yellow  fever,  which  was  transferred  by  the  Cuban  authorities  to  Las 
Animas  Hospital.     Case  recovered. 

July  13,  1903. — American  steamship  Vigilancia  from  Progreso  arrived  the  7th  and  1 
pas.senger  was  landed  as  immune.  Case  developed  at  home  and  was  taken  by  the 
Cuban  authorities  to  Las  Animas  Hospital.     Case  ended  fatally. 

August  5,  1903. — American  steamship  Vigilancia  from  Veracruz  to  New  York. 
One  passenger  in  transit  sent  to  Las  Animas  Hospital  as  suspicious.  Temperature, 
39°  C. 

August  11,  1903. — Norwegian  bark  Endymion  arrived  at  Caibarien,  Cuba,  from 
South  Africa  the  3d  of  August,  with  foul  bill  of  health  and  was  remanded  to  Habana 
for  disinfection,  and  was  disinfected  by  request  of  the  chief  quarantine  officer  of 
Cuba. 

August  11,  1903. — American  steamship  Monterey  from  Veracruz  and  Progreso  landed 
a  second-class  passenger  with  yellow  fever. 

August  14,  1903. — Norwegian  steamship  Nord,  bound  for  Galveston,  was  disinfected 
upon  request  of  agents,  Messrs.  Silveira  &  Co. 

Octobers,  i,90,?.— American  steamship  3fonte?'«/ arrived  from  Progreso;  had  a  case 
of  yellow  fever  which  was  transferred  to  Las  Animas  Hospital. 

October  9,  1903. — German  steamship  Prince  Albert  from  Veracruz.  Two  of  crew 
were  sent  to  Las  Animas  Hospital,  diagnosed  by  the  commission  as  yellow  fever. 


PUBLIC    HEALTH    AND    MARINE  HOSPITAL    SERVICE.  107 

Nuvemher  9,  1903. — Cuban  steamship  Falnma,  from  (iuanta,  Venezuela,  entered  port 
with  1  of  the  crew  ill  with  yellow  fever.  Man  removed  to  \j&s  Animas  Hospital, 
where  he  dietl  shortly  after  entranre. 

April  4,  1904.  —  Britisli  steamship  ll'iVrfrro/y  arrive<l  at  the  port  of  Sagua,  Cuba,  with 
a  man  of  the  <rew  ill  with  a  li^dit  attack  of  yellow  fever.  The  \Vildrroft  arrive*!  at 
this  ])ort  on  tiie  itth  an<l  was  kejit  at  (luarantine. 

Mnii  17,  1!>(>4. — American  steamship  Moiderty  arrived  from  Mexico;  liad  a  cabin 
pa«!«?n'rer  in  transit  to  New  York  ill,  who  was  transferred  to  I^s  Animas  Hospital  as 
suspicious  of  yellow  fi-ver. 

^fnl|  SO,  1904. — American  steamship  Vigllancia  arrived  from  Vera<'ruz  with  a  pas- 
sentier  suspicious  of  yellow  fever,  who  was  taken  by  the  CuV)an  authorities  to  La« 
Animas  Hospital;  was  fouinl  l)y  the  commission  not  to  be  yellow  fever. 

Jutie  5,  1904- — French  steamship  Ln  Navdrre  arrived  the  5th  instant  from  St. 
Xazaire;  was  developed  1  case  of  smallpox  in  one  of  the  passengers  in  transit  to 
Mexico.  The  case  wa><  removed  to  Las  Animas  Hospital,  and  the  steamer  and  bag- 
gage disinfected  by  the  Cuban  authorities.  All  the  passengers  were  revaccinated  and 
^nt  to  Mariel.     The  steanishii)  cleared  for  Mexico. 

June  IS,  1904. — American  steamshij)  Montpreij  arrived  from  Progreso;  had  4  non- 
immune pa«sengers  with  high  fever  of  suspicious  nature.  They  were  taken  by  the 
Cuban  authorities  to  I^as  Animas  Hospital,  where  it  was  found  by  the  commission  t<j 
he  malarial  fever. 

Annual  report  of  transactions  at  Hubana,  Cuba,  for  year  ended  June  SO,  1904. 

Steamers: 

Insjiected  and  passed 944 

Disinfected 1 

Sailing  vessels: 

Inspected  and  passed 256 

Disinfected 1 

Number  of  crews: 

Steamers 48, 156 

Sailing  vessels 2,  225 

Number  of  passengers: 

Steamers 27,  741 

Sailing  vessels 68 

MATANZAS. 

Report  from  Acting  A.s.st.  Scrg.  E.  F.  NuSez. 

Public  Health  and  Marijte-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Matanzas,  Cuba,  July  8,  1904. 

Sir:  I  have  the  honor  to  submit  herewith  an  annual  report  of  the  transactions  at 
this  port  for  the  fiscal  year  ended  June  30,  1904. 

In  carrying  out  the  various  operations  of  this  office  I  have  endeavored  to  follow 
out  a  line  of  conduct  Ijased  upon  a  strict  observance  of  the  quarantine  regulations  of 
the  United  States.  Where  a  vessel  has  left  for  a  port  in  the  United  States  direct, 
the  sanitary  condition  of  the^hip,  cargo,  crew,  and  passengers  have  been  carefully 
ascertained  from  personal  insjjection  on  board,  before  the  bill  of  health  was  granted, 
noting  the  abnormal  conditions  observed,  if  any.  under  the  heading  of  "Remarks." 
In  the  case  of  a  ves-sel  leaving  for  the  United  States  or  its  possessions,  via  foreign 
ports,  the  bill  of  health  was  issued  at  the  office,  after  being  assured  by  the  ship's 
master  or  its  chief  officer  that  the  sanitary  condition  aboard  was  satisfactory. 
When,  on  the  other  hand,  a  vessel  in  quarantine  was  aVjout  to  leave  without  com- 
pleting the  period  of  detention,  a  careful  inspection  was  invariaVjly  made,  prior  to 
granting  the  bill  of  health,  whether  the  vessel  cleared  for  the  United  States  direct 
or  via  foreign  porfe. 

Xo  quarantinable  disease  has  appeared  on  board  of  any  vessel  entering  this  harbor 
or  within  this  district  throughout  the  year  just  ended. 

So  far  the  necessity  of  disinfection  of  vessels  bound  for  the  United  States  has 
not  arisen,  inasmuch  as  Cuba  has  continued  free  from  epidemics  of  quarantinable 
diseases,  and  vessels  bound  for  the  United  States,  originally  from  infected  ports  other 
than  those  with  yellow  fever,  have  been  carefully  disinfected  on  entering  this  port 
and  before  taking  on  their  cargoes,  as  required  by  the  Cuban  quarantine  regulations. 

The  quarantine  service  as  conducted  1\v  the  Cuban  authorities  at  this  port  .«o  far 
has  been  efficient.     Any  suggestions  that  I  have  deemed  proper  to  make  in  behalf 


108  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

of  the  Cuban  service  have  been  welcomed  and  courteously  accepted  and  carried  out 
by  its  officer,  Dr.  Felix  Garcia.  This  service  still  retains  the  same  officer  and  em- 
ployees trained  during  the  American  intervention.  It  may  be  said  that  in  some 
respects  the  Cuban  quarantine  service  is  carried  out  to  the  extreme,  differing  from 
the  nsual  proceedings  of  our  service,  as  drawn  from  scientific  experience  and  obser- 
vation, as  in  the  following  instance:  When  a  vessel  originally  from  a  port  infected 
or  suspicious  of  being  infected  with  yellow  fever  arrives  at  a  Cuban  port  it  is  held  in 
quarantine  indefinitely,  irrespective  of  the  time  elapsed  since  leaving  the  infected 
port,  so  long  as  it  is  not  disinfected.  The  period  of  detention  formerly  was  but  five 
days  from  the  time  of  arrival,  and  free  pratique  was  granted  at  the  expiration  of 
such  time  if  no  quarantinable  disease  had  appeared  on  board.  Fortunately,  the 
vessel  so  detained  is  allowed  to  carry  out  its  operations  of  unloading  and  taking  on 
cargo,  provided  the  stevedores  from  shore,  helping  in  the  work,  are  provided  with 
certificates  of  immunity  to  yellow  fever  issued  by  the  Cuban  quarantine  officer. 

A  quarantine  by  Cuba  in  reference  to  yellow  fever  has  been  in  force  against  Mex- 
ico, the  Central  American  Republics,  "^Colombia,  and  Venezuela  uninterruptedly 
through  the  whole  year,  and  it  is  likely  to  be  so  maintained  indefinitely  until  yello\Y 
fever  ceases  to  be  endemic  in  those  countries. 

The  good  sanitary  work  in  the  city  under  the  charge  of  its  competent  and  efficient 
health  officer.  Dr.  Alberto  Schweyer,  is  bound  to  experience  a  change  for  the  worse 
in  the  near  future. 

The  annual  appropriation  funds  of  $36,000,  which  was  hitherto  allowed  by  the 
treasury  department  of  the  Republic  to  defray  the  expenses  of  this  particular  serv- 
ice in  this  city,  has  been  totally  withdrawn  since  July  1  of  the  present  year.  The 
municipal  council,  having  made  no  provision  in  its  cunnal  budget  for  the  important 
service  of  public  hygiene,  simply  through  carelessness,  has  placed  the  health  officer 
in  very  embarrassing  circumstances  to  solve  the  conflict  in  a  satisfactory  manner. 
The  municipal  council,  after  holding  several  meetings  and  deliberating  at  length  on 
the  new  situation,  in  view  of  the  lack  of  available  funds  to  continue  on  the  work 
and  as  a  last  resource  passed  the  following  resolution,  which  has  since  been  carried 
into  effect,  viz,  to  reduce  the  personnel  belonging  to  the  sanitary  department  and  the 
pay  of  those  remaining  in  so  much  as  to  bring  down  the  total  expenditure»to  $18,000 
a  year.  The  reduction  has  been  carried  to  such  an  extent  that  in  my  opinion  it  has 
rendered  the  service  extremely  deficient.  Not  less  than  42  men,  al^out  two-thirds 
of  the  total  force,  which  was  barely  sufficient  before  to  do  the  work  properly,  has 
been  discharged,  including  the  mosquito  brigades,  the  force  in  (charge  of  the  daily 
irrigations  of  the  streets,  and  that  devoted  to  the  house-to-house  inspection. 

The  outcome  of  all  this  can  readily  be  foreseen  if  the  existing  conditions  are  not 
corrected  in  time. 

The  mortality  of  the  city  of  Matanzas  during  the  fiscal  year  just  ended  shows  an 
increase  of  28  deaths  as  compared  with  that  of  the  previous  year.  It  will  be  noticed 
from  the  comparative  statistics  hereby  submitted  that  the  mortality  since  January, 
1904,  is  still  considerably  greater,  as  compared  with  the  corresponding  months  in 
1903. 

The  statistics  of  contagious  and  infectious  diseases  reported  during  the  year  are  also 
submitted. 

The  following  is  a  summary  of  the  transactions  of  this  office  for  the  period  covered 
by  this  report: 

Bills  of  health  issued 259 

Crew  of  vessels 7,  730 

Passengers 989 

Vessels  disinfected 0 

Total  number  of  deaths 776 

Annual  rate  of  mortality 16. 16 

Estimated  population 48, 000 

Summary  of  contagious  and  infectious  diseases  reported  during  the  year. 

Cases. 

Typhoid  fever 27 

Diphtheria 21 

Scarlet  fever 14 

Dysentery ^ ^ 

Leprosy 4 

Varicella 3 

Measles 2 

Rotheln 1 

Total - 73 


1 


PUBLIC    HP:ALTn     AND    M  AUliNK-lK  )S1>ITAL    SERVIGP:.  109 

My  rclaliniis  witli  tlu-  ("iiltaii  autlioritifs  liavr  been  cunlially  niaiiitaiiH-d;  c'v«!ry 
I'ourti'sy  lias  \)vvn  sliown,  and  facilities  offered  iiie  f(tr  the  operations  of  this  ollice. 
liospectfully, 

E.  F.  Nu5;e/., 
Acting  Assislmd  Surgeon. 
NUEVITAS. 

Rei'ort  of  Actin(!  Asst.  Surg.  E.  F.  McConnell. 

Public  Health  and  Makine-Hospital  Service, 

Office  of  Medical  Offkek  in  Command, 

NuevituH,  Oiiba,  Jubj  24,  IOO4. 
Sir:  I  have  tlie  lionor  to  make  the  following  report  of  the  transactions  of  this  sta- 
tion for  the  fiscal  year  ended  June  HO,  1904: 

No  cases  of  (]narantinal)le  diseases  liave  been  reported.  All  vessels  leaving  this 
port  for  ports  in  the  United  States  have  lieei:  boarded  and  crews  and  passengers 
inspected.  Baggage  going  on  board  vessels  bound  to  ports  on  the  Ciulf  ha.s  Ijeen  flis- 
infected.     I  inclose  reports  of  bills  of  health  issued,  crews  and  passengers  examined. 

Annual  report  of  transactions  at  Nucvitas,  Cuba,  for  the  year  ended  June  30,  1904- 

Steamers  inspected  and  passed 66 

Sailing  vessels  inspected  and  j^assed 31 

Crew  on  steamers 3, 110 

Crew  on  sailing  vessels 262 

Passengers  on  steamers 574 

Respectfully  submitted. 

E.  F,  McCoNNELL, 

Acting  Assistant  Surgeon. 
The  Surgeon-General. 

SANTIAGO. 

Report  op  Acting  Asst.  Surg.  Richard  AVi'.son. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Santiago  de  Cuba,  July  28,  1904. 
Sir:  I  have  the  honor  to  make  the  following  report  for  the  fiscal  year  1903—4: 

Bills  of  health  issued 201 

Crews  inspected 7, 597 

Passengers  inspected 3, 217 

The  main  trouble  with  the  sanitary  department  has  been  the  lack  of  funds.  For- 
merly the  city  used  to  receive  from  the  insular  government  $3,000  a  month  for  sani- 
tary purposes;  this  paid  for  the  personnel  and  the  material.  February  1,  1904,  this 
was  discontinued  in  spite  of  the  energetic  protest  of  the  local  authorities.  Since  this 
time  the  city  has  had  a  hard  struggle  to  clean  the  streets,  remove  the  garbage,  and 
attend  to  other  sanitary  matters.  Although  the  city  property  is  taxed  10  per  cent  of 
its  estimated  net  income  (which  is  the  limit  the  law  allows)  the  city  is  not  able  to 
pay  all  its  expenses,  and,  as  sanitation  had  not  been  provided  for  in  the  estimate  for 
the  fiscal  year  just  finished,  it  had  to  readjust  its  other  expenses,  cutting  them  down 
as  much  as  possible,  also  taking  all  unexpended  balances  remaining  from  other  appro- 
priations. But  all  this  was  not  sufficient.  For  economy's  sake  the  number  of 
employees  of  the  sanitary  department  was  reduced  on  one  or  two  occasions,  but  in 
spite  of  all  the  city  can  not  raise  the  mone}'  to  pay  them.  The  city  now  owes  the 
sanitary  department  and  the  police  the  wages  for  May  and  June  and  Jiily  up  to  date. 
This  was  the  cause  of  a  strike  of  the  sanitary  department  the  beginning  of  this  month, 
which  was  settled  through  the  intervention  of  the  alcalde  and  a  small  payment  on 
account. 

As  a  matter  of  economy  the  city  has  now  only  30  street  sweepers  and  15  drivers 
for  the  garbage  carts,  a  number  insufficient  for  its  needs. 

Condition  of  the  city. — Comparing  the  condition  of  the  city  with  what  it  was  a  j'ear 
ago,  it  is  certainly  worse,  that  is,  the  streets  are  dirtier  and  in  a  worse  condition.  The 
garbage  is  not  removed  as  regularly  or  as  often  as  it  ought  to  be,  etc.  The  city 
authorities  have  done  the  best  they  can,  but  they  have  not  sufficient  funds,  so  the 
work  has  almost  stopped.     This  change  has  been  gradual. 


110 


PUBLIO    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


For  want  of  money  the  streets  are  not  kept  in  repair,  and,  with  a  few  exceptions 
(principally  the  asphalted  streets),  they  are  in  very  bad  condition,  some  of  them 
with  holes  that  make  them  dangerous. 

Mosquito  brigade. — The  mosquito  brigade,  which,  in  my  last  yearly  report,  I  reported 
had  been  organized,  was  very  short  lived.  Early  in  August,  1903,  it  was  abolished 
for  lack  of  funds. 

Contagious  diseases. — In  spite  of  all  these  conditions  and  of  partial  neglect  through 
lack  of  funds  and  reduced  personnel,  the  city  has  remained  healthy  and  free  from 
epidemic  diseases. 

The  only  contagious  diseases  reported  have  been  diphtheria,  varicella,  and  measles. 
The  number  of  each  of  these  reported  has  seldom  exceeded  3  a  month,  and  some 
months  there  have  been  none. 

There  is  a  medical  board  whose  duty  it  is  to  examine  every  case  of  contagious  dis- 
ease reported  and  confirm  or  correct  the  diagnosis. 

The  city  just  now  is  worse  off  for  water  than  it  was  last  year,  for  the  storm  of  June 
13  burst  the  aqueduct  near  the  dam,  and  it  was  repaired  "temporarily  "  by  inserting 
a  piece  of  pipe  of  much  smaller  diameter.  While  this  was  going  on  the  city  was 
without  water  for  three  days.  As  we  are  in  the  rainy  season,  there  is  now  plenty  of 
water,  but  if  this  is  not  properly  fixed  before  next  winter  we  will  certainly  suffer 
from  want  of  water. 

H^MOGLOBINURIC    FEVER   AT   DAIQUIRI. 

On  September  3,  1903,  I  reported  the  existence  of  numerous  cases  of  hsemoglobin- 
uric  fever  occurring  at  Daiquiri,  a  mining  town  al)Out  15  miles  to  the  east  (see  Public 
Health  Reports,  Vol.  XVIII,  No.  38,  p.  1565).  The  report  of  these  cases  reached 
the  press  of  the  United  States  and  the  newspapers  published  a  series  of  sensational 
and  alarming  articles,  which  were  very  annoying  to  people  living  here  or  interested 
in  this  end  of  the  island.  The  Cuban  health  authorities  sent  Dr.  John  Guiteras  to 
Daiquiri  to  investigate.  His  report  v.as  accepted,  that  there  was  no  epidemic  or  con- 
tagious disease — only  a  severe  form  of  malaria.  This  quieted  public  fears,  and  the 
mining  company,  under  the  advice  of  the  health  authorities,  took  some  precautions 
to  try  and  prevent  the  continuance  of  this  fever,  the  principal  one  being  the  empty- 
ing of  a  lagoon  by  means  of  a  steam  pump. 

MORTALITY    STATISTICS. 

The  total  number  of  deaths  in  Santiago  de  Cuba  for  the  fiscal  year  1903-4  was  907; 
besides  this  there  were  103  stillbirths,  making  a  total  of  1,010. 
Respectfully, 

Richard  Wilson, 
Acting  Assistant  Surgeon,  in  charge. 
The  Surgeon-General. 

[Inclosures.] 

Summary  of  work  at  Santiago  de  Cuba  for  the  fiscal  year  1903-4. 


Bills  of  health  issued 

Crews 

Passengers 

Deaths  from  yellow  fever 

Deaths  from  other  contagious  diseases. 

Deaths  from  all  causes  (stillbirths  not 
counted ) 

Cases  of  quarantinable  diseases  re- 
ported in  city 

Cases  of  other  contagious  diseases  re- 
ported in  city 

Certificates  issued  for  shipping  remains 
of  dead  bodies  to  the  United  States. . 


16 

527 

102 

0 

0 

112 
0 

62 
0 


19 

680 

243 

0 

0 

65 
0 

c-9 
0 


13 

454 

227 

0 

0 

60 

0 

d2 

0 


18 

589 

269 

0 

al 

65 

0 


17 

861 

623 

0 

&1 

48 
0 

e& 
0 


461 
0 
0 

63 

0 

/lO 

1 


19 

647 

147 

0 

0 

71 

0 

hi 

0 


18 

626 

309 

0 

0 


14 

459 

214 

0 

0 

112 

0 

0 

0 


a  Leprosy. 
t>  Dipntheria. 

''Measles,  7;  diphtheria,  2. 
d  Measles,  2. 

^Measles,  1;   diphtheria,  1;   varicella,  3;  an- 
thrax, 1. 


/Diphtheria,  2:  varicella,  8. 

ff  Measles,  1;  diphtheria,  2;  varicella,  1. 

^1  Measles,  4;  diphtheria,  3. 

J  Varicella,  1. 


rUHLlC    IIKALTH    AND    MARINK-IIOSl'ITAL    SKKVICE. 


Ill 


tSnimititru  uf  irurk  at  >>im(iu(ju  dc  Cuba  J'ur  the  Jiscal  ytur  l'M3-4 — Continued. 


Bills  of  health  issued 

(^revvs 

I'ussengers 

Deaths  from  yellow  fever 

Deaths  from  otherooiitiiKious  diseases 

Deaths  from  all  causes  (stillbirths  not 
counted ) 

Cases  of  quarantinable  diseases  re- 
ported in  city 

Cases  of  other  contagious  diseases  re- 
ported in  city 

Certitieates  issued  for  shipping  re- 
mains of  dead  bodies  to  the  United 
States 


1903. 


1904. 


1903. 


1904. 


Third 
quarter. 


48 

572 
0 
0 

237 

0 

13 

0 


Fourth      First 
quarter,  quarter. 


48 

1,720 

527 

0 

1 

218 

0 

5 

0 


54 

2,484 

1,448 

0 

1 

181 

1 

20 


Second 
quarter. 


Second  I    First 
semes-     semes- 
ter, ter. 


51  9<5 

1,732  3,381         4, 

670  1,099         2, 

0  0 

0  I  1 

271  455 

0  I  0 

8  i  18 

1  i  0 


105 

210 

118 

0 

1 

452 

1 

28 


Total 
fiscal 
year. 


201 

7, 597 

3,217 

0 

2 

907 

1 

46 


Summarij  of  mortality  statistics,  Santiago  de  Cuba,  Jwcal  year  190S-4. 
[Bertillon  classification.    Estimated  population,  45,500.] 


1903. 

1904. 

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o 

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a 

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53 

3 

I.  General  diseases: 

Intermittent    fever   and     malarial    ca- 
chexia   

8 
16 
3 

27 

2 
2 

4 

8 

12 

5 
4 

9 

3 
3 

6 

34 
4 
3 

41 
0 
3 

44 

1 

2 

3 

11 

7 

1 

19 

1 
0 

1 
6 

7 

5 
4 

9 

1 

2 

3 

9 

4 
2 

15 
2 
2 

19 

1 
0 

1 

13 
8 
5 

26 

1 
0 

1 
4 

5 

5 
0 

5 

0 
4 

4 

3 
0 
0 

3 
4 
1 

8 

2 

1 

3 

8 
13 
3 

24 

1 
0 

1 
5 

6 

5 

1 

6 

3 
2 

5 

^1 
0 

5 
3 
3 

11 

2 
2 

4 

3 

12 
6 

21 

3 
0 

3 
6 

9 

5 

1 

6 

3 
6 

9 

1 
2 

1 

4 
1 
4 

9 

1 
2 

3 

7 

22 

5 

34 

2 
2 

4 
6 

10 

6 
2 

8 

3 

1 

4 

6 
3 
0 

9 
1 

1 

11 

2 
1 

3 

2 

14 

6 

22 

4 
0 

4 
2 

6 

4 
4 

8 

3 
1 

4 

4 
1 

1 

6 
0 

1 

7 

2 
0 

2 

6 

16 

6 

28 

0 
0 

0 
2 

2 

5 

1 

6 

2 
3 

5 

3 
3 
1 

7 
2 

1 

10 

0 
0 

0 

8 
12 
9 

29 

1 
1 

2 
4 

6 

6 
1 

7 

5 
0 

5 

4 

1 
0 

5 
3 
3 

11 

2 
0 

2 

13 

8 
7 

28 

4 
0 

4 
7 

11 

3 
2 

5 

1 
4 

5 

1 
2 
1 

4 
3 
3 

10 

1 
0 

1 

9 
13 
4 

26 

3 
1 

4 
6 

10 

7 
4 

11 

4 

4 

8 

12 
3 
3 

18 

Ov 

3 
21 

0 
2 

Tuberculous  diseases 

7 

7 

Group  total 

?1 

II.  Diseases  of  the  nervous  system  and  organs  of 
special  sense: 
Tetanus  (infantile) 

3 

Tetanus  ( traumatic ) 

0 

3 

Other  diseases  of  the  nervous  system,  etc. 

10 
13 

III.  Diseases  of  the  circulatory  system: 

Organic  diseases  of  the  heart 

6 

Other  diseases  of  the  circulatory  system.. 
Group  total 

2 

8 

IV.  Diseases  of  the  respiratory  system: 

2 

Other  diseases  of  the  respiratory  system.. 

4 
6 

V.  Diseases  of  the  digestive  system: 

Diarrhea  and  enteritis  (under  2  years) ... 
Diarrhea  and  enteritis  (chronic) 

33 
1 

Diarrhea  and  enteritis(2yearsandover),. 
Total  diarrhea  and  enteritis 

2 
.36 

Diseases  of  the  liver 

2 

Other  diseases  of  the  digestive  system 

Group  total 

4 
42 

VI.  Diseases  of  the  genito-urinary  apparatus  and 
its  adnexa: 
Bright's  disease 

0 

Other  diseases  of  this  group .• 

Group  total 

2 
2 

112 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Summary  of  morUtlUii  ulatidict^,  Smiliago  dc  Oitlxi,  Jiscal  year  1903-4 — Continued. 


1903. 

1904. 

1-5 

0 

in 

p. 

0) 

o 
1 

0) 
X! 

a 

^1 
.a 

a 

OJ 

o 

« 

a 

1^ 
0 

1 
1 

0 
0 

1 

3 
1 

4 

0 

0 
0 

0 

2 
2 
4 

63 

8 

71 

a 

2 
0 

2 

0 
0 
0 

1 
2 

3 

0 

0 

1 

1 

4 

0 

4 

70 
17 

87 

P. 
<! 

0 
0 

0 

1 

0 

1 

3 
0 

3 

~Y 

0 
0 

0 
3 

1 

4 

71 
4 

75 

0 
0 

0 

0 
0 
0 

2 
1 

3 

~0~ 

0 
4 

4 

2 

1 

3 

88 
8 

96 

VII.  The  {nierjicral  state: 

0 
0 

0 

1 

0 
0 

0 
0 

0 

0 

1 

•2 
3 

5 
2 

7 

112 
9 

121 

1 
0 

1 

0 
0 

1 

1 

0 

1 

0 

0 
2 

2 

2 

0 

2 

65 
9 

74 

0 
0 

0 

0 
0 
0 

2 
0 

2 

2 

0 
0 

0 

5 
0 
5 

To" 

10 
70 

0 

1 
1 

0 

1 
1 

1 

2 
3 

1 

0 
1 

1 

10 

0 

10 

74 
11 

85 

0 
0 

0 

0 
0 
0 

2 

1 

3 
2 

0 
0 

0 

3 

0 

3 

65 
5 

70 

0 
0 

0 

2 
0 
0 

2 
0 

2 

2 

0 
1 

1 

2 

0 

2 

"^ 
6 

85 

0 
0 

0 

0 
0 
0 

0 
0 

0 

1 

0 
0 

0 

0 

0 

0 

48 
10 

58 

0 

0 

Group  total 

0 

V^III.  Diseases  of  the  skin  and  cellular  tissue 

1 

IX.  Diseases   of   organs  of   locomotion   (group 
total)    

0 

X.  Malformations:  Congenital,  still    births  not 

9 

XI.  Early  infancy: 

Congenital  debility 

? 

Other  diseases 

n 

Group  total 

9 

XII.  Old  age:  Senile  debility  (group  total) 

XIII.  Affections  produced  by  external  causes: 

Suicides    

0 

n 

Accidents 

s 

Group  total 

8 

XIV.  111-deflned  diseases: 

Autopsied 

7 

Other  ill-defined  or  unspecified  causes  of 

1 

Group  total 

K 

Total  deaths  by  months 

11? 

6 

118 

1903. 

1904. 

1903. 

1904. 

o3 

s 

3 
§ 

u 

<D 
U 

oj 
3 

u 

3 

cr  . 

o 
t> 

CO 

i 

o  a 
<o 

CO 

a 

1 

I.  General  diseases: 

Intermittent     fever    and    malarial    ca- 

32 

81 

9 

18 
47 
14 

16 
42 
21 

29 

28 
18 

50 
78 
23 

45 
70 
39 

95 

148 

Other  general  diseases 

62 

Group  total 

72 

79 

79 

75 

151 

154 

305 

II.  Diseases  of  the  nervous  system  and  organs  of 
special  sense: 
Tetanus  (infantile) 

4 
2 

6 
2 

5 
1 

10 
1 

10 

4 

15 

2 

25 

6 

6 
18 

S 
17 

6 

8 

11 
23 

14 
35 

17 
31 

31 

Other  diseases  of  the  nervous  system,  etc. . 

66 

Group  total 

24 

25 

14 

34 

49 

48 

97 

III.  Diseases  of  the  circulatory  system: 

15 

8 

16 

4 

15 
6 

16 

8 

31 
12 

31 

14 

62 

Other  diseases  of  the  circulatory  system  . . 

26 

Group  total 

23 

20 

21 

24 

43 

45 

88 

IV.  Diseases  of  the  respiratory  system: 

4 
9 

9 
9 

10 
4 

7 
12 

13 

18 

17 
16 

30 

Other  diseases  of  the  respiratory  system  . . 

34 

13 

18 

14 

19 

31 

33 

64 

PUJJLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


113 


Summary  oj  mortality  statistics,  Santiago  tie  Cuba,  Jiscul  year  1003-4 — Continued. 


1903. 

1904. 

1903. 

1904. 

u 

as 

3 

h 
3 

H 

0) 

3 

cr  . 

r 

First  quarter. 

Ut 

a) 

3 
o*   . 

Q  *-* 

8 

k 

o  a 

0) 

a 

t 

i 

V.  Diseases  of  the  digestive  system: 

Diarrhea  aii(i  enteritis  (under  2  years) 

16 

8 
5 

11 
1 

11 
5 
2 

46 
6 
6 

57 
14 
6 

57 
11 
8 

114 

25 

Diarrhea  and  enteritis(2  yearsand  over).. 

14 

61  ;      18 

18 
5 
5 

58 
5 
10 

77  I        'fi 

153 

6 

5 

11 

10 

21 

Other  disease.^  of  the  digestive  system  — 

6 

8 

14 

16 

29 

73 

31 

28 

73 

102 

101             203 

VI.  Diseases  of  the  genito-uriuary  apparatus  and 
itsadnexa: 

4 
3 

5 

5 

4 
0 

3 

2 

9 

8 

7               16 

2               10 

7 

10 

4 

5 

17 

9  ]            26 

VII.  The  puerperal  state: 

1 
0 

0 
1 

2 
1 

0 
0 

1 
1 

2                3 

1                  2 

1 

1 

3 

0 

2 

3  1              5 

VIII.  Diseases  of   the  skin  and  cellular  tissue 
(group  total') 

1 
0 

1 

2 

1 

1 

0 
0 

1 

2 
0 

3 

3 
1 

2 

2 
0 

4 

5 

IX.  Diseases  of  organs  of  locomotion  (group  total). 

X.  Malformations:  Congenital,  still  births  not  in- 

cluded (group  total) 

1 
6 

XI.  Early  infancy: 

Congenital  debility 

3 
0 

5 
3 

4 
3 

7 
1 

8 
3 

11 

4 

19 

Other  diseases 

7 

Group  total 

3 

8 

7 

8 

11 

16 

26 

XII.  01<1  age:  Senile  debility  (group  total) 

2 

5 

1 

2 

7 

3  1            10 

XIII.  Affections  produced  by  external  causes: 

1 
4 

0 
2 

0 

1 

0 
12 

1 
6 

0 
13 

1 

Accidents 

19 

Group  total 

5l          2 

1 

12 

7 

13 

20 

XIV.  Ill-defined  diseases: 

Autopsied 

12 
14 

15 

0 

15 

6 
2 

8 

12 
3 

15 

27 

2 

29 

18 

5 

23 

45 

Other  ill-defined  or  uiispeeitied  causes  of 
death 

Group  total 

7 
52 

237 

28 

218 
22 

181 
■.ir> 

271 

18 

455 
50 

452 
53 

907 

Still  births  reported 

103 

Total  number  of  death 

265 

240 

210 

289 

505 

505 

1,010 

CIENFUEGOS. 

Eeport  by  AcTiNCi  AssT.  8uRG.  R.  L.  McMahon. 

CiENFUEGos,  Cuba,  /»/// 1,  1904- 
Sir:  I  have  the  honor  to  make  the  following  annual  report  of  the  transactions  at 
this  station  for  the  fiscal  year  ended  June  30,  1904: 

Statement  of  the  office  transactions  and  inspection  service. 

Bills  of  health 192 

Vessels  inspected 192 

Members  of  crews  inspected 5,  815 

Passengers  inspected 375 

Vessels  di. '51  n fee/-   '     3 

8629—01^ 8 


114  rUBLIC    HEALTH    AXD    MARINE-HOSPITAL    SERVICE. 

All  bills  of  health  issued  at  this  port  during  this  year  were  flean. 

No  qiiaraiitiiiable  disease  appeared  among  either  crews  or  passengers. 

Only  water  liallast  has  been  taken  from  this  port  during  this  year. 

Instriictions  were  received  at  this  office  by  circular  letter  from  the  Bureau  dated 
March  2,  1904,  to  act  the  same  for  vessels  sailing  for  the  ports  of  the  Republic  of 
Panama  as  for  porta  in  the  United  States. 

SAXITATIOX. 

There  has  been  no  improvement  made  in  this  city  during  the  past  year  regarding 
the  matter  of  bettering  the  sanitary  condition  of  the  city,  and  the  same  conditions 
exist  now  as  were  reported  July  1,  1903.  The  water  supply  of  the  city  is  worse  now 
than  it  was  a  year  ago  on  account  of  worse  condition  of  the  river  from  where  it  is 
obtained,  and  also  on  account  of  no  improvement  having  been  made  in  the  plant  in 
the  city. 

The  city  still  remains  without  a  sewerage  system,  and  no  prospects  of  any  improve- 
ment in  this  line  soon. 

Mosquitoes  of  all  varieties  abound  in  great  numbers  in  all  parts  of  the  city,  and  no 
effort  has  been  made  looking  to  their  destruction.  It  is  worthy  of  note  that  mos- 
quitoes are  to  be  generally  found  quite  numerous  aboard  of  all  vessels  that  lie  in  this 
harbor,  even  if  the  vessel  is  anchored  2  or  .3  miles  from  the  shore. 

The  sanitary  condition  of  the  city  at  present  is  very  bad  in  many  sections,  and  no 
douVjt  the  great  increase  of  sickness  in  the  city  is  due  to  this  and  the  bad  water. 

The  inspection  ser\ice  by  the  Cuban  quarantine  officials  has  been  done  efficiently, 
and  no  sickness  of  a  quarantinable  nature  has  been  allowed  to  enter  the  city  during 
this  year. 

Strict  quarantine  is  maintained  against  all  Mexican  and  Central  American  ports. 

During  this  year  steamers  have  been  calling  at  this  port  from  Buenos  Ayres,  Monte- 
video, and  Para  once  a  month.  They  usually  bring  a  cargo  of  jerked  beef,  and  this 
is  discharged  while  the  ship  is  held  in  quarantine. 


During  this  year  three  aliens  have  been  examined  and  passed  for  the  United 
States;  two  in  the  month  of  July,  1903;  one  in  June,  1904.     Total  number  of  deaths 
for  the  fiscal  year,  823.     Estimated  population,  30,080. 
Respectfully, 

R.  L.  'SIc^Iahos,  Acling  AssistaiU  Surgeon. 
The  Surgeox-General. 

Porto  Rico. 

During  the  fiscal  year  ending  June  3o.  1904,  the  sanitary  conditions 
in  Porto  Rico  have  been  ver}'  .•satisfactory.  Passed  Asst.  Surg.  W.  W. 
King  still  heing  on  duty  as  chief  quarantine  officer  at  San  Juan,  with 
Pedro  del  Valle  Atilles  as  assistant. 

TITLE    TO   MIRAFLORES   ISLAND. 

The  Attorney-General  of  the  United  States  has  declared  that,  in  his 
opinion,  the  United  States  now  possesses  a  valid  and  complete  title  to 
the  whole  of  this  island.  During  the  3'ear  Congress  made  an  appro- 
priation of  ^23,500  for  improvements  to  the  quarantine  station  on  the 
island. 

OBSERVATIONS   ON   LEPROSY   IX    PORTO    RICO. 

Public  Health  and  Marixe-Hospital  Service, 

Office  of  Medical  Officer  in  Co.mmaxd, 

San  Juan,  P.  R.,  Xovemher  2,  1903. 
Sir:  As  a  matter  of  probable  interest  to  the  Bureau,  I  have  the  honor  to  submit 
the  following  data  concerning  leprosy  in  the  island  of  Porto  Rico,  the  probable  num- 
ber of  cases  existent  at  present,  their  segregation  and  treatment,  as  observed  by  me 
upon  the  occasion  of  a  visit  to  the  leper  colony  on  the  28th  ultimo,  and  subsequent 


rUBLIC    HEALTH    AND    MAKlNK-UUSJ'I'i AL    SKKVICK.  115 

(lisouppinn  of  tho  matter  witli  Dr.  K.  HtTiiaudi'/-,  ])resident  of  the  superior  board  of 
healtli  of  I'orto  l\ii;o,  and  otlicrn. 

Altli()ii<i;li  duriiiir  tlu-  Spaiiisli  Uoveniment  there  was  a  eonipnlsory  law  in  Port*) 
Rii'o  rejinlatiiiji  the  isolation  in  the;  snhnrhs  of  San  Jnan  of  all  lepccH  on  the  island, 
such  law  was  not  enforced  in  all  canes.  Oflicial  and  other  influences  made  th((  law 
aijplicable  only  to  the  poorer  classes,  while  it  was  avoidable  by  others.  Practically 
there  was  not  isolation  in  the  true  sense  of  the  word,  because  the  colony  of  lepers 
was  situated  in  the  environs  of  San  Juan,  where  many  poor  people  lived  in  small 
wootlen  houses  and  huts. 

The  buildinu;  in  which  the  lepers  were  confined  consisted  of  a  one-story  wood  con- 
struction })laced  to  the  south  of  the  city  jail,  and  surrounde<l  by  the  al)ove-mentioned 
houses  anil  huts.  The  medical  attendance  was  intrusted  to  one  of  the  nmnicipal 
physicians. 

After  the  American  occupation  of  Porto  Rico  and  during  the  period  the  island  was 
under  military  government,  the  lepers  were  conveyed  to  "Isla  <le  Cabras,"  the  old 
Spanish  (|uarantine  station,  a  full  description  of  which  has  been  given  in  one  of  Surg. 
A.  11.  (ilennan's  reports  to  the  Bureau  in  1S99. 

The  island  is  situated  at  the  entrance  of  San  Juan  Harbor,  between  the  Morro 
Castle  fortifications  on  the  east  and  the  village  of  Palo  Seco  on  the  south.  The  loca- 
tion of  the  island  is  an  ideal  one  for  the  purpose,  the  prevailing  winds  being  east  and 
southeast. 

The  leper  colony  is  actually  under  the  control  of  the  board  of  charities  and,  to 
some  extent,  the  superior  board  of  health. 

I  am  inde])ted  to  Dr.  F.  R.  Goenaga,  superintendent  of  the  insane  asylum  and  acting 
director  of  the  board  of  charities,  lor  affording  me  the  opportunity  of  visiting  the 
colony.  The  recently-appointed  director  of  the  board  of  charities,  Mr.  Haeselbarth, 
together  with  Dr.  Quevedo  Baez,  the  physician  in  charge  of  the  colony,  and  myself 
left  San  Juan  in  a  sailboat  on  the  afternoon  of* the  28th  ultimo,  and  after  a  pleasant 
trip  of  about  one  hour  arrived  at  Cabras  Island  where  we  were  met  by  the  steward 
of  the  colony  and  invitetl  to  make  an  inspection  of  the  grounds  and  l)uildings.  The 
first  building  visited  was  a  wooden  construction  in  which  the  steward  and  other 
employees  are  (juartered.  This  is  situated  on  the  east  side  of  the  island  and  was 
found  to  be  in  a  cleanly  and  well  ventilated  condition. 

We  next  visited  the  male  lepers'  quarters,  a  solid  brick  construction  with  a  wide 
veranda  extending  all  around.  This  building  was  formerly  used  as  a  detention 
building  when  the  island  was  used  as  a  quarantine  station.  There  are  four  rooms, 
divided  by  a  central  hall,  with  acconnnodations  for  some  sixteen  or  twenty  patients. 
Actually,  there  are  10  lepers  in  this  building. 

The  next  building  we  visited,  separated  from  the  first  by  about  800  meters,  was 
found  to  be  occupied  by  the  female  lepers,  7  in  number.  This  building,  similar  to 
the  barracks  occupied  l)y  the  male  lepers,  was  used  during  Spanish  quarantine  times 
as  a  lazaretto.  Between  this  and  the  male  ward  or  barracks  is  located  the  nurse's 
room,  and  adjacent  to  this  the  kitchen  and  dispensary  and  also  the  general  store- 
room. The  kitchen  is  a  very  small  room  containing  a  charcoal  stove  of  brick,  the 
provisions  being  kept  in  wooden  boxes.  These  provisions  consist  chiefly  of  Irish 
potatoes,  rice,  beans,  ham,  bacon,  etc. 

The  duties  of  the  steward  (if  the  colony  are  to  live  on  the  island,  fill  all  prescrip- 
tions of  the  physician  in  charge,  and  to  oversee  all  the  work  of  the  employees.  The 
physician  pays  a  visit  to  the  colony  three  times  a  week. 

The  total  number  of  lepers  on  the  island  is  17,  and  it  is  supposed  that  these  are 
the  only  confirmed  cases  of  leprosy  in  the  island  of  Porto  Rico.  At  least  this  is  the 
opinion  of  the  president  of  the  superior  board  of  health.  Dr.  R.  Hernandez,  with 
whom  I  had  the  honor  to  talk  this  matter  over.  Doctor  Hernandez  suspects,  how- 
ever, that  there  may  be  some  six  or  seven  cases  concealed  in  the  mountainous  districts 
of  the  island. 

The  cases  of  leprosy  that  I  saw  on  Cabras  Island  may  be  classified  as  follows: 
Among  the  males  there  are  9  of  the  typical  nodular  form  and  1  anaesthetic;  among 
the  women  there  are  5  nodular  and  2  anaesthetic.  Two  of  these  patients  have  devel- 
oped tuberculosis  of  the  lungs  and  are  in  a  pitiable  condition. 

All  inmates  of  the  colony  are  now  well  cared  for,  their  meals  consisting  in  coffee, 
milk,  bread,  fresh  beef,  beans,  peas,  rice,  etc. 

Though  the  fresh  water-supply  is  very  poor,  the  patients  are  kept  in  a  fairly  clean 
condition. 

As  a  matter  of  curiosity,  I  should  like  to  invite  attention  here  to  the  fact  that  only 
one  of  the  seventeen  lepers  seen  confess  to  have  acquired  the  disease  from  another 
person  affected  with  it.     All  of  the  others  say  they  never  have  seen  a  case  before, 


116  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

and,  while  some  of  them  iiscribe  tlie  cause  of  their  illness  to  bathing  in  salt,  muddy 
sea  water,  others  claim  that  they  got  the  disease  from  bathing  in  cold  water,  their 
bodies  at  the  time  being  too  warm. 

Respectfully,  Pedro  del  Valle  Atilles, 

Acting  Assistant  Surgeon. 
To  the  Surgeon-General. 

San  Juan,  P.  R.,  November  4,  1903. 
Respectfully  forwarded, 

W.  W.  King, 
Assistant  Surgeon,  Chief  Quarantine  Officer  for  Porto  Rico. 

SAN   JUAN    AND    SUBPORTS. 

Report  of  Passed  Asst.  Surg.  W.  W.  King,  Chief  Quarantine  Officer. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command. 

San  Juan,  P.  R.,  July  2,  1904. 

Sir:  As  directed  by  Bureau  circular  letter  of  March  18,  I  have  the  honor  to  make 
the  following  report  of  the  transactions  at  this  station  during  the  fiscal  year  ended 
June  30,  1904: 

In  quarantine. — There  has  been  no  change  in  the  equipment  of  the  station  during 
the  fiscal  year.  The  same  methods  of  procedure  and  regulations  as  those  previously 
enforced  have  been  continued  during  the  present  year.  Owing  to  the  diflSculty  in 
determining  the  amount  of  yelloAv  fever  existing  in  Venezuela  and  the  South  American 
countries,  vessels  from  these  ports  are  on  arrival  held  in  quarantine,  business  being 
transacted  under  guard.  This  quarantine  affects  two  steamship  lines,  the  American 
"Red  D"  line,  touching  here  biweekly,  and  the  Spanish  Transatlantic  line,  touching 
monthly.  Occasionally  some  tramp  vessel  arrives  from  those  ports  and  is  subjected 
to  the  same  treatment.  As  this  class  of  vessels  is  possibly  infested  by  stegomyia 
mosquitoes,  the  passengers  are  held  under  observation  for  a  period  of  five  days  after 
arrival,  unless  they  show  satisfactory  evidence  of  immunity  to  yellow  fever. 

To  stop  the  practice  of  small  sailing  vessels  from  St.  Thomas  and  other  near-by 
ports  touching  at  Culebra  to  land  cargo  and  passengers  without  quarantine  and 
immigration  inspection,  an  arrangement  v.as  made  with  the  naval  officer  in  command 
of  Culebra  Station  that  he  should  remand  all  such  vessels  to  Fajardo  for  inspection 
before  allowing  them  to  land  at  Culebra. 

At  the  request  of  the  commandant  of  the  naval  station,  1,382  pieces  of  dunnage  and 
bedding  of  the  crew  of  the  U.  S.  training  ship  Monongaheta  were  disinfected  during 
an  epidemic  of  diphtheria  on  board. 

During  the  year  no  vessel  has  arrived  at  any  Porto  Rican  port  with  quarantinable 
disease  on  board.  No  case  of  yellow  fever  has  been  known  on  the  island.  From 
reports  received  from  the  board  of  health,  72  cases  of  smallpox,  with  1  death,  have 
occurred  in  Porto  Rico. 

Out  quarantine. — With  the  exception  that  vaccination  certificates  are  viseed  for 
passengers  for  C'uba,  there  has  been  practically  no  outgoing  quarantine. 

Personnel. — The  following  changes  have  occurr-ed  among  the  officers  of  the  Service 
in  Porto  Rico.  At  the  beginning  of  the  fiscal  year  Passed  Asst.  Surg.  L.  L.  Lumsden 
was  in  temporary  command  during  the  absence  on  leave  of  Asst.  Surg.  W.  W.  King, 
who  reassumed  charge  on  August  10,  1903.  Again  Passed  Asst.  Surg.  Taliaferro 
Clark  was  in  temporary  command  from  March  1  to  April  1,  1904,  during  the  absence 
on  special  temporary  duty  of  Assistant  Surgeon  King.  Pharmacist  B.  E.  Holsendorf 
relieved  Pharmacist  F.  J.  Herty  at  San  Juan  on  March  20,  1904.  Acting  Asst.  Surg. 
James  W.  Brice  relieved  Acting  Asst.  Surg.  Pablo  Font  y  Martelo  at  Humacao  on 
April  1,  1904. 

Nothing  of  special  interest  has  occurred  at  any  of  the  subports,  which  are  only 
inspection  stations.     The  boat  house  at  Humacao  was  completed  shortly  after  the 
beginning  of  the  fiscal  year.     Tabulated  statements  are  inclosed  showing  the  inspec- 
tion of  immigrants  and  quarantine  transactions  at  San  Juan  and  the  six  subports. 
Respectfully, 

W.  W.  King, 
Passed  Assistant  Surgeon,  Chief  Quarantine  Officer  for  Porto  Rico. 

The  Surgeon-General. 


PUBLIC    HEALTH    AND    MAKINK-HOSl'lTAL    SERVICE.  117 

[Iiiclosiires.] 

Siiiiiiiiiiry  of  transaction  at  the  United  States  (|uarantine  station,  San  Juan,  1'.  R., 
(luring  the  tiseal  year  en(le<i  June  'AO,  1904: 

Vessels  inspected 241 

Vessels  held  in  i|uarantine 42 

Vessels  disinfected 0 

Bills  of  health  issued  to  outgoing  vessels 330 

Crew  of  vessels  inspected 19, 521 

Passengers,  local,  inspected 2, 014 

Passengers,  in  transit,  inspected H,  372 

Passengers  detained  f( )r  observation 59 

Pieces  of  baggage  an<l  dunnage  "  disinfected J ,  '.',82 

SUBI'OKTS. 

[Mtiynguez,  P.  R.    Acting  Asst.  Suix.  Rafael  U.  Lunge  Miranda,  in  charge  of  station.] 

Vessels  inspected 92 

Bills  of  liealth  issued 160 

Crew  of  \  essels  inspected 5, 358 

Passengers  inspected 2,  734 

Vessels  held  in  quarantine 7 

Pieces  of  baggage  disinfected 0 

[Arecibo,  P.  R.    Acting  Asst.  Surg.  M.  Martinez  Rossello,  in  charge  of  station.] 

Vessels  inspected 29 

Bills  of  health  issued 53 

Crew  of  vessels  insj)ected 973 

Passengers  inspected - 83 

Vessels  held  in  quarantine 8 

Pieces  of  baggage  disinfected 0 

[Humacao,  P.  R.    Acting  Asst.  Surg.  James  \V.  Brice,  in  charge  of  station.] 

Vessels  inspected 34 

Bills  of  health  issued 35 

Crew  of  vessels  inspected 422 

Passengers  inspected 12 

Vessels  held  in  quarantine 0 

Pieces  of  baggage  disinfected 0 

[Aguadilla.    Acting  Asst.  Surg.  Julian  Benejam,  in  charge  of  station.] 

Vessels  inspected 31 

Bills  of  health  issued 32 

Crew  of  vessels  inspected    1, 588 

Passengers  inspected 389 

Vessels  h^ld  in  quarantine 6 

Pieces  of  baggage  disinfected 0 

[Arroyo,  P.  R.    Acting  Asst.  Surg.  Juan  Tnijillo  Piza,  in  charge  of  station.] 

Vessels  inspected 11 

Bills  of  health  issfled 8 

Crew  of  vessels  inspected 260 

Passengers  inspected 2 

Vessels  held  in  quarantine 0 

Pieces  of  baggage  disinfected 0 

[Fajardo,  P.  R.    Acting  Asst.  Surg.  Esteban  Lopez,  in  charge  of  station.] 

Vessels  inspected _ 32 

Bills  of  health  issued 33 

Crew  of  vessels  inspected 181 

Passengers  inspected 22 

Vessels  held  in  quarantine 0 

Pieces  of  baggage  disinfected 0 

«The  dunnage  was  disinfected  for  diphtheria,  which  was  prevalent  among  the 
apprentice  boys  aboard  of  the  U.  S.  training  ship  Moaongahela,  at  the  request  of  the 
commandant  of  the  naval  station  at  this  port. 


118  PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 

PONCE. 

Report  from  Ponce,  by  Acting  Asst.  Surg.  Julio  Ferrer  Torres. 

Public  Health  and  ilARiNE-HospiTAL  Service, 

Office  of  Medical  Officer  in  Command, 

Ponce,  P.  P.,  July  6,  190.}. 
Sir:  I  have  the  honor  to  forward  the  following  report  of  the  quarantine  transacti(  / 
at  this  station  for  the  fiscal  year  ended  June  30,  1904: 

Vessels  inspected 1  7l' 

Vessels  in  quarantine -Id 

Vessels  disinfected 0 

Crew  inspected 8, 101 

Passengers  for  Ponce  inspected 626 

Passengers  in  transit  inspected 4, 489 

Pieces  of  baggage  disinfected 54 

Bills  of  health  issued 239 

During  the  year  no  vessels  arrived  with  quarantinable  disease  on  board.  Ve&sels 
from  suspicious  ports  of  Central  and  South  America  have  been  held  in  quarantine, 
but  were  not  dif^infected,  as  they  remained  in  port  only  a  few  hour.'J,  transacting 
business  under  guard  and  only  such  communication  with  the  shore  allowed  as  was 
necessary  and  not  considered  dangerous. 

Nonimmune  passengers  from  suspicious  or  infected  ports  were  detained  on  the 
barge  Arguif.     Baggage  of  these  ports  was  also  duly  disinfected  on  the  barge. 

Bills  of  health  were  issued  to  all  vessels  sailing  for  American  ports  and  to  other 
ports  when  application  was  made  for  them. 

Weekly  sanitary  reports  were  made  of  the  sanitary  condition,  mortality,  et(%,  of 
this  district. 

Very  respectfully,  Julio  Ferrer  Torres, 

Acting  Assistant  Surgeon. 

The  Surgeon-General. 

Office  of  Chief  Quarantine  Officer, 

San  Juan,  P.  R.,  July  7, 1904. 

Respectfully  forwarded  to  the  Surgeon-General,  United  States  Public  Health  and 
Marine-Hospital  Service,  Washington,  D.  C. 

Pedro  del  Valle  Atiles, 
Acting  AxsiHtdnl  Surgeon,  in  temporary  charge. 

Mexico. 

season  of  1903. 

The  following-named  medical  officers  on  duty  at  the  end  of  the  fiscal 
year  ended  June  30.  1903.  were  continued  on  duty  at  their  respective 
ports  until  the  end  of  the  close  quarantine  season:  AsSt.  Surg.  Joseph 
Goldberger,  at  Veracruz :  Acting  Asst.  Surg.  John  Frick,  at  Tampico, 
and  Acting  Asst.  Surg.  J.  F.  Harrison,  at  Progreso. 

VERACRUZ. 

Report  of  Transactions  at  Vebacbxjz,  Mexico,  by  Passed  Asst.  Sukg.  L.  L. 

Lumsden. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Veracruz,  Mexico.  July  5,  IDO.'/. 
Sir  :  I  have  the  honor  to  submit,  in  compliance  with  Bureau  letter  of  June  23, 
the  following  report  of  transactions  of  the  Service  at  the  port  of  Veracruz  from 


PUBLIC    HEALTH    AND    MAKINK-HOSJ'ITAL    SERVICE.  Ill) 

July  1  to  December  ol,  lOOll,  tlie  same  being  eompileU  from  the  records  of  the 
station : 

Steamers  inspected  and  passed 141 

Steamer  disinfected 1 

Sailinjr  vessels  inspected  and  passed 8 

Sailing  vessels  disinfected 0 

Crew  on  steamers 0,330 

Crew  on  sailing  vessels 57 

I'ass«^igers  on  steamers 3.101 

I'asseiiger  on  sailing  vessel 1 

During  the  period  covered  by  this  report  2  vessels  destined  for  TTnited  States 
l)orts  had  quarantinable  disease  (yellow  fever)  on  board  while  at  Veracruz. 
They  weiv  the  British  S.  S.  Cayo  Lanio  from  Habana  via  Tampico.  with  1 
case  of  yellow  fever  on  board  ui)on  arrival  here.  .July  23.  1!X)3.  and  the  British 
S.  S.  Kaxdhi.  which  vessel,  after  having  been  at  this  port  for  eleven  days,  was 
found,  when  insi)ected,  September  22.  to  have  1  case  of  yellow  fever  among 
the  members  of  the  crew.  Both  vessels,  in  i)art.  were  fumigated  with  sulphur 
dioxide  by  the  Mexican  quarantine  officials  after  the  cases  of  fever  had  been 
talien  asiiore. 

Iies))ectfully,  L.  L.  Lumsden.  Passed  Assistant  Surgeon. 

The  Surgeon-Genebal. 

TAMPICO. 

Report  by  Acting  Asst.  Surg.  F.  B.  Lippincott. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command. 

Tdinpico.  ilc.ilco.  Jatiuary  5.  IdOJf. 
Sir  :  I  have  the  honor  to  report  the  followiug  transactions  at  this  station  up 
to  December  31.  1903: 

Bills  of  health  issued 13 

Vessels  inspected  and  passed 10 

Vessels  disinfected  and  passed 3 

Personnel  of  crew 437 

Passengers    11 

Baggage    (pieces) 15 

There  were  23  deaths  from  all  causes,  of  which  1  was  from  tuberculosis.  1 
from  tetanus.  1  from  cachexia  palustre.  and  20  from  noncontagious  causes. 

The  ix>rt.  as  well  as  the  surrounding  country,  is  at  present  free  from  all  con- 
tagious diseases. 

Respectfully.  F.  B.  Lippincott, 

Temporary  Aetiuij  Assistant  Surgeon. 
The  Surgeon-General. 

PROGRESO. 
Report  by  A(^ing  Asst.  Sukg.  .7.  F.  Harrison. 

Report  of  transaetions  at  Progreso.  Mexlvo.  for  the  four  tnonths  ended 
Xoremher  1,  19()S. 

Steamers  inspected  and  passed ^~ 

Steamers  disinfected  f 

Sailing  vessels  insjjec-ted  and  i)assetl 10 

Sailing  vessels  disinfectetl 0 

Crew   on    steamers 2,094 

Crew  on  sailing  vessels '^^ 

Passengers  on  steamers 1,138 

Passengers  on  sailing  vessels 0 

Respectfully,  J-  F.  Harrison. 

Acting  Assi.<itant  Surgeon. 
The  Surgeon-General. 


120  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

SEASON  or  1904. 

Soon  after  the  close  of  the  active  quarantine  season  of  1903  the 
services  of  the  medical  officers  on  duty  at  Veracruz.  Tampico,  and 
Progreso,  Mexico,  were  discontinued. 

Immediately  Ijefore  the  close  quarantine  season  for  the  presei^j; 
3^ear  the  following-named  medical  officers  were  assigned  to  duty  at 
those  ports:  Passed  Asst.  Surg.  L.  L.  Lumsden,  in  the  office  of  the 
United  States  consul  at  Veracruz;  Asst.  Surgs.  T.  B.  McClintic  and 
Joseph  Goldberger,  in  the  office  of  the  United  States  consul  at  Tam- 
pico, and  Acting  Asst.  Surg.  J.  F.  Harrison,  in  the  office  of  the  United 
States  consul  at  Progreso. 

The  agreement  of  the  previous  season  with  the  various  steamship 
comj^anies  running  ships  regularly  between  these  ports  and  the  Gulf 
and  southern  ports  of  the  United  States  for  the  fumigation  of  their 
vessels  at  the  port  of  departure  was  renewed,  the  agents  or  owners  of 
the  vessels  to  furnish  the  appliances  and  materials  for  this  fumiga- 
tion to  destroy  any  mosquitoes  that  may  have  come  on  board  the  ves- 
sels. After  this  fumigation,  which  was  to  take  place  under  the 
supervision  of  the  medical  officer  immediately  l^efore  the  sailing  of 
the  vessel,  a  certificate  setting  forth  the  facts  was  given  to  the  vessel, 
which  would  prevent  the  five-day  detention,  upon  arrival  at  the  port 
in  the  United  States,  imposed  l)y  the  quarantine  laws,  as  the  number 
of  days  consumed  in  the  voyage*  could  l)e  subtracted  from  this  period 
of  detention. 

In  February,  1901,  upon  request  of  the  health  officers  of  certain 
Southern  States,  Surg.  C.  P."  Wertenl)aker,  of  the  Service,  was 
detailed  to  accompany  these  health  officers  on  a  tour  of  sanitary 
observation  through  Mexico.  They  visited  Mexico  City,  Veracruz, 
Tampico,  Victoria,  and  ^Monterey,  and  were  everywhere  treated  with 
the  utmost  courtesy  and  consideration  by  the  Mexican  authorities. 
The  visit  of  the  Surgeon-General  to  the  City  of  Mexico  early  in  Jan- 
uary and  the  cooperative  measures  agi^eed  upon  with  the  Mexican 
health  authorities  are  mentioned  elsewhere  (see  pages  291  et  seq). 

VERACRUZ. 

Report  by  Passed  Asst.  Subg.  L.  L.  Lumsden. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Veracruz,  Mexico,  July  18,  WOfi. 
Sib:  I  have  the  honor  to  transmit  herewith  a* tabulated  statement  of  trans- 
actions at  this  station  during  April,  May,  and  .Tune  of  the  fiscal  year  ended  June 
30,  1904. 

Bills  of  health  were  issued  to  84  vessels,  having  a  total  of  3,422  crew  and 
carrying  1,978  passengers.  Included  in  this  number  are  3  steamers — with  9G 
crew  and  2  passengers — which  cleared  for  Colon,  Republic  of  Panama. 

INSPECTION. 

All  vessels  granted  bills  of  health  were  inspected.  Inspections  were  made 
invariably  l)y  daylight  and  as  late  as  practicable  l)efore  departui-e  of  vessels. 
As  the  port  was  considered  infected  with  quarantinable  disease  (yellow  fever) 
continually  during  the  three  months,  especial  care  was  taken  in  making  the 
inspection' to  determine  that  all  passengers  and  members  of  crews  were  free  of 
symptoms  of  quarantinaljle  disease  at  time  of  inspection.  On  board  vessels 
bound  directly  for  southern  ports  in  the  United  States  and  for  ports  in  the 
Republic  of  Panama  temperatures  of  all  i)ersons  were  taken. 


PUBLIC    HEALTH    AND    MARlNE-HOSriTAL    SEKVICE. 


121 


DISINFECTION. 

Two  vessels  wore  disinfoctod  beeause  there  had  l)eeii  yellow  fever  on  li-ard. 
These  were  the  Anieriean  steamers  Viirdunvia  and  Hunt  no.  arriviiij,'  here  June 
17  and  June  2."),  respectively,  each  of  them  with  a  case  of  yellow  fever  anions 
the  i>assenj,'ers  taken  on  at  Projireso.  The  local  quarantine  officials  took  the 
cases  of  fever  ashore  and  fumigated  the  vessels  in  i»art.  After  cargoes  had 
been  dischar,i,'ed  the  entire  vessels  were  fumigated  under  my  sui»ervision,  with 
the  t)hj\H't  of  destr()yin,i,'  all  mos(inito«'s  i)ossihly  on  hoard  l)«'foro  the  vessels  were 
cleared  for  a  Tnited  States  jjort  (New  York). 

Fifteen  vessels  hound  for  ports  on  the  (iulf  coast  of  the  United  States  were 
fumii^ated  with  sulphur  dioxid.  in  order  to  kill  mosiiuitoes,  and  furnished  cer- 
tifuates.  The  method  of  fumiirating  these  vessels  was  as  follows:  The  vessel, 
after  havins;  cleared  from  the  port,  was  anchored  in  the  outer  iiart  of  the 
harbor  as  far  as  j>racticable — 200  meters  at  least — from  other  vessels  and  the 
shore.  All  compartments  of  the  vessel  were  then  simultaneously  sub.lected  for 
two  hours  to  the  fumes  generated  by  the  burning  of  2  ])ounds  of  suli)hur  to  each 
1.000  cubic  feet  of  space  to  be  disinfected.  The  vessel  was  required  to  depart 
immediately  upon  the  completion  of  fumigation. 

So  far  as  this  office  is  aware,  none  of  the  vessels  fumigated  here  have  had 
eases  of  yellow  fever  develop  on  board  while  en  route  to  or  while  undergoing 
quarantine  detention  at  port  of  arrival  in  the  United  States.  Thus  the  benefits 
of  this  disinfection  at  port  of  dei)arture  have  been,  from  a  sanitary  standpoint, 
the  protection  of  passengers  and  crew  from  exposure  to  possible  infection  en 
route,  and,  from  a  commercial  standpoint,  the  shortening  of  the  period  of  deten- 
tion of  vessels  in  quarantine  at  port  of  arrival  by  the  amount  of  time  consumed 
on  the  voyage,  on  an  average  about  four  days. 

Rejiort  of  transactions  at  Veracruz,  Mexico,  for  last  quarter  of  fiscal  year  ending 

June  30,  1904. 


April. 

May. 

June. 

:k 

22 

21 

3 

5 

8 

2 

4 

0 

0 

1 

0 

1,409 

957 

1,008 

14 

34 

0 

680 

757 

541 

" 

0 

0 

Total. 


Steamers  inspected  and  passed 

Steamers  disinfected _-. 

Sailing  vessels  inspected  and  passed 

Sailing  vessels  disinfected 

Crew  on  steamers 

Crew  on  sailing  vessels 

Passengers  on  steamers 

Passengers  on  sailing  vessels 


78 

16 

6 

1 

3,374 

48 

1,978 

0 


SANITARY   CONDITION   OF   THE   PORT. 


During  the  three  months  under  consideration  the  quarantinable  diseases 
reported  in  the  city  of  Veracruz  were  as  follows :  Yellow  fever.  17  cases  with 
4  deaths :  smallpox,  3  cases  and  1  death.  Three  of  the  cases  of  yellow  fever 
were  infected  at  outside  points — 1  at  Boca  del  Rio  and  2  at  Merida — and  were 
ill  when  they  arrived  here.  These  figures  show  a  marked  improvement  in  the 
yellow-fever  situation  for  the  present  year  as  compared  with  the  corresponding 
three  months  of  1903,  during  which  period  there  were  183  cases  with  Gl  deaths. 
In  fact,  the  number  of  deaths  reported  to  have  been  caused  by  yellow  fever 
during  this  quarter  of  1904  is  less  than  that  recorded  for  the  corresponding 
quarter  of  any  other  year  since  189S. 

The  number  of  deaths  recorded  in  the  city  of  Veracruz  from  all  causes  dur- 
ing the  thirteen  weeks  ending  June  2.").  1904,  was  441 — an  annual  death  rate  of 
54.27  per  1,000.  For  the  corresiionding  thirteen  weeks  ending  June  27,  1903, 
the  total  number  of  deaths  was  .'504 — an  annual  death  rate  of  (i9.38  per  1,000. 
The  rates  for  both  years  are  based  on  an  estimated  jioimlaticm  of  .32,.^00.  Of 
the  deaths  recorded  for  the  thirteen  weeks  ending  June  27.  1903.  .59  were 
reported  to  have  been  caused  by  malarial  fevers  (including  "  fiebre  per- 
niciosa  ").  while  of  those  recorded  for  the  corresponding  thirteen  weeks  ending 
June  2.5.  1904.  only  39  were  rejiorted  to  have  been  caused  l)y  malarial  fevers, 
a  decrease  of  20.  This  consideration  of  the  mortuary  records  shows  that  the 
lowered  deaj;h  rate  for  the  last  (piarter  of  the  fiscal  year  ending  June  30,  1904. 
as  compared  with  the  same  quarter  of  1903,  may  be  explained  to  a  hirge  extent 


122 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


by  the  decrease  in  the  luimber  of  deaths  from  the  two  mosquito-borne  diseases^ — 
yellow  fever  and  malaria. 

The  improvement  in  the  yellow-fever  situation  for  the  present  year  may  be 
entirely,  and  pi'obably  is  to  some  extent,  the  result  of  the  campaign  against  this 
disease  which  has  been  carried  on  by  the  sanitary  officials  since  September  1, 
1903.  The  general  plan  of  this  campaign  has  been  to  pnmiptly  discover  all 
cases  of  yellow  fever  and  place  them  in  the  screened  rooms  or  wards  of  the  city 
hospitals,  to  disinfect  all  infected  houses,  and  to  prevent  the  breeding  of  mos- 
quitoes by  oiling  or  covering  water  receptacles.  However  perfect  the  plan  of 
the  sanitary  campaign  may  have  been,  the  execution  of  certain  of  its  details 
has  been,  as  would  be  expected  by  anyone  familiar  with  conditions  in  Vera- 
cruz, far  from  perfect ;  therefore  I  think  it  safe  to  conclude  that  causes  other 
than  sanitary  measures  nuist  have  contributed  somewhat  to  bringing  about  the 
improvement  in  the  situation.  One  fact  to  be  considered  in  this  connection  is 
that  during  April,  May,  and  Jiuie  of  1903  about  3,000  lalxn-ers  were  brought 
from  the  interior  country  districts  to  Veracruz  for  work  on  the  city's  public 
buildings  and  sewerage  system,  w^hile  for  the  cori-esponding  three  months  of  the 
present  year  no  extensive  public  works  were  going  on  and  probably  not  more 
than  500  or  GOO  such  laborers  were  in  Veracruz.  A  large  [iroportion  of  these 
laborers  are  nonimnuines,  and  when  .large  numbers  of  them  are  in  Veracruz 
there  is  generally  a  marked  increase  in  the  number  of  cases  of  yellow  fever. 
For  instance,  during  the  three  months  ending  June  .30,  1900,  when  extensive 
work  on  the  harbor  imi)rovements  was  being  carried  on,  there  were  recorded  77 
deaths  from  yellow  fever,  while  for  the  corresponding  period  of  the  following 
year  (1901)  there  were  recorded  only  G  deaths  from  that  disease.  The  sanitary 
nieasiu'es  carried  out  diu'ing  these  two  years  were,  so  far  as  I  am  aware,  prac- 
tically identical ;  so  the  difference  in  the  number  of  cases  for  the  two  periods 
considered  could  hardly  have  been  due  to  sanitary  efforts,  but  must  be  explained 
by  a  difference  in  the  number  of  ncniimmune  residents,  and  perhaps  also  to  a 
change  in  some  (as  yet  not  understood)  natural  conditions  which  influence  the 
prevalence  of  yellow  fever. 

The  laying  of  the  mains  for  a  good  water  and  sewerage  system  was  com- 
pleted in' March  of  this  year,  but  as  yet,  largely  on  account  of  the  exorbitant 
prices  charged  for  piping,  only  a  few  house  connections  have  been  made  with 
the  mains.  When  these  new  water  and  sewerage  systems  have  been  extended 
to  all  houses,  of  rich  and  poor  alike,  in  the  city,  when  the  old  cesspools  and 
mosquito-breeding  water  bai-rels  and  cisterns  have  been  done  away  with,  and 
when  a  cami)aign  against  yellow  fever,  thorough  in  design  and  in  execution,  has 
been  begun  Veracruz,  so  long  considered  a  pest  hole,  will  he  well  on  the  way 
to  take  her  place  among  those  tropical  American  cities  which  to-day  stand  as 
monuments  to  the  triumphs  of  modern  sanitation. 

Respectfully,  L.  L.  Lumsden, 

Passed  Assistant  Surgeon. 

The  Sukgeon-Generai.. 

TAMPICO. 
Report  of  Transactions  at  Tampico,  Mexico,  by  Asst.  Surg.  T.  B.  McClintic. 

Public  Health  and  Marine-FIospital  Service, 

Office  of  Medical  Officer  in  Command, 

Tampieo,  Mexieo,  July  5,  190^. 
Sir:  In  accordance  with  instructions  contained  in  P>ureau  letter  of  April  1, 
detailing  me  for  duty  at  the  port  of  Tampico,  T  have  the  honor  to  submit  here- 
with report  of  the  transactions  at  this  station  for  the  jteriod  from  April  1,  the 
date  the  Service  resumed  operations  here,  to  ,Iune  .'JO,  1904. 

The  following  is  a  sunuuary,  by  months,  of  the  transactions  during  this  time: 


Steamers  inspected 

Sailing  vessels  inspected -  - 

Steamers  fumigated  and  certified 

Sailing  vessels  fumigated  and  certified 

Crews  on  steamere 

Crews  on  sailing  vessels 

Passengers  on  steamers 

Passengers  on  sailing  vessels 


April.     May.     June.    Total. 


1,07 


0 
7.53 


17.5 
0 


29 

1 
13 

0 
904 

8 
59 

0 


a5 

3 

31 

1 

2,734 

23 

283 

0 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    RERVIOE. 


123 


As  will  ho  observed  rroiii  the  above,  :V2  vess(>Is  were  fuini^^ated,  and  tbe  fol- 
lowing shows,  by  nutiitlis,  the  ports  for  which  tlu'y  were  bound : 


April. 

May. 

June. 

Total. 

Pensacola .     

8 
0 
2 
1 
0 

5 
1 

1 
2 
0 

4 
0 
3 
3 
2 

17 

1 

Norfolk,  via  New  York 

0 

New  Orleans 

6 

2 

A  new  line  of  steanishii)s  between  Tanipifo  and  Galveston  has  Just  been 
started  iind  has  one  vessel  each  week  for  fumigation.  This  fumigation  is  an 
item  of  great  tinancial  importance  to  vessels  bound  from  here  for  a  south<»rn 
port,  as  their  period  of  detention  at  the  port  of  destination  is  reduced  by  the  time 
in  transit  about  three  and  one-half  days,  and  the  time  and  cost  of  fumigation  is 
small. 

Tampico  being  situated  on  the  Panuco  River,  7  miles  from  its  mouth,  the  fumi- 
gation is  done  where  it  empties  into  the  sea,  off  I^a  Barra.  This  i)ractically 
eliminates  the  possibility  of  reinfection  with  mosquitoes  under  conditions  as  they 
have  e.xisted  since  my  arrival  here,  as  the  season  lias  been  dry  and  mosquitoes 
comparatively  few. 

I  do  not  deem  it  necessary  from  a  sanitary  point  of  view,  but  at  the  request 
of  the  masters,  to  avoid  the  difficulty  of  turning  the  vessels  in  the  river,  a  large 
proportion  of  them  are  fumigated  a  mile  or  more  at  sea. 

After  fumigating,  the  temperatures  of  all  on  board  are  talien,  the  vessel  given 
a  certificate  as  to  what  has  been  done,  and  allowed  to  proceed  on  her  voyage. 
Respectfully, 

T.  B.  McClintic,  Assistant  Surgeon. 

The  Surged  n-Genebal. 

PKOGRESO. 

Report  of  Transactions  at  Progreso,  Mexico,  by   Acting  Asst. 

Harrison. 


Surg.  J.  F. 


Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Progreso,  Mexico,  July  J,  190.'/. 

Report  of  tranmctionN  for  three  months  ending  July  1,  WO-'i. 

Steamers  inspected  and  passed 4S 

Steamers  disinfected 9 

Sailing  vessels  inspected  and  passed T) 

Sailing  vessels  disinfected -1 

Crews  on  steaiifiers 1,049 

Crews  on  sailing  vessels '^^ 

Passengers  on  steamers^ 1,275 

Passengers  on  sailing  vessels None. 

Respectfully,  J.  F.  Harrison. 

Acting  Assistant  i^iirgeo)i. 
The  Surgeon-General. 


Central  and  South  America. 


FRUIT-PORT  inspection   SERNTCE. 


In  accordance  with  the  custom  of  previous  years,  the  work  of 
inspection  at  the  fruit  ports  of  Central  and  South  America  was  dis- 
continued at  the  close  of  the  active  quarantine  season  of  1908  and  the 
officers  recalled. 


124  PUBLIC    HEALTH    AND    :SIARTNE-HOSPITAL    SERVICE. 

At  the  beginning  of  the  close  quarantine  season  for  the  present  year 
the  following-named  officers  were  ordered  to  the  Aarious  jjorts  for  the 
purpose  of  carrying  out  the  special  quarantine  regulations  for  fruit 
vessels:  Acting  Asst.  Surg.  Paul  Osterhout,  Bocas  del  Toro,  Republic 
of  Panama ;  Acting  Asst.  Surg,  W.  H.  Carson,  Belize,  British  Hon- 
duras; Acting  Asst.  Surg.  R.  H.  Peters,  Livingston,  Guatemala; 
Acting  Asst.  Surg.  C.  S.  Carter,  Puerto  Cortez,  Honduras;  Acting 
Asst.  Surg.  D.  W.  Goodman,  Port  Liinon,  Costa  Rica ;  Acting  xVsst. 
Surg.  W.  B.  Robertson,  Ceiba,  Honduras,  and  Acting  Asst.  Surg. 
W.  H.  Reilley,  Bluefields,  Xicarauga. 

The  following  letter  of  instructions  was  sent  to  officers  at  al)  fruit 

ports : 

Treasury  Department, 
Bureau  of  Public  Heaxth  and  ]\Iarike-Hospital  Service, 

Washiiifjton,  March  :'.".^,  190^. 

Sir  :  Referring  to  Bureau  letter  of  March  28,  1004,  approved  by  the  Secretary 
and  the  President,  detailing  you  for  duty  in  the  office  of  the  United  States  con- 
sul at  Port  Limon.  Costa  Rica,  under  the  act  of  February  lo,  1893,  yoa  are 
informed  that  your  duties  at  that  port  will  consist  in  the  enforcement  of  the 
United  States  quarantine  laws  and  regulations  for  foreign  ports,  inchidiii:?  the 
inspection  of  all  vessels  leaving  your  port  for  ports  in  the  United  States  its 
dependencies  or  jiossesious,  either  direct  or  via  otlier  ports,  and  signing,  iii  con- 
junction with  the  United  States  consular  officer,  the  bills  of  health  issued  lo  the 
same.  You  will  also  carry  out  the  special  regulations  for  vessels  plying  between 
infected  or  suspected  fruit  ports  and  ports  of  the  United  States,  its  possessions 
or  dependencies.  A  copy  of  Department  circular  No.  2.">,  revised  i-egulations 
covering  same,  will  be  sent  for  your  instruction.  You  are  informed  that  the 
Government  of  the  Republic  of  Panama  has  requested  that  vessels  leaving  your 
port  for  ports  in  Panama  be  submitted  to  the  same  restrictions  by  yourself  as 
if  they  were  bound  for  United  States  ports,  and  you  are  directed  to  comply 
with  this  request. 

Your  attention  is  especially  called  to  the  agency  of  the  ^tcgomyia  fasciata 
mosquito  in  the  conveyance  of  yellow  fever,  and  you  will  take  all  due  precau- 
tions to  prevent  vessels  leaving  your  port  for  United  States  ports,  its  posses- 
sions or  dependencies,  from  carrying  these  mosquitoes.  The  State  Department 
has  been  requested  to  inform  the  consular  officer  at  your  port  of  yoiu-  detail  and 
to  instruct  him  to  transfer  to  you  the  public  property  left  in  his  custody  by 
your  predecessor  at  the  close  of  the  last  quarantine  season.  As  soon  after 
your  arrival  as  possible  you  will  transmit  a  list  of  this  proiierty  turned  over  to 
you  by  the  consular  officer  to  the  Bureau  for  comparison  with  the  list  now  on 
file  here.  Blank  forms  necessary  for  your  use  will  be  transmitted  to  you  under 
separate  cover;  also  copy  of  the  United  States  Quarantine  Laws  and  Regula- 
tions. 

You  will  note  that  the  disinfection  of  baggage  and  passengers'  effects  to  pre- 
vent infection  from  yellow  fever  is  no  longer  required. 

The  supply  of  blanks  transmitted  to  you  consist  of,  first,  an  individual  certifi- 
cate to  be  issued  to  each  passenger  about  to  embark  on  a  fruit  vessel  bound 
for  United  States  ports.  The  other  is  a  certificate  to  l)e  issued  in  duplicate  to 
the  master  of  the  vessel  as  an  adjunct  to  the  bill  of  health  and  duplicate  bill  of 
health.  The  master  may  deliver  the  duplicate  certificate  if  requested  to  the 
quarantine  officer  at  the  port  of  arrival.  One  copy  of  each  of  these  certificates 
issued  by  you  should  be  inclosed  with  the  weekly  report  from  your  station. 

At  the  close  of  each  week  you  will  transmit  a  report  of  condition  and  traiis- 
actions  at  your  jiort  on  the  blank  form  transmitted. 

Should  yellow  fever  break  out  at  your  port  you  will  inuuediately  cable  to 
the  Bureau  jiarticulars  of  the  matter. 

You  should  keep  conqilete  records  of  all  transactions,  in  order  that  a  report 
of  the  same  mav  be  submitted  at  the  close  of  the  fiscal  year  ending  June  .SO. 
1904. 

You  are  informed  that  the  active  quarantine  season  for  the  States  of  Louisi- 
ana, Alabama,  and  Texas  will  take  effect  April  1,  1904. 

Should  yellow  fever  break  out  at  your  port  you  will  take  the  temperature 
of  all  the  crew  and  passengers  of  vessels  leaving  for  ITnited  States  ports,  and 
in  case  any  of  them  show  a  rise  in  temperature  you  will  detain  them,  unless 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SP:RVICE.  125 

a  positive  dia.irnosis  that  the  case  is  not  yellow  fev(>r  or  any  otlier  (luarantiuable 
disease  can  lu*  made. 

You  sliould.  inunediately  upon  y(»ur  arrival,  ascertain  the  amount  of  supitlies 

on  hand,  so  that,  if  necessary,  you  can  make  timely  retiuisition  for  replenish- 

ini;   the   same.     An    inunediate   acknowled.sjemeiit    of    receipt   of    this    letter    is 

i'e(iuested.  and  you  will  report  to  the  Bureau  the  date  of  arrival  at  your  station. 

Respectful  ly, 

Waltek  Wvma.n, 

8urgcon-Ocneral. 
Dr.  I>.  W.  Goodman. 

Acting  A.s.si.staiit  Sitr(H'0)i  in  ('liari/c. 

(Care  Uuited  States  Consulate,  I'ort  Limon,  Costa  Kica.) 

rOKT    LlilOX. 

Ki:roRT  OF  Transactions  by  Acting  Asst.  Surg.  Fleetwood  Gruver,  Season  of 

ino.3. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  (Command. 
Port  Limon,  Costa  Rica,  Novcniher  1,  1903,. 

Sir:  I  have  the  honor  to  sul)mit  the  following:  report  of  transactions  and  con- 
ditions at  this  port  for  the  quarantine  season  ended  October  31,  ir)0.*5. 

Since  my  a.rrival  here  on  Ai>ril  0,  lOOo,  this  port  has  not  lieen  free  of  yellow 
fever  infection.  During  that  time  SI  cases  have  been  treated  at  the  several 
hospitals,  with  total  mortality  of  .'iO — over  4S  per  cent.  Among  these  were 
.11  Americans  and  11  Englislunen.  of  whom  5  of  the  former  and  3  of  the  latter 
died.  Of  the  81  cases,  10  were  female,  7  of  whom  died.  One  case  of  leprosy 
and  1  case  of  smallpox  were  imi)orted  into  this  city.  These  were  reported  at 
the  time.  P>l;ickwater  fever  is  very  conniion  and  very  fatal :  one  attack  predis- 
posing to  another. 

The  sanitary  condition  of  Limon  is  A-ery  poor.  Yellow  fever  and  malaria  in 
its  severest  types  are  alwa.vs  present,  and  but  little  effort  is  made  by  the  author- 
ities to  impi-ove  the  condition.  Much  of  the  sickness  reported  from  Limon  is 
brought  into  the  city  from  suburi)an  towns:  nearl.v  all  which  are  infected  with 
yellow  fever  and  send  their  iiatients  to  the  hospitals  here.  Two  years  ago  the 
Costa  Rican  Congress  enacted  a  law  providing  for  the  removal  outside  of  the 
city  limits  of  all  hospitals  where  contagious  and  infectious  diseases  were 
treated.  This  law  has  never  been  enforced.  There  is  very  little  doubt  that  the 
hospitals  are  a  source  of  infection  and  a  menace  to  the  health  of  the  city. 

During  this  season  yellow  fever  has  appeared  in  nearl.v  every  block  in  Limon. 
The  cuartel,  or  jail,  furnished  10  cases.  The  result,  however,  obtained  in  this 
instance  by  attention  to  the  mosquito  theory  is  significant,  as  not  a  case  has 
appeared  since  the  cuartel  was  made  mosquito  proof  and  fumigated. 

During  the  season  ending  October  31,  100.3,  I  have  examined  157  ships  and 
f>,785  passengers  and  crew,  as  follows :  Crew,  5,731  ;  passengers  direct,  535 ; 
l)assengers  in  transit,  719.     I  have  also  fuml.-^ated  4  ships. 

The  health  of  the  passengers  on  all  the  steniiers  examined  was  satisfactory. 
A  few  cases  of  malarial  infection  w'ere  noted  amon.g  the  crews  of  several  steam- 
ers, and  in  only  one  instance  was  it  found  necessary  to  remove  any  member  of 
the  crew  of  a  ship  before  a  ])ositive  diagnosis  could  be  made.  I  can  say  that 
the  enforcement  of  the  regulations  adopted  I)y  the  Treasury  Department 
imposes  no  hardship  on  commerce,  and  in  no  instance  has  a  delay  of  any  length 
been  occasioned  by  their  thorough  observation,  including  a  close  examination 
of  passengers  and  ci'ews. 

During  the  season  .just  closed  only  one  vesel  clearing  from  this  port  arrived 
at  an  United  States  port  with  a  case  of  yellow  fever.  It  is  a  fact,  however, 
worth.v  of  notice  that  the  initial  fever  oceured  fifty-six  hours  after  leaving 
this  port.  This  vessel  bad  remained  in  Limon  eight  days;  another  vessel  which 
remained  here  one  month  developed  a  case  of  yellow  fever  among  its  crew. 
These  two  instances  .iustify  me  in  recommending  a  removal  of  restrictions  as  to 
night  loading,  and  rather  i)lncing  a  premium  on  quick  dispatch.  Many  vessels 
are  kept  in  port  longer  than  would  otherwise  be  necessary  by  the  regulations 
which  establish  an  hour  up  to  which  they  are  permitted  to  discharge  and  load 
cargo. 

It  were  better  to  set  limits  as  to  the  length  of  time  which  a  vt^s-^el  may  lay  at 
anchor  here  not  working  than  to  enforce  a  useless  delay.     If  the  State  boards 


126  PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    8ERVICE. 

of   health   \aouU1   acloi)t   the   national  (iuarautiue   regulations  every   protection 

would   l)o  obtained,   and   also   closer  cooperation   insured   on   the  part  of  the 
shipping  iniblic. 

Respectfully,  Fleetwood  Gruver, 


The  Surgeon-Geneeal. 


Acting  Assistant  Surf/eon. 


Report  of  Transactions  by  Acting  Asst.   Surg.  D.  W.  Goodman.  Season  of 

1904. 

Public  Health  and  Marine-Hospital  Ser\t;ce. 

Office  of  Medical  Officer  in  Command, 

Port  Limon.  Costa  Rica,  Jtily  1,  190-'f. 

Sir:  I  have  the  honor  to  submit  the  following  report  of  the  conditions  and 
transactions  of  this  port  during  the  trimester  ended  June  30,  1904 : 

Limon  is  situated  on  the  sea,  protected  on  the  east  and  south  by  a  concrete 
sea  wall.  Its  northern  and  portions  of  its  western  limits  are  marked  by  low, 
swamijy  lands.  lioughly  speaking,  the  town  extends  one-half  mile  from  east 
to  vi-est  and  one-fourth  mile  from  north  to  south.  It  has  an  officially  esti- 
mated population  of  nearly  4.000,  a  large  majority  being  negroes  from  Jamaica. 
Many  of  these  live  in  two  or  three  story  tenement  houses,  thickly  congre- 
gated ;  others  occupy  small  cottages,  raised  only  a  few  inches  from  the  ground. 
Under  some  of  these  houses  the  surface  of  the  ground  has  been  made  or 
allowed  to  assume  a  basin  shape,  which,  being  filled  by  the  rains,  remains  more 
or  less  wet  and  forms  good  breeding  places  for  mos(iuitoes. 

The  water  supply  is  from  two  sources — one  from  r>!!nana  liiver,  a  continu- 
ously flowing  stream  with  few  habitations  near  its  banks.  Its  water  is  gen- 
erally clear  and  inviting  looking.  The  reservoir  is  some  10  miles  from  Limon 
on  tiie  bank  of  the  river,  and  the  water  is  conveyed  to  the  town  through  iron 
pipes,  l)ut  not  with  enough  pressure  for  fire  [lurposes  or  even  for  domestic  use 
in  houses  of  more  than  one  story.  This  supply  is  limited  in  amount,  and  is 
used  only  by  the  larger  and  newer  houses  and  by  those  in  which  w^ater-closets 
have  been  placed.  The  other  source  of  supply  is  t;inks  and  barrels,  in  which 
rain  water  from  the  roofs  is  kept  for  drinking  and  domestic  purposes. 

The  sanitary  condition  of  Limon  is  not  good.  There  is  some  slight  improve- 
ment in  this  respect  since  1901,  when  I  was  stationed  here  first.  This  imi)rove- 
ment  in  the  sanitary  condition  results  from  tlu>  filling  in  of  some  swamps  in 
and  near  the  town,  incident  to  the  constructing  of  a  railroad  by  the  United 
Fruit  Company. 

Mosquitoes,  especially  anopheles  and  stegomyia,  abound,  and  show  their  evil 
presence  by  the  constant  prevalence  of  acute  malarial  troubles  and  regularity 
of  recurrpnce  of  yellow  fever  among  the  population.  Nothing  is  done  to 
destroy  these  insects  or  to  prevent  their  propagation,  and  but  little  to  bar  them 
from  access  to  patients  sick  of  malarial  or  yellow  fever.  This  is  to  be  deplored, 
for  by  the  wise  expenditure  of  a  comparatively  small  sum  of  money  the  surface 
puddles  of  water  could  be  filled  in  or  kept  oiled,  the  water  barrels  and  tanks 
covered  with  wire  gauze,  and  a  careful  and  persistent  protection  of  all  fever 
patients  had. 

A  few  inadequate  and  poorly  constructed  sewers  were  laid  some  years  ago, 
and  serve  to  receive  the  output  from  what  water-closets  and  bath  tubs  are  con- 
nected therewith,  but  not  always  to  discharge  their  contents  into  the  sea,  as 
intended. 

Three  hospitals — one  of  the  Costa  Rican  Railroad,  one  of  the  United  Fruit 
Company,  and  the  other  the  Charity — are  situated  in  the  town  and  are  by  no 
means  modern  or  sanitary. 

A  new  and  large  hospital  is  now  being  erected  about  1  mile  north  of  Limon 
on  the  seacoast.  and  is  to  be  used  jointly  by  the  United  Fruit  Company  and 
the  Government  of  Costa  Rica. 

A  new  and  more  extensive  sewer  system  and  the  enlargement  and  improve- 
ment of  the  waterworks  are  in  contemplation  by  the  governmental  authorities. 
The  completion  of  these  will  add  greatly  to  the  comfort  and  good  health  of  the 
port  and  vicinity. 

The  morbidity  and  mortality  of  the  town  continues  very  great.  More  than 
60  per  cent  of  the  cases  treated  in  the  hospitals  are  of  malarial  origin,  largely 
of  the  frank  intermittent  type  and  among  negroes,  who  are  far  from  being 
immune  ta  malarial  infection. 


rilBLIC    HEALTH    AND    M AKINK-lIOSl'ITAL    SEllVKK 


l'J7 


'i'ho  pliysiciaii  of  tlio  I'liilcd  Fruit  Coiiiiiaii.v's  hospital  iiiforincd  me  on  my 
jurivai  iicro  Ajiril  S,  tliat  lie  had  discliarK<'<l  a  (-asc  of  .vcilow  fi'vcr  March  2;"). 
No  othor  cnsv  coidd  Ik*  found  until  May  llS,  when  I  reported  1  case  i)y  cable, 
quickly  followed  hy  2  others.  All  wore  mild  aud  recovered,  and  up  to  lliis  date 
no  other  cases  have  l)een  repcu'led. 

No  other  (luarantinahle  disease  has  made  its  aitpearanc(>  in  this  port  in  the 
time  covered  hy  this  report. 

The  total  lunnher  of  deaths  for  April,  May,  and  .Tune  is  TM.  Of  these,  20  died 
v{  malaiMal  fever  or  some  of  its  complications,  2(1  of  infantile  troubles,  (i  of 
syphilis,  5  of  tuberculosis,  0  slillhorn.  and  the  remaininir  1<;  of  various  other 
causes.  Thirteen  of  the  7'i  deaths  were  of  i)atients  brous^ht  from  the  banana 
farms  to  the  hospitals  here,  and  can  not  be  charged  fairly  to  liimon's  mor- 
tality. The  remainin.g  (>()  deaths,  with  an  estimated  population  of  4,W0,  gives 
us  the  very  hijjli  annual  death  rate  per  !,()(»(>  of  (!0. 

Since  April  S  I  have  ins])ected  78  stoamshii)s,  disinfected  with  burning  sul- 
phur in  open  pots  the  living  ((uarters  of  oT,  insi)ected  and  passed  crews  to  flu; 
nund)er  of  .'?,1'.).">,  and  passengers  710,  all  for  ports  of  the  United  States. 

Nineteen  bills  of  health  for  [torts  of  the  Republic  of  Panama  have  been  viseed, 
according  to  special  instructions. 

Respectfully,  D.  W.  fJoooMAN, 

Acting  Assiatiuit  Sur(jcon. 

The  Surgeon-General. 

PUERTO  C()rtp:z, 
Report  of  Transactions  i:v  Actino  Asst.  Surg.  C.  S.  Carter,  Season  ok  190.''i. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Puerto  (Jortcz,  Honduras,  Octoljer  31,  1003 
Sir:  I  have  the  honor  to  submit  the  following  as  final  report  of  transactions 
at  Puerto  Cortez,  Honduras,  during  the  quarantine  season  euded  October  ol, 

ino::;,  viz: 


Steamers  , 
Passengers 
Crew 

Baggage  . . 


July. 


18 

84 

39.5 

i:« 


Au- 
gust. 


16 

47 

;^2i 

86 


Septem- 
ber. 

Octo 
ber. 

17 
66 
:^41 
112 

17 
91 

:^)9 
17;^ 

Total. 


68 

288 

1,426 

.-)06 


Number  of  pieces  of  baggage  re.ieoted,  18  for  the  season. 

I   have  the  honor  to  state  that  the  health  conditions  of  Puerto  Cortez  and 
surrounding  country  have  been  good  throughout  the  entire  season,  there  being 
very  little  sickness  of  any  kind  and  no  quarantinable  diseases. 
Respectfullj', 

C.  S.  Carter, 
Acting  Assistant  Surgeon. 
The  Surgeon-General. 


Report  of  Transactions  by  Acting  Asst.  Surg.  C.  S.  Carter,  Season  of  1904. 

Public  Health  and  Marine-Hospital  Service. 

Office  of  Medical  Officer  in  Command. 

Puerto  Cortez,  Honduras,  June  30,  lHO'/. 
Sir  :   I  have  the  honor  to  submit  to  you  the  report  of  transactions  occurring 
at  this  station  during  April,  May,  and  June,  1904 : 


Steamers  inspected. . 
Schooners  inspected. 
Passengei's  inspected 

Crew  inspected 

Baggage  inspected. . . 

Aliens  inspected 

Aliens  rejected 

Baggage  rejected 


April. 


May. 


19 
0 

54 
417 

98 

19 
0 

10 


June.    Total. 


19 

0 

43 

311 

8,3 
17 
0 
10 


55 

2 

144 

1,126 

261 

57 

0 

40 


128  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

SA^'ITATION    AM)    iNEW    PLANS. 

I  have  tlio  lionor  to  state  that  the  healtli  and  sanitary  condition  of.  Puerto 
Cortez  has  heen  very  good.  No  quarantinable  diseases  have  Ijeen  reported,  and 
very  little  sickness  of  any  kind  either  in  the  port  or  surrounding  country,  the 
prevailing  diseases  being  malarial :  but,  as  the  rainy  season  has  set  in,  sickness 
will  increase  more  during  this  period,  which  extends  through  the  rest  of  the 
quarantine  season  ;uid  into  December.  There  has  also  been  an  increase  in  the 
number  of  mosciuitos  during  the  last  few  days,  owing  to  the  continued  rains. 

In  the  surrounding  country  very  little  sickness  of  any  kind  has  been  reported. 
Consular  certificates  brought  from  Tegucigali)a,  Tela,  and  San  Pedro,  by  passen- 
gers going  to  the  States,  report  no  quarantinable  diseases  and  little  sickness. 

The  sanitation  of  Puerto  Cortez  during  the  sunnner  has  been  fairly  good,  and 
will  conipare  favorably  with  most  of  Centi'al  American  ports,  and,  indeed,  much 
better  than  some,  and  if  the  present  plans  go  through  it  will  be  much  more  sani- 
tary than  it  is  now. 

The  city  is  bounded  on  the  north  by  a  salt  marsh  covered  with  foliage  of  all 
kinds.  In  area  tliis  marsh  is  3  miles  long  and  2  wide,  and  entirely  surrounds 
the  town  on  the  north  side ;  beyond  this  marsh  is  the  sea. 

The  Government  is  about  to  let  a  contract  to  have  this  swamp  filled  and 
cleared  its  entire  length  and  breadth,  and  make  it  level  with  the  city.  I  under- 
stand this  bill  is  now  before  Congress  and  will  surely  pass.  As  the  ground  is 
so  low,  very  little  drainage  can  now  I.)e  obtained.  The  intention  is,  if  the  plans 
are  carried  out,  to  cut  canals  the  whole  length  of  the  swamp,  connecting  with 
the  lagoon  and  cross  canals  from  ocean  to  I>:iy.  This  will  give  them  practically 
a  salt  water  sewerage,  as  they  have  12  to  14  inches  of  tide  on  the  ocean  side. 
This  contract  claims  to  be  finished  in  three  years  or  less,  and  is  to  begin  at  once, 
or  as  soon  as  the  concession  is  signed.  If  this  contract  is  completed,  I  think 
this  will  be  as  healthy  as  any  city  on  the  coast.  The  sea  wall,  which  we  find  in 
most  tropical  ports  where  sanitary  improvements  have  been  attempted,  will  not 
be  built,  and  the  drainage  will  be  a  great  deal  better  than  in  most  of  such  ports. 

QUARANTINE. 

There  has  been  no  trouble  at  this  port  in  regard  to  enforcing  the  regulations. 
The  consular  certificate  required  by  the  regulation  has  been  strictly  adhered  to 
by  persons  coming  from  interior  towns.  Baggage  is  also  inspected  very  closely. 
There  has  been  very  little  travel  from  either  Amapala,  on  the  Pacific  coast,  or 
San  Salvador.  None  from  Amapala  direct,  and  only  two  from  San  Salvador. 
These  were  eight  days  en  route,  and  wei"e  under  observation  here  about  fifteen 
to  twenty  days.  Their  business  also  kept  them  here  for  some  time.  Both  of 
these  gentlemen  claimed  to  be  immune,  but  only  one  had  his  certificate. 

Fifty-seven  aliens  were  also  inspected  at  this  port,  passed,  and  none  rejected. 

C.  S.  Cartee,  Acting  Assistant  Surgeon. 

The  Surgeon-General. 

LIVINGSTON. 

Report    of    Transactions    by    Acting    Asst.  Surg.  R.    II.    Peters,  Season  of 

100.3. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Liviiig.stoi),  Guatemala,  yovemhcr  2,  1903. 
Sir  :  I  have  the  honor  to  submit  report  of  the  transactions  at  this  station  for 
the  period  from  .July  1  to  October  31,  1903. 

Vessels  cleared 37 

Crews    inspected 1,008 

Passengers  inspected 51 

Baggage  inspected 93 

The  health  of  Living.ston  remained  good.     No  quarantinable  disease  in  Liv- 
ingston or  ad,iacent  country  during  the  season. 
Respectfully, 

R.  H.  Peters,  Acting  Assistant  Surgeon. 
The  Surgeon-General. 


rilMI.lC    HKALTH     AND    M  A  UINK-IK  »SIMTAL    SKRN'ICK.  129 

IIll'OKI      111       'I'KA.NSAi   I  li)\s      l!V      A(   II.\(i      ASST.     Si  IKi.     1{.     II.     I'KrKltS.     SKASON    OF 
rnU.tC    llKAI.TII    AND    MaKI  NK-IIoSI'ITAI.    Sk.KVICK, 

Ofitck  ok  Mkduai,  ()n-i<i:i{   in   Com m ami. 

IJrinf/stiiii.  (liKitciiKilfi,  Jiih/   i.  UK)'/. 

Sik:  1  liMvc  (lie  lioiior  to  siil>iuit  the  rKllowiiiir  report  of  tr.-iiisiictioiis  for  yi'ar 
(MKlt'd  .Iiiiu'  .".(I.  I'.HM: 

Tlu'  station  was  opciu'd  April  .").  P.Mi4.  from  which  date  w(irl<  (•(iiiiiiiciiccd.  and. 
as  directed  in  Hurean  letter  of  Aitril  I'l'.  liXM,  I  have  reKul.irly  visited  the  port 
of  I'uerto  Harries,  Cuateiiiala,  to  inspect  vessels  and  issue  certiticati's  to  jias- 
senj^ers  Jeavinir  that  i»ort  for  the  I'nited  States.  Xo  jiassenjrers  have  left 
Livingston  diri'ct.  as  the  mail  steamers  of  the  Tnited  Fruit  Comjiany  do  not 
stop  at  this  i»ort.  only  call  at  Tuei-to  Uarrios,  from  which  i)ort  all  mail  and 
most  cf  the  jiasseiiuers  (>mhark.  The  steamei's  which  come  to  Livin,iiston  are 
simply  fruit  ves.-<els  and  only  have  limited  jtassen^^er  acconnnodations. 

The  steamers  at  Livingston  anchor  al>out  a  mile  and  a  half  from  shore,  and 
the  fruit  is  taken  out  to  them  in  liijhters.  and  there  is  very  little  dan^'er  from 
mosipiitoes.  whereas  in  Puertct  Barrios  the  vessels  co  alongside  the  dock  and 
iire  liahle  to  invasion,  as  the  mos(|uitoes  are  very  plentiful  owinj;  to  the 
swamjiy  nature  of  the  surroundini;  coun.try. 

The  jtassenirers  from  I'uerto  Barrios  come  from  the  interior  of  (Juatemala 
and  Salvadoi'.  and,  as  it  also  has  conuimnications  with  tlie  I'acific  side,  it  makes 
it  one  of  the  danijerons  jjorts  id  this  coast. 

Since  the  openiuisr  of  the  station  27  vessels  have  been  in.spected  and  iiiven  bills 
of  health,  725  crew  inspected,  and  89  passengers  given  certificates;  of  this 
number  32  were  aliens. 

The  destination  of  the  vessels  cleared  from  Livingston  (14)  and  Puerto  B>ar- 
rios  (^'^)  were  as  follows:  New  Orleans.  18;  Mobile.  7;  \ew  York.  1;  Apa- 
lachicola.  Fla.,  1. 

Livingston  and  I'uerto  BaiM-ios  have  been  free  from  all  (luarantinalde  diseases 
so  far  this  season,  malarial  fever  of  a  mild  type  being  the  princiiial  sickness. 
Respectfully. 


The  Surgeo.n-General. 

BOCAS    DEL    TORO. 


K.   II.   Beteus, 
Actinft  Assifttant  burgeon. 


Keport  of  Transactions  by  Acting  Asst.  Surg.  I'aul  Osterhout,  Season  of 

1903. 

Public  Health  and  Marine-Hospital  Service. 

Office  of  ^Iedtcal  Officer  in  Command. 
BocfiK  flcl  Toro,  Colomh'nu  Xorrinhrr  •>.  1003. 
Sir:  I  have  the  honor  to  submit  the  following  report  of  the  tran.sactions  at 
this  station  for  the  period  July  1.  1903,  to  and  inclu<ling  November  4.  1903.  when 
the  service  was  discontinued  : 

Vessels   insjiected 70 

Pieces  of  baggage  disinfected 19 

Persons  ins]»ected: 

Ship's  crews 1.  W9 

Passengers 11 

Total 1.620 

Respectfully, 

Paul  Osterhoit, 
Acting  Ansixtant  Surgeon, 

The  Surgeon-General. 
8629—04 9 


180  PUHLIO    HEALTH    AND    MARrNK-n()Sl>ITAL    SERVICE. 

Report  of  Transactions  isy  Acting  Asst.  Surg.  I'aul  Ostkkhout,  Season  of 

1904. 

PuHLic  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officeij  in  Command, 

Bocas  del  Toro,  Panama,  Jnly  2,  190^/. 
Sir  :  I  liavo  the  honor  to  submit  tlie  following;:  sintonient  of  the  transactions 
at  this  station  for  tlio  fiscal  year  ended  June  .'^>(».  I!)(i4.  inchisive: 

Vessels  not  l)eln,LC  allowed  to  come  alonii:si<le  of  the  wharves,  transportation  lo 
them  is  furnished  ))y  the  consignee. 

All  vessels  are  hoarded  by  me  on  arrival  in  order  to  see  that  the  vessel  is  in  a 
sanitary  condition  and  that  no  sickness  e.xists.  Immediately  prior  to  dei)artnre 
of  vessels  from  this  port  they  are  again  hoarded  by  me,  the  crew  and  passengers, 
if  any,  ins])e<'ted  and  certificates  issued  in  accordance  with  the  quarantine  reg- 
ulations of  the  United  States.  The  consular  bill  of  health  is  also  signed  after 
this  inspection. 

Vessels   inspected 40 

Pieces  of  baggage  inspected 98 

Persons  inspected : 

Ship's   crews 1.  KIT 

Passengers . 5S 

Total 1,  22n 

Quaraiitinohic  diseases. — No  infectious  or  contagious  disease  has  existed  in 
this  iilace  during  the  present  year.  The  last  case  of  yellow  fever  that  occurred 
in  this  section  of  country  was  a  man  that  came  hei-e  from  Limon,  Costa  Rica, 
during  Octol)er,  1901.  He  fell  sick  Just  twenty-four  hours  after  arriving  here. 
The  last  case  to  originate  here  was  in  August,  1901.  The  energetic  methods 
employed  by  the  local  government  last  year  to  rid  this  section  of  smallpox  has 
shown  good  results,  as  there  has  lieen  no  recurrence. 

I  am  ])le,ased  to  report  that  this  place  is  now  connected  with  the  outside 
world  l>y  means  of  the  wireless  telcgrai)h  system,  operated  by  the  United  Fruil 
Company.  Tlie  connecting  station  is  located  in  Limon,  Costa  Rica.  The  tariff 
rate  of  10  cents  (United  States  currency)  per  word  to  be  added  to  the  rate  to 
Limon  (all  words  counted) 

Respectfully,  Paul  Osterhout, 

Acthifj  Assistant  Hurgeon. 

The  Surgeon-General. 

CEIBA. 

Report  of  Transactions  by  Acting  Asst.  Surg.  W.  B.  Robertson,  Season 

of  1903. 

PuisLic   Health   and   Marine-Hospital   Service, 

Office  of  Medical  Officer  in  Command, 

Cciha,  Hoiidunis,  Octoher  31,  1D03. 
Sir  :   I  have  the  honor  to  submit  the  following  supplemental  report  on  the 
conditions  and  transactions  at  this  station  from  Jidy  1  to  November  1,  1908, 
inclusive : 

The  conditions,  as  a  whole,  remain  the  same  as  those  stated  in  the  general 
reimrt  for  the  i)eriod  ending  June  .''.(».   19(«.  inclusive. 

Since  the  latter  i>art  of  August  there  h;is  I)een  a  considerable  increase  in 
the  tonnage  of  this  port  in  conscciucnce  of  th(>  depression  of  the  .Jamaica  fruit 
trade  from  the  effects  of  the  recent  hurricane  there.     The  statistics  are: 

Vessels : 

Inspected     '''4 

Disinfected    <• 

Crews  (number  of)  : 

Inspected  1.  40.'") 

Vaccinated    0 

Passengers : 

Inspected   4 

Vaccinated    0 

Baggage  inspected  and  disinfected,  pieces 5 


^ 


puinjr  nKALTiT   and  makink-iiosimtal  skrvice.         181 

Health  of  nrirs.—Tlu'  >,'i'ii(M'iil  licaltli  of  tlio  crews  on  the  vessels  IradiiiK 
here  lias  been  except ionally  jrood,  t-veii  cases  of  niiiior  ailiiieiits  l»eiii«,'  iiracii- 
cally  ai)seiit. 

Mostmilocs  on  vessels. — PcM'soiial  observalidii  and  carerid  iiKiuii-ics  Tailed  t(> 
demoiislrate  the  presence  or  cominir  on  hoai-d  of  in(>s(|ni1oes  while  vessels  are  at 
anchor  eithei-  here  or  alon^  th(>  coast.  In  the  few  cases  in  which  a  stray  one 
was  observed  it  was  probably  brought  In  the  shi])  from  the  home  poi'l.  The 
al)senc(>  of  them  Is  itr(>sinnably  the  result  of  the  ships  seldom  approachin;;  closei- 
to  shore  than  one-third  of  a  mile  at  the  various  points  of  loading;. 

I'(i.sscii!/cr  ira/jic. — This  is  not  re.uularly  en^'a.L'ed  in.  owinj^  to  the  Louisiana 
and  Alabama  State  boards  recpiirin,!;:  a  nu'dical  ollicer  on  board  all  vessels  cai-ry 
int:  passi'iiirers  and  the  small  amount  of  such  trathc  not  justifyint;  such  "a 
procedure,  the  few  cases  in  which  passengers  were  carried  beinj;  either  under 
special  iiermit  or  on  a  boat  carryin.t;:  a  medical  ollicer  bein.i^  sent  to  load  here. 

Haillli    coiKJilioiis   of  port. — The   health   conditions,   both    from   a    (piai'antin 
able  and  general   standi)oiut,   hav(>  been   very  .i^ood.     With  an  estimated  jtopu- 
lation  of  about  4,0()(>,  there  ha\e  been  durin.i,'  the  past  two  and  one-half  months 
about  l.'l  deaths. 

In  comi)arison  with  tlie  same  period  of  last  year,  there  has  been  an  a])pre- 
ciable  anu>lioration  in  both  the  types  and  the  number  of  cases  of  malaria, 
the  most  of  them  beiuir  mild  forms  of  "  intermittents  "  with  a  few  ■'  i-emit- 
tents,"  the  "  bilious  remittent  "  type  being  id)sent. 

Several  cases  of  dysentery  and  a  f(>w  deaths  th(>r(>from  have  b(>en  rei»orted. 
These,  so  far  as  could  be  ascertained,  wer(>  malarial  in  ori.i,nn. 

Among  children  there  have  been  the  usual  gastrointestinal  derangements, 
with  but  few  (leaths  resulting  therefrom. 

The  remaining  cases  of  sickness  being  of  ordinary  types,  call  for  no  special 
mention. 

SaiiitdtioH. — With  the  advent  of  a  new  administration  considerable  improve- 
ment in  the  sanitation  of  the  town  has  been  effected.  The  streets  are  kept 
clean  and  free  from  grass  and  weeds.  Under  penalty  of  an  incremental  fine,  all 
proi)erties  must  I»e  kept  free  from  refuse,  rubbish,  and  weeds.  The  dirt  must 
be  collected  in  suitable  receptacles  and  is  removed  by  nuniicii)al  carts  beycmd 
the  limits  of  the  town  at  least  once  a  week.  ^Measures  are  now  l)eing  insti- 
tuted to  have  the  .garbage  btn-ned ;  also  for  enforcing  sanitary  care  of  the 
lirivies  and  cesspools  attached  to  dwellings. 


The  Surgeon-General. 


W.    B.    RODEKTSON, 

Acting  Assistant  Surgeon. 


Report  of  Transactions  by  Acting  Asst.  Surg.  W.  B.  Robertson,  Season  of 

1904. 

PtTBLic  Health  and  .Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command. 

Cciha.  Honduras,  -lulu  1.  lOd.'/. 
Sir:  T  have  the  honor  to  transuiit  the  following  general  report  of  the  condi- 
tions and  transactions  at  this  station  from  the  date  of  opening,  April  20,  to 
June  30,  inclusive : 

The  l)oarding  (  f  vessels  is  done  by  boats  furnished  by  the  agent  or  master  of 
the  vessel  for  -Ahich  the  insi»ection  is  made.  Owing  to  the  uncertainties  of 
loading  and  clearance,  this  has  at  times  to  be  done  at  night,  and  often  through 
rough  surf. 

'I'raii.'iavtions. 

Steamers  inspected  and  passed 100 

Steamers    disinfected 1 

Sailing  vessels  inspected  and  passed 7 

Sailing  vessels  disinfected 0 

Crew   on   steamers 2,026 

Crew  on  sailing  vessels 44 

Passengers  on  steamers 17 

Passengers  on  sailing  vessels 1 


132  PUBLIC    HEALTH    AND    MARINE.-HOSPITAL    SERVICE. 

Seldom,  if  ever,  are  mosquitoes  found  on  the  vessels  while  loadinj?  on  this 
coast.  This  immunity  is  very  probably  due  to  the  distance  from  the  coast  at 
which  the  ships  are  anchored. 

From  a  quarantine  standpoint,  the  health  conditions  of  this  port  have  been 
excellent  since  the  openin;^  of  the  .season,  and  such  has  been  the  case  for  several 
years.  As  yet  the  local  government  has  not  instituted  any  reliable  system  of 
quarantine  with  other  ports. 

The  mortality  record  seems  about  the  same  as  in  former  years,  but  it  is  diffi- 
cult to  get  reliable  statistics,  as  the  system  of  recording  deaths  is  a  rather 
crude  one. 

Malaria  is  the  prevailing  disease,  generally  manifesting  itself  in  the  milder 
types,  occasionally  assuming  the  graver  forms. 

There  has  been  a  slight  increase  in  the  number  of  cases  of  dysentery,  com- 
pared with  the  same  time  last  year. 

Respectfully  submitted. 


The  Surgeon-Genebal. 

BLUEFIELDS. 


W.  B.  Robertson, 
Acting  Assislant  Surgeon. 


Report  of  Transactions  bt  Acting  Asst.  Surg.  D.  W.  Goodman,  Season  of 

1903. 

Sir  :  I  have  the  honor  to  make  the  following  report  of  the  transactions  at  the 
Port  of  Bluefields.  Nicaragua,  from  .July  1  to  October  31.  1903,  inclusive: 

Fort>'-six  steamships,  with  their  crews,  aggregating  845  men.  were  inspected 
and  given  bills  of  health:  11.")  passengers  were  inspected  and  passed,  and  their 
baggage,  149  pieces,  was  disinfected. 

During  these  four  months  there  occurred  in  Bluefields  and  vicinity  28  deaths, 
which,  based  ui)on  a  population  of  4,000,  gives  an  annual  death  rate  per  1,000 
of  21. 

The  general  health  and  sanitary  conditions  of  the  port  wei'e  good,  with  no  evi- 
dence at  any  time  of  quarantinable  diseases. 

Respectfully,  D.  W.  Goodman. 

Acting  Assistant  Surgeon. 

The  Surgeon-General. 


Report  of  Transactions  by  Acting  Asst.  Surg.  W.  H.  Reilley,  Season  of  1904. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command. 

Bluefields,  'Nicaragua.  July  1.  IDOJf. 

Sir  :  In  compliance  with  Bureau  letter  dated  March  18,  I  have  the  honor  to 
submit  report  of  conditions  and  trans.'utions  at  this  station  from  the  date  of 
my  arrival,  April  10,  to  June  .30,  inclusive. 

The  disinfecting  plant,  which  was  the  property  of  the  Bluefields  Steamship 
Company,  was  destroyed  by  fire  last  year. 

All  vessels  are  boarded  by  the  marine-hospital  inspector  just  prior  to  their 
departure,  and  a  thorough  inspection  of  the  shij).  crew,  and  iiassengers  made. 

Certificates  giving  the  number  of  crew  and  ]iassengers.  nature  of  cargo,  the 
sanitary  condition  of  crew,  ixissengers.  ship,  and  surrounding  country  are 
attached  to  the  original  and  duplicate  l>ills  of  health  and  a  triplicate  sent  to  the 
Surgeon-General  with  the  weekly  report. 

All  passengers,  with  the  exception  of  those  coming  from  elevated  and  non- 
infectible  points,  are  requested  to  be  under  the  observation  of  the  marine- 
hospital  inspector  for  at  least  five  days  i>rior  to  their  departure,  at  which  time 
a  personal  certificate  of  identification  is  given  and  a  duplicate  sent  the  Surgeon- 
General. 

In  accordance  with  the  regulations,  there  was  no  fumigation  of  baggage. 

The  sanitary  condition  of  Bluefields  and  surrounding  country  is  very  good 
from  a  quarantine  standpoint.     The  estimated  population  is  about  4.000. 

From  April  10  to  .July  1  there  occurred  2(j  deaths,  from  the  following  causes : 
Tuberculosis  8,  dysentery  3,  premature  birth   1,  accidents  2,   ascaris   lumbri- 


PTTRLTC    IIKALTII    AND    M ARTNE-nOSPTTAL    SKRVIOK.  183 

foidos  1.  stMiilily  1,  tlirusli  1.  iiscitcs  1.  iiialMii:il  fcvci'  I.  heart  disease  1,  eirrliosis 
of  liver  1.  appendicitis  1,  tetamis  1. 

Vessels  inspeclxMl    (sailiiij:  to  United   States) 29 

Crews  inspected  (sailins;  to  TTnited  States) 531 

Passeni^ers  insitecled  (saiiinii  to  United  States) 115 

\'essels  inspected  (sailiii.i;  to  Panama) 2 

Crew  inspected   (saiiinji  to  Panama) 11 

Passenjjcers  Inspected  (sailing  to  Panama) 17 

Respectfully.  W.  IT.  REii.r.EY. 

Acting  Assistant  fiiirgeon. 
The  Surgeon-General. 

BELIZE, 
REPor.T  oi-  Transactions  nx  Acting  Asst.  Surc.  W.  H.  Carson,  Season  of  1903. 

Public  Health  and  Marine-Hospital  Service. 

Office  of  Medical  Officer  in  Command. 
Belize,  British  Honduras,  Novemhcr  1, 1903. 

Report  of  transactions  at  the  port  of  Belize,  British  Honduras,  from  July  1. 

to  Xovemher  1,  1903. 

Steamers  inspected  and  passed 49 

Steamers  disinfected 0 

Sailing  vessels  inspected  and  passed 2 

Sailing  vessels  disinfected 0 

Crews  on  steamers 1,370 

Crews  on  sailing;;  vessels 11 

Passengers  on  steamers 103 

Passengers  on  sailing  vessels -_ 0 

Respectfully,  Wm.  II.  Carson. 

Actiiif/  Assistant  Surgeon. 
The  Surgeon-General. 

Report  of  Transactions  by  Acting  Asst.  Surg.  Wm.  II.  Carson.  Season  of  1904. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command. 

Belize,  British  Honduras,  July  1, 190fi. 

Sir:  I  have  the  honor,  complying  with  circular  letter  dated  Washington, 
March  18  last,  to  transmit  herewith  report  of  the  transactions  at  this  station, 
a  fruit  port,  for  (eighty-one  dnys)  April,  May,  and  June,  the  fiscal  year  ending 
June  30,  1904. 

The  sanitary  condition  of  the  town  of  Belize  during  the  period  of  time  noted 
above  has  been  good,  for  a  tropical  seaport ;  nor  has  there  been  the  least  sus- 
picion as  to  the  existence  of  any  contagious  or  infectious  disease  in  the  sur- 
rounding territory. 

It  may  be  observed  here  that  while  Belize  has  had  several  recorded  outbreaks 
of  yellow  fever  since  1800  there  is  no  record  as  to  its  reappearance  since  1891, 
when  2  deaths  occurred  here. 

The  Belize  Public  Hospital  (Dr.  C.  H.  Eyles,  colonial  surgeon,  and  I.  H.  H. 
Harrison,  resident  surgeon),  accommodating  48  patients,  is  one  of  the  three 
government  hospitals  located  in  British  Honduras.  This  institution  has  34 
I>atients  (7  white),  and  none  of  any  interest  from  a  quarantine  point  of  view. 

There  have  been  42  deaths  (1  white)  from  all  causes  at  this  port  (21.72  per 
1,000  per  annum)  ;  none  due  to  a  contagious  or  infectious  disease. 

Since  June,  1903,  extensive  sanitary  improvements,  such  as  filling  town  lots 
to  a  standard  grade  with  sand  and  silt  dredged  from  the  shallow  harbor,  cement- 
ing drains,  and  other  systematic  efforts'  to  rid  this  port  of  dangerous  mosquitoes, 
have  been  in  active  prosecution. 


134  PFPLTC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Report  nf  transactions  at  the  fruit  port  of  Belize,  British  Honduras,  for  (April, 
Mail,  and  ■/inic)  the  fiscal  year  endintj  June  SO,  IfX)'/. 

Steamers  inspected  and  passed 127 

Steamers  disinfected 0 

Sailing  vessel  insi)ected  and  passed 1 

Sailing  vessel  disinfected 0 

Crews  on  steamers 800 

Crews  on  sailing  vessels 7 

Passengers  on  steamers 94 

Passengex's  on  sailing  vessels 0 

Number  of  aliens  inspected 54 

Respectfully,  *  Wm.  11.  Carson, 

Acting  Assistant  Surgeon. 
The  Surgeon-General. 

Panama. 

detail  of  officers  to  colon  and  panama. 

Soon  after  it  "was  positively  decided  that  the  ITnited  States  "wonkl 
purchase  the  Panama  Canal  the  following  officers  were  detailed  to 
the  consular  offices  in  Panama  and  Colon  to  inspect  vessels  f:n- 
United  States  ports  and  to  transmit  sanitary  information,  viz :  xVsst. 
Surg.  Claude  C.  Pierce,  Panama,  December  8,  1903;  Surg.  J.  C. 
Perry,  Colon,  January  10,  1904;  Acting  Asst.  Surg.  Herman  B. 
Mohr  as  assistant  to  Surgeon  Perry,  February  12,  190-1. 

Details  were  also  made  to  other  foreign  ports  for  the  protection  of 
the  United  States  with  the  expectation  that  the  services  of  these  offi- 
cers would  be  also  of  value  to  Panama  ports,  viz :  Acting  Asst.  Surg. 
Fleetwood  Gruver,  Guayaquil,  Ecuador,  Februarv  3,  1904;  Asst. 
Surg.  B.  J.  Lloyd,  Callao,  Peru,  February  26,  1904;' and  Passed  Asst. 
Surg.  L.  D.  Fricks,  La  Guayra,  Venezuela,  February  29,  1904. 

Special  attention  is  invited  to  the  very  excellent  reports  on  sani- 
tary matters  on  the  Isthmus  of  Panama,  the  cities  of  Colon  and  Pan- 
ama, and  the  territory  between  them,  by  Surg.  J.  C.  Perry  and  Asst. 
Surg.  Claude  C.  Pierce.  These  reports  were  timely  and  of  great 
service.  (See  "Preliminary  report  on  sanitary  condition  of  Colon 
and  Panama,  and  the  Isthmus  between  these  points,"  Public  Health 
Reports,  March  4,  1904,  by  J.  C.  Perry;  and  by  the  same  officer, 
"  Prevailing  diseases  on  the  Isthmus  along  the  canal  route.""'  Public 
Health  Reports,  April  29,  1904.  Also  by  Assistant  Surgeon  Pierce, 
"  Sanitary  report  of  Panama  and  vicinity,"  Public  Health  Reports, 
Februarys,  1904). 

REPUBLIC    OF    PANAMA    REQUESTS    ASSISTANCE    OF    SERVICE    OFFICERS    ON 
DUTY    AT    FOREIGN    PORTS. 

Official  request  was  received  from  the  Panama  Republic  for  the 
assistance  of  the  officers  in  neighboring  republics,  as  shown  by  the 
following  correspondence : 

DEPARTilENT    OF    StVTE, 

Washington,  Fehruary  24,  190.'i. 
Sir  :  I  have  the  honor  to  inclose  for  your  consideration  cojiy  of  a  note  from 
the  minister  of  Panama  at  this  capital,  in  which  he  suggests  that  United  Stales 
medical  officers  at  contaminated  ports  in  foreign  countries  may  he  instructed  to 
act  in  regard  to  vessels  sailing  for  ports.of  Panama  as  they  do  in  regard  to  ves- 
sels sailing  for  ITnited  States  ports. 

Awaiting  your  reply,  I  have  the  honor  to  be,  sir,  your  obedient  servant, 

•ToHN  Hay. 
The  Secretary  of  the  Treasuky. 


PUHLU'    llKALTIl    AND    M  ARI N  K-IIOSI'ITAl.    SERVICE.  185 

1  Iiiclosiiro.  1 

LE(i.\Ti()N  OK  TiiK  Republic  of  I'anama. 

Wasliimjton,  I).  C.  February  20,  IDO.',. 
Sib:  The  Duroau  of  Public  Ilejiltli  iind  Miiriiu'-IIospital  Service  details  in  for 
eign  ports,  wliicli  ai-c  under  the  suspicion  of  contaf^inns  diseases,  inedica!  officers 
to  assist  tl>e  consuls  of  (lie  I'nited  States,  in  order  t<i  prevent  tlie  ti-ansportation 
of  diseases  from  said  ports  to  ports  of  the  I'nited  States  li.v  ships  hound  for 
tlieni. 

In  view  of  the  importance  of  the  sanitar.v  i)recautions  for  the  j^reat  work 
that  is  going  to  he  acconii)lished  by  the  United  States  on  tlie  territor.v  of  the 
Republic  of  I'anama.  I  lu'g  to  suggest  to  your  excellency  tliat  orders  lie  given  to 
tlie  medical  oMicers  detailed  at  the  contaminated  jtorts  to  exercise  their  author- 
ity and  to  di<-tate  the  sanitaiy  measures  for  all  ships  leaving  s.aid  jtorts  for  the 
Republic  of  I'anama  exactly  in  the  same  manner  as  they  are  instructed  to  do 
for  ships  bound  for  the  United  States. 

The   adoption   of   this   suggestion   I)y   the   (Jovei'nment   of   the   TTnited    States 
would  be  highly  ai)preciated  by  the  (iovernment  of  the  Rejmblic  of  r.uiama. 
I  am,  sir.  with  great  respect,  your  very  obedient  servant. 

I'.  Bunau-Varilla. 
His  Excellency  John  Hay, 

Secretary  of  State.  Wasliiiif/ton. 


February  27,  1904. 

Sir  :  Referring  to  your  letter  of  the  24th  instant,  inclosing,  for  my  considera- 
tion, copy  of  a  note  from  the  minister  of  Panama  at  this  capital,  in  which  he 
suggests  that  the  United  States  medical  officers  at  contaminated  ports  in  for- 
eign countries  may  be  instructed  to  act  in  regard  to  vessels  sailing  for  ports  of 
Panama  as  the.v  do  in  regard  to  vessels  sailing  for  T'nited  States  ports,  I  have 
the  honor  to  state  that  the  Surgeon-Oeneral  of  the  Public  Health  and  Marine- 
Hospital  Service  will  issue  instructions  to  officers  of  the  Service  serving  in 
such  foreign  ports  to  comi)ly  with  this  request. 

To  facilitate  the  carrying  out  of  these  instructions  it  is  requested  that  a  cir- 
cular letter  of  instructions  be  issued  to  all  consuls  in  foreign  ports  to  insure  their 
cooperation  in  this  work. 

Respectfully.  R.  B.  Armstrong. 

Actiiif/  Secretary. 

The  Secretary  of  State. 

The  folloAving  circular  letter  of  instructions  was  sent  to  all  officers 
serving  in  foreign  ports  and  ports  in  the  possession  and  dependencies 
of  the  United  States: 

[Circular  letter.] 

March  2.  1004. 
To  commissioned  medical  officers,  actiuf/  assistant  surgeons  of  the  Putilic  Uealth 
and  Marine-Hosj)itaI  Scrricc,  and  others  concerned: 

You  are  hereby  informed  that  the  minister  of  Panama  at  Washington  has 
requested,  through  the  Department  of  State,  that  United  States  medical  officers 
at  contaminated  ports  in  foreign  countries  may  be  instructed  to  act  in  regard  to 
vessels  sailing  for  ports  of  Panama  as  they  do  in  regard  to  vessels  sailing  to  the 
United  States:  and  the  Secretary  of  the  Treasury  has  informed  the  Secretary 
of  State  that  instructions  will  I)e  sent  to  officers  of  the  Service  serving  in  foreign 
ftorts  to  comply  with  this  rerpiest. 

You  are  therefore  directed  to  carry  out  the  instructions  as  above  indicated. 
Respectfully, 

Walter  Wyman,  S urtfcon-Getieral. 

BILLS  OF  HEALTH  FOR   PANAMA  TO   RE   SIGNED  BY   SERVICE   OFFICERS. 

Complaints  having  been  received  from  the  medical  officers  at  Cal- 
lao.  Pern,  and  Guavaqnil,  Ecuador,  that  the  Panama  authorities  at 
Panama  were  not  requiring  their  certificates  and  bills  of  health  upon 


136  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

the  arrival  of  tho  vessels  at  Panama,  and  that  this  ^Yeakened  their 
authority  in  their  respective  ports,  representation  was  made  to  the 
State  Department,  with  reconnnendation  that  the  attention  of  the 
Panama  authorities  be  called  to  this  matter,  and  the  gvi^nt  importance 
of  cooperation  in  this  sanitary  work  be  shown.  The  matter  was 
actively  taken  up  Avith  Panama  by  the  State  Department,  and  accord- 
ingly instructions  were  cabled  on  April  2.5,  1901,  by  the  Panama  Gov- 
ernment to  its  consuls  at  Callao,  Guayaquil,  and  La  Guayara  to  coop- 
erate with  the  officers  of  this  Service  in  the  clearance  of  vessels  bound 
for  ports  in  the  Republic  of  Panama.  The  following  decrees  were 
issued  by  the  Panaman  Government : 

Decree  No.  8  of  IDOJ/. 

[April  30,   1904.1 

P>y  which  is  dictated  a  regulation  for  the  sanitary  service. 

The  President  of  the  Kepublic,  by  the  power  vested  in  him  and  in  considera- 
tion of  a  re(iuest  made  to  him  liy  the  national  board  of  health  in  letter  No.  532, 
dated  April  22,  1904,  hereby  decrees : 

Article  1. 

In  order  that  vessels  be  received  in  the  port  of  Panama,  coming  from  Peru- 
vian or  intermediate  ports,  it  is  required  that  the  bills  of  health  of  such  vessels 
shall  be  viseed  by  the  medical  otticer  of  the  United  States  Public  Health  and 
Marine-Hospital  Service  in  those  ports  that  have  such  officers  attached  to  the 
United  States  consul's  office,  as  is  the  case  at  (Juayaquil. 

Article  2. 

The  agents  of  the  Pacific  Steam  Navigation  Company  and  of  the  Company  of 
South  American  Steamers  are  oblige*!  to  gi\'e  strict  compliance  to  the  regulations 
dictated  or  that  shall  be  dictated  in  the  future  by  the  medical  officers  of  the 
above-named  service,  in  reference  to  those  steamers  of  either  company  that  are 
dispatched  to  Panama. 

Communicate  and  publish  this  law. 

Manuel    Amador    Guerra. 
M.  (}uiNTERO,  v., 

Secretary  of  Public  Worhs. 
Pan.\ma,  April  30,  VJOJ,. 


No.  0. 


Decree  of  May  11,  lOOJ/.  Ity  rvhich  is  set  forth  a  measure  in  relation  to  the  puWc 

health  serrice. 

The  President  of  the  Republic,  in  accordance  with  powers  invested  in  him, 
decrees : 

Article  1. 

The  regulations  of  the  decree  of  the  nati' nal  executive  No.  8,  of  April  .^O 
last,  have  been  extended  to  the  port  of  Colon. 

In  consequence,  in  order  that  steamers  proceeding  from  foreign  ports  may 
have  permission  to  enter  the  port  of  Colon,  it  is  required  that  their  respective 
bills  of  health  shall  have  been  viseed  by  the  doctor  of  the  Public  Health  and 
Marine-Hospital  Service  of  the  United  States  if  the  steamers  proceed  from  ports 
where  a  doctor  of  the  above-named  Service  is  attached  to  the  United  States  con- 
sulate. 

Article  2. 

The  agents  at  Colon  of  the  respective  steamship  companies  are  obliged  strictly 
to  comply  with  the  said  regulations,  or  with  the  regulations  which  may  be  made 


TITHLTC    HKALTH    AND    MAUINK-HOSIMTAL    rtEKVlCE.  187 

ill  tli(>  fiitiin-  liy  11i(>  (li)clnr  of  the  .iliDvc-iiicnlioiu'd  Service,  in  respect  to  vessels 
wiiicli  are  (lisjcilclKMl  (o  tiie  |i(»rt  of  Colon. 

("(iminuiiic.ile  niul  piildisli. 

(Jiveii  nl  l';ni;iin:i  M:i.v  11,   I;K)4. 

M.  Amadou  (jueuua. 

The  secretiiry  of  public  works.  Manuel  Quintero.  V. 

The  subsecretiir.v  <tf  puhlie  works,  Adoijtio  Ai.eman. 

For  the  snksecretaiy  of  government,  II.  (Jonzales  Guiix. 

KIX'OMMENDATION    THAT    INCOMING    QUARANTINE    BE    PLACKI)    IN    HANDS 

OF    SERVICE. 

Notwithstniuliiio-  the  ahove  ineasiiivs.  tho  situation  was  still  unsat- 
isfactory, since  the  (luarantine  authorities  at  Panama  were  not 
demandino:  bills  of  health  i.ssued  l)v  representatives  of  this  Service. 
This  and  other  facts  made  it  desirable  that  the  quarantine  at  Panama 
should  be  conducted  by  the  Service. 

On  May  1'2  the  followino;  letter,  with  two  inclosures,  was  addressed 
to  Rear- Admiral  John  (i.  ^^'^alker  in  regard  to  this  subject,  one  from 
the  medical  officer  of  this  Service  at  Panama,  the  other  from  the  medi- 
cal officer  at  Guayaquil,  Ecuador: 

Treasury  Department. 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Washiiwton,  May  12,  WOJf. 
My  Dear  Sir  :  Referring  to  luy  conversation  with  yon  yesterday,  I  transmit 
herewith  for  your  infoi-iiiation  a  coi)y  of  a  letter  received  from  Assistant  Sur- 
geon Pierce,  at  Panama,  showing  the  apprehension  which  exists  concerning  the 
management  of  quarantine  at  Panama  by  the  local  authorities.  It  seems  that 
jiassengers  coming  from  districts  in  Peru  infected  with  bubonic  plague  were 
transferred  at  Guayaquil,  Ecuador,  and  immediately  came  on  to  Panama  and 
received  no  inspection. 

I  also  inclose  a  copy  of  a  portion  of  a  letter  received  from  Acting  Assistant 

Surgeon  C4ruver.  at  (Guayaquil,  from  which  it  will  be  seen  that  the  vessels  which 

conveyed  the  iiassengers  from  Peru  to  Guayaquil  and  subsequently  came  through 

to  Panama  without  inspection  developed  a  case  of  bubonic  plague  on  board. 

I  am  sure  you  will  appreciate,  as  I  do,  that  this  is  a  dangerous  state  of  affairs. 

Respectfully, 

Walter  Wyman,  Surgeon-General. 

Rear- Admiral  .John  G.  Walker.  U.  S.  Navy, 

Chairman  Isthmian  Canal  Commission,  Washinr/ton,  D.  C. 

[Inclosures.] 

Panama,  Panama,  April  2Jf,  lOOJf. 

Sir  :  I  have  the  honor  to  quote  as  follows  from  the  Panama  Star-Herald 
of  this  date  an  article  by  the  editor  in  criticism  of  the  quarantine  officer  at  this 
port.     The  article,  appeared  only  in  the  Spanish  side  of  the  publication : 

"  It  is  asserted  here,  with  just  cause,  that  the  power  of  the  i)oard  of  health  in 
reference  to  the  vigilance  necessary  to  prevent  the  contagion  of  the  bubonic  pest 
that  to-day  exists  in  the  south,  principally  in  Lima  and  Antofogasta,  has  been 
abused,  and  by  their  transgression  they  have  exposed  this  city  to  infection  by 
this  terrible  disease.  We  know  of  a  certainty  that  the  steamer  Tiicapcl  returned 
to  this  port  with  the  passengers  of  the  steamer  Liiiiiri.  who  w(>re  transferred 
at  Puna  during  the  late  hours  of  the  night.  These  passengers  entered  into  this 
city  without  difficulty,  because  the  Tiicaprl  was  at  once  given  free  pratiipie. 
This  deed,  more  than  being  censurable,  should  l)e  jniblished  and  the  remedy 
should  be  applied  to  prevent  its  recurrence.  It  is  no  longer  possible  to  bear 
patiently  that  the  whole  vital  interests  of  a  community  should  be  injured  for 
the  simple  motive  of  business." 

This  steamer,  the  Tucaprl,  took  her  passengers  aboai'd  at  Puna,  the  island 
at  the  mouth  of  the  river  at  Guayaquil,  and  landed  them  in  Panama  without 


138  rUBLIO    HEALTH    AND    MARINE-HOSPITAL    SERVICI3. 

detention   or   observation.     Tlie   passengers   were   from   southern    i)orts,   but   I    ■ 
do   not   know    which   ones.     The   quarantine    authorities    ai-e   not   equipped   to 
care  for  vessels  from  infected  ports,  as  they  have  absolutely  no  quarantine  plant 
or  facilities  at  this  port. 

Respectfully,  Claude  (\  Pierce, 

Assistant  Hurgeon. 

Colon,  Panama,  Ai)ril  25,  IDO.'/. 
Respectfully  forwarded. 

J.  C.  Perry,  Siirf/eori. 
The  Surgeon-General. 


Office  of  Medical  Officer  in  Command, 
Public  Health  and  Marine-Hospital  Service, 

Gi((iyaqiiil,  Ecuador,  April  23,  190Jf. 
gjg .     *     *     *     ^   cable  message  has  been   received   here   from   Callao   that 
the  steamship  Liniiri,  which  was  i-efused  entrance  here  on  the  10th  instant,  but 
which  exchanged  passengers  with  the  steamship  Tiicaprl.  bound  for  Panama  and 
returned  to  Calloa,  developed  a  case  of  bubonic  i)lague  on  board. 
Respectfully, 

Fleetwood  Gruver, 
Acting  Assista)it  Surgeon. 
The  Surgeon-General. 

The  importance  of  the  subject  being  so  great  the  Secretary  of  the 
Treasury  addressed  the  following  letter  to  the  Secretary'  of  State: 

[Letter.] 

Treasury  Department, 

Washington,  May  16,  1904- 

Sir  :  I  have  to  transmit  here\A'ith  a  letter  from  the  Surgeon-General  of  the 
Public  Health  and  Marine-Hospital  Service,  with  two  inclosures,  showing  the 
status  of  the  quarantine  situation  at  Panama. 

If  consistent  with  the  views  of  your  Department,  I  would  recommend  that 
the  suggestions  of  the  Surgeon-General  be  favorably  acted  upon  and  that, 
through  the  diplomatic  representatives  of  the  Panama  Government,  the  quaran- 
tine inspection,  particularly  at  the  ports  of  Panama  and  Colon,  be  at  once 
placed  in  the  hands  of  the  representative  of  the  United  States. 

I  am  informed  by  the  Surgeon-General  of  the  Public  Health  and  Marine- 
Hospital  Service  that  Asst.  Surg.  Claude  C.  Pierce,  now  on  duty  in  the  office 
of  tlie  United  States  consul-general  at  Panama,  is  not  only  familiar  with  all 
quarantine  procedures,  but  is  believed  to  have  the  confidence  and  good  will  of 
the  Panama  authorities. 

Respectfully,  H.  A.  Taylor,  Acting  Secretary. 

The  Secretary  of  State. 


[Inclosures.] 

Treasury  Department, 

BUREAU^    OF    PurtLIC    HEALTH    AND    MaRINE-HoSPITAL    SERVICE, 

Washington,  May  16,  IOO4. 

Sir  :  I  have  the  honor  to  inclose  herewith  copy  of  a  memorandum  sulimitted 
to  Admiral  Walker,  chairman  of  the  Isthmian  Canal  Commission,  on  May  14, 
which  sets  forth  somewhat  in  detail  the  danger  now  existing  of  the  introduc- 
tion of  epidemic  disease,  particularly  yellow  fever  and  bubonic  i)lagne,  into  the 
port  of  Panama  through  inefiicient  quarantine  administration  by  the  Panama 
authorities. 

I  also  transmit  a  memorandum,  headed  "  Memorandum  No.  2,"  showing  the 
efforts  which  have  been  put  forth  by  the  State  Deiiartment  to  secure  the  cooi)era- 
tion  of  the  Panama  Government  in  requiring  the  assistance  of  their  consuls  in 


PUBLIC    HP]ALTH    AND   MARINE-HOflPITAL    SP:RVICE.  139 

foroijjii  ports,  jiiid  riMiuiriiij;  llic  iircsciit.-ilioii  (tf  hills  i»t'  lic.-illii  .-iiid  ciTtiUcutes 
of  vessels  iirriviiiji  at  the  ports  of  I'aiiaiiia  and  ("oloii. 

r>.v  reipiest  of  the  (;ov<>riiiiieiit  of  Panama,  all  ollicers  of  the  United  States  I'ub- 
lie  Ilealtli  and  Marine-Hospital  Siwviee  stationed  at  ("allao,  I'eru.  <Juaya(iuil, 
Eeuador.  and  La  (Iiiayra,  ^■enezuela,  have  l)een  dir(>cte(l  to  take  the  same  i»re- 
cautions  with  re.ixard  to  vessels  leavinj;  those  ports  for  the  ports  of  Panama  as 
the.v  are  ohlij^ed  under  the  law  to  take  with  rei,'ard  to  vessels  leavinj,'  for  ports  in 
tlie  United  States,  and  it  is  believed  that,  as  shown  in  "  Aleniorandum  No.  2,"  tlie 
necessary  action  has  l»(>en  taken  hy  the  State  Department  to  render  this  meas- 
uri'  «'trective. 

In  the  meantime,  however,  as  shown  in  tlie  memorandum  to  Admiral  Walker 
(Memorandum  Xo.  1).  the  insi)ection  at  the  l'an:uua  quarantine  is  very  defec- 
tive, and  since  the  exclusion  of  epidemic  disease  from  the  Canal  /one  is  at  pres- 
ent deiHMident  upon  the  achuinistration  of  (piarantine  at  Uanania  and  Colon,  and 
since  it  is  believed  that  under  the  terms  of  the  treaty  arrangements  are  to  be 
ett'eeted  by  which  the  administration  of  this  (piarautiiie  will  fall  to  the  United 
States  (Joverumeiit.  I  would  urg:e  that  the  assumption  of  this  function  by  the 
United  States  throuijh  an  understanding  with  the  Panama  Government  should  be 
inuuediate. 

Respectfully, 

Walter  Wyman,  iiuigeon-Oeneral. 

The  Secretary  of  the  Treasury. 


[Memorandum  (No.  1)  for  Admiral  Walker,  chairman  of  the  Isthmian  Canal  Commission.] 

Treasury  Department, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Washiiif/tor),  May  ///.  190/,. 

The  quarantine  situation  at  I'anama  demands  immediate  attention.  At  pres- 
ent the  protection  of  the  Canal  Zone  from  the  introduction  of  contagious  diseases 
is  dependent  upon  the  etfieiency  of  the  quarantine  administration  in  Panama  by 
the  Panama  authorities.  It  is  well  know'n  that  there  is  no  (luarantine  plant 
at  Panama,  and.  from  advices  received  by  myself,  the  quarantine  inspection  is 
very  faulty.  This  latter,  at  least,  should  be  rectified  at  once ;  otherwise  there  is 
danger  that  while  the  T'nited  States  Government  is  perfecting  its  plans  and 
initiating  its  government  of  the  Canal  Zone  and  its  surveillance  of  Panama 
under  the  treaty,  epidemic  diseases  may  slip  in. 

The  records  sho\v  that  Panama  in  the  past  has  been  repeatedl.v  infected  from 
South  American  ports.  Yellow  fever  has  been  the  principal  epidemic  disease 
thus  introduced,  but  the  recent  invasion  of  Peru  and  Chile  by  the  bubon.ic 
plague  presents  a  new  danger  to  Panama  and  the  Canal  Zone  which  is  real  and 
imminent  by  reason  of  the  insidious  transmission  of  bubonic  plague  and  the 
extreme  diflficult.v  of  eradicating  the  same  when  once  introduced. 

An  illustration  of  the  present  laxity  of  the  quarantine  at  Panama  has  been 
received  in  official  communications  at  the  Public  Health  and  Marine-Hospital 
Service  Bureau.  The  steamship  Lhuiri.  from  Callao  to  Guayaquil.  Ecuador, 
was  refused  entrance  on  April  10  at  Guayaquil  on  account  of  the  bubonic 
plague  in  Peru.  The  passengers.  ho\\ever.  were  transferred  to  the  steamer 
Tucapeh  and  the  latter  vessel  sailed  for  Panama  and  lauded  them  in  Panama 
without  detention  or- observation.  The  steamship  Liniiri  on  her  return  trip 
from  Guayaquil  to  Callao  developed  a  case  of  bubonic  plague  on  board. 

In  my  o])inion.  arrangements  should  be  effected  by  which  the  quarantine 
inspection  at  Panama  may  be  conducted  by  the  United  States  Government. 
Although  Colonel  (jorgas  and  Surgeon  Carter  are  expected  to  sail  for  the 
Istlunus  shortly,  it  seems  imperative  thit  the  quarantine  inspection  by  a 
United  States  officer  and  in  accordance  with  the  system  in  vogue  in  the  United 
States  should  not  await  their  arrival,  but  should  begin  at  once.  Assistant  Sur- 
geon Pierce,  on  duty  in  the  otfice  of  the  United  States  consul-general  at  Panama, 
is  an  experienced  quarantine  officer  and  has  the  confidence  of  the  Panama 
authorities.  It  is  suggested  that  such  representations  should  be  made  to  the 
Panama  Government  as  will  induce  them  to  assign  to  Assistant  Surgeon  Pierce 
the  duty  of  quarantine  inspection,  or,  if  this  is  impracticable,  to  have  him  pres- 
ent and  assist  at  the  inspection. 


140  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

It  is  also  suggested  that  bills  of  health  given  at  foreign  ports  by  the  eonsnl 
of  the  Panama  (Government  and  the  eertittcates  given  by  the  officers  of  th| 
Publie  Health  and  Marine-Hospital  Ser^■ic•e  by  request  of  the  Panama  Govern4 
ment  should  be  required  as  a  prerequisite  to  the  entry  of  vessels  at  the  port 
of  Panama. 

Walter  Wyman, 
Surgeon-Oeneral ,  Public  Health  and  Marine-Hospital  Service. 


[Memorandum  No.  2.] 

It  appears  from  the  con'espondence  that  the  consul  of  Panama  at  Callao, 
Peru,  having  received  no  instructions  from  his  (Government,  refused  to  cooperate 
with  the  Public  Health  and  Marine-llosjjital  Service  officer  in  the  inspection 
and  clearance  of  vessels  bound  for  ports  in  Panama.  The  failure  of  the  Gov- 
ernment of  Panama  to  instruct  its  consular  officers  was  brought  to  the  atten- 
tion of  the  minister  of  Panama  at  this  capital  and  also  cabled  to  Mr.  Russell, 
charge  d'affaires  of  tlie  United  States  at  Panama.  Mr.  Russell  replied  on  the 
25th  of  April  that  instructions  were  that  day  lieing  telegraphed  to  consuls  of 
Panama  at  Callao,  Valparaiso,  and  Guayaquil,  and  that  instructions  would  be 
sent  to  the  consul  at  La  Guaira. 

Information  in  the  possession  of  the  Surgeon-General  of  the  Public  Health 
and  Marine-Hospital  Service  indicated  tliat  the  introduction  of  disease  into 
Panama  was  nnide  possible  by  the  failure  of  the  authorities  of  Panama  to 
require  vessels  arriving  at  ports  of  the  Republic  to  present  bills  of  health. 
The  following  instruction  was  accordingly  sent  to  Mr.  Russell  on  the  2Sth  of 
April,  1904: 

"  I  have  to  acknowledge  the  receipt  of  yonr  telegram  of  the  25th  instant, 
reading  as  follows : 

" '  Panama  Government  cables  instructions  to-day  to  its  consuls,  Callao, 
Valparaiso,  Guayaquil,  to  cooperate  with  health  officers  of  the  LTnited  States 
in  the  matter  of  clearance  of  vessels  for  ports  in  the  Republic  of  Panama. 
Instructions  will  be  sent  to  the  consul  at  La  Guaira  also.' 

"  It  is  understood  by  the  Department  that  masters  of  some  vessels  decline  to 
accept  the  papers  furnished  by  ITnited  States  medical  officers  on  the  ground 
that  they  are  not  demanded  by  the  authorities  at  Panama.  You  will  inform 
the  Panaman  Government  of  this  and  say  that  the  effectiveness  of  the  work  of 
our  consular  and  medical  officers  in  behalf  of  Panama  will  depend  almost 
entirely  upon  a  strict  enforcement  of  the  i*equirement  that  masters  of  vessels 
shall  produce  to  the  pro])er  authorities  of  the  port  of  arrival  in  Panama,  as 
condition  to  entry,  the  bills  of  health  and  certificates  of  disinfection  issued  by 
our  officers." 


[Letter.] 

Department  of  State, 

Washington.  May  IS,  190.',. 
Sir:  I  have  the  honor  to  acknowledge  the  receipt  of  your  Department's  letter 
of  the  K'.th   instant  with   inclosures  from  the   Surgeon-General  of  the  Public 
Health   and    Marine-Hospital    Service   concerning  tlie   quarantine   situation    at 
Panama. 

An  instruction  by  telegraph  was  dispatched  to  the  United  States  chai'ge 
d'affaires  ad  interim  at  Panama  in  the  sense  desired  by  the  Surgeon-Genei'al. 
This  was  followed  on  May  17  by  an  instruction  by  mail,  with  which  were 
inclosed  copies  of  your  Department's  letter  and  the  memorandums  accompany- 
ing it. 

I  have  the  honor  to  be,  sir,  your  obedient  servant, 

Francis  B.  Loomis. 

Acting  Secretary. 
The  Secretary  of  the  Treasury. 


PUHLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  141 

ASSISTANT  SURGEON   PIEIU  K  Ari'()lN'H:i)   IlKAr/ril  OIFKER  AT  PORT  OF 

PANAMA. 

[Letter.] 

I)i;pART\fKN'T  or  State. 

WasliiiH/ton,  May  2.),  I'JOJ,. 
Sra:  Refcrrini,'  (o  your  Dopartmoiit's  lottor  of  llio  Kith  instant,  in  rcuard  to 
the  (iuarantin»>  situation  :it  P;in;unii,  I   liavo  tlic  lioiior  to  (juoto  for  yotu-  infor- 
mation tlu'  text  of  a  tolo.ixrani.  d.-ttcd  tlio  iMst  instant,  from  the  eharfj;c'  d'affaires 
ad  interim  of  the  I'nited  States  at  Panama  : 

"  Surjjeon  Pieree  lias  been  apitointed  health  otiieer  of  the  port  of  Panama  in 
compliance  with  recpiest  contained  in  your  cable  of  the  KJth  instant." 

For  the  completion  of  your  Department's  files,  I  inclose  a  copy  of  the  telegram 
sent  by  this  Department  to  Mr.  Russell  on  ^Lly  !(!,  to  which  he  refers. 
I  have  the  honor  to  be.  sir.  your  obedient  servant, 

John  JIay. 
The  Secretary  of  the  Treasury. 

[Inclosiire.] 

Department  of  State, 

Washington,  May  1(1,  1901,. 
Russell,  Chaif/c,  Panama: 

In  view  bubonic  iilague  Peru  and  Chile  and  past  infections  Panama  from 
South  America  and  to  prevent  slipi)ing  in  of  epidemic  diseases  while  this  Gov- 
ernment is  jterfecting  plans  and  initiating  government  Canal  Zone,  we  desire  to 
conduct  (luarantine  iusiiection  at  Panama  under  treaty  at  once  in  accordance 
with  United  States  system.  Pending  arri\al  Colonel  Gorgas  and  Surgeon 
Carter.  exi)ected  to  sail  shortly,  request  Panaman  Government  to  assign  to 
Assistant  Surgeon-General  Pierce,  at  consulate-general,  duty  of  <iuarantine 
inspection,  or  have  him  present  to  assist.  Also  desired  bills  health  given  by 
Panaman  consuls  and  certificates  given  at  request  Panaman  Government  by 
officials  Marine-Hospital  Service  be  required  as  prerequisite  to  entry  vessels. 

Loom  IS,  Acting. 

On  May  26  Assistant  Surgeon  Pierce  notified  the  different  steam- 
ship companies  interested,  at  Panama,  tliat  he  had  assumed  the  duties 
of  the  doctor  of  the  port  at  Panama,  and  that  the  quarantine  regula- 
tions of  the  United  States  would  be  observed  at  that  port,  in  the  fol- 
lowing letter : 

[Letter.] 

Panama,  Panama,  May  26,  1904- 
Sir  :  You  are  hereby  advised  for  your  information  and  action  that  by  decree 
No.  12.  of  May  24,  P.)0-l,  His  Excellency  the  President  of  the  Re])ublic  of  Panama 
abolished  the  i)osition  of  doctor  at  tlie  i)ort  and  assigned  those  functions  per- 
taining to  the  maritime  quarantine  to  the  United  States  Public  Health  and 
Marine-Hosi)ital  Service. 

I.  having  l)een  designated  by  the  Surgeon-General  of  the  above-named  Service 
as  the  officer  charged  with  these  duties,  inform  you  that  the  (juarantine  regula- 
tions of  the  T'nited  States  will  be  ol)served  at  this  i)ort.  and  that  one  of  the 
requisites  to  entry  of  vessels  will  be  the  bills  of  health  and  supi>lemental  bills  of 
health  issued  by  American  consuls,  acting  for  Panama,  and  the  certificates  of 
insiiection  or  disinfection  that  will  be  issued  by  officers  of  the  United  States 
Public  Health  and  Marine-Hosi)ital  Service  in  those  iwrts  where  such  officers 
are  stationed. 

You  will  notify  the  masters  of  the  vessels  of  your  company  and  others 
concerned. 

Respectfully, 

Claude  C.  Pierce, 
Assistant  Surgeon.  V.  S.  PuWic  Health  and  Marine-Eosirital  Service, 

Quarantine  Officer  at  Panama. 

Copies  sent  to  the  agents  of  the  Pacific  Mail  Steamship  Company,  Pacific 
Steam  Navigation  Company,  and  Compania  Sud  America  de  Vapores. 


142        riTBLio  hp:alth  and  maktnp>hc)si'ital  skrvice. 

DETAIL    OF    SURG.   II.  U.  CARTER    FOR    DUTY    ITXDKR    ISTHMIAN    CANAL 

COMMISSION. 

Isthmian  Canal  Commission, 

Wa^hiiu/toit,  D.  €.,  May  11,  190/,. 
Sir  :    I  have  the  honor  to  request  that  the  Recretary  of  the  Treasury  he  asked 
to  order  Surg.  11.  K.  Carter,  of  the  I'tihlic  Health  and  Marine-Hospital  Service, 
to  report  to  me  for  duty  under  the  Isthmian  Canal  Commission,  upon  the  Isth- 
mus of  I'anama,  in  connectidn  with  (luarantine  matters  there. 
I  am,  with  great  respect, 

J.  G.  Walker, 
Chairman  of  Couunission. 
The  Secretary  of  War,  Washiutiton,  D.  C. 

I  Indorsement.! 

War  Department,  May  1-'/,  lOOff. 
Respectfully  referred  to  the  honorable  the  Secretary  of  the  Treasury  for  his 
consideration. 

Robert  Shaw  Oliver, 

Acting  (Secretary  of  Wa)\ 


Treasury  Department, 

May  W,  190',. 
Sir:  I  have  the  lionor  to  acknowledge  receipt,  by  indorsement  from  you  under 
date  of  INIay  14,  1004,  of  letter  from  Rear-Admiral  .John  G.  Walker,  chairman  of 
the  Isthmian  Canal  Connnission,  in  whicli  he  re(|uests  the  detail  of  Surg.  H.  H. 
Carter,  of  the  I'ublic  Health  and  ;Marine-IIosi)ital  Service,  to  rejiort  to  hin) 
for  duty  under  tlie  Isthmian  Canal  Conmiission  ui)()n  tlie  Isthmus  of  Panama  in 
connection  with  (piarantine  matters,  and  to  state  that  Surgeon  Carter  will  he 
detailed  for  the  duty  in  question. 

Respectfully.  II.  A.  Taylor, 

Acting  Secretary. 
The  Secretary  of  War. 


Treasury  Department, 
Washington.  D.  C,  May  25,  190.',. 
Surg.  H.  R.  Carter, 

Ptihiic  Health  and  Marine-Hospital  Service.  Baltimore.  M'J. 
Sir:  In  accordance  with  a  request  of  Rear-Adniiral  John  G.  Walker,  U.  S. 
Navy,  dated  May  11,  1004,  and  approved  by  the  Secretary  of  the  Treasury,  you 
are  hereby  directed  to  rejxirt  by  letter  or  in  person  to  Kear-Admiral  John  G. 
Walker,  chairman  of  the  Isthmian  Canal  Connnission,  for  duty  in  connection 
with  quar.mtine  matters  upon  the  Isthmus  of  Panama. 
Respectfully, 

W^alter  Wyman,  Surgeon-General. 

SURG.   J.    C.    PERRY   AND   ASST.    SURG.    C.    C.    PIERCE   ORDERED   TO   REPORT   TO 
ISTHMIAN    CANAL    COMMISSION    FOR    DI^TY. 

Admiral  John  G.  Walker,  chairman  Isthmian  Canal  Commission, 
ha  vino-  reqiiested  that  Surii'.  J.  C.  Perry,  stationed  at  Colon,  Pan- 
ama, and  Asst.  Surii'.  C.  C.  Pierce,  at  Panama,  both  of  the  Puhlie 
Health  and  Marine-Hospital  Service,  be  ordered  to  report  to  the 
Canal  Commission  for  duty  in  connection  with  the  maritime  quaran- 
tine at  Colon  and  Panama,  on  June  24  orders  as  follows  were  cabled 

to  Surgeon  Periy : 

Washington,  June  2',.  190-',. 
Perry,  American  Consulate,  Colon.  Panama: 

Report  by  letter  to  Canal  Connnission,  Washington,  for  duty  maritime  quaran- 
antine;  pending  orders  report  in  person  to  General  Davis.  Instruct  Pierce 
same. 

Wyman. 


IMIHLIC    UKALTH     AND    M AKINK-IIOSIMTAL    SKRVICK, 


143 


COLON. 


HKroRT  or  TuANSACTioNs  Ai'  Colon.  Tanama.  my  Sum;.  J.  C.  Perry. 

Public  Health  and  Makink-IIosimtal  Service, 

Oi'iicK  OK  Medical  Oekkek  in  Command. 

Colon.  I'anaiiia,  ./iilj/  J.  lf)f)/f. 

Sir:  I  liavo  the  honor  to  submit  report  of  trjuisnctions  :it  tliis  stiitiou  for  the 
period  eiuled  June  ;!(),  1!HI4.  The  woric  of  inspection  of  vessels  s.iilinj;  for 
Tnited  Stiites  ports,  in  order  to  (>iiDiin;ite  ms  far  as  possible  the  dani,'er  of  tr;ins- 
niittins;  y<>!lo\v  fever  to  ports  of  Uic  United  Slat«'s,  was  instituted  on  I<'obrnar.v 
'.).  r.K)4.  During;  the  period  cniitraced  by  this  report.  February  !»  to  .Iiuie  ."'.(», 
11M)4,  no  e.-ises  of  yellow  fever  or  other  ((uarantinable  diseases  have  been 
reported  in  Colon  ;  therefore  disinfection  work  at  this  port  has  been  nil.  How- 
ever, when  the  fact  that  a  number  of  vessels  sailed  from  this  port  to  places  in 
the  United  States  susceptible  of  infection  with  yellow  fever  is  taken  into  con- 
sideration, it  will  be  seen  that  the  detail  of  an  oflicer  for  the  maintenance  of 
this  inspection  service  at  Colon  is  a  wise  precaution. 

The  followin.sj:  facts  concerniufi:  the  vessels  sailing  between  Colon  and  ports  on 
the  (iulf  coast  of  th(>  United  States  are  submitted  : 

The  vessels  i)lyin.ij:  between  Colon  and  New  Orleans  belong  to  the  Leyland, 
Harrison,  and  T^nited  Fruit  Company  lines,  the  two  former  touching  at  Kings- 
ton, Jamaica;  Belize.  P.ritish  Honduras,  and  Veracruz,  Tampico.  and  Progreso, 
Mexico,  before  reaching  New  Orleans.  During  the  close  seasoiL  from  April  1 
to  November  1.  they  are  detained  at  the  Mississippi  River  Quarantine  Station, 
where  they  are  subjected  to  the  regulations  of  the  Louisiana  State  board  of 
health.  The  vessels  of  the  United  Fruit  Company  come  direct  from  New 
Orleans  and  then  clear  for  New  Orleans  via  either  Bocas  del  Toro  or  Limon, 
Costa  Kica,  and  during  the  close  season  are  not  allowed  to  carry  passengers 
from  this  port.  Any  passengers  on  board,  coining  from  New  Orleans  and  bound 
to  Bocas  or  Limon,  are  not  allowed  to  come  on  shore  at  Colon,  and  neither  is 
the  crew  allowed  ashore  while  in  this  port.  During  this  season  these  vessels 
also  have  on  board  a  medical  inspector  of  the  Louisiana  State  I)oard  of  health 
who  fumigates  with  sulphur  all  the  compartments  for  passengers  and  crew  in 
order  to  destroy  mosquitoes,  and  a  daily  pulse  and  temperature  record  of  every 
one  on  board  is  kei)t  during  the  voyage. 

The  vessels  that  have  cleared  for  other  ports  on  the  Gulf  coast  were,  with  the 
exception  of  the  shijis  of  the  United  States  Navy  to  Pensacola  and  Key  West, 
all  small  sailing  craft,  which,  l)efore  entering,  touch  at  the  national  quarantine 
stations  for  disinfection  and  detention. 

All  vessels  were  inspected,  passengers  and  crew'  being  carefully  examined 
just  previous  to  sailing,  and  during  the  period  covered  by  this  report  no  person 
was  rejected  or  found  suffering  with  any  quarantinable  disease. 

The  tabulated  statement  submitted  below  gives  the  number  of  vessels  and  the 
number  of  crew  and  passengers  on  board  inspected,  by  months ;  and  othei 
tables  show  the  number  of  vessels  of  different  countries  and  the  ports  to  which 
they  have  sailed  during  this  period. 

Summary  of  transactions  at  Colon,  Panama,  from  February  9  to  June  ,W,  1904. 


Febru- 
ary. 

March. 

April. 

May. 

June. 

Total. 

Steamers  inspected  and  passed 

6 

1 
443 

8 
581 

0 

2T 
2 

2,281 

18 

888 

0 

12 
1 

9.50 
8 

.504 
0 

12 

1 

1,054 

8 

457 

0 

1(5 

1,524 
22 

444 
0 

73 

Sailing  vessels  inspected  and  passed  .  _ 

8 

Crew  on  steamers,  _ 

Crew  on  sailing  vessels 

6,2.52 
64 

Passengers  on  steamers 

Passengers  on  sailing  vessels 

2,874 
0 

Of  the  above  vessels  during  the 
American 

period  mentioned  there  were  : 

40 

British 

25 

Norwegian 

5 

German 

5 

Spanish 

4 

Italian 

1 

Austrian 

1 

Total           _..._... 

.       81 

144  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Of  the  Anierleaii  vessels  si)ecified  !(»  were  slii|»s  (»f  the  United  St:ites  Navy. 
Rills  of  health  were  issued  to  vessels  sailing  for  the  following  ports  in  the 
United  States : 

New  York 2'.i 

Philadelphia   __' 1 

^Norfolk.   Va 2 

Key  West.  Fla 2 

Ai)alachicola,   Fla 1 

Pensacola,  Fla 4 

Pascagoula,    Miss ?> 

Biloxi,  Miss '. 1 

New  Orleans,  I^a__* 29 

Ponce,  P.  R C 

San  Juan,  P.  R 2 

Port  not  specified 7 

Total 81 

In  addition  to  the  inspection  service  a  study  of  the  sanitary  and  health  con- 
ditions on  the  Isthmus  has  heen  made  in  order  to  determine  their  hearing  on 
vessels  sailing  from  Isthmian  ports  to  places  in  the  Uniced  States.     This  series 
of  reports  has  already  heen  puhlished  in  the  Puhlic  Health  Reports. 
Respectfully. 

J.  C.  Perry.  Surgeon. 
The  Surgeon-General. 

paxa:\[a. 

Report   of   Transactions   at   Panama,   Panama,   by   Asst.    Surg.   Claude   C. 

Pierce. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command. 

F'anavia.  Panama,  July  2,  WO). 

Sir:  I  have  the  honor  to  make  the  following  report  of  transactions  for  the 
port  of  I'anama  during  the  six  months  ending  .Tune  30.  1004: 

The  duties  of  the  station  were  assumed  on  .January  o.  1904.  prior  to  which 
time  the  bills  of  health  had  been  issued  by  the  consul-general  without  medical 
inspection  of  passengers  or  crew.  exce])t  during  the  period  of  yellow-fever 
epidemic  in  1897.  when  he  was  authorized  to  employ  an  acting  assistant  sur- 
geon to  inspect  the  personnel  of  those  vessels  clearing  for  San  Francisco. 

The  bills  of  health  issued  by  the  consul-general  during  the  year  1904  have 
been  signed  by  myself,  in  conjunction  with  the  consul-general,  after  inspection 
of  the  vessel,  crew,  and  passengers.. 

P.elow  is  given  a  svnopsis  of  the  work  done  during  the  six  months  ending  June 
.",0,  1904 : 

Bills  of  health  issued 40 

Officers  and  crew  of  vessels  inspected 1,797 

Cabin  passengers  inspected 342 

Steerage  passeugers  inspected 420 

Total    inspected 2,  .5.59 

Destination  of  vessels : 

San  Francisco 37 

Port  Townsend 1 

Honolulu    2 

Class  of  vessels : 

Pacific  Mail  i)assenger  steamers 27 

Sailing  vessels,  British 1 

Auxiliary  schooner,  British 1 

United  States  naval  vessels 11 

The  vessels  of  the  Navy  to  which  bills  of  health  were  issued  were  not  in- 
spected and  their  crews  are  not  included  in  the  number  given  above.     The  ves- 


IM'HLIC    IIKALTH     AND    M  ARINK-IK  »S1>ITAL    SKKVIOK.  ]  4f) 

sols    were    as    follows:   I'cfrcl.    M (trbUliciuJ.    Concord,    Xrir     Vo/7,-,    litiiiiiiii/loii, 
Wyoiniitij.  I'dul  JoticH.  I'rcblc.  Hosloii.  aii<l  tlio  (•(lUior  AVto. 

Dui-iiij;  the  period  covorod  by  tiiis  rcinprt  the  only  (|iiarniitiii.ii>U'  diseases  that 
liave  occurred  in  the  city  of  raiiaina  lia\e  heeii  six  cases  of  yellow  fever  and  one 
case  of  snialljiox.  The  jreneral  mortality  for  this  period  will  be  made  the  sub- 
ject of  a  lattM"  report. 

No  cases  of  tpiarantinalde  infectious  or  contagious  diseases  have  been  found 
among  the  civw  of  passengers  inspected. 
Uespeitfully. 

Clalde  C  I'ikrck,  A.ssiNidiit  Sint/con. 

V  be  S  L'Ku  i;o  N  -(J  k  n  kk a  i.. 

Ecuador, 
guayaquil. 

Report  ()!••  Transactions  at  <Ji  avaquii..  Ecuaoor,  ry  Acting  Asst.  Suro. 

Flektwooi)  (Jruver. 

Public  Health  and  ^Iarine-Hospital  Service, 

Office  or  Medical  Officer  in  Command, 

Guaijaqnlh  'InUj  1.  lOO.'/. 

Sir:  I  have  the  honor  to  make  the  following  report  of  conditions  and  trans- 
actions at  this  port  for  that  part  of  the  six  months  ending  .June  '10,  1004,  during 
which  I  have  been  here  (from  February  27,  1904). 

The  following  bills  of  health  were  issued:  Panama  and  internie(li:iti>  i)orts, 
7:  Panama  direct.  !>;  San  Francisco  and  intermediate  ports,  8;  New  Y(jrk  and 
intermediate  ports,  V, :  Habana,  1.    Of  these,  11  were  original  and  12  supplemental. 

During  the  month  of  March  I  examined  the  total  personnel  of  all  vessels 
leaving  for  Panama  or  the  I'nited  States. 

Quarantine  has  been  of  a  very  indefinite  character.  On  March  30  a  uoninter- 
course  (luarantine  was  established  against  all  vessels  coming  from  Peruvian 
ports.  This  was  because  of  the  reported  condition  of  plague  in  the  south.  On 
April  10  this  quarantine  was  partially  raised  and  vessels  were  received  "  in- 
comunicado."  Since  then,  for  this  reason,  I  have  not  been  able  to  examine 
vessels,  passengers  in  transit,  or  crews,  except  those  embarking  at  this  port, 
and  coasting  vessels.  From  April  10  to  May  .^  no  bills  of  health  were  issued 
to  vessels  clearing  for  Panama.  This  was  fully  reported  by  cable  and  letter. 
under  dates  of  April  17  and  IS. 

On  June  4  the  board  of  health  decided  again  to  close  the  port  against  all 
vessels  which  had  touched  at  any  infected  port,  and  not  even  to  admit  them 
on  their  return  voyage.  This  continued  to  June  25,  during  which  time  there 
was  no  communication  with  Panama  save  by  coasting  steamers,  which  take 
ten  days  to  make  the  trip.  The  board  of  health  has  since  decided  to  receive 
all  vessels  "  in  strict  quarantine."  A  copy  of  the  regulations  forwarded  in  this 
luail. 

Health  on  vessels. — The  sanitary  condition  of  vessels  and  personnel  clearing 
for  ports  in  the  United  States  or  Panama  which  I  have  examined  has  been 
satisfactory.  Several  vessels  plying  between  this  and  other  ports,  however, 
have  developed  quarantinable  diseases  on  boai'd. 

April  10  steamship  Llmari  was  refused  entrance  here.  She  changed  passen- 
gers with  steamship  Tncapcl  at  Puna  and  returned  south.  After  leaving  Callao 
a  passenger  is  reported  to  have  died  of  plague.     (Reported  April  2:).) 

May  10  steamship  Lou.  from  Panama,  brought  a  passenger  who  developed 
yellow  fever  here  next  day.  This  was  reported  May  13,  with  attending  physi- 
cian's history  of  the  case. 

May  29  a  cable  was  received  here  from  Callao  that  the  steamship  Aconcagua, 
en  route  from  Valparaiso  to  r'anama.  developed  a  case  of  plague  on  board. 
(Reported  June  3.) 

June  10  a  cable  was  received  from  Callao  that  yellow  fever  occurred  on 
board  steamship  Guatemala,  en  route  from  Panama  to  Valparaiso  via  this  port. 
(Reported  June  10.) 

Sanitary  condition  of  Guayaquil  is  much  more  satisfactory  than  when  I 
arrived.     A  yellow-fever  hospital  has  been  established,  streets  and  vacant  lots 

8629—04 10 


146        ruuLic  hp:alth  and  marine-hospital  sp:rvice. 

ck'iiiied.  ;i  Clnytou  luachiiu'  iiistalh'il  for  luiulyutiii.t,'  vt'ssols,  grass  and  weeds 
cut.  an  attempt  made  to  fill  some  of  the  lower  parts  of  the  city,  places  where 
water  accumulated  ti-eated  with  coal  oil :  in  short,  a  general  attempt,  on  a 
modified  scale,  is  being  m.ide  to  enforce  some  of  the  modern  sanitary  methods 
for  tlie  prevention  of  the  spread  of  yellow  fever. 

Kespectfully,  Fleetwood  (JnuvEU, 


Actliuj  Assistant  kiunjeon. 


The  Surgeon-General. 

Peru. 


CALI.AO. 

Kepout  v.x  Asst.  Surg.  P..  .J.  Luovn. 

I'UBLic  Health  and  Marine-Hospital  Service. 

OiFicE  OF  Medical  Officer  in  Command, 

CaUao.  Peru,  July  1',,  inn/,. 

Sir:    I    have  the  honor   to   suhmit  the   following   report   of   transactions   at 
Cnllao.  I'eru.  fcr  the  period  April  IG  to  June  30,  i;j04 : 

Bills  of  health  Issued  : 

United  States  consular T 

Panama  consular 11 

Total  1« 

•  — 

Vessels  Inspected: 

For   I'anama 11 

For  New  York , 5 

For  San  Francisco - 

Total  18 

Vessels  fumigated  to  kill  vermin: 

For   Panama 1^ 

For  New  York 5 

For  San  Francisco " 

Total 1<! 

I'ersons  insi)ected: 

For  Panama  and  intermediate  ports — 

Crew   T()8 

Cabin  passengers -1-1 

Steerage   passengers -iSl 

Total 1,  f>70 

For  New  York — 

Crew    1^01 

Cabin    passengers •> 

Total   J . :i07 

For  San  Francisco — 

Crew   !<»(; 

Steerage  passengers 10 

Total  11<^ 

Pieces  of  baggage  disinfected: 

For  Panama  and  intermediate  ports  (estimated) 2,400 

For  New  York 10 

For  San  Francisco V- 

Total 2,431 


rUHLK!    HEALTH    AND    MAKINK-HOSI'lTAL    SEUVHIK.  147 

FMcilitit's  ;ii'i>  iii:i(l«'(|iiiil(>  for  itrcscnt  work.  'I'lic  rcruvian  ({ovcniiiiciit  iimiii 
tiiiiis  .-it  till'  niuiiiciiial  (lisiiifcctiiij^  station  a  vacmiiii  steam  cliamlx'i-  lor  tlic 
(jisinfi'ction  of  sucii  articles  as  retiuiri?  to  hi'  (lisiiil'ccti'il  |)y  slcaiii.  Foniial- 
ik'liydc  disinfoctioii  is  perlornu'd  in  a  room  wliicli  can  he  li'ormetically  scaled, 
the  .i,'as  heinj;  fj;enerated  from  an  autodave.  There  are  at  present  no  hatliin^j; 
facilities  for  passenjjers  and  crew  and  no  detention  sheds. 

There  is  an  arrangement  hetween  the  Ollieo  of  the  I'nhlic  Health  and  .Marine- 
Hospital  Service  and  the  Direction  de  Saluhridad  whereby  the  use  of  the  dis- 
infecting,' chambers  and  tlie  services  of  the  disinfectinj,'  force  are  availaide  for 
the  disinfection  of  ba.i,'j,'a;;e  destined  for  ports  in  the  I'nited  States  and  Panama. 

So  far  the  fumitration  of  vessels  has  been  accomplished  by  the  use  of  sulphur 
pots,  but  an  ellicient  sulphur  furnace  is  being  installed.  Other  improvements 
are  under  consideration. 

The  hyj:ienic  laboratory  in  liima  is  oi)en  to  the  officer  of  the  l'ul)lic  Health 
and  Marine-Hospital  Service  for  bacteriological  investigations. 

The  i)ort  and  sanitary  authorities  have  e.\i)ressed  their  willintcness  to  cooper- 
ate in  the  enforcement  of  .sanitary  measures. 


Kesi)ectfully. 
The  Sukgeon-General. 


B.  J.  Lloyd,  Asf<istiiiit  Hiiryeon. 
Brazil, 
rio  de  janeiro, 

On  account  of  the  prevalence  of  plague  and  yellow  fever  in  Rio  de 
Janeiro  and  the  large  number  of  vessels  that  leave  that  port  for  ports 
in  the  United  States,  Acting  Asst.  Surg.  AV.  J.  S.  Stewart  was 
detailed  by  the  President  on  October  30  for  duty  in  the  office  of  the 
United  States  consul-general  at  that  port,  under  the  act  approved 
P^ebruary  15,  1893.  He  inspects  all  vessels  leaving  Rio  for  United 
States  ports  and  ports  in  Panama  and  signs  the  bills  of  health  in  con- 
junction with  the  consul.  He  makes  weekly  reports  to  the  Bureau  of 
the  sanitaiy  conditions  in  Rio  and  the  neighboring  cities  on  the  Bra- 
zilian coast.  These  reports  have  been  published  regularly  in  the 
Public  Health  Reports. 

The  report  of  Acting  Assistant  Surgeon  Stewart  is  herewith 
appended : 

Report  of  Transactions  by  Acting  Asst.  Surg.  W.  .T.  S.  Stewart. 

Rio  de  Janeiro,  Brazil,  JhIij  J,  lOO//. 

Sir:  I  have  the  honor  to  make  the  following  report  of  the  work  done  at  this 
port  during  the  seven  months  ended  .June  30,  1904.  As  I  arrived  at  this  port 
during  the  last  week  in  November,  1003,  it  is  impossible  to  make  this  report 
embrace  the  full  period,  of  one  year,  there  having  heeu  no  representative  of  the 
United  States  Public  Health  aud  Marine-Hospital  Service  on  duty  in  this  con- 
sulate for  some  months  previous  to  my  arrival. 

During  this  period  this  consulate  has  issued  78  bills  of  health  to  vessels  sail- 
ing from  Rio  de  Janeiro  to  United  States  ports  and  1  bill  of  health  to  a  vessel 
sailing  from  here  to  Cultan  ports.  Of  this  number.  3:>  were  original  bills  and  the 
remainder  were  supplemental  bills  issued  to  vessels  touching  here  on  their  way 
to  ports  in  the  United  States.  To  this  latter  class  belong,  without  exception,  all 
vessels  carrying  third-class  passengers,  as  all  passenger  vessels  consider  Santos 
as  the  end  and  as  the  beginning  of  their  voyages  from  and  to  New  York  or  to 
New  Orleans. 

All  these  vessels  to  which  bills  of  health  were  issued  were  inspected  by  me 
shortly  before  departure,  and  all  crews  and  third-class  passengers  were  also 
inspected  by  me  on  board  ship,  and  since  the  last  four  months  at  my  office  in 
the  consulate  I  have  inspected  all  steerage  for  trachoma  before  any  tickets  are 
issued  to  them  by  the  steamship  lines. 

The  total  number  of  persons  inspected  by  me  since  November  1.  1903,  is 
3,146.     This  number  is  divided  as  follows :    Officers  and  crews  of  vessels,  2,490 ; 


148  PUBLIC    HEALTH    AND    MARINP>HOSPITAL    SERVICE. 

first-class  passengers  from  this  port,  151 ;  and  third-class  passengers  from  Rio 
de  Janeiro,  490.  At  first  glance  the  number  of  persons  composing  the  crews  of 
vessels  looks  rather  large — i.  e..  for  78  vessels — but  this  is  explained  jiartly  by 
the  fact  that  H25  persons  comi)osed  the  crew  of  one  vessel  alone,  an  Argentine 
naval  vessel — a  training  ship. 

Since  the  steamship  lines  have  referred  intending  steerage  passengers  to  my 
office  for  examination  for  trachoma  and  other  diseases  before  issuing  them 
tickets  I  have  there  examined  lo!)  such  jjersons,  rejecting  for  various  causes  2:.*. 

This  arrangement  of  examining  intending  passengers  for  United  States  ports 
is  of  considerable  convenience  to  the  steamship  companies,  and  in  the  end 
saves  them  more  or  less  money. 

In  all  my  work  here  I  have  great  pleasure  in  saying  I  have  in  every  way  been 
aided  by  the  officers  of  this  consulate  and  by  the  managers  of  the  various 
steamship  lines. 

Nine-tenths  of  all  passengers,  steerage  and  first  class,  are  carried  from  this' 
port  to  the  United  States  by  the  ships  of  the  Lamport  and  Holt  Line.  These 
shii»s,  as  a  rule,  are  not  very  large,  the  two  most  popular  ones,  the  Byron  and 
the  Tennyson,  being  of  about  4.000  tons  register,  while  the  freight  boats  of  this 
line,  although  carrying  fewer  passengers,  are  considerably  larger  in  size,  and 
are  very  comfortably  fitted  up  for  carrying  passengers  of  both  classes,  and  the 
food  and  water  furnished  the  third-class  passengers  is  excellent  in  quality  and 
abundant  in  quantity.  As  I  have  said  above,  while  the  ships  are  not  large, 
they  compare  most  favorably  with  ships  of  much  larger  tonnage  in  all  respects, 
and  the  emigrant  who  leaves  here  on  one  of  them  has  but  little  to  complain  of. 

The  few  other  vessels  that  cari-y  occasional  steerage  passengers  to  the  States 
are  for  the  most  part  freight  boats,  and  their  accommodations  are  very  limited ; 
but  these  vessels  also  furnish  the  emigrant  with  food  in  abundance  and  of  good 
quality,  and  they  have  plenty  of  air  f<pace  in  their  sleeping  apartments,  etc. 

All  the  passenger  boats  of  the  Lamport  and  Holt  Line  and  all  the  freight 
boats  of  this  line  that  are  fitted  up  for  carrying  steerage  passengers  in  any 
quantity  carry  physicians,  and  as  a  rule  they  are  men  of  good  education  and 
well  qualified  for  the  positions  that  they  hold. 

In  all  respects,  therefore,  the  emigrant  going  from  here  to  the  States  is'well 
treated  and  cared  for. 

In  respect  to  the  sanitary  conditions  of  this  port,  as  a  general  thing,  I  would 
say  as  follows : 

As  I  have  in  several  of  my  sanitary  reports  already  commented,  one  comes  to 
the  tropical  or  semitropical  countries  for  the  first  time  with  an  idea  that  they 
are  hotbeds  of  all  disease  and  veritable  pest  holes.  Usually  a  period  of  a  few 
months  is  sufficient  to  remove  these  ideas ;  and  the  question  then  comes.  Why  do 
not  more  deaths  occur  than  do?  Of  course,  one  reason  is  the  open-air,  outdoor 
life  that  is  led  by  people  in  the  Tropics,  for,  as  a  rule,  compared  with  our  dwell- 
ings, even  their  houses  are  virtually  "  out  of  doors  "  inside.  When  I  arrived 
here  I  naturally  expected  the  summer  time  to  be  the  period  of  the  greatest 
mortality,  and  of  course  when  yellow  fever  is  epidemic  to  the  extent  that  it 
often  has  been  here  such  is  the  case.  But  this  year  the  opposite  has  been  the 
occurrence.  The  death  rate  during  the  months. of  November,  December,  Janu- 
ary, and  February  was  markedly  lower  and  the  real  health  conditions  better 
than  at  present.  Of  course,  in  summer  time  many  people  go  away  to  Petropolis 
and  to  other  resorts  not  far  removed  from  Rio.  but  the  number,  absolute  number 
(for,  of  course,  as  regards  one's  acquaintances  the  number  of  persons  leaving 
town  for  the  summer  may  be  very  large),  can  make  no  appreciable  difference  in 
the  number  of  persons  remaining  in  a  city  of  this  size  or  as  a  consequence  affect 
in  any  appreciable  manner  the  death  rate.  Last  week,  ended  July  3,  1904,  the 
average  number  of  deaths  daily  in  this  city,  with  its  jwpulation  of  650,000, 
was  over  02.  The  summei-  showed — I  pick  up  a  weekly  report  at  random,  the 
one  for  the  fifth  week  of  this  year— a  daily  average  of  41.85  ;  or,  to  go  more  fully 
into  it,  the  daily  average  was  as  follows  for  the  first  ten  weeks  of  the  year, 
right  in  the  very  hottest  part  of  the  season  here:  44.14,  42.14,  45.28,  53^41.85, 
45,  42.85,  47.28,  44.71,  and  42.85. 

The.se  facts  are  a  little  astonishing,  that  in  a  hot  country  there  should,  as  a 
matter  of  fact,  be  more  deaths  in  the  winter  season  than  in  the  hot  season ;  of 
course,  always  excepting  the  presence  of  yellow  fever,  which  of  course  flour- 
ished more  in  hot  weather  than  in  cool  seasons.  At  present  the  rai-idly  increas- 
ing epidemic  of  variola  is  one,  and  a  great,  cause  of  the  increase  in  death  rate 


PUBLIC    HEALTH    AND    MAKINK-HOSl'ITAL    SERVICE.  149 

hero,  and  lliis  iiuT(":is(>  I  im;i.i,'iii(>  is  largely  due  to  llic  cool  wcatlicr  as  a  direct 
(ause,  by  its  coiiipelliii^'  liie  people  to  crowd  in  tiieir  iiiiserai)le  and  squalid 
lionies,  thus  lucreasiiif,'  tlu>  chances  of  the  conlaj,MOM.  For  liic  same  reason  one 
finds  the  plaf,'ue  more  prevalent  when  the  weather  is  cool,  allhou;,'h  as  far  as  the 
pla.u'ne  here  is  concerned,  it  can,  I  think,  now  he  r(>«arded  ;is  no  lonf,'er  e|)ideudc 
in  any  sense,  only  a  few  sporadic  cases  occurrinj;  from  time  to  time.  Whether 
or  not  it  has  become  sliirhlly  endemic  all  alons;  the  coast  of  Brazil  and  in  some 
portions  of  the  interior  time  only  will  reveal.  'I'liere  is  no  doubt  about  the 
endendcity  and,  in  m.my  jdaces,  the  epidemicity  of  variola.  This  has  been  the 
case  lu>re  for  many  years  ;ind  will  continu(>.  doubtless,  to  be  the  case  for  a  lonj; 
Iieriod.  notwithstaniliuij  the  excellent  work  of  the  various  health  de|iartmenfs  in 
different  cities,  as  lonj,'  as  there  is  the  opposition  to  vaccination  amon«  tlie  lower 
classes  which  has  existed  here  for  over  a  half  century,  and  still  exists  most 
markedly  in  the  interior  districts,  where  it  is  looked  upon,  as  is  the  j)laKne  and 
cholera  in  Asia,  as  the  visitation  of  some  deity,  and  therefore  not  to  be  contended 
with. 

Durinj;  the  year  lltu:!  there  were  in  all  Kt.l'.H!  diviths  from  all  cau.ses.  Inclu- 
sive of  the  causes  of  deaths  j^iven  above  thei-e  was  the  following  classification 
of  the  deaths:  Yellow  fever.  584;  plai^ue.  'A~)\) ;  variola.  Si)~> ;  measles.  7."!;  scarlet 
fever.  4:  whooi)inf,'  cou^h.  IC;  tli|)htheria  and  croup.  .")!  ;  Ki'ippf,  41M»;  typhoid 
fever.  KM!;  dysentery.  5!);  beriljeri.  100;  leprosy,  20;  erysipelas,  24;'  acute 
malarial  fevers,  ;"!)!»;  chronic  malarial  fevers,  I'oT ;  tuberculosis  (pulmonary 
variety).  2.747;  tuberculosis  (meningeal),  24;  tuberculosis  (other  varieties  than 
the  two  above  named),  130;  septicannic  infection  (other  than  the  jmerperal 
variety),  109;  hydrophobia,  2;  syphilis,  75;  cancers  and  other  malignant 
tumors,  230 ;  tumors,  4 ;  other  molesting  growths,  167 ;  diseases  of  the  nervous 
system,  1,521 ;  diseases  of  the  circulatory  ajiparatus,  2,077 ;  diseases  of  the 
respiratory  apparatus.  1,5!)7;  disease  of  the  digestive  system,  2.301;  diseases  of 
the  urinary  apparatus,  422;  diseases  of  the  genital  organs,  11;  puerperal  sep- 
ticaemia, fever,  peritonitis,  and  phlebitis,  46 ;  other  accidents  connected  with  the 
puerperal  state  from  conception  to  parturition,  40 ;  diseases  of  the  skin  and 
cellular  tissues,  48 ;  diseases  of  the  organs  of  locomotion,  19 ;  congenital  del)ility 
and  defects  of  conformation,  405;  senile  debility,  309;  violent  deaths  (except 
suicides),  270;  suicides,  60;  diseases  uuKnown  or  badly  defined,  110. 

If  from  this  total  number  of  deaths  be  removed  the  number  of  those  occurring 
from  yellow  fever.  584 ;  malarial  fevers,  706 ;  of  which  number  it  is  easily  to  be 
supposed  that  a  very  cousideral)le  number  were  due  to  yellow  fever  and  incor- 
rectly diagnosed  or  reported,  these  two  diseases  giving  a  total  of  1,320 ;  from 
variola  and  plague,  1,164,  making  so  far  a  grand  total  of  2,484  ;  and  lastly,  from 
tuberculosis  of  all  varieties,  in  num))er  2,901,  in  all  a  grand  total  from  these  five 
diseases  of  5,385 — if,  I  say,  these  numbers  be  subtracted  from  the  whole  number 
of  deaths  an  excellent  showing  for  the  city  is  given,  namely,  only  10,811 
deaths  in  a  city  whose  population  is  at  least  650,000  persons. 

Were  it  not  for  variola  the  statistics  of  the  present  year  when  completed, 
should  the  same  condition  of  health  continue  throughout  this  year  as  has 
been  the  case  so  far,  would  show  a  very  different  state  of  affairs.  The  campaign 
against  yellow  fever,  more  especially  against  the  cause  or  the  transmitting  agent 
of  this  disease,  the  mosquito,  has  this  year  caused  such  a  gi'eat  diminution  in 
the  deaths  from  yellow  fever  and  malarial  affections  that  up  to  date  there  h.ave 
been  only  292  deaths  frohi  these  two  diseases  in  half  a  .vear  against  1,320  in 
twelve  months  last  year.  Plague  this  year  has  caused  52  deaths  in  six  months 
against  359  in  twelve  months  of  last  year.  These  improvements  in  sanitai*y 
matters  are  not  extended,  however,  to  either  tuberculosis  or  variola.  As  said 
above,  the  objection  to  and  refusal  of  vaccination,  so  general  here  in  all  cla.sses, 
still  obtains,  and  as  a  consequence  the  colder  season  here  this  spring  has  had 
the  result  of  an  increase  in  variola.  In  regard  to  tuberculosis,  the  disease  is  so 
firndy  fixed  in  tliis  country,  as  everywhere  else  in  the  world  apparently,  that 
its  early  control  is  as  jn'oblematical  here  as  anywiiere  else 

There  is  a  saying,  an  old  proverb  of  the  country,  dating  back  to  the  early 
days  when  the  Portuguese  intermarried  with  their  slaves,  or  at  least  had  issue 
by  the  colored  people  of  the  country,  to  the  effect  that  "  if  the  father  is  a  Por- 
tuguese or  white  man.  and  the  mother  is  a  negro,  the  son  will  be  a  mulatto,  and 
the  grandchild  will  be  a  tubercular  child."  This  state  of  affairs  has,  of  course, 
been  increased  by  the  freeing  of  the  slaves  and  the  very  remarkable  number  of 
intermarriages  with  the  negi'oes  on  the  part  of  the  white  Portuguese  or  Brazil- 


150  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

inns.  Tlie  negro  proiilom  (ilTcrs  no  (li/Iifultios  in  ils  solution  in  this  country,  as 
it  is  lieiiif,'  nipidly  solved  by  the  absotittion  of  the  negro  raee  by  intermarriage. 
I  believe  that  the  statistics  of  some  of  the  larger  life  insurance  com]»anies  of 
the  United  States  show  it  to  be  an  almost  certainly  proven  fact  that  the  light- 
colored  negroes  or  mulattoes  are  espefially  subject  to  tuberculosis,  especially  the 
pulmonary  variety.  Certainly  such  any  one  can  see,  eveu  the  casual  observer, 
to  be  the  condition  of  the  mulattoes  here  in  Brazil. 

Since  my  arrival  here  the  city  has  been  very  much  improved  in  many  ways. 
New  and  very  sanitary  street  urinals  and  water-closets  have  taken  the  place  of 
the  old  and  stinking  ])laces  in  use  a  year  ago.  Tlie  new  ones  are  constructed  of 
iron,  with  cement  floors,  and  are  tiled  and  automatically  flushed  out,  and  above 
all  have  a  man  in  charge  all  the  time  to  see  that  no  nuisances  are  committc-d 
and  that  they  are  kept  clean,  ajid  besides  this,  they  ;ire  regularly  inspected  aud 
their  condition  reported  upon.  Hundreds  of  old  and  insanitarily  constructed 
buildings,  hundreds  of  excellent  buildings  also,  have  l)een  torn  down  to  make 
room  for  the  new  Avenida  Central,  which  is  to  pass  through  tlie  central  portion 
of  the  city.  This,  as  a  matter  of  fact,  has  caused  a  tremendous  amount  of  dirt 
and  debris  to  be  strewn  around  tlie  city,  and  many  of  the  jieople  here  think  that 
this  atmosphere  of  dust  and  i)laster  debris,  in  Avhich  a  small  jjart  of  the  city  is 
continually  f(jrced  to  live  during  the  alterations  and  destructive  process  now 
going  on.  is  responsible  fisr  the  increase  in  the  cases  of  variola.  Possibly  tuber- 
culosis, but  hardly  variola  one  would  imagine. 

But  at  the  completion  of  this  work  the  city  will  have  at  least  one  fine  modern 
wide  street  and  several  new  i)arks  and  breathing  places  for  the  population. 

New  sewers  of  modern  construction  .".re  being  laid,  and  these  things,  in  addi- 
tion to  the  sanitary  work  reported  to  y(-u  l)y  myself  in  the  monthly  reports  from 
the  health  department,  can  give  one  some  idea  of  the  care  now  practised  in  this 
city  by  the  health  authorities.  The  ivgular  systematic  cleaning  up  of  old  locali- 
ties whei-e  yellow  fever  has  occurred  in  previous  years,  the  drying  up  or  oiling 
of  all  stagnant  pools  (they  are  always  dried  up  and  filled  in  where  jiossible). 
the  care  taken  to  see  that  the  many  fountains  and  small  lagoons  in  the  pictur- 
esque s(!u;ires  and  gardens  of  the  city  shall  not  become  a  breeding  place  for 
mosquitoes,  as  they  undoubtedly  were  in  previous  years,  the  systematic  removal 
of  accumulated  dirt  from  back  yards  and  even  house  tcjjs,  the  weekly  cleansing 
of  all  water-closets  by  the  health-bo;!rd  inspectors,  the  cleaning  of  all  water 
containers  of  every  sort,  the  cleriiiing  of  the  sewers  and  conduits  for  rain  water 
and  the  removal  of  accumulated  filth  therein,  and  the  destruction  of  garbage, 
and.  altlKmgh  not  comi)Iete.  the  disinfection  of  a  large  portion  of  the  sewage 
at  the  three  central  stations  on  the  bay  before  lumping  out  the  sp.me  into  the 
bay,  all  these  matters  have  wrought  a  vei-y  great  change  in  the  last  twelve 
months  in  the  sanitary  conditions  prevailing  in  Rio  de  Janeiro.  To  those  who 
live  here,  or  rather  to  those  who  have  li\ed  hei-e  for  some  years,  the  differences 
are  of  course  most  striking,  and  now  even  the  fault-finders  can  only  say  that 
if  the  good  system  now  in  use  '"  can  onlj-  be  kept  up  "  there  is  some  hope  of  this 
city  losing  the  bad  name  for  health  which  has  always  clung  to  it,  like  a  bad 
name  to  a  dog. 

In  addition  to  all  these  sanitary  pi'ecautions.  the  care  with  which  yellow- 
fever  and  malarial-fever  patients  are  screened,  as  described  to  you  in  a  report 
some  ni'  ntlis  ago.  has  had  the  most  beneficial  results  here,  as  in  all  other 
localities  where  this  system  of  prophylaxis  has  l)eea  usetl.  Reference  is  made 
above  to  the  many  fountains  and  small  lagoons  here  in  the  public  parks.  They 
are  strictly  ornamental,  and.  with  the  swans  and  other  waterfowl  swimming 
thereon,  very  picturesque,  but  as  a  resting  and  breeding  place  for  mosquitoes 
and  their  consequent  larv.-e  nothing  more  suitable  could  be  asked  for.  Hereto- 
fore, on  account  of  the  liiiiite<l  water  suiiply.  the  water  was  often  stagnant, 
even  to  the  stage  of  masses  of  green  scum  floating  on  the  top.  and  these  condi- 
tions no  one  seemed  to  give  any  attention  to  until  within  the  last  year.  Now 
all  this  is  changed ;  the  water  is  running  all  the  time,  and  in  many  instances 
when  I  have  carefullj-  examined  large  surfaces  of  water,  in  no  case  have  I  ever 
seen  any  larvse.  and  no  more  nn'Siiuitocs  in  the  vicinity  of  these  lakes  than 
elsewhere.  As  a  matter  of  fact,  however.  I  have  not  been  in  th<*  least  troubled 
by  mos(|uitoes  during  my  stay  here,  in  town  or  in  the  suburbs.  I  have  caught  at' 
different  times,  however,  a  number  of  healthy-looking  specimens  of  the  Htr/jo- 
myla  fasrinta,  and  also  of  several  other  varieties. 

As  I  have  written  before  now,  many  per.sous  think  that  the  port  works  now  in 


PUHLIC    HEALTH    AND    MAHINK-ROSPITAL    SERVICE.  151 

t'diirsc  of  const nicrmii  will  lu'  imKinclivo  oT  a  v(>i-y  Imi-j^c  incrciisc  in  tiic  mor- 
tality from  yellow  fover.  This  I  do  not  (liink  to  ix'  llic  case,  nor  dctcs  l)o<tor 
Cruz,  tiio  ]u>!iltli  ollicor  of  the  Ki'itui»lic.  nor  the  French  savants  who  came  iii-re 
to  study  yelh)w  fever. 

I  refer,  of  course,  to  Doctors  Marchoux  and  Simon.  If  the  mosiiuito  theory 
of  yellow  fever  he  correct — and  it  is  i)ast  the  experimental  sta^'e  certainly — the 
dredsiiif?  <'f  a  salt-water  bay  and  the  huildin^  of  retaining  walls  and  ttlliiiK  in 
with  nuid  and  sand  from  the  hottom  of  the  hay  should  not,  with  pi-oiter  care 
to  prevent  the  formation  and  sta.i^natiou  of  pools  of  water,  foi-minj;-  hreeding 
l)laces  for  mos(iuitoes.  lie  producti\-e  of  yellow  fev(M'.  At  ])resent  all  the  work 
on  the  port  works  is  contined  to  deej)  dred.ginj,'.  The  nuid.  ete.,  from  the  hottom 
of  the  hay  is  loaded  onto  steam  lifjchters  and  removed  out  to  sea,  where  it  is 
dumpod  automatically. 

This  i)rocedure  is  to  he  continued  until  all  the  top  layer  of  mud  and  dehris 
fi'oui  the  hottom  of  the  hay  in  the  vicinity  of  the  site  for  the  retaininj?  walls  has 
beeu  removed. 

Then,  after  the  walls  are  built,  the  idea  is  to  fill  in  behind  tliese  walls  with 
sand  t.iken  from  underneath  where  the  present  dredjiiug  has  been  completed. 
In  this  way  but  little  of  the  surface  nuid  of  the  bay  will  find  its  way  behind  the 
walls.  If  feasible  and  practicable,  this  is  certainly  an  idea  which  seems  com- 
mendable, as  the  new  ground  will  be  formed  of  fairly  clean  material.  Thei-e  is 
no  doubt  that  from  the  formation  of  this  bay — in  shape  rather  similar  to  that  of 
the  baj'  of  Ilabaua,  landlocked  all  except  one  narrow  entrance,  .-ind  tlie  dumping 
ground  not  only  for  most  of  the  city's  drainage  aud  sewage,  Init  also  for  the 
marsh  mud  for  an  area  of  hundreds  of  thousands  of  square  miles,  all  the  land 
around  Rio  being  high,  sloping  down  to  the  bay  shores,  and  for  a  distance  of 
from  1  to  20  miles  from  the  foot  of  the  mountains  being  nothing  btit  marsh, 
flooded  after  heavy  rains  and  at  tlie  time  of  very  high  tides,  but  recking  and 
stinking  in  the  hot  summer  suns — from  this  character  of  formation  the  bottcjm 
of  this  bay  must  be  formed  of  the  collections  aud  debris  of  centuries.  Owing  to 
the  narrowness  of  the  harbor  mouth,  the  water  of  the  bay  is  not  frequently 
changed  by  additions  of  fresh  sea  water.  After  lieavj-  rains,  when  the  water 
from  the  swamps  has  drained  down  from  tlie  marshes  into  the  bay,  one  often 
sees  the  whole  appearance  of  tlie  bay  \vater  to  be  changed.  Ordinarily  the  color 
of  the  water  is  from  bright  blue,  as  in  most  tropical  waters,  to  light  blue  and 
green,  but  at  these  times  the  wliole  bay  appears  to  the  observer  to  be  from  light: 
to  dark  brown.  On  letting  down  a  bucket  and  taking  up  this  surface  water  it 
appears  the  same  color  in  a  glass,  and  is  far  from  odorless,  having  a  swampy 
smell :  but  at  the  same  time  if  a  bucket  l)e  sent  down  inverted  and  turned  over 
at  about  2  feet  below  the  surface,  the  water  then  obtained  will  be  clear  in  color 
and  fairly  free  from  any  odor.  This  is  something  that  I  have  never  setni  any- 
where except  here.  This  ajjpearance  of  the  bay  is  well  known  to  the  inliabitants 
of  the  city,  who  have  their  own  name  for  it.  and  it  has  long  been  considered  \ery 
dangerous  to  health  to  go  in  bathing  or  swimming  there  at  such  times. 

It  is,  of  course,  due  to  the  swampj'  water  being  washed  down  into  the  bay  and 
to  the  slow  change  of  tlie' bay  water,  owing  to  the  narrowness  of  the  mouth  of 
the  bay. 

In  regard  to  the  continuance  of  the  plague  in  this  city  this  will  be  borne  out 
by  what  I  said  in  my  report  to  you  of  the  1st  of  May  of  this  year.  Thei-e  con- 
tinues to  be  sporadic  ca.ses,  but  as  long  as  this  disease  is  to  all  appearances 
firmly  seated  in  so  many  of  the  Brazilian  se:iports,  sporadic  cases  aiipearing 
from  time  to  time,  it  is  a  condition  of  affairs  only  to  be  expected.  That  the 
epidemic  is  over  here  for  the  time  being  is,  I  hope,  a  fact,  but  a  recrudescence 
of  it  at  any  time  would  not  be  a  very  suri)rising  matter. 

The  health  department  certainly  is  exercising  every  care  possible  at  their  com- 
mand, and  their  good  work  must  tell. 

So  far  there  has  been  no  particular  sicliness  among  the  workers,  either  on  the 
works  of  the  port  or  on  the  part  of  those  engaged  in  the  construction  of  the 
Aveuida  Central,  the  new  street  referred  to  above,  and  this  bears  out  the  expres- 
sions of  opinion  on  this  matter  given  al)ove. 

Therefore  in  my  opinion  the  health  conditions  are  being  improved  daily,  and 
I  think  that  the  next  year's  mortality  records  will  bear  me  out  in  this  forecast. 

In  every  w^ay,  therefore,  the  city  is  being  improved,  and  with  the  present  very 
efficient  head  of  the  health  department  I  think  one  may  look  for  a  very  much 
better  state  of  sanitary  affairs  in  the  future  than  in  the  past. 


152        prHLir  health   and  marine-hospital  service. 

lU'fore  I  I»riiij<  this  rt-iiorl  to  ;i  close  I  must  s;iy  n  word  in  rc.^ard  to  the  iiMturc 
of  the  exports  from  lier<'.  Tlie  very  Kre;it  hiilU  of  iiU  cir^o  ;ioniK  from  hei-e  is 
(.•(;ffee,  Jiiid  next  to  that  eoiiu-s  luaiij^aiiese  ore,  wliich  is  obtained  from  tiie  Stale 
of  Minas  Geraes,  to  the  nf»rth  of  Uio.  A  v(.>ry  few  hides  are  sluj)j)ed,  in  all  since 
my  arrival  here  hut  three  small  shipments.  These  hides  are  chemically  cured, 
and  the  quarantine  regulations  have  been  observed  in  respect  to  the  shipuieut  of 
this  class  of  carj^o. 

Besides  these  articles  of  commerce  there  is  nothinj^  exported  worthy  of  com- 
ment. For  the  St.  Louis  exposition,  of  c((Urse,  there  were  .some  shijanents  of 
miscellaneous  car^o,  but  nothinjj  of  a  quarantiiial)le  nature. 

As  you  doubtless  know,  the  coffee  is  <arried  by  the  Lamport  and  Holt,  the  Slo- 
man,  and  the  Prince  lines,  all  of  which  lines  have  at  least  one  steamer  monthly 
to  or  from  >s'ew  York.  Also  coffee  is  carried  l)y  many  tramp  steamers,  chieMy. 
however,  of  the  better  cTass.  The  only  other  re^idar  lines  rnnning  here  are  tbf 
Baltimore  line  of  sailing  vessels,  owned  and  operated  by  C.  Morton  Stewarts 
Sons,  <»f  Baltimore,  and  a  new  line  of  steamers  just  formed  to  run  from  New 
York  to  the  River  Plate,  stopi)ing  here  both  going  and  returning.  Manganesi 
is  carried  by  any  ti-amj)  steamer  that  may  lie  available  for  cargo  at  the  time  ■■■■ 
shijiment  is  desii-ed  to  be  sent  out. 

In  regaid  to  sailing  vessels,  as  I  have  often  written  before,  it  is  in  this  class 
of  vessels  that  whatever  (hinger  there  may  be  to  our  home  ports  lies. 

These  ve.ssels  during  the  open  season  here — that  is,  during  the  fall  and  winter 
months — are  allowed  to  come  to  the  coffee  docks.  During  the  closed  season  no 
ships  are  allowed  at  the  docks,  whether  sailing  or  steam  vessels,  except  a  line  of 
coasting  vessels  which  go  to  varicms  j)orts  of  this  c(mntry.  ^Vhen  ships  lie  at 
the  docks  there  at  once  is  a  sus|»ension  of  disci])lino,  partly  from  acijuiescence 
on  the  part  of  the  ship  captains  and  consignees,  but  chiefly  from  nece.ssity.  The 
men  will  desert  if  a  shij)  is  alongside,  and  luiving  deserted  they  go  to  all  sorts 
of  low  dives  in  the  jioorer  ]»oi'tions  of  the  city  and  there  run  a  much  greater  risk 
of  infection  <jf  all  sorts.  Having  deserted,  it  becomes  necessary  to  till  their 
places  with  l)each  combers  or  anyone  whom  the  captain  can  get.  In  many  in- 
.stances  the  iteojile  i)icked  uii  here  have;  been  loitering  around  the  town  for 
weeks  and  months,  and  are  the  ideals  as  regards  possibly  infected  men.  This  is 
not  so  in  regard  to  steamers.  This  class  of  vessels  rarely  changes  any  of  the 
crew  jiersonnel  here,  and  never  under  any  circumstances  allows  its  crews  to  g() 
ashore.  This  is  a  rule  that  is  honored  absolutely  in  its  observance.  And  this, 
f)f  course,  makes  tliis  class  of  ships  fairly  safe. 

However,  the  number  of  sailing  vessels  is  very  small  as  compared  wifli  the 
number  of  steamers,  and  even  sailing  vessels  can  only  dock  during  six  months 
of  the  year. 

Altogether,  neither  the  emigration  from  this  port  nor  the  character  of  the 
cargoes  shipped  to  I'liited  States  ports  is  a  menace  of  much  importance  as 
regards  the  national  health  of  the  Tnited  States,  and  the  former  is  true  by  rea- 
son chiefly  of  its  small  numbers,  the  liiver  Pl;ita  I'egion  furnishing  all  steamers 
for  New  York  with  many  nioi"e  emigr.ints  than  Kio  de  Janeiro,  and  as  long  as 
the  health  of  this  city  remains  more  or  less  un<-ertaitt  perhaps  this  coincidence 
is  a  very  h.appy  one. 

In  my  weekly  reports  of  sanitai-y  coiHliti()ns  in  tlii<  city  and  vicinity  I  have 
dwelt  so  much  ujion  many  things  tliat  could  well  enter  into  a  report  like  this 
that  I  will  omit  them  in  order  to  prevent  rei)etition. 

I  think  that  the  above  will  give  the  Bureau  some  idea  of  the  character  of  the 
work  to  be  done  here  and  th<'  jirevailing  conditions  at  this  time.  I  am  not  over- 
estimating the  facts  when  I  state  tluit  in  my  opinion  the  health  itself  of  this  city 
and  the  conditions  ui»on  which  health  is  always  contingent  are  im|»roving  from 
day  to  day.  and  tlie  time  is  not  f;ir  distant  when  this  city  will  be  no  more  of  a 
menace  to  the  Tnited  States  th:in  is  Habana  to-diiy. 

Kesjiectfully.  W.  J.  S.  Stewart, 

Actiny  Assistant  Siivf/eon. 

The  Surgeon-Genebal. 

TlAA\'.\ir. 

On  Marcli  H,  1003,  an  appropriation  of  $80,000  for  improvements 
was  Miade.  and  tlie  iiiatlcr  has  been  placed  in  the  hands  of  the  Super- 
visinof  Architect,  and  i)lans  are  now  beins"  i)re[)ared  to  carry  out  this 
work  on  tlie  (iiiaraiiline  station  at  lloiiolidu. 


I'mU.IU    IIKALTII     AND    M  A  lilN  l-MlOSl'ITAL    SKKVK'K.  153 

II<)X()!,rM'    AM)    SIP.I'OIMS. 
IxKi'oiM    l■.^    l'.\ssi:i>  Assi'.  Si  nc.   I..   Iv  (  "oi-kk. 

riMi.ic   IIkai.iii   AiNit  Maiunk-Hosimtai,  SKiivrrK, 

Oi-iicK  or   Mkiiicai.  OiiicKit  i\  Commanm. 

ll<>)i')liilii,  IhnntiK  -lulu  II.   lUil'/. 
Sir:   I  liavo  tlic  honor  1(»  iiiaUi'  tlK'  annual  report  of  transactions  at  this  sta- 
lion  for  tlic  fiscal  year  (Mulini;  June  ."io,   1!)0-1,  as  follows: 

KOSTI  U   Ol     ori'lCKKS    AM)    M  KN   OX    DUTY    IX    TIIK    KAWAIIAX    I.SF.AXnS. 

Passed  Asst.  Snru.  L.  K.  Col'er.  I'nited  States  IMihiic  Ilealtli  and  .Marine- 
Hospital  Service,  chief  (|uai'antine  otlicer  for  the  Hawaiian  Islands. 

Port  of  Ifoitoliihi. — Passed  Asst.  Sui-p;.  L.  10.  Cofer  (in  connnand).  Passed 
Asst.  Surii.  W.  ('.  llohdy.  Asst.  Sun,'.  R.  L.  Wilson,  Actinji  A.sst.  Surj;.  A.  N. 
Sinclair  (suspended  duriiifj  May  and  June!,  Actiui;  Asst.  Sur^.  William  F. 
James,  Pharmacist  Fi'ank  L.  (iihson.  :Medical  Inspectross  E.  F.  Smith  (sus- 
l)ended  during;  May  and  June). 

Port  of  I/ilo.  /lairaii. — Acting  Asst.  Surj:.  J.  (J.  Graoo. 

I'ort  of  KaJtiihii,  Maui. — Acting  Asst.  Surg.  John  Weddick. 

Poll  of  KiJici.  Maid. — Acting  Asst.  Surg.  K.  II.  Dinegai-, 

Port  of  Lahahia,  il/f/»/.— Acting  Asst.  Surg.  James  Maloney. 

Port  of  Kotoa.  Kauai. — Acting  Asst.  Surg.  ( ".  K.  M<-Lean. 

Port  of  Maliukoiia,  Ilaintii. — Acting  Asst.  Surg.  K.  I).  IJond. 

DIVISION    or    OUTfiOIXG    QUARANTTNF. 

The  following  circular  letter  shows  the  character  of  the  work  done  in  this 
division.  .These  i-estrictions  were  in  force  on  July  1,  190;^>,  and  were  continued 
hoth  at  ITonolulu  and  at  Ililo  until  Xovemher  !.">,  1003: 

itiosTKicTioxs   riii:   miTii   si'ham   and  sailim;  vkssels. 

( 1 )  Your  vessel  to  lie  not  less  than  (i  feet  from  the  dock  at  all  times,  with  rat 
fuiuiels  and  tar  on  all  lines.  Funnels  to  be  not  less  than  :>  feet  in  diameter. 
All  ropes  to  he  tarred  for  at  least  '2  feet  immediately  to  the  landward  side  of 
the  funnels.  Funnels  to  he  so  placed  that  they  will  he  iit  least  (>  feet  from  the 
wharf,  from  all  other  roi)es,  and  from  contact  with  anything  whatsoever.  Fiui- 
nels  nuist  he  kept  stiffened,  so  that  the  rim  of  same  is  at  all  times  equally  dis- 
tant from  the  line  encircled. 

(2)  The  gangway  to  be  well  lighted  at  night  and  a  si»ecial  guard  (man) 
stationed  there  to  prevent  any  rats  from  going  aboard  or  coming  ashore. 
When  it  is  not  practicable  to  have  this  gangway  guard  you  will  have  the  gang- 
way raised  clear  of  the  dock  at  night  by  not  less  than  (>  feet. 

(.">)  All  i)ersons  to  he  on  board  by  10  p.  m.  every  night  and  to  i)ass  the  rest 
of  the  night  on  board. 

(4)  This  oltice  must  be  notified  of  the  intended  shipment  of  all  baggage  and 
certain  freight,  as  hides,  scrap  iron,  household  goods,  and  personal  effects. 

(."))  Ail  [)ersons  embarking  at  this  port  to  be  inspected  immediately  before 
sailing. 

RICSTUICTION    FOR    SAILINT;    VESSELS    ONLY    IX    APDITIOX    TO    ABOVE. 

(1)  Must  he  fumigated  unless  they  have  laid  either  in  the  stream  or  at  rail- 
road wharf  No.  2  during  their  entire  stay  in  port.  In  the  latter  case  there 
must  be  no  contact  with  other  wharfs  or  vessels. 

(2)  Must  not  lie  at  night  alongside  of  interisland  steamers. 

(.">)  Crew  must  be  inspected  just  befoi-e  departure  of  vessel  and  crew's  bag- 
gage must  he  disinfected  at  the  I'nited  States  quarantine  wharf  (Channel 
Wharf)  the  night  before  sailing  day.  After  crew's  baggage  has  been  disin- 
fected and  returned  aboard  your  vessel  it  nuist  not  he  unsealed,  unpacked,  nor 
disturbed  in  any  way  until  inspected  by  the  officer  in  charge  of  outgoing  quaran- 
tine business  immediately  before  sailing. 

(4)  Masters  nuist  arrange  personally  for  the  disinfection  of  their  vessels  or 
else  through  their  accredited  commercial  agents. 


154 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


UESTUICTIO.NS    FOK    STKA  M  KI!S,    I  .\    ADDITION    TO    ABOVE,    FOK    liOTII     STEAM     AND    SAILINC 

VESSELS. 

(1)  An  alphabetical  typewritten  list  of  cabin  and  steerage  passengers,  in 
(Inplicate,  embarking  at  this  i)()rt  to  be  furnished  the  officer  in  charge  of  out- 
going quarantine  business  two  hours  before  sailing  hoin*. 

(2)  On  day  of  departure,  as  soon  as  hour  for  sailing  has  been  determined 
upon,  the  officer  in  charge  of  outgoing  quarantine  Imsiness  nmst  be  notified  of 
such  sailing  hour. 

(3)  Steerage  i)assengers  and  new  crew  to  report  at  Ignited  States  quarantine 
wharf,  foot  of  Punchbowl  street,  at  9  a.  m.  on  the  day  jtrior  to  the  steamer's 
sailing  day.  bringing  all  iKiggage,  after  which  permits  for  travel  will  be  issued. 
Steerage  jjassengers  must  have  the  final  inspection  at  the  gang  plank  upon  the 
wharf  and  will  not  be  j)ermltted  to  embark  carrying  personal  effects,  as  hand 
baggage,  undisinfected. 

7'ra}iK(ictioiix  at  Hoiiolnlii. 

Vessels    disinfected 76 

Vessels  inspected  and  i)assed 127 

Cabin  passengers  insi^ected  and  passed 1,129 

Steerage  passengers  inspected  and  passed 1,447 

Crew  inspected  and  passed -  1.S14 

Pieces  of  baggage  disinfected -  3,201 

Passengers  refused  certification 22 

Parcels  of  freight  disinfected 878 

Hides    disinfected 10,831 

Trtnisdctiiiiis-  at  HiJo. 

Vessels  disinfected,  then  inspected  and  passed 10 

Passengers  insi)ected  and  passed 158 

Crew  inspected  and  passed 210 

Pieces  of  baggage  disinfected 192 

Trnnfiactions  in  the  dirision  of  tlic  fiiifirantiiic  station  proper. 

Persons  detained  under  observation 154 

Persons   bathed 329 

Persons  sick  with  quarantinable  disease 3 

Pieces  of  baggage  disinfected 335 

Pieces  of  freight  disinfected 44 

Persons   vaccinated 153 

Annual  report  of  incoming  transactions  at  Honolulu  national  quarantine  station 
for  the  year  ending  June  W,  1904. ■ 


Steam  vessels  in- 
spected .-- 

Crew  on  steam 
vessels 

Passengers  on 
steam  vessels  . 

Sailing  vessels  in- 
spected  

Crew  on  sailing 
vessels 

Passengers  on 
sailing  vessels  . 

Steam  vessels  dis- 
infected  

Sailing  vessels 
disinfected , 


July. 

Aug.  1  Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 
18 

Apr. 

1        : 

May.  June. .  Total. 

i           1 

21 

1 
17         21         17 

20 

31 

22        16 

17 

31        20  '       251 

2,689 

2,382  3,072  2,235 

3,219 

6,301 

3,041   2,282 

3,346 

2,223 

6,  .589  2,724     40,103 

2,883 

2,554  3,534 

3,286 

6,203 

3,963 

4,102  3,675 

7,802 

.5,022 

4,244  .5,261     .52,529 

1 

19 

18         22 

24 

11 

14 

19        16 

15 

23 

19         18  ■        218 

274 

303      :«4 

;i53 

239 

200 

289      235 

2.58 

343 

271       2.56      3,:i44 

18 

25         26 

31 

6 

13 

8  :       9 

13 

23 

25  .      29  ;        236 

0 

0          0 

0 

0 

0 

0  1        0 

0 

0 

0  '        0  !           0 

1 

0          1 

0 

0 

0 

0 

0 

0 

0 

0  1        0              2 

ITHLIC    HKALTH    AND    M  ARI  NK-HoSI'TTAL    SKRVTOE.  155 

Incomnu/  quaranliiic  irdiisdctioii.s  (tl  ilir  siihjxnls  in  Ihr  llawaiiau  Islandn. 


'    ■  im  vessels inspoftod  nnd  pa  a.'d 

( 'I'l'W  on  stoiiiu  vessels 

Piisseni,'ers  nil  strain  vessels 

Sjiilinj:  vessi-ls  insi)ected  and  passed... 

Crew  on  sailing  vessels 

Pas-senKers  on  sailing  vessels 


Hilo,  Ha- 

Maliu- 
koua, 

Hawaii. 

- 

0 

199 

0 

^ 

0 

36 

10 

457 

86 

112 

(1 

Kaliului,  Labaiiia, 


Maui. 


3 

108 
0 
9 

125 


Maui. 


Kibei,       Koloa, 
Maui,    j   Kauai. 


Respec-tfnlly. 

L.  E.  Coi'ER, 
Passed  Assistditf  Sniy('0)t.  C'liicf  (^nm-antiiu'  OJJiecr, 

Territory  of  llairaii. 
The  Surgeon-General. 

T'liiLippiXE  Islands. 


TH.VXSFEK    OF    ^l.VIjn  ELKS    <^T   AIJAXTIXE    STATION. 

On  May  21,  100:5,  Lieut.  H.  L.  Wigmore,  Corps  of  Engineers,  aid- 
(le-canip  to  the  division  commander,  Philippines,  adch-essed  the  fol- 
lowing letter  to  Asst.  Surg.  Victor  G.  Heiser,  chief  quarantine  officer 
of  the  Philippine  Islands : 

Headquarters  Division  of  the  Philippines, 

Manila,  P.  I..  May  21.  lOOS. 
To  fJic  QiKiraiitiitr  Officer  for  tlw  I'hilipyinc  Islands,  Manila,  P.  I. 

Sir:  The  division  cniuinandef  directs  use  to  advise  you  that  the  limits  of 
the  Mariveles  Military  Ueservation  will  be  materially  reduced  and  that  the 
new  re.servation  lines  will  nut  include  the  ground  on  which  your  corps  is  now 
located.  Letters  will  lie  soon  forwarded  from  this  oflice  requesting  the  reser- 
vation of  land  in  accordance  with  the  new  lines.  It  is  not  knowu  under  what 
jurisdiction  your  corps  holds  its  land  in  these  islauds,  aud  for  that  reason  this 
letter  is  written,  in  order  that  the  necessary  steps  may  be  taken  by  your  office 
to  prevent  the  land  you  now  occupy  returning  to  the  public  domain. 

Any  assistance  that  can  be  rendered  by  this  offlte  will  be  cordially  given. 
Very  respectfully, 

H.  L.  Wigmore, 

First  Liriitenant.  Corjis  of  Enf/inrcrs,  Aid-dc-Camp. 

Upon  receipt  of  this  letter  Doctor  Heiser  wrote  to  Lieutenant  Wig- 
more, as  follows: 

Public  Health  and  Marine-Hospital  Service, 

Office  of  the  Chief  Quaranti.ne  Officer 
FOR  THE  Philippine  Isla.nds, 

Manila,  May  2r>,  1903. 
Sir  :  I  have  the  honor  to  acknowledge  with  thanks  the  receipt  of  your  letter 
of  May  21,  stating  that  the  division  commander  directs  you  to  advise  this  (irtice 
that  the  limits  of  the  Mariveles  Reservation  will  be  materially  reduced  and 
that  the  new  lines  will  not  include  the  ground  on  which  our  corps  is  now  located, 
and  that  any  assistance  your  office  can  offer  will  be  cordially  given.  In  view 
of  the  foregoing,  and  in  order  that  there  may  be  no  injury  to  the  pulilic  service 
during  the  period  which  will  be  required  to  settle  the  "ownership  of  the  land, 
I  would  respectfully  request  that  you  state  in  the  papers  about  to  be  forwarded 
to  the  War  Department  at  Washington  that  this  office  claims  for  the  United 
States  Public  Health  and  Marine-Hospital  Service  the  site  up;)n  which  the 
present  quarantine  buildings  at  Mariveles  are  erected,  as  shown  roughly  by 
map    No.   4249,    United    States    Coast   aud   Geodetic    Survey,    Manila    suboffice, 


15()  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Decenibor,  1001.  In  addition,  ;ill  that  i)()iiit  of  land  shown  on  above-describe,! 
niai)  which  extends  in  a  soutlieasterly  (lircction  from  the  Mariveles  Quarantine 
Station  and  whieh  is  east  of  lon,!j;itude  "J.S"  42'  08",  line  to  eoninience  at  the 
junction  of  the  above  longitude  and  the  present  line  of  the  south  barbed-wire 
fence  vf  the  quarantine  station.  It  beini^  understood  that  such  portions  of  this 
point  of  land  be  reserved  b.v  the  War  Department  as  are  necessary  for  military 
purposes. 

This  last-described  land  was  formerly  part  of  the  Spanish  quarantine  reser- 
vation. The  same  is  a  necessary  ad.iunet  to  the  station  in  order  to  serve  as  a 
burying  ground,  to  furnish  wood,  sand,  gravel,  and  other  material  which  is 
constantly  necessary  tor  fuel,  repairs,  etc.,  to  the  quarantine  plant. 

The  water  rights  of  the  present  pipe  and  reservoir,  which  furnishes  fresh 
water  to  the  post  and  quarantine  station,  are  also  claimed  in  case  the  army 
evacuates  the  land  over  which  it  runs. 

In  connection  with  reserving  the  land  rights,  it  would  also  be  well  to  have  the 
quarantine  anchorage  for  vessels  definitely  fixed. 

I  have  written  the  Surgeon-General  of  the  United  States  Public  Health  and 
Marine-Hospital  Service  a  letter  which  embodies  the  foregoing  facts,  and  I 
would  therefore  respectfully  suggest  that,  if  agreeable  to  you,  that  you  so 
arrange  your  papers  that  this  matter  can  be  finally  settled  at  Washington 
between  the  War  and  Treasury  Departments,  and  that  until  such  settlement 
takes  i)lace  that  the  claims  of  this  office,  as  roughly  outlined  above,  be  respected. 

I  should  like  to  have  your  views  as  to  whether  it  would  not  be  well  to  have 
an  accurate  survey  of  the  proposed  quarantine  reservation  accompany  the  papers 
and  as  to  how  this  survey  could  be  obtained. 

Respectfully,  Victor  G.  Heiser, 

Assistant  Siir(/C()ii, 
Chief  Quarantine  Officer  for  the  Philippine  Islands. 

Lieut.  II.  L.  WiGMOKK. 

Ai<l-<le-Canip  to  the  Division  Commander,  Manila,  P.  I. 


War  Department, 
Office  of  the  Judge- Advocate  General, 

Washinyton,  April  7,  I904. 
Sir:  I  have  the  honor  to  inclose  a  copy  of  General  Orders.  No.  50.  War  De- 
partment, March  2~->.  1004,  announcing  the  reduction,  by  Executive  Order  of 
March  14,  10C»4,  of  the  military  reservations  made  by  Executive  Order  of  April 
n,  1002,  at  the  entrance  to  Manila  Bay,  Luzon,  Philippine  Islands.  Tiiis  reduc- 
tion excludes  from  the  military  reservation  on  the  north  side  of  the  entrance 
to  Manila  Bay — i.  e.,  the  Mariveles  Reservation — the  lands  now  occupied,  as 
well  as  any  additional  lands  that  may  be  desired  as  a  site  for  the  quarantine 
station. 

As  it  is  thought  that  the  Treasury  Department  may  desire  to  have  such  lands 
reserved  for  quarantine  purposes  I  inclose  letters,  or  copies  thereof,  between 
the  militarv  authorities  and  the  quarantine  oHicer  regarding  this  matter,  to- 
gether witli  a  description  of  the  lands  desired  for  quarantine  purposes,  and  a 
blueprint  showing  the  location  of  the  same  with  reference  to  the  reduced  mili- 
tarv reservations. 

Robert  Shaw  Oliver. 

Acting  Secretary  of  War. 
The  Secretary  of  the  Treasury. 


Treasury  Department. 

April  22,  100.',. 

Sir-  Referring  to  vour  letter  of  the  7th  instant,  inclosing  copy  of  General 
Orders  No  ">().  of  the  War  Department.  March  2;".,  1004.  announcing  the  reduc- 
tion l)y  Executive  Order  of  March  14,  1004.  of  the  military  reservations  made 
by  Executive  order  of  April  11,  1002,  at  the  entrance  to  Manila  Bay,  Luzon, 
Philippine  Islands;  also  inclosing  copies  of  the  correspondence  between  the 
military  authorities  and  the  quarantine  officer  of  the  Philippines  regarding 
this  matter,  together  with  description  of  the  land  desired  for  quarantine  pur- 


ri'HJ.lC    HKALTII     AND    M  A  Kl  N  K-IK  (Sl'ITAL    SKUVICK.  157 

|i(»s(>s,  since  it  is  tliotijrlit  (liat  (lie  TrcMsury  I)('i);irtiii<Mit  iiii;,'lil  desire  to  have 
these  ImiuIs  reserved  for  (Hiaraidiiie  imriioses,  I  iiave  tlu-  lioiior  to  inform  yon 
tliat  the  Snr^'eon-(;eneral  of  the  Public  lleaitii  and  Marine  IIosi)ital  S<'rvice 
states  tliat  nearly  all  of  the  part  of  the  land  descriix-d  in  th(>  papers  within  is 
now  used  as  quarantine  station,  and  that  it  would  he  very  desirable  to  secure 
the  hind  in  the  proper  way  for  the  ruhlic  Health  and  .Marine-Hospital  Seivice. 
to  he  used  as  a  quarantine  station  for  Manila  I'.ay. 

I  have.  tluM-efore,  to  rniuest  that,  if  it  meets  with  your  approval,  such  a<tion 
;is  may  be  necess.iry  be  tal<(>n  to  secure  suili  part  of  the  within-described  reser- 
vation for  tlu>  use  of  a  (juarantine  station  luider  this  Department. 

The  papers  referring  to  the  case  are  herewith  respectfully  returned. 
Kespectfully, 

II.  \.  Tayi.ok, 

Acting  i^ccrrtary. 

The  Secketaky  of  War. 


War  Department, 
Washington.  May  2.  100.',. 
Sir:  In  compliance'  with  your  request,  dated  Ai)ril  22,  inO-1,  tlie  order  of  the 
rresident,  dated  April  20.  ]D(>4.  has  liecMi  olitained  makiiif:  the  reservation  of 
tlie  lands  desired  for  tlie  Marlveles  Quarantine  Station,  and  I  have  the  honor 
to  transmit  said  order,  and  to  return  for  tile  therewith  the  papers  received  with 
your  letter. 

Very  respectfully.  Koijekt  Shaw  Oliver. 

Acting  Secretary  of  War 
The  Secretary  oe  the  Treasury. 

[Inclosure.] 

War  Department, 

Washington,  April  28,  100 Jf. 

By  Executive  order,  dated  March  14,  1904,  published  in  General  Orders.  No. 
nO.  War  Department,  March  25.  1!)04,  the  ndlitnry  reservation,  made  by  Execu- 
tive order  of  April  11.  1002.  on  the  north  side  of  tlie  entrance  to  Manila  Ray.  in 
the  province  of  Bataan,  Luzon  (tlie  Marlveles  Reservation),  was  reduced  so  as 
to  exclude,  inter  alia,  the  lands  occupied  by  the  Treasury  Deiiartment  for  quar- 
antine purposes.  The  Secretary  of  the  Treasury  was  advised  of  this  reduction, 
and  in  accompanying  letter,  dated  April  22.  1004.  he  requests  that  such  action 
be  taken  as  may  be  necessary  to  secure  tlie  lands  hereinafter  described  for  the 
use  of  a  quarantine  station  under  the  Treasury  Department. 

I  have  the  honor,  therefore,  to  recommend  the  reservation  for  the  Mariveles 
Quarantine  Station,  situated  on  the  nortli  side  of  the  entrance  to  Manila  Bay. 
in  the  province  of  Bataan.  Luzon,  of  all  lands  included  within  l;'-iindaries 
descr'lied  as  follows,  viz  : 

"  Beginning  at  a  point  on  the  lo\V-water  line  of  Mariveles  Bay,  on  prolongation 
of  the  northeastern  boundary  line  of  quarantine  station,  as  now  inclosed  by 
barbed-wire  fence,  and  running  thence  nortli  72°  O.j'  west  a  distance  of  18.")  feet 
more  or  less  to  the  northeastern  corner  of  said  wire  fence;  thence  along  said 
wire  fence  north  72°  05'  west  a  distance  of  187  feet  to  corner;  thence  along 
fence  north  36°  2'.V  west  a  distance  of  106.07  feet  to  corner;  thence  along  fence 
south  80°  07'  west  a  distance  of  106.25  feet  to  corner ;  thence  along  fence  south 
71°  07'  west  a  distance  of  OO.-'jS  feet  to  corner;  thence  along  fence  south  21°  07' 
a  distance  of  644.1  feet  to  corner ;  thence  along  fence  south  20°  29'  east  a  dis- 
tance of  71.75  feet  to  corner;  thence  north  88°  07'  east  a  distance  of  20.25  feet 
to  a  stake  set  3..')3  feet  from  wire  fence;  thence  due  south  across  Tucot  River 
and  Peninsula  to  a  point  at  low  water  on  the  China  Sea  ;  thenc<»  along  said  low- 
water  line  in  a  general  southeasterly  direction  to  Cochinos  Point;  thence  in  a 
general  northwesterly  direction  along  low-water  line  of  Mariveles  Bay  to  mouth 
of  Tucot  River;  thence  across  mouth  of  said  river  and  along  low-water  line  of 
Mariveles  Bay  in  a  general  northerly  direction  to  point  of  starting." 

There  is  also  reserved  for  the  quarantine  station  the  water  rights  for  the 
maintenance  of  the  iiresent  pijie  and  reservoir  which  furnish  fH'sh  water  to  said 
station,  with  perpetual  easement  over  lauds  not  included  in  the  quarantine  or 


158  PUBLIC    HEALTH    AND    MAKINE-HOiSPITAL    SERVICE. 

i 


military  resiTvation  for  their  iiiaiuteiiaiicf  and  roi)air,  so  far  as  sufli  riglits  do 
not  pertain  to  tlie  reduced  military  reservation. 

Very  respectfully,  Rolsert  Shaw  Oliver, 

Acting  .Secretary  of  War.   ;■ 
The  President. 


White  House,  Ai)ril  2f).  IDO', 
The  within  recommendation  is  api)roved,  and  the  reservation  is  made  acctn-d- 


I 


ingly. 


T.  Roosevelt. 


f  Letter.] 


Treasury  Department, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Wusliington,  May  6,  190 Jf. 
Sir:  I  have  to  inclose  for  your  information  copy  of  Executive  order,  dated 
April  20,  1904.  setting  aside  the  reservation  of  the  Mariveles  Quarantine  Sta- 
tion, situated  on  the  north  side  of  tlie  entrance  of  Manila  Bay,  of  all  the  lands 
included  within  the  houndaries  described  in  the  paper  mentioned. 
Res))ectfully, 

Walter  Wyman,  t^ariicon-Ocncral. 
Passed  Asst.  Surg.  Victor  G.  Heiser, 

Chief  Quarantine  Officer.  J/«/((7«,  /'.  /. 


DECISION  OF  THE  SOLICITOR  OF  THE  TREASURY  THAT  VESSELS  FR03I  PORTS 
IX  THE  ITNITEI)  STATES  ARRIVING  AT  PORTS  IN  THE  PHILIPPINE  ISLANDS 
ARE  NOT  REQUIRED  TO  CARRY  BILLS  OF  HEALTH. 

[Letter.] 

Treasury  Department,  Office  of  the  Secretary. 

Wa.sJiinf/ton,  July  28.  1003. 
Sir  :  I  have  to  acknowledge  the  receii)t  of  your  reference  of  a  letter  of  the 
assistant  surgeon  and  chief  (|uarantine  oflicer  for  the  Philippine  Islands,  who 
wishes  to  he  informed  whether  a  bill  of  health  can  he  demanded  from  vessels 
arriving  from  United  States  i)orts.  You  request  that  the  question  be  referred 
to  the  Solicitor  of  the  Treasury  for  an  o])ini(in.  In  reply  find  o])inion  of  the 
Solicitor,  who  decides  that  bills  of  liealth  can  not  be  demanded  of  vessels 
arriving  in  those  islands  from  the  United  States. 

The  letter  of  the  assistant  surgeon  is  returned  herewith. 
Respectfully, 

L.  ;M.  Shaw,  Secretary. 
Surgeon-General, 

Public  Health  and  Marine-Hospital  Service. 

i  liiclosiire.] 

Department  of  .Justice. 
Office  of  the  Solicitor  of  the  Treasury. 

Washington,  D.  C,  July  21,  1903. 
Sir:  Assistant  Secretary  Armstrong,  by  indorsement  of  the  2r)th  instant, 
requests  my  opinion  ui)on  the  question  whether  hills  of  health  can  be  de- 
manded from  vessels  arriving  in  the  Philippine  Islands  from  the  United  States. 
In  reply  I  have  to  inform  you  that  the  act  of  February  1.5,  189.'^,  section  2, 
as  amended  by  the  act  of  August  L*^.  1894  (28  Stat..  ."!72)',  provides  that  "any 
vessel  at  any  foreign  port  clearing  for  any  port  or  place  in  the  United  States" 
shall  be  required  to  obtain  a  bill  of  health  from  the  consul  of  the  United  States 
at  the  point  of  dei)arture,  or  from  the  medical  officer  detaihMl  to  serve  in  the 
office  of  the  consul. 

As  it  is  plain  from  the  reading  of  this  act  that  bills  of  health  can  be  fur- 


1'IM?M(;    lIKAl/ril     AND    M  ARl  N  K-IK  (SITIAL    SKRVICK.  15*.) 

iiishod  only  l>y  coiisulMr  (illiccrs  of  llic  lliiitcd  Stnlrs  in  fuiH'ijiii  ports,  or  l)y 
tlic  iiiotliciil  ollicor  (k'taiknl  to  sorvc  in  Uic  ollicc  of  tlic  consul,  nnd  that  IIumv 
an'  no  ollifcrs  in  the  ports  of  the  United  States  fioni  whom  su<'h  a  hill  of 
health  could  he  |)rocured,  I  have  to  advise  yon  that  hills  of  health  can  not  he 
demanded  of  vessels  arrivinij  in  those  islands  from  the  I'nited  States. 
The  letter  inclosed  to  me  is  herewith  returned. 
Very  respectfully, 

Mauuu  K  1).  ()'("o.\m:i,i,.  ,sv>//r//o/-. 
The  Seckktauy  of  tiik  Tukasury. 

COKKKSrONDEN'CK    IX     KK(;A1;1)     to    COM.Ml   TATION     I'Olt    (,)l  AKTKli.S    AMJtWKI) 
OFFICERS  l)F  THE  .SEKVUE  OX  Ql  AUANTIXK  UV'VY  IN   TIIK  rillMl'I'IXKS. 

[  Letters.  I 

\L  S.  Tkkasl:ry  Depart.mknt, 
Public  Health  and  Makine-Hospital  Service, 
Office  Chief  (Juarantine  Officer  for  the  riiiupiMNE  Islands, 

Miniihi,  P.  I.,  July  31,  IfW.i. 

Sir:  I  have  the  honor  to  rei)ort  that  thc>  I'hilippiiie  Conunission  has  refused 
to  aiipi'opriate  money  to  meet  the  hills  for  the  first  half  of  the  fiscal  year  1!)04, 
which  will  he  rendered  hy  the  olHcers  on  duty  in  the  I'hilii)pines  in  accordance 
with  i)ara.i,'rai)li  1)8  of  the  Kegulations  of  the  I'uhlic  Health  and  Marine-Hosi)itaI 
St>rvice. 

I'pon  the  receipt  of  a  copy  of  act  No.  807,  entitled,  "An  act  makin.i?  appropria- 
tions for  sundr.v  expenses  of  the  insular  p)vernment  for  the  fiscal  year  endin.s; 
June  thirtieth,  nineteen  hundred  and  four,  and  other  designated  periods,"  I 
wrote  a  letter  to  the  I'hilippine  Conunission  (copy  inclosed)  calling  attention 
to  the  fact  that  the  amount  allowed  hy  them  for  commutation  was  not  in 
accordance  witli  paragraph  08,  and  requested  that  the  amount  suhmitted  in  the 
original  estimate  he  allowed.  I  also  called  upon  Governor  Taft  in  person  and 
lie  informed  me  that  the  action  in  appropriating  the  amounts  given  in  act  807 
was  done  with  the  full  knowled.ge  that  it  was  not  in  accordance  with  paragraph 
08  of  the  Regulations  of  the  I'uhlic  Health  and  Marine-Hospital  Service,  and  that 
it  had  also  heen  decided  that  the  matter  should  come  to  an  issue.  Accordingly, 
I  liave  this  daj'  cabled  the  following  message: 

"Secretary  Treasury'  (through  Wymau)  : 

"  Protest  action  Commission  refusing  allow  commutation  i)aragraph  08. 
^i  "  Heiser." 

The  officers  on  duty  here  have  refused  to  receive  the  amounts  allowed  hy  the 
Commission,  because  they  fear  that  they  would  .ieopardize  their  legal  claim  to 
the  i-onmiutation  at  the  rate  allowed  them  by  paragraph  08. 

I  would  respectfully  reciuest  that  this  matter  receive  immediate  attention. 
The  cost  of  living  here  is  very  high,  and  the  married  officers  will  be  unable  to 
meet  their  ordinary  living  expenses  with  their  salaries.  It  is  most  unjust  to 
expect  them  to  work  for  the  compensation  and  allowances  the  Commission  jiro- 
poses  to  give  them.  The  insular  government  has  experienced  great  difficulty  in 
obtaining  medical  officers,  at  $2,500  per  aunum,  and  heads  of  divisions  are 
offered  $3,500.  Our  officers  feel  that  the  self-sacrifice  and  the  enormous  amount 
of  \vork  done  iu  combating  the  cholera  epidemic  has  not  been  appreciated. 
Even  with  the  salary  and  alkn^'ances  as  paid  in  the  past,  they  are  the  poorest 
compensated  medical  men  in  the  insular  service,  considering  the  work  done. 

The  official  records  of  the  board  of  health  show  that  out  of  8  medical  officers 
employed  only  2  are  from  the  Army,  who  receive,  in  additon  to  their  army  pay, 
$5  and  $8  per  diem,  respectively.  The  remaining  (;  are  paid  entirely  from 
insular  funds:  2  receive  $3,500  per  annum,  and  4  $2,500.  It  wHl  therefore  be 
seen  that  none  receive  less  than  the  Public  Health  and  Marine-Hospital  Service 
officers,  and  the  majority  receive  far  more. 
■  A  copy  of  all  correspondence  is  inclosed. 
Respectfully, 

Victor  (i.  Heiser. 
Assifitant  >Siin/coii,  Chief  Quarantine  Officer  for  the  I'hiliiipine  Islands. 

To  the  Surgeon-General. 


100  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

War  Depaktme.nt.  Bureau  of  Insular  Afkaius, 

Washinrjto)!,  IJ.  ('.,  August  27.  11)03. 
Sir  :  To  confirm  our  several  conversations  (  p.  this  subject.  I  have  the  honor  to 
inform  you  that  on  .July  11  the  Secretary  of  War  recehed  a  cal)legram  from  the 
civil  governor  of  the  Philippine  Islands  stating  that  the  Philippine  Commission 
was  indisposed  to  allow  connnutation  of  tiuarlers  to  quarantine  officers  at  rates 
named  hy  Treasury  regulations,  assistant  surgeons'  conmiutation  exceeding  that 
of  major-general,  and  that  comnuitation  for  officers  six  months  is  .$.3,720.  The 
Commission  requested  an  expression  of  opinion  from  the  Secretary  of  War 
relative  to  reducing  the  rates  to  a  reasonable  amount,  stating  that  naturally  the 
power  of  the  Commission  to  reduce  the  allowance  or  furnish  quarters  in  kind 
was  clear.  On  July  IT  the  Secretary  of  War  replied  to  Governor  Taft,  direct- 
ing that  in  making  allowance  for  connnutation  of  quarters  the  Philippine  Com- 
mission exercise  their  discretion,  and  if  the  Treasury  Department  objected  to 
the  amounts  allowed  that  the  War  Department  would  take  up  the  matter  with 
the  Treasury  Department. 

An  extract  from  a  cable  received  August  1    from  the  civil  governor  of  the 
Philippines  is  as  follows  : 

"  Forward  following  from  chief  t|uarantine  officer.  Secretary  of  the  Treasury, 
through  Wyman  : 

"'Protest  action  Counnission  refusing  to  allow  commutation,  paragraph  OS. 

"  '  Hkiser.'  " 
Very  respectfully. 

Clarexi  E  R.  Edwards. 
Colonel,  U.  8.  Anny.  Chief  of  Bureau. 
Hon.  Walter  Wyman, 

Surrjcon-Griieral.  Publie  Health  and  Mariiie-HosijUal  Service. 


Treasury  Department, 
Bureau  ok  I'rin.u    Health  and  Marine-Hosimtal  Service. 

Washiiwto)!.  August  31.  1903. 

Sirs:  I  have  to  acknowledge  receipt  of  your  letter  of  August  27.  stating  that 
on  .July  11  the  Seci'etary  of  War  received  a  cablegram  from  the  civil  governor 
of  the  Philippines  informing  him  that  the  I'hilippine  Conunission  was  indis- 
posed to  allow  commutation  of  quarters  to  (luarantine  officers  at  rates  named 
by  the  Treasury  Regulations,  etc. ;  also  that  on  .Tuly  17  the  Secretary  of  War 
replied  to  Governor  Taft.  directing  that  in  making  allowance  for  commutation 
of  quarters  the  Philippine  Commission  exercise  their  discretion,  and  if  the 
Treasury  Department  objected  to  the  amounts  allowed,  that  the  War  Depart- 
ment would  take  u])  the  matter  with  the  Treasury  Department.  Your  letter  also 
contains  an  extract  of  a  cable  of  August  1  from  the  civil  governor  of  the  Philip- 
pines forwarding  the  jirotest  of  Passed  Assistant  Surgeon  Ileiser.  chief  quaran- 
tine officer,  against  the  refusal  of  the  Commission  to  allow  conunntation  as 
l)rovided  in  paragraph  98  of  the  Regulations  of  the  Pultlic  Health  and  Marine- 
Hospital  Service. 

One  reason  given  for  the  action  of  the  Commission  is  that  the  assistant  sur- 
geon's commutation  exceeds  that  of  major-general.  With  reference  to  this 
matter  I  beg  leave  to  inclose  herewith  circular  No.  182,  November  0,  1809, 
fixing  the  rate  of  commutation  for  officers  on  duty  at  foreign  ports  and  at  any 
port  beyond  the  geographical  limits  of  the  United  States  as  they  existed  .Jan- 
uary 1,  1898,  said  circular  being  approved  by  the  Secretary  of  the  Treasury  and 
by  the  President.  The  provisions  of  this  circular  have  been  enacted  into 
law  by  the  act  of  Congress  approved  .July  1,  1902,  entitled  "An  act  to  increase 
the  efficiency  and  change  the  name  of  the  Marine-Hospital  Service." 

The  object  of  increasing  the  commutation  of  officers  on  detail  in  tropical 
ports  was  simply  to  increase  their  compensation,  inasmuch  as  the  salaries  are 
fixed  by  law  and  there  is  no  other  way  in  which  increase  of  compensation, 
which  is  necessary  under  these  circumstances,  can  be  provided. 

It  is  understood  that  some  provision  of  law  does  exist  by  which  army  and 
naval  officers  are  allowed  increased  compensation  when  serving  outside  of  the 
United  States.  If  I  mistake  not,  it  is  an  allow;ince  of  10  jier  cent  of  their 
salary  additional  thereto.     No  such  provision  exists  for  the  officers  of  the  Pub- 


I'UBLIO    HEALTH    AND    MARINK-HOSI'ITAL    SEK\  ICK.  H\l 

lie  Ilcnltli  and  Mariiic-IIospital  Service,  their  salaries  reiiiaiiiiii;,'  the  saino  as 
tliou;,'h  they  were  serviiii,'  in  the  eoiitineiital  I'nited  States.  .Moreover,  if  1  am 
informed  eorreetiy.  olHcers  of  tlie  Army  or  Navy  servini,'  tlie  IMiilipnine  urovern- 
ment  in  ehar^'e  of  hureaus  are  allowed  $4  to  $.'.  jier  diem  in  addition  to  their 
regular  army  and  navy  salaries.  So  that  the  total  comitensation  of  the  ollicers 
of  tills  service  .st>rvinj;  in  the  rhiliiii)ines,  as  comjiared  with  that  of  ollicers  of 
other  hranches  of  the  Ignited  States  (Jovernment,  is  no  j,'rea(er,  and  in  fact  it  is 
helieved  is  still  somewhat  less. 

With  this  exi)lanation.  I  trust  that  the  I'hilii)|)ine  Connnission  will  see  lit  to 
allow  the  connmitation  as  provided  for  hy  the  United  States  laws  and  regula- 
tions governing  the  service. 

Ke.spect fully.  Waltkk  Wyman. 

Surgcon-Gcncral. 
Col.  Cl.\rence  R.  EuwAKhs.  U.  S.  Army, 

Chief  Bureau  of  Jii-siiliiy  Affairs.  War  Dcijartnteiii, 

WashiiKjton,  I).  V. 

[Copy  of  letter  from  executive  secretary,   with   resolution   of  the   rhi!ipi)ine  ('ommisslon 
to  restore  the  allowance  for  commutation  for  quarters  to  officers  of  the  Service.] 

GOVER.NSIENT  OF  THE  PlIILIPPI.NE   ISLA.NDS, 

ExEcrrivE  Bikeau. 
Manila.  Xoremhcr  .'/,  1903. 
SiK :  I  have  the  honor  to  inform  you  that  correspond eiue,  forwarded  hy  the 
chief  of  the  Bureau  of  Insular  Affairs,  with  reference  to  commutation  of  quar- 
ters for  memhers  of  the  ^Slarine-Hospital  Service  serving  in  the  I'hilippine 
quarantine  service  was  suhmitted  to  the  I'hilippine  Conunission  at  its  session 
of  Xovemher  '2,  1!J03.  After  full  consideration  of  all  the  correspondence  and  of 
the  recommendations  of  the  civil  governor  in  his  indorsement  ui)on  the  papers, 
the  following  action  was  taken  : 

"  On  motion,  Nrsolrcd.  That  in  the  next  appropriation  hill  the  commutation 
of  quarters  provided  in  the  regulations  ai)plicable  to  the  Marine-Hospital  Serv- 
ice be  restored  for  the  officers  of  the  Marine-Hospital  Service  detailed  to  the 
I'hilippine  quarantine  service." 

Very  respectfully,  A.  W.  Fergusson, 

Executive  Secretary. 
The  Chief  Quarantine  Officer,  Manila,  P.  I. 

IXSTIU  vTIO>:S     TO     OFFICERS     IX     ORIENT     TO     COOPERATE     AVITH     CHIEF 
QUARANTINE  OFFICER  OF  PHILIPPINES. 

At  a  meeting  of  the  sanitary  board  of  the  Public  Health  and  Marine- 
Hospital  Service,  held  at  the  Bureau  on  September  24.  100-^.  it  was 
recommended  that  the  following  instructions  be  issued  to  regular 
officers  of  the  Service  in  Japan  and  China  : 

In  view  of  the  fact  that  epidemic  diseases  prevail  in  most  ports  in  China  and 
Japan,  causing  danger  to  the  Philippine  Islands  from  tlie  proximity  of  these 
places,  it  is  of  paramount  importance  that  you  exercise  every  vigilance  relative 
to  steerage  passengers  and  cargo,  as  well  as  to  the  vessels  tliemselves,  that  sail 
from  your  port  to  the  Philippine  Islands  during  the  prevalence  of  quarantinalde 
diseases  at  the  port  of  departure,  and  you  are  instructed  as  follows : 

"  Send  a  copy  of  the  weekly  report  made  to  the  Bureau  direct  to  the  chief 
<iuarantine  officer  of  the  Philippine  Islands  relative  to  the  sanitary  condition 
of  your  port  and  of  the  prevalence  of  quarantinable  diseases,  and  in  the  event 
of  an  epidemic  disease  ajipearing  at  your  port  or  vicinity  promptly  notify  the 
chief  quarantine  officer  at  Manila  of  this  fact  by  cable.  Furthermore,  cooper- 
ate in  every  manner  possible  witli  the  chief  quarantine  officer  of  the  Philip- 
pine Islands  and  carry  out,  so  far  as  practical»le.  such  regulations  concerning 
the  disinfection  of  ships,  passengers,  and  certification  of  cargo  as  may  be 
required  for  the  purpose  of  expediting  the  entrance  of  these  vessels  upon 
arrival  at  tlie  Philipi)ine  ports." 

8629—04 11 


162  PUBLIC    HEALTH    AND   MAKINE-HOSPITAL    SEEVICE. 

The  following  letter  of  instructions  was  isiied  to  all  officers  of  the 
Service  stationed  in  China  and  Japan. 

[Letter  of  instructions.] 

Treasury  Department, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Washington,  October  2Jf,  1903. 
Passed  Asst.  Surg.  John  McMullen, 

Public  Health  and  3Iarine-Hospital  Service,  Hongkong,  China. 
Sir:  A  copy  of  the  recorumendtitions  made  by  the  sanitary  board  of  the  Public 
Health  and  Marine-Hospital  Service,  convened  at  the  Bureau  on  September  24, 
1903,  to  consider  the  best  plan  for  cooperation  between  the  officers  of  the  Service 
stationed  at  the  different  ports  in  the  Orient  and  the  chief  quarantine  officer 
of  the  Philippines  to  protect  the  Philippines  from  the  epidemic  diseases  that 
prevail  in  most  of  the  ports  in  China  and  Japan,  is  inclosed  for  your  information 
and  guidance,  and  you  are  directed  as  far  as  possible  to  carry  out  these  recom- 
mendations when  granting  bills  of  health  to  vessels  leaving  your  port  for  ports 
in  the  Philippine  Islands. 

You  will  acknowledge  receipt  of  this  letter. 
Respectfully, 

Walter  Wyman,  tS urgeon-Oeneral. 

MILITARY    SERVICES   OF   ASST.    SURCx.    M.    K.    GW^YN. 

Hbaoquarters  Department  of  Mindanao, 

Zaiiiboaiiga,  P.  I.,  islovember  28,  1903. 
Sir:  Attention  is  invited  to  the  valued  cooperation  of  Asst.  Surg.  Matthew 
K.  Gwyn,  Public  Health  and  Marine-Hospital  Service,  during  the  recent 
operations  on  the  island  of  Sulu.  This  ofhcer  offered  his  services  as  a  medical 
officer  when  the  troops  landed  on  the  be.-ich  near  Siet  Lake,  and  remained 
on  duty  with  the  column  commanded  by  Lieutenant-Colonel  Scott  until  Colonel 
Scott  was  wounded,  when  he  returned  to  Jolo  with  the  Colonel,  dressed  his 
wounds,  and  cared  for  him  until  the  return  of  Captain  Lewis,  post  surgeon. 
This  officer's  service  was  most  efficient  while  with  the  fighting  column,  and  his 
presence  was  fortunate  at  the  time  Colonel  Scott  was  wounded,  as  that  column 
would  have  been  left  without  a  medical  officer  if  Captain  Lewis  had  returned  to 
Jolo  without  a  medical  officer. 

The   entire   Army    should   appreciate   Doctor   Gwyn's    skilled   attentions   to 
Lieutenant-Colonel  Scott. 

Very  respectfully,  Edgar  A.  Mearns, 

Major.  Surgeon,  U.  S.  Army, 
Chief  Surgeon  of  Jolo  Expedition. 
The  Chief  of  Staff, 

Headquarters  Department  of  Mindanao,  Zamboanga,  P.  I. 

[First  indorsement.] 

Headquarters  Department  of  Mindanao, 

Zamboanga.  P.  I.,  November  30,  1903. 
Respectfully    forwarded    to    the    Surgeon-General    JLxrine-Hospital    Service, 
Washington,  b.  C,  through  military  chaiuiels.     I  thoroughly  appreciate  Doctor 
Gwyn's  services,  and  concur  in  all  that  Major  Mearns  says  of  him. 

Leonard  Wood. 
Major-General,  Commanding. 

Treasury  Department, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Washington,  D.  C,  January  29,  190^. 
Respectfully  forwarded  to  Asst.  Surg.  ISIatthew  K.  Gwyn,  Public  Health  and 
Marine-Hospital  Service,  Jolo,  P.  I.,  through  chief  quarantine  officer,  Manila,  P.  I. 

Walter  Wyman,  Surgeon-General. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICPL  103 

MANILA    AND    .SUBPORTS. 

HKPoin-  15Y  AssT.  SuRCi.  Vicrou  (J.  IIkiser,  Ciiiei'  Quahantink  OfI'Icer. 

U.  S.  Treasury  Department, 
I'uitLic  IIkaltii  and  Mauine-IIospital  Service, 
Office  Ciiiee  Quarantine  Officer  for  1'iiilippine  Islands, 

Manila,  I'.  /.,  Auf/ust  J,,  100/,. 

Sir:  In  ficeordiinco  with  the  instructions  cont;iino(l  in  Kuroiin  ciivular  letter 
of  .Miircli  IS.  11)04,  I  have  the  honor  to  nialce  tlie  foUowinj;  rejiort  of  th«'  trans- 
actions of  the  Service  in  the  I'iiiliitpine  Islands  for  the  fiscal  vear  ended  June 
30,  1004. 

The  past  year  has  been  one  of  heavy  resi»(»nsibility  for  the  ollicer  in  charge  of 
(luarantine  matters  in  the  IMiilippines.  'fhere  has  been  no  time  to  speculate* 
and  theorize  upon  theoretical  conditions.  The  islands  have  been  practically 
surrounded  by  c()untri(>s  in  which  (luarantinable  diseases  were  either  itrevaleiil 
iu  epidemic  or  endemic  form  and  with  which  constant  coinnnnii<'ation  has  lu'cn 
maintained  by  swift  vessels.  The  port  of  Hongkong,  at  which  plague  has  been 
continually  present  for  many  years,  and  which,  in  more  recent  times,  has  been 
visited  yearly  by  cholera,  is  only  two  days'  steaming  distance  from  this  port. 
Vessels  arrive  from  there  almost  daily.  Owing  to  the  fact  that  most  of  the 
food  stuffs  and  other  supplies  must  be  regularly  imported,  one  of  the  first 
requisites  of  any  (juarantine  measure  nuist  be  that  comnuniication  can  be  car- 
ried on  without  placing  such  restrictions  upon  commerce  as  to  make  it  pi'ohibi- 
tive.  The  business  of  the  islands  is  largely  maritime  and  any  incuml»rance 
placed  upon  it  is  severely  felt  throughout  the  islands.  It  is,  therefore,  ver.v 
satisfactory  to  report  that  the  Philippines  have  been  successfully  i)rotected 
during  the  year  from  the  entrance  of  <iuarantinable  diseases,  and,  at  the  same 
time,  with  practically  no  interference  with  shipping.  Instead  of  being  a  hin- 
drance to  commerce,  the  enforcement  of  rational  sanitary  measures  with  regard 
to  vessels  has  become  so  well  recognized  as  being  beneficial  that  objections  are 
no  longer  made  and  iu  many  instances  the  masters  of  vessels  request  them. 
The  sanitary  work  done  in  the  Philippine  Islands  has  been  favorably  connnented 
upcni  throughout  the  civilized  world,  and  so  well  is  its  efiiciency  regarded  that  a 
vessel  that  holds  a  good  health  certificate  from  the  Philippine  Islands  is  now 
granted  unconditional  pratique  in  nearly  all  ports  of  the  world.  Japan  has 
lately  granted  the  same  privileges  to  vessels  that  come  from  the  Philij)pine 
quarantine  stations  as  though  they  had  passed  through  the  Japanese  quarantine. 

This  change  in  the  attitude  of  other  countries  toward  vessels  from  the  Philip- 
pines is  very  gratifying  and  can  not  help  but  be  of  great  benefit  to  Philippine 
commerce. 

During  the  year  cholera  has  ocurred  in  the  principal  ports  along  the  entire 
eastern  coast  of  Asia,  from  Japan  to  the  Straits  Settlements.  Plague  has  i)re- 
vailed  in  epidemic  form  to  th,e  north  of  us  in  Formosa,  and  in  Australia,  to  the 
south  of  us.  It  speaks  volumes  for  sanitary  science  that  business  has  been  car- 
ried on  with  these  coimtries  in  an  unintei-ru])ted  manner  without  a  single  case 
of  quarantinable  disease  being  imported  into  the  Philii)pines.  Actual  results 
of  this  nature  mean  much  to  the  islands  in  a  commercial  way  iu  demonstrating 
that  people  can  live  here  with  the  same  security  from  contracting  quarantinable 
diseases  as  they  would  enjoy  by  residing  in  the  United  States. 

A  particularly  fortunate  featui-e  of  the  sanitary  situation  has  been  that  it  has 
been  possible  to  safeguard  the  islands  against  the  importation  of  disease  without 
interfering  in  an  undue  manner  with  commerce.  The  restrictions  in  force  have 
all  been  of  such  nature  that  there  has  been  very  little  delay  to  shipping  and 
little  expense  involved  in  carrying  them  out. 

In  addition  to  the  strictly  professional  duties,  the  chief  (luarantine  ofticer  has 
had  charge  of  the  quarantine  aiipropriation,  which  amounted  to  $117,500  United 
States  currency.  The  economical  administration  of  this  fund  required  a  great 
amount  of  painstaking  labor.  The  resi)ons!bility  of  passing  upon  the  necessity 
and  legality  of  the  expenditures  and  arriving  at  results  that  would  be  satisfac- 
tory to  the"  Bureau  as  well  as  the  insular  government  has  been  very  great. 

The  great  distance  of  this  station  from  Washingtim  and  great  cost  of  cable 
messages  has  made  consultation  with  the  P.ureau  practically  impossible.  This 
office,  therefore,  has  often  been  deprived  of  valuable  advice,  many  knotty  prob- 
lems have  had  to  be  solved  alone,  and  the  full  responsibility  assumed. 


164  PUBLIC    HEALTH    AND    MAKINE-HOMPITAL    SEEVICE. 

It  is  with  luucli  pleasure  tluit  I  report  that  pleasaut  i-ehitions  exist  between 
the  shipping  interests,  the  Army,  the  Customs  Service,  and  the  insular  govern- 
ment in  general. 

PERSONNEL. 

Passed  Asst.  Surg.  Vctor  G.  Ileiser,  chief  quarantine  officer  for  the  Philippine 
Islands. 

Manila  :  Passed  Asst.  Sur.i^.  Vict«n-  G.  Ileiser,  in  command  ;  Asst.  Surgs.  John 
D.  Long  and  R.  H.  Creel;   Pharmacists  N.  C.  Comfort  and  Charles  R.  McBride. 

Mariveles  :  Asst.  Surgs.  Charles  W.  Vogel  and  II.  M.  Manning. 

Iloilo:  Asst.  Surg.  George  W.  McCoy. 

Celni :  Asst.  Surg.  Carroll  Fox. 

Jolo:  Asst.  Surg.  M.  K.  (Jwyn. 

Seventy  more  persons  are  employed  by  the  Service  who  perform  the  duties 
of  clerks,  disinfectors,  vaccinators,  etc. ;  total  personnel,  78. 

The  work  of  the  year  has  been  very  heavy  and  of  a  most  trying  character. 
Asst.  Surg.  II.  A.  Stansfield,  who  had  already  been  in  the  islands  for  over  three 
years,  iierforming  duty  of  the  most  arduous  character,  broke  down  com- 
pletely from  the  strain.  He  was  subsetiuently  relieved  by  the  Bureau  from 
further  duty  in  the  Philii)pines.  The  effect  of  the  continuous  responsibility 
which  the  officers  stationed  at  the  outlying  ports  are  compelled  to  bear,  coupled 
with  the  fact  that  they  are  on  duty  every  day,  holidays  and  Sundays  Included, 
from  daylight  to  sundown,  without  being  relieved  occasionally  for  even  half  a 
day,  which,  added  to  the  enervating  influence  of  the  climate  and  dilliculty  of 
dealing  with  a  population  that  speaks  a  foreign  tongue,  makes  the  detail  in  the 
Phili])pines  a  i)articularly  trying  one.  It  has  been  the  endeavor,  so  far  as 
practicable,  to  select  officers  in  turn  for  the  special  details  which  arise  from 
time  to  time,  thus  relieving  them  occasionally  from  the  continuous  boarding 
duty. 

The  Service  has  caiise  for  congratulation  in  the  faithful  and  uncomplaining 
manner  In  which  its  officers  and  employees  have  performed  their  work  in  the 
Philippines.  I  would  respectfully  suggest  that  it  woidd  add  much  to  the  con- 
tentment of  the  officers  if  they  could  be  on  a  sure  and  certain  footing  in  the 
islands  with  regard  to  the  length  of  their  detail.  Since  the  Service  officers 
come  in  contact  with  very  few  white  persons  outside  of  the  Army,  the  practice 
followed  by  the  latter  is  constantly  before  them.  Army  details  in  the  Philip- 
pines are  two  years  for  line  oflicers  and  three  years  for  staff  officers.  The 
detail  of  a  naval  officer,  medical  or  otherwise,  in  the  Philippines  is  for  two 
years.  It  would  therefore  be  more  satisfactory  to  oin*  officers  if  they  also 
could  look  forward  to  a  definite  date  at  which  their  tour  of  duty  would  be 
accomplished. 

VESSELS  BOARDED. 

There  were  4.0S0  vessels  boarded  at  the  port  of  IManila  and  7,7G4  at  the  other 
three  ports  of  the  islands  at  which  the  Service  has  officers  stationed. 

VESSELS    DISINFECTED. 

Two  hundred  and  three  vessels  were  disinfected.  Of  this  number  ir>7  were 
disinfected  at  the  Manila  station.  Fifty-eight  vessels  were  disinfected  because 
cases  of  quarantinable  diseases  were  found  on  board  on  tlieir  arrival.  The 
balance  were  either  disinfected  because  they  came  from  infected  ports,  or  at 
the  request  of  the  board  of  health  on  account  of  being  infected  with  rinderpest 
or  other  cattle  diseases. 

VESSELS  FUMIGATED. 

Four  hundred  and  thirty-two  vessels  were  fumigated  with  sulphur  to  kill 
rats  and  other  vermin  aboard.  The  vessels  ranged  in  size  from  the  largest 
steamers  that  are  found  on  the  Pacific  Ocean  to  the  smallest  sail  vessel.  It  is 
impossible  to  estimate  the  amount  of  good  that  this  fumigation  has  accom- 
plished. In  many  cases  it  nuist  undoul)tedly  have  prevented  the  transmission 
of  disease,  to  say  nothing  of  the  great  amount  of  actual  comfort  that  has  been 
afforded  the  traveling  public  and  the  crews.  Vermin  naturally  propagates 
much  more  abundantly  in  tropical  climates  than  in  temperate  ones.     This  is 


PTTBLTC    HEALTH    AND    MAKINK-IIOSPITAL    SERVICE.  1(55 

«'s|K'<i.iIly  Inic  (111  lio.ird  vessels,  .iiid  uiiloss  nieiiiis  two  fnkon  fo  oxfenninnle  it 

froiii  time  to  lime  Hie  amoniil  of  vei-miii  is  only  iimiteil  by  the  ol»l:iiii:il>le  f I 

supply.  'J'lie  discomrorl  wliicli  is  ciiiised  by  itedlni.^s.  rojiclies,  o\r.,  ciii  well  he 
im;is,'iiied.  'rii.il  vermin  is  Inr^'ely  concerned  in  the  transmission  of  disease 
tlieri>  is  no  ioniser  any  douht.  From  the  sanitarian's  standpoint,  it  is  almost 
a  fortunate  thin?,'  that  vermin  is  also  a  source  of  annoyance  to  the  travelinj,' 
public,  because  the  measures  which  lie  uses  to  destroy  it  then  receive  the  hearty 
support  of  till'  shiiipinj,'  interests.  Thus  it  has  bec<»me  possible  to  fumigate  ail 
vessels  without  c:iusiii,<,'  friction.  The  j,'reat  imiiortance  of  this  f:ict  will  be 
ai)|>reciated  when  it  is  reiiuMubered  that  no  perin.-iiieiit  sanitary  :idvaiicement 
can  be  mad(>  unless  the  measures  have  the  support  of  the  i)ublic. 

Hi  the  funiij,'atiou  of  this  lars^e  number  of  vessels  the  jiot  method  was  u.sed 
almost  entirely,  because  it  was  found  much  more  satisfactory  than  the  regula- 
tion sulphur  furnace  and  many  times  more  economical.  The  penetrability  of 
suli)hur  iias  generated  in  pots  set  in  water  is  nuicli  j^reater  than  that  f,'enerated 
in  the  sulphur  furnace.  It  is  not  my  jiurpose  to  enter  into  a  technical  discussion 
here  of  the  relative  merits  of  the  two  systems,  but  only  to  point  out  that  the 
liot  method  has  proven  very  successful  and  that,  owiuf?  to  the  siiiijdicity  of  its 
ojieration,  there  is  no  reason  wliy  it  should  not  he  used  at  all  foreij^n  ports 
wliere  the  Service  has  officers  stationed  and  where  it  may  be  required. 


This  year  lias  seen  what  is  generally  believed  to  be  the  complete  cessation 
of  cholera  througliout  the  islands.  The  last  case  was  reported  in  Manila 
Feliruary  20,  1004.  The  last  case  reported  in  the  provinces  was  on  April 
18,  1004. 

During  the  fiscal  year  there  have  been  (JOG  cases  witli  ."42  deaths  reported 
in  the  city  of  Manila.  Twenty -tliree  tliousand,  two  liuiidred  and  thirty-three 
cases  and  18,o<)0  deaths  were  reported  in  the  provinces.  Thus  has  ended  one 
of  the  most  devastating  epidemics,  witli  the  exception  of  the  plague  in  India, 
which  has  affected  man  in  recent  times.  In  round  numlKn's  there  liave  been 
more  than  :>00,000  deatlis.  Actually,  over  one-twentieth  of  the  population  was 
destroyed  in  a  little  over  a  year  by  tliis  one  disease  alone.  Since  we  know  that 
the  disease  is  introduced  into  a  community  only  by  anotlier  case,  by  water,  or 
by  certain  food  products,  it  will  be  seen  that  it  is  possible  to  prevent  its  rein- 
troduction,  but  since  communication  is  Indispensable  it  will  also  be  apparent 
that  the  quarantine  officer  assumes  a  tremendous  responsil)ility  in  attempting 
to  regulate  tlie  shipping  wliich  arrives  liere  from  ports  infected  with  cholera. 
In  connection  with  the  recent  outbreak  of  cliolera  on  the  eastern  coast  of  China 
an  interesting  question  has  presented  itself  here.  Did  cholera  finally  extinguish 
itself  here  because  all  the  available  material  was  u.sed  up,  or  because  the  organ- 
ism had  become  so  attenuated  that  it  was  no  longer  able  to  convey  cholera  to  an 
individual?  If  the  former  was  the  case,  there  was  not  much  danger  to  lie  appre- 
i^.ended  in  tlie  Philippines  by  the  outbreak  of  the  disease  in  Hongkong  and 
Saigon.  If  the  latter  was  the  case,  the  introduction  of  a  case  of  cholera  into 
the  islands  was  of  tlie  gravest  import.  In  tlie  absence  of  definite  infornintion 
to  the  contrary  the  latter  was  assumed  to  be  the  case  and  those  parts  of  the 
quarantine  regulations  which  were  ai)plicable  were  enforced.  An  important  fact 
brought  out  by  the  recent  epidemic  was  that  the  incubation  period  was  very 
rarely  found  to  be  more  than  forty-eight  hours.  AVith  this  in  mind  when  the 
cholera  again  made  its  appearance  in  Hongkong  last  May  the  following  action 
was  taken  :  In  addition  to  the  measures  imposed  upon  vessels  at  Hongkong  by 
the  Service  officer  stationed  there  vessels  are  required  to  call  at  Mariveles, 
where  a  thorough  inspection  is  made  and  any  additional  disinfection  that  is 
necessai'y  is  done.  The  inspection  at  Mariveles  also  affords  an  excellent  oppor- 
tunity to  search  for  fresh  vegetaliles  and  other  prohibited  articles  that  may 
have  gotten  aboard  unauthorized.  T'pon  the  completion  of  the  iusiiection,  if 
everything  is  found  satisfactory,  the  vessel  proceeds  to  Manil:i  witlKmt  deten- 
tion." It  is  believed  that  by  this  method  of  treating  Hongkong  vessels  the  islands 
are  as  efficiently  safeguarded  against  the  invasion  of  cholera  as  by  a  five-days' 
quarantine,  and  the  losses  and  annoynces  to  the  shipping  interests  are  reduced 
to  a  minimum.  An  administrative  detail  that  has  been  of  the  greatest  assist- 
ance in  dealing  with  vessels  from  infected  ports  was  the  carrying  into  effect 
a  regulation  tiiat  nothing  other  than  articles  actually  on  the  cargo  manifest 
should  be  removed  from  the  vessels  while  in  the  ports  of  the  Philii)pines  unless 
written  authority  was  obtained  from  the  quarantine  officer.     By  this  method 


166  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

many  snsiioctod  tliiiiirs  woro  jirovontod  from  landinjr.  and  osiK-fially  was  this  true 
if  ships'  stort's.  Tlir  < 'ustuuis  Service  has  hi-cn  of  the  fireatest  assistance  to 
ns  in  eari'vinir  lliis  retrnlation  into  successful  effect. 

At  Cel>u  at  tlie  lie.ijinnins  of  the  fiscal  year  the  cholera  ajiaiu  became  so 
severe  that  it  was  deemed  necessary  to  institute  a  partial  outgoing  quarantine. 
Accordingly  Asst.  Surg.  Carroll  Fox.  the  officer  in  command  at  Cehu.  issued 
a  circular  letter  stating  that  beginning  with  July  1  it  would  be  necessary  for 
all  steerage  iiassengei-s  who  desired  to  leave  Cebu  by  boat  to  fii-st  undergo  a 
quarantine  detention  of  five  days.  During  the  early  part  of  August  the  situa- 
tion was  so  nuich  imi)roved  that  on  August  10  the  quarantine  was  lifted. 

In  the  latter  part  of  August  the  village  of  Mariveles  (pojnilation  about  1,000). 
at  which  is  also  located  the  Mariveles  Quarantine  Station,  after  enjoying 
entire  freedom  from  cholera  since  the  beginning  of  the  eiMdemic,  became  infected 
The  labor  supply  for  the  station  is  drawn  from  this  village,  and  it  was  therefore 
necessary  to  take  all  precautious  to  prevent  the  station  from  becoming  infectetl. 
because  this  would  have  seriously  affected  the  efficiency  of  the  quarantine  sta- 
tion at  a  time  when  its  uninterrupted  operation  was  essential  to  the  health  of 
the  entire  island. 

The  im])ortance  of  this  matter  was  appreciated  by  the  insular  health  authori- 
ties and  the  Army.  The  Service  cooperated  with  the  foregoing  officials,  and  in 
a  few  days  the  disease  was  under  entire  control  and  by  September  12  no  fur- 
ther cases  occurred.     Total  number  of  cases  12,  with  5  death*. 

Investigation  showed  that  the  disease  was  not  introduced  into  the  village  from 
the  quarantine  station.  Coincident  with  the  outbreak  of  the  disease  the  popula- 
tion of  the  village  was  augmented  liy  the  arrival  of  .''.OO  stevedores,  who  remained 
there  permanently  to  coal  the  army  transports.  In  the  desire  of  the  local  mer- 
chants to  cater  to  the  wants  of  this  increased  population  a  supply  of  vegetables 
from  Manila  was  obtained  and  with  it.  in  all  probability,  the  cholera.  Cases 
were  immediately  isolated  and  the  premises  disinfected.  The  stevedores  were 
placed  in  a  camp  by  themselves,  a  rigid  daily  inspection  made  of  all  persons, 
and  all  suspicious  cargo  was  refused  landing.  The  watfr  supply  being  above 
suspicion,  these  measures  sjieedily  accomplished  the  eradication  of  the  dis- 
ease. It  was  an  excellent  illustration  of  what  may  be  accomplished  by  sani- 
tary science  when  the  proper  means  are  at  hand  for  its  application.  The  mari- 
time quarantine  inspection  at  Mariveles  of  vessels  from  Manila  was  maintained 
until  the  cessation  of  the  disease  at  Manila,  and  it  was  completely  successful. 

In  the  early  part  of  Septemlier  there  was  suddenly  a  decided  increase  in  the 
number  of  cholera  cases  in  Manila.  For  the  week  eude<l  September  12,  10(»:?. 
instead  of  the  usual  numlter  of  from  IS  to  2.")  cases  per  week,  there  were  7".t 
cases  and  0.3  deaths  reported.  The  increase  was  soon  traced  to  some  fresh 
water  which  bubbled  up  througli  the  salt  water  of  the  bay  at  a  point  just  off 
the  Tondo  district.  The  fact  that  fresh  water  could  be  dipped  from  a  salt 
water  bay  was  regarded  as  a  miracle  by  the  natives  and  they  flocked  there  in 
gi-eat  numbers  to  drink  of  and  bathe  in  this  water,  to  which  wonderful  curative 
properties  were  ascribed.  Investigation  showed  that  some  pipes  of  a  sewer 
which  ran  for  some  distance  into  the  bay  had  become  broken  and  that  fresh 
water  therefrom  came  directly  to  the  surface.  On  September  10  there  were 
8  cases  reported,  on  Seiitember  11,  1(J.  and  on  September  12.  30.  Access  to  the 
spring  was  then  prohii)ited  by  the  authorities  and  there  was  a  rapid  decline  in 
the  number  of  cases.  Small  sailing  craft,  called  "  paraos."  which  anchored  in 
the  inunediate  vicinity  of  the  spring,  were  required  to  undergo  five  days'  quar- 
antine detention  at  a  remote  place  in  the  harl)or  before  being  permitted  to  sail. 
This  was  done  with  the  view  of  preventing  any  of  this  water  being  carried  to 
the  provinces  and  to  guard  against  the  fiutbreak  of  the  disease  among  the  i)erson- 
nel  of  the  vessels  after  leaving  here.  .Vs  the  danger  from  this  source  was  over  in 
a  few  weeks,  the  ((uarantine  was  declared  off.  From  that  time  on  there  was  :i 
general  decline  of  cholera  throughout  the  island.  This  was  in  accord  with 
the  previous  history  of  the  disease,  viz,  that  cholera  in  the  Philippines  never 
lasts  bevond  the  third  year. 

In  the  early  part  of  the  spring  the  insular  board  of  health  felt  warranted  in 
passing  the  following  resolutions: 

[I'assed  March  '2S,  1904.] 

"  Whereas  the  last  case  of  suspected  Asiatic  cholera  occurred  in  the  city  of 
Manila  on  February  2!).  1904.  and  the  last  known  case  occurred  in  the  city  on 
February  ?..  1004.  "there  having  been  but  four  positive  or  suspected  cases  of 
Asiatic  cholera  in  the  city  since  January  G,  1904;  and 


PUBLIC    HEALTH    AND    MARTNE-HOSl'ITAL    SEKVICE.  1()7 

"  WIkmv.is  tilt'  provinces  ;ul.i:i(('ii(  to  M.iiiil;i  Iimvi-  hccii  Irco  from  cliolcrii  diir- 
iiifi  the  in'i'sciit  cMlciidMr  year,  on  motion 

"  Rc.solnd.  TliJit  the  city  of  .Manila  is.  and  is  hereby,  dechired  free  from  the 
infection  of  Asiatic  cholera." 

fl'assed  April  27,  1004.] 

"Whereas  cases  of  Asiatic  cholera  have  occurred  in  hut  three  provincial 
towns  of  the  riiilippine  Islands  since  Fehruary  S,  1!K)4,  and 

"  Whei'eas  only  one  case  of  Asiatic  cholera  has  been  reported  as  occurrinj^  at 
any  place  in  the  I'liilippine  Islands  since  March  S.  I'.Mtl,  and 

"  Whereas  the  city  of  Manila  was  declared,  on  March  2'A,  to  he  free  from  the 
Infection  of  Asiatic  cholera,  on  motion 

"  licsolrrd.  That  the  islands  coniprisin.ic  the  I'hilii)i)ine  Archijx'laf^o  he,  and 
hereby  are.  declared  to  be  free  from  the  infection  of  Asiatic  cholera  :   and  be  it 

"Further  rcKolrcil,  That  the  coiiiniissioner  of  public  health  iie  directed  to 
send  a  copy  of  these  resolutions  to  the  honorable  the  secretary  of  the  intei'ior, 
the  nuuiicipal  board,  the  collector  of  customs,  and  the  United  States  Marine- 
Hospital  Service." 


The  reduction  in  the  number  of  i)laf?ue  cases  over  that  of  last  year  is  prob- 
iibly  one  of  the  most  satisfactory  sanitary  results  that  have  been  achieved  dur- 
ing the  .year.  The  energetic  ap])lication  of  modern  sanitary  principles  has  had 
its  reward.  During  the  fiscal  year  ended  June  30,  1002,  there  were  121  cases 
reported,  but  probably  many  more  occurred.  This  year  there  were  101  ciises. 
Briefly,  the  plan  inaugurated  was  as  follows :  From  carefully  prepared  statis- 
tics it  was  foinid  that  the  Chinese  were  many  times  more  liable  to  contract  the 
disease  than  the  Filipinos.  Accordingly,  the  Chinese  population  of  Manila  was 
inoculated  with  Shiga's  antipest  serum.  It  was  the  aim  to  give  a  i)rimary  and  a 
month  later  a  secondary  inoculation.  The  records  of  the  board  of  health  show 
that  no  Chinaman  contracted  plague  who  had  received  a  secondary  inoculation, 
and  only  a  few  contracted  the  disease  who  had  received  the  primary  inoculation. 
The  Chinese,  then,  instead  of  being  the  race  most  likely  to  contract  the  disease 
became  the  one  least  likely  to  contract  it.  During  the  last  six  months  the  plague 
has  been  confined  almost  entirely  to  the  Filipinos.  Since  the  period  during 
which  the  Chinese  have  been  free  from  plague  cori-esponds  to  the  period  during 
which  they  were  first  inoculated  with  serum  it  would  appear  to  be  a  fair  infer- 
ence that  the  result  was  due  to  the  serum.  Contacts  are  no  longer  ((uarantined. 
When  an  individual  contracts  plague  be  is  immediately  removed  to  the  hosjiital 
and  the  contacts  to  the  disinfecting  station.  The  house  from  which  he  has 
been  taken  is  disinfected  ;  the  contacts  are  similarly  treated  and  then  discharged. 
Rat  catchers  are  immediately  sent  to  the  house  and  directed  to  catch  not  only 
the  rats  in  the  house,  but  also  in  the  Immediate  neighborhood.  When  it  is 
remembered  that  plague  has  prevailed  with  undiminished  vigor  in  nearby  for- 
eign ports  and  that  the  climate  and  other  conditions  in  Manila  are  favorable  for 
its  development  it  will  be  seen  that  the  situation  is  encouraging.  It  is  also 
worthy  of  note  to  mention  that  of  all  of  the  cases  found  not  a  single  case  could 
be  traced  to  having  l)een  contracted  outside  of  the  islands.  This  shows  that  the 
maritime  quarantine  has  been  efficient,  and  no  doubt  has  been  of  much  assist- 
ance in  stamping  out  the  disease,  because  no  fresh  cultures  were  introduced. 

Another  imi)ortant  point  for  the  quarantine  ofiicer  is  the  fact  that  while 
several  cases  have  occurred  in  widely  separated  provinces  there  was  no  spread 
from  them.  This  would  indicate  a  case  of  plague  in  a  Innnan  being  is  not  so 
great  a  source  of  danger  as  the  introduction  of  infected  rats  or  cargo.  The 
application  of  the  latter  principle  has  been  used  by  the  Service  almost  entirely 
in  pi-eventing  the  spread  of  the  disease  to  other  ports  of  the  islands  during  the 
])ast  four  years. 

For  a  number  of  years  past  there  has  been  an  occasional  sporadic  case  at 
Cebu.  The  finding  of  a  case  is  generally  preceded  by  dead  rats  being  found  in 
the  neighborhood.  In  September  last  11  cases  made  their  appearance  within 
comparatively  a  few  days  and  the  disease  then  disappeared  again  almost  com- 
pletely before  the  elaborate  measures  instituted  by  the  board  of  health  were 
properly  started.  Since  that  time  there  has  been  an  occasional  case,  averaging 
possibly  1  a  month.  The  Service  has  been  fumigating  with  suliilnir  all  vessels 
that  leave  either  Cebu  or  Manila  for  other  island  ports.  It  has  been  the  aim 
to  fumigate  all  vessels  that  ply  between  Hongkong  or  other  plague-infected  ports 


168  PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 

and  Manila  about  twice  a  year,  an<l  osjiecialiy  after  they  have  been  in  dry  tloelv 
at  Ilonj^kong,  during  which  process  it  is  quite  i)robal)le  that  I'ats  came  aiward. 
Since  some  of  the  dry  doclcs  ai-e  located  in  sections  of  the  city  that  are  plague 
infected  the  importance  of  this  matter  will  he  appreciated.  In  my  opinion,  one 
of  the  most  important  factors  in  the  plague  not  easily  gaining  entrance  here  is 
the  fact  that  there  are  no  dry  docks  and  that  foreign  vessels  always  unload  into 
lighters. 

During  the  active  plague  season  at  Amoy  (generally  May,  June,  July,  and 
August)  the  consular  sui-geon  there  was  reipiested  to  detain  all  steerage  i)assen- 
gers  for  the  Philippines  in  quarantine  for  the  incubation  period  of  the  disease. 

SMALLPOX   AND   VACCINATION. 

Smallpox  continues  to  be  the  disease  which  the  quarantine  officer  meets  with 
most  frequently  on  board  vessels.  During  the  year  0  vessels  were  disinfected  at 
Mariveles  on  account  of  smallpox  and  8  at  the  other  ports  of  the  islands.  The 
Commission  has  passed  an  act  making  vaccination  compulsory,  and  the  board  of 
health  is  at  present  engaged  in  carrying  the  act  into  effect.  If  the  health 
authorities  are  furnished  with  a  reasonable  amount  of  funds  there  is  no  reason 
why  the  Philippines  should  not  become  as  free  from  smallpox  as  Porto  Rico. 
The  Service  commenced  the  systematic  vaccination  of  crews  last  September. 
Since  that  time  there  have  been  18,773  persons  vaccinated  at  all  the  ports  at 
which  Service  officers  are  stationed.  Of  11,300  persons  vaccinated  in  Manila,  it 
is  known  that  there  were  (),502  "  takes."  There  were  probably  many  more,  but 
as  they  did  not  come  under  observation  again,  the  exact  number  is  unknown.  At 
Iloilo  there  were  3,358  persons  vaccinated,  with  1,200  known  "  takes  "  (estimated 
"takes"  2,070).  At  Cebu  there  were  4,030  persons  vaccinated,  with  500  known 
"  takes."  At  Jolo  420  persons  were  vaccinated ;  number  of  "  takes "  not  re- 
ported. When  it  is  rememliered  that  many  of  these  persons  had  been  vaccinated 
before,  it  will  be  seen  that  the  results  were  very  satisfactory.  At  Manila  the 
"  takes  "  averaged  over  50  per  cent. 

An  administrative  detail  that  was  of  great  assistance  from  the  standpoint  of 
efficiency  and  as  a  time-saving  device  was  tlie  issuing  of  cards  to  all  i>ersons 
vaccinated.  A  red  card,  which,  among  other  things,  included  the  individual's 
name  and  the  date  of  the  vaccination,  was  used  for  the  first  vaccination,  a  white 
card  for  a  second  vaccination,  and  a  blue  card  if  the  vaccination  was  successful. 
The  cards  were  numbered  consecutively.  Starting  with  a  definite  number  of 
cards,  it  therefore  required  only  a  few  minutes'  work  to  arrive  at  the  number  of 
vaccinations  i)erformed  and  with  what  result.  The  greatest  time  saving  was 
effected,  however,  at  the  inspection.  The  crews  were  mustered.  All  holding 
blue  cards  were  immediately  dismissed.  Thus  there  was  no  confusion,  and  the 
remaining  ones  were  rai)idly  dealt  with.  After  the  work  was  well  under  way 
the  various  shipping  firms  were  requested  to  employ  only  iiersons  holding  blue 
cards.  This  had  an  excellent  effect  and  acted  as  a  direct  stimulant  for  sea- 
faring people  to  be  vaccinated  and  obtain  the  blue  cards  in  order  that  they 
might  be  eligible  in  this  respect  for  such  positions  as  they  desired. 

LEPROSY. 

Cases  of  leprosy  were  detected  on  0  vessels.  Two  other  vessels  had  suspicious 
cases  on  board,  but  the  diagnosis  ccmld  not  be  bacteriologically  confirmed. 

The  insular  government  has  set  aside  the  island  of  Culion  as  a  leper  island. 
It  is  the  intention  ultimately  to  collect  the  lepers  from  all  over  the  islands  and 
send  them  there.  It  is  estimated  that  there  are  3.511  lepers  in  the  Philijipines. 
They  are  collected  into  various-sized  gi-oups  at  40  different  places  throughout 
the  provinces.  By  gathering  them  all  at  one  place  the  danger  of  the  spread  of 
the  disease  will  be  much  i-educed  and  the  per  capita  cost  of  keeping  them 
lessened. 

AID   TO   OTHER   SERVICES. 

During  the  fiscal  year  thei"e  were  737  physical  examinations  made  of  masters, 
mates,  pilots,  engineers,  and  other  ships'  officers  at  the  reipiest  of  the  insular 
collector  of  customs.  Of  this  numlier  04  were  rejected.  For  the  Innnigration 
Service  5,750  immigrants  were  insjiected  and  351  rejected. 

Thirty  vessels  were  disinfected  at  the  request  of  the  board  of  health  on  ac- 
count of  being  infected  with  cholera,  rinderpest,  etc. 


VVmAC    HKALTIl    AND    MARINE-HOSPITAL    SKKVKK.  1('»'.) 

Two  spcciiil  pliysic.-il  (>x:iiiiin:iti(»iis  \v('n>  iikkIc  ;i1  tlic  r(M|iicst  of  tlic  riiilip- 
|iiii(>  civil-service  Itoanl. 

Al  llic  rc(Hics(  of  llii'  Anii.v,  lr:iiis|t<(iis  were  iiis|(c<lc(|  ;il  .M;irivclcs  ;il  siicli 
limes  as  (liey  (U'sired.  'I'lie  stevedores  located  at  Mai-iveles  were  iiisiiecled 
daily  for  many  weeks,  and  aid  was  rendered  in  establisliint;  an  isolation  canii» 
foi'  iliem. 

APPROPRIATION    FOR    A    QTARANTIiNK   STATION    AT   CKIiU. 

The  riiilippine  Connnission,  in  act  Xo.  Sol.  passed  Anj^nst  12.  l!)0.''i,  appropri- 
ated .f.'JO.OOO,  I'nited  States  currency,  for  the  erection  and  etpiipment  of  a  (luar 
antine  station  at  the  i)ort  of  C'ebu.  On  Auj,'nst  i;5.  1!K).''>,  the  followinj^  cablegram 
was  sent  to  the  Burean : 

'•  Wyman.  W(is}iin(/t()ii,  D.  C: 

"Conunission  appropriated  .^530,000  station  ("ebu.  Have  I  authority  to  com- 
mouce  building? 

"  IIlCISKK." 

The  reply  received  was  as  follows : 

"  Washington,  D.  C,  Augmt  J!),  IHOS. 
"  IIeiser,  Manila: 

"Yes,  under  regulation  proper  Pliilippine  authority. 

"  Wyman." 

Steps  were  then  at  once  talcen  for  the  erection  of  the  same.  A  board  of  otti- 
cers.  composed  of  Passed  Asst.  Surg.  Victor  G.  IIeiser,  Asst.  Surgs.  Carroll  Fox 
and  J.  D.  Long,  decided  that  the  island  of  Cauit.  situated  in  the  harbor  of  Cebu. 
about  a  mile  below  the  port,  was  its  first  choice  for  a  location.  A  piece  of  land 
about  3  miles  above  Cebu,  on  Mactan  Island,  was  its  second  choice.  The  island 
of  Cauit  was  considered  by  far  tlie  most  desirable  site,  and,  since  it  was  in  all 
probability  (Tovennnent  property,  it  was  thought  best  to  malie  every  effort  to 
obtain  it.  When  this  intention  became  known  at  Cebn  a  claimant  appeared. 
The  court  of  land  registration  decided  in  favor  of  the  Government.  The  case 
has  been  ap])ealed  to  tlie  court  of  first  instance  of  Cebu.  (The  case  is  to  come 
uj)  for  trial  in  tlie  early  part  of  August,  and  as  soon  as  the  outcome  tliereof  is 
known  a  complete  report  of  the  steps  taken  since  the  appropriation  was  made 
will  be  forwarded.) 

APPROPRIATION    FOR   AN    ADDITIONAL   LAUNCH. 

The  Philippine  Commission,  recognizing  the  great  need  of  another  launch  for 
u-se  of  the  (luarantine  service  at  Manila,  appropriated,  in  act  No.  831,  passed 
August  12,  1903,  the  sum  of  $4,000,  United  States  currency,  for  this  purpose. 
Through  the  proper  channels  a  contract  was  awarded  to  a  San  Francisco  lirm 
for  building  the  same.  Owing  to  the  innuense  amount  of  work  to  l)e  done  a 
certain  amount  of  speed  is  absolutely  essential,  and  owing  to  the  weather  con- 
ditions which  prevail  in  Manila  Bay  it  is  necessary  that  a  certain  type  of 
launch  be  adopted.  The  contractors  failed  to  meet  the  specifications  in  both 
these  reiiuests,  as  well  as  in  other  essentials,  and  in  conse(]uenca  the  contract 
was  canceled.  Negotiations  are  now  under  way  for  the  purchase  of  a  launch 
elsewhere. 

INTERISLAND   QUARANTINE. 

The  interisland  quarantine  inspection  of  vessels  was  in  charge  of  the  insu- 
lar board  of  health  for  all  ports  other  than  ports  of  entry,  and  the  Service  has 
had  control  of  the  latter.  Whenever  an  infected  vessel  was  encountered  i)y  the 
board  of  health,  if  practicable,  it  was  remanded  to  the  nciirest  Service  (piaran- 
tiue  station  for  treatment.  Up  to  the  beginning  of  the  second  half  of  the  fiscal 
year  quarantine  inspection  of  incoming  vessels  had  been  general  throughout  the 
islands.  In  the  latter  part  of  February  the  cholera  situation  had  improved  so 
nuich  that  the  insular  board  of  health  requested  the  opinion  of  this  office  as  to 
whether  it  was  considered  necessary  to  continue  it.  The  reply  was  made  that 
it  was  considered  advisable  to  discontinue  all  maritime  quarantine  insjiections 
at  other  than  iiorts  of  entry,  unless  some  sjiecial  local  condition  demanded  it. 
It  is  thought  that  a  rigid  inspection  should  still  be  made  at  present  at  the  ports 


170  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

of  entry  iicjt  only  of  foreign  vessels,  luit  also  of  all  interisland  vessels,  for  the 
purpose  of  keeping  a  surveillance  over  their  sanitary  eondition.  Since  prac- 
tically all  local  vessels  sooner  or  later  call  at  the  ports  of  entry,  it  is  thought 
that  ii  good  check  can  he  established  by  this  method.  There  has  been  a  great 
improvement  in  the  sanitary  condition  of  interisland  vessels  during  the  past 
year,  but  there  is  still  much  left  to  be  desired.  Inspection  by  experienced  offi- 
cei\s  is  considered  necessary  from  tiuje  to  time,  in  order  thiit  the  improvement 
which  lias  been  brought  about  may  be  maintained  and  other  necessary  ones 
instituted. 

Ever.v  effort  is  made  to  inspect  incoming  vessels  with  i)r(jmptness  and  dis- 
patch. It  is  not  believed  tliat  the  sanitary  condition  of  the  islands  is  sulii- 
ciently  grave  to  warrant  an  inspection  that  would  interfere  with  the  free  move- 
ment of  interisland  vessels,  and  with  that  object  in  view  the  launch  service  has 
been  so  arranged  that  an  incoming  vessel  can  be  inspected  at  any  time  of  the 
day  a  few  nunutes  after  its  arrival. 

The  insular  collector  of  customs  very  kindly  set  aside  three  rooms  in  the  cus- 
tom-Iiouse  for  the  use  of  the  Service,  and  on  June  28,  1904,  the  office  of  the  chief 
quarantine  officer  was  removed  thereto.  It  is  the  intention  to  use  the  building 
at  78  Calle  Madrid,  which  was  formerly  devoted  to  Service  office  purposes,  as  a 
laboratory  and  storehouse.  In  view  of  the  fact  that  night  woi'k  is  frequently 
necessary,  tlie  latter  will  also  serve  as  a  night  office.  The  present  location  of  the 
office  is  a  decided  convenience  to  the  public,  and  the  change  in  location  has  been 
generally  appreciated. 

The  circular  letters,  the  statistics,  the  reports  from  the  substations,  and  the 
financial  statement  follow : 

[Circular  letters.] 

Manila,  P.  I.,  July  7,  1903. 
To  the  {Steamship  Agcnta  and  Othrifi,  Manila,  P.  I. 

Sirs  :  You  are  hereljy  informed  that  from  this  date  it  will  not  be  necessary 
for  vessels  entering  the  port  of  Manila  from  domestic  ports  north  of  Corre- 
gidor  to  call  at  Mariveles  for  inspection. 

This  repeals  the  order  issued  by  this  ofKce  in  circular  letter  dated  April  20, 
1903. 

Respectfully,  Victor  G.  IIeiser, 

Passed  Assistant  Huroeon, 
Chief  Quarantine  Officer  for  the  Philippine  Islands. 


Manila,  P.  I.,  Heptemher  26,  190S. 

Medical  Officer  in  Command, 

1'nited  t^tates  Public  Health  and  Marinr-IIospital  Hervice. 

Sir:  Owing  to  the  continued  absence  of  smallpox  thi-cnighout  the  islands 
and  to  reduce  the  possibility  of  the  infection  being  conveyed  by  shijis,  it  has 
been  decided  to  vaccinate  the  crews  and  foreign  steerage  passengers  of  vessels 
which  enter  llie  ports  under  the  control  of  this  Service. 

In  order  to  facilitate  the  work,  and  that  the  records  of  the  same  may  be  of 
value,  a  mimber  of  cards  have  been  printed,  a  supply  being  sent  you  herewith. 

\]\nm  vaccinating  a  member  of  a  crew  you  are  directed  to  hand  the  person 
a  red  card  properly  filled  out.  The  next  time  this  individual  comes  under 
observation  you  will  examine  the  vaccination,  and  if  it  has  been  successful 
you  will  destroy  the  red  card  and  supply  a  blue  one  instead.  The  presentation 
of  this  latter  card  will  exempt  the  individual  from  further  vaccination.  When- 
ever a  red  card  is  pi-esented  and  there  is  no  evidence  of  a  succesful  vaccination 
the  person  presenting  the  same  should  lie  revaccinated,  the  red  card  destroyed, 
and  a  white  one  supplied.  An  individual  who  presents  a  white  card  and  shows 
evidence  of  having  iieen  twice  vaccinated  by  you,  whether  successfully  or  not, 
should  have  the  white  card  destroyed  and  a  blue. one  sui)plied. 

Practical  exjierience  has  shown  that  if  the  matter  is  properly  explained  to 
the  shipping  interests  that  in  hiring  crews  they  will  always  give  preference  to  a 
perscm  with  a  blue  card,  because  he  is  nuich  safer  from  a  sanitary  standpoint. 
Sailors  and  others  who  follow  a  seafai-ing  life  soon  learn  this  and  are  anxious 
to  obtain  blue  cards,  and  once  having  obtained  them  they  preserve  them. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  171 

An  iicciirMic  nMunl  slioiild   lu'  kt'pt   of  the  iiuiiiIkm-  <>f  ■.  ;icciii;iti<»iis  done,  the 
mnnltt'i-  succt'ssfnl  <ni  llic  tirsl    v;ic<Mn;iti(in,  the  nuiiiln'i-  successful  on  rcvaerl- 
uatiuii.  and  tlu'  nunilier  luisuecessfully  vaccinated  after  two  trials. 
iiesi»ectfully. 

VicTOK  (J.  IIeisek, 
Pasftcfl  Afisistdiit  Siirneou, 
Chief  Quanuithie  Officer  for  the  I'hilipitiiie  IniandH. 


Manila,  P.  I..  Xorcniher  12,  1903 
Medical  Officer  in  Command, 

United  States  Public  Health  and  ilarine-Hofipital  .s'm/cr. 
Sir:  In  order  to  make  the  vaccination  of  crews  still  more  elficient,  the  fol- 
lowing additions  are  made  to  the  circular  letter  of  Sei)tember  2i>.  11)03: 

When  a  white  card  is  presented  and  on  inspection  it  is  found  that  the  indi- 
vidual was  twice  unsuccessfully  vaccinated,  he  should  he  revaccinated  and  the 
white  card  marked  with  an  "  X."  When  a  white  card  with  an  "X  "  is  pre- 
sented, and  when  it  is  found  that  the  individual  was  three  times  unsuccessfully 
vaccinated,  he  should  be  given  a  blue  card,  which,  in  addition  to  the  other  data, 
should  have  the  figure  "3"  written  upon  it.  When  persons  with  the  latter  card 
are  found  at  future  inspections  it  will  indicate  to  the  inspector  that  the  indi- 
vidual was  vaccinated  three  times  unsuccessfully  and  that  further  attempts 
would  probably  be  useless. 

Respectfully,  "\'ictor  -G.  Heiseb, 

Passed  Assistant  Surgeon, 
Chief  Quarantine  Officer  for  the  Philippine  Islands. 


Manila,  P.  I.,  January  S,  190 >i. 
To  shipoicners,  shippers,  agents,  masters  of  vessels,  and  others  concerned: 

In  order  that  the  requirements  of  the  United  States  Quarantine  Laws  and 
Regulations  in  force  in  this  port  with  regard  to  vessels  and  their  i)assengers, 
crew,  and  cargo  may  be  better  understood,  the  following  regulations  are  hereby 
promulgated.  Nothing  in  these  rules,  however,  whether  by  omission  or  other- 
wise, is  to  be  construed  as  exempting  a  vessel  from  complying  with  the  United 
States  Quarantine  Laws  and  Reguhitious. 

INCOMING    VESSELS. 

1.  All  vessels  entering  from  ports  outside  of  Manila  Bay  shall  fly  a  yellow 
flag  at  the  foremast  head  until  boarded  and  granted  pratique  by  the  quarantine 
officer. 

2.  LTntil  vessels  have  been,  granted  pratique  no  person  or  vessel  shall  he  allowed 
to  come  close  enough  to  hold  communication,  blasters  of  incoming  vessels  will 
be  held  to  strict  accountability  for  the  enforcement  of  this  rule. 

3.  All  cases  of  sickness  of  a  contagious  nature  or  deaths  due  to  any  cause 
while  vessels  are  lying  in  i)ort  should  be  reported  innuediately  to  the  <iuarantine 
office,  or  the  (luarantine  ollicer  on  duty  on  the  l)ay  nuiy  be  notified  by  hoisting 
the  letter  I)  of  the  International  Code  of  Signals. 

4.  Vessels  entering  the  ports  of  the  I'hilippines  .are  required  to  be  mechan- 
ically clean  and  kept  in  good  sanitary  condition.  Special  attention  should  be 
given  to  the  forecastles,  galleys,  toilets,  baths,  and  living  apartments. 

5.  In  the  event  of  any  incoming  vessel  having  sickness  of  any  kind  on  board 
it  is  recommendetl  that  slie  call  at  Mariveles  for  inspection.  If  the  disease  is 
not  of  a  quarantinable  nature  the  vessel  will  be  released  at  once  and  allowed  to 
proceed  to  Manila  and  there  granted  praticiue  in  the  ordinary  way.  This  sug- 
gestion is  made  with  a  view  of  avoiding  the  delay  caused  by  the  ship  returning 
to  Mariveles  in  the  event  of  such  disease  being  of  a  ciuarantinable  nature. 

0.  All  vessels   arriving  from    infected  ports,  the  ordinary   running  distance 


172  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

from  wliioli  is  not  over  seven  <l;i.vs  from  Manila,  or  vessels  whose  erew  and 
steeraj,^e  i)assen.i;ers  have  not  lieen  disinfocted  at  port  of  departure,  will  Ix- 
retiiiired  to  call  at  Mariveles  for  disinfection. 

7.  The  carf?o  manifests  of  all  vessels  sailinj^  from  foreign  ports  to  the  riiilip- 
pines  should  he  suhmitted  to  the  medical  officer  on  duty  at  the  United  States 
consulate  at  the  port  of  departui-e  for  signature. 

8.  Ilabhits,  dogs,  guinea  pigs,  cats,  and  small  animals  in  general  frf)m  infected 
ports  can  not  be  landed,  and  all  such  animals,  regardless  of  the  port  of  origin, 
re(iuire  a  permit  from  this  office  prior  to  being  landed. 

0.  Ship's  stores  and  all  other  articles  not  on  the  manifest  are  not  to  be  landed 
unless  a  permit  has  first  been  obtained  from  this  oHice. 

10.  The  quarantine  anchorage,  for  the  purpose  of  these  regulations,  is  Manila 
Bay. 

ODTGOING    VESSELS     (INCLUDES    ONLY    VESSELS    BOUND    FOR    THE    UNITED    STATES    OR    ITS 

DEPENDENCIES). 

1.  As  soon  as  it  has  been  determined  to  dispatch  a  vessel  to  a  United  States 
port  or  to  a  port  in  its  dependencies  this  office  should  be  immediately  notified. 

2.  Masters  of  vessels  de])arting  from  this  port  nmst  obtain  a  bill  of  health  in 
duplicate,  signed  by  the  medical  officer  of  the  LTnited  States  Public  Health  and 
Marine-Hospital  Service.  The  applicant  for  the  bill  of  health  must  be  able  to 
supply  the  following  data;  Name  of  vessel,  nationality,  rig,  name  of  master, 
tonnage  (gross),  tonnage  (net),  iron  or  wood,  number  of  compartments  for 
cargo,  compartments  for  crew,  compartments  for  steerage  passengers,  name 
of  medical  oflicer,  number  of  ship's  officers,  number  of  crew  (including  petty 
officers),  number  of  cabin  passengers,  numl)er  of  steerage  passengers,  number 
of  crew  or  passengers  landed  at  this  port,  number  of  crew  or  passengers 
embarked  at  this  port,  total  number  of  persons  on  board,  port  of  departure, 
where  last  from,  destination,  source  of  water  and  food  sui>t)lies,  number  of  cases 
of  sickness  and  character  of  same  during  last  voyage,  and  number  of  cases  of 
sickness  and  character  of  same  while  vessel  was  in  port.  Before  such  bill  of 
health  can  be  issued  the  following  rules  must  be  complied  with : 

3.  Before  loading  is  begun  vessels  will  be  subject  to  ins])ection,  and  upon  its 
completion  the  master  will  be  informed  as  to  wliat  sanitary  measures  arc 
deemed  necessary  and  the  ])robable  time  required  to  carry  them  into  effect. 

4.  As  early  as  possible  the  cargo  manifests  should  be  presented  at  this  office 
for  examination.  If  it  is  not  })racticable  to  present  manifest,  l)oat  notes  or 
bills  of  lading  should  be  i»resented  instead.  In  every  case,  before  cargo,  stores, 
or  other  articles  are  taken  aboard,  the  consent  of  this  office  should  first  be 
obtained ;  otherwise,  suspected  cargo  might  have  to  be  unloaded  and  the  vessel 
disinfected. 

r».  All  persons,  including  crew  and  passengers  and  their  effects,  taken  on  at 
this  port,  are  sul).ject  to  inspection  before  embarkation.  The  effects  of  cabin 
j>assengers  should  be  assembled  at  least  twelve  hours  prior  to  embarkation, 
those  of  the  crew  or  steerage  passengers  at  least  twenty-four  hours  previously. 
This  timely  inspection  is  necessary  in  order  that  there  may  be  no  delay  caused 
to  the  vessel  in  the  event  of  disinfection  being  deemed  necessary. 

<!.  All  baggage  and  other  goods  not  on  the  shijt's  manifest  must  be  labeled 
before  being  placed  on  board.  All  unlabled  baggage  found  on  hoard  at  the  time 
of  the  final  inspection  will  have  to  be  removed  from  the  vessel 

7.  After  the  final  inspection,  which  is  made  by  the  quarantine  officer  on  board, 
no  further  communication  with  shore  or  with  other  vessels  in  the  harbor  can  be 
allowed. 

Victor  G.  Heiser, 
Paxstpd  A.'i.sistant  .SV//y/coh, 
Chief  Qitarantiiic  Officer  for  the  PMUppine  Islands. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  173 


Quarantinable  diseases  in  Manila  during  fiscal  year  1904. 


"Wook 
ended— 


Cholera.     Smallpox.      Plague 


Week 
ended— 


1904. 
Jan.  'i... 
Jan.  9... 
Jan.  1().. 
Jan.  23.. 
Jan. ;«.. 
Feb.  6... 
Feb.  1:5. . 
Feb.  2(1. . 
Feb.  27. . 
Mar.  5 . . 
Mar.  12  . 
Mar.  19  . 
Mar.  2i)  _ 
Apr.  2... 
Apr.  9... 
Apr.  16.. 
Apr.  28. . 
Apr.  30.. 
May  7_.. 
May  14.. 
May  21.. 
May  28.. 
June  4 . . 
June  11 . 
June  18 . 
June  25  - 
June  30 o 


Cholera.     Smallpox. 


Total  .     561       497        81        34       101 


Plague. 


92 


"  To  and  including. 

Report  of  the  2Kitients  treated  in  the  hospital  at  the  Mariveles  quarantine  station 
during  the  fiscal  year  ended  June  30,  1904. 


Num- 
ber. 

Nationality. 

Result. 

Disease. 

Norwe- 
gians. 

Filipi- 
nos. 

Recov- 
ery. 

Death. 

Smallpox 

11 
2 
2 

1 
0 
0 

10 
2 
2 

10 
2 
2 

1 

Cholera  suspects 

Malarial  fever -. 

0 

0 

Total 

15 

1 

14 

14 

1 

Incoming  quarantine  transactions  at  the  port  of  Manila,  P.  I.,  for  the  fiscal  year 

ended  June  30,  1904. 


Month. 

Vessels  inspected 
from— 

Vessels 
in  quar- 
antine. 

Vessels 
disin- 
fected. 

Bills  of 
health 
issued. 

Pieces  of 
baggage 
disin- 
fected. 

Pieces 
inspect- 

Foreign 
ports. 

Domestic 
ports. 

ed  and 
passed. 

1903. 
July 

61 
70 
69 
69 
67 
59 

45 
49 
.58 
57 
58 
.55 

267 
263 

277 
280 
263 
249 

2.56 
270 
a56 
343 
314 
225 

4 
8 
5 
2 

39 
28 
3t 
34 
49 
18 

55 

22 
34 

:« 

49 
22 

309 
326 
341 
349 
316 
313 

295 
333 
422 

400 

:*9 
322 

5, 196 

4,276 
3,267 
3,718 
2,621 
2,463 

8.58 

252 

1,961 

2,S« 

4,688 

492 

1,734 

August - 

September 

October 

November 

December 

923 
746 
4a5 
324 
221 

1904. 
January 

122 

February  

March 

1 

.53 
219 

April... 

May 

June 

7 
3 

377 
20 

Total 

717 

3,363 

32 

422 

4,095 

32,131 

6,101 

174 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Incoming  quarantine  transactions  at  the  port  of  Manila,  P.  I.,  etc. — Continued. 


Month. 


Crew  in- 
spected. 


Passengers  in- 
spected. 


Persons  vacci- 
nated. 


Cabin. 


Steer- 
age. 


Crew. 


Passen- 
gers. 


Persons 

bathed 

and 


Persons 
quaran- 
tined 


1903. 


July 

August 

September- 
October  

November . 
December  . 


January 
February . 

March 

April 

May 

June 


19(4. 


11,110 
12,396 
11.889 
12,096 
11.484 
11,566 


10,029 
10,:340 
12.272 
12,651 
11,554 


Total. 


137,066 


1,690 
1,673 
1,495 
1,7.58 
1,682 
],8a5 


1,330 
1,212 
1,743 
1,709 
1,671 
1,6.38 


8,057 
6,881 
5,820 
6,484 
7,. 5.54 
6,883 


4,996 
5, 775 

7,720 
7,7»4 
6,721 
6,. 509 


19,495 


81,134 


215 
178 
1.467 
2,342 
1.291 
1.571 


1,367 
1,4.33 

1,268 

1,.306 

1,064 

943 


1,626 

1,079 

24 

195 


48 


14.445 


2,975 


3,295 
3,170 
1,906 
2,440 
2,850 
1,724 


747 
234 
872 
1,362 
719 
239 


19,560 


505 

1,.393 

196 

221 


295 
60 


2,8.39 


Outgoing  quarantine  transactio7is  at  the  port  of  Manila,  P.  I.,  for  the  fiscal  year 

ended  June  JO,  1904. 


Mouth. 


Vessels 

in- 
spected. 


Vessels 
in  quar- 
antine. 


Vessels 
disin- 
fected. 


Vessels 
remand- 
ed to 
Marive- 

t      les. 


Pieces 
baggage 
disin- 
fected. 


Pieces 


Crew 


in.spect- 
ed  and 
passed. 


Crew 

(outgo-  ,,„„_„,, 
ing)ln-  ,  ^l"f^|" 
spected.     """^^ 


1903 

July - 

August 

September 
October  ... 
November 
December . 

1904 
January . . . 
February  . 

March 

April 

May 

June 

Total 


32 


29  2 

8    

4    

5   

.5   

4    

1 

3   

2  i , 

4    


4,389 
4,414 
1.52 
1,433 
1,812 
2,386 


2.726 
3,746 
4,3:« 
3,059 
3,050 
2,464 


2.154 
2,1.53 

982 
1,4.30 
1,182 
2,274 


2,467 
2,952 
2,616 
3,641 
2,629 
3,807 


111 


23 


79 


33,966 


28,287 


1,415      124 

5.56 

493       M 

543  

507  

572  

i 

383  

330 

501  

368  

791  

423  


205 


Mouth. 

Passengers 
( outgoing ) 
inspected. 

Passengers  quar- 
antined. 

Pei-sons 
vacci- 
nated. 

Bathed 
and  cloth- 
ing disin- 

Cases quarantinable 
diseases  among  per- 
sons in  quai-autine. 

Cabin. 

Steer- 
age. 

fected. 

Lep- 
rosy. 

Small- 
pox. 

Chol- 
era. 

1903. 
July 

2.144 

210 

2. 475 

1 

1 

., 

August    2^  063 

923 

2.103  1 

September 1.333 

October  .     .                          1.121 

27 

1,2:» 

1,107 

867 

1,356 

1.263 
1.943 
1,6&5 
1,275 
1.092 
958 



1 

November                                998 

December...         .             1,338 

1 

1904. 
Januarv                               1,24^ 



i                 i 

March    '                                1  8->7 

1 1 "" 

1,229 
645 
990 

May 

Total 



16.776 

;i37                 923 

17,:^43 

1 

1                 2 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  175 

CEBU. 

Report  of  .l.s'.s/.  Siinj.  rnnoll  Fox. 

U.    S.    TUEASl'KY    DKPARTNrKNT, 

Public   Health   and   Makink-IIosimtai,   Seuvice. 

Office  of  the  U.  S.  Quarantine  Officer, 

dchu,  /'.  /..  Jidi/  I,  lOn.'i. 

Sir:  I  have  the  honor  to  make  the  followiii.t,'  bricl"  narrative  report  relative 
to  the  transactions  of  this  station  for  the  fiscal  y(>ar  en<le(l  .Tnne  ."!(),  11)04. 

On  account  of  the  s(>con(l  outhi'cak  of  cholera  in  this  i)ort  it  was  necessary  to 
start  the  year  witli  the  institution  of  an  outuoin^  (luarantine.  At  this  time  the 
nuuiher  of  cases  reported  reached  as  \u^h  as  22  a  day.  and  there  were  undoulit- 
edly  many  more  that  were  iievtM-  re])orted  at  all.  Tiie  method  of  (piarantine 
pursued  consisted  in  keepinj;  the  crews  ahoard  vessels  while  in  this  port  and  pro- 
hihiting  the  emharkation  of  steerage  passenjiers  uidess  they  underwent  the  neces- 
sary detention  prior  to  the  sailinj;  of  the  vessel.  The  vessel  di.schar^ed  and 
loaded  in  quarantine  undei-  uuard.  the  jruard  lieing  paid  \)y  the  owner  or  aijent  of 
the  vessel  and  emi)loyed  hy  us.  This  method  was  very  satisfactory  from  a 
quarantine  standpoint  and  did  not  interfere  with  the  shipping  as  does  the 
ordinary  fi\e-dny  (luarantine.  A  copy  of  the  circular  letter  sent  out  at  this 
time  is  inclosed. 

By  Aujrust  the  conditions  In  Cehu  having  greatly  improved,  and  cholera  heiug 
present  in  many  of  the  other  ports,  it  was  thought  advisahle  to  raise  the  ((uar- 
antine,  which  was  done  on  August  10,  1003.  The  cholera  then  steadily 
declined,  until  the  month  of  XoA'emher  there  was  hut  one  case,  and  there  has 
been  none  since  then. 

The  water  which  is  supplied  to  the  steam  and  larger  sailing  vessels  has 
fortunately  always  heen  free  from  contaniination.  It  is  taken  from  a  well  on  a 
coral  island  opposite  Cehu,  is  owned  hy  the  *'  Marino  Water  Company,''  and  is 
well  guarded.  If  this  water  had  ever  hecome  infected  with  the  cholera  germ 
there  would  have  heen  many  more  cases  of  cholera  on  the  local  steamers.  The 
hancas.  on  the  other  hand,  frequently  developed  cholera  after  heing  in  this  port  a 
week  or  more,  as  they  procure  their  water  from  the  shallow  wells  along  the 
water  front  of  Cehu.  These  wells,  by  reason  of  their  position  and  character, 
receive  the  drainage  from  a  large  part  of  the  city.  Cehu  has  no  sewage  sys- 
tem, much  of  the  effete  matter  being  deposited  upon  the  ground,  and  it  can  be 
readily  seen  how  these  shallow  wells,  dug  in  a  low,  porous  soil,  can  be  the 
means  of  spreading  disease. 

Smallpox  and  leprosy  have  been  present  here  during  the  year,  as  well  as  in 
other  parts  of  the  islands,  and  both  of  these  diseases  have  been  found  on 
incoming  vessels.  We  have  made  in  this  port  4,036  vaccinations,  all  but  a  few 
of  those  vaccinated  being  sailors  employed  on  the  local  boats.  This  should 
undoubtedly  greatly  lessen  the  chances  of  smallpox  being  conveyed  by  vessels. 

The  boats  which  give  the  most  trouI)le  in  this  port  and  which  have  been  and 
always  will  be  the  means  of  carrying  contagion  are  the  hancas,  or  paraos,  as 
they  are  called  elsewhere.  These  are  native  craft  of  from  under  1  ton  to  33 
tons  burden.  On  account  of  the  very  narrow  beam  they  are  all  built  with  out- 
riggers. They  carry  from  3  to  85  people,  including  crew  and  passengers,  and 
enter  port  at  times  as  high  as  25  a  day.  Few  of  them  are  in  good  hygienic 
condition,  and  any  perfect  control  of  them  is  very  difficult. 

In  July  a  case  of  plague  was  found  in  the  town  in  a  Filipino  boy.  This  boy 
Lad  not  been  away  from  Cehu  and  the  origin  of  the  case  could  not  be  traced, 
although  it  was  said  that  a  case  of  plague  had  occurred  in  the  same  house  a 
year  before.  There  have  been  all  told  this  year  20  cases  of  bubonic  plague, 
mostly  involving  the  femoral  glands,  although  there  have  been  a  few  cases  iu 
which  the  glands  at  the  angle  of  the  jaw  have  been  affected.  These  latter  have 
occurred  in  children.  The  disease  has  been  typical  clinically  and  since  receiv- 
ing the  microscope  have  been  able  to  demonstrate  the  bacillus  pestis  in  smears 
from  the  glands. 

In  looking  over  the  records  of  the  station  it  will  be  seen  that  my  predecessor, 
Passed  Assistant  Surgeon  Stansfield.  saw  and  reported  five  cases  of  plague,  in 
none  of  which  was  the  origin  determined.  This  is  also  true  of  the  cases 
reported  during  the  last  year.  From  the  facts  that  all  of  those  infected  had 
been  residing  iu  Cebu  for  some  time  previous  to  the  development  of  plague, 
that  no  origin  could  be  traced  in  any  case,  and  that  they  appeared  at  such 


176  rUHLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

irroKular  and  loiiRtliy  intorvuls  in  different  parts  of  tlie  city,  it  is  probable  tliat 
phif^ue  lias  been  here  for  some  time  and  is  only  awaiting  the  proper  conditions 
to  become  epidemic. 

No  plagne  was  found  on  any  vessel  arriving  at  tliis  port  during  tl»(>  year, 
and  to  guard  against  the  exportation  of  the  disease  ))y  infected  rats  all  of  the 
vessels  hailing  from  tliis  i)ort  liave  l)een  fumigated  with  sulphur  twice,  and  this 
fumigation  will  l)e  done  again  twice  during  the  coming  year.  There  has  been 
no  noticeal)le  increased  mortality  among  rats  in  Celju. 

After  constant  scolding  and  threatening  tlie  cajitains  are  at  last  taking  an 
interest  in  keei)ing  their  vessels  clean,  and  witli  the  end  of  the  year  there  has 
been  a  great  improvement  in  the  sanitary  condition  of  the  coastwise  boats. 

On  November  7,  IDO.'i,  a  board  com])osed  of  Passed  Asst.  Surg.  V.  G.  Ileiser, 
chairman  ;  Asst.  Surg.  Carroll  Fox,  and  Asst.  Surg.  J.  D.  Long,  recorder,  met 
to  select  a  suitable  site  for  a  quarantine  station  at  this  port.  The  first  choice 
was  a  small  island  in  Cebu  Ilarljor  known  as  Cauit  Island;  the  second  choice 
a  piece  of  land  on  Mactan  Island,  op])osite  Cebu,  and  the  third  choice  some  land 
situated  near  the  second  choice.  Cauit  Island  is  Ijy  far  the  best  of  the  three, 
as  there  is  a  small  harbor  well  pi-otected  from  the  strong  winds,  plenty  of 
water  can  be  gotten  clyse  to  the  shore  so  that  only  a  small  wharf  need  be 
built,  and  there  is  good  holding  ground.  At  present  there  is  no  fresh  water 
on  the  island,  but  this  difficulty  can  be  overcome  by  a  deep  well,  by  a  distilling 
ai)pai-atus,  by  collecting  rain  water,  or  some  other  means.  This  island  was 
claimed  by  another  party  and  the  case  was  taken  to  court  and  decided  in  favor 
of  the  Government.  It  was  then  appealed  to  the  next  higher  court  and  is  now 
awaiting  trial. 

During  tl)e  year  there  were  only   19  immigrants  exanrined,  none  of  which 
were  certified  for  deportation.     Nearly  all  of  the  immigrants  coming  to  this 
port  enter  by  way  of  Manila  and  undergo  the  medical  inspection  there. 
Respectfully, 

Carroll  Fox,  Affsifftant  Surgeon. 

The  Chief   Quarantine   Officer  for  the   Philippine   Islands. 

( Inclosure — Circular    Letter. ) 

Office  of  the  Unitki)  States  Quarantine  Officer, 

I'L'i'.Lic  Health  and  Marine-Hospital  Service, 

Cebu,  P.  I.,  June  26,  1903. 

To  steamshii)  companies,  ouriicrs  and  agetits  of  vessels,  and  otherss 

On  account  of  the  prevalence  of  cholera  in  this  port  it  has  become  necessary 
to  impose  certain  restrictions  on  outgoing  vessels  so  that  the  exportation  of 
cholera  will  be  jirevented. 

In  order  that  the  shipping  will  be  interfered  with  as  little  as  possible  the  fol- 
lowing regulations  have  been  pronmlgated : 

1.  Crews  of  vessels  while  in  this  port  must  remain  aboard  and  will  not  be 
allowed  to  have  any  communication  with  the  shore.  The  captain  only  will  be 
permitted  to  leave  the  vessel  to  attend  to  necessary  business. 

2.  Steerage  passengers  nuist  remain  in  quarantine  a  sufficient  length  of  time 
to  make  five  days  upon  arriving  at  destination.  If  detention  is  not  possible 
they  will  not  be  allowed  to  embark. 

3*.  The  above  paragraph  also  applies  to  members  of  the  crew  shipped  at  this 
port. 

4.  Bills  of  health  will  be  issued  in  the  bay  just  before  the  departure  of  the 
vessel. 

These  regulations  will  go  into  effect  on  and  after  July  1,  1903,  by  direction 
of  the  chief  quarantine  ofiicer  of  the  Philippines. 

Respectfully,  Carroll  Fox, 

Assistant  Hiirf/eon,  J'lihlic  Health  and 
Marine-Hosiiitai  Service,  Quarantine  Officer. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SEKVICE. 


177 


IncomhKj  qitarduthu'  transactions  at  the  port  of  Cebii,  P.  I.,  for  tin-  Jisntl  ijear 

ended  June  SO,  1904. 


Month. 


Vessels   in- 
I      spected 
!      from— 


1903. 
July 

Auj^ust 

September 

October 

November. 
December  . 

19(M. 
January . . . 
February . . 

March 

April 

May 

June 

Total 


u  o 

O  P< 


O  Pi 


343 
345 
319 
311 
286 
352 


506 

622 
438 
414 
364 


4,832 


.„.j-, 
to  a 


""s 

4 

1 

2 

1 

""2 

"T 

2 

15 

14 

2 

18 


1,708 


(U^ 

162 

161 

1!»4 

63 

i;r> 

165 

36 

125 

140 

132 

134 

148 

29 

129 

17 

115 

129 

306 


5, 845 

6,ih;9 

5,034 
5, 121 

4,588 
5,256 


5,69!i 
6,2:^6 
7,243 
5,568 
5,405 
4,789 


66,846 


PasHonKers 
iu.spectod. 


160 
147 
la") 
157 
174 
223 


282 
211 
315 

266 
288 
255 


2,613 


1,511 
I.CkJC) 
1,443 
1,431 
1,527 
1,576 


2,728 
2,296 
7,243 
1,970 
1,907 
1,894 


27,162 


9=a 


KK) 
16 


190 


^  9  a  5  o-  S 

n.  rj 


109 
16 


306 


822 
203 
406 


403 
781 
698 
280 
148 
223 


4,036 


Outgoing  quarantine  transactions  at  the  port  of  Cebu,  P.  I.,  for  the  fiscal  year 

ended  June  SO,  1904- 


& 
s 

ID 

t 

_,  ® 
fie 

> 

1 
fl 

IS 

<D 
SB    ■ 

1- 
.Q  0 

o.S 

CO 

0 

<D 

.St3 
be  CO 

MP. 

0)0 

.s 

fi 

^» 

^& 

m 

0 

-d 

01 

fl 

i 

a 

m 

(B 
(I 
0 

0 

■3  © 

is 

ia 
1 

Passen- 
gers quar- 
antined. 

i 
a 

to 

fl 

A® 

CS+j 

^« 
.CO 

fl.S 
P40 

fl 
0 

Month. 

d 

OS 
0 

1 

9-1   P 

0  t» 

CO 

a 

1903. 
July 

316 
41 

158 
41 

2 

57 

40 

16 

127 

5,043 
856 

1,068 
384 

1,154 
383 

42 

477 
116 

43 
45 

3 

August. 

September 

1 

1 

1904. 
January 

February 

1 

May 

June 

[  ■ 

1 

Total. . . 

357 

199 

2 

97 

143 

5,899 

1,452 

1,537 

43 

593 

88 

3 

ILOILO. 
[Report  of  Asst.  Surg.  G.  W.  McCoy.] 

U.  S.  Treasury  Department, 
Public  Health  and  Marine-Hospital  Service, 

Office  of  the  U.  S.  Quarantine  Officer, 

Iloilo,  P.  I.,  July  1,  190Jf. 
Sir:  I  have  the  honor  to  render  the  followhig  report  of  quarantine  transac- 
tions at  this  port  for  tlie  year  ending  June  30,  1904 : 
The  station  was  in  charge  of  Asst.  Surg.  M.  K.  Gwyn  until  August  3,  1903. 


8629—04- 


-12 


178  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

From  Septonihor  i:'.  to  (Jctubor  2:i,  lltOH,  it  was  in  charge  of  Asst.  Surg.  J.  W. 
Amesse.  During  the  remainder  of  the  year  it  has  l»een  in  charge  of  Asst. 
Surg.  G.  W.  McCoy. 

A  number  of  vessels  arrived  with  cholera  and  snialli)ox  on  board  and  have 
in  all  cases  been  treated  as  nearly  in  accordance  with  the  regulations  as  our 
facilities  would  permit. 

One  vessel  arrived  with  a  case  of  leprosy.  As  the  victim  was  a  native  of 
Iloilo,  the  case  was  tui'ned  over  to  the  local  board  of  health.  The  vessel  was 
disinfe<-ted  i)y  this  Service. 

A  numlter  of  vessels  have  been  held  from  a  few  hours  to  a  day  for  the  pur- 
pose of  making  a  diagnosis  in  cases  that  presented  a  doubtful  eruption  or  fever, 
the  cause  of  which  was  not  at  once  apparent. 

Crews  of  all  inteiisland  vessels  coming  here  have  been  vaccinated  from  time 
to  time. 

At  intervals  of  a  few  months  local  vessels  have  been  fumigated  for  the  pur- 
pose of  destroying  vermin.  Foreign  vessels  have  been  fumigated  whenever 
they  were  empty.  Experience  has  taught  us  that  it  is  almost  a  waste  of  time 
to  fumigate  a  vessel  with  cargo. 

The  only  class  of  vessels  with  which  we  have  had  any  difficulty  are  the  small 
boats  known  as  "  bancas  "  and  '"  paraos."  They  sometimes  enter  the  port  at 
night,  crews  going  ashore,  claiming  ignorance  of  quarantine  regulations.  They 
are  then  required  to  collect  their  crews,  proceed  to  the  bay,  and  await  inspec 
tion,  but  one  can  not  be  certain  that  he  is  seeing  the  people  who  arrived  on  the 
vessel. 

During  the  year  cholera  is  the  only  quarantinable  disease,  aside  from  lepi'osy, 
that  has  prevailed  at  this  port.  The  first  cases  were  reported  in  July  and  the 
last  cases  in  Fel>ruary.  Accurate  figures  were  dittlcult  to  oljtain,  but  at  no 
time  did  the  death  rate  exceed  20  per  day.  Practically  no  measures  were  taken 
to  limit  its  spread,  and  it  simply  died  out  by  the  operation  of  natural  causes. 
It  was  rather  discouraging,  at  a  time  when  we  were  holding  infected  vessels  in 
strict  (luaraiitine.  to  know  that  the  cases  were  occurring  in  the  city  and  not  even 
the  sinijilest  precautions  taken  to  prevent  the  spread  of  the  disease.  Indeed,  on 
one  occasion  the  office  messenger  asked  for  half  a  day's  leave  of  absence  to 
attend  the  funeral  of  his  father  and  mother,  who  had,  he  said,  died  the  previous 
night  of  cholei-a.  Investigation  showed  that  he  had  given  a  truthful  reason  for 
making  the  reiiuest.  While  the  cholera  prevailed  in  the  port  a  rigid  outgoing 
inspection  was  maintained. 

During  the  prevalence  of  cholera  on  the  island  of  Xegros,  vessels  coming 
from  there  were  inspected  even  though  they  were  but  two  or  three  hours  on 
the  voyage. 

The  inclosed  circular  letter  shows  what  special  precautions  have  been  taken 
in  dealing  with  vessels  from  plague-infected  ports  while  they  were  in  port. 

There  have  been  a  number  of  violations  of  (juarantine  regulations.  They 
have  usually  been  punished  by  a  fine  imposed  by  the  collector  of  customs. 

Arriving  aliens  have  been  inspected  for  inniiigration  purposes.  There  have 
been  several  rejections  for  trachoma  and  conditions  rendering  persons  liable 
to  become  public  charges.  It  is  to  be  regretted  that  there  are  no  hospital 
facilities  where  doubtful  cases  can  be  placed  for  observation. 

Throughout  the  year  cordial  relations  have  been  maintained  with  both  the 
civil  and  military  authorities,  and  shipping  people  have  very  generally  willingly 
complied  with  all  regulations. 

Respectfully,  George  W.  McCoy, 

Assistant  Surgeon. 

The  Chief  Quarantine  Officer  for  the  Philippine  Islands. 

[Inclosure — Circular  letter.] 

begulations  governing  vessels  from  plague  ports. 

Office  of  the  U.  S.  Quarantine  Officer, 

Iloilo.  P.  I..  May  Id,  WO/,. 
Owners  and  af/ents  of  vessels,  Iloilo,  P.  I. 

Sirs:  Tn  future  all  vessels  from  ports  infected  or  sus])ected  of  being  infected 
with  plague  will  be  reciuired  to  have  all  lines  and  cables  connecting  the  vessels 
and  the  shore  guarded  by  rat  funnels  while  moored  in  the  Iloilo  River. 


PUBLIC    HKAI/rn     .\MD    MARINK-IIOSPITAL    SERVICE. 


17«> 


This  iticliides  vessels  from  itracticMlly  all  loreiKii  ports  juid  Manila  and  ("elm 
in  tilt'  lMiiliii]iin«'s. 

IU't\v(>on  suns»'t  and  siuiriso  all  planks  to  the  shore  shall  he  taken  ui)  and 
lif,'hters  or  other  vessels  will  not  he  peniiitled  to  remain  alonj^sido  tlie  vessels 
al)ove  indieate<l  at  nifj;ht. 

\'essels  failinj:  to  eomply  with  these  re,i,'nlalions  will  not  he  jiermittiMl  to 
remain  in  the  river. 

Respect lully,  <ji:ok(;k  \V.   MeCov. 

Assistant  Suri/ron,  1'.  II.  aiid  M.  If.  S., 

Qua  rail  tine  O/Jiccr. 
Copy  furnished, — ,  lloilo.  1*.  I. 

Iiu'oviing  quarantine  transact io)is  at  the  port  of  lloilo,  /'.  I.,  for  the  fiscal  year 

ended  June  JO,  1004. 


Vessels 
fro 

Foreign 
ports. 

mspected 
m^         • 

Vessels 

Vessels 
disin- 
fected. 

Bills 

of  health 

issued. 

Pieces  baggage— 

Month. 

Domestic 
ports. 

in  quar- 
antine. 

Di.sin- 
fected. 

Inspect- 
ed and 
passed. 

190;^. 
July 

9 

12 
5 
3 
6 

1 

6 
6 
12 

53 

3 
4 

201 
327 
220 

2m 

280 

301 
308 
460 
442 
278 
129 

15 

78 

August - 

213  1              3 

September 

222 

October 

2.56 
218 
279 

206 

1 

1 

November 

December 

I'.HU. 
January _.. 

1 

1 
3 

8 
9 
3 

February 

2()1                 1 
222    

191                 1 

1S4                 2 
134                  2 

March- 

April 

May 

June 

Total 

82 

2,3T9 

11 

36 

3,476 

93 

Month. 


Passengers  in-  ^             I 

I          spected.  Persons      Persons    i  Crew  and 

Crewsin- "  held  in   bathed  andjpassengers 

spected.  ~.     .     ,. 


Cabin. 


«toc      quaran-   effects  dis 
age  *™®-        infected. 


vacci- 
nated. 


July 

August 

September 
October  . . . 
November. 
December . 


1903. 


January . . . 
February.. 

March 

April 

May 

June 

Total 


1904. 


2,597 
4,690 
4,544 
4,376 
4,717 
4,645 


3,760 
4,051 
4,654 
4,273 
3,916 
3,122 

49,345 


320 
263 
275 
256 
388 
335 


422 
315 
447 
480 
361 
249 

4,111 


1,157 
1.817 
2,614 
2,a50 
1,981 
1,636 


1,564 
1,526 
1,626 
1,455 
1,327 
1,159 

19,912 


54 


.54 


38 


22 
178 


38 

""9" 

9 

22 

135 


217 
520 

508 


490 
495 
380 
234 
254 


3,a58 


180 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Oiityniiig  quarantine  transactions  at  the  port  of  Iloilo,  P.  I.,  for  the  fiscal  year 

ended  June  30,  ID04. 


Month. 

Vessels     Vessels 

in-         in  quar- 

spected.    antine. 

Vessels 
disin- 
fected. 

Pieces 
baggage 
disin- 
fected. 

Crew 
(outgo- 
ing) in- 
spected. 

Passen- 
gers 
(outgo- 
ing) m- 
spected. 

Persons 
bathed  and 
clothing 
disin- 
fected. 

190:j. 
July 

August 

SeiJtember .... 

223                 H 

3 

64 
6 

2,455 
3,261 
1,625 

1,666 
2,537 
1,049 

'.i' 

October 

228 
235 

November 

December 

19<J4. 
January  

February 

March _ 

April 

May.. 

• 

June 

Total 

686 

3 

3 

70 

7,341 

5,252 

32 

JOLO. 

[Report  of  Asst.  Surg.  M.  K.  Gwyn.] 

United  States  Treasiry  Department, 
Public  Health  and  Marine-Hospital  Service, 

Office  of  the  U.  S.  Quarantine  Officer, 

Jolo,  P.  I.,  July  7,  1904. 

Sir  :  I  have  the  honor  to  transmit  herewitli  the  annual  report  of  the  quaran- 
tine transactions  at  the  port  of  Jolo,  P.  I.,  for  the  fiscal  year  ending  June  30, 
1904.     The  tabulated  statistical  report  will  be  found  elsewhere. 

Jolo  has  been  maintained  as  an  inspection  station  by  the  Service  since  May 
20,  1903,  after  a  comparison  of  the  relative  merits  of  it  and  Zamboauga  in  a 
report  made  by  Assistant  Surgeon  Amesse  to  the  chief  quarantine  officer.  Pre- 
vious to  this  time  the  quarantine  work  was  conducted  by  the  military  authorities. 

For  the  purpose  of  boarding,  a  rowboat  and  two  attendants  are  employed  at  a 
cost  of  $20  per  month  United  States  currency.  There  are  no  facilities  for  the 
handling  of  infected  vessels.  Should  such  an  emergency  arise  it  would  be 
necessary  to  remand  the  vessel  to  Iloilo  or  Cebu,  about  thirty  hours'  steaming 
from  Jolo.     So  far  the  necessity  has  never  arisen. 

The  average  number  of  vessels  insjiected  per  month  is  about  25.  Of  these 
there  are  three  regular  steamers  from  Singapore  via  British  North  Borneo 
ports.  The  other  vessels  are  all  interisland  vessels,  a  number  being  small 
native  boats  of  the  type  known  as  "  sampans,"  and  a  few  pearlers. 

One  of  the  principal  sources  of  dangin-  to  the  southern  Philipppines  is  from 
the  native  boats  trading  between  the  Borneo  coast  and  the  adjacent  Islands  of 
the  Sulu  Archipelago.  The  earliest  recorded  invasion  of  cholera  came  through 
the  island  of  Tawi  Tawi  into  the  Philii)pine  Islands.  At  present  no  sanitary 
suijervision  can  be  exercised  over  these  vessels,  as  they  rarely  come  to  Jolo;  to 
do  so  they  would  have  to  make  a  journey  of  several  hundred  miles,  which 
naturally  they  do  not  do  unless  there  is  some  i)ressing  necessity. 

As  a  result  of  ten  months"  observation  and  service  at  this  iiort,  I  would  rec- 
ommend that  an.  acting  assistant  be  appointed  to  take  charge  of  the  station, 
to  be  paid  a  suitable  fee,  say  $5  per  vessel,  and  that  the  quarantine  work  be 
confined  to  the  foreign  ships.  This  \Aould  make  the  running  expenses  about  $30 
per  month.  Arrangements  can  be  made  to  have  one  of  the  army  surgeons  on 
duty  at  Jolo  do  this  work  at  the  rate  named.  It  would  also  be  wise  to  have  a 
similar  arrangement  made  at  the  port  of  Zamboanga.  This  would  give  the 
Service  control  of  all  the  ports  of  entry  in  the  IMiilippines. 

Systematic  vaccination  of  the  crews  of  all  vessels  touching  at  this  port  have 
been  carried   on   for   several   months   with   good   results.     No   difficulties   have 
been  met  with  in  vaccinating  natives,  as  they  look  on  it  as  a  matter  of  course. 
Whether  they  ai)preciate  the  ))en('fit  they  derive  from  it  I  do  not  know. 
Respectfully, 

M.  K.  Gwyn,  Assistant  Surgeon. 

The  Chief  Quarantine  Officer  for  the  Piiilippin'e  Islands. 


I'TMUJC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


181 


liK'oiiiiiKj  <iiiiir<iiiliiif  fniiisdctions  at  ihv  port  of  Join,  /'.  /..  I'm- I  In-  lisro/  i/tur 

elided  ,/iiiir  .iU,  r.io.',. 


Month. 

Vossols  insiMM'tcd 
from 

Vessels 
disin- 
fe(-tecl. 

Bills  of 
health 
issued. 

Crew  in- 
spected. 

PasH«mjjerH  in- 
spected. 

Crow 

and  pas- 

Foreign 
ports. 

Domestic 
ports. 

Cabin. 

Steer- 
age. 

vac- 
cinated. 

1903. 
,Tulv 

3 

7 
2 
2 
1 
5 

4 
3 
5 

1 
2 
1 

32 
42 
19 

18 
28 
14 

23 
20 
38 
40 
24 
42 

1 

:«) 
32 
13 
19 
16 
13 

14 
15 
24 
20 
26 
37 

1,057 
1,.574 

758 
1,019 
1,176 

834 

1,080 
1,214 
1,232 
1,021 
1,225 
843 

(S8 
1(K) 
134 

8t! 

177 
148 
1.58 

ia5 

147 
104 

479 
1,.520 

125) 

679 
1,X» 

2i)3 

•my 

2KJ 

2:^1 

437 
456 

Septeinbor 

October 

December 

1904. 
January 

50 

February  

March 

106 
23 

April  .     ...        ..  . 

241 

May 

June 

Total 

36 

346 

1 

265 

13,033 

1,539 

6,614 

420 

FINANCIAL      STxVTEMENT,     QUARANTINE      SERVICE     IN     THE      PIIIMI'I'INE 
ISLANDS    (united    STATES    CURRENCY). 

I. — General  aiiprojiriatioii  account,  iii><ii1ar  treasurer,  fiscal  year  lUO). 

Debits. 

To  appropi'iatlon,  act  807,  quarantine  service .$42,800.00 

To  appropriation,  act  1010,  quarantine  service 2, 140.  00 

To  appropriation,  act  1040,  quarantine  service .S3,  87.'j.  00 

To  appropriation,  act  1188,  quarantine  service 5,000.00 

Total   83,  815.  00 

Credits. 

By  withdrawals  by  disbursing  officer 58,290.00 

By  amount  expended  l)y  auditor,  claim  J.  W.  Amesse 301.  .33 

By  amount  credited  insular  purchasing  agent 15,008.07 

By  balance  unwitlidrawn 14,  225.  (»0 

Total 1 83,  815.  00 

II. — Statement  of  fiinilN  (<1ix1)iirsiii(/  officer),  a  ii  pro  lariat  ions  of  fi.'<eal  year  1903. 

Debits. 
1903. 

Oct.    10.  Received  from  treasurer,  A.  W.  3974 1 $3,-370.000 

Nov.     7.  Refund  to  expenditures 8.095 

1904. 
June  11.  Received  from  treasurer,  A.  W.  .5014 41.815 

Total 3,  419.  910 

Credits. 
1903. 
Nov.     7.  Refund  to  treasurer,  receipt  3327 8.095 

1904. 
June  30.  Balance  to  be  accounted  for  by  disbursements 3,411.815 

Total 3,  419.  910 


182  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

III. — statement  of  funds  ((lit<l>iir-'<iii!/  o/ficer),  approiuidtions  of  fiscal  year  19U4 
{United  Htdtes  curreiwy). 

Debits. 
1903. 

July  31.  Received  from  treasurer,  A.  W.  3598 $0,000.00 

Aug.  12.  liefuuds    to    expenditures 48.00 

Aug.  20.  Received  from  treasurer,  A.  W.  3718 1  4,000.00 

Sept.    7.  Refunds  to  expenditures 09.  HO 

Sept.  30.  Received  from  treasurer,  A.  W.  3888 3,000.00 

Oct.    12.  Refunds    to    expenditures (;r>.  r>0 

Oct.    20.  Received  from  treasurer,  A.  \V.  4002 (J,  000.  00 

Oct.    2().  Refunds    to    expenditures 3.5.50 

Nov.  25.  Refunds    to    expenditures 39.50 

Nov.  20.  Received  from  treasurer,  A.  W.  41.59 3,000.00 

Dec.   11.  Received  from  treasurer,  A.  W.  4212 2,140.00 

Dec.   12.  Refunds    to    expenditures ^__  51.50 

Dec.   18.  Received  from  treasurer,  A.  W.  4256 2,750.00 

1904. 

Jan.     9.  Refunds    to    expenditures i GO.  00 

Feb.   11.  Received  from  treasurer,  A.  W.  4489 3,750.00 

Feb.   25.  Received  from  treasurer,  A.  W.  4.501 4,  .500.  00 

I'eb.    2.5.  Refunds  to  expend!  tiH'es 25.00 

Mar.  25.  Iteceived  from  treasurer,  A.  W.  4704 4,000.00 

Mar.  28.  Refunds    to    expenditures 45.00 

Apr.     2.  Refunds    to    expenditures 44.00 

Apr.   28.  Received  from  treasurer,  A.  W.  4840 4,  .500.  00 

May     3.  Refunds    to    expenditures 32.50 

May   13.  Received  from  treasurer.  A.  W.  4897 5,000.00 

June  10.  Refunds    to    expenditures 34.50 

June  27.  Received  from  treasurer,  A.  W.  5088 4,050.00 

Total 5.3,  830.  .50 

Credits. 
1903. 

Aug.  12.  Refimd  to  treasurer,  receipt  1178 $48,000 

1904. 

June  30.  Cash  balance  on  band  June  .30,  1904 2,9.37.815 

June  30.  Balance  to  be  accounted  for  by  disbursements 50,844.085 

Total 53,  830.  500 

IV.— Special  apiiroin-iation,  act  831,  Aiif/iist  12,  1903. 

Cebu  Quarantine   Station , .$.30,000,000 

Launch  4,  000.  000 

Total 34,  000.  000 

Balance  on  hand  June  30,  1904 34,000.000 

Statement  of  funds  to  he  accounted  for  hv  expenditures  during  the  period  from 
July  1,  1903,  to  June  30,  190.',. 

Disburseiuents  by  disbursing  officer,  funds  fiscal  year  1903 .$3,411,815 

Disbursements  by  disbursing  officer,  funds  fiscal  year  1904 50,844.085 

Disbursements  bv  auditor,  commutation  of  quarters,  funds  fiscal 

year  1904 "_ 301.  330 

Insular  purchasing  agent,  supplies,  funds  fiscal  year  1904 1.5,998.070 

Total 70,  555.  900 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    HERVICK.  183 

/•I.rpriKlitiircs. 

July,   mVA: 

('KiiiIH'iisntion  of  iktsohiu'I $•_',  SIC. 'J'jn 

OHkt  iiiid  i,'('iK>niI  S('i-vic(>  ('xpciisos 44.  r»(K) 

Sfiitioii  supplies  .•111(1  (lisiiilVM't.-nits .'W.  20() 

Aii.i,Mist.  1  !>().•',:  .f;-.s.  !.»..>-.. 

('(Hiipi'usation  of  pcrsomuM 'J,  .'{I.l.  KiO 

Ollicc  iiiid  uciuM-iil  Service  expenses H~>. '_'()() 

liMiiiicli  Mild  li:iit,'e  expenses,  supplies,  and  repairs 121).  4l2."i 

StMtlon  sui>i)lies  and  disinfectants ;i77.  KiO 

September.  liXW:  12,  s:',(j.  <Mr, 

Compensation  of  personnel 3,404.  8ir> 

Ollice  and  f^eneral  Service  exi)enses 2.s;{.  540 

Launch  and  bai'i^e  expenses,  supplies,  and  repairs 1,  104.080 

Station  supplies  and  disinfectants 1,  !):'>4.  0.*{0 

Itepairs  to  buildings  and  wharves 104.  ~()~> 

October,  1903:  r,0S0.170 

Compensation  of  personnel 3,003.020 

Office  and  general  Service  expenses IHS.  (570 

Launch  and  barge  expenses.  sui)])lies,  and  repairs 050.505 

Station  sui)plies  and  disinfectants 423.870 

Repairs  to  buildings  and  whai'ves 2,  050.  000 

New  construction  and  new  e<iuipment 20.  500 

November.  1903 :  7,277.105 

Compensation  of  personnel 3,099.580 

Office  and  general  Service  expen.ses 5.50.  105 

Launch  and  barge  exjienses,  supplies,  and  repairs 78.  .500 

Station  supplies  and  disinfectants 340.  7()5 

December,  1903:  4,07.5.010 

Compens.ation  of  personnel 3,078.890 

Office  and  genei'al  Service  expenses 2,7.55.235 

Launch  and  barge  expenses,  supplies,  and  repairs 1,  .531.  315 

Station  supplies  and  disinfectants 1,708.045 

Repairs  to  buildings  and  wharves (!.  KJO 

New  construction  and  new  equipment 543.510 

January,  1904:  9,683.155 

Compensation  of  personnel 23.000 

Office  and  general  Service  expenses 80.000 

Launch  and  barge  expenses,  supplies,  and  repairs 7.  135 

Station  supplies  and  disinfectants 380.320 

February,  1904:  ^96. 455 

Compensation  of  personnel 5,955.525 

Office  and  general  Service  expenses 1, 1.37.270 

Launch  and  barge  expenses,  supplies,  and  repairs 70. 190 

Station  supplies  and  disinfectants 4.3.3.  .300 

New  construction  and  new  equipment 154.  000 

March,  1904  :  '^'  ''^'^-  -^^' 

Compensation  of  personnel 3,172.095 

Office  and  general  Service  expenses 846.425 

Launch  and  barge  expenses,  supplies,  and  repairs 970.420 

Station  supplies  and  disinfectants 1, 162.  315 

Repairs  to  buildings  and  wharves 797.  550 

New  construction  and  new  equipment 346.  060 

A      -1    -.HA.  7,294.865 

April,  1904 : 

Comi)ensation  of  personnel 2,  87.3.  375 

Office  and  general  Service  expenses 6.37.035 

Launch  and  barge  exi>euses,  supjdies,  and  repairs —  726.000 

Station  supplies  and  disinfectants 2,040.225 

New  construction  and  new  equipment 463.  730 

6,  740.  365 


184  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

May.  1904: 

Compensation  of  personnel 3,242.765 

Office  and  general  Service  exi)enses 1,  1.36.915 

Launch  and  Itarge  expenses,  supplies,  and  repairs 620.  295 

Station  sui)plies  and  disinfectants 200.  795 

Repairs  to  buildings  and  wharves 150.  000 

New  construction  and  new  equipment 2.58.  745                          < 

5, 609. 515     i 

June,  1904: 

Com])ensation  of  personnel .3,  101.  680 

Office  and  general  Service  expenses 78.3.  770 

Launch  and  barge  expenses,  supplies,  and  repairs 1,  146.  2.55 

Station  supplies  and  disinfectants .3,648.465 

Repairs  to  buildings  and  wharves 144.  985 

New  construction  and  new  equipment 86.  890 

8,  912.  045 

Total 70,5.55.900 

Total  expenditures  quarantine  service  in  the  Philippine  Islands,  July  1,  1903. 

to  June  30,  190/f. 

DETAILS. 

Compensation  of  personnel $36,170.73 

Office  and  general  service  expenses 8,498.725 

Launch  and  barge  supplies  and  repairs 7,033.12 

Station  supplies  and  disinfectants 12,760.49 

Repairs  to  buildings  and  wharves 4,21.3.40 

New  construction  and  new  equipment 1,87.3.4.35 

Total  (United  States  currency) ,     70,555.90 

Expenditures  hii  station. 
Manila : 

General  service  expenses 116,6.30.770 

Launch  expenses 5,  ()92.  470 

New  station  equipment 36.3.  295 

22,  686.  535 

Mariveles : 

General  service  expenses  and  supplies 22,0.30.330 

Repairs  to  buildings  and  wharves 4,21.3.400 

New  construction  and  new  equipment 982.  .555 

27,  226.  285 

Iloilo : 

General  service  expenses 3,318.830 

Launch  and  barge  expenses 4,892.255 

New  station  equipment 72.  .3.35 

8,  283. 420 

Cebu : 

General  service  expenses 4,506.120 

Launeli  and  l)arge  expenses 4,298.470 

New  station  e(iuipment 328.415  ' 

9,  133. 005     i 

Jolo : 

General  service  expenses 2,840.380 

Boat  expenses   2.59.440 

New  station  equipment 126.835 

3,  226.  655 

Total  (United  States  currency) 70,555.900 

Respectfully  submitted. 

Victor  G.  Heiser, 
Passed  Assistant  Surgeon, 
Chief  Quarantine  Officer  for  the  Philijjpine  Islands. 
The  Surgeon-General. 


l'liJ?LI("    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  iSf) 

YOKOHAMA. 
UkIMIKT    I!Y    ASST.    SUK<!.    DUNLOI*    !M(»()KK. 

ruiii.u'  Health  and  Marine-IIosimtal  Servtce, 

(^I'FK'E  OK  THE  Medical  Okkueii  ln  Command, 

V(i]c()h(tinu,  ./aiKiii,  Jiily  U,  lOOf/. 

Silt :  I  have  tlio  honor  to  Iransuiit  liovowilh  a  statistical  report  of  IransactionB 
at  this  station  diirinj:  tlio  year  ending  .luly  ;5tl,  1!K)4. 

A  nioro  detailed  report  is  in  pr(>paratioiL  hut  it  can  not  he  satisfactorily  coni- 
pleted  prior  to  the  dei)arture  of  the  writer  for  Manila.  It  is  proposed  to  inclnde 
therein  some  account  of  the  peculiar  .laj)anese  disease  known  as  "  shinia  nuishi  " 
or  "  tsutsufja  mushi,"  a  malady  which  possesses  special  interest  owins  to  the 
strikinjj:  points  of  analojry  hetween  it  and  the  spotted  fever  of  the  Rocky  Moun- 
tains, as  described  by  Anderson  in  Ilyjxienic  Laboratory  Bulletin  Xo.  11.  For 
instance,  it  is  conlined  to  the  banks  of  a  few  rivers  in  western  .Japan  ;  the 
syniptoniatolo.i,'y  is  somewhat  similar,  it  beins;  characterized  by  a  cutaneous  rash 
and  considerable  mortality:  a  haMiiatozoon  has  been  described  as  occnrrini:  in 
the  erythrocytes  of  infected  individuals;  the  infection  is  apparently  conveyed 
by  the  bite  of  an  insect. 

Number  of  l)ills  of  health  issued:  To  sailing  vessels,  20;  to  steamers,  210; 
total,  230. 

Destination  of  sailing  vessels  :  Guam,  11  ;  Tuget  Sound,  4 ;  New  York,  2  ;  San 
Francisco.  1 ;  Manila.  1  :  Dutch  HarI)or,  1. 

Destination  of  steamers  :  I'uget  Sound,  57 ;  San  Francisco,  49 ;  Manila,  48 ; 
New  York,  ?>r> ;  Portland.  Greg.,  i;^ ;  Honolulu,  0 ;  IjOs  Angeles,  1 ;  Hollo,  1. 

Seven  vessels  were  granted  bills  of  health  without  inspcetion ;  22.3  vessels, 
having  a  total  personnel  of  4,400  cabin  passengers,  20,142  steerage  passengers, 
and  20.840  crew,  were  inspected ;  9,740  steerage  passengers  and  2.3.5  crew  were 
bathed,  and  their  body  clothing  was  disinfected  by  steam  ;  13,4(51  pieces  of  hag- 
gage  were  disinfected  by  formaldehyde  gas. 
Respectfully, 

D.  MooRE,  A-Sfiistatit  Surgeon. 

The  Surgeon-General. 

NAGASAKI. 
Report  of  Sanitary  Inspector  Robert  I.  Bowi:e. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  the  Medical  Officer  in  Command, 

Nagasaki,  Japan,  July  1,  WOJf. 

SiK :  I  have  the  honor  to  inclose  herewith  a  recapitulation  of  the  inspection 
work  done  on  shipboard  by  the  undersigned  during  the  fiscal  year  ending  June 
30,  1904.  Owing  to  the  outbreak  of  the  war,  thousands  of  Japanese  refugees 
returned  from  Siberia  and  Manchuria,  and  immediately  thereafter  smallpox  of 
a  virulent  type  broke  out  in  several  localities,  of  which  Nagasaki  seemed  to 
suffer  the  most.  We  are  not  yet  entirely  free,  the  epidemic  having  lasted  five 
months  already,  but  at  present  the  cases  are  only  sporadic.  It  is  only  reason- 
able to  infer,  since  Amoy.  Canton,  and  Hongkong  have  been  declared  plague- 
infected  ports,  and  war  existing  in  Chinese  territory,  that  the  Far  East  offers 
at  present  the  most  favorable  opportunities  for  tlie  widespread  diffusion  of 
quarantinable  diseases.  It  is  practically  impossible  for  us  to  obtain  reliable 
data  as  to  the  character  and  amount  of  sickness  at  the  front,  as  well  as  at  the 
emergency  hospitals.  I  only  know  that  those  in  Japan  are  rapidly  filling,  and 
that  new  places  are  being  utilized  for  medical  purposes.  Lately  I  reciuested 
permission  to  visit  one  of  the  principal  hospitals  at  Sasebo,  hut  was  refused. 
The  same  secrecy  observed  in  the  conduct  of  all  their  military  operations  holds 
good  in  all  matters  indirectly  connected  therewith. 

I  have  not  kept  a  record  of  the  immigrants  leaving  for  American  ports,  hut 
of  the  total  number  050  were  recommended  for  rejection :  of  these,  1  only  was 
for  favus,  the  balance  for  trachoma. 


186  PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE. 

After  au  exjjerieuce  based  upon  at  least  4,()()0  examinations  of  Chinese.  Jap- 
anese, and  Koreans.  I  am  of  tiie  opinion  tliat  liundreds  of  cases  are  improperly 
diagnosed  and  rejected  as  trachomatous.  I  have  also  noticed  that  the  con- 
junctival surfaces  of  Orientals  are  far  less  sensitive  than  those  of  Caucasians. 

The  local  quarantine  station  is  a,i,';nn  in  woi'king  order,  and  I  am  informed 
by  those  who  have  had  occasion  to  use  it  that  it  leaves  nothing  to  bo  desired  in 
the  way  of  comfort  and  convenience. 

Vessels  inspected 91 

Steamers    00 

Sailing  vessels . 1 

Crews  examined  14,075 

Passengers  examined 2G,  925 

Respectfully,  Rodt  I.  Bowie, 

Sanitary  Inspector. 
The  Subgeon-Genebal. 

KOBE. 

Acting  Asst.  Surg.  J.  B,  Fowler  continued  on  duty  in  the  office  of 
the  United  States  consul  at  Kobe,  Japan,  inspecting  vessels  and  crews 
bound  for  ports  of  the  United  States.  He  also  inspected  all  emi- 
grants about  to  embark  for  this  country. 

China. 

hongkong. 

Report  by  Passed  Asst.  Subg.  M.  J.  White. 

Public  Health  and  Mabine-Hospital  Sebvice. 

Office  of  Medical  Officer  in  Command. 

Honr/konff,  July  11,  IQOJf. 
Sib  :  The  report  of  this  station  for  the  fiscal  year  ended  June  30,  1904,  is 
herewith  submitted. 

PUBLIC    health    MEASUEES    FOB   THE   PBOTECTION    OF    THE    UNITED    STATES    AND 

INSULAB   TEBBITOBY. 

The  work  has  furnished  further  evidence  that  the  enforcement  of  the  foreign 
quarantine  regulations  is  a  veiy  difficult  problem.  Quarantinable  diseases 
in  Hongkong,  with  the  exception  of  a  few  cases  of  smallpox,  were  confined  to 
Asiatics,  many  of  whom  went  as  cabin  passengers  along  with  presumably  non- 
exposetl  Europeans,  and  the  same  conditions  applied  to  steerage  passengers 
and  personnel.  A  Chinaman  may  reside  and  work  outside  the  infected  district 
of  the  city,  yet  his  racial  status  is  sutticlent  evidence  that  he  frequents  it  for 
amusement  and  association  with  his  friends,  in  whose  houses  he  is  as  much 
exposed  to  infection  as  they  are.  All  cabhi  passengers  must  be  treated  alike  or 
exceptions  uuist  be  made  and  the  l)aggage  of  the  Chinese  disinfected.  Should 
this  be  done,  racial  discrimination  will  be  alleged  vociferously,  and  it  will  be 
cited  that  Europeans  trade  with  Chinese  storekeepers,  and  therefore  should  be 
considered  ex]iosed  and  subjected  to  the  same  treatment.  The  fact  that  the 
quarantinable  diseases  were  confined  almost  entirely  to  Asiatics  indicates  that 
the  exposure  of  Europeans  is  insignificant. 

The  fairly  well-to-do  Chinaman,  who  from  financial  necessity  would  go  steer- 
age to  San  Francisco,  would  go  second-class  cabin  to  Manila  on  the  more  expen- 
sive vessels  and  first-class  caliin  on  the  chea]ier  A-essels. 

At  this  post  it  is  not  possible  to  detain  passengers,  as  indicated  in  paragraphs 
30  to  37,  and  through  course  of  time  the  practice  has  arisen  of  requiring  steer- 
age passengers  and  the  strictly  laboring  element  of  the  personnel  to  bathe  and 
have  their  baggage  disinfected.  Some  Chinese  steerage  passengers  and  crew 
have  resorted  to  substitution  to  avoid  bathing  and  disinfection,  and  their  cloth- 
ing have  been  hidden  on  sampans  to  be  passed  aboard  just  before  sailing. 


rTTHLr(1    HKALTH    AND    M ARINE-nOSlMTAL    SKKVTrE.  1  S7 

In  cortilyiiiK  liills  ol    IkmUIi   I   li;i\c  iiddptod   (lie  f(ill(»\\  iiit;   rMiin.   Ihr   St-rvict' 
seal  beinn  aftixed  : 

"  n.    S.    I'lni.ic   IIkaitii   ami  .Maki  nk-IIosi'ital  Skkvuk. 

"  lloHnkouu, .  lOOfi. 

"  I  cortily  that  tliis  hill  of  health  is  (•(urcct. 


"Punned  Assiniaiit  ,^iiriiron, 
"U.  .S'.  Public  Ilidllh  (ind  .]f<iiiii(-lf(txi)Uiil  ,SVrr/cr." 

On  oriffinal  hills  the  iippor  ri«ht  t-ornor  is  utilized  and  on  sni>i)lenienlal  hills 
Ihe  reverse  side,  there  heinjr  insnliicient  room  elsewhere. 
The  result  of  the  work  is  tahulated  as  follows: 

Steamships  inspected  and  passed 465 

Sailinij  vessels  inspected  and  passed 11 

Personnel  on  steamships 39,005 

Personnel  on  sailing  vessels 241 

Cabin  passengers  on  steam  vessels 8,800 

Cabin  passengers  on  sailing  vessels .3 

Steerage  passengers  on  steam  vessels 13,77;') 

Steerage  passengers  on  sailing  vessels 0 

Persons  recpiired  to  bathe 40,  G53 

Persons   rejected 77 

Baggage  disinfected  and   labeled 41.  (J8'! 

Vessels   disinfected    15 

Cargo  labeled  and  held  in  godninis,  parar/raph  22. 

Hides    bales__  38 

Feathers  do 313 

Bristles do 270 

Human  hair boxes__  177 

Cargo  disinfected. 

Hides    bales__  121 

Lighters    2 

The  shipment  of  cargo  was  supervised  by  inspection,  disinfection,  detention, 
and  certification  of  shipping  orders,  and  due  attention  was  given  to  shij)  sup-, 
plies  and  jirivate  supplies  of  passengers  and  personnel.     Shipping  orders  were 
certified  as  follows,  for  the  purpose  of  preventing  the  taking  aboard  of  pro- 
hibited cargo : 

"  To  the  Master: 

" items  passed.     If  any  evidence  of  alteration  for  substitution  of  items, 

do  not  accept  this  shipment. 


"  Passed  Assi.Htant  f^urgeon, 
"17.  ,S?.  Public  Health  and  Marine-Hospital  Service." 

The  shipment  of  fresh  vegetables  hence  to  the  Philippine  Islands  has  been 
prohibited,  because  it  was  impossible  for  this  office  to  exercise  such  sanitary 
supervision  as  would  enable  the  issuance  of  a  certificate  that  such  vegetables 
had  not  been  exposed  to  the  infection  of  cholera,  nor  is  it  possible  to  determine 
the  essential  fact  of  the  existence  or  nonexistence  of  cholera  on  the  distant  vege- 
table farms  along  the  West  and  Canton  rivers,  whence  the  export  and  local 
trade  is  supplied. 

PUBLIC    HEALTH    AID   TO   THE   REPUBLIC    OF   PANAMA, 

This  was  but  recently  begun.  The  shipment  of  cargo  for  transshipment  at 
San  Francisco  was  supervised.  No  vessels  have  departed  hence  for  ports  of 
Panama. 

During  the  year  the  quarantinable  diseases  in  the  colony  have  been  returned 
as  follows :  Bubonic  plague,  526  cases,  473  deaths.  The  epidemic  appears  to  be 
under  very  good  control.    It  is  customary  to  examine  rats  trapped  in  different 


188  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

sections  of  the  city,  and  if  foiind  pest  infected  to  institute  measures  to  prevent 
occurrence  of  hunmn  cases  tlicroaltouts.  it  satisfactorily  appearing  that  rat 
plague  precedes  human  plague  in  a  district.  The  other  ordinarily  recognized 
measures  are  carried  out.  A  number  of  human  plague  cases  have  been  imported 
from  other  ports  of  the  Orient.     The  rats  contiiuie  infected. 

Cholera,  42  cases,  39  deaths.  Two  cases  were  imported  from  Saigon.  Only 
Asiatics  were  attacked. 

Smallpox,  G5  cases,  41  deaths.    There  were  several  European  victims. 

Typhus  fever,  no  cases,  no  deaths. 

Yellow  fever,  no  cases,  no  deaths.  The  conditions  here  would  support  an 
epidemic. 

Leprosy,  occasional  cases  drifted  into  the  colony,  but  were  deported  to  Chi- 
nese territory. 

M.  J.  White. 
Passed  Assistant  Surgeon. 

The  Surgeon-General. 

SHANGHAI, 
Report  by  Acting  Asst.  Surg.  S.  A.  Ransom. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Shanghia,  China,  July  18,  190',. 

Sir:  I  have  the  honor  to  transmit  herewith  the  annual  report  of  the  transac- 
tions at  this  station  during  the  fiscal  year  ended  June  30,  1904. 

The  opposition  demonstrated  during  the  previous  year  to  the  restrictions 
imposed  l)y  the  Service  has  to  some  extent  subsided,  owing  probably  to  the  facts 
that  those  interested  have  become  more  or  less  familiar  with  the  reasonable 
demands  made,  and  that  absolute  impartiality  has  been  shown  toward  all.  At 
times,  however,  some  slight  hostility  is  yet  apparent. 

It  has  been  the  constant  effort  of  this  office  to  avoid  inflicting  any  unnecessary 
liardship  on  vessels,  and  to  conciliate  the  shipping  interests  generally  as  far  as 
this  can  be  done  without  in  any  way  diminishing  the  efficiency  of  the  Service,  and 
it  is  believed  that  in  the  main  this  effort  has  been  successful. 

No  effort  has  been  spared  to  become  acquainted  with  all  conditions  affecting 
the  health  of  Shanghai,  and  the  various  outports  which  ship  goods  through  this 
place  to  the  LTnited  States.  This  has  been  attended  with  some  difficulty,  but 
the  practice  of  securing  from  the  various  consular  officers  situated  at  out- 
ports weekly  sanitary  reports,  inaugurated  with  the  assistance  of  the  Depart- 
ment of  State  in  June,  1903,  has  aided  considerably  in  this  direction.  In  this 
way  information  as  to  the  reported  and  estimated  number  of  deaths  from  quar- 
antinable  diseases  is  obtained,  and  a  space  for  remarks  is  utilized  for  the  men- 
tion of  any  special  facts  of  interest  from  a  sanitary  standpoint.  The  data  are 
necessarily  incomplete  owing  to  the  difficulty  in  securing  reliable  statistics  from 
Chinese  quarters,  but  the  information  thus  obtained  is  nevertheless  of  consider- 
able assistance.  Through  this  means  this  office  has  been  advised  of  the  exist- 
ence of  the  following  diseases  at  different  periods  during  the  year  at  the  places 
named :  Tientsin,  plague,  cholera,  and  variola  ;  Hankow,  cholera  and  typhus 
fever  ;   Foochow,  plague ;   Chefoo,  cholera  ;   Niuchwang,  plague — epidemic. 

The  various  concerns  in  Shanghai  engaged  in  packing  goods  for  export  to  the 
United  States  have  been  inspected  from  time  to  time  so  that  the  processes  in 
vogue  might  be  kept  up  to  the  standard  required  by  the  Service.  Consular  certi- 
ficates are  required  from  outports,  showing  what  methods  have  been  employed  in 
preparing  transshipment  cargo. 

In  this  connection  it  may  not  be  out  of  place  to  mention  briefly  the  various 
methods  employed :  The  curing  of  hides  of  neat  cattle  is  effected  by  immersing 
ftach  hide  in  a  one-fourth  to  one-half  of  1  per  cent  solution  of  Cowan's  or  Erkei*- 
brach's  arsenical  paste  and  then  hang  them  in  the  sun  to  dry.  Long-haired 
skins  are  sometimes  painted  on  the  fleshy  side  with  this  solution,  but  are  usually 
packed  dry  in  powdered  naphthalene  in  the  proportion  of  6  pounds  of  the  pow- 
der to  the  bale  of  from  400  to  <iOO  skins,  according  to  their  size.  It  is  supposed 
that  500  gallons  of  the  arsenical  solution  will  cure  from  1.000  to  1.200  heavy 
hides  and  from  8.000  to  10,000  light  skins.  While  it  has  been  impossible  to  learn 
the  constituents  of  the  paste  from  which  this  solution  is  made,  it  seems  to  at 
least  satisfatorily  preserve  the  hides  treated.     There  are  very  few  dry  salted 


PUHLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  1  <S9 

lii(lossliii)iHHl  Mild  raw  skins  aro  rcioctod.  Bristlos  arc  Ixjilcd  and  cloaiKnl,  and.  in 
addition,  sonictinios  jtaflccd  in  naplitiiaicMU'  \)v'un'  to  sliipniciit.  Wool  is  paclccd 
wit!)  naplitlialtMio.  ('.  i)onnds  to  tlic  haii'  ol"  (iSO  ixainds.  wlicn  (luarantinaldc  dis- 
oaso  prevails  at  point  of  oriirin.  Unman  iiair  is  disinfcctcMl  witli  foniialinc  as 
aro  also  ptu-sonal  and  lionscliold  cCrccts  sliijipod  as  fn'ij,'lit.  \'o;,'ctal)l»'s.  siidi  as 
onions  atid  potatoes,  the  only  articles  (d"  this  class  shipped  to  Tnited  Slates 
ports,  Jire  reipiired  to  lie  dijtped  in  a  12  per  cent  solntion  of  forni.aline.  Silk, 
straw  braid,  tea.  di'ied  rluiharli,  and  wood  and  init  oil  are  not  especially  prei>jii'ed, 
as  it  is  thon.i:ht  that  they  are  comparatively  fn'e  from  danf:er  of  conveying  infec- 
tion. It  m.iy  he  mentioned  in  passini;.  howev(>i',  that  the  two  latter  articles  are 
merely  exjiressd  oils,  and  are  not  treated  by  any  process  which  would  render 
thorn  sterile.     These  include  the  i)rinciple  .articles  of  export  from  here. 

Supervision  over  freijiht  shipped  from  or  through  this  jjort  is  exercised,  when 
no  (luarantinal)le  disease  is  present,  hy  n'quirin.i;  that  all  manifests  lie  sub- 
mitted to  this  ofHce  for  approval  and  signature,  and  any  manifest  containing: 
an  entry  of  .icoods  which  h.-ive  not  complied  with  the  (luarantine  rej^ulations  is 
refused  approval.  In  addition,  the  shipping  orders  or  boat  notes  for  human 
hair,  household  and  personal  effects,  cowhides,  etc.,  are  required  to  be  coun- 
tersigned the  year  round,  so  that  proper  precautions  may  be  taken  with  these 
articles. 

During  the  prevalence  of  a  (luarantinable  disease  this  i»ractice  is  super- 
seded by  that  of  countersigning  all  shipi)ing  orders,  and  the  otticers  of  vessels 
are  instructed  to  receive  on  board  absolutely  no  freight  the  shipping  order  for 
which  is  not  jiroperly  signed. 

The  methods  of  dealing  with  ships  and  their  personnel  are  the  same  as  last 
year,  with  but  slight  alterations.  A  careful  examination  is  made  of  the  crew 
and  passengers  and  temperatures  taken  where  necessary.  Steerage  passen- 
gers and  members  of  crews  shipped  here  are  required  to  submit  their  effects 
for  disinfection,  which  is  accomplished  I)y  having  all  articles  contained  in 
tight  wooden  boxes  or  trunks  and  sprinkling  between  each  layer  of  clothing 
formaline  saturated  sawdust,  about  40  cc.  of  a  40  per  cent  solution  being  used 
to  each  ordinary-sized  trunk.  The  container  is  then  labeled,  and  to  guard 
against  its  being  opened  before  being  placed  on  board  the  vessel  is  sealed,  it 
being  required  that  the  seal  shall  be  intact  at  the  time  of  inspection  innne- 
diately  prior  to  the  sailing  of  the  ship.  The  office  bo.v.  the  only  assistant  here, 
is  required  to  see  to  the  unpacking  of  articles  to  be  disinfected,  while  the  med- 
ical officer  superintends  in  person  the  process  of  disinfection,  labeling,  and 
sealing. 

It  is  not  practicable  to  bathe  and  disinfect  the  body  clothing  of  crew  and 
steerage  passengers  here,  as  there  is  no  apparatus  on  hand  with  which  to  do  the 
work  and  no  place  to  detain  the  individuals  after  such  treatment  pending  the 
sailing  of  the  vessel. 

The  rule  that  the  Asiatic  crew  and  steerage  passengers  on  board  vessels  must 
be  prevented  from  going  ashore  here  is  still  in  force,  and  it  is  believed  is  carried 
out  with  trifling  exceiitions  on  the  through  liners.  In  the  case  of  vessels  coming 
up  the  river  and  lying  alongside  docks  for  several  days,  the  control  of  the  Asiat- 
ics, especially  the  crew,  in  this  i-espect  is  a  rather  difficult  task.  The  officers  of 
the  shii)s  are  cautioned  to  enforce  the  restrictions  as  closely  as  possilde,  but 
undoul>tedl.v  the  men  get  ashore  more  or  less  frequently.  It  is  tliought.  how- 
ever, that  their  baggage  remains  on  board  during  their  stay  here,  and  thus  one 
source  of  infection  is  guarded  against. 

In  the  disinfection  of  vessels,  where  this  has  been  considered  necessary,  sul- 
phur di(ixide  4  per  cent,  produced  b.v  the  pot  method,  has  been  the  agent  gen- 
erally employed,  although  bichloride  of  mercury  solution,  1 :  800,  has  been  used 
in  several  instances  where  gaseous  disinfection  was  not  needed.  Where  vessels 
have  been  treated  with  sulphur  ,gas  the  effects  of  the  crew  have  also  been 
fumigated  with  the  same  agent.  The  municipal  steam  chamber  is  too  inaccessi- 
ble for  use. 

On  account  of  the  presence  of  smallpox  at  this  port  at  all  seasons,  it  has  been 
deemed  wise  to  suggest  to  masters  that  as  many  as  possible  of  the  persoiniel  of 
their  vessels,  when  bound  direct  to  a  United  States  poi't,  be  vaccinated,  espe- 
cially the  crew  and  steerage.  The  suggestion  has  usually  been  adopted,  and  is 
in  line  with  ;i  conunnnication  received  from  the  chief  quarantine  officer  of  the 
Philippines,  and  will  uniiuestionably  prevent  to  a  considerable  extent  the  devel- 
opment of  smallpox  on  board  vessels  after  their  departure  from  Shanghai,  as 
happened  in  several  instances  last  year. 

In  view  of  the  fact  that  plague  prevails  more  or  less  extensively  throughout 


190  PUBLIC    HEALTH    AND    MAEHSTE-HOSPITAL    SERVICE. 

the  year  at  ports  both  north  and  south  of  this  place,  which  ports  have  intimate 
connection  with  Shanghai  through  tlie  medium  of  local  steamers,  and  the  further 
fact  that  at  most  of  these  places  there  is  a  total  lack  of  precautions  against 
rat  invasion  of  the  vessels,  rendering  it  at  least  possible  that  infected  rats  may 
gain  access  to  shii)s,  contaminate  the  rats  already  thereon,  which  in  turn  may 
infect  the  rats  at  the  docks  here  at  any  time,  it  has  been  reconnnended  by  this 
office  that  the  various  shii)ping  agents  adopt  the  practice  of  requiring  the  use  of 
rat  guards  on  all  lines  of  vessels  while  at  the  various  docks  here,  remove  the 
gangways  at  night,  keei)  the  vessels  a  short  distance  from  the  wharf  liy  means  of 
booms,  etc.,  and  thus  guard  against  the  possibilit.v  of  rats  getting  aboard  here. 
Compliance  with  this  suggestion  will  eliminate  the  necessity  of  fumigating  ves- 
sels at  this  point  for  the  destruction  of  nits  only. 

The  use  of  rat  guards  has  not  been  made  obligatory  because  of  lack  of  ability 
on  the  part  of  this  office  to  enforce  it.  This  would  require  close  supervision, 
which  could  only  be  had  by  means  of  a  launch  to  take  the  quarantine  officer  on 
inspection  trips  up  and  down  the  river  at  irregular  intervals  to  see  that  the 
orders  were  being  carred  out  by  the  different  vesseLs  at  the  docks.  The  matter 
is  therefore  left  largely  to  the  good  will  of  the  masters  and  agents,  and  in  a 
fair  proportion  of  cases  the  suggestion  has  been  adopted. 

Notwithstanding  the  fact  that  the  war  between  Russia  and  .Japan  has  caused 
the  withdrawal  of  practically  all  the  Japanese  vessels  carrying  freight  and  pas- 
sengers to  the  United  States,  the  work  of  this  office  shows  a  very  appreciable 
increase  over  that  done  during  the  previous  year. 

Among  other  things  it  was  found  necessary,  on  account  of  the  lack  of  facilities 
afforded  l)y  the  various  steamship  companies,  and  their  ai)i)arent  total  inabilitj' 
to  control  passengers  on  the  tenders,  owing  chiefly  to  the  large  increase  in  the 
passenger  traffic  of  late,  to  discontinue  from  May  7  the  practice  of  inspecting  at 
the  jetty  in  Shanghai  those  taking  passage  on  the  mail  boats,  and  substitute 
therefor  an  inspection  of  the  vessel  and  her  entire  personnel  at  Woosung.  This 
has  entailed  considerable  additional  labor  on  the  part  of  the  medical  officer, 
as  he  must  now  visit  Woosung  much  more  frequently,  each  trip  consuming  the 
better  jiart  of  a  day.  This  is,  however,  the  only  satisfactory  plan  at  this  time, 
although  it  is  hoped  that  it  may  be  possible  to  return  to  the  former  practice  upon 
the  completion  of  the  customs  jetty  now  in  course  of  construction. 

Transactions  at  Shanghai  duriny  fiscal  year  ended  June  30,  IBO-ff. 

Steamers  inspected  and  passed 100 

Steamers    disinfected 12 

Sailing  vessels  inspected  and  passed 16 

Sailing  vessels  disinfected 6 

Crew  on  steamers 6,433 

Crew  on  sailing  vessels 319 

Passengers  on  steamers 3,747 

Passengers  on  sailing  vessels 2 

Transactions  at  Shanghai  national  quarantine  station  during  fiscal  year  ended 

June  30,  190],. 

Bills  of  health  issued 148 

Pieces  of  freight  viseed 679,841 

Pieces  of  freight  inspected  and  passed 586 

Pieces  of  freight  disinfected 40.5 

Pieces  of  freight  rejected 133 

Pieces  of  baggage  disinfected 497 

Immigrants   examined 82 

Immigrants   rejected 7 

A  comparison  of  the  tables  submitted  herewith  with  those  prepared  last  year 
will  show  that  there  were  18  more  steamers  inspected  and  1-4  more  vessels  disin- 
fected than  during  the  same  period  last  year.  The  increase  over  last  year  in  the 
personnel  inspected  was  l.(;06  crew  and  983  pessengers.  The  total  number  of 
individuals  insjiected  was  10,501.  The  disinfection  of  baggage  in  1903  amounted 
to  175  pieces,  as  compared  with  497  pieces  this  year.  These  figures  do  not  in- 
clude the  baggage  of  crew  fumigated  on  board  vessels  where  the  latter  were  dis- 
infected. No  correct  estimate  as  to  the  increase  or  otherwise  of  freight  viseed 
this  year  can  be  made,  as  the  figures  of  last  year  were  incomplete. 


I 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL   SERVICE.  191 


TluM-c  were  iiivcstij,'.il(Ml  duriiij;  llic  ycMr  •_'."»  ciiscs  of  illness  occiiniii;;  on  ves- 
sels, only  ."5  of  which  in'oved  to  he  of  a  (lUiiraiitiiiiihle  iialtiie,  viz,  choieni.  In 
two  instiinces  the  vessels  and  crews  were  disinfected  thn»u;,'hout  l»y  this  ofHce. 
In  tlie  third  instance,  th.it  of  the  ship  Olirchniih-.  the  vessel  s.iil(>d  without  coiii- 
plyinf;  with  the  n-conniiendations  of  this  oMice  and  without  hill  of  health. 

As  stated  in  last  years  report,  an  autoclave  could  he  used  to  some  advantage 
at  this  station  foi-  the  disinfection  of  eff«>(ts  of  stecra^^e  i>asseiij,'ers,  et<-.,  and  for 
the  tn'alnient  of  small  infected  sjiaces  on  hitard  vessels,  such  .-is  staterooms  or 
cal)ins.  For  this  latter  pur]iose  it  could  not  he  used  unless  thi'  station  is  sup- 
plied with  a  m(>aiis  for  takini!;  it  on  hoard. 

One  serious  dilliculty  met  with  in  the  disinfection  of  vessels  with  sulphur  has 
been  the  in.ihility  to  secure  in  Shan.i^h.ii  ji  sullicient  (piautity  of  this  article  for 
the  treatment  of  larj^e  sjiaces,  its  importation  heing  curtailed  hy  tlu?  Chinese 
authorities  on  account  of  suli)hur  heinj;  classed  as  a  munition  of  war.  It  is 
suf^i^ested.  therefore,  that  if  this  ollice  w(M-e  supplied  with  sulphur  hy  the  Bureau, 
or  iiermitted  to  imi-chase  here  and  keep  on  hand  a'stock  of  J'lOU  to  l.(MK)  pounds, 
with  the  ni'cessary  pots,  wood  alcohol,  etc.,  and  furnish  it  to  vessels  at  a  cost 
just  sullicient  to  cover  expenses,  this  dilliculty  would  lie  successfully  met.  I  am 
told  that  the  stores  here  char.ire  the  exorhitant  i)rice  of  40  cents  iNIexican  per 
pound  ft)r  sulphur. 

There  is  one  other  j>oint  which  it  is  desired  to  hriui;  to  the  attention  of  the 
Bureau.  L*assenj,'ers  are  taken  at  all  points  in  the  Orient  hy  the  Empress  Line 
of  steamer.s.  destined  to  Seattle  via  Vancouver.  As  these  vessels  do  not  touch 
at  an  American  port,  they  and  their  ])assenfrers  do  not  come  under  the  sui»er- 
vision  of  the  olhcers  of  this  Service  stationed  in  China  and  Jai)an.  There  is 
nothing  to  prevent  passengers  of  any  class  coming  from  infected  districts  hy 
coast  hoats  or  overland,  and  going  hy  the  Empress  route  almost  direct  to  Seattle 
without  any  treatment  at  this  end.  This  applies  to  freight  as  well.  It  may  be 
that  jtrovisiou  is  made  to  meet  this  contingency  at  Seattle. 

Shanghai,  viewed  from  a  (pi.-irantine  standpoint,  has  this  year  undergone  in 
her  health  conditions  a  considerable  improvement  over  last  year.  The  annual 
report  of  the  niunicii)al  health  officer  for  the  calendar  year  1003  shows  that 
there  were  reported  a  total  of  ITS  deaths  only  from  Asiatic  cholera,  10  among 
the  foreign  population  and  102  among  the  natives,  and  a  total  mortality  of  251 
from  smallpox — 10  foreigners  and  241  natives.  It  is  noticeable,  however,  in 
this  connection  that  there  was  a  very  marked  increase  in  the  total  number  of 
deaths  reported  among  the  natives,  commencing  about  the  middle  of  July  and 
continuing  until  the  second  week  in  October.  Cholera  was  officially  reported 
present  August  0,  so  it  will  be  seen  that  the  outbreak  of  that  disease  corresponds 
closely  with  the  increased  death  rate.  There  was  an  increase  of  1,722  in  the 
total  deaths  among  natives  during  the  four  months  of  Jul.y,  August,  September, 
and  October,  the  same  months  during  which  cholera  prevailed  in  1003,  over 
those  for  the  same  period  in  1901,  wlien  the  disease  was  not  present.  While 
there  was  an  estimated  increase  of  25,000  in  the  population  for  1003,  this  would 
not,  of  course,  account  for  much  of  the  difference.  It  is  fair  to  presume,  tliere- 
fore.  that  cholera  was  responsil)le  for  a  majority,  at  least,  of  the  additional 
deaths,  which  sui)ports  the  theory  that  but  little  over  10  per  cent  of  the  actual 
deaths  are  officially  reported. 

Vital  statistics  are  necessarily  very  imperfect  in  a  community  of  this  kind 
where  so  much  has  to  be  left  to  information  obtained  through  nonprofessional 
sources,  and  the  efficient  health  department  here  can  hardly  1)6  held  accountable 
for  discrepancies.  Report  of  communicable  diseases  by  physicians  is  not  obliga- 
tory, and  there  are  hundreds  of  cases  of  all  kinds  which  are  never  seen  bj^  a 
medical  man. 

There  were  no  other  quarantinable  diseases  reported  present  within  the  mu- 
iiicii)ality.  although  leprosy  is  known  to  exist  to  a  greater  or  less  extent.  Well- 
marked  cases  have  been  seen  at  large  on  the  streets,  and  no  systematic  attempt 
is  made  at  isolation. 

The  following  is  the  reported  mortality  from  communicable  diseases  other 
than  those  already  mentioned  for  the  year  among  the  foreign  population : 
Enteric  fever,  22  deaths ;  diiditheria,  4  deaths ;  scarlet  fever,  1  death ;  tuber- 
culosis, .32  deaths ;  rabies,  1  death.  The  ordinary  diarrheal  diseases  were 
responsible  for  20  deaths. 

Among  the  natives  the  oidy  connnunicaltle  disease  reiuu'ted  in  addition  to 
those  previously  s]»ecified  was  tuberculosis,  whicli  is  credited  with  1,070  deaths. 

Beriberi  is  at  all  times  present  here,  and  dengue  was  epidemic  during 
August  and  September,  about  half  the  poi)ulation,  native  and  foreign,  suCfering 


192  PUBLIC    HEALTH    AND    MAKINKHOSl'lTAL    SERVICK. 

from  ;i  iiioro  or  loss  sevoro  attack  of  tbo  latter  disease.  The  eruiition  and  ijaiii 
were  the  prinoipal  features  ohsei'ved,  although  some  cases  without  the  former 
were  seeu.     The  mortality  was  nil. 

The  beril)eri  mortality  was  reported  as  7  deaths  out  of  47  reported  cases. 

The  total  uiortality  from  all  causes  amoug  foreigners  in  VM'.i  was  214,  with 
an  estimated  population  of  S,;;(t(»,  and  among  natives  there  were  7,!J8tj  deaths 
reported,  with  an  estimated  population  of  .".75,000. 

It  should  be  remembered  that  the  figures  given  above  do  not  include  the 
residents  of  the  native  city,  Pootung,  or  the  districts  lying  outside  the  limits 
of  the  foreign  concession,  which,  so  far  as  sanitary  considerations  are  co"n- 
cerned,  might  be  considered  as  a  continuation  of  the  latter,  although  the  munic- 
ipal council  can  exercise  no  supervision  over  them.  The  population  of  these 
districts  umst  aggregate  much  over  1,000,000,  but  there  is  no  way  in  which 
anything  like  a  correct  estimate  can  be  had  as  to  either  population,  morbidity, 
or  mortality.     All  of  these  places  are  in  a  filthy  state,  which  defies  description. 

Among  animals  within  the  municipality  and  in  the  adjacent  country,  rinder- 
pest, foot-and-mouth  disease,  glanders,  and  rabies  have  prevailed. 

From  January  1  to  June  30,  1904,  the  only  quarantinable  disease  reported 
present  in  Shangliai  was  smallpox,  which  caused  25G  deaths  during  that  inter- 
val. This  is  40  deaths  more  than  during  the  same  period  last  year.  There 
were  21  cases  reported  among  foreigners. 

While  plague  has  not  made  its  appearance  within  the  foreign  concession  here, 
several  cases — it  has  not  been  possible  to  learn  the  exact  number — have  been 
removed  from  vessels  at  the  Imperial  Chinese  quarantine  station  at  Woosung. 
This  disease  constantly  threatens  Shanghai  from  the  north  and  south,  and 
whether  it  exists  in  the  country  back  of  the  city  can  only  be  surmised.  If  so, 
it  is  certainly  not  epidemic  at  this  time.  The  general  conditions  are  such  that 
if  this  disease  once  gained  a  foothold  here  it  is  thought  there  would  be  a  severe 
epidemic. 

An  examination  of  the  mosquitoes  of  this  section  reveals  the  fact  that  while 
culex  largely  predominate,  anopheles  and  stcf/onnjia  fasciata  are  found  in  fair 
l>roportion.  Shanghai  is  an  ideal  breeding  place  for  these  insects,  which 
abound.  It  is  essentially  a  flat  city,  being  only  from  5  to  20  feet  above  sea  level, 
and  is  surrounded  on  almost  every  side  by  fields  which  are  during  a  large  part 
of  the  year  converted  by  irrigation  for  agricultural  purposes  into  veritable 
swamps.  Malarial  fever  is  present  all  the  time,  mostly  of  the  ordinary  tertian 
type.  If  yellow  fever  were  once  introduced  it  is  hard  to  say  where  its  ravages 
would  cease,  as  it  would  be,  it  is  believed,  absolutely  impossible  to  eradicate 
the  intermediate  host  of  this  disease,  the  mosquito. 

The  following  were  the  recorded  meteorological  conditions  for  the  year :  Mean 
barometer,  30.08 ;  mean  temperature,  59°  F. ;  mean  daily  range,  15.9°  F. ;  mean 
humidity,  78  (saturation,  100)  ;    rainfall,  42.70  inches. 

The  bacteriological  examination  of  the  water  supply,  which  is  obtained  by 
pumping  river  water  at  a  station  below  the  city  upon  sand  and  gravel  filter 
beds  at  high  tide,  showed  a  maximum  of  140  in  August,  a  minimum  of  52  in 
February,  and  an  average  of  77  colonies  per  cubic  centimeter. 

It  has  been  very  gratifying  to  note  that  the  bills  of  health  issued  by  the 
various  officers  of  this  Service  in  the  Orient  seem  to  be  the  basis  upon  which 
quarantine  officers  of  other  services  form  their  opinion  as  to  the  health  of 
vessels  and  ports  of  departure.  This  notwithstanding  the  fact  that  bills  of 
health  are  issued  by  other  nationalities. 

I  have  again  to  acknowledge  my  indebtedness  to  Consul-Geueral  Goodnow  for 
cordial  support  and  assistance  in  carrying  on  the  work  of  this  office. 
Respectfully, 

S.  A.  Ransom, 
Acting  Assistant  Surgeon. 

The  Surgeon-Genebai-. 

India. 

detail  of  officers  at  calcutta  and  bombay. 

On  account  of  the  wide  prevalence  of  cholera  and  plague  in  India, 
Passed  Asst.  Surg.  E.  K.  Spragne  was,  on  June  25,  1903,  detailed  by 
the  President,  under  the  puarantine  act  of  February  15,  1893,  for 


rUIiLlC    IIKALTH    AND    MARINE-HOSPITAL    SERVICE.  193 

duly  in  ihv  oflico  ol"  llu>  Aiiu'ricaii  consul-general  at  Calcutta,  aiitl  on 
August  IT,  liXK),  Actin<;  Asst.  Surg.  E.  II.  Hume  was  similarly 
detailed  at  Bombay.  These  oflicers  inspect  all  vessels  and  crews  leav- 
ing their  respective  ports  for  United  States  ports  and,  with  the  con- 
sul, issue  the  consular  or  supplementary  bills  of  health.  They  also 
furnish  the  Bureau  with  weekly  sanitary  reports  concerning  their 
station,  which  are  regularly  published  in  the  Public  Health  Reports. 
They  also  transmit  special  rc'ports  concerning  different  parts  of  the 
countrv  where  thev  are  stationed  that  may  be  of  sanitary  interest  to 
the  United  States.'  (See  Public  Health  Report,  November  20,  1!)08, 
"Topography  and  sanitary  condition  at  port  of  Calcutta,'"  by  P.  A. 
Surg.  E.  K.  Spragne:  also  Public  Health  Report,  December  4,  11)0^), 
"  AVater  supply  of  Calcutta ;"  Public  Health  Report,  May  '20,  11)04, 
•'  Plague  investigation  "  and  "  Ijcprosy  in  India,"  by  Acting  Assist- 
ant Surgeon  Hume.) 

As  a  preliminary  to  granting  the  bill  of  health,  it  is  their  duty 
to  see  that  the  United  States  quarantine  regulations  for  vessels  leav- 
ing foreign  })orts  infected  with  cholera  or  plague  for  ports  of  the 
United  States,  its  possessions  or  dependencies,  are  complied  wdth. 

MEDICAL  INSPECTION  OF  IMMIGRANTS. 

During  the  fiscal  year  ended  June  30,  1004,  840,714  aliens  came  to 
the  United  States.  As  required  by  the  immigration  law,  practically 
all  these  were  examined  by  officers  of  the  Service  at  the  i)ort  where 
they  entered.  Upon  the  request  of  the  Commissioner-General  of  Immi- 
gration oflicers  of  the  Service  were  detailed  exclusively  for  examina- 
tion of  aliens  about  to  embark  for  the  United  States  at  the  ports  of 
Victoria  and  Vancouver,  British  Columbia — Asst.  Surg.  M.  W.  Glover 
at  Victoria  and  Acting  Asst.  Surg.  Herbert  W.  Riggs  at  Vancouver. 
British  Columbia.  An  officer  of  the  Service  was  also  detailed  for 
the  inspection  of  aliens  at  Xogales,  Ariz.  The  medical  inspectors 
were  continued  at  Naples  and  Palermo,  Italy,  and  at  Quebec,  Canada. 
On  July  25  Surg.  George  W.  Stoner,  in  charge  of  the  medical  inspec- 
tion of  aliens  at  Ellis  Island,  N.  Y.,  was  directed  to  proceed  to  Rich- 
ford,  Vt. :  Malone,  N,  Y. ;  Montreal  and  Quebec,  Canada;  Niagara 
Falls  and  Buffalo,  N.  Y.,  and  Port  Huron,  Detroit,  and  Sault  Ste. 
Marie,  ]Mich.,  to  instruct  the  medical  officers  at  these  places  as  to  the 
methods  for  examination  of  aliens,  so  that  a  uniform  system  should 
be  established.  On  August  G  Asst,  Surg.  C.  E.  D.  Lord,  medical 
inspector  at  San  Francisco,  was  ordered  to  proceed  to  Seattle, 
Tacoma,  Port  Townsend,  and  Sumas,  Wash. ;  Victoria  and  Van- 
couver, British  Columbia;  Portal,  N.  Dak.,  and  Winnipeg,  Manitoba, 
for  the  same  purpose. 

CORRESPONDENCE  RELATIVE  TO  QUESTION  or  STRIPPING  IMMIGKxVNTS  FOR 

EXAMINATION. 

[Letter.] 

United  States  Immigration  Ser\tce,  Medical  Division, 

New  York,  N.  Y.,  August  15.  1903. 
Sir  :  I  have  the  houor  to  submit  herewith  for  sucli  advice  as  tlie  Bureau  may 
be  pleased  to  extend,  u  letter  addressed  to  me  by  the  commissioiier  of  immigra- 

8639—04 13 


194        PUBLIC  hp:alth  and  marine-hospital  service. 

tion  at  this  station,  nncler  date  of  tbc  12tli  instant,  requesting  an  opinion  as 
to  the  necessity  of  stiipiilng  all  aliens  of  their  clothing  to  enable  us  to  deter- 
mine whether  they  are  suffering  from  any  disease  (including  particularly 
diseases  mentioned  in  the  statute)  or  whether  they  are  physically  unsound  in 
any  particular  which  is  likely  to  render  them  pul)lic  charges.  In  case  this  is 
not  necessary  in  all  cases,  an  opinion  is  requested  as  to  whether  it  is  necessary 
as  to  any  great  percentage,  and.  if  so,  approximately  what  percentage? 

In  connection  with  the  foregoing  I  may  say  that  during  my  recent  absence 
on  special  duty,  the  medical  officer  in  temporary  charge  was  requested  by  the 
commissioner  to  strip  and  exaniine  all  unmanied  male  aliens  arrlA'ing  at  this 
station,  with  the  view  to  determine  by  such  examination  whether  syphilis  or 
any  form  of  venereal  disease  exists  to  any  considerable  extent  among  arriving 
immigrants. 

An  examination  was  then  made  of  the  arrivals  covering  a  number  of  different 
vessels  at  intervals,  during  a  period  of  a  week  or  more,  and  so  far  as  I  could 
learn,  upon  my  return  to  this  station  last  week,  the  only  cases  foiind  were  one 
of  gonorrhea  and  one  of  sujipurative  inguinal  glands,  as  reported  by  Surgeon 
Peckham  in  his  letter  to  the  Bureau  of  July  20,  1003,  and  one  case  since  that 
date  of  ulcer  of  penis. 

I  therefore  directed  that  the  wholesale  stripping  inethod  be  discontinued 
and  the  usual  form  of  examination  be  resumed,  as  per  book  of  instructions,  by 
which  always  a  certain  proportion  of  the  arriving  aliens  are  examined  in  suffi- 
cient detail  to  determine  the  exi.stence  of  any  marked  form  of  disease,  to  wit: 

"  Cases  turned  aside  for  speciiil  examination,  as  well  as  any  others  to  whom 
the  attention  of  the  examiner  has  been  l>rought,  should  be  sul)jected  to  a  suffi- 
ciently thorough  i»hysicnl  examination  to  determine  whether  there  are  other 
defects  besides  those  which  primarily  attracted  attention.  The  examiner  should 
detain  any  alien  or  aliens  as  long  as  may  ])e  necessary  to  insure  a  correct 
diagnosis." 

I  then  informed  the  commissioner  that,  in  my  opinion,  the  stripping  method 
has  been  given  a  sufficient  trial  to  prove  the  correctness  of  the  observations  pre- 
viously made  at  this  station,  as  shown  by  the  medical  reports,  that  s.yphilis  is 
one  of  the  rarest  diseases  among  innnigrants.  For  example,  of  the  :>,427  arriv- 
ing aliens  admitted  to  the  immigrant  hospital  at  Kills  Island  during  the  year 
ending  .lune  ."JO.  1008,  only  two  were  found  to  be  suffering  with  syphilis. 

The  commissioner  has  no  desire  whatever  to  iirge  the  matter.  l)ut  now  that  it 
has  been  inider  consideration  requests  an  expression  of  an  official  opinion. 
Respectfully. 

G.  W.  Stoneb, 
Surgeon  in  Charge. 

The  Subgeon-General. 

[Inclosure.] 

OiFiCE  OF  Commissioner  of  Immigration, 

AT(r  York.  A'.  Y.,  August  12.  1903. 
Sir:  I  request  that  you  give  me  your  opinion  as  to  the  necessity  of  stripjting 
all  aliens  of  their  clothing  to  enable  you  to  determine  (1)  whether  they  an^ 
suffering  from  any  disease  (including  particularly  diseases  mentioned  in  the 
statute),  or  (2)  whether  they  are  physically  unsound  in  any  particular,  which  is 
liable  to  render  them  public  charges.  In  case  you  are  of  the  opinion  that  this 
is  not  necessary  as  to  all  aliens,  then  jilease  state  whether  or  not.  in  your 
ojiinion,  it  is  necessary  as  to  any  gi-eat  percentage,  and,  if  so,  approximately 
what  percentage. 

Respectfully,  Wm.  Williams, 

Commissioner. 
Dr.  George  W.  Stoner, 

Surgeon  in  Charge  at  Ellifi  Ixlancl. 

[Letter  in  reply  to  above.] 

Washington.  Septemher  •>.  1903. 

Sir:    Referring  to  your  letter  of  August  l.">.  1008.  inclosing  a  communication 

from  William  Williams,  commissioner  of  innnigration  at  the  port  of  New  York, 

requesting  an  opinion  as  to  the  necessity  of  stri])ping  all  aliens  of  their  clothing 

in  order  to  determine  whether  they  are  suffering  from  any  disease,  including 


PUBLIC    HEALTH    AND    MARINK-HOSPITAL    SEKVICK.  195 

iiiirticularly  disoast's  nioiitionoil  in  tlic  statute,  or  wlu'tluM"  tlicy  aro  pliysioally 
uiisouikI  in  any  particular  wliit-li  is  li]<('ly  to  render  tiiein  pnlilic  ciiar^es,  you 
are  infornied  tliat  a  nieetinj:  of  tlie  Service  Board  was  called  to  consider  this 
(luestion,  and  it  decided  that  your  action  in  discctntinuin^  further  stripping  of 
male  ininiij,'rants  was  a  proper  one,  as  tlio  information  i)efore  tiie  iioanl  con- 
vinced them  that  the  nundter  of  cases  of  venereal  disease  discovered  in  aliens 
ent<>rin,ir  the  port  of  New  Yorlc  under  this  system  of  strippinj^  tliem  was  too 
small  to  justify  such  a  procedure;  hesides  there  were  other  reasons  which  ren- 
dered it  object ionahle. 

Respectfully,  Walter  Wyman, 

Surgcon-Ocncral. 
Surg.  Geokok  W.  Stoner, 

Medical  Division,  United  States  lni>ni(jnition  Herviee. 

Ellis  Island,  N.  Y. 

(il'l'ICERS  OX  DUTY  AT  THE  CONSULATE  IN  CHINA  AND  JAPAN  INSTRUCTED 
TO  EXAMINE  ALIENS  BY  REQUEST  OF  SECRETARY  OF  COMMERCE  AND 
LABOR. 

[Letter.] 

Treasury  Department, 
Washiiif/toii,  Amnist  li),  1903. 

Sir:  I  have  the  honor  to  Invite  your  attention  to  the  inclosed  letter  from  the 
honorable  the  Secretary  of  the  Department  of  Commerce  and  Labor,  bearing 
date  August  15,  1903,  addressed  to  yourself,  upon  the  subject  of  the  m(?dical 
inspection,  by  officers  of  this  Service,  of  aliens  embarking  for  tlie  TTnited  States 
at  the  ports  of  Kobe,  Nagasaki,  and  Yokohama,  Japan,  and  Hongkong  and 
Shanghai,  China,  and  to  make  the  following  statement  and  recommendation  in 
relation  thereto : 

The  Bureau  lias  medical  officers  detailed  in  each  one  of  the  ports  mentioned 
in  said  communication.  They  are  detailed  l)y  tlie  President,  under  the  (luaran- 
tiiie  law  of  180o.  in  the  offices  of  the  United  States  consuls,  to  enforce  the  Trea.s- 
ury  quarantine  regulations. 

The  diseases  mentioned  in  said  letter  are  not  quarantinable  diseases  mider 
tlie  regulations,  but  it  is  evident  the  immigration  act  of  March  o,  IJMt;!,  gives 
ample  authority  for  the  examination  I'equested  to  be  maile  by  our  officers  in  Uw 
foreign  ports.  It  is  understood  that  the  Department  of  Commerce  and  Labor 
requests  the  detail,  for  this  purpose,  of  these  Service  officers  by  the  Treasury 
Department. 

These  additional  duties  can  be  performed  by  these  officers  without  interfering 
with  their  present  duties ;  in  fact,  it  will  aid  them ;  but  it  will  be  made  plain  to 
these  officers  that  on  finding  any  of  tliese  loathsome  or  dangerous  contagious 
diseases  referred  to  in  tlie  immigration  act  their  power  is  only  to  notify  steam- 
ship companies  that  if  carried  they  will  be  subject  to  penalties  on  arrival  on 
this  side. 

I  have  to  recommend,  therefore,  that  the  request  of  the  Secretary  of  Com- 
merce and  Labor  be  complied  with,  and  that  necessary  instructions,  as  above 
indicated,  be  transmitted  to  the  officers  in  the  ports  named. 

Respectfully,  Walter  Wyman. 

Surgeon-General. 

The  Secretary  of  the  Treasury. 

Approved : 

R.  B.  Armstrong,  Assistant  Secretary. 


[Letter.] 


Department  of  Commerce  and  Labor, 

Office  of  the  Secretary, 

Washington,  Augiiftt  15,  1903. 
Sre :  In  conformity  with  the  provisions  of  sections   17   and  22  of  the  act 
approved  March  3.  1003,  entitled  "An  act  to  regulate  the  inimigi-ation  of  aliens 
into  the  United  States,"  it  is  the  desire  of  the  Department  to  adopt  every  means 


196  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

to  prevent  the  migi-ation  to  this  counti-y  of  ijersous  afflicted  with  loathsome  or 
daugerous  contagious  diseases. 

I  therefore  have  the  honor  to  request,  subjec-t  to  your  approval,  that  arrange- 
ments be  maile  wherel»y  officers  of  the  I'ui)lie  Health  and  Marine-Hospital  Serv- 
ice will  make  medical  inspection  of  aliens  embarking  for  the  United  States  at 
the  ports  of  Kobe.  Nagasaki,  and  Yokohama.  .Japan,  and  Hongkong  and  Shang- 
hai. China,  the  said  officers  to  l)e  instructed  to  certify  upon  each  immigration 
manifest  that  the  aliens  whose  names  are  entered  thereon  have  lieen  examined 
and  found  to  be  fi'ee  from  diseases  of  the  class  above  mentioned,  particularly 
tuberculosis,  favus.  and  ti*achoma. 

This  rec-ommendation  is  laade  with  the  understanding  that  all  expen.ses 
incident  to  special  details  of  officers  at  any  of  the  ports  specified  will  be  reim- 
bursed from  the  appropriation  "  Expenses  of  regulating  immigration." 

As  it  is  particularly  desired  to  inaugurate  this  improved  service  at  an  early 
date,  the  Department  would  appreciate  information  as  to  the  progress  made  in 
arranging  the  assignments  requested. 

Respectfully.  Geo.  B.  Cobtelyou,  Secretary. 

The  Seceetaby  of  the  Tbeasuby. 


[Circular  letter  of  instructions.] 

August  21,  1903. 
Pas.sed  A.sst.  Surg.  Johx  McMulle>-. 

Public  Health  and  Mfuiuc-Hoisiiitul  Service,  Uougkoiifi,  China. 

(Care  United  States  Consulate-General.) 

Sib  :  Ton  are  informed  that  at  the  re«iuest  of  the  honorable  the  Secretary 
of  the  Department  of -Commerce  and  Labor,  and  with  the  aiiproval  of  the  hon- 
orable the  Secretarj-  of  the  Treasury,  medical  inspection  of  aliens  embarking 
for  the  United  States  at  the  i>orts  of  Kobe.  Nagasaki,  and  Yokohama.  Japan, 
and  Hongkong  and  Shanghai.  China,  will  be  instituted,  and  medical  officers  at 
those  ix>rts  will  be  instructed  to  certify  ur>on  each  immigi-ation  manifest  that 
the  aliens  whose  names  are  entered  thereon  have  been  examined  and  found  to 
be  free  from  loathsome  or  dangerous  contagious  disease,  particularly  with  refer- 
ence to  tuberciilosis.  favus.  and  trachoma. 

You  are  hereby  directed  to  make  this  inspection  of  aliens  destined  to  the 
United  States,  certifying,  as  re<iuired  by  law.  upon  the  manifest  that  those 
whose  names  are  inscribed  on  the  manifest  are  free  from  loathsome  fjr  danger- 
ous contagious  diseases ;  and  in  the  event  of  detecting  a  would-be  emigrant  with 
such  disease,  you  will  notify  the  steamship  company  accordingly. 

A  copy  of  the  letter  of  the  Secretary  of  Commerce  and  Labor  of  August  1.5, 
1903:  a  copy  of  P.ureau  letter  of  August  19.  19fi.'>.  to  the  honorable  the  Secre- 
tary of  the  Treasury :  and  also  a  copy  of  the  Book  of  Instructions  for  the  Med- 
ical Inspection  of  Immigi-ants.  approved  January  15,  1903.  are  inclosed  herewith 
for  your  information  and  guidance. 

Special  care  in  your  examinations  will  be  taken  with  regard  to  tuberculcsis, 
favus,  and  ti'achoma. 

Respectfully.  Walteb  Wymax,  Surgeon-General. 

P.  S. — You  are  directed  to  make  a  descriptive  list  of  the  aliens  rec-ommended 
by  you  for  rejection,  said  list  to  be  in  duplicate,  one  copy  to  be  forwarded  by 
you,  in  the  most  expeditious  manner,  to  the  medical  officer  in  charge  of  the 
medical  insr>ection  of  immigrants  at  the  iwrt  of  arrival  and  one  copy  to  be 
mailed  to  the  Bureau. 

Walteb  Wym;a>',  Surgeon-General. 

A  similar  letter  sent  to  each  of  the  following  named : 

Acting  Asst.  Surg.  J.  Bucknill  Fowler,  Public  Health  and  Marine-Hospital 
Service,  care  United  States  consulate.  Kobe.  Japan. 

Acting  Asst.  Surg.  Robert  S.  Bowie.  Public  Health  and  Marine-Hospital 
Service,  care  United  States  constilate-general.  Nagasaki.  Japan. 

Asst.  Surg.  Dunlop  Moore.  Public  Health  and  Marine-Ho.spital  Service,  care 
United  States  consulate-general.  Yokohanni.  Japan. 

Acting  Asst.  Surg.  S.  A.  Ransom.  Public  Health  and  Marine-Hospital  Service, 
care  United  States  consulate-general,  Shanghai,  China. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


1«»' 


United  States, 
astoria,  orecj. 

Report  of  inspection  of  aliens  at  jiort  of  Astoria,  Oreg.  (Columbia  River  quar- 
antine station),  during  the  year  ended  June  30,  IU04,  by  Asst.  Surg.  Baylis 
H.  Earle. 


Month. 

Number 
inspected. 

Number 
certified. 

Number 
deported. 

Cause  of  deportation. 

July 

34 
52 
12 

77 
65 
88 
4 
0 
71 
36 

0 
0 
0 
0 
0 
0 
0 
0 
0 
0 

0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 

August 

September 

October 

November 

February          .    . 

March      

May-              

0                   0 
3                   0 

June               ..    .. 

Total 

393                     0 

0 

Respectfully. 
The  Subgeon-Genekal. 


Baylis  H.  Eable, 
Assistant  Surgeon  in  Command  of  Station. 


BALTIMORE. 

Report  of  inspection  of  aliens  at  port  of  Baltimore,  Md.,  during  the  year  ended 
June  30,  1904,  by  Asst.  Surg.  C.  W.  Wille. 


Month. 


'  Number 

in- 
spected. 


Number 
certified. 


Number 

de- 
ported. 


Cause  of  deportation. 


July.... 
August. 


September. 

October 

Novemljer . 
December  . 


January  .. 
February . 
March 


April. 
May.. 
June  . 


Total. 


4,085 

4,996 

7,828 
.5,&t9 
4.074 

1,12.5 

4,875 

4,. 529 

6,a«o 

6,089 


61 


109 

96 

115 

23 
21 
63 

68 
92 
73 


56,371 


865 


10 

14 

11 
9 

15 

2 
0 
12 


Talipes  equinus,  1:  deformed  leg,  2;  poor  phy- 
sique and  hernia,  1;  curvature  of  spine,  1; 
pregnancy,  2:  senility.  3. 

Chronic  inflammation  glands  of  neck,  1:  tra- 
choma, 5;  bUnd,  1;  pregnancy,  1;  hernia,  3; 
curvature  of  spine,  1;  chronic  osteomyelitis,  1; 
senile.  1. 

Trachoma.  3:  hernia,  2:  cataract,  1;  valvular 
diseaseof  heart,  2;  insanity.  1;  senility,  1;  poor 
physique.  1. 

Trachoma,  4;  hernia,  3:  lameness,  1:  curvature 
of  spine,  1. 

Trachoma,  1;  poor  physique,  1;  senile,  2;  lame, 
1;  hernia.  3. 

Trachoma.  9:  poor  phvsique,  1;  hernia,  4;  syph- 
ilis, 1. 

Insanity,  1;  hernia  1. 

Trachoma, 9;  insanity,  1:  syphilis,!;  pulmonary 

tuberculosis,  1. 
Ti-achoma,  ■):  hernia.  1. 
Trachoma,  4;  senility,  1;  syphilis,  1. 
Trachoma,  5:  senility,  1;  syphilis,  1. 


The  Sukgeox-Genekal. 


C.  W.  Wille, 
Asssistant  Surpeon,  in  Temporary  Charge. 


BOSTON. 

Report  on  Medical  Inspection  of  Aliens  at  Boston,  Mass..  by  Acting  Asst. 

Surg.  M.  V.  Safford. 

Boston.  Mass..  .July  1.  190.'/. 
Sir  :  In  connection  with  the  "  annual  report  of  detained  iniuiigrants,''  trans- 
mitted herewith,  I  beg  to  submit  also  the  following,  which  seems  to  cover  any 
other  features  of  interest  in  the  iuunigration  work  at  this  port: 


198  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Certiftcdtion. — During  the  pnst  fiscnl  year  approximately  .'5,000  diseased  or 
mentally  or  physically  defective  immigrants  were  bi-onght  to  the  attention  of 
the  iimnigration  otiicials  at  this  port. 

(1)  Of  this  number.  rA'A  were  certilieate  cases;  that  is,  cases  to  be  regarded 
ijs  certifiable  in  accordance  with  the  bureau  book  of  instructions,  and  compris- 
ing cases  of  idiots,  insane  i)ersons,  epileptics,  persons  atHicted  with  a  loathsome 
or  with  a  dangerous  contagious  disease,  and  cases  of  diseases,  deformities,  and 
defects  which  might  seem  likely  to  render  an  individual  unable  to  earn  a  living. 
In  all  these  cases  a  formal  certificate  (Form  147)  addressed  to  the  commis- 
sioner of  immigration  is  issued,  and  in  accordance-  with  the  practice  in  force 
at  this  station  the  existence  of  such  certificate  makes  it  obligatory  upon  the 
inmiigration  inspector  to  hold  for  the  board  of  special  inqury  every  alien  so 
certified. 

(2)  The  remainder,  constituting  approximately-  2.500  out  of  the  ?5,000  cases 
Inferred  to  above,  presented  on  medical  examination  abnormal  or  defective  con- 
ditions of  less  serious  significance  from  the  point  of  view  of  the  administration 
of  the  immigration  lav.'S. 

These  cases  are  brought  to  the  attention  of  the  inunigrant  inspector  by  mark- 
ings on  the  face  of  the  passenger's  identification  card. 

The  identification  cards  now  required  at  this  port  for  cabin  passengers  are 
marked  in  a  similar  manner. 

Whenever  an  alien's  identification  card  is  so  marked  it  is  understood  that  the 
inunigrant  inspector  before  whom  the  alien  may  come  shall  take  the  defect 
stated  into  account  in  passing  upon  the  alien's  right  to  land,  but  shall  not  regard 
the  defect  as  necessarily  constituting  a  sutlicient  reason  for  holding  the  alien 
for  the  board  of  special  inquiry.  Further  explanation  or  advice  regarding 
defects  thus  recorded  on  identification  cards  is  given  by  the  medical  examiner 
upon  request.  Inunigrant  inspectors  here  are  instructed  to  transcribe  to  colunnis 
21  and  22  of  the  i)assenger  manifest  and  on  detention  cards  when  issued  any 
notation  placed  iipon  passengers'  identification  cards  by  the  medical  examiner 
and  also  to  discharge  no  alien  without  an  identification  card  until  the  case  shall 
have  been  si)ecially  brought  to  the  attention  of  the  medical  examiner.  In 
order  to  avoid  an  unnecessary  nuiltiplication  of  special  inciuiry  hearings,  it  is 
the  practice  of  the  examining  medical  otticer  at  this  station  to  bring  all  eases  of 
uncomplicated  senility,  loss  of  one  eye  (the  other  eye  being  normal),  deficien- 
cies in  physique  of  a  minor  degi'ee,  and  instances  of  temporary  debility  from 
seasickness  to  the  attention  of  the  immigration  officers  in  the  manner  just 
described  r.ather  than  by  formal  certificates. 

(3)  In  further  connection  with  this  matter  of  certification  it  may  be  stated 
that  in  instances  of  some  obvious  abnormality  or  defect  of  no  practical  signifi- 
cance, effort  is  made  to  see  that  the  passenger's  identification  card  shall  be 
stamped  accordingly. 

The  immigrant  inspectors  at  this  station  are  given  to  understand  that  any 
departure  from  the  normal  of  body  or  mind  on  the  part  of  an  alien  should 
receive  appropriate  recognition  by  the  medical  examiner  in  some  one  of  the 
three  ways  just  described,  and  they  are  encouraged  to  bring  back  for  medical 
i-eexamination  any  alien  whose  mental  or  physical  condition  they  may  believe 
to  have  escaped  the  notice  of  the  medical  examiner. 

Medical  inspection. — The  number  of  passengers «  covered  by  the  medical 
examiner  at  this  port  during  the  past  fiscal  year  was  110,462,  made  up  of  53,005 
cabin  and  56,797  steerage  passengei's,a  and  including  in  this  mnnber  80,017 
aliens.6 

The  four  principal  trans-Atlantic  lines  now  bringing  passengers  are  the 
Cunard,  Leyland,  White  Star,  and  Allan  lines.  The  first  two  dock  at  East 
Boston,  the  White  Star  at  Charlestown,  and  the  Allan  Line  near  Chelsea.  In 
each  instance  the  steamship  company  merely  has  the  use  of  wharves  and  sheds, 
which  are  owned,  equipped,  and  controlled  by  a  railroad  company. 

All  cabin  passengers  are  examined  on  shii)l)oard.  The  second-cabin  passen- 
gers, which  occasionally  reach  the  number  of  300  on  a  ship,  are  made  to  pass  a 

o  On  May  1  of  this  year  the  United  States  immigration  inspection  of  passen- 
gers from  Canadian  ports  was  transferred  to  the  Canadian  ports  of  departure. 

6  The  Immigration  Bureau's  report  of  immigration  at  this  port  gives  only  the 
niimber  of  aliens  on  whom  the  head  tax  is  collected.  Citizens  of  the  Dominion 
of  Canada  and  of  the  Republics  of  Mexico  and  Cuba  and  aliens  in  transit  to 
foreign  contiguous  territory  are  exempt  from  the  head  tax,  although  they  are 
in  every  other  way  subject  to  the  innnigration  laws  just  as  any  other  aliens. 


PUBLIC    HKALTli    A:,i>    M AUlNK-IIOSl»ITAL    flERVIOE.  199 

lino  inspection  lik(>  tlio  stocrn^'o.  Stoci-njxc  ]>iiss<Miij;('i-s  arc  t'Xiiniin«>(l  in  tlic 
sp.-u-e  sot  apart  f(ir  tin-  i)Ui|iiiso  on  tlio  (loclcs,  cxcoiil  in  I  he  case  of  ilic  Allan 
Lino.  Thoso  stcora^o  iiassoiij^ors  arc  (vxaniinod  on  (lio  ship's  deck,  as  nn'dical 
oxamination  is  a  physical  iniijossihility  in  the  place  on  the  dock  provided  for 
tho  purpose." 

Former  arrangements  ollered  for  the  medical  oxandnation  at  the  Cunard  do<'k 
wore  remodeled  early  in  I'.Xi,'!.  The  facilities  now  jjrovided  there  for  the  pri- 
mary line  inspection  are  very  satisfactory  with  respect  to  li.i,'ht  and  space,  hut 
the  provisions  for  handlinjjc  and  examinin.i;  those  turned  aside  are  wholly  inad- 
equate with  th(>  present  class  of  travel.  Tho  conditions  under  which  the  medical 
oxamination  must  he  conducted  at  the  White  Star  IJn(>  dock  are  almost  intoler- 
able for  passen,i;ers  and  medical  exannner  alike.  I'lans  which  wo(dd  improve 
the  conditions  there  wore  ai^roed  to  by  tho  P.oston  and  Main(>  Itailroad,  the 
owner  of  the  proi)erty.  over  a  year  a.t;o  and  incorjiorated  in  general  plans  for 
alterations  in  tho  dock.  Work  on  these  alterations,  which  since  then  it  has 
been  expivtod  would  commence  from  week  to  week,  is  not  yet  Itejiun.  In  addi- 
tion to  the  lines  above  mentioned  and  the  Canadian  lines,  there  is  a  roi^ulai- 
passenger  service, from  West  Indian  i)()rts.  Alien  i)assen.i;ors  in  small  number 
are  also  constantly  arrivinj;  by  various  rofjidar  lines  and  by  tram]>  ships. 

Superiority  in  quality  is  no  lon.i^iu"  characteristic  of  the  inimiirratiou  at  this 
port,  and  durini;  the  past  year  the  inade(iuacy  of  tho  facilities  for  conductiui,' 
the  medical  oxamination  has  Ikhmi  enq)liasized  by  the  increasinj?  lunnbors  it 
has  boon  found  necessary  at  tho  line  insi)ection  to  turn  asi(l(>  for  special  examina- 
tion. On  a  recent  ship  20  per  cent  of  the  total  stoora.s^e  passen^'ers  wore  thus 
"  turned  off  the  lino."  To  some  extent  this  low  physical  standard  is  the  out- 
come of  the  extension  of  the  business  of  the  British  linos  into  continental  terri- 
tory, but  there  also  seems  to  be  a  decided  increase  in  the  jihysically  and 
mentally  defective  from  Groat  Britain  and  Ireland  as  well.  With  a  slight 
decrease  in  total  inmii.cration,  the  number  of  certificate  cases  for  the  past  year 
was  513.  as  conqiarod  with  o08  for  the  previous  year.  This  sain  in  certificate 
cases  should  not.  however,  bo  taken  as  moasurin,;;  the  extent  of  tlie  deterioration 
in  the  immigration.  Such  deterioration  woidd  be  better  shown  by  the  increased 
instances  of  physical  inferiority,  without  actual  disease,  which  claim  the  atten- 
tion of  the  medical  examiner  and  are  turned  over  to  the  immigrant  inspectors 
witli  notations  on  the  identification  cards,  after  the  manner  above  described. 

ITnder  the  stimulatit)n  of  fines  for  bringing  certain  diseases,  there  has  l)een  a 
decided  improvement  (whether  permanent  or  not  remains  to  be  seen)  in  the 
methods  for  securing  a  proper  medical  examination  of  prosjiective  inunigrants 
prior  to  embarkation.  Exannnation  processes  have  not  only  been  inqiroved  at 
seaports  of  departure,  Init  marked  efforts  have  l)een  made  as  w<'ll  to  insure 
more  effective  measures  for  eliminating  unprofitable  risks  at  interior  liooking 
points  and  central  stations. 

Most  of  the  cases  of  easily  discoverable  diseases  or  moi-e  serious  physical 
defects  now  found  liore  on  arrival  have  been  accepted  for  passage  as  good  busi- 
ness risks  in  spite  of  the  disease  or  defect.  Not  infrequently  such  passengers 
are  required  to  make  a  deposit  of  a  sum  sufliciont  in  amount  to  pay  the  steam- 
ship conqiany  for  the  return  passage  in  the  event  of  permission  to  land  being 
refused  here,  and  in  two  recent  instances  of  lilopharitis  and  ectropion,  due  to 
old  tear-duct  trouble,  it  was  found  that  deposits  of  $100  had  also  boon  exacted 
to  cover  the  fine  in  case  the  condition  should  be  pronounced  trachoma  on  arriv:il 
here. 

The  accuracy  of  tlie  judgment  of  the  representatives  of  the  transportation 
lines  in  these  matters  is  well  shown  by  the  fact  that  only  about  one-fifth  of  the 
certificate  cases  were  actually  excluded  at  this  port  during  tho  year  and  that 
the  total  certificate  cases  deported,  numbering  10(J,  represented  only  one  alien 
for  every  800  landed.  To  accomplish  this  result  it  is  also  doubtless  true  that 
the  transportation  companies  refused  many  risks  which  might  have  been  prof- 
itably accepted  for  passage. 

Trachoma. — That  the  increased  prominence  of  the  continental  immigrant 
has  been  acconq)aniod  by  no  greater  aggregate  increase  in  trachoma  cases  is 
undoubtedly  duo  to  the  recent  improvement  in  medical  examination  at  British 
ports.  The  lial)llity  to  fines  for  bringing  cases  of  this  disease  leads  the  repre- 
sentatives of  the  steamship  conq^anies  throughout  Europe  to  take  few  chances, 
and  although  it  is  customary  for  those  concerned  to  refer  all  refused  passage 
on  account  of  abnormal  appearance  of  the  eyes  as  "trachoma  cases"  Avithout 

1  This  dock  has  since  Inirned. 


200 


PUBLIC    HEALTH    AND    MARINE -HOSPITAL    SERVICE. 


qualification,  many  of  them  are  unquestionably  eye  affections  of  a  very  tem- 
porary and  trivial  character.  Many  of  these  so  rejected  are  subsequently 
accepted  by  the  same  or  another  line.  In  the  latter  instance  notification  of 
the  sailing  of  a  case  of  "trachoma"  by  a  rival  line  is  likely  to  reach  us  in 
advance  of  the  passenger's  arrival.  I  do  not  recall  a  single  instance  during  the 
past  year  when  such  a  case  has  turned  out  on  arrival  to  be  even  suspicious. 
This  pc)licy  at  ports  of  eml)arkation  with  respect  to  eye  affections  has  vir- 
tually eliminated  at  this  port  that  tj'pe  of  cases  whose  diagnosis  is  sometimes 
u  very  difficult  matter.  I'ractically  all  cases  of  trachonja  now  being  found 
here  are  well  pronounced,  suggesting  either  successful  evasion  of  a  medical 
examination  at  the  port  of  embarkation  or  acceptance  for  passage  because  of 
belief  of  United  States  citizenship.  This  cautious  i)olicy  perhaps  also  accounts 
for  the  remarkable  infrequency  among  arrivals  at  this  port  of  cases  of  mild 
catarrhal  (?)  conjunctivitis,  which  are  apt  to  be  so  common  among  steeragi- 
passengers. 

In  further  connection  with  this  disease  it  may  be  observed  that  out  of  the  04 
cases  certified  10  were  cal)in  passengers  and  7  were  either  discovered  stowaways 
or  members  of  the  crew  foolishly  applying  for  discharge  instead  of  deserting. 

Disposition  of  detdined  iinniitirants. — In  connectitm  with  the  amiual  report 
of  detained  immigrants,  transmitted  herewith,  it  will  be  observed  that  out  of 
G21  certificate  cases,  representing  only  the  worst  instances  of  physical  and  men- 
tal shortcomings  among  those  arriving  during  the  year,  41.">  were  released.  The 
list  of  those  released  includes  32  out  of  the  i'A  cases  of  trachoma  detained,  and 
in  explanation  it  may  be  stated  that  while  probably,  without  exception,  the  .32 
cases  of  trachoma  released  were  immigrants,  in  that  they  had  never  been  in 
the  country  before  and  were  coming  here  for  permanent  settlement,  they  were 
able  to  show  conclusively  after  arrival  that  they  were  either  the  wives  or 
minor  children  of  naturalized  citizens  of  the  United  States,  and  therefore 
exempt  from  the  application  of  the  immigration  laws.  Others  were  iuial)le  to 
substantiate  the  same  claims  and  were  deported.  No  alien  afflicted  with  tra- 
choma was  ijcinuitted  to  land  or  was  held  for  treatment  at  this  port  during  the 
year. 

Out  of  440  cases  certified  for  conditions  not  specifically  excludable  by  law. 
except  as  they  might  be  regarded  as  aliens  "  likely  to  become  a  public  charge," 
all  but  70  were  allowed  to  land. 

Below  are  given  the  results  in  two  groups  of  cases  in  which  the  condition 
certified  practically  jtrecludes  the  possibility  of  self-support. 

(1.) 


Very  defective  vision  (caiises  other  tban  remediable  refractive  errors) . 

Blindness,  total .._ - - -. 

Cataracts,  both  eyes — --- 

Chronic  keratitis - -- 

Blindness,  total  and  partial  paralysis 

Nearly  blind  and  deafness 

Defective  vision  and  general  debility  ._ 

Glaucoma 

Total - -- - 


Certified.    Released. 


1.5 

9 

1 

7 

19 

17 

12 

10 

1 

1 

1 

1 

1 

1 

1 

1 

47 


(2.) 


Mentally  unbalanced - 

Mental  and  physical  weakness. 

Neurasth'-nia - 

Neurasthenia  and  disea,sed  spinal  cord 

Paralysis,  incomplete  and  mental  deficiency 

Spastic  paralysis  and  mental  deficiency 

Bysteria 

IiuVjecility 

Imbecility  and  lameness .-- 

Mental  dullness  and  chronic  anaemia 

Total - ..-. 


PUBLIC  h7<:altii  axd  marine-hospital  service.        201 

In  ronnoction  with  the  roloaso  of  the  ahovo  cases  tlie  followinjj:  facts  may 
he  noted:  In  few.  if  any.  of  the  cases  cited  did  the  matter  of  citizensliiit  arise. 
Practically  all  were  deemed  hy  the  legally  constituted  authority  to  he  aliens 
lawfully  entitled  to  admission  into  the  Hnited  States.  Nont'  was  adndtted  on 
the  judfiment  ot  an  individual  inimigrant  inspector.  All  i-ame  hefore  a  hoard 
of  sjK'cial  iniiuiry,  :i  i^ood  proportion  came  u)»  to  the  Secretary  of  Commerce  and 
r^ahoi"  on  appeal  I'roiii  an  adverse  decision  of  lliis  hoaril,  and  many  wei'c  jn'r- 
mitted  to  land  only  after  tiie  njiproval  and  acceptance  l»y  the  Department  of  a 
honded  j,'uaranty  deemed  sullicient  hy  the  Dt'partment  to  remove  the  possiiiility 
that  the  alien  in  (jnestion  would  hecome  a  puhlic  charjie.  The  certificate  of 
the  examinin,!.';  medical  ollicer  furnished  the  means  which  enahled  the  immij;ra- 
tion  authorities  to  exact  pui)lic  protection  in  the  shape  of  such  honded  guaranty. 
In  a  good  i)roportion  of  these  cases,  owing  to  maintenance  charges  pending 
final  decision,  no  direct  jjrotit  resulted  to  the  steamship  company  from  their 
accei)tance  for  passage.  The  disposition  nnide  of  these  cases  well  illustrates 
the  fact  that  i)liysical  or  mental  disability  does  not  per  se  constitute  a  legal 
ground  for  excluding  a  ikm-sou  from  landing.  That  such  a  lai'g<>  i»roi)ortion  of 
the  seriously  defective  were  landed  is  due  to  the  fact  that  such  defects  are 
usually  ohviims  and  the  jx-rsons  are  accei)ted  for  i)assage  oidy  because  of  good 
assurance  that  they  will  be  able  to  overcome  the  ol»stacles  in  the  way  of  their 
lauding.  The  notations  made  on  identiiication  cards  of  less  serions  defective 
conditions,  when  combined  with  poor  individual  prospects,  are  perhai)s  more 
likely  than  formal  certificates  to  serve  as  the  factor  which  determines  the 
exclusion  of  an  alien,  because  less  serious  physical  defects  are  more  apt  to  he 
overlooked  at  the  time  of  acceptanc  e  for  passage. 

Hospital  cttiTS. — During  the  past  year  211  aliens  have  been  sent  to  hospital 
on  arrival  or  while  under  di'tention.  The  nnniber  of  hospital  cases  for  the 
previous  year  was  125.  The  immigration  service  at  this  port  is  as  yet  unable 
to  secure  either  adetjuate  (iuai"ters  under  its  own  control  or  a  formal  contract 
with  local  hospitals  to  care , for  aliens  not  yet  landed.  Arrangements  for  treat- 
ment are  therefore  still  made  sei)arately  in  each  case  as  it  arises.  Bills  for 
hospital  maintenance  are  rendered  directly  to  the  steamship  company  concerned. 
With  respect  to  noncontagious  cases  no  trouble  has  been  found  in  securing 
l)romi)t  removal  and  good  care  for  our  cases,  hut  it  has  thus  far  been  found 
impossible  to  secure  a  prompt,  Imsinesslike  arrangement  for  the  removal  and 
treatment  of  cases  of  contagious  or  communicable  diseases,  particularly  those 
developing  among  the  detained  passengers.  Owing  to  the  necessity  of  making 
different  arrangements  for  the  various  classes  of  cases,  it  has  happened  that 
for  the  greater  portion  of  the  year  passengers  detained  by  the  medical  examiner 
were  to  he  found  distributed  in  seven  ditJerent  institutions  in  this  vicinit.v. 
Acute  contagious  diseases  are,  of  course,  left  entirely  to  the  hospital  authorities, 
but  in  order  that  aliens  "may  he  promptly  landed  or  deported"  the  medical 
examiner  is  obliged  to  keep  posted  on  the  condition  of  patients  in  at  least  three 
or  four  different  hospitals. 

Landed  cases. — During  the  past  year  397  aliens  who  had  been  less  than  two 
years  in  the  United  States  were  reported  to  this  office  by  the  Massachusetts 
State  hoard  of  charity  to  be  inmates  of  various  hospitals  and  institutions  in  this 
State.  By  virtue  of  a  si)ecial  contract  between  the  State  of  Massachusetts  and 
the  United  States,  the  latter,  through  the  Bureau  of  Immigration,  is  lial)le  for 
maintenance  charges  in  such  cases  at  the  rate  of  ^~t  per  week.  Each  case  so 
reported  is  investigated  by  the  TTnited  States  connnissioner  of  innnigration  at 
Boston,  and  bills  are  rendered  through  this  office  whether  the  alien  may  have 
entered  the  United  States  at  this  port  or  elsewhere.  A  majority  of  these  cases 
are  accidents  or  acute  diseases.  In  cases  of  a  chronic  nature  or  of  permanent 
disability  the  United  States  can  only  terminate  its  liability  for  maintenance 
charges  by  deporting  the  alien.  As  an  alien  can  not  be  deported  against  his  will, 
unle.ss  he  has  become  a  public  charge  from  causes  existing  i)rior  to  landing,  the 
medical  aspect  of  these  cases  is  often  of  considerable  imiiortance.  It  is  the 
practice  of  the  connnissioner  to  refer  these  cases  to  me  for  opinion  as  to  whether 
causes  were  prior  or  subsequent  to  landing.  Generally  the  reports  of  the  inmii- 
grant  inspector  who  investigates  the  case  and  the  statement  of  the  attending 
hospital  physician  are  sufficient  to  determine  this  matter.  When  information 
from  these  sources  seems  inconclusive  I  am  accustomed,  on  the  request  of  the 
commissioner,  to  visit  the  institution  and  make  a  personal  investigation.  Out 
of  the  397  cases  thus  reported  during  the  year,  18G  landed  at  the  port  of  New 


202  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

York,  173  at  the  port  of  Boston,  and  38  at  Aarious  other  ports  of  the  United 
States  or  Canada.  About  ~>0  iier  cent  of  the  total  annual  inmiliJrratlon  to  the 
State  of  Massachusetts  enters  the  country  at  the  port  of  Boston.  Twenty-five 
of  the  above-mentioned  cases  landed  at  this  jiort  were  deported  as  pul>lic  charges 
from  causes  existing  prior  to  lauding..  The  reasons  for  deportation  were 
reported  as  follows : 

Cases. 

Insanity  10 

Pulmonary   tuberculosis 3 

Epilepsy  1 

Rheumatism    2 

Pregnancy   3 

Appendicitis    2 

Laceration  of  pelvis 1 

Hernia    ^ 1 

Venereal  disease —       1 

Typhoid  fever 1 

Total 25 

In  this  connection  it  may  be  stated  that  out  of  the  397  cases  reported  37  were 
eases  of  insanity,  24  having  landed  at  New  York,  11  at  Boston,  and  2  at  other 
ports  of  entry.  Proliably  other  recently  arrived  aliens  whose  landing  could  not 
be  verified  became  inmates  of  insane  asylums  in  this  State  during  the  year.  It 
is  equally  probable  that  few  of  those  becoming  insane  had  had  previous  attacks 
of  insanity  or  presented  definite  symptoms  of  insanity  at  the  time  of  arrival. 
Hundreds  of  arriving  aliens  may  be  seen  at  this  port  in  the  course  of  the  year 
who  show  unmistakable  signs  of  a  poor  nervous  organization,  yet  without  offer- 
ing any  definite  symtonis  on  which  an  excluding  decision  could  be  based.  Some 
of  these  meet  in  their  new  and  strange  environment  conditions  which  prove  too 
much  for  their  mental  balance,  Imt  the  great  majority  never  become  insane. 

DcirniU>n  stcition. — During  the  past  year  the  Immigration  Bureau  fitted  up  a 
portion  of  the  second  story  of  the  wharf  shed  at  Long  Wharf  to  provide  quar- 
ters for  detained  passengers,  thus  relieving  the  steamship  companies  of  their 
custody.  These  quarters  were  first  occupied  early  in  March  of  this  year.  The  pri- 
mary innnigration  examination  and  the  special  inquiry  hearings  are  gone  through 
witli  at  the  various  docks,  just  as  formerly,  but  passengers  then  remaining  de- 
tained are  transferred  to  the  detention  station,  with  the  exception  of  cases  of 
contagious  or  communicable  diseases.  The  counuissioner  still  refuses  to  remove 
from  the  custody  of  the  steamship  company  cases  of  trachoma,  ringworm,  or 
any  other  form  of  communical)le  disease  except  pediculosis. 

During  the  months  of  March,  April,  and  May  it  was  found  necessary  to 
accommodate  constantly  at  the  detention  quarters  much  larger  numbers  than 
previous  exi>erience  at  this  port  gave  any  reason  to  expect.  During  this  time 
the  health  of  the  detained  was  notably  bad.  Foi-ty-five  were  sent  to  hospital  for 
various  diseases,  and  cases  of  tonsilitis.  bronchitis,  and  catarrhal  conditions  sug- 
gestive of  an  epidemic  nature  were  continuously  prevalent.  The  quarters  were 
kept  scrupulously  clean  and  all  blankets  were  subjected  to  a  steam  disinfection 
twice  a  week.  The  sickness  seems  attributable  to  overcrowding,  overheating, 
and  lack  of  ventilation.  A  roof  garden  has  since  been  constructed  and  some 
other  changes  are  contemplated  which  may  improve  the  sanitary  condition  of  the 
station. 

A  matter  which  also  gave  serious  concern  during  the  spring  arose  from  the 
fact  that  no  arrangement  could  be  made  with  the  municipal  health  authorities 
which  would  insure  the  removal  of  a  contagious  case  before  everybody  else  in  the 
quarters  was  exposed  to  the  disease.  Effective  isolation  of  a  suspicious  or  con- 
tagious case  within  the  limits  of  the  space  controlled  by  the  immigration  authoi-- 
ities  is  impossible  and  can  not  be  made  otherwise.  Any  increase  in  the  height 
of  the  present  structure  is  prevented  l)y  city  ordinances. 

Pursuant  to  section  808  of  the  Regulations  of  the  Public  Health  and  Marine- 
Hospital  Service  I  have,  whenever  requested,  given  advice  on  sanitary  matters 
relating  to  the  detained,  both  prior  and  subsequent  to  the  construction  of  the 
present  detention  quarter.s.  I  have  also  attempted  to  undertake  the  professional 
care  of  cases  of  sickness  occurring  in  the  detention  quarters,  but  it  is  clearly 


PUBLIC    HEALTH    AND    MARIN K-IIOSPITAL    SERVICE. 


203 


evident   tli.it   I    cmii   not   conlinno  to  do  so   withont   ;it    times   nc^loctinjx   woric 
directly  connected  witli  (li(>  niediciil  inspection  of  arriviii};  iiliens. 

I  wish  to  t.ilve  tliis  occasion  to  express  my  appi-cciation  of  the  constant  efforts 
of  tlie  commissioner,  ("ol.  (;eor.i,'e  1>.  I'.illinLCs.  and  Iiis  dejjnty,  Mr.  J.  J.  Ilnrley,  to 
facilitate  the  work  of  the  medical  I'xamination  and  to  mal<<^  it  serve  the  i)nrpose 
for  wliicli  it  is  intended.  It  is  only  by  tlieir  assistance  and  the  intellij,'ent  cooj)- 
eration  of  every  inspector  attached  to  this  station  that  I  have  been  able  to  main- 
tain an  etiicient  URHlical  examination  under  couditions  that  are  often  far  from 
ideal. 

Respectfully,  M.  Victor  Safford. 

Actinij  Asfsistunt  tiurgcon. 

The  Surgeon-General. 


[Inclosiire.] 

Report  of  inspection  of  alienti  at  port  of  Boston,  Mass.,  during  the  year  ended 

June  30,  lUUJf. 


Month. 

Number 

in- 
spected. 

Number 
certified. 

Number 

de- 
ported. 

Cause  of  deportation. 

1903. 
Jnly             

6,274 

7,974 
12,5:^5 
8,334 
4,400 
2,740 

1,898 
2,885 
7,487 
11,926 
7,885 
5,679 

50 
61 
54 
.56 
27 
12 

25 
19 
30 
60 

73 
46 

9 
17 

(i 
15 

3 

5 

9 

10 
7 

10 
9 
6 

Prohibited  diseases,  3;  likely  to  become  public 

charges,  G. 
Prohibited  diseases,  5;  likely  to  become  public 

charges,  12. 
Prohibited  diseases,  3;  likely  to  become  public 

charges,  3. 
Prohibited  diseases,  8;  likely  to  become  public 

charges,  7. 
Prohibited  diseases,  0;  likely  to  become  public 

charges,  3. 
Prohibited  disease,  1;  likely  to  become  public 

charges,  4. 

Prohibited  diseases,  2;  likely  to  become  public 

charges,  7. 
Prohibited  diseases,  6;  likely  to  become  public 

charges,  4. 
■  Prohibited  diseases,  8;  likely  to  become  public 

charges,  4. 
Prohibited  diseases,  3;  likely  to  become  public 

charges,  7. 
Prohibited  disease,  1;  likely  to  become  public 

charges,  8. 
Prohibited  disease,  1;  likely  to  become  public 

charges,  5. 

August 

September 

October        

November 

December 

1904. 
January    . . 

Febriiar  V 

March  _ 

April 

June« 

Total 

80,017 

513 

106 

Prohibited  diseases,  36;  likely  to  become  public 
charges,  70. 

"  On  May  1  the  inspection  of  aliens  from  Canadian  ports  was  transferred  to  the  Cana- 
dian port  of  embarkation.     Above  liguros  for  May  and  .Tune  do  not  include  such  aliens. 

'SI.  V.  Saffori), 
Acthuj  Assistant  Surgeon,  -a 


204 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 


CHARLESTON. 


Report  of  insjjection  of  aliens  at  port  of  Charleston,  S. 
June  30,  1904,  ^W  Acting  Asst.  Surg.  F. 


C. ,  during  the  year  ended 
F.  Sams. 


Month. 

Number 

in- 
spected. 

Number 
certified. 

Number 

de- 
ported. 

Cause  of  deportation. 

1903. 
July 

0 
5 
2 

1 
1 
0 

7 
8 
1 
0 
0 
0 

0 
0 
0 
0 

1 
0 

1 

0 
0 
0 
0 
0 

0 
0 
0 
0 

1 
0 

1 
0 
0 
0 
0 
0 

August               

September  _ 

November 

December 

1904. 
January  

Tubercle. 

Valvular  disease  of  heart. 

February 

Marp.h 

May 

June 

Total 

2.5 

2 

2 

The  Surgeon-General. 


F.  F.  Sams, 
Acting  Assistant  Surgeon. 


EAGLE   PASS. 

Report  of  inspection  of  aliens  at  port  of  Eagle  Pass,  Tex.,  during  the  year  ended 
June  30,  1904,  by  Acting  Asst.  Surg.  Lea  Hume. 


Month. 

Number 
inspected. 

Number 
certified. 

Number 
deported. 

Cause  of  deportation. 

1903. 
July         

110 
150 

105 
109 
122 
102 

130 

147 

123 

164 

162 
195 

5 
15 

3 
3 

7 
2 

8 

8 

5 

19 

5 
16 

5 
15 

3 
3 

2 

8 

8 

5 

19 

5 
16 

Trachoma,  4;  blind,  1. 

Trachoma,  2:  tuberculosis,  7;  cripple,  1; 

September 

Oct(jber 

epithelioma,  1;  paralysis,  1;  pertussis,  1; 

deaf,  1;  idiocy,  1. 
Tuberculosis,  1;  deaf,  1;  senile,  1. 
Trachoma,  1;  idiocy,  2. 

November 

December 

1904. 
Januarv  -- 

Trachoma,  3;  feeble-minded,  2;  lunatics,  2. 
Senile,  1;  trachoma,  1. 

Acute  conjunctivitis,  1;  trachoma,  3;  blind. 

February  

1;  idiocy,  1;  lunacy,  1;  leprosy,  1. 
Trachoma,  1;  blind,  2;  paralysis,  1;  deaf,  1; 

March 

lunacy,  2;  senile,  1. 
Trachoma,  1;  blind,  1;  tuberculosis,  1;  se- 

April   

nile,  2. 
Trachoma,  16;  feeble-minded,  1;  lunacy,  1; 

Ma  V 

senile,  1. 

Cripple,  2;  lunacy,  1;  senile,  2. 

Blind,  2;  cripple,  3;  feeble-minded,  1;  lu- 
nacy, 2;  senile,  8. 

June 

Total 

1,619 

96 

96 

Respectfully, 
The  Surgeon-Geneeal. 


\ 


Lea  Hume. 
Acting  Assistant  Surgeon,  in  Charge. 


rU15LT(;    IlKALTH     .\  N  I )     M  A  KI  NIMK  )S|'ITA  L    SKKVICK 


205 


EL    I'ASU. 
Report  hy  Actinc  Asst.  Sukc;.  E.  Ai.kxa.ndkr. 

Public   IIioAi/ni   a.nd   Marine-IIosimtai,   Skkvkk. 

Oi'KicK  oi'  Medical  Officer  in  ("ommand. 

/;/  I'uso,  Tc.i:,  .June  SO,  J!IO.',. 
Sir:  I  liavo  the  lioiior  to  transmit  licrcwitli  suniniary  of  iiispoction  of  iiuinl- 
,'rants  at  this  port  from  July  1,  1!>0:',,  to  June  .".O,   1004. 


Mexi- 
cans. 

Syrians. 

Chinese. 

Mexi- 
cans in 
bond. 

Deten- 
tions. 

Re- 
turned. 

July 

1903. 

349 

496 
413 
377 
a52 
364 

32T 

297 
171 

:m 

26 
297 

2 
6 
9 
9 

12 
3 

12 
8 

August        ..     -- 

Septemtor  ... 
October  

1904. 

1 

November.. 

15 
66 

313 

258 

18« 

2 

Dccembei' 

17 

1 

r 
11 

1 

January   .  .. 

February 

March 

4 
2 

April    

May 

2 

June 

1 

1 

1 

Total  ... 

3,793 

64 

2 

840 

41 

3 

Detentions  from  one  to  three  days;  having  arrived  during  the  prevalence  of 
jellow  fever  and  smallpox  in  Mexico,  and  being  out  less  than  five  days  from  the 
infected  points. 

Respectfully,  E.  Alexander. 

Acting  Assistant  Surtjcon. 
The  Surgeon-General. 


KEY   WEST. 


Report  of  iniviiqrants  inspected  at  the  port  of  Key  West,  Fla.,  during  the  fiscal 
year  ended  June  SO.  ID04,  by  Passed  Asst.  Surg.  C.  H.  Gardner. 


Month               Number 
Mo'^**!-             inspected. 

Number 
certified. 

Number 
depoi-ted. 

Cause  for  deportation. 

1903.  1 

July '                  0 

August 0 

September '                 0 

October 0 

NovemVjer 0 

December 1 

1904.  i 

.January 1                 5 

February .1                  2 

March 1                  1 

April '                  1 

0 
0 
0 
0 
0 
0 

2 

1 
1 
1 
5 
1 

0 
0 
0 
0 
0 
0 

2 
1 

1 
1 
1 
0 

Class  II  (1),  Class  IV  (1). 
Class  IV. 
Class  IV. 
Class  IV. 

May 7.52 

June 4 

Class  I. 

Total 766 

1 

11                      6 

The  Subgeon-Oeneral. 


C.  H.  Gardner. 
Passed  Assistant  Surgeon. 


20(i 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


LAREDO. 

Report  of  inspection  of  aliens  at  2^ort  of  Laredo,  Tex.,  during  the  year  ended 
June  30,  1004,  by  Acting  Asst.  Surg.  H.  J.  Hamilton. 


Month. 


Number      Number 
inspected. ;  certified. 


Number 
deported. 


Cause  of  deportation. 


1903. 


July 

August - 


215 


320 


September. 

October 

November . 
December  . 


10 


1904. 
January  ... 
February  .. 

March 

April 

May 

June 


Total. 


163 
39 
150 
128 
61 
75 


10 


l,:a5 


Trachoma,  6;  catarrhal  opthalmia,  2;  am- 
aurosis (right  eye),  pannus  (left  eye).  1: 
left  eye  destroyed,  meibomian  cyst  of 
lid.  1. 

Trachoma,  6;  gonorrhea,  3;  catarrhal  op- 
thalmia,  3;  loss  of  1  eye,  senile  debility, 
2;  alcoholism,  senility,  1;  juvenile  age,  1; 
ankylosis  right  elbow,  ankylosis  fingers 
right  hand,  1. 

Trachoma.  2. 

Nothing  to  report. 

Trachoma,  1;  gonorrhea,  1;  total,  2. 

Trachoma,  3;  alcoholism,  1;  favus,  1. 


Idiocy  (congenital) ,  1;  amaurosis,  1. 
Nothmg  to  report. 

Do. 
Trachoma,  i. 
Nothing  to  report. 

Ti"achoma,  4;  blind  and  partial  paralysis 
left  side,  1. 


The  Slkgeox-Gexekal. 


H.   J.   H.\MILTO.\. 

Acting  Assistant  Surgeon. 


LOS  ANGELES. 


Report  of  inspection  of  aliens  at  port  of  Los  Augeles.  Cal.,  during  the  year  ended 
June  -JO,  1904,  %  Acting  Asst.  Surg.  M.  H.  Ross. 

Inspected    1,081 

0 


Deported 


The  Subgeon-Genebax. 


M.  H.  Ross, 
Acting  Assistant  Surgeon. 


M ALONE. 

Report  of  inspection  of  cdiens  at  port  of  Malone,  X.  Y..  during  the  year  ended 
June  30,  1004,  by  Acting  Asst.  Surg.  S.  D.  Williamson. 


Month. 

Number 
inspected. 

Numljer 
certified. 

Number 
deported. 

Cause  of  deportation. 

1903. 
July 

Trachoma,  2. 

Pulmonary  tuberculosis,  1;  trachoma, 

Trachoma,  5. 

Trachoma,  1. 

Trachoma,  1, 
Trachoma.  1. 

September 

October      

106 
100 
190 
32 

45 
31 

12 
53 

48 
80 

4 
10 

7 
.    1 

0 
0 
0 
0 

1 

2 

2 
9 
5 

1 

0 
0 
0 
0 

1 
1 

8. 

November 

December 

1904. 
Januarv       

March          .    

April 

May 

June 

Total 

697 

25 

19 

S.  D.  Williamson, 
Acting  Assistant  Surgeon. 


The  Subgeon-Genebal. 


IMTBLIC    HEALTH     AND    MARINE-HOSI'ITAL    SKliVK'K.  207 

MOBILE. 


BtjKivt  of  i)is])ection  of  ulieiis  at  the  port  of  Mobile,  Alo.,  fltiriiir/  the  year  ended 
June  oO,  r.Ki.',,  hji  Actintj  Atist.  Surg.  J.  Greij  Thomas',  jr. 


Month.              Number 
inspectod. 

Number 
certified. 

Number 
deported. 

Cause  of  deportation. 

1903.              ' 
July 5 

5 
6 
3 

1 
14 
10 

11 

•s» 

53 
35 
45 
24 

August 6 

September 3 

October 1 

November 14 

December 10 

1904. 
January 11 

February SJ 

March 53 

April 36 

May 45 

June 24 

Total 240 

240 

The  Sukoeox-Cteneral. 


J.  Grey  Thomas,  Jr., 
Acting  ^issistaiit  Surgeon  in  teniporanj  charge. 


NEW    ORLEANS. 


Report  of  inspeetiou  of  aliens  at  port  of  New  Orleans,  La.,  during  the  year  ended 
June  30,  lUU^,  by  Siirg.  C.  P.  Wertenbaker. 


Month.           |NJ^-J-. 

Number 
certified. 

Number 
deported. 

Cause  of  deportation. 

1903. 
July.- 

August 

September 

October 

68 

70 

131 

2,226 

239 

101 

130 
598 
234 

203 

1,028 
204 

1 

0 
0 

17 
4 

1 

0 
7 
3 
0 
5 
0 

1 

0 
0 
0 
2 

aO 

0 

bO 

0 

0 

1 
0 

Suppurative  inflammation  of  middle  ear, 
and  poor  physique. 

November 

December --. 

1904. 

January -.. 

February ._ 

March 

Suppurating  wound  right  forefinger,  1; 
lameness;  recent  fracture  of  wrist,  1. 

April 

May 

Favus  of  scalp. 

June 

Total 

5,232 

38 

04 

"  Patient  at  Charity  Hospital   landed  within  one  year,  ordered  deported,  but  escaped 
from  hospital. 

''  One  case  of  trachoma  certified  and  ordered  deported  escaped. 
'  Two  more  cases  ordered  deported,  but  escaped. 


The  Subgeon-Genebal. 


C.  P.  Wertexbaker,  Surgeon. 


208 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


NEW   YORK. 

Report  of  inspection  of  aliens  at  port  of  New  York  during  the  year  ended  June 
SO,  1904,  l>y  Surg.  George  W.  Stoner. 


1 

c 

fit 

a 

s 

Number  certified. 

u 

o 
ft 

Hi 

.a 

a 
1 

Cause  of  deportation. 

Class  I. 

Class  II. 

Class  III.       PjY^ 

Mouth. 

5 

o 

a 
% 

•3 

t-H 

a 

■ft 

> 

.2 

1 

02 

Gonorrhea. 

Extensive 
chancroids. 

All  other  dis- 
eases and 
injuries. 

190.3. 
July 

49,214 

49,894 
57,7.58 
60,482 
5.3,277 
34,237 

23,129 

28,067 
65,316 
73, 177 

79, 7(H) 
59,  .560 

480 
491 
525 
478 
410 
276 

241 
316 
390 
361 
:«1 
473 

274 
130 
97 
93 
92 
62 

61 
54 
118 
168 
100 
119 

179 
54 
37 
61 
42 
44 

47 
32 
.55 
107 

58 
40 

2 

6 
2 
3 
1 

1 

...J    1          &5 

August _.. 

September 

2 
2 

1 
1 
2 

1 

.... 

1  1    1 

1 

69 
54 
30 
46 

October.. _ 

November 

2  1 

1 

December 

|--- 

1 

1 

1 

2 

I 



14 

1904. 
Januarv  

1 

12 

February _ 

1 

1 

"2" 

3 

1 
3 
5 
3 

3 

2 

17 

March 

4 
3 

2 

1 

47 

April _.. 

Z? 

49 

May _ 

34 

June 

1 

I 

(:8 

Total 

633,811 

4,802 

1,368 

756 

10 

22 

12 

3    28 

' 

3 

2 

5;;5 

The  Surgeo>'-Gexei{al. 


Gkokge  W.   Signer,  ,Sur(/eon  hi  (Jomniand. 


NOGALES. 


Report  of  inspection  of  aliens  at  the  port  of  Xof/ales,  Ariz.,  during  the  year 
ended  June  30,  lOOJ/,  by  Acting  Asst.  t'iurg.  A.  L.  Gnstetter. 

Inspected 1,202 

Rejected 


10 


Tlie    SURGE()N-(iENERAL. 


A.    L.    GUSTETTER. 

Acting  Assistant  Surgeon. 


PHILADELPHIA. 


Report  by  Asst.  Surg.  W.  A.  Korn. 


I'uiiLic  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Philadelphia.  Pa..  July  1,  1901,. 
Sir  :  I  have  the  honor  to  forward  a  report  of  the  transactions  at  this  station 
for  the  fiscal  year  ended  June  30,  1904,  as  follows : 

Immigrants  inspected 19.739 

Immigrants  certified 2(>4 

Immigrants  deported  24 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL   SERVICE.  209 

Ciniscs  of  (lci)urlation  and  nuiiihcr  of  cuscfi. 

Trnchoina H 

Favus 2 

Pulmonary  tuberculosis 1 

Hernia 2 

Pdor  pliysujue 2 

Burns  of  chest 1 

LiH'oniotor  ataxia 1 

Orchitis    1 

Valvular  disease  of  the  heart 1 

Varicocele   1 

Feoble-uiinded ] 

In  addition  to  the  above,  the  following: 

Landed  immigrants  examined  at  office 74 

Landed  innnigrants  examined  at  hospital 4:^."') 

Total  numltor  of  times  that  cases  at  hospital  were  visited \,~n'2 

Respectfully. 

W.  A.  KoR.\.  Assi.^tdiif  Siirr/ron. 

Respectfully  forwarded. 

Fairfax  Irwin,  Surgeon. 


PORT  TOWNSEND. 

Report  of  inspection  of  aliens  of   port  of  Port   Townsend  quarantine  from 
January  1  to  June  30,  1904,  t>y  Passed  Asst.  Surg.  J.  H.  Oakley. 


Mr,r.+»i               Number      Number 
^o"^*^-            inspected,    certified. 

Number 
deported. 

Cause  of  deportation. 

1903. 
Julv 



August           .          ' 

September 

1 

November 

December 

1904. 
January       .   

477 
316 
164 
153 

80 
488 

14 
4 
6 
5 
3 
6 

February 

March 

April 

May 

June 

Total 

1,678                   38 



The  Surgeox-Gexeral. 
8629—04 14 


J.  H.  Oakley, 
Passed  Assistant  Surgeon. 


210 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


RICHFORD. 


Rejiorf  of  intipection  of  aliens  at  port  of  Richford,  Vt. ,  during  the  year  ended 
June  SO,  1904,  by  Acting  Asst.  Surg.  J.  H.  Hamilton. 


Month. 

Number 
inspected. 

Number 
certified. 

Number 
deported. 

Cause  of  deportation. 

1903. 
July... 

August 

September 

October 

November 

December 

1904. 
January 

33 

47 
12 
14 
3 

4 
3 
1 

7 
4 
5 

1 
0 
0 
0 

1 

0 
0 

1 
1) 

1 
0 
0 
0 

1 

0 
0 

1 

n 

Trachoma. 
Do 

February 

March 

Do. 

April 

0  !                  0 

1  1 

June 

Do. 

Total 

133 

4                     4 

The  Surgeon-General 


J.  H.  Hamilton,  Acting  Assistant  Surgeon. 


SAN   FRANCISCO, 


Report  by  Asst.  Surg.  C.  E.  D.  liORD. 


Public  Health  and  Marine-Hospital  Service, 

Office  of  ^Medical  Officer  in  Command, 
^an  Francisco  Quarantine  Station,  Anf/el  Island,  CaJ.,  June  30,  1904. 

Sir  :  I  have  the  honor  to  transmit  herewith  report  of  the  medical  inspection 
of  immigrants  for  the  fiscal  year  ended  June  30,  1904. 

I  would  respectfully  call  attention  to  the  fact  that  a  majority  of  the  cases  of 
trachoma  were  amonj?  Chinese  en  route  to  INIexico,  Panama,  Peru,  and  British 
Columhia,  and  that  no  attempt  was  made  by  the  steamship  companies  to  keep 
such  aliens  separate,  while  on  board  ship,  from  those  destined  to  the  United 
States  and  who  had  been  carefully  inspected  at  port  of  departure  by  medical 
officers  of  this  Service,  so  as  to  prevent  the  embarkation  of  persons  afflicted  with 
this  disease.  Such  "  transit "  aliens  were  transshipped  at  San  Francisco  to 
American  vessels  and  carried  to  their  destinations. 

This  recognized  procedure  must,  in  great  measure,  nullify  the  effect  of  foreign 
medical  inspection  on  the  Pacific  so  far  as  dangerous  contagious  diseases  are 
concerned,  as  this  transit  disease  must  he  as  contagious  for  persons  bound  direct 
to  the  Ignited  States  as  any  other  trachoma. 

I  would  state  that  mnch  difficulty  has  been  experienced  in  completing  medical 
examinations,  esiiecially  in  cases  of  suspected  trachoma  and  tubei'cle  of  the 
lungs,  owing  to  the  stand  taken  by  the  conunissioner  at  this  port — that  the  medi- 
cal inspector  has  no  right  to  detain  aliens  for  the  purpose  of  observation  more 
than  a  few  days,  because  no  accommodations  have  been  provided ;  on  this  ac- 
count several  cases  detained  for  diagnosis  for  disease  of  the  eyes  and  disease 
of  the  skin  have  been  discharged  by  the  inspectors  before  a  reexamination  could 
be  made. 

The  conditions  existing  at  San  Francisco  render  it  necessary  for  the  medical 
Inspector  to  conduct  immigrant  medical  insjiection  in  conjunction  with  that  of 
the  Federal  quarantine  officers,  so  as  to  cause  the  least  jwssible  delay  to  com- 
merce. Advantage  is  taken  of  the  glandular  examination  made  by  these  officers 
to  discover  hernia,  varicose  veins,  and  eruptions  otherwise  concealed  by  the 
clothes. 

I  would  resijectfully  state  that,  at  the  request  of  the  commissioner,  the  crews 
of  all  foreign  vessels  and  seamen  on  American  vessels  shipped  at  foreign  ports 
are  examined  upon  arrival  and  a  provisional  certificate,  upon  which  are  noted 


PUBLIC    HEALTH    AND    MARINE-HOSl'ITAL    SJ:RVICK. 


211 


flic  iiainos  of  sucli  soaiuon  as  two  inoli!?il)le  for  landing  uiulor  the  immigration 
laws.  rondcriHl.  T'pon  proscntation  of  tliis  fortitieatc  witliiii  a  wct'lc  after 
arrival,  seamen  not  noted  on  the  eertilicate  are  passed  by  the  immi.i,'ration  ofR- 
eials  without  seeond  medical  exannnation.  If,  however,  more  than  a  we(Mv  has 
elapsed,  all  seamen  desirin.i:  dis('har;,'(>  are  referred  to  the  medical  officer  for 
examination.  This  procedure  doubles  the  number  of  inspections  at  this  station 
and  renders  dail.v  duty  from  sunrise  to  sunset  a  necessity. 

I  have  the  honor  to  state  that  it  has  b(>en  impossible  for  me  to  render  a  com- 
plete report  on  "  Number  deported,"  I)ecause  of  my  inability  to  obtain  such  data 
from  the  olHce  of  the  commissioner. 

Respectfully,  C.  E.  D.  Lord, 

Assistant  Surgeon. 

The  Surgeon-General. 


Respectfully  forwarded,  approved. 


Hugh  S.  Gumming, 
Passed  Assistant  Surgeon,  in  Command. 


[Inclosure.] 

Report  of  insj)ection  of  aliens  at  port  of  San  Francisco,  Cat.,  during  the  year 

ended  June  30,  1904. 


Month. 

Number 
inspected. 

Number 
certified. 

Number 
deported. 

Cause  of  deportation. 

1903. 
July 

1,251 
1,257 
1,755 
1,378 
1,639 
1,563 

1,053 
952 
941 
1,443 
2,186 
1,550 

34 
27 

37 
37 
60 
76 

17 
23 
13 
17 
22 
24 

August 

October 

November 

December  .      

1904. 
January  

February          

4 
5 
1 

4 

Trachoma,  2;  syphilis,  8 

March  . " 

April 

May - 

June 

Trachoma,  3;  syphilis,  1;  insanity,  1. 

Syphilis. 

Trachoma,  3;  tubercle  of  lungs,  1. 

Total 

16,968 

387 

14 

Class  "A"  certificates,  2,55,  of  which  208  were  for  trachoma,  3  tubercle  of  lungs,  4  syphillis,  36 
scabies,  4  insane.    Class  "  B  "  cei-tiflcates,  132. 

SEATTLE. 

Report  of  inspection  of  aliens  at  port  of  Seattle,  Wash.,  during  the  year  ended 
June  30,  1904,  i>y  Asst.  Surg.  J.  W.  Aviesse. 


Month. 

Number 
inspected. 

Number 
certified. 

Number 
deported. 

Cause  of  deportation. 

1903. 
July     

160 
166 
193 
524 
640 
621 

330 
219 

18 

August 

September 

October 

3 
3 
5 

2 
3 

1 

2 
3 
5 

2 
3 

1 

November 

December 

1904. 

January  

February 

March _.. 

April 

Trachoma,  3. 
Trachoma,  5. 

Loss  of  left  eye,  2. 

Gonorrhea  with  bubo,  1;  inguinal  hernia,  1; 

chronic  deafness,  1. 
Syphilis,  1. 

May 

1 
257 

i 

1 

1 
1 

Trachoma,  1. 

June 

Do. 

Total 

3,129 

19 

18 

The  Surgeon-General. 


J.  W.  Amesse,  Assistant  Surgeon. 


212  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Porto  Rico. 
san  juan  and  subports. 

Public  Health  and  Maeine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

San  Juan,  P.  R.,  July  2,  1904. 
Sir:  I  have  the  honor  to  submit  the  following  report  of  medical  inspections 
of  immigrants  at  San  Juan,  P.  R.,  during  the  fiscal  year  ended  June  30,  1904 : 

Total  number  of  inunigrants  inspected 1,355 

Total  number  of  immigrants  passed 1,348 

Total  number  certified  on  account  of  dangerous,  contagious,  or  loathsome 
diseases : 

Class   III    (deported)    1 

Class  IV   (landed) 6 

Total    7 

Respectfully, 

Pedro  del  Valle  Atiles, 
Acting  Assistant  Surgeon. 
Respectfully  forwarded. 

W.  W.  King, 
Passed  Assistant  Surgeon 
The  Surgeon-General 


[Subports.] 

Summary  of  inspection  of  immigrants  at  the  six  suhports  of  Porto  Rico  during 
the  fiscal  year  ended  June  30,  1901f. 

Mayaguez : 

Immigrants    inspected 117 

Passed    117 

Rejected     0 

riumacao : 

Immigrants    inspected 2 

Passed 2 

Rejected     0 

Arecibo : 

Immigrants    inspected 1 

Passed    1 

Rejected     0 

No  transactions  at  the  other  three  suhports. 


PONCE. 

Report  by  Acting  Asst.  Subg.  J.  F,  Torres. 

Public  Health  and  IMaeine-IIospital  Service, 

Office  of  Medical  Officer  in  Command. 

Ponce,  P.  R.,  July  6,  1904. 
Sir  :  In  accordance  with  paragraph  646,  Revised  Regulations,  Marine-Hospital 
Service,  I  have  the  honor  to  make  the  following  report  of  medical  inspection 
of  immigrants  at  this  port  during  the  fiscal  year  ended  June  30,  1904 : 

Inspected  321 

Passed    316 

Rejected     5 

Very  respectfully, 

Julio  Ferrer  Torres, 

Acting  Assistant  Surgeon. 


IMTRLIf    HKALTII    AXI)    MAKINE-HOSPITAL    SKRVICK.  213 

OkKUK    ("HIKF    QlARAMINK    OfIMCKR    FOK    PoKTO    RICO, 

San  ./nan,  /'.  /?..  July  7,  190.'f. 
Kosportfully  lurwiinltHl  to  the  .Sui-jreon-CWMUMiil.  I'liitod  States  Public  Health 
and  Maiine-IIospital  Service.  Washiiifrtoii.  D.  ('. 

Pedro  del  Vali.e  Atii.es, 
Artinij  Assistant  Snrffcon,  in  tcmiinrary  charge. 
The  Strokon-General. 


Hawaii. 


H(^X()LI'Lr 


Schednh',  by  month.'i,  of  inspection  of  aliens  at  port  of  Honolulu,  Hawaii,  during 
the  year  ended  June  30,  1904,  by  Passed  Asst.  Surg.  L.  E.  C'ofer. 


Month. 


1903. 

July 

August 

September 
October , . . 
November 
December 

1904. 
January  .. 
February . 

March 

April 

May 

June 

Total 


Number 
inspected. 


419 
4i5 

872 
695 

tu; 


426 

i.-im 

1.2(^2 
&31 


1,334 


Number      Number 
certified,     deported. 


Cause  of  deportation. 


Ti-achoma. 

Do. 
Trachoma.  1;  leprosy,  1. 
Trachoma.  6;  syphilis,  1;  beriberi,  1. 
Certified  ti'achoma:  escaped. 


Ti-achoma. 
Do. 

Trachoma,  .5:  varicose  iilcers  legs  and 
ankylosis  ankle,  1:  1  senility  and  general 
debility  and  1  curvature  spine  admitted. 

Trachoma,  .5;  1  los.s  light  four  fingers  ad- 
mitted. 


9,471 


58 


The  Surgeon-General. 


L.  E.  COFER. 

Pa.'ised  Assistant  Surgeon. 


PlIILiri'lNF.S. 


Report  by  Passed  Asst.  Sitig. 


V.    G.    HeISER    on    lM.\fIGRATION    AT    MANILA    AND 

Slbports. 


Public  Health  and  Marine-IIo.spital  Service. 
Office    Chief    Quarantine   Officer   for   the    Philippine    Islands. 

Manila.  P.  I..  August  5.  WOJ,. 

Sir:  In  accordance  with  the  instructions  contained  in  P>ureau  letter  of  March 
IS,  1004.  I  have  the  honor  to  transmit  herewith  the  olHcial  blank  forms  of  the 
medical  inspection  of  immigrants  at  the  ports  of  the  Philippines  for  the  fiscal 
year  ended  June  80.  1904. 

The  fii-st  systematic  and  official  medical  inspection  of  immigrants  began  July 
1,  1903,  and  was  done  at  the  request  of  the  insular  collector  of  customs,  who  rep- 
resents the  United  States  Immigration  Service  in  the  Philippines.  The  immi- 
grant medical  inspection  is  made  on  the  deck  of  the  vessel  immediately  after  the 
quarantine  inspection  is  concluded.  The  climate  is  so  mild  that  it  is  possible 
to  do  this,  but  it  would  be  much  more  satisfactory  if  better  facilities  could  be 
provided.  All  those  that  are  i)assed  by  the  medical  officer  then  go  before  the 
immigration  officer,  and  if  passed  by  him  they  go  ashore.  All  those  immigrants 
who  have  not  passed  the  medical  inspection  are  then  examined  a  second  time, 
in  the  presence  of  the  medical  officer  in  charge.     For  all  those  failing  to  pass 


214 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


this  last  examination  tlie  regulation  certificate  is  issuetl.  signed  l).v  the  metlical 
officer  in  charge  and  initialed  by  all  the  medical  ofiicers  who  have  seen  the  case. 
The  rejected  immigrants  are  then  turned  over  to  the  immigrant  authorities.  By 
this  method  rejected  immigrants  are  speedily  returned  to  the  i)ort  from  whence 
they  came,  and  they  seldom  ever  have  an  opportunity  to  leave  the  vessel  while 
it  is  in  a  port  of  the  Philippines. 

Immigrants  are  brought  to  Manila  by  ten  different  steamship  lines.  A  number 
of  instances  have  already  come  under  observation  in  which  an  immigrant  would 
be  deported  on  one  line  and  return  several  times  sul)sequently  on  other  lines, 
only  to  be  again  deported.  The  great  majority  of  immigrants  arrive  by  the 
trails-Pacific  steamers,  which  make  Japanese  ports  a  place  of  call  while  en  route 
to  ^lanila. 

The  total  number  of  immigrants  inspected  during  the  fiscal  year  was  6,111 ; 
total  number  of  rejections  for  medical  causes.  351 ;  total  number  of  persons 
ordered  dei)orted  on  account  of  being  medically  rejected,  340 ;  percentage  of 
rejections,  .">!  per  cent. 

Several  facts,  which  differ  entirely  from  the  experience  at  other  stations,  are 
shown  liy  the  foregoing  figures.  First,  the  number  of  rejections  for  medical 
causes  is'  exceedingly  high,  when  it  is  considered  that  all  aliens  not  likely  to  be 
permitted  to  land  in  the  Philippines  are  already  supposed  to  have  been  advised 
not  to  embark  l)y  the  Service  officers  stationed  at  ports  from  which  the  Immi- 
gi'ants  come ;  second,  the  number  of  innnigrants  ordered  dei)orted  for  medical 
cause  closely  corresponds  to  the  number  of  medical  certificates  issued.  This 
shows  that  the  diseases  for  v>hich  the  innnigrants  are  rejected  in  all  proba- 
bility belong  to  one  of  the  absolutely  excludable  classes.  On  examination  of  the 
medical  report  it  will  be  seen  that  this  observation  is  borne  out  by  the  fact  that 
nearly  all  the  rejections  have  been  made  on  account  of  trachoma.  At  first  sight 
it  might  seem  tliat  in  the  examination  of  0,111  immigrants  many  other  more 
or  less  grave  physical  defects  should  have  been  detected.  But  when  it  is  remem- 
bered that,  with  the  excei>tion  of  an  insignificant  few,  the  entire  immigra- 
tion that  comes  to  the  Philippines  is  Japanese;  that  they  are  nearly  all  male 
adults  in  the  prime  of  life,  and  that  this  race  of  people  are  noted  for  their 
sound  physique,  the  matter  assumes  a  new  aspect.  Another  important  consid- 
eration is  the  fact  that  the  tide  of  inunigration  to  the  Philippines  has  only  begun, 
and  the  history  of  all  peoples  shows  that  when  inunigration  to  another  country 
begins,  at  first  only  the  more  hardy  members  immigrate.  After  they  establish 
themselves  the  weaker  ones  follow. 

Respectfully.  Victor  G.  Heiser, 

Pas><cd  Assist fint  Surgeon, 
Chief  Qnnrantine  Officer  for  the  Philippine  Islands. 

The  Surgeon-General. 

[Inclosures.] 

Report  of  innpection  of  aliens  at  the  various  ports  of  the  Philippine  Islands 
during  the  year  ended  June  30,  1903. 

MANILA,  P.  I. 


Month. 

Number 
inspected. 

Number 
certified. 

Number 
deported. 

Cause  of  deportation. 

1903. 
Julv 

195 
237 
190 
694 

694 

498 

237 

270 

i,aj8 

290 
291 
5.33 

.5,437 

1 
0 
0 

7 

48 
46 

41 
29 
38 
32 

27 

77 

0 

n 
u 

48 
46 

41 
29 
.38 
32 
25 
77 

September 

October         

Heart  disease,  valvular,  aortic.  1;  tracho- 

November  

December 

1904. 

January  

February 

March 

April 

Bfey 

June 

ma,  6. 
Heart  disease,  organic,  1;    trachoma,  35; 

trachoma,  12  {':)■ 
Trachoma,  46. 

Trachoma.  31;  trachoma,  10  (?). 
Trachoma.  29. 
Tmchoma,  38. 
Trachoma,  31;  syphilis,  1. 
Traclioma.  25. 
Trachoma,  77. 

Total.- 

346 

343 

I'niUJC    IIKALTH    AND    MARINE-HOSPITAL    SKKVK.'K. 


215 


Repori  of  iiisj)rrtii)ii  of  dlinis,  r/c— ( 'ontinuHd. 
CEBU,  P.  I. 


->,  „,,,               Number      Numlwr 
Mcutli.              inspected,     certified. 

Number 
deported. 

clause  of  di-iMjrtution. 

1903. 
July          .                                  1 

0 

0 
0 
0 
0 
0 
0 

0 
0 
0 
0 
0 
0 

August 0 

September 1                 0 

October 1 

0 
0 
0 
0 
0 

0 
0 
0 
0 
0 
0 

November 0 

December 1 

1W4. 
January  .                                  3 

Fel)rua"ry           1 

March  0 

April 0 

May 0 

June .--                  9 

Total 16  i                 0,                 0 

ILOILO,  P.  I. 


1903. 
July 

2.")    

August  .              .  . 

22   . 

September 

17    

October 

I 

November 

1  L. 

December 

1  1 

1901. 
January  

.39    

February .     

10       .     . 

Trachoma,  2;  ulcer  of  skin,  feet;  chronic  1. 

March 

29   

April 

May 

June 

44                    1 
70                    4 
18 

0 
3 

Total 

277  :                 .5  1         ,3 

JOLO,  P.  I. 


1903. 

July 

August 

September. 

October 

November . 
December  . 

1904. 
January  ... 
February . . 

March 

April 

May 

June 

Total. 


0 

173 

17 

43 

9 
24 


17 
20 
8 
18 
31 
22 

381 


216 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Canada. 

QUEBEC. 
Report  by  Asst.  Surg.  W.  C.  Billings. 

Report  of  inspection  of  aliens  at  the  jjort  of  Quebec,  Canada,  during  the  year 

ended  June  30,  IM4. 


Month. 

XumVjer 
inspected. 

Number 
cei'tifled. 

Number 
deported. 

Cause  of  deportation. 

1903. 

July... 

2,200 

81 

30 

Neurasthenia.  1:  trachoma.  26;  undersized. 
1:  senility  and  debility.  1:  hip-joint  dis- 
ease. 1. 

August 

...   .        1,918 

79 

19 

Poor  physique.  3;  trachoma.  14:  partially 
deaf.  1:  lateral  curvature  spine.  1. 

September 

1,715 

43 

7 

Trachoma.  4;  poor  physique.  1:  favus,  1: 
observation  for  favus,  1. 

October 

1..547 

55 

3 

Trachoma.  3. 

November 

l,:i24 

37 

9 

Trachoma.  5;  hysteria,  1:  poor  physique,  1; 
syphilis.  1:  favus,  1. 

December 

815 

3D 

16 

Trachoma,  16. 

1904. 

.January 

511 

19 

6 

Trachoma,  5;  poor  physique,  1. 

Febi*uarv 

5.31 

25 

1 

Favus,  1. 

March 

504 

11 

3 

Ti-achoma,  1:  dislocation  shoulder,  1;  in- 
sular sclerosis.  1. 

ApriL 

25.3 

11 

1 

Tuberculous  glands  neck.  1. 

May.. 

1,311 

40 

7 

Adenitis  glands  neck,  1;  trachoma,  6. 

June 

1,143 

(>4 

1 

Pit5Tia.sis.  1. 

Total 

13,772 

495 

108 

' 

The  Surgeon-Gexeral. 


W.  C.  Billings,  Passed  Assistant  Surgeon. 


VANCOUVER. 

Report  of  inspection  of  aliens  at  port  of  Vancouver  for  three  months  ended  June 
30,  1904,  by  Acting  Asst.  Surg.  H.  W.  Riggs. 


Month. 


April  (6-30) 
May 

June 

Total - 


I  Number  <  Number      Number 
inspected,    certified.  ,  excluded. 


13 
408 

687 


1.113 


Cause  of  deportation. 


38  '  Class  I.  38. 
4     Class  I,  4. 


42 


VICTORIA. 

Report  of  inspection  of  aliens  at  port  of  Victoria,  British  C'ohnnbia.  during  seven 
months  ended  June  30.  190A,  by  Asst.  Sii7-g.  M.  W.  Glover. 


Month. 


Number      Number      Number 
inspected,    certified,    deiwrted. 


19tS. 
December 

1904. 
Januai-y  .. 
February . 
March.."... 

April 

May 

Jane 

Total 


200 

6 

5 

200 

•8 

- 

108 

7 

6 

264 

20 

14 

261 

17 

12 

164 

8 

3 

Wi 

20 

14 

1,600 


Cause  of  deportation. 


Class  I,  4;  Class  IV,  1. 


Class  I,  5:  aass  III,  1;  Cla-ss  IV,  1. 

Class  I,  4:  Class  IV.  2. 

Class  I,  13:  Class  III,  1. 

Class  1. 12. 

Class  1.2:  Class  IV.  1. 

Class  1,  10;  Cla.ss  111,  1;  Clas.s  IV,  3. 

Class  I,  .50;  Class  111.  3,  Class  IV,  8. 


1»ITBLIC    HEALTH    AND    MARINP>HOSPITAL    SKUVICE. 

Italy. 


217 


NAPLES    AND    I'AI.KRMO. 

Rkpoim"  I!y  I'asski)  Asst.  Sukc.  J.  >L   Eager. 

rtnti.ic  1Ii:ai.'I'ii  anii  Marine-IIospitai,  Skrvice, 

Oki'U'k  ok  Mi.DKAr,  Oki'uer  in  Command, 

\(il)l(s,  Ital!/,  JiiL)/  /,  mo.',. 
Sir:  I  have  tho  honor  to  iii:\ko  tlio  following;  report  of  the  traiisju-tions  of  the 
S(M-vifo  at  tht'  ports  of  Naples  ami  Palermo,  eovering  the  i>eriod  from  July  1, 
1!)()3,  to  June  oO,  1004,  inehisive: 

Statist  id  (if  the  S(  rrirc  at  yaplm  and  Patcrmo. 


Month. 


Number  of  emi- 
grants. 

Baggage. 

Ships. 

Naples. 

Palermo. 

Inspected. 

Disin- 
fected. 

14 

8,037 

752 

1,650 

13,736 

1.5 

9,511 

1,;355 

1,830 

16,226 

19 

10,678 

3,089 

2,090 

19,893 

19 

11,990 

1,290 

2,727 

19,144 

19 

9,411 

1,147 

2,080 

15,722 

13 

4,715 

442 

885 

7,551 

ir 

4,029 

754 

771 

6,627 

19 

12,729 

1,571 

1,210 

17,922 

32 

33,012 

1,400 

3,169 

44,393 

27 

25,443 

1,509 

3,585 

35,671 

18 

13,737 

714 

2,330 

19,222 

18 

7,463 

699 

1,756 

13,762 

229 

150,755 

14,782 

24,083 

229,869 

ItWl 

July 

August - 

September 

October 

November 

December 

1904 

January 

February 

March _ . 

April 

May 

June _ 

Total 


Rejections  advised. 


Months. 

a 

o 

1 

3 
> 

a 

u 
o 

(S 

1 

a 

1 

u 

> 

fa 

m 
0 

<n 
S 

W 

o 

1 
Eh 

19(J3. 
July  .  .. 

464 
541 
634 
451 
313 
195 

220 
367 
568 
475 
319 
338 

25 
16 
19 
16 
10 
2 

7 

15 
49 
37 
17 
14 

16 
13 

18 
5 
1 
2 

1 
7 

10 
4 
4 
8 

505 

August .      -              - 

1 

3 

574 

September 

671 

October 

1 

473 

November 

1 

325 

December . 

199 

January   . . 



1904. 

1 

f 
1 

1 

229 

February 

2" 

3 
2 

1 

391 

March   . 

2 

631 

April 

520 

May 

1 
1 

1 

345 

June.. 

362 

Total 

4,885 

227 

8 

3 

5 

8 

89 

5,225 

During  the  period  covered  by  the  report  355  persons  were  embarked  at  the 
ship's  responsibility,  the  facts  in  each  case  being  sent  to  the  receiving  officer 
at  the  port  of  arrival.  These  persons  were  individuals  tho  subjects  of  some 
disease  or  deformity,  sucli  as  hernia,  that  would  not  necessarily  prevent  their 
entering  at  the  port  of  arrival. 


218  PUULIO    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

EMIGRATION    FROM    ITALY. 

Aiiproximateiy  iv,\\t  a  million  of  Italians  go  abroad  every  year  in  search  of 
work,  nearly  hall'  of  them  to  the  United  States.  A  considerable  proportion 
returns  to  Italy.  The  official  reports  of  the  Italian  commissioner-general  of 
emigration  for  1903  show  that  during  the  calendar  year  214,ir)7  Italians  went 
to  the  United  States,  and  during  the  same  period  7S,2:!:)  returned  to  Italy  from 
the  United  States.  In  li^()^2  the  number  of  Italians  departing  was  191,707,  and 
the  number  returning  52,000. 

Emigration  is  an  important  feature  of  Italian  life  and  the  movement  is  on 
the  increase.  This  may  be  seen  from  the  following  official  figures:  In  ISSl 
there  were  1.082,892  Italian  emigrants  living  abroad;  1,983,20()  in  1891.  and 
3,439,014  in  1901.  Of  the  number  :i,489.014  for  the  latter  year,  about  0.54,000 
were  scattered  throughout  Europe ;  108,000  were  in  Africa ;  729,000  in  the 
United  States;  1,10()  in  Canada;  500  elsewhere  in  North  America,  and  1,852,000 
in  South  America,  of  which  number  018,000  were  in  Ai'gentina  and  1,100,000  in 
Brazil. 

The  figures  quoted  show  how  extensive  a  movement  Italian  emigration  has 
become,  and  without  ]>r()])er  sanitary  control  how  easy  a  medium  it  might  be 
for  the  i)r()pagation  of  those  diseases  and  defects  iieculiar  to  the  Italian  lower 
classes,  conditions  which  have  already  been  considered  in  previous  annual 
reports  for  this  station. 

In  recent  years  emigration  from  Naples  to  the  I'nited  States  has  been  decid- 
edly on  the  increase.  The  inspection  records  of  the  Public  Health  and  Marine- 
Hospital  Service  show  that  during  the  fiscal  year  1899-1900  the  number  of 
emigrants  l)ound  for  the  United  States  was  82.001  ;  109,208  in  1900-1,  145,447 
in  1901-2,  180,011  in  1902-8,  and  150,755  during  the  year  just  completed. 

In  regard  to  the  character  of  Italian  emigrants  the  following  is  part  of  a 
report  which  I  prepared  on  request  of  United  States  Consul  Byington,  Naj^les. 

EMIGRANTS  NEARLY  ALL  PEASANTS. 

Nearly  the  entire  mass  of  emigrants  from  Naples  is  composed  of  peasants 
from  southern  Italy.  Among  them  are  seen  from  time  to  time  northern  Ital- 
ians, Greeks,  and  natives  of  countries  to  the  east  of  Italy.  There  is  a  notable 
increase  of  late  years  in  the  number  of  Greeks  sailing  from  Naples.  The  aver- 
age Italian  emigrant,  though  he  has  previous  to  leaving  Italy  been  entirely 
devoted  to  agricultural  work,  adapts  himself  readily  to  any  labor  not  calling 
for  higher  qualities  than  muscular  force,  quick  apprehension,  and  willingness 
to  work.  An  inclination  in  favor  of  laboring  in  the  construction  of  great  engi- 
neering works  is  noticeable  among  southern  Italians,  probably  arising  from  the 
fact  that  in  former  times  large  numbers  of  these  peasants  were  employed 
throughout  Italy  in  the  construction  of  railroads,  enterprises  which,  owing  to 
the  character  of  the  country,  called  for  huge  operations,  as  tunneling  and  bridge 
building,  re(]uiring  the  services  of  armies  of  laborers.  There  is  always  among 
the  emigrants  from  southern  Italy,  esi)ecially  from  Naples,  Calabria,  Cosenza. 
and  the  Province  of  Salerno,  a  small  [)roportion  of  stonecutters  and  quarrymen. 
Among  the  emigrants  from  all  parts  of  southern  Italy  there  is  always  found  a 
certain  number  of  tailors,  cobblers,  barbers,  and  makers  of  musical  instruments, 
especially  string  instruments,  such  as  the  guitar  and  mandolin. 

In  regard  to  the  moral  and  intellectual  status  of  those  going  to  the  United 
States  from  Naples,  it  can  be  said  that  the  average  emigrant  from  this  port  is 
a  fair  representative  of  the  Italian  peasant.  Intellectually  he  is  willing  and 
quick  to  learn,  but  is  deplorably  ignorant.  In  1807  the  proportion  of  Italians 
who  could  not  read  was  78  per  cent,  and  in  1881,  when  the  census  was  made, 
it  was  07  per  cent.  This  shows  an  increase  in  education  which  is  in  all  prob- 
ability due  to  increased  educational  advantages  in  cities,  a  condition  which 
does  not  concern  in  any  important  degree  the  Italian  emigrant. 

The  improvement  is  much  more  marked  in  the  north  of  Italy  than  in  the 
south.  The  great  majority  of  tlie  emigrants  are  Roman  C.-itholics.  It  is 
believed  that  there  are  very  few  paupers  or  beggars  among  the  Naples  emi- 
grants.    They  are  generally  poor  people  who  earnestly  desire  an  opportunity  to 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  219 

ciii'ii  ill!  honost  livin.u'.  As  lo  their  moi-ality,  it  is  that  of  the  i.i,'ii(»r;\iit  and  ciiio- 
lioiial  lower  classes  (if  tlieir  race.  It  is,  liowever.  dillicult  for  any  criminal  to 
leave  Xaiiles  for  Ihe  riiited  States.  'rii(>  Italian  eniij;ralion  conniiission  exer- 
cises a  ri.icid  control  of  this  matter. 

At  the  hcf^inninj;  of  summer  the  bulk  of  emij,'rants  from  Naples  consists  of 
men:  toward  autunm  the  women  leave  to  join  Ihe  male  memi)ers  of  their  fam- 
ilies at  the  conclusion  of  what  is  presumahly  a  successful  sunnner's  work. 

Althon,i;h  tlu>  avera^'c  Italian  i)easant  is  comi)aratively  undersized,  he  is 
must'ular,  hardy,  and  Ht  for  the  iierformaiice  of  heavy  m.-mual  labor.  His 
healthful  appearance  is  often  masked  by  a  skin  tanned  by  i'xposurt'  to  the  sun. 
Another  circumstance  that  often  ^ives  an  unfavorable  appearance  to  enu.;,'rants 
from  the  littoral  of  southern  Italy  is  what  is  known  as  "black  teeth,"  a  dis- 
figuration rather  than  a  disease,  since  it  is  not  necessarily  accompanied  by 
decay  of  the  teeth.  The  teeth  of  these  persons  are  atfected  during  the  ju'i-ioil 
of  fxrowth  by  some  ,!j;aseous  constituent  of  drinking  water,  i)robabIy  from 
impregnation  with  volcanic  vapors.  The  defect  often  .i,'ives  a  sinister  look  to 
an  otherwise  handsome  face,  but  fortunately  does  not,  it  seems,  affect  the 
strength  or  durability  of  the  teeth. 

Many  of  the  emij^rants  have  had  military  training;  in  general,  all  the  men 
over  '20  years  of  age  have  performed  more  or  less  military  duty.  In  Italy  all 
males  not  having  physical  defects  rendering  them  unfit  are  subject  to  ri'gular 
military  duty,  the  exceptions  being  only  sons,  Uie  first-born  sons  of  widowed 
mothers,  and  the  sons  of  fathers  over  (>(>  years  of  age  when  there  is  a  brother 
in  the  mother's  arms.  Even  these  excepted  individuals  are  held  to  some  serv- 
ice, hut  it  is  generally  Hunted  to  tw(>nty  or  thirty  days  at  a  time.  As  to  habits 
of  cleanliness  of  the  person  and  dress,  there  is  nuu-h  left  to  be  desired.  An 
absence  of  the  habit  of  bathing  is  evident,  and  the  enngrants  who  present  them- 
selves for  departure  almost  invarial)ly  carry  cheese  and  s:uisages  concealed 
upon  their  persons. 

The  Italian  enngrant  has  been  accustomed  in  most  cases  to  eat  the  simplest 
food,  chielly  fruit  and  greens;  he  is  sober,  but  almost  always  drinks  wine  in 
moderation.  In  very  exceptional  cases  when  given  to  drink  in  excess  he  is 
very  likely  to  become  boisterous  and  even  dangerous. 

Respectfully,  J.  M.  Eager, 

Passed  Assistant  tSiirgcon. 

The  Surgeon-General. 


Japan. 

YOKOHA?irA. 

Report  of  Medical   Inspection   of  Alien   Emigrants   at   Yokohama,   .Japan, 
during  the  period  september  212,   1903,  to  june  30,   1904,  by  asst.   surg. 

DUNLOP    MoORE. 

Aliens   inspected   9,  .'jSS 

Aliens  suffering  from  loathsome  or  dangerous  contagious  diseases  recom- 
mended  for   rejection G29 

Aliens  certified  as  free  from  loathsome  or  dangerous  contagious  diseases-  7,2.58 
Respectfully, 

D.  Moore,  Assistant  Surfjeon. 
The  Surgeon-General. 


220 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


KOBE. 

Report  of  Inspection  of  Aliens  at  Port  of  Kobe,  Japan,  during  the  Year 
ENDED  June  30,  1904,  by  Acting  Asst.  Surg.  J.  B.  Fowler. 


Month. 

Number 
inspected. 

Number 
passed. 

Number 
rejected. 

Cause  of  rejection. 

1903.              t 
July      -' 

311 
195 

178 
449 
441 

298 

407 
393 

m 

508 

553 
756 

September 

November.. 

December 

1904. 
January            

518 
439 

428 
424 
511 
625 

586 
1,033 

77 
131 

21 
31 

72 
117 

33 

2.'7 

Trachoma.  71;  high  fever,  3;  tuberculosis, 

1;  syphilis,  1;  favus,  1. 
Trachoma,  l28:  tuberculosis,  1;  scabies,  1; 

senile  decay,  1. 

Trachoma,  21. 

February 

March 

Trachoma,  31. 
Trachoma,  72. 

April 

Ti"aehoma,  111;  high  fever,  2;  tuberculosis. 

May. 

June 

2;  scabies,  1;  corneal  ulcer,  1. 
Trachoma,  33. 
Trachoma,  272;  scabies,  2;   high  fever,  1; 

tuberculosis,  1;  deformity,  1. 

Total 

4,554 

4,928 

759 

This  report  does  not  include  any  way  passengers,  but  only  Japanese  and  Koreans 
taken  on  at  Kobe. 

J.  BucKNiLL  Fowler, 

Acting  Assistant  Surgeon. 
The  Surgeon-General. 


China, 
hongkong. 

Report  of  Medical  Inspection  of  Aliens  at  Hongkong  by  Passed  Asst.  Surg. 

M.  J.  White. 


From  the  eoniuiencement  of  the  work  in.  October,  1003,  4,1G8  aliens  were 
examined  for  tlie  communicable  diseases  contemplated  in  the  laws  governing 
immigration. 

The  aliens  having  bathed,  were  carefully  e.xamined  for  trachoma,  tul)erculosis. 
venereal  diseases,  leprosy,  .scabies,  ringworm,  favus,  etc.  While  phtheiriasis  and 
chromaphytosis  were  of  frequent  occurrence,  the  aliens  afflicted  were  not 
rejected,  because  the  steam  disinfection  of  clothing  and  the  bath  removed  the 
lice,  and  the  mildness,  i)erhaps  insignificance,  of  tinea  versicolor  seemed  hardly 
sufficient  to  warrant  their  classification  for  immigration  purposes  as  loath- 
some or  dangerous  contagious  diseases,  although  etiologically  and  clinically 
they  are  grouped,  the  one  with  scabies,  the  ctlier  with  ringworm  and  favus. 
Several  cases  of  eczema,  Icucoderma,  and  ichthyosis  were  obser\ed  but  not 
rejected. 

The  majority  of  trachoma  cases  were  without  complications  and  in  only  a 
few  was  entropion  present,  and  then  not  to  the  degree  of  causing  trichiasis. 
Trachoma  among  the  Chinese  is  very  prevalent,  but  far  less  severe  than  among 
Americans  and  Europeans.  I  have  never  seen  i)annus,  keratitis,  or  any  other 
evidence  of  corneal  involvement  among  them,  although  the  granulations  in  con- 
sistency and  size,  as  well  as  the  palpebral  thickening,  vascularit.v,  and  scars,  are 
readily  comparable  to  the  lesions  in  white  persons. 

A  very  connnon  eye  aflection  of  Chinese  is  the  retention  in  the  meibomian 
glands  of  a  light  yellow,  wa.xy  material  with  or  without  a  coexisting  palpebral 
thickening. 

The  examination  of  aliens  was  limited  to  those  of  the  second-class  and  steer- 
age passengers  listed  on  the  aliens'  manifest  by  the  steamship  companies,  and 


miHLic  hp:alth  and  marine-hospital  servick. 


221 


Itouiul  to  the  States.  All  i)ersoiis  so  iiiiiiiifested  were  exainiiied  as  aliens, 
altlioutjli  some  of  them  muiuestiouahly  were  citizens  of  the  United  States  and 
therefore  not  legally  subject  to  such.  It  does  not  clearly  aiii)ear  to  he  the 
function  of  this  office  to  decide  uiwn  the  validity  of  a  t'hinaman's  claim  to 
United  States  citizenship,  and  it  has  been  customary  to  accept  the  classlflcution 
of  the  steamship  companies.  After  the  examination  the  alien  manifests  are  cer- 
tified as  follows,  the  Service  seal  beiuir  athxed  : 

The  rejected  aliens  are  entered  on  the  descrii»tive  list  (Form  "A"  inclosed), 
copies  of  which  are  also  forwarded  to  the  Surgcon-Cieneral  and  to  the  Commis- 
sioner-General of  Immigration  through  the  Surgeon-General.  The  representa- 
tive of  the  steamsliip  company  is  duly  informed,  and  he  has  instructions  to 
refuse  passage  to  such  diseased  aliens. 

This  foreign  examination  is  not  only  a  valuable  public-health  measure,  but  to 
the  attlicted  a  benevolent  accomuHulation.  and  one  richly  deserving  permanent 
support.  But  the  examination  unintentionally  emljarrasses  native-born  and 
naturalized  Chinese  citizens  of  tiie  United  States,  for  ordinarily  they  are  classi- 
fied as  aliens  by  the  steamship  agents,  who  are  extremely  anxious  to  avoid  the 
possibility  of  tines  imposed  by  the  imniigi'ation  laws.  Such  citizens  may  be 
rejected  as  aliens  with  loathsome  or  dangerous  contagious  diseases,  and  there- 
fore find  it  impossible  to  obtain  passage.  Should  the  steamship  agents  adjudge 
the  "citizen's  jiaiters"  valid,  the  proper  authorities  of  the  United  States  might 
disagree  and  fine  the  company  for  bringing  diseased  aliens.  Such  Chinese 
citizens  do  not  aiijiear  to  be  cognizant  of  their  right  to  invoke  the  aid  of  the 
consul-general,  and  heretofore  the  steamship  agents  have  not  seen  the  value  of 
such. 

Alien  c.raminat'wii  tahuJoted. 

Aliens    examined    4, 168 

Aliens  afflicted  with  trachoma 526 

Aliens  atflicted  with  syphilis 2 

Aliens  afflicted  with  gonorrhea 3 

Aliens  afflicted  with  chancroids 1 

Aliens  afflicted  with  scabies 15 

Aliens  afflicted  with  other  lo.athsome  or  dangerous  contagious  diseases 0 

Respectfully,  M.  J.  White. 

Passed  Assistant  Surgeon. 
The  Suegeon-Gexebal. 

[Inclosure.] 

Report  of  inspection  of  aliens  at  port  of  Shanghai,  China,  during  the  year  ended 

June  30,  1904. 


Month. 


I  Ntunber 
I  inspected. 


Number 
certified. 


Number 
deported. 


Cause  of  depor- 
tation. 


1903 

July 

August 

September 

October 

November 

December 

1904, 

January  

February 

March 

April 

May 

June 

Total 


None. 

None. 

None. 
3 
5 
15 


None. 

None. 

None. 
3 
4 
14 


None. 

None. 

None. 
0 
1 
1 


Trachoma. 
Do. 


Syphilis. 
Trachoma. 


The  above  report  cotters  the  transactions  of  the  division  under  my 
charge  for  the  fiscal  year. 
Respectfully  submitted. 

W.  J.  Pettus, 
Assistan t  Surgeon-General. 
The  Subgeon-General. 


DIVISION  OF  DOMESTIC  QUARANTINE. 


223 


REPORT  OF  THE  DIVISION  OF  DOMESTIC  QUARANTINE. 

By  A.  II.  CJlennan, 
Assistant  Si(r(/con-Gciicrul  Public  Health  and  Marine-Hospital  tService,  in  charge. 

Sir  :  I  have  the  honor  to  submit  the  following  report  of  the  opera- 
tions of  the  division  of  domestic  quarantine  of  the  Public  Health  and 
Marine-Hospital  Service  for  the  fiscal  year  ended  June  30,  1904. 

Plague  in  San  Francisco. 

The  satisfactory  cooperation  of  the  State  and  municipal  authorities 
of  California  with  the  Public  Health  and  Marine-Hosital  Service  in 
the  eradication  of  plague  infection  in  the  Chinese  district  of  San 
Francisco  has  been  steadily  carried  on  under  the  immediate  direction 
of  officers  of  this  Service.  As  anticipated,  and  originally  planned, 
the  sanitary  supervision  and  regulation  of  this  Chinese  district  was 
expected  to  occupy  a  considerable  length  of  time.  Wliile  there  were 
24  cases  reported  with  one  recovery  during  the  fiscal  year,  the  results 
attained,  together  with  the  present  long  interim  without  further 
appearance  have  justified  the  methods  adopted  for  the  extermination 
of  this  infection. 

In  a  few  instances,  rumors  of  the  existence  of  plague  in  places  out- 
side of  San  Francisco  were  immediately  investigated  by  officers  of 
the  Service  and  the  nonexistence  of  the  infection  definitely  deter- 
mined, or  suitable  suppressive  measures  instituted  where  suspicion 
existed. 

Under  date  of  August  11,  1903,  Passed  Asst.  Surg.  Rupert  Blue 
transmitted  a  signed  statement  setting  forth  the  unanimity  of  opinion 
as  to  the  methods  being  prosecuted  in  the  sanitary  regeneration  of  the 
Chinese  quarter,  as  follows : 

[Statement.] 

San  Francisco,  Cal.,  August  18,  1903. 
It  has  been  the  experience  of  the  health  authorities  now  engaged  in  the  sani- 
tary improvement  of  the  city  of  San  Francisco  that  in  that  particular  area 
bounded  by  .California,  vStockton,  and  Montgomery  streets  and  the  bay  the  most 
objectionable  features  coming  under  our  observation  have  been  the  filthy  accu- 
mulation of  back  ai-eas  and  the  building  into  said  areas  from  the  original  struc- 
tures to  the  extent  that  all  sunlight  and  fresh  air  are  prevented  from  permeat- 
ing these  spaces,  and  in  accordance  with  this  evidence  it  has  been  agreed  and 
found  necessary  by  all  that  all  these  mentioned  places  shall  be  thoroughly 
cleansed  and  structures  removed ;  that  in  any  instance  where  it  is  desired  to 
restore  these  places  the  following  shall  be  the  mode  of  procedure,  namely,  at 
least  1  foot  of  surface  soil  shall  l)e  removed,  a  concrete  floor  placed  thereon, 
upon  which  may  be  built  a  one-story  brick  structure,  with  glass  roof,  properly 
ventilated,  for  the  purpose  of  storeroom,  kitchens,  or  toilet,  and  that  no  other 

8639—04 15  335 


226  PUBLIC    HKALTH    AND    MARI2iE-HOSPITAL    SERVICE. 

structure  be  permitted  in  said  areas  except  a  halt  ony  5  feet  square  for  the  con- 
venience of  the  different  stories  for  toilet  purposes,  to  lie  built  in  accordance 
with  the  building  and  i)luniliing  regulations  of  this  city  and  county. 

It  is  further  agreed  that  this  ruling  shall  a])i)ly  to  all  parts  of  the  city  and 
county  of  San  Francisco  wlien,  in  the  opinion  of  the  health  authorities,  the  sani- 
tary conditions  require  it. 

Maktin  Regexsbukger,  M.  D., 

J'rcsidcnt  State  Board  of  Health. 
N.  K.  Foster.  M.  D., 

Secretaru  State  Board  of  Health. 
Rupert  Blue, 
Passed  A.^sistant  Surgeon,  P.  H.  and  M.  H.  S. 
A.  P.  O'Brien,  M.  D.. 
Health  Officer,  City  and  County  of  San  Francisco. 
Wm.  C.  Hassler.  M.  D., 
Chief  Sanitary  Inspector  Health  Department,  San  Francisco. 

RESOLUTIONS   RELATIVE   TO  ,COOPERATlVE    WORK    IN   THE    SANITATION    OF 

CHINATOWN. 

San  Francisco,  Cax.,  February  8,  WO). 
Sir  :  I  have  the  honor  to  transmit  herewith  a  co]\v  of  the  resolutions  adopted 
at  a  conference  of  the  Federal.  State,  and  city  health  authorities  with  members 
of  the  finance  committee  of  the  board  of  supervisors  and  representatives  of  the 
mercantile  organizations,  held  in  the  offices  of  the  merchants'  joint  committee, 
February  6,  1904.  This  meeting  was  called  for  the  purpose  of  discussing  the 
situation  in  Chinatown,  and  also  to  reach  an  understanding  as  to  tlie  sanitary 
measures  to  be  adopted  in  future.  The  agi'eement  under  which  the  work  had 
been  prosecuted  for  the  past  year  having  expired,  and  a  new  city  board  of 
health  having  been  recently  appointed,  it  was  deemed  advisable  to  renew  the 
plan  of  cooperation  at  this  time.  The  inclosed  resolutions  were  unanimously 
adopted. 

Respectfully,  Rupert  Blue, 

Passed  Assistant  Surgeon. 


The  Subgeon-Generaz. 


resolutions. 


Resolved,  That  it  is  the  sense  of  this  meeting  that  the  sanitary  measures 
adopted  by  the  city.  State,  and  Federal  health  authorities  in  February.  1003, 
for  the  eradication  of  contagious  diseases  in  Chinatown  be  continued  for  so  long 
a  time  as  may  be  considered  necessary ;  that  the  city  board  of  health  be 
requested  to  recommend  to  the  board  of  supervisors  additional  measures  for  the 
wliolesale  destruction  of  rats. 

Resolved,  That  all  cellars,  basements,  and  underground  places  in  the  district 
between  California  and  Pacific.  Stockton  and  Kearny,  be  condemned  as  places 
of  abode  and  the  same  be  destroyed :  that  in  case  of  reconstruction  the  owners 
be  required  to  remove  surface  soil  and  to  concrete  the  area  thus  exposed  solidly 
from  wall  to  wall. 

Resolved,  That  the  work  be  done  under  the  direction  and  supervision  of  the 
Public  Health  and  Marine-Hospital  Service,  and  that  a  meeting  of  tlie  represen- 
tatives of  the  Public  Health  and  Marine-Hospital  Service,  the  city  board  of 
health,  and  the  State  board  of  health  be  held  once  every  two  weeks  for 
consultation. 

Martin  Regensburgeb. 

President  State  Board'of  Health. 
Rupert  Blue, 
Passed  Assistant  Surgeon  V.  S.  P.  H.  and  M.  H.  S. 
James  W.  Ward,  :M.  D.. 
President  San  Francisco  Board  of  Health. 
N.  K.  Foster. 

Secretary  State  Board  of  Health. 
A.  A.  D'Ancona, 
Member  Hospital  and  Finance  Committees,  Board  of  Supervisors. 

Wm.  C.  Hassler,  M.  D., 

Chief  Inspecting  Physician. 
San  Francisco,  February  6,  1904- 


PUBLIC  hp:alth  and  marine-hospital  sp:rvice.        227 

The  practical  oxperience  obtained  in  the  use  of  vermin  destroyers 

r  considei-able  areas  of  a  city,  such  as  arsenic  and  phosphorus 

paste  and   Daiiysz   virus,   for  the  destruction  of  rats  and   vermin, 

is  worthy  of  notice.     Tiie  expense  of  tlie  Danysz  virus  was  lessened 

and  its  viruhMice  raised  by  cultivation  in  bouillon  with  jrood  residt. 

The  report  of  Passed  Assistant  Surjjeon  Blue,  <i!:ivinfr  the  details  of 
the  work  durin<r  the  fiscal  year,  follows,  and.  as  a  matter  of  interest 
on  account  of  tlie  rarity  of  systematic  necropsies  in  deaths  from 
plague,  attention  is  called  to  some  valual)le  reports  of  such  necropsies, 
which  will  be  found  included  under  the  reports  of  fatal  cases  with 
necropsies,  miscellaneous  division  of  this  anniYal  report. 

Connnendation  is  due  to  Asst.  Sur":.  Donald  II.  Currie  for  his  work 
in  the  laliorntory  in  San  Francisco,  in  connection  with  the  verification 
of  the  provisional  diagnoses  of  plague  made  from  the  necropsic  find- 
ings, and  to  him  and  Asst.  Surg. "Bolivar  J.  Lloyd,  for  intelligent 
aid  rendered  the  medical  officer  in  command  in  the  sanitary  super- 
vision of  the  Chinese  quarter. 

Report  of  Passed  Asst.  Surg.  Kupkrt  P>LrE. 

UxiTKD  States  Pcblic  Health  and 

Marine-Hospital  Service  Laboratory, 

Sun  Francisco,  Cal..  July  28,  190.',. 
Sib:  I  have  the  honor  to  submit  the  foUowintc  report  of  the  trausnetions  of 
the  Service  at  this  statiou  for  the  year  ended  .Tune  30,  1904:  During  the  year 
tJiere  was  officially  recorded  by  the  city  statistician  a  total  of  371  Chinese 
deaths  from  all  causes.  Deducting  from  this  number  17  deaths  classed  as  vio- 
lent and  basing  the  calculation  on  an  average  population  of  13.000.  gives  au 
annual  mortality  rate  of  27.23  per  thousand.  The  mortality  last  year  was  con- 
siderably higher,  amounting  to  31.70  per  thousand.  The  decrease  in  the  death 
rate  is  undoubtedly  due  to  the  improved  sanitary  conditions  and  to  the  altered 
mode  of  living  of  the  Chinese,  which  has  been  accomplished  through  conferences 
with  the  headmen  of  the  various  tongs  and  associations.  Daily  domiciliary 
inspections  have  also  had  a  marked  influence  in  developing  in  the  oriental  mind 
the  ix)wer  of  grasping  the  significance  of  the  rales  of  cleanliness  as  aiiplied  to 
everyday  life.     Following  is  a  transcript  of  all  registered  deaths  since  1S97 : 


Year. 

Deaths.  , 

Year. 

Death-s. 

1897  98 

'           4M 

1900-1901.... 
1901  1902 

!             418 

1898-99 

1899-1900.... 

;       .si8 

562 

1 

1              4.% 

1  1902-19(8 

464 

MORTrART    statistics. 

Deaths  due  to  irfectious  and  contagious  diseases  for  the  year  under  review : 
Pulmonary  Uiberculosis.  132 ;  other  forms  of  tubercular  disease.  11 ;  diphtheria, 
1 ;  typhoid  fever,  2  ;  beriberi.  11 :  bubonic  plague.  23. 

NECROPSY   REPORT  (UNITED    STATES    L.\B0RAT0R Y )  . 

Number  of  dead  e.xamined.  388:  number  of  bodies  necropsied.  138;  number 
passed  not  requiring  necropsy,  2.50;  number  showing  pest  infection.  22  (Chinese, 
13;  whites,  7  ;  Japanese,  2).     See  list  of  cases. 

PLAGUE — TYPES  OF  THE  DISEASE. 

Plague  incidence  this  year  followed  the  same  course  as  that  observed  in  1001. 
In  San  Francisco  most  of  the  cases  occur  in  the  summer  and  fall  (the  winter 
months  being  almost  entirelv  free  from  the  disease),  but  in  1004  a  few  cases 
api>eared  in  January  and  Febniary  and  the  infection  continued  to  manifest 


228  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

itself  till  February  V.),  wheu  it  disappeared  and  did  not  again  return  during  the 
year. 

With  regard  to  types,  it  will  be  remembered  that  there  were  three  cases  of  the 
I>urely  pneumonic  type  of  the  disease,  all  fatal,  in  a  family  of  Sicilians  living 
under  unhygienic  conditions  in  close  proximity  to  the  Chinese  (piarter.  Infected 
rats  were  found  in  this  neighborhood  before  the  outbreak,  but  it  was  thought 
that  everything  had  been  done  to  destroy  the  infection  and  the  api>earance  of 
these  cases  was  unexp(>cted.  A  thorough  inspection  and  disinfection  of  this  sec- 
tion of  the  city  was  inunediately  ordered  and  carried  out.  with  the  result  that 
no  further  cases  have  ai)peared.  Of  the  24  cases  1  \A'as  purely  bubonic,  16  bubo- 
septicaemic,  2  septicaemic,  2  tonsilo-bubo-septicaemic,  and  3  primarily  pneu- 
monic. 

LABOEATORY   REPORT   OF   RATS   EXAMINED. 

Number  caught  alive  and  delivered  at  laboratory 1,952 

Number  found  dead  and  delivered  at  laboratory 1,001 

Number  showing  pest  infection 22 

The  epidemic  among  rats  was  very  light,  there  being  but  22  infected  cadavers 
found  out  of  the  3,000  or  more  examined  in  the  laboratory  for  li.  pestis.  Quite 
a  large  mortality  was  due  to  the  phosphorus  poison  prepared  in  the  laboratory 
and  placed  in  sewers  and  protected  runways  above-ground  from  time  to  time. 
Good  results  also  wore  obtained  from  the  Pasteur  rat  virus  (Danysz)  procured 
through  the  San  Francisco  agents  of  the  Pasteur  Vaccine  Company  and  spread 
liberally  in  the  homes  of  the  Chinese  and  Japanese.  This  virus,  being  harmless 
to  man  and  domestic  animals,  would  appear  to  be  an  ideal  poison  for  home  use, 
but  may  be  objected  to  on  the  ground  of  cost  and  from  the  fact  that  it  undergoes 
a  rapid  deterioration  when  exposed.  One  of  these  objections  can  be  overcome 
and  a  saving  effected  in  the  cost  of  the  virus  by  incubating  in  bouillon  for  from 
twenty-four  to  forty-eight  hours.  By  this  process  the  numbers  of  the  organism 
{B.  typhi  iintriuni)  are  increased  and  possibly  their  virulence  as  well.  In  proof 
of  its  efficacy  it  should  be  stated  that  numbers  of  rats  trapped  alive  in  China- 
town and  quarantined  at  the  laboratory  have  died  from  the  effects  of  B.  typhi 
murium.     In  a  cage  of  24  rats  so  trapped  14  died  of  this  disease  in  a  short  time. 

SANITARY    MEASTJBES. 

The  sanitary  measures  taken  with  a  view  to  the  suppression  of  disease 
have  been  carried  out  thoroughly  and  embrace  the  following :  Special  disinfec- 
tion of  houses  and  i)remises  wherein  the  disease  occurred,  general  disinfection 
of  the  infected  district,  isolation  of  those  sick  with  the  disease,  surveillance  of 
and  prophylactic  inoculation  with  Yersin  serum  of  contacts,  the  destruction  of 
rats  by  means  of  Danysz  virus  and  phosphoi-us  paste  in  the  infected  area, 
the  general  sanitary  improvement  of  the  dwellings  tmd  stores  with  regard  to 
the  correction  of  faults  of  construction  and  plumbing.  For  the  purpose  of 
excluding  rats  from  dwellings  and  shops  the  cementing  of  ground  floors  was 
early  recognized  as  a  necessity,  because  as  soon  as  the  rats  of  the  infected  dis- 
trict were  killed  or  driven  away  others  would  eventually  crowd  in  from  adjoin- 
ing districts  and  reinfest  the  homes  of  the  Chinese.  This  measure,  while 
expensive  and  necessarily  slow  of  accomplishment,  is  recognized  as  the  most 
important  feature  of  the  year's  work  and  worthy  of  the  highest  commendation 
as  a  means  of  protection  against  infection.  Up  to  this  time  more  than  half 
the  basements  and  cellars  situated  in  the  worst  parts  of  the  Chinese  quarter 
have  been  cemented,  and  the  walls  in  many  instances  repaired  with  brick  at  the 
expense  of  the  owner  or  lessor.  Shocking  conditions  in  many  instances  were 
uncovered  by  removal  of  the  floors.  Broken  soil  pipes  and  often  cesspools  filled^ 
with  the  excretions  of  years  were  found  under  the  rotting  floors  of  cellar  dormi- 
tories in  which  the  cubic  air  space  ordinance  of  the  board  of  health  had  long 
been  violated.  Owing  to  the  ill  usage  of  the  occupants  and  defective  plumbing 
the  woodwork  in  many  of  those  homes  had  become  saturated  with  germ-laden 
filth  to  such  an  extent  that  imrification  could  only  be  attained  by  summary 
removal  and  destruction  l)y  burning.  Firing  the  soil,  in  view  of  the  theory  of 
the  saprophytic  existence  of  the  bacillus  in  soil,  has  been  practiced  in  the  places 
left  vacant  by  the  removal  of  small  buildings  in  back  areas. 

By  referring  to  the  list  it  will  be  seen  that  9  out  of  the  13  Chinatown  cases 
occurred  on  Jackson  street  and  Fish  alley,  near  their  junction.  These  deaths 
coming  so  near  together  pointed  to  a  central  focus  of  infection  situated  some- 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  2'29 

wliere  on  Jackson  stroot  lu'twt'tMi  Koarny  and  Dnpont.  It  was  dctcrniinod  to 
tt'ar  out  and  Imrn  all  tlu'  woodwork  of  tlu'  Itascnicnts  and  cellars  in  lliis 
neif^liliorhood  and  to  rciiuirc  the  owners  to  cement  the  jjrouiid  iielore  reoccnpa- 
tion  would  he  allowed.  The  old  Chinese  theater  on  the  corner  of  Fish  alley  and 
Jackson  street  was  one  t)f  the  tirst  places  to  he  reached,  and  under  its  floors 
were  found  the  conditions  descrihed  ahove.  It  is  a  significant  fact  that  no  cases 
have  occurred  in  San  Francisco  since  the  coniiiletioii  of  this  work.  Followinji 
is  a  sunnuary  of  the  sanitary  iujprovenients  of  this  nature: 

Rasenients  and  cellars  torn  out 155 

Pasenients  and  cellars  cemented 130 

Rear  areas  torn  out 173 

Ix'ear  areas  rehuilt  under  sanitary  regulations 11.3 

Huildin.ijs  totally  destroyed 7 

liuildings  refitted  witli  new  pluuihing 71 

New  toilets  erectetl 72 

In  addition  the  old  rookery  at  020  Jackson  street,  formerly  known  as  the 
"  Grand  Hotel."  Mhich  accommodated  400  to  500  Chinese  lodgers,  has  heen 
gutted  and  entirely  rehuilt  l)y  the  ownei's.  No  Chinese  tenants  will  he  allowed 
to  occupy  this  new  huilding.  None  of  tlie  alleged  subterranean  passages  from 
house  to  house  or  from  house  to  sewer  have  been  discovered.  This  fact  is  inter- 
esting when  taken  in  connection  with  the  stiitement  so  often  made  that  the 
Chinese,  in  liJOO,  during  the  quarantine  of  Chinatown,  passed  in  and  out  of  the 
quarantined  district  at  will  through  some  underground  route. 

OBSERVATIONS. 

Our  observations  with  regard  to  the  transmission  of  plague  from  person  to 
person  bear  out  the  statements  of  other  observers  engaged  in  similar  work, 
namely,  that  spread  of  the  infection  through  contact  with  uncomplicated  bul)onic 
cases  is  of  very  rare  occurrence.  With  the  primarily  pneumonic  cases,  how- 
ever, results  have  been  very  different.  As  illustrative  of  the  iufeetivity  of  this 
tj-pe  of  the  disease,  the  following  cases  may  be  reviewed :  On  February  8  a 
young  woman  of  Sicilian  parentage  died  of  what  \^'as  proved  to  be  pneumonic 
jtlague  at  necropsy.  In  exactly  eleven  days  after  (19th)  both  the  father  and 
mother  had  succumbed  to  tlie  same  malady.  It  would  appear  from  these  cases, 
however,  that  residence  under  the  same  roof  is  the  real  danger,  and  not  mere 
contact,  such  as  would  follow  from  the  sliort  visits  of  physicians  and  friends. 
Many  people  visited  the  girl  while  she  was  ill,  and  more  than  15  young  girls, 
members  of  the  same  confraternity,  kissed  the  corpse  on  the  day  of  the  funeral, 
yet  not  one  of  them  contracted  the  disease. 

THE   CASE   OF   PLAGUE   IX    CONTRA   COSTA   COUNTY. 

The  source  of  infection  of  the  ease  of  plague  which  occurred  in  Contra  Costa 
County,  near  Concord,  in  the  month  of  February,  has  not  as  yet  been  definitely 
traced.  It  might,  however,  have  been  conveyed  tlirough  the  agency  of  food  or 
wearing  apparel  brought  in  from  some  other  place.  This  agricultural  section  of 
the  State  is  devoted  largely  to  the  cultivation  of  fruits  and  vegetables,  and  is 
so  dry  and  parched  during  six  or  seven  montlis  of  the  year  that,  barring  the 
existence  of  rodent  life  in  large  numbers,  no  fears  should  be  entertained  of  a 
permanent  lodgment  of  the  disease  therein.  No  cases  have  been  reported  from 
the  other  sections  of  the  State. 

RELATIONS    WITH    STATE   AND    CITY   AUTHORITIES. 

All  the  sanitary  measures  of  last  year  have  been  prosecuted  uninterruptedly 
and  with  unflagging  zeal  upon  the  part  of  the  medical  officers  (Federal,  State, 
and  city)  in  charge  of  the  work.  The  new  board  of  liealth  appointed  liy  Mayor 
Schmitz  in  January  elected  Dr.  James  W.  Ward,  president ;  Dr.  D.  F.  Ragan, 
health  officer,  and  retained  Dr.  Wm.  C.  Hassler,  chief  sanitary  inspector  of  the  old 
board,  in  oltice.  These  gentlemen  have  rendered  every  assistance  in  their  powex', 
and  have  shown  at  all  times  a  deep  professional  interest  in  the  execution  of  the 
sanitary  plans  and  reconmiendation  of  the  Service  representative.  Out  of  the 
monthly  conferences  of  the  Federal.  State,  and  city  health  authorities  has  grown 
a  permanent  organization  known  as  the  "  Public  Health  Commission  of  Cali- 
fornia," which  will  pass  upon,  at  its  monthly  meetings,  all  questions  relating  to 


230  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

rjuai'antinable  diseases  in  the  State,  with  especial  reference  to  the  i>hi2:ue  situa- 
tion in  San  Francisco.  The  commission  has  organized  as  follows:  Officers — the 
Service  representative,  president;  chairman  State  hoard  of  health,  first  vice- 
president;  chairman  city  hoard  of  health,  second  vice-president;  the  secretary 
of  the  city  hoard  of  health  will  he  secretary  of  the  commission.  Memhers — 
officers  of  the  Public  Health  and  ^larine-Hospital  Ser\  ice,  officers  and  members 
State  and  city  boards  of  health,  county  health  officers,  surgeons  of  the  maritime 
and  inland  transportation  companies,  ex-presidents  State  and  city  boards  of 
health,  members  of  the  finance  committee  of  the  board  of  supervi.sors.  chairman 
and  secretary  of  the  joint  committee  of  the  merchants'  associations,  and  the 
governor  and  mayor,  ex  officio. 

The  attitude  of  the  State  board  of  health  has  been  all  that  could  be  desired. 
Drs.  Martin  Regensburger  and  N.  K.  Foster,  president  and  secretary,  respec- 
tively, of  the  board,  have  attended  regularly  the  monthly  conferences  held  in  this 
laboratory,  and  their  assistance  has  at  all  times  been  freely  given. 
Respectfully, 

RupEBT  Blue, 
Passed  Assistant  Surgeon. 

The  Surgeon-General. 

[Inclosure.] 
List  of  plaf/iic  f^nses  for  the  year  ended  June  30.  lOOJf. 

90.  Chin  Guie :  aged  iil'.  July  14,  100-3:  74.3  Jackson;  male. 

97.  Pieti'o  Spadafora  :  aged  35;  July  19.  1903:  19  Jasper  place;  male. 

98.  Mrs.  Pietra  Braucato  :  aged  62  :  July  20.  1903  :  19  Jasper  place  ;  female. 

99.  Yee  Ku  Jin:  aged  44:  July  29.  1903:  722  Jackson:  male. 

100.  Charles  Bock :  aged  33 :  August  10,  1903 :  German  Hospital :  male. 

101.  Wo  Coev  Chung :  aged  44 :  August  21,  1903 :  73."i  Commercial :  male. 

102.  E.  T.  Slater:  aged  31:  September  1:3.  1903;  Railroad  Hospital;  male. 

103.  K.  Imai ;  aged  •2v, ;  October  7.  1903 :  41Sa  Post :  male. 

104.  Jung  Mou  Tzang  Shee;  aged  23;  October  21,  1903;  30  Fish  alley; 
female. 

105.  Chin  Lai ;  aged  54 ;  October  22.  1903 :  30  Fish  alley :  male. 
100.  H.  Inouye;  aged  15;  October  24.  1903:  .334  Bush:  male. 

107.  Lai  Shew  :  aged  57 :  OctoI)er  29.  1903 ;  027  Jackson :  male. 

108.  Slick  Chat ;  aged  7 :  November  4.  1003 ;  742  Washington ;  female. 

109.  Jew  Soo :  aged  7:  November  7.  1903;  844  Washington:  female. 

110.  Chin  Mon  Tzer  Shee:  aged  54;  November  11,  1903;  1016  Stockton; 
female. 

111.  Ho  Mon  Chin  Shee;  aged  26:  January  10.  1904:  628  Jackson:  female. 

112.  Lee  Woon  Wing:  aged  62;  January  11,  1904;  624*  -Jackson;  male. 

113.  Lee  Ngin  Lean:  aged  61;  January  1.3.  1904:  18  Fish  alley;  male. 

114.  Katie  Cuka ;  aged  18 :  recovered ;  5.58a  Natoma  ;  female. 

115.  Irene  Rossi ;  aged  IS ;  February  S.  1904 :  0  Verrauess ;  female. 
110.  Giusepi»e  Rossi :  aged  -54 :  February  12.  1904 :  0  Verraness ;  male. 

117.  Fung  Bu  :  aged  42:  Febi'uary  14,  1904:  714*  Jackson;  male. 

118.  Luisa  Rossi;  aged  45;  February  19.  1904;  died  City  and  County  Hos- 
pital :  female. 

119.  Mrs.  Frank  Soto ;  aged  39 ;  February  29,  1904 ;  Concord,  Cal. ;  female. 

Yellow  Fever. 

The  prevalence  of  yellow  fever  in  some  of  the  ports  of  Mexico,  and 
more  southern  countries,  was  noted  in  the  last  annual  report.  Subse- 
quently the  disease  spread  rapidly  in  the  territory'  adjacent  to  our 
southern  border,  finally  assuming  epidemic  proportions.  The  land 
quarantine  along  the  Texas-Mexican  border  was  strengthened  as  far 
and  as  j^romptly  as  possible  in  aid  and  cooperation  with  the  State 
authorities  of  Texas. 

At  Tampico.  Mexico,  for  the  week  ended  July  4.  1903.  28  new  cases 
of  yellow  fever  were  rej^orted.  with  40  cases  for  the  previous  week 
and  31  deaths,  vrhile  at  Vera  Cruz  110  cases  and  36  deaths  were 


PUHLIC    IlKAI/ril    AND    MA  RINK-IK  (SIMTAL    SERVICE.  231 

reported  during'  the  month  of  June,  I'.X))},  with  n  few  cases  at  Oi'izaba, 
180  kih)iueters  by  rail  from  Vera  Ci'iiz  and  1,'2()()  meters  above  the  sea 
level.  This  condition  of  allaii's  was  i-eco<i;ni/A'd  as  a  menace  to  the 
Gulf  coast  of  the  United  States  and  bv  rail  to  the  Texas  border  as 
well. 

Upon  July  3,  100:^,  the  steamer  Mouiif  Vernon,  from  Port  Limon, 
arrived  at  the  Mobile  quarantine  station  with  the  medical  inspector 
ill  with  v«-'llow  fever.  The  vessel  ^Yas  remanded  to  the  National 
Gulf  quarantine  station,  where  the  patient  died  the  morning  after 
arrival ;  no  further  spread  of  the  disease  occurred. 

INSTRUCTIONS  TO  OFFICERS  RELATIVE  TO  YELLOW  FEVER. 

Yellow  fever  being  actualh'  present  at  Tampico,  Mexico,  and 
Limon,  Costa  Rica,  the  following  telegrams  were  sent: 

July  7,  1903. 
LipriNCOTT,  America))  Coiixuhite,  Tampico,  Mexico: 

Take  teuiperatin-o  pussengprs  and  crews  on  vessels  bound  for  United  States 
ports  and  detain  those  above  normal.  Authorized  to  puix-hase  one  dozen  clinical 
thermometers. 

Wyman,  Siirgeon-General. 


July  8,  1903. 
Gruveb,  America))  Co))sulate,  Po)-f  Li)))0)i,  Costa  Rica: 

During  prevalence  yellow  fever  take  temperature  passengers  and  crews  ves- 
sels bound  for  United  States.  Detain  all  with  temperature  above  normal. 
Authorized  to  purchase  dozen  thermometers. 

Walteb  Wyman,  Su)-geoji-Gene)-a1. 


VESSELS    FROM     MEXICAN    PORTS    TO    BE    FUMIGATED    AND    HELD    AT    PENSACOLA    AND 

CARRABELLE,  FLA. 

[Telegrams.] 

Key  West,  Fla.,  July  7.  1903. 
Wyman,  Washinr/ton: 

In  view  of  marked  increase  yellow  fever  Tampico  and  Merida,  100  eases,  with 
01  deaths,  have  instructed  White,  at  Pensacola,  and  Stewart,  at  Carrabelle,  to 
fumigate  all  vessels  from  Mexican  ports  and  hold  five  days  from  completion  of 
fumigation.     Request  your  approval  of  these  instructions. 

Porter. 


Washington,  .J)du  8,  1903. 
Dr.  J.  Y.  Porter,  Ta))ipa.  FJa.: 

*     *     *     Your  instructions  to  White,  at  Pensacola,  and  Stewart,  at  Carra- 
belle, mentioned  in  telegram  July  7,  approved.     *     *     * 

Wyman. 


[Letters.] 

Washington,  July  15,  1908. 

Dear  Sir:  Referring  to  the  subject  of  the  fruit  steamer  Mount  Ver)ion, 
recently  from  Port  Limon  to  your  r)ort,  on  which  the  temporary  medical  in- 
spector sickened  and  died  of  yellow  fever,  I  would  be  pleased  to  know  whether 
he  was  considered  immune  to  that  disease. 

Paragraph  5.5  of  the  United  States  Quarantine  Laws  and  Regulations,  1903, 
page  23,  requires  that  the  personnel  of  fruit  vessels  bound  for  our  Southern 


232  PUBLIC    Hf:ALTH    AND    MARINE-HOSPITAL    SERVICE. 

ports  should  Ix*  iiuiiiune,  and  this  unfnrtunate  fatality  demonstrates  the  wisdom 
of  this  r('(inirt'inent. 

Itesiiec-tfully.  W.  Wymax. 

Surgeon-General. 
Dr.  Henby  Goldthwaite. 

Health  and  Executive  Officer. 

Quarantine  Board  of  Mobile  Bay,  Mobile,  Ala. 


Mobile.  Ala.,  July  H.  190.3. 
Sir  :  Replying  to  yours  of  the  l.jth  instant,  regarding  death  of  inspector  on 
fi"uit  steamer  Mount  Vernon,  and  calling  our  attention  to  paragraph  .">."5,  United 
States  Quarantine  Laws  and  Regulations,  regarding  i)ersonnel  of  fruit  vessels, 
I  heg  t(i  say  that  where  it  is  possible  persons  known  to  be  immune  are  secured 
for  these  positions  and  eveiy  effort  is  made  to  secure  such  persons. 

Doctor  Parker,  of  the  Mount  Vernon,  had  lived  here  for  some  time,  and  while 
not  an  immune  we  considered  him  an  acclimated  individual.  In  this  connection 
I  would  say  that  the  crews  of  the  fruit  steamers  are  constantly  changing,  and 
without  placing  an  absolute  embargo  against  this  class  of  business  it  is  almost 
an  impossibility  to  adhere  to  the  strict  letter  of  the  law. 
Very  truly,  yours, 

Henky  Goldthwaite. 
Health  and  Executive  Officer. 
The  Subgeon-Geneeal. 

SITUATIOX    UPOX    THE    TEXAS-IIEXICAX    BORDER. 

On  July  2,  1903.  telegi'aphic  inquiry  was  addressed  to  the  acting 
assistant  surgeon  in  charge  at  Laredo,  Tex.,  as  to  the  advisability  of 
investigating  rumored  yellow  fever  at  Monterey,  Mexico.  His  reply 
upon  same  date  stated  that  his  personal  investigation  of  that  point 
was  not  necessary,  Monterey  having  quarantined  Tampico,  Mexico. 
The  Bureau,  however,  carefully  observed  the  condition  of  affairs 
which  threatened  the  Texas  border,  and  was  prepared  to  send  addi- 
tional officers  to  the  points  of  danger  and  also  to  reinforce  the  small 
camps  for  detention  of  suspects. 

DANGER  OF  TRANSMISSION  OF  YELLOW  FEVER  TO  MONTEREY  FROM  TAMPICO. 

Acting  Assistant  Surgeon  Hamilton,  at  Laredo,  Tex.,  reported  July 
10  as  follows : 

Referring  to  danger  of  yellow  fever  reaching  Monterey  from  Tampico,  I  quote 
telegram  received  of  Consul-General  Hanna.  at  Monterey,  dated  .Tuly  10 : 

"  Have  made  careful  investigation.  Am  thoroughly  convinced  that  everything 
is  clean  as  far  south  as  Victoria.  No  cases  of  yellow  fever  known  in  Victoria 
nor  Montex-ey.     Two  quarantines  between  here  and  Tampico." 

I  have  written  the  consul  at  Victoria  to  give  me  early  information  should 
cases  occur  there. 

The  death  of  a  railroad  official  at  Cardenas  of  yellow  fever  acquired  in  Tam- 
pico is  reported  by  the  press.  Cardenas  is  1.50  miles  from  Tampico  on  railroad 
between  Tampico  and  San  Luis  Potosi.  There  is  no  quarantine  on  this  line  of 
travel.  San  Luis  Potosi  is  claimed  to  be  noninfectible.  It  has  an  altitude  of 
fi,000  feet.  Monterey  may  be  reachetl  via  San  Luis  Potosi  from  Tampico  in 
thirtj'-nine  hours  without  quarantine  inspection,  which  includes  a  delay  at  San 
Luis  Potosi  of  twelve  hours  on  account  of  trains  not  making  connection.  There- 
fore persons  infected  at  Tampico  may  reach  Monterey  notwithstanding  the 
double  quarantine  on  the  direct  route.  Acting  Asst.  Surg.  .John  Frick.  of  Tam- 
pico, who  passed  through  here  a  short  time  ago,  informed  me  that  the  quaran- 
tine inspection  consisted  in  taking  the  temperature  of  passengers  and  a  change 
of  train  crews.  Pei-sons  having  normal  temperature  are  allowed  to  pass.  Time 
consumed  from  Tampico  to  Monterey  is  thirteen  and  one-half  hours. 

Two  families  cjf  railroad  employees  between  Tampico  and  Monterey  have 
passed  through  here.     The  employees  believed  that  yellow  fever  would  soon 


iniHLlO    HFALTll    AND    M  A  RI NK-IIOSIMTAL    SKKVICK.  28.*^ 

hroMk  out  in  Monterey  niid  they  weit'  nt'raid  to  rtMn.iin  tlicre.  Tliey  liad  been 
ninnin.u;  between  .Montei-ey  and  'I'aniitico.  'I'licy  inl'ornied  me  tbat  ercnvs  of 
fivifiht  trains  ran  lin-ouirli  to  'I'anipit'o.  only  tlie  [(assenyer  crews  lieinjj;  cliauf^ed 
at  (luanintino  station. 

riJECAUTIONS   WITH    RE(5AK1)    TO   VESSELS   ARRIVING   VIA    NORTHERN    PORTS. 

Stoi)s  Avorc  silso  tukon  to  protect  ports  south  of  the  southern  bound- 
iiry  of  Marvhmd  from  vessels  via  northern  ports  arriving  from  phices 
infected  with  yeHow  fever,  as  will  be  shown  in  the  following  corre- 
spondence : 

Treasuky  Dkpartment, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Wu.shinntnu.  July  9,  1003. 
Sir:  Referring  to  tliat  jwrtion  of  tbe  Quarantine  Laws  and  Kegubitions  of 
the  Uuited  States,  revised  edition,  I'.Hlo,  entitled  "  Si)eeial  Itef^ulations  on 
account  of  Yellow  Fever."  page  '27,  and  particuhudy  to  i)aragraph  107  of  this 
section,  it  is  desired  that  if  possible  an  arrangement  in  the  interest  of  com- 
merce be  entered  into  with  the  (luarantine  ollicer  of  the  port  of  New  York, 
whereby  "  via  "  vessels  arriving  at  his  port  from  territory  infected  or  sus- 
pected of  infection  witli  yellow  fever  and  expecting  to  proceed  to  southern 
ports  of  the  Ignited  States  may  l)e  disinfected  and  a  certificate  issued  to  that 
effect  for  the  use  and  guidance  of  the  quarantine  officers  south  of  the  Maryland 
line.  Such  an  arrangement  will  obviate  delay  to  this  class  of  vessels  at 
southern  ports  and  carry  out  the  provisions  of  the  Quarantine  Laws  and 
Regulations  of  the  United  States. 

Yon  are  therefore  directed  to  confer  with  Dr.  A.  H.  Doty,  health  officer  for 
the  port  of  New  York,  Quarantine,  Staten  Island,  N.  Y.,  and  endeavor  to  elTect 
such  an  arrangement  and  agree  upon  a  form  of  certificate  setting  forth  the 
treatment  given  to  such  vessels  at  his  port  for  exhibit  to  quarantine  otflcers 
south  of  the  Maryland  line. 
Respectfully, 

Walter  Wyman,  Surgeon-General. 
Surg.  P.  H.  Bailhache, 

Public  Ileultli  and  Mariiic-IIospital  Service, 

StapJeton,  Staten  Island,  N.  Y. 

A  similar  letter  of  direction  was  addressed  to  the  medical  officer 
in  command,  Public  Health  and  Marine-Hospital  Service,  Baltimore, 
Md.,  to  confer  with  the  commissioner  of  health  at  that  port  upon  the 
same  subject. 

Treasury  Department, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Washington,  July  9,  1903. 
Sir  :  Referring  to  Bureau  letter  of  even  date,  directing  you  to  confer  with 
the  health  officer  for  the  port  of  New  York  in  regard  to  the  arri\al  of  "  via  " 
vessels  from  yellow-fever  latitudes,  you  are  also  directed  at  the  same  time  to 
make  inquiry  as  to  whether  any  examination  of  rats  is  made  upon  vessels  arriv- 
ing from  ports  infected  or  susi)ected  of  being  infected  with  plague.  Also 
to  ascertain  as  to  the  advisibility  for  the  occasional  sulphurization  of  this 
class  of  vessels  to  destroy  rats  and  vermin,  after  the  discharge  of  cargo. 
Respectfully, 

W.  Wyman,  Surgeon-General. 
Surg.  P.  H.  Bailhache, 

Public  Health  and  Marine-Hospital  Service, 

Stapleton,  Staten  Island,  N.  Y. 


United  States  Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 
Port  of  New  York  (Stapleton),  N.  Y.,  July  14,  1903. 
Sir  :  I  have  the  honor  to  acknowledge  receipt  of  Bureau  letter  of  July  9,  1903, 
directing  me  to  confer  with  Dr.  A.  H.  Doty,  health  officer  of  the  port  of  New 


234  PUBLIC    HEALTH    AND    MAKINP>HOSPITAL    SERVICE. 

York,  in  regard  to  the  arrival  of  "  via  "  vessels  from  yellow-fever  latitndes.  and 
endeavor  to  effect  an  arrangement  and  agree  njion  a  form  of  certHicate  setting 
forth  the  treatment  given  to  "  via  "  vessels  at  the  port  of  New  York,  for  exhibit 
to  quarantine  olHcers  south  of  the  Maryland  line.  In  the  absence  of  Doctor 
Doty,  who  is  now  in  Europe,  I  called  on  Doctor  I/IIonnnedleu  and  explained 
the  matter  to  him.  He  informed  me  that  they  were  furnishing  a  certificate  to 
"  via  "  vessels,  and  at  my  suggestion  it  was  amended  to  include  the  Treasury 
regulations.     Copy  of  the  certificate  agreed  iii)on  is  herewith  inclosed. 

In  regai'd  to  the  matter  of  examination  of  rats  in  vessels  from  ports  infected 
or  suspected  to  be  infected  with  plague,  such  examinations  are  made,  and  these 
vessels  are  fumigated  with  sulphur  for  the  purpose  of  destroying  rats  and  other 
vermin. 

Respectfully,  Preston  H.  Bailhache, 

8ur(/con  in  Command. 

The  Surgeon-General. 

[Inclosure.] 

To  tvlwm  it  may  concern: 

This  is  to  certify  that  the  S.  S. has  this  day  been  disinfected  in  accord- 
ance with  the  rules  and  regulations  of  this  department  and  the  Treasury 
Department.  The  bedding,  clothing,  and  effects  of  the  crew  have  been  sub- 
jected to  steam,  and  the  cabin,  forecastle,  and  hold  of  vessel  disinfected  with 
sulphur  and  bichloride  of  mercury.  The  crew  took  no  part  in  the  above  dis- 
Infectiou. 


I 


Health  Officer,  Port  of  New  York. 


Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

BaUhnore,  Md.,  July  15,  1903. 
Sir:  As  directed  by  Bureau  letter  of  July  D,  1903,  I  have  conferred  with 
Doctor  Bosley,  the  commissioner  of  health  of  Baltimore,  Md.,  under  whose 
jurisdiction  comes  the  maritime  quarantine  of  this  port  relative  to  the  disin- 
fection of  vessels  from  yellow-fever  ports  for  southern  ports  via  Baltimore — the 
so-called  "  via  vessels." 

We  find  that  such  vessels  very  rarel.y  come  to  this  port.  When  all  Cuban 
ports  were  considered  as  infected  or  suspicious  the  case  was  different,  but  at 
present,  for  the  past  two  years,  practically  no  vessels  are  entered  here  from 
ports  where  yellow  fever  now  prevails,  except  a  few  sailing  vessels  from  Santos 
and  Rio  Janeiro,  and  these  have  not  cleared  for  ports  south. 
Respectfully, 

II.  R.  Carter,  Surgeon. 
The  Surgeon-General. 


Treasury  Department, 
Bureau  op  Public  Health  and  Marine-Hospital  Service, 

Waslunuton,  July  24,  1903. 
Sir  :  In  reply  to  your  telegram  of  July  IG,  1903,  "  White,  Pensacola  quaran- 
tine, asks  if  vessels  from  Tampico  via  New  York  having  health  officers  of  New 
York  certificate  of  disinfection  should  be  refumigated  at  Pensacola,  my  opinion  is 
no  necessity,  but  would  request  Bureau's  opinion  and  decision,"  you  are  informed 
steps  had  already  been  taken  for  a  conference  with  the  health  officer  of  the  port 
of  New  York  with  a  view  to  the  issuance  of  a  certificate  to  vessels  expecting  to 
proceed  to  Southern  ports,  for  exhibit  to  quarantine  officers  south  of  the  Mary- 
lajid  line,  showing  that  they  had  received  the  treatment  required  by  the  quaran- 
tine laws  and  regulations  for  "  via  "  vessels.  A  copy  of  the  letter  of  the  medical 
officer  in  conunand  of  this  Service  at  New  York  is  herewith  inclosed,  together 
with  form  of  the  certificate  which  will  be  issued. 

If  this  certificate  is  presented,  it  is  the  opinion  of  the  Bureau  that  no  further 
treatment  will  be  necessary,  provided  the  vessel  arrives  with  no  sickness  on 
board. 

Respectfully,  Walter  Wyman,  Surgeon-Oeneral. 

Sanitary  Inspector  J.  Y.  Porter, 

Puhlic  Health  and  Marine-Hospital  t^ervicc.  Key  West,  Fla. 


PUHLIC    IIKALTII    AND    MAKINK-IIUSI'ITAL    SKKVICK.  '285 

'I'UIOASllRY     I  )KPAUTM  KNT, 
Hl'KKAU     OF     rUIM.lC     IlKAI/ni     AND     AI  AH  I  NK-I  loSIMTAI,    SKRVICK, 

Wiisliiiu/liiii,  Aiii/iisl.  J,l,  I'Kt.l. 

Sir:  The  atli'iitioii  of  the  sliii)i)iiii;  iiitci-csts  coiiforiuHl  is  iiivitod  to  the  fact 
tliJit  vessels  arrivins:;  at  our  Xoftlicni  ports  troni  i)orts  or  places  suspected  or 
infected  with  yellow  fever  and  proceeding;  s(»ulh  of  the  soul  hern  boundary  of 
Maryland  are  subject,  under  the  United  States  Quarantine  Laws  and  KeKida- 
tions,  to  disinfection  and  detention  at  these  Southern  i»orts,  coniin.i;  under  the 
class  of  "  via  "  vessels. 

The  fact  that  they  are  adniitt<>d  and  remain  in  Northern  ports  for  a  few  days 
to  several  weeks  does  not  modify  this  restriction.  In  order  to  avoid  delay  to 
connnerc(>.  it  is  suiiiiested  that  such  vessels — say,  at  the  port  of  New  York — 
i-eceive  fumi,i;ation  and  taki>  the  certificate  of  the  quarantine  oflicer  of  that  port, 
setting  forth  the  fact  and  manner  of  procedure,  for  exhibit  to  the  quarantine 
oflicer  south  of  the  .Maryland  line.  The  time  of  detenticm  after  fiunigation  may 
then  be  inuuedialely  reckoned  and  the  vessel  he  subject  upon  arrival  to  inspec- 
tion and  verification  of  the  fumigation  only  without  further  delay  except  to 
complete  the  five-day  period  of  observation,  if  not  already  completed  ;  provided 
no  susi)iciofis  illness  occurs  after  the  fumigation. 

In  like  manner  "  via  "  vessels  proceeding  to  the  port  of  Philadelphia  may  be 
fumigated  at  the  United  States  quarantine  station,  Reedy  Island,  Delaware,  and 
a  certiticate  taken  to  that  effect. 

Very  truly,  yours,  Walter  Wyman,  Surrjcon-General. 

Secretary'  Maritime  Exchange, 

New  York,  N.  Y. 

A  similar  letter  was  addressed  to  the  Secretary  Maritime  Exchange, 
Philadelphia,  Pa. 

PROTECTION  OF  GULF  PORTS  AGAINST  YELLOW  FEVER  FROM  :MEXIC0. 

On  account  of  the  epidemic  proportions  of  yellow  fever  in  certain 
Mexican  ports  during  the  month  of  July  and  the  illness  of  the  imnnme 
acting  assistant  surgeon  detailed  for  duty  at  Tampico,  Mexico,  it  was 
found  necessary  to  take  extra  precautions  for  the  protection  of  the 
Gulf  coast. 

An  immune  medical  officer  of  the  Service  was  directed  to  proceed 
to  Tampico,  Mexico,  via  Pensacola,  Fla.,  to  make  special  reports 
upon  the  conditions  along  that  line  of  water  travel,  while  at  the  same 
time  reports  received  from  the  sanitary  inspector  of  the  Service  in 
Florida  coincided  with  the  necessity  for  these  additional  precautions. 

[Telegrams.] 

Washington,  Jnltj  16,  1903. 
Walter  D.  Hines, 

First  Vice-President  Louisville  and  Nashville  Railroad, 

Louisville,  Ky.: 

Illness  of  accredited  Service  inspector  and  marked  increase  of  yellow  fever 
has  caused  temporary  disarrangement  of  plan  at  Tampico.  An  arrangement 
might  possibly  be  made  whereby  your  vessels  could  be  innnediately  released 
after  removal  of  crew  and  disinfection  of  vessel  at  Pensacola  (|uarantine. 

W^YMAN,  Surgeon-General. 


Washington,  July  22,  1903. 

Doctor  GOLDTHWAITE, 

Health  and  Executive  Officer,  Mobile,  Ala.: 
As  previously  wired  you.  Acting  Assistant  Surgeon  Frick,  who  was  detailed  by 
President  in  office  consul,  Tampico,  obliged  to  withdraw  on  account  of  sickness. 
Lippincott,  a  locum  tenens,  not  detailed  by  Pi-esident,  and  while  he  is  disinfecting 
in  accordance  with  instructions,  still  Bureau  does  not  regard  Tampico  equipped 
with  an  accredited  medical  officer,  as  contemplated  by  regulations.     Therefore, 


236  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

until  commissioned  officer  reaches  Tampico.  Bureau  bokls  regulations  require 
disinfection  and  five-day  detention  thereafter  of  vessels  from  Tanii)i<'o.  Please 
wire  if  you  are  doing  this.  Above  instructions  have  been  sent  to  other  ports. 
Richardson  ordered  from  New  Orleans  to  Tampico. 

Wyman. 

This  telegram  was  repeated  to  State  health  officers  of  Louisiana  and 
Texas,  and  to  Passed  Assistant  Surgeon  Grubbs,  at  Gulf  quarantine, 
Mississippi. 


Mobile,  Ala..  July  23,  1903. 
Wyman,  Washington: 

We  are  disinfecting  all  vessels  from  Tampico,  with  five  days'  detention  there- 
after. 

GoLDTHWAiTE,  Health  Officer. 


Austin.  Tex.,  July  23,  1903. 
Wyman,  Wasliinr/ton: 

Vessels  from  Tampico  are  disinfected  and  held  five  days.     Texas  quarantine 
against  Mexican  ports  very  rigid. 

Tacok.  State  Health  Officer. 


New  Orleans,  La.,  July  23,  1903. 
Wyman,  Washington: 

We  have  always  disinfected  and  detained  fi\e  days  vessels  from  Tampico  and 
will  continue  to  do  so.     «     *     * 

Edmond  Souchon, 
President  LouiHiana  Utatc  Board  of  Health. 

INSPECTION    OF    GULF    COAST. 

The  patrol  of  the  Mississippi  Gulf  coast  against  yellow  fever 
mentioned  in  the  annual  report  for  the  fiscal  year  1903,  was  continued, 
and  in  addition  thereto  the  medical  officer  of  the  Service  stationed  at 
New  Orleans  was  directed  to  make  periodical  visits  along  this  coast 
line.     Xo  suspicion  of  yellow  fever  was  reported  during  the  season. 

[Letter.] 

Treasury  Department, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Washington,  July  23,  1903. 

Sib:  Your  attention  is  called  to  a  copy  of  the  instructions  sent  to  officers  in 
Mexican  ports,  bearing  date  ilay  18,  1903,  mailed  to  you  yesterday. 

First  Vice-President  Hines,  of  the  Louisville  and  Nashville  Railroad  Com- 
pany, was  yesterday  in  consultation  with  myself  concerning  the  quarantine 
restrictions  on  the  vessels  of  his  line.  These  are  three  in  number  and  ply  regu- 
larly in  the  coal  traffic  between  Tampico  and  Pensacola,  taking  coal  to  Tampico 
and  returning  empty.  They  carry  and  will  carry  no  passengers.  They  are  the 
Belmont  and  the  Pensacola,  owned  by  the  Louisville  and  Nashville,  and  the 
Dorisbrook,  chartered  by  them.  Their  crews  vary  from  .30  to  40  each.  In 
accordance  with  suggestions  from  the  Bureau,  it  is  understood  each  vessel  has 
been  provided  with  a  sufficient  number  of  Dutch  ovens,  alcohol,  sulphur,  and 
pans,  or  containers,  for  thoroughly  disinfecting  the  ship  at  Tampico. 

It  would  seem  that  if  the  vessels  at  Tampico,  while  thus  empty  and  at  a  safe 
distance  from  the  shore,  are  thoroughly  disinfected  for  at  least  two  hours  before 
weighing  anchor  and  weighing  anchor  immediately  after  the  disinfection,  all 
the  crew  having  been  inspected  before  departure,  might  with  safety  be  admitted 
at  the  port  of  Pensacola.  after  a  sufficient  detention  to  make  five  full  days  from 
Tampico,  provided  no  sickness  occurring  on  board. 

To  be  on  the  safe  side,  however,  the  arrangement  should  include  the  taking  of 
the  temperatures  of  the  crew  at  the  foreign  port  and  the  detention  of  any 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  237 

whose  temperature  is  altuve  uorinal.  unless  the  cause  thereof  is  evidently  due  to 
some  other  trouble  than  yellow  fever,  care  being  taken  to  avoid  deceit  on  the 
part  of  the  crew  by  holding  water  or  ice  in  their  mouths  liefcjre  the  insertion  of 
the  thermometer. 

On  arrival  at  Peusacola  the  arrangement  includes  again  taking  the  tempera- 
tures with  thermometers  and.  for  additional  safety,  another  fumigation,  which, 
it  is  understood,  will  not  be  particularly  objected  to.  After  the  fumigation 
then'  will  be  reiiuired  a  detentit)n  to  complete  five  full  days  from  the  completion 
of  the  fumigation  at  Tampico,  .md.  moreover,  a  further  detention  for  a  day  or 
more,  if  in  the  opinion  of  the  quarantine  officer,  for  any  reason,  it  seems  desir- 
able to  impose  it.  it  being  understood  that  further  detention  after  fumigation 
at  Pensacola  may  be  imposed  up  to  five  days,  but  that  it  is  not  required  as  a 
routine  procedure,  and.  in  point  of  fact,  it  is  not  improbable  that  it  would  be 
equally  safe  to  allow  the  vessel  to  proceed  after  one  or  two  days'  detention. 

A  certificate  must  accompany  each  vessel  from  the  officer  at  Tampico,  giving 
the  exact  day  and  hour  on  which  the  fumigation  is  considei'ed  completed.  If  it 
is  contemplated  to  allow  the  fumigation  to  be  continued  at  sea.  this  may  be 
done,  but  it  should  be  considered  as  supplementary  time,  the  orders  previously 
given  standing  good,  that  the  medical  officer  at  Tampico  shall  not  leave  the 
vessel  or  give  it  pratique  until  the  two  hours'  fumigation  have  been  completed. 

While  you  are  making  the  formal  inspection  of  Santa  Rosa  Quarantine  you 
are  directed  to  investigate  the  feasibility,  and  make  a  full  report  upon  the  plan 
of  treatment  of  these  particular  vessels  arriving  from  Tampico. 

You  are  directed  also  to  report  by  wire  as  to  the  advisability  of  placing 
immune  medical  inspectors  upon  these  vessels. 
Respectfully, 

Walter  Wyman,  Hurgeon-General. 

Asst.  Surg.  T.  F.  Richakdsox. 

Public  Health  and  Marine-Hospital  Service,  Pensacola,  Fla. 

Doctor  Richardson  was  directed  to  confer  with  Sanitary  Inspector 
Porter  at  Pensacola.  and  show  him  Bureau  letter  of  instructions  rela- 
tive to  the  safety  of  communication  between  that  port  and  Tampico, 
Mexico. 

[Letters.] 

Treasury  Department, 
BuEEAu  OF  Public  Health  and  Marixe-Hospital  Service, 

Washington.  July  31.  1903. 
Sib  :  Referring  to  telegram  of  this  date,  and  to  your  report  of  the  27th  instant 
in  regard  to  vessels  from  Tampico.  Mexico,  you  are  directed  to  make  a  careful 
investigation  of  the  situation  at  Tampico,  especially  noting  the  place  where  ves- 
sels bound  for  the  United  States  ports  are  fumigated  before  bill  of  health  is 
granted,  as  per  agreement  of  May  IS.  with  the  regular  steamship  lines,  a  copy 
of  which  was  forwarded  to  you  at  Peusacola.  It  is  the  desire  of  the  Bureau 
that  this  disinfection  should  be  made  at  a  point  where  there  will  be  no  danger 
of  mosquitoes  coming  aboard  the  vessel  while  being  disinfected,  or  afterwards 
before  she  sails.  The  question  of  the  jwssibility  of  the  reinfection  of  the  vessel 
after  those  mosquitoes  already  on  board  have  been  killed,  is  a  most  important 
one,  and  if  this  agreement  is  to  hold  good  every  precaution  must  be  adopted 
to  prevent  such  an  occurrence.  You  are  requesed  to  transmit  with  your  reix)rt 
a  sketch  of  the  bay  at  Tampico.  including  the  Panuco  River,  showing  the  ix>int 
where  the  disinfection  has  been  done  in  the  past:  also  where  it  should  be  done 
in  the  future,  if  you  consider  tlie  present  place  unsafe ;  also  any  facts  that 
may  be  of  interest  in  regard  to  the  matter. 
Respectfully. 

Walter  Wyman,  Surgeon-Oeneral. 
Asst.  Surg.  T.  F.  Richardson. 

Public  Health  and  MarinC'Hospital  Service,  Pensacola,  Fla, 


Public  Health  and  Marine-Hospital  Service, 

OmcE  OF  Medical  Officer  in  Command, 

Pensacola.  Fla.,  July  27.  1903. 
Sir  :  I   have  the  honor  to  acknowledge  the  receipt  of  Bureau  letter  of  2.3d 
instant  concerning  the  proposed  treatment  of  vessels  of  the  Gulf  Transit  Com- 


238  PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE. 

pany  (Louisville  and  Nashville  Railroad  Cojiipauy)  at  Tampico  and  at  this  port, 
so  as  to  avoid  the  five  days"  detention  here  after  disinfection,  and  directing  me 
while  making  the  formal  inspection  of  Santa  Rosa  Quarantine  "  to  investigate 
the  feasibility  and  make  a  full  report  upon  the  plan  of  treatment  of  these  par- 
ticular vessels  arriving  from  Tampico." 

The  vessels  of  the  Gulf  Transit  Company,  I  am  informed  by  Mr.  E.  O.  Salt- 
marsh,  general  manager  of  that  company,  are  only  in  this  port  from  twenty- 
four  to  thirty-six  hours  when  coal  is  coming  in  in  normal  quantity.  At  present 
a  strike  in  the  coal  fields  is  on.  and  the  three  steamers  are  idle,  all  three  of  them 
being  now  in  this  port,  the  Peiisdcoht  and  the  Dorisbrook  in  the  city,  and  the 
Auffiifit  Bchiioiit  at  quarantine  undergoing  disinfection  and  detention. 

In  company  with  Mr.  Saltmarsh  I  have  inspected  these  vessels  (except  the 
Belmont,  which  I  saw  at  quarantine)  and  find  them  all  well  suited  to  disin- 
fection by  the  pot  method.  The  Belnio)it  carries  a  Chinese  crew,  the  other  two 
ordinary  crews. 

The  advisability  of  securing  immune  crews  was  stated  to  Mr.  Saltmarsh,  but 
this  he  considers  impossible.  It  is  difficult  to  secure  any  crew  at  all  for  this  par- 
ticular work  in  the  coal  trade,  the  stay  in  port  being  so  short.  ^Ir.  Saltmarsh 
also  considered  the  plan  of  leaving  the  crew  in  quarantine  and  allowing  the 
vessel  to  come  up  to  the  city  after  redisinfection  here  as  impracticable,  for  the 
reason  that  the  masters  ^vould  not  allow  their  vessels  to  get  from  under  their 
immediate  charge  and  that  of  their  regular  engineers.  Besides  there  are  at 
present  no  facilities  for  detaining  crews  at  the  Santa  Rosa  station. 

It  would  seem,  then,  that  the  only  practicable  means  to  safely  avoid  a  delay  to 
vessel  and  crew  at  quarantine  here  of  five  full  days  after  disinfection  is  to  be 
sure  that  the  process  of  disinfection  at  Tampico  is  thorough  and  efficient,  that 
there  is  no  possibility  of  any  mosquitoes  gaining  access  to  the  vessel  during  or 
after  this  disinfection,  and  that  the  crew  remains  well  during  the  voyage  and 
for  five  days  after  last  possible  exposure. 

An  efficient  disinfection  at  Tamiiico  with  the  means  provided  on  the  vessel 
is  comparatively  easy  of  accomplishment.  The  crew's  health  can  be  observed 
by  attaching  an  immune  medical  inspector  to  each  vessel,  but  I  do  not  believe  it 
is  possible,  if  the  disinfection  is  done  in  the  Panuco  River  at  Tampico,  to  make 
sure  that  no  mosquito  comes  aboard  while  the  vessel  is  under  treatment  or  leav- 
ing the  stream  after  completion. 

The  vessels'  masters  inform  me  that  mosquitoes  are  at  times  very  plentiful  in 
the  river  at  Tampico,  their  presence  or  absence  being  dependent  upon  the 
direction  and  force  of  the  wind.  The  only  certain  way  to  be  sure  that  none 
come  on  board  is  to  proceed  to  sea  a  certain  distance  and  there  do  the  disin- 
fecting. I  believe  this  jtlan  to  i^e  feasible,  and  the  steamship  authorities  here 
state  that  they  could  arrange  for  the  return  of  the  medical  officer  to  Tampico 
by  launch  or  small  boat  after  the  disinfection  was  completed. 

I  have  already  wired  the  Bureau  recommending  the  appointment  of  medical 
inspectors  on  these  vessels  and  nominating  two  immune  physicians  for  the 
positions. 

Respectfully,  T.  F.  Richardson, 

Assistant  8ii)-geon. 

The  Surgeon-General. 

REPORT   ON    THE    IMPRACTICABILITY    OF   THOROUGHLY    DISINFECTING    VESSELS    AT 
TAMPICO   AND   OTHER   PORTS. 

The  attention  of  quarantine  officers,  both  at  foreign  and  domestic 
ports,  is  called  to  the  followinji^  report  from  Tampico,  and  especially 
to  that  portion  of  it  which  relates  to  the  entwine  rooms  and  stokeholes 
of  steamers  at  an  infected  port  and  the  liability  of  mosquitoes  making 
these  portions  of  the  vessels  harbors  of  refuge : 

TAMPICO,  Mexico,  August  19,  1903. 

Sir  :  In  accordance  with  instructions  contained  in  Bureau  letter  of  the  31st 
ultimo  I  have  the  honor  to  submit  the  following  rei»ort : 

The  city  of  Tampico  is  situated  on  the  left  l)ank  of  the  Rio  Panuco.  about  0 
nautical  miles  from  its  mouth,  and  has  an  estimated  population  of  17.<KMt.  About 
3  miles  below  Tampico,  on  the  same  bank  <if  the  river,  is  the  town  or  settle- 
ment of  Dona  Cecilia,  where  the  coal  docks  of  the  aiexican  Central  Railway 


PUBLIC    HEALTH    AND    MAKINE-HOHl'lTAL    SERVICE.  239 

iire  located  and  wlieiv  tlio  slcaiiicrs  ui  the  reiisacdla-Tanipieo  trade  are  dis- 
charged. At  the  mouth  of  the  raiiuco  is  the  small  village  of  La  Barra.  The 
hospital  of  the  Mexican  Central  Railway  is  located  here. 

Tampico  is  surrounded  on  every  side  by  lagoons  and  marshes,  and  these,  in 
conjunction  with  the  i-ain-water  I)arrels  and  oi>en  cisterns  which  ai)onnd  in  the 
city,  furnish  une(|ualed  breeding  places  fnr  tlie  mos(iuito. 

I)ona  Cecilia,  which  is  incorporated  with  Tampico.  as  is  al.so  F>m  I'.arra,  is 
almost  entirt'ly  a  si>l(l(>iiient  <!f  railway  eniplou'cs  and  dock  lal)orers.  These  are, 
or  rather  were  before  the  ei)ideniic.  largely  niniiuununes.  The  dock  laborers  at 
pres(>nt,  howc>ver,  are  almost  enlirely  negroes  from  the  I'>ritish  V>'est  Indies,  the 
peons  who  formerly  did  nmch  of  this  work  having  (led  from  the  fever.  It  is 
claimed  by  the  physicians  here  that  these  negroes  are  all  inmiune.  Doctor  Car- 
rigan,  surgeon  in  charge  id"  the  railway  hospital  at  La  liarra,  states  that  he  has 
never  seen  a  case  among  them.     Doctor  Lippincott  makes  the  same  assertion. 

Tami)ico  and  Dona  Cecilia  are  undoubtedly  badly  infected  i)laces.  I  am 
informed  by  physici.ans  who  i)ractice  here  that  there  is  no  part  of  either  place  in 
which  cases  of  fever  have  not  originated  and  are  not  originating. 

At  La  I>arra.  however,  only  a  few  cases  have  developed,  probably  because  the 
strong  sea  breeze  which  blows  almost  constantly  keeps  the  mosquitoes  down. 
The  few  nonimnnnie  Americans  who  have  thus  far  escaped  the  fever  have  done 
so  b.v  sleei)ing  at  La  R.irra. 

The  surrounding  country,  both  on  the  railroad  and  water  routes  inland,  has 
had,  I  am  informed,  many  deaths  from  yellow  fever  among  persons  who  have 
come  down  to  Tampico,  sickened  there,  and  started  back  to  their  homes.  It  is 
said  that  canoes  with  natives  in  them  dead  or  dying  of  the  fever  have  been 
found  in  sevei'al  instances  up  the  river. 

The  percentage  of  deaths,  if  all  cases  are  reported,  is  vei'y  high.  Doctor 
Matienzo,  the  physician  in  charge  of  the  civil  hospital,  states  that  it  has  been 
over  50  per  cent  in  hospital  practice.  At  the  Mexican  Central  Hospital  the 
results  have  Ix'cn  better — 04  cases,  with  3(;  deaths,  since  May  18. 

Most  of  the  reported  cases  occurring  in  Tau)pico  have  been  sent  to  the  civil 
hosi)ital,  where  they  are  put  into  screened  wards.  However,  in  some  cases  the 
patient  is  alhnved  to  i*emain  at  his  home,  in  which  event  a  kind  of  mosquito 
house  with  double  doors  is  erected  around  the  sick  bed.  There  have  undoubtedly 
been  many  unreported  and  untreated  cases. 

The  stegomyia  is  ubi(|uit(Uis.  Tliere  is  now  sitting  in  Tampico  a  medical  com- 
mission sent  by  the  Mexican  National  Government  to  investigate  and  report 
upon  the  conditions  there.  Doctor  Del  Kio,  of  this  Federal  commission,  in- 
foi'med  me  this  morning  that  the  town  of  Victoria,  about  250  kilometers  north 
of  Tanqiico  on  the  line  of  the  INIontei'ey  and  Mexican  Gulf  Railway,  was  infected 
from  Tamjuco,  and  there  bad  been  at  the  time  of  his  visit  last  week  5  cases  and 
1  death. 

Since  the  storm  of  the  15th  instant  telegraphic  and  rail  facilities  have  been 
interrupted,  and  there  are  no  recent  reports  from  the  interior. 

The  disinfection  of  vessels  under  the  supervision  of  Service  officers  here  has 
been  done  entirely  in  the  I'anuco  River  at  points  marked  by  red  anchors  on  the 
accompanying  chart.  As  will  be  seen  by  reference  to  the  chart,  the  river  is 
nowhere  much  over  a  third  of  a  mile  wide,  and  I  believe  it  is  absolutely  impos- 
sible to  do  a  satisfactory  disinfection  at  any  point  in  the  river,  because  of  the 
great  probability  of  mosquito  contamination  of  the  vessel  while  or  immediately 
after  disinfecting.  There  are  undoubtedly  days  when,  on  account  of  the  strong 
sea  breeze,  it  would  be  possible  to  disinfect  with  safety  near  the  land  end  of  the 
stone  jetty  at  the  mouth  of  the  river,  but  as  the  disinfected  vessel,  if  of  any 
size,  would  have  to  go  up  the  river  again,  at  least  above  Dona  Cecilia,  in  order 
to  turn  around,  she  would  prol)al)ly  receive  a  fresh  influx  of  mosquitoes.  In 
fair  weather  it  might  be  possible  to  do  the  disinfection  a  few  miles  outside  of 
the  mouth  of  the  river  without  danger  of  mosquito  contamination,  but  there  are, 
especially  at  this  time  of  the  year,  many  days  when  this  would  not  be  prac- 
ticable. 

There  is,  however,  a  point  of  extreme  imi)ortance  in  this  matter  of  disinfec- 
tion at  infected  ports  of  departure,  and  that  is  the  possibility  of  engine  and  fire 
rooms  harboring  infected  nios(iuitoes.  I  have  talked  with  engineers  of  steamers 
on  this  matter,  and  they  inform  me.  v,-ithout  excejition,  that  mosquitoes  are  as 
bad  in  the  stokeholes  and  engine  rooms  when  in  port  as  in  any  other  part  of 
their  ships,  but  that  after  a  vessel  has  been  out  a  day  or  so  the  mosfpiitoes  leave 
these  parts.  I  have  not  as  yet  been  able  to  catch  any  mosquitoes  in  these  com- 
partments of  the  vessels  here  that  I  have  visited,  but  one  of  the  engineers  of  the 


240  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

steamer  Avgtist  Belmont  told  me  that  be  bad  the  morning  of  my  visit  been  bitten 
by  several  mosquitoes  while  working  in  the  stokehole  about  the  boilers. 

It  would  seem  that  to  be  effective,  fumigation  here  should  comprise  the  simul- 
taneous treatment  of  all  parts  of  a  vessel,  including  fire  and  engine  rooms,  at 
some  point  outside  of  the  seaward  end  of  the  jetty.  I  do  not  believe,  however, 
that  this  is  feasible.  There  would  be  some  danger  to  the  safety  of  a  vessel  in 
anchoring  in  an  open  roadstead  and  closing  up  the  engine  rooms  for  at  least 
two  hours. 

It  is  therefore  my  opinion.  In  view  of  the  widespread  character  and  severity 
of  the  epidemic  in  Tampico  and  vicinity,  the  great  prevalence  of  mosquitoes,  and 
the  impossibility  of  disinfecting  without  danger  of  mosquito  infection  during  or 
after  the  process,  that  it  is  impracticable  to  do  an  absolutely  safe  disinfection 
of  outward  bound  vessels  at  the  port  of  Tampico  at  this  time,  and  I  would 
respectfully  recommend  that  the  unmodified  quarantine  regulations  be  enforced 
at  all  Gulf  ports  against  vessels  from  Tampico. 

Respectfully,  T,  F.  Richardson, 

Assistant  Surgeon. 

The  Surgeon-General. 

EARLY    PRECAUTIONS    AGAINST    INTRODUCTION    OF    YELLOAV    FEVER    INTO 

TEXAS. 

During  the  month  of  July,  1903,  cases  of  yellow  fever  appeared 
inland  along  the  railway  lines  in  Mexico,  as  will  be  seen  in  the  follow- 
ing correspondence,  setting  forth  the  precautions  taken,  even  at  that 
early  date. 

[Telegram.] 

Washington,  July  18,  1903. 
Weetenbaker,  Neiv  Orleans,  La.: 

Direct  Ilalstead  ship  immediately  poles  and  pins  for  four  tents  to  Hamilton, 
Laredo,  fast  freight. 

Wyman. 


YELLOW    FEVER    REPORTED    AT    SAN    I.UIS    POTOSI,    MEXICO — NOTIFICATION    TO    INSPEC- 
TORS  ON    MEXICAN    BORDER— CAR    DISINFECTION. 

[Telegram.] 

Vera  Cruz,  Mexico,  July  31,  1903. 
Wyman,  Washington: 

Reliable  newspaper  dispatch  reports  yellow  fever  San  Luis  Potosi.    Important 
because  close  to  Texas  by  rail. 

GOLDBEEGER. 


NOTIFICATION     TO     INSPECTORS     ON     MEXICAN     BORDER — CAR     DISINFECTION     ORDERED. 

[Telegram.] 

August  1,  1903. 
Acting  Assistant  Hume,  Eagle  Pass,  Tex.: 

Goldberger,  Veracruz,  reports  yellow  fever  San  Luis  Potosi.  On  account  this 
and  other  contagious  diseases  Mexico,  Secretary  Treasury  has  determined, 
under  paragraph  147,  Quarantine  Regulations,  through  Pullman  cars  will  not 
be  allowed  without  thorough  disinfection,  requiring  at  least  twelve  hours. 
Method  will  be:  Preliminary  fumigation  with  pyrethrum  powder,  1  pound  per 
thousand  cubic  feet,  two  hours'  exposure,  followed  by  formaldehyde,  per  para- 
graph 1G5,  regulation  A  or  B.  Give  notice  in  reasonable  time  to  railroad  offi- 
eials.     Inform  collector  customs.     Wire  report  of  action. 

/  Wyman. 

This  telegram  was  repeated  to  Acting  Assistant  Hamilton,  Laredo, 
Tex. 


PUBLIC    HKALTH    AND    MAKINE-HOSPITAL    SERVICE.  241 

BEPLIES    RECEIVED   TO   TELEGRAM    OF    INSTRUCTIONS. 

[Telegrams.] 

Eagle  Pass.  Tex.,  Augmt  },  1903. 
Wyman.  Washington: 

Fresh  Pulluiaiis  arc  to  bo  spnt  hero  from  San  Antonio.  Mexican  Pullman  will 
not  cross  Irontier.  but  transfer  jjassen^ers  at  river  to  fresh  cars.  Pass('nt,'ers 
other  than  I'uUman  are  always  transferred  to  fresh  coaches  in  Diaz.  Any  Mex- 
ican car  entering  United  States  will  be  disinfected  after  to-day. 

Lea  Hume. 


Laredo,  Tex.,  August  2,  1903. 
Wyman.  Washington : 

Arranged  with  railroad  passengers  on  Mexican  Pullman  transfer  to  American 
Pullman  commencing  August  3.  Mexican  Pullman  to  remain  in  Mexico.  There- 
fore no  disinfection  at  present.  Detained  three  passengers  from  San  Luis 
Potosi  to-day. 

Hamilton. 


PRECAUTIONS  AT  EL  PASO  AGAINST   IMPORTATION   OF  YELLOW   FEVER. 

August  4,  1903. 
Acting  Assistant  Alexander,  El  Paso,  Te.r.: 

Are  there  any  through  Pullmans  or  other  cars  from  Mexico  at  present? 
Bureau  informed  yellow  fever  San  Luis  Potosi  has  passed  quarantine  at  Mon- 
terey and  at  Gulf  Railroad,  and  is  also  at  Linares,  Ciudad  Valles,  and  Panuco. 

Wyman. 

[Reply.] 

El  Paso,  Tex.,  August  5.  1903. 
Wi'MAN,  Washington: 

No  direct  line  from  any  infected  city;  passenger's  arriving  on  Central  from 
there  are  carefully  inspected ;  if  necessary,  detained  and  their  baggage  disinfected. 

Alexander. 


request    FROM    STATE    HEALTH    OFFICER    OF    TEXAS,    RELATIVE    TO    YELLOW    FE\TR    IN 
SAN  LUIS  POTOSI  AND  TO  BORDER  RESTRICTIONS. 

AUSTIN,  Tex.,  August  3,  1903. 
Wy'man,  Washington: 

Will  you  kindly  wire  me  what  Information  you  have  relating  to  yellow  fever 
in  San  Luis  Potosi  and  what  restrictions  you  have  placed  on  border?  This 
department  will  appreciate  information  as  to  contagious  diseases  contiguous  to 
Texas. 

Tabor,  State  Health  Officer. 

[Reply  to  State  health  officer.] 

August  4,  1903. 
Tabor,  State  Health  Officer.  Austin,  Tex.: 

Goldberger.  Vera  Cruz,  wires  yellow  fever  San  Luis  Potosi ;  Lippincott,  Tam- 
pico.  writes,  dated  July  28.  infection  passed  quarantine  Monterey  and  Gulf 
Railroad,  reported  Linares.  Ciudad  Valles,  and  by  river  to  Panuco.  Bureau  now 
requires  disinfection  through  Pullmans  at  Laredo  and  Eagle  Pass.  Griffith, 
consul,  Matamoras,  wires  no  precautions  taken  at  Matamoras  against  Tampico. 


Wyman. 


8639—04 10 


242  PUBLIC    HEALTH    AND   MARINE-HOSPITAL   SERVICE. 

PKECAUTIONS   AT    MATAMOEAS   AGAINST    YELLOW    FEVER   IN    MEXICO. 

BROWNSVII.I.E.  Tex.,  August  3.  1903. 
Secretary  of  State,  Washinf/ton: 

Yellow  Tampico ;  no  precautious  being  taken  at  Mataiuoras  opposite  Browns- 
ville, Tex. 

Griffith, 
U.  S.  Consul  at  Matamoras. 


August  4,  1903. 
Acting  Assistant  Surgeon  Combe. 

BroH-usviJIc.  Tex.: 
Yellow  fever  i-eported  Tan)i)ico  and  other  places  in  Mexico.     No  precautious 
taken  at  Matamoras.     Wire  what  precautions  you  deem  necessary  at  Browns- 
ville. 

Wyman. 


Brownsville,  Tex.,  August  7,  1903. 
Sukgeon-General,  Washington: 

In  company  with  American  con.*;ul  interviewed  Mexican  authorities  to-day. 
They  gave  us  assurances  that  they  would  immediately  establish  observation 
stations  at  San  Miguel  and  San  Fernando  on  the  only  avenues  of  entrance  into 
Matamoras.  No  yellow  fever  along  the  Rio  Grande.  Will  wire  any  develop- 
ments here. 

Combe. 


TEXAS  state   quarantine   AGAINST    SAN    LUIS    POTOSI   REMOVED. 

Austin,  Tex.,  August  9,  1903. 
Surgeon-General,  Wash  ington : 

After  thorough  investigation  I  fail  to  find  yellow  fever  in  San  Luis  Potosi. 
Have  removed  Texas  quarantine  against  that  place.  All  actually  infected  places 
in  Mexico  will  be  rigidly  iiuaraiitiued  ;  have  detailed  special  inspector  at  San 
Luis  Potosi.  Every  precaution  will  be  taken  by  Texas  authorities.  Rigid 
inspection  will  be  maintained  on  frontier.  Will  advise  you  of  any  information 
this  department  gets  and  will  appreciate  similar  courtesy  from  you. 

Tabor, 
State  Health  Officer  of  Texas. 


Washington,  August  10,  1903. 
Sir  :  You  are  hereby  directed  to  make  a  quiet  insi)ection  of  the  Gulf  coast 
between  New  Orleans,  La.,  and  Scranton,  Miss.     Inclosed  you  will  find  a  list  of 
temporary  acting  assistant  surgeons  on  duty  at  the  various  stations  between 
the  points  mentioned. 

«  «  *  4:  *  *  * 

Respectfully, 

Walter  Wyman,  Surgeon-General. 
Passed  Asst.  Surg.  C.  P.  Wertenbaker. 

PuMic  Health  and  Marine-Hospital  Service,  New  Orleans,  La. 


[Telegrams.] 

Washington,  August  12,  1903. 
State  Health  Officer  Tabor.  Austin.  Te.r.: 

Hamilton  wires  three  cases  yellow  fever  Victoria,  Mexico;  one  death  officially 
reported. 

Wyman. 


PUiJLlC    HEALTH    AND    MAKIN]-:-H()SI>lTAL    SEKVICK.  243 

Washinoton,  Ata/Ksl  J'l,   l!H).]. 
Pn-sidoiit  LiCEAGA,  Siiiirriar  Hoard  TlcuJIh,  M<  .rico,  Mexico: 

SliiU'  Ilciiltli  odiccr  'r.-ihor.  of  'i'cxiis.  ti'lc.ixriiplicd  Aujrnst  !),  lio  had  widitlrawii 
Stato  (luaraiitinc  ajraiiist  Sau  Luis  I'otosi.  lUiri-au  wired  this  to  Scrvico 
iusin'cturs  at  Larodo  and  Eagle  I'ass. 

W  V.MAN. 


rondltions  at   montkkiov — imtkca  i  ;'i'i(».\s  takkn  i5v  .mexican  (iuvkunment. 

Larkdo,  Tex.,  AuuuM  11,  1903. 

Sir:   I   have  tiio  lionor  to  aclsiiowlod.nc  tolei^rani  (^ated  Auf^ust   10,  190.3,  viz: 

"  Proceed  Monterey.  Suhinit  noiiiiiiatioii  and  phice  on  duty  temporary  actiuf; 
assistant  and  three  jruards.     IJiton  completion  duty  rejoin  station." 

Telejjram  received  in  evening  late,  but  sekn-ted  temporary  actinji;  assist;int 
and  guards  to  report  to  me  early  in  niorni'ig  for  duty.  August  11  Instructed 
temporary  acting  .issistant  on  train;  also  i)laced  on  duty  guards,  one  on  foot- 
hridge,  the  other  two  at  railroad  bridge. 

1  took  afternoon  train  of  August  11  for  Monterey  and  telegraphed  Bureau 
from  Xuevo  Laredo,  Mexico,  I  had  left  for  Monterey.  August  12  arrived  at 
Monterey. 

^Monterey,  Me.xico,  the  ca])ital  of  the  State  of  Nuevo  Leon,  has  alxmt  75,000 
inhabitants,  probably  more  including  the  niuiilcipalit.v,  with  an  area  of  20J 
square  miles.  The  altitude  of  city  is  1,()24  feet.  Distance  by  railroad  from 
Laredo,  Tex..  1(18  miles:  from  Eagle  Pass,  Tex.,  284  miles;  from  Tampico,  322 
miles:  from  Victoria  (uow  infected),  175  miles;  from  Linares  (1  case  yellow 
fever  in  July),  00  miles. 

I  found  the  streets  fairly  clean.  The  central  ])ortion  of  the  city  is  paved 
with  semivitrified  brick  and  cobblestone.  The  center  of  the  cit.y  is  pretty  well 
drained,  being  rolling.  The  three  trunk  lines  of  railroads,  viz,  Mexican  Central, 
National  de  Mexico,  and  International,  have  their  freight  and  passenger  depots 
in  the  same  part  of  city,  within  a  few  blocks  of  each  other  This  is  a  low  part 
of  the  city  and  water  accumulates  and  stands  for  some  time,  therefore  a  good 
breeding  ground  for  mosquitoes. 

Consul-General  Ilanna,  who  had  been  taking  quite  an  interest  in  the  quaran- 
tine and  health  of  city,  was  pleased  that  I  had  come  to  look  over  situation ;  he 
knew  of  no  cases  nor  suspicion  of  cases,  and  he  frequently  inquires.  Visited  rail- 
road engineer  reported  sick  with  yellow  fever  at  Monterey  Hospital  (he  was 
reported  at  Laredo  to  I)e  under  (piarantine  or  guard)  that  evening,  and  I  found 
him  not  under  guard  and  suffering  from  an  attack  of  appendicitis. 

I  saw  Doctor  Turpln,  i\X  one  time  acting  assistant  surgeon,  Marine-Hospital 
Service,  at  Mexico  City  during  1899.  He  had  not  seen  anything  to  arouse  his 
suspicions.  He  also  informed  me  that  he  had  caught  and  examined  several 
mosquitoes  and  as  yet  had  not  found  any  stegomyia. 

Morning  of  the  13th  I  Iiad  a  consultation  with  the  governor  of  the  State,  who 
received  me  cordially  and  told  me  the  steps  he  had  taken  to  prevent  the  intro- 
duction of  the  disease.  He  confirmed  my  information  about  Linares  having  had 
yellow  fever.  He  stated  the  latter  part  of  July  a  person  died  there  from  fever, 
having  come  from  Tampico.  Xo  cases  since  then,  but  it  now  should  have  a  crop 
from  that  case,  and  I  therefore  consider  it  suspicious,  and  persons  from  there 
are  detained. 

The  governor  informed  me  that  a  lazaretto  and  detention  station  were  being 
completed  at  ^laguierar,  a  station  on  the  border  line  of  the  State.  There  are 
practically  no  inhabitants  at  this  point.  The  buildings  are  to  be  quite  complete, 
consisting  of  buildings  to  accommodate  those  having  disease,  suspicious  cases, 
and  persons  detained  but  not  having  any  suspicious  disease ;  also  accommoda- 
tions for  physicians  and  employees,  etc.  This  is  to  be  completed  about  the  end 
of  the  coming  week,  so  that  it  can  be  occupied.  It  will  cost,  when  finished, 
$20,000  (Mexican). 

I  obtained  a  written  order  from  the  governor  to  those  in  charge  of  death-reg- 
ister records  to  allow  me  to  see  them  myself.  During  the  day  I  made  the 
acquaintance  of  and  interviewed  eight  physicians,  and,  although  they  nearly  all 
had  cases  of  typhoid  fever  ou  hand,  none  had  anything  suspicious.  I  had  a  con- 
sultation with  the  British  vice-consul,  a  i)racticing  physician,  who  was  at  Mon- 
tei'ey  during  the  fornu^r  epidemic  of  IS'.tS.  ;ind  he  assured  m(>  of  nothing  at  pres- 
ent.    I  examined  the  record  of  deaths  during  month  of  August  from  1st  to  14th, 


244  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

inclusive,  and  found  typhoid  fever  4,  remittent  fever  3,  pernicious  intermittent 
1,  other  causes  80 ;  total,  88  for  fourteen  days. 

The  status  as  I  found  it  at  present  between  Monterey  and  Tampico  is  as  fol- 
lows:  A  shuttle  passenger  train  leaves  Tampico  daily  for  a  point  named  Gon- 
zales, Gl  miles  from  Tampico.  All  passengers  are  inspected  at  Tampico,  tem- 
perature taken,  etc.  At  Gonzales,  three  hours  from  Tampico,  a  change  of  cars, 
temperature,  pulse,  and  general  condition,  with  name  of  person,  are  noted  on  a 
card  retained  by  passenger.  Just  before  arriving  at  A'ictoria,  the  capital  of  the 
State,  another  similar  inspection  is  made  and  noted  on  person's  card,  and  all 
persons  destined  for  Victoria  are  required  to  furnish  their  addresses.  Victoria 
is  divded  into  districts  and  a  physician  appointed  for  each  district.  These 
addresses  are  furnished  to  physician  in  charge  of  district  where  person  resides 
or  lives  for  the  present  and  the  doctor  visits  him  daily  for  ten  days.  If  anything 
develops,  he  is  isolated  and  protected  from  mosquitoes.  Victoria  has  an  altitude 
of  1,473  feet,  population  about  10,000,  and  is  about  six  hours  distant  by  rail  from 
Tampico. 

Passengers  are  again  now  inspected  at  State  line,  where  there  is  a  detention 
station  nearing  completion.  All  those  showing  symptoms  are  detained.  Others 
have  temperature,  etc.,  noted  on  card,  and  proceed.  Again  at  Linares  an  inspec- 
tion is  made,  as  before,  with  same  precaution.  Linares  has  a  population  of  about 
8,000;  altitude,  1,187  feet.  That  is  the  last  inspection  on  line.  No  fruit  from 
infected  places  is  allowed  to  enter  Monterey.  Freight  trains  with  crews  run 
through  to  Tampico,  but  train  is  supposed  to  be  ready  at  Tampico  for  immedi- 
ate return ;  but  I  am  informed  by  railroad  employees  that  sometimes  they  are 
delayed  there  from  two  to  four  hours.  The  crews  live  in  Monterey  (which  is 
bad).  Cars  ai*e  disinfected  with  sulphur  dioxide  at  Gonzales,  and  since  my 
arrival  they  have  commenced  refumigating  cars  at  State  line  with  same  disin- 
fectant.    I  am  to  be  informed  of  first  suspicious  case  at  Monterey. 

There  is  no  precaution  taken  where  passenger  goes  after  arrival  at  Monterey. 
No  disinfection  of  baggage.  Between  Victoria  and  Tampico  the  Federal  and 
State  health  authorities  are  erecting  a  lazaretto  which  will  cost  $40,000;  there- 
fore, I  suppose,  with  suflBcient  buildings  for  all  purposes,  but  no  detention  of  well 
passengers  or  persons. 

After  leaving  Monterey  at  a  siding  called  Sanchez,  12  miles  from  United 
States  border,  a  quarantine  has  been  established  by  the  city  of  Nuevo  I^aredo, 
Mexico,  against  Tampico  and  Victoria,  where  all  persons  from  those  points  are 
detained  and  a  certificate  issued  to  them  of  such  detention ;  also  all  persons,  not 
train  crew,  found  on  freight  trains  are  arrested  and  detained  irrespective  of 
where  they  claim  to  be  from.  Freight  trains  as  a  rule  pass  this  place  at  night. 
I  found  they  had  six  persons  in  detention  taken  from  freight  trains.  This  is  of 
great  benefit  to  Service  at  this  port,  as  the  freight  trains  arrive  at  Nuevo  Laredo 
at  night  and  are  broken  up  as  such  at  that  place.  The -passenger-train  inspection 
does  not  amount  to  much. 

I  believe  it  is  probable  that  yellow  fever  will  reach  Monterey.  There  has  been 
an  abundance  of  rain  and  the  breeding  grounds  for  mosquitoes  about  and  in 
Monterey  are  plentiful. 

Respectfully,  H.  J.  Hamilton, 

Acting  Assistant  Surgeon, 
Public  Health  and  Marine-Hospital  Service. 

The  Sukgeon-Genebai,. 


[Telegrams.] 

Washington,  August  17,  1903. 
President  Souchon, 

State  Board  of  Hcaltli,  New  Orleans,  La.: 
Hamilton.  Laredo,  wires  no  yellow  fever  Monterey  at  present.     State  Health 
Officer   Tabor   has  withdrawn   quarantine   against   San   Luis   Potosi.     Liceaga 
wires  yellow  fever  exists  only  in  Vera  Cruz  and  Tampico. 

Wyman. 


Washington,  August  22,  1903. 
Hamilton,  Laredo,  Tex.: 
Nominate  and  place  on  duty  two  guards.     *     *     * 

Wyman. 


rUHLIC    HEALTH    AND    MAKINK-HOSI'ITAL    SERVICE.  245 

ACTING    ASSISTANT    SrR(;i;OX    IIAMIUON's    RKI'OUr    IPON    INSPECTION    AT    FERRIKS    IN 

VICINITY    OF    LAREDO. 

Aiif/iist  21,  1903. — To-day  four  persons,  tlircc  days  from  Vera  Cruz,  arrlvott  on 
inoriiiiig  train  at  Nuevo  Laredo,  Mexico.  Tliey  had  some  baggage.  rul)lic 
Ileaitii  and  ^Lirine-IIosjiital  Service  guard  detin-ted  them.  It  appears  tliey 
erossed  to  tliis  side  one  l»y  one  during  tlie  day  on  slcilfs  or  by  ferr.v  a  sliort  dis- 
tance below  footliridge,  but  were  dett'cted  in  city  l»y  immigration  detective  and 
taken  to  detention  camp.  Tlieir  baggage  had  not  as  yet  arrivecL  Tliey  had 
arranged  to  have  it  sent  to  a  hotel  on  this  side.  I  infcn-med  hotel  keeper  and 
told  him  if  baggage  arrivi'd  during  the  night  to  have  it  sent  to  detention  camp 
for  disinfection,  as  it  was  from  \'era  Cruz.  Two  of  these  persons  were  natural- 
izetl  Americans  of  Greek  nationality ;  others  were  Greeks  not  naturalized. 
They  informed  me  that  the.v  learned  on  train  that  they  would  not  be  allowed 
entry  on  railroad  train  or  footbridge,  so  they  watched  their  chance  and  came 
over  singly  by  skiff.  They  had  been  told  in  Xuevo  Laredo,  where  the  skiffs 
were  let.  I  therefore  wired  liiu'eau  autliorit.v  to  nominate  two  guards  to  watch 
these  skiffs  or  ferries.     There  are  several  in  neighborhood  of  city. 

Aiifiust  22.  IflOJ. — Temi>orary  guards,  two  in  number,  i)laced  on  duty  to-day; 
one  at  most  frequent  skitf  ferrj- ;  the  other  will  l)e  one  night  at  detention 
camp  watching  detained  i)ersons,  and  he  will  be  sent  to-morrow  to  notify  all 
skiffs  not  landing  where  I  have  a  guard  placed  to  inspect  them  not  to  carry 
passengers  from  Mexico  to  this  side.  This  guard,  in  conjunction  with  t'nited 
States  Inspector,  will  see  that  skiffs  do  not  land  passengers  except  only  at  one 
designated  place. 


YELLOW    FEVER    AT    LINARES,    MEXICO REPORTED    PRESENT    AT    MONTEREY. 

[Telegrams.] 

Labedo,  Tex.,  August  27,  1903. 
Wyman,  Wasltinrjton : 

There  have  been  14  deaths  from  yellow  fever  at  Linares  August  24.  Yellow 
fever  is  now  present  in  Teran,  .50  miles  frorh  Monterey.  Thei-e  is  an  uneasy 
feeling  prevailing  Monterey.  It  is  rumored  2  cases  suspected  yellow  fever 
at  Monterey.  Think  disease  was  brought  by  refugees  and  other  passengers 
from  Linares. 

Hamilton. 


YELLOW   FEVER  AT   MONTEREY — ORIGINATED  AT  LINARES. 

Laredo,  Tex.,  August  29,  1903. 
Wyman,  Wasliington: 

One  case  suspected  yellow  fever  at  hotel.  Monterey.  August  25,  taken  hos- 
pital. Monterey.  August  20.  taken  yellow-fever  hospital  near  Victoria.  There 
is  1  case  reported  at  Monterey ;  reliable.  Originated  Linares.  Gave  Informa- 
tion to  State  health  authorities  of  Texas. 

Hamilton. 


TEXAS    quarantine    AUTHORITIES    CLT    OFF    COMMUNICATION    WITH    MONTEREY, 
LINABES,    and   VICTORIA. 

Labedo,  Tex.,  August  29,  1903. 
Wyman.  ^yash  ington : 

The  State  quarantine  officer  telegraphs  cut  off  communication  from  Monterey, 
Linares,  Victoria.  No  one  to  enter  Texas  from  these  points  under  tive  days. 
Cordon  needs  sti-engthening  to  meet  new  conditions. 

Hamilton. 


24G  PUBLIC    HEALTH    AND    MARTNlvHOSPITAL    SERVICE. 

no  cases  of  yellow  fevek  have  originated  at  monterey. 

August  31,  1903. 
Hamilton,  Laredo,  Tex.: 

It  is  iintlerstootl  no  cases  have  originated  in  Monterey  and  that  sick  refugees 
are  now  isolated  in  hospital.     Wire  further  facts. 

Glenn  AN. 


Laredo,  Tex.,  Septemher  1,  1903. 
Wy'man  : 

No  cases  known  to  have  originated  in  Monterey.  Consul-general  states 
effective  detention  quarantine  now  established  against  infected  points.  Many 
rumors — nothing  definite.     *     *     * 

Hamilton. 


Washington.  An  fin  fit  27.  1003. 
State  Health  Officer  Tabor.  Austiti.  Tex.: 

Hamilton  wires :  "  Yellow  fever  now  present  in  Linai'es  in  epidemic  form. 
Monterey  has  quarantine,  requiring  five  days'  detention." 

Wyman. 


Washington,  August  31.  1903. 
SoucHON,  yew  Orleans,  La.: 

Hamilton  at  Laredo  wires  one  case  at  Monterey  isolated  in  hospital,  orig- 
inated in   Linares.     L'nited  States  detains  passengers  from   infected  districts. 
Informed  health  officer  Texas  requires  five  days'  quarantine  upon  all  persons 
from  Monterey,  Linares,  and  Victoria. 
By  direction  Surgeon-General.  Glennan, 

Assistant  Surgeon-Oeneral. 


Washington,  September  11.  1903. 
Hamilton.  Laredo,  Tex.: 

Authorized  to  continue  not  to  exceed  thirty  days  three  temporary  guards 
named  in  your  letter  September  5. 

Wyman. 


Washington,  Septemher  12,  1903. 
Richardson,  Care  United  States  Consulate,  Tampico,  Mexico: 

Upon  return  of  Frick,  you  are  relieved  from  duty  at  Tampico.  Rejoin  your 
station  at  New  Orleans.  Inspect  en  route  Linares,  Monterey,  Victoria,  Mexico; 
Laredo,  Eagle  Pass,  Tex.     Wire  arrival  and  departure  each  place. 

Wyman. 


quarantine    station    established    BY'    MEXICAN    AUTHORITIES    ON    THE    MEXICAN 
NATIONAL  RAU,ROAD — DETENTIO.N  OF  PASSENGERS. 

Laredo.  Tex.,  Septemlter  5,  1903. 
Sir:  I  have  the  honor  to  inform  the  Bureau  that  a  quarantine  station  has 
been  established  12  miles  from  the  border,  on  the  Mexican  National  Railroad,  by 
the  Mexican  authorities  for  the  purpose  of  detaining  for  five  days  (complete) 
all  persons  from  Monterey,  Mexico,  or  any  jilace  infected  with  yellow  fever. 
There  are  no  habitations  near  said  station  and  the  railroad  company  has  placed 
two  passenger  coaches  on  switch  for  acconnnodiition  of  jiersons  detained.  They 
also  have  several  tents.  This  has  simplified  the  quarantine  situation  here  con- 
siderably. 


PUBLIC    HEALTH    AND    MARTNE-HOSI'ITAL    SERVICE.  247 

Since  the  estal>lisliiii»'iit  of  s;iitl  stnlioii  only  one  iicrsoii  liiis  piisscd  lli.-it  sl:i- 
tion — tliMt  is,  lie  esciiped.  We  were  iiiunedijitely  iiotilied  iuid  lie  \v;is  in  I^aredo 
only  a  few  hours  when  foiuid  and  returned  to  the  Mexican  autliorities.  The 
through  Mexico  train  (i)assenger)  does  not  stoj*  between  Saltillo  and  Lani- 
pazos,  (18  miles  south  t)f  Monterey  and  !>."»  miles  north  of  Monterey,  either  goin« 
north  or  south.  Persons  hoardini^  train  at  Saltillo  have  I'nited  States  consular 
certificates  as  evidence  of  havini;  been  there  live  or  more  days.  Freight-train 
crews  from  Xuevo  Laredo,  .Mexico,  do  not  run  to  Monterey,  but  receive  their 
trains  at  a  station  this  (north)  side  of  Monterey. 

State  Health  Oliicer  (J.  K.  Tabor,  after  visiting  Monterey,  thought  it  advisable 
to  continue  ciuarantine.     lie  informed  me  he  would  send  an  inspector  there.     1 
have  n«tt  learned  of  any  yellow-fever  cases  originating  in  Monterey,  Mexico. 
Itespectfully, 

II.  J.  Hamilton, 
Act  ill!/  .\xsis1<iiil  Surf/con. 


I  Telegrams.] 
DETENTION    ANn   DISINFECTION    OF    MAIL   FROM    MONTEREY. 

Laredo,  Tex.,  Hcptemhrr  13,  1903. 
Wyman,  Wasliiiif/toii  : 

Texas  inspector  at  Monterey  reports  ten  days'  detention  and  disinfection  of 
mail  from  Monterey. 

Hamilton. 


YELLOW    fever    AT    MONTEREY — DETENTION    AND    DISINFECTION    OF    MAIL. 

Laredo,  Tex.,  Scptcmhcr  13,  1903. 
Wyman.  Washington: 

Texas  inspector  at  Monterey  reports  yellow  fever  now  present  in  Monterey. 
Texas  now  requires  ten  days'  detention  and  disinfection  of  mail  fi*om  Monterey. 

Hamilton. 


YELLOW   FEVER  AT   NUEVO  LAREDO,   MEXICO. 

Austin,  Tex..  f^cptemhcr  15.  1903. 
Wyman,  Washington: 

One  case  yellow  fever  officially  reported,  after  necropsy,  at  Nuevo  Laredo, 
Mexico.  I  go  there  to-night  to  personally  conduct  quarantine,  which  will  pro- 
hibit all  communication  with  Mexico. 

Taboe,  State  Health  Offlcer. 


EPIDEMIC  DENGUE  REPORTED  AT  NUEVO  LAREDO,  SUSPECT  YELLOW  FE\'ER. 

Laredo,  Tex,,  f^cptrniher  15,  1903. 
Wyman,  Washington: 

The  local  authorities  report  epidemic  dengue,  Xuevo  Laredo,  Mexico.  I'hysi- 
cian  died  yesterday  with  black  vomit ;  sick  five  days.  Had  jaundice.  Necropsy 
to-day.  Present,  State  quarantine  officer.  L'.  S.  Army  surgeon,  the  health  officer 
of  Laredo,  the  local  board  of  health,  self.  Diagnosis,  suspicious  yellow  fever ; 
another  person  urine  contains  albumen  and  bile;  another  urine  contains  albu- 
min; both  jaundice.  Is  very  suspicious  ;  have  quarantined.  State  health  officer 
and  chief  U.  S.  Ai-my  surgeon  Department  of  Texas,  will  be  here  to-morrow. 
Think  the  disease  w^as  introduced  by  person  from  Victoria,  Mexico.  Sliall  have 
a  consultation  and  will  advise  you  of  result. 

Hamilton. 


248  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

PRECAUTIONS   AGAINST  IiMPORTATION   OF  YELLOW   FEVEK — CAMP   EQUIPMENT.  1 

Washington,  Heptemher  16,  1903. 
Hamilton,  Laredo,  Tex.: 

Have  wired  State  health  otRcer.that  you  will  cooperate.  "Will  order  sent  you 
by  freight  to-day  additional  tentage  and  camp  equipage  for  100  people.  This 
simply  by  way  of  anticipation.  Service  officers  also  will  be  ordered  as  pre- 
^-entive  against  emergency,  but  you  will  retain  your  present  duties  if  they  come. 

Wyman. 


Washington,  8epteml)er  16,  1903. 
Hume,  Eagle  Pass.  Tex.: 

Have  wired  State  health  officer  you  will  cooperate  with  him.     Wire  requi- 
sition for  any  additional  equipment  or  help  needed. 

Wyman. 


[Telegrams.] 

Washington,  September  16,  1903. 
Von  Ezdorf,  Matan:;as,  Cuba: 

Relieved  ^Matanzas.  Proceed  by  first  steamer  to  New  Orleans.  Wire  arrival. 
Instructions  will  be  sent  you  to  proceed  to  Laredo  for  protection  against  yellow 
fever.     Nunez,  Cienfuegos,  ordered  to  relieve  you. 

Wyman. 


Washington,  September  16,  1903. 
GuiTERAS,  Cairo,  IJl,: 

Be  prepared  for  orders  temporary  duty  Laredo.  Situation  there  acute.  May 
l)ave  to  wire  you  to-morrow,  and  you  may  have  to  leave  hospital  with  temporary 
acting  assistant  pending  arrival  of  assistant. 

Wyman. 


SPREAD     OF     YELLOW     FEVER     IN     STATE     OF     TAMAULIPAS,     MEXICO NECESSITY     FOR 

QUAR.^NTINE. 

[  Telegrams.  ] 

Brownsville,  Tex,,  September  16,  1903. 
Wyman,  Washington: 

Spread  of  yellow   fever  epidemic  in  the   State  of  Tamaulipas  requires  the 
immediate  establishment  of  a  rigid  quarantine  against  the  entire  State. 

Maris.    Collector. 


Washington,  September  21,  1903. 
Collector  Customs.  Brotrnsville,  Tex.: 

Thanks  for  information — your  telegram  IGth.  Guards  will  be  authorized, 
if  necessity  arises,  under  supervision  Acting  Assistant  Surgeon  Combe,  upon 
plan  now  in  operation  at  Laredo  and  Eagle  Pass. 

Wyman. 


Washington,  September  17,  1903. 
Acting  Asst.  Surg.  J.  K.  Combe,  Broivnsville,  Tex.: 

Confer  with  collector  customs  and  wire  recommendations  regarding  necessity 
establishment  quarantine  against  introduction  yellow  fever.  Report  regarding 
conditions. 

Wyman. 


PITHLIC    HEALTH    AND    M ARINK-MoSl'ITAL    SERVICE.  249 

HuctwNSViixK,  Tex.,  Srptonhrr  IS,  1903. 
Wym AN.  ir«.v7/ inptrni : 

Matamoras  is  iu>\v  quarantimHl  against  all  liifoctcd  points  in  Mexico,  ami 
every  precaution  being  taken  by  tlie  Mexican  antliorities  there  to  prevent  intro- 
duction of  yellow  fever.  Do  not  think  quarantine  JH'tween  Hrownsville  and 
Matanioras  at  present  necessary.     Collector  should  be  authorized  to  ai»point  a 


number  of  guard.s  for  emergency. 


J.  K.  Combe,  Acting  Assistant  Surgeon. 


Washington,  Septemher  21,  1903. 
Acting  Assistant  Surgeon  Combe,  Broicnsvillc,  Tex.: 

If   necessity   arises  you   will   be   authorized   to   employ   guards   under  your 
supervision. 

Wyman. 


GUARDS     AND    CAMP    EQUIPMENT    AT    EAGLE    PASS. 

Eagle  Pass,  Tex.,  Septemher  19,  1903. 
Wyman,  Washington: 

County  and  State  anxious  over  fever  situation.     Four  additional  guards  and 
camp  outfit  absolutely  necessary  for  protection.     Will  put  all  suspects  in  camp. 

Hume. 


Washington,  September  21,  1903. 
Hume.  Eagle  Pass,  Tex.: 

Submit  nomination  by  letter  and  place  on  duty  immediately  four  additional 
guards.     Twelve  tents  and  outfit  ordei'ed  shipped  you  from  New  Orleans. 

Wyman. 


GUABDS   at   LAREDO.   TEX. 

Washington.  Septemher  21.  1903. 
Hamilton,  Laredo,  Tex.: 

You  are  authorized  to  employ  four  additional  guards  18th.  W^hy  are  two 
additional  mounted  guards  necessary,  as  requested  your  message  20th?  Wire 
present  situation. 

Wyman, 


QUARANTINE  ON   TEXAS  BORDER — YELLOW   FEVER  AT   NUEVO  LAREDO. 

Austin,  Tex..  September  17,  1903. 
Wyman.  Washington: 

Thanks  for  your  assistance.  Texas  Rangers  will  aid  us  on  border,  as  well  as 
other  guards.  Quarantine  at  Laredo  is  perfect.  I  was  there  yesterday.  Saw 
one  case  yellcrw  fever.  Mexican  officials  claim  epidemic  of  dengue,  but  it  is 
evidentlv  yellow  fever.     No  cases  on  Texas  side. 

Tabor.  State  Health  Officer. 


attempts  at    NUEVO  LAREDO,    MEXICO,    TO  BREAK   THROUGH    RIVER   CORDON. 

Laredo.  Tex.,  Septemher  18,  1903. 
Wyman.  Wash  ington : 

County  judge  and  postmaster  Zapata  County  telegraphs  this  morning :  "  Peo- 
ple from  Nuevo  Laredo,  ilexico,  attempting  to  cross  at  various  points.  Need  at 
least  four  more  guards  for  few  days."     Request  authority  to  employ  guards. 

Hamilton. 


250  PUBLIC    ilKALTll     AND    M  AIUN  E-H(>WI*ITAL    SERVICE. 

ADDITIONAL   GUARDS    FOK    ZAI'ATA    COUNTY. 

Washington,  fieptcmhcr  18,  1903. 
Hamilton,  Laredo,  Tex.: 

Place  on  duty  and  submit  nomination  to  Bureau  by  letter  four  additional 
guards  for  Zapata  County. 

PuBViANCE,  Acting  Surgeon-General. 


Laredo,  Tex.,  September  21,  1003. 
Wyman,  Wa.'ihington  : 

Regarding  matter  mentioned  in  your  telegram,  September  21,  guard  line  cov- 
ers about  ;>0(»  miles  river.  On  duty,  P.ureau  guards.  Zapata.  10;  Webb,  IS; 
Texas  guards,  S;  city  Laredo,  3;  Webb  County,  2;  Zapata  County.  12;  tlie 
customs  olHcer,  10  for  nigbt  and  day;  about  .lo  skiffs  and  .jO  fords  in  territory 
guarded.  Two  guards  are  needed  at  15  miles  from  Laredo  to  watch  5  miles  of 
river  where  are  3  skiffs.  The  vice-consul  reports  dengue  epidemic  raging  Nuevo 
Laredo,  Mexico ;  few  deaths ;  believes  no  cases  yellow  fever  exist.  This  is  the 
situation  at  the  present  writing,  but  it  may  change  at  any  moment. 

Hamilton. 


quarantine   at   LAREDO,   TEX. — EPIDEMIC   DENGUE. 

Laredo,  Tex.,  September  18,  1903. 
Wyman,  Wash  ington  : 

Laredo.  Mexico,  authorities  claim  yellow  fever  does  not  exist.  Case  seen  now 
convalescent.  Officials  report  no  suspicious  cases  there.  Epidemic  dengue  ac- 
knowledged. Total  guards,  including  customs,  immigration.  State,  county,  city, 
and  Bureau,  52,  all  under  supervision  of  customs  inspectors,  cover  100  miles 
frontier. 

Hamilton. 


Laredo,  Tex.,  September  20, 1903. 
Wyman,  Washington: 

Arrived  Laredo.     Have  inspected  Service  quarantine.     City,  State,  and  Serv- 
ice working  in  harmony  and  efficiently. 

if  *  ^  *  if  *  * 

Leaving  for  New  Orleans  to-morrow.  Richardson. 


YELLOW    fever   IN    MONTEREY. 

Laredo.  Tex.,  September  21,  1903. 
Wyman,  Washington : 

Texas  inspector  at  Monterey  reports  yellow  fever  is  now  present  in  Monterey. 
Will  return  to  Texas  via  Eagle  Pass,  Tex. 

Hamilton. 

Monterey,  September  23,  1903. 
Secretary  of  State,  Washington: 
Doctors  report  yellow  fever  in  Monterey.     Hope  to  control  it. 

Hanna,  Consul-General. 


assistant    surgeon    RICHARDSON    ORDERED   TO   RETURN   TO   LAREDO,   TEX. 

Washington,  September  16,  1903. 
Richardson,  V.  S.  Consulate,  Tanipico,  Mexico: 

Orders  amended.  Return  direct  via  Laredo.  On  arrival  Laredo,  inspect 
Service  quarantine  there  and  wire  any  necessary  recommendations.  If  too  ill, 
wire  from  Laredo  and  go  on. 

Wyman, 


I 


PUBLIC    HKAl/rH    AND    M ARINE-IIOSVTTAL    SKRVICK.  251 

ACTING     ASSISTANT    SHROKONS     AT     I.AHKIM)     AMI     i:.\(il,IO     I'ASS     To     COOl-KKAlK     WITH 

STATE    IIKAI/ril    Ol'l'IC'KU. 

Washington,  September  17,  lOiK]. 
State  Health  Officer  Tahor.  AiiKtiii.  Tc.r.: 

Have  instructed  Actiiifr  Assistant  Surjxeon  Ilaniilton,  Laredo,  and  also  Ifunie, 
Eajjle  Pass,  to  cooperate  with  you  and  to  wire  P.ureau  proniiitly  requisitions  for 
eiiuipiuent  needed  for  additional  help. 

Wyman. 


MOSQUITO    NETTING    FOR    USE   AT    EAGLE   PASS    AND   LAREDO. 

Washington.  Srpfciiihrr  77,  1903. 
Wertendaker,  Marine  IlospitaJ,  ISIeir  Orleans,  La.: 

Ship  50  mosquito  I»;irs  from  Camp  Ilutton  to  Ilume,  Ea^le  Pass,  Tex.     All 
articles  sent  to  Laredo  and  Eagle  Pass  should  he  in  serviceable  condition. 

Wyman. 


GUARDS    FOR    WEBB   AND   ZAPATA    COUNTIES. 

Washington,  Septemher  11,  1903. 
Hamilton,  Laredo,  Tex.: 

Submit  nomination  by  wire  and  immediately  place  on  duty  G  mounted  guards 
Zapata  County  and  12  additional  mounted  guards  Webb  County.     *     *     * 

Wyman. 


CAMP   equipment   FOR   EAGLE   PASS. 

Washington,  September  21,  1903. 
Wertenbakee,  Marine  Hospital,  New  Orlemis,  La.: 

Ship  to  Hume,  Eagle  Pass,  Tex.,  from  Camp  Hutton,  by  fast  freight,  12  tents, 
12  by  14,  complete,  with  files,  floors,  frames,  poles,  and  pins;  50  camp  stools;  2 
Buzzacott  ovens ;  cots,  mattresses,  and  pillows,  .50  each ;  pillowcases  and  sheets, 
200  each ;  50  additional  mosquito  bars,  and  50  blankets. 

Wyman. 


SUSPECT   YELLOW    FEVER   AT   LAREDO,  TEX. 

Laredo,  Tex.,  September  22,  1903. 
Wyman,  Washington: 

Two  cases  suspected  yellow  fever  at  Laredo,  Tex.;  personally  examined  one; 
found  suspicious  history,  jaundice,  vomiting;  urine  contains  albumin;  has  been 
sick  three  days ;  information  given  the  State  health  authorities.  There  is  an 
uneasy  feeling  prevailing.  This  is  the  situation  at  present  writing,  but  it  may 
ciiange  for  the  worse  at  any  moment.  The  consul  reports  no  cases  suspicious 
yellow  fever  at  Nuevo  Laredo,  Mexico.     Better  advise  Spohn  conditions. 

Hamilton. 


DENGUE   AT   LAREDO,   TEX. 

Laredo,  Tex.,  September  22,  1903. 
Wyman,  Washington: 

Sixteen  dengue  Laredo,  Tex.;  11  specimens  urine  examined;  urine  contains 
albumin,  7  ;  a  few  have  vomiting  ;  no  deaths. 

Hamilton. 


252  PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE. 

MOSQUITO    NETTING    ADVISED   TO   BE   USED   AT   LAREDO. 

WAsiiiNtiTON,  September  22,  1903. 
Hamilton,  Laredo,  Tex.: 

Guiteras  from  Cairo,  Von  Ezdorf,  and  Frick  ordered  to  Laredo.  Tex.  Dengue 
conveyed  by  mosquito.  Suggest  iumiediate  use  netting  and  method  described 
page  121.%  Public  Health  Reports,  July  31,  Have  wired  Tabor  suggesting  he 
order  this. 

Wyman. 


SURGEON  GUITERAS  ORDERED  TO  LAREDO. 

Washington,  Septcmher  22,  1903. 
GuiTERAS,  Marine  HofipitaL  Cairo,  111.: 

Nominate,  place  on  duty  acting  assistant.  Take  first  possible  train  to  Laredo. 
Wire  departure  and  arrival.  Hamilton  wires  16  cases  dengue,  7  with  albumin; 
no  deaths.  Dengue  also  in  Nuevo  Laredo  and  1  case  of  yellow,  fatal.  Camp 
outfit  complete  for  100,  including  mosquito  bars,  should  reach  Laredo  to-morrow. 
Von  Ezdorf  will  arrive  by  Monday.  Frick  ordered  from  Tampico.  On  arrival 
investigate,  wire  facts  and  recounnendations.  Have  wired  Hamilton  and  Tabor 
advising  Habaua  method,  even  for  dengue,  as  described  in  Public  Health,  July  .31. 

Wyman. 

In  anticipation  of  a  situation  such  as  existed  at  this  time  at  Laredo, 
the  Bureau  had  published  in  Public  Health  Reports  of  July  31,  1903, 
a  paper  read  by  Dr.  John  Guiteras  before  the  First  International 
Sanitary  Convention  of  American  Republics  in  Washington,  Decem- 
ber, 1902,  narrating  in  detail  the  methods  successfully  adopted  for 
the  suppression  of  the  spread  of  yellow  fever  in  Habana,  with  a  note 
stating  that  the  paper  would  be  of  practical  value  at  any  port  or  place 
where  yellow  fever  might  exist,  whether  in  epidemic  or  sporadic 
form,  and  that  the  same  precautions  should  be  taken  with  regard  to 
cases  suspected  of  being  yellow  fever.  Attention  was  also  called  to 
the  necessity  of  putting  the  precautions  indicated  around  the  first 
case.  One  object  in  making  this  publication  was  to  have  for  ready 
reference,  wherever  the  Public  Health  Reports  Avere  received,  full 
details  of  how  to  suppress  the  disease. 


DENGUE  CASES  PRESENT  INDICATIONS  OF  YELLOW  FEVER — TiSE  OF   MOSQUITO   NETTING 

ADVISED. 

Washington,  September  22,  1903. 
State  liealth  Officer  Tabor,  Austin,  Tex.: 

Hamilton  wires  10  cases  dengue  Laredo,  7  with  albumin.  Have  ordered  two 
officers  there.  Recent  writers  declare  dengue  conveyed  by  mosquito,  therefore 
believe  these  cases  should  be  guarded  by  mosquito  netting  and  in  manner 
described  page  1213,  Public  Health  Reports,  July  31.  One  hundred  and  fifty 
mosquito  nets  were  sent  Laredo  last  week.     Will  j'ou  order  their  use? 

Wyman. 


Washington,  September  23,  1903. 
Surgeon  Murray,  Key  West,  Fla.: 

Dengue  and  suspicious  cases  at  Laredo.  Leave  hospital  in  temporary  charge 
of  acting  assistant  surgeon  ;  proceed  first  available  route  to  New  Orleans.  Wire 
Bureau  date  of  departure  and  probable  arrival  at  New  Orleans.  Will  have 
Wertenbaker  or  assistant  meet  you  at  train  if  decided  you  should  immediately 
proceed.  Otherwise  await  orders  and  wire  address.  If  you  go  to  Laredo, 
it  will  be  as  inspector  and  diagnostician.  Guiteras,  von  Ezdorf,  and  Frick  will 
be  there. 

Wyman. 


PUBLIC    HEALTH    AND    M AR1NK-H08P1TAL    SERVICE.  253 

Washington.  Sriitrinbrr  2,i.  1D03. 
Hamilton,  Laredo,  Tcj:: 

Autliorizod  rent  buildiufj  iiicntioiUHl  your  tclojrrmn  Septciuhor  22.  Wiro  iinme- 
diiitcly  wiii'ii  ciiiiiit  outfit  Iims  nn-ivcd.  rupiu-k  nios(iuito  uetting  at  once  and 
uutliorizod  to  uso  iu  any  way  you  sco  lit. 

Wyman. 


ACTING   ASSISTANT   STURGEON    FRICK   ORDERED   TO   LAREDO. 

Washington.  SIrolcwhcr  22,  1903. 
Frick.  T\  .9.  Cn)i.'>iihttc,  Tanipiro,  Mexico: 

Instruct   Lii)pinoott   to   continue   disinfections   and   proceed   immediately   to 
Laredo  and  report  to  Hamilton.     Wire  departure  and  arrival. 

Wyman. 


GUARDS  FOR   LAREDO. 

Washington,  September  22,  1903. 
Hamilton.  Laredo,  Tex.: 

Submit  nomination  by  letter  and  place  on  duty  immediately  two  additional 
mounted  guai'ds     *     *     *     foi-  juty  15  miles  from  Laredo. 

W^YMAN. 


DETAIL  OF   OFFICERS   FOB   DUTY'   AT   LAREDO — ilEASURES   ADVISED   SHOULD   CONDITIONS 

GROW    WORSE. 

Washington,  Septemher  23,  1903. 
State  Health  Officer  Tabor,  Austin,  Tex.: 

Have  ordered  following  officers  to  Laredo:  Murray,  from  Key  West,  as  diag- 
nostician; will  await  orders  at  New  Orleans,  and  can  reach  Laredo  Saturday 
morning.  Assistant  Surgeon  Frick.  from  Tampico.  Passed  Assistant  Surgeon 
Von  Ezdorf,  from  INIatanzas.  should  arrive  about  Saturday  night  or  Sunday. 
Pharmacist  Walerius.  from  St.  Louis,  and  Surg.  G.  M.  Guiteras,  from  Cairo,  111. 
Last  named  will  be  Bureau  representative  in  active  measures,  his  superior,  Mur- 
ray, being  detailed  as  expert  diagnostician.  Interstate  quarantine  regulations, 
Treasury  Department,  require  siu'veillance  of  people  leaving  infected  locality. 
If  conditions  grow  worse,  experience  indicates  rapid  depopulation  at  Laredo  at 
once,  most  probable  destination  along  lines  leading  to  San  Antonio  and  Corpus 
Christi.  Deem  necessary,  therefore,  surveillance  of  people  leaving  Laredo,  list 
of  passengers  and  destinations  being  taken  at  ticket  office,  and  health  authorities 
at  destination  notified  to  keep  them  under  observation,  immediately  isolating 
any  arriving  sick. 

Train-inspection  service  should  be  immediately  established  between  at  least 
Laredo  and  San  Antonio  and  Laredo  and  Corpus  Christi,  and  authorities  at  both 
points  notified  to  look  out  for  passengers  from  Laredo  and  secure  their  isolation 
if  necessary. 

Necessity  of  detention  camp  may  be  determined  later.  Complete  outfit  for  100 
was  sent  last  week  and  is  probably  in  Laredo  to-day. 

Guiteras  instructed  to  confer  with  you.     He  left  Cairo  1  p.  m.  to-day. 

If  you  will  select  four  medical  inspectors,  two  for  each  road  from  Laredo,  and 
place  them  on  duty.  Bureau  will  have  them  appointed.  *  *  *  Wire  their 
names  promptly. 

Wyman. 


MEDICAL  INSPECTORS   APPOINTED. 

Austin,  Tex.,  Septemher  23,  1903. 
Wyman,  Washington: 

Will  go  to  Laredo  to-morrow,  and  if  cases  are  yellow  fever  will  put  train- 
inspection  service  into  immediate  effect.     Will  remain  there  until  arrival  of 


254  PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE. 

your  representatives.  Will  be  glatl  to  confer  with  them  and  hope  we  will  be 
able  to  assist  each  other.  I  have  selected  following  medical  inspectors  at  your 
suggestion  and  directed  them  to  report  to-morrow  at  Laredo :  P.  M.  Kavson, 
B.  V.  Ellis,  K.  L.  Dinwiddle,  A.  G.  Barnhill. 

Tabor. 


DENGUE    CASES    PBESEM    INDICATIONS    OF   YELLOW    FEVER — WILL   USE    MOSQUITO 

NETTING. 

Austin,  Tex.,  September  23,  1903. 
Wyman,  Washington: 

Several  cases  dengue  reported  Laredo,  but  presence  of  albumin  and  absence  of 
malaria  Plasmodia  indicate  yellov\'.  ^Yire  me  names  of  officers  ordered  there 
and  when  will  they  arrive.  I  will  meet  them  there.  Have  directed  use  of 
mosquito  netting  you  sent. 

Tabor. 


pharmacist   WALERIUS   ordered   to   LAREDO. 

Washington,  September  23,  1903. 
Pharmacist  Walerius 

(through  medical  oflacer  in  command), 

Marine  Hospital,  St.  Louis.  Mo.: 
Take  first  train  possible  for  Laredo.  Tex.     Report  to  Surgeon  Guiteras  for 
duty  in  connection  with  epidemic  dengue,  possibly  yellow.     Wire  departure. 

Wyman. 


Pyrethrum  poicder  for  use  at  Laredo. 

Washington,  September  23,  1903. 
Wertenbaker,  Marine  Hospital,  iVejc  Orleans,  La.: 

Ship  immediately  by  express  200  pounds  pyrethrum  powder  to  Hamilton, 
Laredo. 

Wy*man. 

Washington,  September  2.'i,  1903. 
Surgeon  Murray,  Key  West,  Fla.: 

*  *  *  Pharmacist  Stier  ordered  from  Tampa  Bay  during  your  absence. 
Your  relations  with  Guiteras  should  be  the  same  as  with  Tabor,  that  of  co- 
operation. Necessary  for  Bureau  to  have  clearly  defined  organization.  You 
are  expert  diagnostician  at  Laredo  and  to  decide  upon  suspected  cases  at  any 
other  places,  and  you  must  therefore  be  free  from  administrative  duties.  Gui- 
teras will  have  charge  of  these  latter.  You  should  wire  Bureau  direct  and 
give  all  reasonable  information  to  Guiteras  and  Tabor.  From  later  infor- 
mation no  necessity  your  stopping  at  New  Orleans ;  proceed  Laredo. 

Wyman. 


Washington,  September  2'h  1903. 
Wertenbaker,  yew  Orleans,  La.: 

Von  Ezdorf  took  steamer  Havana  Tuesday.  22d ;  should  arrive  New  Orleans 
Saturday  morning.  Deliver  telegram  immediately  on  arrival  and  give  or  send 
him  transcript  of  the  following,  which  is  also  for  your  information,  and  at 
present  partly  confidential.  One  death  yellow  fever.  Laredo,  Mexico;  16  cases 
dengue  Laredo,  Tex..  7  with  albumin.  Tabor  thinks  some  may  be  yellow 
fever,  but  diagnosis  is  not  made.  Guiteras  arrives  there  to-morrow  night  in 
administrative  charge.     Murray   will   arrive  about   Saturday   night  as  expert 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  255 

diagnostician  liavedo  and  snrronndiii};  places.  Frick  leaves  this  niornint^  from 
Tanipico.  'I'ahor  will  I»e  thei-(>  t()-ni.i,'li1.  and  pr()!)al»l.v  will  to-morrow  place  train- 
insi)ection  service  from  Laredo  willi  Service  acting  assistants  nominated  ]).v 
him.  Wire  me  any  information  yon  receive  from  New  Orleans.  Have  notified 
Soiichon  confidentially  of  the  situation.  Will  mail  you  copies  of  telegrams  for 
further  information.     May  require  you  to  consult  with  Souchou. 

Wyman. 


Washington,  8ei)tcmher  2-'f,  1903. 
Von  Ezdorf,  'New  Orleans,  La.: 
Proceed  immediately  Laredo  and  report  to  Guiteriis. 

Wyman. 


Washington.  September  2.;,  WOS. 
GuiTERAS.  Laredo,  Tex.: 

On  arrival  confer  with  Tabor.  Bureau  i)Osition  will  be,  as  in  all  previous 
like  occasions,  as  follows  :  Treasury  reguhitions  are  expected  to  be  enforced 
and  State  health  authorities  to  enforce  them.  Bureau  will  assist  State  health 
officer.  Frick  has  had  experience  iu  train-inspection  service,  and  advise  yoxi 
to  place  him  in  charge  of  that  work.  I'ending  your  arrival  I  authorized 
Tabor  to  nominate  four  train  inspectors,  which  he  has  done,  and  they  have 
been  appointed  acting  assistant  surgeons.  Request  Hamilton  to  show  you  all 
telegrams  received  from  me.  Believed  hei-e  good  opportunity  for  demonstrat- 
ing possibility  of  restricting  spread  of  fever  by  new  methods,  as  at  Habana, 
screening  patients  and  destroying  mosquitoes. 

Wyman. 


Washington,  September  25,  1093.  • 
Acting  Asst.  Surg.  H.  S.  Bxirke,  Corpus  Christ!,  Tex.: 

Hamilton  reports  2  cases  yellow  fever  at  Laredo.     This  Bureau  has  appointed 
medical  train  inspectors  to  supervise  travel  at  Laredo. 

W^yman. 


Washington,  September  25,  1903. 
Acting  Asst.  Surg.  J.  K.  Combe,  BroioisviUe,  Tex.: 
Three  guards  nominated  by  you  approved.     *     *     * 

Wyman. 


Washington,  September  25,  1903. 
Hamu^ton,  Laredo.  Tex.: 

Referring  to  my  telegram  September  22,  is  mosquito  netting  being  used? 
Wire  full  report  of  what  is  being  done  to  prevent  spread  in  Laredo.  Expressed 
500  yards  mosquito  netting  from  New  Orleans  yesterday,  but  pending  arrival, 
if  necessary,  should  purchase  in  Laredo  if  possible  and  use.  State  health 
officer  coincides. 

Wyman. 


AEBIVAL   or    SURGEON    GUITERAS. 

Laredo,  Tex.,  September  25,  1903. 
Wyman.  WashUiyton: 
Arrived  this  afternoon.     Have  met  Tabor. 

GUITEBAS. 


256  PUBLIC   HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

SUB\'EILLANCE    OF    PERSONS     LEAVING    LAREDO    AND    TRAIN     INSPECTION     CONSIDERED 

NECESSARY. 

Washington,  Seiitemher  25,  1903. 
Gliteras  (care  Hamilton),  Laredo.  Tex.  (to  arrive)  : 

For  your  information  I  send  you  following  copy  of  portion  telegram  wired 
Tabor  September  23 :  "  Interstate  quarantine  regulations  Treasury  Department 
require  surveillance  of  people  leaving  infected  locality.  If  conditions  grow- 
worse,  experience  indicates  rapid  depopulation  of  Laredo  at  once :  most  probable 
destination  along  lines  leading  to  San  Antonio  and  Corpus  Christi.  Deem  neces- 
sary, tberefore.  surveillance  of  people  leaving  Laredo,  list  of  passengers,  and 
destination  being  taken  at  ticket  office  and  bealth  authorities  at  destination 
notified  to  keep  them  under  observation,  immediately  isolating  any  arriving 
sick.  Train-inspection  service  should  Ite  immediately  established  at  least 
between  Laredo  and  San  Antonio  and  I„aredo  and  Corpus  Christi.  and  author- 
ities at  both  points  notified  to  look  out  for  passengers  from  Laredo  and  secure 
their  isolation  if  necessary.  Necessity  of  detention  camp  may  be  determined 
later." 

Wyman. 


POST-MORTEM    CONFIRMS    DIAGNOSIS   OF   YELLOW   rE%*ER. 

Laredo,  Tex.,  September  2-5,  1903. 
Wyman,  Washington: 

All  sanitaiy  authorities  here  concur  that  the  2  deaths  here  to-day  were  yellow. 
Necropsy  performed  in  one  case  typical.  There  are  two  separate  foci  of  infec- 
tion known  at  present.     Three  suspicious  cases  have  been  reported. 

GUITERAS. 


EMPLOYMENT   AND   PAYMENT    OF   GUABOS. 

Washington,  September  26,  1903. 
Surgeon  Guiteras,  Laredo.  Tex.: 

Regarding  expenditures,  State,  city,  and  countj-  authorities  are  expected  to 
render  all  assistance  possible.  This  has  been  the  rule  in  other  epidemics.  If 
necessary  to  employ  personal  service  of  any  character,  nominations  by  name  and 
rate  must  be  promptly  wired  Bureau,  as  must  also  any  contemplatetl  expendi- 
ture. If  in  emergency  the  expenditure  must  be  made,  notify  Bureau.  Who  is 
])aying  for  the  disinfecting  gangs  you  started  to-day?  Walerius  can  render  you 
much  assistance  in  keeping  finances  straight,  and,  if  necessary,  you  are  author- 
ized to  nominate  a  clerk  for  him. 

Wyman. 

[Reply.] 

Laredo,  Tex.,  September  26, 1903. 
Wyman,  Washington: 

City  and  county  have  no  funds ;  State  has  employed  guards  along  border.  We 
are  paying  for  disinfecting  gangs. 

Guiteras. 


PYBETHRUM    POWDER   FOR   USE   AT   LAREDO. 

New  Orleans,  La.,  September  26,  1903. 
Wyman,  Wash  ingtoii : 

Guiteras  wires  me  to  forward  5(X)  pounds  pyrethrum  powder  by  express.  Am 
sending  it  and  request  Bureau  approval,  also  authority  to  honor  similar  requi- 
sitions. 

Webtenbakeb. 


riJlJLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  257 

TIIKKK    SUSI'K'IOIJS    t'ASKfS IIOIJ.SK    DISI  Nl'ECTrON. 

Lakkdo.  Tkx.,  Scplciiibcr  .id,  U)()3. 
AVymam,  \Vaxlihi(it())i: 

II:iV(>   seen   ;',   su.si)ifi(>us   ciiscs    to-day.      Disiiirccted    7A    houses   coiitaiiiiiiK   21 
rooms. 

GUlTEKAS. 


PLAN   OK   CA.Ml'AIGN   AGAINST  INTKOUUCTION   AND   SPREAD  OE  YELLOW   FEVEK. 

Laredo,  Tex.,  firptrmhrr  20, 1903. 
WvitAN.  Waiihiiir/loii : 

rrosont  plan  of  (•aiiii)ai,c;ii  is  as  follows:  (1)  Ext(«riiiina(i'  local  infection, 
followinj;  methods  employed  in  Ilabana  ;  (2)  to  prevent  introduction  of  any 
new  infection  from  without;  (8)  to  prevent  spread  of  the  disease  to  other 
localities.  Th(>  first  item  was  put  in  o|)eration  this  morninj,'.  The  second  has 
been  in  operation  for  some  time  and  is  fairly  elHcient  as  far  as  work  on  the 
border  is  concerned.  Ilowevei-,  consular  C(>rtificates  of  five  days  from  yellow- 
fever  foci  are  discredited.  Would  su.^LCest  ai)pointment  of  .ijood  medical  ins])ect- 
ors  at  San  Luis  I'otosi  and  Saltillo.  The  third  is  principally  in  Tabor's  hands. 
The  State  has  (luarantine  a.txainst  Laredo,  and  only  throuj^h  i)assen,L,'er  tradic 
to  points  north  of  Arkansas,  Indian  Territory,  and  Ohio  River  permitted.  All 
tratlit-  with  Corpus  Christi  is  stopped.  We  are  making  efforts  to  reestablish  it. 
Tabor  has  not  yet  agreed  to  train  inspection.  There  is  nothing  to  prevent  pas- 
sengers getting  off  along  the  line  except  local  quarantines.  These  are  effective 
enough  at  stations,  but  it  is  possible  for  passengers  to  get  off  between  stations. 
About  three  thousand  people  have  left  Laredo  since  the  IGth  instant. 

GUITERAS. 


premises     of     yellow-fever     cases     disinfected — LAREDO     PLACED     UNDER     STRICT 

QUARANTINE. 

Laredo,  Tex.,  September  26,1903. 
Wyman,   Washington: 

Frick  arrived  this  morning;  have  disinfected  premises  of  two  fatal  cases; 
will  disinfect  surroundings  this  afternoon  ;  no  new  cases  reported.  Tabor  has 
put  Laredo  under  strict  (luarantine.  Through  passenger  traffic  for  points  out- 
side of  Texas  opened  up  this  morning  with  notiflcation  of  proper  health  author- 
ities. Camp  outfit  and  mosquito  netting  not  arrived ;  it  is  an  urgent  need,  as 
supply  here  is  very  small.  Have  employed  about  20  men  and  divided  them  into 
two  mosquito  gangs.  Request  authority  to  order  material,  if  necessary,  from 
Werteubaker. 

GUITERAS, 


detention    camp   OUTFIT   TO   BE    HELD   AT    CACTUS. 

Washington,  Heptemher  26,  1903. 
Surgeon  Guiteras,  Laredo,  Tex.: 

Referring  to  detention  camp  due  to  arrive,  have  it  sidetracked  and  retained 
on  cars  at  some  point  outside  Laredo,  say  Cactus,  until  otherwise  ordered. 

Wyman. 


USE    OF    PETROLEUM    IN    WATER    BARRELS    AND    CISTERNS. 

Laredo,  Tex.,  September  25,  1903. 
Wyman,  Washington : 

Moquito  netting  used.  Fumigation  with  sulphur.  Petroleum  in  water  barrels 
and  cisterns.  Cleaning  up  of  weeds  and  burning  is  being  done  slowly.  City 
short  of  money.     Two  cases  died  to-day.     Three  cases  not  confirmed  on  hand. 

Hamilton. 
8629—04 17 


258  rUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

UNCONDITIONAL    QUARANTINE    AGAINST    LAREDO. 

Laredo,  Tex.,  Septcmhcr  25,  1903. 
Wyman,  Washinyton: 

From  iiifoniiution  whicli  I  have  obtained  here  yellow  has  probably  existed  in 
Nuevo  Laredo  for  six  weeks  and  in  Laredo  for  two.  The  two  fatal  eases 
reported  in  ])i-ior  telegram  form  two  distinct  foc-i.  I  fear  we  will  find  others. 
All  counties  along  the  International  and  Great  Northern,  including  Bexar 
(San  Antonio),  have  (piarantined  Laredo  unconditionally.  The  road  to  Corpus 
Christi  has  stopped  all  traffic.  It  is  hoped  that  the  influence  of  Tabor  and  the 
quarantine  measures  taken  here  will  relieve  the  situation  and  inspire  conli- 
dence.  Conference  held  here  to-night  with  city,  county,  and  State  authorities. 
Tabor  assumes  charge,  accepts  our  cooperation,  and  leaves  me  a  free  hand  to 
handle  the  situation.  Wire  if  this  acceptable  to  Bureau.  I  will  start  two 
gangs  disinfecting  and  screening  to-morrow.  The  authorities  of  Neuvo  Laredo 
confess  to  0  cases  yellow  and  4  deaths.  The  border  here  appears  well  protected. 
Reports  on  cases  of  dengue  in  Nueces  County  have  just  been  received.  No 
Service  officers  have  arrived  here,  nor  the  camp  equipment. 

Guiteras. 

[Reply.] 

Washington,  September  26,  1903. 
Surgeon  Guiteras,  Laredo,  Tex.: 

Arrangement  with  Tabor,  as  in  your  wire  received  to-day.  acceptable  to 
Bureau.  Your  efforts,  of  course,  then  will  be  to  prevent  spread  in  Laredo  and 
prevent  its  reaching  other  towns,  and  Bureau  expects  you  to  plan  and  operate 
accordingly.  Wire  fully  your  plans,  that  Bureau  may  cooperate  with  or  advise 
you.  Bureau's  views  have  already  been  given  you  and  Tabor.  Notify  if  you 
think  detention  cam])  will  be  needed.  Also  wire  Bureau  daily  the  situation. 
Souchon  has  Nolte  at  San  Antonio  for  observation.  Von  Ezdorf  and  Pharma- 
cist Walerius  should  arrive  shortly.  Advise  you  allow  Hamilton  to  continue 
his  customary  work.  lie  has  been  notified,  however,  that  you  are  in  conmiand. 
Financial  matters  in  succeeding  telegram. 

Wyman. 

On  September  2G,  1903,  telegraphic  inquiry  was  made  by  the 
Bureau  of  the  acting  assistant  surgeon  stationed  at  Corpus  Christi, 
Tex.,  as  to  rumors  of  the  presence  of  dengue  in  that  vicinity,  and  a 
negative  reply  was  received  the  folloAviug  day. 

Passed  Asst.  Surg.  R.  H.  Von  Ezdorf,  an  immune  to  yellow  fever, 
arrived  at  Laredo,  Tex.,  September  27  and  reported  to  Surgeon 
Guiteras  for  duty.  At  the  same  time  a  house-to-house  inspection  of 
Laredo  was  undertaken  by  the  State  and  municipal  authorities,  and 
the  Service  camp  outfit,  already  at  that  point,  was  placed  at  the  dis- 
posal of  the  State  health  officer  at  his  request. 

SIX    NEW    CASES DETENTION    CAMP   TO   BE   ESTABLISHED   AT    SANCHEZ. 

Laredo,  Tex.,  September  27,  1903. 
Wyman,  Washington: 

Six  new  cases  to-day  ;  one  death.  Tabor  has  again  stopi)ed  through  passen- 
ger traffic  from  Laredo  to  points  north.  Mexico  is  still  open  for  those  who  desire 
to  leave,  but  at  present  there  is  little  desire  expressed  to  leave  the  city.  A 
house-to-house  inspection  will  probably  connnence  Tuesday.  Tabor  desires  to 
establish'  camp  for  2.'')  persons  at  Sanchez,  5  miles  from  Laredo,  and  requests 
loan  of  oufit,  he  to  ])ay  all  running  expenses  and  to  have  charge  Service  repre- 
sentation, if  desired.  Detention,  ten  days.  Tabor  does  not  accept  mosquito 
theory  in  toto,  and  old  quarantine  methods  are  in  vogue.  Recommend  that  his 
request  for  camp  be  granted.  Am  confining  my  efforts  principally  to  mosquito 
disinfection  and  pre\-ention  of  entrance  of  new  infection.  Will  have  four  sec- 
tions at  work  to-morrow.     The  situation  is  grave. 

Guiteras. 


I'UHLIC    HEALTH    AND    MARINK-HOSIMTAL    SKKVIOK.  251) 

>\'asiun(;t().\,  .Srjilciiihcr  .Hi,  UHl.i. 
I  )i-.  IOdmoni)  Souciion, 

J'rcKidriit  State  Hoard  of  Hraltli,  Ar/r  Orleans.  La.: 
liispiM-tors  oil  all  trains  out  of  Laredo  \v«M(>  (n-dcrcd  day  Ix'foro  yos((>rda.v. 
Arc  you  >;oiiif?  to  kcop  Nolto  in  San  Antonio  for  oliscrvation V  I'.clicvo  it  would 
be  wise  for  present  at  least.  Am  advised  no  trains  niiiiiin;;;  from  Laredo  to 
Corpus  (Miristi.  Also  informed  all  eounties  alonj;  the  International  and  (Jreat 
Northern,  including,'  Kexar  (San  Antonio),  have  (luarantined  against  Laredo 
uneonditioiially.  Kindly  show  this  to  Wertenhaker.  Am  sending  additional 
otlieers  for  future  emergencies. 

W  Y.MAN. 


Washington,  Seiitemher  2(1,  i!)0.i. 
Acting  Assistant  Surgeon  HAMii/rox. 

Laredo.  Te.r.: 
lieferring  to  my  telegram  September  Kith,  1   have  advised  Guiteras  to  con.- 
timie  yon  in  yt)ur  present  work;  but  there  can  be  but  one  head,  and  Guiteras  is 
in  command,  and  you  will  accept  directions  from  hhii. 

Wyaian. 


DOCTOR    NOLTE    TO    REMAIN    AT    SAN    ANTONIO. 

New  Orleans,  La.,  >Sei)teiii1>er  27,  1903. 
W Y M AN.  Wa s hill (/ l(jii : 

Thanks  for  telegram.     Told  Wertenhaker.     Iliive  wired  Nolte  to  stay.     Noth- 
ing new'. 

Edmond  Souchon. 


Washington,  Hci>temhcr  2S,  1003. 
Dr.  Edmund  Souchon, 

New  Orleans,  La.: 
Thanks  for  leaving  Nolte  at  San  Antonio.     Please  wire  me  any  information 
you  receive  from  him  and  whether  any  persons  are  arriving  from  Laredo. 

Wyman. 


PY'RETHRUM    powder    for    use    at    LAREDO. 

September  28,  1903. 
Wertenbaker, 

Marine  Hospital,  New  Orleans,  La.: 
Your  action  in  sending  50(1  pounds  pyrethrum,  Guiteras,  aijproved.     Any  re- 
quests after  to-day  notify  Bureau. 

Wyman. 

no  disinfection  of  mail  at  present. 

El  Paso,  Tex.,  September  28,  1903. 
Wy'man,  Wash iugton : 

Should  mail  arriving  at  El  Paso  from  infected  i)oints  be  fumigated ;    and  by 
whom?     Please  wire. 

Alexander. 

[Reply.! 

Washington,  September  28,  1903. 
Alexander,  El  Paso,  Tex.: 

No  disinfection  of  mail  at  present.  Wyman. 


260  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

requisitions  for  pyretiirum — nominations. 

September  28,  1903. 
GuiTERAS,  Laredo,  Tex.: 

Itoferring  to  your  telegram,  September  20,  asking  authority  to  order  material 
if  necessary  direct  from  AVertenl)al^er.  lietter  malce  your  re(iuisitions  direct  to 
Bureau.  Have  approved  your  retiuisitiou  on  Wertenltaker  for  500  i)ounds 
pyretlirum.  Have  forwarded  for  a])proval  your  nominations  of  acting  assistant 
surgeons,  clerk,  and  laborers.  Will  wire  as  to  disbursing  officer  to-morrow. 
Murray  en  route. 

Wyman. 


Washington,  September  27,  1903. 
Acting  Assistant  Surgeon  Combe,  BroirnsviUc,  Tea.: 

Protection  of  United  States  cities  against  Laredo  has  been  provided  by 
measures  at  Laredo,  including  train-inspection  service.  Half  dozen  Service 
o'fficers  are  there,  with  Surgeon  [Murray  as  expert  and  Surgeon  Guiteras  in 
charge  of  protective  measures.  Bureau  can  not  authorize  guards  at  towns  and 
cities  as  a  cordon  against  Laredo.  The  guards  previously  authorized  to  be 
appointed  by  you  were  to  protect  against  ]\[oxico.  Situation  well  in  hand  at 
Laredo.     Can  not  grant  20  guards  requested  in  your  telegram  of  26th. 

Wyman. 


Washington,  September  2S,  1903. 
Guiteras,  Laredo,  Tex.: 

Iteferring  to  your  telegram  28th,  authorized  to  loan  Tabor  camp  outfit  for  25 
persons.     Wire  if  sufficient  camp  outfit  in  Laredo  now  for  this  purpose. 

Wy'Man. 


Nashville.  Tenn..  September  27,  1903. 
Wyman,  Wash  in  {/ton: 

Please  furnish  this  board  and  Dr.  Heber  Jones,  vice-president  at  Memphis, 
with  information  concerning  yellow  fever  situation.  Such  information  from 
you  to  this  board  will  be  treated  as  confidential. 

J.  A.  Albright,  Secretary. 


Washington,  September  28,  1903. 
Dr.  J.  A.  Albright,  XashviUe.  Tenn.: 

Three  deaths  from  yellow  fever  at  Laredo,  Tex.,  in  last  week.  State  Health 
Officer  Tabor  there  and  half  dozen  Service  officers.  Laredo  quarantined. 
Active  measures  I>eing  taken  to  suppress  disease  and  prevent  spread.  Please 
forward  information  to  Dr.  Heber  Jones. 

Wy'man. 


house  disinfection. 

Laredo.  Tex.,  September  2S,  1903. 
Wyaian,  Washington: 

Ten  houses  and  34  rooms  disinfected  yesterday.  Diagnosis  in  2  suspicious 
cases  confirmed  to-day ;  6  suspects  reitorted :  no  deaths.  Seventeen  houses  dis- 
infected, with  84  rooms,  since  2r>th  instant.  There  have  been  3  deaths  and  13 
positive  cases ;  7  suspects  are  now  under  observation. 

Guiteras. 


train  inspection  proposed. 

Washington,  September  28,  1903. 
Guiteras,  Laredo.  Tex.: 

Referring  to  your  telegram  of  26th.  outlining  plan  of  campaign,  train-inspec- 
tion service  considered  by  Bureau  very  necessary,  and  suggest  Frick  for  super- 


rUHLK"    IlEALTII    AND    M AKINK-ITOSIMTAL    SERVICE.  2(»1 

vising  sjiino.  Four  iiioii  wore  iiulliorizcd  iiiid  iirc  uiidcr  p;iy  for  this  i»iir|)os('. 
This  is  (lociiuvl  cssciitiiil  even  willi  tr.-iiiis  Koliii;  iiorlii.  At  smuio  time  do  not 
oppose,  for  prcsont  at  least.  Stale  i|uai-aii(liie  a.icaiiist  l.aredo,  even  if  considered 
too  excessive. 

Wy.ma.n. 


TRAIN    INSPECTION     NOT    ItKQUIKKI). 

Lakkik),  'I'kx.,  Sriitrinhcr  ,?.S',  HIO.l. 
Wyman,  W(ishiii(/t()ii : 

IvcfeiTiuf;  to  youi'  toloffram  of  2,Sth  referring  to  train  inspection,  Murray, 
Tabor,  and  myself  are  of  the  oi>lnion  that  the  circumstances 'do  not  reciuire  it. 
If  r.ureau  still  considers  it  necessary,  \vir(>  so  that  I  may  establish  it  at  once. 
The  four  actinix  assistants  are  each  in  charge  of  a  section  of  mosquito  brit^ades ; 
iiuarantine  restrictions  aj^ainst  Laredo  are  excessive. 

GUITEKAS. 


AKRIVAT.   OF   SURGEON    MURRAY. 

Laredo,  Tex.,  Ficptcmhcr  28,  1U03. 
Wyman,  Washinf/ton : 

Arrived  4  afternoon,  28th. 

Murray,  fiiirf/con. 


HOUSE  DISINFECTION CAMP  OUTFIT   AT  CACTUS. 

September  20,  in03. 
SoucHON,  ?iew  Orleans,  La.: 

Murray  arrived  Laredo  yesterday.  Guiteras  wires  17  houses,  84  rooms  disin- 
fected. Habana  method  used  since  2r>th.  Have  camp  outfit  for  100  at  Cactus. 
Service  has  11  medical  inspectors  in  Laredo.  Am  sending  Purnell  to  inspect  ter- 
ritory around  Laredo.  Acting  Assistant  Surgeon  Burke,  in  response  to  inquiry, 
wires  no  dengue  in  Nueces  County  as  rumored. 

Wyman. 


Washington,  ^eptemher  29,  1903. 
Guiteras,  Laredo,  Tex.: 

If  there  is  passenger  traffic  out  of  Laredo,  it  sliould  be  under  medical  super- 
vision ;  this  means  train-inspection  service. 

Wyman. 


Washington,  September  30.  1903. 
SoucHON,  NeiD  Orleans,  La:: 

Guiteras  wires  absolutely  no  passenger  traffic  out  of  Laredo.  Thirteen  cases 
reported  for  twenty-four  hours  ending  last  night.  No  new  deaths.  Have  been 
but  3  deaths  altogether.  Purnell  left  here  last  night  for  San  Antonio.  He  will 
confei'  with  Nolte  and  then  iiis])ect  surnmnding  country.  Have  sent  Assistant 
Surgeon  Ebersole  from  Ship  Island  to  Houston.  House-to-house  inspection 
under  way  at  Laredo.  ^ 

Wyman. 


INSPECTION     SERVICE,     MEXICAN     BORDER PRECAUTIONS    AGAINST     YELLOW    FEVER    AT 

EAGLE    PASS. 

Eagle  Pass,  Tex.,  September  30,  1903. 

Sir:  I  have  the  honor  to  inform  you  that  this  county  and  State  are  becoming 
much  exercised  over  the  yellow-fever  situation  in  Mexico. 

The  county  officials  requested  the  State  to  have  all  mail  from  Mexico  fumi- 
gated before  allowing  same  to  enter  the  State.     The  State  quarantine  officer 


262  PTBLir    HEALTH    AXD    MAKIXE-HOSPITAL    SERVICE. 

here  was  ordered  l»y  the   State  Liealth  officer,  DfK-tor  Talx.r.  to  disinfect  all 
mail.     *     *     * 

Tljo  whole  of  the  (luaraiitiue  work  here  iiractically  devolves  uiwn  the  Service, 
and  I  am  on  the  go  at  all  hours,  answering  (questions  and  allaying  fear. 

A  quarantine  is  to  t»e  estahlished  at  Reata.  Mexicfj.  by  the  State  of  Coahuila 
(Mexic-o)  against  Monterey.     This  will  be  accomplished  in  a  few  days. 

The  Federal  (Mexican)  health  officer  at  Ciudad  Porfirio  Diaz.  Mexico,  is 
boarding  all  ti-ains  coming  into  Diaz  and  insi>ecting  same  for  susiticious  cases, 
also  taking  note  of  persons  arriving  from  infecte<l  localities,  and  giving  me  all 
of  the  information  which  he  secures,  thus  making  the  quarantine  here  practi- 
cally impos-sible  to  pass. 

I  also  have  a  guard  in  Mexico  to  meet  the  incoming  trains,  who  takes  note  of 
all  persons  arriving  in  Diaz.  This  guard  then  crosses  the  river  to- this  side, 
reports  what  he  has  learned,  and  what  the  Mexican  health  officer  (Doctor 
Carter  I  has  to  say. 

In  other  words,  all  persons  arriving  in  Diaz  are  spotted.  I  get  their  descrip- 
tions and  turn  them  over  to  the  guards  on  the  bridges.  Besides  this.  I  know  of 
everj'  ticket  sold  at  Monterey  and  other  iwints  on  the  Mexican  International 
Railroad. 

I  am  free  to  state  that  I  think  it  impossible  for  anyone  to  get  here  without 
my  knowledge. 

Respectfully,  Lea  Hume. 

Actinrj  Axftistant  Surgeon  in  Charge. 

The  StrBGEOJf-GENERAI.. 


CONDITIOXS    AT    I.ABEDO    AND     MEASt^ES    FOB    PBE\*EN"TING    INTBODUCTION     INTO    AND 
SPREAD   OF   TELLOW    FEVEB   IN    TEXAS. 

grAR-^XTIXE    AT     1IATAMORA.S     EFFECTm: QFARAXTIXE    AT    BKOWXSTILLE    ADVISED. 

[Telegrams.] 

Bbownsville.  Tex..  Septemhrr  29.  1903. 
Francis  B.  Loomis, 

Assifstant  Secretary  of  State.  Washington: 
Have  inspec-tefl  Mexican  quarantine,  this  district.  Matamoras  well  protected 
by  civil  and  militaiy  authorities.  Brown.svillle  should  establish  immediate  and 
rigid  quarantine  against  Laredo.  Tex.  City  and  c-ounty  funds  insufficient.  Cit- 
izens earnestly  retjuest  that  I  advise  I)epartnient  they  will  aiipreciate  all 
Federal  aid  ix»ssible. 

P.  Mebrill  Griffith, 
Lnited  States  Consul  at  Matamoras. 


DOCTORS    NOLTE   .\ND   PUBNEI.L    AT    SAX    ANTONIO. 

Washington,  Septemher  30.  1903. 
GriTERAS.  Laredo.  Tex.: 

Inform  Tabor  as  follows :  "  Souchon  informs  me  he  has  Xolte  at  San  Antonio 
to  keep  him  itostetl.  and  that  Nolte  is  in  touch  with  local  health  authorities." 
Purnell,  an  immune,  has  been  sent  by  me  to  San  Antonio  and  then  will  proceed 
on  line  of  railroad  from  San  Antonio  to  Cactus  to  keep  informed  as  to  situation. 
The  effe<t  will  be  to  stop  iimiors.  as  Purnell  is  expert  Have  also  sent  Ebersole 
to  Houston  to  be  available  for  dutj-  anywhere. 

Wyman. 


PHARMACIST   GOOD.M.\N    APPOINTED    lUSBL'BSING    AGENT. 

Washington.  Oetober  1.  1903. 
GiTiTERAS.  Laredo.  Tex.: 

Pharmacist  Goodman  has  been  appointed  disbursing  agent  and  will  leave  with 
funds  to-morrow. 

Wyman. 


PUBLIC    HEALTH    AND    iMARINE-HOSl'ITAL    SKRVICK.  2()3 

PASSED    ASSISTANT    SlUCKON    WKUTKNItAKKK    OKDKKKl)    TO    ItKAUMONT,   TKX. 

WASiiiMiToN.  Octohrr  2,  li)tl,l. 
WEKTExnAKEK,  .Yr/r  Orleans,  Lu.: 

S(.H'  toI('j,'rain  to  riUiusden.  rroceed  with  liiiii  to  r.cauiiioiit.  Alter  iiistallinf; 
liiin  and  obsorviiifr  uiatttTs  yourself  for  a  day  or  two  at  lieauiiioiit  itroceed  to 
Houston,  whoro  sauio  orders  have  been  sent  Kbersole.  After  a  day  or  two  in 
Houston  wire.  lUireau  expects  then  to  order  you  back  to  New  Orleans,  I)ut 
await  orders  before  leaving.  Wire  situation  on  leaving  Ijeaujuont ;  also  on 
leaving  Houston. 

Wymax. 


PASSED    ASSISTANT    SURGEON    I.UMSDEN    ORDERED   TO   BEAUMONT. 

Washington.  Octohrr  2.  lOOH. 
LuMSDEX,  ycir  Orlcaiifi,  La.: 

Proceed  to  P.eaumont.  Tex.  :  confer  with  local  health  autliorities :  advise  tlu'ir 
looking  out  for  any  refugees  from  Laredo  and  keei)ing  them  under  observation. 
Wire  report  as  to  general  conditions,  and  advise  with  Wertenbaker.  who  will  go 
with  yon  and  will  remain  a  day  or  two.     Wire  Bureau  at  least  every  other  day. 

Wyman. 


YELLOW  FEVER  AT  MINERA. 

Laredo,  Tex.,  October  2,  1903. 
Wyman,  Washington: 

Forenoon  visited  Minera.  a  mining  camp  2(!  miles  northwest,  with  Tabor. 
Found  7  yellow-fever  convalescents  :  1  death,  with  all  signs.  On  30th.  after- 
noon, visited  many  sick  people ;   confirmed  4  cases,  ruled  out  2,  1  doubtful. 

Murray',  burgeon. 


camp   at    SANCHEZ    ST.\RTED. 

Washington,  October  2.  1903. 
GuiTERAS,  Laredo,  Tex.: 

Is  Tabor  conducting  camp  at  Sanchez?  If  so,  did  he  take  tents  and  equip- 
ment from  Laredo  or  from  camp  outfit  now  at  Cactus?  I'urnell  now  in  San 
Antonio  examining  territory  l>etween  there  and  Cactus. 

Wy'man. 


Laredo,  Tex.,  October  2,  1903. 
Wy'Man,  Washington : 

Tabor  started  camp  at  Sanchez  yesterday,  taking  about  one-third  of  our  camp 
outfit,  which  is  now  at  Sanchez  and  not  at  Cactus. 

GuiTERAS. 


CERTIFICATES    TO    PASSENGERS    BOUND    FOR    UNITED    STATES. 

Washington.  Octohrr  2,  1903. 
GuiTERAS,  Laredo,  Tex.: 

Replying  to  your  telegram  September  29,  can  you  spare  Von  Ezdorf  to  visit 
San  Luis  Potosi  and  Saltillo  to  confer  with  United  States  consuls  and  ascertain 
if  any  reliable  system  can  be  established  for  giving  certificates  to  passengers 
bound  for  the  United  States  that  they  have  not  been  in  infected  districts? 
Regulations  already  require  that  passengers  arriving  at  all  border  inspection 
stations  must  give  proof  of  absence  from  infected  districts  or  be  detained. 
Answer  and  await  orders  to  send. 

Wyman. 


264  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Laijedo,  Tex.,  October  2,  1903. 
Wyman,  M'ushhidion : 

Imi)ossible  to  spare  Von  Ezdorf  at  present  witliout  iipsettiiif?  our. system  of 
disinfection.  No  reliable  system  can  be  established  for  jtciving  certificates  to 
passengers  bound  for  United  States  unless  they  are  issued  by  reliable  men. 
The  men  who  issue  these  certificates  nnist  be  reliable,  and  must  satisfy  them- 
selves that  the  passengers  ha\e  not  been  in  any  infected  district  during  the  five 
previous  days. 

GUITERAS. 


PROPOSAL   TO    STOP    TIIROLIGH    PASSENGER    TRAFFIC    FROM     MONTEREY. 

Laredo  Tex.,  October  2,  1903. 
Wyman,  Washington: 

Tabor  proposes  to  stop  all  through  ])assengor  traflic  from  IMonterey  through 
Laredo  unless  detained  in  detention  camp  for  ten  days.  This  measure,  while 
severe,  will  not  work  much  hardshi[(  in  so  far  as  Laredo  is  concerned,  inasnuich 
as  passengers  from  IMonterey  and  points  south  of  it  can  come  through  Eagle 
Pass  or  El  Paso.  This  will  do  away  with  necessity  for  medical  inspection 
recommended  in  my  wire  of  September  2(i. 

Guiteras. 


SIX    NEW    CASES,    ONE    DEATH,    Y'ELLOW    FEVER    AT    LAREDO EPIDEMIC    SPREADING    IN 

NUEVO    LAREDO. 

Laredo,  Tex.,  October  3,  1903. 
Wy'man,  Wasliington : 

To-day's  ret)ort.  Six  new  cases  with  1  death ;  suspicious  cases,  none ;  previ- 
ously reported,  4.5;  total  cases  to  date,  .51;  total  (deaths),  3.  Six  houses  dis- 
infected to-day,  with  02  rooms.  Will  put  on  two  additional  mosquito  sections 
to-morrow  morning.  The  situation  is  about  the  same.  Murray  and  I  believe 
there  is  still  some  hope  of  controlling  the  ei)idemic.  The  next  few  days  will 
tell.  In  twenty-four  hours  ending  to-day  at  10  a.  m.  O  deaths  were  reporte<l  in 
Nuevo  Laredo.  This  indicates  that  the  epidemic  there  is  widesi)reading.  On 
the  .'ioth  ultimo  Doctor  Trevino,  Vera  Cruz,  exi)ected  on  duty  at  Nuevo  Laredo, 
reported  to  Murray  300  cases  positive  plasmodial  and  12  total  yellow  fever,  with 
9  deaths. 

Guitekas. 


inspection  of  refugees  from  LAREDO. 

Washington,  October  2,  1903. 
PuENELL,  aS"^.  James  Hotel,  »S«»  Antonio,  Tex.: 

Wire  Bureau  whether  local  authorities  are  paying  attention  to  refugees  who 
left  Laredo  on  or  after  September  1.5,  and  whethei-  Nolte  is  looking  after  same 
matter.  How  far  down  does  railroad  run  from  Laredo  and  return?  Wish  all 
information  possible  from  San  Antonio,  after  wiring  which  proceed  in  accord- 
ance with  letter  of  instructions.  Suggest  inspection  of  each  principal  station 
from  San  iVntonio  to  Laredo,  and  wire  from  each  place  you  stop  on  this  route, 
if  reason  therefor. 

Wyman. 


meeting   of    SAN    ANTONIO   BOARD   OF   HEALTH — QUARANTINE   OF   SMALL   TOWNS. 

San  Antonio,  Tex.,  October  3,  1903. 
Wyman,  Washington: 

Attended  meeting  board  of  health.  Business  men  and  railroad  oflicials  work- 
ing harmoniously.  Proper  attention  given  refugees.  Trains  run  to  Encinal, 
where  crews  change.     Small  towns  on  road  strictly  quarantined.     San  Antonio's 


PUHLIC    IIEAI/ni    AND    M ARINE-HOSI'ITAL    SKRVICK.  20)5 

qu;irantiii(>  siMisiltlc.  Sullicieiitly  nh'rt.  N<)tlliIl^'  suspicious.  Noltc  has  1»0(M1 
looUiui,'  after  sauie  nin(t(>r.  but  leaves  to-ni.i^lit.  Will  make  iiis|)ecti(in  lirst  possi- 
1)1(>  uuiuient.  Teleplieue  counuuiiiealioii  with  surrouuduig  tuwus  extensive.  Xo 
ruuiDi-s. 

PUKNKLL. 


CONFKRKNCE    WITH    COUNTY    IIKAI.TII    OP^FICKR,    LASALT.E    COUNTY. 

CoTi'iJ.A,  Tkx.,  Oclohcr  //,  1903. 
WyiMan,  WasliiiH/loii  : 

Had  confereuce  with  health  ollicer  of  county.     Found  everythini^  clean.     (Juar- 
antine  measures  otroetive. 

I'UUNKr.L. 


NOTHING    SUSPICIOUS    AT    SAN    ANTONIO. 

Washington,  October  .7,  1!)()3. 
Ebeusoi-e.  Rice  Hotel ,  Houston.  Te.r.: 

Nolte  and  I'urnell  report  uothint:  susi)ici()us  at  San  Antonio.     Wire  result  of 
your  conference  with  local  authorities. 

Wyman. 


passed   assistant    surgeon    WERTENBAKEU   ordered   TO   EL   PASO. 

Washington,  October  J,  0)03. 
Wertenbaker.  Oaks' s  Hot  eh  Beaumont,  Tex.: 

After  completion  of  duty  in  Houston,  proceed  to  El  Paso.  Confer  with  Alex- 
ander. Make  thoroui^h  inspection  and  report.  Investigate  evidence  accepted 
for  passenger  traflic  from  noninfected  phices  in  Mexico.  Wire  departure  and 
arrival. 

Wyman. 


passed  assistant  surgeon  lumsden  ordered  to  eagle  pass. 

Washington,  Octol)er  J,  1903. 
Lumsden,  Oaks's  Hotel,  Beaumont,  Tex.: 

If  sanitary  conditions  in  Beaumont  are  satisfactory,  proceed  immediately  to 
Eagle  Pass."  Confer  with  llume.  Make  thorough  inspection.  Report  what 
evidence  is  accepted  that  i)assenger  trattie  is  not  from  infected  places  in  Mexico. 
Wire  departure  and  arrival. 

Wyman. 


information    received    at    SAN    ANTONIO    FAVORABLE. 

San  Antonio,  Tex.,  October  .',,  19(13. 
Wyman.  WasJi'mf/ton  : 

All    information    favorable   and    precautionary    measures    satisfactory.     Mail 
report  to-night. 

PURNELL. 


NO    NECESSITY   FOR    QUARANTINE   AGAINST    COTULLA. 

CoTULLA,  Tex.,  October  5,  1903. 
Wyman,  Wash ington  : 

Points  between  here  and  San  Antonio  quarantined  against  this  place  without 
cause.     I  return  to  San  Antonio  in  few  minutes.     All  quiet. 

PURNELL. 


2G<)  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

TWENTY-J'WO    CASES    AT    LAREDO YEIJOW    FEVER    KEPOKTEI)    AT    COI-UMniA. 

Laredo,  Tex..  October  '>,  l!)(l.i. 
Wyman,  U'«s7(  hKjton : 

Twenty-two  cases  reported  to-day;  no  deaths.  Seventeen  houses  disinfected, 
with  !)5  rooms.  No  new  cases  at  Minera.  lUunor  ot  5  cases  at  Colunil)ia,  oppo- 
site Minera,  on  American  side.  Nuevo  Laredo  reports  1  death.  Fifteen  cases 
under  treatment  and  .3  suspicious.  To-day's  report  for  Laredo  is  discounted, 
but  it  is  evident  that  tliere  are  cases  resulting  from  mosquitoes  infected  prior 
to  beginning  our  disinfection  work.  Tlie  epidemic  is  so  widely  disseminated 
that  good  results  are  doubtful,  but  still  have  some  hope.  Doctor  Lowry,  rail- 
road surgeon,  reports  11  new  cases  in  NueA'o  Laredo,  these  not  having  been 
reported  by  the  authorities. 

GUITERAS. 


TOTAL  CASES  OF  YELLOW  FEVER  AT  LAREDO  TO  DATE. 

Laredo,  Tex.,  October  6,  1903. 
Wy'man,  Washlnffton: 

New  cases  rei)orted  to-day,  ID ;  deaths,  none ;  cases  previously  reported,  83 ; 
total  to  date,  102 ;  total  deaths,  r,.  Twenty  houses  disinfected,  with  93  rooms. 
From  Minera  1  death  reiiorted  and  no  new  cases. 

GUITEKAS. 


report  of  yellow  FEVER  AT  CORPUS  CHRISTI. 

Laredo,  Tex..  October  G.  1903. 
Wyman,  Wafihington : 

Persistent  rumors  yellow  fever  Corpus  Christi.  Suspicious  detained  to-day. 
Arrangements  being  ma<le  for  Tabor  and  iMurray  to  go  to-night  to  investigate 
again. 

GUITERAS. 


PASSED     ASSISTANT     SURGEON      W^ERTENBAKER     REPORTS     CONDITIONS     AT     liEAUMONT 
SATISFACTORY ORDERS    TO    EL    PASO    RECEIVED. 

Beaumont,  Tex.,  October  6,  1903. 
Wyman,  ^YashUifjton : 

Conditions    here    apparently    satisfactory.     Stiegomnia    abundant.     Orders    to 
El  Paso  received  this  a.  m.     Leaving  for  Houston.     Address  Caintal  Hotel. 

Wertenbaker. 


arrival   of   passed   assistant    surgeon    wertenbaker   at    HOUSTON. 

IIousTON,  Tex..  October  G,  1903. 
Wyman,  Wash ington : 

Arrived  at  midnight.  Have  had  conference  with  Ebersole  and  city  health 
officials.  Conditions  here  appear  satisfactory.  Have  Iiad  conference  to-day 
with  southern  health  officials.  They  are  willing  to  cooperate  with  any  arrange- 
ments we  may  make  regarding  i>assenger  traftic  across  the  boi'der.  Leave  at 
midnight  for  El  Paso.     No  news  iiere  beyond  press  dispatches. 

Wertenbaker. 


PASSED    ASSISTANT    SURGEON    LUMSDEN    LEAVES    FOR    EAGLE    PASS. 

Beaumont,  Tex.,  October  G,  1903. 
Wyman,  WatiJi ington: 

Orders  received.     Will  depart  for  Eagle  Pass  to-morrow  morning. 

Lumsden. 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE.  2()7 

Dr.l'ARTl  KK    OK    STATK     IIKALTII    OKFICEB    TABOU    AND    SUK(iK()N     MIKRAY     I'OU    COUPWH 

CIIKISTI. 

Laukim*.  Tkx.,  Ocldlxr  7.   I!K).{. 
Wyman.   W'dxIiiiKjlon : 

Tiiltor  and  .Murray  left  for  Corpus  Christ i  at  1  this  morning. 

GmTKKAH. 


BEPOnT   FROM    CORPUS    CIIRISTI. 

Laricdo.  Tex.,  Oclohrr  -S'.  J903. 
Wyman.  Washingt07i : 

Visitod  Corpus  Christi  witli  Tabor;    made  necropsy;    malarial;    no  eases  of 
fever  in  town  aocordinj;  to  statements  of  iho  four  doctors. 

Murray.  Siirj/con. 


REPORT   OF   CONDITIONS  EXISTING   IN    SAN   ANTONIO,   TEX.,   AND  VICINITY    WITH    RELA- 
TION TO  PREVENTING  SPREAD  OF  Y'ELLOW  FEVER. 

San  Antonio,  Tex.,  Octohcr  .j.  191)3. 

Sir:  I  have  the  honor  to  submit  a  report  of  the  conditions  existinii  in  and 
south  of  San  Antonio,  and  of  the  work  done  up  to  the  present  time. 

San  Antonio  was  reached  on  the  morning  of  October  2,  190.''>,  and  as  soon  as 
practical)le  I  visited  the  local  health  authorities,  and  Doctor  Nolte,  of  the  Louisi- 
ana State  board  of  health,  that  I  might  acquaint  myself  with  the  situation  as 
regards  yellow  fever  and  (juarantines. 

From  the  health  authorities  I  learned  that  ;is  soon  as  the  first  cases  of  fever 
had  been  announced  in  Laredo  a  quarantine  was  put  on  against  passengers  and 
baggage  coming  from  that  point,  and  officers  met  the  incoming  train  and  pre- 
vented passengers  disembarking.  Measures  were  also  taken  to  ]>revent  those 
who  had  gone  north  from  coming  back  to  the  city  until  five  days  had  expired 
since  leaving  the  fever  district,  and  as  far  as  possible  those  wlio  had  come  into 
the  city  were  located  and  kept  under  observation.  Besides  quarantining 
Laredo,  a  quarantine  was  declared  against  tliose  counties  which  had  failed  to 
close  their  doors  against  the  infected  center. 

All  counties  are  now  quarantined.  Frotn  a  sanitary  point  of  view  San 
Antonio  presents  a  better  condition  than  most  places  of  its  size,  and  measures 
for  its  improvement  are  l)eing  prosecuted.  The  local  board  of  health  is  com- 
posed of  four  physicians  and  the  mayor  ex  officio.  The  physicians  are  Dr.  D. 
Berry,  president  and  county  physician ;  Dr.  S.  Burg,  city  physician  ;  I^r.  E.  F. 
Hertz  Berg,  and  Dr.  II.  D.  Barnitz.  all  intelligent,  alert,  and  active  gentlemen. 
They  met  me  very  courteously  and  promised  to  give  all  aid  in  their  power, 
and  have  extended  an  invitation  to  me  to  be  present  at  their  meetings  and  to 
take  part  in  tliem. 

From  Doctor  Nolte  I  learned  that  there  had  been  a  few  rumors  relative  to 
there  being  yellow  fever  in  the  city,  but  upon  investigation  it  was  found  that 
they  were  without  foundation.  He  further  stated  that  he  had  attended  a  meet- 
ing" of  the  local  medical  society  on  the  evening  of  October  1,  at  which  there 
were  present  50  iiractitioners  of  the  city,  and  upon  inciuiry  it  was  established 
that  none  of  them  had  seen  any  case  that  was  at  all  suspicious.  T'p  to  the 
jiresent  time  I  am  satisfied  there  has  l)een  no  case  of  fever  as  far  as  is  known 
outside  of  Laredo  and  the  mines,  the  latter  having  had  constant  and  intimate 
association  with  Laredo. 

On  October  3  I  drove  with  Doctor  Burg,  the  city  physician,  over  the  city,  and, 
among  other  places,  visited  the  city  hos])ital.  This  institution  accommodates 
about  GO  beds,  but  at  present  there  are  only  about  ;'>()  patients  in  its  wards,  and 
among  these  there  were  only  3  fever  cases,  and  these  plainly  malarial.  A 
room  has  been  prepared  here  for  the  recei)tion  of  actual  or  suspected  yellow- 
fever  cases.  The  windows  and  doors  are  protected  by  mosquito  netting,  and  a 
low  ceiling  has  been  put  in  of  the  same  material. 

To  revert  a  moment.  On  Friday  evening  I  attended  a  meeting  of  the  board 
of  health,  a  copy  of  the  proceedings  of  which  was  mailed  the  Department  on  Sat- 
urdav  last.  Sunday,  October  4,  I  took  the  !>  o'clock  train  (only  one  train  each 
way  "daily)    and  went  to  Cotulla,  the  first  place  of  importance  after  leaving 


2CS  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Laredo  coining  north.  Before  reaching  tliis  phice  I  had  an  opportunity  for 
gaining  a  few  items  concerning  r<'arsall,  tlie  only  otlier  point  of  any  impor- 
tance on  tlie  International  (ireat  Xortliern  Itailroad  between  San  Antonio  and 
Laredo,  the  train  having  stopjied  there  for  half  an  hour  awaiting  the  north 
l)ound.  Inquiries  made  of  the  merchants  elicited  the  fact  that  there  was  no 
.sickness,  and  that  no  strangers  were  allowed  within  their  gates.  On  reaching 
Cotulla  the  health  officer,  Dr.  J.  M.  Williams,  of  Lasalle  County,  of  whicli 
Cotulla  is  the  county  seat,  was  called  on,  and  from  liim  a  correct  understanding 
of  the  (juarantine  measures  was  obtained. 

At  Cotulla  the  Nueces  River  i>asses,  dividing  Lasalle  County  into  two,  running 
in  a  southeasterly  direction,  and  there  are  only  three  i)laces  at  which  people  can 
cross  when  it  is  swollen,  as  is  now  the  case,  without  swinuning.  There  are  two 
bridges  for  the  public  roads  and  one  railroa.d  Inidge.  At  each  of  these  crossings 
guards  are  placed,  and  no  one  is  jiermitted  to  i»ass  unless  he  can  establish  the 
fact  that  he  has  not  been  in  the  yellow-fever  neighborhood.  It  is  possible  for 
one  to  get  across  the  river  liy  swinnuing,  but  very  few  would  ever  attemi)t  it. 
and  before  they  could  i-e.ich  their  destination,  dodging  through  the  thick  under- 
growth, the  five  days  would  elapse  and  the  danger  would  have  jiassed.  In  the 
lower  part  of  the  county  the  little  hamlet  of  Eucinal  is  located.  This  is 
under  Doctor  Williams's  jurisdiction. 

There  ai'e  two  dirt  roads  entering  the  county  here,  both  of  which  are  strongly 
guarded.  All  of  the  contiguous  cr)unties  have  adopted  the  same  measures  that 
Lasalle  has.  Along  the  line  of  the  International  Great  Northern  road  are  a 
nuuiber  of  little  hamlets,  the  best  (»f  which  being  a  very  small  affair,  peopled 
mostly — say  fully  two-thirds — by  Mexicans.  Each  place  has  established  its 
own  (luarantine  and  posititvely  refuses  to  permit  anyone  from  the  south  to  come 
in.  No  one  conies  in  unless  he  Iiears  the  inevitable  health  certificate.  A  great 
number  of  the  Americans  left  these  towns  for  their  ranches  when  the  fei'er  was 
first  announced.  In  Cotulla,  for  instance,  fully  two-thirds  of  the  white  popu- 
lation either  took  the  train  for  the  north  or  went  to  the  ranches. 

On  October  5  (this  morning),  not  being  able  to  enter  any  of  the  towns  between 
Cotulla  and  this  place,  coming  from  the  south,  I  returned  to  San  Antonio,  which 
is  really  the  key  to  the  situation.  If  no  fever  gets  here,  then  there  is  no  dan- 
ger to  the  country  north  or  east,  ))roviding,  of  cour.se,  that  none  has  been 
already  carried  by  the  exodus  from  Laredo. 

The  country  south  is  one  of  maguificeiit  distances,  the  ranches  being  from  5 
to  30  miles  apart,  and  each  one  is  a  principality  unto  itself,  with  its  own  little 
shotgun  quarantine.  There  is,  of  course,  a  little  danger  of  the  disease  getting 
on  some  of  the  large  ranches  near  Laredo,  from  the  fact  that  quite  a  number 
of  Mexicans  come  north  at  this  season  to  pick  cotton  and  some  one  might  slip 
on  a  ranch  and  be  hidden  by  his  friends. 

I  reached  San  Antonio  this  aft(  riioon  and  called  on  Doctor  Berry,  the  presi- 
dent of  the  board  of  health.  He  reports  everything  (luiet  and  no  rumors  of 
any  kind. 

Respectfully,  John  H.  Pubnell, 

Actinu  Assistant  Surf/eoti. 

The  Subgeon-Genebal. 


[Telegrams.! 

El.  Paso,  Tex.,  Ocioher  R,  1903. 
Wyman,  Wuslihigton : 

See  my  report  this  station  last  March  for  general  conditions.  Consular  cer- 
tificates and  iiersonal  statements  of  passengers  Ix'iiig  accepted  as  to  previous 
movements.  *  *  *  Recommend  authority  to  nominate  acting  assistant  to 
hel])  Alexander  and  make  careful  inspection  on  train  before  reaching  Juarez. 
Think  no  trouble  to  arrange  such  inspection.     *     *     * 

Wertenbaker. 


Laredo.  Tex.,  Octohrr  8,  1903. 
W^YMAN,  W(i.<ihinfi1o}i : 

At  Tabor's  request  have  lent  him  additional  camp  outfit.     A  small  camp  is 
to  be  established  on  Texas-Mexican  road. 

GUITEBAS. 


PUBLIC    HEALTH    ANL>    MAR1NK-H<)SI>ITAL    SERVICE.  2()V) 

Laukim),  Tkx.,  Oclohcr  ,S,  Uni.l. 
Wyman,  Mafthiiif/toit : 

New  cases  r(>i><»i"t<'<l  to-day,  2'>:  (Icallis,  I;  houses  (lisiiifertcd,  lit,  with  72 
rooms.  The  situation  is  (liscoiifaLCiii};.  ("Ircuuistaiices  are  siicii  tliat  it  is  iiii- 
possihle  to  make  mos(|uito  (lisiiifection  elTeetive.  Am  ]»ushiii;;  it.  however,  Kiv- 
iii!^  liarliciiiar  atti'iitioii  to  oiliiij;  sla.uiiaiit  water  in  infected  districts. 

GUITEKAS. 


WASiiiNfiTON.  Ortohrr  <),  I'.Uhi. 
(JiUTEUAS.  Laredo,  Tex.: 

In  sjiite  of  discoin-.-iLCiiii;  situation  due  to  jtrevalence  of  fever  lu'tore  you  took 
liold.  r.ureau  .-ipprovcs  your  determination  to  contiini(>  in  i)resent  efforts.  Am 
iufornuul  tliat  in  eliminating'  yellow  fever  from  Ilahana  not  only  patients  and 
suspects  weri'  screened,  hut  ,i,'enei-al  encourajiement  was  jjiven  to  citizens  to 
protect  themselves  hy  netting.     You  must  not  exi)ect  results  too  soon. 

Wyman. 


Washington,  Octohrr  10,  PMS. 
(JiMTKRAS.  Laredo,  Tc.i-.: 

If  possihle  make  arrangements  for  daily  report  of  cases  and  deaths  at  Xeuvo 
Laredo,  Mexico,  to  he  wired  here. 

Wyman. 


Eaglk  Pass,  Tex.,  October  8,  1003. 
Wyman,  Washington : 

Evidence  accepted  here  by  Service  and  State  rei>resentative  that  passenger 
tratiic  is  not  from  infected  places  in  Mexico  comprises  statement  under  oath  hy 
passenger,  corrohorated  by  examination  of  railroad  ticket,  marks  on  baggage, 
and  report  of  railroad  otHcials.  Keata,  on  ^Mexican  International  Railroad,  in 
Coahuila  State,  is  key  to  i)assenger  traffic  to  Eagle  Pass  from  infected  locali- 
ties in  Mexico.  Mexican  quarantine  authorities  have  establislied  detention 
camp  there.  Will  report  as  observations  are  completed.  Address  me  care 
Hume. 

Lumsden. 


Eagle  Pass,  Tex.,  October  12,  1903. 
Wyman,  Washington : 

Made  practically  house-to-house  inspection  Quemado ;  found  S  cases  undoubted 
malaria :  no  indications  yellow  lYner.  River  there  now  high,  consequently 
very  few  attempt  crossing  from  Mexico.  Consider  my  remaining  longer  at 
Eagle  Pass  unnecessary.     Hume  is  handling  situation  well. 

,  Lumsden. 


Washington,  October  13,  1003. 
Lumsden,  care  Hume,  Eagle  Pass,  Tea:: 

Proceed  innnediately  to  El  Paso  and  assiune  temporary  charge  of  station. 
Alexander  directed  to  report  to  you.  Wertenbaker  will  remain  a  day  or  so 
to  post  you  on  situation. 

Wy'man. 


INSPECTION      SER\aCE,      MEXICAN     BORDER Y'ELLOW      FEVER     AT     LAREDO     AND     OTHER 

POINTS  IN  TEXAS  AND  MEXICO. 

Laredo.  Tex..  October  l-i,  1003. 
Wyman.  Washington: 

New  cases  to-day.  27;  deaths.  1;  houses  disinfected,  22,  with  85  rooms;  242 
containers,  40  premises  and  2,000  square  feet  standing  water  oiled;  33  spigots 
put  in  water  barrels ;  114  premises,  covering  16  city  blocks,  inspected.     Maxi- 


270  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

imiiii  teuipernture,  94°  ;  ininiiinini,  70°.     Nuevo  Laredo  reports  G  new  cases ;  no 
deaths.     No  report  obtainable  from  Minerva. 

GUITERAS. 


Washington,  October  11,  1903. 
GuiTEEAS,  Laredo,  Tex.: 

E.  II.  II.  Green  wires  request  from  Dallas.  Tex.,  that  disinfectinfi  scpiad  be 
sent  from  Laredo  to  Minera  for  puriwse  screening  and  fumigating;  that  con- 
ditions among  miners  there  becoming  serious.  Confer  with  Tabor  concerning 
disinfection  Minera. 

Wyman. 


Laredo,  Tex.,  October  17,  1903. 
AVyman,  Washington: 

Have  already  arranged  with  Tabor  to  send  Dinwiddle  with  Thompson,  of 
Tabor's  medical  staff,  to  Minera  Monday  morning  for  screening  and  disinfecting. 

GUITERAS. 


Laredo,  Tex.,  October  11,  1903. 
Wyman,  Washington: 

New  cases  to-day,  22 ;  deaths,  3 ;  22  houses  disinfected,  with  75  rooms ;  39.3 
containers  oiled,  51  premises  and  15  excavations  sprinkled,  G  barrels  of  crude 
oil  sprinkled  in  open  lots  and  streets,  203  pi'emises  inspected,  covering  35  city 
blocks.  Maximum  temperature,  83°  ;  minimum,  44°.  New  Laredo  reports  3 
liew  cases  and  1  death.  jMinera,  up  to  yesterday,  reports  a  total  of  90  cases  and 
5  deaths.  I  look  for  a  marked  diminution  in  the  number  of  cases  in  the  next 
few  days  as  a  result  of  the  work  being  done  and  the  favorable  weather. 

GUITERAS. 


[Telegrams.] 

El  Paso,  Tex.,  October  IS,  1903. 
Wyman,  Washington: 

Have  tightened  inspection  here ;  all  passengers  from  Mexico  now  required  to 
make  affidavit  they  are  not  from  infected  districts.  State  quarantine  officer 
here  informs  me  officially  that  persons  five  days  from  yellow-fever  districts  can 
be  admitted  without  further  detention.  Am  cooperating  with  him.  Everything 
going  smoothly. 

Lumsden. 


Laredo,  Tex.,  October  18,1903. 
AVyman,  Washington: 

13th,  visit  many  and  confirm  7;  14th,  confirm  15  (also),  with  Consul  Garrett; 
15th,  IGth,  17th,  and  ISth,  make  some  visits  in  Laredo.  Consul  Garrett  will 
recover.  Have  spent  five  nights  and  four  days  with  him.  Subject  of  future 
letter. 

Murray. 


Laredo,  Tex.,  October  18,  1903. 
Wyman,  Washington: 

New  cases  to-day,  20,  deaths  G;  houses  disinfected  11,  with  55  rooms;  160 
containers  oiled,  42  premises  sprinkled,  and  18  faucets  put  in  water  barrels ; 
spigots  or  faucets  are  put  in  all  barrels  that  are  covered  with  oil;  82  premises 
inspected,  7  barrels  of  crude  oil  sprinkled  on  vacant  lot  and  intervening  streets. 
Maximiun  temperature,  80°  ;  minimum,  48°.  No  report  from  New  Laredo. 
Pharmacist  Goodman  leaves  for  Minera  to-morrow  morning  with  disinfecting 
gang. 

GUITERAS. 


PUBLIC    HEALTH    AND    MAlilNK-HOSPITAL    SKRVICK.  271 

Lakkim).  'I'kx.,  Oclolxr  I!),  l!>il,l. 
Wyman,  Washiiir/loii : 

Tiibor  I'lMiut'sls  iimii(Mli;ilt>  iircsciicc  uf  Miirrii.v  in  San  Aiiloiiin.  .Murray  h'avs 
to-morrow  luorninj;.  Koports  rt'ccixcd  licro  slate  -  cases  yellow  fever  at  that 
l)laoe. 

GUITEKAb. 


Lakkdo,  Ticx.,  Ortobcr  I'J,  J!)03. 
W Y M A N,  ir«.s7( iii(/t()ii  : 

Tahor  reports  as  follows:    Hondo  ease  positive;    isolated;    no  Ntcf/oniyiu  in 
iiei.i;lil)orbood  ;   origin  being  investigated. 

GUITEBAS. 


Laredo,  Ticx..  Octubcr  19,  1903. 
Wv.MAX,  Watiliiiu/toit : 

Worked  in  Laredo  all  day.     Will  lie  in  San  Antonio  at  noon  liOth  in  resi)onse 
to  Tabor's  request  to  (Juiteras. 

Murray. 


Laredo,  Tex.,  Octohcr  19,  1903. 
Wyman,  Washiiifftoii  : 

New  eases  to-day  'Mi,  deatlis  o ;  liouses  disinfected  l(i,  witb  .14  rooms;  lof] 
containers  and  12  excavations  oiled.  70  premises  sprinkled,  102  premises  inspected 
covering  20  city  blocks.  12  faucets  applied.  1.5  barrels  of  crude  oil  sprinkled  on 
40  l)locks  of  vacant  lots  and  intei-vening  streets.  Maximum  temperature  So°, 
mininuun  41°.  One  case  and  1  deatb  sui)posed  to  be  from  yellow  fever  at  Can- 
nel,  a  mining  camp  2*  miles  tbis  side  of  Minera.     Will  investigate  to-mori-ow. 

GUITERAS. 


El  Paso,  Tex.,  Octohcr  20,  1903. 
Wy'-man,  Washhigtoii : 

Far  as  ascertainable,  no  travel  recently  througb  bere  from  infected  district. 
Inspection  worlc  going  smootbly. 

LUMSDEN. 


Houston,  Tex.,  Octohcr  20,  1903. 
Wyman,  Washington: 

Local  conditions  remain  good. 

Ebersole. 


Laredo,  Tex.,  Octohcr  20,  1903. 
Wyman,  Washington: 

New  cases  reported  to-day,  36;  deaths.  2.  Investigation  shows  tbat  only  13 
of  the  new  cases  can  be  credited  to  the  last  twenty-four  hours ;  the  balance  are 
old  cases  discovered  to-day.  Houses  disinfected,  13.  with  .51  rooms ;  244  con- 
tainers and  1  excavation  oiled ;  07  premises  sprinkled,  covering  10  city  blocks ; 
29  sr)igots  imt  in  barrels ;  15  barrels  of  crude  oil  sprinkled  on  vacant  lots  and 
intervening  streets,  covering  15  blocks ;  maximum  temperature.  S0°  :  minimum, 
47°.  New  Laredo  reports  8  new  cases  and  1  death  for  yesterday  and  4  new 
cases  and  4  deaths  to-day.  Inspected  Cannel"  and  Minera,  and  found  1  case  at 
Gannel.  of  uncertain  origin;  proper  precautions  taken.  Cannel  is  a  mining 
camp  3  miles  this  side  of  Minera:  population  about  1,000.  Minera  has  had  96 
cases  with  7  deaths.  There  are  about  40  cases  now  under  treatment.  Good- 
man is  rapidly  pushing  disinfection  of  ^linera.  No  train  arrived  to-day  from 
San  Antonio.     Have  heard  nothing  new  from  there. 

GUITERAS. 


Eagle  Pass,  Tex.,  Octohcr  21,  1903. 
Wtman,  Washington : 

County  authorities.  Mexican  health  officer  at  C.  P.  Diaz,  and  at  mass  meeting 
I  itizens  here  to-night  all  request  Service,  through  me,  to  take  in  full  charge 


272  PUBLIC    HEALTH    AND    MARINE-HOSriTAL    SERVICE. 

niul  enforce  rigid  quarantine  against  San  Antonio,  holding  all  individuals  from 
there  five  days.  This  will  entail  eonsiderable  expense.  Will  need  more  tents 
and  15  more  guards,  besides  cook  and  matron.  Fair  now  going  on  in  San 
iNntonio.  At  least  l."iO  ])ersons  will  arrive  on  train  to-morrow.  Service  should 
handle  the  (|uarantine.  Advise  at  once  Bureau  desires.  Cold  weather  already 
here,  and  (juarantine  will  not  last  long. 

Hume. 


Eagle  Pass,  Tex.,  Octohcr  21,  1903. 
Wyman,  Washington: 

Maverick  County  quarantined  against  San  Antonio  account  3  deaths  yellow 
fever  to-day.  County  authorities  reciuest  service  and  desire  use  of  camp  for 
detention  of  passengers.     Wire  if  I  shall  cooi)erate  with  county. 

Hume. 


Washington,  Octoher  22,  1903. 
IIuME,  Eagle  Pass,  Tex.: 

Telegram  21st  received  this  morning.  Bvu-eau  can  not  undertake  preventive  i 
m<'asures  at  noninfected  cities  and  towns,  its  o[)erations  being  at  seat  of  infec- 
tion and  border.  You  are  authorized,  however,  to  cooperate  with  local  or 
county  authorities  in  their  protective  measui-es  against  Texas  points  with  such 
materials  and  force,  including  mosquito  netting,  as  you  have  on  hand.  Same 
action  was  tukeu  at  Corpus  Christi  and  Brownsville. 

Wyman. 


San  Antonio,  Tex.,  Octoher  21,  1903. 
Wyman,  Washington : 

Arrived  20th,  examined  13  sick.  Confirmed  Tal)or's  Academy  case;  decided  2 
others ;  ruled  out  7 ;  3  doubtful.  Have  had  a  consultation  of  physicians  with 
following  result :  Yellow  fever.  Wednesday  held  .'5  necropsies.  Two  positive, 
1  spoiled  by  embalmer,  but  presume  will  have  consultation  of  physicians  this 
afternoon.  Do  not  think  there  will  be  any  fiu'ther  spread.  Disinfection  mails 
unnecessary.  A  frost  is  reported  to  have  occurred  at  Palestine  last  night. 
Assured  public  that  everything  itossible  is  being  done  and  will  be  kept  fully 
advised.     Am  subject  to  Tabor's  directions,  and  wish  to  return  Laredo. 

Murray,  Surgeon. 


Washington,  Octoher  21,  1903. 
SoucHON,  NciV  Orleans,  La.: 

Murray  at  San  Antonio  confirms  3  oases.     States  he  does  not  think  there  will 
be  further  spread,  i)robably  account  frost  Palestine. 

Wyman. 


Washington,  Octoher  21,  1903. 
Murray',  San  Antonio,  Tex.: 
Wire  what  measures  are  being  taken  to  prevent  spread. 

Wyman. 


San  Antonio,  Tex.,  October  21,  1903. 
Wyman,  Washington: 

Your  telegram  of  21st  received.  Medical  society,  fiO  members,  met  and 
indorsed  diagnosis  and  proffered  support.  Listened  to  addresses  by  Tabor  and 
Murray ;  promised  to  screen  all  fever  patients  promptly,  as  ordered  by  city 
board.  To-day  1  new  case  reported,  not  yet  acted  on.  Aledical  inspectors  are 
acting  in  the  suspected  districts.  Visitors  at  international  fair  to  go  home 
and  be  subject  to  six  days'  observation  if  home  towns  will  admit  them.  While 
there  is  reason  to  believe  yellow  fever  has  existed  for  a  month,  the  profession 
and  authorities  are  impressed  with  the  importance  of  prompt  action.  Both 
city  and  county  authorities  assure  all  needed  funds.     *     *     * 

Murray. 


rUIJLIC    HEALTH    AND    MARINP>H()SPITAL    SKRVICK.  273 

Washinoton,  October  .'J,   t!Ki,l. 
MuKRAY,  San  Antonio.  Tr.r.: 

KtMiiaiii   Sail   Antonio   until    Kiiliarilson   arrives.     Will   llion   wire  you   ayaln. 
Wire  daily  until  arrival  of  Kichardson. 

VVVMAN. 


Washington,  October  21,  ino.i. 
KiciiAHDsoN,  Scir  Orleans,  La.: 

If  Wcrtonhakcr  lias  ri'lurncd.  prococd  iiiiincdiately  to  San  Antonio.  Murray 
wiivs  ;>  easels,  hut  does  not  foar  si)ivad.  Koitort  your  address  and  wire  all 
iiil'orniation  soon  as  i)ossiblo  alter  arrival.  Confer  first  thing  with  Doctor 
Tiibor  and  local  board. 

Wyman. 


Larkdo,  Tex.,  October  21.  Hio.i. 
Wyman,  WanJihtffton : 

Thirteen  cases  reported  to-dny.  Only  8  of  these  are  new.  Five  are  old  cases 
just  come  to  lij^lit.  The  situation  is  encouraging,  although  these  hidden  cases 
interfere  with  ediciency  of  our  wrok.  Deaths  reported,  4.  Twenty-eight  houses 
disinfected,  with  S4  rooms.  Two  hundred  and  thirteen  containers  and  excava- 
tions oiled.  Forty  premises  sprinkled.  One  hundred  and  fifty  premises 
inspected,  covering  21  city  blocks.  Twenty-one  barrels  of  crude  oil  sprinkled 
on  vacant  lots  and  intervening  streets,  covering  10  city  blocks.  Fifteen  faucets 
put  in  water  barrels.  Maximum  temperature,  83°  ;  minimum,  47°.  Miiiera 
reports  2  new  cases  and  I  death.  Goodman  returned  to-night  after  completing 
disinfection  of  Minera — excellent  work.  No  report  from  New  Laredo.  Murray 
reports  13  cases  at  San  Antonio,  and  2  positive  autopsies  and  1  presumable. 
Tabor  reports  1  case  at  Castroville,  originating  in  San  Antonio. 

GUITEKAS. 


TRANSACTIONS    ON    ACCOUNT    OF    \'ELLOW    FEVER,  AT    LAREDO    AND    SAN    ANTONIO. 

El  Paso,  Tex.,  October  22,  1903. 
Wyman,  Washington : 

Indications  are  the  local  authorities  will  impose  no  restrictions  on  passenger 
traffic  coming  here  from  San  Antonio,  Tex.,  on  ground  this  uninfectable  terri- 
tory. The  local  board  of  health  meets  to-morrow  to  discuss  question ;  other- 
wise nothing  new  here. 

LUMSDEN. 


El  Paso,  Tex.,  October  23.  1903. 
Wyman,  Washington: 

At  meeting  this  afternoon  of  local  board  of  health  and  prominent  citizens, 
resolutions  adopted  to  invite  people  from  San  Antonio,  Tex.,  to  come  here  with- 
out restrictions.  I  consider  this  safe  for  El  Paso,  but  there  is  some  danger  of 
refugees  coming  here  and  going  to  infectable  territory  before  incubation  period 
is  completed.  Will  suggest  this  unofficially  to  the  local  board  of  health.  Local 
board  of  health  accepts  mosquito  as  sole  agent,  and  members  are  much  pleased 
to  learn  decision  of  Pasteur  Institute  Connnissiou. 

LUMSDEN. 


Washington,  October  2.'i.  1903. 
LuMSDEN,  El  Paso,  Tex.: 

Telegram  received.     Have  any  measures  been  set  on  foot  by  local  board  for 
screening  febrile  cases? 

Wyman. 
8629—04 18 


274  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

El  Paso,  Tex.,  October  25,  1903. 
Wyman,  Wasliingion : 

Vilas,  president  local  board,  informs  me  suspicious  febrile  cases  occurring 
here  will  be  thoroughly  isolated  and  screened.  No  extraordinary  precautions, 
as  State  is  maintaining  quarantine  of  San  Antonio.  Little  travel  from  there 
here  is  anticipated,  notwithstanding  invitation  referred  to  in  my  telegram  of 
October  23. 

LUMSDEN. 


Houston,  Tex.,  October  22,  1903. 
Wyman,  Wa.'^hiiigton: 

Houston  and  Harris  counties  quarantined  against  San  Antonio.     Passenger 
traffic  from  that  point  suspended. 

Ebebsole. 


Washington    October  2.'f,  1903. 
Edersole,  Rice  Hotel,  Houston,  Te.r.: 

Desired  no  tickets  be  sold  for  Louisiana  without  assurance  that  passengers 
from  western  Texas  have  not  been  within  last  five  days  in  any  place  infected 
with  yellow  fever.  Believe  this  can  be  arranged  through  railroad  and  ticket 
agents.     Wire  feasibility.     Same  will  be  done  at  Beaumont. 

Wyman. 


New  Orleans.  La.,  October  23,  1903. 
Wyman,  WasMngton: 

Will  you  not  station  officer  at  Houston  and  Beaumont  to  cooperate  with 
Louisiana  State  board  of  health  in  seeing  that  passengers  from  western  Texas 
swear  that  they  have  not  been  within  the  last  five  days  in  any  place  infected 
with  yellow  fever?     *     *     *     Can  furnish  two  men  if  desired. 

Edmond  Souchon. 


Washington,  October  2Jf,  1903. 
Dr.  Edmond  Souchon, 

Xeir  Orleans.  La.: 
Send  name  of  i>hysician  and  address  for  nomination  for  duty  at  Beamount. 
Ebersolo  will  do  at  Houston.  I  shall  instruct  that  they  operate  at  ticket  offices 
or  through  ticket  agents  and  demand  satisfactory  evidence  of  absence  from 
yellow-fever  district  for  five  days  and  require  affidavit.  Richardson.  San 
Antonio,  wires  to-day  no  tickets  being  sold  to  Texas  or  Louisiana  itoints;  trains 
pass  through  without  stopping.  Governor  himself  has  quarantined  entire  State 
against  San  Antonio. 

Wyman. 


Washington,  October  26,  1903. 
Dr.  J.  G.  Henderson. 

1100  FAiixian  Fields,  Xew  Orleans.  La.: 
Appointment  as  temporary  acting  assistant  surgeon  recommended.  Proceed 
at  once  Beaumont :  arrange  with  railroad  and  ticket  agents  so  that  no  tickets 
be  sold  to  i>oints  in  Louisiana  without  their  first  l)eing  assured  that  passengers 
from  western  Texas  have  not  been  in  the  yellow-fever  infected  places  within  five 
days.    Wire  departure  and  arrival,  giving  address  in  Beaumont. 

Wyman. 


New  Orleans.  La.,  October  27,  1903. 
Wy'man,  Washinfito)i : 

Leave  to-night ;   agents  Beaumont  ordered  to  comply  your  telegram. 

Henderson- 


PUBLIC    HEALTH    AND    MAKINK-IIOSPITAL    SERVICE.  275 

LAIIEDO    AND    MINf:i{A. 

WASHiNtiTON,  Octohrr  ;?,.^  1D(K3. 
GriTEHAS,  Laredo.  Tc.r.: 

For  .vour  (MicourM^'cmciit  I  soiul  extract  Iroiu  letter  from  (Jeddiiij^s  from  I'jiris, 
reeeiv^'d  to-day:  "Doctor  Koux  tells  me  rMsteur  Institute  Coiniiiissioii  has 
absolutely  settled  upon  the  mosquito  us  the  sole  agent  in  the  dissemination  of 
yellow  fever." 

Wyman. 


Laredo,  Tex.,  October  22,  1903. 
Wyman,  Washingion: 

New  cases,  (i ;  old  oasos  discovored,  (i ;  total  to-day,  12;  deaths,  1;  houses 
disinfected,  .'il.  witii  141  rooms;  10r>  containers  and  5  excavations  oiled;  40 
premises  sprinkled;  V2:\  premises  inspected,  covering  2.">  city  blocks;  24  barrels 
crude  oil  sprinkled  on  vacant  lots  and  intervening  streets,  covering  :{8  city 
blocks;  2,?  faucets  applied.  Maxinunn  temperature.  8.")°;  mininunn.  .^5°.  One 
new  case  and  1  death  reported  from  Minera  ;  no  report  from  New  I.riiredo.  Argu- 
ellas,  governor  of  Taniaulipas,  is  now  in  New  Laredo,  directing  efforts  to  stamp 
out  epidemic;  he  called  at  this  otlice;  the  visit  was  returned.  Your  telegram 
stating  that  the  Pasteur  Institute  has  accepted  the  mosquito  as  the  sole  means 
of  transmitting  yellow  fever  received ;   it  will  have  a  good  effect. 

GUITEBAS. 


Laredo,  Tex..  October  23,  1903. 
Wyman,  Washiiigton: 

Seven  new  cases  to-day,  5  old  cases  discovered,  making  a  total  of  12  cases 
reported ;  3  deatlis ;  .'52  houses  disinfected,  with  12G  rooms ;  99  containers  and 
5  excavations  oiled;  lO.j  premises  inspected,  4.3  sprinkled;  15  faucets  lait  in 
water  barrels ;  30  barrels  of  crude  oil  siirinkled  on  premises,  vacant  lots,  and 
intervening  streets,  covering  61  city  blocks.  Maximum  temperature,  81°  ;  mini- 
mum, 59°.  Minera  reports  2  new  cases ;  no  deaths.  The  one  case  at  Canuel 
died ;   no  new  cases.    New  Laredo  reports  3  new  cases  and  2  deaths. 

Guitebas. 


Laredo,  Tex.,  October  2-i,  1903. 
Wyman,  Washington: 

New  cases,  7 ;  old  cases,  6 :  total  reported  to-day,  13 ;  deaths,  1 ;  30  houses 
disinfected,  with  101  rooms;  180  containers  and  3  excavations  oiled;  100  prem- 
ises inspected  and  GO  sprinkled ;  23  faucets  put  in  water  barrels ;  20  barrels  of 
crude  oil  sprinkled  on  vacant  lots  and  intervening  streets,  covering  02  city  blocks. 
Maximum  temperature,  70°  ;  minimum,  45°.  No  new  cases  at  Minera  nor 
Canuel.     New  Laredo  reports  2  cases  and  1  death.    Murray  arrived. 

Guitebas. 


Laredo,  Tex.,  October  25,  1903. 
Wyman,  Washington: 

New  cases  to-day,  8 ;  old  cases.  4 ;  total  reported  to-day,  12 ;  13  houses  disin- 
fected, with  42  rooms ;  95  containers  and  3  excavations  oiled ;  62  premises  in- 
spected and  36  sjtrinkled;  29  barrels  of  crude  oil  sprinkled  on  vacant  lots  and 
intervening  streets,  covering  34  city  hlocks ;  16  faucets  put  in  water  barrels. 
Maximum  temperature,  78°  ;  minimum,  38°.  New  Laredo  reports  1  new  case 
and  2  deaths.    No  report  from  Minera  or  Canuel. 

Guitebas. 


Labedo,  Tex.,  October  26,  1903. 
Wyman,  Washington: 

New  cases,  2 ;  old  cases  discovered,  6,  making  a  total  of  8  reported  to-day ; 
no  deaths ;  28  houses  disinfected,  with  106  rooms ;  118  containers  and  9  exca- 
vations oiled ;  51  premises  inspected  and  97  sprinkled ;  18  faucets  put  in 
water  barrels.     The  oiling  of  the  entire  city  was  completed  to-day.     During 


276  rUBLTC    HEALTH    AND    MAEINE-HOSPITAL    SERVICE. 

the  progress  of  this  work  3,425  water  barrels  were  oiled.  The  work  will  be 
continued  with  the  object  of  covering  the  city  a  second  time.  The  disinfecting 
of  empty  houses  and  i)ublic  buildings  will  now  be  undertaken.  JNIaxinunn  tem- 
perature, S()°  ;  minimum,  48°.  New  Laredo  rejiorts  2  new  cases  and  no  deaths. 
No  new  cases  at  Miuera  and  Cannel.     The  situation  is  very  gratifying. 

GUITERAS. 


Laredo,  Tex.,  Octohcr  27,  1903. 
Wyman,  Washinf/ton: 

New  cases,  S;  old  cases  discovered,  15,  making  a  total  of  2.'i  reported.  Twelve 
houses  disinfected,  with  245  rooms.  This  includes  the  Hotel  Hamilton.  Two 
hundred  and  eighty-four  containers,  50  excavations,  and  94  premises  oiled;  192 
premises  inspected ;  2.'i  faucets  put  in  barrels ;  (51  barrels  crude  oil  sprinkled  on 
vacant  lots  and  intervening  streets,  covering  70  city  blocks.  Maximum  tem- 
perature, 77°  ;  mininunn,  47°.  No  cases  at  Minora  or  Cannel.  Over  six  days 
have  elapsed  since  the  thorough  disinfection  of  Mlnera  by  Goodman  without 
new  cases.  The  epidemic  evidently  stamped  out.  New  Laredo  reports  4  new 
cases  and  no  deaths. 

GUITEBAS. 


Laredo,  Tex.,  October  28,  1903. 
Wyman,  Washington: 

New  cases,  (! ;  old  cases  diseoverM,  9;  total  reported  to-day,  15;  deaths,  5; 
27  houses  disinfected,  with  87  rooms;  127  containers  and  51  excavations  oiled; 
(i7  i)remises  sprinkled,  31  inspected;  14  faucets  ])ut  in  water  barrels;  ;^1  barrels 
of  crude  oil  sprinkled  on  vacant  lots  and  intervening  streets.  jNIaxinuuu  tein- 
perature,  81°  ;  minimum,  57°.  Heavy  rain  last  night,  covering  large  areas  with 
water.  (Quarantine  between  the  two  Larcdos  raised  to-day  for  innnunes.  No 
report  from  New  Laredo  or  Minera.    Cannel  continues  free  from  disease. 

GUITERAS. 


DISINFECTING    METHODS   USED   IN    FIGHTING    YEI.LOW    FEVER   AT   LAREDO. 

Laredo,  Tex.,  October  23,  1903. 

Sir:  As  directed  in  Bureau  letter  of  October  17,  I  have  the  honor  to  make 
the  following  brief  report  upon  the  character  and  application  of  the  disinfect- 
ing material,  etc.,  used  in  screening  houses  in  the  suppression  of  the  present 
epidemic  of  yellow  fever. 

The  term  "  disinfecting  material  "  includes  everything  utilized  in  the  preven- 
tion of  the  spread  of  yellow  fever,  based  upon  a  complete  acceptance  of  the  fact 
that  the  mosquito  is  tiie  only  means  of  transmitting  the  disease.  It  therefore 
includes  disinfecting  material,  as  usually  understood,  such  as  sulphur,  pyre- 
thrum,  etc.,  and  also  lumber  for  screening  purposes,  mosquito  and  wire  netting, 
oil,  wooden  faucets,  etc. 

The  methods  instituted  are  as  follows :  There  are  3  screening  and  5  disin- 
fecting crews.  When  a  suspicious  or  jwsitive  case  of  yellow  fever  is  reported, 
a  screening  crew  is  at  once  sent  to  the  house  with  a  cart  containing  the  neces- 
sary material,  and  the  patient  is  inmiediately  screened,  the  carpenters  putting  in 
ready-made  screen  doors  or  windows,  or,  when  these  are  not  available,  making 
them  on  the  spot.  Where  screening  is  impossible  or  impracticable,  the  patient 
is  placed  under  a  mosquito  bar.  The  disinfecting  crew  follows  immediately 
after  the  screening  crew  and  disinfects  that  part  of  the  house  not  occupied  by 
the  patient.  On  the  conclusion  of  this  disinfection  the  patient,  if  able  to  be 
moved,  is  transferred  to  one  of  the  disinfected  rooms  and  liis  room  disinfected. 

All  water  containers  in  a  house  are  covered  with  oil,  and  faucets  inserted  in 
the  barrels  of  drinking  water. 

Sulphur  and  pyrethrum  are  used  in  disinfection — the  former  where  there  is 
no  danger  of  injury  to  the  contents  of  the  room,  the  latter  where  such  injury 
may  be  apprehended.  Where  pyretlu-um  is  used  care  is  talcen  to  sweep  the 
room,  so  as  to  collect  all  the  moscpiitoes  that  may  have  been  sim]ily  stunned 
by  the  fumes  of  the  powder.     In  the  disinfection  large  quantities  of  paper  strips 


PIJULIC    IIKALTII    AND    MARINK-IIOSPITAL    SKRVIOK.  277 

iiro  usod  in  ordor  lo  niaUc  the  rooms  iiir-tij^lit.      In  some  of  the  liouscs  if  is  iiw- 
cssury  to  iinpcr  .-iliuosl  tin-  culin'  liuildiuK. 
Kespectrully  subiuittod. 

(J.    M.   CJlHTEBAS. 

The  Subgeon-Gknebal. 


[ToIcKfams.  1 

Washington,  Ortohcr  22,  1903. 
MuRUAY,  H(ni  Antonio,  Tcr.: 

I  (]uot('  from  Icllcr  from  Assistant  Snrj:o<)n-(J(MUM-al  (Jcddin.LCs,  rcccivt'd  to-day 
from  I'aris :  "Doctor  Uonx  tells  me  Pastonr  Institute  ("ommission  lias  abso- 
lutely settled  ui)ou  the  moscjuito  as  a  sole  agent  in  the  dissemination  of  yellow 
fever."     Use  this  as  you  see  lit. 

Wyman. 

Similar  message  sent  to  Assistant  Siirgecm  Tjunisden,  El  Paso,  and 
Assistant  Surgeon  Ebersole,  Houston,  Tex. 

San  Antonio,  Tex.,  Octohcr  22,  1003. 
Wyman,  Washington: 

Your  telegram  22d  received ;  published  to-morrow.  Have  seen  5 — 4  ])ositive,  1 
pneumonia.  State  quarantine  proclaimed  by  Tabor  in  accedence  to  Texas 
counties  and  New  Orleans  for  mails  and  freights.  I'.oards  are  in  earnest  as  to 
mosquito  and  prompt  rei)orts  of  cases.  People  left  here  will  have  to  camp 
unless  towns  will  admit  them. 

Murray. 


San  Antonio,  Tex.,  Octohcr  2.?,  1D03. 
Wyman,  Washington : 

One  case  in  city,  1  in  Fort  Sam  Houston  ;  inspected  all  da,v  with  9  doctors. 
Evidently  some  cases  are  not  mentioned  for  fear  of  ofl'ending  patrons.  Large 
mass  meeting  this  forenoon  proffering  aid,  moral  cause;  in  fact,  to  local  boards 
it  was  a  soul-stirring  and  confidence-inspiring  affair.  Murray  nuist  go  to 
Laredo  to  treat  Doctor  Garrett  and  Doctor  Mc(iregor. 

Murray. 


San  Antonio,  Tex.,  Octoher  2Ji,  1903. 
Wyman,  WasJiington: 

Governor's  proclamation  of  yesterday  quarantines  entire  State  against  San 
Antonio.  To  date  have  been  9  cases  reported  with  3  deaths..  There  are 
undoubtedly  unreported  and  unrecognized  cases.  One  case  at  Fort  Sam  Houston 
declared  yesterday.  Local  board  has  divided  city  into  31  sanitary  districts 
and  i)roposes  to  make  daily  house-to-house  inspections,  screening  all  febrile 
cases  found.  Disinfection  mail,  freight,  and  baggage  leaving  here  required  by- 
governor's  proclamation.  No  tickets  being  sold  to  Texas  or  Louisiana  points. 
Trains  pass  through  without  stopping.  Stcgomyia  apparently  not  plentiful. 
Much  local  interest  in  mos-iuito  extermination.     Weather  quite  cool. 

Richardson. 


San  Antonio,  Tex.,  Octoher  2.',,  1903. 
Wy'man,  Washington: 

One  case,   3    death  reported  to-day ;  mininuun   temperature  last  night,  40°  ; 
maximum  yesterday,  74°.     Cooler  possibly.     Frost  predicted  to-day. 

Richardson. 


278  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

San  Antonio,  Tex.,  Octohrr  2-'>,  lOOS. 
Wyman,  ir(/.s7(  iiif/toii  : 

One  oaso,  no  doiitli  ofTicial  report  to-dfiy.  Temperature  last  twenty-four  hours, 
7(!°  niaxinmni,  40°  niinimuni.  I  louse-to-house  inspection  not  yet  in  general 
operation.     No  frost  last  night. 

Richardson. 


San  Antonio,  Tex.,  Ortohrr  2G,  lOOS. 
Wyman,  Washington  : 

By   request   Doctor  Tal)or,   I   accompany   him   to   C'uero,   Tex.,   to-day   to  see 
suspected  cases.     Will  return  here  to-niglit. 

Richardson. 


San  Antonio,  Tex.,  October  26,  1903. 
Wyman,  Washinf/ton,  D.  C: 

Returned  from  Cuero.  Saw  with  Doctor  Tabor  2  cases  yellow  fever  in  De- 
witt  County,  on  ranch  11  miles  north  of  Cuero.  Held  necropsy  on  third  case 
at  same  house.  Finding  typical.  Several  Htciiomji'ni'  seen  in  house.  Infection 
l)robal)ly  through  mild  case  from  Laredo.  Do  not  fear  spread ;  2  miles  to 
nearest  house. 

Richardson. 


suspicions    CA.SES    IN    MEDINA    COUNTY. 

Houston,  Tex.,  October  20,  1903. 

Sir:  I  have  the  honor  to  submit  for  consideration,  with  regard  to  the  situa- 
tion in  San  Antonio  and  Medina  ('ounty,  the  following  history  of  suspicious 
cases  which  have  occurred  there,  the  details  being  furnished  by  Health  Officer 
Bruml)y,  of  this  city,  wlio  was  over  the  ground  a  few  days  since. 

The  first  case,  that  of  Mrs.  ,  a  nurse,  and  motlier-in-law  of  one  Sylvester 

Rimero,  was  taken  siclv  suddenly  with  fever  at  the  house  of  Rimero.  After  tlie 
lapse  of  ten  or  twelve  days  the  (tther  inmates  of  the  house  were  taken  sick 
suddenly,  first  one  (ionzales.  then  Rimero's  wife,  next  his  child,  and  lastly 
Rimero  himself,  all  develoiting  a  fever  in  quick  succession.  All  had  similar 
symptoms,  viz,  high  fever,  subsiding  in  three  or  four  days,  and  this  followed 
by  a  secondary  fever,  or,  as  they  say,  a  relapse. 

Upon  the  third  or  fourth  day  of  his  illness  the  man  Gonzales  went  to  San 
Antonio  by  train  and  was  admitted  to  hospital.  He  wrote  to  the  other  mem- 
bers of  the  household  to  come  to  the  hospital.  Rimero's  wife  died  before  re- 
ceipt of  Gonzales's  letter,  Imt  Rimero  started  with  his  child  in  a  wagon  for  San 
Antonio.  The  child  died  en  route,  but  Rimero  reached  the  hospital  and  was 
admitted  in  a  delirious  condition.  I  am  informed  by  Doctor  Brumby  that  he 
saw  this  man  October  9,  ten  days  after  his  admission  to  hospital,  and  that  he 
noticed  some  bronzing  of  patient's  skin  with  a  yellowish  tint  of  the  conjunctiva^, 
but  not  knowing  patient's  previous  history  at  that  time  did  not  investigate 
further.  This  patient  was  again  seen  by  Doctor  Brumby,  I  am  informed,  on  the 
14th  instant,  upon  his  return  to  San  Antonio,  at  which  time  he  elicited  the 
above  facts  witli  regard  to  ])atient"s  history,  and  also  found  slight  albuminuria 
upon  examining  patient's  urine,  and  noticed  some  congestion  of  the  conjunctivte 
remaining. 

From  a  seai'ch  of  the  files  of  the  local  papers  I  found  a  reference  in  one  of 
them  to  the  admission  of  one  Rimero  to  hospital  on  the  29th  ultimo.  From  the 
history  given,  these  patients  lived  about  18  or  20  miles  from  San  Antonio,  west, 
near  the  line  of  the  Southern  Pacific. 

In  view  of  the  present  reports  from  Hondo  and  San  Antonio,  I  would  respect- 
fully submit  the  history  of  these  cases  for  consideration,  with  due  acknowledg- 
ment to  Health  Officer  W.  M.  Brumby,  of  this  city,  for  the  main  details  of  tt»e 
cases  which  were  furnished  me  upon  his  return  to  the  city  on  the  18th  instant. 
Respectfully, 

R.  E.  Ebersole,  Assistant  Surgeon. 

The  Surgeon-General. 


PUBLIC    HEALTH    AND    MARINK-IIOSPITAL    SERVICE.  270 

I<]i.  I'Aso.  Tkx.,  October  31,  J!)()3. 
Wymam,  W(iNJii)i!jl(>ii : 

'Piibur  to-day  wirinl  Jnstico.  Stnto  does  not  riMjuiri'  riiiiiiirMtioii  Mexican  Cen- 
tral trains  Irmv.  Justirc  has  conniumicatiMl  information  1(»  .Mexican  autiiorities, 
and  funiitjation  probably  will  be  discontinued  to-niorrow.  Weather  hen-  cool; 
f,'(HHl  frost  last  night. 

LlIMSOK.N. 


El  I*aso.  Tex.,  l^'orcmhcr  /,  J!>0.i. 
Wyman,  WofiJiiiifitoii : 

.Mexican  su])erior  board  health  has  directed  Sainanigo  to  continue  funiisation 
Mexican  ('(>ntral  trains.  Taltor  wires  Texas  does  not  reciuire  it.  Fumigation 
lasts  few  minutes  only,  therefore  it  does  not  interfere  with  our  inspection  of 
passengers. 

LUMSDEN. 


LAREDO. 

Lakedo,  Tex..  Octohcr  2,9,  jnos. 
Wyman,  Washington: 

Now  cases.  G;  old  cases  discovered,  1;  total  reported  to-day,  7;  deaths,  1  ;  27 
houses  disinfected,  with  131  rooms;  25()  containers  and  13  excavations  oiled;  (!!) 
premises  inspected;  27  faucets  jmt  in  water  barrels;  32  barrels  crude  oil 
si)rinkled  on  vacant  lots  and  intervening  streets,  covering  .'jf)  city  blocks;  25,000 
square  feet  standing  water  oiled.  jNIaximmn  temperature,  85°  ;  minimum,  5!)°  ; 
weather  close  and  sultry.  Ten  frontier  guards  in  Zapata  County  discharged 
yesterday.  New  Laredo  rei)orted  3  new  cases  yesterday.  No  cases  or  deaths 
to-day.    No  report  from  Minera  or  Cannel. 

Guiteras. 


Lareoo.  Tex.,  Octohcr  30,  JD03. 
Wymax,  Wasli  inffton  : 

New  cases,  9 ;  old  cases  discovered,  0 ;  total  reported  to-day,  15 ;  deaths,  4 ;  62 
houses  disinfected,  with  Ki!)  rooms ;  242  containers,  3  excavations,  and  10,000 
square  feet  standing  water  oiled;  210  premises  inspected,  1)5  sprinkled;  19 
faucets  put  in  water  barrels ;  22  barrels  crude  oil  sprinkled  on  vacant  lots  and 
intervening  streets,  covering  02  city  l)locks.  Maximum  temperature,  80°  ;  mini- 
mum, 07°.  Superintendent  at  Minera  rei)orted  down  with  yellow  fever  yester- 
day— had  been  in  Laredo  day  before.  No  cases  at  Cannel.  New  Laredo  reports 
2  new  cases. 

Guiteras. 


Laredo,  Tex.,  Oc1ot)cr  30,  1903. 
Wyman,  Wafih'uigton: 

About  40  enlisted  men  are  to  be  discharged  from  Fort  Mcintosh  from  Novem- 
ber 15  to  December  1  in  batches  of  two  or  three  at  a  time.  Detention  camp  at 
Sanchez  will  be  practically  suspended  Monday,  November  2.  Would  like  to 
arrange  with  the  Secretary  of  War  to  discharge  all  on  November  15.  Special 
cars  could  be  arranged  here  with  medical  inspector  and  quarantine  guards  to 
take  them  to  Texas  boundary  after  five  days"  (juarantine  detention  within  Fort 
Mcintosh  Reservation ;  otherwise  these  men  will  remain  about  town,  exposed  to 
infection. 

Guiteras. 


Laredo,  Tex.,  Octohcr  31,  1903. 
Wyman,  WasJiiiioton: 

New  cases,  3 ;  old  cases,  4 ;  total  reported  to-day,  7 ;  deaths,  1 ;  52  bouses  disin- 
fected, with  147  rooms;  437  containers  oiled;  274  premises  inspected,  05 
sprinkled ;  29  faucets  put  in  water  barrels ;  28  barrels  crude  oil  sprinkled  on 
vacant  lots  and  intervening  streets,  covering  58  city  blocks.     Maximum  temper- 


280  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

ature,  79°  ;  ininiuiuni,  <;(J°.  At  my  sujij?estion  city  council  ])assed  ordinance  to-day 
requiring  all  barrels  and  water  containers  to  be  covered  with  oil  under  penalty 
for  violation,  and  giving  service  officers  right  to  enter  premises  and  houses  for 
oiling  and  disinfection  jnirposes.  City  officials  are  giving  us  efficient  aid.  Can- 
nel  reports  a  ease  to-day;  no  report  from  Minera  or  New  Laredo. 

GUITEKAS. 


Laredo,  Tex..  Xovember'  1,  190S. 
Wyman,  Washington: 

New  cases.  .I ;  old  cases  discovered,  G;  total  rei)orted  to-day,  11 ;  deaths,  2;  52 
houses  disinfected,  with  lit!  rooms;  i>41)  containers  and  5  excavations  oiled;  1.32 
premises  si)rinkled,  o2<i  inspected;  27  faucets  put  in  water  barrels;  14  bari-els 
crude  oil  s])rinkled  on  vacant  lots  and  intervening  streets,  covering  (JO  city 
blocks.  Maximum  temperature,  82°  ;  minimum,  47°.  Hundreds  of  lal)orers  are 
returning  to  town  from  cotton  fields :  these  afford  new  material  for  the  disease. 
State  attorney-general  has  rendered  an  opinion  that  there  is  no  law  to  preAent 
their  coming.  Nine  frontier  guards  discharged  yesterday.  No  new  cases 
reported  at  New  Laredo ;  no  reports  from  Miuera  or  Cannel. 

GUITEBAS. 


Laredo,  Tex.,  November  1,  1903. 
Wyman,  W(i.<<Tiin{/toii : 

Busily  engaged  in  diagnosing  and  treating  cases.     Earnestly  tried  to  save  sev- 
eral critical  cases,  with  success  in  some;  have  been  too  busy  to  telegraph. 

Murray. 


Laredo,  Tex.,  Xovember  2,  1903. 
Wyman.  Washington: 

New  cases,  5 ;  old  cases,  4 ;  total  reported  to-day,  9 ;  deaths,  9 ;  5G  houses  dis- 
infected, with  l.iiG  rooms.  Report  from  one  crew  lacking.  Three  hundred  and 
twenty-one  containers  and  6  excavations  oiled,  188  premises  inspected,  48 
sprinkled.  IG  faucets  put  in  water  barrels,  ,34  barrels  of  crude  oil  sprinkled  on 
vacant  lots  and  inter\ening  streets,  covering  51  city  l)locks.  Maximum  tempera- 
ture, 81°;  minimum,  47°.  No  cases  or  deaths  reported  from  New  Laredo. 
Murray  went  to  Cannel  to  investigtite  2  suspicious  cases.  State  detention  camp 
at  Sanchez  and  on  Texas-Mexican  road  practically  closed  to-day. 

•  Guitebas. 


Laredo,  Tex.,  November  3,  1903. 
Wyman,  Washington : 

New  cases  G  and  old  cases  12;  total  reported.  18.  N'o  deaths.  Of  the  old 
cases  reported  some  are  so  old  that  a  positive  diagnosis  is  impossible.  Sixty- 
six  houses  disinfected,  with  1G9  rooms.  Yesterday's  missing  report  was  10 
houses,  with  29  rooms;  28.3  containers  and  4  excavations  oiled.  227  premises 
inspected  and  (J7  sprinkled.  25  f.uicets  put  in  liarrels.  45  barrels  crude  oil 
sprinkled  on  vacant  .lots  and  intervening  streets,  covering  SO  city  blocks.  Maxi- 
mum temperature,  78°  ;  minimum,  57°.  One  case  reported  at  Cannel;  no  report 
from  New  Laredo. 

Guitebas. 


Labedo.  Tex.,  November  3,  1903. 
Wyman,  Wash ington : 

Visited  Cannel  mine  at  Darwin,  2d;  1  new,  1  convalescent;  no  focus.  Man- 
agement claims  illicit  contact  with  Columbia,  Mexico.  No  cases  at  Minera. 
Darwin  houses  will  be  fumigated  daily  for  a  week. 

MtlBBAY. 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE.  281 

SAX    ANTONIO. 

San  Antonio.  Tkx.,  October  29,  1903. 
W  YM  AN.  ir«.s7/  in  (/ton  : 

()iu>  case  in  sixth  day  of  disoaso  and  2  deaths  roi)ort('d  to-day.     Toiiipt'raturo 
last  twenty-fom-  hours,  .">(J°  and  70°. 

UUIIAKDSON. 


San  Anionio,  Tex.,  Xovrmlicr  2,  1903. 
Wyman.  Wash'm<;ton  : 

Two  t-asos :  no  doatiis  to-day.     Toiiiporaturos  hist  twenty-four  iiours  ~>(\°  and 
7t!°.     State  (luaraiitiiu'  nmdified  to  aUow  travel  to  north  and  west  Texas. 

Richaudson. 


CASES    of   yellow    FEVER   IN    DEWITT   COUNTY'. 

San  ANTONIO,  Tex.,  October  27,  1903. 

Sir:  I  have  the  honor  to  inform  you  that,  as  stated  in  my  telegram  of  yes- 
terday, the  yellow  fever  seen  by  Doctor  Tabor  and  myself  in  Dewitt  Couiity, 
near  Cuero,  can  be  quite  certainly  traced  to  Laredo. 

The  house  in  which  these  cases  have  all  occurred  is  located  on  a  ranch  about 
n  miles  north  of  Cuero  and  the  railroad,  nearly  2  miles  from  any  other  habita- 
tion, and  about  the  same  distance  from  the  public  road. 

On  September  21  a  Mr.  A.,  who  had  been  employed  in  Laredo,  left  that  place 
for  Cuero,  going  directly  to  the  house  in  question  and  arriving  there  about  Sep- 
tember 25.  It  will  be  recalled  that  the  former  date  is  only  a  day  or  so  in 
advance  of  the  official  declaration  of  the  fever  at  Laredo. 

On  September  25  Mr.  A.  was  taken  sick.  He  was  not  seen  by  any  physician, 
but  was  prescribed  for  over  the  telephone,  his  case  being  diagnosed,  from  the 
symptoms  given,  as  dengue  fever.  He  made  an  uneventful  recovery  and  left  the 
ranch  soon  after. 

On  October  13,  or  eighteen  days  after  Mr.  A.'s  being  taken  sick,  Mrs.  B. 
became  ill.  She  was  seen  and  treated  by  a  physician,  her  case  being  at  first 
considered  a  severe  one  of  dengue. 

On  October  10  Mr.  B.  was  taken  with  the  same  disease.  His  case  from  the 
first  excited  the  suspicion  of  the  attending  physician,  and  during  the  course  of 
the  disease  not  a  symptom  of  yellow  fever  was  wanting.  He  died  with  black 
\omit  and  sui)pression  of  urine  on  the  morning  of  October  2(>. 

During  the  night  of  October  25  Mrs.  C.  was  taken  sick  with  the  same  symp- 
toms that  had  characterized  the  other  three  cases. 

Doctor  Tabor  and  myself  arrived  on  the  ranch  the  afternoon  ftf  the  2Cth. 
Mr.s.  B.  was  considered  by  us  both  and  by  the  attending  physician,  Doctor 
Reuss,  as  convalescing  from  yellow  fever,  and  Mrs.  C.  the  first  day  of  the 
disease. 

Several  Stegomyiw  were  seen  in  the  house,  one  in  particular  being  caught  in 
Mrs.  B.'s  sick  room. 

A  necropsy  was  held  on  the  body  of  Mr.  B.  about  eight  hours  after  death. 
The  appearance  of  the  cadaver  and  the  necropsic  finding.s  were  absolutely 
typical  and  conclusive. 

These  cases,  I  think,  isolated  as  they  were  on  this  ranch,  present  a  very  con- 
clusive example  of  the  period  of  extrinsic  incubation  of  the  disease,  and  for 
that  reason  I  have  reported  them  in  detail. 

Respectfully,  T.  F.  Richardson, 

Assistant  Surgeoti. 

The  Surgeon-General. 


On  account  of  continued  warm  weather  during  the  early  part  of 
November,  and  considerable  prevalence  of  yellow  fever  at  Tampico, 
Mexico,  it  was  considered  advisable  to  continue  the  restrictions  upon 
vessels  sailing  from  that  port  to  the  United  States.  Quarantine  offi- 
cers were  so  informed  and  these  restrictions  were  acquiesced  in  by  the 
State  health  authorities  concerned.     The  acting  assistant  surgeon  at 


282  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICP:. 

Tampico  was   directed  to   continue   the   funiigation   of  vessels   for 
mosquitoes. 

TRANSACTIONS   ON    ACCOUNT   OF    YELLOW    FEVER   AT   LAREDO   AND   SAN    ANTONIO. 


El  Paso,  Tex.,  yovember  5,  1903. 
Wyman,  Washington: 

About  50  people,  mostly  railroad  employees,  arrived  here  to-day  from  San 
Antonio ;  supposed  intention  to  remain  hei-e  for  completion  incubation  period, 
so  they  can  go  to  otlier  i)arts  of  State  upon  completion  six  days  from  San 
Antonio.  Representative  State  board  here  gives  passenger  certificate.  Service 
work  here  §oing  as  usual. 

LUMSDEN. 


Houston.  Tex.,  'Sovemher,  10,  1903. 
Wyman,  Washington: 

Detention  camp  near  Houston,  with  guard,  still  in  operation.    Local  conditions 
appear  satisfactory.     Letter  follows. 

Ebebsole. 


Laredo,  Tex..  November  /f,  1903. 
Wyman,  Washington: 

New  cases.  7;  old  cases,  7;  total  reported,  14;  deaths,  3;  45  houses  disin- 
fected, with  174  rooms ;  431  containers  and  7  excavations  oiled,  27.5  premises 
inspected,  03  sprinkled,  45  faucets  put  in  water  barrels.  83  barrels  crude  oil 
sprinkled  on  streets  and  vacant  lots,  covering  GO  city  blocks.  Maximum  tem- 
perature. 07° ;  minimum,  56° ;  weatlier  very  unfavorable.  No  cases  reported 
in  New  Laredo,  Miuera,  or  Caunel. 

Guitebas. 


Laredo,  Tex.,  y^ovemier  5,  1903. 
Wyman,  Washington: 

New  cases,  8 ;  old  cases,  4 ;  total  reported  to-day,  12 :  no  deaths ;  72  houses 
disinfected,  with  1G7  rooms;  747  containers.  44  excavations,  and  4  tanks  oiled; 
355  premises  inspected,  115  premises  sprinkled,  30  faucets  put  in  water  barrels, 
34  barrels  crude  oil  sprinkled  on  streets  and  vacant  lots,  covering  85  city  blocks. 
Maximum  temperature,  88°  ;  minimum,  57°.  One  new  case  reported  at  Caunel. 
Nothing  new  from  New  Laredo.     No  report  from  Minera. 

Guitebas. 


Laredo,  Tex.,  Xovember  6.  1903. 
Wyman,  Washington: 

Please  add  to  last  night's  report  as  follows:  Systematic  disinfection  of  the 
entire  city  commenced  October  30.  Up  to  November  5,  35  city  blocks  have  been 
disinfected.  This  is  being  done  without  interfering  with  the  disinfection  of 
infected  premises  as  soon  as  cases  are  reported. 

Guitebas. 


Washington,  Xovemher  7,  1903. 
Guitebas,  Laredo,  Tex.: 

Am  informed  by  War  Department  that  garrison  will  be  temporarily  removed 
to  camp  few  miles  from  post. 

Wyman. 


PUHLIO    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  283 

Washington,  Xovcwbcr  7,  1903. 
CriTERAS,  Laredo,  'I'cr.: 

Aulliorizi'd  to  suhiuit   iioiiiinatioii   Doctor  McCJroiLror  liy   li'ttcr  and  place  on 
duty  Iroiii  Novcinl)cr  7. 

WVMAN. 


Laredo,  Tex.,  Xovcmhrr  li,  lUd.i. 
Wyman,  Wofihinijtoii : 

New  cases,  il ;  old  cases,  !) ;  total  reported  to-day,  IS;  deaths,  4;  82  houses  dis- 
infected, with  241  rooms;  (i.JJS  containers,  .")  tanlcs,  and  111  excavations  oiled; 
WM)  premises  inspected  and  12."!  spriuicled.  covering;  .">2  city  blocks;  4(i  faucets 
put  in  water  barrels.  Oilers  of  water  containers  have  covered  the  city  for  the 
second  time  and  are  now  on  third  roiuid.  Maximum  temperature.  S<;°  ;  mini- 
mum. 47°.  Cannel  reports  1  new  case,  making  a  total  of  .">  to  date.  Mincra 
reports  3  new  cases,  all  from  the  same  source  of  iufectiou  as  the  first  case 
after  general  disinfection.  No  report  from  New  Laredo.  Necessary  to  have 
medical  inspectors  to  inspect  disinfected  districts  to  report  all  cases  of  illness, 
to  prevent  spread  of  new  foci  that  may  arise.  Have  nonnnated  to-day 
McGregor  for  this  purpose.    'Will  require  additional  inspectors  later  on. 

GUITERAS. 


Laredo,  Tex.,  Xovcmher  7,  1903. 
Wymax,  Washiiioton : 

A  visit  for  two  days  at  Monterey  convinces  me  that  yellow  fever  has  existed 
there  since  August  1  and  had  original  different  dates.  Over  one-half  the  miui- 
umm  population  of  GU.UUO  has  suffered  with  a  disease,  and  the  deaths  exceeil 
many  times  the  reported  number.  Over  ."j(iO  jiersons  down  with  this  disease 
at  this  moment.  All  the  stations  from  Saltillo  to  Laredo  have  borne  the  stigma 
of  deaths  and  the  distresses  of  sickness.  In  fact,  about  every  ranch  has  suf- 
fered. The  number  of  cases  and  deaths  will  never  be  known,  but  there  has 
been  only  a  moderate  amount  of  dread,  fear,  and  disorder  of  business.  There 
are  no  quarantines  "south  of  Monterey  worthy  of  the  name,  and  that  on  the 
Mexican  National  has  become  useless  on  account  of  the  immunizing  of  residents 
and  crews.  Commercial  interests  in  Mexico  begin  to  dread  the  effect  of  next 
year's  embargoes  and  seem  willing  to  have  more  explicit  statements  from  the 
infected  region,  rather  than  suffer  in  future  more  than  will  be  fair  to  the  people 
and  their  interests.  I  found  no  hint  of  infection  at  Saltillo,  although  many 
cases  have  been  treated  there  and  several  deaths  occurred.  There  seems  to 
be  uo  Stcgomyia  at  that  point. 

Murray. 


Washington,  Xovei)ihcr  7, 1903. 
Guiteras,  Laredo,  Tex.: 

Wire  on  what  grounds  detention  camp  for  I^aredo  was  closed.  If  for  pecuni- 
ary reasons,  why  not  confer  with  Tabin*  \\itli  regard  to  opening  it  by  Bureau? 
Wire  number  of  people  who  were  passed  through  it. 

Wyman. 


L.\REDO,  Tex..  Xovemher  7.  1903. 
Wyman,  Wash ington  : 

Detention  camp  for  Laredo  was  closed  for  following  reasons :  Pecuniary, 
and  because  certificates  issued  were  not  honored  by  various  points  in  Texas. 
State  quarantine  officer  McKnight  infoi-ms  me  that  Tabor  does  not  now  object 
to  the  Service  opening  camp.  I  received  no  information  of  the  closing  of  the 
detention  camp  until  two  days  prior  to  closing,  and  then  not  oflicially.  I  hesi- 
tate to  i-econunend  reopening  under  Service  auspices,  fearing  certificates  might 
not  be  honored.  Will  obtain  information  relative  to  this  point.  About  70 
jiersons  passed  through  camp  from  October  1  to  November  2. 

Guiteras. 


284  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Laredo,  Tex.,  Noveinhcr  7,  1903. 
Wyman,  Washington: 

New  cases,  15;  old  cases,  5;  total  reported  to-day,  20;  deaths,  2;  81  houses, 
with  202  rooms,  disinfected;  tliis  'nchulos  :'.  churches,  715  containers,  10  exca- 
vations, 0  tanks,  and  12,000  feet  standing  water  oiled ;  o92  premises  inspected 
and  10!)  sprinlcled,  covering  (j(j  city  hlocks ;  70  faucets  put  into  barrels.  Maxi- 
mum temperature  83°,  minimum  52°.  No  new  cases  at  Cannel,  Minera,  or  New 
Laredo.  The  weather  continues  unfavorable,  and  hundreds  of  laborers  from 
the  cotton  fields  of  northern  T(-xas  are  returning  daily.  This,  and  the  impossi- 
bility of  having  all  cases  reported  promptly,  ac(;ounts  for  the  increase  in  the 
number  of  cases.  The  city  ordinance  referred  to  in  my  telegram  of  October  31 
goes  into  effect  the  loth  instant;  at  the  same  time  a  volunteer  force  of  inspect- 
ors, composed  of  prominent  citizens,  will  patrol  the  town  to  report  all  cases  of 
illness. 

GUITEBAS. 


Laredo,  Tex.,  November  8,  1903. 
Wyman,  Wushi)i(jton: 

New  cases,  8 ;  old  cases,  4 ;  total  reported  to-day,  12 ;  45  houses  disinfected, 
with  190  rooms;  580  containers,  32  excavations,  5  tanks,  and  01  premises  oiled; 
303  premises  insiiected,  covering  42  city  blocks.  Maximum  temperature,  82°  ; 
minimum,  50°.  No  cases  at  Nuevo  Laredo.  No  report  from  Cannel  or  Minera. 
Mvirray  goes  to  Monterey. 

GUITEBAS. 


Laredo,  Tex.,  Novemher  9.  1903. 
Wyman,  Washington  : 

New  cases,  13;  old  cases,  12;  total  reported  to-day,  25;  deaths,  4,  all  dis- 
covered dead ;  59  houses  disinfected,  with  257  rooms — this  includes  post-office 
and  custom-house;  550  containers.  19  excavations,  3  tanks,  and  88  premises 
oiled ;  30(i  in-emises  inspected,  55  faucets  put  in  barrels,  31  barrels  of  crude 
oil  sprinkled  on  streets  and  vacant  lots,  covering  52  city  blocks.  Maximum 
temperature,  .S()°  ;  miiiin.um,  54°.  Two  new  cases  reported  at  Cannel.  No 
report  from  itinera  or  New  Laredo.  From  the  fact  that  12  old  cases  and  4 
dead  were  discovered  to-day,  you  may  .judge  of  the  difficulties  we  have  to  con- 
tend with  in  controlling  the  disease.  The  protracted  warm  sj>ell,  the  hundreds 
of  laborers  returning  to  town  from  the  cotton  fields,  and  the  hidden  cases  have 
given  new  impulse  to  the  epidemic  and  upset  all  my  calculations.  Am  now  put- 
ting on  my  own  inspectors  to  report  cases  of  sickness  in  those  quarters  of  the 
town  that  have  been  disinfected.  For  this  jmrpose  am  using  acting  assistant 
surgeons  heretofore  in  charge  of  disinfection  crews,  and  appointed  a  few  new 
ones  as  inspectors.  Tlie  disinfecting  crews  will  be  directed  by  the  foremen. 
Tabor  wires  that  detention  camp  will  be  at  once  resumed  by  State  if  considered 
necessary. 

Guiteras. 


Washington,  'Novemher  10,  1903. 
Guiteras,  Laredo,  Tex.: 

Recent  rains,  v/arm  weather,  and  return  of  laborers  evidently  complicate 
your  work,  but  it  should  he  prosecuted  vigorously  upon  same  lines  as  not  only 
beneficial  at  ])resent  time  Init  also  for  next  year.  If  reopening  detention  camp 
by  State  is  desirable,  suggest  matter  to  Tabor. 

W^yman. 

Laredo,  Tex.,  Noi-emher  10,  1903. 
Wyman,  Wash  ington : 

New  cases,  5;  old  cases,  14;  total  reported  to-day,  19;  deaths,  5;  75  houses 
disinfected,  with  292  rooms  ;  421  houses  insiiected ;  051  containers,  12  tanks, 
82  excavations,  and  120  premises  oiled :    300  j)remises  inspected,  20  faucets  put 


I 

rUBLIC    HKALTH    AND    M ARINK-HOSPITAL    SERVICE.  285 

in  hnrrols,  .'?">  l);irn>ls  df  crudo  oil  si»riiiklo(l  on  stroots  and  vacant  lots,  covorniR 
72  city  blocks.  Maxinunn  tcMnpcratMrc.  S4°  ;  niininmni,  t!l2°.  No  cases  or 
deaths  at  Xew  Lartvlo.  Canncl  n'])orts  :i  new  cases,  inakinf;  a  total  of  11  to 
date.  Minera  rei">i"ts  7  new  cases.  The  mass  inet'tinj:  yesterday  did  not 
jicconiplish  as  nnich  as  was  expected  ;  only  ahont  27  citizens  liave  volunt<'en'd 
for  inspection  work,  and  it  is  donhlfnl  if  tiiis  innnher  will  report  for  work 
to-morrow.     Tabor  will  bo  here  to-morrow  nH>rning. 

GUITEKAS. 


San  Antonio,  Tex.,  Novouhcr  I!,  1903. 
VVyman,  WaKhiitfitDn : 

Two  cases,  uo  deaths  reported  to-day.     Temperatures  last  twenly-four  hours, 
■H>°  and  74°. 

Richardson. 


San  Antonio.  Tex..  Novcmhcr  9,  1003. 
Wyman.  Washhif/ton: 

No  ease  or  death  to-day.  Teniporatures  last  twenty-four  hours  .50°  .and  7S°. 
Visited  Sutherland  Springs  to-day — town  .">()  miles  east  of  here:  population 
about  I.IC.  Doctor  Weston,  the  only  practitioner  there,  has  treated  since; 
Au.i^ust  about  KtO  cases  of  a  fever  which,  from  his  description.  I  l)elieve  to 
have  been  yellow,  with  4  deaths.  Disease  seems  to  have  died  out  for  want  of 
material. "  Tabor  h;is  instructed  county  authorities  to  disinfect. 

Richardson. 


San  Antonio,  Tex.,  Xovouhcr  10,  1003. 
Wyman.  Washiufjton  : 

One  case ;    no  deaths  to-day.     Temperature  last  twenty-four  hours,  .58°   and 
78°. 

IRICHARDSON. 


Houston,  Tex.,  November  15,  1003. 
Wy'man,  Wash  iufjton : 

State  health  authorities  meet  San  Antonio  to-morrow  to  consider  State  situ- 
ation and  measures  needed.  Local  authorities  invite  me  to  accompany  them : 
no  expense.  Would  leave  to-night,  return  Tuesday  morning.  Ask  if  my  going 
is  approved. 

Ebersole. 


Washington,  November  15,  1003. 
Ebersole.  Riee  Hotel,  Houston,  Tex.: 

Proceed  to  San  Antonio  and  return,  as  requested. 

Wyman. 

Laredo,  Tex.,  November  11,  1003. 
Wyman.  Washinffton : 

Xew  cases.  1.5:  old  cases.  7;  total  reported  to-day.  22;  deaths,  none;  81 
houses  disinfected,  with  229  rooms :  432  houses  inspected  :  53G  containers.  JJ 
tanks.  57  excavations,  and  118  premises  oiled :  290  premises  inspected,  30 
faucets  put  in  barrels.  32  barrels  of  crude  oil  sprinkled  on  vacant  lots  and  inter- 
vening streets,  covering  70  city  blocks.  Oilers  of  containers  are  now  covering 
the  city  for  the  fourth  time.  Maximum  temperature.  82°  ;  minimum,  Go°.  Cannel 
reports  1  new  case,  making  a  total  of  12  to  date.  No  report  from  New  Laredo 
or  Minera.  Tv\-elve  volunteer  inspectors  reported  for  duty  and  were  assigned. 
Talior  arrived  this  morning ;  several  conferences  were  held  during  day.  The 
principal  object  was  to  devise  means  for  thoi-ough  inspection  of  city  and 
prompt  notification  of  cases.     Differences  of  opinion,   whether  paid  or  voluu- 


286  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

teer  best.  Tabor  decliuefl  to  iiic-ur  expense  of  paid  service,  but  expressed  will- 
ingness to  have  Service  institute  it.  *  *  *  Murray  returned  from  Monterey 
to-night.     Doctor  Nixon  died  this  morning. 

GUITERAS. 


Labedo,  Tex.,  Xovemhcr  12,  1903. 
Wyman,  Wash  ill  (/ton: 

New  eases.  12 :  old  cases,  8 :  total  reported  to-day,  20 ;  deaths,  none ;  76 
liouses  disinfected,  with  238  i-ooms ;  40.3  houses  and  1.087  persons  inspected; 
550  containers.  3  tanks.  109  excavations,  and  171  premises  oiled;  .54  faucets 
put  in  barrels:  384  premises  inspected;  31  barrels  of  crude  oil  sprinkled  on 
vacant  lots  and  intervening  streets,  covering  80  city  blocks.  Maximum  temper- 
ature, 88°  ;  minimum.  4.5°.  Ne«'  Laredo  reports  2  cases  and  1  death.  Two  new 
cases  reported  at  Cannel  and  2  at  Minera. 

GUITERAS. 


Laredo,  Tex..  Xovemhcr  13,  1903. 
Wyman,  Washington: 

New  cases,  11;  old  cases,  20;  total  reiiorted  to-day,  31;  deaths.  4.  The 
increase  is  due  to  the  work  of  the  volunteer  inspectors.  Ninety-seven  of  these 
were  on  duty  to-day  and  did  good  work.  Am  surprised  that  the  number  of 
cases  discovered  is  not  greater.  Ninety-three  houses,  with  .305  rooms,  disin- 
fected; (533  containers.  2  tanks.  03  excavations,  and  125  premises  oiled;  370 
premises  inspected ;  42  faucets  applied  to  barrels ;  30  barrels  of  crude  oil 
sprinkled  on  streets  and  vacant  lots,  covering  85  city  blocks.  Maxiumm  tem- 
perature. 9G°  ;  minimum.  56°.  Nothing  new  at  New  Laredo.  Minera  reports 
7  new  cases  ;   Cannel  2  new  cases. 

GUITEBAS. 


Laredo,  Tex.,  November  1-).  1903. 
Wym  4N,  TF«.s7i  inr/ton : 

New  cases,- 10 ;  old  cases,  15 ;  total  reported  to-day,  25 ;  death,  1 ;  71  houses 
disinfected,  with  288  rooms ;  6.58  containers.  92  excavations.  8  tanks,  and  136 
premises  oiled ;  381  premises  inspected ;  33  faucets  put  in  water  I)arrels ;  34 
barrels  crude  oil  si)rinkled  on  vacant  lots  and  streets,  covering  74  blocks.  Max- 
imum tem])erature,  96°  ;  minimum,  .58°.  New  Laredo  reports  1  death  and  no 
new  cases ;  nothing  new  at  Cannel.  No  reports  from  Minera.  Volunteer  inspec- 
tion service  proving  a  marked  success. 

GlHTERAS. 


Laredo,  Tex.,  November  15,  1903. 
Wyman,  Washington: 

New  cases,  IS;  old  cases,  4;  total  reported  to-day,  22;  deaths,  2;  .55  houses 
disinfected,  with  237  rooms.  Maximum  temperature,  93°  ;  minimum,  51°. 
No  report  Minera  or  Cannel.     New  Laredo  reports  nothing  new. 

GUITEBAS. 


Laredo.  Tex.,  November  15,  1903. 
Wymax.  Washington : 

Murray  badly  injured  in  runaway.  Fracture  of  clavicle,  scapula,  and  both 
bones  of" right  leg:  severe  contusions  around  shoulder.  Now  resting  easily  at 
Mercy  Hospital.  Guiteras  esctaped  with  a  general  shaking  up  and  a  few 
contusions. 

Guiteras. 


Washington,  ls:ovember  15,  1903. ' 
Guiteras,  Laredo,  Tex.: 

Express  to  Murray  my  .sympathy  and  that  of  the  Bureau  and  inform  me  if 
there  is  anything  we  can  do  in  his  behalf.  Trust  your  own  injuries  will  not 
prove  serious. 

Wyman. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  287 

Laredo,  Tkx.,  'Xovriiihrr  Hi  I'lO.i. 
Wvii AN,  TV'ff.s/; inijton  : 

Now  casos."17;  old  cases,  5;  total  ivportcd,  22;  deaths,  (> ;  8;>  houses  dishi- 
fected,  with  .■!()4  rooms;  ;^!)1  eoiitaiuei-s,  IHC  (>xeavatioiis,  10  wells,  and  'AS  i»reiu- 
ises  oiled  ;  2,S  faueets  put  in  harrels ;  372  premises  inspected;  2i)  barrels  of  crude 
oil  sprinkled  on  vacant  lots  and  interveninij  streets,  coverinj;  74  city  blocks. 
Maximum  temperature,  \)()°  \  minimum,  CO".  Minera  reports  4  new  cases  Sat- 
urday aud  4  Sunday.  Cannel  reports  1  new  case.  New  Laredo  reports  nothing 
new. 

GUITERAS. 


Laredo,  Tex.,  November  IG,  1903. 
Wym AN,  ir(/s7(  iiif/ton : 

riease  add  to  last  nisjjht's  report  (iOO  containers,  2U2  excavations,  and  1  tank 
oiled.  102  premis(>s  inspected,  20  faucets  put  in  water  barrels,  80  barrels  of 
crude  oil  sprinkled  on  vacant  lots  and  intervening  streets,  covering  74  city 
blocks. 

GUITERAS. 


Laredo,  Tex.,  Novcinher  17,  1003. 
Wyman,  Wash ington  : 

New  cases.  ;'>:') ;  old  cases,  4 ;  total  reported,  87 ;  deaths,  2 ;  72  houses  disin- 
fected, with  245  rooms;  520  containers,  125  excavations,  4  tanks,  0  wells,  and 
29  premises  oiled;  (!  faucets  put  in  barrels;  191  premises  inspected;  25  barrels 
crude  oil  sprinkled  on  vacant  lots  and  intervening  streets,  covering  118  city 
blocks.  ^Maximum  temperatin-e.  ()8°  ;  minimum,  54°.  Cannel  reports  2  cases. 
No  report  from  Minera.     New  Laredo  reports  nothing  new. 

Guiteras. 


San  Antonio,  Tex.,  November  12,  1903. 
Wyman,  Washington: 

One  case  in  third  day  of  disease ;  no  deaths  x'eported  to-day ;  temperature, 
43°  and  08°  ;  light  frost  last  night. 

Richardson. 


San  Antonio,  Tex.,  November  13,  1903. 
Wyman,  Washington: 

One  ease,  2  deaths  to-day.     Case  was  found  after  death  and  had  no  medical 
attention.     Temperature,  44°  aud  78°. 

Richardson. 


San  Antonio,  Tex.,  November  l),  1903. 
Wyman,  Washington: 

One  case,  1  death  to-day.,    Tliis  case  was  discovered  after  death.     Tempera- 
ture, GG°  and  SG° 

RiCHAEDSON. 


Washington,  Novemoer  16,  1903. 
Sir:  Referring  to  your  telegrams  from  San  Antonio,  it  is  found  that  there  is 
no  explicit  statement  that  mosquito  screens  are  being  used  over  patients  sick 
with  fever.  The  Bureau  would  like  to  have  some  statement  in  regard  to  this,  so 
that  it  may  know  that  in  addition  to  the  measures  taken  to  exterminate  mos- 
quitoes the  other  measure,  equally  necessary,  of  screening  individual  fever  cases, 
is  being  carried  out. 

Respectfully,  Walter  Wyman. 

Surgeon-General. 
Asst.  Surg.  T.  F.  Richardson, 

Public  Health  and  Marinc-IIospital  Service, 

San  Antonio,  Tex. 


288  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

[Telegrams.] 

San  Antonio.  Tex.,  Xovember  19,  1903. 
Wyman,  Washington: 

Reforrinjj:  Bureau  letter  l(>th,  all  physicians  agreed  to  screen  all  febrile  cases. 
The  city  furnishes  nets  to  patients  unable  to  ))urchase.  Believe  screening  sick 
bed  has  been  very  generally  done.     All  cases  I  have  seen  were  screened. 

RiCHABDSON. 


San  Antonio,  Tex.,  yovcmbcr  18,  1903. 
Wyman,  Washington: 

State  quarantine  against  San  Antonio  raised  at  noon  to-day.     Several  counties 
still  holding  their  quarantines. 

RiCHABDSON. 


Austin,  Tex.,  November  21,  1903. 
Wyman,  Washington: 

On  account  of  Richardson  familiar  with  conditions  in  San  Antonio.  I  would 
like  to  see  him  remain  there  for  present  if  does  not  interfere  with  your  plans. 

Geo.  R.  Tabor.  State  Health  Offleer. 


Houston,  Tex..  November  21.  1903. 
Wyman,  Washington: 

State  and  local  quarantines  against   San  Antonio  raised.     Detention  camps 
around  Houston  discontinued.     No  restrictions  upon  traffic  from  there. 

Ebersole. 


Labedo.  Tex.,  November  18,  1903. 
Wyman,  Washington: 

New  cases.  10;  old  eases,  0;  total  I'eported  to-day.  10;  deaths,  2;  63  houses 
disinfected,  with  101  rooms;  420  contjiiners,  IW  excavations.  14  tanks,  7  wells, 
and  77  premises  oiled;  140  premises  inspected.  31  barrels  of  crude  oil  sprinkled 
on  vacant  lots  and  intervening  streets,  covering  06  city  blocks.  Maximum  tem- 
perature, ~j~°  :  minimum.  42°.  Cannel  reports  1  new  case:  Minera  reports  no 
new  cases,  1  death.  Nuevo  Laredo  reports  nothing  new.  Additional  officers  rec- 
ommended in  telegram  of  Noveml)er  11  are  not  now  necessary.  Tabor  sent  f(jr 
additional  physicians,  who  arrived  here  last  Saturday.  The  volunteer  inspec- 
tion service  is  still  in  active  operation  and  giving  good  results.  The  favorable 
change  in  the  weather  and  the  work  being  done  make  me  hope  the  epidemic  may 
soon  be  controlled. 

GUITEKAS. 


Labedo.  Tex..  November  19,  1903. 
Wyman,  Washington: 

New  cases.  17:  old  cases,  2;  total  repci'ted  to-day,  19;  deaths,  2;  98  houses 
disinfected,  with  270  I'ooms ;  5.38  containers.  9  i»remises.  8o  excavations.  6  tanks, 
and  13  wells  oiled :  156  premises  inspected ;  3  faucets  put  in  barrels ;  12,000 
square  feet  of  st;\nding  water  oiled ;  25  barrels  crude  oil  sprinkled  on  vacant 
lots  and  intervening  streets,  covering  73  city  I)locks.  ^laximum  temperature. 
52°  ;  minimum.  33°.  Cannel.  Minera.  and  Nuevo  Laredo  report  nothing  new. 
Considerable  opposition  encountered  in  disinfection  on  account  of  cool  weather. 

Guiteras. 


Laredo.  Tex.,  November  20.  1903. 
Wyman,  Washington: 

Cases  reported  to-day,  19,  all  new:  deaths,  none:  117  houses  disinfected,  with 
278  rooms ;  579  containers,  235  excavations,  16  wells,  7  tanks,  and  21  premises 


I 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE.  289 


oiled:  157  pivinisos  inspected  ;  l;^  Imrrels  of  crude  oil  sprinkled  on  vacant  lots 
and  interveninf,'  streets,  coverlnj;  CO  i)io(  Us.  .Miixiniuni  teiiiiu'rature,  rt(>°  ;  niini- 
luuni.  :Hi°.  Cannel  rei»orts  1  new  case;  Nuevo  Laredo.  2  cases.  Minera  reports 
nothing  new.  Through  trains  on  Mexican  National  will  resume  to-morrow.  It 
is  hoped  to  have  the  International  and  (Jreat  Xortiiern  also  resume  their  trains. 
Six  frontier  jiuards  discliarf^ed  to-da.v.  Six  more  will  he  discliarued  in  a  flay  or 
two.  Have  retained  iruards  at  hrid^res  and  piincipal  crossings  in  the  neiijlihor- 
hood  of  Laredo  and  Minora.  On  account  of  cold  weather  prevailin.i?  I  would 
recommend  raising  the  quarantine  against  Mexico. 

GUITEBAS. 


Laredo,  Tex.,  Novcmhcr  21,  1903. 
Wyman,  Washiugfoti: 

Cases  developed  since  last  report,  10 ;  deaths.  1 ;  102  houses  disinfected,  with 
299  rooms;  S7M  containers,  305  excavations,  20  premises,  17  wells,  and  5  tanks 
oiled;  285  harrels  of  crude  oil  sprinkled  on  vacant  lots  and  interveHins?  streets, 
covering  74  city  hlocks.  Maximum  temperature,  ti(!°  ;  minimum,  50°.  Cannel 
reports  1  new  case,  and  Minera  1.  No  report  from  New  Laredo.  Weather  con- 
tinues favorahle.  and  the  decline  in  the  number  of  cases  should  continue.  Gold- 
berger  arrived  to-night. 

GUITEEAS. 


DEATH   OF   SURGEON    MURRAY. 

Laredo,  Tex.,  November  22,  1903. 
Wyman,  Washington  : 

I  regret  to  have  to  report  the  death  of  Surgeon  ^Murray  at  7.30  this  morning. 

Guiteras. 


Austin,  Tex.,  November  22,  1903. 
Wyman,  Washington : 

Texas  mourns  with  you  in  loss  of  Doctor  IMurray,  whose  noble  work  at  Laredo 
has  endeared  him  to  all  classes.  Will  furnish  escort  of  physicians  for  body 
through  State. 

Tabor,  State  Health  Officer. 


I»earsall,  Tex.,  November  23,  1903. 
Wyman,  Wash  ington : 

Am  sending  four  physicians  as  escort  for  Doctor  Murray's  remains  through 
State.  Have  ordered  flags  at  stations  half-masted  until  after  funeral.  Texas 
appreciates  his  services. 

Tabor,  State  Health  Officer. 

Laredo,  Tex.,  November  22,  1903. 
Wyman,  Wash  ington  : 

Cases  reported  to-day,  6 ;  deatlis.  none ;  50  houses  disinfected,  with  198 
rooms ;  28G  containers,  114  excavations.  31  premises,  and  6  wells  oiled ;  78 
premises  inspected ;  15  harrels  of  crude  oil  siirinkled  on  vacant  lots  and  intei'- 
veniug  streets,  covering  42  city  blocks.  Maximum  temperature.  77"  ;  minimum, 
52°.     New  Laredo  reports  1  death ;  no  report  from  Cannel  or  Minera. 

Guiteras. 


Laredo,  Tex.,  November  23,  1903. 
Wyman,  Washington: 

Cases  developed  since  last  report,  4:  deaths.  2;  52  houses  disinfected.  237 
rooms ;  212  containers,  122  excavations,  C  premises.  1  well,  and  2  tanks  oiled. 
Fifty-eight  premises  inspected ;  21  barrels  of  crude  oil  sprinkled  on  vacant  lots 

8629—04 19 


290  PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 

and  interveuing  streets,  covering  44  city  blocks.  Maximum  temperature,  82°  ; 
minimum,  50°.  Minera  reports  5  new  cases.  Cannel  reports  1  new  case  for 
to-day  and  1  for  yesterday.  Nuevo  Laredo  reports  nothing  new.  Through 
trains  from  Mexico  City  to  St.  Louis,  Mo.,  commenced  during  yesterday.  Do 
not  stop.  Monterey  customs  inspection  of  baggage  will  be  done  at  New  Laredo 
as  in  normal  times.  Passengers  from  Saltillo  will  be  required  to  have  certificate 
of  5  days  from  any  infected  focus.  From  points  south  of  Saltillo,  no  certificates 
required.     This  is  a  great  relief  to  railroad  traffic.     Tabor  arrived  to-night. 

GmXERAS. 


Laredo,  Tex.,  'Sovemher  23,  190^. 
Wyman,  Wash  ington : 

Conditions  in  Laredo  are  rapidly  improving.  Season  too  advanced  to  admit 
of  danger  of  infecting  outside  territory.  Quarantine  against  Mexico  and  La- 
redo, Tex.,  should  be  raised ;  post  epidemic  work  should  be  continued ;  recom- 
mend Frick  remain  in  charge  of  this  work,  assisted  by  Hamilton  and  Sauvignet; 
other  assistant  surgeons  to  be  discharged.  Fully  one-third  of  city,  including 
the  most  densely  populated  center,  has  been  disinfected.  This  does  not  include 
infected  houses  disinfected.  Would  suggest  that  Von  Ezdorf  be  detailed  to 
inspect  along  the  railroad  from  Laredo,  covering  Monterey,  Linares.  Victoria, 
and  other  infected  points,  to  ascertain  what  is  being  done  or  will  be  done  toward 
sanitation  against  continuance  of  disease  of  latent  form  during  winter.  Would 
have  pi-eferred  to  do  this  work  myself,  but  do  not  feel  equal  to  it.  Vertigo  still 
persists,  though  improved.  Events  of  last  week  have  left  me  in  poor  shape,  and 
would  prefer,  if  possible,  to  return  to  my  statiDU  and  start  work  on  my  report 

GUITEBAS. 


Washington,  'Sovemher  27,  1903. 
GuiTERAS,  Laredo,  Tex.: 

Authorized  to  store  camp  equipment  as  recommended.  All  public  property 
should  be  collected,  listed,  and  receipted  for  by  Hamilton.  Discontinue  all 
services  not  now  required.  Frick  will  remain  in  charge.  Wire  specific  recom- 
mendation as  to  ex])ense  and  scope  of  post-epidemic  work.  Von  Ezdorf  will 
receive  letter  of  instructions  as  to  inspection  recommended.  Collect  all  data  for 
full  report  of  operations  and  hold  yourself  in  readiness  for  orders  to  rejoin 
station. 

Wyman. 


i 


Washington,  yovemher  30,  1903. 
GuiTERAS,  Laredo,  Tex.: 

Replying  to  your  telegram  2Sth  relative  to  post-epidemic  disinfection,  wire 
what  necessity  for  continuation  of  considerable  work  in  addition  to  what  has 
already  been  done.  State  exactly  scope  proposed  work  and  personnel  required 
in  addition  to  Frick. 

Wyman. 


Laredo,  Tex.,  November  30,  1903. 
Wyman,  Washingto7}: 

Replying  to  telegram  relative  to  post-epidemic  disinfection,  would  state  that 
it  is  proposed  to  continue  systematic  disinfection  of  houses  until  every  house  in 
the  city  is  disinfected,  and  to  continue  the  oiling  of  containers  at  the  .same  time, 
with  the  object  of  killing  mosquitoes  and  preventing  their  propagation.  Nearly 
one-half  of  the  city  has  been  disinfected.  In  addition  to  Frick.  propose  to  retain 
Sauvignet  and  about  40  laborers,  divided  into  four  oiling  crews  and  two  disin- 
fecting crews.  With  this  force  I  estimate  that  the  work  can  be  done  in  thirty 
days.  The  object  of  this  post-epidemic  disinfection  is  to  prevent  the  disease 
from  continuing  throughout  the  winter  and  appearing  again  in  epidemic  form 
next  summer.  The  work  done  has  confined  the  number  of  cases  during  the 
present  epidemic  to  1,044.  so  that  there  still  remains  a  large  nonimmune  popula- 
tion,  furnishing  material   for   spread  under   favorable  circumstances.     If  the 


I 


PUBLIC    HEALTH    AND    MARINK-HOSPITAL    SKRVICp:.  291 

winter  should  bo  sovoro  tliis  i)ost-i'|»i<liMiiic  work   iniKlit   not  hv  necessary,  but 
the  severity  of  the  weather  here  is  very  uncertain. 

GUITEHAS. 


Washington,  December  1,  1903. 
Frick  (through  Surgeon  Guiteras),  Laredo,  Tex.: 

You  are  herel)y  directed  to  assume  charge  of  Service  worlc  in  Laredo  upon 
departure  of  Surgeon  (Juiteras.  When  i)racticable,  expenditures  should  be 
previously  approved  by  Bureau,  and  in  all  cases  kept  withiu  lowest  ixjssible 
limit. 

Wyman. 


Washington,  December  2,  1903. 
Von  Ezdorf.  Laredo,  Tex.: 

You  are  directed  to  make  quiet  investigation  and  mail  full  reports  upon  sus- 
pected and  inf(>(ted  points  upon  Mexican  National  and  Mexican  CJulf  railroads, 
including  Monterey.  Linari-s,  and  as  far  as  Ciudad  Victoria.  Confer  first  with 
consular  authorities;  obtain  nioi'tality  statistics  for  past  four  months:  prob- 
able number  cases  and  deaths  yellow  fever:  methods  employed  for  sui)pression  ; 
winter  temperatures  and  probable  outlook  for  next  se:ison  ;  also  include  inspec- 
tion of  Saltillo.  Upon  return,  make  full  reports  upon  couditious  in  Nuevo 
Laredo  and  await  orders  Laredo. 

Wyman. 


Laredo,  Tex.,  'November  30,  1903 
Wyman,  Wasfiington: 

Governor's  proclamation  raising  State  quarantine  against  Laredo  goes  into 
effect  at  noon  to-day.  Transferred  property  to  Hamilton  this  morning.  Tabor 
and  I  held  conference  with  city  council  and  got  their  promise,  willingly  given, 
to  aid  and  carry  into  effect  all  measures  of  post-epidemic  work. 

Guiteras. 

Subsequent  to  the  active  prevalence  of  yollow  fever  in  Laredo,Tex., 
the  post-epidemic  work  for  the  suppression  of  the  infection  was  con- 
tinued in  the  general  inspection  of  premises,  oiling  of  water  contain- 
ers, etc.,  as  set  forth  in  the  report  of  Passed  Assistant  Surgeon  Ivich- 
ardson,  embracing  the  period  from  the  early  part  of  December,  1903, 
to  June  30,  1904,  and  it  is  undoubtedly  due  to  this  municipal  sanitary 
work  that  there  has  been  no  recrudescence  of  yellow  fever  in  this 
semitropical  portion  of  the  State. 

The  necessity  for  an  amicable  arrangement  between  the  Republic 
of  Mexico  and  the  United  States,  in  order  to  secure  adequate  measures 
for  the  prevention  of  the  recurrence  of  yellow  fever  in  the  spring, 
received  early  recognition. 

The  principal  results  attained  by  drainage,  mosquito  destruction, 
and  screening  of  water  containers  upon  the  American  side  served  as 
a  basis  for  friendly  agreement  between  the  two  countries  for  a  joint 
effort  in  this  direction.  This  agreement  was  the  result  of  a  confer- 
ence between  the  Surgeon-General  of  the  Public  Health  and  Marine- 
Hospital  Service  and  the  officials  of  the  Republic  of  Mexico,  held  at 
the  Cit}^  of  ]Mexico  in  January  of  the  present  year. 

The  results  of  this  agreement  are  shown  in  the  extensive  improve- 
ments of  sanitary  conditions  in  the  territory  involved. 


292  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

MEASUBES    RECOMMENDED    FOR    ADOPTION    UY    THE    UNITED    STATES    AND    MEXICO   FOB 
THE    PREVENTION    OF   YELLOW    FEV'ER. 

Mexico  City,  Mexico,  January  12,  I904. 
Sib  :  Referring  to  our  several  conferences  regarding  the  yellow-fever  situation 
in  the  United  States  and  Mexico,  I  beg  leave  to  transmit  herewith,  for  your 
consideration,  a  copy  of  an  order  issued  by  myself  December  29,  1903,  convening 
the  sanitary  board  of  the  Bureau  of  the  Public  Health  and  Marine-Hospital 
Service,  in  which  is  set  forth  the  reasons  prompting  me  to  bring  this  matter  to 
your  kind  attention.  Inclosed  also  is  a  copy  of  the  report,  in  which  measures 
are  recommended  for  adoption  in  both  Republics  which  I  am  convinced  would 
be  effective,  if  properly  executed,  in  preventing  a  recurrence  of  this  disease. 

I  have  to  request  that  you  will  give  these  papers  your  serious  consideration, 
and  inform  me  what  action  may  be  expected  of  your  board  with  regard  to  the>^e 
matters. 

I  have  the  honor  to  remain,  respectfully,  yours, 

Walter  Wyman, 
Surgeon-General,  Public  Health  and 
Marine-Hospital  Service  of  the  United  States. 
Dr.  E.  Liceaga, 

President  Superior  Board  of  Health.  Mexico  City,  Mexico. 

[Inclosures.] 

Tbeasubt  Department, 

BUBEAU   OF   PL'BLIC    HEALTH    AND    MaRINE-HOSPITAL    SERVICE, 

Washington,  December  29,  190S. 

SiB :  You  are  directed  to  call  a  meeting  of  the  sanitary  board  and  to  invite 
Passed  Asst.  Surg.  R.  H.  von  Ezdorf  to  meet  with  you,  on  account  of  his 
familiarity  with  the  yellow-fever  situation  in  Mexico.  You  are  informed  that 
on  December  14  Dr.  John  R.  Tabor.  State  health  officer  of  Texas,  and  Dr. 
Edmond  Souchon.  president  of  the  Louisiana  State  board  of  health,  came  to 
Washington  for  the  special  purpose  of  a  consultation  with  the  Surgeon-General 
of  the  Public  Health  and  Marine-Hospital  Service  concerning  this  matter.  For- 
mal request  was  made  for  consultation  with  the  health  authorities  of  Mexico 
to  induce  said  Republic  to  undertake  sanitary  work  in  the  cities  of  Mexico 
recently  infected  with  yellow  fever,  in  order  that  they  should  not  become  a 
menace  to  the  United  States  during  the  coming  season. 

Inclosed  are  letters  from  Representatives  James  L.  Slayden  and  John  N. 
Garner,  of  Texas,  written  with  the  same  end  in  view.  They  have  supplemented 
their  letters  by  personal  interviews. 

You  are  directed  to  report  upon  the  necessity  of  some  such  action  on  the  part 
of  the  Mexican  Government  and  to  indicate  clearly  what  measures  it  should 
be  asked  to  enforce  and  what  reciprocal  measures  should  be  enforced  on  the 
United  States  side  of  the  border. 

The  report  of  Passed  Assistant  Surgeon  Von  Ezdorf  upon  the  infected  Mexican 
cities  is  transmitted  for  your  information.  The  measures  which  the  Mexican 
Government  may  be  asked  to  enforce  should  be  practical  and  no  greater  than 
might  reasonably  be  expected.  You  are  informed  that  it  is  ray  intention  to 
visit  the  City  of  Mexico  within  a  short  time  for  the  purpose  of  bringing  this 
matter  before  the  Mexican  Government,  and  your  report  will  be  a  guide  to 
me  in  my  representations. 

Respectfully,  Walteb  Wyman, 

Surgeon-General. 

Asst  Surg.  Gen.  A.  H.  Glennan, 

Chairman  Sanitary  Board 

Public  Health  and  Marine-Hospital  Service. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  293 

report  of  the  sanitary  boar[). 

Treasury  Dki'artment, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Wdsfiiiif/tuii,  December  30,  1903. 

Sir:  Pursuant  to  your  directions,  datod  Deci'niber  20,  lfK).'*>.  to  convene  a 
nuH'tinj;:  of  the  sanitary  i)oard  of  tlie  I'uldic  Health  and  Marine-Hosjtital  Sonice 
to  formulate  Keneral  plans  of  sanitation,  to  l)e  prosecuted  in  both  the  Kepuhlic 
of  Mexico  and  in  tiie  I'nited  States,  with  a  view  to  the  adoittion  of  measures  for 
the  eradic-ation  of  the  infection  of  yellow  fever  in  places  infectcKl  with  the 
disease  both  in  Mexico  and  the  United  States,  the  following  report  is  respect- 
fully subnuttetl : 

The  board  recounuends,  as  a  basis  for  the  precautions  to  be  taken,  those 
measures  reconunended  in  the  article  entitled  "  Prophyl.-ixis  against  yellow 
fever,"  by  Dr.  John  Guiteras,  imblished  in  the  I'ublic  Health  Reports  of  .July 
31,  1003  (copy  inclosed),  with  the  followinj;  additions  and  alterations.  Some 
of  these  additions  and  recommendations  are  embodied  in  the  article  by  yourself 
entitled  "A  plan  for  international  airreement  of  the  American  Republics  for 
the  sanitation  of  certain  seacoast  cities,"  jaiblished  as  a  reprint  of  the  Public 
Health  Rei)orts  of  October  11,  1!K)1   (copy  also  inclosed). 

The  board,  observing  its  instructions,  considers  that  the  measures  recom- 
mended are  practical  and  no  greater  than  may  be  enforced  with  the  least  pos- 
sible delay  in  either  country.  These  measures  demand  immediate  adoption  and 
prosecution  in  order  to  .'ivert  the  danger  of  a  recrudescence  of  the  disease 
during  the  coming  spring  in  the  cities  recently  infected.  It  is  not  necessary  to 
emphasize  that  such  a  recrudescence  would  cause  serious  embarrassment  to 
commerce,  with  all  of  its  monetary  loss  and  attendant  evils. 

The  measures  reconunended  are  as  follows  : 

1.  The  prompt  report  of  all  cases  of  suspicious  fever  to  the  local  health  au- 
thorities where  they  occur,  the  immediate  screening  of  the  patient,  and  the 
destruction  of  moscjuitoes  on  the  premises,  pending  the  making  of  the  diagnosis. 
The  occurrence  of  the  first  authentic  cases  of  yellow  fever  in  either  Republic 
should  be  immediately  reported  by  wire  to  the  other  Republic. 

2.  Vigorous  methods  of  post-epidemic  fumigation  with  sulphur  to  be  inau- 
gurated without  delay  in  both  Republics  in  places  where  infection  has  occurred 
during  the  latter  part  of  the  past  year. 

3.  EfBcient  sanitarj'  measures  in  towns  and  places  which  have  been  infected 
with  yellow  fever  during  the  past  year,  as  follows :  Burning  of  brush,  drainage 
of  all  stagnant  water,  oiling  of  all  stagnant  water  drainage  of  which  is  imprac- 
ticable, all  water  containers  to  be  treated  at  least  once,  and  oftener  if  necessary, 
with  a  thin  film  of  refined  oil  deposited  upon  their  surfaces,  and  to  be  tightly 
screened  and  to  be  constantly  covered  to  prevent  access  of  mo.squitoes,  a  penalty 
to  be  imposed  for  the  absence  of  said  screens  and  covers. 

4.  The  oiling,  screens,  and  covers  provided  for  in  the  foregoing  paragraph 
shall  be  at  the  expense  of  the  tenants  or  owners,  but  in  the  case  of  tenants  who 
are  unable  to  comply  with  said  provisions  the  municipality  shall  provide  the 
same.  Sanitary  inspection  shall  be  made  from  time  to  time  to  enforce  this  pro- 
vision, and  a  fine  imposed  for  noncompliance. 

5.  In  order  that  these  measures  may  receive  due  credit  in  both  countries,  it 
should  be  agreed  that  agents  of  the  superior  board  of  health  of  Mexico  will  be 
received  in  any  town  or  place  in  the  United  States  where  yellow  fever  has  pre- 
vailed to  note  the  enforcement  of  the  above  provisions  and  to  invite  the  attention 
of  the  sanitary  authorities  to  any  lapse  in  the  same ;  any  fault  in  administra- 
tion or  in  the  completeness  of  measures  to  be  undertaken  to  be  corrected  by 
the  proper  sanitary  authorities  of  the  I'nited  States.  In  like  manner  officers  of 
the  Public  Health  and  Marine-Hospital  Service,  detailed  for  duty  in  the  offices 
of  the  United  States  consulates  in  any  Mexican  citj',  to  be  granted  every  facility 
for  observation  as  to  the  enforcement  of  the  same  measures  in  cities  and  towns 
of  Mexico  that  have  been  infected  with  yellow  fever. 

6.  This  board  is  of  the  opinion,  and  so  recommends,  that  should  the  occurrence 
of  yellow  fever  render  the  establishment  of  border  quarantine  necessary,  the 
period  of  detention,  based  ujion  the  incubation  of  the  disease,  should  not  exceed 
six  days,  and  that  the  disinfection  of  personal  effects,  mails,  and  freights,  not 
harboring  mosquitoes,  should  not  he  required. 

In  compliance  with  the  instructions.  Passed  Asst.  Surg.  R.  H.  Von  Ezdorf, 
Public  Health  and  Marine-Hospital  Service,  was  invited  and  was  present  at  the 


294  PUBLIC)   HEALTH   AND   MARINE-HOSPITAL   SERVICE. 

meetings  of  the  board,  and  use  was  made  by  the  board  of  his  knowledge  of  the 
situation. 

A  copy  of  the  order  convening  the  board  and  the  inclosures  accompanying  the 
original  thereof  are  herewith  returned. 
Respectfully, 

A.  H.  Glennan,  Chairman, 

Assistant  Surgeon-General. 
W.  J.  Pettus. 

Assistant  Surgeon-General. 
George  T.  Vaughan, 

Assistant  Surgeon-General. 
II.  D.  Geddixgs.  Recorder, 

Assistant  Surgeon-General. 

Subgeon-Genebal  U.  S.  Public  Health  and  Mabixe-Hospital  Sebvice, 

Washington,  D.  C. 


SuPERioB  Board  of  Health. 
Mexico  City,  llcjico,  January  13,  1904- 

Dear  Sir  :  I  am  in  receipt  of  your  favor  of  yesterday's  date,  in  which  you 
refer  to  the  different  conferences  that  we  have  had  and  in  which  we  have  dis- 
cussed the  subject  of  yellow  fever  in  the  United  States  and  Mexico,  which  latter 
inclosed  a  copy  of  the  orders,  issued  on  the  2nth  of  December  last,  for  convening 
a  meeting  of  the  sanitary  board  of  the  Public  Health  Department  and  Marine- 
Hospital  Service  of  the  United  States,  and  also  stating  the  reasons  that  prompted 
you  to  communicate  this  matter  to  myself.  Your  letter  also  inclosed  the  report 
presented  by  that  board,  in  which  it  reconmiends  the  measures  that  ought  to  be 
adopted  by  both  Republics,  and  you  ask  me  to  give  all  these  documents  the  care- 
ful consideration  which  they  merit  and  report  to  you  on  the  measure  that  will 
be  adopted  by  the  superior  board  of  health  of  Mexico  in  the  premises. 

In  answer  to  the  above.  I  now  beg  to  state  as  follows : 

The  interest  which  was  aroused  by  the  invasion  of  the  State  of  Texas  by  yel- 
low fever,  in  the  public  officers  of  that  State,  its  Reiiresenta fives  in  Congress, 
the  press  of  the  United  States  and  the  Department  which  you  so  worthily  direct, 
has  suggested  the  idea  that  action  should  be  taken  to  prevent  the  reappearance 
of  the  disease,  both  in  the  southern  part  of  the  United  States  as  well  as  in 
the  north  of  the  Mexican  Republic.  This  reciprocal  interest  in  the  two  nations 
has  decided  you  to  come  to  this  city  in  order  to  exjilain  your  ideas  on  the  subject 
and  inform  yourself  of  those  which  are  held  in  ;Mexico. 

The  wide  views  which  you  have  always  shown  in  the  study  of  sanitary  mat- 
ters are  again  manifesteil  in  the  series  of  orders  that  you  have  issuetl  for  obtain- 
ing information  from  the  officers  of  your  Department  who  are  best  versed  on 
the  question  of  yellow  fever.  These  measures  not  only  reveal  the  solicitude 
with  which  you  carry  out  your  duties,  but  also  the  desire  that  the  Mexican 
Republic  should  cooperate  in  the  same  sense. 

The  Mexican  Republic,  for  its  part,  has  been  taking  active  and  earnest  steps 
to  exterminate  yelli>w  fever  from  its  territory,  and  more  esiiecially  when,  dur- 
ing last  summer,  that  disease  spread  in  an  epidemic  form  to  several  cities  of  the 
Gulf  States  and  to  some  interior  cities  as  well,  such  as  in  the  States  of  Nuevo 
Leon  and  San  Luis  Potosi.  It  would  make  this  letter  too  long  for  me  to  enter 
into  a  relation  of  all  the  labors  imdertaken  by  the  Federal  Government  for  the 
extinguishing  of  the  epidemic  of  yellow  fever,  and  I  therefore  confine  myself  to 
stating  that  the  Executive  of  the  I'niou,  acting  through  the  superior  board  of 
health  took  action  in  all  of  the  States  except  one,  and  was  fortunately  able  to 
detain  the  epidemic,  which  had  spread  over  a  larger  area  than  that  reached  on 
previous  occasions. 

But  in  order  to  correspond  to  your  elevated  ideas,  I  will  now  proceed  to 
explain  the  plan  proposed  by  my  Government  in  order  to  utilize  the  entire 
period  between  this  and  the  approaching  summer,  when  yellow  fever  makes  its 
appearance,  and  thus  avoid  its  jiropagatiou.  You  will  find  all  the  ideas  of  the 
superior  board  of  health  of  Mexico  on  this  matter,  given  in  a  condensed  form, 
in  a  proposed  jilan  that  this  body  has  presented  to  the  deiiartment  of  the  inte- 
rior, asking  that  those  States  in  which  yellow  fever  jirevails  in  an  ejiidemic  form, 
and  in  which  it  has  spread  as  an  epidemic,  to  consent  that  the  supreme  board  of 
health  undertake  the  direction  of  the  campaign,  so  as  to  obtain  uniformity  of 


puHLic  hp:altii  and  marine-hospital  sp:rvice.        295 

action  on  tlio  part  of  tlio  sanitary  autlioritios,  and  diret-t  the  proitor  disi)urst'- 
luent  of  the  snni  of  $1(M».(M)()  wliicli  tlie  C'liaiiilter  of  Deputies  granted  to  the  Fed- 
eral Executive  for  tlie  purposes  of  tliis  canipait^n. 

In  the  "plan  of  c-auipaign  "'  above  nu-nlioned.  we  have  a  clear  statement  of 
the  doctrine  of  the  transmission  of  yellow  fever  by  means  of  the  mosijuito  of 
the  genus  Stviiomiihi  fasciata,  and  the  means  l)est  adajited  for  the  isolation  of 
persons  attacked  by  the  disease  or  sus]»t-cted  of  lieing  so  frcnu  the  lirst  day  of  its 
appearance  are  also  therein  clearly  set  forth  It  also  shows  the  method  to  be 
employed  in  the  disinfection  of  the  houses  that  are  occupied  by  these  patients, 
and  in  which  it  is  to  be  i)resumed  that  infected  mos(iuitoe.s  will  lie  f(»und:  the 
practical  means  for  destroying  the  larvjc  of  the  mosquito  of  the  genus  al)ove 
mentioned;  the  way  to  prevent  the  disease  from  being  carried  from  an  infected 
city  to  another  which  is  healthy,  and  the  steps  to  be  taken  for  avoiding  the 
spread  of  the  epidemic  after  the  appearance  of  the  first  case  in  a  city  that  has 
hitherto  not  been  infected.  I  take  pleasure  in  inclosing  with  this  letter  a  copy, 
in  Spanish,  of  the  above  plan  of  campaign  with  its  translation  in  English. 

The  report  which  the  sanitary  board  of  the  Public  Health  Department  and 
Marine-Hospital  Service  of  the  United  States  jn-esented  to  yourself  on  the  ."ioth 
of  December  last  projioses  a  series  of  measures  that  are  intended  to  be  put  in 
practice  as  soon  as  possible  in  the  two  Itepublics  for  the  purjiose  of  preventing 
the  reappearance  of  yellow  fever  in  the  two  countries  during  the  apiiroaching 
summer.  These  measures,  based  on  the  scientitic  principles  which  have  gov- 
erned the  superior  board  of  health  of  Mexico,  ought  to  be  identical,  and  really 
are  so,  as  can  be  ascertained  by  a  comparison  of  these  documents.  Those 
reports  ask  that  both  nations  be  bound  to  declare  any  new  case  of  yellow  fever 
that  may  present  itself  in  any  locality  of  their  respective  territories.  This 
declaration  has  been  made  by  the  superior  board  of  health  of  Mexico  ever  since 
the  17th  of  December.  1902.  in  compliance  with  one  of  the  resolutions  that  were 
adopted  in  the  International  Sanitary  Convention  which  met  in  Washington 
during  that  month.  As  you  will  see.  the  Mexican  Republic  is  already  in  the 
habit  of  fulfilling  that  obligation. 

The  second  recommendation  advocates  the  rigorous  disinfection  by  sulphur 
of  every  dwelling  which  has  been  used  by  a  yellow-fever  patient.  This  precau- 
tion has  been  observed  in  Mexico  ever  since  the  commencement  of  the  epidemic 
of  the  past  year,  and  will  be  continued  with  even  more  rigor  and  greater  per- 
fection in  the  new  campaign  which  we  are  now  undertaking,  as  you  will  see 
from  the  document  I  inclose  with  this  letter.  In  that  document  you  will  find 
a  series  of  measures  proposed  similar  to  those  that  are  recommended  by  the 
sanitary  board  of  the  Public  Health  Department  of  the  United  States,  with 
the  only  difference  that  it  says  nothing  as  to  the  burning  of  the  brush,  as  we 
were  not  aware  that  the  mosquitoes  hide  there  during  the  period  of  hibernation, 
but  this  idea  is  now  accepted.  Tlie  same  thing  can  be  said  of  the  other  pro- 
posals of  the  sanitary  board  above  mentioned. 

From  the  above  you  will  clearly  understand  that  the  action  recommended  by 
your  Department  for  preventing  the  reappearance  of  yellow  fever  is  very 
similar  to  that  which  has  been  put  in  practice  for  some  time  past  by  the  Gov- 
ernment of  Mexico. 

In  the  numerous  conferences  that  we  have  had  I  have  explained  to  you  the 
manner  to  render  these  measures  more  practical  and  efficacious,  but  I  will  now 
only  remind  you  of  those  which  have  been  put  in  practice  in  Vera  Cruz  since 
the  1st  of  September  of  last  year.  Vera  Cruz  is  the  oldest  and  most  permaiient 
focus  of  endemia  in  the  Mexican  Republic.  All  the  epidemics  have  found  their 
origin  in  this  place,  and  very  seldom  in  the  northern  districts  of  the  iieninsula 
of  Yucatan,  and  even  in  the  case  of  the  last  two  epidemics  in  the  port  of  Tam- 
pico  they  were  started  in  Vera  Cruz,  for  which  reason  this  is  the  place  that 
demands  our  principal  attention. 

The  town  has  been  divided  into  four  districts,  each  of  which  is  placed  under 
the  charge  of  an  experienced  physician,  and  each  of  these  has  sanitary  agents 
of  the  first  class  placed  under  his  orders.  Subordinate  to  these  are  other  agents 
of  the  second  class,  and  a  certain  number  of  servants.  The  inspector  keeps  a 
register  in  which  they  enter  the  full  name  of  every  nonimmune  who  resides  in 
Vera  Cruz,  the  place  whence  he  comes,  the  time  he  has  been  in  the  port,  and  the 
house  in  which  he  lives.  These  persons  are  visited  daily  in  order  to  catch  the 
first  symptom  of  any  fever.  As  soon  as  a  nonimmune  is  found  to  have  a  high 
temperature  he  is  isolated  on  suspicion  in  the  civil  and  military  hospital  of  the 
city,  and  in  the  case  of  healthy  persons,  in  a  special  hospital  that  has  !)een  pro- 
vided by  the  superior  board  of  health  of  ^Mexico  for  tliose  who  are  suspected  or 


296  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SEEVICE. 

known  to  have  yellow  fever.  These  patients  are  isolated  from  the  moment  the 
disease  coiumences,  whatever  may  he  their  sex,  social  position,  or  nationality, 
and  you  will  therefore  see  that  with  such  a  system  it  is  impossihle  for  yellow 
fever  to  Ije  reprodiiced  in  an  epidemic  form  in  the  port  of  Vera  Cruz. 

The  sanitary  st.iff  above  referred  to  also  charges  itself  with  the  disinfection, 
by  means  of  sulphur,  of  the  houses  in  which  yellow-fever  patients  have  been 
attended,  as  well  as  the  neighboring  houses,  for  fear  of  any  infected  mosquitoes 
having  remained  therein.  These  employees  also  see  that  the  garbage  is  taken 
out  of  the  houses,  the  swamps  drained,  the  drinking-water  reservoirs  kept  clean, 
and  that  they  are  covered  in  such  a  way  as  to  prevent  the  mosquitoes  depositing 
their  eggs  in  them,  as  well  as  that  petroleum  be  spread  over  all  bodies  of  water 
that  can  not  be  covered.  By  following  these  methods  the  epidemic  which 
appeared  in  Vera  Cruz  was  controlled,  and  it  will  be  possible  to  avoid  the  reap- 
pearance of  the  epidemic  during  the  coming  summer. 

During  the  coming  week  a  sanitary  board  will  commence  its  duties,  composed 
of  an  experienced  physician  in  this  class  of  work  and  four  first-class  sanitary 
agents,  such  as  I  have  above  referred  to.  This  staff  will  visit  every  one  of 
those  places  that  were  invaded  by  yellow  fever  during  last  summer,  so  as  to 
carry  out  a  fresh  disinfection  of  the  houses.  The  physician  will  in  each  place 
give  instructions  to  a  select  staff  on  the  methods  of  executing  this  operation, 
show  the  way  to  drain  the  swamps,  to  fill  up  those  which  can  not  be  di'ained, 
and  to  spread  petroleum  over  bodies  of  water  that  necessarily  must  remain 
uncovered,  and  to  see  that  all  others  are  constantly  covered.  These  operations 
will  be  carried  out  in  ^Monterey  and  Linares. 

I  hope.  General,  that  you  will  now  be  convinced  of  all  the  efforts  that  are 
being  made  in  the  Mexican  Republic  to  stamp  out  yellow  fever  from  its  terri- 
tory, and  of  the  efficiency  of  those  that  are  about  to  be  put  in  practice  during 
the  remaining  months  of  the  winter,  and  I  believe  that  you  will  also  be  con- 
vinced of  our  good  will  to  carry  out  that  work,  not  only  on  the  part  of  the  Presi- 
dent of  the  Repul)lic  and  secretary  of  the  interior.  I)ut  still  more  on  the  part  of 
the  superioi-  board  f^f  health,  wliich  is  charged  with  the  execution  of  those  orders. 
I  have  the  honor  to  remain,  yours,  very  sincerely, 

E.   LiCEAGA. 

Dr.  Walter  Wyman, 

Surgeon-General  of  the  Puhlic  Health  and  Marine-Hospital 

Herviee  of  the  United  States,  City. 


LEGISLATION    IX    TEXAS    IN   EEGAKD   TO   DISINFECTION. 

AN  ACT  Requiring  the  disinfection  of  public  buildings,  railway  coaches,  and  sleeping  cars, 
and  providing  a  penalty  for  the  violation  thereof,  and  declaring  an  emergency. 

Section  1.  Be  it  enacted  hy  thr  lecjislatiire  of  the  State  of  Texas.  That  it 
shall  be  the  duty  of  the  State  health  officer  of  Texas,  and  he  is  hereby  authorized 
and  empowered,  to  jjrepare  rules  and  regulations  governing  the  proper  disinfec- 
tion and  sanitation  of  public  buildings  and  all  railway  coaches  and  sleeping  cars 
operated  in  the  State  of  Texas. 

Sec.  2.  It  shall  be  his  duty,  and  he  is  hereby  authorized  and  empowered,  to 
prescribe  a  sanitary  code,  which  shall  contain  and  provide  rules  and  regulations 
of  a  general  nature  for  the  improvement  and  amelioration  of  the  hygienic  and 
sanitary  condition  of  said  public  buildings,  railway  coaches,  and  sleeping  cars. 

Sec.  3.  Every  person  having  control  of  any  public  building,  railway  company, 
sleeping  car  company,  or  other  corporation,  company,  or  individual,  or  the 
receiver  thereof,  engaged  in  the  carrying  of  passengers  in  this  State,  shall,  at 
their  own  expense,  within  a  prescribed  time  after  receiving  notice  from  the 
State  health  officer  of  the  promulgation  of  the  rules  and  regulations  in  the  above 
sections  mentioned,  carry  the  same  into  effect. 

Sec.  4.  If  any  person  having  control  of  any  public  building,  or  any  agent,  man- 
ager, operator,  employee,  or  receiver  of  any  railway  company,  sleeping  car  com- 
pany, or  any  individual  shall  fail  to  comply  with  the  provisions  of  this  act  and 
the  I'ules  and  regulations  promulgated  by  the  State  health  officer  under  the  pro- 
visions thereof,  he  shall  be  deemed  guilty  of  a  misdemeanor,  and  upon  conviction 
shall  be  punished  by  a  fine  of  not  less  than  fifty  nor  more  than  two  hundred 
dollars. 

Approved  April  6,  1903. 


PUBLIC   HEALTH    AND   MARINE-HOSPITAL   SERVICE.  297 

Circular  Xo.   1. 

By  virtue  of  the  authority  vcstod  in  ino  by  the  n))OVP  not  of  tho  twonty-oiRlith 
legislature,  tiie  followiiif;  rules  are  hereby  prescribed,  wliicii  sliall  j^overn  the 
disinfection  and  sanitatiduof  jiulilic  buildings,  railway  coaclics,  and  slecjiin;;  cars 
in  the  Stale  of  Texas,  .-ind  shall  be  cfVcctive  on  and  aftci-  Feiirnai'v  11.  I'.Ktl : 

1.  Each  passt'nj^er  coach  or  sleejiini,'  car  used  for  passcnjjjcrs  nuist  be  provided 
with  one  cuspidor  for  ea<'h  seat  or  (Mcry  two  cliiiirs.  Each  cuspidor  nnist  con- 
tain not  less  than  (J  ounces  of  a  disinfectant  solution  api)roved  by  this  depart- 
ment. The  cuspidors  to  be  enii>tied,  washed  in  a  similar  solution,  and  rejden- 
ished  each  trip  or  every  twenty-four  hours. 

2.  Public  l)uildin.i,'s  nuist  l)e  i>rovi(led  with  sufticient  number  of  cuspidors,  or 
not  less  than  one  in  e.ich  room  or  hall,  treated  in  a  like  manner,  and  emptied, 
washed,  and  replenished  daily. 

.'{.  The  tloors  of  cars  and  public  buildings  must  be  si)rinkled  w'ith  a  sinular 
solution  before  each  sw(>e])ing. 

4.  Sweeping  and  dusting  of  cars  are  prohibited  in  transit,  except  that  floors 
of  cars  may  be  swept  at  division  terminals  or  meal  stations,  where  passengers 
will  be  given  ail  opportunity  to  leave  the  cars  during  that  time.  Seats,  windows, 
and  walls  of  cars  must  be  wi])ed  off  with  a  cloth  or  sponge  and  not  dusted  in 
transit. 

5.  All  sleeping  cars  must  be  disinfected  by  fumigation  in  a  manner  approved 
by  this  department  at  the  end  of  each  round  trip  in  the  State  of  Texas  where 
sleeping  cars  do  not  leave  the  State. 

(>.  All  sleeping  cars  passing  through  or  coming  into  the  State  of  Texas  must 
be  disinfected  in  the  same  manner  each  trip  at  some  i)oint  in  the  State  ai)i)roved 
by  this  dei)artment.  All  carpets,  curtains,  blankets,  and  bedding,  except  linen, 
to  be  disinfected  with  cars. 

7.  Day  coaches  used  for  passengers  must  be  fumigated,  whenever  the  necessity 
exists,  at  some  point  in  this  State  acceptable  to  this  department.  If  a  car  be- 
comes infected  l)y  being  occui)ied  by  a  person  having  a  contagious  disease,  it 
must  be  disinfected  immediately  at  end  of  run. 

8.  All  public  buildings  nuist  be  disinfected  by  fumigation  w'henever  the  neces- 
sity exists  for  it. 

9.  Containers  of  water  for  drinking  in  cars  and  public  buildings  must  be 
emptied  and  thoroughly  cleansed  at  least  once  every  forty-eight  hours.  (Public 
schools  should  be  provided  with  a  separate  cup  at  each  desk  for  each  pupil  to 
drink  from  or  the  pupils  should  be  required  to  provide  same.) 

10.  Ice  which  is  used  in  water  coolers  in  cars  must  not  be  dumped  on  the 
floors,  sidewalks,  and  car  platforms  where  people  have  trod  and  expectorated, 
and  then  i)icked  up  Iiy  unclean  hands  and  put  into  the  drinking  water.  It  should 
be  washed  and  handled  with  ice  tongs. 

11.  Passengers,  patrons,  employees,  or  others  must  be  prohibited  from  washing 
their  teeth  over  or  expectorating  in  basins  in  sleeping  cars,  passenger  coaches, 
or  public  Iniildings  which  are  used  for  bathing  the  face  and  hands.  Large  cus- 
pidors must  be  provided  for  such  purposes. 

All  local  health  ofllcers  and  citizens  are  requested  to  assist  in  the  enforcement 
of  the  above  rules. 

George  R.  Tabor, 
State  Health  Officer. 
Austin,  Tex.,  January  11,  IDOJf. 

In  the  early  spring  additional  measures  were  inaugurated  for  a  close 
surveillance  of  the  territory  infected  the  previous  season.  A  memo- 
randum was  prepared  by  the  Bureau,  setting  forth  the  regulations 
which  should  be  enforced  by  the  local  authorities,  and  transmitted  to 
the  medical  officer  in  command  at  Laredo,  Tex.  The  city  council 
passed  an  ordinance  based  upon  this  memorandum,  and  subsequently 
other  municipalities  in  the  St.ife  of  Texas  passed  similar  measures. 
The  matter  is  set  forth  in  the  following  correspondence : 


298  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

COBBESPONDENCE     RELATIVE     TO     PKEVENTION     OF     THE     RECRUDESCENCE     OF     YELLOW 
FEVEB   ALONG    THE    TEXAS-MEXICAN    IJORDER. 

[Telegrams.] 

Washington,  March  5,  1901f. 
State  Health  Officer  Tador.  Austin,  Tex.: 

Have  just  received  teleiiram  from  Frick.  at  Laredo,  statins  city  council,  Marcli 
3.  after  statement  of  their  inability  by  reason  of  exhausted  treasury,  had  passed 
the  following  resolution : 
(Quoted  in  full  below.) 

"A  resolution. 

"  Whereas  it  is  generally  believed  that  yellow  fever  exists  all  seasons  of  the 
year  in  Vera  Cruz,  Republic  of  Mexico,  wliich  point  is  of  no  great  distance  from 
Laredo,  and  is  in  daily  railway  communication  with  this  city ;  and 

"  Whereas  the  warm  season  is  rapidly  approaching  and  the  quarantine  here- 
tofore established  and  maintained  against  Vera  Cruz  has  not  beeu  of  such 
nature  as  to  inspire  contidence  or  arrest  the  spread  of  the  disease ;  and 

"  Whereas  the  citj^  of  Laredo  has  in  the  past  five  years  suffered  so  intensely 
from  the  blight  of  droughts  and  eiiidemics  that  her  financial  conditon  is 
strained  to  the  limit  of  the'  constitution  and  her  ti-easury  exhausted,  and  is 
therefore  unable  to  employ  the  means  to  carry  on  the  necessary  precautions 
to  prevent  a  recurrence  of  the  yellow  fever  during  the  coming  warm  season : 
Therefore,  be  it 

"Resolved  hi/  the  citij  council  of  the  city  of  Laredo,  Texas,  That  the  Public 
Health  and  ^Marine-Hospital  Service  of  the  United  States  be,  and  it  is  hereby, 
requested  to  at  once  furnish  the  means  and  reassume  the  inspection,  disinfec- 
tion, and  all  other  means  necessary  for  the  prevention  and  suppression  of  all 
contagious  and  infectious  diseases,  and  esjiecially  that  of  yellow  fever ;  and  said 
city  does  hereliy  pledge  itself  to  render  all  moral  support  and  legal  aid  to  the 
Public  Health  and  Marine-Hospital  Service  of  the  LTnited  States  in  carrying  out 
the  purpose  of  this  i-esolution." 

Frick  recommends  immediate  resumption  special  inspection  and  oiling  of 
water  containers  I)y  the  Service:  estimated  cost,  witli  screening  of  fever  cases, 
$30  per  day.  Kte;/otnyia'  larv;v  have  recently  been  found  in  various  portions  of 
Laredo.  Desire  to  have  statement  from  you  whether  your  Department  or  the 
State  of  Texas  can  take  charge  of  this  matter  and  perform  the  work  or  whether 
the  State  has  the  i)ower  to  require  the  city  of  Laredo  to  do  it.     Kindly  answer. 

Wyman. 


Austin,  Tex.,  March  7,  190.^. 
Wyman,  Wash ington : 

Will  communicate  with  Lareilo  authorities  and  advise  you  earliest  possible. 

Tabob. 


Austin,  Tex.,  March  17,  190.'/. 
Wyman,  Washiugton: 

State  of  Texas  will  render  your  Department  every  assistance  in  continuing 
sanitary  work  and  inspection  service  at  Laredo  and  would  like  to  see  you  place 
larger  force  there  immediately.  Full  authority  and  any  other  a.ssistance  your 
men  require  will  be  given,  but  this  deiiartment  will  retain  control  of  quarantine 
in  the  State. 

Tabob. 


Washington.  March  IS.  190'^. 
Tabor,  Health  Officer,  Austin,  Tex.: 

With  approval  Secretary  Treasury  propose  to  act  in  accordance  with  your 
telegram  of  March  17  and  on  request  of  city  couucil  of  Laredo. 

Wyman. 


PUBLIC    HEALTH    AND    MARINE-HoSPlTAL    SERVICE.  299 

Washington,  March  16,  lUOI,. 

Deab  Doctor:  HeforriiiK  to  my  tele^raiu  to  you  to-day,  statin};  that  Assistant 

Surgeon  Richardson,  who  has  rerently  jiasscd  liis  examination  lor  promotion  to 

be  passed  assistant  suri;(H)n,   lias  been   assif^ned   to  duty   at   Laredo.   I    have  to 

inform  you  that  this  is  done  as  part  of  a  phm  for  the  eominf;  sunnner  and  fall. 

Respectfully, 

Walter  Wyman,  Hurgcon-General. 
Dr.  George  R.  Tabor. 

atatc  Health  Officer,  Austin  Tex. 


Washington,  March  21,  190Ji. 
SfR :  Confirmin5J   telegram    of   to-day.    which   concluded    with    the   statement 
"  letter  follows."  addressed  to  Acting  Assistant  Surgeon  Fi'ick.  I  transmit  here- 
with a  memorandum  outlining  the  plan  of  o])eratious  which  the  Bureau  considers 
necessary  at  the  present  time  in  Laredo.  Tex. 

It  will  he  observed  that  to  carry  out  the  measures  indicated  some  provision 
should  be  made  by  the  city  council  for  penalties  ff)r  failure  to  comply  with  the 
re(iuirements.  It  may  be  advisable  also  that  an  ordin.ince  be  passed  authorizing 
the  inspections  and  other  requirements  mentioned  in  the  memorandum  together 
with  the  penalty. 

Respectfully,  Walter  Wyman, 

^uryeon-Qeneral. 
Asst.  Surg.  T.  F.  Richardson, 

Puhlic  Health  and  Marine-Hosfrital  l^rrv'^r,  Laredo,  Tex. 

[Memorandum — Laredo,  Tex.] 

March  IS,  1904. 

1.  The  city  council  should  pass  an  ordinance  requiring  both  physicians  and 
all  householders  to  report  to  the  city  health  officer  every  case  of  fever  coming 
within  their  knowledge.  By  "  fever  "*  is  meant  fever  of  any  character,  whether 
it  is  deemed  malarial,  or  from  a  cold,  or  rheumatissm,  or  any  other  cause. 

2.  Every  case  of  fever  as  described  in  paragrajjh  1  shall  be  immediately  cov- 
ered with  a  mosquito  netting  until  its  removal  is  authorized  by  the  city  health 
office!'.  The  householder  will  be  held  responsible  for  seeing  that  this  jn'ovision 
is  enforced.  If  the  patient  or  his  friends,  or  the  householder,  is  unable  to  sup- 
ply said  mosquito  netting  the  same  will  be  furnished  on  application  by  the 
Public  Health  and  Marine-Hospital  Service. 

.3.  Every  such  case,  as  soon  as  i-eported,  will  be  immediately  visited  by  the 
cltj'  health  officer,  or  his  accredited  medical  agent,  who  shall  report  to  the 
health  officer ;  and  the  said  mosquito  netting  shall  be  kept  over  the  patient  until 
permission  is  given  l)y  the  city  health  officer  or  agent,  in  writing,  for  its  removal. 

4.  If  the  health  officer  considers  the  case  suspicious  of  yellow  fever,  unless 
the  diagnosis  of  yellow  fever  is  positively  excluded,  he  shall  place  a  guard  at 
the  house  to  see  that  the  mosquito  netting  is  kept  over  the  patient. 

.5.  A  house-to-house  inspection  must  be  innnediately  organized.  The  city 
should  be  divided  into  twenty  or  thirty  districts  and  a  lay  inspector  appointed 
for  each  district,  whose  whole  time  shall  be  given  to  the  inspection.  Of  first 
importance  is  the  discovery  of  cases,  but  I'eport  of  inspector  should  include  sani- 
tary conditions,  particularly  as  regards  water  barrels  and  other  places  where 
mosquitoes  might  breed.  Each  inspector  should  go  over  his  whole  district  daily, 
Sundays  included. 

G.  Fumigation  to  destroy  mosqxiitoes  should  l)e  made  for  all  such  fever  cases 
as,  in  the  opinion  of  the  health  officer,  require  it.  This  shall  not  only  include 
the  houses  containing  such  cases,  but  such  adjoining  premises  and  houses  as 
the  health  officer  may  indicate. 

7.  Blank  forms  should  be  furnished  the  inspectors  who  make  the  house-to- 
house  inspection,  and  these  forms  should  also  contain  a  blank  space  for  rer»ort- 
ing  on  the  cisterns  and  water  barrels,  etc.,  whether  the  same  are  covered  to  pre- 
vent the  breeding  of  mosquitoes. 

8.  An  ordinance  should  be  passed  inflicting  a  fine  upon  householders  on  whose 
premises  the  larvip  of  mosquitoes  are  found,  at  the  same  time  the  ordinance 
should  require  all  water  containers  to  be  so  screened  or  treated  with  petroleum 
as  to  prevent  the  breeding  of  mosquitoes.  Notice  should  be  given  that  any 
householder  unable  to  provide  the  necessary  covering  or  petroleum  will  have  the 


300  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

same  furnished  upon  application  to  the  Public  Health  and  Marine-Hospita' 
Service. 

9.  On  the  report  of  the  inspector  showing  that  any  of  the  above  requirements 
have  been  neglected,  the  health  officer  will  hnniediately  remedy  the  defects  and 
report  the  cases  to  the  proper  legal  authority  for  prosecution.  The  health 
officer  shall  have  power  to  suspend  the  penalty  in  his  discretion  if  the  defect 
complained  of  is  immediately  remedied. 

10.  When  in  the  opinion  of  the  health  officer  a  case  suspected  of  being  yellow 
fever  can  not  be  efficiently  screened  and  treated  at  the  patient's  home,  the 
health  officer  shall  have  power  to  transfer  the  patient  to  a  properly  screened 
fever  sanitarium. 


daily  house-to-house  inspection  of  laredo,  tex. — objects  to  be  attained 
and  theory  on  which  is  based  determination  of  the  length  of  time  it 
should  be  continued. 

Treasitiy  Department, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Washingtoh,  April  11,  190/,. 
Sir:  The  Bureau  has  been  in  receipt  of  your  daily  telegrams  announcing  the 
number  of  premises  insi)eoted,  water  containers  treated,  etc.,  and  it  is  under- 
stood that  since  March  24  there  has  been  a  daily  house-to-house  inspection  of 
Laredo,  the  city  having  been  divided  into  30  districts  and  each  district  inspected 
every  twenty-four  hours.  It  l)ecomes  necessai-y  to  have  an  understanding  with 
you  as  to  tlie  length  of  time  this  work  is  to  be  continued.  For  this  reason  the 
objects  to  be  attained  and  the  theory  involved  may  be  reviewed  as  follows : 

1.  The  detection  of  any  case  of  yellow  fever  and  the  prevention  of  any  such 
case  becoming  an  infecting  agent  by  screening  the  patients,  fumigation,  etc. 

2.  The  disc^overy  of  fevers  of  any  kind  and  screening  the  cases  until  they  are 
positively  Ivuown  not  to  be  yellow  fever. 

3.  The  treating  of  water  containers,  etc.,  to  prevent  breeding  of  mosquitoes. 

4.  The  last  case  declared  to  be  yellow  fever,  in  Laredo,  was  noted  March  14, 
Mosquitoes  which  may  have  bitten  this  case  would  have  required  12  days  to 
become  infective  and  an  individual  bitten  l)y  them  after  the  twelfth  day  would 
have  required  five  days  for  development  of  the  disease.  Therefore,  in  seven- 
teen days  the  second  infection  might  have  developed. 

Of  course  the  mosquito  remains  infective  after  the  twelfth  day,  and  the  sec- 
ond infection  may  develop,  therefore,  long  after  the  seventeen  days,  but  each 
daily  house-to-hoiise  inspection  after  the  seventeenth  day,  which  has  developed 
no  case  of  yellow  fever,  increases  the  probability  of  safety. 

In  the  event  that  the  patient  was  bitten  by  a  mosquito  before  IMarch  14  the 
second  infection  should  have  been  developed  by  the  inspections  before  March  31. 

If  all  fever  cases  had  been  screened  since  March  14  the  probability  of  mos- 
quitoes becoming  infected  after  March  14  would  be  remote,  and  after  20  or  22 
days  from  March  14,  viz,  April  3  to  5.  a  daily  house-to-house  inspection  having 
shown  no  succeeding  case  of  yellow  fever,  the  probabilities  of  there  being  any 
case  of  yellow  fever  on  April  o  would  not  have  been  great. 

But  although  the  city  was  under  surveillance  and  partial  inspection,  there  was 
not  a  daily  house-to-house  inspection  until  March  24.  Therefore  it  would  seem 
advisable  to  advance  the  date  on  which  the  house-to-house  inspection  is  to  be 
discontinued  a  corresponding  number  days,  namely,  ten  days,  or  April  15. 

^Yhen,  however,  the  daily  house-to-house  inspection  is  discontinued,  it  would 
be  well  to  have  a  select  corjis  to  make  a  more  circumscribed  inspection ;  and 
should  occasion  arise,  the  daily  inspection  of  the  whole  30  districts  could  be 
resumed.  You  will  wire  for  instructions  before  discontinuing  the  daily 
inspection. 

Some  of  the  force  which  you  have  had  in  operation,  being  well  trained,  might 
be  detailed  for  the  work  along  the  railroads  in  the  carrying  on  of  the  mosquito 
warfare,  which  has  been  the  subject  of  communications  between  the  Bureau, 
State  Health  Officer  Tabor,  and  yourself. 

Respectfully,  •  Walter  Wyman, 

Surgeon-General, 

Asst.  Surg.  T.  F.  Richardson. 

PttJ)lic  Health  and  Murlnc-Hosintal  Service,  Laredo,  Tex. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  301 

[Memorandum  prepared  by  the  Bureau,  relative  to  mosquito  destruction.] 
MOSQUITOES,     THEIR     DANGER,     AND     AfETIIODS     OK     DESTROYING     THEM. 

The  presence  of  mosquitoes  nenr  any  locality  inhal)ited  by  people  is  an  ele- 
ment o"  danger  on  account  of  the  diseases  that  may  be  conveyed  l)y  them, 
especially  malaria  and  yellow  fever;  therefore,  it  is  a  matter  of  great  imi»or- 
tance  to  bring  about  the  destruction  of  mosquitoes  and  their  larvic  in  such 
localities. 

Inuring  warm  weather  from  one  to  three  weeks  is  necessary  for  the  stages 
of  development  of  the  mosquito  from  the  egg  to  the  winged  insect. 

The  mosquit<i  lays  its  eggs  on  the  water.  In  the  course  of  from  one  to  two 
days  these  eggs  hatch  into  wrigglers,  which  may  be  seen  in  your  water  barrels. 
After  a  week  or  t(Mi  days  these  wrigglers  change  into  the  mature  winged  insects. 
There  are  two  stages  in  the  develoi)ment  of  the  wriggler;  the  first,  as  it  hatches 
from  the  egg,  is  called  the  larva,  and  the  second,  the  i)upa. 

Mosquitoes  breed  only  in  water — usually  fresh  standing  water.  Yellow-fever 
mosquitoes  prefer  water  in  barrels,  cisterns,  pools,  old  cans,  broken  bottles, 
and  similar  containers  in  the  back  yard  of  your  house  or  about  your  premises. 
The  malarial  niosquitoes  prefer  natural  pools,  ponds  and  puddles  in  the  fields, 
streams,  and  woods. 

INIosquitoes  usually  live  and  feed  in  the  neighborhood  of  the  water  in  which 
they  breed,  and  as  a  rule  do  not  fly  far. 

Although  the  wrigglers  live  in  water  they  must  come  frequently  to  the  sur- 
face to  breathe.  Coal  oil  on  the  surface  of  the  water  prevents  the  wrigglers 
from  breathing.  Destroy  the  breeding  places  and  you  will  exterminate  the 
mosquitoes. 

Place  fine  wire  netting,  at  least  18  meshes  to  the  inch,  over  cisterns,  wells, 
and  tanks  of  water  which  can  not  b^  dispensed  with.  Water  should  not  be 
allowed  to  stand  about  i)remises  in  tubs,  buckets,  cans,  flower  pots,  vases, 
broken  bottles,  or  any  other  receptacle,  however  small.  Such  deposits  of  water 
can  at  once  become  breeding  places  for  mosquitoes,  and  should  under  no 
circumstances  be  allowed  to  stand  xmdisturbed  even  as  long  as  forty-eight  hours. 

The  presence  of  mosquito  larvje  in  premises  constitutes  "  a  nuisance  prejudi- 
cial to  the  public  health  "  and  should  be  punishable  by  a  fine. 

Where  there  are  ponds  near  the  house  which  can  not  be  oiled  or  drained,  on 
account  of  their  being  used  for  watering  stock,  they  should  be  stocked  with 
some  small  varieties  of  fish,  such  as  perch,  minnows,  or  goldfish,  which  eat 
the  eggs  and  wrigglers  of  the  mosquitoes  as  they  float,  and  in  this  way  pre- 
vent them  from  hatching  into  full-fledged  insects.  These  ponds  should  be  kept 
free  from  vegetation  of  any  kind,  as  weeds,  water  lilies,  etc.,  especially  around 
the  edges,  which  may  afford  hiding  places  for  the  eggs  and  larvae  and  prevent 
the  fish  from  catching  them. 

Screen  your  house  and  always  sleep  under  a  mosquito  bar,  even  while  you 
lie  down  for  a  short  rest  at  noon. 

All  mosquito  bars  and  screens  should  be  closely  woven  and  contain  not  less 
than  18  meshes  to  the  inch. 

Winged  insects  in  the  house  may  be  best  killed  as  follows :  First,  bj'  burning 
sulphur,  not  less  than  one  pound  per  thousand  cubic  feet,  with  an  exposure  of 
two  hours ;  second,  by  burning  pyrethrum,  sometimes  called  "  Persian  "  insect 
powder,  or  buhach,  in  proportion  of  two  pounds  per  thousand  cubic  feet,  and 
an  exposure  of  two  hours  ;  third,  by  burning  tobacco  in  the  proportion  of  two 
pounds  per  thousand  cubic  feet  and  an  exposure  of  not  less  than  two  hours. 
Hydrocyanic-acid  gas  will  kill  mosquitoes,  but  is  too  dangerous  to  use  about 
the  house  or  other  inhabited  places. 

All  openings,  such  as  windows,  doors,  crevices,  etc.,  should  be  tightly  closed 
while  fumigating  to  kill  insects. 

The  question  having  arisen  as  to  the  evidence  to  be  furnished  by 
persons  traveling  from  places  infected  or  suspected  of  yellow  fever 
the  previous  season  and  where  a  recrudescence  of  the  disease  might 
take  place,  the  Bureau,  after  mature  consideration  and  conference 
with  the  State  health  officer  of  Texas,  decided  that  the  stationing  of 
officers  of  the  Service  at  points  in  Mexico  to  issue  certificates  of 
absence  from  such  points  was  inadvisable. 


302  PUBLIC   HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Washington,  April  25,  1901,. 

Sir  :  You  are  hereby  directed  to  convene  a  meeting  of  the  sanitary  board  for  the 
purpose  of  talking  into  consideration  measures  to  be  adopted  by  the  Bureau  in 
connection  with  tlie  inspection  service  on  the  Texas-Mexican  border. 

Your  attention  is  called  to  disjjatch  from  Passed  Assistant  Surgeon  Richard- 
son stating  that  an  order  has  been  issiied  by  the  State  health  officer  of  Texas 
requiring  all  passengers  at  the  border  of  Mexico  to  bring  certificates  from  either 
the  State  or  Public  Health  and  Marine-IT()si)ital  Service  officers  to  the  effect 
that  they  have  not  been  in  an  infected  place  for  five  days  i)revious.  Your  atten- 
tion is  also  called  to  the  existing  regulations  of  the  Service  for  the  Mexican 
border,  paragraph  143,  which  requires  persons  not  i)ositively  identified  as  immune 
to  yellow  fever,  coming  from  places  where  yellow  fever  prevails,  to  be  forbid- 
den entry  until  they  have  been  away  from  said  localities  five  full  days.  At  the 
present  time  it  is  not  known  that  yellow  fever  prevails  anywhere  in  Mexico, 
although  it  is  supposed  to  exist  in  Veracruz. 

Doctor  Tabor  has  requested,  through  Doctor  Richardson,  that  medical  officers 
be  stationed  at  consulates  in  Mexico  City,  San  Luis  Potosi,  Saltillo.  and  Torreon, 
to  issue  certificates.  The  placing  of  officers  of  this  Government  in  the  Republic 
of  Mexico  for  this  purpose  when  it  is  not  known  that  yellow  fever  is  prevailing 
anywhere  is  questionable. 

You  are  reciuested  to  canvass  the  subject  and  make  report  as  to  what  require- 
ments are  advisable  at  the  present  time. 

Respectfully,  Walter  Wtman.  Surgeon-General. 

Chairman  Sanitary  Board 

Public  Health  and  Marine-Hospital  Service. 

Washington,  D.  C. 


Washington,  April  2G.  1904. 
Sir:  As  directed  in  Bureau  order  dated  April  25,  1904,  directing  a  meeting 
of  the  sanitary  board  for  the  purpose  of  taking  into  consideration  measures  to 
be  adopted  by  the  Bureau  in  connection  with  the  inspection  service  on  the 
Texas-Mexican  border,  the  board  have  the  honor  to  submit  the  following  report: 
After  carefully  considering  the  different  sections  of  the  quarantine  regula- 
tions promulgated  against  Mexico  by  the  State  health  officer  of  Texas,  to  be 
enforced  and  take  effect  after  the  30th  of  April,  1904,  the  board  arrived  at  the 
following  conclusion : 

We  are  of  the  opinion  that  the  danger  of  infection  of  yellow  fever  may  be 
disregarded,  unless  the  disease  has  prevailed  in  a  given  locality  within  sixty- 
five  days  immediately  preceding  this  date,  provided  that  all  cases  of  fever  have 
been  investigated,  screened  against  the  access  of  mosquitoes,  and  treated  as 
suspicious  until  a  diagnosis  of  "  not  yellow  fever  "  has  been  arrived  at. 

The  board  is  of  the  further  opinion  that  the  stationing  of  Service  officers  at 
points  in  the  interior  of  Mexico  for  the  purpose  of  issning  certificates  of  non- 
residence  in  an  infected  locality  to  passengers  leaving  for  the  United  States 
possesses  no  advantage  over  the  presentation  of  evidence  by  all  such  passengers 
to  the  Service  inspectors  at  the  Texas-Mexican  border,  as  has  been  the  system 
in  pa.st  years. 

We  believe  that  the  inspection  service  at  Eagle  Pass  and  El  Paso.  Tex., 
should  be  strengthened  from  this  time  by  the  stationing  of  additional  officers  at 
those  points. 

We  further  believe  that  a  quarantine  directed  against  the  whole  of  a  large 
country,  certain  limited  portions  of  which  only  are  known  to  have  been  infected 
with  yellow  fever  within  the  past  twelve  months,  is  unscientific  and  a  distinct 
retrograde  step.  A  rational  measure,  however,  would  be  occasional  inspection 
during  the  present  season  of  places  in  Mexico  along  the  railroad  lines  reported 
last  year  as  having  the  infection  of  yellow  fever,  with  a  view  to  obtaining  early 
information  of  any  recrudescence  of  the  disease  in  those  places,  which  could 
then  be  guarded  against  by  appropriate  measures. 

Respectfully,  A.  H.  Glennan, 

Assistant  Surgeon-General,  Chairman. 
W.  J.  Pettus. 
Assistant  Surgeon-General. 

G.  T.  Vaughan, 
Assistant  Surgeon-General. 

H.  D.  Geddings, 
Assistant  Surgeon-General. 
M.  J.  Rosenau, 
Passed  Assistant  Surgeon.  Director  of  Hygienic  Laboratory,  Recorder. 


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PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  303 

A  sanitary  inspection  of  the  torritory  silnatcMl  in  tho  trian<«jles 
between  San  Antonio,  Laredo,  Corpus  Cliristi,  and  Hrownsville  was 
inaii<iurate(l  and  officers  detailed  to  investigate  the  conditions  along 
the  lines  of  railway  travel  to  detect  any  possible  recrudescence  of  the 
disease.  A  canipaii>:n  of  instruction,  showing  the  methods  of  drain- 
age, destruction  of  mosquitoes,  oiling  of  water  containers,  etc.,  and  the 
screening  of  all  fever  patients,  was  carried  out,  supplemented  with  aid 
in  fumigation  of  premises,  (tc,  where  requested,  and  no  doubt  the 
generally  satisfactory  condition  of  affairs  at  the  time  of  this  report  is 
due  to  this  early  anticipatory  sanitary  campaign  in  aid  of  the  State 
and  local  authorities. 

In  addition  to  the  measures  already  enumerated,  it  was  considered 
advisable  as  a  precautionary  measure  to  prepare,  pack,  and  store 
small  camp  outfits  at  five  points  upon  the  Louisiana-Texas  border, 
thereby  saving  time  in  shipment  should  an  emergency  arise.  These 
camp  outfits  were  accordingly  stored  at  the  selected  points. 

The  reports  of  the  officers  engaged  in  the  work  of  suppression  of 
yellow  fever  are  appended. 

Report  on  the  Epidemic  of  Yellow  Fever  of  1903  at  Laredo,  Minera,  and 
Cannel,  Tex.,  by  Surg.  G.  M.  Guiteras. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Cairo,  III,  March  19,  WOJ,. 

Sir  :  In  accordance  with  Bureau  orders  dated  September  22,  190.3,  I  left  Cairo, 
111.,  at  1.30  p.  m.,  arriving  at  San  Antonio,  Tex.,  the  morning  of  September  25. 
Here  I  met  Dr.  George  R.  Tabor,  State  health  officer  of  Texas,  and  we  together 
proceeded  to  Laredo,  Tex.,  arriving  at  4.30  p.  m.  of  the  same  day.  During  the 
trip  we  discussed  the  probable  situation  at  Laredo  and  the  steps  to  be  taken  to 
combat  the  outbreak  at  that  point. 

Among  other  things,  we  touched  on  the  necessity  of  a  detention  camp.  In 
the  name  of  the  Government  I  offered  to  establish  and  run  such  a  camp.  The 
offer,  however,  was  coiu'teously  refused  by  Doctor  Tabor  for  the  reason  that 
he  believed  it  would  appear  derogatory  to  the  dignity  of  the  State  of  Texas  so 
to  do. 

On  our  arrival  at  Laredo  we  were  met  by  Acting  Asst.  Surg.  H.  .J.  Hamilton, 
United  States  Public  Health  and  Marine-Hospital  Service,  Doctor  McKnight, 
State  health  officer  at  Laredo,  and  several  other  physicians.  In  company  with 
these  gentlemen  we  went  at  once  to  view  the  two  fatal  cases  of  supposed  yellow 
fever  that  had  occurred  during  the  day,  Cortina  and  Gilkerson.  In  both  the 
history  was  that  of  yellow  fever,  and  the  external  appearances  in  connection 
with  the  history  left  no  doubt  as  to  the  diagnosis. 

An  autopsy  was  performed  in  the  case  of  Gilkerson,  and  all  the  characteristic 
post-mortem  signs  of  the  disease  were  found.  These  cases  resided  in  two 
widely  separated  parts  of  the  town.  It  was  impossible  to  define  the  source  of 
infection  in  either  case. 

In  the  evening  a  conference  was  held  between  the  city  and  county  authorities, 
physicians  of  Laredo,  and  Doctor  Tabor  and  myself.  At  this  conference  the 
city  and  county  authorities  expressed  their  willingness  to  aid  in  every  way 
except  financially,  stating  that  both  city  and  county  were  without  funds,  and 
pointing  out  the  fact  that  their  position  in  this  respect  was  so  hopeless  that  the 
mayor,  Dr.  Amador  Sanchez,  had  generously  refused  to  accept  his  salary  as 
mayor,  amounting  to  .$1,500  per  annum. 

Thereupon  Doctor  Tabor  took  charge  of  the  situation,  accepting  the  cooperav 
tion  of  the  Public  Health  and  Marine-Hospital  Service,  offered  by  the  writer. 
It  was  determined  that  the  mayor  should  issue  a  proclamation  declaring  the 
presence  of  yellow  fever  in  the  city  and  advising  the  citizens  as  to  their  duties 
under  the  circumstances. 

Doctor  Talwr  likewise  issued  a  proclamation  declaring  a  State  quarantine 
against  Laredo,  herewith  appended,  marked  "  Exhibit  A." 

It  was  decided  later  between  Doctor  Tabor  and  myself  that  the  Public  Health 


304  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

and  Mai-ino-IIospitiil  Service  should  take  charge  of  the  sanitary  measures  to 
stamp  out  the  ei)ideniic  and  lieep  up  the  quarantine  guard  on  the  frontier,  which 
had  been  previously  established  by  Acting  Assistant  Surgeon  Hamilton.  Doctor 
Tabor  was  to  establish  and  control  a  detention  camp  and  look  after  the  protec- 
tion of  the  State  of  Texas  against  infection. 

I  regretted  not  being  able  to  take  charge  of  this  camp,  but  the  fact  that  the 
distance  from  Laredo  to  the  nearest  point  on  the  Texas  frontier  within  the 
L^nited  States  is  about  575  miles  the  ijrotcction  of  the  surrounding  territory 
amounted  in  fact  to  the  protection  of  the  St;ite  of  Texas  and  evidently  devolved 
upon  the  State  authorities  if  they  were  willing  to  luidertake  it. 

Doctor  T^ibor  also  was  to  organize  and  enforce  a  house-to-house  inspection, 
should  su<;h  become  necessary,  as,  in  fact,  it  did  within  a  few  days. 

The  fact  that  2  deaths  from  yellow  fever  had  occurred  in  two  widely  sepa- 
rated points  led  to  the  belief  that  the  disease  had  been  present  in  Laredo  for 
some  time  and  had  obtained  considerable  headway.  This  was  shown  to  be  true 
when  3  suspicious  cases  were  reported  the  following  day,  September  20,  which 
were  promptly  confirmed,  and  G  positive  cases  and  1  death  reported  on  Septem- 
ber 27.  From  September  25  to  28,  L3  positive  cases.  ?,  deaths,  and  7  suspects 
were  recorded.  No  clearly  defined  connection  could  be  found  between  these 
cases,  although  they  seemed  grouped  around  three  foci.  It  was,  moreover, 
very  probalile  that  the  number  of  cases  was  gi-eater  than  appeared  from  the 
official  record,  inasmuch  as,  with  one  or  two  exceptions,  the  Laredo  physicians 
were  unacquainted  with  yellow  fever,  and  at  that  time,  when  there  were  still 
many  persons  who  denied  the  existence  of  the  disease,  they  were  lukewarm  in 
reporting  cases.  In  addition,  the  ignorant  class  of  the  population  seldom  called 
in  a  physician,  fearful  that  they  might  be  quarantined  or  sent  to  a  hospital. 

It  was,  therefore,  evident  at  this  time  that  the  disease  had  obtained  a  firm 
foothold  and  was  widely  disseminated  in  a  population  consisting  almost  entirely 
of  nonimmunes.  It  was  reasonable  to  supi)ose  that  the  disease  had  existed  for 
several  weeks  and  that  we  were  in  the  period  of  the  third  mosquito  infection. 

Now,  turning  our  attention  toward  the  other  side  of  the  Rio  Grande,  to  the 
Mexican  town  of  Nuevo  Laredo,  situated  directly  opposite  to  Laredo,  Tex.,  and 
connected  therewith  l)y  a  railroad  bridge,  a  foot  bridge,  boat  ferries,  and  several 
easily  travelled  fords,  we  find  that  \\\)  to  September  25  the  health  authorities 
there  had  reported  G  cases  and  4  deaths  from  yellow  fever.  The  first  officially 
reported  case  was  a  death,  that  of  Doctor  Ruiz  on  September  14,  and  inmiedi- 
ately  thereafter  quarantine  was  declared  against  Xue\o  Laredo.  A  conference 
witli  the  health  authorities  of  the  town  and  an  inspection  of  the  same  showed 
conclusively  that  the  number  of  cases  was  much  greater  than  that  reported,  and 
that  the  disease  was  widely  spread. 

ORIGIN    OF    THE   EPIDEMIC, 

Yellow  fever  appeared  in  Tampico.  Mexico,  during  the  spring  of  1903,  as 
early  as  May  4,  and  si)read  rapidly.  From  here  the  disease  was  propagated 
along  the  line  of  the  Mexican  National  Railroad,  reaching  Victoria,  Linares, 
and  Monterey. 

The  Mexican  sanitary  authorities  established  quarantines  to. protect  these 
places,  but  it  is  well  known,  and  the  results  clearly  show,  that  these  quarantines 
were  not  effective.  The  authoritites  of  these  towns,  moreover,  instituted  a  sys- 
tem of  denials  of  the  presence  of  yellow  fever  in  their  midst,  the  same  methods 
usually  practiced  among  us  in  the  Southern  States  under  like  circumstances, 
with  the  result  that  a  feeling  of  false  security  was  established  and  the  disease 
given  every  opportunity  to  spread. 

There  is  good  reason  to  believe  that  yellow  fever  existed  in  Monterey  as  early 
as  the  latter  part  of  June,  a  death  from  what  would  apjiear  to  be  that  disease 
having  occurred  on  June  24.  The  deceased,  Manuel  Porras,  was  a  near  relative 
of  Mr!  Barker,  our  clerk  in  the  office  of  the  Public  Health  and  Marine-Hospital 
Service  at  Laredo,  Tex.,  and  the  history  of  the  case  herewith  appended  (marked 
"  Exhibit  B  ")  was  obtained  with  great  care  and  is  worthy  of  credence. 

The  first  published  report  of  a  case  of  yellow  fever  in  Monterey  was  issued 
August  29.  It  will  be  seen,  therefore,  that  if  the  case  of  Porras  was  yellow 
fever,  as  I  am  inclined  to  believe,  two  months  and  over  elapsed  before  any  steps 
were  taken  to  prevent  its  spread  from  that  city.  Under  such  circumstances  it 
is  easy  to  conceive  how  the  disease  extended  along  the  Mexican  National  Rail- 
road and  reached  the  two  Laredos  on  the  Rio  (^rande. 

Careful  investigation  shows  that  the  infection  of  Nuevo  Laredo  may  have 


PUBLIC    UKALTII    AND    MAKINK-HOSPITAL    SERVICK.  305 

originatod  from  Victorin,  in  tho  State  of  Tainaulipas.  Moxioo.  This  town,  which 
is  tho  capital  of  tlic  State  above  nuMitioiied.  is  situated  on  tlio  line  of  th«'  Mex- 
ican National  Railroad  and  about  ].",()  miles  to  tlie  north  and  west  of  'J'ampico. 
I  quote  from  Actini;  Assistant  Surjieon  Hamilton's  rei)ort  on  this  subject,  he 
havinjr  been  detailed  especially  to  make  this  investijration  :  '*  *  *  ♦  A  family 
left  Victoria.  Mexico,  for  Nuevo  Laredo  on  Auirust  4.  arriving  in  Nuevo  Laredo 
August  .").  One  diild  had  come  down  with  fever  at  Monterey,  another  took  ill 
upon  .arrival  at  Nuevo  Lartnlo.  This  family  lived  near  the  jirincipal  i)l.iza  of 
Nuevo  Laredo,  where  jtersons  from  both  sides  of  the  l)order  resort  for  amuse- 
ment. Neiirhbors  ami  visitors  of  this  family  began  having  mild  att.icks  of  fever 
about  August  L.*.").  many  of  whom  lived  ai>ont  the  above-mentioned  plaza.  *  *  * 
In  Nuevo  Laredo  the  fever  s])read  rapidly,  so  that  when  the  fir.st  known  ca.se 
died  on  September  14.  recognized  through  an  autopsy,  the  town  was  completely 
infected,  especially  the  central  ]iortion." 

From  all  the  information  obtainable  there  is  good  reason  to  believe  that  the 
disease  intrtxhiced  into  Nuevo  Laredo  from  \ictoria  was  yellow  fever,  and  it 
was  notefl  further  that  persons  attacked  did  not  subse^iuently  contract  yellow 
fever  when  the  epidemic  was  at  its  height. 

Inasmuch  as  the  two  Laredos  are  practicably  one  town  and  the  plaza,  above 
referred  to.  is  freciuented  night  and  day  by  Americans  from  La.redo.  Tex.,  it  is 
evident  that  but  a  short  time  would  have  elapsed  l)efore  the  disease  could  have 
been  introduced  into  Larwlo.  On  the  other  hand  we  have  the  evidence  of  Doctor 
Lowry  to  the  effect  that  Mr.  Clarke,  president  of  the  Texas-Mexican  Railroad, 
was  treate<l  l\v  him  at  Laredo.  Tex.,  for  yellow  fever  on  or  about  July  25.  Mr. 
Clarke  had  come  directly  from  ilonterey  before  being  taken  ill. 

Doctor  Lowry  is  one  of  the  most  prominent  physicians  of  Laredo,  and  had 
had  considerable  experience  with  yellow  fever.  He  states  that  he  was  i»uzzled 
us  to  the  diagnosis  in  Mr.  Clarke's  case  at  the  time,  but  in  the  light  of  after 
events  he  felt  so  sure  that  it  had  been  a  case  of  yellow  fever  that  he  issued  a 
certificate  to  that  effect. 

All  the  alx)ve  facts  show  the  impossibility  of  fixing  the  exact  date  or  mode 
of  the  introduction  of  yellow  fever  into  Laredo.  Tex.,  but  they  also  go  to  demon- 
strate the  fact  that  it  must  have  been  late  in  .July  or  the  beginning  of  August, 
and  that  the  disease  was  imi)orted  from  Monterey  or  Victoria  or  perh.aps  both. 

The  disease  at  first  must  have  si)read  slowly  (as  was  to  be  expected),  for  an 
examination  of  the  mortality  reports  do  not  show  anything  suspicious  until  the 
month  of  September.  During  the  last  half  of  this  month  the  disease  evidently 
gathered  rapid  headway,  and  within  a  few  days  after  our  arrival  (September  li.j) 
it  was  found  to  be  pretty  generally  disseminate<l  throughout  the  two  Laredos. 

The  Stcf/otin/id  fiiscirita  was  also  found  in  enormous  numbers  and  widely  dis- 
tributefl.  and  this,  with  the  existing  conditions  with  regard  to  the  water  supply, 
were  such  that  every  facility  was  being  afforded  for  the  active  propagation  of 
this  mosquito. 

GENERAL   CONDmONS. 

The  two  Laredos  are  situated  opposite  each  other  on  either  side  of  the  Rio 
Grande,  which  is  at  this  iK»int  about  .500  yards  wide,  with  a  small  islet  over 
toward  the  American  shore.  Two  bridges  span  the  river — one  for  pedestrians 
and  vehicles,  the  other  a  railroad  hridge.  Besides  these  means  of  connnunication 
there  is  a  boat  ferry,  and  the  stream  itself  is  easily  fordable  at  several  i>:iints. 

Lender  normal  conditions  the  population  of  Laredo.  Tex.,  is  estimated  at  1S.(m>0. 
and  that  of  Nuevo  Laredo  at  8.<^»<^t0  souls.  During  the  late  sununer  and  fall 
there  is  a  large  efflux  of  the  lalvoring  classes  who  go  to  the  Texas  cotton  fields 
to  obtain  employment  in  gathering  that  crop.  The  rumors  of  the  existence  of 
yellow  fever  and  the  final  declaration  of  its  presence  in  Nuevo  Laredo  on  Sep- 
tember l.";.  and  in  Laredo  on  September  25,  caused  a  large  exodus,  the  extent  of 
which  is  variously  estimated. 

The  general  impression  is  that  during  the  epidemic  there  remained  about 
10,000  people  in  Laredo  and  0.(X>0  in  Nuevo  Laredo.  This  number  was  materially 
increased  during  the  latter  stages  of  the  epidemic — that  is.  during  the  month  of 
November — by  the  return  of  the  cotton  pickers.  This  introduction  of  new  mate- 
rial at  that  time  exerted  a  baneful  influence  in  the  suppression  of  the  epidemic. 

The  population  of  .Nuevo  Laredo,  of  course,  consists  almost  entirely  of  Mexi- 
cans, there  being  very  few  Americans.  In  a  measure  the  same  might  be  .said  of 
Laredo,  Tex.     It  is  estimated  that  there  are  but  3,000  Americans  in  the  place. 

8629—04 20 


306  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

^loreover,  the  Mexicau  population  consists  almost  entirely  of  Mexicans  of  the 
lower  class,  ignorant  and  su{»erstitious. 

The  water  supply  of  both  towns  is  obtained  from  the  same  source,  the  Rio 
Grande.  A  private  waterworks  company  situated  on  the  American  side  sup- 
plies both  towns,  although  the  rates  are  such  that  the  poorer  classes  do  not  or 
can  not  avail  themselves  of  its  advantages,  so  that  the  sale  of  water  on  the 
streets  by  means  of  water  carts  is  a  thriving  industry.  These  carts  obtain 
their  water  directly  from  the  river.  The  water  suiiplied  by  the  waterworks 
company,  although  filtered,  is  claimed  to  be  very  muddy  the  greater  part  of 
the  year.  This  and  the  use  of  water  taken  directly  from  the  river  have 
given  rise  to  the  general  custom  of  using  barrels  for  the  purpose  of  allowing 
the  water  to  settle.  Every  house  is  supplied  with  from  one  to  ten  water  casks. 
These  are  naturally  kept  in  sheds  or  some  dark  or  shady  place  around  the  prem- 
ises. As  breeding  places  for  mosquitoes,  and  especially  the  fiteyomyiu  fasciata, 
it  would  be  difficult  to  improve  upon  them. 

The  habitations  of  the  poorer  classes  are  of  the  very  worst  type.  Many  are 
simply  adobe  huts  with  thatched  roofs  and  consist  of  but  one  room,  with  prob- 
ably a  shed  outside,  utilized  as  a  kitchen.  Others  are  niatle  of  lumber  with  no 
attempt  at  apposition  of  the  planks,  while  others,  again,  are  partly  or  wholly 
constructed  of  old  pieces  of  tin  or  iron,  with  just  enough  lumber  to  attach 
these  thereto.  It  is  no  exaggeration  to  say  that  in  most  parts  of  the  States 
domestic  animals  are  housed  better  than  many  of  the  people  of  Laredo. 

Two  railroads  enter  Laredo  from  the  north  and  east,  the  International  and 
Great  Northern  and  the  Texas-Mexican,  respectively.  These  connect  across  the 
railway  bridge  already  mentioned  with  the  Mexican  National  on  the  other  side 
of  the  Rio  Grande. 

As  already  stated,  the  financial  condition  of  the  city  of  Laredo  and  of  Webb 
County  was  such  that  neither  had  any  funds  available  to  carry  out  measures 
for  the  suppression  of  the  epidemic. 

Such,  then,  in  brief,  were  the  suroundings  and  circumstances  which  con- 
fronted us  when  the  presence  of  yellow  fever  was  officially  declared  at  Laredo 
September  2."). 

Quarantine  against  Laredo  having  been  declared  by  the  State  health  officer, 
all  railroad  traffic  out  of  Laredo  to  i)oints  in  the  Unitetl  States  was  at  once 
stopped.  Through  traffic  southward,  that  is,  to  points  in  Mexico,  was  continued. 
So  far  as  the  Texas-Mexican  Railroad  running  from  Laredo  to  Corpus  Christi 
is  concerned,  this  suspension  of  traffic  continued  throughout  the  epidemic,  de- 
spite the  efforts  made  to  reestablish  it. 

Through  passenger  travel  via  the  International  and  Great  Northern  Railroad 
to  points  north  of  Arkansas,  Indian  Territory,  and  the  Ohio  River  was  resumed 
on  September  28  and  continued,  with  several  interruptions,  during  the  epi- 
demic. These  interruptions  were  due  in  part  to  the  shotgun  quarantines  insti- 
tuted along  the  line,  particularly  by  Encinal  and  Frio  counties,  and  also  to 
the  lack  of  effort  on  the  part  of  the  railroad.  They  were  doing  a  losing  busi- 
ness, and  it  was  innnaterial  to  them  whether  they  continued  operations  or  not. 
and  the  Federal  and  State  authorities  seemed  impotent  to  compel  them  to  fulfill 
the  requirements  of  their  charter. 

In  view  of  the  accepted  laws,  based  on  well-proven  and  indisputable  facts 
relative  to  the  jiropagation  of  yellow  fever  by  the  Htcfjomyia  fasciata,  it  must  be 
said  that  the  (juarantine  restrictions  imposed  by  the  State  health  oflicer  were 
unnecessarily  severe  and  likely  to  defeat  the  end  in  view  on  account  of  their 
severity.  The  restrictions  were,  in  fact,  the  same  that  have  been  imposed  in 
lu-evious  yellow-fever  epidemics,  and.  if  anything,  somewhat  more  stringent.  In 
this,  however.  Doctor  Tabor  was  perfectly  frank  and  honest.  While  accepting 
the  facts  so  brilliantly  shown  in  the  extermination  of  yellow  fever  in  Habana, 
he  felt  that  he  could  not  accept  in  their  entirety  the  deductions  resulting  there- 
from. He  also  argued,  and  I  think  justly,  that  even  if  he  wei'e  to  establish  an 
intelligent  and  rational  system  of  quarantine,  public  opinion  would  not  support 
him,  and  the  result  would  have  been  that  the  State  quarantine  would  have  been 
supplanted  by  innumerable  vexatious  county,  shotgun,  and  other  irrational  sys- 
tems of  quarantine.  In  this  Doctor  Tabor  was  quite  right;  but  yet  it  remains  a 
debatable  question  whether  it  is  better  under  such  circumstances  to  yield  to  pub- 
lic clamor  or  to  insist  on  the  truth  and  act  accordingly.  I  confess  that  I  would 
prefer  the  latter. 

Freight  traffic  from  Laredo  was  entirely  suspended  during  the  epidemic,  work- 
ing great  hardship  to  the  business  interests  of  the  town.     It  seemed  a  pity  to 


PUBLIC    HKALTH    AND    MARINE-HOSPITAL    SKRVICE.  ilO? 

see  these  interests  sacrificed  wlicii  tlicrc  were  means  whereby  they  could  have 
been  conserved  witliout  danger  of  carrying  infection. 


DETENTION    CAMP. 

A  detention  or  refugee  oanip  was.  of  course,  necessary  to  facilitate  the  exit 
of  i)eople  from  Laredo.  The  Puidic  Health  and  .Marine-Hospital  Hureau  had 
made  provision  for  such  an  cnicrircncy  when  the  first  minors  of  yellow  fever 
on  the  border  were  circulated,  two  or  thnv  weeks  before  the  <lis(>ase  was  ofii- 
clally  announced  to  be  present  in  Laredo.  A  complete  cam])  outfit  for  luo  per- 
sons had  been  shipped  from  New  Orleans  and  arrived  in  the  neighborhood  of 
Laredo  at  the  very  moment  when  it  was  most  needed.  Owing  to  this  wise  jiro- 
vision  of  the  Bureau,  we  were  enabled  at  a  critical  moment  to  offer  Doctor 
Tabor  the  material  necessary  for  a  detention  camp,  of  which,  for  the  reasons 
already  stated,  he  considered  it  his  duty  to  take  charge. 

One  of  the  camps  was  situated  at  Sanchez,  a  siding  about  five  miles  north  of 
Laredo,  on  the  International  and  (Jreat  Northern  Railroad,  and  Doctor  Cock, 
a  capable  officer,  placed  in  charge  of  the  same.  The  camp  was  opened  October 
2,  with  sufficient  accommodation  for  25  refugees.  Later  on  its  capacity  was 
increased  to  40. 

A  small  camp,  known  as  "  Camp  Daniel,"  was  also  established  on  the  Texas- 
Mexican  Railroad,  about  5  miles  to  the  east  of  the  city.  This  was  scarcely  util- 
ized, for  the  reason  that  Duval  and  Nueces  counties,  through  which  the  road 
runs,  had  instituted  a  quarantine  of  absolute  non intercourse.  The  outfit  for 
both  camps  was  loaned  to  the  State  authorities  by  the  Public  Health  and  Marine- 
Hospital  Service. 

Camp  Sanchez  had  a  varied  existence.  It  served  a  good  purpose,  although  not 
much  patronized,  only  about  70  persons  passing  through  the  camp  from  October 
1  to  November  2.  It  became  infected  October  14 ;  that  is,  a  case  of  yellow  fever 
developed  among  the  refugees  and  remained  there  for  seven  or  eight  hours  be- 
fore it  was  removed,  long  enough  to  have  infected  some  mosquitoes,  if  any  were 
present.  Another  case  of  yellow  fever  occurred  at  the  camp  during  the  month 
of  October.  The  camp  was  closed  November  2,  and  then  reopened  about  Novem- 
ber 14  at  the  urgent  request  of  citizens. 

The  certificates  of  Camp  Sanchez  were,  in  some  cases,  rejected  by  county 
authorities. 

QUARANTINE   AGAINST    MEXICO. 

To  prevent  the  introduction  of  further  infection,  a  strict  quarantine  was  kept 
up  against  infected  points  in  Mexico.  The  border — that  is,  the  Rio  Grande — 
was  patroled  by  guards.  These  consisted  of  a  number  of  Texas  Rangers,  under 
the  direction  of  State  Health  Officer  Tabor,  and  about  50  men  employed  by  the 
Service  and  aided  by  United  States  customs  inspectors.  They  worked  harmoni- 
ously together  and  did  good  service,  although  I  do  not  consider  that  the  patrol 
was  entirely  effective.  The  natural  conditions  of  the  river  b'etween  the  two 
cities,  and  for  miles  above  and  below,  are  such  that  it  would  take  a  very  large 
force  of  well-disciplined  men  to  make  it  absolutely  secure  against  the  possibility 
of  anyone  crossing  who  had  especial  interest  in  doing  so  and  possessed  the 
necessary  courage. 

A  chart  is  herewith  appended  (marked  "Exhibit  C")  showing  the  frontier 
protected  by  the  guards,  as  also  the  numerous  fords  and  ferries  affording  means 
of  communication  across  the  river.  Of  course,  when  quarantine  was  declared 
against  New  Laredo,  September  15,  all  skiffs  were  prohibited  from  crossing. 

SANITAEY   WORK   OF   SERVICE. 

As  before  stated,  the  work  assigned  to  the  Public  Health  and  Marine-Hospital 
Service,  at  the  conference  of  September  25,  was  the  most  important  in  the  cam- 
paign against  the  prevailing  epidemic  of  yellow  fever.  It  consisted,  firstly,  of 
protecting  the  border  against  the  admission  of  any  additional  infection,  and. 
secondly,  the  stamping  out  of  the  epidemic  in  Laredo.  The  frontier  guard  had 
already  been  established  by  Acting  Assistant  Surgeon  Hamilton,  and  has  been 
briefly  described  above. 


308  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

The  second  and  more  important  part  of  our  undertaking  was  entered  into 
with  great  enthusiasm,  and  during  the  first  few  days  we  were  filled  with  the 
hope  that  our  efforts  would  be  crowned  with  brilliant  results;  that  is,  that  we 
would  be  able  to  wipe  out  the  epidemic  in  a  month  or  six  weeks.  In  this  we 
were  doomed  to  disappointment.  It  was  soon  found  that  the  disease  was  too 
widely  spread  and  that  the  obstacles  to  be  overcome  in  carrying  out  the 
necessary  sanitary  measures  were  many  and  serious,  and  in  some  cases  insur- 
mountable under  existing  circumstances.  However,  while  the  results  of  our 
efforts  did  not  come  up  to  our  exi)ectations,  they  were  gratifying  and  productive 
of  much  good,  as  the  seijuel  will  show. 

The  day  after  my  arrival  two  disinfecting  and  screening  gangs  were  at  work 
under  my  personal  supervision,  and  the  newly  appointed  acting  assistant  sur- 
geons, E.  H.  Sanvignet,  A.  W.  Wilcox,  and  Robert  L..  Dinwiddle,  were  given 
instructions  on  mosquito  disinfection  as  practiced  in  Habana  and  as  described 
by  Dr.  John  Guiteras  in  Public  Health  Reports  of  July  12.  1903. 

Acting  Asst.  Surg.  John  Frick  reported  for  duty  the  morning  of  September  26, 
Pharmacist  M.  Walerius  the  same  afternoon,  and  Passed  Asst.  Surg.  R.  H.  von 
Ezdorf  the  following  day.  Surg.  R.  D.  Murray  joined  us  on  the  28th.  Pharma- 
cist and  Special  Disbursing  Agent  F.  S.  Goodman  reported  first  week  in  October. 

On  September  2G  an  office  was  established  in  the  central  part  of  the  city 
for  the  transaction  of  business,  and  on  the  27th  the  sanitary  corps  under  my 
command  was  given  a  definite  organization.  Four  mosquito  sections  had  been 
formed  with  an  acting  assistant  surgeon  in  charge  of  each,  and  Passed  Assistant 
Surgeon  von  Ezdorf  given  general  supervision  over  the  entire  squad.  Each 
section  consisted  of  al)out  8  men,  one  of  whom  was  a  carpenter  and  another  was 
designated  as  foreman  and  had  charge  of  the  material.  Each  section  was  sup- 
plied with  a  cart  containing  all  the  material  necessary  for  the  work,  to  wit, 
sulphur  and  pyrethrum  powder  in  sufficient  quantity,  25  pots,  25  pans,  5-gallon 
can  wood  alcohol,  roll  of  paper,  shears,  knives,  bucket  of  paste,  brushes,  brooms, 
wall  brushes,  mosquito  netting,  a  nuujber  of  strips  of  laths,  nails,  hatchet,  saw, 
ready-made  screen  doors  and  windows,  ladder,  5-gallon  can  kerosene  oil. 

Within  a  short  time  the  above  system  was  somewhat  modified  with  the  object 
of  gaining  time  and  effectiveness.  The  carpenters  were  separated  from  the 
general  disinfecting  sections  and  formed  at  first  into  two,  and  later  into  three, 
"  screening  "  sections.  These  were  composed  each  of  two  or  three  carpenters, 
supplied  with  a  wagon,  carrying  tools,  lumber,  mosquito  l)ars  and  mosquito 
netting.  The  modus  operandi  was  then  as  follows :  Immediately  on  a  case 
(whether  suspicious  or  positive)  being  reported  to  us  from  the  State  board  of 
health  or  anyone  having  authority  to  do  so,  a  screening  si'ction  was  at  once 
sent  out  and  the  infected  house  "screened."  This  "screening"  varied  accord- 
ing to  circumstances.  Unnecessary  doors  and  windows  were  closed  tight.  One 
window  and  a  door  of  the  patient's  room  were  left  open  for  ventilation  and  to 
admit  those  caring  for  him,  and  both  of  these  fitted  with  screens.  Often  the 
conditions  did  not  admit  of  this.  The  shacks  or  "  jacals  "  of  the  poorer  classes 
consisted  of  but  one  room  with  innumerable  cracks  and  openings  in  the  walls 
and  rooms.  Screening  was  impracticable  here  and  the  patient  was  placed  under 
a  mosquito  bar.  Toward  the  end  of  the  epidemic  I  had  a  portable  mosquito 
house  built,  covered  with  wire  gauze  and  with  double  doors,  which  was  applica- 
ble to  such  cases.  The  patient  being  thus  isolated  and  rendered  as  safe  as  possi- 
ble against  propagating  the  disease  by  infecting  the  mosquito,  the  disinfecting 
section  would  come  along  and  disinfect  the  i>remises  and  surrounding  houses  to 
kill  the  insects  already  infected.  It  was  the  duty  also  of  the  disinfecting  section 
to  pour  oil  in  all  cisterns,  barrels,  or  other  receptacles  of  stagnant  waters 
found  on  the  premises  disinfected. 

PROCESS  OF  DISINFECTION. 

The  details  of  the  process  were  as  follows :  The  room  or  house  was  made 
mosquito  tight.  To  accomplish  this  all  doors  and  windows  were  closed.  Paper 
was  then  cut  into  strips  and  pasted  over  all  cracks  or  openings  through  which 
mosquitoes  might  escape  ;   the  chimney  was  made  secure. 

In  manj^  cases  houses  were  in  such  bad  condition  that  they  had  to  be  almost 
completely  papered  over,  both  inside  and  out,  and  large,  unprotected  openings 
covered  entirely  with  sheets  of  paper.  In  the  meantime  the  pots  were  being 
tilled  with  sulphur  or  ijyrethrum.  as  the  case  might  demand,  and  placed  in  posi- 
tion on  pans  filled  with  water.  These  water  pans  served  a  double  purpose :  To 
prevent  danger  from  fire  and  for  the  purpose  of  collecting  mosquitoes,  for  expe- 


PUBLIC    HEALTH    AND    MARINE-HOSPTTAL    SERVICE.  309 

rlence  had  shown  that  after  ilisiiifeotion  nearly  all  the  dead  mosquitoes  within 
the  room  were  found  in  these  pans. 

The  plan  used  in  Uahana  to  faeilitate  the  patherinir  of  the  mos(]uito  was 
employed  at  first:  that  is,  to  place  a  moist  piece  of  paper  in  front  of  a  window 
or  wherever  li.^'ht  mi.t,'ht  enter,  with  the  oliject  that  after  disinfection  the  major- 
ity of  the  dead  or  stunned  insects  would  he  found  on  this  i)aper.  Tliis  plan 
was  hased  on  the  supposition  that  the  mosipiito  soutrht  the  lijiht  and  fell  upon 
the  moist  paper  and  adhered  to  it.  This  method  was  discontinued  when  expe- 
rience showed  us  that  what  attracted  the  moscjuito  during  the  process  of 
asi)hyxiation  was  the  water  and  not  the  light,  for  they  were  invariahly  found 
in  the  water  pans  even  when  these  were  in  dark  corners. 

The  i)ots  and  pans  being  in  i)ositi<)n,  about  50  cubic  centimeters  of  alcohol 
were  poured  on  the  sulphur  or  iiyi-ethrum,  as  the  case  might  be,  and  the  contents 
ignited.  Then  without  loss  of  time  the  disinfectors  would  retire,  closing  the 
last  door  of  exit  and  pasting  i)aper  over  any  cracks  that  might  be  found  in  the 
same.  ^Yhen  the  house  admitted  of  it  all  rooms  except  that  of  the  patient 
were  first  disinfected,  and  he  was  then  removed  to  one  of  the  disinfected  rooms 
duly  protected  from  mos(iuitoes,  so  as  to  admit  of  the  disinfection  of  the  I'oom 
occupied  by  him.  A  great  number  of  the  houses  or  "  jacals  "  consisted  of  hut 
one  apartment,  in  which  case  the  patient  was  removed,  temporarily,  under  a 
tent  during  the  process  of  disinfection.  The  latter  plan  was  inapplicable  in 
cold  or  bad  weather,  and  then  it  A^as  necessary  to  wait  until  circumstances 
would  admit  of  disinfection,  keeping  the  patient  screened  in  the  meantime. 

For  the  purposes  of  mosquito  disinfection  sulphur  was  burned  in  the  propor- 
tion of  4  pounds  to  the  1,000  cubic  feet  with  four  hours"  exposure ;  jiyrethrum 
6  pounds  to  the  1,000  cubic  feet  and  0  hours'  exposure. 

On  the  termination  of  the  disinfection  the  house  was  opened  and  the  floors, 
walls,  furniture,  etc.,  carefully  swept  for  the  purpose  of  collecting  all  asphyx- 
iated mosquitoes  and  inunediately  incinerating  them.  When  pyrethrum  was 
used  as  a  disinfectant  this  ojteration  was  done  with  scrupulous  care,  when 
using  sulphur  it  was  not  so  necessary,  as  the  insects  were  always  found  dead. 
As  before  stated,  the  great  ma.1ority  of  the  insects  were  found  iu  the  water  pans 
beneath  the  pots. 

There  is  no  question  but  that  sulphur  is  the  best  agent  for  mosquito  disinfec- 
tion. It  is  certain  in  its  effects,  and  during  the  short  exposiu'e  necessary  to  kill 
the  mosquito  little  or  no  harm  is  done  to  fabrics  or  other  articles  usually 
injured  in  this  process  when  the  exposure  is  of  longer  duration.  Sulphur  was 
our  main  relianc.e,  although  pyrethrum  was  used  where  any  possibility  of  dam- 
age was  to  be  apprehended.  Of  the  large  number  of  houses  disinfected — 2.952 — 
there  was  not  a  single  case  of  well-founded  complaint  of  appreciable  injury 
caused  by  the  process  of  disinfection. 

The  above-described  plan  was  adhered  to  until  the  end  of  the  epidemic,  with 
the  modification  that  the  duties  of  oiling  cisterns,  barrels,  and  receptacles 
assumed  such  proportions  and  were  of  such  paramount  importance  that  they 
were  in  great  part  taken  away  from  the  disinfecting  sections  and  turned  over 
to  an  independent  section.  The  former,  however,  always  carried  a  supply  of 
oil  and  were  ordered  to  inspect  and  oil  all  standing  water  not  previously  oiled. 

The  importance  of  destroying  all  breeding  places  for  mosquitoes  was  apparent 
from  the  beginning  of  the  campaign,  and  the  disinfecting  sections  were  duly 
instructed  as  to  their  duties  in  that  respect.  But  of  course  these  only  reached 
premises  that  had  been  reported  infected  and  their  immediate  surroundings. 

It  had  been  arranged  that  the  State  and  city  liealth  authorities  would  under- 
take a  general  sanitary  inspection  and  oiling  of  all  water  containers.  This  was 
carried  out  on  a  small  scale  for  a  couple  of  weeks,  but  it  soon  became  apparent 
that  the  work  was  not  thorough  and  therefore  not  effective.  This  was  due 
apparently  to  lack  of  funds. 

Deeming  the  destruction  of  breeding  places  for  the  mosquito  of  the  utmost 
importance,  I  suggested  to  Health  Officer  Tabor  that  I  undertake  the  work. 
To  this  he  assented  very  willingly,  offering  to  aid  us  in  every  way  in  his  power 
to  carry  out  our  designs.  Doctor  Tabor's  aid  was  very  effective  iu  procuring 
a  large' quantity  of  crude  oil  and  in  enforcing  a  strict  quarantine  against  those 
who  refused  toallow  us  to  proceed  with  our  work.  So  that  on  the  9th  of  Octo- 
ber an  oiling  section  was  organized  and  set  to  work.  This  section  was  put  in 
charge  of  Acting  Assistant  Surgeon  Frick,  with  a  wagon  carrying  the  necessary 
material.  Subsequently  it  was  divided  into  two  sections,  one  attending  to  the 
snriukling  of  streets,  pools,  ponds,  and  other  large  bodies  of  standing  water,  the 


310  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

other  looking  after  water  barrels,  cisterns,  pails,  tin  cans,  and  all  other  water 
containers  fonnd  in  the  neighborhood  of  houses. 

Naturally  much  opposition  arose  against  the  oiling  of  water  barrels,  espe- 
cially among  the  ignorant  classes,  who  were  led  to  believe  that  our  object  was 
to  poison  the  water.  On  several  occasions  this  opposition  assumed  serious  and 
menacing  proportions,  so  much  so  that  the  lives  of  the  officers  and  men  engaged 
in  the  work  were  threatened.  To  obviate  this  difficulty  it  was  decided  to  put 
wooden  faucets  in  the  barrels  of  drinking  water,  so  that  the  water  might  be 
drawn  from  below  free  from  oil  contamination.  The  "oiling  section"  was  duly 
supplied  with  these  faucets,  with  instructions  to  apply  them  to  all  barrels  con- 
taining water  for  drinking  purposes.  This  measure  was  very  effective  in  allay- 
ing irritation  and  averting  trouble  with  the  people.  It  greatly  facilitated  the 
work  and  made  it  more  effective,  although  there  were  always  some  who  objected 
violently  against  any  interference  on  our  jiart  with  their  water  barrels. 

Within  a  short  time  the  "oiling  section,"  under  its  efficient  chief,  became  so 
apt  in  its  duties  that  the  entire  city  could  be  inspected  and  oiled  in  five  or  six 
days,  so  that  within  that  time  every  water  container  and  other  deposits  of 
standing  water  was  inspected  and  treated,  making  it  impossible  for  the  mos- 
quito larva>  to  arrive  at  maturity.  During  the  first  tour  of  the  town  3,500 
barrels,  without  including  other  containers,  were  oiled. 

I  consider  this  as  one  of  the  most  important  features  in  the  campaign  against 
yellow  fever  at  Laredo,  and  too  much  praise  can  not  be  given  Doctor  Frick  for 
the  energy  and  intelligence  with  which  he  handled  every  detail  of  the  work 
committed  to  him.  The  results  were  so  gratifying  that  when  Assistant  Sur- 
geon Goldberger  arrived  in  Laredo  November  21,  under  orders  from  the 
Bureau  to  secure  specimens  of  larvii?  of  the  t^tajomyia  fasciata,  he  found  it 
impossible  to  secure  a  sufficient  number  for  the  purposes  contemplated.  A 
thorough  inspection  of  the  town  on  three  or  four  successive  days  yielded  but 
about  100  mos(iuito  larvjne  half  of  which  were  anopheles. 

The  following  table  gives  a  synopsis  of  the  immense  amount  of  work  done 
by  the  oiling  brigade  from  October  9  to  November  30,  both  dates  inclusive.  The 
entire  town  was  gone  over  six  times. 

8y)iopsis  of  tvorlc  done  hij  oiling  brigade. 

Containers  oiled 22,  458 

Excavations   oiled 2,  582 

Tanks  and  wells  oiled 499 

Premises  oiled 3, 134 

Premises   inspected 10,  040 

Faucets  applied  to  water  barrels 1,075 

City  blocks  sprinkled  with  oil 2,134 

In  addition,  about  70,000  square  feet  of  standing  water  were  oiled  in  neigh- 
boring "  arroyos  "  or  creeks  and  on  the  streets  after  rainstorms. 

As  the  epidemic  increased  the  number  of  disinfecting  sections  was  increased 
by  the  addition  of  two  large  ones,  composed  of  10  men  each  with  an  experienced 
foreman  and  the  necessary  outfit.  It  had  become  evident  that  the  Habana 
methods  of  controlling  yellow  fever  were  not  (luite  applicable  to  Laredo  under 
existing  circumstances,  and  it  was  determined  to  undertake  a  systematic  and 
complete  disinfection  of  the  entire  city.  These  two  sections  were  started  at  the 
southeast  and  southwest  extremities  of  the  town,  working  toward  each  other 
and  at  the  same  time  pushing  north.  Every  house  and  building  was  included  in 
this  disinfection — schools,  public  buildings,  and  churches — no  matter  whether 
or  not  they  had  been  previously  disinfected.  By  December  1  two-thirds  of  the 
town  had  been  covered  by  this  general  disinfection,  including  its  most  thickly 
populated  portions.  This  work  was  continued  after  December  1  by  Acting 
Assistant  Surgeon  Frick  and  completed  under  his  direction. 

From  September  20  to  November  30,  both  dates  inclusive,  2,952  houses  and 
buildings,  containing  10,045  rooms,  were  disinfected.  Repetitions  are  included 
in  the  above  figures,  quite  a  number  of  houses  having  been  disinfected  more 
than  once,  a  few  as  many  as  three  or  four  times. 

The  following  table  gives  a  resume  of  the  work  of  disinfection: 

Houses  or  rooms  screened 304 

Patients  screened  under  mosquito  bars 115 

Houses   disinfected ^»  952 

Rooms  disinfected , 10,045 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  311 

It  is  ostiiii;ito(l  (hilt  llioro  arc  2.1)(;;>  hoUses  in  Laredo.  This  figure  was 
obtained  after  careful  investigation. 

Of  the  above  number  r>S(),  or  I!).")-!  per  eent,  were  infected— in  other  words,  one 
liouse  in  live.  Tliese  figures  show  tliat  tlie  infection  was  well  generalized.  The 
work  of  screening  and  disinfection  was  under  (he  innnediate  suitervision  of 
Passed  Assistant  Surgeon  Von  Ezdorf  and  was  admirably  directed  by  him. 

Such  then,  in  brief,  was  the  plan  of  c;impaign  adopted  to  stamp  out  the 
epidemic. 

To  recapitulate:  («)  The  isolation  of  the  patient  by  screening;  (h)  the  fumi- 
gation of  the  infected  premises  for  the  purpose  of  killing  infected  and  other 
mos(piitoes  ;  (c)  to  prevent  tlie  propagation  of  the  Stc(;<»ii!/ia  fusciatd  by  covering 
all  stagnant  water  with  oil,  killing  the  larva',  and  preventing  the  laying  of  eggs; 
((/)  the  general  and  systematic  disinfection  of  the  entire  city. 

It  may  be  well  now  to  discuss  the  dilliculties  encountered  in  the  progress  of 
the  work  and  which  interfered  materially  with  its  effectiveness.  These  may  be 
discussed  undtM-  four  heads  :  ( 1 )  Lack  of  sufficient  authority  to  carry  out  neces- 
sary sanitary  measures;  (•2)  ignorance  of  the  people;  i^.^)  the  possibiliy  of  the 
introduction  of  infected  mosquitoes  from  Neuvo  liaredo,  across  the  Kio  Grande; 
(4)  unfavorable  weather. 

The  first  two  items  being  closely  associated  will  be  taken  up  together. 

(1)  Lack  of  sutlicient  authority  to  carry  out  sanitary  measures  and  (2) 
ignorance  of  the  people. 

When  yellow  fever  was  declared  to  be  present  in  Laredo  and  the  town  quar- 
antined, a  large  part  of  the  people,  particularly  the  ignorant  class,  were 
filled  with  the  idea  that  the  doctors  and  the  authorities  were  in  a  conspiracy 
against  them,  and  that  the  main  object  they  had  in  view  was  the  making  of 
money.  They  wont  even  further,  and  it  was  quite  generally  believed  that  the 
physicians  poisoned  their  iKitients  to  get  rid  of  them  as  soon  as  possible  and  in 
this  summary  manner  end  the  epidemic.  Patients  not  only  refused  treatment, 
but  resisted  frequently  to  permit  the  use  of  the  clinical  thermometer,  thinking 
that  this  too  was  poisoned.  This  was  certainly  an  amazing  condition  of  affairs, 
and  it  was  difficult  to  believe  that  such  perversion  and  crass  ignorance  could 
exist  within  the  confines  of  the  Republic.  These  extravagant  opinions  were  sup- 
ported by  one  or  two  irresponsible  sheets  printed  in  Laredo. 

Under  such  circumstances  it  is  not  to  be  wondered  at  that  all  possible  means 
were  resorted  to  to  hide  cases  from  the  physicians  and  inspectors.  It  frequently 
happened  that  when  a  doctor  reached  a  house  where  some  one  had  been  reported 
sick  no  patient  was  found,  the  sick  one  having  been  removed  to  other  quarters 
or  else  the  house  would  be  found  empty  and  closed,  the  entire  family  having 
moved  away. 

Patients  very  ill  with  yellow  fever  have  been  known  to  get  out  of  bed  and 
hide  in  a  privy  or  other  outbuilding  when  informed  that  a  doctor  or  inspector 
was  approaching.  And,  moreover,  they  usuall.v  had  some  member  of  the  family 
on  guard  to  give  the  required  information. 

A  house-to-house  inspection  was  couuneuced  under  the  direction  of  the  State 
health  officer  Septemlfer  20.  This  was  later  on  supplemented  by  volunteer 
inspectors  named  by  the  mayor.  The  results  were  not  satisfactory.  This  is  not 
to  be  wondered  at,  remembering  the  difficulties  mentioned  above.  Finally  it 
became  so  apparent  that  cases  were  being  hidden  and  that  this  was  one  of  the 
principal  reasons  why  the  epidemic  could  not  be  controlled  that  I  witlidrew  tlio 
four  acting  assistant  surgeons  in  charge  of  disinfecting  work,  and,  appoint- 
ing an  individual  one,  started  them  on  house-to-house  inspection  on  November  0. 
They  worked  with  good  results  for  several  days,  when  the  better  class  of  citi- 
zens becoming  interested  in  the  matter  offered  their  services  as  inspectors. 
These  were  put  to  work  under  tlie  direction  of  a  committee  consisting  of  the 
sheriff,  the  county  clerk,  the  State  health  officer,  the  representative  of  the 
Public  Health  and  Marine-IIospital  Service,  and  several  prominent  citizens. 
The  results  of  this  intelligent  volunteer  inspection  force,  working  in  conjunction 
with  and  under  the  direction  of  the  sanitary  officers,  were  excellent.  In  a  little 
over  two  weeks,  with  the  aid  of  favorable  weather,  the  epidemic  was  entirely 
under  control.  Too  much  praise  can  not  be  given  these  citizens  for  the  disin- 
terested and  effective  work  done  by  them,  and  it  is  to  be  regretted  that  their 
services  were  not  offered  at  an  earlier  date. 

In  organizing  the  plan  of  campaign  against  the  epidemic,  one  of  the  first  things 
that  occurred  to  the  writer  was  the  establishment  of  a  hospital.  Without  one 
the  entire  system  appeared  faulty  and  ineffective.     This  was  especially  the  case 


312  PUBLIC    HEALTH    AND    MARINK-H()«P1TAL    SERVICE. 

in  a  town,  such  as  Laredo  has  boeii  describeil  to  be,  witli  a  very  large  and  igno- 
rant i)roletai'int  living  in  houses  which  scarcely  merited  the  name  and  under 
hygenic  conditions  which  must  be  seen  to  be  l)elieved.  Here  was  a  large  part 
of  the  i)()i)idati()n  unable  to  care  for  its  sick,  and  among  whom  the  problem  of 
mosquito  disinfection  was  surmounted  with  dilHcnlties  which  were  at  times 
insurmountable. 

How  was  a  miserable  "jacal  "  consisting  of  but  one  room  8  or  10  feet  square 
and  about  <!  or  S  feet  in  height  made  up  of  boards  loosely  thrown  together  or  tin 
cans  or  old  sheets  of  tin  or  iron  and  other  inconceival)le  materials,  with  cracks 
and  open  spaces  everywhere — how,  I  say,  could  such  a  structure  be  effectively 
disinfected? 

In  many  cases  the  patient  had  to  be  removed  to  the  shelter  of  a  tent  and  the 
house  papered  inside  and  out  before  disinfection  could  be  attempted.  But  in  a 
structure  such  as  has  been  described  the  removal  of  the  patient  and  the  very 
process  of  making  it  tit  for  moscpiito  disinfection  defeated  in  a  measure  the 
object  in  view,  for  the  movements  of  the  men  of  the  disinfecting  gang  within  a 
space  so  reduced  would  be  sufficient  to  dri\e  out  the  mosquitoes  within  the 
inclosure. 

The  attempt  to  screen  a  patient  under  such  circumstances  was  equally  difficult 
and  naturally  was    not  as  effective  as  c(mld  have  been  wished. 

A  mosijuito-proof  hospital,  where  such  patients  could  have  been  removed  at 
once,  was  therefore  of  the  greatest  importance.  P.ut  here  again  we  were  con- 
fronted with  the  ignorance  of  the  people  and  the  lack  of  authority  to  enforce 
sanitary  measures.  After  consultation  with  the  mayor  and  other  prominent 
citizens  I  was  dissuaded  from  carrying  out  my  intentions  respecting  the  estab- 
lishment of  a  hospital.  It  was  impressed  upon  me  that  the  very  class  of  cases 
I  wished  to  remove  to  a  hospital  would  absolutely  refuse  to  go,  and  that  there 
was  no  authority  to  force  them  to  do  so.  My  experience  with  the  people 
soon  showed  me  that  this  was  true,  and  the  plan  to  establish  a  hosi)ital,  while 
ever  present  to  my  mind,  was  finally  abandoned.  However,  I  believe  it  was  an 
error  not  to  have  carried  out  my  original  intention,  and,  under  similar  circum- 
stances and  with  my  experience  at  Laredo,  I  would  insist  on  a  hospital,  well 
appointed  and  well  managed,  hoi)ing  in  a  short  time  by  a  demonstration  of  its 
merits  to  overcome  the  prejudice  against  it. 

The  lack  of  authority  to  carry  out  sanitary  measures  was,  as  may  be  seen 
from  what  has  gone  before,  the  most  important  obstacle  to  our  success  in 
dominating  the  epidemic.  It  interfered  with  the  h(mse-to-house  inspection,  with 
the  oiling  of  barrels  and  cisterns,  with  the  screening  and  disinfection  of  houses 
and  premises,  and  prevented  the  establishment  of  a  yellow-fever  hospital. 
Doubtless  the  necessary  authority  could  have  been  assumed,  legally  or  otherwise 
(as  had  been  done  before  in  Laredo  during  a  smalli)ox  epidemic  in  1895). 
There  is  every  reason  to  suppose  that,  as  in  the  instance  cited  above,  this  would 
have  led  to  some  bloodshed,  but  the  situation  would  have  been  controlled.  There 
was  no  one  in  authority,  however,  ready  to  take  the  necessary  risk,  and  the  sheriff 
of  Webb  County,  who  could  have  been  of  great  assistance  in  such  a  case,  was  luke- 
warm in  his  efforts  to  aid  us.  On  the  other  hand  the  mayor  and  the  city 
council  gave  us  their  assistance  to  the  limit  of  their  powers.  The  mayor  was 
always  ready  to  follow  or  enforce  any  suggestions  that  were  offered.  Unfor- 
tunately his  powers  were  limited.  The  city  council  at  my  suggestion  passed  an 
ordinance  October  31  (which  became  effective  ten  days  later)  giving  quarantine 
and  sanitary  officers,  whether  Federal,  State,  or  county,  authority  to  inspect  and 
carry  out  all  necessary  sanitary  measures  within  the  city,  imposing  certain 
penalties  upon  those  who  resisted.  It  is  the  first  time  to  my  knowledge  that 
such  powers  have  been  given  to  Federal  officers  under  similar  circumstances. 
Copy  of  the  ordinance  is  herewith  appended,  marked  "  Exhibit  D."  This 
measure  of  the  city  council  was  of  considerable  moral  and  practical  assistance 
in  the  work  we  had  in  hand.  I'nfortunately  it  came  too  late,  and,  moreover, 
it  is  doubtful  if  the  city  had  sufficient  police  power  to  make  it  effective. 

The  Laredo  epidemic  has  shown  conclusively  to  my  mind  that  results  such  as 
were  obtained  in  Ilabana  in  the  suppression  of  yellow  fever  during  the  American 
occupation  can  not  be  obtained  elsewhere,  where  the  disease  is  widely  spread, 
without  the  undisputed  authority  and  the  means  that  were  at  the  command  of  the 
government  of  intervention  in  Cuba.  These  powers  in  reality  amounted  to  mar- 
tial law.  In  Habana,  too,  there  was  no  tendency  to  hide  cases,  and  Spanish 
emigrants,  who  furnished  the  majority  of  the  cnses,  were  promptly  taken  by 
their  friends  to  a  "  quinta  de  salud  "  or  private  hosjatal,  connected  with  bene- 
ficial aid  societies,  of  which  there  are  several   in   Ilabana,  and  in  this  way 


PUBLIC    HEALTH    AND    MAKINK-HOSl'ITAL    SKRVICE.  313 

promptly  c:\mo  under  tlio  ohsorvatioii  of  the  autlioritios,  so  that  proper  pre- 
caution eoulil  !«(>  taUcu.     This  siiiiplilicd  matters  very  much. 

I  l)elieve  that  under  martial  law  the  Laredo  epidemic  could  have  heen  eon- 
trolled  within  three  or  four  weel<s  after  the  disease  had  ItecMi  ollicially  declared, 
Septend)er  25.  even  thoufrh  at  that  time  it  had  already  invaded  maiiy  parts  of 
the  town.  When  one  considers  what  this  would  have  meant  to  Laredo  in  the 
savinjj  of  life,  the  conservation  of  couunercial  and  raih-oad  interests,  and  in 
addition  the  benelits  to  the  surroundinu;  districts,  it  becomes  a  serious  (pies- 
tion  whether  under  such  circumstances  the  establishment  of  martial  law  or 
something:  (Mpiivalent  to  it  should  not  be  the  very  first  stej)  to  be  taken  in  the 
supi>ression  of  an  outbreak  of  yellow  fever  or,  in  fact,  (jf  any  other  of  the 
epidemic  diseases. 

In  most  ei)i(lenucs  the  hardshiiis  endured  by  th(>  i»eople,  the  loss  of  life,  the 
interrui>tion  of  conuuerce,  causinic  heavy  tinancial  losses,  all  .are  greater  thiiu  in 
the  case  of  riots  or  other  disturbances  of  the  peace  for  which  ordinarily  mar- 
tial law  is  impos(>d.  Such  beinj^  the  case,  it  is  not  clear  why  this  efficient 
means  of  combating;  an  ei)idemic  should  not  be  more  stron.i,dy  reconnnended, 
nor  why  so  much  opi)osition  should  be  aroused  aj^aiust  it  when  it  is  s\ij^jjcested. 

Now,  let  us  imiuire  into  the  third  ditliculty  which  presented  itself  to  our 
efforts  to  control  the  epidemic  ;  that  is,  the  i)roxinuty  of  Nuevo  Laredo  and  the 
possibility  of  nios(iuitoes  beinjj;  carried  by  the  wind  iuross  the  Hio  (irande. 

In  Nuevo  Laredo  no  jtractical  or  jiener.il  mosquito  disinfection  was  done  initil 
late  in  the  epidemic,  when  somethini;  was  attempted  in  that  line.  I'revious  to 
that  but  few  houses  had  been  disinfected,  for  those  only  were  treated  where  a 
lecognized  case  of  yellow  fever  bad  occurred,  and  inasmuch  as  the  Mexican 
experts  refused  or  could  not  recognize  yellow  fever  in  its  mild  or  even  semi- 
severe  form,  calling  all  such  cases  malaria,  the  large  majority  of  infected  houses 
were  unattended  to. 

The  number  of  infected  Stegomyia  must  therefore  have  been  very  great.  Dur- 
ing the  snnniier  and  fall,  and  until  such  time  as  the  northers  begin  to  blow  with 
frequency,  the  i)revailing  wind  is  from  the  southeast  and  south;  that  is,  directly 
across  the  river  from  Nuevo  Laredo  toward  Laredo.  Ilie  wind  at  times  blows 
with  considerable  force.  As  already  stated,  the  width  of  the  river  is  about  L500 
feet,  and  there  is  a  long,  narrow  island,  covered  in  part  with  thick  brush,  situ- 
ated near  the  American  side.  The  distance  from  the  Mexican  bank  of  the  river 
to  this  island  is  about  900  feet,  the  width  of  the  island  400  feet,  and  from  it  to 
the  American  side  200  feet. 

Under  these  circumstances  I  can  readily  believe  that  the  fitego^nyia  might 
easily  be  carried  across  the  river  by  the  wind. 

Knowing  that  the  Slci/oniiiid  is  a  house  mosquito  and  therefore  usually  is  in 
a  position  to  obtain  shelter  against  the  wind,  I  do  not  consider  that  they  would 
be  carried  over  in  any  great  numbers,  but  it  is  very  probable  that  quite  a  few 
were  introduced  into  Laredo,  Tex.,  in  that  way. 

The  authorities  of  Nuevo  Laredo  were  urged  to  take  more  effective  sanitary 
measures,  and,  in  fact,  a  good  deal  of  work  was  acconq)lished  under  the  direction 
of  the  active  and  efficient  mayor  and  health  officer.  Doctor  de  le  Garza,  but  for 
lack  of  funds  it  was  far  from  being  what  it  should  have  been.  The  INIexican 
authorities,  indeed,  had  the  advantage  of  power,  which  we  lacked.  They  were 
not  confronted  by  the  good(?)  citizen  insisting  that  "  his  house  was  his  castle" 
and  that  he  would  shoot  the  first  one  who  attempted  an  entrance,  but;  on  the 
other  hand,  they  lacked  the  "  sinews  of  war  "  to  make  their  power  effective. 

As  has  been  said,  the  two  liaredos  are  practically  one,  and  the  epidemic  could 
have  been  handled  much  more  effectively  had  it  been  possible  to  so  consider 
them  for  epidemic  purposes. 

The  necessary  arrangements  should  certainly  be  made  with  the  countries  con- 
tiguous to  the  United  States,  so  that  under  such  circumstances  as  existed  in 
Laredo  sanitary  measures  against  an  epidemic  could  be  taken  conjointly  by  the 
nations  interested. 

To  the  drawbacks  already  mentioned  may  be  added  another,  the  weather. 
With  the  exception  of  two  or  three  comparatively  cool  days  in  the  latter  half 
of  October,  the  weather  was  unseasonably  warm  and  wet  until  l;ite  in  Novem- 
ber.    This  naturallj'  made  our  war  against  the  mosquito  all  the  more  difficult. 

The  accompanying  chart  shows  the  number  of  cases  and  deaths  daily,  in  con- 
nection with  the  daily  mean  temperature.  It  will  be  noted  that  there  is  no  very 
marked  relationship  between  the  two. 

One  thousand  and  fifty  cases  of  yellow  fever  were  reported  up  to  November 
30,  when  the  epidemic  w^as  declared  over  and  quarantine  against  Laredo  raised. 


314  PUBLIC    HEALTH    AND   MAKINE-HOSPITAL    SERVICE. 

Only  a  few  isolated  cases  were  reported  after  that  date.  These  1,050  cases 
occurred  in  580  houses,  the  patients  being  screened  and  the  houses  disinfected. 

Of  the  above  number  of  cases,  lo:^,  or  0.80  per  cent,  died.  This  mortality  is 
about  the  same  as  that  in  recent  epidemics.  While  I  believe  that  quite  a  num- 
ber of  the  cases  reported  as  such  were  not  yellow  fever,  there  is  no  doubt  that 
many  cases  of  mild  yellow  fever  escaped  the  inspectors  and  were  not  reported. 
These  two  sets  of  cases  probably  balance  each  other,  and  the  figures  given  may 
be  considered  close  to  the  actual  truth. 

The  following  table  is  of  interest  as  showing  the  difference  in  mortality  among 
the  Americans  and  Mexicans,  and  also  emphasizes  the  difficulty  we  had  to  con- 
tend with  in  reaching  the  latter  class : 

Yellow-fever  statistics,  Laredo,  Tex.,  from  Heptemher  25  to  'November  SO. 

Number  of  cases,  Mexicans 691 

Number  of  cases,  Americans 359 

Total 1.  050 

Number  of  deaths,  Mexicans 95 

Number  of  deaths,  Americans 8 

Total 103 

Death  rate : 

Mexican per  cent—  13.75 

American  do 2.  23 

Total  death  rate do 9.80 

Fifty-five  Mexicans  vi-ere  discovered  dead  or  in  a  dying  condition. 

It  is'  estimated  by  Dr.  Juan  F.  de  la  Garza,  of  Nuevo  Laredo,  a  rather  unwill- 
ing witness,  that  there  occurred  in  that  town  during  the  epidemic  from  2,500 
to  3,000  cases  of  yellow  fever.  From  personal  observation  and  from  infoi-mation 
obtained  from  reliable  citizens  of  the  place  I  am  inclined  to  agree  with  him. 

Estimating  the  population  of  Nuevo  Laredo  at  the  time  of  the  epidemic  at 
G,000  souls,  we  deduce  that  nearly  or  fully  50  per  cent  of  the  inhabitants  were 
attacked  by  the  disease. 

On  the  other  hand,  in  Laredo,  Tex.,  with  an  estimated  population  of  10,000 
souls  during  the  epidemic,  there  were  only  1,050  cases,  or  about  10  per  cent  of 
the  inhabitants  thereof.  I  consider  this  an  excellent  showing  and  sufficient 
compensation  for  the  labor  and  expen.se  incurred  in  fighting  the  epidemic.  To 
this  should  be  added  the  steps  taken  and  subseciuently  carried  out  for  com- 
pleting post-epidemic  disinfection  of  the  city  and  surrounding  districts,  v>-ith  the 
object  of  preventing  infected  mosquitoes  and  a  few  isolated  cases  keeping  up 
the  di.sease  during  the  winter  months  and  giving  rise  to  a  fresh  outbreak  in 
the  spring.  For,  as  a  result  of  our  efforts,  Laredo  can  not  be  considered  as  an 
immune  town,  such  as  I  believe  Nuevo  Laredo  to  be.  In  Nuevo  Laredo  the 
epidemic  had  full  sway,  and  all  those  naturally  subject  to  the  disease  I  think 
had  it,  whereas  in  Laredo,  Tex.,  as  a  result  of  the  sanitary  measures  taken, 
there  still  remains  a  very  large  majority  of  the  inhabitants  who  are  liable  to 
contract  and  spread  the  disease. 

The  above  figures  also  compare  very  favorably  with  those  of  the  yellow-fever 
epidemic  of  1899  at  Key  West,  where  a  totnl  of  1,3.50  cases  were  reported  and 
G8  deaths. 

I  have  no  way  of  knowing  what  the  estimated  population  of  Key  West  may 
have  been  during  the  epidemic,  but  judge  it  would  not  have  been  over  12,000. 
It  is  probable  that  of  those  who  remained  in  the  city  one-half  were  immunes, 
through  previous  epidemics  or  on  account  of  their  Cuban  birth,  having  been 
immunized  by  an  attack  of  the  disease  in  childhood.  So  that,  with  very  much 
less  available  nonimmune  material  in  Key  West,  the  number  of  cases  was  con- 
siderably greater  than  in  Laredo.  This  shows  clearly  the  controlling  influence 
of  mosquito  disinfection. 

The  quarantine  against  Laredo  by  the  State  of  Texas  was  oflicially  raised 
November  30,  a  proclamation  to  that  effect  being  issued  by  the  governor  on  that 
date.     Copy  of  the  proclamation  is  herewith  appended,  marked  "  Exhibit  E." 

No  place  appears  more  appropriate  than  this  to  mention  the  eminent 
services  rendered  by  our  distinguished  fellow-officer  and  esteemed  friend,  the 
late  Surg.  R.  D.  Murray,  late  ranking  surgeon  of  the  Public  Health  and  Marine- 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  315 

Hospital  Service  and  tiie  veteran  of  many  canijiaiyns,  botii  of  arms  and  of 
sanitation.  He  came  to  Laredo  nnder  special  orders  front  tlie  Bureau  and 
iniited  himself  witli  ns.  joining;  in  our  laitors,  assisting  us  witii  liis  counsel  and 
advice.  His  special  duty  was  to  act  as  expert  dia{,'nostician  and  ferret  out  and 
report  cases  of  yellow  fever.  He  supplemented  this  hy  treating  a  large  number 
of  cases,  especially  of  the  poorer  da.sses. 

The  number  of  physicians  in  Laredo  was  limited  and  often  insufficient  for  the 
calls  made  upon  them,  so  that  all  the  ollicers  of  the  Service  were  at  times  occu- 
pied in  the  treatment  of  cases,  work  which  was  foreign  to  their  duties,  but 
which  had  to  be  done  under  stress  of  circumstances. 

I>octor  Murray  did  by  far  the  greatest  amount  of  this  volunteer  work.  The 
effects  of  his  kind  treatment  of  the  Mexicans,  remaining  niglit  after  night  at 
their  bedsides  in  the  hoi)e  of  saving  some  poor  and  abandoned  patient,  was  most 
salutary  on  the  minds  of  these  people  and  was  rapidly  lireaking  down  tlieir 
antipathy  and  suspicion  ag-iinst  the  American  doctors,  when  destiny  called  him 
away  from  the  scene  of  his  labors  and,  through  a  deplorable  runaway  accident 
on  November  15,  while  on  his  way  to  visit  a  case,  he  met  with  injuries  which 
caused  bis  death  a  week  later,  on  November  22.  The  demonstrations  of  grief 
on  this  occasion  from  his  fellow-officers  and  the  people  of  Laredo  were  great 
indeed,  but  not  more  than  a  fitting  tribute  to  the  great-liearted  and  generous 
soul  that  had  passed  away. 

The  tragic  death  of  Surgeon  Murray  will  always  leave  a  si)ecial  feeling  of 
sadness  in  connection  with  the  epidemic  of  1903  at  Laredo.  He  died  in  full 
armor,  in  the  discharge  of  his  duties  as  an  officer,  a  gentleman,  and  a  physician. 

Laredo  was  our  principal  field  of  operations,  and  we  were  fully  occupie<l 
tlierein,  but.  notwithstanding  this,  we  were  obliged  at  times  to  devote  some  of 
our  attention  to  near-by  towns.  Of  tliese  Minera  and  Cannel  furnished  some 
interesting  data  and  will  be  now  considered. 

Minera  is  a  mining  camp  situated  about  25  miles  northwest  of  Laredo  and 
communicating  with  it  by  means  of  tlie  Rio  Grande  and  Eagle  Pass  Railroad, 
one  mixed  train  running  daily,  except  Sundays,  over  this  road.  It  has  a  popu- 
lation of  about  l.ldO  souls,  consisting  of  miners  and  their  families,  almost  all 
Mexicans.  The  majority  live  in  houses  constructed  and  belonging  to  the  Rio 
(Grande  Coal  Company,  but  quite  a  number  inhabit  miserable  huts  of  the  worst 
kind,  built  by  themselves.  The  camp  is  situated  close  to  the  banks  of  the  Rio 
Grande,  and  on  the  opposite  side  of  the  river  is  the  Mexican  town  of  Colombia, 
with  a  po|>ulation  of  about  1.500. 

Suspicious  cases  of  illness  having  been  reported  from  Minera,  Surg.  R.  D. 
Murray  visited  the  place  October  1  and  found  7  cases  and  1  death  from  yellow 
fever. 

Acting  Assistant  Surgeon  Dinwiddle  was  ordered  to  Minera  on  October  10, 
but,  on  account  of  some  misunderstanding  with  the  superintendent  of  the  mines, 
he  accomplished  nothing  and  returned  to  Laredo  on  the  r2th.  Doctor  Diuwiddie 
reported  on  his  return  tliat  there  liad  been  Gl  cases  and  1  death  up  to  October 
12,  over  two-thirds  of  which  number  had  been  reported  within  the  last  forty- 
eight  hours.  Unavoidai)le  circumstances  made  it  impossible  to  renew  the  attack 
against  the  Minera  epidemic  before  October  18,  when  the  pharmacist  and 
special  disbursing  agent  of  the  Public  Health  and  ]Marine-Hospital  Service, 
F.  S.  Goodman,  was  sent  to  Minera  with  a  disinfecting  gang  and  a  complete 
outfit,  with  instructions  to  disinfect  every  liouse  in  the  place  and  to  cover  all 
standing  water  witli  oil.  It  should  be  stated  here  that  Pharmacist  Goodman 
has  a  medical  degree  and  lias  had  consideral)!e  experience  in  (disinfection.  He 
was  accompanied  by  Doctor  Thompson,  tlie  Texas  State  health  representative, 
and  Mr.  George  W.  Derby,  assistant  general  manager  of  the  Rio  Grande  Coal 
Company,  both  of  which  gentlemen  rendered  efficient  assistance  in  carrying  out 
the  proposed  sanitary  measures. 

DISINFECTION    OF    MINFRA. 

The  mission  of  Pharmacist  Goodman  was  executed  with  extraordinary  vigor, 
thoroughness,  and  success.  His  interesting  report  upon  the  subject  is  herewith 
appended. 

[Report   of  Pharmacist   Goodman.] 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  ix  Command, 

Laredo,  Tex.,  Octoher  23,  1903. 
Sib  :  In  compliance  v,-itli  orders  contained  in  your  letter  of  October  18,  1903, 
directing  me  to  proceed  to  iMinera.  Tex.,  for  the  purpose  of  disinfecting  that 


316  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

place,  I  have  the  honor  to  report  that  I  left  this  city  for  Minera  on  the  morning 
of  the  19th  instant,  in  company  with  Doctor  TJiompson,  the  Texas  State  health 
representative,  and  Mr.  George  W.  Derby,  assistant  general  manager  of  the  Rio 
Grande  Coal  Company,  reaching  our  destination  about  noon  of  the  same  date. 

Minera  is  located  on  the  Rio  Grande  and  Eagle  Pass  Railway  and  is  owned 
by  the  Rio  Grande  Coal  Company.  It  is  situated  2G  miles  from  Laredo  and 
inhabited  by  a  few  Americans,  but  mostly  by  Mexicans. 

The  dwellings  occupied  by  the  miners  may  be  arranged  under  two  classes — 
] -story  wooden  frames,  and  shacks  known  as  "  .iacals."  Of  the  former  class 
many  are  located  in  a  hollow,  while  others  occupy  a  more  elevated  position  on 
the  reservation.  The  shack  class  are  of  rude  construction,  unsanitary,  and, 
being  consistent  with  the  occupants'  habits  and  chosen  mode  of  living,  are  dirty, 
pot)riy  ventilated,  and  offer  sufficient  inducements  for  the  propagation  and  abode 
of  the  mosquito. 

The  first  case  of  yellow  fever  in  this  camp  (as  reported)  occurred  during  the 
month  of  September,  patient  having  arrived  a  few  days  previous  to  his  illness 
from  Coloniltia,  Mexico.  The  infection  seems  to  have  been  and  is  now  confined 
to  the  lower  section  of  the  camp,  as  several  deaths  and  many  cases  (number  not 
•known)  have  been  reported.  In  the  upper  .section  of  the  camp  the  health  of  the 
miners  appears  to  be  good. 

"ARUOVO." 

On  the  border  of  the  reservation,  and  separating  Camp  Minera  from  Camp 
Cannell,  is  a  standing  stream  of  water  known  as  the  "  arroyo."  This  stream 
extends  in  a  northeasterly  and  westerly  direction,  with  a  width  of  10  to  40  feet ; 
depth,  1  to  3  feet,  with  a  muddy  bottom,  and  length  about  8,000  feet.  It  has 
undoubtedly  been  a  menace  to  the  health  of  both  camps  for  some  time  on 
account  of  tlie  standing  water,  and  more  especially  conducive  to  the  propaga- 
tion of  mosquitoes.  Along  the  shores  swarms  of  these  insects  were  circulating, 
and  in  some  places,  notably  where  large  exposed  rocks  were  found  embedded  in 
the  mire,  were  they  especially  troublesome.  The  process  of  oiling  this  stream, 
while  performed  under  difficulties,  was  successfully  accomplished. 

FtlMIGATION    IIF    HOU.SES. 

The  fumigation  of  miners'  houses  was  carried  out  in  both  the  infected  and 
noninfected  districts  of  the  camp.  Much  trouble  was  experienced  with  some 
houses,  especially  shacks,  to  prepare  them  properly  for  fumigation,  on  account 
of  their  construction,  in  which  cases  an  excess  of  sulphur  was  used. 

WATEK    BARRELS. 

All  barrels  and  water  containers  were  thoroughly  oiled,  and  one  spigot  was 
furnished  to  each  house  where  desired  by  the  occupant. 

OILlXr,    OF    PREMISES. 

A  close  examination  of  several  dwellings  revealed  the  existence  of  small 
pools  of  standing  water  in  the  rear  of  houses  and  adjacent  to  the  kitchens. 
These  places  were  thoroughly  oiled. 

A  summary  of  the  entire  work  performed  during  my  stay  at  Minera  is  here- 
with appended.  . 

In  conclusion,  I  desire  to  express  my  sincere  thanks  to  Mr.  George  W.  Derby, 
assistant  general  manager  of  the  Rio  Grande  Coal  Company;  Doctor  Thompson, 
the  Texas  Statchealth  representative,  .and  Mr.  D.  T.  Roy,  superintendent  of  the 
coal  company  at  Minera,  for  their  many  acts  of  kindness  and  valuable  assistance 
rendered  me  in  the  execution  of  this  work. 

Respectfully,  F.  S.  Goodman, 

Pharmacist,  Public  Health  and  Marine-Hospital  Service. 
Surg.  G.  M.  GuiTERAS, 

Medical  Offlcer  in  Command,  Laredo,  Te,x. 

Detail  of  ivorJc  performed  at  Minera,  Tex. 

Barrels  oiled 295 

Containers  oiled 75 

Excavations  oiled 29 

Premises  oiled 48 

Houses  fumigated » 192 

Arroyo  oiled feet—  8,  000 

Spigots  furnished  water  barrels 147 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  317 

The  history  of  the  Miiiera  epidoiuio  is  extronioly  intorostiiiff  aiul  sliows  con- 
clusivoly  tlio  oHifi(>iu'y  of  niosiiuito  (lisiiifoctioii  in  controilinf:  and  stainpiii}?  out 
an  epldeniif.  I'p  to  Octol)or  20  tlioiv  liad  occurred  in  Minora,  a  town  or  niininj; 
camp  of  about  l.IdO  inliabitauts,  1»(!  cases  and  7  dcatlis  from  y(>Ilo\v  fevor,  show- 
inj;  that  tlio  disoaso  was  ^'onoralizcd.  A  tiiorous^h  disinfection  of  the  village 
done  under  extreme  pressure  and  witliiu  the  remarkably  short  time  of  something 
less  than  three  days  was  concluded  on  the  21st  of  ()ctob(>r. 

On  that  day  2  new  cases  and  1  death  were  repitrted  ;  1  case  and  1  death  on 
October  22,  and  2  cases  on  October  2;i.  From  the  latter  date  not  a  single  case 
was  reported  until  October  ;5(),  an  interval  of  more  tlian  six  days,  when  1  case 
was  reported:  tlien  another  interval  of  five  days  until  Novemix'r  ('),  wlien  .'} 
cases  were  reported,  after  which  date  a  few  eases  were  reported  from  time  to 
time  until  the  advent  of  cold  weather,  aided  by  the  efforts  of  the  ollicers  of  the 
coal  company  to  stem  the  recrudescence  of  the  disease,  following  our  methods, 
finally  stamped  it  out. 

Considering  the  incubation  period  of  yellow  fever  as  from  five  to  six  days,  the 
above  figures  show  conclusively  that  the  mosquito  disinfection  of  Minera  was 
effective  in  stamping  out  the  disease.  Whether  the  .second  outbrealv  was  due  to 
importation  from  witliout  or  to  some  infected  mos(iuito  that  had  escajied  destruc- 
tion during  the  disinfection  of  the  camp  is  uncertain,  but  in  any  case  it  is  clear 
that  the  disease  had  been  practically  exterminated  and  that  if  reasonable  vigi- 
lance had  been  exercised  by  the  officers  of  the  coal  company,  or  we  had  been 
in  a  position  to  devote  our  attention  to  the  work,  the  disease  would  never  have 
been  permitted  to  again  obtain  any  headway.  As  it  is,  subsequently  to  the  gen- 
eral disinfection  of  Minera,  on  October  21,  only  8G  new  cases  and  2  deaths 
occurred  up  to  December  1,  without  counting  the  .5  cases  and  2  deaths  which 
were  reported  October  21,  22,  and  2,3,  and  which  it  is  clear  had  been  infected 
before  the  process  of  disinfection  had  been  concluded. 

It  is  indeed  more  probable  that  the  second  infection  was  introduced  from  with- 
out, as  the  Mexican  town  of  Colombia,  on  the  other  side  of  the  Kio  Grande,  was 
at  that  time  ravaged  with  yellow  fever,  and  in  spite  of  the  guards  maintained 
along  the  river  by  the  Service,  the  State,  and  the  coal  company  itself,  it  is  well 
known  that  there  was  illicit  communication  between  the  two  villages. 

Cannel  is  a  coal-mining  camp  similar  in  all  respects  to  Minera  and  having 
about  the  same  population.  It  is  located  2  or  .3  miles  eastward  of  Minera  and 
separated  by  the  Arroyo  Santo  Tomas.  A  suspicious  case  was  reported  there 
October  22  and  was  at  once  seen  by  State  Quarantine  Officer  McKnight  and 
myself,  and  as  it  presented  all  the  clinical  symptoms  of  yellow  fever  there  was 
no  difficulty  in  arriving  at  a  diagnosis.  No  other  cases  were  found  at  the  time. 
The  camp  employed  an  intelligent  physician.  Doctor  Moore,  to  look  after  its  sick, 
and  as  Mr.  Jackson,  the  manager  of  the  coal  company,  was  willing  to  undertake 
the  work  of  disinfection  under  the  supervision  of  Doctor  Moore  the  necessary 
instructions  as  to  screening  and  fumigating  were  given  and  evidently  carried 
out,  for  not  a  new  case  appeared  until  October  31,  a  period  of  nine  days.  From 
this  time  on  cases  appeared  occasionally,  but  it  is  evident  that  a  fair  amount  of 
sanitary  precautions  were  taken  by  Doctor  Moore  and  Mr.  Jackson  to  prevent 
the  spread  of  the  disease,  as  only  27  cases  in  all  occurred  up  to  December  1. 

The  press  of  work  in  Laredo  made  it  impossible  to  give  the  i)ersonal  attention 
of  officers  of  the  Service  to  Cannel  or  to  Minera  during  the  second  outbreak, 
especially  as  these  camps  were  not  considered  a  great  menace  to  the  surrounding 
country,  as  their  only  railroad  connection  was  with  Laredo  and  they  were  pretty 
well  removed  from  other  centers  of  population. 

CONCLUSIONS. 

1.  The  results  obtained  through  the  efforts  to  combat  the  yellow  fever  epi- 
demic at  Laredo  go  to  demonstrate  that  the  mosquito  (Stegomyia  fasciata)  is 
the  only  means  of  transmitting  yellow  fever  and  that  the  efforts  to  destroy  the 
same  were  productive  of  much  good,  greatly  limiting  the  number  of  cases. 

2.  The  measures  taken  to  prevent  the  reproduction  of  the  Stegomyia  fasciata 
or  other  mosquitoes  l>y  oiling  all  water  containers  and  deposits  of  stagnant  water 
were  completely  successful. 

3.  It  was  demonstrated  that  to  control  an  epidemic  of  yellow  fever  which  has 
gained  considerable  headway  (and  such  is  the  condition  usually  met  with)  it  is 
necessary  to  have  absolute  power  to  enforce  sanitary  measures  until  such  time 
as  the  people  are  educated  up  to  the  importance  of  such  measures. 


318  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

4.  Iiiasiiuu'li  as  the  Hfcf/oniyia  fasciata  can  only  become  infected  by  biting  the 
patient  dnrinj,'  the  first  three  days  of  the  disease  it  is  of  vital  importance  that 
cases  of  fever  be  reported  at  the  earliest  possible  moment  so  that  they  may  be 
screened  and  the  mosquito  prevented  from  biting  them.  Such  being  the  case,  an 
efficient  system  of  inspection  is  necessary,  especially  where  there  is  a  tendency 
to  hide  cases. 

5.  It  is  impossible  to  obtain  good  results  without  a  mosquito-proof  yellow-fever 
hospital. 

G.  The  difficulties  of  handling  an  epidemic  are  increased  when  such  outbreak 
occurs  on  the  frontier.  Arrangements  should,  therefore,  be  entered  Into  by 
treaty  with  contiguous  foreign  countries,  so  that  under  such  circumstances  sani- 
tary measures  may  be  carried  out  jointly  by  the  countries  interested  for  mutual 
protection. 

7.  Insistent  and  continued  efforts  should  be  made  through  the  public  press 
and  other  available  means  to  educate  tlie  people  within  the  sphere  of  influence 
of  the  Stcf/niinjia  fasciata,  so  that  they  will  learn  to  protect  themselves  against 
the  invasion  or  possible  spread  of  yellow  fever  in  their  midst  by  destroying  the 
means  for  the -propagation  of  said  mosquito,  and  by  protecting  themselves 
against  the  mosquito  by  efficient  screening. 

Above  all.  to  eradicate  the  existing  fear  in  the  medical  profession,  as  well  as 
among  the  laity,  of  declaring  the  existence  of  yellow  fever.  If  the  first  case 
presenting  the  slightest  suspicious  synjptoms  of  that  disease  were  promptly 
made  public  and  the  proper  modern  precautions  taken  there  would  be  no  danger 
of  the  disease  spreading.  In  fact,  the  public  should  be  taught  to  acknowledge 
the  existence  of  yellow  fever  in  their  midst  with  the  same  equanimity  as  in  the 
case  of  measles  or  scarlatina. 

8.  The  effort  to  control  the  epidemic  at  Minera  was  decidedly  successful,  and 
would  have  been  entirely  so  if  we  could  have  given  it  undivided  attention.  The 
results  at  Minera  demonstrate  almost  as  clearly  as  those  in  Habana  that  the 
mosquito  is  the  only  means  of  conveying  yellow  fever. 

Finally,  it  is  a  pleasure  to  state  that  our  relations  with  Dr.  R.  G.  Tabor,  State 
health  officer  of  the  State  of  Texas,  and  his  staff,  as  also  the  city  and  county 
authorities,  were  most  cordial  and  happy.  This  accord  was  of  the  greatest 
importance  in  obtaining  the  best  possible  results  from  our  mutual  labors. 
While  Doctor  Tabor  and  myself  may  have  differed  slightly  as  to  whether  or  not 
the  Stcgomyia  fasciata  was  the  only  means  of  transmitting  yellow  fever,  we  did 
not  allow  this  difference  of  opinion  to  interfere  in  any  way  with  the  work  in 
which  we  were  all  deeply  interested. 

As  to  my  personal  staff,  several  of  whom  I  have  already  mentioned  in  the 
body  of  this  report,  I  have  to  say  that  one  and  all  complied  faithfully  with  their 
duties,  and  to  them  is  due  in  large  part  such  success  as  we  may  have  achieved. 
Respectfully, 

G.  M.  GuiTERAS.  Surgeon. 

The  Subgeon-Genebal. 

[Inclosures.] 
Exhibit  A. — Quarantine  proclamation. 

Laredo,  Tex.,  September  26,  1903. 

Whereas  yellow  fever  now  exists  in  the  city  of  Laredo,  I,  George  R.  Tabor, 
State  health  officer  of  Texas,  assume  control  of  all  matters  pertaining  to 
quarantine  and  by  virtue  of  the  authority  vested  in  me  by  the  laws  of  this  State 
do  hereby  proclaim  that  quarantine  is  this  day  established  against  the  city  of 
Lai-edo  by  the  State  of  Texas  and  shall  continue  until  closed  by  proclamation 
of  the  governor. 

Said  quarantine  shall  apply  to  all  persons,  freight,  baggage,  express,  mail,  or 
other  matter  originating  in  the  city  of  Laredo,  and  none  of  the  above  will  be 
permitted  to  leave  the  corporate  limits  of  said  city  of  Laredo  for  points  in 
Texas  except  health  officials  of  the  United  States  and  the  State  of  Texas. 

All  citizens  are  requested  to  promptly  report  to  the  health  authorities  cases 
of  sickness  of  any  character.  No  pest  house  will  be  established  and  persons 
sick  will  be  permitted  to  remain  in  their  homes  for  treatment. 

Immediate  sanitation  of  the  city  will  begin  under  the  immediate  supervision 
of  an  officer  of  the  United  States  Public  Health  Service  and  all  persons  are 
solicited  to  give  him  prompt  assistance  and  support.  We  do  not  apprehend  a 
continuation  of  yellow  fever  here  if  proper  sanitary  precautions  are  observed. 


VIUUAG    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  31^ 

All  (ifriciMls  ■•111(1  citizens  are  solicited  to  assist  the  health  authorities  in  the 
execution  of  (|n;ir:intine  regulations.  Competent  officers  will  be  in  charKi'  until 
the  disease  is  stamped  out. 

Geokge  II.  Taisok, 
State  Health  Officer  of  Texas. 


Exhibit  B. — Case  of  Manuel  Pnrras,  did  at  Monterey,  Mexico,  June  ;?.'/,  1003. 

Patient  had  been  suffering  with  hemorrhoids  for  some  months  and  was  to  be 
operated  upon;  but  before  being  ])repared  for  operation  fell  ill,  complaining  of 
aches  all  over  the  body.  Illness  lasted  seven  days,  j)atient  suffering  from 
attacks  of  syncope,  vomiting  yellowish  green  and  unable  to  retain  auytliing  on 
his  stomach;  kept  repeating  that  the  "next"  attack  would  be  the  last;  passed 
hardly  any  urine  until  a  few  moments  before  death.  I'hysician  told  patient  he 
would  get  well  unless  disease  was  attended  by  complications;  but  after  death 
said  he  knew  on  third  day  that  there  was  no  hope.  Physician  was  always  in  a 
hurry  to  leave,  and  not  sit  down  ;  apparently  avoided  going  near  patient.  Chill, 
dizziness.  Nose  and  mouth  hemorrhages,  but  no  black  vomit  observed.  After 
death,  the  whole  body,  eyes,  finger  nails  were  yellow.  Physician  gave  direc- 
tions to  inter  body  as  soon  as  possible;  certificate  of  death  read  "  ictericia. 
grave."  Patient  had  been  employed  at  the  Central  Railroad,  which  enters 
Monterey  from  Tampico. 

Exhibit  D. — An  ordinance  for  the  prevention  and  suppression  of  yelloiv  fever 
and  other  contagious  and  infectious  diseases,  having  the  mosquito  q«  one,  if 
not  the  only,  means  of  transmitting  such  disease  from  person  to  person. 

Be  it  ordained  hy  the  city  council  of  the  city  of  Laredo: 

Section  1.  That  all  wells,  cisterns,  tanks,  reservoirs,  barrels,  tubs,  vats,  pools, 
lakes,  ponds,  puddles,  and  other  receptacles  holding  and  containing  water  within 
the  incorporated  limits  of  the  city  of  Laredo,  other  than  those  in  which  the 
water  therein  contained  is  coated  and  kept  coated  with  oil,  are  hereby  declared 
public  nuisances. 

Sec  2.  Any  person,  firm,  company,  or  corporation  having  any  of  the  water 
receptacles  mentioned  in  section  1  of  this  ordinance  on  his,  her,  their,  or  its 
place,  premises,  or  upon  any  lot  or  block  of  land  under  his,  her,  their,  or  its 
control  within  the  incorporated  limits  of  said  city,  which  contains  water,  who 
shall  fail  or  refuse  to  cover  the  surface  of  such  water  with  oil  and  keep  the  same 
so  covered  with  oil,  shall  be  deemed  guilty  of  a  nuisance,  and  upon  conviction 
shall  be  fined  in  any  sum  not  less  than  .$5  nor  more  than  .$25,  and  each  day's 
refusal,  neglect,  or  failure  shall  constitute  a  separate  offense. 

Sec  3.  It  is  hereby  made  the  duty  of  the  sanitary  inspector  of  said  city, 
together  with  such  assistant  inspectors  as  he  may  appoint,  to  enter  the  house  or 
premises  of  any  inhabitant  of  said  city  and  inspect  and  disinfect  the  same, 
and  for  this  i»urpose  may  use  all  such  force  as  may  be  necessary  to  effect  such 
entry,  insi)ection,  and  disinfection. 

Sec.  4.  Tlie  city,  county,  and  State  health  physicians  and  the  several  physi- 
cians of  the  Public  Health  and  Marine-Hospital  Service  of  the  United  States, 
and  their  aids  and  assistants,  while  engaged  in  the  treatment  and  supi)ression 
of  any  contagious  or  infectious  disease  in  said  city,  are  hereby  vested  with  the 
same  powers  and  authority  delegated  to  the  sanitary  inspector  of  said  citj'  and 
his  assistants  by  the  third  section  of  this  ordinance. 

Sec  .").  Any  person,  firm,  company,  or  corporation  who  shall  refuse  i)ermission 
to  any  of  the  officers,  physicians,  or  their  assistants  mentioned  in  tlie  third  and 
fourth  sections  of  this  ordinance  to  inspect  his,  her,  their,  or  its  house  or  prem- 
ises shall  be  deemed  guilty  of  an  offense  and  upon  conviction  shall  be  fined  in 
any  sum  not  less  than  .$5  nor  more  than  $25. 

Sec  0.  This  ordinance  is  cumulative  to  that  of  all  other  ordinances  heretofore 
passed  and  now  in  force  on  the  subject  upon  which  it  treats. 

Sec  7.  All  ordinances  and  parts  of  ordinances  in  conflict  with  the  provisions 
of  this  ordinance  be,  and  the  same  are  hereby,  repealed. 

Amadob  Sanchez,  Mayor, 

Attest : 

A.  R.  Gabcia,  tSecretary. 


820  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Exhibit  E. — Proclamation  issued  hy  Governor  Lanham. 

LAREDO  AWAKENS  FROM  HER  LONG  NIGHTMARE  OF  DEATH-DEALING  DISEASE  AND 
BUSINESS-DESTROYING  EMBARGO — QUARANTINE  PROCLAMATION  BY  THE  GOVERNOR 
OF   THE    STATE   OF   TEXAS. 

Whereas  I  am  advised  by  the  State  liealth  officer  tliat  quarantine  against. 
Laredo  is  no  longer  necessary,  as  the  epidemic  of  yellow  fever  there  has  ended, 
and  the  temperature  having  fallen  to  '.\\° ,  which  will  prevent  the  recurrence  of 
the  disease,  and  as  the  cause  has  been  removed  by  the  thorough  sanitary  worlc 
of  the  T'nited  States  Public  Health  and  Marine-Hospital  Service,  which  will  be 
continued  through  the  winter: 

Therefore  L  S.  W.  T.  Lanham,  governor  of  the  State  of  Texas,  do,  by  the 
authority  vested  in  me  by  the  laws  of  this  State,  hereby  remove  the  quarantine 
proclainied  by  the  State  "health  officer  against  said  city  of  Laredo  the  26th  day 
of  September,  100.''..     This  proclamation  to  take  effect  at  12  o'clock  noon  to-day.  . 

In  testimony  whereof  I  hereunto  sign  my  name  and  cause  the  seal  of  state 
to  be  affixed  at  the  city  of  Austin  this  :jOth  day  of  November,  1!J0.3. 

S.  W.  T.  Lanham, 
Governor  of  Texas. 

By  the  Governor : 

.T.  It.  Carl,  Secretary  of  State. 

Report  of  Passed  Asst.  Surg.  T.  F.  Richardson  for  Period  December  1,  190.3, 

TO  June  30,  1904. 

Public  Health  and  Marine-Hospital  Service, 

Office  of  Medical  Officer  in  Command, 

Laredo,  Tex.,  June  30,  190.',. 

Sir:  In  compliance  with  instructions  contained  in  Bureau  letter  of  .''.Otli 
ultimo.  I  have  the  honor  to  submit  the  following  report  of  operations  at  this 
station  for  the  period  December  1.  1903,  to  .Tune  30,  1904: 

On  December  2,  1903.  Surgeon  Guiteras  was  relievcHl  by  Acting  Assistant  Sur- 
geon Frick,  under  whose  direction  the  Service  operations  were  conducted  until 
March  23,  1904,  when  Passed  Asst.  Surg.  T.  F.  Richardson  assumed  charge  under 
Bureau  orders. 

At  the  date  of  Surgeon  Ouiteras's  dej)arture  the  force  on  duly  at  Laredo  con- 
sisted of  Acting  Assist;int  Surgeons  Friclc,  Hamilton,  and  Sauvignet  and  40  lay 
employees.  The.se  were  continued  until  Decfiiiiti'i-  :!1,  1903,  when  the  force  was 
reduced  to  2  acting  assistant  surgeons  and  9  employees. 

Between  r>ecember  1  and  31,  the  entire  portion  of  the  city  (roughly  one-half) 
which  had  not  Ix-en  fumigated  under  Surgeon  Guiteras  was  gone  over  block  by 
block,  so  that  by  the  1st  day  of  .January  every  house  in  Laredo  had  been  treated, 
to  kill  possibly  infected  mo.'^iultoes. 

This  systematic  work  was  somewhat  interfered  with  by  the  occurrence  of  sus- 
picious and  i)ositive  cases  of  yellow  fever,  of  which  there  were  27  during  Decem- 
ber in  various  i)ai'ts  of  the  city,  necessitating  tlie  immediate  refumigation  of  the 
neighborlKjod  in  which  they  occurred. 

On  December  20  the  inspection  and  oiling  of  water  containers  was  discon- 
tinued. 

After  .January  1,  1904.  the  reduced  force  was  engaged  in  fumigation  work  in 
Laredo  and  outlying  ranches  witliin  a  r.idius  of  12  to  1.")  miles  of  the  city.  The 
towns  of  Aguilares,  Ojuelos.  Cannel,  Minora,  and  I'alafox  were  al.so  fumigated 
by  the  force  during  tiie  months  of  .January  and  February  and  the  early  part 
of  March. 

On  March  3,  1904,  the  city  council  of  Laredo  passed  the  following  resolution, 
which  was  transmitted  to  the  Bureau  by  Acting  Assistant  Surgeon  Frick : 

"a  resolution. 

"  Whereas  it  is  generally  believed  that  yellow  fever  exists  all  seasons  of  the 
year  in  Vera  Cruz,  Republic  of  Mexico,  which  i)oint  is  of  no  great  distance  from 
Laredo,  and  is  in  daily  railway  communication  with  this  city  ;  and 

"  Whereas  the  warm  season  is  rapidly  apjiroaching,  and  the  quarantine  here- 
tofore established  and  maintainetl  against  Vera  Cruz  has  not  been  of  such  a 
nature  as  to  inspire  confidence  or  arrest  the  spread  of  the  disease ;  and 


PUBLU!    HEALTH    AND    MAUINK-UOSl'lTAL    .^EliVICK.  321 

"  Wlioro.MS  tlu>  city  of  Liircvlo  lins  in  the  piist  five  yoars  sufTcrod  so  intcnsoly 
from  the  l)lii,'lit  of  (lroiij,'lits  iiiKl  ciiidt'inics  thai  Iicr  tiiiaiicial  coiiditioii  is  strained 
to  the  limit  of  the  coiistitut ion,  and  lici'  treasury  exlianstcd,  and  is  tlicrcfore 
unahlo  to  employ  tiio  means  to  carry  on  the  necessary  ]»recaiitions  to  prevent  u 
recurrence  of  the  yellow  fever  durinj^  the  conuni^  warm  season:  'IMierefore,  he  it 

■■  li'csolrcd,  hji  llic  citj/  council  of  tJic  cit])  of  Laredo,  Tc.r.,  That  the  I'uhllc 
Health  and  Marine-Hospital  Service  of  tlie  TTuited  States  he,  and  it  is  herehy, 
reipiested  to  at  once  furnish  the  means  and  reassume  the  inspection,  disiid'ection, 
and  all  means  nec-essary  for  the  i)reventioii  and  suppression  of  all  contaj^ious 
and  infectious  dise.-ises,  and  es|)ecially  that  of  yellow  fever,  and  said  city  does 
hert'liy  i»li'dj,'e  itself  to  render  all  moral  support  and  lej^ai  aid  to  the  Tuhlic 
Hi'altii  antl  Marine-Hospital  Service  of  the  United  States  hi  carryin;^  out  the 
I>urposes  of  this  resolution." 

While  this  matter  was  still  pending  hefore  the  Bureau,  on  March  11,  a  case  of 
yellow  fever  in  the  third  day  of  the  disease  was  discovered  hy  Dr.  W.  E.  Lowry. 
This  case  was  i)romptly  screened,  and  thorou.t,'h  fumigation  of  the  entire  neigh- 
horhood  in  which  it  occurred  was  done. 

Again,  on  March  18,  a  case,  in  the  fifth  day,  arrived  in  Laredo  from  up  the  Rio 
Grande. 

The  first  of  these  cases  was  undouhtedly  infected  in  one  of  the  Laredos ;  the 
second,  in  all  prohahility,  at  Tordillo,  where  he  had  been  at  work  with  the  disin- 
fecting gang  of  the  Service. 

On  account  of  these  cases,  something  over  100  liouses  were  fumigated  in 
Laredo,  with  tlie  fortunate  result  that  there  was  absolutely  no  spread  of  the 
disease.     Fumigation  was  also  repeated  at  Tordillo.  with  like  result. 

lender  dates  of  March  18  and  21,  the  following  telegrams  were  received  from 
the  Bureau : 

"  March  18. 
"  Bureau  is  about  to  take  action  favorable  to  x'equest  of  city  council  and  State 
liealth  otiicer  supplying  necessary  water  covers  and  mosquito  nets  to  those 
unable  to  purchase,  and  will  soon  forward  a  memorandum  containing  suggested 
ordinance  by  the  city  council.  House-to-house  inspection  should  be  begun  imme- 
diately. Wire  your  ])lan  for  instituting  same.  *  *  *  Authorized  to  nomi- 
nate lay  inspectors  and  two  or  three  medical  inspectors  to  assist,  if  needed. 
*  *  *  Autlun-ized  to  have  cards  or  books  printed  for  inspectors'  reports, 
which  should  include  reports  on  water  containers. 

"  Wyman." 

"  March  21. 
"Adopt  following  plan  for  house-to-house  inspection.  Divide  city  into  20  or  30 
districts.  Nominate  and  put  on  duty  lay  inspector  for  each  district  at  $1.25  per 
day,  whose  whole  time  shall  be  given  to  said  inspection,  and  who  shall  cover  his 
whole  district  each  day,  including  Sundays.  Most  important  duty  of  inspector 
is  to  ascertain  cases  and  separate  same,  but  at  same  time  should  report  condition 
on  water  containers  and  other  breeding  places  of  mosquitoes.  Every  case  of 
fever,  from  whatever  cause,  must  be  immediately  reported  to  Service  office  and 
a  mosquito  bar  shall  be  immediately  placed  around  patient.  Service  furnishing 
same  if  necessary.  Cases  must  then  be  seen  by  one  of  the  medical  inspectors. 
On  receiving  information  as  to  necessity  for  covering  water  containers  or  oiling, 
this  must  be  done  at  once.  Service  furnishing,  if  necessary,  required  material. 
This  involves  preparing  both  mosquito  bars  and  covers  for  water  barrels. 
Authority  for  measures  outlined  herein  is  evidently  contained  in  recent  I'esolu- 
tions  of  city  council,  and,  it  is  lielieved,  in  the  ordinances  passed  last  year. 
Letter  follows. 

"  Wyman." 

Accordingly,  the  city  was  divided  into  25  districts,  each  district  being  assigned 
to  a  lay  inspector.  These  inspectors  were  directed  to  report  immediately  to  the 
office  all  sick  discovered  in  their  districts,  for  investigation  by  a  medical  officer. 
They  were  each  also  sui)plied  with  a  large  canteen  of  the  best  grade  of  refined 
oil,  for  the  purpose  of  oiling  all  exposed  water  containers  found  on  their  beats. 

Much  difficulty  was  experienced  in  securing  the  services  of  satisfactory 
inspectors  ;  for,  while  there  was  no  lack  of  applicants,  men  who  would  do  the 
work  required  thoroughly  and  without  fear  nor  favor  were  not  easily  found. 

8629—04 21 


322  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Constant  and  close  supervision  of  the  inspectors'  work  was  early  found  to  be 
necessary,  so  nnich  so  that  two  medical  officers  have  been  required  to  give  their 
entire  time  to  this. 

House-to-house  inspection  of  the  entire  city  each  day  was  continued  -until 
April  18,  after  which  date,  no  yellow  fever  having  been  discovered  in  the  mean- 
time, the  foive  of  inspectors  was  reduced  to  10  men  and  the  city  divided  into 
that  number  of  districts. 

Under  this  arrangement,  which  has  continued  steadily,  the  entire  city  is 
covered  in  two  and  a  lialf  to  three  days;  in  other  words,  there  are  at  least  two 
complete  inspections  of  all  premises  and  water  containers  weelily. 

The  prime  object  of  this  twice-weelily  inspection  has  been  the  prevention  of 
the  breeding  of  the  mosquito  in  the  water  barrels,  wells,  and  cisterns,  with 
which  Laredo  is  so  plentifully  sup])lied,  though  all  sick  are  reported  as  during 
the  complete  daily  inspections,  and  are  investigated  by  a  medical  ofBcer  and 
screened  if  the  diagnosis  is  doubtful. 

This  antimosquito  work  has  met  with  a  very  large  measure  of  success.  It  is 
the  e-\cei)tion  to  hear  or  see  a  single  mosquito  in  most  parts  of  the  city.  There 
has  been  and  is,  however,  a  great  deal  of  passive,  and  some  active,  opposition  to 
this  work  of  the  .Service  inspectors,  and  there  is,  mi  fortunately,  little,  if  any, 
cooperation  on  the  part  of  the  householders.  It  would  almost  seem  that  certain 
elements  of  the  population  endeavor  by  every  nutans  in  their  power  to  promote 
and  facilitate  the  breeding  of  mosquitoes  on  their  premises,  exercising  the  great- 
est ingenuity  in  concealing  unscreened  barrels  and  tubs  full  of  water  under  beds 
and  in  dark  corners,  and  when  these  containers  are  discovered  and  oiled,  remov- 
ing with  bibulous  paper  all  oil  from  the  water  surfaces  before  the  larv;e  in  them 
have  had  time  to  be  asphyxiated.  This  practice  of  removing  oil  became  so  fre- 
quent that  it  was  necessary  to  order  inspectors  oiling  water  with  larvse  to  stay 
on  the  premises  until  all  larva^  were  dead. 

Only  the  highest  grade  of  refined  illuminating  oil  has  been  used  in  this  oiling 
of  water  containers,  yet  there  is  a  somewhat  general  impression  among  the 
Mexican  population  that  a  subtle  poison  is  really  what  is  put  into  their  water 
barrels,  and  that  to  allow  it  to  remain  there  is  dangerous  to  health  and  even 
life. 

During  the  epidemic  of  last  year  a  city  ordinance  requiring  the  oiling  of  all 
collections  of  water  of  whatever  character  was  enacted  and  was  nominally  in 
force  when  operations  were  begun  in  the  si)ring.  It  was  felt,  however,  that  the 
requirements  of  this  ordinance  were  unnecessarily  rigid;  it  was  feared  also  by 
the  city  attorney  that  the  ordinance,  having  been  jiassed  during  the  epidemic, 
might  not  be  sustained  by  the  courts  if  prosecutions  were  brought  for  violations 
when  no  epidemic  was  prevailing. 

Accordingly,  on  March  2~)  the  city  council  was  requested  to  amend  and  extend 
the  existing  ordinance  along  the  lines  embodied  in  the  following  memorandum : 

MEMORANDUM   OF  ORDINANCE  SUGGESTED  TO  BE  PASSED  BY  CITY  COUNCIL,  EXTENDING 
AND    AMENDING    ORDINANCE    OF   OCTOBER   30,    1903. 

1.  Requiring  all  physicians  and  householders  to  report  to  the  city  health  offi- 
cer without  delay  every  case  of  fever  of  any  character,  and  from  whatever 
cause,  coming  within  their  knowledge,  and  prescribing  penalties  for  noncompli- 
ance. 

2.  Requiring  all  cases,  as  described  in  paragraph  1,  to  be  covered  immediately 
with  a  mosquito  netting  until  its  removal  is  authorized  by  city  health  officer  or 
his  representative,  and  prescribing  penalties  for  noncompliance. 

3.  Making  it  a  finable  offense  for  any  householder  to  have  on  his  premises  the 
larvfe  of  mos(iuitoes,  and  requiring  either  oiling  or  screening  of  water  containers 
to  prevent  breeding  of  mos(iuitoes. 

4.  Authorizing  the  health  officer  to  remove  cases  suspected  of  being  yellow 
fever  to  a  fever  sanatorium  when,  in  his  opinion,  such  cases  can  not  be  efficiently 
treated  and  screened  at  the  patient's  house. 

After  much  delay  an  ordinance  embodying  most  of  the  points  suggested  was 
finally  passed.     A  copy  of  this  ordinance  is  transmitted  herev^Mtti. 

To  date  (July  25,  1904)  339  complaints  for  violation  of  this  ordinance  have 
been  filed  in  the  corporation  court.  Of  this  large  number  only  9  have  had  fines 
imposed,  the  remainder  being  dismissed  with  a  warning  and  lecture.  It  is 
unfortunate  that  the  very  first  cases  brought  to  trial  were  not  fined,  for  as  a 
consequence  of  the  failure  to  do  this  there  have  undoubtedly  been  many  more 
violations  of  the  ordinance  than  would  have  occurred  otherwise. 


PUBLIC    HEALTH    AND    MARINK-noSPITAL    SERVICE.  323 

To  avoid  tlio  nocossity  of  constant  oiling  of  all  wator  containers,  1,000  l)arrel 
tops  of  18-iiK'sii  s^alvanizod  wire  f^auzc,  on  metal  frames,  were  purchased  by  the 
Service  and  <listrii)n((Ml  amonj^  the  poorer  ])opuIation.  These,  when  kept  on  the 
barrels,  are  of  course  ctTi'ctive;  but  many  are  found  each  day  by  the  inspectors 
either  propi»ed  ojien  on  the  barrel  itself  or  else  removed  entirely. 

The  city  authorities  have  recently  ordered  1, (»(•()  sci-ccmi  tops  similar  to  those 
supplied  by  the  Service.     These  are  beinj?  distrii)uted  as  rapidly  as  made. 

One  disinfectiuf^  j?ang  of  r>  men  has  been  constantly  maintained  in  Laredo 
fundfiatinj;  wherever  mosquitoes  have  been  reported,  and  also  upon  recpiest  from 
citizens,  which  re<iuests  .-ire  (piite  numerous.  This  force  has  also  attended  to  the 
oilinj;  of  the  ponds  and  puddles  which  occur  after  each  rain. 

Stati-stics  of  fumij^ation,  inspection,  and  oiling  work  in  Laredo  are  embodied 
in  A  PI  tend  ix  A. 

WOKK    OUTSIDE   OF   LAREDO. 

During  the  months  of  January,  February,  and  March,  a.s  stated  above,  fumi- 
gation of  outlying  ranches  within  a  radius  of  a  day's  team  travel  of  Laredo  was 
done,  and  the  towns  of  Ojuelos,  Aguilares,  Palafox,  Minera,  and  Canuel  were 
also  treated. 

AVith  the  beginning  of  active  operations  in  Laredo  inspections  of  places  along 
the  lines  running  out  of  Laredo  were  instituted.  This  work  was  assigned  to 
Acting  Asst.  Surg.  L.  W.  Cock,  and  by  the  latter  part  of  April  the  International 
and  Great  Northern  Railroad  had  been  inspected  as  far  as  San  Antonio,  the 
Texas  Mexican  Railway  to  Alice,  and  the  Rio  Grande  and  Eagle  Pass  to  its 
terminus. 

On  April  25  a  force,  consisting  of  Acting  Assistant  Surgeon  Cock  and  4  experi- 
enced lay  inspectors  and  fumigators,  was  organized  for  demonstrating  by  actual 
work  antimos(iuito  warfare  along  the  lines  of  travel  out  of  Laredo.  The  cam- 
paign was  opened  at  Moore,  on  the  International  and  Great  Northern  Railroad, 
and  each  town  and  station  on  that  road  from  Laredo  to  San  Antonio  was  visited 
by  this  force.  Circulars  on  antimosquito  work,  in  both  English  and  Spanish, 
were  distributed  at  each  place,  every  effort  being  made  to  arouse  the  interest 
and  secure  the  cooperation  of  the  citizens. 

Much  actual  fumigation  and  oiling  was  also  done  in  places  where  there  was 
suspicious  disease  last  year,  as  may  be  seen'  from  the  statistics  of  this  work  in 
Appendix   B. 

On  May  11  another  force,  consisting  of  Acting  Assistant  Surgeon  MacGregor 
and  3  inspectors,  was  started  along  the  line  of  the  Texas-Mexican  Railway. 
Statistics  of  work  done  along  this  road  are  also  embodied  in  Appendix  B. 

Much  lasting  good  has  undoubtedly  I'esulted  from  these  carapaign.s,  for  while 
at  several  of  the  places  visited  the  effort  to  arouse  enthusiasm  and  continuation 
of  the  work  among  the  citizens  failed  flatly,  in  the  majority  of  instances  much 
interest  was  awakened  and  every  evidence  manifested  that  the  work  would  be 
continued. 

At  some  of  the  larger  towns  along  the  Texas  Mexican  Railway,  notably 
San  Diego  and  Corpus*  Christi,  public  meetings  were  addressed  by  Doctor 
MacGregor  on  the  subject  of  mosquitoes  and  their  destruction. 

The  mining  towns  of  Minera  and  Cannel  have  been  inspected  on  several 
occasions  by  acting  assistants  from  this  station,  and  advice  as  to  mosquito 
destruction  given  the  coal  companies.  About  2.'50  vaccinations  of  unprotected 
individuals  were  also  done  at  the  above-named  places. 

On  May  17  Acting  Assistant  Surgeon  Sauvignet  was  sent  to  inspect  and  report 
upon  conditions  in  Rio  Grande  City,  Starr  County.  Some  apprehension  was  felt 
as  to  this  place  because  of  the  large  number  of  workmen  who  were  engaged 
on  the  Mexican  side  of  the  Rio  Grande  in  constructing  the  Monterey-Matamoras 
extension  of  the  Mexican  National  Railroad,  and  also  because  it  was  feared 
that  on  account  of  the  rigid  quarantine  requirements  at  Laredo  and  Eagle  Pass, 
Rio  Grande  City  would  become  more  poi)ular  as  a  crossing  point.  No  quaran- 
tinable  disease  was  found  by  Doctor  Sauvignet.  On  June  21  Acting  Asst. 
Surg.  W.  R.  Dashiell  was  placed  on  duty  at  Rio  Grande  City  to  act  as  quaran- 
tine officer  and  for  information  duty.  Doctor  Dashiell  has  advised  wnth  the 
county  authorities  on  mosquito  destruction,  with  the  result  that  active  measures 
have  been  undertaken. 

SUSPICIOUS    CASES   IN    ALICE. 

Under  date  of  June  8  Acting  Assistant  Surgeon  MacGregor  reported  from 
Alice,  Nueces  County,  the  existence  of  fever  with  suspicious  symptoms.     These 


324  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

cases  were  at  once  investigated  by  officers  of  the  Service  and  the  State  of 
Texas,  and  were  not  considered  yellow  fever.  However,  it  was  decided  to  fumi- 
gate without  delay  the  entire  town  of  Alice.  This  was  done  rapidly  and 
thoroughly  under  the  supervision  of  Acting  Assistant  Surgeon  Frick.  Much 
oiling  and  screening  work  was  also  done  in  Alice,  and  every  case  of  fever  in  the 
town  was  placed  under  a  mosquito  bar  until  clearly  proven  not  yellow. 

Every  facility  was  given  the  Service  by  the  physicians  and  citizens  of  Alice 
and  the  county  authorities. 

INSPECTION    OF    NUEVO   LAREDO. 

Daily  visits  have  been  made  to  Nuevo  Laredo  for  purposes  of  inspection  and 
for  exchanging  reports  of  operations  with  the  authorities  there.  Much  anti- 
mosquito  work  has  undoubtedly  been  done  in  Nuevo  Laredo  under  the  direction 
of  the  accomplished  mayor.  Dr.  J.  F.  de  la  Garza,  who  is  also  the  medical 
sanitary  agent  of  the  superior  board  of  health  of  Mexico.  Mosquitoes  are,  how- 
ever, still  very  noticeable  in  that  city. 

BOEDER   QUARANTINE. 

Quarantine  inspection  of  all  incoming  trains  and  passengers  has  been  con- 
ducted under  the  immediate  supervision  of  Acting  Assistant  Surgeon  Hamilton, 
whose  report  for  the  fiscal  year  is  transmitted  herewith. 

With  the  opening  of  the  close  quarantine  season  night  and  day  guards  were 
placed  on  the  foot  and  railroad  bridges  to  stop  passengers  entering  on  foot  by 
those  routes. 

During  former  years  a  small  detention  camp  had  been  maintained  on  grounds 
belonging  to  the  city  near  the  railroad  bridge  on  the  river  front.  In  March, 
1904,  the  city  of  Laredo  formally  leased  this  entire  square  of  ground  for  a  period 
of  twenty  years  to  the  Public  Health  and  Marine-Hospital  Service  for  a  deten- 
tion camp  site.  A  portion  of  this  square  which  bad  been  fenced  by  the  Service  in 
former  years  was  graded,  ditched,  and  grassed,  and  tents  sufficient  for  the 
accommodation  of  35  persons  have  been  pitched  upon  it. 

This  camp  site  is  ideal,  but  mosquito-proof  barracks  should  be  used  Instead  of 
tents. 

In  concluding  this  report  it  may  be  stated  with  certainty  that  the  work  of  the 
Service  in  Laredo  has  proven  that  all  danger  of  a  recrudescence  of  yellow  fever 
is  now  long  passed.  If  the  disease  appears  later  in  the  season  the  infection 
must  be  imported,  and  it  is  because  of  this  ever-present  and  increasing  danger 
of  importation  by  man  or  mosquito  that  the  work  of  inspection  and  mosquito 
destruction  must  be  continued. 

The  cordial  relations  and  mutual  cooperation  established  by  Surgeon  Guiteras 
between  the  Service  and  the  State  and  municipal  authorities  have  continued 
uninterruptedlv. 

Respectfully,  T.  F.  Richardson, 

Passed  Assistant  Surgeon. 

The  Surgeon-General. 


[Inclosiire.] 

An  ordinance  for  the  prevention  of  yelloir  fever  and  other  contagious  and 
infectious  diseases,  having  the  mosquito  as  one,  if  not  the  only,  means  of 
transmitting  such  diseases  from  person  to  person. 

[Passed  by  the  city  council  of  Laredo,  Tex.,  April  23,  1904.] 

Be  it  ordained  hy  the  city  council  of  the  city  of  Laredo: 

Section  1.  That  all  wells,  cisterns,  tanks,  reservoirs,  barrels,  tubs,  vats,  pools, 
lakes,  ponds,  puddles,  and  other  water  containers  holding  and  containing  water 
therein  within  the  corporated  limits  of  the  city  of  Laredo  other  than  those  in 
which  the  water  therein  contained  is  either  coated  and  kept  coated  with  oil  or 
such  water  container  screened  in  such  manner  as  to  prevent  mosquitoes  from 
getting  therein  or  escaping  therefrom  is  hereby  declared  a  public  nuisance. 

Sec.  2.  Any  person,  firm,  company,  or  corporation  having  any  of  the  water 
containers  mentioned  in  section  1  of  this  ordinance  on  his,  her.  or  its  premises 
or  upon  any  lot  or  block  of  land  under  his,  her,  or  its  control  within  the  incorpo- 
rated limits  of  said  city  which  contains  water  who  shall  fail  or  refuse  to  cover 
the  surface  of  such  water  with  oil  and  keep  the  same  so  covered  or  in  lieu 


i'l'HLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


325 


thereof  keep  sucli  water  container  so  screened  as  to  i)revent  mosquitoes  from 
getting  therein  or  escajtinj,'  tlx-refi-oin  shall  he  deemed  guilty  of  a  nnisance, 
ami  upon  conviction  shall  he  lined  in  any  sum  not  less  than  .$0  nor  moi'e  thaii 
$2"),  and  each  day's  refusal,  neglect,  or  failure  shall  constitute   a    separate   offense. 

Skc.  ;{.  It  is  herehy  made  the  duty  of  the  city  liealth  i)hysician,  toKether  with 
such  assistant  physicians  and  h«'alth  inspectors  as  he  may  appoint,  to  enter  the 
house  or  premises  of  any  inhahitant  of  said  city  and  inspect,  fumifrate,  and 
disinfect  the  same  and  to  remove  any  sick  pei'son  therefrom  to  the  Mercy  Hos- 
pital whom  he  has  reason  to  helieve  is  suffering:  from  yellow  fever  when  in  his 
judiiment  such  case  can  not  he  efliciently  treated  at  the  i)atient's  house,  the 
exi)enses  to  he  home  hy  either  the  {government  of  the  State  of  Texas  or  that  of 
the  United  States  of  America. 

Skc.  4.  The  <-ounty  and  State  health  physicians  and  the  several  pliy.sicians  of 
the  Puhlic  Health  and  Marine-Hospital  Service  of  the  United  States  and  their 
aids,  assistants,  inspectors,  and  employees,  wliile  eui^a^ed  either  in  the  treat- 
ment, sui)pression.  or  prevention  of  yellow  fever  or  other  contafi;ious  or  infec- 
tious diseases  in  said  city,  are  herehy  vested  witli  the  same  powers  and  authority 
delegated  to  the  city  healtli  physician  and  his  assistant  physicians  and  health 
inspectors  l)y  the  third  section  of  this  ordinance. 

Sec.  .'').  Any  person,  firm,  company,  or  corporation  who  shall  refuse  to  permit 
any  of  the  i>liysicians,  inspectors,  and  employees  mentioned  in  the  tliird  and 
fourth  sections  of  tliis  ordinance  to  ins])ect  liis,  her,  or  its  premises  or  who  shall 
resist  the  removal  of  any  sick  person  to  the  Mercy  Hospital  wliom  tlie  attending 
physician  has  pronounced  to  be  afflicted  with  yellow  fever  or  other  infectious  or 
contagious  disease  shall  be  deemed  guilty  of  an  offense,  and  upon  conviction 
shall  he  fined  in  any  sum  not  less  than  $5  nor  more  than  $25. 

Sec.  G.  Any  person,  firm,  company,  or  corporation  who  shall  permit  the  larvse 
of  mosquitoes  to  exist  on  his,  lier,  or  its  premises  within  the  corporate  limits 
of  said  city  shall  be  deemed  guilty  of  an  offense,  and  upon  conviction  shall  be 
fined  in  any  sum  not  exceeding  .$10. 

Sec.  7.  All  ordinances  and  parts  of  ordinances  in  conflict  with  the  provisions 
of  this  ordinance  he,  and  the  sauie  are  hereby,  repealed. 

L.  C.  Navarko,  Mayor  pro  tempore. 

Attest : 

A.  It.  Garcia,  Secretary. 

Appendix  A. — Report  of  Service  operations  at  Laredo,  Tex. ,  for  period  December 

1, 19U3,  to  June  30,  1904. 


Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Inspected: 

Premises 

4,  .551 

17,869 

42,296 

46 

119 
295 

61,133 

40,219 

38,134 

161,906 

42,296 

315 

Persons 

Sick 

140  .          fi2 

67 

219 
629 

Fumigated: 

Houses - 

Rooms - - - 

Oiled: 

Premises  -. _ 

1,404 
5,496 

9a5 
9,590 

94 

221 

11 
38 

120 
286 

323 

772 

2,290 
7,737 

935 

Containers _ 

10,950 
190 
79 

26,900 
932 
4.54 

13,589 

448 
472 

11,766 
308. 
419 
130 

72,795 

2,184 

1,584 

171 

WeUs 

306 
160 
41 

Tanks,  cisterns 

Ponds,  excavations  - 

Appendix  B. 


-Report  of  operations  on  lines  of  travel  out  of  Laredo,  Tex.,  for 
period  December  1,  1903,  to  June  30,  1904. 


Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Inspected: 

Premises 

868 

464 
1,733 

820 
254 
378 
134 

1  248 

9  lift 

Fumigated: 

Houses 

56 
86 

237          341 
514          642 

196 
549 

199        1  ±(& 

Rooms 

711 

968 
37 

4,234 

1,788 

5«1 

Oiled: 

Containers 

WeUs _ _ 1. 

Tanks,  cisterns  _ ! 

259            637 

Ponds,  excavations 1 

""■| "1"" 

185            319 

1 

1               i 

326  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Smallpox  in  the  United  States. 

Further  aid  was  extended  to  the  health  authorities  of  the  State  of 
Maine,  upon  the  Canadian  border,  in  the  exclusion  and  suppression  of 
smallpox,  the  report  from  officers  detailed  for  this  work  showing  a 
total  of  1)3  families  under  observation,  3,752  persons  inspected,  1,736 
persons  vaccinated,  20G  cases  of  smallpox  treated,  and  111  dwellings 
and  20  schoolhouses  disinfected. 

Upon  request  of  the  proper  State  authorities  expert  officers  have 
been  detailed  in  an  advisory  capacity  to  several  points  in  other  States 
to  afford  aid  in  the  diagnosis  and  proper  method  for  the  suppression 
of  the  disease. 

In  October,  1903,  upon  request  of  State  health  authorities,  Passed 
Asst.  Surg.  J.  C.  Perrj'  was  directed  to  proceed  to  Charles  Town,  W. 
Va.,  to  investigate  the  prevailing  disease  in  that  region.  His  report 
was  published  in  Public  Health  Reports  of  October  23,  1903. 

REPORT   OF   OPERATIONS    FOR   THE   EXCLUSION    AND    SUPPRESSION    OF 
SMALLPOX    IN    THE    STATE    OF    MAINE. 

Report  of  Sukg.  P.  C.  Kaixoch. 

Quarantine, 
Portland,  Me.,  July  6,  1904. 

Sib  :  In  accordance  with  Bureau  letter  of  the  17th  ultimo,  I  have  the  honor  to 
make  the  following  report  of  the  efforts  made  under  the  direction  of  the  Public 
Health  and  Marine-Hospital  Service  for  the  suppression  of  smallpox  in  northern 
Maine  during  the  year  ended  June  30,  1!>04.  This  work  was  continued  from  the 
previous  year  and  was  undertaken  for  the  purpose  of  assisting  the  State  board 
of  health,  which  found  itself  in  need  of  help  owing  to  a  lack  of  funds  at  its 
disposal. 

The  work  of  suppressing  smallpox  on  the  Canadian  border  is  exceedingly  diflB- 
cult  on  account  of  the  seasonal  character  of  the  prevailing  occupation.  The 
lumbermen  go  long  distances  into  the  forest  to  cut  timl)er,  which  is  conveyed  to 
the  streams  where  it  awaits  the  spring  rise  of  water.  In  the  late  spring  another 
expedition  is  made  for  the  purpose  of  driving  the  h^gs  down  the  rivers  to  the 
mills.  These  two  excursions  are  made  by  large  numbers  of  men,  but  between 
times  there  is  a  constant  passing  from  camp  to  camp  and  to  larger  centers  of 
population,  so  that  an  infectious  disease  like  smallpox  is  easily  disseminated. 

Another  feature  which  adds  to  the  difficulty  is  the  ignorance  of  this  part  of 
the  population,  as  it  consists  largely  of  French  Canadians  who  have  not  been 
instructed  in  sanitary  matters.  They  not  only  fail  to  aid  in  measures  intended 
for  their  benefit,  but  often  oppose  such  measures.  The  efforts  therefore  in 
sparsely  settled  regions  are  less  successful  than  they  would  be  in  more  enlight- 
ened and  more  densely  i)opulated  communities. 

The  work  of  the  Service  has  consisted  in  the  inspection  of  persons  in  transit 
to  and  from  the  lumber  camps,  the  disinfection  of  tlie  clothing  of  suspects,  and 
the  vaccination  of  those  persons  who  were  not  already  protected.  The  disinfec- 
tion of  houses  was  also  practiced  where  tliey  were  suspected  of  being  infected. 

At  the  beginning  of  the  year  Doctor  Mason  was  appointed  as  acting  assistant 
surgeon  at  Fort  Kent,  and,  with  the  aid  of  a  helper,  disinfected  several  houses 
in  that  locality.  Twelve  cases  of  smallpox  were  found  in  a  single  house,  making 
a  total  of  24  cases  during  the  first  ten  days  of  .July.  Through  vigorous  treat- 
ment the  disease  was  subdued  and  the  work  at  this  point  discontinued  .July  31. 

Acting  Assistant  Surgeon  Nichols  was  engaged  at  Jackman  at  the  same  time, 
having  also  an  assistant  in  the  work  of  disinfection.  Among  the  persons  pass- 
ing at  this  point,  several  cases  of  smallpox  were  discovered  and  isolated.  The 
inspections  were  also  discontinued  at  this  place  on  .July  31. 

On  .July  25  Doctor  Young,  secretai-y  of  the  State  board  of  health,  reported 
several  outbreaks  of  smallpox  in  the  Madawaska  region,  in  the  northeastern 
part  of  the  State,  20  houses  having  been  disinfected  l)y  the  State  board.  Doctor 
Hammond,  of  Van  Buren,  was  employed  by  the  Service  to  visit  infected  points 
and  to  carry  out  the  necessary  sanitary  measures.     The  disease  has  continued 


PU15L1C    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


327 


at  (liffoivnt  places  in  this  section  u])  to  the  present  time,  new  focuses  appearing 
as  fast  as  (hi'  ohi  ones  are  ohiiterated. 

At  Loweiltown.  which  is  situated  on  the  Canadian  I'acific  Raih'oad  near  the 
border  of  the  State.  Doctor  Bootiihy  has  Ixmmi  enij)loyed  duriui?  most  of  the  year. 
The  trains  have  been  inspected  and  the  same  sanitary  measures  enforced  as  at 
otiier  inspection  stations. 

Respectfully,  P.  ('.  Kaixoch, 

Surf/con,  Puhl'ic  Ilrallh  tnul  Mariiic-lldniiitiil  Service. 
The  Surgeon-General. 


Quarantine. 
Portland,  Me.,  July  18,  1904. 
Sir  :  Referrinj;  to  my  report  of  the  .5th  instant  on  the  subject  of  the  efforts 
made  to  overcome  smallpox  in  northern  Maine  durins?  the  last  fiscal  year,  I  have 
the  honor  to  inclose  a  letter  just  received  frt)ni  Dr.  A.  (i.  Youuf?.  secretary  of  the 
State  board  of  health,  on  the  subject,  which  you  may  desire  to  use  in  connection 
with  the  report. 

Resi)ectfully,  P.  C.  Kalloch, 

Siirfjeofi,  PuhVic  Health  and  Marine-Hospital  Service. 
The  Surgeon-General. 


[Inclosui-e.l 

LETTER  FROM    SECRETARY   OF  THE    MAINE   STATE   BOARD  OF   HEALTH    ON   THE   EPIDEMIC 
WORK    IN    NORTHERN    MAINE. 

In  the  autumn  of  190.3  the  lumber  camps  in  the  northern  part  of  the  State  of 
Maine  were  seriously  exposed  to  the  danger  of  smallpox  from  the  direction  of 
the  cities  of  Bangor  and  Oldtown,  from  which  cities  many  of  the  lumbermen 
are  hired,  and  in  both  of  which  smallpox  had  broken  out.  There  was  also  seri- 
ous danger  of  the  importation  of  infection  from  the  provinces  of  Quebec  and 
New  Bi'unswick  by  the  many  men  seeking  work  in  the  lumber  regions. 

Although  the  lumber  operators  complied  fairly  well  with  the  special  order  of 
the  State  board  of  health  requiring  the  vaccination  of  all  lumbermen  before 
going  to  the  camps,  many  outbreaks  occurred  in  the  camps,  but  in  all  of  those 
outbreaks  they  were  restricted  to  but  four  cases.  In  accomplishing  this  the 
State  board  worked  under  the  disadvantage  of  an  insufficient  epidemic  fund  for 
covering  so  vast  a  forest  region.  Work  in  this  region,  where  the  medical 
inspectors  and  nurses  of  the  State  board  have  l)een  obliged  to  make  many  trips 
through  the  forest  of  from  40  to  To  miles  or  moi'e  by  buckboard,  tote  team,  canoe, 
or  on  foot,  has  been  found  to  be  hard  and  costly  work.  Under  these  circum- 
stances, as  they  were  stated  by  the  State  board  of  health,  the  Public  Health  and 
Marine-Hospital  Service  felt  it  expedient  and  best  to  render  aid  at  the  border  in 
preventing  the  importation  of  infection  from  without  the  State.  The  inspection 
services,  therefore,  which  the  State  board  of  health  had  already  put  on  at 
Loweiltown,  on  the  Canadian  I*acific  Railway,  and  at  Van  Buren,  Me.,  were 
taken  over  by.  the  national  authorities. 

At  the  Loweiltown  station  the  number  of  men  coming  into  the  State  by  train 
seeking  employment  in  the  lumber  camps,  and  the  number  who  were  found 
unprotected  by  vaccination  and  who  were  vaccinated,  was  as  follows : 


1903. 

September 

October _ 

November 

December 

1904. 
Jannary  


Passed. 


344 


Vacci- 
nated. 


.50 

16 

m> 

307 

722 

297 

359 

139 

137 


1904 

Pebruai-y 

March 

April _.. 

May 

June 


Passed. 


324 

172 
743 
244 
110 


Vacci- 
nated. 


136 
58 

220 
32 
19 


In  addition  to  these,  30  men  were  refused  admittance  into  the  State  and  were 
turned  back.  Sixty  men  were  required  to  take  a  disinfecting  bath  and  to  have 
their  clothing  and  other  effects  disinfected. 


328 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


The  work  done  under  the  direction  of  Acting  Asst.  Surg.  H.  H.  Hammond  at 
Van  Buren  is  shown  in*  the  following  tabulation : 


Families. 

Cases     '  Dwellings 
oases,     fumigated. 

School- 
houses. 

Vaccina- 
tions. 

1903. 
September               ..    

16 

10 

20 

9 

12 
5 
11 
10 

2.5                  16 
40                  10 

2 
10 

1*) 

(Ml 

m 

17 

13 

3 

23 

20 

12 
39 

7 
6 
11 
10 

,5IJ 

45 

1904. 

February                             -            - 

8 

90 

Total                                                    

93 

206 

•       111 

20 

375 

The  National  Quarantine  Stations. 

The  protection  aflPordecl  the  Unit<»cl  States  proper  in  the  exclusion 
of  qiiarantinable  disease  has  been  continued  at  the  40  national  mari- 
time inspection  and  disinfection  stations  located  in  the  waterways  to 
ports  of  entry  upon  the  Atlantic,  Gulf,  and  Pacific  coasts. 

A  total  number  of  7,021  vessels  were  inspected  and  1323  vessels  dis- 
infected before  permitted  entry,  with  as  little  delay  as  possible  to  com- 
mercial interests. 

These  detention  and  disinfection  stations  are  equipped  with  a  total 
of  30  substantial  wharves,  9()  main  buildings,  and  00  small  buildings. 
The  floating  property  consists  of  0  boarding  steamers,  4  disinfecting 
barges,  and  22  steam  and  naphtha  launches,  which  statistical  facts 
serve  in  a  way  to  show  the  character  and  importance  of  these  stations. 

On  March  31,  1004,  a  request  was  made  for  a  deficiency  appropria- 
tion of  $9,500  for  '•  Repairs  to  vessels,  quarantine  service."  This 
amount  was  made  available,  and  these  vessels  are  now  being  placed 
in  efficient  condition. 

On  account  of  the  danger  of  the  introduction  of  yellow  fever  into 
the  United  States,  the  following  amendments  to  the  quarantine  regu- 
lations were  promulgated : 

[1904.     Department  Circular  No.  30.     Public  Health  and  Marine-Hospital  Service.] 

Treasury  Department,  Office  of  the  Secretary, 

Washington,  March  30,  190Ji. 

To  the  national,  Htate,  and  local  quarantine  officers,  collectors  of  customs,  ship- 
owners and  agents,  and  others  concerned: 
Paragraph  G8  (c),  quarantine  regulations  of  1903,  is  hereby  amended  to  read 

as  follows  : 

"  Paragraph  68  (c)  :    If  arriving  at  a  port  south  of  the  southern  boundary  of 

Maryland  in  the  season  of  close  ((uarantine.  A)>ril  1  to  NoveinDer  1,  directly  or 

via  a  northern  port,  from  a  tropical  American  port,  unless  said  port  is  known  to 

be  free  from  yellow  fever." 

The  effect  of  this  amenchnent  is  to  cause  the  close  quarantine  season  to  begin 

April  1  instead  of  May  1.  with  regard  to  vessels  from  ports  known  or  suspected 

of  being  infected  with  yellow  fever,  and  arriving  at  southern  ports,  either  direct 

or  via  northern  ports. 

Paragraph  107  (a)  is  hereby  amended  to  read  as  follows: 

"  Paragraiih  107  (a)  :    If  arriving  in  five  days  or  less  she  may  be  admitted  to 

pratique  after  being  fmiiigated  again,  but  without  further  detention  than  is 

necessary  to  complete  the  five  days  from  port  of  departure." 

RoiiERT  E.  Armstrong,  Assistant  Secretary. 


PUBLIC   HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


329 


[Circular  lottoi-.l 

MimthJy  rcptnl  upon  coiKlitioii  af  iiditlitlni  Ifiiiiiclics  and  sail  mid  f<iii(ill  hoal.s  at 

(juurantiiics. 

Treasury  Department, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Waiihiiii/ton,  \orrmhrr  11,  1903. 
To  medical  officers  in  command.  United  Statefi  national  (juarantincfi: 

You  are  heri'by  directed  to  make  a  report  at  the  end  of  each  month  upon  the 
naphtha  launclies  and  all  sail  and  small  boats  at  your  station.  A  general 
description  of  these  boats  is  desired,  fjcivinuc  the  name,  lenjith,  beam,  draft, 
date  when  received,  when  the  last  repairs  were  made  and  by  whom,  and  a  state- 
ment as  to  the  condition  of  each.  If  any  of  these  boats  are  not  in  serviceable 
condition,  and  can  not  be  repaired  by  the  station  force,  report  should  be  made  as 
to  the  cause  of  the  defects,  accompanied  by  an  estimate  of  the  probable  cost  of 
repair. 

You  are  directed  to  make  the  first  report  for  the  month  of  October,  1903. 
You  are  directed  to  acknowledge  receipt  of  this  letter. 
Respectfully. 

Walter  Wyman.  Hurgcon-Gcneral. 

A  report  of  transactions  from  each  quarantine  station  follows: 

PORTLAND,    ME. 

[Portland  Quarantine;  post-office  address,  Portland,  Me.l 

[Report   of   the   medical    officer    in    command,    Surg.    P.    C.    Kallocli.     Assumed    command 
under  official  orders  of  December  27,  1901.] 

Quarantine,  Portland,  Me.,  July  5,  190^. 

Sir  :  The  transactions  of  this  station  for  the  fiscal  year  ended  .Tune  .30.  1904, 
have  been  limited  to  tlie  (piarantine  inspection  of  vessels  and  crews  from  for- 
eign ports  and  the  inspection  of  immigrants.  A  site  foi*  a  quarantine  station 
has  been  piu'chased.  consisting  of  al>out  10  acres  of  land  on  House  Island,  at 
at  cost  of  .$20,000.  This  site  is  well  adapted  to  the  purpose.  No  plans  for  the 
establishment  of  the  station  have  thus  far  been  made. 

The  steam  launch,  received  in  November.  1903.  and  named  Petrel,  is  40  feet 
in  length,  is  well  constructed,  and  very  well  answers  the  purpose  for  which  it 
was  supplied. 

No  cases  of  a  quarantinable  nature  have  arrived  from  foreign  ports  during  the 
year  at  this  port. 
Respectfully, 

P.  C.  K ALLOC II,  Surgeon. 

The  Surgeon-General. 


[Inclosure.] 


Transactions  (it  Portland  (Me.)  National  Quarantine  Station  for  year  ending 

June  30,  1904. 


July. 


Aug. 


Sept. 


Oct. 


Nov. 


Dec. 


Jan. 


Feb. 


Mar. 


Apr. 


May. 


June. 


Total 


Vessels  spoken 
and  passed. 

Steamers  inspect- 
ed and  passed. . . 

Steamers  disin- 
fected   

Sailing  vessels  in- 
spected  and 
passed 

Sailing  vessels 
disinfected 

Crew  on  steamers 

Crew  on  sailing 
vessels .  _ 

Passengers  on 
steaniei*s __ 

Passengers  on 
sailing  vessels  .. 


0 

387 

0 
0 
0 


0 
439 

21 

0 

0 


0 
193 

0 

0 

0 


0 
323 


0 
14 
0 

0 

0 

882 

0 

8.5 
0 


0 
14 
0 

0 

0 
896 

0 

75 

0 


0 
640 

0 

49 

0 


0 
931 

14 

183 

0 


0 
870 

15 

483 

0 


0 
271 

0 

0 

0 


0 
331 

15 

0 

0 


0 

1(10 

0 


0 
6,661 

65 

1,342 

0 


330 


PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 


EASTPORT. 

[Eastport  (Me.)  Quarantine.] 
[Report  of  Acting  Asst.  Surg.  E.  M.  Small,  in  charge.] 

Eastport,  Me.,  July  1,  WOJf. 

Sir  :  I  herewith  submit  my  annual  report  for  the  year  ending  June  30,  1904. 

I  liave  been  so  fortunate  as  to  discover  nothing  of  a  contagions  nature  among 
the  large  number  of  persons  subjected  to  my  inspection.  I  think  this  is  largely 
due  to  the  fact  that  travelers  are  aware  of  the  fact  that  this  is  a  quarantine 
station ;   consequently  the  sick  or  suspects  avoid  Eastport. 

I  have  urged  on  the  officers  of  all  steamers  the  imiDortance  of  refusing  passage 
to  all  suspects,  and  they  have  followed  my  advice.  Smallpox  and  diphtheria 
have  been  all  around  us,  but  by  closely  watching  infected  places  we  have 
escaped.  I  endeavor  to  keep  in  touch  with  the  neighboring  towns,  and  find 
their  boards  of  health  willing  to  give  me  such  information  as  I  desire. 

I  am  happy  to  state  that  at  the  present  time  this  section  is  particularly 
healthy. 

Respectfully,  Edward  M.  Small, 

Acting  Assistant  Surgeon. 

The  Surgeon-General. 


[Inclosure.] 


Transactions  at  Eastport  {Me.)  National  Quarantine  Station  for  year  ending 

June  30,  1904. 


July. 

Aug. 

0 

0 

117 

110 

0 

0 

14 

13 

0 

2,888 

0 
2,705 

82 

73 

5,  .511 

5,713 

13 

0 

Sept. 

Oct. 

Nov. 

0 

0 

0 

110 

105 

72 

0 

0 

0 

12 

13 

6 

0 
2,676 

0 
2,540 

0 
1,523 

62 

68 

31 

4,743 

3,288 

1,932 

0 

0 

0 

Dec. 


Jan. 

Feb. 

Mar. 

Apr. 

May 

June. 

0 

0 

0 

0 

0 

0 

51 

55 

62 

ft) 

91 

1  r, 

0 

0 

0 

0 

0 

0 

1 

1 

5 

12 

15 

8 

0 
874 

0 

894 

0 
1,108 

0 
1,322 

0 
2,361 

0 
2,577 

9 

6 

24 

68 

83 

56 

1,200 

975 

1,327 

1,538 

2,296 

4,855 

0 

0 

0 

0 

0 

10 

Total. 


Vessels  spoken 
and  passed- 

Steamers  inspect- 
ed and  passed, . . 

Steamers  disin- 
fected  

Sailing  vessels  in- 
spected  and 
passed 

Sailing  vessels 
disinfected 

Crew  on  steamers. 

Crew  on  sailing 
vessels 

Passengers  on 
steamei"s 5,  .511 

Passengers  on 
sailing  vessels  . 


0 
1,254 

57 

1,529 

0 


0 

1,012 

0 

109 

0 
22,722 

619 

34,907 

23 


REEDY    ISLAND. 

[Reedy  Island  Quarantine;  post-office  address,  via  Port  Penn,  Del.] 

[Report  of  Passed  Asst.   Surg.   H.  W.   Wickes.     Assumed  command  under  official   orders 

of  March  12,  1903.] 


Reedy  Island  Quarantine,  July  1,  1904. 

Sir  :  I  have  the  honor  to  submit  the  following  report  of  transactions  at  this 
station,  together  with  the  tabulated  statistical  report  for  the  fiscal  year  ending 
June  30,  1904 : 

During  the  year  30  vessels  were  spoken  and  passed ;  901  vessels  inspected 
and  passed,  of  which  785  were  steam  vessels  and  116  were  sail  vessels ;  a  total 
of  57,787  persons  were  inspected,  of  which  31,911  were  members  of  crews  of 
steam  vessels,  1.89G  members  of  crews  of  sail  vessels,  23,977  passengers  on  steam 
vessels,  and  3  passengers  on  sail  vessels. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


331 


Five  vossols  woro  (lisinrcctiMl,  nf  which  two  wciv  stciiiu  vessels  and  tliroo  sail 
vessels,  us  follows : 

July  14,  1008,  Amork-an  shij)  Vhuciicc  S.  lioiiciil,  from  Honolulu,  with  cargo 
of  sui^ar.  24  in  crow,  was  hold  on  advice  of  the  iiuarantine  (jllicer  at  Honolulu  on 
account  of  noncompliance  with  the  special  (luarantine  i-e;,'nlations  of  the  Terri- 
tory of  Hawaii.  The  hold  was  fumigated  with  sulphur  and  the  crew  hathed 
and  their  dnnnaf^e  disinfected. 

July  1!),  1!»(>4,  Anu'iican  S.  S.  JInwaiian,  from  Honolulu,  with  cargo  of  sugar, 
44  in  crew,  was  remanded  to  tiiis  station  from  Delaware  Breakwater  for  fumi- 
gation an<l  disinfertidn  of  dunnage. 

Fel)ruary  24,  liritish  ship  Mcrsci/.  from  Den)erara,  in  hallast,  35  in  crew,  was 
held  ;ind  the  hold  fumigated  for  destruction  of  rats.  Ninety-seven  dead  rats 
were  fo\nid  and  hurned  after  fumigation.  This  vessel  had  heen  engaged  in 
carrying  coolies  from  Calcutta  to  Demerara. 

March  1),  1!)()4,  r.ritish  S.  S.  Montauk  I'oint,  from  London,  with  a  general 
cargo,  :n  in  crew,  and  12  passengers  (cattlemen),  with  1  ease  of  smallpox  in 
crew,  was  held  and  all  living  compartments  and  dunnage  disinfected.  Tlie  case 
of  smallpox  was  isolaled  on  the  island  and  all  on  board,  including  the  pilot,  were 
held  for  observation  until  ordered  released  by  the  Bureau.. 

May  17,  1004,  American  schooner  Madalcne  Cooncy,  from  Fernandina,  with 
lumber,  0  in  crew,  among  which  there  was  1  case  of  small])ox,  was  held  for 
disinfection.  The  case  of  smallpox  was  removed  to  the  island,  and  after  disin- 
fection the  vessel  and  the  remainder  of  the  crew,  with  the  exception  of  the 
steward  and  his  wife,  were  released  by  order  of  the  Bureau. 
Respectfully, 

H.  W.  WrcKES, 
Passed  Assistant  Surgeon. 

The  Surgeon-General. 


[Inclosure.] 


Trmisactions  at  Reedy  Island  National  Quarantine  Station  for  year  ending  June 

30, 1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels   spoken 
and  passed 

3 

72 

1 

7 

1 

2,787 

76 
2,653 

6 

77 

8 
69 

2 

51 

4 

73 

5 
46 

1 
80 

1 

50 

30 

Steamers  inspect- 
ed and  passed  . . 

Steamers  disin- 
fected  

64 

64 

67 

1 

13 

72 

785 
2 

Sailing  vessels  in- 
spected    and 
passed 

Sailing    vessels 
disinfected 

15 

13 

8 

6 

13 

2 

4 

1 
1,763 

67 

778 

11 

13 

1 
3,631 

172 

2,790 

13 

2,"l65" 

163 

1,617 

116 
3 

Crewon  steamers. 
Crew   on  sailing 
vessels 

2,829 

306 

2,441 

1 

2,684 

171 

4,014 

2 

1,999 

177 

1,795 

3,057 

75 

2,130 

2,456 

239 

1,146 

2,473 

65 

957 

3,135 

192 

1,790 

2,992 

193 

1,866 

31,911 

1,896 

23,977 

3 

Passengers  on 
steamei's 

Passengers  on 
sailing  vessels  .- 

DELAWARE    BREAKWATER. 

[Delaware  Breakwater  Quarantine;  post-office  address,  via  Lewes,  Del.] 

[Report  of  the  medical  officer  in  command.  Passed  Asst.  Surg.  C.  H.  Lavinder.     Assumed 
command  under  official  orders  of  March  8,   1901.] 


Delaware  Breakwater  Quarantine,  July  1,  lOOff. 

Sir  :  I  have  the  honor  to  inclose  herewith  tabulated  quarantine  report  of  this 
station  for  the  fiscal  year  ending  June  30,  1904,  and  I  submit  below  an  addi- 
tional report. 

As  will  be  noticed,  the  boarding  work  of  this  station  has  very  much  decreased. 


332 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


A  total  of  only  107  vessels  of  all  classes  Inspected  foi-  the  entire  year.  This  is 
probably  the  smallest  number  of  vessels  ever  inspected  at  this  station  during 
any  previous  year  of  its  existence.  The  shipping  here  has  been  steadily  decreas- 
ing for  some  time.  As  to  the  cause  of  this,  I  am  told  l)y  shipping  people  that 
it  is  due  to  falling  off  in  the  sugar  importations  from  Java,  Cuban  and  West 
Indies  sugar  apparently  replacing  the  Java  .sugar.  A  large  part  of  the  shipping 
at  this  port  has  always  been  sugar-laden  vessels  from  Java  sent  here  to  await 
orders. 

Following  is  a  brief  account  of  all  vessels  which  arrived  during  the  year 
requiring  any  connnent ;  Ship  Clarence  S.  Benieiit,  with  sugar  from  Honolulu, 
inspected  and  passed  without  pratique  on  account  of  refusing  disinfection  by 
Service  officers  at  port  of  departure.  S.  S.  Haicaiian,  with  sugar  from  Honolulu 
via  South  American  ports,  remanded  to  Reedy  Island  after  removal  of  a  suspi- 
cious case  of  inguinal  bubo.  S.  S.  Haint  Hugo,  with  sugar  from  Java,  inspected 
and  released  without  pratique  Ity  reason  of  suspicious  sickness  on  the  voyage. 
S.  S.  Marie,  with  sugar  from  Peruvian  j^orts,  held  a  few  hours  by  reason  of  call- 
ing at  jilague-infected  port  and  sbipj)ing  men  there,  released  and  quarantine 
officer  at  port  of  destination  advised. 

The  following  vessels  may  be  noticed:  S.  S.  Knight  Errant,  with  sugar  from 
Java,  Chinese  crew,  had  2  deaths  on  the  voyage  from  beriberi  and  a  third  from 
the  same  cause  in  this  harbor.  Bark  Coniliehank,  in  ballast,  from  Lourengo 
Marquez,  wi'ecked  on  the  coast  near  here,  was  passed  after  visiting  the  master 
at  the  life-saving  station  and  examining  the  vessel's  papers.  The  .school  ship 
Saratoga  was  passed  twice  during  the  year  on  the  medical  officer's  certificate. 

Glandular  examinations  were  made  on  several  vessels  during  the  year. 

The  practice  of  passing  some  vessels  without  pratique,  as  above,  is,  by  reason 
of  local  conditions,  often  the  best  quarantine  disposition  of  them  at  this  port. 
Such  a  procedure  often  saves  the  vessel  both  time  and  annoyance,  and  seems 
safe. 

Respectfully,  C.  H.  Lavinder, 

Passed  Assistant  Surgeon. 

The  Surgeon-General. 


[Inclosure.l 

Transactions  at  Delaware  Breakivater  National  Quarantine  Station  for  year 

ending  June  30,  1904. 


July. 


Aug. 


Set. 


Oct. 


Nov. 


Dec. 


Jan. 


Feb. 


Mar. 


Apr. 


May. 


June. 


Total. 


Vessels  spoken 
and  passed 

Steamers  inspect- 
ed and  passed-.- 

Steamers  disin- 
fected  - 

Sailing  vessels  in- 
spected and 
passed 

Sailing  vessels 
disinfected 

Crewon  steamers. 

Crew  on  sailing 
vessels 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels  . . 


0 
249 

120 

2 

0 


0 
133 

120 

15 

0 


0 
139 

35 

0 
0 


0 
137 

104 

0 

4 


0 
141 

111 

0 

5 


0 
183 

161 

0 

0 


0 
68 

150 

0 

0 


0 
141 

54 

5 

1 


0 
162 

69 

1 

0 


0 

54 
0 

53 

0 
1,508 

1,157 


10 


PUBLIC    HKALTH    AND    MARIXK-HOSl'ITAL    SP:RVICK. 


388 


ALEXANDRIA. 
[Report  of  Acting  Asst.  Surg.  Arthur  Snowden,  in  charge.] 

Trausactioiis  at  Alcrajidrid  (Va.)  National  Quarantine  Station  for  year  ending 

June  JO,  1904. 


July. 

Aug. 

Sept.  Oct.   Nov. 

Dec.    Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels  spoken 
and  pas-sed. 

1 

1 

Steamers  inspect- 
ed and  jiasst'd--- 

St earners  disin- 
fected  

- 

Sailing  vessels  in- 
spected and 
passed 

1 

2 

2 

2 

3 

1 

1 

1 

13 

Sailing  vessels 
disinfected 

1 

Crew  on  steamers. 

1. 

Crew   on   sailing 
vessels 

7 

15 

16 

14 

1 

26 

7  1       7 

8 

100 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels  .. 

'"""i 

2 

2 

1           1           i 

CAPE    CHARLES, 


[Cape  Charles  Quarantine;  post-office  address,  via  Fortress  Monroe,  Va.] 

[Report  of  the  medical  officer  in  command,  Asst.  Surg.  J.  S.  Boggess.     Assumed  command 
under  <  fficlal  orders  of  November  21,  1902.] 

Cape  Charles  Quabaxtixe.  July  1,  1904- 

Sib:  In  compliance  with  Bureau  circular  letter  of  April  18,  iri04,  relative  to 
annual  reijorts  from  domestic  quarantine  stations,  I  have  the  honor  to  state  that 
during  the  fi.scal  year  ending  June  3U,  1904,  28  sailing  vessels,  carrying  crews 
aggregating  321  men  and  8  passengers,  and  226  steam  vessels,  carrying  crews 
aggregating  10.010  men  and  1,924  passengers,  came  under  the  jurisdiction  of  this 
station.  This  includes  3  foreign  and  5  domestic  men-of-war  (which  were  passed 
upon  the  certificates  of  the  naval  surgeons  on  board),  which  carried  comple- 
ments aggregating  788  and  2,779.  respectively.  No  sailing  vessels  were  fumi- 
gated, but  4  steam  vessels,  carrying  132  oflicers  and  men  were,  sulphur  being 
used  by  the  pot  method  in  all  cases.  No  cases  of  quarantinable  disease  came 
under  observation. 

In  addition  to  the  above  strictly  quarantine  work  the  medical  officer  in  com- 
mand (acting  under  Bureau  telegraphic  orders  of  April  2)  proceeded  to  New- 
port News,  Va..  on  April  6,  with  the  British  steamship  Donne  Castle,  after  the 
quarantine  inspection  of  that  vessel  was  completed,  for  the  purpose  of  inspect- 
ing, in  accordance  with  the  inmiigration  laws,  38G  Boer  and  British  soldiers 
destined  for  the  St.  Louis  E.xposition. 

Relations  with  the  other  branches  of  the  Government  service  and  with  the 
local  health  authorities  have  been  entirely  harmonious  during  the  past  year. 

A  statistical  table  showing  the  station  work  for  the  fiscal  year  Is  inclosed 
herewith. 

Respectfully,  Jis'o.  S.  Boggess, 

Assist (uit  Surgeon  in  Command. 

The  Subgeon-Genebal, 


334 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


[Inclosure.] 

Transactions  at  Cape  Charles  National  Quarantine  Station  for  jjear  ending  June 

30,  100.1,. 


July.  Aug. 

Sept.!  Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

"Vessels  spoken 

0 

Steamers  inspect- 
ed and  passed. -- 
Steamers  di sin- 

21 
1 

3 

20 
2 

1 

22        23 

1 

22 

13 

23 

15 

9 

15 

21 

22 

1 

7 

226 

4 

Sailing  vessels 
inspected     and 

1 

3 

4 

2 

1 

6 

28 

Sailing    vessels 

0 

Crew  on  steamers. 
Crew   on    sailing 

720 
26 
62 

660 
13 
134 

729 

1,457 

1,322 

793 
10 
89 

920 
47 
190 

499 
46 
89 

1 

322 

21 
104 

564 

28 

481 

3 

1,919 

62 

4«6 

3 

705 

68 

68 

1 

10,610 
321 

Passengers  on 

steamers 

Passengers  on 

43 

110        68 

1,924 
8 

1 

CAPJ:    FEAR. 

[Cape  Fear  Quarantine;  post-ofBce  address,  via  Southport,  N.  C] 

[Report  of  the  medical  officer  in  command,  Asst.  Surg.  B.  S.  Warren.     Assumed  command 
under  official  orders  of  March  19,  1903.] 

Cape  Feab  Quarantine.  July  1,  IDO.'f. 
Sir:  I  have  the  honor  to  transmit  herewith  a  report  of  transactions  at  this 
station  during  the  fiscal  year  ended  June  :'.0,  1904.     Of  the  60  vessels  reported 
15  were  from  the  West  Indies,  o  from  South  America.  3  from  South  Africa,  Kj 
from  Europe.  3  from  Cuba,  and  18  from  domestic  ports. 

Four  vessels  were  disinfected — 1  from  Cuba,  1  from  South  Africa,  and  2  from 
South  America. 

Respectfully,  B.  S.  Wabben, 

Assistant  Surgeon. 
The  Subgeon-Genebal. 


[Inclosure.] 

Transactions  at  Cape  Fear  National  Quarantine  Station  for  year  ending  June  30, 

1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels  spoken 

0 

0 

2 

0 

0 

0 

0 

0 

0 

0 

0 

0 

2 

and  passed 

Steamers  inspect- 

4 

0 

8 

11 

2 

0 

4 

0 

0 

0 

1 

2 

32 

ed  and  pas.sed... 

Steamers  disin- 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

fected 

Sailing   vessels 

inspected   and 

1 

1 

1 
0 

3 

0 

1 

0 

2 

0 

2 
0 

2 
0 

3 
0 

1 
1 

4 
1 

1 
0 

1 
1 

22 

Sailing  vessels 

4 

disinfected 

Crew  on  steamers . 

91 

0 

213 

253 

44 

0 

105 

0 

0 

0 

20 

54 

V«0 

Crew  on    sailing 

vessels 

15 

6 

19 

9 

20 

17 

22 

Zi 

25 

40 

8 

16 

220 

Passengers  on 

steamers 

0 

0 

0 

0 

0 

0 

5 

0 

0 

0 

0 

0 

5 

Passengers  on 

sailing  vessels  . . 

0 

0 

0 

0 

0 

0 

0 

1 

" 

0 

'^ 

0 

' 

PUBLIC    HKALTH    AND    MARINE-HOSPITAL    S?:RVICE. 


335 


NEVVI$ERN,   N.    C. 

Under  date  of  Jidy  '28,  1904,  the  acting  assistant  surgeon  in  charge 
of  quarantine  at  Newbern,  N.  C,  reported  that  there  had  been  no 
transactions  during  the  fiscal  year  ending  June  30,  1904. 

WASHINGTON,    N.    C. 

Under  date  of  June  30,  1904:,  the  acting  assistant  surgeon  in  charge 
of  quarantine  at  AVasliington,  N.  C,  rejiorted  that  there  had  been  no 
transactions  during  the  fiscal  year  ending  June  30,  1904. 

SAVANNAH. 

r  Savannah  Quarautino  ;  post-offlce  address,  via  Savannah,  Ga.  ] 

[  IJeport  of  the  medical  officer  in  charge.  Acting  Asst.  Surg.  William  J.  Linley.     Assumed 
charge  under  official  orders  of  May  2,  1899.] 

Savannah  QiArantine,  July  6.  100.',. 

Sib  :  In  compliance  with  in.structions  received  in  Bureau  circular  letter  dated 
April  18,  1!)04,  T  have  the  honor  to  transmit  the  following  rei)ort  of  transactions 
at  this  station  for  the  fiscal  year  ended  June  oO,  1004 : 

One  hundred  and  sixty -two  steamships  and  73  sailing  vessels,  carrying  5,604 
seamen  and  22  passengers,  were  boarded  and  inspected.  One  hundred  and  forty- 
nine  of  the  former  were  given  pratique  immediately  on  inspection,  2  disinfected 
and  held  for  observation,  2  fumigated  and  released,  3  held  to  complete  period 
of  observation,  0  held  from  one  to  three  days  pending  diagnosis  of  cases  of  sick- 
ness aboard,  and  1  held  subject  to  disinfection,  but  departed  without  it,  having 
received  orders  for  another  port.  Thirty-five  of  the  latter  were  inspected  and 
given  pratique  at  once,  10  disinfected  and  detained  for  observation,  G  fumigated 
and  released,  4  fumigated  and  released  after  discharge  of  ballast,  1  held  under 
observation  and  released  without  pratique,  and  17  held  subject  to  disinfection  or 
fumigation,  but  released  without  disinfection  and  consequently  without  pratique, 
having  received  orders  for  some  other  ])ort.  Twenty-nine  vessels  were  boarded 
in  Tybee  Roads.  The  average  period  of  detention  of  vessels  held  for  di,sinfection 
and  subsequent  observation  was  six  and  three-fourths  days,  and  of  those  held 
simply  for  fumigiition  two  and  three-tenths  days. 

Xatioitalit!/  and  class  of  vessels  hoarded  during  the  year. 


Steam- 
ships. 

Barken- 

tines. 

Barks. 

Ships.      S-^l;?-- 

Tug- 
boats. 

Total. 

British 

106 
4 

4 

11 

121 

28 
3 

1 

33 

Swedish 

3 

Danish                               

6 
2 
1 
2 

6 

Russian .             

5 
3 

7 

Italian _ 

4 

Belgian  __  _ 

1 

2 

Uruguayan         

2 

1 

1 

2 

German 

13 
12 

1 
12 
2 

1 

1.5 

Austrian 

12 

Spanish . 

1 

1 

3 

Dutch.. 

13 

American 

1 

1 

10 

1 

1.5 

Total 

161 

5 

44 

3  1              21   1            1 

2;i5 

Two  vessels  arrived  with  fitegomyia  fasciata  aboard — ^the  British  barkentine 
Meteor,  October  2,  twenty-five  days  from  Para,  and  the  American  schooner 
Lejolc,  October  6,  eleven  days  from  Habana. 

One  thousand  and  seventy-five  tons  of  ballast  were  discharged  during  the 
year. 


336 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Transiictionii  at  Havanuah   (Ga.)   National  Quarantine  Station  for  year  ending 

June  30,  190J,. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels     spoken 
and  passed 

Steamers  inspect- 
ed and  passed... 

Steamers    disin- 

0 
6 
0 

4 

1 
141 

57 

0 

0 
9 
1 

3 

1 
2.57 

•Si 

2 

0 
19 
0 

10 

0 
.555 

118 

2 

0 

24 

3 

4 

815 

103 

3 

0 
29 
0 

7 

1 
815 

118 

1 

0 

14 

0 

6 

0 
483 

72 

0 

0 
19 
0 

3 

2 
581 

50 

1 

0 

7 
0 

1 

2 
264 

43 

4 

0 

9 
0 

3 

1 
217 

39 

0 

0 

8 
0 

6 

4 
289 

115 

2 

0 
6 
0 

4 

3 
151 

73 

0 

0 
8 
0 

1 

1 

196 

19 
0 

0 

158 

4 

Sailing  vessels  in- 
spected    and 

52 

Sailing    vessels 
disinfected 

Crew  on  steamers. 

Crew   on   sailing 
vessels       

21 
4,764 

840 

Passengers  on 
steamers 

15 

Passengers  on 
sailing  vessels... 

0 

0 

1 

5 

0 

0 

1 

0 

0 

0 

0 

0 

7 

Under  "  inspected  and  passed  "  in  the  above  table  are  included  18  vessels  held  subject 
to  fumigation,  but  which  i)«t  to  sea  without  it,  having  received  orders  for  some  other 
port ;  3  held  from  one  to  three  days  to  complete  period  of  observation,  and  5  held  from 
one  to  two  days  pending  diagnosis  of  cases  of  sickness  aboard. 


Countries  from  tvhich  vcfiscls  detained  came. 


South  Africa i 10 

Cuba    12 

Brazil    9 

United    States 5 

We«t    Indies 2 


Peru    

Cul)a  via  United  States. _. 
Brazil  via  United  States  . 
Mexico  via  United  States- 
Ireland    


Sand 

Stone 

Water 


Ballast  and  cargoes  brought  by  i^csscls  treated  at  station. 


Light    __ 

General 

Nitrates 


Sickness  observed  aboard  vessels  on  arrival. 


Acne    

Beriberi    

Catarrhal    fever- 
Chancroids    

Cystitis    

Dysentery    

Enteralgia      

Enteric    fever 


1  Enteritis    3 

7  Jaundice    1 

1  Malaria    4 

1  Neuralgia    2 

1  Pneumonia    4 

1  Rheumatism    2 

1  Scabies    4 

2  Traumatic    gangrene 1 


During  the  month  of  January  two  negro  servants  employed  by  the  medical 
officer  developed  mild  atypical  smallpox.  The  women  were  isolated  in  the  sta- 
tion hospital,  all  unprotected  persons  vaccinated,  and  the  medical  officer's 
quarters  thoroughly  disinfected. 

Respectfully,  Wm.  J.  Linley, 

Acting  Assistant  Surgeon. 
The  Surgeon-Gejjeral. 


PUBLIC    HEALTH    AND    MARINE-HOSl'lTAL    SKKVICE. 


'637 


SOUTH  ATLANTIC. 

[South  Atlantic  Quarantine;  post-office  address,  via  Inverness,  Ga.] 

[Report  of  tlie  medical  officer  in  command.  Passed  Asst.  Surg.  0.   M.  Corput.      Assumed 
command  under  offlciai  orders  of  November  25,   1901.] 

South  Atlantic  Quarantine,  Jiiiie  30,  1!)()J,. 

Sir:  T  liavo  tlio  honor  to  submit  the  foIlowitiK  roi)ort  of  trausiiftioiis  at  tliis 
station  durinfi  tlio  liscal  yoar  ondiui?  June  'M),  1!)04  : 

Twenty-five  steanisbi[»s,  witli  a  total  tonna5:;eof  r)0,(;ir)  tons,  were  insi)ected  and 
I)assed.  Tliree  steainsliii)s  were  s])olven  and  i)assed.  No  steanisliii»s  Iiave  been 
disinfected  durinj:  tlie  year.  Tbree  sailing  vessels,  with  a  total  tonnas^e  of  3,040 
tons,  were  disinfected,  and  820  tons  of  l)allast  discharged.  Nine  sailing  vessels, 
with  a  total  tonnage  of  (J.SOS  tons,  were  insi)ected  and  pased.  No  vessels  were 
remanded  to  this  station  from  other  i)<)rts  during  the  year,  and  no  sickness  has 
occurred  in  quarantine.  Four  jetties  to  prevent  encroachment  by  the  sea  at 
the  south  end  of  the  island  have  been  built  and  washing  at  this  [loint  stopi)ed. 
Seventy-four  new  creosoted  piles  have  been  driven  at  the  north  end  and  other 
minor  rei)airs  made.  Painting  and  other  minor  repairs  have  been  done  by 
attendants  on  the  buildings  at  the  south  end.  The  tele[)hone  line  between 
north  and  south  ends  of  the  island  has  been  thoroughly  repaired.  The  marine 
railway  at  the  south  end  has  been  repaired  and  new  timbers  put  in,  in  place  of 
old  ones  which  had  rotted  out.  New  tire  apparatus  has  been  installed  and  the 
tire  protection  is  now  better  than  it  has  ever  been. 

The  health  of  officer  and  attendants  has  been  exceptionally  good  and  no  sick- 
ness has  occurred  in  the  station  force  during  the  year. 

In  conclusion,  I  have  the  honor  to  report  that  relations  with  local  and  other 
health  authorities  have  been  pleasant  throughout. 

Respectfully,  G.  M.  Corput, 

Passed  Assistant  Surgeon. 

The  Surgeon-General. 


[Inclosure.] 

Annual  report  of  transactions  at  Soiitli  Atlantic  National  Quarantine  Station 
for  year  ending  June  30,  1904.. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dee. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels  spoken 
and  passed 

1 
3 

2 

3 

Steamers  inspect- 
ed and  passed. . . 

Steamers  disin- 
fected  

1 

T 

2 

1 

1 

1 

2 

5 

25 

0 

Sailing  vessels  in- 
spect e  d   and 
passed  

1 

"'26' 
12 

2 

1 
8.5 

45 

3 

1 

2 

1 

39 

g 

Sailing  vessels  dis- 
infected   

1 
16 

3 

Crew  on  steamers . 

Crew   on   sailing 

vessels 

23 

172 

49 

26 

50 
39 

20 

43 

9 

124 
3 

618 
160 

Passengers  on 
steamers 

3 

Passengers  on 
sailing  vessels. . . 

0 

8629—04- 

— 33 

338 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


I5RUNSWICK. 

[Brunswick  Quarantine;  post-ofBce  address,  via  Brunswick,  Ga.] 

[Report  of  medical  officer  in  command,  Asst.  Surg.  J.  T.  Burkhalter.     Assumed  command 
under  official  orders  of  July  18,  1902.] 

Brunswick  Quarantine,  July  2,  1904- 

Sir  :  I  Lave  the  honor  to  submit  the  following  report  of  transactions  at  this 
station  for  the  year  ended  June  30,  1904,  together  with  attached  statistical  form 
letter : 

The  inclosed  schedule  shows  that  29  vessels  were  si^oken  and  passed,  14  steam- 
ers insiiected  and  passed,  09  sailing  vessels  inspected  and  passed,  and  14  sailing 
vessels  disinfected.. 

Nationality  of  vessels  disinfected:  Simnish,  3;  British,  1;  Norwegian,  G; 
Uruguayan,  1 ;  Portuguese,  1 ;  Italian,  2. 

Ports  from  which  they  arrived:  South  African,  0;  Cuban,  4;  Brazilian,  2; 
French  Guiana,  via  West  Indian,  1 ;  South  Africa,  via  West  Indian,  1. 

No  vessel  arrived  with  a  quarantinable  disease  aboard. 

The  following  diseases  were  discovered  on  board  during  the  year:  Malarial 
fever,  1;  beriberi,  4;  heat  stroke,  1;    intestinal  obstruction,  1;  valvular  disease^ 
of  heart,  aortic,  1. 

The  following  vessels  arrived  in  quarantine  with  mosquitoes  aboard : 

(1)  Spanish  brigautine  Alfredo,  six  days  out  from  llabana ;  arrived  July  8. 
Mosquitoes  found  in  cabin  and  larvie  in  tub  on  deck.  No  Stegomyia  fasciata 
among  specimens  examined. 

(2)  British  barkentine  Jno.  *S'.  Bennett,  five  days  out  from  Habana  ;  arrived 
on  July  27.  Cabin,  forecastle,  and  between  decks  literally  swarming  with  mos- 
quitoes. Two  tanks  on  deck  alive  with  larva>  and  [juixt?.  All  specimens 
examined  were  Stegonnjia :  also  those  hatched  out  from  tanks. 

(3)  Sixanish  bark  F.  G.,  arrived  July  29,  six  days  out  from  Habana.  A  few 
Steyomyia  caught  and  examined.     No  breeding -ijiace  discovered  aboard. 

(4)  British  schooner  Brooklyn,  five  days  out  from  Habana;  arrived  August 
20.     Stegomyia  discovered  in  cabin  and  forecastle.     No  breeding  place  aboard. 

(5)  Uruguayan  bark  Giiernika,  forty-one  days  out  frou)  Kio;  arrived  March 
25.  Given  preliminary  disinfection  in  stream,  after  which  I  discovered  larvie 
in  tank  on  deck  and  c'ai)tured  one  ^tegomy'ia  from  cabin  and  tank,  respectively. 
Vessel  laid  2  miles  out  from  Rio.  in  ojien  stream. 

(6)  Spanish  bark  Angclita,  eight  days  out  from  Habana,  arrived  in  quarantine 
June  30,  with  Stcgomyia  in  cabin  and  tank  of  water  on  deck  alive  with  larvie. 

Respectfully, 

Jno.  T.  Burkhalter,  Assistant  Surgeon. 
The  Surgeon-General. 


[Inclosure.] 


Transactions  at  Brunswick  {Ga.)  National  Quarantine  Station  for  year  ending 

June  30,  1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels  spoken 
and  passed- 

Steamers  inspect- 
ed and  passed.  .. 

Steamers     disin- 
fected 

3 

1 

2 

3 

1 

2 

4 
2 

1 
3 

2 
2 

5 

1 

3 

2 

2 
1 

2 
1 

29 
14 

Sailing  vessels  In- 
spected   and 

1 

4 
2:i 

54 

7 
89 

2 

2 

17 

48 
2 
1 

3 

3 

50 

81 

9 

2 
52 

124 

10 

1 
71 

108 

9 

4 

10 
1 

6 

7 

1 

1 
24 

34 

1 

69 

Sailing  vessels  dis- 

14 

Crew  on  steamers 
Crew   on  sailing 

40 
93 

19 

48 

35 
62 

331 

128 

70 

939 

Passengers  on 

3 

Passengers  on  sail- 

1 

3 

2 

3 

2 

1 

1 

14 

rUBLIC    HEALTH    AND    MARlNP:HOSriTAL    SERVICE. 


339 


TAMPA    BAY. 

[Tampa  Ray  Quarantine;  post-office  address,  v!a  Tampa,  Fla.] 

[Report  of  medical  officer  in  command,  Asst.   Surj;.   U.   K.   Eljersole.     Assumed  command 
under  official  orders  of  December  7,   1003.] 

Tampa  Bay  Quarantine,  June  30,  JDOJf. 
Sir:   I  have  the  honor  to  forward  herowitli  report  of  transactions  at  this  sta- 
tion during  the  fiscal  year  ended  June  .*!(),  1904,  as  directed  by  Bureau  circular 
letter  of  April  18,  1904. 

Number  of  steamers  in.spected  and  pas.sed 44 

Number  of  sailing  vessels  inspected  and  passed 110 

Number  of  steamers  disinfected 2 

Number  of  sailing?  vessels  disinfected 0 

The  vessels  entering  here  are  mainly  vessels  from  Cuban  and  clean  Central 
American  ports,  with  a  few  steamers  from  European  i)orts.  They  are  usually 
empty  or  in  ballast.  The  only  vessels  carrying  cargo  which  enter  here  are  sail- 
ing vessels  returning  from  C'uba  with  cedar  logs,  and  fruiters,  sailing  ves.sels, 
from  ports  in  Honduras.  Being  from  clean  ports,  these  vessels  are  subject  to  no 
further  treatment  at  quarantine  than  inspection. 

As  compared  with  the  number  of  vessels  inspected  and  i)assed  at  this  station 
last  year,  there  is  noted  a  decrease  of  23  steamers  and  13  sailing  vessels  inspected 
and  passed  during  this  year.  I  am  unable  to  account  for  the  decrease  in  the 
number  of  vessels  entering  this  port  unless  it  be  due  to  the  almost  complete  dis- 
continuance of  exportation  of  cattle  to  Cuba. 

Two  steamers  from  Mexican  ports  were  disinfected  and  held  during  the  year. 
One  vessel,  British  ship  Dynomene,  from  Cape  Town,  discharged  her  ballast 
here  without  further  treatment  in  quarantine.  No  sailing  vessels  were  disin- 
fected during  the  year. 

No  case  of  quarantinable  disease  was  treated  at  this  station  during  the  year. 
Respectfully, 

R.  E.  Ebebsole,  Assistant  Surgeon. 

The  Sukgeon-Genekal. 


[Inclosure.] 


Transactions  at  Tampa  Bay  National  Quarantine  Station  for  year  ending  June 

80,  1904. 


July. 


Aug. 


Sept. 


Oct. 


Nov. 


Dec. 


Jan. 


Feb. 


Mar. 


Apr. 


May. 


June. 


Total. 


Vessels  spoken 
and  passed 

Steamers  in- 
spected and 
passed 

Steamei-s  disin- 
fected-  

Sailing  vessels  in- 
spected and 
passed 

Sailing  vesselsdia- 
infected 

Crewonsteamers- 

C3rew  on  sailing 
vessels 

Passengers  on 
steamers.. 

Passengers  on 
sailing  vessels  _ . 


0 
4.5 

105 

0 

8 


207 

124 

1 

11 


0 
.50 

108 

0 

4 


0 

177 


0 
242 

61 

1 

4 


0 
145 


108 


0 
1,170 


911 


63 


340 


rUBLIC    HEALTH    AND    M AKINE-HOiSPITAL    SERVICE. 


CUMBERLAND    SOUND. 

[Cumberland  Sound  quarantine  ;  post-office  address,  via  Fernandina,  Fla.] 
[Report  of  Acting  Asst.  Surg.  J.  Louis  Horsey,  in  charge.] 

Transactions  at  Cumberland  So^ind  National  Quarantine  Station  for  the  year 

ending  June  30,  ID04. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

"Vessels  spoken 
and  passed 

Steamers  inspect- 
ed and  passed... 

Steamers     disin- 
fected          -  ... 

30 
9 
0 

1 

2 
235 

276 

0 

19 

8 
0 

1 

2 
200 

193 

0 

29 

7 
0 

4 

3 

208 

296 
0 

30 
3 
0 

6 

4 

87 

353 
0 

0 
3 
0 

4 

3 
91 

75 

0 

0 

7 
0 

8 

0 
170 

86 

0 

0 
3 
0 

9 

0 
95 

72 

0 

0 
5 
0 

8 

0 
141 

65 

0 

0 
2 
0 

7 

1 
59 

86 

0 

15 
4 
0 

7 

2 
114 

206 

0 

28 
7 
0 

2 

2 
195 

268 

0 

24 
6 
0 

0 

1 
213 

190 

0 

175 

64 

0 

Sailing   vessels 
inspected  and 

57 

Sailing    vessels 

disinfected 

Crew  on  steamers. 
Crew  on   sailing 

20 
1,817 

2,166 

Passengers  on 
steamers 

0 

Passengers  on 
sailing  vessels  . . 

3 

0 

4 

6 

0 

0 

1 

0 

6 

1 

4 

7 

32 

ST.    JOHNS    RIVER    INSPECTION    STATION. 

[St.  Johns  River  Inspection  Station  ;  post-office  address,  Mayport,  Fla.] 

[Report  of  Acting  Asst.  Surg.  George  Macaulay,  in  charge.] 

St.  Johns  River  Inspection  Station, 

Julv  23,  1904. 
Sir:  I  herewith  transmit  the  annual  report  of  all  transactions  at  this  station 
during  the  past  fiscal  year  ended  June  30,  1904. 

The  statistical  reports  show  a  decided  increase  of  "  vessels  spoken  and  passed  " 
and  "  sailing  vessels  inspected  and  passed,"  as  compared  with  similar  statistical 
report  for  the  fiscal  j'ear  ended  June  30,  1903. 

Respectfully,  George  Macaulay, 

Acting  Assistant  Surgeon. 
The  Surgeon-General. 


[Inclosure.] 


Transactions  at  St.  Johns  River  National  Inspection  Station  for  year  ending  June 

30,  1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels  spoken 

and  passed 

41 

25 

31 

;34 

0 

0 

0 

0 

0 

29 

27 

23 

210 

Steamers  inspect- 

ed and  passed  . . 

(1 

0 

0 

0 

0 

0 

1 

0 

1 

2 

1 

0 

5 

Steamers     disin- 

fected  

U 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

Sailing  vessels  in- 

spected     and 

passed 

4 

3 

7 

7 

3 

13 

10 

10 

12 

7 

3 

6 

85 

Sailing   vessels 

disinfected 

0 

0 

0 

0 

0 

0 

0 

1 

0 

0 

0 

0 

I 

Crew  on  steamers. 

26 

103 

89 

110 

0 

0 

19 

0 

20 

120 

85 

49 

621 

Crew  on   sailing 

vessels 

313 

144 

277 

2.56 

22 

102 

66 

78 

85 

218 

188 

203 

1,95 

Passengers  on 

steamers 

0 

9 

0 

0 

0 

0 

0 

0 

0 

11 

6 

0 

19 

Passengers  on 

sailing  vessels . . 

(! 

9 

5 

15 

13 

3 

5 

4 

5 

17 

5 

19 

106 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  341 

KEY   WEST. 

[Key  West  Quarantine;  post-office  address,  Key  West,  Fla.] 
[Report  of  Sanitary  Inspector  J.  Y.  Porter,  in  temporary  cliarj?e. ] 

Kky  Wkst  Quarantine.  June  30,  190^. 

Sir:  I  have  tho  honor  to  inclose  a  statistical  table  of  the  quarantine  transac- 
tions of  this  port  for  the  year  ending  June  80,  1904. 

There  have  been  no  unusual  occurrences  in  quarantine  inanageiuent  and  pro- 
cedure during  the  year;  no  arrivals  of  infected  vessels  nor  of  vessels  reciuiring 
disinfection.  .\s  was  remarked  in  the  last  animal  report  of  this  character,  the 
cleaning  up  of  Ilahana  and  the  seaports  of  Cuba,  with  the  extermination  of 
yellow  fever,  ((uarantine  supervision  of  this  i)ort  with  the  other  ports  of  Florida 
extending  to  tiie  ('hattahoociiee  River,  Carral)elle  and  Apalachicola,  has  reduced 
the  care,  anxiety,  and  vigilant  tension  which  formerly  existed  each  summer  sea- 
sou  to  almost  a  minimum  in  oversight  of  arrivals. 

The  commerce  of  Key  West  is  mainly  with  domestic  ports,  and  with  Cuba, 
Ilabana.  A  weekly  line,  Mallory,  plies  between  New  York  and  Galveston,  Tex., 
stojiping  at  Key  West  both  in  coming  and  returning.  The  Peninsular  and  Occi- 
dental Steamship  Company  operates  the  mail  line  between  'Florida  and  Habana, 
stopping  at  Key  West  both  ways,  and  from  both  sides  of  the  peninsula,  from 
Tampa  and  from  Miami.  From  Tampa  there  are  three  trips  a  week  by  these 
steamers,  and  from  Miami  two.  Fruiters,  sailing,  make  trips  from  Bouaco, 
a  small  island  off  the  coast  of  British  Honduras,  bringing  mostly  bananas, 
and  an  occasional  sail  craft  arrives  from  Nassau,  with  fruit  and  passen- 
gers. The  fruiters  from  the  coast  of  British  Honduras  bring  no  passengers, 
as  a  rule.  Now  and  again  a  supercargo  may  come  with  his  fruit,  but  these  visits 
are  rare.  It  will  be  understood  therefore  that  with  Cuba  entirely  free  from 
yellow  fever  there  is  no  occasion  for  aiiprehension  of  yellow  fever  introduction 
in  Key  West,  because  of  the  lack  of  communication  with  ports  under  suspicion 
of  that  disease. 

Although  relief  from  yellow  fever  has  been  afforded  through  its  elimination 
from  Cuba,  yet  the  steamers  arriving  therefrom,  as  well  as  from  other  foreign 
l)orts,  are  carefully  inspected  for  the  other  quarantiuable  diseases.  From 
Cuba  there  is  reason  to  fear  introduction  of  tuberculosis  and  leprosy,  and  the 
latter-named  disease  also  from  Nassau,  Bahamas.  Therefore  the  passenger 
list  is  scanned  carefully  for  these  diseases,  and,  when  found,  report  is  made  to 
the  immigration  agent,  who  then  refers  the  cases  to  the  surgeon  of  the  Service 
having  this  department  in  charge  for  his  determination  and  disposition. 

There  has  been  no  construction  of  buildings  for  this  station  during  the  year 
nor  has  any  money  been  expended  for  improvement  or  repairs  other  than  the 
usual  monthly  expenditures  for  the  care  and  safe-running  of  the  naphtha 
boarding  launch  and  rentals  of  dock  and  boathouse  space  for  the  shore  disin- 
fecting machinery  and  the  boarding  launch. 

It  is  to  be  regretted  that  it  is  impossible  to  obtain  a  suitable  site  along  the 
northern  and  southwestern  water  front  of  the  town  on  which  a  boathouse  can 
be  erected  which  will  meet  the  requirements  of  the  quarantine  service  of  this 
port.  The  space  from  the  "  bight,"  on  the  northeastern  face  of  the  island, 
extending  around  the  water  front  to  the  marine-hospital  property  is  all  taken 
up  by  private  corporations  and  by  the  Navy  Department,  and  it  is  impossible 
to  acquire  by  purchase  an  inch  of  this  property.  There  is  an  excellent  basin 
on  the  Navy  Department  water  property  where  a  safely  protected  boathouse 
could  be  built  and  where  boarding  facilities  would  be  especially  adapted  for 
prompt  and  speedy  service  to  arrivals,  but  I  am  informed  that  it  would  not  be 
possible  to  obtain  any  concession  from  the  Navy  Department  for  the  permanent 
use  of  this  water  front,  because  it  is  contemplated  to  "  fill  in  "  at  that  point 
for  foundation  of  coal  sheds  and  other  attachments  of  a  naval  station.  When 
writing  on  this  subject  last  year,  in  a  lengthy  and  exhaustive  report,  it  was 
pointed  out  that  the  property  of  the  marine  hospital  was  uusuited  to  the  purpose, 
because,  first  and  principally,  the  rapid  shoaling  of  the  water  off  the  break- 
water of  the  hospital  grounds,  due  to  the  construction  of  the  navy  coal  sheds 
out  in  the  harbor  to  the  eastward  of  the  hospital  and  Fort  Taylor  to  the  south- 
west of  the  hospital,  both  of  which  serve  to  throw  in  the  sand  from  the  channel 
toward  the  shore,  and  to  build  a  dock  to  or  near  to  the  channel  would  be  an 
expensive  procedure  both  in  construction  and  afterwards  in  maintaining.     The 


342 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


second  objection  to  the  hospital  property  as  a  site  for  a  hoathouse  for  quaran- 
tine boarding  purposes  is  the  exposure  to  the  oi)en  and  main  roadstead  of  the 
harbor,  demanding  a  building  at  this  point  of  more  than  usual  strength  to 
withstand  wind  and  water  from  southwest  storms. 

An  effort  has  been  made  to  engage  the  commercial  attention  of  parties  own- 
ing water-front  property  to  build  a  suitable  hoathouse  and  rent  the  same  at 
a  fair  and  reasonable  rental  to  the  quarantine  service.  It  was  thought  at  one 
time  that  such  a  proposition  had  been  accepted,  but  the  plan  has  unfortunately 
fallen  through,  and  efforts  will  have  to  be  directed  to  another  source. 

The  disinfecting  barge  Protector  and  the  schooner  Glacier  are  both  tempora- 
rily attached  to  this  station  and  are  anchored  in  the  harbor  with  care  takers. 
The  Protector  has  been  overhauled  and  repaired  during  the  year,  by  replacing 
worm-sucked  planking  with  new  and  by  recaulking  and  remetaling  both  hull 
and  topsides,  besides  renewing  other  minor  unsound  parts.  It  is  feared,  how- 
ever, that  the  timbers  of  the  barge,  which  are  of  white  oak.  are  not  in  a  sound 
condition,  as  the  examination  of  those  under  worm-sucked  planking  which  was 
removed  to  replace  with  sound  wood  showed  a  punk-rotten  condition,  requir- 
ing new  timbers  at  those  points.  It  is  conjectured  therefore  that  the  .same 
condition  may  exist  at  other  parts  of  the  vessel  where  the  planking  was  not 
removed  for  examination.  The  interior  of  the  boat  is  well  kept  and  is  clean 
and  bright.  The  schooner  Glacier  formerly  was  a  "  tender  "  to  the  Tortugas 
Quarantine  Station.  She  is  a  fast-sailing  craft,  but  draws  too  much  water 
except  for  stations  having  great  depth  of  ai)proach.  The  Glacier  needs  "  coming 
out "  of  water  to  be  cleaned,  which  has  been  recommended.  The  boat  is  cop- 
pered. The  boat  is  also  well  equipped  with  almost  new  sails  and  could  be 
placed  in  commission  at  early  notice. 

A  new  boarding  launch  is  needed  for  the  station,  as  the  launch  Annie  has 
been  inspected  and  condemned,  and  is  being  now  run  at  some  risk  both  from 
fire  and  sinking,  as  the  forward  bulkhead,  containing  the  naphtha  tank,  leaks 
water  into  the  main  body  of  the  boat,  making  frequent  bailings  necessary. 
It  is  understood  that  a  new  launch  has  been  authorized  and  ordered  especially 
constructed  for  this  station. 

Respectfully,  Joseph  Y.  Pobtek, 

Sanitary  Inspector. 

The  Subgeo>'-Gexeral. 


[  Inclosiire.] 


Transactions  at  Key  West,  Fla.,  National  Quarantine  Station  for  year  ending 

June  30,  190 Jt. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels   spoken 

Steamers  inspect- 
ed and  passed... 
Steamers     disin- 

35 

36 

19 

22 

13 

14 

17 

14 

15 

27 

32 

34 

278 

Sailing  vessels  in- 
spected     and 
passed 

25 

36 

10 

14 

9 

11 

13 

3 

16 

12 

22 

18 

189 

Sailing   vessels 

Crewon  steamers. 

Crew  on    sailing 

vessels 

1,188 

174 

420 

49 

9SS, 
277 
434 

32 

671 

65 
406 
37 

819 
88 

459 
57 

642 
57 
549 

715 
70 

652 
32 

1,202 
89 

1,013 
89 

671 

23 

1,071 

39 

737 

130 

1,298 

56 

1,059 

76 

697 

67 

1,263  1,205 

143  '    129 

11,094 
1,321 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels . . 

1,484 
60 

532 
67 

9,015 
624 

J.  B.  Maloney. 
Acting  Assistant  Surgeon,  Boarding  Officer. 


PUHLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 


343 


BOCA  GRANDE. 

[Boca  Grande  Quarantine;  post  office  address,  via  I'unta  (Jorda,  Fla.] 
[Keport  of  Acting  Asst.  Surf,'.  P..  B.  Blount,  in  cliar.i,'e.  ] 

Transactions  at  Boca  Grande  National  Quarantine  Station  for  year  ending  June 

30,  1904. 

Total. 


Vessels  spoken 
and  passed 

Steamers  inspect- 
ed and  passed... 

Steamers  disin- 
fected  

Sailing  vessels  in- 
spected and 
passed 

Sailing  vessels 
disinfected 

Crewon  steamers. 

Crew  on  sailing 
vessels 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels .. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

3 

2 

3 

u 

3 

2 

2 

1 

2 

3 

1 

2 

0 

0 

0 

0 

1 

0 

0 

0 

2 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

2 

1 

1 

0 

2 

0 

3 

1 

1 

1 

0 

5 

0 

1 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

24 

0 

0 

0 

99 

0 

0 

0 

23 

18 

11 

0 

23 

0 

31 

9 

11 

9 

0 

45 

0 

0 

0 

0 

0 

0 

0 

0 

15 

0 

0 

0 

0 

0 

0 

0 

U 

0 

0 

0 

0 

0 

0 

0 

1 
12:3 

182 
15 
0 


CEDAR  KEYS,  FLA. 

Under  date  of  June  30,  lOO-t,  the  acting  assistant  surgeon  in  charge 
of  quarantine  at  Cedar  Keys.  Fla..  reported  there  had  been  no  trans- 
actions during  the  fiscal  year  ended  June  30,  1904. 

ST.  GEORGES    SOUND. 

[St.  Georges  Sound  Quarantine  (East  and  West  Pass),  Carrabelle,  Fla.] 

[Report  of  Acting  Asst.  Surg.  E.  L.  Stewart,  in  charge.] 

St.  Georges  Sound  Quarantine,  July  1,  190^. 
Sir  :  I  have  the  honor  to  inclose  statement  of  transactions  at  St.  Georges 
Sound  Quarantine  for  the  fiscal  year  ended  June  30,  1904. 

There  was  nothing  done  at  West  Pass  excei)t  under  the  head  of  "  spolcen  and 
passed."     All  the  inspection  is  done  at  East  Pass. 

Respectfully.  E.  L.  Stewart, 

Acting  Assistant  Surgeon. 
The  Surgeon-General. 


[Inclosure.] 

Transactions  at  St.  Georges  Sound  National  Quarantine  Station  for  year  ending 

June  30,  1904. 


July. 

Aug.  Sept.'  Oct. 

1           1 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels  spoken 
and  passed 

Steamers  inspect- 
ed and  passed 

5 

6 

0 

0 

3 
1 

0 

3 

0 

0 

1 

3 

1 

1 

22 
2 

Steamers     disin- 
fected.   

■ 

Sailing  vessels  in- 
spected  and 
passed 

Sailing  vessels  dis- 
infected  

3 

1 

0 

3 

7 

4 

6 

4 

5 

4 

5 

4 

46 

Crew  on  steamers 

20 
99 

1 

20 

40 

Crew   on   sailing 
vessels 

Passengers  on 
steamers 

48 

sr 

0 

24 

36 

57 

41 

64 

31 

72 

51 

540 
1 

Passengers  on 
sailing  vessels  .. 

. 

344 


PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 


SANTA    ROSA. 

[Santa  Rosa  Quarantine;  post-office  address,  via  I'ensacola,  Fla.] 

[Report  of  Acting  Asst.  Surg.  R.  C  White,  in  charge.] 

Santa  Rosa  Quarantine,  Jiily  19,  lOOJ). 
Sir:  In  compliance  with  Bureau  circular  letter  elated  Aiiril  18,  1904,  I  have 
the  honor  to  transmit  herewith  report  of  transactions  at  this  station  during 
the  fiscal  year  ended  June  30,  1904. 

No  quarantinable  disease  has  appeared  on  any  vessel.  During  the  year  19 
patients  were  treated  in  the  station  hospital,  mainly  cases  of  malarial  fevers. 
One  death  occurred  from  the  same  cause. 

Respectfully,  R.  C.  White, 

Actinf)  Assistant  Surgeon,  in  Charge. 
The  Surgeon-General. 


[Inclosure.  ] 

Transactions  at  Santa  Rosa  National  Quarantine  Station  for  year  ending  June 

30,  1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels  spoken 

1 

10 
9 

7 

3 
491 

122 

4 

4 

6 

12 
6 

7 

5 
501 

147 

0 

0 

7 

1 

17 
5 

4 

.5 
6;» 

143 

7 
0 

3 

1 
22 
0 

16 

6 
641 

302 

5 

0 

7 

21 
0 

12 

3 

574 

166 
4 
5 

3 

1 

12 
8 

8 

3 
567 

144 

;> 
5 

6 

4 

Steamers  inspect- 
ed and  passed.  .. 

Steamers  disin- 
fected   - 

19 
9 

5 

1 
722 

80 

3 

1 

3 

6 
6 

8 

4 
371 

128 

3 

1 

5 

29 
.5 

19 

5 

918 

347 

.') 

8 

19 
0 

10 

4 
573 

175 

5 

1 

6 

11 
9 

15 

4 
572 

261 

3 

5 

9 

16 

7 

9 

4 
607 

185 

1 

1 

8 

194 
64 

Sailing  vessels  in- 
spected  and 

120 

Sailing    vessels 

disinfected 

Crew  on  steamers. 
Crew   on    sailing 

47 
7,166 

2,200 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels  . . 

Vessels  discharg- 
ing   ballast    at 
quarantine 

44 

28 

71 

Note. — Besides  the  number  of  passengers  enumerated  on  steamers  and  sailing  vessels 
there  were  the  following  stowaways: 


On  steamers  : 

November,   1903 
January,  1904    . 
February,  1904  _ 

April,   1904 

May,  1904 

June,  1904 


Total- 


On  sailing  ships : 
October,   1903  _ 
December,  1903 
February,  1904 
June,  1904 


Total 11 


PUBLIC    HEALTH    AND    MARIlf E-HOSPITAL    SERVICE. 


345 


HISCAVNK    HAV. 

[IMscayiie  r.a.v  (Juaraiitino  ;  post-ofllco  address,  via  Miaiui,   Fla.  1 
[Report  of  Acdiiir  Assl.  Sui-jj:.  .lames  M.  .lackson,  jr.,  in  charge.] 

Transactions  at  Biscaijne  Bay  National  Quarantine  Station  for  year  ending  June 

30,  WU4. 


Total. 


Vessels  spoken 
and  passed 

Steamers  inspect- 
ed and  passed  . . 

Steamers  disin- 
fected  

Sailing  vessels 
inspected  and 
I)a^sed 

Sailing  vessels 
di.sinfected 

Crew  on  steamers 

Crew  on  sailing 
vessels 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels  .. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

8 

9 

2 

11 

9 

10 

16 

15 

15 

30 

78 

67 

0 

0 

0 

0 

0 

4 

14 

20 

22 

13 

1 

0 

0 

0 

0 

0 

0 

(1 

0 

0 

0 

0 

0 

0 

1 

0 

0 

3 

2 

1 

1 

0 

1 

1 

1 

1 

0 
0 

0 
0 

0 
0 

0 
0 

0 
0 

0 
250 

0 

685 

0 
992 

0 
1,091 

0 
644 

0 
50 

0 
0 

14 

0 

0 

23 

14 

8 

4 

0 

10 

4 

3 

5 

0 

0 

0 

0 

0 

5(; 

217 

1,096 

1,645 

366 

13 

0 

0 

0 

0 

36 

14 

6 

0 

0 

9 

2 

0 

0 

276 


0 
3,712 


85 
3,393 


PASCAGOULA. 

[Pascagoula,  Miss.,  Quarantine.] 
[Report  of  Acting  Asst.  Surg.  B.  F.  Duke,  in  charge.] 

Transactions  at  Pascagoula  National  Quarantine  Station  for  year  ending  June 

SO,  1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels   spoken 
and  passed 

Steamers  inspect- 
ed and  passed  . . 

5 

2 

2 

5 

0 

2 

1 

0 

1 

2 
1 

1 
1 

4 

3 

27 
3 

Steamers  disin- 
fected  

Sailing   vessels 
inspected    and 
passed 

Sailing  vessels 
disinfected 

7 

3 

5 

10 

8 

12 

18 

12 

8 

5 

10 

4 

102 

Crew  on  steamers 

15 
63 

23 
120 

25 
95 

23 

49 

86 

Crew  on   sailing 
vessels 

108 

45 

140 

77 

168 

117 

126 

63 

1,171 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels  . . 

1 

1 

2 

; 

1 

1      ■      i 

GULF. 


[Gulf  Quarantine;  post-office  address  via  Biloxi,  Miss.] 

[Report  of  medical  officer  in  command.  Passed  Asst  Surg.  S.  B.  Grubbs.     Assumed  com- 
mand under  official  order  of  April  18,  1902.] 

Gulf  Quarantine,  July  1,  190Ji, 
Sir  :    I  have  the  honor  to  make  the  following  reiiort  of  transactions  at  this 

station  for  the  year  ending  June  30,  1904,  as  per  attached  table. 

Four  cases  of  yellow  fever  were  received  and  treated  in  the  station  hospital. 

Of  these,  2  died  and  2  recovered. 


346 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Several  cases  of  malaria,  1  case  of  lobar  puemuonia,  aiul  1  case  at  first  sup- 
posed to  be  bubonic  plague  were  also  treated. 

As  will  be  noted,  2G2  vessels  arrived  at  the  station,  of  which  75  (14  steamers 
and  61  sailing  vessels)  were  disinfected. 

This  is  a  decided  increase  over  the  two  previous  years,  and  owing  to  the 
great  proportionate  increase  of  large  sailing  vessels  and  steamers  the  tonnage 
has  increased  to  a  much  greater  extent. 

The  total  tonnage  arriving  during  the  year  just  closed  was  264,124,  of  which 
62.517  were  disinfected. 

Respectfully,  S.  B.  Grubbs, 

Passed  Assistant  Surgeon. 

The  Surgeon-Genebal. 


[Inclosure.] 
Transactions  at  Gulf  National  Quarantine  Station  for  year  ending  June  30,1904. 


Vessels  spoken 
aud  passed- 

Steamers  inspect- 
ed and  passed.-. 

Steamers  disin- 
fected   

Sailing  vessels  in- 
spected  and 
passed 

Sailing  vessels 
disinfected 

Grew  on  steamers 

Crew  on  sailing 
vessels 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels.. 


July. 


319 

168 
1 
4 


Ang. 


4 
238 


Sept. 


5 
115 


136 
0 
1 


Oct. 


2 
133 


131 
0 
1 


Nov. 


4 
199 


156 
0 
1 


Dec. 


4 

248 

2()2 
0 
3 


Jan. 


Ill 
17.5 


Feb. 


3 

189 


143 
0 
3 


Mar. 


1 
119 

68 

0 

0 


Apr. 


4 
169 

239 

0 

3 


May. 


June. 


9 

127 


176 
1 
0 


11 
173 

278 

5 

1 


Total. 


2 
72 
14 

113 

61 
2,140 

1,971 

11 

22 


SAN    DIEGO. 


[San  Diego  Quarantine;  post-office  address,  via  San  Diego,  Cal.] 

[Report  of  medical  officer  in  charge.  Acting  Asst.  Surg.  W.  W.  McKay.     Assumed  charge 
under  official  orders  of  April  4,  1889.] 

San  Diego  Quarantine,  July  1,  190//. 

Sib:  In  compliance  with  instructions  contained  in  Bureau  circular  letter  of 
date  April  18,  1904,  I  have  the  honor  to  submit  herewith  report  of  transactions 
of  this  station  for  the  fiscal  year  ended  June  30.  1904. 

As  will  be  noted  by  the  statistical  table  herewith  inclosed,  122  vessels  were 
inspected  and  passed,  2  navy  vessels  spoken  and  passed,  and  2  steamers  disin- 
fected, making  a  total  of  126  for  the  year,  96  of  which  were  steamers. 

By  request  of  their  respective  commanding  officers  assistance  was  rendered 
during  the  year  in  three  instances  to  training  ships  of  the  United  States  Navy  in 
checking  epidemics  of  measles  and  diphtheria  which  had  broken  out  aboard.  In 
the  ease  of  the  one  having  measles  aboard  the  sick  and  suspects  were  isolated  in 
tents  ashore,  their  quarters  on  the  vessel  disinfected,  and  the  convalescents 
before  being  allowed  to  return  to  the  ship  were  bathed,  their  clothing,  baggage, 
and  bedding  disinfected  ;  no  further  cases  appeared.  In  the  other  two  instances 
diphtheria  had  broken  out  aboard,  deaths  had  occurred,  new  cases  appearing 
daily,  and  matters  looked  serious.  By  advice  of  the  quarantine  oflicer  the  vessel 
in  these  cases  was  depopulated  at  once,  only  two  officers  and  four  of  the  crew 
being  left  on  the  spar  deck,  quartered  under  tents  to  look  after  the  vessel,  the 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  347 

entire  porsomid  Ikmmj:  l.ikcii  Msliore  mikI  Itiillit'd,  and  l)ii{^fiafj;(',  clothing.  .in<l  l)od 
diiij;  disiiifi'ctcd.  Allt'r  carcrul  iiisiicctidii  tliosc  who  appeared  in  .t^ood  licaltli 
were  (luartercd  aslioi'e  in  the  sUn'ra^^c  passcn/^'crs'  dcteiitioii  l)arracks ;  six  ofli- 
cers  were  quartered  in  (lie  woiiieii's  room  of  the  detention  harraeks,  in  order  to 
be  near  at  hand  to  maintain  dis('ii)!ine  anions  the  crew  and  apprentices.  Thi; 
commander  of  tlie  vessel  was  (piartered  in  a  small  room  upstairs  in  the  hospital. 
The  medical  ollicer  of  the  ship,  toj^etlier  with  his  apothecary,  nurse,  cook,  the  cap- 
tain's boy,  and  one  seaman  ill  with  adenitis,  were  quartered  in  the  hospital.  The 
diphtheritic  cases  and  susi)ects  with  their  attendants  were  isolated  in  tents  in 
separate  i)arts  of  the  j,'rounds.  The  ship  (after  all  hrij^lit  metal  work  and  the 
guns  had  been  smeared  with  a  mixture  of  tallow  and  linseed  oil  or  tallow  and 
white  lead  and  all  suliihuric  ether,  which  was  found  stored  away  in  2,()()()  c.  c. 
tin  cans  and  which  boils  at  ;!4°  to  .'5.1°  C.  had  been  removed)  was  thoroughly 
disinfected  in  every  part  with  sulphur  dioxide,  in  order  to  kill  vermin  (with 
which  the  ship  was  overrun,  she  beng  an  old  wooden  vessel)  as  well  as  to  dis- 
infect the  vessel.  The  removal  of  the  sulphuric  ether  was  shown  to  have  been  a 
wise  precaution,  as  after  the  disinfection  the  self-registering  thermometers  in 
the  powder  magazine  showed  the  temperature  to  have  been  98°F. — this  in  the 
closed  magazine  below  water  line,  where  it  was  naturally  bound  to  remain  cooler 
than  on  the  gun  and  berth  decks,  where  the  30  sulphur  pots  were  burning.  The 
ether  was  in  a  locker  on  the  berth  deck.  Cultures  on  blood  serum  were  made 
from  the  throats  of  all  suspects,  diphtheria  cases,  and  convalescents.  Anti- 
diphtheritic  serum  was  administered  immediately  upon  the  discovery  of  new 
cases  and  pushed  vigorously  in  all  the  worst  ones.  Thorough  examination  of 
the  personnel  of  the  ship  was  made  morning  and  evening.  If  suspects  were 
found,  they  were  immediately  isolated  and  cultures  taken  from  their  throats. 
At  the  end  of  twelve  days,  no  new  cases  having  occurred  among  those  quartered 
hi  the  detention  barracks,  they  were  returned  to  the  clean  ship.  The  convales- 
cents were  detained  isolated  ashore  until  such  time  as  no  virulent  bacili  could 
be  detected  in  cultures  made  from  their  throats,  when  they,  too,  with  their 
nurses  and  attendants  were  bathed,  their  clothing,  baggage,  and  bedding  disin- 
fected, and  all  returned  to  the  vessel.  No  further  cases  occurred  among  that 
lot  of  apprentices.  The  naval  authorities  furnished  their  own  subsistence, 
medicines,  medical  attendance,  nurses,  and  fuel.  The  disinfection  of  the  vessels 
and  of  the  effects,  clothing,  and  bedding  of  the  crews  was  accomplished  by  the 
station  force  under  supervision  of  the  quarantine  officer.  Altogether  400  offi- 
cers and  crew  were  bathed  and  effects  disinfected.  All  disinfectants  were 
supplied  by  the  quarantine  station. 

On  account  of  the  location  here  of  a  large  coaling  station  and  a  naval  training 
station,  the  harbor  entrance  having  been  deepened  to  30  feet  of  water  at  mean 
low  tide,  the  work  of  this  station  will  probably  increase  in  the  near  future.  Our 
relations  with  the  Navy  are  most  pleasant  and  they  seem  to  fully  appreciate  what 
is  done  for  them  by  this  Service,  also  with  municipal  and  State  health  authori- 
ties, as  they  are  with  the  local  Immigration  Service  officials.  In  addition  to  the 
quarantine  work  at  this  port  the  medical  inspection  of  immigrants  is  made  for 
the  Immigration  Service  by  the  quarantine  officer.  The  assurance  of  the  early 
completion  of  the  Panama  Canal,  the  past  appearance  of  plague  in  epidemic  form 
and  its  liability  to  recrudescence  on  the  Pacific  coast  of  Mexico  and  Central  and 
South  America  render  it  highly  necessary  that  this  station  be  a  complete  and 
well  equipped  one. 

Respectfully,  W.  W.  McKay, 

Acting  Assistant  Surgeon. 

The  Subqeon-Genebal. 


348  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

[Inclosurc] 

Transactions  at  San  Bicyo  {Ca}.)  National  Quarantine  Station  for  year  ending 

June  SO,  190J,. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels   spoken 

1 
9 

6 

1 
7 

2 

Steamers  inspect- 
ed and  passed  . . 

Steamers     disin- 
fected 

7 

1 

6 

0 
586 

58 

161 

0 

7 

10 

C 

6 

1 

2 

0 
292 

47 

147 

1 

7 

8 

8 

8 

89 
2 

Sailing  vessels 
inspected   and 

4 

0 
343 

12 

150 

5 

2 

0 
394 

64 

127 

0 

1 

0 
417 

7 

140 

0 

4 

0 
102 

54 

145 

0 

3 

0 
806 

17 

laj 

1 

3 

0 
102 

10 

120 

1 

4 

0 
155 

58 

164 

0 

1 

0 

415 

2 

170 
0 

1 

0 
412 

3 

105 

0 

0 

180 

99 
0 

33 

Sailing   vessels 

disinfected 

Crewonsteamers- 
Crew  on    sailing 

0 
3,703 

334 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels  .. 

1,630 
14 

LOS   ANGELES. 

[Los  Angeles  Quarantine;  post-oflBce  address,  via  Los  Angeles,  Cal.] 
[Report  of  Acting  Asst.  Surg.  M.  H.  Ross,  in  temporary  charge.] 

Los  Angeles,  Cal.,  July  2,  1904- 
Sir  :  Replying  to  circular  letter  of  April  18,  1904,  I  have  the  honor  to  inclose 
in  duplicate  the  report  of  transactions  for  this  station  for  the  fiscal  year  ended 
June  30,  1904.  nnd  to  state  that  there  were  more  vessels  inspected  this  year 
than  in  any  previous  year,  carrying  more  crew  and  cargo. 

In  the  matter  of  repairs  and  improvements  would  state  that  we  have  received 
the  regulation  quarantine  flags  and  a  copy  of  the  Quarantine  Laws  and  Regula- 
tions of  1903  edition,  and  that  the  railroad  company  has  painted  and  put  a  flag- 
staff in  the  boat  used  for  the  quarantine  oflicer  at  I'ort  Los  Angeles. 
Respectfully, 

M.  H.  Ross, 
Acting  Assistant  Surgeon. 
The  Surgeon-General. 


[Inclosure.] 

Transactions  at  Los  Angeles  (Cal.)  National  Quarantine  Station  for  year  ending 

June  30,  1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels  spoken 

and  passed 

3 

2 

4 

1 

4 

1 

3 

5 

3 

5 

3 

36 

Steamers  inspect- 

ed and  passed... 

1 

1 

3 

0 

0 

0 

0 

a 

0 

0 

0 

2 

10 

Steamers  disin- 

fected      - 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

Sailing  vessels  in- 

spected   and 

2 

1 

1 

1 

4 

1 

3 

2 

3 

5 

2 

1 

26 

Sailing  vessels 

disinfected 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

Crew  on  steamers. 

39 

35 

108 

0 

0 

0 

0 

171 

0 

0 

0 

70 

423 

Crew  on    sailing 

55 

28 

29 

21 

101 

13 

77 

47 

75 

137 

61 

14 

658 

Passengers  on 

steamers 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

Passengers  on 

sailing  vessels .. 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

2 

2 

PUBLIC    HEALTH    AND    MAKINK-HUiSri'J'AL    SKKVICE. 


349 


SAN    FRANCISCO. 
[Sail  I'-raiuisci)  (.Jiiaraiilinc  ;  post-oflice  address,  via  Aiif^cl  Island,  Cal.] 

[Uoport  of  niodical  officer  in  coinniand.  Passed  Asst.  Siir^.  Ilii^h  S.  CiimmiiiK.     Assumed 
command  under  oflacial  orders  of  December  liS,  1901.1 

San  Francisco  Quarantink.  June  30,  IDOJ/. 
Sir:    I  have  the  honor  to  submit  the  followinj;  report  of  the  traiisaetioiis  at 
this  quarantuie  station  during  the  year  ended  June  oO,  1!»04: 


July.  Aug.  Sept.  Oct.   Nov.   Dec.    Jan.    Feb.   Mar.  Apr.   May.  June.  Total. 


Vessels  spoken 
and  passed 

Steamer.s  in- 
spected and 
passed 

Steamers  d  i  s  i  n  - 
fee  ted 

Sailing  vessels  in- 
spected  and 
I)assed 

Sailing  vessels 
disinfected 

Crew  on  steamers 

Crew  on  sailing 
vessels 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels  . 

Vessels  from 
ports  infected 
with  cholera 
and  plague 

Vessels  from  yel- 
low-fover  ports 

Persons  detained 
in  quarantine. - 

Cases  treated  in 
isolation  h  o  s  - 
pitals 

Vessels  held  for 
diagnosis 


4 
;5,618 


727 
3,711 


33 
14 

736 


2 

2,615 

1,154 

4,770 

78 

22 

6 
552 

1 
1 


4 
3,513 

3,181 

5,716 

2,847 

24 

8 
580 

3 
1 


39 
3 

58 

0 
2,923 

1,408 

4,882 
791 


276 


36 
0 

41 

0 
2,861 

1,199 

5,188 
246 

12 
5 
0 


:i5 
3 

36 

1 

2,799 

667 

4,512 

40 

29 

7 
184 


0 

2,968 

458 

3,824 

11 

16 

5 
0 


0 
2,365 

403 

2,718 

41 

24 
7 
0 


0 
2,913 

473 

4,046 

9 


614 


33 
1 

22 

0 
3,251 

389 

4,979 

43 

21 

8 

275 


32 

2 

26 

1 
,591 

409 

,575 

51 

21 

7 
124 


37 
2 

23 

1 
3,297 

353 


83 


26 


1,016 


4:« 

21 


13 
a5,714 

10,821 

54,881 

4,338 

274 

88 

4,357 

5 
4 


During  the  year  917  vessels  (459  steamers  and  458  sailing  vessels)  were 
inspected  and  34  vessels  were  disinfected.  Upon  these  vessels  a  total  of  105,754 
persons  (4(;,535  crew  and  59,219  passengers)  were  inspected  and  4,857  were 
detained  in  quarantine. 

One  case  each  of  yellow  fever,  leprosy,  and  septicemia,  and  two  of  malaria, 
were  treated  in  hospitals ;   there  was  one  death  from  yellow  fever. 

In  addition  to  the  above,  10  vessels  lying  in  the  Straits  of  Carquinez.  off  Mar- 
tinez, were  inspected,  and  5  fumigated  to  kill  vermin,  by  request  of  the  State 
board  of  health. 

Four  vessels  were  detained  pending  a  diagnosis  of  suspected  cases,  one  of 
which,  the  case  of  septicjemia  mentioned  above,  clinically  somewhat  resembled 
pest.  This  case  was  later  determined  to  have  been  due  to  a  pneumococcus  infec- 
tion, the  diagnosis  being  confirmed  by  Asst.  Surg.  D.  II.  Currie. 

To  better  guard  against  the  possibility  of  infection  by  means  of  rats  passing 
from  vessels  to  the  docks,  a  circular  letter  was  sent  by  me  to  the  representatives 
of  the  various  transportation  companies  having  vessels  from  the  ports  of  the 
Orient,  Australia,  and  South  America,  directing  the  use  of  rat  guards  on  lines, 
hoisting  gang  planks,  etc.,  at  night.  The  aid  of  the  customs  officials  was 
requested  to  assist  in  this  work,  to  which  the  collector  of  customs  heartily 
agreed. 

The  west  coast  of  South  America  continues  to  be  a  menace,  and  disinfection 
of  vessels  therefrom  has  been  continued. 

The  quarantine  officer  was  invited  to  and  became  a  member  of  the  public 
health  commission  of  California,  and  by  request  delivered  an  address  before 
that  body,  giving  an  account  of  the  work  done  both  at  this  port  and  at  ports  of 
departure  for  the  protection  of  this  State,  and  received  a  vote  of  thanks. 

Representatives  of  the  State  and  city  boards  of  health,  including  the  presi- 
dent of  the  State  board  and  city  health  and  sanitary  officers,  visited  the  station 
by  invitation. 


350 


PUHLKl    HEALTH    AND    M AKINE-HOSPITAL    SERVICE. 


Tbe  relations  of  the  station  wltli  all  the  coordinate  branches  of  the  Federal 
departments  and  State  and  municipal  authorities  continue  friendly. 
Respectfully, 

Hugh  S.  Gumming, 
Passed  Assistant  Surgeon,  in  Command. 
The  Surgeon-General. 

EUREKA. 


[Eureka  ((^al.)   Quarantine.] 
[Report  of  Acting  Asst.  Surg.  B.  Y.  Harris,  in  charge.] 

Transactions  at  Eureka  (Cal.)  National  Quarantine  Station  for  year  ending  June 

30,  1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels  spoken 

Steamers  inspect- 

Steamers  di sin- 

Sailing  vessels  in- 
spected  and 
passed 

Sailing  vessels 

2 

1 

3 

1 

2 

3 

2 

3 

2 

1 

24 
5 

Crew  on   sailing 

vessels  -. 

Passengers  on 

118 

:« 

46 

28 

31 

29 

23 

22 

8 

340 

Passengers  on 
sailing  vessels  . . 

6 

2 

.    3 

2 

1 

14 

COLUMBIA    RIVER, 


[Columbia  River  Quarantine;  post-office  address,  via  Astoria,  Oreg.] 

[Report  of  medical  officer  in  command,  Asst.  Surg.  Baylis  II.  Earle.     Assumed  command 
under  official  orders  of  November  28,  1900.] 

Columbia  River  Quarantine,  July  1,  190Jf. 

Sir  :  I  have  the  honor  to  submit  the  following  reiwrt  of  the  transactions  of 
the  Service  at  this  station  during  the  fiscal  year  ended  June  30,  1904: 

Sanitary. — The  British  ship  Agnes  Osirald,  which  had  arrived  at  this  port 
June  10,  1903,  from  Honolulu,  11.  L,  was  still  being  held  under  seven  days' 
observation  at  the  close  of  the  fiscal  year  ended  June  30,  1903,  and  was  released 
from  quarantine  July  .3,  1903.  An  account  of  the  detention  and  disinfection  of 
this  vessel  was  given  in  my  annual  reiiort  of  the  transactions  of  the  Service  at 
this  station  during  the  fiscal  year  ended  June  30,  1903. 

Sixty-nine  A^essels  of  all  classes  arrived  at  this  port  during  the  fiscal  year 
just  closed  for  quarantine  inspection,  of  which  number  (54  were  inspected  and 
passed  and  5  were  detained.  Of  those  detained  1  was  from  Honolulu,  H.  I.,  a 
plague-infected  port ;  1  from  Nushigak,  Alaska,  of  which  port  the  health  con- 
ditions were  unknown;  1  from  Shanghai,  China,  a  cholera-infected  port;  1  from 
East  London,  South  Africa,  a  plague-infected  port,  and  1  from  Hongkong, 
China,  a  plague  and  smallpox  infected  port.  Histories  of  these  will  be  given 
separately  and  in  detail. 

The  American  schooner  David  Evans,  of  748  net  tons,  arrived  in  thirty-one 
days  out  from  Honolulu,  H.  I.,  July  17,  1903,  with  12  men  and  (50  tons  of  rock 
ballast  on  board,  1  of  the  12  men  being  a  stowaway.  On  examination,  the  men 
were  found  to  be  in  good  health  and  the  vessel  mechanically  clean.  However, 
the  bill  of  health,  signed  by  Passed  Asst.  Surg.  L.  E.  Cofer,  of  the  Service, 
stated  that  the  crew  and  their  effects  had  been  only  partially  disinfected  and 
recommended  the  disinfection  of  the  entire  crew  and  their  effects  on  arrival  at 
this  port.  Because  of  this  fact,  and  also  because  of  the  presence  on  board  of 
the  stowaway,  who  had  not  been  seen  by  the  quarantine  officers  at  Honolulu,  it 
was  decided  not  only  to  bathe  tbe  entire  crew  and  disinfect  their  effects,  but  also 
to  disinfect  the  entire  vessel  on  which  the  crew  and  stowaway  had  been  w^orking. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  351 

Aorordinsjly.  tlic  vosscl  was  roinaiulod  to  tlu^  (luaranlino  station,  (lisinfoctod. 
and  tlu'ii  held  uiidor  s(>vi'ii  days'  observation  and  i-clcasod  July  27,  li)();'>. 

Till'  Pritish  hark  AiixtniUa,  of  2,()!I7  ni-t  tons,  arfivcd  in  forty-seven  days  out 
from  Shanghai,  China,  September  7,  11K);5,  with  2t)  men  and  1,200  tons  of  mud 
ballast  on  board.  On  examination,  the  crew  were  found  to  be  in  good  health 
and  the  ves.sel  niechanieally  clean.  However,  the  bill  of  health,  signed  by 
Acting  Asst.  Surg.  S.  A.  Hansom,  of  the  Service,  stated  that  the  ballast  had  been 
taken  from  the  river  tiats  below  the  city,  which  receive  drainage  from  the  city, 
and  that  it  should  therefore  be  considered  dangerous  and  treated  accordingly. 
The  vessel  was  therefore  remanded  to  the  quarantine  station  and  treated  the 
same  as  was  the  schooner  Da  rid  Eniiis,  mentioned  above,  the  ballast  being 
hinded  on  the  beach  by  means  of  lighters  after  having  been  thoroughly  wetted 
with  IlgCl,  solution  (1  :  1,000).  After  disinfection,  the  vessel  and  crew  were 
held  under  five  days'  observation  and  then  released  from  quarantine  October  3, 
1903. 

The  British  ship  Olenesslin,  of  1,644  net  tons,  ari-ived  in  ninety-eight  days 
out  fi'om  East  London,  South  Africa,  December  5,  1903,  with  22  men  and  850 
tons  of  earth  ballast  on  board.  The  ballast  w'as  taken  from  the  quarry 
which  is  situated  across  the  river  from  East  London  and  which  is  worked  by 
convicts.  On  examination,  the  crew  were  found  to  be  in  good  health  and  the 
vessel  mechanically  clean.  The  American  bill  of  health,  dated  August  2<;,  1903, 
and  signed  by  TTnited  States  Consular  Agent  W.  II.  Fuller,  stated  that  there  had 
been  27  cases  of  bubonic  plague,  with  17  deaths,  in  East  London  and  vicinity,  but 
that  there  had  been  no  new  cases  since  July  24,  1903,  and  that  the  sanitary  con- 
ditions and  histories  of  the  vessel  and  all  on  board  were  good.  However,  the 
British  bill  of  health,  dated  same  and  signed  by  II.  C.  Kolbe,  His  Majesty's  col- 
lector of  customs,  stated  that  the  rats  on  the  wharf  at  which  the  vessel  lay 
were  infected  with  plague.  As  the  rat  shields  placed  in  evidence  and  said  to 
have  been  used  were  simply  small  perforated  disks  of  zinc  which  could  not  pos- 
sibly have  been  made  to  fit  any  of  the  ropes  accurately,  and  over  and  through 
which  rats  might  crawl  with  ease,  it  was  decided  to  detain  and  disinfect  the 
vessel  and  crew.  The  vessel  was  accordingly  remanded  to  the  quarantine  sta- 
tion, where  the  same  processes  were  gone  through  as  in  the  cases  of  the  schooner 
David  Evans  and  bark  Australia,  mentioned  above,  except  that  only  the  top 
layer  of  the  ballast  was  wetted  with  the  HgCL  solution  (1  :  1,000)  and  all  of 
the  ballast  was  allowed  to  remain  in  place.  The  vessel  and  crew  were  then 
held  under  seven  days'  observation  and  released  from  quarantine  December  IG, 
1903. 

The  British  steamship  Ching  Wo,  of  2,517  net  tons,  arrived  in  sixty-four  days 
out  from  Hongkong,  China,  and  eight  days  out  from  Manzanillo,  Mexico,  April  20, 
1904,  with  52  Chinese  and  12  European  members  of  crew  and  233  tons  of  sea- 
water  ballast  on  board.  On  examination,  the  crew  were  found  to  be  in  good 
health  and  the  vessel  mechanically  clean.  The  vessel  had  come  via  Moji  and 
Kobe,  Japan,  and  Salina  Cruz  and  Manzanillo,  Mexico,  Consular  bills  of 
health,  certified  by  Service  officers  abroad,  stated  that  all  Asiatics  had  been 
bathed  and  their  effects  disinfected  before  embarkation.  However,  the  ship's 
doctor  stated  that  a  few  days  before  reaching  Salina  Cruz,  Mexico,  8  of  the 
Chinese  passengers  and  1  of  the  Chinese  crew  were  taken  ill  with  smallpox; 
that  they  were  at  once  isolated  on  the  after  deck  and  all  hands  vaccinated ; 
that  the  sick  were  transferred  to  the  hospital  on  shore  immediately  after  arrival 
at  Salina  Cruz,  April  5,  1903;  that  the  vessel  was  then  fumigated  with  SOo  gas 
by  him,  after  which  it  proceeded  to  Manzanillo,  where  the  remaining  Asiatic 
passengers,  192  in  number,  were  landed;  and  that  twenty  days  had  elapsed 
since  the  appearance  of  the  last  case  when  the  vessel  arrived  at  this  port.  The 
vessel  was  detained  and  remanded  to  the  quarantine  station,  where  all  persons 
were  again  vaccinated  and  the  same  processes  gone  through  as  in  the  cases  of 
the  vessels  mentioned  above,  except  that  the  water  ballast  was  not  disturbed  in 
any  way.  After  the  completion  of  the  vaccinations  and  disinfection,  it  was  not 
considered  necessary  to  hold  the  vessel  and  crew  under  observation,  more  than 
three  weeks  having  elapsed  since  the  appearance  of  the  first  case  and  eighteen 
days  having  elapsed  since  the  departure  of  the  last  case  from  the  vessel. 
Accordingly,  the  vessel  and  all  on  board  were  released  from  quarantine  April  23, 
1904. 

On  November  8,  1903,  a  letter  bearing  date  of  November  7,  1903,  was  received 
from  Mr.  J.  H.  Barbour,  inspector  in  charge  of  the  Immigration  Service  at  Port- 
land, Oreg.,  calling  my  attention  to  rule  20  of  the  Immigration  Laws  and  Regu- 
lations, approved  August  26,  1903;   and,  acting  under  the  authority  granted  by 


352 


PUBLIC    HEALTH    AND    MAEINEHOSPITAL    SERVICE. 


said  rule,  diivctiiig  iiie  thereafter  to  make  an  exhaustive  and  scrupulous  mental 
and  physical  examination  of  each  alien  seaman  arriving  at  this  port.  Accord- 
ingly, from  November  18,  1903,  to  June  30,  1904,  I  examined  932  alien  sea- 
men on  32  vessels,  of  which  number  I  found  50  seamen  to  be  physically 
deficient. 

Ten  new  signal-code  flags,  to  complete  the  old  set  on  hand  in  accordance  with 
the  requirements  of  the  new  code  of  190.3,  asked  for  on  special  requisition  of 
November  19,  1903,  were  received  December  23,  1903.  Ten  3-gallon  "Under- 
writers' "  portable  chemical  fire  extinguishers  and  suitable  chemicals  for  charg- 
ing same  were  received  February  20,  1904,  and  placed  in  proper  and  convenient 
positions  for  use  when  necessary. 

Respectfully,  Baylis  H.  Earle, 

Assistant  Surgeon. 

The  Subgeon-General. 


[Inclosure.] 


Transactions  at  the  Columbia  River  National  Quarantine  Station  for  the  year 

ending  June  30,  1904. 


Vessels  spoken 
and  passed 

Steamers  inspect- 
ed and  passed -- 

Steamer  disin- 
fected   

Sailing  vessels  in- 
spected  and 
passed 

Sailing  vessels 
disinfected 

Crew  on  steamers 

Crew  on  sailing 
vessels -.- 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels  . 


July. 


Aug. 


0 
70 

101 

5-5 

0 


Sept. 


Oct. 


0 
137 

170 

77 
1 


Nov. 


0 
104 


101 


Dec. 


Jan. 


Feb. 


Mar. 


0 
124 

0 

78 
0 


Apr. 


0 
221 

as 

42 
1 


May. 


June. 


Total. 


18 
1 

47 

3 
1,0.56 

1,527 

412 

29 


HOQUIAM. 

[Hoquiam   (Wash.)   Quarantine.] 
[Report  of  Acting  Asst.  Surg.  T.  C.  Frary,  in  charge.] 

Transactions  at  Hoquiam  National  Quarantine  Station  for  year  ending  June  30, 

1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels   spoken 

Steamers  inspect- 

Steamers  di sin- 

Sailing  vessels  in- 
spected    and 

2 

5 

2 

2 

1 

1 

6 

1 

2 

3 

3 

27 

Sailing    vessels 

1 

Crew  on    sailing 

22 

53 

21 

22 

8 

10 

61 

21 

28 

27 

272 

Passengers  on 

Passengers  on 

1 

PUBLIC    HEALTH    AND    MARINK-HoyiMTAL    HEKVICE. 


353 


POKT   TOWNSEND    AND    SUBPORTS. 

[Port  Townsend  Quarantine;  post-office  address,  via  Port  Tovvnsend,  Wash.,  and  siibports 
Seattle,  South  Bend,  and  Port  Angeles.] 


Iioijort  of  uiedicul 


iliicor  in  command.  Passed  Asst.  Surg, 
niand  under  official  orders  of  May  2i 


J.  11.  Oakley. 
,   1903.1 


Assumed  com- 


PoRT  Townsend  Quarantine,  July  1,  IDOJ/. 

SiK :  T  have  tho  honor  to  I'oitort  (»ii  tho  tfaiisiu-tioiis  at  this  quarantine  station 
(lurifiiJ:  tlie  fiscal  year  efuliiij;  Jufie  :'>0,  1!)()-1,  as  follows: 

The  total  mnnlier  of  vessels  hoarded  was  I'>1'4.  of  which  149  were  steamers  and 
17r>  sailini,'  vessi'ls.  Of  the  total  fiuiiiher  of  vessels  hoarded,  ."{l^  were  inspected 
and  passed  and  11  (all  sailitis  vessels)  were  sent  to  (luarantine  for  disinfection 
of  holds  atid  for(>castle  (piarters.  One  steamer  was  fumigated  for  destruction  of 
rats  after  she  had  discharged  her  carjio  at  tlie  Tacoma  docks.  Special  precau- 
tions a,!j;ainst  the  landins^  of  rats  were  taken  with  three  steamers  at  the  Seattle  and 
Tacoma  docks.  Attendants  served  as  jru;irds  ofi  the  four  steamers  ahove  men- 
tioned. The  total  luunher  of  persons  composing  the  crews  of  the  .■5124  vessels 
was  15,25!),  and  1!),(;22  passengers  were  insi)ected.  The  glandular  regions  of  all 
male  steerage  i)assengers  and  of  the  crew  of  all  vessels  from  plague-infected 
ports  were  examitied.  On  April  lo,  11)04,  a  sailor  from  the  steamer  Senator,  that 
bad  just  arrived  in  Seattle  from  San  Francisco,  via  Victoria  and  this  port, 
applied  at  the  Seattle  oftice  of  this  Service  for  treatment  of  a  skin  disease.  It 
was  discovered  that  he  had  smallpox,  and  he  was  sent  to  the  pesthouse. 

The  contacts  aboard  the  vessel  were  vaccinated,  and  the- part  of  the  vessel 
occupied  by  the  man  was  disinfected  under  the  supervision  of  the  officer  of  this 
Service  on  duty  at  Seattle. 

The  case  of  smallpox  from  the  United  States  Fish  Commission  steamer  Alba- 
tross, made  mention  of  in  my  last  annual  rei}ort  of  transactions,  was  discharged 
recovered  on  July  15,  1903.  No  other  case  developed  on  the  Albatross,  and  she 
completed  her  cruise  to  Alaskan  waters. 

On  October  (J.  190.3,  a  seaman  on  the  British  ship  DiinfcrniJirie,  discharging 
ballast  at  (piarantine,  fell  down  the  hold  and  was  killed;  his  remains  were 
interred  in  the  quarantine  cemetery. 

Respectfully,  J.  H.  Oakley, 

Passed  Assistant  burgeon. 

The  Sukgeon-Genebal. 


[Inclosure.] 


Transactions  at  Port  Townsend  ( Wash. )  National  Quarantine  Station  for  year 

ending  June  30,  1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total 

Vessels  spoken 

Steamers  inspect- 
ed and  passed... 

Steamer  d  i  s  i  n  - 
fected-. 

Sailing  vessels  in- 
spected  and 
passed 

Sailing  vessels 
disinfected 

Ci'ew  on  steamers 

Crew  on  sailing 
vessels 

Passengers  on 
steamers 

Passengers  on 
sailing  vessels... 

17 
0 

21 

2 

1,384 

422 

1,976 

20 

16 
0 

19 

3 
1,243 

410 

2,012 

7 

11 
1 

17 

2 

1,063 

311 

2,212 

10 

16 
0 

16 

2 
1,228 

298 

2,532 

15 

12 
0 

19 

0 
951 

332 

2,177 

18 

12 
0 

11 

0 
1,116 

200 

1,458 

4 

14 
0 

12 

0 
1,212 

194 

1,286 

2 

9 
0 

17 

0 

717 

253 

821 

13 

10 
0 

6 

1 
764 

123 

999 

9 

9 
0 

14 

1 
802 

243 

1,226 

4 

11 
0 

5 

0 

879 

57 

1,054 

4 

11 
0 

7 

0 
1,030 

137 

1,759 

4 

148 
1 

164 

11 

12,289 

2,970 

19,512 

110 

8639—04- 


-23 


354 


PUBLIC    HEALTH    AND   MAKINE-HOSPITAL    SERVICE. 


Port  Townsend  Quarantine.  July  15,  lOOIf. 
Sir  :  I  have  the  honor  to  transmit  herewith  annual  reports  of  transactions  at 
the  substations  of  Port  Angeles  and  Southbend,  Wash.,  for  the  fiscal  year  ending 
June  30.  1904. 

Respectfully.  J-  H.  Oakley, 

Passed  Assistant  Surgeon. 
The  Subgeon-General. 


[Inclosure.] 

Transactions  at  Seattle  (Wash.)  National  Quarantine  Station  for  year  ending 

June  30,  1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr.   May. 

June. 

Total. 

Vessels   spoken 

Steamers  inspect- 
ed and  passed.  ._ 
Steamers  di sin- 

1 

2 

3 

3 

3 

3 

2 

1 

1 

1 

19 

Sailing  vessels  in- 
spected  and 

1 

11 

2 

2 

1 

17 

Sailing  vessels 

• 

Crewon  steamers. 
Crew   on  sailing 

268 

26 

230 

171 
263 

206 

346 
31 
244 

190 
44 
96 

89 
130 

99 

1,163 

15 
3 

379 

Passengers  on 

steamers 

Passengers  on 

58 

166 

193 

158 

1,484 

1 

Chas.  H.  Eixiott, 
Acting  Assi.'itnnt  Surgeon  in  Temporary  Charge. 


[Inclosure.] 

Transactions  at  Sonth  Bend  (Wash.)  National  Quarantine  Station  for  year 
ending  June  30,  1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels  spoken 

Steamers  inspect- 

Steamers  disin- 
fected        

Sailing  vessels  in- 
spected   and 

1 

1 

2 

Sailing    vessels 

1 

■    r 

..  .1 

Crew  on   sailing 

10 

1 

11 

21 

Passengers  on 

1 

Passengers  on 

i 

1 

ruBLic  hp:alth  and  marin?:-hospital  sp:rvice. 

[Inclosure.] 


355 


Transncfioiis  at  Port  Angeles  (Wojih.)  National  Quarantine  Station  for  the  year 

ending  June  30,  100 4. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Vessels  spoken 
and  passed 

Steamers  inspect- 
ed and  passed... 

SU»amers  disin- 
fected  

Sailing  vessels  in- 
spected  and 
passed            

1 

1 

1 

1 

1 

4 

Sailing  vessels 
disinfected 

1 

Crew  on  steamers  '           ' 

Crew  on   sailing 
vessels 

19 

13 

27 

13 

11 

83 

Passengerson 
steamers 

Passengers  on 
sailing  vessels . 

1 

1 

i 

i 

1 

F.  S.  Lewis, 
Acting  Assistant  Surgeon. 


SITKA,    ALASKA. 

[Sitka  (Alaska)  Quarantine.] 
[Report  of  Acting  Asst.  Surg.  J.  C.  Koosher,  in  charge.] 

Transactions  at  Sitka  (Alaska)  National  Quarantine  Station  for  the  year  ending 

June  30,  1904. 


July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

Total. 

Steamers    in- 
spected and 
passed 

Steamers  disin- 
fected 

16 

14 

11 

13 

13 

12 

13 

13 

11 

15 

11 

14 

156 

Sailing  vessels  in- 
spec ted  and 
passed _.. 

1 

1 

Sailing   vessels 
disinfected 

Crews  on  steam- 
ers   

731 

518 

314 

445       420 

396 

418 

483 

352 

556 

402 

602 
27 
536 

5,637 

Crews  on  sailing 
vessels 

27 

Passengers  on 

steamers 

Passengers  on 

624 

581 

318 

491 

464 

335 

248 

229 

272 

722 

545 

5,365 

1 

j  

Texas-Mexican  Border  Quarantine. 

(See  under  heading  "  Yellow  fever,"  for  report  of  that  disease  at 
Laredo,  Mexico.) 


356 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 


LAREDO,    TEX. 

Report  of  Acting  Asst.  Surg.  H.  J.  Hamilton. 

Laredo,  Tex.,  July  28,  lOO.'f. 
Sir:   I  have  the  honor  to  submit  the  following  train-inspection  report  for  year 
ended  June  30,  1904,  at  Laredo,  Tex.,  station : 

Passenger  trains  from  Mexico  inspected 557 

Persons  on  trains  from  Mexico  inspected 17,380 

Persons  on  passenger  trains  from  Mexico  detained 215 

Immigrants  from  Mexico  vaccinated  upon  entrj- 37!) 

Persons  entering  via  foot  and  carriage  bridge 42,693 

Persons  presenting  at  foot  and  carriage  In'idge  refused  entry 112 

Pullman  coaches  disinfected 360 

Private  coaches  disinfected 12 

Day  coaches  disinfected 5 

Trunks  disinfected 41 

Corpses  inspected  and  passed 2 

Respectfully,  H.  J.  Hamilton, 

Acting  Asiistant  Surgeon. 
The  Surgeon-General. 


EL   PASO,   TEX. 
Report  of  Acting  Asst.  Surg.  E.  Alexander. 

El  Paso,  Tex.,  June  30,  190.',. 
Sir  :  I  have  the  honor  to  transmit  herewith  summary  of  transactions  at  this 
port  from  July  1,  1903,  to  June  30,  1904 : 


Mexican 
Central 
passen- 
gers. 

Disinfec- 
tions of 

soiled 
linen  and 

othei 
articles. 

Certifi- 
cates of 
death. 

Vaccina- 
tions. 

Rio 
Grande 
passen- 
gers. 

Fumigation  of 
hides. 

Loose. 

Carloads. 

1903. 
July 

733 
1,115 

919 
1.244 
1,068 

8.38 

900 

792 

909 

1,362 

558 
869 

1,642 

2,436 
2,0ft5 
1,968 
1,796 
1,569 

1,9.38 
1,614 
l,ft57 
1,986 
1,610 
1,.548 

1 


20 
16 
21 
7 
6 
19 

17 
37 
32 
59 

93 
107 
102 
194 

24 

421 

2 

1 
4 
1 

October 

1 

644 

1904. 
January 

3 

1 

2 

5 

24: 

1 

June 

1 

Total  ..  . 

11,-307 

22,069 

11 

263 

520 

1,065 

7 

Also  during  the  year  four  Pullman  cars  were  disinfected,  having  arrived  from 
infected  points  in  Mexico. 

Respectfully,  E.  Alexander, 

Acting  Assistant  Surgeon. 
The  Surgeon-Genebal. 

CONCLUSION. 

The  above  report  covers  the  work  of  the  Service  coming  under  the 
purview  of  the  Bureau  division  of  domestic  quarantine  during  the 
fiscal  year. 

Kespectfully  submitted. 

A.  H.  Glennan, 
Assistant  Surgeon-General. 
To  the  Surgeon-General, 


DIVISION  OF  SCIENTIFIC  RESEARCH  AND 
SANITATION. 


357 


REPORT  OF  THE  DIVISION  OF  SCIENTIFIC  RESEARCH  AND 

SANITATION. 

By  H.  D.  Geddings, 

Assistant  Siirgeon-Oeneral,  Puhlic  Health  and  Marine-Hospital  f^ervice,  in 

Cliarge. 

Sir  :  I  have  the  honor  to  submit  the  following  report  of  the  opera- 
tions of  the  Bureau  division  of  scientific  research  for  the  fiscal  year 
ending  June  30,  1903 : 

Transactions  of  the  Division. 

The  -work  of  the  division  has  been  continued  this  year  as  in  the 
previous  years,  embracing  the  review  of  medical  and  scientific  jour- 
nals and  the  card  indexing  of  all  subjects  pertinent  to  the  communica- 
ble diseases  and  to  the  public  health. 

Yellow  Fever  Institute. 

Xo  publications  were  issued  by  the  Yellow  Fever  Institute  during 
the  fiscal  year,  but  the  report  of  the  French  yellow  fever  commission 
of  the  Pasteur  Institute,  operating  at  Rio  de  Janeiro,  Brazil,  was 
translated  in  the  Bureau  and  prepared  for  publication.  It  will  appear 
during  the  coming  year. 

ETIOLOGY   or    YELLOW   FEV'ER. 

It  was  deemed  important  to  still  further  investigate  this  subject, 
and  about  May  1,  1903,  working  party  Xo.  2,  composed  of  Passed 
Asst.  Surg.  H.  B.  Parker,  chairman;  Asst.  Surg.  Edward  Francis, 
and  Acting  Asst.  Surg.  George  E.  Beyer  was  dispatched  to  Vera  Cruz 
for  this  purpose.  Subsequently,  Doctor  Parker  was  relieved  as  chair- 
man, but  retained  as  a  member  of  the  part,  and  Passed  Asst.  Surg. 
M,  J.  Rosenau.  the  director  of  the  Hygienic  Laboratory,  was  detailed 
as  chairman. 

As  a  result  of  their  observations,  working  party  Xo.  2  submitted  a 
preliminary  report,  which  was  published  in  the  Public  Health  Re- 
ports of  December  18.  1903,  in  which  it  was  stated  that  the  party  was 
unable  to  corroborate  all  the  findings  of  working  party  Xo.  1,  phases 
of  the  organism  described  by  the  latter  party  under  the  name  of 
Myxococcidium  stegomyice  having  been  found  in  normal  mosquitoe-. 

The  final  report  of  the  party  is  in  course  of  preparation  as  a  bulle- 
tin of  the  yelow  fever  institute,  and  while  the  question  of  the  etio- 
logical factor  of  yellow  fever  has  not  as  yet  been  settled,  this  report 
will  contain  many  items  of  interest  in  regard  to  the  relation  of  the 
mosquito  Stegomyia  fasHata  to  yellow  fever  and  observations  upon 
mosquitoes  in  their  relation  to  other  diseases,  notably,  the  malarial 
fevers. 

359 


800  PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 

The  fiirtlior  investigation  of  questions  relating  to  the  etioh)gy  and 
methods  of  the  transmission  of  ydlow  fever  is  contempLated.  and  an 
opportunity  is  awaited  to  enter  upon  the  investigation  of  dengue  and 
other  communicable  diseases. 

COLLECTION    AND    IDENTIFICATION    OF    MOSQUITOES. 

In  view  of  the  recent  discoveries  of  the  role  played  by  mosquitoes 
of  the  genus  Stegoniyia  in  the  transmission  of  yellow  fever,  the 
importance  was  realized  of  determining  the  geographical  distribu- 
tion of  this  particular  insect. 

Instructions  were  therefore  given  to  medical  officers  looking  to  the 
collection  of  specimens  in  their  various  localities,  and  these  specimens, 
when  received  at  the  Bureau,  w^ere  referred  to  Prof.  L.  O.  Howard,  of 
the  Division  of  Entomology  of  the  Department  of  Agriculture,  for 
identification  and  classification.  With  the  approval  of  the  Secretary 
of  the  Treasury  and  the  consent  of  the  Secretary  of  the  Department  of 
Agriculture,  Professor  Howard  has  been  appointed  consulting  ento- 
mologist of  the  Service,  and  the  collection  of  specimens  will  be  con- 
tinued and  pushed. 

By  this  plan  not  only  will  the  geographical  distribution  of  the 
mosquito  in  question  be  arrived  at,  but  the  territory  infectible  by 
yellow  fever  will  be  defined,  and  valuable  information  will  be  derived 
as  to  the  distribution  of  other  species  of  mosquitoes,  notably  the 
malaria-bearing  Anopheles. 

The  following  circular  of  information  and  instruction  was  issued, 
and  numerous  replies  and  specimens  have  been  received: 

GEOGRAPHIC   DISTRIBUTION    OF   YELLOW-FEVER   MOSQUITOES,    AND   THE   IMPORTANCE   OP 
ACCURATE  KNOWLEDGE  CONCERNING  ALL  MOSQUITOES   OF  THE  UNITED  STATES. 

[1903.     Department  Circular  No.  111.] 

Treasury  Department, 
Bureau  of  Public  Health  and  Marine-Hospital  Service, 

Washinffton,  September  30,  1903. 
To  medical  officers  of  the  Public  Health  and  Marine-Hospital  Service, 

State  and  local  health  and  quarantine  officers,  and.  others  concerned: 

At  the  first  International  Sanitary  Convention,  belcl  in  Washington,  Decem- 
ber 2  to  December  .5,  1902,  it  was  resolved — 

"  That  the  different  Governments  study,  in  their  respective  territories,  the 
geographical  distribution  of  the  mosquito  of  the  genus  Stegomyia,  in  order  that 
said  study  may  have  practical  application  in  subsequent  conventions." 

In  addition  to  information  as  to  the  yellow-fever  mosquito  (Stegomyia  fasci- 
ata),  the  desirability  of  exact  knowledge  concerning  all  of  the  mosquitoes  of  the 
United  States  is  apparent. 

It  is  desired  that  every  effort  be  made  to  collect  specimens  of  mosquitoes  in 
your  vicinity  and  to  have  them  transmitted,  with  notes  on  the  accompanying 
blank  form,  under  franked  envelope,  to  this  Bureau.  They  will  be  transmitted 
by  the  Bureau  to  Dr.  L.  O.  Howard,  Chief  Entomologist  of  the  United  States 
Department  of  Agriculture,  and  recently  appointed  consulting  entomologist  of 
the  Public  Health  and  Marine-Hospital  Service,  now  engaged  in  the  preparation 
of  a  monograph  upon  the  mosquitoes  of  North  and  Central  America  and  the 
West  Indies. 

The  following  suggestions  as  to  collecting  mosquitoes  are  offered  for  your 
guidance : 

The  collector  should  be  provided  with  a  number  of  small,  wide-mouthed  vials ; 
an  open-mouthed  vial  being  placed  over  a  mosquito  found  resting  upon  a  sur- 
face, the  finger  is  then  placed  over  the  mouth  of  the  vial  and  a  wad  of  cotton 
stuffed  in.     The  mosquitoes  can  be  killed  by  blowing  tobacco  smoke  into  the 


PUBLIC    HEALTn    AND    MARINE-HOSPITAL    SERVICE.  361 

vial  or  by  a  drop  of  chloroform  plaood  upon  tlio  coflon  stoppor.  Spocimoiis  thus 
folloftod  and  killed  should  thou  ho  placed  iu  a  iiill  hox,  lictwceu  two  or  more 
layers  of  cotton,  and  the  memorandum,  with  all  facts  ohtaiuahle,  such  as 
approximate  elevation  ahove  the  sea,  whether  captured  iu  house,  outhouses, 
marshes,  woods,  (ields.  or  on  vessels,  should  he  folded  and  pl;iced  under  the  cover 
of  the  hox.  A  sin;rle  hox  or  series  of  boxes  may  llien  be  packed  in  a  small  tin 
or  wooden  box  and  mailed  under  the  franked  enveloi)e  furnished  for  the 
puriHise. 
Your  cooperation  in  this  work  is  respectfully  requested. 

Walter  Wyman,  S urgeon-Oeneral. 
Approved : 

ROBEKT    B.  ARAfSTRONO. 

Assistant  Secretary  of  the  Treasury. 

An  article  "  Concerning  the  geographic  distribution  of  the  yellow- 
fever  mosquito,"  by  Prof.  li  .  O,  Howard,  consulting  entomologist  of 
the  United  States  Public  Health  and  Marine-Hospital  Service,  was 
published  as  a  supplement  of  the  Public  Health  Reports  of  November 
13,  1903. 

MOSQUITO    DESTRUCTION. 

The  subject  of  the  destruction  of  mosquitoes  as  one  means  for  the 
preservation  of  the  public  health  is  annually  attracting  an  increased 
amount  of  attention  in  the  United  States. 

FIRST   ANTIMOSQUITO    CONVENTION. 

This  convention  met  in  the  city  of  New  York  on  December  16, 1903, 
and  was  numerously  attended,  and  the  proceedings  were  of  a  highly 
interesting  character.  The  Service  was  represented  by  delegates, 
and  the  remarks  of  one  of  them  appear  in  another  part  of  this  report. 

The  results  of  the  Service  operations  against  mosquitoes  in  certain 
portions  of  Texas  have  been  interesting  and  of  a  high  degree  of 
efficiency.  In  Laredo,  Tex.,  where  mosquitoes  of  the  genus  Stegomyia 
were  formerly  very  abundant,  it  is  now  reported  that  it  is  only  with 
difficulty  that  specimens  can  be  found  for  observation,  and  the  same 
results  have  been  arrived  at  in  other  portions  of  the  State  with  a 
corresponding  decrease  in  the  number  of  other  species.  The  methods 
employed  are  set  forth  in  the  account  of  operations  at  Laredo  by 
Assistant  Surgeon  Richardson,  published  elsewhere  in  this  report. 

COOPERATION    WITH    STATE    AND    LOCAL   BOARDS    OF    HEALTH. 

In  several  instances  questions  on  sanitation,  sewage,  water  supply, 
contamination  of  streams,  and  the  establishment  of  hospitals  for  con- 
tagious diseases  with  reference  to  proximity  to  habitations  have  been 
referred  to  the  Bureau  for  settlement. 

In  accordance  with  a  well-defined  policy,  when  these  questions  were 
referred  by  local  boards  in  States  in  which  a  State  board  of  health 
existed,  these  questions  were  not  discussed  until  a  request  or  indorse- 
ment was  received  from  the  State  board.  Such  cooperation  seemed 
to  be  always  welcomed  by  the  State  boards,  and  information  in  the 
possession  of  the  Bureau  was  then  always  cheerfully  furnished.  It  is 
contemplated  in  the  near  future  to  refer  these  questions  to  the  appro- 
priate committees  of  the  conference  of  State  health  officers  for  report 


362  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

to  the  Bureau,  and  in  this  way  concerted  action  can  be  taken  on  ques- 
tions without  any  possibility  of  friction. 

During  the  year  the  Surgeon-General  was  requested  to  act  M'ith 
Doctor  Walcott,  of  the  Massachusetts  State  board  of  health,  as  a 
committee  to  suggest  to  the  city  of  Columbia,  S.  C,  names  of  those  best 
fitted  to  serve  on  a  proposed  expert  board  for  the  consideration  of  a 
source  and  system  of  water  supply  for  that  city.  Through  this  con- 
cert of  action  a  number  of  eminent  waterworks  and  sanitary  engineers 
were  suggested  for  the  action  of  the  city  council  of  Columbia. 

Spotted  Fever. 

For  a  number  of  years  a  disease  of  mj^sterious  nature  and  attended 
by  considerable  mortality  has  annually  made  its  appearance  in  the 
spring  of  the  year  in  the  Bitter  Root  Valley  of  Montana,  and  while 
some  attempts  have  been  made  to  investigate  its  nature  and  to  suggest 
measures  for  its  suppression,  they  have  so  far  met  with  only  a  limited 
amount  of  success. 

On  May  2, 1904,  Dr.  Charles  Wardell  Stiles,  chief  of  the  division  of 
zoology  of  the  Hygienic  Laboratory,  was  detailed  to  visit  Missoula, 
Mont.,  to  continue  the  investigations  from  a  zoological  point  of  view. 

Doctor  Stiles  reached  Missoula  on  May  7,  and  remained  on  the 
ground  until  July  6,  1904. 

He  has  made  the  following  preliminary  report: 

PRELIMINARY  REPORT  UPON  A  ZOOLOGICAL  INVESTIGATION  INTO  THE  CAUSE,  TRANS- 
MISSION, AND  SOURCE  OF  THE  SO-CALLED  SPOTTED  FEVER  OF  THE  ROCKY  MOUN- 
TAINS. 

Hygienic  Laboratory, 
Washington,  D.  C,  July  22,  1904. 
The  Surgeon-General. 

(Through  Director  Hygienic  Laboratory.) 
Sir  :  In  accordance  with  Bureau  instructions,  dated  May  2,  1904.  I  visited 
the  Bitter  Root  Valley,  Montana,  to  study  the  so-called  "  spotted  fever " 
("tick  fever."  "'Pyroplasmosis  hominis"),  from  a  zoological  point  of  view, 
and  remained  in  that  locality  from  May  7  to  July  6,  1904.  In  view  of  the  fact 
that  it  will  require  several  months  for  me  to  prepare  my  final  report  upon  the 
worli  undertalven.  I  have  the  honor  to  transmit  herewith  a  brief  summary  of 
the  results  thus  far  obtained. 

1.  I  saw  10  cases  of  this  disease  and  was  able  to  study  9  of  them  more  or 
less  in  detail,  but  I  obtained  only  1  necropsy. 

2.  I  have  been  unable  to  confirm  the  hypothesis  that  this  spotted  fever  is 
caused  by  a  Pyroplasma,  that  it  is  transmitted  by  ticks,  and  that  it  originates 
in  spermophiles  (poj)ularly  known  as  "gophers"). 

3.  Even  if  it  is  admitted  that  a  Pyroplasma  occurs  in  the  spermophiles  and 
that  I  have  overlooked  it,  it  seems  a  priori  very  improbable,  from  our  present 
knowledge  of  this  genus,  that  such  a  parasite  of  rodents  would  develop  in 
man,  since  Smith  was  not  able  to  infect  sheep  with  Pyroplasma  higeminum  of 
cattle. 

4.  I  find  rather  serious  arguments,  of  a  zoogeographic  nature,  against  assum- 
ing that  "  spotted  fever  "  originates  in  spermophiles. 

5.  The  spermophiles  in  the  Bitter  Root  Valley  are  frequently  infested  with 
fleas  and  lice,  less  frequently  with  ticks,  so  that  even  if  these  rodents  harbor  a 
Pyroplasma,  the  tick  is  not  the  only  arthropod  which  must  be  taken  into  consid- 
eration as  the  possible  intermediate  host,  although  a  priori  consideration  would 
of  course  be  in  favor  of  the  tick. 

6.  The  tick  most  common  in  the  valley  is  a  dermacentor,  which  is  very  closely 
allied  to  D.  reticnlatus.  The  data  now  at  my  disposal  indicate,  however,  that 
it  represents  a  distinct  species. 

7.  These  ticks  are  common  on  horses,  cattle,  and  dogs,   and  more  or   less 


PUBLIC    HEALTH    AND    MARIN K-HOSPITAL   SERVICE.  36H 

frequent  on  man.  but  there  is  nothing  to  indioate  that  a  hibernating  animal  is 
necessary  for  their  development;  in  fact,  indications  (seasonal  distribution) 
arc  not  entirely  lacking  that  the  spermophile  forms  a  more  or  less  accidental 
lu>st  for  this  species. 

8.  I  was  unable  to  confirm  the  view  that  all  cases  of  "spotted  fever"  are 
jireceded  by  tick  bites.  In  five  of  the  ten  cases  I  saw  I  was  unable  to  establish 
a  history  of  tick  bite. 

0.  I  find  rather  serious  arguments  of  a  zoogeograi)hic  as  well  as  of  seasonal 
nature  which  fail  to  support  the  view  that  ticks  form  the  transmitting  agent 
of  ".spotted  fever." 

10.  Despite  a  total  of  at  least  one  hundred  hours'  microscopic  work  on  fresh 
Mood,  taken  at  various  times  night  and  day  from  9  cases,  I  have  been  unable 
to  find  any  structure  which  I  can  iuteriiret  as  a  protozoon.  Likewise  one  hun- 
dred hours'  work  on  stained  blood  from  10  cases  gave  negative  results. 

11.  Certain  clinical  features  of  the  disease,  notably  the  thickened  condition 
of  the  blood  and  the  condition  of  the  urine,  do  not  support  the  view  that  this 
disease  is  due  to  a  PinopJasma. 

12.  The  nervous  symptoms  noticed  this  year  were  greatly  in  excess  of  what 
the  i)ublished  accounts  of  the  disease  had  led  me  to  expect. 

13.  Necropsy  (1  case)  did  not  show  any  lesions  in  the  central  nervous  system 
which  could  be  interpreted  as  meningitis. 

14.  My  work  is  negative,  so  far  as  cause,  treatment,  and  pi'evention  are  con- 
cerned ;  the  greater  part  of  my  time  was,  of  course,  occupied  in  testing  the 
present  theories  regarding  the  disease,  and  my  results  are  entirely  of  a  destruc- 
tive nature. 

15.  The  tick  theory  has  caused  serious  financial  loss  to  the  Bitter  Root  Valley 
and  has  produced  an  effect  which  in  a  few  cases  bordered  on  hysteria.  In 
justice  to  the  property  interests  of  the  valley  and  the  peace  of  mind  of  the 
inhabitants.  I  think  no  time  should  be  lost  in  publishing  the  statement  that  the 
results  of  study  this  year  have  absolutely  and  totally  failed  to  confirm  this 
liypothesis. 

10.  I  am  under  numerous  obligations  to  the  physicians  of  the  valley,  par- 
ticularly to  Dr.  J.  J.  Buckley,  for  many  courtesies  extended  to  me  in  connection 
with  my  work,  and  I  shall  look  forward  with  pleasure  to  acknowledging  the 
indebtedness  more  in  detail  in  my  final  report. 

Second  General  International  Sanitary  Convention  of  Amer- 
ican Republics. 

The  Second  Convention  of  American  Republics  was  to  have  been 
held  in  Santiago  de  Chile  on  March  15,  1904,  but  owing  to  the  prev- 
alence of  yellow  fever  upon  the  Texas-Mexican  border  in  the  fall  of 
1903  and  the  repressive  measures  which  were  necessary  during  the 
winter  of  1903  and  the  spring  of  1904  to  prevent  a  recrudescence  of 
the  disease,  it  was  impracticable  for  the  Surgeon-General  of  the  Pub- 
lic Health  and  Marine-Hospital  Service,  who  is  also  chairman  of  the 
international  sanitary  bureau,  to  be  absent  from  his  post  of  duty  for 
the  time  necessary  to  attend  a  meeting  at  such  a  distance.  It  was 
thought,  also,  that  for  the  same  reason  the  Mexican  national  health 
authorities  would  probably  be  unable  to  attend.  Upon  consultation, 
therefore,  with  members  of  the  international  sanitary  bureau  it  was 
unanimously  agreed  to  postjDone  the  meeting,  which  it  is  now  con- 
templated to  hold  in  Santiago  de  Chile  in  April,  1905. 

Second  Annual  Conference  of  State  Health  Officers  with  the 
United  States  Public  Health  and  Marine-Hospital  Service. 

In  accordance  with  the  provisions  of  section  7  of  the  act  of  Congress 
approved  July  1,  1902,  entitled  "An  act  to  increase  the  efficiency  and 


364  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

change  tlie  name  of  the  Marine-Hospital  Service,"  the  second  annual 
conference  of  State  health  authorities  with  the  Public  Health  and 
Marine-PIospital  Service  Avas  held  in  Washington  on  June  o,  li)OI, 
being  called  to  order  at  10  o'clock  a.  m.  The  meeting  was  held  at  the 
New  Willard  Hotel,  the  Surgeon-General  presiding,  and  Asst.  Surg. 
Gen.  H.  D.  Geddings  assisting  him  as  secretary. 

The  delegates  present  were :  Dr.  N.  K.  Foster,  Sacramento,  Cal. ; 
Dr.  C.  E.  Cooper,  Denver,  Colo.;  Dr.  C.  A.  Lindslev,  New  Haven, 
Conn.;  Dr.  E.  W.  Cooper,  Camden,  Del.;  Dr.  Wm.  C.  Fowler,  1141 
Fifth  street  NW.,  Washington,  D.  C. ;  Dr.  J.  Y.  Porter,  Key  West, 
Fla. ;  Dr.  Charles  B.  Cooper,  Honolulu,  Hawaii;  Dr.  J.  N.  Hurty, 
Indianaj)olis,  Ind. ;  Dr.  F.  W.  Powers,  Waterloo,  low^a ;  Dr.  Edmond 
Souchon,  New  Orleans,  La. ;  Dr.  John  S.  Fulton,  Baltimore,  Md. ; 
Dr.  H.  B.  Baker,  Lansing,  Mich. ;  Dr.  H.  M.  Bracken,  St.  Paul,  Minn. ; 
Dr.  T.  B.  Tuttle,  Helena,  Mont. ;  Dr.  Henry  Mitchell,  Asbury  Park, 
N.  J.;  Dr.  Eichard  H.  Lewis,  Raleigh,  N.  C;  Dr.  H.  H.  Healey, 
Grancl  Forks,  N.  Dak.;  Dr.  Benjamin  Lee,  Philadelphia,  Pa.;  Dr. 
Gardner  T.  Swarts,  Providence,  R.  I. ;  Dr.  George  R.  Tabor,  Austin, 
Tex. ;  Dr.  F.  S.  Bascom,  Salt  Lake  Citv,  Utah ;  Dr.  C.  S.  Caverley, 
Rutland,  Vt. 

The  Surgeon-General,  in  calling  the  conference  to  order,  stated  that 
nothing  had  transpired  during  the  past  year  to  render  any  special 
conference  necessary  and  that  the  meeting  was  simply  in  compliance 
with  the  provisions  of  the  laAv  of  1902,  i3roviding  that  such  a  confer- 
ence be  held  at  least  once  in  each  year. 

The  operations  upon  the  Texas-Mexican  border  were  review^ed,  and 
a  statement  was  made  to  the  conference  of  what  had  been  accom- 
plished by  the  united  efforts  of  the  Service,  the  State  health  officer  of 
Texas,  and  the  Mexican  authorities  in  controlling  the  epidemic  and 
controlling  its  recrudescence. 

The  delegates  were  then  called  upon  in  alphabetical  order  and  gave 
brief  addresses  upon  the  operations  of  their  respective  boards  during 
the  past  year. 

The  following  committees  were  announced : 

Scientific  research  and  sanitation. — Di\  William  H.  Welch,  Dr.  William  C. 
Woodward,  and  Dr.  U.  O.  B.  Wiugate. 

Prevention  and  spread  of  epidemic  diseases. — Dr.  N.  K.  Foster,  Dr.  Edmond 
Souchon,  and  Dr.  J.  N.  Hurty. 

Morbidity  and,  mortality  statistics. — Dr.  Henry  B.  Baker,  Dr.  Gardner  T. 
Swarts,  and  Dr.  H.  M.  Bracken. 

State  legislation. — Dr.  Benjamin  Lee,  Dr.  C.  O.  Probst,  and  Dr.  Irving  A. 
Watson. 

Education. — Dr.  C.  A.  Lindsley,  Dr.  Paulus  A.  Irving,  and  Dr.  J.  A.  Albright. 

Cholera. — Dr.  Samuel  W.  Abbott,  Dr.  Daniel  Lewis,  and  Dr.  Andrew  C.  Smith. 

Yelloiv  fever. — Dr.  Joseph  Y.  Porter,  Dr.  J.  F.  Hunter,  Dr.  George  R.  Tabor, 
Dr.  William  H.  Saunders,  and  Dr.  T.  Grange  Simons. 

Plague.—'Dr.  F.  F.  Wesbrook,  Dr.  J.  S.  Fulton,  and  D.r  Andrew  C.  Smith. 

Smallpox.— Dr.  Henry  Mitchell,  Dr.  G.  E.  Young,  Dr.  S.  N.  Meyers,  Dr.  T.  B. 
Beatty,  and  Dr.  ,1.  N.  McCormack. 

Tuherctilosis. — Dr.  C.  E.  Cooper,  of  Colorado,  and  Dr.  W.  G.  Hope. 

Leprosy. — Dr.  J.  C.  Nolte,  Dr.  Charles  B.  Cooper,  of  Hawaii,  and  Dr.  J.  F. 
Smith,  of  Porto  Rico. 

Typhoid  fever.— Dr.  William  C.  Woodward,  Dr.  J.  A.  Egan,  Dr.  S.  W.  Abbott, 
Dr.  J.  N.  Hurty,  and  Dr.  J.  S.  Fulton. 


PUBLIC    HEALTH    AND    MARINK-HUSriTAL    SERVICE.  365 

CONFIDENCE   AS    TO    PLAGUE    MEASURES    IN    SAN    FRANCISCO. 

The  conference  also  passed  the  following  resolution  with  regard  to 
the  plague  situation  in  California: 

Resolved,  That  this  conference  expresses  its  confidence  in  the  present  methods 
in  force  in  California  in  doalinsr  witli  i)la.;;no,  and  tliat  it  extends  its  congratuhi- 
tioiis  to  the  national.  State,  and  ninnicii)al  sanitary  autliorities  for  their  har- 
monious action  in  the  control  of  this  disease. 

The  transactions  of  the  conference  will  be  published  in  full  at  an 
early  date. 

Aid  to  the  Management  of  the  Louisiana  Purchase  Exposition. 

Upon  the  request  of  the  medical  director  of  the  exposition,  approved 
by  the  president  of  the  same,  Surg.  James  M.  Gassaway,  of  the  Serv- 
ice, was  detailed  as  sanitaiT  officer  of  the  exposition  grounds  and 
buildings,  and  has  entered  upon  the  discharge  of  his  duties. 

As  has  been  the  custom  at  previous  World's  Fairs,  an  exhibit  calcu- 
lated to  illustrate  the  various  functions  and  operations  of  the  Service 
was  made,  and  has  been  installed  at  the  Louisiana  Purchase  Exposi- 
tion. The  exhibit  embraces  models  of  quarantine  camjDS  and  maritime 
quarantine  stations,  disinfecting  apparatus,  exhibits  of  ward  furni- 
ture and  hospital  appliances,  one  of  the  traveling  laboratories  of  the 
Service,  exhibits  of  cultures,  pathogenic  and  nonpathogenic  speci- 
mens of  mosquitoes,  photomicrographs  of  mosquitoes,  and  various 
pathogenic  organisms,  models  showing  the  contamination  of  water 
supplies  and  drawings  showing  methods  of  Avater  purification,  elec- 
trical apparatus,  and  a  full  outfit  for  X-ray  work. 

The  exhibit  has  attracted  much  comment  of  a  favorable  nature. 

Meeting  or  the  National  Association  for  the  Study  and  Pre- 
vention OF  Tuberculosis^ 

As  a  consequence  of  the  organization  of  this  society,  the  first  meet- 
ing was  held  at  Atlantic  City.  X.  J.,  just  prior  to  the  meeting  of  the 
American  Medical  Association  at  the  same  place,  and  was  called  to 
order  on  the  evening  of  June  6,  1904.  The  Service  was  represented 
by  Passed  Asst.  Surg.  M.  J.  Rosenau,  whose  report  follows  in  another 
i:)art  of  this  publication. 

Dr.  E.  L.  Trudeau,  of  Saranac  Lake,  N.  Y.,  was  chosen  president, 
and  the  following  directors  were  likewise  chosen :  Massachusetts, 
Bowditch  and  Otis;  Connecticut.  Foster:  New  York.  Biggs,  Tru- 
deau, Devine,  and  Knopf:  Pennsylvania,  P'lick.  Ravenel,  Anders,  and 
Pearson;  New  Jersey,  Hoffman;  ^Maryland.  "William  H.  Welch, 
Osier,  Jacobs,  and  Fulton:  District  of  Columbia.  Sternberg;  Xorth 
Carolina.  Minor:  Colorado.  Soley;  Illinois.  Klebs  and  Babcock; 
Minnesota,  Bracken;  Missouri,  Porter:  Indiana,  Hurty;  Michigan, 
Vaughan:  Ohio,  Probst:  California,  Briggs;  Texas,  M.  M.  Smith; 
Public  Health  and  Marine-Hospital  Service,  Surgeon-General 
AVyman,  and  the  United  States  Army.  Major  and  Surgeon  Bushnell. 


366  PUBLIC    HEALTH    AXD    MARINE-HOSPITAL   SEKVICE. 

Porto  Rico  Anemia  CoMiiissiox. 

appointilent  of  asst.  surg.  w.  w.  kixg,  and  preliminary  reports 
ox  progress  or  the  ixvestigatioxs. 

Treasury  Departmext, 

Bureau  of  Public  Health  axd  Marixe-Hospital  Service, 

Washington^  April  -5,  190 Ji.. 

Sir:  Replying  to  your  communication  of  January  26.  1904,  rela- 
tive to  your  desire  to  engage  with  Assistant  Surgeon  Ashford,  U.  S. 
Army,  in  an  endeavor  to  eradicate  certain  forms  of  anaemia  caused  by 
uncinariasis  in  the  island  of  Porto  Rico,  and  to  the  Bureau  reply  to 
the  same,  under  date  of  February  6,  1004,  and  to  a  subsequent  com- 
munication from  you  inclosing  a  rec{uest  from  His  Excellency  Gov- 
ernor Hunt,  of  Porto  Rico,  that  you  be  detailed  for  the  continuance 
of  the  investigation  above  named,  you  are  informed  that,  in  addition 
to  the  duties  at  present  devolving  upon  j'ou,  the  Bureau  desires  that 
you  undertake  the  investigation  and  the  operations  requested  by  Gov- 
ernor Hunt. 

"With  this  end  in  view,  you  are  directed  to  report  to  Governor  Hunt, 
and  in  connection  with  Doctor  Ashford  to  pursue  such  plans  as  may 
be  agreed  upon  by  you  for  the  iuA^estigation  and  eradication  of 
uncinariasis  in  the  island. 

In  the  future,  should  you  find  it  impossible  to  continue  the  Service 
work  and  these  investigations,  you  are  directed  to  inform  the  Bureau, 
and  an  assistant  will  be  detailed  to  report  to  you. 

You  are  requested  to  report  from  time  to  time,  about  once  in  each 
month,  the  progress  of  the  investigations.  It  is  not  the  intention  of 
the  Bureau  to  publish  these  reports  until  such  time  as  your  work  may 
be  completed  and  the  wishes  of  Governor  Hunt  in  regard  to  publica- 
tion are  ascertained. 

You  are  further  directed,  during  the  prosecution  of  your  investiga- 
tions, to  make  report  upon  any  other  parasites  which  you  may  come 
across,  especially  those  of  an  intestinal  nature  affecting  human  beings. 
Any  specimens  of  this  nature  which  you  may  desire  to  have  investi- 
gated may  be  forwarded  to  the  Bureau,  and  they  will  be  referred  to 
the  Hygienic  Laboratory  for  identification  and  classification  if  so 
desired  by  you. 

Respectfully,  AValter  Wymax, 

Surgeon-  General. 

Asst.  Surg.  "\V.  TV.  Kixg,  San  Juan,  P.  R. 


Porto  Rico  Ax^emia  Commission, 

Utiiado,  P.  Pl.,  May  16,  IGOJf. 

Sir  :  In  accordance  with  instructions  contained  in  Bureau  letter  of 
April  5.  1904,  authorizing  me  to  undertake  some  investigations  of 
uncinariasis  in  Porto  Rico,  in  company  with  Capt.  and  Asst.  Surg. 
B.  K.  Ashford,  U.  S.  Army,  I  have  the  honor  to  make  the  following 
report  of  the  work  up  to  May  1,  1904: 

We  are  engaged  in  this  work  under  the  name  of  the  "Anaemia  Com- 
mission," having  associated  with  us  Dr.  Pedro  Gutierrez,  of  Bayamon, 
P.  R.,  as  member  of  the  commission  and  its  disbursinsr  officer. 


IMIHLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE.  367 

Work  was  be<;iin  on  March  1,  when  Doctor  Ashford  reported  to  the 
governor. 

Under  authority  from  the  United  States  War  Department  practi- 
cally all  the  camp  equipment  was  loaned  to  the  commission  by  the 
military  authorities  in  San  Juan. 

The  location  selected  for  the  first  camp  was  at  Bayamon,  P.  R.,  near 
the  local  city  hospital.  The  laboratory  work  was  done  in  several 
rooms  of  this  city  hospital,  for  the  use  of  which  we  are  indebted  to 
the  city  authorities. 

The  camp  consisted  of  10  tents,  as  follows:  Eight  tents  of  G  beds 
each,  1  dining-room  tent,  and  1  administration  tent.  The  camp  was 
ready  to  receive  patients  on  March  14. 

The  worst  patients  were  admitted  only  for  three  or  four  days  while 
thymol  was  being  administered.  Some  few  had  to  be  kept  for  a  short 
time  longer.  Most  patients  were  given  their  medicine  to  take  at  their 
homes. 

During  March  and  April  937  cases  of  anaemia  were  examined  and 
treated.  In  each  case  the  diagnosis  was  corroborated  by  microscop- 
ical examination  of  the  feces.  In  all  but  7  cases  w^as  the  ova  of  the 
Uncinaria  ameHcana  found.  In  these  exceptions  other  adequate 
causes  of  their  anaemia  were  found. 

They  were  given  medicine  and  instructed  to  return  at  the  end  of 
each  w^eek's  treatment  for  a  reexaminaton  and  more  medicine.  Al- 
though we  were  told  that  this  class  of  people  were  so  irresponsible 
that  they  would  not  return,  yet  over  tw^o-thirds  did  return  with  more 
or  less  regularity.  In  about  640  cases  a  record  of  the  original  and 
successive  hemoglobin  readings  was  made  to  precisely  determine  their 
progress  toward  cure.  Up  to  April  30  about  one-third  of  the  cases 
which  were  reexamined  one  or  more  times  had  been  discharged  cured. 
The  vast  majority  of  the  remaining  two-thirds  had  so  greatly  im- 
proved that  it  is  but  a  question  of  time  until  their  cure  will  be  com- 
plete. The  number  of  applicants  finally  became  so  great  that  it  was 
a  phj^sical  impossibility  to  take  hemoglobin  readings  from  all.  Not 
wishing  to  turn  away  any  genuine  case  without  treatment,  we  adopted 
the  plan  of  treating  them  without  blood  examination. 

In  so  far  as  w^e  have  been  able  to  learn,  there  has  been  no  death 
among  the  patients  of  the  commission.  One  patient  died  in  the  hos- 
pital before  treatment  could  be  instituted;  hence  is  not  included 
among  our  patients. 

^Mien  the  conmiission  began  its  work  there  was  openly  expressed 
skej)ticism  among  both  physicians  and  laity.  This,  however,  has  been 
entirely  broken  down  in  the  locality  in  which  we  have  been  working 
and  among  all  who  have  seen  the  remarkable  difference  between  the 
use  of  iron  and  quinine  and  thymol. 

The  work  is  attracting  great  attention,  and  its  immense  importance 
is  beginning  to  be  realized. 

This  report  is  somewhat  delayed,  owing  to  the  fact  that  it  was  due 
about  the  time  the  camp  hospital  w^as  transferred  from  Bayamon  to 
Utuado,  where  we  are  now  established. 

Respectfully,  AV^.  W.  King, 

Passed  Assistant  Surgeon. 

The  Surgeon-General. 


3(38  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Porto  Rico  ANiEMiA  Commission, 

Utuado,  P.  E.,  June  13, 1901 

Sir:  I  have  the  honor  to  make  the  following  rejDort  of  the  work  of 
the  anpemia  commission  during  the  month  of  ^lay,  1904. 

The  operations  of  the  commission  at  Bayamon  were  practically 
closed  April  30,  and  during  the  first  week  in  May  camp  was  broken 
and  the  material  transported  by  rail  to  Arecibo.  Thence  by  ox  cart 
to  Utuado,  where  it  is  now  established.  The  tents  are  the  same  as  at 
Bayamon,  except  that  the  administration  tent  has  been  converted  into 
a  bed  tent.  Fifty-four  patients  can  be  accommodated,  and  the  appli- 
cants far  exceed  the  bed  room. 

The  tents  are  pitched  on  high  rolling  ground,  across  a  small  stream 
from  the  town.  Some  200  3^ards  from  the  tents  is  a  large  house  which 
is  occupied  by  the  commission  for  laboratories,  workrooms,  treatment 
of  out-patients,  kitchen,  etc. 

Treatment  of  patients  was  begun  in  Utuado  on  May  9,  since  which 
time  677  patients  have  been  examined  and  treated.  The  patients  are 
divided  into  three  classes,  which  for  convenience  we  have  designated 
(1)  "study  cases,"  (2)  "clinical  cases,"  (3)  "miscellaneous  cases." 
The  first  class,  30  in  number,  are  those  in  which  special  study  of  the 
blood  is  made  by  weekly  examinations.  They  are  selected  typical 
cases  of  the  disease.  The  records  of  these  cases  when  completed  will 
be  very  valuable  and  interesting. 

The  second  class  (clinical  cases),  G30  in  number,  comprises  the  great 
mass  of  the  patients.  They  present  every  grade  of  anaemia,  from 
the  moribund  to  those  infected  with  nncinaria,  but  yet  presenting 
scarcely  any  symptoms  and  no  anaemia. 

The  diagnosis  in  each  case  is  made  by  microscopic  examination  of 
feces.  An  identification  card  is  issued  to  each  patient  and  thymol  pre- 
scribed. They  return  usually  each  week,  when  their  excrement  is  re- 
examined and  further  treatment  given.  The  examination  of  new 
arrivals  and  reexamination  of  old  cases  involves  an  immense  amount 
of  labor  and  time,  so  that  generally  but  one  slide  of  each  patient  is 
examined.  Realizing  that  if  the  ora  are  very  few  they  may  not  be 
found  in  a  single  slide,  hence  thymol  is  repeated  after  the  first  exami- 
nation showing  no  ora.  After  three  such  examinations  it  is  consid- 
ered that  all  uncinaria  have  been  expelled,  and  the  treatment  is 
reconstructive.  In  markedly  anaemic  patients  reconstructive  treat- 
ment is  begun  from  the  first.  The  third  class  (miscellaneous)  are  a 
few  cases  of  patients  with  parasites  other  than  the  uncinaria  and 
having  no  anaemia  and  other  cases  for  comparison  with  uncinariasis. 

At  the  beginning  of  the  work  at  Utuado,  at  our  request  the  alcalde 
(mayor)  directed  his  representatives  in  the  24  districts  of  the  munici- 
pality to  send  in  the  worst  cases  of  ana?mia  in  his  district.  As  a  result 
we  have  received  many  extreme  cases,  carried  in  hammocks  from  their 
homes  up  in  the  mountains.  One  died  before  arrival  and  two  did  not 
live  long  enough  to  be  treated  after  arrival.  It  will  be  seen  that  our 
first  cases  have  been  profoinidly  an.Tmic  and  their  recovery  slow ;  hence 
it  will  be  understood  that  while  all  but  a  few  have  improved  there 
have  been  scarcely  any  completely  cured  as  yet. 

Besides  infection  with  uncinaria,  we  find  very  frequently  infection 
with  ascaris  lumbricoides,  oxyuris  vermiculosis,  trichocephalus  dispar, 


PUBLIC    HKALTH    AND    MARINE-HOSPITAL    SERVICE.  369 

and  strono;ylns  iiitestinalis.     Also  one  case  each  of  distomum  hepati- 
cum  and  billiarzin  honiatobia. 

Tlic  ai)])r()|)i-iat  ion  of  $.").000  has  beon  about  half  expended,  and  bas- 
in<>:  our  calculations  on  past  expenditures,  we  expect  to  be  able  to  con- 
tinue about  three  months  longer. 

Respectfully,  W._W.  King, 

Passed  Assistant  Surgeon. 
The  Surgeon-General. 


Porto  Rico  An/Emia  Commission, 

TJtuado,  P.  /?.,  July  25,  1904. 

Sir:  I  have  the  honor  to  report  upon  the  progress  of  the  work 
being  done  by  the  ana-mia  connnission  for  the  month  of  June,  1904. 

There  has  been  no  radical  change  in  our  mode  of  procedure  from 
that  outlined  in  my  last  report. 

The  results  of  our  first  cases  here  have  attracted  so  large  a  number 
of  persons  that  it  is  with  difficulty  that  the  commission  copes  with 
the  increased  clinic.  From  200  to  2.50  patients  daily  receive  atten- 
tion, and  of  this  number  about  two-thirds  are  old  cases  returning  for 
further  treatment.  The  number  of  patients  treated  at  Utuado  has 
readied  a  total  of  2,185. 

During  the  month  five  deaths  occurred  among  our  patients.  Three 
were  from  uncinariasis  alone;  all  extreme  cases.  The  other  two 
were  old  men,  one  of  which  died  of  diarrhea  complicating  uncinaria- 
sis; the  other  had  little  anaemia,  death  being  due  to  old  age. 

It  is  impossible  to  state  definitely  the  number  of  cases  cured  to 
date,  because  a  large  number  have  not  yet  returned  for  their  final 
examination  and  discharge.  To  one  in  constant  contact  wnth  tliese 
i:)atients  the  betterment  observed  in  nearh"  all  of  them  is  astonishing. 
Men  who  at  the  beginning  of  treatment  could  scarcely  walk  are 
now  at  work.  Practically  they  are  cured,  but  technically  their  blood 
lacks  a  few  per  cent  of  the  arbitrary  standard  of  ha?moglobin  per- 
centage to  which  we  endeavor  to  raise  it,  85  per  cent  or  more. 

Thus  many  patients,  feeling  themselves  cured,  do  not  think  it  nec- 
essary to  make  a  long  journey  to  tell  us  that  fact,  not  appreciating 
the  statistical  importance  of  a  final  examination  of  the  blood.  Hence 
our  difficulty  in  this  report  of  incomplete  work  to  state  exact  number 
of  cured  patients. 

As  all  cases  admitted  to  the  hospital  are  severe  ones,  and  as,  with 
scarcely  an  exception,  they  are  rapidly  improving,  it  is  but  reasonable 
to  believe  that  the  out-patients,  as  a  rule  lighter  cases,  are  being 
cured  at  an  equal  rate  at  least. 

On  June  11  the  first  patient  was  discharged,  having  above  the 
required  85  per  cent  of  haemoglobin.  Since  that  date  103  cases  have 
been  discharged  in  tliis  manner.  A  great  many  others  will  be  dis- 
charged within  the  next  few  weeks,  as  the  bulk  of  them  have  not  yet 
been  under  treatment  sufficient  time. 

In  those  cases  in  which  a  special  study  of  the  blood  is  made  the 
patients  are  not  discharged  until  the  haemoglobin  reaches  100  per  cent. 

However,  some  patients  can  not  be  held  under  observation  long 
enough,  as  they  feel  perfectly  well,  and  wish  to  go  home  before  the 
haemoglobin  reaches  that  mark.     The  first  cases  of  this  kind  were 
8629—04 24 


370  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

picked  from  among  the  sickest  patients,  in  whom  the  progress  of 
cure  is  slower.  However,  I  anticipate  that  with  my  next  report  I 
will  be  able  to  inclose  a  copy  of  the  clinical  history  and  blood  charts 
of  a  typical  cured  severe  case.  Some  very  interesting  observations 
have  been  made  on  the  avenue  of  infection,  symptoms,  course,  and 
treatment  of  uncinariasis,  \\liile  we  have  not  yet  completed  any 
experimental  proof,  yet  clinical  observations  strongly  suggest  that 
infection  is  through  the  skin.  Practically  all  cases  have  had  an 
eruption  closely  resembling  if  not  identical  with  the  ground  itch 
observed  by  various  writers  on  this  disease.  We  hope  to  be  able  to 
prove  or  disprove  the  theory.  The  time  of  the  commission  is  so 
taken  up  with  the  daily  clinic  hospital  cases  and  blood  counts  that 
we  have  not  had  an  opportunity  to  tabulate  or  reflect  upon  the  im- 
mense mass  of  records  and  material  that  we  jDOSsess. 
Repectfully, 

W.  W.  King, 
Passed  Assistant  Surgeon. 
The  Surgeon-General. 

International  Sanitary  Conference  of  Paris,  1903. 

This  conference  was  invited  by  the  Government  of  the  French 
Republic  at  the  instance  of  the  Government  of  the  Kingdom  of  Italy, 
and  had  for  is  object  the  condensing  into  one  text  the  provisions  of 
existing  conventions,  with  such  modifications  as  the  progress  of 
epidemiolog}',  the  interests  of  the  commerce  of  the  world,  and  the 
requirements  of  the  public  health  might  demand.  The  conference 
was  originally  called  for  the  first  half  of  June,  1903,  but  the  time  being 
considered  too  short  hy  some  of  the  signatory  powers  a  postponement 
was  asked  for,  and  the  conference  was  finally  called  for  October  10, 
1903.  Delegates  from  the  United  States  having  been  asked  for, 
Asst.  Surg.  Gen.  H.  D.  Geddings  was  detailed  on  behalf  of  the  Public 
Health  and  Marine-Hospital  Service;  Col.  William  C.  Gorgas  was 
detailed  on  behalf  of  the  United  States  Army,  and  Medical  Inspector 
Frank  Anderson  on  behalf  of  the  United  States  Navy.  These  dele- 
gates were  duly  accredited  by  the  Department  of  State,  but  not  being 
furnished  with  any  plenary  powers  the  extent  of  their  functions  was 
to  attend  the  conference,  take  part  in  the  discussions  of  the  conference 
and  its  various  commissions,  and  to  finally  sign  the  convention 
adopted  ad  referendum. 

The  conference  was  attended  by  delegates,  both  technical  and  dip- 
lomatic, from  all  the  powers  of  Europe,  from  Egypt,  Persia,  the 
United  States,  and  British  India. 

The  delegates  from  the  United  States  were  hospitably  received 
and  treated  with  most  distinguished  consideration,  being  given  places 
on  all  of  the  three  great  commissions  into  w^hich  the  conference  was 
resolved,  and  in  addition  Doctor  Geddings  was  appointed  as  one  of 
the  subcommission  of  15  technicians. 

The  discussions  of  the  conference  and  the  commissions  were  ani- 
mated and  full  of  interest,  and  many  important  changes  were  made 
in  the  previous  conventions  in  regard  to  plague  and  cholera.  A 
tendency  was  manifested  to  impose  as  few  restrictions  upon  commerce 
as  possible,  many  restrictions  were  removed  from  merchandise,  and 
restrictions  upon  persons  were  in  some  instances  entirely  removed 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE.  371 

and  in  others  modified;  but  the  underlying  principle  seemed  to  be 
accepted  that  the  persons  actually  stricken  with  plague  and  cholera 
were  not  dangerous  per  se,  but  were  to  be  guarded  against  as  prob- 
ably or  possibly  infecting  their  surroundings  and  belongings.  Yel- 
low fever  was  touched  upon,  and  enthusiastic  support  was  given  to 
the  American  doctrine  and  discovery  of  its  mosquito  conveyance,  and 
the  conference  in  regard  to  this  disease  limited  itself  to  a  recommenda- 
tion to  countries  exposed  to  the  disease  to  modify  their  requirements 
to  conform  to  the  modern  discoveries  on  the  subject. 

On  December  8,  1903,  the  texts  of  preceding  conventions  having 
been  edited  and  consolidated,  the  convention  as  prepared  was  sub- 
mitted for  signature. 

Delegates  on  behalf  of  Great  Britain  and  Germany  made  numerous 
reservations,  Great  Britain  in  particular  declining  to  adhere  to  the 
generally  expressed  view  that  the  rat  was  the  principal  agent  in  the 
dissemination  of  plague,  and  in  support  of  this  vieAv  striking  facts 
were  presented  by  Dr.  Theodore  Thomson,  of  the  British  local  gov- 
ernment board. 

Upon  the  return  of  Doctor  Geddings  to  the  United  States  the  con- 
vention and  many  of  the  communications  to  the  conference  were 
translated  in  the  Bureau  and  submitted  in  a  report  to  the  Surgeon- 
General,  by  whom  they  were  referred  to  the  Bureau  sanitary  board 
for  review  and  report.  The  board  excepted  to  a  few  paragraphs  as 
being  contrary  to  the  letter  and  spirit  of  the  quarantine  laws  and 
regulations  of  the  United  States,  and  this  report  was  duly  transmit- 
ted to  the  Secretary  of  the  Treasury.  In  the  meantime  correspond- 
ence was  received  from  the  Department  of  State,  representing  that 
the  Government  of  the  French  Republic  attached  particular  impor- 
tance to  the  adherence  of  the  United  States  to  the  convention,  and 
that  the  Secretary  of  State  desired  to  submit  the  convention  to  the 
Senate  of  the  United  States  for  ratification  by  that  body.  The  Sec- 
retary of  the  Treasury  therefore  transmitted  the  report  of  the  Sur- 
geon-General with  a  letter  to  the  Department  of  State,  and  the  con- 
vention, with  the  exceptions  noted,  was  transmitted  to  the  Senate, 
but  owing  to  the  approach  of  the  adjournment  of  Congress,  the 
convention  failed  of  ratification  at  that  session.  In  the  meantime 
correspondence  has  passed  between  the  French  embassy  in  Washing- 
ton and  the  Department  of  State,  requesting  that  the  United  States 
recede  from  certain  of  its  reservations,  and  at  the  close  of  the  fiscal 
year  the  question  of  these  recessions  is  still  under  consideration.  It 
is  believed  to  be  quite  possible,  however,  to  meet  the  views  of  the 
French  Government  without  sacrificing  any  public  health  considera- 
tions, and  it  is  hoped  that  the  convention  will  receive  the  approval  of 
the  Senate  at  its  next  session. 

It  is  gi'atifying  to  be  able  to  report  that  the  convention  as  adopted 
by  the  conference  presents  few  departures  of  moment  from  the  law, 
the  regulations,  and  the  quarantine  practices  of  the  United  States. 

The  convention,  with  its  accompanying  reports  and  documents, 
Avill  be  published  at  a  future  time  as  a  separate  publication. 

Inspectiox  or  Manufacture  of  Vaccints,  Serums,  etc. 

As  provided  in  the  act  above  named,  regulations  under  the  act  were 
prepared  and  promulgated  on  February  21,  1903,  becoming  effective, 
therefore,  August  21  of  the  same  year. 


372 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


The  inspections  provided  for  by  section  ■>  of  the  act  were  made  by 
the  director  and  assistant  director  of  the  hygienic  laboratory  of  the 
Service,  and  their  reports,  having  been  canvassed  by  the  sanitary 
board  of  the  Service,  were  referred  to  the  Surgeon-General,  by  whom 
recommendations  relative  to  the  issuance  of  licenses  were  made  to  the 
Secretary  of  the  Treasury. 

The  following  establishments  have  been  inspected  and  licensed — 11 
in  the  United  States,  and  2  abroad : 


No.  of 
license. 

Firm  or  person. 

Products. 

1 

Vaccine  virus,  serums,  and  toxins. 

2 

H.  K  Mulford  Co..  Philadelphia,  Pa 

Do. 

3 

4 
5 
6 

7 

8 
9 

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

The  Pennsylvania  Vaccine  Co.,  Conewago,  Pa 

The  Fluid  Vaccine  Co.,  Milwaukee.  Wis 

The  Pocono  Laboratories,  Swiftwater,  Pa 

The  National  Vaccine  Establishment,  Washing- 
ton, D.  C. 

The  Cutter  Analytic  Laboratory,  San  Francisco, 
Cal. 

Frederick  Steams  &  Co.,  Detroit,  Mich        

Vaccine  virtis  and  diphtheria  anti- 
toxin. 
Vaccine  virus. 

Do. 

Do. 

Do. 

Diphtheria   antitoxin  and  vaccine 

virus. 
Diphtheria  antitoxin  and  antisti-ep- 

10 

do ... 

tococcus  serum. 
Vaccine  virus. 

11 

The  Pasteur  Institute,  Paris,  France 

Viruses  (other  than  vaccinia),  se- 

12 
13 

The  Chemische  Fabrik  auf  Actien  (vorm  E.  Scher- 
ing),  Berlin,  Germany. 

The  National  Vaccine  and  Antitoxin  Establish- 
ment, Washington,  D.  C. 

rums,  toxins,  and  analogous  prod- 
ucts. 

Diphtheria  antitoxin  and  antistrep- 
tococcus  serum. 

Diphtheria  antitoxin. 

Samples  of  the  products  of  these  firms  are  purchased  from  time  to 
time  in  open  market  and  examined  in  the  hygienic  laboratory  for 
jDurity  and  potency. 

No  examination  as  yet  made  has  revealed  the  presence  of  any  con- 
taminating organism  or  foreign  toxin  in  any  diphtlieria  antitoxin 
offered  for  sale,  and  there  has  been  a  marked  and  gratifying  improve- 
ment in  the  quality"  of  the  vaccine  virus  sold  in  open  market  as  evi- 
denced by  the  decrease  in  the  number  of  organisms  of  all  kinds  found 
and  the  diminution,  and  in  mam'  cases  total  absence,  of  all  pathogenic 
and  pyogenic  cocci. 

The  procedure  of  inspection  is  as  follows:  A  medical  officer  of  the 
Service,  above  the  grade  of  assistant  surgeon,  is  detailed  by  the  Secre- 
tary of  the  Treasury,  upon  the  recommendation  of  the  Surgeon- 
General,  as  inspector.  This  inspector  visits  the  establishment  to  be 
reported  upon,  nnannoimced,  but  is  required  before  beginning  the 
actual  inspection,  to  visit  the  office  of  the  individual  or  firm  and 
state  the  object  of  his  visit.  He  is  provided  with  blank  forms  upon 
which  are  stated  in  the  shape  of  questions  and  answers  all  points 
which  it  is  desired  to  observe.  There  is  also  abundant  space  left 
under  the  head  of  "  remarks  "  for  any  additional  points  which  it  is 
desired  to  emphasize. 

The  inspector  makes  his  report  on  tliese  forms  to  the  Surgeon- 
General,  and  upon  their  receipt  in  the  Bureau  they  are  referred  to  the 
Bureau  sanitary  board,  by  whom  the}'  are  reviewed,  and  a  report 
with  recommendations  thereon  is  then  made  to  the  Surgeon-General. 
The  report  is  reviewed  by  the  Surgeon-General,  and  if  a  license  is 
recommended  by  the  board,  such  a  recommendation  is  made  by  him 
to  the  Secretary  of  the  Treasury,  by  whom  a  license  is  then  issued, 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  378 

wliic'li  liolds  o<K)(l  foi-  ()iu>  year,  unless  revoked  for  cause,  such  as 
faulty  methods  of  jireparation,  faulty  construction  or  administration 
of  estaMishnient.  or  inipui'ities  or  lack  of  i)otency  of  products  as 
cst;d)lished  liy  laboratory  examination. 

Upon  the  discovery  of  such  faults  or  conditions  the  Surgeon- 
(leneral  may  make  recommendations  to  the  Secretary  that  the  license 
of  the  offending  establishment  be  suspended  if  not  corrected  within 
thirty  days,  or  revoked  if  not  corrected  within  sixty  days.  Should  a 
license  be  suspended  or  revoked  the  fact  is  to  be  announced  in  circular 
signed  by  the  Secretary  of  the  Treasury. 

Hygienic  Laboratory. 
Report  of  Passed  Asst.  Surg.  M.  J.  Rosenau,  Director. 

Sir:  In  accordance  with  the  regnlations  I  have  the  honor  to  sub<- 
mit  the  following  condensed  summary  of  the  activities  of  the  Hy- 
gienic Laboratory  for  the  fiscal  year  ended  June  30,  1904. 

The  scientific  work  was  seriously  interrupted  last  winter  during 
the  moving  of  the  laboratory  from  its  old  quarters  in  the  Butler 
Building. 

The  reorganization  of  the  laboratory''  in  accordance  with  recent 
laws  has  greatly  increased  its  work  and  broadened  its  scope.  Many 
important  ])roblems,  especially  those  affecting  the  public  health,  are 
made  the  subject  of  investigation,  so  that  there  is  scarcely  a  branch 
of  the  sanitary  sciences  that  has  not  engaged  our  attention  during  the 
year. 

NEW  BUILDING. 

The  laboratory  had  long  outgrown  its  quarters  on  the  top  floor  of 
the  Butler  Building,  so  that  the  new  structure  provided  for  by  Con- 
gress "svas  absolutely  necessary  to  accommodate  the  divisions  of  zool- 
ogy, pharmacology,  and  chemistry,  as  well  as  the  division  of  pathol- 
ogy and  bacteriology^. 

The  l)uilding  was  constructed  under  the  direction  of  the  Super- 
vising Architect  at  a  cost  of  $35,000  and  was  equipped  and  furnished 
by  the  Service  at  a  further  cost  of  about  $13,000.  The  keys  were 
turned  over  to  us  July  '2,  1003,  and  the  task  of  equipping  the  building 
and  preparing  it  for  our  work  was  then  diligently  carried  out. 

IMPROVEMENTS    NEEDFJ). 


The  grounds  about  the  laboratory  are  in  a  very  untidy  condition, 
need  grading  and  terracing,  and  should  be  arranged  by  a  landscape 
gardener,  so  that  the  planting  of  trees  and  shrubbery  may  be  done  to 
attain  an  artistic  end  result.  There  is  at  present  no  separate  entrance 
to  our  reservation,  and  the  necessity  for  one  need  not  be  emphasized. 
The  cost  of  these  imf)rovements  is  estimated  at  $10,000. 

NEW    BUILDINGS. 

It  must  not  be  forgotten  that  the  present  building  was  designed  to 
accommodate  only  the  division  of  pathology  and  bacteriology.     Since 


374  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

the  money  was  appropriated  for  this  building  three  other  divisions 
have  been  added,  and  the  laboratory  has  also  greatly  increased  its 
scope  of  usefulness,  so  that  the  present  quarters  are  cramped  and 
insufficient.  I  therefore  have  the  honor  to  recommend  that  the  Con- 
gress be  asked  for  an  appropriation  of  $150,000  to  construct  increased 
facilities  for  the  laboratory  work,  including  a  disinfecting  shed,  ani- 
mal house,  and  power  plant. 

LABORATORY   COURSE   FOR   STUDENT   OBTICERS. 

The  course  for  student  officers  of  the  Service  has  developed  into  a 
complete  course  of  instruction  in  the  sanitary  sciences.  Beginning 
with  a  review  of  histology,  pathology,  and  bacteriology  as  funda- 
mental branches,  the  course  takes  up  the  more  practical  subjects  of 
the  infectious  diseases,  their  causes  and  methods  of  control,  quaran- 
tine, principles  and  practice  of  disinfection,  and  sanitary  problems 
connected  with  pure  water,  ventilation,  and  impurities  in  the  air,  vital 
statistics,  sanitary  laws  and  regulations,  and  similar  problems  affect- 
ing the  public  health. 

During  the  fiscal  year  just  ended  eight  student  officers  were  assigned 
to  the  laboratory  for  instruction,  viz : 

Asst.  Surg.  Clarence  W.  Wille.  In  the  laboratory  at  the  beginning  of  the 
fiscal  year ;  detailed  to  Baltimore,  Md.,  August  4,  1903. 

Asst.  Surg.  Thomas  B.  McClintic.  In  tlie  laboratory  at  the  beginning  of  the 
fiscal  year;  continued  the  course  until  April  4,  1904,  when  he  was  detailed  to 
Tampico,  Mexico. 

Surg.  J.  C.  Perry.  Began  the  laboratory  course  August  17,  1903;  detached 
January  30,  1904,  for  duty  in  Panama. 

Surg.  Duncan  A.  Carmichael.  Began  the  course  August  27,  1903;  detached 
September  28,  1903. 

Asst.  Surg.  Halstead  A.  Stansfield.  Began  the  course  November  17,  1903; 
under  instruction  at  the  close  of  the  fiscal  year. 

Asst.  Surg.  Joseph  Goidberger.  Began  the  laboratory  course  December  17, 
1903;    detailed  to  Tampico,  Mexico,  March  23,  1904. 

Asst.  Surg.  Edward  Francis.  Resumed  the  course,  part  of  which  had  been 
taken  the  year  before;    still  under  instruction  at  the  close  of  the  fiscal  year. 

Passed  Asst.  Surg.  R.  H.  von  Ezdorf.  Began  the  course  December  23,  1903; 
still  under  instruction  June  30,  1904. 

With  each  succeeding  year  the  course  of  instruction  to  student 
officers  is  improved  and  enlarged,  useless  material  is  expunged,  and 
each  subject  made  as  practical  as  possible,  so  as  to  be  of  use  to  the 
officer  in  his  official  duties  in  connection  with  his  quarantine,  hospital, 
and  epidemic  work. 

One  evening  each  week  the  workers  of  the  laboratory  meet  at  the 
home  of  the  director  for  a  review  of  the  current  literature  and  dis- 
cussion of  the  work  in  progress. 

LABORATORY    BULLETINS. 

During  the  fiscal  year  the  following  laboratory   bulletins  were 

issued : 

Bulletin  No.  14.  Spotted  Fever  (Tick  Fever)  of  the  Rocky  Mountains.  A 
new  disease.     By  John  F.  Anderson. 

This  bulletin  by  Passed  Asst.  Surg.  John  F.  Anderson,  the  assistant 
director  of  the  laboratory,  materially  advanced  the  difficult  subject 
of  the  cause  and  methods  of  transmission  of  this  strange  disease. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE.  375 

Doctor  Anderson  confirms  the  j)arasite  found  in  tlie  blood  and  dis- 
covered by  Doctors  Wilson  and  Chowning. 

Bulletin  No.  15.  Ineflicienoy  of  Ferrous  Sulphate  as  an  Antiseptic  and  Germi- 
cide.    By  Allan  J.  McLaughlin. 

In  this  bulletin  Doctor  McLaughlin  has  made  a  careful  study  of 
green  vitriol,  or  "  copperas,"  as  it  is  commonly  called,  showing  by 
laboratory  tests  that  it  has  exceedingly  feeble  germicidal  properties 
and  can  not  be  depended  upon  in  practical  work. 

Bulletin  No.  1(!.  The  Antiseptic  and  Germicidal  Properties  of  Glycerin.  By 
M.  J.  Rosonau. 

This  bulletin  deals  largely  with  the  vaccine  problem,  especially  the 
preparation  of  glycerinated  vaccine  virus.  The  work  conclusively 
shows  that  glycerin  should  be  classed  more  as  a  bland  preservative 
than  as  an  antiseptic  or  germicide.  In  this  bulletin  attention  is 
called  to  the  overconfidence  in  the  germicidal  properties  of  glycerin 
formerly  held  by  some  manufacturers  of  vaccine  virus.  The  correc- 
tion of  this  one  error  in  making  the  virus  has  in  itself  resulted  in  a 
decided  lessening  of  the  impurities  of  vaccine  virus  found  on  the 
market. 

Bulletin  No.  8.  Laboratory  Course  in  Pathology  and  Bacteriology.  (Re- 
vised edition.)     By  M.  J.  Rosenau. 

This  bulletin  contains  a  syllabus  of  the  course  in  pathology  and 
l)acteriology  given  student  officers  in  the  Service. 

There  are  a  number  of  bulletins  in  preparation  for  the  coming  fiscal 
year. 

STANDARD  UNIT  FOR  DIPHTHERIA  ANTITOXIN. 

The  regulations  prepared  in  accordance  with  the  law  approved 
July  1,  1002,  provided  that  the  director  of  the  Hygienic  Laboratory 
shall  examine  antitoxins  for  purity  and  potency.  The  examination 
of  an  antitoxic  serum  for  purity  is  comparatively  simple  and  regu- 
larly carried  out  in  the  laboratory  as  part  of  the  routine.  Examina- 
tions are  made  of  the  products  of  each  establishment  requesting  a 
license.  After  the  license  is  issued  the  products  are  examined  each 
montJi  to  see  that  the  standard  of  excellence  is  maintained. 

So  far  no  tests  have  been  made  of  the  exact  potency  of  these  prod- 
ucts, the  delay  having  been  caused  by  the  fact  that  there  is  no  stand- 
ard unit  recognized  by  the  United  States.  The  director  of  the 
laboratory  has,  therefore,  taken  steps  to  duplicate  the  unit  for  meas- 
uring the  strength  of  diphtheria  antitoxin  establisJied  and  made  by 
Professor  Ehrlich,  and  as  soon  as  this  unit  is  issued  it  will  become  the 
Government  standard,  and  all  manufacturers  making  this  serum  will 
be  required  to  standardize  their  product  in  accordance  with  the 
official  unit. 

]\Iuch  time  of  the  director  during  the  past  few  months  was  taken 
up  with  the  preparation  of  this  standard  unit  for  diphtheria  anti- 
toxin. Large  quantities  of  diphtheria  toxin  were  made  and  stand- 
ardized in  order  to  determine  what  is. known  as  the  "  L+  dose,"  and 
samples  of  Ehrlich's  unit  were  obtained  from  his  laboratory  in 
Frankfort-on-the-Main,  Germany.  A  large  quantity  of  dried  horse 
serum  was  obtained  by  Doctor  Anderson  from  Parke,  Davis  &  Co.,  of 
Detroit,  Mich.,  which  is  now  being  standardized  and  compared  with 
that  of  Ehrlich. 


376  PUBLIC    HEALTH    AND    MAKINK-HOSPITAL    SERVICE. 

This  Avork  is  now  well  under  way,  and  it  is  hoped  by  next  Avinter 
to  have  a  thoroughly  established  unit  of  unvarying  strength  ready 
for  distribution. 

The  director  of  the  laboratory  was  a  member  of  a  subcommittee 
appointed  by  Prof.  Joseph  Remington  to  determine  the  desirability 
of  admitting  diphtheria  antitoxin  into  the  Pharmacopoeia.  This 
committee  made  the  following  report : 

Dear  Sir:  The  special  committee  appointed  by  you  to  consider  the  proposi- 
tion to  introduce  diphtheria  antitoxin  into  the  next  issue  of  the  United  States 
Pharmacopoeia  begs  to  nial^e  the  following  recommendations : 

1.  That  diphtheria  antitoxin  be  introduced  into  the  United  States  Pharma- 
copoeia. 

2.  That  descriptions  of  the  following  physical  characteristics  be  included: 
(a)   Microscopic  appearance  of  fluid  antitoxic  horse  serum. 

(1)  Fresh  normal  antitoxic  horse  serum  to  which  no  antiseptic  has  been 
added. 

(2)  Same  when  kept  under  proper  conditions  (see  below)  for  from  six 
months  to  one  year. 

(3)  Fresh  antitoxic  horse  serum  to  which  an  antiseptic  has  been  added. 

(4)  Same  when  kept  for  period  of  six  months  to  one  year. 

(h)  Specific  gravity:  The  specific  gravity  of  normal  antitoxic  horse  serum 
taken  at  25°  C.  should  be  within  the  following  limts.  1.02.")-!. (140. 

(c)  The  odor  of  normal  antitoxic  horse  serum  is  i)ractically  imperceptible. 
When  an  antiseptic  has  been  used  in  its  preparation  the  odor  'of  the  antiseptic 
may  be  present. 

.3.  That  each  vial  of  diphtheria  antitoxin  should  have  upon  the  label  attached 
to  the  bottle  or  inclosed  in  the  sealed  package  containing  the  bottle  the  follow- 
ing data  : 

(«)  The  name  and  percentage  by  volume  of  any  antiseptic  used  in  the 
pi-eparation  of  the  antitoxin. 

(ft)   The  date  on  which  the  antitoxin  was  tested. 

4.  That  a  statement  be  introduced  to  the  effect  that  diphtheria  antitoxin 
should  be  kept  at  a  temperature  ranging  from  40°  to  G0°  F.,  in  a  dark  place,  and 
that  when  properly  sealed  and  kept  under  these  conditions  it  decreases  in  anti- 
toxin units  very  gradually.  The  decrease  in  one  year  has  been  found  to  vary 
between  10  and  .'>0  per  cent. 

5.  That  the  average  initial  dose  for  the  treatment  of  cases  of  dii)htheria  be 
3,000  units;  for  the  immunization  of  well  persons,  500  units. 

0.  That  the  strength  of  dii)htheria  antitoxin  be  expressed  in  terms  of  the  unit 
established  by  Ehrlich. 

Yours,  very  respectfully, 

Theobold  Smith,   Chairman. 

Thomas  C.  Craig. 

H.  A.  Hare. 

E.  M.  Houghton. 

.1.  J.  KiNYOUN. 

M.  .7.  Rosenau. 
II.  D.  Pease,  Secretary. 
Prof.  Joseph  Remington, 

Chairman  Coiiiiiiittee  of  Rcvi.^ioii  of  Ihc 

PJiarniacoiiaia  of  the  Vvitcd  Statc-'<, 

Philadelphia,  Pa. 

EXAMINATION    OF    VACCINES. 

Vaccine  virus  made  b}'  each  licensed  manufacturer  is  purchased  on 
the  open  market  and  examined  in  the  laboratory  for  impurities  by 
Dr.  John  F.  Anderson,  assistant  director.  This  work  is  done  under 
my  direction,  as  prescribed  by  the  regulations  made  in  accordance 
with  the  law  approved  July  1,  1902. 

Each  month  a  number  of  vaccine  points  or  tubes,  as  the  case  may 
be,  made  by  each  licensed  manufacturer,  are  examined  bacteriolog- 
ically.     Since  the  operation  of  the  law  a  great  improvement  in  the 


PUBLIC    HEALTH    AND    MARINP]-HOSPlTAL    SERVICE.  377 

imj)iiri(ios  fouiul  in  vaccine  vims  has  been  notiHl.  Whereas  we  used 
(()  (ind  thousands  of  contaminatin<ji;  or^janisnis,  some  of  them  patho- 
genic, we  now  rarely  hnd  more  than  a  hini(h-ed  or  two,  and  sehh)m 
virulent  bacteria.  We  feel  sure  that  the  law  has  eil'ected  this  xwy 
beneiicial  result;  but  in  the  efl'orts  to  i)roduce  a  pure  vaccine  it  is 
feared  that  the  manufacturers  have  in  some  instances  not  only  killed 
contaminating  organisms,  but  also  the  vaccine. virus  itself. 

It  is  therefore  evident  that  it  is  equally  as  important  to  examine 
the  vaccine  virus  for  potency  as  for  purity.  With  your  permission, 
arrangements  are  noAV  being  made  with  the  various  cliildreirs  asy- 
lums in  the  District  by  which  cases  may  be  had  for  observing  the 
potency  of  the  vaccines,  in  order  to  carry  out  this  part  of  the  work.  As 
soon  as  these  arrangements  are  completed  and  the  vaccine  virus  is 
examined  each  month  for  both  purity  and  potency,  we  feel  that  the 
laboratory  i)art  of  the  work  will  be  as  complete  as  the  present  state 
of  our  knowledge  allows. 

In  several  instances  faults  were  found  in  the  vaccine,  and  the 
Bureau's  attention  to  this  was  called  and  the  manufacturer  notified, 
and  the  faults  were  promptly  corrected. 

The  knowledge  which  manufacturers  have  of  this  constant  super- 
vision of  their  product  has  a  beneficial  effect. 

The  present  method  of  examining  vaccine  virus  is  as  follows: 

Dry  points. — The  point  is  immersed  in  1  e.  e.  of  physiological  salt  solution  for 
fifteen  minutes  to  soften  the  vaccine  matter.  It  is  then  scrai)ed  off  with  a 
sterilized  platinum  scraper  and  thoroughly  agitated  by  blowing  in  and  out  of  a 
sterilized  pipette  This  enudsion  is  then  put  in  three  Petri  dishes,  as  follows: 
5  drops  in  the  first,  10  droi)s  in  the  second,  and  the  remainder  in  the  third. 
Then  melted  iigar  is  poured  over  them  and  they  are  incubated  at  .37°  C.  for 
three  days,  then  at  room  temperature  for  two  days.  The  numi)er  of  colonies 
is  then  counted.  When  the  number  is  small  per  plate,  the  entire  number  is 
counted.  In  the  case  of  vaccine  in  the  capillary  tubes,  the  contents  of  the 
tubes  are  iilanted  in  1  c.  c.  physiologicaT  salt  solution,  and  then  thoroughly  agi- 
tated to  break  up  the  clumps,  as  in  the  case  of  the  point.  After  the  plates  have 
been  incubated  the  various  colonies  are  examined,  and  in  this  way  we  deter- 
mine the  various  kinds  of  contaminating  organisms.  The  pus  cocci  appear  to 
pi'edominate  in  all  vaccine,  though  many  contain  "  spreader,"  which  often 
causes  trouble  in  counting  the  plates.  Molds  are  frequent;  yeasts  are  some- 
times found;  the  hay  bacillus  is  very  frequently  present;  and  streptothrices 
have  been  found  in  a  great  many  vaccines.  Further  work  with  these  latter  is 
now  being  done  in  the  laI)oratory. 

Tubes. — The  entire  contents  of  10  tubes  and  the  tubes  themselves  are  planted 
in  200  c.  c.  of  freshly  prepared  and  recently  boiled  glucose  bouillon.  Ten  points 
are  also  i)lanted  in  2(!0  c.  c.  of  the  same  media,  then  incul)ated  at  37°  C.  At 
the  end  of  forty-eight  hours  1  c.  c.  of  the  top  growth  i)er  1,0(J0  gm.  of  rabbit  is 
inoculated  into  the  peritoneal  cavity  of  a  rabbit.  If  the  rabbit  dies  or  shows 
signs  of  illnes  from  the  injection,  a  careful  examination  is  made  of  the  body 
to  determine,  if  possible,  the  organism  causing  the  symptoms.  At  the  end  of 
seven  days  the  bouillon  growth  is  filtered  through  porcelain  and  0.2  c.  c.  of  the 
filtrate  is  subcutaneously  injected  into  a  white  mouse.  This  latter  inoculation 
is"  especially  to  determine  the  presence  of  tetanus  toxin,  it  having  been  deter- 
mined by  work  in  the  laboratory  that  this  inoculation  of  the  filtered  toxin  was 
a  very  sure  and  efficient  way  to  determine  the  presence  of  small  numbers  of 
tetanus  bacilli. 

CAR    SANITATION. 

For  many  years  car  sanitation  has  been  a  subject  for  scientific  study 
in  this  laboratory  on  account  of  its  great  interest  to  the  public  health. 

The  director  of  the  laboratory,  in  addresses  which  he  has  delivered 
before  one  or  two  meetings  Avhich  he  Avas  delegated  to  attend  as  a  rep- 
resentative of  the  Service,  has  endeavored  to  impress  upon  railroad 


378 


PUBLIC    HEALTH    AND    MAEINE-HOSPITAL    SERVICE. 


companies  the  desirability  of  improving  the  sanitary  conditions  of 
their  passenger  coaches. 

He  has  advocated  plain,  smooth,  hard  surfaces  that  may  readily  be 
cleaned,  and  shown  the  dangers  of  the  tapestries,  plush,  and  other 
unsanitary  luxuries  with  which  cars  are  sometimes  burdened.  He 
has  called  attention  to  the  open  hopper  of  the  water-closet,  especially 
in  s])reading  typhoid  fever  throughout  the  country,  and  has  indicated 
the  insanitary  arrangement  of  the  washbowls,  as  well  as  the  need  for 
a  sejjarate  sink  for  teeth-cleaning  and  throat-gargling  processes. 

One  of  the  dangers  that  has  agitated  the  public  mind  is  the  menace 
in  occupying  cars  w^ith  cases  of  tuberculosis  or  traveling  in  sleepers 
that  have  been  occupied  by  such  cases.  The  question  as  to  how  much 
danger  there  really  is  of  contracting  tuberculosis  from  dried  sputum 
has  been  raised  by  some  railroads.  Although  considerable  work  has 
})een  done  on  this  line  by  several  workers,  it  was  decided  to  investigate 
the  problem  in  this  laboratory,  and  the  following  experiments  were 
planned : 

A  number  of  sj^ecimens  of  tuberculous  sputum  were  obtained, 
examined  in  stained  preparations  for  tubercle  bacilli,  and  then  inocu- 
lated into  guinea  pigs  in  the  usual  manner.  This  same  sputum  was 
then  placed  upon  carpet,  plush,  and  other  surfaces  and  allowed  to 
dry  at  the  ordinary  temperature.  From  month  to  month  some  of 
this  dried  material  was  inoculated  into  guinea  pigs.  It  is  too  early 
to  speak  of  the  results.  The  work  is  one  which  will  be  continued  over 
several  months  and  promises  useful  and  definite  knowledge  on  the 
subject. 

PATHOLOGIC   SPECIMENS    EXAMINED. 


During  the  year  a  number  of  pathologic  and  bacteriologic  speci- 
mens were  received  in  the  laboratory  for  diagnosis.  Many  of  these 
were  received  from  the  various  hospitals  and  quarantine  stations  of 
the  Service.  Apart  from  their  scientific  interest,  they  were  of  much 
service  in  the  instruction  of  student-officers. 

The  samples  of  water  which  were  received  were  examined  in  most 
instances  both  chemically  and  bacteriologically.  TVlien  the  bacterio- 
logical examination  of  the  water  was  made,  it  was  complete;  the 
number  of  organisms  per  cubic  centimeter  being  accurately  deter- 
mined, and  in  each  instance  a  search  was  made  for  the  colon  baccilus 
and  the  number  of  them  determined.  It  is  of  interest,  in  this  connec- 
tion, to  state  that  in  one  instance  the  Bacillus  typhosus  was  isolated 
in  a  sample  of  water  which  was  received  from  a  badly  infected  source. 

The  numbers  of  various  specimens  are  contained  in  the  following 
table : 


Appendices 1 

Blood  for  Widal  test 76 

Carciiiom;i    4 

Fibi'oma    .5 

Papilloma 3 

Peritoneal  fluid 1 

Plague  1 

Pus  for  tubercle 1 

Pus  for  gonecoccus 4 

Prostate  gland 1 

Round  celled  sarcoma 2 


Alveolar   saiHi-oma 1 

Scrotal  fluid 1 

Spindle  celled  sarcoma 2 

Sputum  6 

Testicle  tuberculous) 3 

Tuberculous   glands 1 

Urine 62 

Urinary   calculi 1 

Water    21 

Yellow  fever 21 


PUBLIC    HEA.LTH    AND    MAKINE-HOHPITAL    8P:RVICE.  379 

Sonic  of  tlio  ofticvrs  of  the  Service  frequently  send  specimens  of 
tumors  and  other  piithoh><2jical  processes  to  tiie  hd)oratory  to  assist 
in  inaiviuii-  diaiiiiosis  and  <>uidin«>-  treatment.  It  is  probably  not  gen- 
erally  known  that  the  laboratory  is  prepared  to  do  this  work.  Each 
specimen  received  is  examined  and  a  report  submitted,  and  a  section 
appropriately  stained  sent  to  the  officer  sending  tlu;  specimen. 

Tumors  and  parts  of  organs  may  be  sent  in  alcohol  or  formalin. 

SUSPECTED   CASES   OF   PLAGUE   AT    QUARANTINE. 

Several  specimens  were  received  during  the  year  from  near-by 
quarantine  stations  of  suspected  cases  of  plague.  These  were  exam- 
ined in  the  division  of  patliology  and  bacteriology,  but  in  no  instance 
was  the  plague  bacillus  isolated. 

EXAMINATION    OF   DRUGS    AND    CHEMICALS. 

The  following  letter  is  self-explanatory : 

Treasury  Department, 
Washington,  April  1,  lOOJi. 
Sir  :  You  are  hereby  directed,  in  so  far  as  the  facilities  at  your  disposal  will 
permit,  to  make  an  examination  as  to  purity  and  potency  of  such  drugs,  phar- 
maceutical preparations,  etc.,  as  may  from  time  to  time  be  forwarded  to  you 
for  tliiit  purpose  from  the  Bureau  or  the  medical  purveyor  of  the  Service.  Re- 
l»orts  of  tiie  findings  in  such  case  should  be  forwarded  to  the  purveyor  through 
the  Bureau. 

Respectfully,  Walter  Wyman, 

Surgeon-Qeneral. 
Director  Hygienic  Laboratory. 

Arrangements  were  entered  into  with  the  medical  purveyor,  who 
sent  us  numerous  samples  of  supplies  on  his  annual  contract.  Many 
of  these  samjiles  were  found  upon  analysis  to  be  satisfactory.  Some 
were  below  the  pharmacopoeial  standard,  and  a  few  showed  fraudu- 
lent substitution  and  adulteration. 

This  work  has  just  been  begun  and  is  destined  to  grow  in  time  to 
large  proportions  and  useful  results. 

EXHIBIT    FOR    THE    ST.    LOUIS    EXPOSITION. 

The  laboratoiy  exhibit  for  the  St.  Louis  Exposition  was  prepared 
in  the  Hygienic  Laboratory.  This  embraced  a  traveling  laboratory 
which  contains  the  full  and  complete  apparatus  for  original  investi- 
gation in  bacteriology.  Four  hundred  and  eighty  tubes,  showing 
growths  of  the  various  organisms,  were  also  prepared.  These  growths 
were  made  on  the  various  kinds  of  media.  After  obtaining  the  maxi- 
mum growth,  they  were  formalinized,  then  sealed  with  paraffin,  and 
were  then  ready  for  exhibition.  A  number  of  Petri  dishes  showing 
colonies  of  the  various  bacteria,  and  also  a  fine  collection  of  Petri 
dishes  showing  the  contaminating  organisms  of  vaccine  virus  were 
prepared. 

DISINFECTANTS    AND    GERMICIDES. 

Many  germicidal  substances  were  examined  to  determine  their  theo- 
retical power  and  practical  value. 


380  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Asst.  Siirg.  II.  A.  Stansfield  did  some  generiil  work  upon  the  power 
of  chlorine  and  its  vapor. 

Doctor  Anderson  has  worked  over  a  year  upon  formalin  and  will 
soon  announce  important  results,  which  will  probably  change  our  esti- 
mate of  the  value  of  this  solution  for  practical  purposes. 

Asst.  Surg.  T.  B.  McClintic  worked  upon  chlorinated  lime  and  zinc 
chlorid.  The  preliminary  report  and  results  accomplished  are  in- 
cluded in  this  report. 

Passed  Asst.  Surg.  E.  H.  von  Ezdorf  carried  on  work  on  the  same 
lines  with  sulphate  of  copper. 

Many  samples  of  proprietary  disinfectants  and  the  coal-tar  creosote 
class  were  examined  in  the  laboratory  for  the  Treasury  Department, 
Revenue-Cutter  Service,  and  the  Immigration  Service,  and  separate 
reports  made  thereon. 

YELLOW  FEVER. 

The  director  of  the  laboratory  spent  the  greater  part  of  last  summer 
and  fall  in  Vera  Cruz.  Mexico,  under  the  auspices  of  the  Yellow 
Fever  Institute,  as  chairman  of  working  party  Xo.  2.  The  work  of 
this  commission  was  largely  confined  to  repeating  the  work  of  work- 
ing party  Xo.  1  in  relation  to  the  Myxococcidinm  stef/omi/'ue  in  the 
mosquito.  A  brief  report  was  submitted  December  18,  190)^,  which 
was  published  in  the  Public  Health  Reports  January  15,  1901. 

A  large  amount  of  material  collected  in  Vera  Cruz  was  brought 
back  to  the  laboratory  for  study. 

The  cause  of  yellow  fever  is  still  an  unsolved  problem,  and  I  have 
the  honor  to  recommend  that  another  working  party  be  sent  out  early 
in  the  spring  of  next  year  for  further  work  on  this  infection,  than 
which  there  is  no  more  important  one  on  account  of  the  great  fear  of 
this  disease,  requiring  stringent  quarantine  regulations  which  seri- 
ously interfere  with  commerce  and  with  the  economical  development 
of  a  large  jDart  of  South  and  Central  America. 

MALARIAL    FEVERS. 

Some  work  ujjon  malarial  fevers  Avas  done  in  the  Hygienic  Labora- 
tory at  Washington  and  attempts  made  to  grow  the  various  species 
of  anopheles  mosquitoes.  Considerable  work  upon  this  subject  was 
also  undertaken  at  Vera  Cruz  by  the  director  and  Doctor  Francis,  the 
results  of  their  observations  being  included  in  the  report  on  experi- 
mental studies  on  yellow  fever. 

Although  the  malarial  fev^ers  are  the  cause  of  more  deaths  and  invali- 
dation than  any  other  tropical  malady,  the  disease  is  not  feared,  prob- 
ably on  account  of  the  value  of  quinine  as  a  remedy  and  on  account 
of  the  large  number  of  mild  cases  with  wdiich  jDcrsons  living  in  sub- 
tropical and  temperate  regions  are  familiar. 

There  are  many  points  concerning  the  particular  species  of  anoph- 
eles in  relation  to  the  various  forms  of  yellow  fever  and  also  in  rela- 
tion to  various  hsematozoa  found  in  man,  in  domestic  and  wild 
animals.  A  locality  is  considered  healthful  or  unhealthful  depend- 
ent upon  the  prevalence  of  malaria,  and  I  believe  from  a  public- 
health  standpoint  this  subject  should  be  given  a  large  share  of  our 
consideration,  particularly  the  methods  of  its  transmission  and  exter- 
mination. 


PUBLIC    HEALTH    AND    MAK1NK-H08PITAL    SERVICE.  381 

DENGUE    PEVER. 

From  time  to  time  epidemics  of  dengue  fever  are  reported  from 
troi)ic!il  and  subtropical  portions  of  the  United  States  and  its  insular 
j)ossessions. 

The  cause  of  this  disease  is  unknown  and  the  methods  of  its  trans- 
ference only  guesswork.  I  therefore  have  to  respectfully  reconnnend 
that  a  scientific  commission  be  detailed  to  study  the  next  outbreak 
that  may  be  reported. 

While  deno^ue  does  not  kill,  it  is  a  very  painful  disease  and  is  a 
serious  cause  of  invalidism,  and  so  far  as  the  diagnosis  is  concerned 
it  is  frcnpiently  confused  with  yellow  fever;  so  that  exact  knowledge 
of  the  disease  would  very  materially  help  our  quarantine  and  public- 
health  Avork. 

HOOKWORM    DISEASE. 

It  is  a  pleasure  to  recall  the  valuable  work  done  by  American 
scientists  in  the  diagnosis  and  treatment  of  this  infection,  which  is 
much  more  j^revalent  in  the  United  States  and  its  possessions  than 
was  suspected  a  few  years  ago.  Research  work  on  this  topic  has  been 
conducted  in  the  Division  of  Zoology  during  the  past  year. 

The  work  of  Ashford  and  King  in  Porto  Rico  is  deserving  of  the 
highest  praise,  and  I  have  to  respectfully  recommend  that  work  along 
similar  lines  might  well  be  carried  out  in  Florida  and  adjoining 
States  where  the  infection  is,  according  to  Stiles,  very  widespread. 

TUBERCULOSIS. 

Miscellaneous  work  was  done  with  the  tubercle  bacillus  of  man  in 
its  relation  to  other  acid-fast  organisms,  and  particularly  the  relation 
between  human  and  bovine  tuberculosis  engaged  the  attention  of  the 
laboratory  during  the  fiscal  year,  although  no  definite  results  were 
achieved.  On  account  of  the  great  importance  of  this  subject,  how- 
ever, this  work  will  be  continued. 

A  study  of  the  health  records  of  our  tropical  possessions  shows  that 
in  most  of  them  more  people  die  of  tuberculosis  than  of  any  other 
disease,  indicating  the  importance  of  improving  the  sanitary  condi- 
tion of  these  places  and  teaching  the  inhabitants  the  methods  of 
spread  and  the  necessary  means  of  avoiding  infection. 

TYPHOID    BACILLUS    FOUND    IN    DRINKING   WATER. 

Passed  Asst.  Surgs.  J.  C.  Perry  and  John  F.  Anderson,  the  assistant 
director  of  the  laboratory,  were  detailed  by  the  Surgeon-General  in 
November  of  last  year  to  investigate  an  outbreak  of  typhoid  fever  in 
Lexington,  Va.,  and  as  their  report  is  of  particular  interest  from  a 
technical  and  practical  standpoint  it  is  inclosed  herewith. 

The  typhoicl  bacillus  has  been  rarely  isolated  from  drinking  water, 
particularly  water  that  is  suspected  of  causing  an  epidemic  of  the 
disease.  Doctors  Perry  and  Anderson  isolated  from  the  drinking 
water  used  by  the  inhabitants  of  Lexington  an  organism  which  gave 
every  reaction,  both  biologically  and  bacteriologically,  to  the  Bacillus 
typhosus. 


382  PUBLIC    HEALTH    AND    MARHSTE-HOSPITAL    SERVICE. 

Washington,  November  14,  190S. 

Sib  :  We  have  the  honor  to  submit  the  following  report  on  the  typhoid  fever 
in  Lexington,  Va.,  and  the  investigation  made  in  compliance  with  Bureau  orders 
of  the  23d  ultimo  I'elative  to  the  prevalence  of  this  fever  and  the  causative 
factors  operative. 

L^pon  arrival  in  Lexington  we  had  a  conference  with  Dr.  A.  D.  Estell,  health 
officer;  Dr.  H.  D.  Campbell,  and  other  members  of  the  board  of  health,  and  all 
the  data  relative  to  the  history  and  occurrence  of  the  cases  were  given  us  for 
our  guidance  in  an  endeavor  to  ascertain  the  cause  of  the  mild  epidemic.  Every 
assistance  was  given  us  in  our  work  by  the  board  of  health  and  members  of  the 
faculty  of  the  colleges  in  Lexington. 

The  history  gleaned  showed  that  moi-e  or  less  typhoid  fever  of  a  mild  type  has 
occurred  in  the  town  for  several  years  and  this  year  has  been  more  prevalent, 
markedly  so  in  October,  until  it  assumed  the  nature  of  a  mild  epidemic.  Most 
of  tlie  cases  this  season  have  been  among  the  students  of  the  colleges  and  the 
children  attending  the  public  school.  This  fact  would  seem  to  indicate  that  a 
far  larger  percentage  of  the  resident  population,  especially  adults,  are  immune, 
from  previous  mild  attacks,  or  that  special  centers  of  infection  are  operative  in 
causing  the  disease  among  the  transient  popidation  and  the  unprotected  younger 
members  of  the  resident  population.  Probably  both  of  these  factors  should  be 
considered  as  operative. 

Lexington  has  a  population  of  4.000,  including  the  600  students  attending 
Washington  and  Lee  University  and  the  Virginia  Military  Institute.  It  is 
situated  on  a  hill  of  moderate  elevation,  with  a  decided  slope  on  either  side  from 
Main  street,  the  center  of  the  town.  It  is  provided  with  a  water  supply 
obtained  from  6  springs,  the  water  being  piped  a  distance  of  2  and  3  miles 
through  -I-inch  and  6-inch  mains  to  a  reservoir  about  three-fourths  of  a  mile 
from  the  town,  from  which  the  water  is  supplied  to  the  houses  in  town. 

The  town  also  has  a  sewerage  system  in  certain  portions.  Three  sewers  have 
been  installed,  and  many  of  the  better  houses  are  provided  with  water-closets 
connected  with  the  sewers.  Hox^ever,  the  latter  provide  for  the  disposal  of 
fecal  matter  of  only  a  small  proportion  of  the  population,  and  the  usual  primi- 
tive class  of  privies  so  common  in  small  towns,  villages,  and  rural  districts  is 
the  almost  universal  method  in  practice,  since  even  those  houses  that  are 
equipped  with  water-closets  are  also  provided  with  common  privies  for  the  use 
of  the  servants.  These  privies  are  located  on  the  slope  of  the  hill  and  the  fecal 
matter  is  simply  deposited  on  the  ground,  without  even  a  pit  or  trench  in  most 
cases  to  receive  it,  to  be  washed  away  by  the  first  rain  that  occurs.  In  many 
places  these  privies  are  situated  near  the  hydrant  from  which  the  water  is 
obtained,  and  if  the  water  pipes  about  the  hydrant  are  in  any  way  defective  it 
is  difficult  to  see  how  the  water  can  escape  contamination.  This  method  of 
disposing  of  fecal  matter  is  crude  and  dangerous.  There  is  no  organized  system 
for  the  removal  and  disposal  of  this  fecal  matter. 

Another  arrangement  noted  was  the  location  of  an  open  6-inch  sewer  pipe  imme- 
diately beneath  the  hydrant  from  which  the  water  was  secured.  This  opens  in  a 
small  .square  compartment  and  is  covered  with  a  coarse  wire  screen.  This 
receptacle  is  for  the  kitchen  slops,  but  no  doubt  chambers  are  emptied  and 
washed  here  and  fecal  matter  is  probably  disposed  of  in  apposition  with  the 
pipes  from  which  the  drinking  water  is  secured.  If  this  sewer  pipe  is  not 
pi'operly  trapited  or  becomes  leaky,  the  danger  to  the  individual  water  supply  is 
apparent.  This  location  of  cesspools  is  insanitary  and  a  source  of  danger  and 
should  be  condemned.  The  same  arrangement  could  be  effected  in  some  other 
part  of  the  yard  removed  from  the  vicinity  of  the  water  hydrant,  and  this 
danger  would  be  remedied. 

Inquiry  relative  to  the  occurrence  of  the  fever  showed  that  69  cases  had 
occurred  since  June  12,  1903,  to  October  23,  1903,  and  that  of  this  number  43 
had  developed  since  September  30.  The  distribution  of  these  later  cases  was 
as  follows :  Six  on  upper  Jefferson  street  occurring  in  adjacent  houses  and 
practically  in  one  short  block,  6  cases  on  Washington  street  within  a  short  dis- 
tance of  each  other,  11  cases  among  the  students  of  the  public  school  on  the 
same  street  (piite  near  the  cases  just  mentioned,  and  9  cases  among  the  students 
of  the  Virginia  Military  Institute.  The  remaining  11  cases  were  widely  dis- 
tributed throughout  the  citj-. 

A  study  of  the  cases  cited  seemed  to  point  to  local  centers  of  infection  in  the 
three  districts  mentioned,  instead  of  a  general  infection  of  the  water  supply ; 
and  the  theory  that  flies  conveyed  the  infection  and  were  the  responsible  fac- 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  383 

tors  did  not  appear  tenable,  because  tbe  rapid  increase  in  the  number  of  cases 
occurred  wlion  these  insects  were  least  numerous. 

An  analysis  of  the  <»  cases  in  upi)er  Jefferson  street  showed  that  3  were 
students  of  the  Washinj^ton  and  Lee  University,  2  were  children  of  the  public 
school,  and  1  a  noj::ro  servant.  The  children  may  be  eliminated  from  this  cen- 
ter, as  they  may  have  contracted  the  infection  while  at  the  ])nblic  school  from 
usinj;  the  water  tlKM'e.  It  was  coTisidered  probable  that  the  cases  on  Washing- 
ton street  contracted  the  disease  from  local  centers  of  infection,  infected  water 
by  contamination  through  leaky  i)ipes  or  defective  hydrants,  and  that  the 
children  of  the  public  school  were  infected  by  the  water  supply  at  the  school 
building. 

Tbe  privies  at  the  school  building  are  only  20  feet  distant  from  the  hydrant 
from  which  the  drinking  water  is  obtained,  and  that  in  use  by  the  boys  is  so 
situated  that  after  a  heavy  rain  the  fecal  matter  is  washed  toward  the  hydrant, 
although  drainage  in  another  direction  has  been  attempted.  In  these  i)rivies 
the  fecal  matter  is  simply  deposited  on  the  ground  and  they  are  of  the  most 
prinutive  type.  That  used  by  the  hosfi  is  the  most  dangerous  from  the  location 
and  sloi)e  of  the  hill,  and  in  this  connection  it  may  be  pertinent  to  state  that 
the  greater  number  of  cases  among  the  school  children  occurred  in  boys. 

The  cause  of  9  cases  in  the  Virginia  Military  Institute  was  considered  in 
connection  with  the  possibility  of  a  local  center  of  infection,  either  through  the 
water  or  milk  supplied  the  institution ;  but  the  fact  that  these  students  had 
been  at  liberty  in  the  town  and  had  probably  contracted  the  infection  elsewhere 
was  borne  in  mind. 

Samples  of  water  were  taken  from  all  these  centers  for  bacteriological  exam- 
ination and  the  results  obtained,  with  deductions,  will  be  given  further  on  in 
this  report. 

One  spring  in  the  city,  known  as  "  Back  Spring,"  from  which  the  city  supply 
of  ice  is  made,  was  considered  especially  suspicious  on  account  of  its  location 
and  the  topography  of  its  surroundings,  and  was  made  the  subject  of  a  prelimi- 
nary report  which  should  be  considered  in  connection  with  this. 

In  this  connection  it  may  be  stated  that  the  Virginia  Military  Institute  secures 
its  supply  of  ice  fx'om  a  pond  about  three  miles  distant  from  the  town ;  but  as 
This  had  been  used  during  the  spring  months,  when  the  college  was  in  session, 
and  no  cases  of  fever  occurred  at  that  time,  it  was  eliminated  as  a  source  of 
danger. 

The  water  supply  of  the  town,  as  already  mentioned,  is  derived  from  6  springs. 
Three  of  these  springs  are  known  as  the  "  Brushy  Hill  Springs,"  designated  1,  2, 
and  3.  The  watershed  from  which  these  springs  derive  their  supply  is  a  nar- 
row valley  three-fourths  mile  long  by  one-half  mile  wide  at  its  lower  part  and 
three-fourths  mile  wide  at  the  upper  end.  This  valley  is  wooded  throughout 
and  no  one  lives  on  this  watershed,  except  a  family  at  the  extreme  upper  end 
of  the  basin.  A  public  road  runs  through  one  portion  of  this  watershed,  but 
as  the  amount  of  travel  is  not  great  and  it  is  located  higher  up  on  the  hills  it 
is  not  considered  dangerous  to  the  water  supply.  The  springs  are  closed  in 
with  stone,  and  concrete  houses  and  the  oi)euings,  or  doors,  are  always  kept 
locked.  However,  in  spring  No.  2  of  this  series  it  is  apparent  that  after  heavy 
rains  surface  water  drains  into  the  springs  and  measures  should  be  taken  to 
improve  the  wall  around  the  spring  in  order  to  obviate  this  danger. 

Below  the  commencement  of  this  watershed,  about  300  yards  from  spring  No. 
1,  two  cases  of  typhoid  fever  have  occurred  recently  in  one  family.  Inquiry 
relative  to  the  source  of  this  water  supply  revealed  the  fact  that  they  secured 
it  from  a  hydrant  inmiediately  adjacent  to  spring  No.  1.  Samples  of  water 
were  taken  from  this  hydrant,  as  well  as  from  the  3  springs,  for  bacteriological 
examination. 

The  other  3  springs,  known  as  "  Connor  Springs,"  are  situated  beyond  the 
watershed  just  mentioned  and  are  entirely  separate  from  it.  Spring  No.  3  of 
this  series  has  a  watershed  of  its  own,  which  is  about  three-fourths  mile  long 
by  one-fourth  mile  wide  in  a  deep  valley.  Connor  Spring  Nos.  2  and  3  have  a 
watershed  about  three-fourths  mile  long  by  one-half  mile  wide.  The  latter  is 
inclosed  by  a  fence  and  about  .50  cattle  are  pastured  on  the  watershed.  Spring 
No.  2  is  not  in  excellent  condition,  as  considerable  surface  water  was  found 
immediately  adjacent,  which  no  doubt  drains  into  the  spring. 

The  springs  should  furnish  a  pure  water  supply  and  the  watersheds  were 
found  in  good  condition,  free  from  habitations,  and  all  that  could  be  desired, 
with  the  possible  exception  of  allowing  cattle  to  graze  on  one  of  the  basins. 
The  water  is  piped  from  these  springs  into  a  reservoir  situated  about  three- 


884 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 


fourths  mile  from  the  city.  There  are  no  people  living  anywhere  near  this 
place.  The  reservoir  is  inclosed  with  a  high  picliet  fence,  the  gates  of  which 
are  kept  constantly  locked,  so  that  in  our  opinion  there  was  little  if  any  danger 
of  infecting  the  water  at  this  site.  Furthermore,  it  was  not  deemed  probable 
that  the  springs  themselves  were  infected,  with  the  possible  exception  of  Spring 
No.  1  of  the  Brushy  Hill  series,  as  the  history  of  the  cases  pointed  more  to  local 
centers  of  infection  than  to  a  general  infection  of  the  water  supply.  Samples 
of  water,  however,  were  taken  from  the  reservoir  and  each  spring,  in  order  to 
make  our  investigations  as  thorough  as  possible. 

BACTERIOLOGICAL   EXAMINATION. 

Nineteen  samples  of  water  were  taken  from  various  places  and  immediately 
placed  upon  ice  and  transported  in  this  condition  to  Washington,  where  the 
examination  was  n>ude  in  the  Hygienic  Laboratory  of  the  Service.  The  samples 
were  planted  within  twenty-four  hours  after  collection.  Counts  were  made  of 
all  samples,  with  the  exception  of  the  last  seven  on  the  table. 


Source  of  water. 

Num- 
ber of 
bacte- 
ria. 

Minimum 
quantity  pro- 
ducing fermen- 
tation at  43°  C. 

o 

CO 

O  SB 

Behavior  on  media  of  those  or- 
ganisms resembling  most  the 
Bacillus  coli  communis. 

"p. 

Glu- 
cose. 

Lac- 
tose. 

5*2 

Glucose 
bouillon. 

Neutral 
red  lac- 
tose 
bouillon. 

Boiiillon. 

1 

Distillitig  tank,  ice  factory 

Back  Spring                .  . 

Per  c.  c. 
1,063 

245 

1,150 
114 

577 

98 
105 
268 

84 
184 

14,293 

295 

c.  c. 

c.  c. 

9, 

LO 

LO 
2.0 
2.0 

2.0 

a5.0 

LO 

1 

1 
2 

+ 

+ 
+ 

Ferment 
.-..do-... 

Positive^, 
--..do.... 

Cloudy and 

scum. 

Do. 

3 

Tank,  ice  factory 

Schoolhouse 

4- 

..  do 

do 

Do. 

,5 

Mrs.  Campbell's,  Jefferson 

street. 
White  house,  Jefferson  street  . 

Tap,  Mrs.  Humphrey's 

Wm.     Washington     house, 

kitchen  tap. 
Waddell  house 

6 

r 

8 

Ferment 

Positive. 

Do. 

9 

in 

Anderson  house,  Jeff  erson 

street. 
Virginia    Military    Institute, 
second  stoop  sink. 

Hotel--- 

Reservoir    - 

"5.0 
"5.0 

b  + 

Ferment 

Positive 

Do. 

11 

^9. 

13 

14 

Conner  Spring  No.  2 

3.0 
.1 

15 

Outside  spring  No.  1 

b+ 

Ferment 

Positive. 

Do. 

16 

Spigot,  Hor ton  Massie 

17 

Spring  No.  1 

.1 

1 

Ferment 

Positive- 

Do 

18 

Conner  Spring  No.  3- 

19 

Spring  No.  2 

3.0 

Ferment 

Positive. 

Do 

Pi 

Source  of  water. 

Behavior  on  media  of  those  organisms  resembling  most  the 
Bacillus  coli  communis. 

Litmus  milk. 

Dun- 
ham's 

Potato. 

Gelatin. 

1 

Distilling  tank,  ice  factory 

?. 

Back  Spring . 

No  lique- 
faction. 

Do 

3 

Tank,  ice  factory- 

tion. 
do 

do 

moist,  abundant 
growth, 
do 

4 

Schoolhouse 

do 

-  .do 

do 

Do. 

5 

Mrs.    Campbell's,    Jefferson 

street. 
White  house,  Jefferson  street - 
Tap,  Mrs.  Humphrey's 

6 

7 

8 
9 

Wm.    Washington    house, 
kitchen  tap. 

Waddell  house 

No  acid;  no  coagu- 
lation. 

Indol 

Whitish  brown, 
moist,  abundant 
growth. 

Do. 

10 

Anderson    house,    Jefferson 
street. 

No  aci 
latioE 

d;  no  c 

jagu- 

tadol 

Whitish 
moist, 
growt 

brown, 
abundant 

Do. 

1  Slight. 

6  Pathogenic  to  guinea  pigs  at  first  inoculation  only. 

''  A  positive  reaction  on  neutral  red  lactose  boiiillon  consists  of  canary -yellow  color  and  fluo- 
rescence in  closed  bulb,  the  open  bulb  remaining  a  wine  color;  gas  formation  in  proportion  of 
1  part  CO2  to  2  of  H,  and  acidity. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


385 


6 
c. 
S 
1 

11 

12 
13 
14 
1.) 

1(( 

Sourco  of  wator. 

Behavior  on  media  of  those  organisms  resembling  most  the 
Bacillus  coli  communis. 

Litmus  milk.        j^^un^ 

Potato. 

Gelatin. 

Virginia   Military  Institute, 

second  stoop  sink. 
Hotel 

No  lique- 
faction. 

Do. 

Reservoir ' 

Conner  Spring  No.  2 ! 

Ontside  spring  No.  1 No  acid;  no  coaga- 

lation. 

Spigot,  Horton  Massie 

Indol. 

Whitish  brown, 
moist,  abundant 
growth. 

i; 

is 

Spring  No.  1 Acid   and    coagula- 
tion. 

Conner  Spring  No  H 

Indol. 

Whiti.sh  brown, 
moist,  abundant 
growth. 

19 

Spring  No.  2 Acid;  no  coagulation. 

Indol. 

Whitish  brown, 
moist,  abundant 
growth. 

Do. 

g                Source  of  water. 

cS 

Staining— Gi-am's. 

Motility. 

Bacillus  coli  com- 
munis. 

1     Distilling  tank,  ice  factory 

Absent. 

2  Back  Spring 

3  Tank,  ice  factory 

4  Schoolhouse 

5  Mrs.    Campbeirs,     Jeflferson 

street. 

6  White  house.  Jefferson  street  . 

Decolorized. 

do. 

do- 

Slight,  but  not  marked 

do. _. 

do 

Present. 
Do. 
Do. 

7     Tap.  Mrs.  Humphrey's 

8  Wm.    Washington    house, 

kitchen  tap. 

9  Waddell  house 

Decolorized 

Slight— brownian 

Not     demon- 
strated. 

10     Anderson     house,     Jeflferson 

street 
li      Virginia    Mihtarv    Institute. 

Decolorized 

Slight — brownian 

Do. 

second  stoop  sink. 
12     Hotel     

13     Reservoir 

14  1  Conner  Spring  No.  2 

15  !  Outside  spring  No.  1 

16  j  Spigot.  Horton  Massie 

Decolorized '. 

Sligh1>— brownian 

Do. 

17  !  Spring  No.  1 

18  Conner  Spring  No.  3 ... 

Decolorized. 

Slight— brownian 

•    Do. 

19     Spring  No.  2 

Decolorized 

Slight — bro'wnian 

Do. 

An  examination  of  the  foregoing  table  shows  that  water  from  Back  Spring, 
water  from  the  storage  tank  in  the  ice  factory,  and  water  from  the  school- 
house  tap  contained  colon  bacillus. 

Plants  were  made  on  as  high  as  8  c.  c.  in  glucose  and  lactose  media ;  but  with 
the  exception  of  the  above  three  places  we  were  unable  to  find  colon  in  any  of 
the  samples  of  water  collected.  This  does  not  necessarily  exclude  the  fact  that 
the  infection  is  in  the  general  water  supply,  but  lends  additional  weight  to  the 
supposition  that  the  schoolhouse  is  a  decided  center  of  infection,  11  cases  hav- 
ing occurred  among  the  children  attending  this  school. 

There  was  isolated  from  the  sample  of  water  taken  from  the  storage  tank  in 
the  ice  factory  an  organism  which  has  given  every  reaction,  both  biologically 
and  culturally,  of  thp  BaciUus  typlion)!^.  This  organism,  however,  was  not 
obtained  from  any  of  the  other  samples.  This  is  not  of  especial  importance, 
as  the  gi'eat  difficulty  of  isolating  the  typhoid  organi.sm  from  water  known  to 
be  infected  has  long  been  recognized. 

From  the  foregoing  the  following  conclusions  may  be  drawn : 

1.  That  the  general  water  supply,  at  its  source  or  reservoir,  is  not  infected. 

2.  That  on  account  of  the  leaks  which  have  been  reported  in  Itoth  the  sewers 
and  water  mains  on  the  same  street  there  is  a  strong  probability  of  infection  of 
the  water  supply  after  it  reaches  the  town. 

8629—04 25 


386  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

?,.  That  the  cases  of  fever  are.  in  our  opinion,  clue  to  loealized  infection  of 
water,  and  that  tlie  conveyance  of  infection  by  Hies  does  not  explain  the  rapid 
increase  and  '.vide  distrilmtion  of  the  cases  in  the  month  of  October. 

4.  Tliat  tlie  i)resent  arrangement  of  cesspools  in  immediate  apposition  with 
hydrants  from  which  drinking  water  is  secured  is  insanitary  and  should  l^e 
remedied. 

5.  That  considering  the  topography  and  the  location  of  Baclj;  Spring  and  tak- 
ing into  consideration  the  results  of  bacteriological  examination  of  the  water 
from  this  spring  and  from  the  tank  in  the  ice  factory  containing  water  from 
this  spring,  the  manufacture  of  ice  therefrom  should  be  considered  dangerous 
and  the  spring  should  be  closed  for  use  for  all  purposes. 

G.  That  the  cadets  of  the  institute  should  be  prohibited  from  using  the  water 
from  the  spring  located  at  the  base  of  the  hill  on  which  the  institute  is  situated : 
that  this  spring  shouhl  be  closed,  the  water  having  been  found  infected  witli 
colon  bacillus,  and  that,  being  under  military  control,  the  drinking  water  fur- 
nished the  cadets  should  be  boiled. 

7.  That  arrangements  in  regard  to  obtaining  water  in  the  lavatories  at  the 
institute  should  lie  remedied. 

8.  That  the  present  arrangement  of  privies  and  disi)osal  of  fecal  matter  is 
crude,  and  is  no  doulit  a  factor  in  perpetuating  the  jtrevalence  of  typhoid  fever 
in  this  town  :  that  measures  should  be  taken  to  devise  a  system  for  the  dis- 
posal of  human  excreta,  and  in  this  connection  it  may  be  suggested  that  the 
pail  system  properly  installed  and  managed  under  municipal  control  would 
be  the  one  best  adapted  to  remedy  the  existing  conditions. 

9.  That  the  great  importance  of  the  proper  and  thorough  disinfection  of  the 
discharges  from  jjersons  suffering  from  tyiihoid  fever  should  be  impressed  upon 
the  physicians  and  families  of  those  affected;  for  this  purpose  we  recommend 
chlorinated  lime. 

Respectfully,  J.  C  I'icrry. 

Passed  Assistant  Surr/eon. 
John  F.   Anderson, 
Passed  Assistant  Surgeon  and  Assistant  Director  Hygienic  Laboratory. 

The  Surgeon-Genebal. 
CHLORIDE  OF  ZINC  AND  "  CHLORIDE  OF  LIME  "  AS  DISINFECTANTS. 

Asst.  Sur^.  T.  B.  ]\IcClintic  made  a  stiirlv  of  the  antiseptic  and 
germicidal  properties  of  chloride  of  zinc  and  chloride  of  lime.  This 
work  is  not  yet  finished.     His  preliminary  report  follows : 

OB.JECT    OF    THE    WORK. 

These  preparations  of  chlorine  have  long  enjoyed  reputations  as  disinfectants 
and  deodorants.  They  were  both  used  long  before  bacteriology  had  become  a 
science  or  had  even  been  suspected  of  taking  the  important  rank  in  the  scien- 
tific field  that  it  to-day  so  rightly  holds. 

The  exiierimental  work  with  either  one  seems  to  be  rather  meager,  especially 
with  chloride  of  zinc,  and  it  was  for  the  purpose  of  determining  the  real  value 
of  each  as  germicidal  agents  under  varying  conditions  that  this  work  was 
undertaken. 

PROPERTIES   OF   CHLORIDE   OF   ZINC. 

Zinc  chloride,  as  found  on  the  market  to-day,  is  a  white,  friable,  translucent 
powder,  odorless,  and  of  such  caustic  properties  as  to  make  tasting  dangerous 
unless  the  salt  is  highly  diluted,  when  It  has  an  astringent,  metallic  taste.  It 
is  very  deliquescent  and  possessed  of  strong  dehydrating  powers,  removing  oxy- 
gen and  hydrogen  from  organic  matter  in  the  form  of  water.  In  this  latter 
particular  and  as  a  deodorant  it  resembles  permanganate  of  potash.  It  is  solu- 
ble in  0.3  part  of  water,  very  soluble  in  alcohol,  and  in  aqueous  solution  ap- 
proximating anything  like  saturation  is  a  viscid,  colorless  fluid  jn-oducing  no 
precipitate.  l)ut  in  somewhat  dilute  solutions  easily  undergoes  partial  hydroly- 
sis, the  precipitate  consisting  of  basic  or  hydroxy-chlorides,  e.  g. — 

ZnCL+H,0=Il(;i  +  Z!  I^j^- 


PU15LIC    HEALTH    AND    M AKIX?>H<>SPITAL    SERVICE.  887 

Though  it  has  long  luul  a  ri'putatiun  as  au  antiseptic  and  disinfectant,  it  has 
been  gradually  realizc^l  to  be  much  overrated  and  its  use  in  that  fleld  to-day 
is  very  liniitttl.  It  is  sonietinies  used  as  one  of  the  ingredients  of  some  of  the 
l>roi>rietary  preparations  found  on  the  market  to-day  and  vaunted  for  their 
disinfectant  powers,  but  its  use  is  principally  that  of  a  deodorant. 

PROPEBTIES    OF    "  CHLORIUE    OF    LIME"   (CIILORI^'ATED    LIME). 

This  is  a  white  powder  foimd  on  the  market  under  the  trade  name  of  bleach- 
ing powder. 

It  is  prepared  by  passing  na.^cent  hydrogen  over  unslaked  lime  and.  according 
to  the  United  States  Pharmacopceia,  should  contain  not  less  than  S^  per  cent 
of  available  chlorine.  It  has  great  affinity  for  water,  and  if  exposed  to  the  air 
the  powder  becomes  moi.st.  graduall\-  liberating  its  chlorine. 

It  is  very  sparingly  soluble  in  water — about  1  ijer  cent — and  even  this,  on 
standing,  throws  down  a  white  precii)itate.  leaving  a  turbid  liquid  above.  The 
.solution  has  an  indefinite  composition,  but  is  generally  supposed  to  contain 
calcium  hypochlorite,  calcium  cldoride  (which  has  a  great  atfinity  for  water), 
and  calcium  hydrate,  which  is  largely  insoluble  and  in  the  dilute  solutions 
forms  the  bulk  of  the  precipitate. 

The  calcium  hypochlorite,  upon  which  the  efBcieucy  of  the  solution  depends, 
is  easily  broken  up.  even  by  the  carbon  dioxide  found  in  the  air  and  water, 
into  hypochlorous  acid,  and  this  acid  is  so  unstable  that  in  the  presence  of  light 
it  is  decompose<l  into  hydrochloric  acid  and  free  chlorine,  both  of  which  are 
active  germicidal  agents." 

Penofs  method  for  determining  the  available  chlorine  was  used  as  follows  :& 

"The  sample  is  well  and  quickly  mixed,  and  7.17  gm.  weighed,  put  into  a 
mortar,  a  little  water  added  and  the  mixture  rubbed  to  a  smooth  cream  ;  more 
water  is  then  stirred  in  v.-ith  the  pestle,  allowed  to  settle  a  little  while, 
then  poured  off  into  a  liter  flask ;  the  sediment  again  rubbed  with  water, 
poured  off.  and  so  on  repeatedly,  until  the  whole  of  the  chloride  has  been 
conveyed  into  the  flask  without  loss,  and  the  mortar  washed  quite  clean.  The 
flask  is  then  filled  to  the  mark  with  water,  well  shaken,  and  .50  cubic  centimeters 
of  the  milky  liquid  taken  out  with  a  pipette,  emptied  into  a  beaker,  and  the 
j^^  arsenious  solution  delivered  in  from  a  burette  until  a  drop  of  the  mixture 
taken  out  with  a  glass  rod  and  brought  in  contact  with  the  prepared  starch 
paper  gives  no  blue  stain. 

The  starch  pai>er  may  be  dispensed  with  by  adding  arsenious  solution  in 
excess,  then  starch,  and  titrating  residually  with  j^  iodine  till  the  blue  color 
appears.  The  number  of  cubic  centimeters  of  arsenic  used  shows  direct  per- 
centage of  available  chlorine." 

The  essential  reaction  consists  in  the  conversion  of  sodium  arsenite  into 
sodium  arseniate,  thus : 

Na3As03+CL+H,0=2HCl-Xa3AsO,. 

lodin  acts  in  the  same  way  and  is  used  to  mark  the  end  of  the  reaction. 

By  this  method  it  was  found  that  chlorinated  lime,  in  aqueous  solution,  left 
exposed  to  the  air  loses  about  1  per  cent  of  available  chlorine  daily.  The 
highest  percentage  found  in  several  specimens  of  '"bleaching  powder  "bought 
on  the  open  market  was  29  per  cent,  and  it  was  with  this  specimen  that  these 
experiments  were  made,  though  it  will  be  noticed  that  this  strength  is  below 
that  required  by  the  United  States  Pharmacopoeia. 

It  was  kept  in  a  sealed  jar  and  made  up  fresh  when  needed.  Some  of  the 
specimens  obtained  on  the  market  contained  a  very  low  percentage  of  chlorine. 
one  as  low  as  2  per  cent,  and  one  that  had  been  on  hand  at  the  laboratory  for 
some  time  about  1.3  per  cent.  These  specimens  were  in  a  more  or  less  pasty 
condition,  holes  having  been  oxidized  in  the  container,  water  absorbed,  and  the 
chlorine  liberated. 

Chlorinated  lime,  unlike  chloride  of  zinc,  has  etiiciently  withstood  the  tests  of 
practical  use  and  scientific  investigaton,  and  to-day  is  one  of  the  most  widely 
used  disinfectants  and  deodorants  we  possess.  Its  insolubility  and  unstability 
are  objectionable  features,  but  its  greatest  fault  is  the  power  that  organic 
matter  has  of  uniting  with  it  to  form  a  comparatively  inert  substance  and 

"  Rosenau  :  Disinfection  and  disinfectants. 
&  Sutton  :  Volumetric  analysis,  p.  186, 


388 


PUBLIC  hp:alth  and  marine-hospital  service. 


probably  prevents  it  from  Iteing  the  most  jiotent  gerjiiicide  we  possess.  This  is 
why  in  the  disinfeetion  of  the  excreta  from  the  sick  it  is  necessary  to  use  al>out 
a  4  per  cent  sohition,  although,  as  will  be  shown  later,  it  will  kill  most  of  the 
pathogenic  organisms  almost  instantly  in  dilutions  as  high  as  1 :  10,000  in  the 
absence  of  organic  matter. 

ANTISEPTIC    TROPERTIES    OF    CHLORIDE    OF    ZINC. 


For  this  purpose  Erlenmeyer  flasks  of  about  100  c.  c.  capacity  were  partially 
filled  with  nutrient  bouillon  and  the  zinc  chloride  added  in  various  definite 
percentages. 

When  prepared  in  this  way  the  chloride  of  zinc  causes  a  white  cloudy  precipi- 
tate to  form  in  the  lower  portion  of  the  bouillion,  leaving  the  upper  portion  a 
straw  color,  as  if  nothing  had  been  added  to  it,  the  amount  of  the  precipitate 
depending  upon  the  amount  of  chloride  of  zinc  added.  The  flasks,  having  been 
prepared  in  this  way.  were  abundantly  inoculated  with  different  materials,  such 
as  garden  earth,  fresh  stable  manure,  particles  of  hay,  etc..  and  placed  at  room 
temperature.  From  day  to  day  up  to  the  end  of  the  fourteenth  day  the  appear- 
ance of  molds,  odors,  and  liacterial  gi'owths  was  noted,  the  latter  by  the  clouding 
of  the  bouillon  and  the  use  of  the  microscope. 

The  following  are  the  results  when  kept  at  room  temperature : 


[  +    means  bacterial  growth  ; 


means  no  bacterial  growth  ;  s. 
b.  m.,  mold  on  the  bottom,  etc.] 


m.   means  surface  mold  ; 


WISPS  OF  HAY. 


Percent- 
age used. 

Day  on  which  growth  appeared. 

Second. 

Third. 

Sixth.     Seventh. 

Tenth. 

e^l:     Twelfth. 

Four- 
teenth. 

1:1000 

1:500 

1:300 

1:200 

1:100 

1:75 

1:50 

1:45 

1:40 

1:35 

s.  m.  — 
s.  m.  — 

a.m.  + 
8.  m.  -h 
8.  m.  — 



i 

1 

"' '                 1 

1                 1 

;8.m.  - 

s.  m.  -f-  1 i -  1 

8.  m.  — 
a.m.  — 

s.  m.  — 

s.  m.  — 

1  aMoid. 

"Mold. 

C") 

■"                '"\ 

1 



1 

1                   1 

"This  was  only  mold  on  head  of  hay  and  was  really  not  in  the  solution, 
ft  No  growth. 

STABLE  MANURE. 


Percent- 
age used. 

Day  on  which  growth  appeared. 

Second. 

Third. 

Fourth,  i    Fifth.      Eighth.  ,  Tenth. 

Elev- 
enth. 

Twelfth. 

Four- 
teenth. 

1:1000 
1:5000 
1:3000 
1:2000 
1:1000 
1:7.500 
1:5000 
1:4,500 
1:4000 
1:3500 

s.  m.  + 

1                 1                 1 

s.  m.  + 

+ 

s.m.  -1- 

1 

s  Tn     —   1  R  Tn,    +   \ 

' -b.m.  — 

b.m.  — 
b.m.  — 
b.m.  — 
b.m.  — 
b.m.  — 

b.m.  — 

b.m.  — 
b.m.  — 
b.  m.  — 

[ 

1 

! 

' 

1 

r 

<"> 

i                     1                     i                     . 

"No  growth. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  389 

GARDEN  EARTH. 


Percent- 
age used. 

Day  on  which  growth  appeared. 

Second. 

Third. 

Fourth. 

Fifth. 

Sixth. 

Seventh. 

Tenth. 

Thir- 
teenth. 

Four- 
teenth. 

1:1000 

I -.sum 

1:3000 
1:2000 
1:1(X)0 
1:7500 
1:5000 
1:4500 
1:4000 
1:3500 

s.m.  + 
s.m.  -f 

+ 

s.m.  + 

s.m.  — 
s.m.  — 

s.m.  -f 



s.m.  — 
b.m.  — 

s.m.  — 
s.m.  — 
b.m.  — 

C) 

b.m.  — 

s.m.  — 
s.m.  — 

1                 1 

a  No  growth. 

These  experiments  were  repeated  and  the  results  verified. 

From  the  above  it  will  be  observed  that  the  minimum  strength  of  chlorid  of 
zinc  that  will  inhibit  the  growth  of  molds  is  about  1  part  in  4o,  varying  slightly 
with  the  character  of  the  material  used  for  contamination  :  while  the  strength 
necessary  to  prevent  bacterial  growth  is  between  one-half  and  1  per  cent. 

In  the  dilutions  as  high  as  1 :500  there  were  no  unpleasant  odors  given  off. 

CHLORINATED   LIME. 

Limited  work  was  done  along  the  same  lines  with  chlorinated  lime  as  with 
chlorid  of  zinc  in  order  to  find  out  how  their  antiseptic  properties  compared. 
Various  strengths  were  prepared  in  imtrient  bouillon  and  inoculated  in  the 
same  manner  as  before — with  garden  earth,  stable  manure,  and  wisps  of  hay. 

The  results  show  that  in  streugths  of  1  per  cent  and  less  its  antiseptic  proper- 
ties are  practically  nil.  due,  no  doubt,  to  the  formation  of  a  comparatively  inert 
substance  when  the  chlorinated  lime  comes  into  contact  with  the  organic  matter 
contained  in  the  nutrient  bouillon. 

GEEMJCIDAL   PROPERTIES. 

For  determining  the  germicidal  value  of  these  two  substances  the  experiments 
in  each  were  similar. 

Various  definite  percentages  of  each  were  prepared  in  distilled  water  and 
about  4.5  cubic  centimeters  placed  in  test  tubes.  These  were  then  inoculated  by 
adding  about  0.5  cubic  centimeter  of  a  thick  emulsion,  in  distilled  water,  of  the 
organism  to  be  used,  carrying  over  as  little  organic  matter  as  possible.  Cultures 
of  the  different  pathogenic  organisms  used  were  grown  on  agar  slants  for 
twenty-four  hours  at  a  temperature  of  37°  C. 

Plants  were  then  made  in  sterile  nutrient  bouillon  at  definite  intervals  by 
means  of  the  wire  loop.  Thej'  were  then  placed  in  the  incubator  at  a  tempera- 
ture of  37°  C,  and  the  results  noted  from  day  to  day. 

The  results  from  the  different  organisms  used  with  chlorid  of  zinc  will  be 
given  first,  and  are  as  follows : 

[  +   means  growth  ;   —   means  no  growth.] 
BACILLUS  COLI  COMMUNE. 


Percent- 
age used. 

Time  of  exposure  in  minutes. 

5. 

7.         8. 

10. 

15. 

20. 

25. 

30. 

40. 

50. 

60. 

5 

10 

15 

25 

-1- 
+ 
+ 
+ 

+         + 
+         + 
+         + 
+ 

-f- 
-1- 
+ 

+ 
+ 

+ 
+ 

+ 

+ 

+ 

+ 

+ 

390 


PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 
BACILLUS  TYPHOSUS. 


Percent^ 
age  used. 

Time  of  exposure  in  minutes. 

1. 

2. 

5. 

10. 

]5. 

20. 

30. 

40. 

50.           60. 

5 

10 

15 

25 

+ 
+ 

+ 
+ 

+ 
+ 

+ 

+ 

+ 

+ 

+ 

+ 

+ 

+ 

+ 

111  + 

+ 

VIBRIO  CHOLERA. 


Percent 
age  used. 

Time  of  exposure  in  minutes. 

1. 

2. 

5. 

7. 

10. 

15. 

20. 

30. 

40. 

50. 

60. 

0.5  ..- 
L0-  — 
3.0-  — 
5.0—. 
10.0---- 

+ 

+ 
+ 
+ 
+ 

+ 
+ 
+ 
+ 

+ 
+ 
+ 
+ 

+ 

+ 

+ 

+ 
+ 
+ 

+ 
+ 

+ 

+ 

+ 

= 

- 

BACILLUS  DYSENTERIC  (SHIGA). 


Percent- 
age used. 

Time  of  exposure  in  minutes.                 1 

1. 

4.         5. 

10. 

20. 

30. 

.50. 

60. 

5 

10 

15 

25 

+ 
+ 
+ 

+ 

+ 
+ 

+ 
+ 

+ 
+ 
+ 

+ 

+ 
+ 

+ 

+ 

+ 
+ 

+ 
+ 

+ 

BACILLUS  DIPHTHERI.^. 


Percent- 
age used. 

Time  of  exposure  in  minutes. 

1. 

3. 

5. 

10. 

20. 

30. 

50. 

60. 

3 

5 

10 

25 

+ 
+ 
+ 
+ 

+ 
+ 
+ 

+ 
+ 

_ 

+ 
+ 

+ 

+ 

+ 

+ 

STAPHYLOCOCCUS  PYOGENES  AUREUS. 


Percent- 
age used. 

Time  of  exposure  in  minutes. 

5. 

10. 

15. 

20.       30. 

40. 

50. 

60. 

5 

10 

15 

25 

+ 
+ 
+ 
+ 

+ 

+ 
+ 
+ 

+ 
+ 
+ 
+ 

+ 
+ 
+ 
+ 

+ 
+ 

+ 

+ 

+ 
+ 

+ 

+ 

+ 

STAPHYLOCOCCUS  EPIDERMIS  ALBUS. 


Percent- 
age used. 

Time  of  exposure  in  minutes. 

1. 

3. 

5. 

10. 

20. 

30. 

40.        50. 

60. 

3 

5 

10 

15 

25 

+ 
+ 
+ 
+ 
+ 

+ 

+ 
+ 
+ 
+ 

+ 
+ 
+ 
+ 

+ 
+ 

+ 
+ 

+ 

+ 
+ 

+ 
+ 

+ 

+ 
+ 

+ 

+ 

Controls  all  grew  within  twenty-four  hours. 


PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 


891 


The  above  rosults  dcMiionstrato  tiio  iiietrKioncy  of  chlorido  of  '/Anc  as  a  sermi- 
eiile.  as  it  will  Ito  observod  that  tbo  i),vt)j;t'ni('  orjjaiiisni  staithijlDCDCcus  pi/oi/nici 
aureus  livos  for  lifty  luiuuti's  in  a  stroni^tb  of  10  {wv  cent  and  colon  bacilli  for 
twenty  minutes  in  tbe  same  stren.utb.  Tbe  Mhrio  chlrnr  is  the  only  one 
destroyed  by  reasonable  strength  in  a  reasonable  time. 

For  its  action  on  spore-bearinj;  orjianisms  exi)eriments  were  made  with  seven- 
day  old  cultiires  of  the  liuciUii-i  suhfilis  and  liaciUu.'<  (iiitliraci.s.  both  of  which 
showed  many  spores.  The  results  show  that  anthrax  spores  are  still  capable 
of  multiplying  after  having  been  in  2.j  per  cent  solution  for  seventy-two  hours 
and  subtilis  spores  after  having  been  in  100  per  cent  solution  for  seventy-two 
hours. 

The  strength  required  for  germicidal  action  and  its  astringent  proi)erties 
practically  eliminate  chloride  of  zinc  from  the  list  of  useful  disinfectants. 

Results  with  chJorhiatcd  lime  under  the  mmc  conditions  were  as  follows;  avail- 
able chlorine,  20  per  cent. 


[  +  means  g;ro\vth 


means  no  growth.] 


BACILLUS  COLI  COMMUNE. 


Percent- 
age used. 

Time  of  exposure  in  minutes. 

1. 

3. 

5.    !    10. 

20. 

80. 

40. 

1:20,000 

1:10,000 

1:.5,000 

1:2,000 

1:1,000 

+ 
-(- 

-1- 

-1- 
+ 
+ 

-1- 

-1-2 

-1-2 

- 

- 

BACILLUS  TYPHOSUS. 


Percent- 
age used. 

Time 

of  exposure  in  minutes 

]. 

3. 

5. 

10. 

20.    1    30. 

40. 

1:20,000 

-t- 

-f- 

-1- 

-f 

_ 

_ 

_ 

1:10.000 

-f 

-1- 

+ 

— 

— 

— 

— 

1:. 5. 0(10 

+ 

— 

— 

— 

— 

1:2.(KK) 

—  . 

— 

— 

— 

— 

— 

— 

1:1. (XXI 

— 

— ■  * 

— 

— 

— 

— 

— 

BACILLUS  DYSENTERIC. 


Percent- 
age used. 

Time  of  exposure  in  minutes. 

1.    1    3. 

5. 

10. 

15.       20. 

30. 

1:20,000 

l:10.ax) 

]:.5,000 

1:2,000 

1:1,000 

+^. 

+'- 

- 

- 

- 

- 

- 

VIBRIO  CHOLERC 


Percent- 
age used. 

Time  of  exposure  in  minutes.           | 

-1- 

3. 

5. 

10. 

15. 

20. 

30.  : 

1 

1:20.000 
1:10.000 
1:5,000 
1:2,000 
1:1,  (XXI 

~ 



- 

- 

- 

- 

392 


PUBLIC   HEALTH    AND   MARINE-HOSPITAL   SERVICE. 
STAPHYLOCOCCUS  PYOGENES  AUREUS. 


Percent- 
age used. 

Time  of  exposure  in  minutes. 

1. 

3. 

5. 

10. 

15. 

20. 

30. 

1:20,000.. 
1:10,000.. 
1:5,0(X)... 
1:2,000... 
1:1,000... 

+ 
+ 
+2 

+ 
+ 

+ 

+2 

+3 

+3 

+3 

- 

STAPHYLOCOCCUS  EPIDERMIS  ALBUS. 


Percent- 
age used. 

Time  of  exposure  in  minutes. 

1. 

3.     1    5. 

10. 

15. 

20. 

30. 

1:20,000.. 
1:10,000.. 
1:5,000... 
1:2,000... 
1:1,000... 

+ 
+ 
+ 

+ 
+ 

+ 

+ 

+5 

- 

- 

- 

+  -  means  grew  at  end  of  two  days. 

+  ''grew  at  end  of  three  days,  etc. 

Six  controls  all  grew  at  the  end  of  twenty-four  hours. 

It  will  be  seen  that  when  used  under  conditions  as  al)0ve  chlorinated  lime  is 
a  most  powerful  germicide,  destroying  l)oth  the  l)acilhis  coli  communis  and  the 
Staphylococcus  pyogenes  aureus  in  a  percentage  of  1  to  10.000  in  ten  minutes. 
The  bacillus  dysenterite  and  Vibrio  cholera^  were  killed  almost  instantly  in  a 
percentage  of  1  to  20.000.  Under  these  conditions  chlorinated  lime  may  be  con- 
sidered almost  without  equal  from  a  germicidal  point  of  view  :  but  organic 
matter  greatly  reduces  its  efficiency  when  brought  in  contact  with  it,  and  for 
this  reason  some  experiments  were  carried  out  in  order  to  determine  the  meas- 
ure of  this  influence. 

For  this  purpose  certain  definite  quantities  of  substances,  such  as  nutrient 
bouillon,  urine,  etc.,  containing  organic  matter,  were  added  to  the  water  used 
in  making  up  the  solutions  of  chlorinated  lime  and  the  effect  on  the  germicidal 
powers  noted. 

A  strength  of  1  to  1,000  chlorinated  limevas  used  and  the  quantity  of  bouillon 
added  varied  inversely  as  the  quantity  of  water  added.  Chlorinated  lime 
being  so  widely  used  in  the  disinfection  of  the  excreta  fi-om  the  sick,  cultures 
of  typhoid  and  colon  were  mixed  and  used  for  conducting  the  experiments. 

The  cultures  were  grown  on  agar  at  a  temperature  of  37°  C.  for  twenty-four 
hours. 

The  solutions  having  been  thus  prepared  and  placed  in  test  tubes,  the  inocu- 
lations with  the  mixed  cultures  were  made  as  usual  and  plants  taken  from  each 
specimen  by  means  of  the  wire  looii  in  nutrient  bouillon  at  certain  definite 
intervals.  The  jdants  were  placed  in  the  incubator  at  37°  C.  and  the  results 
noted  from  day  to  day. 

The  following  are  the  results  with  nutrient  bouillon : 


[+  means  growth;  —  no  growth.] 


Percentage  of — 

Time  exposure  in  minutes. 

Chloride      w„ter 
of  lime.       water. 

Bouillon. 

1. 

3. 

5. 

10. 

15. 

20.       30. 

40. 

50. 

60. 

1 
l:l,aK)... 

50 
75 
90 
95 
98 
99 
100 

50 
25 

10 
5 
2 

1 
0 

-1- 
+ 
+ 
+ 

-1- 

-t- 
-f 
-t- 

: 

-1- 
+ 
-t- 
+ 
-t- 

+ 

-1- 

X 

-f- 
+ 

+ 
+ 

+ 
+ 

+ 

-1- 
-t- 

-t- 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE. 


893 


Percentage  of— 

Time  exposure  in  minutes. 

Chloride 
of  lime. 

Water. 

Bouillon. 

1. 

3. 

5. 

10. 

15. 

20. 

30.       40. 

50. 

60. 

1:1, (MK1... 

50 
T5 
90 
95 
98 
99 
100 

50 
25 
10 
5 
2 
1 
0 

-f- 
+ 
+ 
+ 
+ 
+ 

-f 
-t- 
+ 
+ 
+ 
+ 

+ 
+ 

-f 
-1- 

+ 

-1- 
+ 

+ 
+ 

+ 
+ 

-1- 
+ 

+ 

+ 

+ 
+ 

From  this  it  will  be  seen  that  the  presence  of  organic  matter  markedly 
reduces  the  germicidal  powers  of  chlorinated  lime  and  makes  necessary  much 
greater  percentages  in  the  disinfection  of  excreta,  etc.,  than  would  otherwise  be 
required. 

For  the  sake  of  comparison  various  percentages  of  chlorinated  lime  in  water 
and  bouillon,  respectively,  were  prepared  and  the  germicidal  powers  tested  and 
compared. 

The  ox-ganisms  used  for  inoculation  were  typhoid  and  colon  bacilli  and  the 
results  were  as  follows  : 


[  +   means  growth  ;  —  no  growth.] 


Percent- 
age chlo- 
ride of 
lime. 

Solvent. 

Time  exposure  in  minutes. 

1. 

5. 

10. 

15. 

20. 

30. 

40. 

50. 

1:5,000. 
1:5,000. 
1:1,000. 
1:1,000. 
1:.500... 
1:500... 

Water 

BouiUon 

Water 

BouiUon  

Water 

Bouillon 

+ 
+ 

-t- 
+ 

-t- 

+ 

-1- 
+ 

+ 

-1- 
+ 
+ 

-t- 
-1- 
+ 

-1- 
-1- 
+ 

+ 
+ 
-f 

-1- 
-f- 

-f 

CONCLUSIONS. 


Chloride  of  zinc. — Chloride  of  zinc  has  feeble  powers  as  a  deodorant  and  anti 
septic.  In  strengths  of  0.2  per  cent  or  greater  it  acts  as  a  deodorant,  while  the 
minimum  strength  that  will  inhibit  bacterial  growth  is  between  0.5  and  1  per 
cent.  The  growth  of  molds  is  not  entirely  inhibited  by  a  strength  of  2  per  cent, 
as  it  will  be  noticed  that  in  a  percentage  of  1  to  -10  there  was  a  slight  growth  on 
the  thirteenth  day. 

The  germicidal  powers  of  chloride  of  zinc  are  weak  and  can  not  be  relied 
upon  for  this  purpose,  as  the  Bacillus  coJi  comiinniis  is  not  destroyed  in  a  5 
per  cent  solution  in  one  hour,  and  it  takes  eight  minutes  for  a  25  per  cent  solu- 
tion to  kill  the  same  organism.  The  HtfiiihiiJococcus  pijot/cucs  (uirciis  is  not 
killed  in  twentj'  minutes  in  a  25  per  cent  solution,  but  is  killed  in  thirty  miniites 
In  the  same  percentage. 

Its  action  on  spores  shows  that  the  spores  of  Bacillus  subtilis  are  not  killed 
in  seventy-two  hours  in  100  per  cent  solution. 

The  feeble  germicidal  powers  of  chloride  of  zinc,  as  well  as  its  cost  and  its 
caustic  properties,  practically  eliminate  it  from  the  useful  and  reliable  dis- 
infectants. 

Chlorinated  lime. — This  is  a  most  powerful  germicide  under  certain  circum- 
stances ;  but  unfortunately  the  conditions  under  which  it  is  usually  used  are 
such  as  to  greatly  reduce  its  potency. 

In  aqueous  solution  free  from  organic  matter  it  will  kill  the  Bacillus  coli  com- 
munis in  five  minutes  in  a  strength  of  1  to  5.000  of  distilled  watei*.  The  Ba- 
cillus typhosus  is  killed  in  three  minutes  in  the  same  strength,  while  the  Vibrio 
cholerw  is  Icilled  in  a  percentage  of  1  to  20,000  of  distilled  water  in  less  than 
three  minutes. 

Coming  into  contact  with  organic  matter,  as  it  does  in  the  disinfection  of 
excreta,  its  germicidal  powers  are  greatly  lowered,  so  that  it  is  necessary  to  use 
much  higher  percentages  than  would  otherwise  be  required.     When  added  to 


394  riTBLIO    HEALTH    AND    MAKINE-HOSPITAL    REKVICE. 

nutrient  bouillon  for  the  purpose  of  determining  its  antiseptic  powers,  the  po- 
tency is  so  much  reduced  by  the  organic  matters  present  as  to  reiiuire  about  the 
same  strengths  as  are  necessary  with  chloride  of  zinc. 

By  referring  to  the  experiments  made  above,  in  which  certain  percentages  of 
nutrient  bouillon  were  added  to  the  distilled  water  used  as  a  solvent,  the  marked 
effect  exerted  by  the  organic  matters  will  be  as  a  strength  of  1  to  1,000  in  00 
per  cent  distilled  water,  and  10  per  cent  bouillon  does  not  kill  the  Bacillus 
t]ji)hof<ufi  and  Bacilliifi  coli  commnv.lfi  in  ten  mimites.  whereas  when  no  bou- 
illon is  added  it  kills  the  same  organisms  in  less  than  a  minute.  The  same  is 
ti-ue  when  urine  is  added  instead  of  bouillon,  and  demonstrates  how  markedly 
its  potency  is  lowered  when  used  for  disinfecting  excreta. 

Chlorinated  lime,  as  found  on  the  market  to-day,  is  unstable,  and  if  exposed 
to  the  air  loses  about  1  per  cent  of  chlorine  daily,  so  that  the  percentage  of 
available  chlorine  is  variable  and  unreliable. 

The  division  of  zoology  was  established  August  26,  1902,  by  the 
ajDpointment  of  Ch.  Wardell  Stiles,  Ph.  D.,  as  chief  of  the  division. 
His  report  for  the  fiscal  year  just  ended  follows: 

Report  of  the  Division  of  Zoology  of  the  Hygienic  Laboratory. 

[I>y  Dr.  Ch.  Wardell  Stile.s,  Chief  of  Division.} 

Sir  :  In  accordance  with  paragraph  707,  Service  Regulations,  I  have  the  honor 
to  submit  the  following  second  annual  report  of  the  division  of  zoology  for  the 
fiscal  year  ending  Jiuie  .30,  1904 : 

quarters. 

The  division  continued  in  temporary  quarters  in  the  Georgetown  Medical 
School  until  March,  11)04,  when  we  moved  into  the  new  laboratory  building, 
where  we  are  now  settled  in  permanent  quarters. 

FIELD   WORK. 

Two  field  trips  have  been  undertaken  during  the  fiscal  year,  as  follows : 
During  the  months  of  May  and  June  I  have  visited  the  Bitter  Root  A'alley, 

Montana,  to  investigate  the  so-called  "  spotted  fever  "  of  that  district. 

Mr.  Garrison  spent  the  early  part  of  the  fiscal  year  in  Middletowu,  Conn., 

studying  the  intestinal  parasites  of  the  insane. 

HOOK-WORM    DISEASE   (UNCINARIASIS). 

Breeding  exi^eriments  of  the  hook-worms  (Vnc'nutr'ut  omericaiia  or  Nccator 
americanufi)  were  inaugurated  in  July,  1003,  in  order  to  study  the  embryo  and 
larva  of  this  parasite  and  its  methods  of  infection.  This  work  was  intei-rupted 
because  of  certain  unfavorable  circumstances  and  has  not  yet  been  completed. 

Publications  by  various  authors  and  deternunations  made  in  this  division 
continue  to  show  the  prevalence  of  this  disease,  more  especially  in  certain 
Southern  States,  and  its  economic  importance  is  coming  more  and  more  into 
prominence. 

PARASITES    OF    PENNSYLVANIA    MINERS. 

In  my  first  annual  report  I  referred  to  the  possibility  of  finding  hook-worm 
disease'in  the  coal  miners  of  Pennsylvania.  During  the  present  fiscal  year  one 
such  case  has  been  reported  by  Dr.  J.  M.  Wainwright.  of  Scranton,  Pa.,  the  diag- 
nosis being  confirmed  in  this  division.  We  have  also  determined  one  case  of 
infection  with  the  parasite  of  Cochin  China  diarrhea  {^tynnfiiiloUlcfi  .stereo 
ralin)  from  specimen  forwarded  by  Doctor  Wainwright.  The  same  patient 
showed  infection  with  eelworms  {Ascaris  himbricoides)  and  whipworms  (Tri- 
churis  tiichlura). 

INTESTINAL    PARASITES    OF    THE    INSANE. 

The  division  has  now  completed  an  examination  of  about  R,.'jOO  insane  patients, 
undertaken  in  order  to  determine  the  frequency  of  iTitestinal  parasites.  The 
results  of  this  work  are  now  being  collated  and  will  be  ready  for  publication 
this  coming  winter. 


riTBLir    HEALTH    AND    MARTNE-HOSPTTAL    ftKRVKn^L  895 

DWAUl'    TAPEWORM     {II IDUOloJcitix    11(1  ll(t). 

In  my  first  nnmial  report  roforciico  was  made  ti>  the  presence  of  the  dwarf 
tapeworm  { II nmciiolciiis  ikiiki)  in  this  conntry.  We  1imv<'  now  demonstrated 
that  it  is  mnrli  mui-e  common  in  the  T'nited  States  than  lias  heen  siisi)ected. 
An  extensive  hniletin  on  this  parasite  and  two  Other  members  of  the  same 
group  has  been  prepared  and  is  now  in  i)ress. 

TREMATODE   PARASITES   OF    MAN. 

It  is  worthy  of  note  that  Passed  Asst.  Sur«.  Mark  J.  White,  of  this  Service, 
lias  rejiorted  IS  cases  of  infection  with  the  Asiatic  liver  Huke  (Opi.stliotcliiK 
siiiciisi.s)  anion?;  Cliines(>  in  California,  and  that  Dr.  A.  I).  MacKenzie,  of  Portland, 
Orei^..  has  found  a  case  of  parasitic  hemoptysis,  caused  by  Paraf/oiiimi(.s  ircs-Zc/- 
iiKiiiii.  in  a  .Japanese  in  Portland.  Roth  of  these  diagnoses  have  been  confirmed 
in  this  division. 

Because  of  these  cases,  also  because  of  inquiries  regarding  trematode  diseases, 
and  finally  because  of  the  increasing  importance  of  this  class  of  parasites  to  the 
coiuitry  on  account  of  our  closer  relations  with  the  Asiatic  countries,  I  have 
prepared  a  bulletin  entitled  "  Illustrated  Key  to  the  Trematode  Parasites  of 
Man."     This  bulletin  is  now  in  press  and  will  soon  be  issued. 

INVESTIGATIONS    ON    SO-CALLED   "  SPOTTED   FEVER  "   OF   THE   ROCKY    MOUNTAINS. 

My  studies  on  "  spotted  fever  "  are  not  yet  pi'epared  for  press,  but  I  have  been 
unable  to  confirm  the  piroplasma-tick-spermophile  theory  relative  to  the  etiology, 
transmission,  and  origin  of  this  disease.  INIv  conclusions  were  published  in  the 
Public  Health  Reports  of  August  19,  1004. 

ZOOLOGICAL   COLLECTION. 

The  following  specimens  have  been  added  to  the  collection  during  the  fiscal 
year : 


396 


PLTBLIC    HEALTH    AND   MAEINE-HOSPITAL   SEEVICE. 


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PUHLIC    HKAI/ril     AND    M  AKIN  K  IK  >SIMTAL    SKKVIOK.  3V)7 

DKTAIl,    TO    I'MTKl)    STATICS    lUKKAU    OK    A.NIMAI,    INDISTUY. 

I'litil  M.in-li,  I'.IOI,  I  continued  in  (•li.irtic  ol'  llio  division  of  zoology.  United 
Stales  Hnreau  of  Animal  Industry,  hut  upon  inoviu};  into  the  new  IlyKlenic 
Lal)ora(ory  I  was  relieviMl  ot'  further  suix'fvision  of  the  said  division  and  now 
act  merely  Jis  :i  consultant  in  medieo-zoolof^ieal  matters. 

DKTAII.KI)    TO    MEDICAL    MEETINGS. 

UiMtu  reiiuest  of  the  .Mississipjti  State  Medical  Association,  I  was  detaile<l  to 
attend  tlie  annual  nieetint?  at  Jackson,  Miss.,  to  g'wv  an  address  on  hookworm 
disease. 

Uespect fully.  Cm.  \Vaiu)ei,i,  Stiles. 

Chief  Division  of  Zooloftll. 
The  Director  of  the  IIycjiemc  Lai^oratory. 

The  division  of  p]i;inncK'oI()i::y  was  established  Maivh  1, 1904,  by  the 
appoiiitiiient  of  Keid  Hunt,  Ph.  1).,  M.  D.,  as  chief  of  the  division. 
The  report  of  this  division  is  as  follows: 

Washington,  JuJy  2S,  lOO.). 
Sir:  In  accordance  with  para£;raph  TfiT  of  the  resiulations,  I  have  the  honor 
to  submit  the  following  report  on  tiie  operations  of  the  division  of  pharmacology 
for  the  fiscal  year  ending  June  30,  1904. 

WORK   ABROAD. 

The  laboratory  not  being  ready  for  occupation  until  ^larch,  1904,  I  spent  the 
greater  part  of  the  year  in  Germany,  working  in  the  Royal  Institute  for  Experi- 
mental Therapeutics  at  Frankfort-on-the-Main  with  Professor  von  Ehrlich. 
Several  lines  of  work  were  carried  on  hei'e.  l"wo  of  these  (on  uitriles  and  some 
new  quinine  derivatives)  were  carried  to  completion.^ 

experiments  with  nitriles. 

An  extensive  series  of  experiments  was  made  with  a  large  number  of  nitriles 
and  their  antidotes.  The  poisonous  action  of  these  substances  resembles  the 
intoxication  seen  in  certain  diseases :  in  fact,  several  eminent  physicians  believe 
that  substances  of  this  class  (formed  in  the  body  by  processes  of  abnormal 
metabolism  from  proteids)  are  the  cause  of  some  of  the  symptoms  seen  in  cer- 
tain diseases  of  man.  Hence  it  seemed  probable  that  a  study  of  the  toxicology 
of  these  compounds  and  their  antidotes  would  prove  of  interest.  Efficient  anti- 
dotes to  a  number  of  these  poisons  were  found,  and  many  interesting  relations 
between  chemical  and  physiological  action  were  brought  to  light.  Among  these 
antidotes  are  certain  sulphur  compounds.  It  is  hoped  that  the  fuller  knowledge 
obtained  of  the  action  of  these  sulphur  compounds  will  aid  in  the  discovery  of 
antidotes  to  a  number  of  other  poisons.  Thus  there  is  every  reason  to  believe 
that  sulphur  compounds  may  bo  found  ^^■hich  will  serve  as  antidotes  to  carbolic 
acid,  to  indol  (probably  a  source  of  auto-intoxication  in  man),  to  thymol  (the 
use  of  which  in  the  treatment  of  the  hookworm  disease,  e.  g.,  is  not  entirely 
unaccompanied  by  danger),  etc. 

experiments  with  alcohol. 

Experiments  were  also  carried  on  on  the  relation  of  alcohol  to  the  toxicity  of 
certain  nitriles  and  isoniti'iles.  Toward  some  of  the  foi'iner  alcohol  was  found 
to  have  a  marked  antidotal  action,  wliile  the  toxicity  of  the  latter  was  greatly 
increased  by  it.  By  using  substances  the  exac-t  composition  of  which  is  known 
it  was  possible  to  tind  probable  explanations  of  the  action  of  alcohol,  and  it  is 
hoped  that  these  results  will  lead  to  a  better  understanding  of  the  fundamental 
action  of  alcohol  in  health  and  disease.     It  is  believed  that  these  are  the  first 

1  The  results  of  these  experiments  have  been  published  in  the  "Archives  Inter- 
nationelles  "  de  Pharmacodynamie  et  de  Therapie.  Vol.  XII.  These  papers  were 
read  by  invitation  to  the  Society  for  Experimental  Biologj-  and  ^Medicine  in.  New 
York  ;  abstracts  have  appeared  in  American  Medicine  and  in  Science. 


898  PUHLIC    HKALTH    AND    MAKINE-HOSPITAL    SERVICE. 

experiments  in  wliicli  alcohol  has  heen  conclusively  shown  to  have  an  antidotal 
action  toward  othei*  poisons,  and  the  results  may  aid  in  formulatin)^  more  defi- 
nitely the  conditions  under  which  it  is  desiral)le  to  use  alcohol  in  therapeutics. 
At  present  the  use  of  alcohol  is  almost  entirely  empirical,  and  ther(>  are  wide 
differences  of  opinion  among  physicians  as  to  when  and  how  it  should  I»e  used. 
Experiments  are  now  heing  performed  on  the  relation  of  chronic  alcohol 
poisoning  to  the  action  of  certain  other  ])oisons  and  some  new  and  interesting 
results  have  already  l)een  obtained.  Here  again  the  advantages  of  using  well- 
known  chemical  compounds  instead  of  such  complicated  agents  as  toxins  and 
bacteria  are  evident  when  the  object  is  to  obtain  a  deeper  insight  into  the 
effects  of  chronic  alcoholism. 

EXPEKIMEXTS    WITH    QLIMNE    DERIVATIVES. 

A  series  of  experiments  was  carried  out  with  a  number  of  new  quinine  deriva- 
tives, the  object  being  to  deternune,  if  i)ossible.  thechenucal  groups  in  the  quinine 
molecule  upon  which  the  desirable  as  well  as  the  undesirable  action  of  this  sul)- 
stance  depends.  The  exjieriinents  led  to  the  discovery  of  some  interesting  rela- 
tions Itetween  the  chemical  composition  and  physiological  action  of  (juinine,  and 
also  to  the  fact  that  one  of  the  new  derivatives  (hydrochlorquinine)  has  proji- 
erties  whch  may  prove  of  decided  therapeutic  value.  This  compound  was  found 
to  be  more  toxic  for  certain  infusoria  than  is  quinine  itself,  while  it  is  less 
poisonous  than  the  latter  for  mammals.  Experiments  will  be  made  in  the  near 
future  to  deternune  whether  it  is  more  efficient  in  the  treatment  of  malaria, 
especially  of  certain  severe  forms,  and  perhaps  of  other  diseases  due  to  protozoa, 
than  is  quinine. 

EXAMINATION    OF    DRUGS. 

According  to  instructions,  samjtles  of  drugs  and  other  medical  supplies  used 
in  this  Service  are  sent  to  this  laboratory  by  the  purveyor  to  be  tested  as  to 
their  strength  and  purity.  Over  a  hundred  such  samjtles  have  already  becTi 
examined.  This  work  has  given  some  definite  data  ujton  which  to  judge  of 
the  frequency  with  which  imi)ure  or  adulterated  drugs  are  placed  on  the  market 
by  "responsible  firms."  In  the  agitation  for  "pure  drugs"  reports  of  actual 
examinations  of  this  kind  are  seldom  given.  Of  the  100  drugs  so  far  examin(>d 
about  a  fourth  have  been  found  not  to  conform  to  the  standards  of  the  United 
States  Pharmacopoeia,  and  the  rejection  of  most  of  these  was  recommended.  It 
should  be  noted,  however,  that  in  none  of  the  cases  investigated  were  more  than 
the  merest  traces  of  injurious  impurities  present,  nor  were  the  preparations 
often  found  to  be  far  below  the  required  strength.  In  very  few  cases  (certain 
volatile  oils)  did  there  seem  to  be  evidence  of  intentional  adidteration ;  in  the 
other  cases  there  was  evidently  a  failure  to  properly  piu'ify  the  product  or  the 
latter  was  made  from  impure  substances. 

In  addition  to  the  above,  various  miscellaneous  analyses  (examinations  of 
water,  formaldehyde,  prepared  milk,  etc.)  have  lieen  made. 

It  is  hoped  to  continue  the  work  of  this  Division  on  the  above  lines   (1)  to 
provide  that  the  drugs  used  in  this  Service  are  the  best  at  present  obtainable, 
and  (2)  to  discover,  when  possible,  remedies  superior  to  those  now  known  and 
to  obtain  a  deei)er  insight  into  their  actions  and  into  pathological  processes. 
Respectfully, 

Reid  Hunt, 
Chief  Division  of  Pharmacology. 

The  Director  of  the  Hygienic  Laboratory. 

The  above  report  covers  the  transactions  in  the  laboratory  for  the 
fiscal  year. 

Respectfully, 

M.  J.  ROSEXAU, 

Passed  Assistant  Surgeon,  Director. 
The  Surgeon-General. 


I'UIJLU"    lIEALTil     AND    IVIAKIN  K-llUSl'lTAL    SERVICE.  309 

Investigation  of  Yellow  Fever, 

ahsthact  of  hefort  of  the  french  vellow-fe\  ek  commission  operat- 
ing at  rio  de  janeiro,  i5razil. 

Ill  l!)OI  a  commission  composed  of  Messrs.  Marchoiix,  SalimlxM)!. 
and  Siiiiond,  of  the  Pasteur  Institute,  were  appointed  to  conduct 
invest i<j:,at ions  in  regard  to  the  etiolo<i:y  of  yelJow  fever  and  the  mos- 
(jiiito  {Stegonu/ia  f<isc}tif(()  in  the  transmission  of  the  disease  at  Eio 
(ie  Janeiro.  This  commission  rendered  a  report  which  was  j)ublished 
in  the  annals  of  the  Pasteur  Institute  in  Xovembei-,  1903.  The  report 
has  been  transhited  in  the  Bureau  of  the  Public  Health  and  Marine- 
Hospital  Service,  and  from  this  translation  the  following  abstract  of 
salient  features  has  been  made : 

The  connnission  concludes  that  the  infecting  principle  in  the  blood 
of  yellow-fever  i)atients  remains  actiA'e  for  five  days  when  kept  in 
defibrinated  blood  under  liquid  A^aseline,  but  that  at  the  end  of  eight 
davs  tho  infectivity  of  the  blood  has  disappeared.  They  deduce  as  <a 
result  of  their  experiments  that  the  blood  contains  this  infecting 
agent  during  only  the  first  three  days  of  the  disease. 

They  deduce  further  from  their  experiments  that  the  blood  serum 
of  a  yellow-fever  convalescent  possesses  clearly  preventive  proper- 
ties. They  further  deduce  as  the  result  of  experiments  upon  11  indi- 
viduals made  in  hospital  that  the  blood  serum  of  a  yellow-fever  con- 
valescent possesses  therapeutic  properties  of  considerable  curative 
value. 

In  regard  to  the  mosquito  Stegomyla  fasciata^  their  Avork  is  particu- 
larly valuable.  They  point  out  that  the  habits  of  the  Stegomyia 
fuse  tat  a  differ  very  much  from  those  of  most  other  mosquitoes.  One 
of  the  marked  peculiarities  of  the  species  is  its  extreme  susceptibility 
to  differences  of  temperature.  It  manifests  its  greatest  activity  when 
the  thermometer  stands  at  25°  C.  Beyond  39°  C.  the  insect  dies.  At 
15°  C.  to  16°  C  the  insect  becomes  inert  and  ceases  to  bite.  At  12°  to 
11°  it  is  benumbed  and  flies  with  great  difficulty.  All  of  the  acts  of 
its  life  are  much  influenced  by  the  temperature  of  the  surrounding 
atmos2:)here. 

The  female  Stegomyia  alone  bites.  The  female  is  perfectly  capable 
of  biting  immediately  after  metamorphosis.  Within  twenty-four 
hours  she  bites  readily.  Within  forty-eight  hours  of  metamorphosis 
and  at  temperatures  between  26°  and  35°  C.  she  will  bite  readily  at 
any  hour  of  the  day  if  recently  fecundated,  but  especially  beginning 
at  about  11  o'clock  in  the  morning.  If  the  temperature  is  between 
19°  and  25°  C.  she  bites  less  readily.  At  temperatures  between  14° 
and  18°  C.  she  does  not  seek  to  bite  at  all  unless  artificial^  warmed  by 
contact  with  the  skin  of  the  victim.  She  bites  less  readily  between  22° 
and  25°  C,  but  a  temperature  of  27°  to  30°  C.  is  that  which  suits  the 
insect  best. 


After  having  filled  herself  with  blood  the  female  seeks  water  upon 
which  to  la}^  her  eggs.  Laying  is  generally  effected  during  the  night. 
The  average  number  of  eggs  is  from  TO  to  80.  Temperature  has  an 
influence  upon  this  act,  it  taking,  place  most  readily  at  a  temperature 


400  I'LUiLlC    HEALTH     AND    MARINE-HOSPITAL    SERVICE. 

of  27°  to  28°  C.  during  the  night,  under  which  conditions  of  tempera- 
ture laying  takes  phice  Avithin  forty-eight  hours  after  biting.  If  the 
night  temperature  is  from  25°  to  27°  C.  the  hiving  takes  phice  on  the 
fourth  or  fifth  daj^  If  between  20°  and  25°  C.  it  is  possible  up  to 
the  seventh  or  eighth  day,  and  if  below  20°  C.  it  may  be  delayed  up 
to  twenty-six  or  twenty-seven  days. 

HATCHIiVG. 

Hatching  is  best  accomplished  at  a  temperature  of  28°  C,  at  which 
temperature  the  eggs  hatch  on  the  second  or  third  day.  If  the  tem- 
perature is  as  low  as  25°  C.  it  takes  place  on  the  fourth  day.  If 
between  20°  to  25°  C.  hatching  take  place  on  the  fifth  to  seventh  day, 
but  does  not  proceed  Avith  regularity.  The  eggs  do  not  seem  to  hatch 
at  a  temperature  below  20°  C,  though  they  may  be  preserved  at  much 
lower  temperatures,  even  as  low  as  zero,  but  if  brought  back  to  favor- 
able conditions  of  temperature,  hatching  proceeds  with  considerable 
regularity.  The  eggs  may  be  immersed  in  water  and  a  considerable 
proportion  of  them  still  hatch.  If  dried  before  immersion,  their 
preservation  is  still  better  assured. 


The  Stegomyia  is  a  domestic  mosquito,  preferring  for  laying  her 
eggs  deposits  of  water  such  as  are  found  in  the  interior  and  in  the 
immediate  neighborhood  of  houses.  They  seem  to  thrive  better  in 
rain  than  in  spring  water. 

PUPAL    STAGE. 

With  temperatures  ranging  from  26°  to  27°  C.  by  night  and  28°  to 
31°  C.  by  day  the  larvse  of  the  StegGmyia  arrive  at  the  pupal  stage 
seven  days  after  hatching,  and  at  the  perfect  insect  stage  on  the  ninth 
day.  In  a  majority  of  instances,  however,  this  latter  stage  does  not 
occur  until  the  tenth  day.  At  temperatures  beloAv  22°  C.  larva?  may 
take  forty  to  sixty  days  to  be  transformed  into  pupfe,  and  these  pupre 
three  to  five  days  to  become  perfect  insects.  The  ordinary  length  of 
the  pupal  stage  is  thirty  to  fifty  hours.  Larvse  do  not  perish  at  a  tem- 
perature in  the  neighborhood  of  zero,  but  under  these  conditions  they 
grow  very  slowly.  Sea  water  is  fatal  to  the  larvse  of  the  Stegomyia^ 
but  in  a  mixture  containing  one-fifth  sea  water  and  four-fifths  fresh 
water  they  develop,  attaining  the  pupal  stage  on  the  eleventh  day 
and  the  perfect  insect  stage  on  the  thirteenth  day.  In  brackish 
water,  containing  one-third  sea  water,  they  die  in  a  few  hours. 
Water  containing  one  one-thousandth  of  its  weight  of  soap  kills  the 
larva?  in  five  minutes.  In  solutions  containing  one  ten-thousandths 
they  do  not  develoj:).  In  solutions  containing  one  two-hundred- 
thousandths  thej^  developed  normally. 

ADULT    CONDITIONS. 

Blood  seems  to  be  necessary  to  enable  the  female  Stegomyia  to 
lay.  Human  blood  appears  to  be  particularly  grateful  to  her.  In 
the  early  days  of  her  existence  she  bites  at  any  time.  The  female 
Stegomyia  prefers  to  bite  by  night  rather  than  b}^  day.  She  may, 
therefore,  be  considered  as  a  night  mosquito. 


rUKLlC    HEALTH    AND    MARINK-HOaPlTAL    SEKVICE.  401 


I-ONOEVITY    Ol'     STKGOMYIA. 


While  the  Strr/omyia  is  very  easily  reared  under  proper  conditions 
of  (enipeiature  and  moisture,  it  dies  rapidly  when  placed  in  dry  air 
and  without  blood  as  food.  In  captivity  they  attain  the  age  of  2 
months  with  comparative  ease,  hut  beijiiinino:  from  the  fortieth  day 
mortality  amonii'  them  becomes  large,  being  greater  among  the  males 
than  among  females.  In  the  laboratorv  females  have  attained  the 
age  of  89,  {)(),  98,  97,  105,  and  lOG  days.'  It  did  not  seem  possible  to 
preserve  males  more  than  fifty  days  In  the  free  state  the  insect  can 
not  live  so  long,  much  of  its  vigor  being  lost  within  a  short  time 
after  its  evolution  and  its  resistance  is  much  diminished  by  danger 
and  destructon  of  its  scales.  High  temperatures  from  3G°  to  39°  are 
unfavorable  to  the  life  of  a  mosquito. 

RACIAL    PREFERENCES    OF    THE    STEGOMYIA. 

The  Stecjomyia  will  bite  individuals  of  any  race,  but  manifests 
in  Brazil  a  preference  for  the  white  over  the  Indian,  and  the  Indian 
over  the  negro.  She  manifests  considerable  repugnance  to  the  negro, 
and  bites  only  after  quite  prolonged  contact.  Among  the  Avhite 
races  she  attacks  by  preference  individuals  with  a  thin  skin  and  a 
fresh  color. 

CLIMATIC    CONDITIONS    FAVORABLE    TO    THE    STEGOMYIA. 

Every  warm  and  moist  climate  Avhose  temperature  at  certain  sea- 
sons varies  between  25°  and  30°  C.  is  peculiarly  suited  to  it. 
Between  22°  and  25°  C.  it  multiplies,  but  more  feebly.  Average 
night  temperatures  below  22°  C.  are  accompanied  by  a  rapid  disap- 
pearance of  the  species.  The  Stegomyia  resists  sudden  changes  of 
temperature  badly. 

INFLtiENCE    OF    ALTITUDE. 

In  the  vicinity  of  Rio  de  Janeiro  the  Stegomyia  is  seldom  encoun- 
tered at  an  altitude  of  more  than  100  meters.  At  Petropolis,  at  an 
altitude  of  800  meters,  it  is  not  found  naturally  and  perishes  when 
introduced.  It  appears,  however,  that  this  is  not  due  to  the  altitude 
itself,  but  to  the  lowered  nightly  average  of  temperature. 

RELATION    OF   OTHER    MOSQUITOES    TO    Y^ELLOW    FEVER. 

The  commission  concludes  that  no  other  mosquito  found  at  Rio 
Janeiro,  or  in  the  vicinity,  has  any  relation  to  the  transmission  of 
yellow  fever.  The  commission  draws  the  following  deductions  in 
regard  to  the  transmission  of  yelloAv  fever  as  a  result  of  their  obser- 
vations: First,  that  yellow  fever  is  not  transmitted  in  nature  either 
by  direct  contact  with  the  patient  or  by  contact  with  personal  effects, 
or  by  his  excretions.  Second,  that  the  transmission  is  effected  by  the 
biting  of  mosquitoes,  and  that  the  only  dangerous  species,  at  least 
in  the  region  in  which  our  researches  haA^e  been  conducted,  is  the 
Ster/omyia  fasciata.  Third,  that  this  transmission  never  takes  place 
during  the  day  while  the  sun  is  above  the  horizon. 

8629—04 26 


402  PUBLIC    HEALTH    AND    MARIXE-HOSPITAL    SERVICE. 

In  regard  to  protection  against  the  infection  of  yellow  fever,  the 
commission  deduces  that  '•  The  introduction  of  merchandise  is  unat- 
tended witJi  danger  at  any  time.*" 

In  regard  to  arrivals  from  a  territory  infected  with  yellow  fever 
at  a  i^ort  or  place  where  the  disease  does  not  prevail,  the  commission 
deduces  that  ''  it  is  perfectly  useless  to  inflict  a  quarantine  if  Ste- 
gomym  do  not  exist  in  the  country  at  the  time  of  arrival,  since  trans- 
mission can  onh^  be  effected  by  this  intermediary." 

MEASURES    LOOKING   TO   THE    DESTUCTION    OF    STEGOMYI.i:. 

The  observations  of  the  commission  present  no  points  of  particular 
interest  for  us  in  the  United  States.  It  is  gratifying  to  find,  how- 
ever, that  they  have  arrived  at  practically  the  same  conclusions  as 
have  been  arrived  at  as  the  result  of  experiment  and  observations  in 
tJie  United  States. 

The  general  conclusions  of  the  commission  may  be  summed  up  as 
follows : 

1.  The  serum  of  a  patient  on  the  third  day  of  the  disease  is  viru- 
lent. 

2.  On  the  fourth  day  of  the  disease  yellow-fever  Ijlood  no  longer 
contains  any  virus,  even  when  the  fever  is  high. 

3.  One-tenth  of  a  cubic  centimeter  of  virulent  serum  injected 
under  the  skin  is  sufficient  to  cause  yellow  fever. 

4.  The  virus  of  yellow  fever  rul^becl  upon  a  blister  on  the  skin, 
made  by  removing  the  epidermis,  does  not  give  the  disease. 

5.  In  the  serum  of  the  patient  the  virus' of  yellow  fever  passes 
through  a  filter — Chamberland  '"  F  " — without  dilution. 

C.  Under  the  same  conditions  it  does  not  aj^pear  to  pass  through 
Filter  B. 

T.  Virulent  serum  preserved  exposed  to  the  air  at  a  temperature  of 
24°  to  30°  is  inactive  at  the  end  of  forty-eight  hours. 

8.  In  defibrinated  blood,  preserved  under  liquid  vaseline  at  a  tem- 
perature of  24°  to  30°.  the  microbe  of  yellow  fever  remains  living  for 
five  days. 

9.  At  the  end  of  eight  days  defibrinated  blood  kept  under  the  same 
conditions  no  longer  contains  active  virus. 

10.  The  A'irulent  serum  becomes  harmless  after  heating  for  five 
minutes  at  55°. 

11.  A  preventive  injection  of  serum  heated  for  five  minutes  at  55° 
confers  a  relative  immunity  which,  followed  by  inoculation  with  a 
\&l'\  small  quantity  of  virus,  may  become  complete. 

12.  The  injection  of  defibrinated  blood  kept  in  the  laboratory  under 
liquid  vaseline  for  eight  days  at  least  confers  a  relative  immunity. 

13.  The  serum  of  a  convalescent  is  endowed  with  clearly  preventive 
properties. 

14.  The  immunity  conferred  by  the  serum  of  the  convalescent  is 
still  in  evidence  at  the  end  of  twenty-six  days. 

15.  The  serum  of  a  convalescent  appears  to  have  therapeutic  prop- 
erties. 

16.  As  has  V)een  proved  by  Reed,  Carroll,  and  Agramonte,  yellow 
fever  is  produced  by  the  bite  of  the  Stegomyia  fasckita. 

17.  To  be  able  to  produce  the  disease  in  man,  this  mosquito  must  be 
previoush^  infected  by  alisorbing  the  blood  of  a  patient  stricken  with 
yellow  fever  during  the  first  three  days  of  the  disease. 


ITHLIC    HEALTH    AND    MAKINE-HoSPITAL    SERVICE.  403 

18.  The  infected  mosquito  is  only  danoferons  after  an  interval  of 
twelve  days  from  the  time  when  it  has  in<rested  virulent  blood. 

11).  The  i)ite  of  two  infected  mos(]uitoes  may  cause  a  serious  illness. 

20.  The  mosquito  appears  to  be  more  dansferous  in  proportion  that 
her  l)ite  is  delayed  after  the  time  when  it  has  become  ijifected. 

'21.  The  bite  of  infected  mosquitoes  does  not  invariably  give  yellow 
fever. 

22.  When  the  bite  of  infected  mosquitoes  has  been  without  effect, 
there  is  no  immunity  conferred  acrainst  the  injection  of  virulent 
serum. 

23.  In  the  neighborhood  of  Rio  de  Janeiro,  as  in  Cuba,  no  other 
mosquito  than  the  Stegomyia  fasciata  is  concerned  in  the  transmission 
of  yellow  fever. 

24.  Contact  with  a  patient,  his  personal  effects,  or  his  excretions  is 
incapable  of  producing  yellow  fever. 

25.  Outside  of  the  bite  of  the  infected  Stegomyia.,  the  only  means 
known  of  producing  the  disease  is  the  injection  into  the  tissues  of  a 
susceptil^le  individual  of  blood  from  a  patient  collected  in  the  first 
three  days  of  the  disease. 

2().  Yellow  fever  can  only  assume  a  contagious  character  in  regions 
where  the  Stef/omijia  fasciata  prevail. 

27.  The  i^rophylaxis  of  yellow  fever  rests  entirely  u])on  measures 
taken  to  prevent  the  Stegomyia  fasciata  from  biting  the  individual 
sick  and  then  a  healthy  individual. 

28.  It  must  be  borne  in  mind  that  the  period  of  incul)ation  of 
yellow  fever  may  be  prolonged  up  to  thirteen  days. 

20.  The  Stegomyia  fasciata  is  frequently  infected  by  molds,  yeasts, 
and  by  sporozoa.  Xo  parasite  of  this  species  recognized  up  to  tins 
time  has  any  causal  relation  to  yellow  fever. 

30.  Xeither  in  the  mosquito  nor  in  the  blood  have  we  succeeded  up 
to  this  time  in  discovering  the  causal  agent  of  yellow  fever. 

Sanitation  of  Railavay  Coachks  and  Pullman  Cars. 

disposal  and  handling  ov  soiled  linen  un  sleep1n(;  cars. 

]\lr.  ;M.  ]\Iain.  district  agent  for  the  Pullman  Palace  Car  Company, 
having  submitted,  under  date  of  February  26,  1004,  a  telegram  from 
Mr.  James  Martin,  of  Philadelphia.  Pa.,  requesting  that  suggestions 
be  made  by  the  Surgeon-General  in  regard  to  the  laundering  and 
handling  of  linen  in  storerooms  and  in  cars,  the  following  memoran- 
dum was  submitted  to  the  Surgeon-General,  and  forwarded  to  Mr. 
>rain : 

Otiservatiou  ou  i>rolouged  trips  in  I'ulluiuu  cars  lias  shown  that  the  bed  linen 
lised  overnight  is  gathered  by  tlie  jmrter  in  the  morning  and  is  siui!>ly  roUed  up 
and  thrown  into  a  locker  or  closet  at  one  end  of  the  car,  and  that  in  the  process 
of  thus  gathering  it  up  it  is  more  or  less  violently  shaken.  It  is  suggested  that 
this  be  avoided  and  that  each  sleeping  car  be  provided  with  strong  canvas  or. 
preferably,  waterin-oof  bags,  of  sufficient  size  to  hold  each  a  full  complement  of 
bed  linen  from  all  the  berths  iu  the  car.  and  that  the  porters  be  instructed  to 
place  the  used  linen  into  these  bags  with  as  little  shaking  as  possible,  carrying 
the  bags  around  the  car  with  them  in  unmaking  the  beds  iu  the  morning. 

The  bags  when  full  are  then  to  be  tightly  closed  with  a  draw  string  or  other 
suitable  fastening  and  the  full  ba.gs  sbaed  in  a  special  locker  until  the  end  of 
the  trip  or  until  put  off  at  a  division  headquarters. 


404  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

It  would  be  an  advantage,  of  course,  if  the  bags  containing  the  soiled  linen 
could  be  passed  through  an  efficient  steam  apparatus,  using  steam  under  pres- 
sure, before  being  sent  to  the  laundry. 

Another  point  which  seems  worthy  of  consideration  is  that  the  woolen  blan- 
kets of  Pulhuan  cars  should  be  provided  with  slip  covers  of  cotton,  linen,  or 
other  washable  material.  It  is  needless  to  say  that  the  blankets  are  a  source 
of  danger  for  the  reason  that,  being  woolen  and  usually  of  dark  color,  they  are 
not  frequently  washed  or  disinfected. 

To  carry  out  the  plan  of  the  slip  covers,  the  method  practiced  in  Germany  of 
using  eiderdown  quilts  upon  beds  is  suggested.  These  quilts,  from  their  extreme 
lightness  and  the  nature  of  their  covering,  usually  silk,  are,  while  very  warm, 
exceedingly  difficult  to  keep  upon  the  bed,  having  a  tendency  to  slip  off  during 
the  night.  This  is  guarded  against  by  having  the  sheets  for  winter  use  of  extra 
large  size  and  pi-ovided  upon  one  long  edge  with  buttons  and  upon  the  other 
long  edge  a  corresponding  set  of  buttonholes.  When  the  bed  is  made  up  for  the 
night  the  upper  sheet  is  simply  folded  upward  and  inward  and  buttoned  in  the 
middle  over  the  eiderdown  quilt,  thus  inclosing  the  quilt  in  a  bag,  as  it  were, 
the  lower  end  of  which  bag  is  tucked  under  the  mattress  and  keeps  the  quilt  in 
place,  both  laterally  and  longitudinally. 

The  plan  is  very  simple  and  is  thought  worthy  of  suggestion  to  the  Pullman 
Company,  as  it  would  keep  the  blankets  from  being  soiled  and  prevent  contami- 
nation, and,  in  addition,  insure  a  sense  of  security  on  the  part  of  the  traveling 
public. 

Reports  of  Officers  Detailed  to  Represent  the  Service  at  Meet- 
ings OF  Medical  and  Public-Healtpi  Associations. 

report  on  the  meeting  of  the  mosquito-exterminating  conven- 
tion  HELD  IN   NEAV   YORK,  DECEMBER   10,    1903. 

Passed  Asst.  Surg,  (now  Surg.)  J.  C.  Perry  reports  as  follows: 

The  convention  was  well  attended.  Two  hundred  persons,  some  of  whom  are 
of  marked  prominence  in  industrial  occupations  in  and  around  New  York,  were 
present,  and  a  number  of  short  papers  dealing  with  the  question  of  mosquito 
extermination  were  read.  Many  of  these  recounted  the  valuable  results  that 
had  alread.v  been  obtained  in  New  Jersey  and  on  Long  Island  as  a  result  of 
measures  instituted  for  the  extermination  of  these  pests.  It  was  shown  that 
districts  of  considerable  area,  in  which  moscpiitoes  had  previously  been  a  source 
of  great  annoyance  and  thereby  diminished  to  a  marked  extent  the  desirability 
of  these  locations  for  summer  resorts,  had  practically  been  freed  from  these 
insects,  not  only  to  the  comfort  but  to  tlie  health  of  the  persons  residing  there. 

Several  papers  dealt  with  the  subject  of  draining  or  so  ditching  the  salt 
marshes  as  to  eliminate  stagnant  water  and  the  marked  results  that  had  been 
obtained  in  exterminating  the  salt-marsh  mosquito,  Ciilc.r  solicitans.  The 
papers  showed  conclusively  that  such  measures  could  be  instituted  and  that 
the  problem  could  be  solved  without  a  great  outlay  of  money,  and  it  was  sug- 
gested that  by  these  means  not  only  could  the  districts  become  rid  of  the 
mosquito  pests,  but  the  increase  in  the  value  of  adjacent  property  would  be 
so  material  and  the  amount  of  land  reclaimed  would  be  sufficient  to  justify 
any  expense  in  this  connection,  and  would  be  not  only  a  benefit  but  a  distinct 
financial  advantage. 

In  addition  to  the  simple  problem  of  eliminating  the  ordinary  Culex  species 
of  mos<iuit()es  for  the  personal  comfort  of  summer  residents  of  these  localities, 
several  pai)ers  dealt  with  that  of  eliminating  the  Anopheles  and  thereby  rid- 
ding certain  districts  of  malarial  fevers.  Some  important  evidence  was  ad- 
duced relative  to  this  subject  showing  results  that  had  been  accomplished  by 
draining,  filing  in,  general  policing  of  grounds,  and  the  use  of  oil  as  a  temporary 
expedient  in  destroying  the  larval  forms  of  these  insects. 

The  representatives  of  the  Public  Health  and  Marine-Hospital  Service  took 
part  in  the  discussion  and  called  attention  to  two  types  of  mosquitoes.  Anopheles 
and  the  ^ter/omyia,  as  of  special  importance  to  sanitarians.  They  stated  in  a 
general  way  what  was  being  done  in  ports  infected  with  yellow  fever  in  order 
to  eliminate  the  danger  of  bringing  infected  mosquitoes  from  those  ports  to 
places  in  the  United  States,  such  action  being  taken  to  shorten  and  simplify 
quarantine  measures  that  might  pertain  to  vessels.     The  principal  disinfectants 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  405 

or  insoctickles  for  tlio  i)un)ose  of  destroy inii;:  luosciuitoes,  ;iiul  the  l)est  methods 
of  usiii;^:  the  same,  were  fully  consiflered"  and  such  remarks  met  with  cordial 
rece|)tion. 

'i'he  consensus  of  (ii)ini<)ii  was  that  the  ),'oo(l  work  of  destroying?  mosquitoes 
and  reclainiln.ti  swamp  lands  should  continue,  and  steps  were  taken  to  effect 
I)ermanent  orjianization  for  the  purpose  of  stinuilating  this  work  in  different 
localities  and  for  the  education  of  the  people  themselves  to  the  point  of 
Ihoroufrhly  ai)preciatins  the  advantages  to  he  derived  from  cooperation  in 
(his  imjtortant  matter.  It  further  appeared,  as  a  result  of  the  work  already 
;iccomplished,  that  the  measures  instituted  for  the  extermination  of  mosciui- 
toes  should  he  permanent  ones ;  and  that  oil.  as  a  temporary  expedient,  was 
advantageous,  hut  was  expensive  and  should  only  he  used  to  afford  teiiiporary 
protection,  instituting  at  the  same  time  measures  of  a  permanent  nature  to 
eliminate  the  breeding  places  of  mosquitoes  and  thereby  rendering  the  dis- 
trict free  from  these  annoying  insects  for  all  time. 

REPORT   ON    THE    MEETING    OF    THE    ASSOCIATION    OI'    AMERICAN    BACTERI- 
OLOGISTS, HELD  IN  PHILADELPHIA,  PA.,  DECEMBER  29,  AND  30,  1903. 

Passed  Asst.  Surg.  M.  J.  Rosenaii,  director  of  the  Hygienic  Labora- 
tory, who  was  detailed  to  represent  the  Service  at  this  meeting, 
reports  as  follows : 

A  very  interesting  programme  was  presented  on  topics  having  particular  in- 
terest to  those  who  devote  their  time  to  the  morphology,  classification,  and 
biology  of  bacteria  and  the  protozoan  group  of  organisms. 

An  article  of  particular  interest  to  the  Service  was  read  by  Dr.  James 
Carroll,  of  the  Army  Medical  Museum,  entitled  "  The  yeast  cells  found  in 
fStef/ovtyia  and  their  relation  to  yellow  fever."  Doctor  Carroll  pointed  out 
that  the  bodies  described  by  working  party  No.  1,  and  believed  by  them  to  be 
phases  of  a  protozoan  organism,  were  yeast  cells.  In  the  discussion  these  views 
were  in  the  main  corroborated  by  Doctor  Rosenau,  as  a  result  of  the  labors 
of  working  party  No.  2  in  Vera  Cruz  this  summer. 

Another  interesting  article  was  read  by  Dr.  J.  J.  Kinyoun  upon  the  subject  of 
"  Glycerin  as  a  germicide  with  cell  exudations  and  serum."  Doctor  Kinyoun's 
work  on  the  germicidal  value  of  glycerin  in  the  main  corroborated  Rosenau's 
work  along  this  line,  especially  as  to  the  feeble  effect  which  glycerin  has  upon 
micro-organisms.  He  also  pointed  out  the  overconfidence  which  obtained  in  the 
l)0wer  of  glycerin  to  purify  vaccine  virus  before  attention  was  called  to  this 
subject.  He  carried  his  work  further  in  experimenting  upon  the  power  of 
glycerin  plus  the  germicidal  power  of  various  serums  upon  the  cell  exudations 
as  a  I'esult  of  which  he  obtained  very  interesting  results. 

Doctor  Rosenau  was  elected  vice-president  of  the  society. 

REPORT   ON   THE    MEETING   OF   THE   AMERICAN   RONTGEN    RAY   SOCIETY   AT 
PHILADELPHIA,  PA.,  DECEMBER  9  AND  10,  1903. 

Surgeon  Irwin  reports  as  follows: 

The  society  met  on  the  morning  of  December  9,  at  Houston  Hall,  University 
of  Pennsylvania,  the  use  of  which  had  been  tendered  the  society  through  the 
courtesy  of  the  provost  of  the  university.  After  the  transaction  of  general  busi- 
ness, the  first  paper  on  the  programme  was  read  by  Dr.  William  S.  Newcomet,  of 
Philadelphia,  the  subject  being  "  Pathologic  changes  in  tissue  under  the  influ- 
ence of  the  X  ray."  This  paper  was  of  very  great  interest  as  showing  the  effect 
of  the  X  ray  on  malignant  and  nonmalignant  growths  with  microscopic  exami- 
nations of  growths  both  before  and  after  the  use  of  the  X  rays.  It  was  brought 
out  among  other  points  that  rapidly  growing  neoplasma  are  not  as  amenable  to 
treatment  as  the  slow  growing  ones.  This  paper  w'-as  fully  discussed  by  Doctor 
Burdick,  of  Chicago ;  Doctor  Clark,  of  Olean,  N.  Y.,  and  Doctor  Hulst,  of  Grand 
Rapids,  Mich. 

The  next  paper  w^as  read  by  Dr.  Charles  L.  Leonard,  of  Philadelphia,  Pa., 
well  known  for  his  work  in  this  line.  The  paper  was  entitled  "The  results  of 
the  Roentgen  method  in  the  diagnosis  of  renal  calculus."  This  paper  very 
clearly  presented  the  advantage  of  this  method  of  diagnosis  and  some  beautiful 


406  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SEEVICE. 

plates  were  shown.  A  point  of  very  great  interest  to  the  observer  was  the  very 
large  proportion  of  calculi  shown  h^  this  method  of  examination  to  bo  in  the 
ureter  instead  of  the  kidney.  In  very  many  cases  this  would  Indicate  that  there 
was  no  necessitj'  for  operation.  Doctor  Bullitt,  of  Kentucky,  opened  the  discus- 
sion, which  was  participated  in  by  Doctor  Ilulst  and  closed  by  Doctor  Leonard. 
He  pointed  out  the  fact  that  the  method  has  acquired  greater  accuracy  in  many 
lines  of  diagnosis  than  had  been  obtained  by  other  methods.  He  said  that  the 
diagnosis  value  of  the  X  ray  should  not  be  lost  sight  of  in  the  enthusiasm  of 
cancer  treatment,  although  this  was  a  very  valuable  application.  He  said  that 
the  progress  of  medicine  would  be  furthered  and  patients  helped  by  the  more 
general  use  of  this  method  of  diagnosing.  He  spoke  particularly  of  the  results 
he  had  obtained  in  examining  over  300  patients  for  stone  in  the  kidney.  He  had 
found  stone  in  89  cases.  Twenty  cases  he  had  examined  had  been  saved  the 
necessity  and  danger  of  operation,  because  the  X  ray  showed  the  stone  was 
small  enough  to  pass.  This  method  he  has  proved  has  the  advantages  of  being 
more  accurate,  of  saving  many  patients  from  operation,  and  of  malving  the 
operation  less  severe  and  dangerous  as  well  as  corai)lete. 

The  next  paper  was  "  Two  cases  of  severe  X-ray  necrosis,  presenting  some 
unusual  features,"  by  Dr.  Clarence  E.  Skinner,  of  New  Haven,  Conn.  This  paper 
was  quite  elaborate  and  the  reporter  took  very  copious  notes.  However,  the 
conclusions  of  Doctor  Skinner  are  here  given. 

First.  That  a  patient  should  not  be  given  X-ray  treatments  at  all  freciuently 
through  a  long  period  of  time,  no  matter  how  well  thev  seem  to  bear  them  at 
first. 

Second.  That  it  is  advisable  in  many  eases  to  remove  tissue  with  the  knife, 
which  has  been  destroyed  by  X  rays,  and  that  galvanic  electrical  currents  will 
be  of  great  assistance  in  healing  these  sores  after  the  gangrenous  tissue  is  out 
of  the  way. 

Third.  As  the  skin  of  botli  of  these  patients  was  very  nuich  browned  by  the 
treatment,  and  yet  they  developed  severe  l)urus,  that  "  tanning  "  does  not  con- 
stitute imnninity  from  burns,  as  is  frequently  believed. 

Fourth.  That  the  i)hysiological  action  of  the  X  ray  is  not  confined  to  destriic- 
tive  influences,  but  thiit  it  modifies  the  development  of  the  cells,  as  indicated 
by  the  development  of  burns  five  or  six  months  after  the  X-ray  treatments  had 
been  suspended,  and  because  "  tanning "  and  other  abnormal  structural  condi- 
tions appeared  in  the  new  skin  which  had  formed  many  weeks  after  the  treat- 
ments were  stopped  and  which  had  not  been  subjected  to  the  X  rays  at  all. 

Fiftli.  That  every  case  of  X-ray  burn  nnist  be  treated  by  itself.  No  one  routine 
method  of  treatment  will  prove  serviceable  in  all  cases,  and  no  condition  exhibits 
so  emphatically  th(»  truth  of  the  old  adage  that  "  What  is  one  man's  meat  is 
another  man's  poison." 

A  general  discussion  on  cancer  followed,  in  which  it  was  the  general  opinion 
that  the  result  of  the  treatment  of  cancerous  growths  by  the  X  ray  could  not 
be  stated.  Certainly  some  cases  have  been  reported  as  cured,  even  sarcomata, 
although  there  appears  to  be  little  hope  from  this  last  mentioned. 

The  a.ssociation  then  adjourned  until  the  afternoon  session.  The  afternoon 
session  began  at  half  past  2  o'clock.  It  was  expected  that  the  proceedings 
would  begin  by  the  reading  of  a  paper  by  Dr.  William  E.  Sweet,  of  Philadelphia, 
on  "  The  localization  of  foreign  bodies  by  the  Roentegn  rays,"  but  as  Doctor 
Sweet  was  absent,  Dr.  Henry  Hulst,  of  INIichigan,  read  his  paper  on  the  "  Skia- 
graphy of  the  chest,"  and  presented  some  very  excellent  plates.  This  was  fol- 
lowed by  Dr.  Mihrau  K.  Kassabian,  who  is  director  of  the  Roentgen  ray  labora- 
tory of  the  Philadelphia  Hospital,  with  his  paper  on  "  How  to  obtain  an 
instantaneous  skiagraph  of  the  thorax."  He  stated  the  time  of  exposure  of 
the  skiagrams  of  the  lungs  and  heart  has  been  reduced  during  the  past  few  years 
from  two  to  five  minutes  to  as  many  seconds.  This  is  possible  owing  to  the 
improvement  of  the  apparatus  and  slvill  from  experience.  A  I'eview  was  talvcn 
of  all  apparatus,  indicating  which  appliance  gave  most  satisfactory  results  in 
"  skiagrai>hy."  Stress  was  laid  upon  the  fact  that  the  larger  induction  coils 
give  better  results  than  smaller  ones.  He  briefly  dwelt  upon  the  sensitive 
plates  best  adapted  to  be  used.  Doctor  Kassabian  predicted  the  production  of 
the  skiagrams  so  rapidly  as  to  show  the  movement  of  the  heart  and  lungs  and 
other  viscera  in  kinetographic  flashing.  This  paper  was  discussed  by  Doctor 
Bui  -lick,  Mr.  Ward,  of  London,  and  others. 

The  session  was  concluded  by  a  paper  by  Dr.  Henry  E.  Waite,  of  New  York, 
"  On  the  care  of  the  static  machine."  The  writer  regrets  that  it  is  not  possible 
to  quote  this  article  entire,  inasmuch  as  nearly  all  marine  hospitals  are  pro- 


PUBLIC    HKALTH    AND    MAHTN  K-HOSlMTA  J.    SKKVICp:.  407 

vidod  with  static  niacliiiR's,  and  tlio  I'osults  tliat  arc  to  be  ol>taino(l  from  them 
depends  very  nnich  on  the  care  taken  of  tlieni.  Doctor  Waite's  article  will 
clear  np  many  j)oints  in  the  care  of  these  machines  that  have  hitherto  l)een  a 
jinzzle  to  o(iic(M-s.  It  is  reconunended  that  a  repiMnt  of  tills  paper  l)e  furnished 
to  eacli  hospital.  The  eveninj;  session  was  devoted  to  the  hearing  of  the  presi- 
dent's address,  by  Prof.  Arthur  W.  (;oodsi)eed.  Ph.  I).,  of  the  University  of 
Pennsylvania;  subject.  "The  trend  of  modern  thout^lit  upon  the  subatonic 
structure  of  matter." 

In  concludin.i,'  an  account  of  the  first  day's  proceedings  the  writer  desires  to 
('Xjtress  ai)i)reci;;tion  of  the  court(>sy  shown  to  him,  as  well  as  to  the  other  dele- 
gates from  the  Covernment  s(>rvices.  Cai)t.  Deane  C.  Howard,  Medical  Depart- 
ment, U.  S.  Army,  and  Surgeon  Stokes,  V.  S.  Navy.  They  were  i)resented  to  all 
the  officers  of  the  association,  given  prominent  places  for  observing  the  pro- 
ceedings, and  in  every  way  treated  with  the  greatest  kindness  and  consideration. 

THURSDAY,    DECEMRER    10. 

The  second  and  last  day  of  the  meeting  began  in  the  morning  with  a  paper 
by  I'reston  I\I.  Ilickey,  M.  D.,  of  Detroit,  the  title  of  which  was  "The  develop- 
ment of  the  skeleton,  radiograi)hically  considered,"  and  this  was  discussed  by 
Doctor  (Jirdwood,  of  Montreal.  Then  followed  an  article,  "The  effects  of  rays 
upon  lower  animal  life,"  by  Kennon  Dunham,  M.  D.,  of  Cincinnati.  The  next 
paper  on  the  iH'ogrannne,  "  The  stereoscope  in  radiography,"  was  not  read, 
owing  to  the  absence  of  the  author. 

Then  followed  a  most  interesting  ])aper  by  W.  A.  Price,  of  Cleveland,  on 
"  Technique  for  making  good  dental  skiagraphs."  This  was,  of  course,  of  special 
interest  for  dentists  and  specialists  in  oral  surgery.  The  afternoon  session 
began  with  what  might  be  considered  the  pap,er  of  the  greatest  interest  of  the 
session,  judging  not  only  from  the  subject  but  from  the  great  interest  shown 
in  the  discussion.  This  p;ii)er  was  prepared  by  Doctors  Pancoast  and  Bartle, 
of  Philadelphia,  with  Mr.  Henry  C.  Welker.  The  title  accounts  in  a  way  for 
the  interest  shovrn,  "  The  therapeutic  effects  of  the  X  rays,  as  shown  from  the 
results  of  treatment  of  one  hundred  cases."  There  were  lantern  photographs 
used  to  illustrate  the  value  of  the  X  ray  in  the  treatment  of  disease.  A  general 
discussion  on  cancer  followed,  in  which  it  was  the  general  opinion  of  the  physi- 
cians present  that  the  X-ray  treatment  of  cancerous  growth  was  beneficial.  Dr. 
Henry  K.  Pancoast  demonstrated  that  the  therapeutic  effects  of  the  X  rays,  as 
shown  from  the  results  of  treatment  in  over  100  cases  at  the  University  Hos- 
pital, were  instriunental  in  relieving  the  patients  of  pain,  in  many  cases  of  com- 
pletely curing  them,  and  in  some  cases  failing  in  ultimate  effects. 

"  The  medical  world  admits,"  said  Doctor  Pancoast,  "  that  the  X  rays,  as 
applied  to  the  treatment  of  cancer,  have  curative  i)owers.  Cancer  has  also  been 
cured  by  operation,  and  many  physicians  prefer  this  method  than  by  the  newer 
system."  It  was  shown  according  to  statistics  that  cancer  is  on  the  increase  in 
the  United  States.  The  prevalent  disease  in  this  country  and  in  Europe  is 
lupus,  a  skin  affection,  with  its  tendency  to  disfigure  the  faces  of  patients.  In 
many  instances  medical  science  can  find  no  absolute  cure  for  the  disease. 
X  rays  have  cvu'ed  hundreds  of  patients,  and  it  has  been  found  that  the  ultra- 
violet light  kills  the  germs,  whicli  are  the  nuclei  for  the  growth  of  the  disease. 
If  the  application  of  any  remedy  does  not  kill  these  germs,  the  patient  con- 
tinually suffers.  It  lias  been  found  that  the  X  ray  has  effected  complete  cures, 
and  by  hundreds  of  physicians  it  has  been  looked  upon  as  the  El  Dorado  of  the 
medical  world  as  applied  to  the  clieck  and  cure  of  cancer.  Dr.  George  G.  Hop- 
kins, of  Brooklyn,  st(irted  the  discussion  on  the  topic,  which  was  easily  tlie 
paramount  feature  of  the  day.  His  earnest  plea  w^as  that  every  effort  should  be 
made  to  perfect  any  and  all  means  of  checking  the  disfiguring  disease.  It  was 
brought  out  in  the  discussion  that  "  cancer  studied  in  a  large  institution  like  a 
hospital  shows  results  that  might  be  improved  under  different  conditions.  Many 
of  the  cases  are  seen  every  day,  and  only  during  dispensary  hours.  Each  case 
is  a  study  by  itself.  In  hospital  statistics  the  X-ray  room  is  the  dumping 
ground  for  every  kind  of  case,  and  as  a  rule  they  get  the  worst.  In  spite  of 
these  conditions  there  is  10  per  cent  of  cures  to  record  in  a  large  hospital. 

A  paper  on  "A  comparative  study  of  fractures  of  the  extremities  "  was  read 
by  Mr.  Martin  I.  Wilbert,  who  is  in  charge  of  the  X-ray  laboratory  of  the  Ger- 
man Hospital  in  Philadelphia.  He  said  he  was  safe  in  asserting  that  precision 
and  exactness  of  diagnosis  are  virtually  impossible  without  the  use  of  the 
X  rays,  and  that  without  a  complete  and  correct  diagnosis  the  subsequent  treat- 


408  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

meut  is  largely  a  matter  of  chance.  At  the  German  Hosi^ital  an  X-ray  plate 
is  made  of  every  case  of  fracture  coming  to  the  hospital  and  filed  for  future 
reference. 

A  paper  on  "  Developers  "  was  next  read  by  Di".  Gordon  G.  Burdick,  of  Chi- 
cago, and  discussed  by  Doctor  Kassabian.  of  Philadelphia,  and  others. 

The  closing  session  of  this  most  interesting  convention  was  lield  in  the  even- 
ing, beginning  with  a  paper  on  "Accuracy  in  X-ray  diagnosis,"  by  Russell  II. 
Boggs,  M.  D..  of  Pittsburg.  lie  stated  that  on  account  of  the  greater  part  of 
every  X  ray  worker's  time  having  been  taken  up  in  the  past  by  the  treatment 
of  light,  many  details  in  the  picture  work  have  been  overlooked.  Doctor  Boggs 
reported  0  interesting  cases  whicli  could  not  be  diagnosed  by  any  other  means 
except  by  the  X  ray. 

Then  followed  a  paper  by  Doctor  Pancoast,  entitled  "  Exploding  tubes." 
Some  amusement  was  caused  by  the  title  of  this  paper,  inasmuch  as  a  tvibe  con- 
taining a  vacuum  could  not  explode.  The  word  "  collapse  "  was  suggested  as 
the  proper  one. 

The  last  paper  was  by  Dr.  John  T.  Pitkin,  of  Buffalo,  "  Dangers  to  the  X-ray 
operator."  Differing  susceptibility  of  operators  makes  it  difficult  to  give  rules 
for  self-protection  in  using  the  X  ray.  Various  forms  of  gloves  are  shown,  all 
of  which  are  necessarily  very  clumsy.  Most  operators  soon  adopt  methods  for 
their  protection.  Care  as  to  exposure  and  a  proi)erly  prepared  cloth  to  throw 
over  the  hands  when  using  the  tube  are  points  of  imi»ortance.  One  very 
important  point,  which  seemed  to  be  generally  held,  may  be  mentioned  in  con- 
cluding this  report :  Referring  to  the  treatment  of  growths,  malignant  and  non- 
malignant,  it  was  stated  that  where  operable  they  should  be  treated  witli  the 
knife,  and  then,  if  recurrent,  to  be  exposed  to  the  action  of  the  X  rays. 

MEETING   OF   THE    NATIONAL   ASSOCIATION    FOR   THE    STUDY   AND 
PREVENTION    OF    TUBERCTTIjOSIS. 

Passed  Asst.  Surg.  M.  J.  Rosenaii  reports  that  he  attended  the 
meeting  on  the  evening  of  June  G. 

The  principal  business  before  the  meeting  was  to  complete  the  organization. 

A  constitution  and  by-laws  were  adoi)ted,  which  had  been  prepared  by  the 
committee  appointed  March  28  at  l'hiladel]>hia  to  organize  the  society. 

Dr.  E.  L.  Trudeau,  of  Saranac  Lake,  N.  Y.,  was  elected  president. 

The  following  directors  were  chosen : 

Massachusetts,  Bowditch  and  Otis ;  Connecticut,  Foster ;  New  York,  Biggs, 
Trudeau,  Devine,  and  Knopf ;  Pennsylvania,  Lawrence  Flick,  Mazyck  P. 
Ravenel,  Howard  S.  Anders,  and  Leonai-d  Pearson ;  New  Jersey,  Hoffman ; 
Maryland,  W.  H.  Welch,  William  Osier,  Jacobs,  and  Fullon ;  District  of  Colum- 
bia, Sternberg;  North  Carolina.  Minor;  Colorado,  Soley ;  Illinois,  Klebs  and 
Babcock  ;  Minnesota,  Bracken ;  Missouri,  Porter ;  Indiana,  llurty  ;  Michigan, 
Vaughan ;  Ohio,  Probst;  California,  Briggs ;  Texas,  M.  M.  Smith;  Public 
Health  and  Marine-Hospital  Service,  Surgeon-General  Wyman,  and  United 
States  Army,  Major  Bushnell,  of  Fort  Bayard. 

A  general  discussion  was  had  as  to  the  best  means  of  preventing  tuberculosis, 
upon  the  scope  of  the  society,  and  the  direction  in  which  its  efforts  should  be 
directed. 

MEETING    OF    THE    AMERICAN    MEDICAL    ASSOCIATION. 

ADDRESS    BY    SURGEON-GENERAL    WYMAN. 

At  the  meeting  of  the  American  Medical  Association,  held  at  Atlan- 
tic City,  N.  J.,  June  7  to  10,  1904,  Surgeon-General  Wyman  presented 
the  following  pa]:)er  in  reply  to  the  question  for  discussion,  "  "Wliat 
can  the  medical  profession  do  for  the  Public  Health  and  Marine- 
Hospital  Service  ?  "     The  paper  made  a  profound  impression. 

WHAT    THE    MEDICAL    PROFESSION    CAN    DO    FOR    THE    PUBLIC    HEALTH    AND    MARINE- 
HOSPITAL    SERVICE. 

It  is  a  great  privilege,  in  response  to  the  invitation  of  our  president  and  in 
the  i)reseuee  of  a   great  audience  such   as   always   charactei'izes   our   general 


PTTHLIO    HKALTH    AND    MAIIINE-IIOSPTTAL    SERVICE.  409 

meetings,  to  s;iy  a  word  for  tlie  United  f^tates  I'nbllc  Health  and  Marine- 
II()si)ital  Service,  a  service  that  Iiad  its  origin  in  17()<S  and  has  sh)\vly  l)ut  steadily 
grown,  as  grows  the  tree,  l»y  putting  out  from  time  to  time  twigs  of  new  duties, 
which  have  developed  into  strong  branches  of  public  service,  until  it  has  reached 
its  present  sturdy  growth,  secure  from  any  casual  uprooting  and  still  growing. 
Its  oOO  or  more  medical  ollicers  may  be  found  in  every  pi'ominent  ])ort  on  the 
seacoast  from  Maine  to  Alaska  and  on  our  (Jreat  Lakes  and  rivers;  on  the 
Isthmus  of  I'anama,  in  I'orto  Kico.  Hawaii,  and  the  IMiilippines ;  in  Canada, 
r.ritish  Columbia,  Japan,  China.  India,  and  in  10nr()i)e. 

In  the  United  Stati'S  you  will  lind  them  administering  22  Government  hos- 
pitals and  125  other  relief  stations,  extending  surgical  and  medical  relief  annu- 
ally to  58,000  seamen  of  the  merchant  marine.  You  will  find  them  administer- 
ing 37  quarantine  stations,  inspecting  and  disinfecting  ships,  and  isolating 
contagion  ai)i)roaching  from  foreign  shores.  You  will  find  them  making 
visual  examin;itions  of  all  our  i)ilots,  rejecting  4  per  cent  annually  for  color 
blindness,  examining  physically  the  crews  of  life-saving  stations  that  physical 
defects  may  not  mar  the  glorious  achie^'ements  of  that  great  service.  At  every 
port  or  place  on  the  seacoast  and  on  the  Canadian  and  Mexican  borders, 
where  alien  immigration  seeks  entrance,  you  will  find  these  officers  examining 
each  inuuigrant  and  rejecting  those  that  are  afflicted  with  loathsome  or  conta- 
gious disease  or  whose  physical  condition  makes  them  liable  to  become  a  public 
charge.  In  times  of  epidemic  you  will  find  them  managing  with  military  pre- 
cision detention  camps,  acting  as  experts  in  the  detection  of  the  disease,  and 
directing  with  coolness  and  judgment  the  necessary  measures  to  prevent  its 
spread.  At  this  very  time  you  may  find  them  in  certain  portions  of  our  coun- 
try liable  to  the  invasion  of  yellow  fever  waging  a  prophylactic  campaign  by 
the  systematic  destruction  of  the  breeding  places  of  the  mosquitoes  which 
convey  this  disease,  and  organizing  in  cities  and  villages  local  working  parties 
to  continue  the  work,  with  free  distribution  of  literature  showing  its  neces- 
sity and  detailing  its  method. 

In  contrast  to  this  field  activity  you  will  find  them  in  the  Service  laboratory 
established  in  Washington  by  act  of  Congress,  delving  into  the  cause  of  disease 
and  in  other  branches  of  scientific  research,  or  receiving  instruction  there  in 
the  latest  scientific  methods  of  diagnosis,  to  be  api)lied  later  in  their  expert 
work.  Thence  they  go  by  request  to  arbitrate  local  disputes  as  to  the  existence 
or  nonexistence  of  bubonic  plague,  yellow  fever,  smallpox,  or  cerebrospinal 
meningitis;  to  advise  with  regard  to  the  source  of  typhoid  infection,  to  address 
societies  on  the  prevention  and  suppression  of  disease,  or  to  investigate  some 
new  or  ill-understood  m;ilady  that  tlireatens  the  material  prosperity  as  well  as 
the  health  of  communities. 

Their  laboratory  work  includes  also  the  test  of  purity  of  vaccine  virus  and 
antitoxic  .serums,  on  which,  and  on  their  personal  inspections  of  the  establish- 
ments producing  them,  depends  a  granting  of  the  license  required  by  law. 

In  Canada  and  British  Colimibia  they  are  stationed  to  prevent  the  side 
entrance  into  the  United  States  of  aliens  Avho  would  be  rejected  for  physical 
causes  at  our  own  ports.  In  Japan  and  China  they  are  inspecting  ships,  pas- 
sengers, and  cargoes  bound  for  the  Pacific  coast,  and  are  pointing  out  to  the 
steamship  companies  such  immigrants  as  they  know  will  be  refused  entrance 
into  the  United  States  under  the  inunigration  law.  In  Calcutta  and  Bombay 
and  in  Naples  they  are  exercising  like  supervision.  All  these  officers  forwarding 
jieriodic  reports  giving  information  concex'ning  the  sanitai-y  conditions  and  epi- 
demic diseases  prevailing  in  these  respective  countries. 

They  are  administering  national  quarantine  in  the  Philippine  Islands,  in 
Hawaii,  and  in  Porto  Rico.  You  will  find  them  in  the  principal  fruit  ports 
of  Central  America,  examining  and  certifying  fruit  vessels  bound  for  our  south- 
ern coasts,  that  they  may  not  be  detained  on  arrival  with  their  perishable  car- 
goes. You  will  find  them  in  Cuba,  stationed  in  the  offices  of  the  consuls  at  the 
several  ports,  still  on  guai'd.  notwithstanding  the  sanitary  regeneration  of  that 
island.  Y"ou  will  find  them  in  the  ports  of  Mexico,  giving  bills  of  health  to  all 
vessels  leaving  for  the  United  States,  causing  a  waiver  of  detention  on  arrival 
and  thus  expediting  commerce.  You  will  find  them  on  the  Isthmus,  in  charge  of 
the  quarantine  at  Panama,  protecting  that  city  and  the  Canal  Zone  from  the 
invasion  of  yellow  fever  from  Ecuador  and  of  the  bubonic  plague  from  Peru  or 
Chile ;  and  in  the  ports  of  Ecuador  and  Peru,  carefully  inspecting  or  disinfect- 
ing vessels  bound  for  the  Isthmus  as  well  as  those  bound  for  the  United  Sts^tes. 
You  will  find  them  also  in  Rio  de  Janeiro  and  La  Guaira,  Venezuela,  for  the 
exerci.se  of  the  same  functions. 


410  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SEEVICE. 

It  is  a  world  service,  its  influence  beinicc  felt  in  all  civilized  countries. 

Now,  who  are  these  medical  oflicers?  They  belong  to  the  medical  profession 
of  the  United  States  and  are  its  product.  There  are  before  me  many  of  their 
instructors.  Safe  to  say.  there  is  not  a  medical  college  represented  at  this 
meeting  of  the  association  which  is  not  also  represented  in  this  medical  corps. 
These  officers  have  entered  the  Service  without  ])olitical  backing,  on  their  merits 
as  decided  after  thorough  physical  and  i)rofession;il  examination,  as  required 
by  law,  and  without  regard  to  locality  or  religion.  They  are,  then,  representa- 
tive of  the  medical  profession,  and  my  first  answer  to  the  tojiical  in(iuiry  is 
that  the  medical  profession  can  assist  the  Public  Health  and  Marine-Hospital 
Service  by  bearing  in  mind  that  the  Service  is  but  a  i^art  of  itself — its  exponent 
in  official  life.  lit  should  not  be  regarded  as  a  body  of  medical  men  set  apart 
from  the  rest,  but  as  an  organization  seeking  in  its  peculiar  field  to  exemplify 
the  best  thouglit  and  effort  of  the  profession.  The  Service  must  be  brought  in 
contact  with  and  must  have  insjjiration  from  the  great  army  of  medical  men  in 
the  United  States,  who,,  besides  their  devotion  to  their  patients  and  their 
specialties,  are  thinking,  thinking  constantly  on  the  great  problems  relating  to 
sanitation  and  puldic  health  the  practical  dealings  with  which,  from  a  national 
standpoint,  has  fallen  to  the  lot  of  this  Service. 

By  maintaining  or  increasing  a  high  standard  of  professional  excellence  the 
medical  profession  stimulates  its  brothers  in  Government  service.  The  medical 
colleges  will  assist  in  perfecting  the  corps,  not  only  by  tlioroughness  of  medical 
education,  but  also  by  raising  the  educational  standard  required  of  matricu- 
lants. Technical  education  alone  is  not  sufficient ;  it  should  be  superimposed  on 
a  general  education  l)road  enough  to  enable  the  medical  officer  to  fitly  represent 
the  general  as  well  as  the  special  intelligence  of  the  American  physician. 

You  can  further  help  this  Service  by  api>reciating  its  aspirations.  What  are 
its  aspirations V  And  what  are  the  agencies  through  which  they  may  be  grati- 
fied? First  may  be  mentioned  perfection  of  organization.  As  organized  effort 
is  sujierior  to  individual  effort,  so  is  legal  organization  in  the  long  run  more 
efficacious  than  voluntary.  In  a  law  passed  two  years  ago  our  organization  was 
expanded.  This  exI)ansion  is  in  line  with  the  expressed  will  of  the  association 
at  its  meeting  in  Atlanta  in  1S9P..  The  new  law  brings  us  in  association,  so 
far  as  may  be  under  the  Constitution,  with  the  several  State  boards  of  health. 
Special  conferences  are  provided  for  on  reriuest,  and  an  annual  conference  is 
made  obligatory  between  the  Pul)lic  Health  and  Marine-Hospital  Service  and 
representatives  of  the  State  boards  of  health.  Two  annual  conferences  have 
been  held,  r(>sulting  in  a  feeling  of  harmony  and  cooi»eration  and  giving  promise 
of  wide  and  practical  results.  As  these  State  boards  of  health  have  their  rela- 
tions with  the  county  and  municii)al  boards,  the  latter  also  have  an  indirect 
relation  with  the  national  Service,  and  the  medical  profession  can  materially 
assist  this  Service  by  giving  aid  to  State  boards  of  herilth  and  local  health  offi- 
cers as  well.  Many  State  health  officers  require  help  in  securing  proper  legis- 
lation, and  local  boards  of  health  require  the  aid  of  the  profession  in  support  of 
the  proper  functions  of  their  office  and  in  making  the  office  itself  so  potential, 
with  such  ii  length  of  tenure  and  with  such  ade(]nate  compensation  as  to  make 
it  attractive  to  the  most  competent  physicians  in  the  connnunity. 

With  this  organization  to  be  developed  and  strengthened  as  the  years  go  by, 
it  is  not  too  much  to  assume  that  general  sanitation  will  be  advanced  to  a  degree 
now  thought  scarcely  possible.  The  profession  can  further  assist  the  Public 
Health  and  Marine-Hospital  Service  in  its  broadened  scope  as  thus  outlined  by 
encouraging  all  (>(lucational  efforts  in  behalf  of  sanitation,  by  supporting  the 
auxiliary  sanitary  associations,  which  I  am  pleased  to  say  exist  in  so  many 
States  and  localities,  seeking  to  arouse  from  a  disgraceful  tor])or  the  interest  of 
those  who  are  affected  by  sanitation,  and  by  creating  a  public  sentiment  which 
will  demand  an  api)lication  of  knowledge  drawn  from  scientific  observation, 
knowledge  which  is  far  in  advance  of  its  practical  utilization. 

One  of  the  asi)irations  of  this  Service  is  a  shunless  country.  I  know  that  this 
will  fall  on  doubting  ears,  but  I  assert  that  there  is  no  adequate  reason  why 
slums  should  exist  anywhere,  and  by  slums  I  mean  places  where,  through  bad 
di'ainage,  imperfect  sewerage,  inadequate  air  space,  lack  of  pure  water,  and  lack 
of  sunlight,  human  beings  are  subject  to  disease  and  crime-inducing  conditions. 

In  conclusion,  in  answer  to  the  question,  What  can  the  medical  profession  do 
for  the  United  States  Public  Health  and  Mar!ne-Hosi)ital  Service?  the  reply  may 
be  summarized  as  follows:  The  profession  can  aid  us  by  regax'ding  us  as  a  part 
of  itself ;  by  supporting  us  in  any  laudible  eftoi'ts  for  legislative  gi'owth ;  by 


rUHLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  411 

rociuirini^  a  sudicieiitly  bro;ul  otlueatioii,  in  addition  to  professional  excellence, 
of  the  f^radnates  from  whom  we  recrnit  onr  ranks;  and  liy  sympathetic  support 
in  our  aspirations,  which  ar(>  the  same  .as  those  of  the  profession  itself. 

REPORT   OF    ASST.    SURO.    GEN.    G.    T.    VAUOIIAN. 

Asst.  Surg.  Gen.  George  T.  Vaiiglian,  who  represented  the  Service 
at  the  above  meeting,  reports  as  follows: 

June  .9. — He  reached  Atlantic  City  and  registered  for  attendance  on  the 
section  of  general  surgery  and  anatomy.  In  the  evening  he  attended  the  general 
meeting,  when  tlu^  oration  on  surgery  was  delivered  by  Dr.  W.  J.  Mayo,  after 
which  came  a  symposium  on  the  "  Mutual  relations  and  duties  of  the  Govern- 
ment medical  services  and  the  ])rofession."'  The  symposium  was  o])ened  by  Dr. 
Victor  C.  Vaughan  in  an  address  entitled  "What  can  the  Medical  Departments 
of  the  Army,  of  the  Xavy,  and  of  the  Public  Health  and  Marine-Hosi)ital  Service 
do  for  medical  science?"  and  was  responded  to  as  follows:  "  What  can  the  niedi- 
cnl  profession  do  for  the  Army?"  by  Dr.  William  C.  Borden,  major  and  surgeon, 
U.  S.  Army;  "What  can  the  medical  profession  do  for  the  Navy?"  by  Dr.  C.  F. 
Stokes,  surgeon,  I'.  S.  Navy;  and  "What  can  the  medical  profession  do  for  the 
Public  Health  and  Marine-Hospital  Service?"  by  Surg.  Gen.  Walter  W^yman. 

June  .9. — He  attended  the  section  on  surgery  and  anatomy  and  heard  the  fol- 
lowing papers  read  and  discussed:  "The  anatomy  of  inguinal  hernia,  Andrew's 
operation  for  radical  cure,"  by  Dr.  D.  N.  Eisendratli,  and  "Three  years'  experi- 
ence with  the  autoi)lastic  suture  for  hernia."  by  Dr.  L.  L.  McArthur.  These 
two  papers  were  discussed  by  Doctors  Coley,  Marcy,  Bloodgood,  De  Garmo, 
Bevan,  Stokes,  Walker,  Leonard,  and  Holmes.  "  Surgei-y  of  the  trifacial  nerve 
and  its  ganglia."  by  Dr.  J.  B.  Murphy;  "  Intracranial  neurectomy  for  trigeminal 
neuralgia,  cases  and  comments,"  by  Dr.  H.  M.  Sherman,  and  "  Summary  of  the 
linal  results  of  four  cases  of  division  of  the  sensory  root  for  tic  douloureux," 
by  Dr.  C.  H.  Frazier.  These  papers  were  discussed  by  Doctors  Mills,  Spiller, 
Weir,  Hoi'sley,  and  Gushing. 

"  Laminectomy,  a  further  contribution,"  by  Di*.  J.  C.  Munro ;  discussed  by 
Doctors  Lund  and  Gushing.  "The  treatment  of  cold  abscesses  and  sinuses  in 
tuberculous  diseases  of  bone,"  by  Dr.  V.  P.  Gibney;  no  discussion.  "Old  unre- 
duced dislocations,"  by  Dr.  De  F.  Willard;  discussed  by  Doctors  Jonas,  Thomp- 
son, Bevan,  Blake,  Vaughan,  and  Lord.  "  Conservative  perineal  prostatectomy, 
report  of  fifty  cases,"  by  Dr.  H.  H.  Young;  "Prostatic  obstruction,"  by  Dr. 
P.  Syms ;  "Prostatectomy  in  general,  especially  by  the  perineal  route,"  by  Dr. 
(}.  Goodfellow,  and  "  Is  it  wise  to  try  to  make  any  one  operative  method  apply 
to  all  prostatectomies?"  by  Dr.  E.  Fuller.  These  papers  were  discussed  by 
Doctors  Ilorwitz,  Dawbarn,  Munro,  Tinker.  McLaren,  and  Eisendrath. 

The  tendency  of  the  papers  and  the  discussion  was  to  minimize  to  an  unsafe 
degree  the  difficulties  and  the  dangers  of  the  operation  of  prostatectomy. 

"Kidney  stone,  diagnosis  and  treatment,"  by  Dr.  A.  D.  Bevan;  discussed  by 
Doctors  Leonard,  Bullitt,.  Blake,  Deaver,  Young,  Winslow,  and  Thompson. 

In  the  evening  he  attended  the  general  meeting,  when  the  oration  on  State 
medicine  was  delivered  !>y  Dr.  Herman  M.  Biggs,  and  after  that  a  symposium 
on  the  departments  of  scientific  research  of  the  Government,  in  which  the  first 
paper  was  entitled  "  The  Bureau  of  Animal  Industry,  its  service  to  medical 
science,"  by  Dr.  W.  II.  Welch ;  second,  "  The  service  of  the  medical  profession 
to  the  Bureau  of  Animal  Industry,"  by  Dr.  D.  E.  Salmon;  third,  "The  bureau 
of  chemistry  and  medical  science,"  by  Dr.  W.  II.  Wiley,  and,  fourth,  "  The 
Hygienic  LaI)oratorv  of  the  Public  Health  and  Marine-Hospital  Service,"  by  Dr. 
H.  D.  Geddings. 

June  10. — The  first  paper  was  "  The  treatment  of  fractures  of  the  patella  by 
lateral  sutures,"  by  Dr.  J.  A.  Blake;  discussed  by  Doctors  Gibbon,  Vaughan. 
Binnie,  Rodman,  Thenau,  Eisendrath,  Bullitt,  and  Lemon.  "  The  surgical  treat- 
ment of  certain  cases  of  arthritis  deformans,"  by  Dr.  M.  B.  Tinker ;  discussed 
by  Doctors  Vaughan  and  Sherman.  "  Impacted  fractures  of  the  neck  of  the 
femur,"  by  Dr.  Le  M.  Wills;  discussed  by  Doctors  Sherman,  Thompson,  Rodman, 
Crane,  Eisendrath,  Bullitt,  and  Fenner.  "  Fat  embolism  of  lung  following 
fractures,  with  report  of  two  cases,"  by  Dr.  F.  G.  Connell.  At  the  conclusion 
of  this  paper  the  section  adjourned,  about  1  p.  m.,  sine  die,  and  at  2.30  he 
returned  to  Washington. 


412  PUBLIC    HEALTH    AND    MAEINE-HOSPITAL    SERVICE. 

REPORT    OF    ASST.  SURG.  GEN.   H.  D.  GEDDINGS. 

Doctor  Geddings  reports  that  upon  registering  he  designated  the 
section  on  hygiene  and  sanitary  science  as  the  one  in  which  he  was 
particularly  interested. 

The  meetings  of  this  section  were  held  at  the  Garden  Hotel,  and  he  attended 
the  two  daily  sessions. 

The  address  of  the  president,  Dr.  Gardner  T.  Swarts,  was  brief  but  interest- 
ing, and  served  more  as  a  fitting  introduction  to  the  general  labors  of  the  sec- 
tion than  as  a  dissertation  on  any  one  subject. 

The  meetings  were,  in  general,  well  attended,  and  the  papers  presented  were 
usually  discussed  fully  and  freely,  but  the  first  day  was  entirely  devoted  to  a 
consideration  on  the  dangers  and  prophylaxis  of  the  venereal  diseases,  and 
the  opinion  is  expressed  that  the  papers  and  the  discussions  thereon  were  aca- 
demic rather  than  practical  in  character,  and  dealt  largely  with  statistics  and 
statements  of  an  ex  parte  character. 

A  paper  on  "  Dairy  hygiene,  with  special  reference  to  tuberculosis,"  by  Dr. 
Richard  Cole  Newton,  of  Montclair,  N.  J.,  was  interesting  and  of  value,  as 
showing  the  extensive  prevalence  of  tuberculosis  in  dairy  herds,  especially  of 
the  finer  milk  and  butter  producing  grades. 

"  The  status  of  antituberculosis  work  in  the  United  States  "  was  presented 
by  Dr.  S.  A.  Knopf,  of  New  York,  and  was  an  able  presentation  of  the  subject. 

"  The  study  of  the  economic  course  of  consumption  in  wage-earners,"  by  Dr. 
Marshall  Langton  Price,  of  Baltimore,  was  a  scholarly  and  striking  presenta- 
tion of  the  economic  cost  of  tuberculosis  in  the  working  classes. 

Dr.  John  S.  Fulton,  of  Baltimore,  Md.,  presented  a  paper  on  the  question,  "  Is 
pneumonia  increasing?  "  which  he  handled  from  the  statistical  point  of  view  in 
a  manner  calculated  to  show  that  the  alarmist  stateuients  to  this  effect  appear- 
ing in  the  daily  and  medical  press  vi^ere  largely  due  to  a  disregard  of  some  cardi- 
nal principles  of  statistical  deduction. 

Other  papers  were  read,  but  presented  nothing  of  particular  value. 

Doctor  Geddings  presented  a  paper  in  one  of  the  general  evening  meetings 
of  the  association  upon  "  Research  work  in  the  hygienic  laboratory  of  the  Serv- 
ice," which,  it  is  believed,  presented  facts  not  before  collated. 

Upon  the  adjournment  of  the  association  he  returned  to  Washington,  in  com- 
pliance with  his  orders. 

Doctor  Geddings  further  reports  that  he  had  the  honor  to  read  the' 
following  address  at  the  third  general  symposium  of  the  association, 
which  was  devoted  to  the  consideration  of  the  scientific  work  of  the 
various  departments  of  the  United  States  Government  in  their  rela- 
tion to  the  public  health. 

RESEARCH     WORK     IN     THE     HYGIENIC     LABORATORY     OF    THE     PUBLIC     HEALTH     AND 
MARINE-HOSPITAL    SERVICE. 

From  small  beginnings,  research  work  in  the  laboratory  of  the  Service  has 
grown  to  important  proportions.  It  is  believed  that  a  short  sketch  of  the 
growth  of  the  laboratory  would  serve  to  show  better  than  extended  remarks 
the  process  of  development  through  which  it  has  passed. 

The  laboratory  was  inaugurated  as  a  lal)oratory  of  pathology  and  bacteriology, 
principally  the  latter,  at  the  marine  hospital  of  the  port  of  New  York,  situ- 
ated at  Stapleton,  Staten  Island,  in  1887.  For  several  years  it  was  in  charge 
of  one  officer,  who  devoted  such  time  to  it  only  as  could  be  spared  from  his  pro- 
fessional duties  in  the  hospital. 

In  1891,  the  Marine-Hospital  Service  having  been  provided  with  an  oflice 
building  for  its  exclusive  use,  the  laboratory  was  removed  from  New  York  to 
Washington,  and  from  1891  to  March,  1904.  occupied  one  fioor  of  the  office  build- 
ing of  the  Service,  undergoing  meanwhile  a  steady  development. 

At  an  early  period  after  this  removal  the  advantage  was  appreciated  of  con- 
stituting in  the  laboratory  a  school  of  instruction  for  officers  whose  bent  of 
mind  was  toward  scientific  research,  and  from  time  to  time  such  officers  were 
assigned  for  duty  in  the  laboratory  as  assistants  and  received  a  more  or  less 
extended  course  of  instruction  and  training.     Such  courses  were   frequently 


IM'HLIC    HEALTH    AND    MARINK-HOSPITAL    SERVICK.  413 

supplanted  li.v  details  abroad,  with  tlic  opportunity  of  visiting  and  studying  at 
laboratories  in  lierlin,  Paris,  and  Vienna. 

Mueh  work  has  been  aeeoniplisbed  during  these  years  i»earing  directly  on  the 
needs  of  the  Serviee.  The  disinfeeting  methods  of  the  Service  as  applied  in  its 
quarantine  and  epidemic  work  were  investigated  and  brought  to  a  scientific 
basis,  both  as  to  agents,  the  method  of  their  api)lication,  and  the  time  necessary 
for  their  emi)l()yment  under  practical  <'onditions.  The  result  of  this  work  was 
the  elaboration  of  a  system  of  disinfecting  apparatus,  which  is  in  use  to-day, 
and  which,  with  the  passing  of  time,  has  been  mechanically  improved  until  it 
now  stands  unrivaled. 

Departing  from  the  routine  use  of  sulphur  dioxide,  steam,  ai:J  solutions  of 
bichloride  of  mercury  and  carbolic  acid,  it  is  believed  that  this  laboratory  was 
the  first  to  exploit  that  extensively  employed  agent  formaldehyde  in  the  combat- 
ing of  infections.  The  first  diphtheria  antitoxin  manufactured  in  the  United 
States  was  the  output  of  the  Hygienic  liaboratory  of  the  Service.  The  first 
authoritative  publication  on  the  treatment  of  diphtheria  by  antitoxin  was  issued 
by  the  Service,  and  was  the  direct  outcome  of  i)ersonal  instruction  aifoi'ded  an 
officer  of  the  Service  by  P.ehring  and  Koux,  who  separately  announced  their 
discovery  at  the  Budapest  ni(>eting  of  the  International  Medical  Congress. 

Steadily  advancing  under  the  enlightened  and  fostering  care  of  the  Surgeon- 
General,  the  results  of  other  research  were  brought  from  abroad  and  practically 
applied  in  the  United  States.  Plague  was  studied  in  the  laboratory  of  the  Pas- 
teur Institute  by  an  officer  of  the  Service,  and  the  methods  of  preparing  a  cura- 
tive serum  and  a  prophylactic  for  the  prevention  of  the  spread  of  the  disease 
were  exploited  in  the  laboratory. 

An  effort  was  also  made,  though  not  crowned  with  success,  to  aiiply  the  serum 
of  vaccinated  calves  to  the  treatment  of  smallpox.  The  time  afforded  was  too 
short  and  the  quantity  of  material  on  hand  too  limited  to  do  more  than  break 
ground  in  this  important  direction. 

From  time  to  time  bulletins  embodying  the  results  of  laboratory  work  have 
been  published.  These  bulletins  now  number  18,  with  others  in  course  of 
preparation  and  in  the  hands  of  the  printer.  Among  other  subjects  investi- 
gated thoroughly  and  made  public  in  this  method  may  be  mentioned  bulletins 
on  the  "  Presence  of  tetanus  in  commercial  gelatin,"  "  Report  on  the  prevalence 
and  geographical  distribution  of  hook-worm  disease,"  "A  study  of  the  impuri- 
.  ties  of  commercial  vaccine  virus,"  "An  experimental  investigation  of  Tnjpano- 
soma  /efc/s/,"  "A  statistical  study  of  the  intestinal  parasites  of  500  patients  at 
the  United  States  Government  Hospital  for  the  Insane,"  "A  study  on  the  spot- 
ted fever  (tick  fever)  of  the  Rocky  Mountains,"  and  others. 

It  is  only  proper  to  say  that  no  subject  has  been  of  more  importance  to  the 
United  States  and  its  dependencies  beyond  the  sea  than  that  of  hook-worm  dis- 
ease, which,  from  the  bodily  weakness  and  mental  depression  which  it  causes 
among  those  infected  by  it,  inflicts  an  economic  loss  in  certain  sections  attained 
by  no  other  disease. 

The  "  spotted  fever  "  of  the  Rocky  Mountains  is  a  subject  of  vast  economic 
impoi'tance  to  one  of  the  most  fertile  and  most  promising  sections  of  our  west- 
ern country,  the  disease  being  attended  with  great  fatality,  and,  recurring  every 
f-pring,  a  panic  almost  has  at  times  prevailed,  which  threatened  to  result  in  the 
abandonment  of  this  most  fruitful  section  and  the  destruction  of  rapidly 
increasing  agricultural  industry. 

From  time  to  time  the  attention  of  Congi'ess  was  invited  to  the  necessity  for 
more  adequate  quarters  for  the  growing  operations  of  the  laboratory,  and  in 
March,  1901,  this  persistence  was  rewarded  by  the  passage  of  a  section  in  the 
bill  making  appropriations  for  the  sundry  civil  expenses  of  the  Government 
giving  .$.35,0()0  for  the  erection  of  the  necessary  buildings  and  dii'ecting  the  ces- 
sion by  the  Secretary  of  the  Navy  of  5  acres  of  the  old  Naval  Observatory  site 
for  laboratory  purposes. 

Some  time  was  sijent  in  the  preparation  of  plans,  and  in  the  meantime  an  act 
was  approved,  July  1,  1902,  which  materially  altered  the  plan  and  scope  of  the 
Service,  and  at  the  same  time  changed  its  name  from  the  "  Marine-Hospital 
Service  "  to  the  "  Public  Health  and  Marine-Hospital  Service." 

In  addition  to  other  important  features  affecting  the  public  health  and  the 
relation  of  the  Service  thereto,  the  scope  of  the  laboratory  was  \A-idely  extended. 
An  advisory  board  was  constituted,  consisting  of  officers  appointed  from  the 
medical  corps  of  the  Army  and  Navy  and  of  a  scientist  from  the  Department  of 
Agriculture,  and.  in  addition.  T)  appointees  from  civil  life  not  connected  with  the 
service  of  the  Government,  Avhom,  it  was  provided,  should  be  persons  skilled  in 


414  PUBLIC    HEALTH    AND    ^SIARINE-HOSPITAL    SERVICE. 

laboratory  work  in  relation  to  the  pubiie  health.  The  advisory  l>oard  consists 
of  Prof.  William  H.  Welch,  Prof.  Siiuon  Flexner,  I'rofessor  Sedgwick,  I'rof. 
Victor  C.  Vaughan,  Prof.  F.  F.  Wesbrook".  Maj.  Walter  D.  McCaw,  U.  S.  Army. 
Surg.  J.  F.  Urie,  U.  S.  Navy,  and  Doctor  Salmon,  United  States  Department  of 
Agriculture. 

From  a  simple  laboratory  of  pathology  and  bacteriology,  the  laboratory  was 
increased  by  this  act  to  one  embracing  three  additional  divisions,  namely,  those 
of  chemistry,  medical  zoology,  and  pharmacology. 

The  building  has  recently  been  completed,  and  the  work  of  these  new  divlsous 
is  now  well  under  way,  the  division  of  zoology  continuing  its  investigation  into 
the  parasitic  disease  of  man,  and  the  division  of  pharmacology,  in  addition  to 
the  scientific  investigations  of  the  highest  import,  being  engaged  in  an  examina- 
tion of  drugs  and  medical  sujiplies  to  determine  their  potency  and  pharmacopeial 
purity. 

In  addition,  an  act  also  passed  July  1.  1902,  and  effective  six  months  after 
the  date  cf  its  passage,  provided  for  the  licensing  of  all  establishments  engaged 
in  interstate  traffic,  or  in  traffic  in  the  District  of  Columbia,  in  viruses,  serums, 
toxins,  antitoxins,  and  analogous  products.  This  law  provides  that  establish- 
ments engaged  in  the  manufacture  of  these  products  shall  be  licensed  by  the 
Secretary  of  the  Treasury,  and  also,  preliminary  to  the  issuance  of  such  license, 
that  the  establishnient  shall  be  inspected  by  officers  detailed  for  the  puri)ose. 
It  further  provides  that  specimens  and  sami)les  of  these  products  may  be  pur- 
chased in  open  market  and  examined  in  the  laboratory  for  purity  and  potency, 
and  that  faulty  methods  of  construction,  faulty  products,  false  labeling,  etc., 
are  punishable  by  fine  and  also  by  suspension  or  revocation  of  the  license. 

This  work  has  been  steadily  progressing  in  a  quiet  and  unostentatious  way. 
and  the  records  of  the  laboratory  show  a  most  remarkable  improvement  in  the 
quality  of  these  products,  especially  vaccine  virus,  whereas  before  the  passage 
of  this  law  and  of  the  regulations  frauKMl  thereunder  it  was  not  an  unconnnon 
thing  to  find  vaccine  which  contained  hundreds  of  micro-organisms.  In  a  point 
of  vaccine  virus  it  is  not  an  uncommon  thing  now  to  find  most  of  it  containing 
le.ss  than  100  per  same  quantity,  with  a  notable  absence  of  pathogenic  and 
p.vogenic  organisms. 

In  accordance  with  the  requests  of  manufacturers  and  with  the  recommenda- 
tions passed  by  the  American  Medieval  Association  and  the  American  Pharma- 
ceutical Association,  the  i)reparation  of  a  standard  antitoxic  unit  for  use  in  the 
United  States  has  been  inaugurated  in  the  laboratory,  and  it  is  hoped  that 
within  a  few  months  it  will  l)e  ready  for  issuance  and  use. 

Aid  has  been  extended  to  State  and  local  health  officers  in  many  directions. 
The  contamination  of  city  and  town  water  supplies  by  tyiihoid  has  been  exten- 
sively investigjited  when  requested,  and  recommendations  have  been  made  as  to 
their  betterment. 

Cases  of  suspected  plague  occurring  in  various  p;irts  of  the  country,  and 
arriving  at  the  quarantine  stations  on  our  shores,  have  from  time  to  time 
been  investigated  by  the  laboratory,  and  have  furnished  an  additional  safeguard 
against  the  invasion  of  this  disease. 

Investigations  as  to  the  etiology  of  yellow  fever,  and  especially  as  to  the  rela- 
tion of  the  mosquito  to  the  transmission  of  yellow  fever,  have  formed  the  subject 
of  investigation  in  epidemic  habitats  of  the  disease  by  members  of  the  laboratory 
force  and  under  the  auspices  of  the  Yellow  Fever  Institute  of  the  Service.  These 
investigations  have  served  to  amply  confirm  the  original  investigations  of  Keed 
as  to  the  role  played  by  the  mosquito  in  the  conve.vance  of  the  disease,  and  are 
at  this  time  in  striking  accord  with  the  recently  published  report  of  a  commis- 
sion of  the  Pasteur  Institute,  of  P.-iris.  France,  on  the  same  subject. 

The  dissemination  of  malarial  fevers  by  mosquitoes  has  also  been  under  inves- 
tigation and  in  a  l)ulletin  now  ready  for  the  press  will  be  found  an  interesting 
memoir  on  the  toxicity  of  filtered  malarial  blood. 

It  is  diflicult  within  the  limits  of  an  address  of  this  sort  to  state  what  has 
been  accomplished  liy  the  laboratory  of  the  Service,  so  wide  and  so  varied  having 
been  its  operations,  and  it  is  even  more  dillicult  to  predict  limits  as  to  its  future 
usefulness.  A  progressive  spirit  actuates  the  director.  Dr.  M.  J.  Rosenau,  who 
is  both  scientific  and  enthusiastic,  and  this  enthusiasm  he  im])arts  to  his  assist- 
ants, and  in  a  qiuet  wa.v,  without  ostentation,  almost  every  important  question 
relating  to  the  jniblic  health  is  the  siibject  of  investigation. 

The  subject  of  the  sanitation  of  railway  coaches  and  sleeping  cars  is  receiving 
careful  attention,  and  it  is  believed  that  this  vital  question  will  be  considerably 
cleared  up  by  investigations  which  have  been  continued  from  time  to  time  over  a 
period  of  several  years. 


PUBLIC    HKALTH    AND    MARINK-IIUSI'ITAL    SKRVICK.  415 

Tlu>  Sorvirr  is  justly  proud  ol"  its  Lilioratury.  ;iutl  Teds  tliul.  wliilc  its  aiiucnuu-t'- 
iMcnts  liavo  Itocn  coniijarativoly  fow.  its  acliicnciucuts  have  l)C'eii  of  value  and 
promise  an  untold  amount  of  ,i:i:od  for  the  future. 

HKPOIfT    OF    SI  lU;.    1\    M.    ('AI{K1  NGTON. 

8nrg.  p.  M.  Carrington  reports  as  follows: 

Arriviuf?  in  Atlantie  City  on  the  eveuinj?  of  June  .">,  he  received  telesrai)liie 
instructions  from  the  Surgeon-General  to  rei)res(>nt  him  in  th(>  house  of  delej^ates 
until  his  arrival. 

On  Monday  and  Tuesday,  the  (Jth  and  7th,  he  therefore  attended  the  meetings 
of  the  house,  reporting'  vei-hally  to  the  Surgeon-(;eneral  upon  his  arrival.  He 
registered  in  the  section  on  hygiene  and  sanitary  science  and  attended  its  ses- 
sions, which  were  well  attendivl,  and  offered  an  interesting  ])rogrannne. 

rai)ers  hy  Drs.  S.  A.  Knopf,  of  New  York,  Richard  Cole  Newton,  of  New 
Jersey,  and  Arnold  C.  Klehs,  of  Chicago,  were  of  especial  interest  as  dealing 
with  tuberculosis  and  allied  questions. 

Upon  adjournment  of  the  association  he  returned  to  his  station,  reporting  at 
the  lUireau  en  route  as  directed,  and  resuming  conmiand  of  the  sanatorium  at 
Fort  Stanton,  N.  >Ie.\.,  on  June  1.3. 

Surgeon  Carrington  fin-ther  reports  tliat,  in  addition  to  attending  the  sessions 
of  the  section  and  the  general  meetings,  he  had  pleasant  and  instructive  confer- 
ences with  a  inunl)(>r  of  delegates  on  subjects  innuediately  connected  with  the 
management  of  sanatoria.  In  the  general  meetings  the  symposiinn  on  the  Gov- 
ernment services  was  most  interesting  and  profitable ;  addresses  by  Dr.  Victor 
C.  Vaughj'.n,  of  Ann  Arbor,  Surgeons  Stokes  and  Borden,  of  the  Navy  and  x\rmy, 
and  Surgeon-(Jeneral  Walter  Wyman  were  well  received  and  elicited  unich 
applause  and  favorable  comment. 

UEPORT   OF    PASSED    ASST.  SURG.  31.  J.  ROSENAU. 

Passed  Asst.  Siirg.  JNl.  J.  Kosenati  reports  that  he  attended  the 
meeting  of  the  American  Medical  Association  at  Atlantic  City  Jtuie  6 
to  9,  ])aying  particular  attention  to  the  proceedings  in  the  section  of 
pathology  and  physiology. 

The  section  meeting  was  one  of  the  best  the  association  ever  held,  and  many 
valuable  papers  were  read  on  the  subjects  in  (luestion. 

The  paper  which  i)erhai)s  elicited  most  attention  was  one  by  Dr.  Victor  C. 
Vaughan,  of  Ann  Arbor,  Mich.,  entitled  "  Further  studies  on  bacterial  intercel- 
lular toxins." 

Vaughan  uses  massive  growths  of  bacteria,  especially  colon  bacilli,  to  study 
the  cellular  toxins,  because  the  bacterial  cell  may  be  obtained  practically  free 
from  all  extraneous  matter,  which  is  scarcely  i)ossil)le  with  multicellular  jilants 
or  animals.  Vaughan  obtained  several  pounds  of  colon  bacilli — typhoid,  anthrax, 
etc. — and  considers  that  he  has,  instead  of  a  great  mass  of  bacterial  cells,  a  defi- 
nite chemical  compound  from  which  he  separates  out,  by  the  use  of  acids,  alkalies, 
and  other  substances,  particularly  sodium  alcsdiolate,  various  substances,  some 
of  which  are  toxic,  some  bacteriolytic,  etc.  In  this  cell  mass  he  has  found  sub- 
stances belonging  to  the  nucleic  group  which,  according  to  Ehrlich.  is  the  admin- 
istrative grouf) ;  also  fats,  carbohydrates,  amido  com])ounds,  etc. 

Based  on  this  work,  Vaughan  has  enunciated  a  theory  of  inmmnlty,  consider- 
ing that  the  toxic  group  combines  with  a  particular  chemic  group  in  the  pro- 
toplasm of  the  cell,  which  may  destroy  this  group  but  not  the  wliole  cell.  In 
this  way  we  have  a  distinction  between  a  poison  and  a  toxin.  All  toxins  jtre 
poisons,  according  to  his  defiiution.  but  all  poisons  are  not  necessarily  toxins; 
and  it  is  only  the  substance  which  is  able  to  destroy  one  group  of  the  cell  com- 
position, leaving  the  rest  of  the  cell  intact  to  regenerate  this  group,  in  that  way 
producing  an  excess  of  this  particular  group  and  thereby  inmiunit.v. 

We  see  here  really  Ehrlich's  theory  in  different  terms.  Instead  of  considering 
a  molecule  with  side  chains  and  a  protoplasmic  substance  with  receptors, 
Vaughan  calls  them  chemical  groups. 

Vaughan's  thoughts  are  clear  and  definite,  and  are  very  helpful  in  formulat- 
ing ideas  upon  immunity,  placing  them  upon  very  material  chemical  bases. 


41(3  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

JNIEETING  or  THP:   MISSISSIPPI  STATE  MEDICAL  ASSOCIATION,   APRIL  20-22, 

1904. 

Dr.  Charles  Wardell  Stiles,  chief  of  division  of  zoology,  Hygienic 
Laboratory,  reports  through  the  director  Hygienic  Laboratory,  as 
follows : 

Nearly  bis  entire  time  on  April  21  was  occupied  in  aiTanging  for  a  patient 
and  finding  fresh  material  for  microscopic  demonstration  before  the  association, 
bence  be  missed  most  of  tbe  papers  delivered  tbe  second  daj'  of  tbe  meeting. 
In  tbe  evening  of  tlie  second  day  be  gave  an  "Address  on  bookworm  disease  or 
uncinariasis,  witb  special  reference  to  its  eradication,"  illustrated  by  lantern 
slides. 

During  tbe  tbird  day  of  the  meetings  bis  time  was  almost  entirely  occupied 
in  exhibiting  a  case  of  bookworm  disease  and  in  a  microscopic  demonstration  of 
tbe  parasite  and  its  eggs,  witb  method  of  preparing  tbe  specimens  for  diagnosis, 
to  tbe  members  of  tbe  association,  who  left  the  general  meeting  two  or  three  at 
a  time. 

He  further  reports  that  during  the  first  year  of  reorganization  of  tbe  State 
association  4G  counties  have  beeii  organized,  witb  a  membership  of  520,  repre- 
senting a  net  gain  of  378  members,  which  is  the  largest  gain  in  tbe  history  of 
tbe  society. 

Dr.  H.  M.  Folkes,  of  Biloxi,  presented  a  paper  on  "  The  prophylaxis  of  enteric 
fever,"  of  which  tbe  following  is  an  abstract : 

Doctor  Folkes  called  attention  to  rapid  and  widespread  dissemination  of 
typhoid  fever,  especially  since  Spanish-American  war.  He  called  attention  to 
what  are  known  as  typhoid  centers,  citing  as  such  Philadelphia  and  Pittsburg, 
and  pointed  out  how  such  places  are  sources  of  the  greatest  danger  to  tbe  entire 
country.  Dwelling  upon  the  known  avenues  of  infection,  be  discussed  tbe 
strong  probability  of  an  entrance  through  respiratory  channels.  Great  stress 
was  laid  upon  diagnosis,  deeming  it  best  to  err  on  tbe  side  of  safety  rather  than 
baA'e  a  hair-splitting  diagnosis  permit  infection  of  an  entire  family  or  commun- 
ity by  an  unrecognized  case  of  typhoid  masquerading  with  a  multiplicity  of 
misleading  names.  In  tbe  matter  of  infection,  be  considered  erroneous  diagnosis 
and  failure  to  disinfect  excretions  as  being  most  prolific  causes  of  tbe  spread  of 
tbe  disease. 

Citing  recent  epidemic  at  Butler,  Pa.,  and  the  fact  that  10  per  cent  of  tbe 
nurses  engaged  at  that  point  were  infected  witb  the  disease,  he  claimed  that 
pure  carelessness  is  at  tbe  bottom  of  much  spreading  of  typhoid  fever. 

As  prophylactic  measures  in  combating  typhoid,  he  advocated  use  of  screened 
windows  and  doors,  or  mosquito  and  fly  bars,  removal  of  all  drapery  and  floor 
coverings,  together  witb  unnecessary  furniture,  burning  of  all  iniused  food  and 
medicine,  boiling  of  all  bed  linen  and  wearing  apparel  used  by  or  on  tbe  patient, 
and  where  this  is  not  practicable,  its  immersion  in  acid  1 :  500  mercuric  chloride 
solution,  tbe  same  course  to  be  pursued  with  all  utensils  utilized  by  patient, 
putting  all  urine,  feces,  and  sputum  in  same  acid  solution  of  mercury,  and 
insisting  that  nurses  disinfect  their  bands  after  each  and  every  contact  with 
patient,  and  that  they  neither  sleep  nor  eat  in  room  witb  patient.  He  laid 
great  stress  upon  disinfection  of  both  urine  and  feces  for  at  least  six  weeks  after 
recovery.  lie  closed  his  paper  by  stating  that  in  diagnosis  and  disinfection  are 
tbe  only  sure  methods  of  preventing  spread  of  typhoid  fever. 

A  paper  by  Dr.  E.  C.  Coleman,  of  Kosciusko,  entitled  "  Summer  diarrhea  of 
children  and  its  treatment,"  resulted  in  considerable  discussion  on  tbe  subject 
of  diagnosis,  treatment,  and  proprietary  foods. 

Dr.  H.  A.  Gant,  of  Jackson,  in  a  paper  entitled  "A  consideration  of  scarlet 
fevei*,"  considered  that  the  quarantine  regulations  requiring  one  month's 
absence  from  school  were  too  severe,  and  expressed  tbe  opinion  that  ten  or  four- 
teen days  were  sufficient. 

In  bis  presidential  address.  Dr.  C.  D.  Mitchell,  of  Pontotoc,  made  a  plea  for  a 
department  of  public  health,  with  a  physician  as  Cabinet  member  at  the  head. 
He  also  urged  the  necessity  for  uniform  medical  practice  laws. 

In  a  symposium  on  syphilis.  Dr.  S.  W.  Johnston,  of  Vicksburg,  gave  a  general 
historical  review  of  tlie  subject:  Dr.  M.  H.  Bell,  of  Vicksburg.  discussed  tbe 
early  symptoms  of  nasal  syphilis.  Dr.  E.  F.  Howard,  of  Vicksburg,  expressed 
tbe  opinion  that  education  of  young  men  in  reference  to  its  dangers  would  not 


PUBLIC    HEALTH    AND    MAKINP>HOSPlTAL    SERVICE.  417 

do  iniioh  jjood  in  provonting  tlu>  disease;  lie  furtlicr  suggested  jmldieity  and  coiii- 
imlsorj-  reitortiiig  of  cases. 

In  an  extensive  paper  on  "  Opium."  Dr.  B.  F.  Ward,  of  Winona,  gave  a  gen- 
eral historical  review  of  the  subject,  conijtared  the  effects  of  this  drug  upon  the 
negro  witli  its  effects  ujion  the  white,  and  discussed  its  use  in  jtostpartuni  heni- 
ori'hage  and  strangulated  hernia.  lie  expressed  the  view  that  opium  maintains 
uniform  contraction  of  the  nonstriated  muscles.  His  views  provoked  con.sider- 
able  discussion  and  met  with  strong  opposition. 

I)r.  J.  M.  Catchings.  of  Ilazleluirst.  discussed  "Treatment  of  the  oi)ium  habit 
l»y  hyoscine-hydrobromate."  reporting  cases  of  cures  in  seven  to  ten  days,  with 
.some  I'ecurrences.  In  the  discussion.  Doctor  Bu<'lianan.  of  the  State  insane 
a.sylum,  considered  the  hyoscine  method  a  dangerous  one  if  not  handled  care- 
fully ;  if  properly  handled  he  thought  it  probably  the  best  method  for  the 
average  practitioner. 

Dr.  Frank  Jones,  of  Memphis,  in  a  paper  on  "  Some  phases  of  acute  nephritis," 
related  an  interesting  case  in  which  the  patient  had  not  lost  consciousness  dui'- 
ing  convulsions :  there  was  a  great  reduction  of  the  salts  in  the  urine ;  urea 
was  reduced  about  one-half. 

ELE^•ENTH    INTERN  ATIOXAL    CONGRESS    OF     HYGIENE    AND    DEMOGRAPHY, 
HELD    IN    P>RI  SSELS,  BELGIU3I.  SEPTEMBER    2    TO    8.   1903. 

The  report  of  Passed  Asst.  Surg.  J.  M.  Eager  follows: 

Bbussels,  Belgium,  September'  10,  1903. 

Sir  :  In  compliance  with  official  orders  dated  August  12  and  13,  1903,  I  have 
the  honor  to  submit  the  following  report  of  the  proceedings  of  the  Eleventh 
International  Congress  of  Hygiene  and  Demography,  held  at  Brussels,  Belgium, 
September  2  to  8,  1903  : 

The  congress  consisted  of  two  divisions,  hygiene  and  demogi'aphy,  the  seven 
sections  of  the  first  division  meeting  in  tlie  Palais  de  la  Nation  and  the  second 
division  holding  conferences  in  the  Palais  des  Academies,  so  that  during  the 
sessions  of  the  congress  eight  meetings  were  held  simultaneously.  The  congress 
was  under  the  patronage  of  King  Leopold  II  of  Belgium  and  the  honorary  presi- 
dency of  Prince  Albert  of  Belgium. 

ORGAXIZATION. 

The  following  is  a  list  of  the  different  sections,  the  subjects  assigned  to  them, 
and  of  their  presidents  : 

First  division — Hygiene. 

First  section.  Bacteriology,  microbiology,  and  parasitology  applied  to  hygiene: 
Honorary  Belgian  president.  Willems,  member  of  the  Royal  Academy  of  Medi- 
cine ;   president.  Van  Ermengen.  professor  of  the  L'niversity  of  Ghent. 

Second  section.  Alimentary  hygiene,  chemical  and  veterinary  science  applied 
to  hygiene :  Honorary  Belgian  president,  Heynen,  vice-president  of  the  Chamber 
of  Representatives. 

Third  section.  Sanitary  technology,  engineering,  and  ai'chitectural  science 
applied  to  hygiene :  President,  Lieutenant-General  Docteur,  inspector-general 
of  fortifications  and  of  the  engineer  corps  of  Belgium. 

Fourth  section.  Industi'ial  and  professional  hygiene :  Honorary  Belgian  presi- 
dent, Cooreman.  president  of  the  upiier  council  of  labor,  member  of  the  Chamber 
of  Representatives ;  president.  Kuborn,  president  of  the  Royal  Society  of  Public 
Medicine,  at  Seraing. 

Fifth  section.  Hygiene  of  common  carriers :  Honorarj-  Belgian  ]>resident,  Leon 
De  Bniyn,  member  of  the  Chamber  of  Rei)resenta fives,  formerly  minister  of 
agriculture  and  public  works ;  president,  Ramaeckers,  secretary-general  of  the 
ministry  of  railroads,  posts,  and  telegraphs,  Biiissels. 

Sixth  section.  Administrative  hygiene,  prophylaxis  of  transmissible  maladies, 
workmen's  habitations,  infant  hygiene :  Honorary  Belgian  president.  Vergote, 
governor  of  Brabant,  pi'esident  of  the  upper  council  of  public  hygiene ;  presi- 
dent, Vleminckx,  member  of  the  upper  council  of  public  hygiene.  Brussels. 

Seventh  section.  Colonial  hygiene :    Honorary  Belgian  president,  Baron  Van 

8629—04 27 


418  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Eetvelde,  minister  of  the  independent  state  of  Kongo ;    president,  Baron  Wahis, 
governor-general  of  the  independent  state  of  Kongo. 

Second  division — D emog >  «;> /( y. 

Honorary  Belgian  president,  Le  Jeune,  minister  of  state  and  formerly  minister 
of  justice;  president,  Sauveur,  secretary-general  of  the  interior  and  public  in- 
struction. 

Twenty-seven  countries  accepted  the  invitation  of  the  Belgian  Government 
to  send  delegates  to  the  congress. 

OPENING    OF    THE    CONGRESS. 

The  congress  was  opened  in  the  Palais  des  Academies  September  3,  having 
been  preceded  by  a  social  meeting  the  previous  evening.  In  the  opening 
address  Prince  Albert,  honorary  president  of  the  congi*ess,  said  that  through 
the  advances  made  in  recent  years  in  hygiene  the  most  widespreading  and 
deadly  infectious  maladies  are  now  if  not  incurable  at  least  avoidable.  The 
hygienist  has  become  the  savior  of  public  health,  his  field  of  usefulness  daily 
increasing  with  the  augmenting  complexity  of  society  and  the  multiplying 
dangers  of  contamination  with  a  population  more  and  more  compact.  The  prog- 
ress of  hygiene  is  not  so  nmch  crippled  by  lack  of  resources  as  by  private  inertia 
and  interested  opposition.  It  is  against  these  obstacles  that  public  hygiene  is  ajipll- 
cable.  At  the  present  time  authoritative  intervention  for  the  protection  of  public 
health  is  a-  principle  accepted  by  all  civilized  nations.  It  is  not  sufficient  that 
hygienic  laws  exist  in  the  public  codes — there  is  need  of  an  active  propaganda. 

Monsieur  Beco,  president  of  the  congress,  in  his  opening  address  said,  referring 
to  the  question  of  the  transmissibility  of  bovine  tuberculosis  to  man,  that  during 
the  past  ten  years  the  Belgian  Government  has  spent  10,000,000  francs  for  sur- 
veillance against  bovine  tuberculosis.  This  costly  protection  of  public  health 
had  its  justification  in  the  scientific  theory  of  the  certainty  of  the  transmissi- 
bility of  animal  tuberculosis  to  man.  To-day  learned  bacteriologists  whose 
authority  is  universally  recognized  openly  combat  this  theory.  Monsieur  Beco 
expressed  the  hope  that  this  question  would  be  considered  in  full  and  that  the 
discord  that  has  divided  large  numbers  of  scientific  men  and  public  authorities 
might  be  calmed. 

Monsieur  Putzeys,  general  secretary  of  the  congress,  referring  to  the  organiza- 
tion of  the  congress  and  the  composition  of  the  sections,  said  that  1,900  members 
had  subscribed,  of  whom  500  were  official  delegates. 

Doctor  Brouardel,  president  of  the  permanent  commission  of  the  congress 
of  hygiene,  said  that  Belgium  is  manifestly  solicitous  in  matters  of  hygiene, 
especially  as  regards  the  habitations  of  the  laboring  classes. 

The  regular  work  of  the  sections  was  begun  the  afternoon  of  September  3, 
after  the  opening  of  the  hygienic  and  demographic  exhibition. 

ARRANGEMENT    OF    CONGRESSIONAL    WORK. 

In  the  present  report  account  will  be  given  of  work  of  particular  moment 
brought  before  the  congress,  considering  the  labor  of  each  section  consecutively. 
More  than  150  formal  addresses  were  delivered,  aside  from  incidental  discussion. 

Firs t  d ivis ion — Hygiene. 

First  section :  In  this  section  were  considered  the  subjects  of  bacteriology, 
microbiology,  and  parasitology  applied  to  hygiene,  and  the  topics  were  taken  up 
in  a  series  of  questions,  as  follows:  (1)  The  mode  of  action  and  the  origin  of 
the  active  substances  of  preventive  and  antitoxic  serums.  (2)  What  are  the 
best  methods  for  measuring  the  activity  of  serums?  (3)  The  value  of  anti- 
diphtheric  serum  from  the  point  of  view  of  prophylaxis.  (4)  The  unification 
of  procedures  for  the  bacterial  analysis  of  water.  (5)  Is  human  tuberculosis 
and  that  of  domestic  animals  due  to  the  same  microbic  species,  namely,  the 
bacillus  of  Koch?  The  fifth  question  was  discussed  in  union  with  the  second 
section. 

Second  section.  The  subject  of  alimentary  hygiene,  together  with  chemical 
and  veterinary  sciences  applied  to  hygiene,  was  laid  before  the  section  in  four 
questiojjs:  (1)  What  are  the  maladies  of  animals  for  slaughter  that  render  the 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  419 

moat  unlit  for  alhnontation,  which  of  those  moats  may  bo  oatoii  after  steriliza- 
tion, and  whioh  sliould  bo  absolutely  destroyedV  (2)  Regulation  of  the  sale 
of  meat  destined  for  food,  study  of  the  eausos  that  determine  a  variation  in 
the  ehomieal  composition  of  milk,  measures  to  be  taken  to  prevent  the  sale  of 
milk  too  poor  in  useful  constituents,  organization  of  control,  and  the  anal.vtical 
methods  to  bo  omploye<l.  (3)  The  sterilization  of  preserved  food,  conditions 
luider  which  this  operation  should  be  effected,  the  voritication  of  the  sterility, 
and  is  there  reason  to  tolerate  a  certain  quantity  of  antiseptic  in  preserved 
foods  not  capable  of  beiuj^  sterilized;  and  if  so.  what  antiseptics  may  be 
employed?  (4)  The  pasteurization  of  milk,  the  conditions  to  be  observed,  and 
the  technical  procinluros  to  be  adopted  to  destroy  pathogenic  microbes  in  milk 
without  compromising  the  quality  and  the  value  of  the  iiroduct. 

Third  section.  Sanitary  toc-hnology.  engineering  and  architectural  science 
applied  to  hygiene,  was  the  subject  considered  by  this  section.  It  was  pre- 
.sentod  in  six  questions:  (1)  Purification  from  bacteria  of  sewage  and  residual 
industrial  waters.  (2)  The  advantages  and  the  inconveniences  of  the  single 
and  the  separate  systems  of  sewage,  (oi  Establish  from  the  point  of  view  of 
the  requii'oments  of  hygiene  the  conditions  that  should  be  fulfilled  at  calcareous 
springs.  (4)  Hygiene  of  public  roads,  the  collection,  transport,  and  final  treat- 
ment of  swill  and  other  filth,  and  the  hygienic  rules  to  be  followed  in  dwellings 
and  towns.  (5)  The  progress  made  in  twenty  years  in  the  warming  and  ven- 
tilation of  private  and  community  buildings.  (G)  The  general  rules  of  hygiene 
to  be  observed  in  the  distribution,  permanent  aeration,  and  the  interior  decora- 
tion of  dwelling  liouses. 

Fourth  section.  Industrial  and  professional  hygiene.  Six  questions  were 
considered  by  this  section:  (1)  Ankylostomiasis.  (2)  Measures  to  be  taken 
with  a  view  to  preserving  the  health  of  workmen  occupied  in  factories  where 
unrefined  zinc  and  lead  are  Iiaudled  or  where  compositions  of  lead  are  pro- 
duced. (3)  By  what  physiological  methods  degrees  of  fatigue  may  be  studied 
in  different  trades,  and  what  are  the  arguments  that  physiological  and  medical 
science  can  advance  in  favor  of  appropriate  organization  of  labor?  (4)  What  is 
the  infiuenee  on  the  health  of  persons  emi)loyed  in  spinning  mills  for  flax,  and 
wliat  measures  should  be  taken  from  the  point  of  view  of  temperature  and  the 
hygrometric  state  of  the  air  for  the  amelioration  of  the  conditions  of  labor  in 
such  places?  (5)  Work  involving  the  handling  of  hair,  the  conditions  of  in.salu- 
brity  of  this  industi-y.  the  nature  and  gravity  of  diseases  provoked  thereby,  and 
the  measures  to  be  taken  to  render  the  work  healthful.  (6)  Indicate  the 
sanitary  measures  taken  in  different  countries  concerning  small  industries  and 
industries  in  domiciles.  Discuss  these  measures,  calling  attention  to  those  that 
it  is  desirable  to  modify  or  perfect. 

Fifth  section.  Hygiene  of  common  carriers :  ( 1 )  The  organization  of  the 
hygienic  propaganda  and  the  struggle  against  transmissible  maladies  by  the 
active  personnel  of  railroads.  (2)  The  best  measures  for  the  disinfection  of 
cars  serving  for  transportation  of  travelers,  animals,  and  merchandise.  This 
question  was  treated  by  the  fifth  and  sixth  sections  in  joint  session. 

Sixth  section.  Administrative  hygiene,  prophylaxis  of  ti*ansmissible  maladies, 
habitations  for  the  laboring  classes,  and  infantile  hygiene :  ( 1 )  Rules  to  be 
followed  in  the  alimentation  of  children  during  the  first  year-  of  life,  means  to 
be  employed  in  order  to  bring  into  practice  the  notions  of  infantile  hygiene, 
and,  above  all,  the  precepts  for  the  feeding  of  nurslings,  legal  and  administra- 
tive protection  of  the  new  born.  (2)  The  aim  in  medical  and  hygienic  inspec- 
tion of  public  and  private  schools,  the  organization  of  such  inspection,  and  con- 
ditions necessary  to  make  it  efficacious.  (3)  The  intervention  of  public  author- 
ity in  the  contest  against  tuberculosis.  (4)  The  sanitary  propliylaxis  of  pest 
and  modifications  to  be  made  in  quarantine  regulations.  (5)  Public  interven- 
tion for  the  construction  of  salubrious  habitations  for  the  needy  laboring  popu- 
lation.     (G)  Practical  disinfection  of  habitations. 

Seventh  section.  Colonial  hygiene :  ( 1 )  Alimentation  of  Europeans  and  indig- 
enous laborers  in  liot  countries.  (2)  Prophylaxis  of  malaria.  (3)  Prophylaxis 
of  the  sleeping  sickness.  (4)  Prophylaxis  of  beriberi.  (5)  Prophylaxis  of 
smallpox  in  hot  countries;  vaccination  and  variolization.  (G)  Organization  of 
instruction  in  colonial  metlicine. 

Second  division — Demography. 

The  division  of  demography  met  in  a  single  section.  Fourteen  questions  were 
considered:   (1)   Causes  of  mortalitj-  and  a  critical  exijose  of  the  statistics  of 


420  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SEKVICE, 

stillbirths  in  the  different  countries.  (2)  Mortality  in  early  infancy,  its  fre- 
(lueney,  its  causes,  and  the  measures  to  be  taken.  (3)  The  organization  of 
uniform  official  statistics  of  the  causes  of  death ;  the  comparative  frequency  of 
the  different  causes  of  death  in  cities  using  the  international  nomenclature. 
(4)  The  basis  of  con-ect  statistics  of  birth;  demographical  study  of  the  ten- 
dencies to  the  increase  and  decrease  of  the  birth  rate;  fluctuations  in  the  birth 
rate.  (5)  What  are  the  best  coefficients  to  employ  in  the  study  of  the  laws 
regulating  the  marriage,  birth,  and  death  rates?  (G)  Examine  the  objections 
made  to  the  law  attributing  a  relation  between  marriage,  birth,  and  death  rates 
and  the  resources  and  needs  of  the  people.  (7)  Statistical  and  dynamic  demog- 
raphy of  city  populations.  (8)  Tables  of  mortality  according  to  the  trades  of 
workers  in  dift"erent  industries ;  the  means  of  promptly  and  scientifically  estab- 
lishing such  stati-stics  where  they  do  not  exist  and  making  them  useful  for  com- 
parison ;  to  what  point  may  the  statistical  tables  of  one  country  be  utilized  by 
another?  (9)  Mental  alienation,  its  development  and  causes  and  the  measures 
to  be  taken ;  the  methods  to  adopt  and  the  demographic  data  to  collect  concern- 
ing insane  persons  cared  for  at  their  homes.  (10)  The  mortality  caused  by 
abuse  of  alcoholic  drink — the  facts,  the  causes,  and  the  measures  to  be  taken. 
(11)  Interior  migrations,  the  depopulation  of  rural  places,  increased  population 
of  cities ;  the  advantages,  inconveniences,  and  causes  of  the  same  and  the 
measures  to  be  taken.  (12)  Of  what  profit  to  demography  would  be  the  estab- 
lishment of  statistics  of  pauperism,  and  what  is  the  best  method  to  arrange  these 
statistics?  (13)  Statistics  and  causes  of  suicide.  (14)  Archives  as  a  source  of 
historic  demography. 

First  section:  Bacteriology. — The  work  of  this  section  was  devoted  principally 
to  a  study  of  the  action  and  origin  of  the  active  substances  of  preventive  and 
antitoxic  serums  and  the  best  methods  of  jueasuring  their  activity,  and  to  the 
unification  of  the  bacterial  analyis  of  water.  These  subjects  were  developed  in 
such  a  technical  manner  that  any  brief  conclusions  as  to  the  results  of  the  dis- 
cussions would  be  luisatisfactory  and  misleading.  The  addresses  of  the  follow- 
ing reporters  are  therefore  transmitted  with  this  report :  Doctor  Bordet,  director 
of  the  serotherapeutic  institute  at  Milan  ;  Doctor  Denys,  professor  at  the  Univer- 
sity of  Louvain;  Dr.  R.  Pfeiffer,  professor  at  the  University  of  Konigsberg; 
Doctor  Roux.  subdirector  of  the  Pasteur  Institute,  Paris ;  Leon  Grimbert,  Paris ; 
Doctor  Loeffler,  professor  of  the  University  of  Griefswald,  and  Doctor  Malvoz, 
of  the  University  of  Liege. 

The  questions  of  the  prophylactic  value  of  antidiijhtheritic  serum  and  of  the 
unity  of  animal  and  human  tuberculosis  attracted  a  general  interest  at  the  con- 
gress. Bearing  on  the  question  of  identity  of  bovine  and  human  tuberculosis, 
Dr.  D.  A.  De  Jong,  state  veterinarian  at  Lyde,  read  a  jiaper  in  which  he  con- 
cluded that  the  tuberculoses  of  man  and  of  the  other  mammalia  are  identical ; 
that  they  are  caused  by  the  same  bacillus  of  Koch ;  that  the  bacilli  isolated 
from  man  vary  only  in  the  degree  of  virulence  from  those  of  animals,  and 
more  especially  the  bovine  bacillus  is  ordinarily  more  \irulent  than  that  of  man, 
though  this  difference  is  not  constant.  The  superior  virulence  of  the  bacilli  of 
beef  constitutes  a  danger  that  menaces  the  health  of  man  not  only  as  far  as 
concerns  the  employment  of  milk  and  meat,  but  also  because  man  may  become 
infected  by  inhaling  bacilli  from  bovines.  Thus  the  study  of  the  pathogenic 
action  of  the  bacillus  of  human  tuberculosis  and  that  of  tuberculosis  of 
beeves  on  the  different  animals  used  for  experiment,  not  only  small  laboratory 
animals  but  also  large  animals,  does  not  give  reason  to  believe  that  these  two 
bacilli  should  be  separated,  but  on  the  contrary  there  is  a  reason  for  considering 
them  as  identical.  Doctor  De  Jong  said  that  the  tuberculosis  of  mammifers 
sometimes  spontaneously  attacks  parrots.  The  tuberculosis  of  the  domestic  fowl 
is  caused  by  a  bacillus  having  a  different  pathogenic  action  from  the  bacillus  of 
mammifers,  and,  though  there  is  reason,  from  experiments  already  made,  to 
believe  that  in  time  it  may  be  possible  by  experimental  methods  to  transform  the 
bacillus  of  mammifers  into  that  of  fowls,  a  conclusion  can  not  at  the  present 
time  be  drawn  as  to  the  identity  of  these  organisms.  It  must  be  admitted,  how- 
ever, that  in  mammifers,  side  by  side  with  ordinary  tuberculosis,  there  is  found 
a  tuberculosis  caused  by  the  bacillus  of  the  fowl.  Thus  the  bacillus  of  the  fowl 
can  infect  man  and  other  domestic  animals,  and,  on  the  other  hand,  the  bacillus 
of  mammifers  is  susceptil)le  of  transmission  to  birds.  Dr.  G.  Gratia,  professor 
of  the  State  School  of  Veterinary  Medicine  at  Cureghem,  presented  an  exhaus- 
tive paper  exiiressing  the  opinion  that,  in  the  present  state  of  knowledge,  it 
must  be  admitted  that  human  tuberculosis  and  tuberculosis  of  the  domestic 
animals  are  of  the  same  morbid  species,  and  caused  by  the  bacillus  of  Koch. 


PUBLIC    HEALTH    AND    MARTNK-HOSPITAL    SERVICE.  421 

Variations,  he  said,  exist  in  tlic  morbid  tyiw  and  in  the  typo  of  the  bacillns, 
ivlatini;  to  form,  cnlturos,  and  virulence.  liut  these  variations  do  not  pass  tlio 
limits  of  a  specific  type,  and  it  may  !)e  added  that,  among  the  characters  of  any 
given  specimen,  there  are  no  ]ieculinrities  that  may  not  he  acquired,  hy  other 
si)ecimens  of  tubercular  bacilli.  The  di£feren<-es  observed  are  due  to  differ- 
ences in  the  culture  medium,  living  or  artiiicial.  and  are  simply  those  of 
varieties.  So  thi-e(>  vnric'ties  of  the  species  bacillus  tuberculosis  may  be  recog- 
nized, namely,  the  human,  the  I)ovine,  and  the  avian.  The  human  and  bovine 
varieties,  nearly  related,  often  become  confused  in  suitable  media  and  this  is 
seen  in  intermediary  animals,  such  as  guinea  pigs,  rabl)its,  dogs,  cats,  monkeys, 
horses,  and  even  hogs  and  goats.  Thus  experiments  have  shown  that  these  varie- 
ties are  reversible  and  susceptil)le  of  passing  from  one  species  of  animal  to 
another.  Still  the  danger  is  only  relative,  because  in  the  real  conditions  of  life 
tuberculosis  is  transmitted  principally  among  congenei-s,  although  it  is  true  that 
it  may  also  be  comnnuiicated  by  heterogenous  contagion. 

In  the  discussion  that  followed  the  reading  of  these  papers,  the  section  of  ali- 
mentary hygiene  .joined  with  the  section  of  bacteriology.  The  united  sections 
adoi)ted  the  following  resolutions  : 

"  Tuberculosis  is  more  particularly  transmissible  from  man  to  man.  Never- 
theless, the  congress  is  of  the  opinion  that  in  the  present  state  of  knowledge 
there  is  reason  to  maintain  and  prescribe  hygienic  measures  against  the  propaga- 
tion of  animal  tuberciilosis  to  the  Imman  species." 

As  to  the  therapeutic  value  of  antidiplitheritic  serum.  Doctor  Netter,  physician 
to  the  Trousseau  Hospital.  I'aris.  stated  that  the  pedriatic  society  of  Paris,  the 
Comite  Consultatif  d'  hygiene  i)ublique  de  France,  and  the  French  Academy  of 
Medicine  have  proclaimed  highly  the  efiicacy  of  preventive  injections  of  anti- 
diphtheritic  serum  and  declare  that  its  injection  constitutes  a  preservative 
method  against  diplitheria.  The  number  of  prophylactic  injections  practiced  in 
France  is  over  11,300.  Doctor  Netter  himself  has  initiated  4.473  injections.  Of 
the  injections  made,  4,121  were  in  the  families  of  diphtheritics,  and  2.000  in 
hospitals,  asylums,  infant  homes,  and  schools  in  the  course  of  an  epidemic  of 
diphtheria.  Five  thousand  three  hundred  children  in  hospitals  were  submitted 
to  systematic  preventive  injections  in  illness  not  fully  recognized  as  diphtheria. 
Of  these,  more  than  3,000  were  subjects  of  measles  and  more  than  1,000  of  scar- 
latina. The  injections  confer  an  almost  complete  immunity  during  a  period 
wliicli  begins  twenty-four  hours  after  the  injection  and  ends  ordinarily  at  the 
end  of  twenty-eiglit  days.  Those  who  develop  diphtheria,  notwithstanding  the 
injections  and  outside  the  period  of  immunity,  habitually  present  a  very  benign 
diphtheria,  in  the  same  way  that  smallpox  is  ordinarily  light  in  the  vaccinated. 
Inoculated  subjects  are  exposed  to  the  accidents  of  serum  employment,  but 
these  are  usuall.v  mild  and  do  not  justify  abandoning  the  procedure.  They  are 
more  common  witli  adults.  Their  frequency  is  less  if  an  old  serum  is  used. 
Sometimes  injections  are  followed  by  abscess.  This,  shows  a  fault  in  asepsis. 
The  dose  of  serum  usually  employed  as  a  preventive  is  500  units.  Five  cubic 
centimeters  are  usually  employed  at  the  Pasteur  Institute.  All  children  in  a 
family  where  there  is  diphtheria  should  receive  injections.  This  practice,  indis- 
pensable where  observation  is  impossible,  should  also  be  followed  in  families  in 
easy  circumstances  where  it  is  not  difficult  to  watch  children.  In  case  of  an 
epidemic  in  the  wards  of  a  hospital  or  similar  institution,  preventive  injections 
should  be  employed  without  delay.  It  is  also  of  great  advantage  to  use  this 
measure  in  day  schools.  Systematic  inoculation,  repeated  every  four  weeks, 
protects  children  in  institutions  from  a  spread  of  the  disease.  It  should  be 
employed  in  all  children's  hospitals  where  the  introduction  of  dij>litheria  is  com- 
mon, more  esi)ecially  in  the  wards  for  measles  and  scarlet  fever.  In  the  measles 
wards  the  doses  should  be  strong  and  the  intervals  between  injections  short. 

Professor  Ehrlich,  director  of  the  Royal  Institute  of  Experimental  Therapeu- 
tics, Frankfort-on-tbe-Main,  said  that  the  elimination  of  diphtheritic  antitoxin 
after  preventive  injections  should  be  studied.  Since  in  these  cases  minimum 
doses  are  used,  ordinary  methods  of  study  can  not  be  euiploj'ed.  It  is  necessary 
to  use  procedures  which  depend  on  the  neutralization  of  small  doses  of  toxins. 
Sucli  research  would  have  for  its  eud  the  determination  of  the  minimum  quan- 
tity of  antitoxin  that  a  serum  must  contain  to  preserve  the  organism  from  diph- 
theria. The  injection  of  the  serum  should  be  renewed  if  analysis  of  the  blood 
shows  the  necessity.  Persons  treated  by  preventive  doses  should  become  sub- 
jects of  a  latent  diphtheria,  characterized  by  the  production  of  an  active  immu- 
nization and  the  augmentation  of  the  antitoxic  contents  of  the  sei-um.  In  the 
interests  of  prophylaxis,  researches  should  be  made  to  determine  if  these  diph- 


422  PUBLIC    HEALTH    AND   MAEINE-HOSPITAL   SERVICE. 

tberias  are  freqiKMit  in  subjects  of  the  preveutive  treatment.  Doctur  Elirlich's 
paper  is  transmitted  in  this  report. 

Papers  presented  by  Dr.  P.  Aaser,  of  Christiania  ;  Dr.  Frangois  de  Torday.  of 
Budapest,  and  Dr.  C.  H.  H.  Spronek,  of  LTtreclit,  testified  to  the  decided  in-opliy- 
lactic  value  of  injections  of  antidiphtheritic  serum  in  practice  in  Norway,  Hun- 
gary, and  Holland,  respectively. 

Second  section:  AUmentary  hygiene. — Sixteen  reports  were  made  to  this  sec- 
tion on  the  subjects  of  slaughterhouse  inspection,  examination,  and  preservation 
of  food,  milk  inspection  and  pasteurization.  The  topics  considered  comprised 
the  whole  range  of  the  diseases  of  food  animals,  tuberculosis  and  trichinosis 
receiving  attention,  but  other  maladies,  such  as  albuminuria,  hydrnemia,  melan- 
osis, carcinoma,  and  diverse  pathological  conditions  being  discussed  with  a 
view  as  to  whether  the  whole  or  part  of  the  carcasses  of  affected  animals  could 
be  used  for  alimentary  purposes  and  what  precautions  are  necessary. 

The  work  on  tuberculosis  which  was  done  in  connection  with  the  first  section 
is  recorded  elsewhere  in  this  report. 

In  regard  to  the  preservation  of  alimentary  substances,  it  was  resolved  by  the 
section  that  the  employment  of  food  stuffs  of  bad  quality  or  in  damaged  condi- 
tion should  be  absolutely  forbidden ;  the  sterilization  of  preserved  food  stuffs 
should  be  complete ;  and  that  it  is  not  possible  to  give  a  formula  for  steriliza- 
tion applicable  to  all  cases,  since  conditions  differ  according  to  the  preparation, 
containers,  and  nature  of  these  aliments,  but  that  in  all  cases  the  containers 
should  be  hermetically  sealed. 

In  regard  to  alimentation  the  following  i-esolution  was  passed: 

"  The  International  Congress  of  Hygiene  is  of  the  opinion  that  alimentation 
is  a  powerful  arm  against  transmissible  maladies  and  that  an  international 
movement  should  be  made  having  for  its  object  the  study  and  popularization  of 
means  to  better  the  food  of  men  and  beasts." 

Third  section:  Sanitary  technology. — This  section  devoted  itself  to  the  ques- 
tions of  water  suiiply,  sewage  systems,  lime-laden  waters,  street  cleaning,  and 
the  ventilation  and  heating  of  habitations.  Of  the  25  papers  presented  many 
were  prepared  by  engineers,  architects,  and  geologists,  and  were  of  such  a  tech- 
nical nature  as  to  preclude  their  being  summarized.  In  the  matter  of  the 
advantages  and  inconveniences  of  sewers  on  the  single  and  separate  systems,  the 
unanimous  resolution  was  adopted  by  the  assembly  that  these  systems  may 
each  be  usefully  employed  according  to  circumstances,  and  that  it  is  only  after 
a  comparative  study  in  each  particular  case  of  the  advantages  and  inconven- 
iences of  each  system  that  the  sanitary  engineer  can  pretend  to  form  well- 
founded  conclusions. 

Fourth  section:  Industrial  and  professional  hygiene. — This  section  devoted 
itself,  as  will  be  seen  from  the  enumeration  of  questions,  to  the  consideration  of 
prophylaxis  of  diseases  of  miners,  workers  in  zinc  and  lead,  flax  spinners,  and 
other  unhealthy  trades,  making  a  study  of  the  degree  of  influence  of  these  trades 
on  the  health  of  the  workmen  and  the  means  to  be  adopted  to  lessen  or  avoid 
illness.  About  25  pajiers  were  read  on  the  subject.  The  greatest  local  interest 
attached  to  the  study  of  ankylostomiasis,  a  disease  particularly  prevalent  among 
coal  miners  in  Belgium. 

Fifth  section:  Hygiene  of  common  carriers. — The  work  of  this  section,  con- 
sisting of  the  organization  of  a  hygienic  propaganda  among  railroad  employees, 
the  consideration  of  the  prevention  of  the  spread  of  transmissible  maladies  by 
railroad  cars,  and  the  methods  of  disinfecting  such  cars  whether  serving  for  the 
transportation  of  passengers,  animals,  or  merchandise,  had  but  little  bearing  on 
general  epidemiology.  Tuberculosis,  skin  diseases,  and  similar  affections  are  the 
maladies  against  which  the  European  sanitarian  has  largely  to  contend.  The 
hygienic  instruction  of  railroad  employees,  as  considered  before  the  sections,  has 
a  moi-e  practical  application  in  relation  to  European  than  to  American  railroads. 
Transportation  of  the  sick  was  also  considered  and  the  necessity  for  separate 
compartments  insisted  upon.  The  movements  of  railroad  trains  in  times  of 
epidemics  was  not  dwelt  upon. 

Relating  to  the  best  methods  for  disinfecting  railroad  cars  serving  for  the 
transport  of  passengers,  animals,  and  merchandise,  papers  which  accompany 
this  report  were  submitted  by  Dr.  P  Redard,  physician  in  chief  of  the  State 
railroads  of  France ;  Dr.  Alois  Lode,  professor  of  hygiene.  University  of 
Innsbruck  ;  Dr.  II.  Kossel,  member  of  the  sanitary  office  of  the  German  Em- 
pire, Berlin,  and  Doctor  De  Rechter.  of  the  hygienic  service  of  Brussels.  Doctor 
Lode  concluded  that  the  disinfection  of  railroad  cars  for  cattle  as  well  as  for 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  423 

passcnsers  is  an  iiiiportunt  factor  in  preventing  the  propagation  of  infectious 
maladies,  but  tliat.  if  the  procedures  adopted  are  not  ai>i)ropriate,  such  treat- 
ment is  not  of  advantage.  In  this  matter  there  is  nuich  to  be  desired  in  the 
regidations  of  tlie  various  countries.  In  the  disinfection  of  cattle  cars  it  is 
necessary  to  destroy  very  resistent  microbes.  For  this  pur])ose  the  most  pref- 
erable method  is  irrigati(»n,  repeated  twelve  or  fourteen  times,  of  a  5  per  cent 
solution  of  chloride  of  lime  employed  cold  under  i)ressure  of  one-half  atmos- 
phere. This  disinfection  should  be  oI)ligatory  only  when  a  case  of  infection 
has  been  discovered  or  when  the  car  is  suspected  of  infection.  Passenger  cars 
may  be  simi)ly  cleaned  with  a  2  ])er  cent  solution  of  .soda  or  a  ;{  per  cent 
solution  of  soft  soaj).  This  should  always  be  done,  too,  in  connection  with 
disinfection.  The  disinfection  of  passenger  coaches  should  also  I>e  obliga- 
tory when  a  case  of  infection  has  been  discovered,  or  the  coach  is  susi)ected  of 
being  infected.  The  best  means  for  this  puri)ose  is  a  combination  of  formalin 
with  the  consecutive  employment  of  antiseptic  solutions,  or  steam  at  100°  C. 
For  coaches  of  the  third  class  it  is  better  to  emiiloy,  for  each  coach,  200  cubic 
centimeters  of  formalin  (40  per  cent  formadehyde)  diluted  in  1,200  cubic 
centimeters  of  water.  For  coaches  of  the  tirst  and  second  classes,  employ 
600  cubic  centimeters  of  formalin  diluted  with  1,500  cubic  centimeters  of  water. 
The  vaporization  of  formalin  should  be  effected  by  means  of  the  Breslau 
apparatus.  For  coaches  of  the  first  and  second  classes  it  is  necessary  to 
remove  the  seats,  if  possible.  The  cushions,  hangings,  and  carpets  should  be 
spread  out  in  such  a  way  as  to  permit  the  vapor  to  reach  all  parts.  To  neutral- 
ize the  formalin,  100  cubic  centimeters  of  a  solution  (25:1000)  of  ammonia 
should  be  used  for  the  third-class  coa(?hes  and  GOO  cubic  centimeters  of  the  same 
for  first  and  second  class  coaches.  When  the  treatment  by  formalin  is  finished 
it  is  necessary  to  wash  the  floors  with  a  1 :1000  solution  of  cornjsive  subli- 
mate, or  a  2  per  cent  solution  of  creosol.  All  places  soiled  with  the  secretions 
or  excretions  of  the  sick  should  be  treated  with  the  solutions  already  indi- 
cated. In  event  of  infection  by  diphtheria,  scarlatina,  measles,  or  tuber- 
culosis, cushions,  mattresses,  and  carpets  ought  to  be  disinfected  by  steam,  a 
procedure  which  is  absolutely  indispensible  in  event  of  smallpox,  pest,  erysipelas, 
enteric  fever,  cliolera,  and  dysentery.  For  corridor  cars  it  is  necessary  to  treat 
the  corridors  and  cabinets  (watei'-closets)  with  formalin  if  objects  not  disiu- 
fectible  by  vapor  of  water  are  found  in  these  places.  The  funnels  of  the  water- 
closets  should  be  cleaned  by  brushing  with  a  2  per  cent  solution  of  lysol. 
It  is  necessary  when  possible  to  institute  uniform  regulations  for  the  disinfec- 
tion of  railroad  cars. 

After  an  exchange  of  views  on  the  subject  of  disinfection  of  railroad  cars, 
tlie  section  by  a  unanimous  vote  adopted  the  following  resolutions : 

"  The  interior  construction  of  railroad  cars  should  be  arranged  in  such  a 
manner  as  to  facilitate  disinfection  and  ordinary  cleaning.  The  suppression 
of  hangings  is  notably  desirable.  All  decorations  should  be  movable.  The 
ordinary  cleaning  of  passenger  cars  sliould  be  made  rigorous  by  using  damp 
cloths  on  all  movable  parts  and  removing  all  decorations.  The  disinfection  of 
passenger  coaches  should  comprise  the  disinfection  of  surfaces,  either  by 
washing,  by  powdering  with  antiseptic  substances,  or  by  vaporization  witli 
formaldehyde  or  other  substances  of  recognized  efiicieucy,  and  the  complete 
removal  of  decorations.  Special  transports  should  be  employed  for  the  sick 
and  the  dead.  These  transports  should  be  built  in  a  way  to  minimize  the 
possibility  of  contamination  and  should  be  disinfected  after  each  trip. 

"  For  the  transportation  of  cadavers  to  a  long  distance,  the  coffin  should  be 
hermetically  sealed  and  the  cadaver  embalmed  by  an  efficacious  process.  Cattle 
oars  should  be  disinfected  after  each  transport  in  a  measure  that  the  service 
permits.  Freight  cars  should  be  disinfected  when  they  have  contained  putresci- 
ble  or  suspected  substances.  The  disinfection  should  be  preceded  by 
mechanical  cleaning.  The  best  methods  for  the  disinfection  of  cattle  and 
freight  cars  are  steam  under  liigh  pressure,  or  the  repeated  ti'eatmeut  of  all 
walls  by  a  liquid  antiseptic  under  pressure,  either  by  the  Legarde  or  similar 
apparatus.  Filtered  solutions  of  the  chloride  of  lime  and  diluted  solutions  of 
the  hypochlorite  of  soda  or  potash  offer  every  guarantee  for  the  destruction 
of  microbes  and  spores,  but  tlie  damage  they  entail  is  an  objection  to  them  as 
well  as  to  steaming.  It  is  desirable  that  the  same  methods  be  employed  in 
all  countries.  It  would  be  useful  to  institute  a  series  of  experiments  by  an 
international  commission  with  a  view  to  determine  one  or  several  methods 
for  the  disinfection  of  cattle  and  freiglit  cars  fulfilling  the  conditions  of 
economy,  rapidity,  and  efficacy  without  damage  to  material." 


424  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

8i,rt]i  section:  Adiiiiiiistrativc  Jii/picnc. — Bearing  on  the  first  (inestion  rela- 
tive to  alimentation  of  children  during  the  first  year  of  life,  papers  were  sub- 
mitted by  Doctors  P.  Baudin,  professor  of  the  faculty  of  medicine  of  Paris ; 
Clerfayt.  seci'etary  of  the  medical  commission  of  Mons;  Ileubner,  director  of 
the  infants'  clinic  and  professor  of  the  University  of  Berlin;  and  Wilhelm 
Knoepfelmacher,  privat-docent  of  pediatry,  Vienna  University,  and  physician 
in  chief  to  th'e  Caroline  Infants'  Hospital.  Vienna.  These  contributions,  treat- 
ing of  nursing,  the  preparation  of  artificial  infant  food,  and  the  propaganda  of 
correct  notions  in  infant  feeding,  are  of  more  interest  from  a  pedriatic  and 
educational  point  of  view  than  from  that  of  public  sanitation. 

The  question  of  the  medical  and  hygienic  inspection  of  public  and  private 
schools  was  e.xhaustively  treated  in  papers  by  Drs.  G.  Chauvin.  of  Liege;  Eris- 
mann,  i)rofessor  of  hygiene,  L^niversity  of  Zurich ;  Axel  Hoist,  professor  of 
hygiene.  University  of  Christiania  ;  Laquer,  Frankfort-on-the-Main,  and  Mosny, 
of  Paris. 

Doctor  Chauvin  stated  in  his  address  that  the  observation  of  transmissible 
maladies  in  schools  permits  of  their  early  recognition  and  the  consequent  appli- 
cation of  prophylactic  measures.  Medical  inspectors  of  schools  should  be  espe- 
cially educated  for  their  work  and  should  be  sufliciently  well  paid  to  enable 
them  to  devote  their  time  exclusively  to  school  work.  They  should  be  teachers 
of  hygiene  not  only  to  the  pupils,  but  to  the  general  teaching  corps.  At  the 
conmiencement  of  the  school  year  they  should  make  a  careful  examination  of 
all  pupils,  keeping  a  special  lookout  for  feeble  children  and  those  with  defective 
sight  and  hearing.  In  times  of  epidemics  all  pupils  should  be  siibmitted  to 
a  daily  medical  examination  on  entering  "class.  The  medical  insj)ectors  should 
pass  on  the  readmission  to  school  of  children  previously  dismissed  for  illness, 
should  make  inquiries  at  the  homes  of  sick  school  children,  should  be  charged 
with  the  vaccination  of  pupils  in  times  of  smallpox,  and  should  be  consulted 
in  the  hygienic  arrangement  of  school  buildings  and  furniture.  The  other 
addresses  were  of  the  same  nature  as  that  of  Doctor  Chauvin. 

The  following  resolution  was  passed : 

"  The  Congress,  considering  that  the  school  has  for  its  aim  to  increase  the 
social  value  of  the  individual  by  a  reasonable  culture  of  the  physical,  intellectual 
and  moral  faculties  of  children,  there  should  be  included  under  the  denomina- 
tion of  medical  and  hygienic  inspection  of  schools  all  that  concerns  the  health 
of  scholars,  not  only  in  the  strict  sense  of  their  preservation  against  trans- 
missible maladies,  but  in  the  larger  sense  of  their  integral  physiological  culture 
and  the  adaptation  of  intellectual  culture  to  the  physical  capacity  of  each 
scholar :  a  resolution  is  passed  that  the  medical  and  hygienic  inspection  of 
schools,  by  a  competent  personnel,  requires :  1.  The  surveillance  and  salubrity 
of  schools.  2.  The  prophylaxis  of  transmissible  maladies.  3.  The  periodic  and 
frequent  control  of  the  normal  functioning  of  organs  and  the  regular  growth 
of  the  physical  organism  and  the  intellectual  faculties  of  the  child.  4.  The 
rational  culture  of  the  physical  organism.  5.  The  adajitation,  in  accord  with 
the  teacher,  of  the  culture  of  the  intellectual  faculties  in  proportion  to  the 
individual  physical  capacity  of  the  child." 

In  connection  with  the  question  of  the  intervention  of  the  public  authorities 
in  the  contest  against  tuberculosis.  Dr.  1'.  Brouardel,  professor  of  the  facultj'  of 
medicine,  Paris,  reviewed  the  laws  regulating  tul)erculosis  in  France,  Great 
Britain,  Germany,  and  Norway.  The  importance  of  individual  hygiene  and  the 
salubrity  of  habitations,  shops,  factories,  and  offices  was  referred  to,  and  the 
direct  intervention  of  the  public  authorities,  especially  in  the  protection  of  man 
against  tuberculosis  in  animals,  was  considered  to  be  of  immense  importance. 
Doctor  Brouardel  expressed  the  opinion  that  it  is  the  duty  of  governments  to 
create  and  subsidize  sanatoria  for  the  tuberculous.  Professor  Pannwitz,  secre- 
tary-general of  the  international  bureau  of  tuberculosis,  Berlin,  gave  an  account 
of  what  has  been  done  in  Germany  by  the  establishment  of  sanatoria,  notably 
through  the  intervention  of  the  German  Empire.  Doctor  Santoliquido,  director- 
general  of  the  hygienic  services  of  Italy,  showed  that  the  mortality  from  tuber- 
culosis has  been  diminished  in  every  place  where  serious  and  scientific  sanitary 
measures  have  been  employed.  lie  said  that  as  to  prophylactic  efiicacy  of 
sanatoria  It  Is  difficult  to  form  an  opinion,  inasmuch  as  their  prophylactic  influ- 
ence is  of  secondary  consideration.  Doctor  Calmette,  director  of  the  Pasteur 
Institute,  at  Lille,  said  that  it  was  the  duty  of  the  state  to  share  the  expenses 
of  sanatoria,  thus  stimulating  private  initiative.  He  considered  dispensaries 
for  tuberculosis  important  instruments  of  prophylaxis. 


PITHLTC    IIKAI/ril    AND    MAKINE-HO^^PITAL    SERVICE.  425 

Doctor  rniunvit/,  oiiunciatod  the  followiiif^  as  luiKlaiiKMital  i)rinciplos  in  tlu' 
coiitost  ajxaiiist  tuln'rculosis  :  That  tiiltiTculosis.  Ix'iii;;  an  infectious  malady,  can 
bo  conii)a(tctl  only  liy  early  detection  of  affected  pei'sons.  the  di'struction  of 
germs  spread  hy  the  sick,  and  liie  isolation  of  the  sick  as  lonj;  as  tliey  are  cast- 
ing out  germs.  Tlie  detection  of  the  sick  can  he  effected  hy  oldigatory  reporting 
of  all  cases  of  tuberculosis,  hy  voluntary  notification  by  the  sick  themselves, 
and  by  a  search  for  tuberculous  persons  by  the  sanitary  personnel.  The 
destruction  of  germs  is  to  be  effected  by  disinfection.  Isolation  may  be  nnide 
in  the  liouses  of  the  sick,  in  general  hospitals,  or  in  special  establishments  for 
the  tuberculous.  Of  these  latter  establishments,  it  is  necessary  to  construct,  in 
addition  to  the  sanatoria,  asylums  for  advanced  cases.  The  duties  of  the  iniblic 
authorities  in  res]»ect  to  tul)erculosis  were  enumerated  l)y  Doctor  Pannwitz.  He 
said  that  these  duties  consisted  in  enforcing  notification  by  law  :  in  favoring  the 
erection  of  small  lodgings,  with  special  arrangements  for  isolation  in  the 
family ;  in  the  inspection  of  hotels,  boarding  houses,  and  such  public  lodging 
places;  in  the  installation  of  isolation  places  iu  hospitals;  in  tlie  erection  of 
santoria  for  curable  cases  and  asylums  for  those  with  advanced  lesions ;  in  the 
surveillance  of  schools,  factories,  military  institutions,  etc. ;  and  iu  the  popu- 
larization of  hygienic  education.  Measures,  such  as  obligatory  life  insurance 
and  other  means  calculated  to  prevent  the  spi-ead  of  neediness  and  pauperism 
acted  also  in  limiting  the  spread  of  tuberculosis.  With  a  view  to  diminishing 
the  predisposition  to  disease,  institutions  should  be  favored  which  give  oppor- 
tunities for  bodily  exercises,  cleanliness,  and  comfort  in  convalescence  from 
any  disease.  A  pro])aganda  against  alcoholism  and  sexual  maladies  is  also 
heljiful  against  tuberculosis.  And,  lastly,  governments  should  concern  them- 
selves with  the  collection  and  publication  of  complete  statistics  of  morbidity 
and  mortality,  in  order  that  the  etflcacy  of  the  measures  recommended  may  be 
determined. 

Papers  were  also  presented  b.v  Dr.  Knud  Faber,  physician  to  the  Federik  Hos- 
jiital,  Copenhagen  ;  Doctor  Moeller,  president  of  the  provincial  medical  comnns- 
sion.  of  Brussels ;  Doctor  Ruysch,  of  Holland ;  Arthur  Newsholme.  medical 
officer  of  liealth.  Brighton,  and  Dr.  Fr.  Scliinid.  director  of  the  federal  sanitary 
bureau.  Berne.  These  speakers  treated  of  tuberculosis  in  their  respective  conn- 
tries  and  the  measui-es  adopted  to  combat  it.  The  principles  set  forth  by 
Doctor  Pannwitz  were  agreed  to  with  such  modifications  as  the  customs  of 
different  countries  necessitate. 

By  a  unanimous  vote  the  following  conclusions,  proposed  by  M.  Leduc,  were 
adopted : 

"Antitubercular  prophylaxis  demands  as  a  duty  of  public  authorities  the 
rigorous  application  of  laws  and  regulations  concerning  the  salubrity  of  habita- 
tions ;  sanitary  police  measures  to  be  prescribed  by  law  ;  legislation  regulating 
the  conditions  and  liours  of  labor  (aproi)os  of  which  it  is  desirable  to  intervene 
by  means  of  an  international  entente)  ;  the  extension  of  communal,  canton,  or 
regional  regulations  according  to  local  necessities.  Concerning  assistance  to 
the  tuberculous  by  popular  sanatoria,  dispensaries,  air  cures,  asylums,  etc..  the 
state  should  favor  these  and  give  aid  in  the  largest  measure  as  an  initiative  to 
private  individuals,  social  groups  (departments,  provinces,  communes,  philau- 
tlii'opic  and  labor  associations,  mutual  companies,  etc.),  so  permitting  them  to 
spread  their  benefits  acordiug  to  the  social  spirit  and  individual  needs  of  each 
nation.  The  state  should  encourage,  b.v  all  means  at  its  disjiosal.  societies  for 
the  promotion  of  cheap  but  suitable  habitations,  cooperative  food  societies,  and 
leagues  against  alcoholism." 

The  next  question  brought  before  the  section  was  that  of  the  sanitary  prophy- 
laxis of  pest  and  the  modifications  necessary  in  quarantine  regulations. 

Dr.  A.  Calmette  said  in  substance  that  to-day,  owing  to  the  present  state  of 
knowledge  of  the  pest  bacillus,  one  can  look  calmly  on  the  possibility  of  the 
importation  of  bubonic  plague  into  Europe.  The  moment  has  come,  the  speaker 
said,  to  suppress  the  employment  of  Draconic  measures  invented  as  a  defense 
against  its  importation.  Quarantine,  which  has  undergone  successive  attenua- 
tions at  each  international  sanitaiy  conference  during  the  ]>ast  half  century, 
must  disappear.  Henceforth  it  will  no  longer  be  .iustified,  either  against  yellow 
fever,  cliolera.  or  pest.  Doctor  Calmette  said  that,  as  far  as  pest  is  concerned, 
he  hoped  to  prove  this  statement  in  his  report.  It  is  well  known  that,  though 
plague  can  propagate  itself  from  man  to  man,  the  principal  agents  of  contamina- 
tion are  rats  b.v  intermediation  of  the  fleas  that  infest  them.  Direct  transmis- 
sion from  man  to  man  is  above  all  effected  by  nasal,  bronchial,  and  throat  secre- 


426  PUBLIC    HEALTH    AND    MARHSTE-HOSPITAL    SERVICE. 

tious,  ill  whicli  the  liacilhis  of  post  ahouiul.  Roux  and  ISatzai-off  have  proved 
how  easy  it  is  to  in-odiu-e  piieuuionic  pest  in  such  susceplihle  animals  as  the  rat. 
the  rabl)it,  and  the  nionliey  by  simply  treating  the  nostrils  with  cultures  of  pest 
cr  with  expectorated  matter  containing  the  microbe.  In  recent  epidenncs  in 
Euro]ie  it  has  been  shown  that  contagion  has  been  conveyed  by  practically  the 
same  mechanism  in  the  persons  of  attendants  or  those  sick  with  the  pest 
(Vienna.  1898;  (Jlasgow,  1901),  or  in  those  having  contact  with  cadavers  of 
pest  patients.  One  must  admit  also  that  soiled  clothes,  garments,  and  other 
objects  belonging  to  the  sick  can  transport  to  a  distance  and  retain  for  many 
months  living  and  virulent  germs  of  pest.  One  of  the  most  striking  examples 
of  this  was  the  importation  of  pest  from  Mauritius  to  Dur])in,  Natal,  in  1900. 
A  Mauritian,  in  order  to  avoid  too  long  a  sojourn  in  quarantine,  contiimed 
his  voyage  to  Port  Elizabeth,  so  as  to  make  a  trip  sufficiently  long  to  be 
immediately  admitted  to  free  pratique.  April  1  he  arrived  at  Durbin.  A  month 
and  a  half  later,  May  13,  he  opened  a  part  of  his  baggage.  Three  days  later 
he  fell  ill,  and  died  May  18.  Many  other  facts  show  that  articles  soiled  with 
pest  bacilli,  even  when  they  have  been  closed  in  trunks  for  several  months, 
are  capable  of  transmitting  pest.  Bags  containing  cereals  and  various  mer- 
chandise in  which  pest-infected  rats  find  lodgment  are  equally  dangerous. 
It  has  happened  several  times  that  men  employed  in  the  deljarkment  of  such 
merchandise  have  fallen  ill  after  having  slept  on  bales  recently  landed  or  on 
empty  bags.  It  is  evident,  then,  that  the  superficial  disinfection  of  baggage 
and  the  cargo  of  vessels  such  as  now  practiced  at  quarantine  stations  is  alto- 
gether insufficient  and  ineflicacious.  On  board  ships  it  is  the  rat  that  is 
most  frequently  responsible  for  the  spread  of  pest.  The  fact  of  having  touched 
the  cadavers  of  rats  is  a  particularly  frequent  cause  of  infection.  In  cities 
pest  finds  special  lodgment  in  dirty  quarters  of  the  town  and  in  houses  in 
the  neighborhood  of  collections  of  filth,  sewers,  docks,  and  storehouses  for  gi'ain, 
places  where  rats  abound.  Among  the  sick  cared  for  in  hospitals  one  can  often 
find  the  trace  of  recent  stings  of  parasitic  insects,  such  as  fleas  and  bedbugs,  the 
point  of  departure  of  a  lymphatic  vessel  leading  to  a  bubo.  Finally,  laboratory 
exijeriments  demonstrate  that  to  infect  healthy  rats  it  suffices  sometimes  mei'ely 
to  place  them  in  a  case  or  j.ir  in  w^hich  there  are  fleas  that  have  deserted  the 
cadaver  of  a  rat  dead  of  pest.  It  has  been  questioned  whether  the  fleas  of  rats 
are  capable  of  biting  man,  bilt  the  recent  work  of  Gauthier  and  Raybaud  (Revue 
d'hygieue,  Paris,  1903)  and  of  Carlo  Tirabosehi  have  put  this  important  ques- 
tion beyond  controversy,  and  it  is  now  perfectly  established  that  certain  species 
of  rat  fleas  bite  man.  The  fleas  met  with  most  commonly  in  rats  belong  to  sev- 
eral species.  Their  scientific  determination  and  their  role  as  agents  for  the 
transmission  of  pest  has  been  well  studied  in  the  memoir  of  Tirabosehi  (Ar- 
chives de  parasitologie  de  Blanchard,  1903).  In  the  gray  rat  {Mus  (lecuviauus) 
and  the  black  rat  (Mus  ratiis)  the  human  flea  (Piilrx  irrituns)  and  the  dog  flea 
(Teciioreplialus  serraticeps)  are  often  found.  Both  bite  man.  Rats  also  carry 
parasites  of  other  species,  which,  even  after  fasting  for  three  or  four  days,  re- 
fuse to  bite  man.  Among  tiiese  Tirabosehi  mentions  as  the  most  frequent,  in 
Italy  at  least,  CeraiophyUus  fanciatus,  CcratophyUns  itaJicus,  and  Ciowpsylla 
mnsciili.  Mice,  though  very  sensitive  to  inoculated  pest,  do  not  appear  to  be 
spontaneously  affected,  at  least  in  a  proportion  com])arable  to  rats,  in  times  of 
epidemics.  There  are  not  found  in  their  fur  the  species  of  fleas  that  bite  man 
or  dogs.  On  the  contrary,  there  exists  in  Mongolia  and  in  the  region  of  Lake 
Baikal  the  Aretomys  hohac,  a  gnawing  animal  closely  resembling  the  marmot, 
which  possesses  a  great  sensibility  to  pest  and  appears  to  transmit  the  malady 
to  man  with  great  facility ;  but  the  parasites  that  aid  in  this  transmission  have 
not  been  determined. 

Everywhere  it  has  been  observed  that  during  prevalences  of  pest  among  rats, 
preceding  or  accompanying  the  disease  auiong  men,  rats  migrate  en  masse  as 
.soon  as  mortality  begins  to  strike  them.  These  emigrations  of  rats  have  been 
in  all  cases  the  sole  factor  in  the  dissemination  of  the  malady.  It  has  also  been 
widely  remarked  in  the  course  of  the  last  few  years  that  rats  embark  in  crowds 
in  the  ports  of  the  Indies  on  vessels  moored  along  the  quays.  They  go  ashore 
in  large  numbers  at  night.  All  the  rats  that  come  from  the  Orient  belong  to  the 
species  Mits  decumcDius,  a  species  so  invading  and  prolific  that  they  completely 
drive  out  of  the  European  cities  the  small  black  rat  (Mus  ratus),  which  is  now 
hardly  found  except  in  inland  places.  On  board  vessels  in  the  Mediterranean  it 
frequently  happens  that  pest  rages  among  the  rats  without  a  single  case  of  the 
disease  being  observed  among  the  crew  or  passengers.  This  is  a  very  great 
danger,  because  the.se  vessels,  having  no  sick  men  aboard  and  not  coming  directly 


PULLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  427 

from  contaniin;itO(l  ports,  are  allowotl  lo  land  their  |)asseii<:ers  and  fari,"».  It  is 
thus  evident  tliat.  at  h'ast  as  far  as  coiicenis  pest,  tlie  sanitary  re^nlatious  at 
present  applied  are  of  no  value.  International  .sanitary  prophylaxis  against  pest 
must  heneeforth  be  based  almost  entirely  on  the  adoption  of  defense  aj^.-iinst  the 
iuipt>rtation  of  exotic  rats  and  on  the  methodical  destruction  of  indi^^enous  rats, 
becau.se  no  serious  epidemic  focus  can  be  created  if  the  dlsea.se  is  not  dissemi- 
nated by  these  animals.  It  will  always  be  easy,  in  fact,  by  means  of  isolation 
and  disinfection  to  hind«'r  the  direct  contaniination  of  man  by  man.  The  pre- 
ventive effect  of  the  antipest  serum  is  sulhcii-ntly  sure  to  i)rotect  ajjainst  infec- 
tion those  persons  brouirht  in  cont.ict  with  the  sick.  It  can  the:i  be  allirmed  that 
it  is  perfectly  useless,  because  of  one  or  several  cases  of  pest  aboard  shij),  to 
oblij^e  the  passen.i^ers  and  crew  of  the  vessel  to  submit  to  detention  in  a  (pi.-iran- 
tine  who.se  material  orj^anization  i.s.  the  majority  of  times,  very  defective.  It  is 
sufficient  to  prevent  the  vessel  from  comim;  near  the  (juays  until  it  hys  been 
efficaciously  disinfected  and  all  the  rats  destroyed.  The  sick  should  be  debai'ked 
and  isoIatcHl  and  the  passenijers  should  be  allowed  to  so  ashore  innuediately, 
provided  they  first  submit  to  a  ju-eventive  inoculatiou  of  antipest  serum,  that 
they  rest  for  five  days  under  sanitary  observation,  and  that  all  their  ba^f^age  be 
submitted  to  complete  disinfection.  For  the  disiufection  of  vessels,  carjjo,  and 
baggage  neither  vapors  under  j)ressure,  spraying,  washings,  or  other  resources 
of  existing  European  lazarettos  are  effective.  The  only  really  sure  means  is 
sulphurization  by  sulphurous  anhydrid  mixed  with  sulphuric  anhydrid  in  high 
concentration — such  as  is  obtained,  for  example,  by  the  American  apparatus  of 
Clayton.  This  gas,  very  diffusible  and  eminently  toxic  for  rats  and  all  insects, 
penetrates  with  great  rapidity  into  the  interior  of  bales  of  merchandise  and  into 
the  remotest  recess  of  the  hold.  It  does  not  cause  the  sensible  deterioration 
of  the  objects  disinfected  and  its  disinfecting  action  on  the  pest  bacillus  is 
perfectly  established.  The  effects  and  baggage  of  passengers  can  be  put  apart 
and  disinfected  on  a  flatboat.  It  is  sufficient  to  open  the  trunks  without  touch- 
ing their  contents  and  to  treat  them  for  four  hours  with  a  gas  containing  at 
least  8  per  cent  of  sulphurous  acid  and  4  to  6  milligrams  of  dry  sulplmric  anhy- 
drid to  the  liter  of  air.  It  has  been  proposed  to  destroy  rats  on  board  sliips  by 
carbonic  acid  and  oxide  of  carlion.  This  procedure  has  been  employed  at  Mar- 
seille and  Hamburg.  It  is  sufficiently  successful  in  killing  rats,  but,  laclcing  a 
dififusibility  comparable  to  that  of  sulphurous  gas,  it  does  not  reach  insects  and 
does  not  exercise  any  disinfectant  action  on  pest  bacilli.  Further,  its  employ- 
ment is  not  exempt  from  danger,  as  it  is  destitute  of  odor.  Doctor  Calmette 
recommended  that  existing  quarantine  measures  be  modified  as  follows : 

1.  The  suppression  of  detention  in  lazarettos  and  its  replacement  by  simple 
sanitary  surveillance  of  five  days  for  sucli  passengers  as  submit  to  a  pre- 
ventive inoculation  of  antipest  serum,  even  when  such  passengers  come  from 
vessels  having  had  cases  of  pest  aboard  during  the  passage. 

2.  Autliorization  for  passengers  of  a  suspected  vessel  who  refuse  to  submit 
to  inoculation  to  debarlv  without  hindrance  at  the  port  of  arrival  on  condition 
that  they  will  reside  there  for  ten  days  and  present  themselves  daily  during 
that  i)eriod  for  observation  by  the  sanitary  authorities. 

3.  Limitation  of  detention  for  vessels  and  cargo  to  the  period  strictly  neces- 
sary for  the  destruction  of  rats  and  insects  and  the  complete  disinfection  of 
all  parts  of  the  vessel  and  cargo. 

4.  Organization  in  all  ports  open  to  international  commerce  of  methodic 
desti'uction  of  rats,  on  shore  and  on  board,  the  disinfection  service  to  be 
severely  and  scientifically  controlled  in  such  a  manner  that  the  efficacy  of 
measures  taken  to  destroy  rats,  insects,  and  the  pest  bacilli  can  be  officially 
guaranteed. 

5.  The  obligation  for  all  vessels  putting  in  at  Mediterranean  ports  of  the 
Levant  or  in  those  of  the  Red  Sea.  of  the  Persian  Gulf,  of  India,  of  Indo-China, 
or  other  suspected  or  contaminated  countries  to  be  provided  with  u  suflicient 
quantity  of  antipest  serum  to  vaccinate  all  the  passengers  and  crew  if  a  case 
of  pest  should  appear  during  the  passage. 

Doctor  Ringeliug,  physician  in  chief  of  the  hygienic  service  of  the  city  of 
Amsterdam,  submitted  the  following  conclusions : 

1.  A  revision  of  the  general  sanitary  regulations  to  prevent  the  invasion 
and  propagation  of  pest,  adopted  by  the  convention  of  Venice,  March  19,  1897, 
is  urgent. 

2.  This  revision  should  have  for  its  results — 

(a)  The  determination  in  general  of  the  rules  according  to  which  the  sani- 
tary service  of  the  different  countries  should  be  organized  to  combat  pest  and 


428  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SPZRVIOE. 

opidemio   maladies.     The  contractiiif,'  goverurueiits   should  eiigap;e   to   organize 
tlie  sanitai-y  siTvit-e  iu  accordance  with  regulations  to  l»e  prescrilied. 

(b)  The  estahlishuient  of  regulations  to  he  followed  in  the  preventive 
treatment  of  persons  having  had  or  likely  to  have  contact  with  pest  patients 
or  with  their  possessions.  The  contracting  governments  should  engage  to  act 
accordingly. 

(c)  The  establishment  of  measures  to  be  taken  for  the  destruction  of  rats 
and  other  vermin  in  docks,  storehouses,  on  board  vessels,  etc.,  at  the  port  of 
departure  during  the  voyage,  and  at  the  port  of  arrival.  The  contracting  gov- 
ernments should  engage  to  follow  the  prescribed  measures. 

(r7)  To  enact  by  law  that  the  discharge  of  cargo  from  vessels  shall  be  under 
the  assiduous  observation  of  the  sanitary  service  and  that  the  employees  of  the 
service  shall  apply  the  prescribed  measures  with  the  least  practicable  delay 
in  event  of  pest  being  found  aboard  among  men  or  animals. 

(e)  To  enact  by  law  that  the  disinfection  of  merchandise  shall  not  be  done 
except  when,  according  to  the  rules  prescribed  by  the  convention,  it  is  judged 
necessary. 

3.  The  revision  of  the  general  sanitary  regulations  can  be  made  in  accordance 
with  Article  V  of  the  convention  through  diplomatic  channels.  It  concerns  the 
Eleventh  International  Congress  of  Hygiene  and  Deniogi-aphy  to  call  the  atten- 
tion of  the  different  governments  to  the  changes  and  deficiencies  in  the  general 
sanitary  regulations,  and  to  request  that  the  desired  changes  be  made  through 
diplomatic  channels. 

4.  That  in  order  to  formulate  and  translate  the  new  articles  to  be  submitted 
to  the  different  countries,  the  executive  committee  of  the  congress  should  be 
assisted  by  a  council  of  experts,  members  of  the  congress,  the  council  to  be  com- 
posed by  preference  of  delegates  of  the  different  countries  adherent  to  the  con- 
vention of  Venice. 

Doctor  Xocht,  physician  to  the  port  of  Hamburg,  director  of  the  Institute  of 
Tropical  Diseases  and  of  the  Seamen's  Hospital,  Hamburg,  said  that  he  did  not 
think  it  admissil)le  to  allow  passengers  from  an  infected  vessel  to  go  about  town 
after  having  been  inoculated.  As  for  sulphurous  gas,  experience  has  shown  that 
it  does  not  kill  everything.  For  example,  it  does  not  kill  pest  bacilli  in  excre- 
ment and  in  the  cadavers  of  rats.  Besides,  the  gas  spoils  flour,  tobacco,  and 
tea,  and  as  a  consequence  there  are  numbers  of  claims  for  damages  when  the 
gas  is  used.  Disinfection  by  oxide  of  carbon  is  preferable  after  discharging  the 
•\essel  of  its  personnel.  As  for  the  visit,  it  should  be  made  by  special  physicians. 
Vessels  should  have  microscopic  apparatus  in  order  that  malaria  may  be  distin- 
guished from  pest  aboard  ship. 

Dr.  Edm.  Franck,  royal  inspector  of  sanitary  services  to  the  ministiy  of  the 
interior,  Budapest,  said  that  if  vessels  were  examined  and  disinfected  properly 
prior  to  sailing  disease  could  not  develop  so  easily  al)oard.  But  maritime  sani- 
tary measures  are  deplorable.  The  inspection  is  made  hastily,  nothing  is  done 
for  the  hygiene  of  the  passengers,  and  the  state  as  i-egards  cleanliness  leaves 
much  to  i)e  desired.  The  disinfection  is  hardly  better.  Even  trunks  are  not 
opened.  Yet  one  is  surprised  to  see  pest  break  out  periodically.  The  confer- 
ence of  Venice  extolled  above  all  the  application  of  quarantine,  but  the  duration 
of  observation  is  not  always  rationally  fixed.  It  is  said  that  in  Greece  and 
Austria  quarantines  hardly  give  efficacious  results.  The  visit  and  observation 
of  passengers  does  not  constitute  a  sufficient  guaranty.  As  concerns  cargo,  the 
measures  taken  are  also  illusory,  because  they  are  based  on  certain  data  regard- 
ing the  nature  of  the  malady,  data  that  are  often  difficult  to  establish.  In  Hun- 
gary the  port  physician  and  the  sanitary  authorities  share  the  responsibility  for 
measures  adopted.  The  speaker,  referring  to  contamination  by  rats,  said  that 
there  are  always  foci  of  pest  in  the  extreme  Orient  and  that  a  control  is  indis- 
l)ensable,  notably  in  the  Suez  Canal.  It  is  essential  that  rules  of  hygiene  be 
strictly  ol)served  on  vessels,  and  that  rat  hunting  be  energetically  pursued.  In 
this  respect  the  education  of  responsible  physicians  should  be  attended  to,  and 
their  authority  increased. 

Dr.  N.  Freyberg,  chief  of  section  of  the  medical  department,  St.  Petersburg, 
said  that  the  detention  of  persons  i)resenting  neither  the  symtoms  of  pest,  nor 
suspected  symptoms  of  the  disease,  is  a  measure  that  can  be  dispensed  with  even 
for  infected  vessels,  and  replaced  by  sanitary  observation  and  antipest  inocula- 
tions. The  destruction  of  rats  sliould  be  i>racticed  on  all  vessels  from  foreign 
ports,  and  should  form  one  of  the  functions  of  quarantine  establishments.  This 
obligation  should  be  established  by  a  sanitary  conference  held  with  that  view. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  429 

It  is  desirnhlo  that  a  s]tocial  intornational  and  ofl'icial  journal  be  croatod  in 
which  should  !)e  rot-ordod  all  information  boarinu:  on  the  march  of  epidemics  of 
jiest  and  cholera,  and  the  measures  taken  in  the  different  countries.  Govern- 
ments should  assume  the  oblijiation  of  fiuMiishinj;  ollii-ially  the  necessary  data 
for  publication  in  such  a  journal.  Title  III,  Chapter  II,  line  2,  of  the  rules 
annexed  to  the  convention  of  Vt'oice  should  be  altered  to  read:  "  liut  this 
restriction,  limited  to  the  contaminated  area,  should  only  be  accepted  on  the 
formal  condition  that  the  j^overnment  of  the  contaminated  country  take  the  nec- 
essary measures  to  prevent  the  exportation  of  susceptiiile  materials  coming 
from  the  contaminated  area,  as  well  as  the  isolation  of  the  sick  and  other  pro- 
phylatic  measures." 

M.  Wilde,  of  Arirentina,  spoke  of  the  large  sums  expended  by  his  Repuitlic  for 
sanitary  improvement  of  ports,  and  said  tha.t  a  system  should  be  adopted 
whereby,  through  a  small  tax  on  the  ships,  these  expenses  could  be  made  to  fall 
on  navigation. 

M.  INIanolescoo,  Roumania,  said  that  it  would  be  better  for  the  congress  to 
enunciate  a  project  of  maritime  regulations  rather  than  to  leave  the  work  to 
committees,  where  the  diplomatic  element,  generally  inconjpetent,  dominates. 
Very  often  the  captains  of  vessels  fail  to  declare  infection  except  in  extremis. 
This  is  a  great  danger.  It  is  important  that  this  declaration  be  imposed  under 
forfeit  of  damages  in  case  of  uondeclaration,  the  damages  payable  to  the  country 
infected.  Most  vessels  have  no  ship's  surgeon  and,  when  there  is  one,  he  is 
generally  not  up  to  his  task.  Sanitation  in  the  oriental  countries  should  be 
insisted  upon.     In  the  Orient  the  regulations  are  often  a  dead  letter. 

Doctor  Brouardel  said  that  it  was  pleasant  to  see  that  ideas  favorable  to 
quarantine  had  lost  ground.  iMoi-e  scientific  ideas  were  gaining  hold.  Commis- 
sions should  be  formed  in  different  ports  in  order  to  reenforce  the  authority  of 
sanitary  directors. 

Monsieur  Ruysch  thought  it  was  not  sufficient  to  have  a  ship's  doctor.  They 
are  generally  incompetent  persons.  If  any  confidence  is  to  be  placed  in  the 
physician  on  board,  the  medical  officer  nmst  be  an  officer  of  the  state. 

The  following  desiderata  were  formulated  in  concluding  the  question  of  pests : 

"  In  consideration  of  the  fact  that  recent  data  incontestably  prove  the  role 
of  rats  as  agents  in  the  propagation  of  pest  aboard  ship,  even  when  there  is  no 
case  of  human  pest  aboard  and  when  the  ship  does  not  come  direct  from 
infected  ports ;  and  also  in  consideration  of  the  security  procured  by  preven- 
tive inoculations  of  antipest  serum  to  crews  and  passengers  brought  in  contact 
with  the  sick  :  ResoJvcfl,  That  the  congress  express  the  opinion  that  quarantine 
measures  now  applied  be  modified  as  follows : 

"  1.  The  limitation,  in  the  largest  sense  of  liberalism,  of  isolation  in  lazaret- 
toes  and  its  replacement,  whenever  the  sanitary  authorities  judge  it  possible, 
by  a  simple  observation  of  ten  days  at  the  ])ort  of  arrival,  this  observation 
being  reduced  to  five  days  for  passengers  who  consent  to  submit  to  a  preventive 
inoculation  of  antipest  serum,  even  when  these  passengers  come  from  a  ship 
having  cases  aboard  during  the  passage. 

"  2.  Limitation  for  vessels  and  cargo  of  the  duration  of  quarantine  to  the 
time  strictly  necessary  for  the  destruction  of  rats  and  insects  and  the  complete 
disinfection  of  all  parts  of  the  vessels  and  cargo. 

"  3.  Organization,  in  all  ports  o]ien  to  international  commerce,  of  a  methodic 
destruction  of  rats,  as  well  ashore  as  aboard,  and  of  disinfection,  severely  and 
scientifically  controlled,  in  such  a  manner  that  the  efficiency  of  measures  taken 
to  destroy  rats,  insects,  and  pest  bacilli  can  be  officially  guaranteed. 

"  4.  Obligation  for  all  vessels  that  put  into  Mediterranean  ports  of  the  Levant 
or  in  those  of  the  Red  Sea,  of  the  Persian  Gulf,  of  India,  of  Indo-China,  or  of 
other  suspected  or  contaminated  countries,  to  be  provided  with  a  sufficient 
quantity  of  antipest  serum  to  vaccinate  the  passengers  and  all  the  crew  if  a 
case  of  pest  should  appear  during  the  voyage. 

"  5.  To  invite  the  attention  of  interested  Governments  to  the  necessity  of 
appointing  sanitary  physicians  specially  instructed  with  a  view  to  the  mission 
they  are  to  fulfill,  commissioned  by  the  controlling  power,  and  independent  of 
companies  of  navigation." 

The  congress  passed  a  resolution  that  the  International  Sanitary  Conference 
that  is  to  meet  at  Paris,  October,  1903,  be  asked  to  deliberate  on  the  foregoing 
desiderata,  with  a  view  to  elaborating  a  set  of  regulations  for  the  defense 
against  pest  more  in  conformity  with  modern  science  and  with  the  needs  of 
international  commerce. 


430  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


HABITATIONS. 


^ 


Passing  to  the  question  of  the  habitations  of  the  hiboring  and  needy  classes, 
a  paper  was  read  by  GniHaume  Fatio,  president  of  the  society  for  the  ameli- 
oration of  lodgements,  Geneva,  in  which  tlie  desirability  for  better  habitations 
in  Switzerland  for  the  classes  in  question,  both  in  the  towns  and  cities,  was 
interestingly  developed. 

Monsieur  Pierson,  formerly  minister  of  finances  at  the  Hague,  said  that  the. 
conditions  of  the  problem  of  habitations  for  the  laboring  classes  is  far  from 
being  uniform  in  different  localities,  and  for  this  reason,  as  well  as  from  an 
economic  standpoint,  it  is  impossible  to  give  fixed  and  detailed  rules  regarding 
the  arrangement  of  such  habitations. 

It  is  only  possible.  Monsieur  Pierson  said,  to  treat  the  subject  on  broad  lines, 
combat  certain  errors,  and  indicate  the  method  to  be  followed  in  applying  general 
principles  to  individual  conditions.  In  this  way  the  speaker  developed  his 
subject,  referring  largely  to  the  fiscal  aspects  of  the  matter.  The  subject  was 
also  treated  of  in  a  paper  by  Dr.  H.  AUtrecht,  of  Berlin,  impi-essing  the  impor- 
tance of  public  intervention  in  the  matter  and  referring  to  the  usefulness  of  life 
assurance  associations.  These  three  papers  are  transmitted  with  the  present 
report. 

Doctor  Dufourmantelle,  of  Paris,  considered  the  subject  from  a  French  stand- 
point, expressing  the  opinion  that  the  state  should  encourage  better  habitations 
for  the  laboring  classes  by  indirect  intervention  in  the  form  of  fiscal  favors  and 
by  direct  intervention  in  the  form  of  insisting  through  public  oflScers  on  the  suit- 
able construction  and  maintenance  of  these  habitations. 

The  question  of  the  practical  disinfection  of  houses  was  interestingly  treated 
by  E.  von  Esmarch,  of  the  University  of  Gottingeu,  and  M.  Herman,  director  of 
the  provincial  laboratory  of  bacteriology,  Mons.  The  papers  are  inclosed  with 
this  report.  Von  Esmarch  said  that  the  disinfection  of  domiciles  is  an  important 
factor  in  the  struggle  against  infectious  diseases.  It  is  necessary  to  distinguish 
continuous  disinfection  at  the  bedside  from  final  disinfection  practiced  when  the 
sickness  is  terminated.  Continuous  disinfection  is  the  most  important,  but  it  is 
the  most  difficult  to  realize  in  a  satisfactory  manner.  In  order  to  accomplish  it, 
it  is  necessary  to  enlighten  the  families  of  the  sick  on  the  subject  of  the  impor- 
tance of  this  disinfection.  This  should  be  one  of  the  tasks  of  the  physician,  but 
should  also  be  promoted  by  popular  brochures  distributed  by  the  public  authori- 
ties as  soon  as  disease  is  declared.  The  public  authorities  should  also  dis- 
tribute disinfectants  gratuitously,  or  at  a  reduced  price,  and  should  exercise  a 
surveillance  as  to  the  manner  in  which  these  disinfectants  are  used.  At  the  con- 
clusion of  the  sickness  disinfection  should  be  practiced  by  public  hygienists. 
There  should  he  uniform  regulations  relative  to  the  final  disinfection,  which 
should  1)0  gratuitous.  Great  importance  attaches  to  the  choice  and  education  of 
emidoyees  engaged  in  the  i)ractice  of  disinfection.  The  final  disinfection  should 
include  the  choice  of  the  disinfectant  appropriate  to  the  malady,  the  degree  of 
extension  necessary  to  give  to  the  disinfection,  the  choice  of  the  most  favorable 
time  for  disinfection,  and  a  care  for  the  lodgment  during  the  disinfection  of  the 
residents  of  the  house  in  which  the  sick  person  has  been  lodged. 

Doctor  Herman  said  that  the  paraphernalia  and  agents  of  disinfection  should 
be  as  limited  as  possible  consistent  with  etticiency.  Progress  iu  the  practice  of 
disinfection  consists  much  less  in  the  discovery  of  new  antiseptics  than  in  the 
proper  application  of  recognized  methods,  which,  indeed,  are  numerous  enough. 
Among  the  agents  which  meet  all  requirements  are  fire,  steam,  and  chemical 
products,  such  as  corrosive  sublimate,  lime,  soda,  aromatic  bodies  (creosol,  for 
example.),  and  formaldehyde.  It  is  much  better  to  employ  these  efficacious  and 
accessible  agents  than  to  burden  the  arsenal  of  disinfection  with  new  products 
more  or  less  active.  It  is  essential,  above  all  things,  to  educate  the  masses  in 
rational  and  progressive  ideas  of  general  hygiene  and  disinfection.  This  should 
begin  with  primary  teaching,  and  should  not  merely  comprise  a  dry  enumeration 
of  methods  and  means  of  disinfection,  but  should  take  the  form  of  lessons  of 
cleanliness  not  only  as  a  virtue  and  polite  quality,  but  as  one  of  the  fundamental 
principles  of  hygiene.  This  education  should  be  continued  in  the  higher  classes 
by  an  expose  of  the  physical  and  chemical  action  of  agents  employed  for  the 
destruction  of  morbid  germs.  Concerning  the  education  of  the  masses,  the  sub- 
ject could  be  made  tangible  to  the  public  by  exhibits  in  museums.  The  hygienic 
house  is  yet  to  be  realized.  In  the  houses  of  the  rich  it  may  be  possible  to  have 
a  special  sick  room,  the  walls  to  be  painted  in  oil  and  covered  with  leather 
hangings,   uustuCCed   furniture,   a   bed   without   curtains,   and  windows   easily 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE.  431 

washed.  This  is  the  idea  of  MeiidelsoliM  (I)er  Conifort  der  Kraiilveii,  Hcrlin, 
1S;t2).  but  it  is  dillieult  to  realize.  Still  it  is  desirable  that  all  habitations^ 
tl)ose  of  the  rich  as  well  as  those  of  the  poor — should  be  constructed  in  such 
a  niaiiner  as  to  permit  of  easy  and  coiiiplete  disinfection. 

Tlie  followinj;  resolutions  were  adopted  rejiardinj;  tlie  disinfection  of  houses: 

"Disinfection  of  habitations  should  not  be  nuule  except  by  procedures  and 
ai)paratus  the  ellicacy  of  which  lias  l)een  determined  l\v  precise  experiments 
and  verification.  The  practice  of  disinfection  of  houses  in  case  of  transmissible 
maladies  should  be  submitted  to  an  administrative  control  and  to  a  technl(|ue 
the  conditions  of  which  it  is  urjrent  to  establish  witli  precision.  Tlie  section 
requests  the  permanent  international  conunittee  to  make  the  control  of  dis- 
infection one  of  the  orders  of  the  day  at  the  next  congress.  Disinfection  should 
be  practiced  by  competent  and  tried  employees  instructed  in  special  schools.  It 
is  desirable  that  disinfection  be  gratuitous.  A  competition  should  l)e  opened 
to  offer,  on  the  occasion  of  the  next  congress,  a  prize  to  the  author  of  the 
most  edicacious  and  simple  procedure  for  disinfection  in  infectious  maladies 
occurring  in  small  houses  in  localities  of  less  than  3,000  inhabitants." 

Scrciith  section:  Colonial  liiKjiciir. — The  work  of  this  section,  relating  prin- 
cipally to  the  prophylaxis  of  diseases  of  tropical  and  subtropical  countries,  was 
of  decided  Interest  from  a  general  sanitary  ])oint  of  view.  The  president  of  the 
section  in  opening  the  session  called  attention  to  the  importance  of  this  branch 
of  the  work  of  the  congress,  esijecially  with  a  view  to  enlightening  Europeans 
who  are  undecided  in  the  matter  of  the  hygiene  that  should  be  adopted  in 
tropical  countries.  Doubt  had  often  led  Europeans  to  neglect  all  hygienic 
measures  applicable  to  hot  countries,  to  the  great  prejudice  of  health  and  often 
to  the  sacrifice  of  life. 

Doctor  Renaud,  physician  in  chief  of  the  colonies  (retired),  professor  in  the 
School  of  Medicine,  Marseille,  and  professor  of  hygiene  at  the  Colonial  Institute; 
Dr.  C.  L.  Van  der  P.urg,  formerly  health  officer  at  Utrecht,  and  Dr.  H.  Dupont, 
surgeon  of  battalion  of  the  regiment  of  engineers  and  physician  to  the  inde- 
pendent Congo  State,  presented  papers  treating  of  the  food  of  Europeans  and 
indigenous  laborers  in  hot  countries.  Doctor  Reynaud  was  of  the  opinion  that 
the  safest  guides  in  determining  the  proper  alimentation  for  the  Tropics  are  cer- 
tain experimental  facts  and  the  composition  of  the  ration  freely  and  instinctively 
chosen  by  the  natives  and  by  i-esident  foreigners  rather  thaji  by  the  imperfectly 
understood  physiology  of  man  inhabiting  liot  countries.  Thus  the  alimentary 
regime  may  be  approximately  established.  The  mode  of  alimentation  of  Euro- 
peans in  these  countries  need  hardly  differ  from  that  in  Europe.  But  it  should 
be  distinguished  above  all  by  sobriety,  which  aids  in  the  adaptation  to  change 
of  climate.  The  ration  should  contain  the  least  possible  quantity  of  aliments 
of  high  calorific  potential ;  a  proportion  of  easily  assimilated  azotic  aliments, 
always  more  than  the  indispensable  minimum;  it  should  necessitate  only  slight 
digestive  exertion  and  should  constitute  a  small  volume,  and  should  be  composed 
of  varied  elements  and  be  exempt  from  morbid  germs.  The  rations,  differing 
according  to  the  season  and  country,  valued  in  calories  per  kilogram  of  living 
weight,  should  be : 

Ordinary  ration  (equaling  35  to  38  calories)  — 
1.25  to  1.75  grams  of  albumin  (nunimum). 
0.75  grams  of  fat  (maximum). 
0.50  grams  of  alcohol  (maximum). 
3.55  to  5.30  grams  of  hydrocarbons. 

Moderate  to  full  working  ration  (equaling  36  to  38  calories)  — 
1.50  to  2.25  grams  of  albumin  (minimum). 
0.75  grams  of  fat  (maximum). 
0.50  grams  of  alcohol  (maximum). 
4..30  to  0.40  grams  of  hydrocarbons. 

Sugar  furnishes  a  part  of  the  supplementary  energy  necessary  for  hard  work. 
Alcohol  has  useful  but  transient  effects.  Its  dangers  are  rapidly  grave  in  the 
hot  zone.  Alterations  in  food  by  heat  and  parasites  should  be  watched  for  and 
avoided  with  care.  The  two  principal  meals  of  the  day,  composed  generally  of 
two  dishes  and  a  dessert,  should  include  as  much  fresh  vegetables  and  fruit  as 
possible.  Tai>le  drinks  should  not  contain  a  total  of  more  than  40  grams  of 
alcohol.  Potable  water,  always  to  be  purified,  should  be  taken  in  sufficient 
quantity  to  cause  an  abundant  diuresis. 

Doctor  Van  der  Burg  said  that  ideas  of  tropical  alimentation  had  formerly 
rested  on  the  assumption  that  the  blood  of  Eux'opeans  is  altered  in  composition 
by  a  sojourn  in  the  Tropics.     Tropical  anaemia  had  heretofore  formed  the  basis 


432  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

of  physiology  in  hot  countries.  But  this  year  Marestang  has  showu  that  the 
number  of  red  corpuscles  in  the  blood  is  not  diminished.  Eijkman  and  Van 
der  Scheer  haA'e  A'erified  these  findings  and  have  further  determined  that  the 
composition  of  the  blood  is  the  same  in  the  Tropics  as  in  Europe,  In  the 
Tropics  there  is  usually  an  aversion  to  fats,  which  are  needed  in  small  quantities 
only.  The  appetite  for  a  albuminous  food  is  not  great,  possibly  from  the  diminu- 
tion of  hydrochloric  acid  in  the  stomach  from  the  loss  of  hydrochlorate  of  soda 
by  excessive  perspiration.  Still  a  vegetarian  diet  is  not  to  be  recommended, 
because  to  obtain  a  sufficient  quantity  of  albunien  too  large  a  bulk  of  vegetable 
aliment  has  to  be  ingested.  A  man  of  good  constitution  can  retain  his  healtli 
in  the  Tropics  if  he  will  not  indulge  in  any  excess  in  the  use  of  preserved  food, 
of  unknown  products  of  the  country,  or  of  alcohol. 

Dr.  II.  Dupont  said  that  it  is  necessary  in  hot  climates,  and  especially  in 
countries  where  malaria  reigns,  to  use  a  mixed  diet,  and  it  is  important  to 
determine  in  a  special  manner  what  food  consumed  by  residents  has  the  property 
of  being  easily  digested. 

Closing  the  question,  a  resolution  was  adopted  to  the  effect  that  it  is  not 
necessary  to  diminish  the  nourishment  in  hot  countries  nor  is  it  necessary  to 
increase  the  ration  of  meat. 

In  regard  to  the  prophylaxis  of  malaria,  papers  were  submitted  by  Doctor 
Celli,  professor  of  hygiene.  University  of  Rome;  Doctor  Plehn,  of  Berlin;  Maj. 
Ronald  Ross,  professor  of  tropical  medicine  in  the  University  College,  Liver- 
pool, and  Dr.  Patrick  Manson,  of  the  Liverpool  School  of  Tropical  Medicine. 
Doctor  Celli  dwelt  emphatically  on  the  prophylactic  use  of  quinine  salts  (20  to 
40  centigrams  per  day  for  adults,  the  half  for  young  children),  claiming  that 
thereljy  a  specific  disinfection  of  the  blood  of  malarial  persons  is  effected.  He 
also  urged  the  importance  of  the  mechanical  prophylaxis  of  habitations  and 
uncovered  portions  of  the  human  body,  the  hydraulic  sanitation  of  agricultural 
land,  and  the  destruction  of  anopheles. 

Major  Ross  said  that  it  is  the  unanimous  opinion  of  himself  and  his  col- 
leagues that  the  ordinary  mosquito  net  when  scrupulously  and  intelligently 
used  affords  the  most  valuable  personal  means  of  protection  against  malaria. 
Unfortunately,  he  said,  nets  can  not  be  afforded  by  the  bulk  of  a  native  popula- 
tion, or  even  by  the  poorer  whites,  such  as  sailors  and  miners,  and  there  are 
many  persons  who,  from  obstinacy,  ignorance,  or  carelessness,  refuse  to  employ 
them,  though  they  can  well  do  so.  Gauze  screens,  punkahs,  and  fans  were  also 
recommended.  Doctor  Ross  believes  in  the  limited  efficacy  of  the  segregation 
of  Europeans  where  possible  in  the  Tropics,  but  says  that  segregation  can 
never  be  perfect  and  probably  the  money  had  better  be  spent  otherwise. 
While  fully  admitting  the  value  of  cinchona  derivatives  as  prophylactics. 
Major  Ross  said  that  because  quinine  is  disagreeable  many  persons  who  quite 
believe  in  its  preventive  efficiency  refuse  to  take  it,  however  great  the  risk 
of  infection.  Notification,  isolation,  and  treatment  of  the  infected  might  be 
practicable  in  countries  where  the  cases  of  malaria  are  few,  but  in  many  tropical 
places,  where  half  the  native  children  and  a  large  proportion  of  the  adults  are 
infected,  where  there  are  few  medical  men,  and  where  there  is  a  constant 
influx  of  infected  persons  from  without,  there  are  insuperable  difficulties  in  the 
way  of  employing  these  measures.  Referring  to  the  suppression  of  mosquitoes, 
the  speaker  said  that  by  this  he  did  not  mean  the  suppression  of  mosquitoes 
over  large  rural  areas,  but  only  in  the  principal  centers  of  population.  There- 
fore, only  approximate,  not  absolute,  results  can  be  expected.  This  w<irk 
implies,  first,  permanent  drainage  and  leveling  of  pools,  and,  secondly,  the  con- 
stant employment  of  sufficient  labor  for  dealing  with  newly  formed  pools,  for 
the  petrolage  of  those  which  can  not  be  drained,  and  the  removal  of  mo.squito- 
breeding  rubbish  from  houses.  It  was  roughly  estimated  that  the  reduction  of 
mosquito-borne  disease  will  vary  as  the  square  of  the  reduction  in  the  number 
of  mosquitoes.  In  answer  to  the. frequent  denial  that  it  is  possible  to  reduce 
the  number  of  mosquitoes  in  any  locality.  Major  Ross  said  that  on  a  small 
scale  many  campaigns  against  these  insects  have  been  recorded,  especially  in 
the  United  States.  He  cited  a  campaign  on  a  large  scale,  the  fight  against  mos- 
quitoes in  Habana,  in  which  the  mosquitoes  were  reduecd  to  10  per  cent  of 
their  former  number  and,  at  the  same  time,  yellow  fever  eradicated  from  that 
large  city. 

Doctor  Manson  said  that  besides  the  mosquitoes  there  is,  in  all  probability,  an 
additional  host  of  malaria.  Whatever  it  is  it  is  removed  by  drainage.  In 
England  anopheles  exist,  but  there  is  no  malaria.  This  additional  host  is 
some  animal  closely  associated  with  man.     It  is  the  duty  of  students  every- 


PUBLIC    HEALTH    AND    MAKINE-HOSPITAL   SERVICE.  433 

whore  to  try  tu  find  it.  Bird  malaria  may  have  a  bearing  on  the  (luestion. 
Doctor  Manson  exiiressed  the  desiral)ility  of  impressing  on  governments  the 
necessity  of  introducing  in  popular  educational  institutions  the  study  of  the 
hygiene  uf  malaria.  He  said  that  many  officers  in  the  Tropics,  and  even  i)ro- 
fessors,  have  an  inclination  to  loiik  on  mosijuito  nets  and  (juinine  as  cowardly 
and  effeminate  measures.  Inability  or  refusal  to  take  (luinine  should  be  a  bar 
to  or  cause  of  dismissal  from  militaiy  service  in  tropical  countries. 

The  prophylaxis  of  the  sleei)ing  sickness  was  then  considered,  five  formal 
papers  being  read  on  the  subject.  The  prophylaxis  of  beriberi  was  next  con- 
sidered. Dr.  A.  Rourguignon,  physician  in  chief  to  the  railway  company  of 
Kongo,  at  Matadi,  gave  an  account  of  an  epidemic  of  beriberi  in  the  Kongo 
State,  in  which  the  susceptibility  of  such  colored  persons  as  were  strangers  to 
the  country  was  apparent.  He  said  that  the  prophylaxis  consisted  in  good  ele- 
vated habitations  and  proper  alimentation.  He  also  said  there  was  reason  to 
study  the  prophylactic  action  of  quinine.  Doctor  Hebrard.  major  surgeon  of  the 
colonial  troops  at  Toulon,  asserted  that  an  important  preventive  measure  con- 
sistetl  in  having  a  care  that  in  all  communities  of  the  colored  race  the  members 
are  treated  humanely  and  submitted  to  proper  hygiene.  In  countries  where 
beriberi  is  endemic  the  authorities  should  insist  on  certificates  of  the  quality  of 
rice  and  other  exported  provisions,  their  proper  stowage,  the  preliminary  clean- 
liness and  disinfection  of  vessels,  and  absence  of  beriberi  patients  among  pas- 
sengei"s  or  crew.  In  event  of  an  epidemic  the  consumption  of  rice  should  be 
radically  suppressed,  other  provisions  should  be  submitted  to  inquiry,  the  sick 
should  be  isolated  and  their  habitations  evacuated  and  disinfected,  and  rigor- 
ous rules  of  general  hygiene  should  be  applied. 

Dr.  C.  L.  Van  der  Burg  reviewed  the  theories  of  the  cause  of  beriberi,  and  as 
prophylactic  measures  recommended  a  rational  alimentation,  variety  of  food, 
proper  ventilation:  spacious,  well-lighted  habitations,  with  outhouses  at  a  dis- 
tance :  avoidance  of  crowding,  as  in  barracks  and  prisons ;  regular  exercise  of 
the  healthy  in  the  open  air,  "  avoidance  of  excess  in  Bacco  and  in  Venere,"  isola- 
tion of  the  siclv  in  elevated  regions,  energetic  disinfection  of  their  liabitations 
and  apparel,  prohibiting  sick  mothers  from  nui^sing  their  babes,  and  the  building 
of  houses  of  Europeans  at  a  great  distance  from  those  of  the  natives. 

Dr.  Ch.  Firket,  professor  of  the  University  of  Liege,  said  that  tliere  existed 
not  only  a  di.sea.se  beriberi,  but  also  beriberis,  specifically  different  from  each 
other,  ejjch  kind  requiring  a  special  prophylaxis.  Many  of  the  cases  are  due  to 
the  same  causes  as  is  the  multiple  neuritis  observed  in  Europe.  At  other  times, 
especially  in  epidemics  among  large  numbers  of  persons,  the  malady  is  due  to 
the  combined  action  of  different  pathogenic  agents,  such  as  rice  and  dried  fish. 
The  prophylaxis  of  beriberi  calls  for  the  conscientious  application  of  general 
hygiene.  In  case  of  an  epidemic  the  measures  to  be  adopted  vary  with  the  local 
existing  etiological  conditions. 

The  question  of  the  prophylaxis  of  smallpox  in  hot  countries  was  the  subject 
of  reports  by  Monsieur  Guerin,  chief  of  the  laboratory  of  serums  and  vaccines  at 
the  Pasteur  Institute,  Lille,  and  Dr.  G.  Grijns,  of  the  Geueeskundig  Laborato- 
rium,  at  Weltevreden.  Doctor  Guerin  said  that  at  the  present  day  it  was  hardly 
necessary  to  express  a  preference  for  animal  in  contradistinction  to  human  virus, 
and  to  condemn  the  dangerous  practice  of  variolization  still  practiced  in  China. 
He  also  considered  the  technique  of  vaccine  production,  treating  of  the  subjects 
of  European  and  indigenous  vaccine  genetic  centers,  the  rabbit  as  a  vaccinifier,  as 
a  regenerator  of  enfeebled  vaccines,  and  as  an  intermediate  animal  in  the  prepa- 
ration of  vaccine  of  the  heifer.  He  came  to  the  conclusion  that  since  the  com- 
bined action  of  glycerin  and  heat  manifests  itself  on  triturated  vaccine  by  a  more 
or  less  i-apid  sterilization  of  all  virulent  elements  it  is  important  in  practice  to 
keep  the  untriturated  vaccinal  pustular  product  at  a  low  temperature  and  in  the 
least  possible  glycerin  :  that  the  difficulty  that  results  in  providing  the  colonies 
with  virulent  European  vaccine  renders  es.sential  the  establishment  of  nimierous 
indigenous  vaccinogenic  centers :  that  in  these  centers  the  rabbit  can  render 
good  service  as  a  vaccinifier  by  reason  of  its  sensibility  to  vaccine  and  the  brief 
evolution  in  the  animal  of  that  infection,  and  that  the  rabbit  becomes  a  valuable 
animal  in  these  institutions  as  a  control  and  as  a  certain  regenerator  of  attenu- 
ated vaccines,  mking  it  possible  to  have  a  rabbit-heifer  cycle  without  the  inter- 
vention of  glycerin.  Doctor  Grijns  submitted  a  report  on  the  question  under 
consideration,  dealing  with  vaccination  and  the  technique  of  the  preparation  of 
vaccine  virus  in  the  Netherland  Indies.  A  copy  of  Dr.  Grijn's  paper  accom- 
panies this  report. 

8629—04 28 


434  PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE. 

In  consideriug  the  question  of  the  organization  of  schools  of  colonial  medicine, 
papers  setting  forth  the  necessity  for  such  teaching,  outlining  courses  of  instruc- 
tion, anil  descrihing  existing  institutions  were  pi'esented  by  Doctor  Brouardel ; 
Dr.  V.  de  (iiaxa,  professor  of  hygiene  of  the  faculty  of  medicine  of  Naples ;  Doc- 
tor Nocht,  director  of  the  Institute  of  Tropical  Maladies.  Hamburg:  Maj.  Ronald 
Ross,  of  the  Liverpool  School  of  Tropical  Medicine;  and  Dr.  W.  J.  Simpson,  pro- 
fessor in  the  School  of  Tropical  Medicine,  London.  It  was  decided  by  an  aftirm- 
ative  vote  of  the  section  that  schools  of  colonial  medicine  with  dependent  hos- 
pitals are  useful,  that  they  should  have  both  an  auxiliary  and  a  native  personnel, 
and  that  sea  captains  should  be  given  hygienic  instruction  at  these  schools. 

Second  division — Demography. 

Beginning  its  work,  the  division  of  demography  examined  the  questions  of 
the  movements  and  causes  of  mortality,  the  statistics  of  stillbirths  in  different 
countries,  and  infant  mortality.  I'ai)ers  on  these  subjects  were  presented  by  Dr. 
W.  Tatham,  general  registrar,  Somerset  House,  London :  Monsieur  Wilmart, 
chief  of  the  division  of  hygiene,  Brussels ;  and  Doctor  Prausuitz,  professor  of 
the  University  of  Graz.  In  the  course  of  the  discussion  Dr.  Jacques  Bertillon, 
chief  of  the  work  of  municipal  statistics,  Paris,  gave  as  his  opinion  that  the  large 
mortality  of  infants  is  due  to  special  microbiological  causes.  Views  were  also 
advanced  that  the  cause  of  infantile  mortality  is  largely  due  to  bad  nourish- 
ment ;  that  hard  and  unhygienic  labor  of  women  has  its  bearing ;  that  false 
views  of  hygiene  and  lack  of  care  for  infants  are  also  responsible;  and  that 
temperature  is  a  potent  factor.     The  division  adopted  the  following  resolution; 

"  Considering  that  the  question  of  infantile  mortality  is  of  great  inqiortance 
for  the  well-being  of  the  people  and  the  social  state  of  nations,  and  that  figures  are 
not  available  on  which  to  form  a  basis  of  statistics  of  stillbirths,  it  is  resolved 
that  the  division  of  demography  reconmiend  all  governments  to  revise  the  admin- 
istrative ordinances  for  the  registration  of  births  (comprising  prematin-e  births 
and  stillbirths),  the  registration  to  include  accessory  circumstances;  and  that 
it  be  considered  the  duty  of  statisticians,  jointly  with  physicians,  to  search  the 
records  of  births  in  order  to  obtain  uniform  lists  of  prematui'e  births  and  still- 
births." 

It  was  also  resolved,  in  substance,  that,  considering  that  the  problem  of 
infant  mortalitj'  is  a  grave  one  among  modern  industrial  nations,  the  compara- 
tive study  of  infant  mortality  should  be  taken  up  from  the  point  of  view  of 
relative  prosperity  and  the  tinancial  circumstances  of  different  parts  of  the 
population,  of  the  nature  and  conditions  of  female  labor,  and  of  the  legitimacy 
of  births. 

The  questions  were  then  considered  of  official  and  uniform  statistics  of  the 
causes  of  death,  the  comparative  frequency  of  the  principal  causes  of  death  in 
towns  using  the  international  nomenclature,  the  basis  for  correct  statistics  of 
birth,  the  means  of  determining  by  demography  the  tendencies  to  augmentation 
and  diminution  of  births,  and  fluctuations  in  the  birth  rate.  Addresses  were 
presented  by  Dr.  Willi.  Hiorth.  chief  of  bureau  of  the  medical  department  of 
Norway ;  Edm.  Nicolai,  director  of  the  ministry  of  the  interior  and  public 
instruction,  Brussels ;  Lucien  ]March,  chief  of  the  general  statistical  service  of 
France,  and  Dr.  George  von  Mayr,  professor  in  the  University  of  Munich. 
These  papers  outlined  in  a  detailed  manner  the  forms  in  which  notification 
should  be  made  impressing  the  importance  of  information  and  reviewing  the 
difficulties  in  obtaining  facts. 

As  a  result  of  the  consideration  of  the  topics  it  was  resolved  that  there  is 
necessity  for  the  effective  and  general  aiiplication  of  a  law  requiring  the  veri- 
fication by  a  medical  officer  of  all  deaths ;  the  introduction  of  laws  enforcing 
physicians  to  give  notification  of  the  cause  of  deaths  in  their  practice,  and 
that  pending  the  passage  of  these  legal  measures  to  put  in  force  an  anonymous 
declaration  of  the  causes  of  death  following  on  broad  lines  the  Swiss  system. 

It  was  also  resolved  that  inasmuch  as  statistical  analysis  by  demographic 
abstracts  is  effected  [)y  analysis  of  homogeneous  groups  of  figures  it  is  neces- 
sary to  be  supplied  with  multiple  details ;  hence,  in  the  pi-eparatious  of  civil 
records  and  in  the  pre]iaration  of  official  abstracts  from  these  records,  it  is 
necessax'y  that  full  details  he  furnished.  These  records  are  capable  of  furnish- 
ing information  on  two  important  facts — first,  the  total  fecundity  of  marriage, 
and,  second,  the  annual  fecundity. 

The  Congress  proceeded  to  the  study  of  the  questions  of  what  are  the  best 
coefficients  to  employ  for  the  study  of  laws  regulating  marriages,  births,  and 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  435 

denllis,  considoriiif:  itarticularly  the  objoctions  niado  to  a  law  tliat  attrihutos  to 
popular  n'soiirc'is  and  noods  tlio  variations  in  the  birth,  niarriajjc  and  death 
rate.  M.  C'auderlier  read  a  paper  in  which  he  declared  his  beliel'  in  a  relation 
between  birth,  niarriaj^e.  and  death  rates  and  the  resources  and  needs  of  the 
l)eoi)le.  JI.  Venyn-Stuart  expressed  the  opinion  that  the  theory  held  by  M. 
("auderller  was  not  of  a  scientific  character.  That  it  is.  indeed,  among  the  easy 
ilasses  that  the  birth  rate  is  lowest,  and  that  it  would  appear  that  poverty 
increases  the  birth  rate. 

The  study  of  demographic  statistics  of  cities  was  then  taken  up,  reports  being 
furnished  on  the  subject  by  M.  .Tacquart.  chief  of  the  general  statistical  bureau 
of  the  ministry  of  the  interior  and  of  public  instruction,  Hrussels,  and  Dr.  Otto 
Landsberg.  director  of  the  otfice  of  statistics  of  the  city  of  Elberfeld.  This 
subject,  together  with  the  (luestions  of  suicide,  mental  alienation,  archives  as  a 
source  of  statistics,  trade  mortality,  and  mortality  from  alcoholic  abuse  were 
develoiied  in  a  manner  such  as  to  make  them  more  of  local  Belgian  interest  than 
of  general  demographic  importance. 

On  the  (luestion  of  interior  migrations,  the  depopulation  of  rural  districts  and 
the  increased  population  of  cities.  Paul  Meuriot.  of  Sceaux.  furnished  an  inter- 
esting paper  sliowing  the  development  of  suburbs,  a  movement  that  has  become 
particularly  marked  in  recent  years  in  the  development  of  London.  Paris,  St. 
Petersburg,  and  other  European  cities.  The  word  city,  said  M.  INIeuriot.  for- 
merly implied  a  well-circumscribed  mass  of  population,  but  nowadays  a  city 
lodges  those  belonging  to  it  in  a  considerable  number  of  scattered  localities. 
This  change  In  the  grouping  of  populations  has  naturally  an  important  demo- 
graphic aspect. 

EXHIBmON    AND   EXCURSIONS. 

Annexed  to  the  congress  was  an  exhibition  of  material,  literature,  drawings, 
and  models  relating  to  hygiene  and  demography. 

In  addition  to  inspecting  the  public  institutions  of  Brussels,  the  delegates 
were  given  opportunities  for  visiting  the  sanitary  installations  of  Antwerp,  the 
baths  at  Spa,  the  provincial  sanatorium  at  Borgoumont,  the  waterworks  at 
Waelhem  (used  for  the  puriticatiou  of  the  Antwerp  city  water),  the  sources  of 
water  supply  at  Sovet  and  Spontin.  in  the  valley  of  the  Bocq,  and  the  reservoir 
at  Boitsford,  the  terminus  of  the  aqueduct  that  carries  water  from  the  springs 
in  the  valley  of  the  Bocq. 

Diu'ing  the  congress  approaches  were  made  to  the  United  States  delegation 
on  the  subject  of  a  congress  of  hygiene  to  be  held  in  the  United  States  in  1909. 
This  information  was  transmitted  to  the  United  States  minister  by  Dr.  Charles 
Harrington,  of  Harvard  University :  Maj.  W.  D.  ^McCaw,  surgeon,  L^.  S.  Army ; 
Surg.  S.  G.  Evans.  U.  S.  Navy,  and  Passed  Asst.  Surg.  J.  M.  Eager.  L'nited 
States  Public  Health  and  Marine-Hospital  Service.  As  a  result,  a  telegram 
was  received  from  the  State  Department  of  the  L^nited  States  sanctioning  a 
provisionary  invitation  subject  to  future  legislation.  This  invitation  to  hold  a 
congi'ess  at  Washington  in  the  year  1909  was  extended  to  the  congress  at  the 
closing  meeting  by  Dr.  Charles  Harrington,  acting  as  speaker  for  the  delegation. 
Respectfully, 

J.  M.  Eager, 
Passed  Assistant  Surgeon. 

The  Surgeon-Genebal. 

MEETING   or   THE    TEXAS    MEDICAL   ASSOCIATION    AT   AUSTIN,   TEX.,   APRIL 

26,  TO  29,  1904. 


Surg.  H.  E.  Carter  reports  as  follows : 


The  Texas  Medical  Association  met  on  the  morning  of  April  26,  at  10  a.  m. 
I  attended  three  sessions  per  day  each  day  except  on  the  last  day,  April  29, 
when  I  was  in  consultation  with  Doctor  Tabor,  the  Texas  health  othcer,  with 
reference  to  sanitary  matters.  The  sections  I  attended  were  those  of  gen- 
eral medicine,  four  sessions  :  State  medicine  and  public  hygiene.  tAvo  sessions ; 
surgery,  and  pathology,  besides  the  general  sessions  of  the  whole  association.  In 
the  section  on  medicine  a  very  suggestive  paper  was  read  by  Doctor  Woldert.  of 
Tyler,  on  "  Malarial  fever  and  its  expense  to  the  people  of  Texas."  Doctor 
Woldert  had  done  some  of  the  earliest  work  in  America,  if  not  the  earliest,  in 
the  anatomy  of  the  anopheles  mosquito.     This  was  done  some  years  ago  in 


436  PUBLIC   HEALTH    AND    MAKINE-HOSPITAL    SEEVICE. 

Philadelphia  uuder  Flexuer,  and  he  exhibited  some  very  interesting  sections, 
made  consecutively,  of  this  insect,  both  uninfected  and  infected,  the  latter  being 
of  a  number  of  insects  in  different  periods  of  infection.  The  species  of  mos- 
quito was  the  A.  maculapcunls,  and  the  work  was  to  my  mind  extremely  good. 
He  laid  especial  stress  on  the  large  morbidity  from  this  class  of  diseases  in 
Texas  and  the  cost  of  the  same,  saying  that  it  exceeded  that  from  the  boll  weevil 
and  other  pests  against  which  large  appropriations  had  been  made,  and  urged 
vigorous  sanitary  measures  against  it  on  well-recognized  lines,  even  if  these 
measures  should  involve  the  expenditure  of  a  considerable  amount  of  money. 
The  debate  on  this  paper  was  less  general  than  its  importance  should  have 
excited. 

A  somewhat  remarkable  and  very  interesting  paper  in  the  same  section  was 
that  of  Doctor  Westphal,  of  Yorktown,  "  Report  of  a  case  of  malarial  cystitis  with 
parasites  in  the  blood  cells  found  in  the  urine."  It  would  be  difficult  to  give  a 
synopsis  other  than  is  given  by  its  title  in  a  short  space. 

"  The  relation  of  the  public  schools  to  the  medical  profession,"  an  address  by 
the  Hon.  Arthur  Le  Fevre,  of  Austin,  in  the  section  of  State  medicine,  excited, 
as  could  be  judged  from  the  number  who  took  part  in  the  debate  on  it,  general 
interest  and  was  an  excellent  paper  in  every  respect.  The  same  may  be  said  of 
a  paper  by  W.  S.  Carter,  of  Galveston,  on  the  "  Prophylaxis  of  tuberculosis." 
He  only  considered  the  dissemination  of  the  disease  by  dried  sputum,  with  the 
respiratory  tract  as  the  atrium,  evidently  regarding  the  alimentary  tract  and 
alimentary  substances  as  of  very  secondary  importance  in  this  connection. 

There  were  a  number  of  other  good  papers,  but  these  especially  bear  on  the 
subject  of  public  health.  I  addressed  the  association,  as  requested,  on  the 
"  Conveyance  of  yellow  fever ;  "  was  followed  by  Doctor  Reuss,  of  Cuero,  on 
"An  outbreak  of  yellow  fever  in  Dewitt  County,"  and  Doctor  Dinwiddle,  of 
San  Antonio,  on  "  The  Laredo  yellow-fever  epidemic."  From  the  debate  on 
these  three  papers  it  is  fair  to  judge  that  the  subject  of  yellow  fever  was  of 
much  interest  to  the  association  and  that  the  profession  is  divided  in  their 
opinions  as  to  conveyance  by  the  mosquito  host  being  the  only  means  of  its 
natural  propagation.  All  who  were  engaged  in  the  yellow-fever  epidemic  of 
last  year  are  subscribers  to  the  doctrine,  and  it  is  hoped  that  the  papers  above 
referred  to  and  the  debate  thereon  were  of  service  in  convincing  some  of  the 
others  who  did  not  so  believe. 

The  association  adjourned  on  April  29,  in  the  evening. 

The  association  has  a  membership  of  2,415,  which  I  think  is  as  large  as  any 
in  the  United  States,  if  it  be  not  the  largest. 

The  Convetance  of  Yellow  FE^^:B,  by  Subg.  H.  R.  Cabteb. 

[Read  before  the  Texas  State  Medical  Association,  April  27,  1904.] 

I  will  say  nothing  of  the  history  of  my  subject.  It  is  interesting  to  read  the 
many  theories  advanced  for  the  causation  and  propagation  of  yellow  fever, 
especially  the  arguments  for  its  conveyance  by  "  infected  air,"  and  its  "  spon- 
taneous origin  "  under  specified  conditions.  Nor  is  it  altogether  unprofitable, 
but  the  interest  is  speculative  now  rather  than  ju-actical,  and  it  would  take 
time.  I  can  not  even  take  the  time  to  give  the  history  of  the  evolution  of  the 
docti'ine  I  shall  advocate,  although  I  should  like  to  show  you  how  blind  we 
were  to  Doctor  Finlay's  arguments  until  Reed's  demonstration  compelled  us  to 
see. 

I  propose  simply  to  announce  what  I  think  to  be  the  true  doctrine  of  the 
propagation  of  yellow  fever,  and  to  give  brietly  the  reasons  for  the  faith  that 
is  in  me. 

This  is  the  proposition,  the  "  creed,"  so  to  si)eak,  of  the  doctrine : 

Yellow  fever  is  conveyed  from  tlie  sick  to  the  well  by  a  mosquito  host,  the 
^tcgomyia  fasciata.  contaminated  by  feeding  on  the  sick  man,  and  in  nature 
it  is  only  thus  conveyed. 

It  does  not  seem  necessary  to  discuss  the  first  part  of  this  prpposition,  as  I 
am  sure  you  all  accept  the  statement  tliat  yellow  fever  is  thus  conveyable.  It 
is  a  positive  proposition  and  thus  admits  of  positive  evidence,  and  that  evi- 
dence is  satisfactory  and  abundant.  The  American  connuission,  of  which  Reed 
was  chairman,  reported,  first  and  last,  32  cases  thus  conveyed;  Reed  and  Car- 
roll, 2 ;  Guiteras,  8  cases ;  Parker,  Porthier,  and  Beyer,  at  Vera  Cruz,  1  case. 
The  second  party  at  Vera  Cruz,  1  case ;  the  Pasteur  Institute  commission  at 
Petropolis,  4  cases ;   Ribas  and  his  confreres  at  Rio  Janeiro  also  reported  sue- 


PUBLIC    HEALTH    AND    MARINR-HOSPITAL    SERVICE.  437 

cessful  oxporinionts,  but  I  luive  not  soon  tlioir  roport  jiiul  do  not  know  how 
many  eases.  Indeed,  all  who  have  tried  to  convey  yellow  fever  in  this  manner 
have  succeeded.  I  do  not  think,  then,  that  any  of  us  doubt  tliat  yellow  fever 
is  thus  conveyable. 

Note,  please,  the  conditions  under  which  this  conveyance  occurred  in  the 
experiments  noted. 

(1)  A  particular  kind  of  mosquito  was  used — Stcf/omyia  fasciata. 

(2)  It  bit  a  patient  in  the  first  three  days  of  yeihtw  fever. 

(0)  It  was  kept  a  considerable  time — twelve  days  was  the  shortest  time — 
and  then  hit  the  well  man. 

After  once  acciuirinj?  the  power  of  conveying  yellow  fever,  for  which  a  cer- 
tain time  after  bltinj;  the  sick  man  is  necessary,  the  n\osquito  seems  to  retain 
the  power  indefinitely ;  at  least  one  of  Reed's  conveyed  yellow  fever  fifty-nine 
days  after  feeding  on  a  yellow-fever  patient. 

Given  the  above  conditions,  yellow  fever  was  i)roduced  with  reasonable 
constancy.  A  few  men,  very  few,  were  found  to  he  immune  to  this  method  of 
conveyance,  and  not  every  mosquito  bite  conveyed  yellow  fever  even  to  those 
who  subsequently  succumbed  to  mos([uito  bites. 

Let  us  inquire  into  these  conditions  one  by  one  and  see  if  we  can  tell  what 
are  the  essentitjls  of  this  method  of  propagation  of  yellow  fever. 

(1)  The  kind  of  mosciuito.  So  far,  except  one  trial  of  Culex  pungens,  only 
the  Stcc/omi/ia  has  been  experimented  with.  It  seems  idle,  then,  to  speculate  if 
some  other  genus  or  species  of  mosquito  will  not  also  act  as  host.  Analogy 
would  lead  us  to  suspect  some  other  species  of  Btegoniyia  would  do  so,  but  that 
no  mosquito  not  of  this  genus  would.  The  genus,  and  this  species  of  it,  is 
widely  distributed  in  hot  countries.  Obviously  we  can  not  exclude  such 
species  as  are  found  in  places  where  yellow  fever  does  not  spread  when 
introduced.  And  here  lot  us  notice  that  if  yellow  fever  is  conveyed  by  only 
one  genus  or  species  of  mosquito,  then  it  is  conveyable  only  where  and  when 
that  particular  mosquito  is  found  and  is  active,  and  that  arguments  concerning 
its  conveyance  drawn  from  the  habits  of  other  mosquitoes  are  valueless  unless 
these  habits  are  common  to  the  Stcgomyia  also,  whose  habits  are  in  many 
respects  different  from  those  of  other  mosquitoes.  Nor  does  the  presence  of 
mosquitoes  in  a  place  in  any  wise  imply  that  yellow  fever  can  be  propagated 
there,  unless  the.v  are  Stegomyke.  I  would  not  state  facts  so  obvious  unless  I 
liad  seen  the  need  of  it.  I  was  asked,  "  How  can  you  say  that  a  vessel  a  few 
hundred  yards  offshore  is  safe  from  the  invasion  of  infected  mosquitoes  when 
you  yourself  say  that  you  have  seen  swarms  of  mosquitoes  come  aboard  a  mile 
out  at  sea?"  Now,  the  "infected  mosquitoes"  are  StegoinyicF,  and  tliosc  that 
boax-ded  me  offshore  were  the  "  salt-water  "  mosquito — a  culex,  a  different  thing 
altogether. 

A  gentleman,  an  excellent  physician  too,  asked  why,  if  mosquitoes  conveyed 
yellow  fever,  could  one  explain  tliat  a  certain  hospital  wdiere  yellow  fever  was 
treated  I'emaiued  uninfected,  "  although,  being  close  to  tlie  marsh,  it  was  swarm- 
ing with  mosquitoes."  There  was  no  evidence  to  show  that  tliese  were  tSteg- 
omylcr.     Indeed,  this  variety  is  not,  as  a  general  thing,  found  in  marshes. 

(2)  In  all  the  exiieriments  the  patients  were  bitten  in  the  first  three  days  of 
yellow  fever.  Is  this  tlie  limit  of  time  during  which  lie  can  infect  the  mosquito? 
You  can  see  what  a  very  important  point  it  is  to  detei-mine  this,  because,  if  it 
be  true,  a  patient  after  this  time  can  no  longer  communicate  the  disease  even  if 
bitten  by  a  mosquito.  The  only  experiments  on  this  matter  are  those  of  the 
Pasteur  Institute  Commission.  They  injected  blood  from  three  cases  of  yellow 
fever,  each  one  in  the  fourth  day  of  the  disease,  into  three  subjects,  it  having 
been  found  that  the  disease  was  conveyed  quite  certainly  by  this  method.  None 
of  these  subjects  developed  yellow  fever.  One  of  them  was  shown  to  be  suscep- 
tible to  yellow  fever  by  being  bitten  afterwards  by  an  infected  mosquito.  This 
commission  concludes  from  this  that  the  power  of  the  patients  to  produce  infec- 
tion lasts  only  three  days.  Yet  this  seems  to  me  too  absolute  a  conclusion  for 
the  number  of  observations  made.  Unquestionably  the  blood  of  these  patients 
did  not  convey  yellow  fever,  but  I  would  prefer  to  see  more  experiments  on  this 
matter  before  I  regard  it  as  settled,  and  it  is  a  very  important  one  for  the  sani- 
tarian— important,  because  we  wish  to  isolate  the  patient  only  while  infective, 
and  if  three  days  is  the  limit  we  will  not  isolate  him  longer ;  not  only  for  his 
sake,  but  for  our  own.  My  experience  has  been,  and  I  think  all  health  otticers 
will  confirm  me,  that  restrictive  measures  of  sanitation,  especially  if  domiciliary 
measures  as  well,  are  hard  enough  to  carry  out  any  way,  and  that  the  least  we 
require,  provided  it  be  all  tliat  is  necessary,  the  better  will  the  work  be  done. 


438  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

The  enforcement  of  unnecessary  me.nsures  of  that  kind  is  generally  at  the 
expense  of  some  essential.  As  of  old,  the  tithing  of  mint,  anise,  and  cumin 
leads  to  the  neglect  of  the  weightier  matters  of  the  law. 

(.3)  How  long  must  the  mosquito  wait  after  l)iting  the  yellow-fever  patient 
before  it  can  conununicate  yellow  fever?  How  long  does  it  take  for  the  infected 
mosquito  to  become  infective? 

Now,  before  Reed's  work  in  Cuba  I  had  determined  the  existence  of  a  period 
of  time,  and  consideral)le  period  of  time,  that  must  elai)se  after  the  development 
of  a  case  of  yellow  fever  in  an  uninfected  place  before  that  place  became  infect- 
ive. During  this  time  yellow  fever  could  not  be  contracted  in  this  place.  This 
period,  the  length  of  which  I  could  only  approximately  determine,  I  had  called 
the  "  extrinsic  inf-ubation  "  of  yellow  fever.  I  did  not  know  the  explanation, 
yet  the  knowledge  of  the  fact  was  of  great  service  to  me  in  ejtidemic  work.  It 
was,  of  course,  the  time  that  it  takes  for  the  mosquito  after  biting  the  sick  man 
to  become  infective.  This  time  depends  on  the  temperature,  as  do  all  of 
the  processes  of  and  in  the  mosquito — being  longer  in  low  temperature.  The 
shortest  time  in  which  this  power  of  conveying  infection  has  been  manifested 
in  the  experimental  cases  was  twelve  days.  It  was  usually  decidedly  longer 
than  this  in  Reed's  experiments,  most  of  which  were  in  the  winter.  The  twelve- 
day  case  was  in  August.  It  seems  to  be  accepted  that  twelve  days  is  the  short- 
est time  in  which  an  infected  mosquito  can  become  infective,  and  this  agrees 
with  my  own  crude  determination  of  the  minimum  period  of  extrinsic  incuba- 
tion, "  somewhat  over  ten  days,"  and  yet  I  can  not  think  that  this  has  been 
experimentally  proven.  Not  enough  attempts  have  been  made  during  hot 
weather  with  mosquitoes  for  less  than  twelve  days.  The  determination  of  the 
minimum  of  this  period  is  of  interset,  but  not  of  great  importance. 

I  am  sory  to  confess  that  we  have  not  found  the  micro-organism  of  yellow 
fever,  although  it  has  been  assiduously  searched  for  both  in  human  blood 
known  to  contain  it  and  in  the  ))i<)S(iuito,  yet  some  direct  observations  have  been 
made  on  it.  In  the  blood,  at  least,  it  exists  in  an  ultramicroscopical  form,  as 
was  first  shown  by  Carroll  working  on  lines  laid  out  by  Reed  and  himself.  lie 
found  that  blood  serum  filtered  through  a  Berkenfeld  filter  would  still  produce 
the  disease.  This  was  confirmed  by  the  Pasteur  Institute  Commission  and,  iji 
my  opinion,  by  the  working  party  at  Vera  Cruz.  The  I'asteur  Institute  (Com- 
mission found  that  serum  passed  through  a  Chamberlain  bougie  B  would  con- 
vey infection,  while  that  passed  through  a  bougie  F  would  not,  thus  determining 
within  limits  the  size  of  the  smallest  of  the  infective  germs.  I  say  "  the  small- 
est infective  germs  "  advisedly,  because  they  may  exist  in  the  blood  in  different 
forms — as  the  Plasmodium  Malarkc  often  does — and  only  the  small  ones  pass 
the  bougie  B. 

It  IK  worthy  of  note  that  the  direct  injections  of  l)lood  and  serum,  filtered  and 
otherwise,  seem  to  differ  from  mos(iuito  inoculations  in  the  length  of  the  period 
of  inoculation.  Of  24  moscjuito  inoculations  in  normal  individuals,  of  which 
the  i)eriod  of  inoculation  was  accurately  recorded,  the  shortest  was  two  hours 
short  of  three  days  and  the  longest  two  hours  over  six  days,  and  all  save  these 
two  were  between  three  and  six  days.  With  this  agrees  my  own  observ;ition  of 
the  period  of  incubation  of  12  cases  of  yellow  fever,  naturally  contracted,  each 
with  a  single  short  exi)osure,  all  of  which  gave  incubations  of  from  three  to  six 
days.  Now,  in  the  14  cases  of  blood  and  serum  injections  the  time  varied  from 
one  day  and  twenty  hours  to  twelve  days  and  eighteen  hours,  3  of  the  cases 
being  eight  days  and  five  hours,  nine  and  one-half  days,  and  twelve  and  three- 
fourths  days.  Whether  there  is  a  real  difference  or  whether  these  mosquito 
inoculations  and  my  observations  happened  to  have  no  very  long  or  very  short 
periods  of  incubation  I  can  not  say.  Only  as  we  have  SG  of  these  cases  recorded 
and  this  is  the  natural  way  of  conveying  the  fever,  I  would  i-ather  base  my  sani- 
tary measures  on  the  data  from  them  than  on  the  results  of  direct  injection  of 
blood. 

The  organisiu  is  very  easily  killed,  blood  heated  to  55°  C.  for  five  minutes  is 
no  longer  ineffective,  and  it  soon  dies  in  blood  exposed  to  the  air,  although  blood 
five  days  old  covered  by  oil  of  vaseline  is  still  infective. 

So  much  for  the  positive  part  of  our  proposition,  that  yellow  fever  can  be  con- 
veyed in  the  manner  stated. 

The  second  part  of  it  is  different  in  its  very  nature.  It  is  a  negative  proposi- 
tion. To  say  that  "  yellow  fever  is  only  conveyed  by  a  mosquito  host "  is  saying 
that  it  is  not  conveyed  in  any  other  way,  in  any  one  of  the  many  other  ways 
which  might  be  claimed  as  the  true  one,  and  to  proceed  logically  one  should 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE.  489 

cxaniiiio  the  ovidonco  julvancoil  for  ovi'iy  such  way  of  conveyance  and  denion- 
sli-ato  its  futility.  'I'here  are  two  reasons  why  I  do  not  do  this:  (1)  Because 
it  would  be  almost  unending;,  and  (2)  because  as  I  do  not  believe  that  it  is  con- 
veyed in  any  other  way,  I  niij^ht  not  state  the  arguments  for  tlie  aflirnrntive 
fairly.  To  demolish  a  man  of  straw  of  one's  own  make  is  seldom  convincing. 
V(4  I  will  give  a  few  reasons  why  we  should  accept  the  conveyance  by  a  Htcf/- 
onii/ia  host  a.s  the  only  means  by  which  it  is  naturally  conveyed.  I  say 
"  naturally  conveyed."  meaning  the  way  yellow  fever  is  contracted  nalui-aliy 
during  epidtMuics.  Tlie  disease  can  be  conveyed,  as  we  have  seen,  without  the 
mediation  of  a  host  by  the  hypodermatic  injection  of  the  l)loo(l  of  the  patient, 
but  that  surely  is  not  a  natural  conv(>yance. 

(1)  Analogy.  Of  such  diseases  as  have  been  fully  investigated  all  that  are 
conveyed  by  living  hosts  are  conveyed  naturally  in  no  other  way.  This  is  a 
biological  law. 

Familiar  illustrations  are  malarial  fevers  and  Texas  cattle  fever,  which  is 
very  like  yellow  fiwer  in  its  epidemiology,  and  there  are  a  number  of  di.seases 
of  the  lower  animals  thus  conveyed,  and  for  all  this  law  holds. 

(2)  The  facts  ol)served  of  the  natural  propagation  of  yellow  fever  agree 
with  this  theory  and  are  explained  by  it. 

For  instance,  the  fact  that  the  disease  is  not  directly  propagated  from  the 
sick  to  the  well,  that  it  is  propagated  only  by  means  of  an  infected  environ- 
ment, that  a  man  sick  of  yellow  fever  may  infect  his  environment. 

By  our  theory  he  infects  the  mosquitoes  which  bite  him,  and  the  presence 
of  these  infected  mosquitoes  constitutes  the  infected  environment. 

The  existence  of  infectible  and  noninfeetible  places. 

An  "  infectible  "  place,  as  you  know,  is  one  which,  if  cases  of  yellow  fever  be 
introduced  therein,  becomes  infected,  i.  e.,  capable  of  inducing  yellow  fever  in 
those  who  visit  or  live  there.  A  "  noninfeetible  "  i)lace  is  one  which  will  not 
become  infected  even  if  cases  of  yellow  fever  be  introduced.  In  such  a  place 
yellow  fever  is  not  a  transmissible  disease.  The  theory  of  conveyance  by  a 
host  would  explain  this  difference  by  the  presence  of  the  proper  host  i^tci/oDnjia 
fasriata)  in  the  one  and  its  absence  in  the  other. 

The  relation  of  the  spread  of  yellow  fever  to  cold  vi^eather,  altitude,  and  ex- 
cessive diyness.  The  very  conditions  under  which  this  mosquito,  mind  you 
I  do  not  say  "  mosquitoes,"  thrives  best  suit  the  propagation  of  yellow  fever. 

The  close  correspondence  of  the  periods  of  incubation  from  infection  in  the 
natural  way — 12  cases  observed  by  myself — with  the  periods  of  incubation  after 
mosquito  inoculation,  24  cases.  Yellov,'  fever  caused  by  the  hypodei'matic 
injection  of  blood  or  strained  serum  from  a  yellow-fever  patient  has  not  shovN'n 
the  same  agreement  in  its  period  of  incubation  with  that  naturally  contracted. 
It  may  be  because  this  is  not  a  natural  method  of  conveyance. 

The  existence  of  a  considerable  interval,  seldom  under  two  to  two  and  one- 
half  weeks,  between  the  infecting  and  the  first  "  secondai-y  "  cases  of  yellow 
fever.  I  mean  that  when  a  case  of  yellow  fever  contracted  elsewhere  develops 
in  a  noninfected  place  no  case  will  develoi>  from  the  first  one  until  .'i.fter  about 
two  weeks,  and  that  then  we  are  apt  to  have  a  considerable  number  together  as 
our  first  crop.  Now  this,  time  is  decidedly  longer  than  the  period  of  incubation 
of  yellow  fever,  and  since  it  is  an  invariable  phenomenon  it  can  only  mean  that 
the  place  requires  a  certain  time  after  receiving  infection  from  the  sick  before 
it  becomes  capable  of  inducing  yellow  fever  in  others.  This  of  course  is  the 
"  extrinsic  incubation  "  we  have  spoken  of  before,  and  its  usual  minimum  dura- 
tion, which  had  been  fixed  by  observations  of  yellow  fever  naturally  occurring 
as  "  somewhat  hi  excess  of  ten  days,"  the  first  secondary  cases  usually  occurring 
in  the  third  week,  is  too  close  to  the  period,  twelve  days  as  a  minimum,  which 
Reed  observed  between  the  date  of  the  feeding  of  the  mosquito  on  the  yellow- 
fever  patient  and  the  date  on  which  yellow  fever  was  conveyable  by  the  same 
insect  for  those  periods  to  be  due  to  different  causes.  That  cause  in  Reed's 
cases  was  the  incubation  in  the  mosquito.  The  same  phenomenon  is  observed 
with  malarial  fever,  i.  e.,  a  certain  time  must  elapse  from  the  infection  of  the 
Anopheles  by  the  ingestion  of  the  Plasmodium  mal  before  it  is  capable  of  pro- 
ducing the  disease  in  those  whom  it  bites,  and  so  with  other  diseases  caused 
by  parasites  conveyed  by  living  hosts. 

Indeed  this  phenomenon  and  the  fact  that  some  places  are  infectible  and  some 
not  infectible  by  a  yellow-fever  patient,  ^^•ith  no  reason  which  we  could  assign 
tor  the  difference,  are,  taken  together,  scarcely  capable  of  any  other  explanation 
than  conveyance  by  the  host. 


440  PUBLTC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Indeod,  I  do  not  know  one  single  fact  established  concerning  the  natural  propa- 
gation of  yellow  fever  which  does  not  agree  with  the  doctrine  of  its  conveyance 
by  the  Stegomyia  fasciata  as  a  host. 

(3)  Measures  founded  on  this  doctrine  have  given  the  results  which  were  to 
be  expected  of  them  if  it  were  true.  And  this  I  hold  to  be  most  convincing  evi- 
dence. 

In  1899  and  1900  "  campaigns  of  cleanliness  "  were  waged  against  the  yellow 
fever  in  Ilabana.  All  the  money  that  could  be  called  for  was  forthcoming,  and 
all  the  men.  Skilled  engineers  were  in  charge  with  the  whole  force  of  militai-y 
power  behind  them.  In  1899  General  Ludlow  was  in  connnand  and  Major 
Davis  was  chief  sanitary  officer :  in  1900  it  \\'as  General  Wood  and  Major  Gorgas. 
And  I  can  give  you  my  word  that  the  work  was  well  done.  Ilabana  v,as  as 
clean  as  a  cobblestone-paved  citj'  can  l)e  kept.  We  begin,  too,  witli  a  city  almost 
free  from  yellow  fever.  There  had  been  but  31  deaths  from  yellow  fever  among 
civilians  the  year  ending  March  31,  1899,  and  there  were  only  .'j  more  to  August 
1.  The  fever  then  spread,  and  we  had  that  year  to  March  31,  1900,  111  deaths 
among  the  civil  population;  less  than  normal,  bnt  just  the  same  numl)er  as  in 
1885,  when  no  sanitary  measures  were  used.  In  1900  the  work  was  probably 
better  organized  and  was  certainly  as  well  done,  yet  the  deaths  that  year  were 
301,  although  this  includes  some  among  the  military,  say  12  or  15.  The  average 
civil  death  rate  from  yellow  fever  in  Ilaljana  for  the  ten  years  prior  to  the  war 
was  211  per  annum.  We  had.  then,  this  year  more  deaths  among  the  civil  popu- 
lation than  normal  in  Spanish  times — nearly  one-third  more.  Indeed,  1900,  after 
all  our  work,  gave  a  higher  civilian  mortality  than  any  one  of  the  ten  years 
prior  to  the  \a  ar  except  1893.  Now,  during  this  time  IIal)ana  was  as  clean  as  it 
could  be  made.  Patients  were  isolated  to  some  extent :  all  moved  to  hospital 
whom  we  could  get  to  go,  probably  75  per  cent,  and  the  premises  carefully  washed 
down  with  bichloride  of  mercury,  and  the  fal)rics  disinfected  by  steam  or  bichlo- 
ride or  boiling.  Yet,  as  I  tell  you,  we  had  an  epidemic.  So  far  as  yellow  fever 
was  concerned,  the  sanitary  work  was  a  failure.  The  next  year,  the  plan  was 
changed.  The  fitcgomyia  was  accepted  as  the  only  means  of  conveying  yellow 
fever  and  all  effort  was  based  on  this  belief.  All  cases  of  yellow  fever  were 
screened  as  soon  as  found,  and  they  were  found  early  and  the  screens  were  Icept 
in  place,  too.  If  the  patient  went  to  hospital  the  house  was  immediately  fumi- 
gated with  either  pyrethrum  or  sulphur.  If  he  did  not  it  was  screened  and 
fumigated  as  soon  as  possible,  the  houses  adjacent  being  also  fumigated.  This 
was  the  key  of  the  plan  : 

(l)To  keep  mosquitoes  from  the  patient. 

(2)   To  kill  all  mosquitoes  which  had  had  access  to  him. 

There  was  also  a  general  war  waged  against  all  mosquitoes  in  town,  draining 
and  oiling  pools  of  water  ;  emptying,  covering,  or  oiling  water  in  containers.  The 
presence  of  mosquito  larva;  on  premises  was  made  a  public  nuisance  and  pun- 
ished by  fine. 

These  measures  unquestionably  did  good  and  there  was  certainly  a  tremendous 
fall  in  the  mortality  in  all  malarial  fevers,  but  the  essential  of  the  work  for 
yellow  fever  was,  as  I  have  said,  to  keep  mosquitoes  from  the  patient  and  to 
kill  those  which  had  had  access  to  him.  Nothing  else  was  done.  The  bedding 
and  clothing  of  the  sick  were  not  touched,  nor  the  bedding  and  clothing  in  the 
houses  where  they  werre  taken  sick. 

Now  the  result. 

Yellow  fever  disappeared.  There  were  about  the  usual  crop  of  cases  in  the 
spring,  but  there  was  no  spread.  Some  were  introduced  from  Santiago  de  la 
Vega  and  other  places  outside  of  Habana,  but  there  was  no  spread  to  amount 
to  anything.  Cases,  a  few,  were  brought  on  the  vessels  from  Vera  Cruz,  taken 
to  the  yellow  fever  hospital  and  screened,  and  there  was  no  spread.  Gentlemen, 
this  was  not  luck.  It  was  not  accident.  Ilabana  had  had  yellow  fever  for  one 
hundi'ed  and  forty  years.  It  was  freed  from  it  in  the  summer  of  1901  by  the 
measures  taken. 

I  am  glad  that  the  same  man.  Doctor  Gorgas,  had  charge  of  the  sanitary  work 
in  both  1900  and  1901,  so  that  everything  should  be  the  same  except  the  plans 
of  the  work  and  the  difference  of  the  results — in  1900  a  failure,  in  1901  a  bril- 
liant success.  Could  this  have  liapi)ened  had  there  been  any  other  means  of  con- 
veying yellow  fever  except  the  insect  host?  What  else  will  screens  exclude? 
What  else  will  insect  powder  kill?  Remember  the  bedding,  clothing,  etc.,  of 
the  patients  were  not  touched. 

There  has  been  no  yellow  fever  in  Flabana  since ;  that  is,  none  contracted 
there.     You  know  that  Ilabana  is  in  weekly  communication  with  Vera  Cruz 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  441 

and  other  Mexican  ports,  reeeivinR  a  considerable  nunii)er  of  passengers  by 
viu-h  vessel.  How  has  she  kept  infection  from  beiiifj;  introduced  from  these 
ports?  There  is  a  maritime  ([uarantine  at  Ilabana  just  as  at  all  seaports 
amonj:  civilized  nations.  As  Doctor  Finlay  directs  it  for  yellow  fever  it  is 
naturally  l)ased  on  the  Stcyoiiiiiia  beinj;  the  only  aiicent  of  conveyance  of  that 
disease  to  man.  Passengers  not  inuninie  to  yellow  fever  are  retained  in  quar- 
antine across  the  bay  five  days  from  tluMr  last  presun)al)le  exi»osure  to  yellow 
fever  before  they  are  allowed  to  enter  the  city.  Vessels  which  may  be  infected 
with  yellow  fever,  i.  e.,  which  may  have  infected  Stpf/oinyia  on  board,  are  not 
allowed  at  the  wharves  or  to  be  boarded  by  nonimmunes  luitil  after  fumigation 
to  (h^stroy  moscpiitoes. 

Baggage  of  all  kinds  from  Vera  Cruz.  Tampico.  and  Merida,  even  that  of 
people  sick  of  yellow  fever,  is  passed  without  disinfection. 

I'eople  arriving  with  yellow  fever  are  taken  at  once  in  an  ambulance  screened 
witli  mos(iuito  wire  to  tlie  yellow-fever  hosjjital.  This  is  a  ward  screened  and 
witli  double  screen  doors  in  the  general  liospital  in  the  city  of  Habana.  A 
number  of  such  cases  have  been  thus  treated  and  there  has  been  no  spread. 
No  sjiread  was  expected  by  those  in  charge,  and  I  venture  to  promise  that  there 
will  be  no  spread  as  long  as  the  present  system  is  carried  out. 

Look  at  tliis  quarantine  I  With  passenger  traffic,  the  most  dangerous  kind 
of  traflic  from  infected  ports,  with  its  protective  measures  directed  only 
against  mosqiiitoes,  witli  absolutely  no  disinfection  of  baggage,  and  yet  giving 
a  perfect  result. 

The  same  regulations  have  been  in  effect  at  a  number  of  our  southern  ports — 
those  of  Virginia.  North  Carolina,  Georgia,  Florida,  and  Mississippi — the  past 
year,  for  the  United  States  regulations  are  also  based  absolutely  on  this  doc- 
trine, and  require  only  what  is  given  above,  and  with  the  same  result.  Could 
this  be  if  yellow  fever  were  conveyed  in  any  way  except  by  an  insect  host? 
Could  it  be  if  fomites  could  convey  yellow  fever? 

Fomites !  A  while  ago  I  said  I  know  of  no  fact  in  the  propagation  of  yellow 
fever  which  was  not  consistent  with  the  doctrine  of  its  propogation  liy  a  host. 
I  am  sure  some  of  you  thought  of  "  fomites  "  then.  I  promised  not  to  set  up 
a  man  of  straw  and  demolish  liim,  and  yet,  as  I  used  to  believe  in  this  means 
of  conveyance  myself,  it  may  be  that  the  arguments  which  convinced  me  that 
I  was  wrong  may  have  weiglit  with  some  one  who  believes  as  I  did.  Obvioiisly. 
if  yellow  fever  can  be  conveyed  by  fomites  tlie  doctrine  that  it  is  only  con- 
veyed naturally  by  a  mosquito  host  is  untrue. 

I  believed  it,  the  conveyance  by  fomites.  (1)  from  the  analogy  with  other 
infectious  diseases — smallpox,  measles,  etc. — and  (2)  because  everyone  else  did. 
The  doctrine  was  not  disputed,  and  I  did  not  examine  the  evidence  for  it 
critically.  Yet  even  before  Reed's  first  papei',  I  had  come  to  rather  more  than 
doubt — almost  to  disbelieve— that  fabrics  conveyed  yellow  fever,  although  I 
knew  that  ships  did.  My  mind  was  not  clianged  simply  to  accept  this  theory. 
In  the  first  place,  for  all  the  yellow-fever  outbreaks  which  I  myself  could 
trace,  a  man  sick  of  yellow  fever  was  the  starting  point.  There  were  many 
which  I  could  not  trace.  In  some  such  outbreaks  fabrics  from  infected  places 
had  come  in,  and  in  the  vast  majority  no  such  fabrics  could  be  traced.  None 
of  the  reported  cases  of  conveyance  by  baggage  which  I  could  personally 
investigate  excluded  other  means  of  conveyance. 

Then  I  found  that  for  the  twenty  years  preceding  1899  the  baggage  from 
Vera  Cruz,  Habana,  and  Santiago  de  Cuba  on  vessels  arriving  at  New  York, 
unless  with  yellow  fever  en  route,  entered  witliout  disinfection.  The  amount 
of  this  baggage  from  Ilabana  and  Vera  Cruz  was  large  and  it  was  not  possible 
but  that  much  of  it  came  from  houses  infected  with  yellow  fever,  and  much  of 
it  was  not  clean.  All  of  this  baggage  was  presumably  opened  at  the  custom- 
house at  New  York,  and  it  was  opened  at  hotels  there  and  at  Saratoga,  and  no 
yellow  fever  was  reported  among  the  customs  inspectors  in  New  York  or  at 
the  hotels  during  this  time. 

The  baggage  going  from  the  same  ports  to  Spain  for  the  twenty-nine  years 
preceding  1899  was  even  more  to  be  considered.  Its  amount  was  enormous. 
Much  of  it  must  have  been  foul.  Yet  no  yellow  fever  was  reported  in  the 
Peninsula  since  the  epidemic  of  1870. 

Of  course,  negative  evidence  is  convincing  only  in  proportion  to  its  mass,  and 
that  a  piece  of  baggage,  or  100  pieces  of  baggage,  from  an  infected  place  did  not 
convey  infection  to  those  exposed  to  it  means  little,  yet  the  amount  of  this  bag- 
gage was  so  large — I  can  not  estimate  it  at  less  than  that  of  300,000  persons  from 
Habana  alone,  not  to  count  Vera  Cruz  and  southern  Cuba — that  we  must  claim 


442  PUBLIC   HEALTH    AND   MAKINE-HOSPITAL    SERVICE. 

that  a  very  large  amoimt  of  baggage  from  infected  bouses  had  been  introduced 
into  New  Yorlv  and  Spanish  towns;  that  numbers  of  suscoptiljle  people  had 
been  exposed  in  these  places  under  various  conditions,  but  had  not  contracted 
yellow  fever. 

To  me  the  mass  of  this  evidence  was  sufficient  to  be  convincing,  and  I 
counted  it  proven  that  baggage  from  Ilabana  and  Vera  Cruz  would  not  convey 
yellow  fever  to  people  in  New  York  or  Spain.  Nor  could  I  say  that  baggage 
does  not  convey  yellow  fever  in  New  York  or  Spain,  but  it  will  do  so  in  the 
South.  I  knew  that  yellow  fever  was  conununicable  from  a  sick  man  only  by 
infecting  his  environment,  and  hence  only  in  an  "  infectible  locality,"  but  the 
contrary  had  always  been  the  teaching  for  fomites.  That  infection  could  b(» 
directly  conveyed  to  man  by  fomites  is  the  doctrine  which  had  been  universnlly 
taught.  All  the  instances  reported  of  conveyance  by  fabrics  of  which  I  had 
cognizance  were  either  explicitly  ascribed  to,  or  explicable  by,  this  direct  con- 
veyance. Now,  if  the  "  infected  "  fabrics  could  convey  yellow  fever  directly  to 
men,  obviously  they  would  convey  it  to  susceptible  people  who  come  into  direct 
contact  with  them  "in  any  place,  whether  the  locality  be  "  infectible  "  or  "  nonin- 
fectible."  Therefore,  as  against  the  possibility  of  direct  conveyance  of  yellow 
fever  from  fabrics  to  men,  the  data  ^from  New  York  and  Spain  which  I  have 
given  above,  if  conclusive  for  those  places,  were  conclusive  against  such  convey- 
ance in  places  known  to  be  "  habitually  infectible." 

As  to  the  positive  instances  of  conveyance  by  baggage,  which  had  been  re- 
ported, none  that  I  was  able  to  inquire  into  personally  certainly  excluded  other 
methods  of  conveyance.  The  reporter  begins  with  the  assumption  that  yellow 
fever  is  conveyed  by  fomites,  and  as  soon  as  ho  can  show  the  introduction  of 
fomites  from  an  infected  place  he  is  satisfied.  He  looks  no  further  for  any  other 
source  of  infection.  Strange  to  say,  the  best-attested  cases  I  came  across  were 
not  those  of  conveyance  by  packed  baggage,  but  by  clothing  worn  on  the  person, 
sometimes  for  a  number  of  hours,  through  the  sun  and  air,  which  wna  against 
all  other  experience  of  this  disease. 

Also,  it  is  common  sense  that  when  there  is  a  great  mass  of  negative  testimony 
on  a  subject  all  tending  one  way,  we  may  not  accept  a  moderate  amount  of 
positive  evidence  in  rebuttal  unless  its  data  be  conclusive,  and  I  thought  the 
evidence  of  the  Cuban  and  ^Mexican  baggage  great  enough  for  this  rule  to  apply. 

Note,  too,  that  the  argument  for  conveyance  by  fabrics  was  really  a  negati\e 
one.  The  reporter  says  "  there  was  no  possible  source  of  infection  except  the 
fomites."  He  means  "that  he  knows  of  no  other.  Exactly  the  same  argument 
was  used,  and  logically,  for  the  spontaneous  origin  of  yellow  fever.  Cases  were 
cited  for  which  no  exposure  to  any  source  of  infection  could  be  made  out,  and 
the  statement  was  made  that  there  was  no  exi>osure.  From  this,  if  admitted, 
the  admission  of  the  "  spontaneous  origin  "  of  the  cases  was  a  necessary  con- 
sequence. These  cases  were  (indeed  are)  not  a  few.  They  were  reported  with 
as  much  detail  and  with  as  much  care  and  by  as  good  men  as  those  for  which  no 
exposure  except  to  fomites  \a  as  known.  The  argument  for  the  spontaneous  ori- 
gin of  yellow  fever  and  that  for  its  conveyance  l)y  fomites  both  depend  on  our 
acceptiiig  that  there  were  no  exposures  unknown  to  the  reporter.  They  stand 
or  fall  on  the  same  class  of  evidence. 

As  to  the  cases  of  infection  carried  by  clothing  worn  on  the  person,  which  I 
have  said  seemed  the  best  attested  of  all  I  had  cognizance  of,  I  knew  that  a 
large  number  of  passengers  had  been  coming  during  all  seasons  of  the  year  from 
1888  to  181)8,  ten  years,  from  Habana  to  Key  West  and  Tampa  with  no  disinfec- 
tion of  the  clothing  they  were  wearing,  and  yet  Key  West  and  Tampa  had  kept 
free  from  yellow  fever.  It  was  not  possible  that  the  thousands  who  thus  came 
over  should  have  carried  no  infection  if  clothing  worn  on  the  person  could 
carry  it.  There  must  then  be  some  other  explanation  for  the  few  cases  reported 
in  the  United  States.  I  think,  then,  that  I  was  right  on  this  evidence  to  count 
the  conveyance  I)y  fabrics  as  "  not  proven." 

If,  in  addition,  I  had  had  what  you  now  have : 

(1)  The  experiments  of  Reed,  of  Ross,  and  of  the  Pasteur  Institute  Commis- 
sion. 

In  these  a  number  of  persons  were  exposed  for  days  and  nights  to  bedding  and 
clothing  used  in  every  conceivable  way  about  yellow-fever  patients.  None  of 
these  people  developed  yellow  fever  from  exposure,  although  a  number  of  them 
did  when  subse(juently  bitten  by  contaminated  mosquitoes.  To  be  fair,  I  wish 
to  admit  here  that  the  fact  that  Reed's  experiments  with  fomites  were  done  late 
in  the  year  detr.-icts  from  their  value.  This,  however,  does  not  apply  to  the 
other  two. 


PUBLIC    HEALTH    AND   MARINE-H08PITAL    SERVICE.  448 

(2)  Tbe  frcH'iufr  of  IIabaii;i  from  yollow  fever  by  Gorgas,  although  the  cloth- 
hig  and  hecUliiig  were  not  disinfecfeil. 

(3)  The  continual  experiment  whieh  the  IIal)ana  (luarantine  and  many  of 
our  own  stations  have  been  giving  us  in  letting  in  baggage  from  yellow-fever 
ports  without  any  disinfeetion,  and  yet  with  no  introduction  of  yellow  fever. 

Note  thjit  in  these  last  two  the  fomites  which  did  not  convey  infection  were 
in  infectible  places  in  the  yellow  fever  season. 

If,  I  say.  I  had  had  all  this  evidence  in  addition  to  that  which  convinced  me, 
I  would,  i  think,  scarcely  have  considered  conveyance  by  fomites  worthy  of  dis- 
cussion.    And  th.'it  v.iietlier  I  knew  of  any  other  method  of  conveyance  or  not. 

Let  us  see  what  we  have  said. 

Theiv  is  no  <iuestion  in  any  man's  mind  that  the  mosquito  ^^tcf/oniyia  fasciata. 
acting  ;!s  a  host,  does  convey  yellow  fever  from  the  sick  to  the  well.  That  this 
is  the  only  method  of  conveyance,  the  argument  is: 

(1)   The  analogy  of  other  diseases  conveyed  by  living  hosts. 

(IM  That  the  facts  observed  of  the  natural  i)ropagation  of  yellow  fever 
agree  with  this  theory. 

(;>)  Tha.t  measures  based  on  this  theory  have  given  the  very  results  which 
they  should  have  given  if  the  theory  were  true. 

(4)  No  other  natural  method  of  conveyance  is  proven. 

Ceuebiu)- Spinal  Meningitis  in  Hartford,  Conn.,  May  25,  1904. 

Passed  Asst,  Surg.  John  F.  Anderson  reports  to  the  Surgeon- 
General  as  follows: 

I  have  the  honor  to  report,  in  obedience  to  Bureau  letter  of  May  20,  1904, 
directing  me  to  proceed  to  Hartford,  ("onn.,  and  give  expert  assistance  in  the 
diagnosis  and  management  of  epidemic  cerebro-spinal  meningitis,  that  I  arrived 
in  Hartford  on  the  evening  of  the  21st  and  called  on  Dr.  Gideon  Segur,  secretary 
of  the  city  board  of  health,  and  explained  the  objects  of  my  mission. 

A  meeting  of  the  board  of  liealth  was  called  for  that  afternoon,  at  which  I 
was  invited  to  be  present,  and  a  general  discussion  of  the  epidemic  was  had. 
There  seemed  to  be  a  unanimity  of  opinion  of  the  doctors  present  that  there 
could  be  no  question  but  that  the  disease  was  epidemic  cerebro-spinal  meningitis. 

The  meeting  was  adjourned  to  the  laboratory  of  the  board  of  health,  where  I 
was  invited  to  examine  slides  and  cultures  from  cases  of  the  disease.  Tlie  next 
day,  Sunday,  in  company  with  members  of  the  board  of  health,  I  visited  several 
cases  in  in-ivate  families  and  saw  3  cases  in  the  Hartford  City  Hospital,  also 
witnessing  there  two  post-mortems.  I  was  shown  cultures  and  slides  made  from 
cases  in  the  hospital,  all  of  them  being  from  undoubted  cases  of  meningitis. 
The  remainder  of  the  day  was  occupied  in  visiting  cases  in  private  families. 

Monday  thensame  programme  was  followed  out  as  on  the  previous  day. 

About  one  month  ago  tie  Hartford  city  board  of  health  passed  a  resolution 
making  cerebro-spinal  meningitis  a  quarantinable  disease.  "SVhen  a  case  occurs 
in  a  house  the  house  is  placarded,  the  children  in  it  are  quarantined  and  remain 
from  school,  although  those  working  are  allowed  to  pursue  their  usual  occupa- 
tions. In  case  of  death  the  body  is  wrapped  in  a  bichloride  sheet  and  buried  as 
soon  as  possible,  the  funeral  being  private.  Upon  removal  of  the  body  the  place 
Is  disinfected,  chlorine  gas  being  used.  This  jnethod  of  disinfection  has  been 
practiced  almost  exclusively  in  Hartford  for  a  number  of  years,  and  I  was 
informed  by  the  bacteriologist  and  by  the  secretary  of  the  hoard  of  health  that 
they  regard  it  as  being  efficient  and  saw  no  reason  why  a  change  in  methods  of 
disinfection  should  he  riiade. 

A.S  showing  the  etiological  relation  of  the  Diplococcus  intracellular  Is,  the  fol- 
lowing data  were  kindly  given  me  by  Doctor  Steiner,  pathologist  of  tbe  city 
hospit:;!.  and  are  of  interest : 

Of  20  cases  examined  by  lumbar  puncture  17  showed  the  presence  of  an  intra- 
cellular diplococcus  decolorizing  by  Gram's.  Seventeen  attempts  were  made  to 
gi'ow  the  organism,  being  successful  in  13  cases.  Cultures  from  the  blood  were 
made  in  5  cases,  in  one  of  which  the  organism  was  recovered.  This  last  i)oint  is 
of  special  interest,  as  there  are  very  few  instances  in  the  literature  reporting  the 
recovery  of  the  organism  from  the  blood. 

Since'  April  4  there  have  been  73  cases  of  the  disease  in  Hartford  with  51 
deaths.     The  diagnosis  is  in  doubt  for  some  of  the  recovered  cases.     Twenty- 


444  PUBLIC    HEALTH    AND    MARHSTE-HOSPITAL    SERVICE. 

four  cpses  were  admitted  to  the  Hartford  City  Hospital,  of  which  number  20 
have  died,  giving  a  mortality  of  83  per  cent. 

A  marlced  feature  of  this  epidemic  is  the  suddenness  of  the  onset  of  severe 
symptoms  and  early  death  of  those  who  succumbed  to  the  disease.  In  many 
instances  death  occurred  within  thirty-six  hours  from  the  onset. 

While  the  disease  has  occurred  in  persons  from  1  year  old  to  65  years,  the 
majority  of  cases  were  in  persons  under  25  years ;  over  half  of  the  cases  being 
in  persons  under  15  years  of  age.  The  disease  seems  to  be  chiefly  confined  to 
persons  living  under  rather  unfavorable  sanitary  conditions,  few  or  no  cases 
having  occuri'ed  in  the  better  class  of  people. 

The  secretary  and  the  president  of  the  board  of  health  expressed  their 
appreciation  of  the  prompt  detail  of  an  officer  to  Hartford.  I  am  indebted  to 
Doctors  Segur  and  Miller,  of  the  city  board  of  health,  for  courtesies,  and  to 
Doctor  Wolf,  bacteriologist  of  the  board  of  health,  for  specimens  and  cultures 
and  other  courtesies ;  to  Doctor  Steiner,  pathologist  at  the  Hartford  City 
Hospital,  for  slides,  cultures,  and  sections,  and  to  other  physicians  who  so 
kindly  showed  me  their  cases. 

On  my  return  journey  I  stopped  in  New  Haven  and  called  upon  Dr.  C.  A. 
Lindsley,  secretary  of  the  Connecticut  board  of  health,  who  expressed  his 
thanks  for  j^our  kindness  in  sending  an  officer  to  Hartford. 

Insanitary  Dwellings  and  the  Rehousing  Problem  in  Foreign 

Cities, 

In  view  of  the  importance  which  these  problems  are  assuming  in 
various  cities  of  the  United  States,  and  the  importance  of  the  prob- 
lem from  a  public  health  point  of  view,  it  was  deemed  advisable 
to  profit  as  far  as  possible  by  the  exj)erience  of  foreign  cities,  in  many 
of  which  the  varied  questions  involved  have  been  under  consideration 
for  a  number  of  years.  ^ 

Through  the  Department  of  State  the  aid  of  United  States  con- 
sular officers  was  invoked,  and  the  following  circular  requesting  infor- 
mation was  issued  by  that  Department. 

In  response  much  information  of  value  and  of  a  varied  character 
has  been  furnished  the  Bureau,  and  the  reports  and  documents  trans- 
mitted are  being  reviewed  and  abstracted  in  a  shape  for  future 
publication. 

Treasury  Department,  Noremher  19,  1003. 

Sir  :  I  have  to  request  that,  if  pi'acticable,  a  letter  of  inquiry  be  addressed  to 
the  United  States  consular  officers  in  the  following-named  cities  directing  them 
to  obtain  and  forward,  for  the  use  of  the  Public  Health  and  Marine-Hospital 
Service,  the  laws  or  regulations  requiring  the  vacation  of  insanitaiy  dwellings 
and  the  laws  or  regulations  requiring  the  demolition  of  such  buildings ;  also  to 
obtain  and  forward  information  concerning  what  ])]'ovision,  if  any,  is  made  in 
the  various  cities  for  reimbursing  either  the  tenant  for  vacating  or  the  owner 
for  the  demolition  of  the  houses. 

The  cities  from  which  this  information  Is  desired  are  as  follows : 

London,  Liverpool,  Manchester,  Birmingham,  and  Leeds,  England  ;  Glasgow 
and  Edinburgh,  Scotland;  Belfast  and  Dublin.  Ireland;  Paris,  Marseille,  and 
Lyons.  France ;  Berlin.  Hamburg,  INIunich.  and  Leipzig.  Germany ;  Vienna  and 
Budapest,  Austria-Hungary  ;  Amsterdam  and  Rotterdam,  Holland ;  Madrid  and 
Barcelona,  Spain ;  Lisbon,  Portugal ;  Naples,  Rome,  and  Milan.  Italy ;  Copen- 
hagen, Denmark ;  Stockholm,  Sweden  ;  Christiania.  Norway  ;  St.  Petersburg. 
Moscow,  Warsaw,  and  Odessa,  Russia ;  Constantinople,  Turkey ;  Bucharest, 
Roumania ;  Rio  de  .Janeiro,  Brazil ;  Buenos  Ayres,  Argentina ;  Montevideo, 
Uruguay ;  Calcutta,  Bombay,  and  Madras,  India  ;  Melbourne  and  Sydney,  Aus- 
tralia ;  and  Montreal  and  Toronto,  Canada. 
Respectfully, 

L.  M.  Shaw,  Secretary. 

The  honorable  the  Seceetaey  of  State. 


PUBLIC    HEALTH    AND    MARINE-H08P1TAL    SERVICE.  445 

[Circular.] 

in8anitaby  dwellings. 

Department  of  State, 
Washinf/ton.  Xovcmhcr  SO,  1003. 
To  certain  consular  ofjicvrs  of  the  United  States: 

Gentlkmen  :  At  tlu'  itHjuost  of  the  Treasurj-  Department  in  a  letter  of  Novem- 
ber 19,  1003,  you  will  please  obtain  and  forward  for  the  use  of  the  Pul)lic  Health 
and  Marine-IIosi)ital  Service  the  laws  or  re.ijulations  of  the  cities  in  which  you 
are  respectively  located  requiring  the  vacation  of  insanitary  dwellings  and  the 
laws  or  regulations  requiring  the  demolition  of  such  buildings. 

You  will  also  report  what  provision,  if  any,  is  made  for  reimbursing  either 
the  tenant  for  vacating  or  the  owner  for  the  demolition  of  the  houses. 
I  am,  gentlemen,  your  obedient  servant, 

Herbert  H.  D.  Peirce, 

Third  Assistant  f^ecretary. 

The  foregoing  contains  the  report  of  the  transactions  of  the  divi- 
sion for  the  fiscal  year. 

Respectfully,  H.  D.  Geddixgs, 

Assistant  Surgeon- General. 
The  Surgeon -General. 


MISCELLANEOUS  DIVISION. 

(INXLUDING  CONTRIBUTED  ARTICLES  AND   NECROPSY  REPORTS.) 


447 


REPORT  OF  THE  MISCELLANEOUS  DIVISION. 

By  A.  J.  McLaughlin, 

Assistant  Surgeon,  Puhlic  Health  and  Marine-Hospital  Service,  in  charge. 

Sir:  I  have  the  honor  to  submit  herewith  the  following  report  upon 
the  work  of  the  miscellaneous  division  for  the  fiscal  vear  ended  June 
30,  1904. 

Four  hundred  and  sixty-five  papers,  referred  to  the  Surgeon- 
.General  for  opinion  by  the  General  Superintendent  of  the  life-Saving 
Service,  were  acted  upon  by  direction  of  the  Surgeon-General.  Those 
papers  called  for  an  opinion  upon  the  medical  evidence  submitted  in 
claims  for  benefits  under  the  act  of  May  4,  1882,  or  upon  cases  of 
rejection  of  candidates  for  enlistment  or  reenlistment. 

The  correspondence  work  of  the  division  included  supervision  of 
all  correspondence  relating  to  requests  for  Service  publications; 
supervision  of  correspondence  of  a  miscellaneous  character,  such  as 
could  not  properly  be  referred  to  any  other  Bureau  division;  making 
necessary  replies ;  acknowledgments  of  books  and  publications  donated 
to  the  Service  library. 

All  books  destined  for  the  Service  library  were  received  and  cared 
for.  The  medical  journals  subscribed  for  or  received  by  the  Bureau 
were  read,  and  all  articles  upon  matters  affecting  the  Service,  upon 
the  communicable  diseases,  and  upon  matters  relating  to  hygiene  and 
the  public  health  were  marked  for  the  notice  of  Bureau  officers.  A 
card  index  was  made  from  the  articles  so  marked  and  sent  with  the 
journals,  after  they  had  been  seen  and  checked  by  the  Surgeon- 
General  and  all  chiefs  of  Bureau  divisions,  to  the  division  of  scientific 
research  for  filing. 

The  necropsy  reports  sent  in  from  the  various  marine  hospitals 
during  the  year  were  edited  and  prepared  for  publication  in  the 
annual  report  of  the  Surgeon-General.  A  classified  table  of  surgical 
operations  performed  during  the  year  at  marine  hospitals  was  com- 
piled from  the  annual  reports  of  surgical  operations  (Form  1925) 
and  prepared  for  publication  in  the  Surgeon-Generars  annual  report. 

To  facilitate  the  work  of  editing  necropsy  reports  and  preparing 
the  table  of  surgical  operations  for  the  annual  report,  the  following 
circular  letters  were  prepared  and  sent  to  all  medical  officers  of  the 
Service : 

[Circular  letter.] 

Treasuby  Depabtment. 
BuBEAU  OF  Public  Health  and  ]Mabine-Hospital  Service, 

Washington,  D.  C,  Septemhcr  30,  1903. 
To  Medical  Officers  Public  Health  and  Marine-Hospital  Service- 
Attention  is  called  to  paragraph  696,  Revised  Regulations  Public  Health  and 
Marine-Hospital  Service,  1903,  in  relation  to  necropsy  reiwrts.  These  reports 
should  be  typewritten,  as  required  in  this  paragraph,  on  ordinary  legal-cap 
paper,  and  not  on  thin  linen  paper  ordinarily  used  for  carbon  copies.  They 
should  be  sent  to  the  Bureau  as  soon  as  completed,  and  unnecessary  delay  in 
completing  the  necropsy  report  should  be  avoided. 

8629—04 29  449 


450  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

It  should  be  borne  in  mind,  in  malviug  these  reports,  that  they  are  primarily 
necropsy  reports,  and  a  careful  systematic  report  of  the  necropsy  findings 
should  be  made.  In  necropsy  reports  the  history  should  always  be  subsidiary 
to  the  necropsy  findings,  and  only  such  facts  in  the  patient's  family  or  personal 
history  which  have  a  direct  bearing  on  the  cause  of  death  should  be  related. 
The  clinical  history  should  contain  important  facts  in  connection  with  patient's 
illness  and  death,  but  these  should  be  concisely  stated  and  all  unnecessary  de- 
tails omitted. 

Whenever  the  i)atient"s  history  contains  remarkable  features,  necessitating  a 
lengthy  statement  of  an  interesting  character,  the  history  of  the  case  should  be 
sent  as  a  special  contributed  article,  the  ueci-opsy  findings  being  then  subsidiary 
to  the  unusual  or  interesting  clinical  history  of  the  case. 
Respectfully, 

Walter  Wyman,  S urgeon-Gencral. 

Considerable  embarrassment  has  been  occasioned  by  the  limited 
editions  of  Bureau  publications  permitted  by  existing  law.  The 
demand  for  bulletins  of  the  Hygienic  Laboratory  and  for  bulletins 
of  the  Yellow  Fever  Institute  so  far  exceeds  the  supply,  which  is 
limited  to  1,000  copies  in  any  fiscal  year,  that  the  refusal  of  many 
requests  for  these  bulletins  was  necessitated.  The  edition  of  the 
annual  report  of  the  Surgeon-General,  which  is  limited  to  2,500 
copies,  is  also  inadequate  to  meet  the  demand. 

These  requests  for  publications  come  from  every  part  of  the  coun- 
try from  reputable  physicians  and  sanitarians,  whose  letters  indicate 
the  value  and  importance  of  the  publications  requested.  It  is  a 
matter  of  regret  that  it  has  been  necessary  to  refuse  many  of  these 
requests,  and  an  effort  was  made  to  obtain  relief  by  Congressional 
action. 

The  following  joint  resolution  was  introduced  in  the  Senate  and 
passed  b}^  that  body  during  the  last  session,  and  is  now  in  the  House 
of  Representatives,  where  it  is  awaiting  action  by  the  Committee  on 
Printing : 

Resolved  by  the  Senate  and  House  of  Representatives  of  the  United  States  of 
Ameriea  in  Congress  assenit)1ed,  That  there  be  printed  each  year  the  Public 
Health  Reports,  bulletins,  and  other  special  publications  of  the  Public  Plealth 
and  ]\Iarine-riospital  Service  of  the  United  States,  to  be  distributed  by  the 
Surgeon-General,  in  such  editions  as  the  interests  of  the  Government  and  the 
public  may  require ;  and  that  there  be  printed  each  year  twelve  thousand  copies 
of  the  Annual  Report  of  the  Surgeon-General  of  the  Public  Health  and  Marine- 
Hospital  Service  of  the  United  States,  five  thousand  copies  for  the  use  of  the 
House,  two  thousand  copies  for  the  use  of  the  Senate,  and  five  thousand  copies, 
bound  in  cloth,  to  be  distributed  by  the  Surgeon-General. 

In  view  of  the  limited  size  of  the  editions,  a  system  was  devised  and 
instituted  whereby  a  penalty  j^ostal  card,  addressed  to  the  Surgeon- 
General,  was  sent  out  with  each  ]5ublication  and  the  recipient 
requested  to  acknowledge  receipt  by  signing  the  card  and  mailing  it 
to  the  Surgeon-General.  Failure  to  sign  and  return  the  card  was 
taken  to  indicate  either  that  the  bulletin  or  report  was  not  delivered 
or  that  the  publication  was  no  longer  desired.  By  means  of  this 
postal-card  system  it  has  been  possible  to  keep  the  various  mailing 
lists  reasonably  clear  of  incorrect  addresses  and  names  of  those 
deceased  or  reinoved. 

Following  are  articles  contributed  by  officers  of  the  Service  for 
publication  in  the  annual  report,  and  reports  of  fatal  cases,  with 
necropsies,  received  from  the  various  stations. 
Respectfidly, 

A.  J.  McLaughlin, 
Assistant  Surgeon  in  Charge. 


contributed  articles. 

Chuonig  Pancreatitis  avitu  Induration. 
By  Asst.  Surg.  L.  P.  11.  Bahrenbubg. 

A  perusal  of  the  available  literature  on  the  subject  of  any  pancre- 
atic disease  reveals  an  unfortunate  paucity  of  definite  sigiis  which 
may  be  directlv  attributed  to  disease  of  this  organ.  This  is  clearly 
shown  by  the  fact  that  in  so  extensive  a  work  as  the  Twentieth  Cen- 
tury Practice  of  Medicine  24  pages  only  are  devoted  to  them,  inclusive 
of  a  brief  bibliography. 

All  writers  seem  agreed  that  chronic  fibrous  pancreatitis  is  an  un- 
common pathological  entity.  Leo,  in  Volume  VIII  of  the  work  just 
mentioned,  says: 

As  chronio  inflamiuatiou  of  the  pancreas  occurs  only  exceptionally  as  an  inde- 
pendent disease,  being  as  a  rule  a  secondary  affection,  there  are  no  character- 
istic symptoms.  A  diagnosis  of  the  disease  is  therefore  impossible.  *  *  * 
From  the  fact  that  a  diagnosis  is  impossible,  there  is  nothing  to  be  said  as  to 
treatment. 

Such  a  statement  bv  an  acknowledged  authority  on  internal  medi- 
cine is  ample  evidence  of  the  necessity  that  no  ol:)servations  made  in 
these  cases  should  be  permitted  to  suffer  loss,  but  that  they  should,  on 
the  contrary,  be  made  accessible  to  others  for  reference  and  com- 
parison. On  this  account  it  has  seemed  expedient,  despite  its  in- 
completeness, to  report  the  following  record  of  a  case  which  came 
under  the  observation  of  the  writer : 

C  R  a  white;  age.  43;  born  in  :\Iichigan ;  admitted  to  the  United  States 
MarineHospital,  Chicago.  111.,  December  5.  1903.  and  died  February  16,  1904. 

Family  history. — Good,  as  far  as  known  to  the  patient. 


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PUBLIC   HEALTH   AND   MARINE-HOSPITAL   SERVICE. 


Personal  history. — The  patient  said  he  liad  never  before  been  ill ;  had  had 
two  attacks  of  gonorrhea,  the  last  about  eighteen  months  ago.  About  two 
weeks  before  admission  to  this  institution  the  left  inguinal  lymphatics  became 
swollen  and  painful ;  he  entered  the  hospital  to  be  treated  for  this,  and  the  con- 
dition promptly  subsided  under  treatment.  Patient  stated  that  about  one 
month  before  admission  his  left  auricle  became  swollen  to  twice  its  natural  size, 
was  painful  only  upon  pressure,  and  there  was  no  discharge  from  the  ear  nor 
earache.  On  December  7  he  complained  of  aching  of  the  muscles  of  the 
nucha,  headache,  and  rather  free  perspiration.  The  next  day  he  felt  better, 
but  a  slight  icteric  tinge  was  noticed  in  the  conjunctivfe.  From  this  time  until 
December  25  his  temperature  assumed  a  peculiar  periodical  undulation,  ranging 
between  37°  and  39.6°.  During  this  time  there  were  no  subjective  nor  objective 
symptoms  except  occasional  occipital  headache,  gradual  loss  of  strength,  and 
momentary  dizziness.  During  the  next  two  weeks  the  temjieratnre  remained 
normal  and  the  patient  seemed  to  be  improving.  Physical  examination  had 
always  proved  negative.  About  this  time  (January  7,  lOOi)  the  temperature 
curve  again  became  somewhat  undulating,  but  not  with  so  high  a  maximum  as 
before,  ranging  between  37°  and  38°.  He  now  began  to  complain  of  fermenta- 
tive indigestion,  with  gaseous  eructations  and  sensations  of  weight  in  the  epi- 
gastrium. On  January  14  he  complained  of  a  "  fluttering  sensation  around  the 
heart "  and  slight  dizziness.  Pulse  was  80,  occasional  intei'missions  were  hoted, 
but  no  cardiac  murmurs  were  present. 


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On  January  17  the  patient  reported  having  pains  in  the  occiput  and  dizziness. 
On  January  19  a  number  of  bright  pinlc  macules,  ranging  in  size  from  a  split 
pea  to  a  silver  (piarter  suddenly  appeared  upon  the  dorsum  of  both  hands ; 
they  were  neither  elevated  above  the  level  of  the  skin  nor  sensitive,  were  irreg- 
ular, in  outline,  and  confined  to  the  distal  half  of  the  dorsum  of  the  hands; 
they  disappeared  during  the  night  of  the  21st.  On  January  23  the  patient 
complained  of  colicky  abdominal  pains,  felt  chilly,  and  his  temperature  rose 
to  38.8°.  The  next  day  the  patient  reported  that  he  had  fainted  and  fallen 
to  the  floor  while  out  of  bed  during  the  night :  this  had  been  preceded  by  a 
sudden  sharp  pain  in  the  left  iliac  fossa,  wliich  continued  several  minutes  after 
he  had  regained  consciousness.  Examination  elicited  nothing  beyond  slight 
swelling  and  tenderness  of  left  spermatic  cord,  and  on  January  2G  the  patient 
said  he  felt  quite  well  again.  Two  days  later  the  patient  was  allowed  to  sit 
out  of  bed  and  was  apparently  improving  daily.  This  continued  until  1  p.  m. 
on  February  1,  when  the  patient  was  suddenly  seized  with  a  sharp  chill,  followed 
by  a  high  temperature,  pains  in  the  head,  nucha,  back,  and  epigastrium ;  he 
had  a  rapid,  full,  bounding  inilse,  and  injunctive  conjunctiva-. 

On  the  following  morning  the  temperature  was  30.7°,  and  all  subjective  symp- 


PUBLIC   HEALTH    AND   MARINE-HOSPITAL   SERVICE. 


453 


toius  had  disappeared.  l)uriii},'  the  iiiKlit  a  miiuber  of  erythoiiiatous  niacuUe 
appeared  upon  the  dorsum  of  both  hands  (one  beiufx  about  2  cm.  in  diameter), 
elevated  and  itchy,  Init  not  painful.  At  r>  p.  m.  a  moderate  chill  occurred,  and 
his  temperature  rose  i^radually  to  lO.  1°  by  mornint;  (February  8).  During  the 
night  he  had  had  meteorism,  with  shar])  intestinal  jtains,  which  yielded  readily 
to  counter  ii-ritation.  The  tonj;ue  had  a  pasty,  white  coating,  the  conjunctivae 
were  injected,  and  the  patient  had  headache.  Toward  evening  these  symptoms 
abated,  but  the  next  morning  (February  4)  another  sharp  chill  was  followed 
by  hyperpyrexia,  and  later  profuse  diaphoresis.  At  .'{.oO  a.  in.  (February  5) 
he  vomited,  and  had  a  sharp  chill  and  high  temperature;  general  hyperesthesia 
of  the  skin  was  his  only  subjective  symptom.  A  sudden  fall  of  temperature  to 
3(5.3°  in  the  afternoon  was  sinularly  followed  by  a  pronounced  chill  and  rise  of 
temperature.  Despite  this  the  patient  said  he  wAs  (piite  comfortable  at  (J  p.  m. 
He  had  a  slight  chill  the  next  morning,  and  this  x-ecurred  at  10  p.  m.,  when  he 
reported  severe  general  abdominal  pains,  which  required  the  exhibition  of 
moriihine  sulphate  hypodermatically.  Slight  delirium  was  notice:!  occasion;illy 
on  this  day.  At  8.45  a.  m.  (February  7)  his  temperature  was  only  35.7°  ;  hot 
water  bottles  v.-ere  applied,  and  a  few  minutes  later  the  patient  iiad  a  slight 
chill.  At  9.30  a.  m.  he  complained  of  only  moderate  headache.  This  proved  to 
be  a  very  comfortable  day  for  the  patient,  although  he  was  perspiring  freely. 
Slight  general  icterus  was  noticed  on  this  day. 


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On  February  8  jaundice  was  very  marked ;  the  conjunetivre  were  deeply 
icteric  and  conjested.  The  stools  had  been  quite  light-colored  for  several 
days,  which  had  been  attributed  to  the  use  of  milk  as  his  only  diet.  During 
the  night  he  had  another  attack  of  acute  pain,  sharpest  in  the  right  lunil)ar 
region,  but  darting  through  entire  right  side  of  body  and  head,  and  requiring  a 
hypodermatic  injection  of  morphine  sulphate  0.015  gram.  On  February  9  the 
icterus  w'as  intense;  i>liysical  examination  elicited  some  tenderness  over  the 
gall  bladder,  but  was  otherwise  negative.  The  bowels  were  moderately  loose. 
On  February  10  the  patient  had  a  slight  chill  at  7  a.  m. ;  the  icterus  had  deep- 
ened into  a  dusky  bronzed  yellow ;  the  tenderness  had  increased  over  the  gall 
bladder  and  extended  over  the  right  lobe  of  the  liver,  which  now  projected  3  cm. 
below  the  costal  arch.  Depression  of  spirits,  noted  for  sevei'al  days  past,  now 
amounted  to  despondency.  Near  midnight  the  patient  had  an  attack  of  very 
sharp  pain  in  the  right  vertex,  necessitating  an  injection  of  morphine  sulphate. 
On  the  12th  he  had  a  slight  chill,  with  temporary  retention  of  urine.  Upon 
being  questioned  patient  reported  that  there  had  been  some  dribbling  of  urine 
for  several  days.  In  the  afternoon  he  had  complete  retention,  and  deeply  bile- 
stained  urine  was  drawn  by  catheter.    On  the  13tU  the  patient  had  an  involun- 


454 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


tary  movement  of  the  bowels,  but  retention  of  the  urine  continued ;  he  had  also 
occasional  periods  of  mild,  talkative  delirium.  On  February  14  oedema  of 
penis  and  scrotum  was  present,  and  the  patient  had  a  slight  chill.  Because  of 
the  continued  urinary  retention  and  the  atonic  state  of  the  bladder  drainage 
was  established  by  permanent  catheterization.  His  bowels  were  now  again 
under  voluntary  control  and  the  stools  were  becoming  yellow ;  for  several  days 
past  they  had  been  of  an  intensely  fetid  odor. 


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On  February  15  the  patient  was  mentally  brighter,  but  petulant  and  despond- 
ent. In  the  afteruoou  a  sudden  rise  of  temperature  to  40°  occurred  without  a 
chill.  The  patient  comjilained  of  great  dryness  of  his  throat,  but  said  he  felt 
quite  comfortable  in  all  other  respects.  Cold  compresses  were  applied  and  soon 
relieved  the  laruygeal  dryness.  At  12  o'clock  midnight  the  patient  told  the 
night  nurse  that  he  felt  "  all  right."  but  fifteen  minutes  later  he  was  found 
dead  in  bed.  with  his  face  free  from  cyanosis  or  muscular  contortion. 

The  treatment  of  this  case  was  symptomatic  and  tonic,  with  the  use  of  a  light, 
nourishing  diet  during  the  pyretic  periods. 

At  the  necropsy  all  the  viscera  were  found  bile-stained  and  all  exhibited  a 
slight  degree  of  passive  congestion.  The  gall  bladder  contained  90  c.  c.  of  bluish- 
black,  moderately  viscid  bile,  which  had  imparted  an  almost  black  color  to  its 
walls.  No  gallstones  were  present,  but  at  and  just  beyond  the  neck  of  the 
bladder  was  a  complete  consti'iction.  whose  origin  could  not  be  determined, 
although  very  careful  examination  was  made.  The  ductus  communis  chole- 
dochus  was  embedded  in  the  tissue  of  the  head  of  the  pancreas  and  completely 
obstructed.  The  pancreas  was  20  cm.  in  length,  of  jiroportionate  breadth  and 
thickness,  and  weighed  I.IO  gm.  (practically  double  the  average  normal  weight). 
It  was  exceedingly  firm,  almost  cartilaginous  in  consistency  throughout,  and 
on  section  the  parenchyma  was  found  to  be  of  a  homogeneous  yellowish-white 
color,  dotted  with  small  red  points  where  congested  vessels  had  lieen  severed. 
No  cysts,  tumors,  nor  other  abnormalities  were  present  in  the  pancreas,  nor  was 
fat  necrosis  noted.  A  more  extended  description  of  the  post-mortem  findings 
is  given  in  the  report  of  the  necropsy  elsewhere  in  this  volume. 

The  syndrome  detailed  al)ove  is  certainly  an  unusual  one.  and  was 
to  the  last  degree  perplexing.  Add  to  these  positive  symptoms  the 
negative  facts  of  the  absence  of  albuminuria,  glycosuria,  lipuria,  and 
fatty  stools,  and  the  picture  is  complete.  But  for  the  findings  post- 
mortem nothing  more  than  the  merest  suspicion  of  pancreatic  disease 
would  have  been  justifiable  because  of  the  absence  of  practically  all 
of  the  symptoms  usually  advanced  as  being  pathognomic. 


Leprosy  in  the  Sulu  Archipelaoo. 
By  Asst.  Surg.  J.  W.  Amesse. 

So  many  pages  of  Moro  history  have  been  written  with  the  point  of 
the  sword  that  a  digression  in  more  peaceful  vein  may  not  be  out  of 
phice  at  this  time,  when  the  nucleus  of  civil  government  is  forming 
and  the  advent  of  so  many  people  wholly  unfamiliar  with  the  country 
is  expected. 

I  have  chosen  the  subject  of  leprosy  because  it  is  an  indigenous 
disease  and  no  insignificant  member  of  that  endemic  plague  trinity  of 
which  d^'sentery  and  malaria  have  furnished  such  world-wide  study. 

The  notes  have  been  obtained  from  careful  observation  extending 
over  a  period  of  five  months,  during  which  time  a  number  of  the  larger 
islands  were  Adsited,  and  from  personal  interviews  with  many  repre- 
sentative Moros  from  various  parts  of  the  archipelago. 

Unfortunately,  political  diiferences  between  our  Government  and 
the  natives,  increasing  as  it  did  their  inherent  distrust  of  the  white 
man  and  his  inevitable  notebook,  prevented  in  some  instances  that 
freedom  of  communication  so  essential  in  investigations  of  this  kind, 
but  it  is  believed  that  sufficient  reliable  data  were  obtained  to  be  of 
use  when  the  ultimate  question  of  segregation  presents  itself. 

It  would  be  strange  if  even  a  disease  so  difficult  of  communication 
as  leprosy  did  not  flourish  in  these  islands  once  a  focus  had  been 
established. 

Meteorological  conditions,  the  squalor  and  general  wretchedness  of 
the  natives,  crowded  together  in  vile  single-roomed  huts,  their  half- 
clad  bodies  disclosing  a  protean  array  of  dermatoses,  all  contribute 
to  the  growth  of  the  specific  organism  and  the  transmission  of  the 
disease. 

Leprosy  has  existed  in  the  Sulu  group  since  early  in  the  eighteentli 
century  and  before  the  arrival  of  the  Chinese,  though  these  "  pig- 
tailed  argonauts  "  have  doubtless  been  an  imjDortant  factor  in  its 
dissemination  since  their  trading  centers  were  established  in  1755. 

It  is  easy  to  believe  the  first  cases  were  carried  here  by  Moro 
pirates,  who  ravaged  the  entire  Philippine  coast  for  centuries  and 
frequentl}^  returned  to  rendezvous  in  these  waters.  Even  at  Manila, 
Foreman  tells  us,  Musselman  corsairs  were  feared  as  late  as  tJie  year 
1800,  and  at  that  time  Luzon  had  been  a  center  of  infection  for  more 
than  one  hundred  and  fifty  years.  It  is  also  probable  that  Javanese 
lepers,  escaping  from  their  own  country,  where  lazarettos  were  in 
vogue  as  early  as  1657,  established  themselves  in  neighboring  islands 
and  contributed  to  the  infection  of  Sulu. 

Later  on,  when  the  Spanish  Government  founded  penal  colonies  in 
the  neighboring  island  of  JSIindanao  and  garrisoned  its  outposts  with 

455 


456  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Tagalog  and  Visayan  soldiers  recruited  from  provinces  where  leprosy 
Avas  common,  numerous  cases  appeared  among  the  Filipinos,  but  at 
no  time  was  segregation  of  these  unfortunates  attempted. 

The  subjoined  history  of  one  of  these  cases  well  illustrates  the  indif- 
ference manifested  by  these  exiles  toward  all  sanitary  matters — an 
apathy  now  bearing  rich  fruitage  in  the  enormous  mortality  from 
tuberculosis,  syphilis,  and  enteric  disease.  From  all  the  sources  of 
information  accessible  at  this  time  it  is  believed  there  are  350  lepers 
in  the  Sulu  group,  which,  allowing  these  islands  a  population  of 
85,000,  implies  a  ratio  of  4  to  1,000.  This  proportion  is  lower  than 
that  found  in  the  Hawaiian  Islands,  New  Caledonia,  British  North 
Borneo,  or  Java,  but  is  much  greater  than  the  percentage  in  India, 
where  leprotics  are  segregated  in  suitable  asylums. 

Both  forms  of  the  disease  are  recognized  by  the  Moros  under  the 
general  name  "  epul,"  the  ana3sthetic  type  being  considered  non- 
contagious and  its  victims  allowed  to  live  out  their  lives  with  the 
family,  while  the  exudative  or  tuberculous  form  is  looked  upon  as 
the  most  baneful  disease  that  afflicts  the  race.  Their  views  on  its 
etiology  are  at  once  interesting  and  jDuerile,  colored  as  they  are  with 
the  vein  of  superstition  that  pervades  their  entire  folklore  and  daily 
life.  They  believe  (1)  that  leprosy  can  originate  de  novo  from  the 
rough  sorcery  or  the  enchantment  of  some  enemy;  (2)  that  it  may 
follow  continued  and  intimate  association  with  one  already  stricken 
with  the  tuberculous  form;  (3)  from  a  fish  diet,  especially  when 
restricted  to  one  species  known  among  the  Moros  as  the  "  ty  yook." 

The  theory  advanced  by  tlie  distinguished  leprologist,  Jonathan 
Hutchinson,  whose  convictions  concerning  this  factor  in  the  etiology 
of  the  disease  have  recently  been  strengthened  by  further  research  in 
India,  would  find  many  earnest  advocates  among  these  primitive 
people. 

In  the  island  of  Panducan,  25  miles  northwest  of  Jolo,  there  are 
15  lepers  in  a  population  of  about  400;  these  people  subsisting  almost 
exclusively  upon  sea  food,  preferring  always  to  eat  it  dried  and 
uncooked. 

"\Miile  it  is  recognized  that  until  the  chain  of  evidence  is  complete 
and  the  bacillus  of  Hansen  demonstrated  in  the  food  itself  such 
observations  as  these  can  be  of  but  subsidiary  value  to  medical 
science,  the  fact  is  strongly  borne  in  on  one  that  here  we  may  find 
the  solution  of  the  question. 

Another  reason  (4)  assigned  for  the  presence  of  sporadic  cases  is 
the  visitation  of  divine  wratli  following  certain  personal  pollutions 
forbidden  by  the  Koran  with  even  greater  emphasis  than  are  similar 
transgressions  in  the  Bible  of  the  Christians. 

TREATMENT. 

As  witchcraft  is  in  many  instances  held  responsible  for  the  appear- 
ance of  leprosy  in  a  community,  so  do  charms  and  amulets  prevail  in 
its  prophylaxis  and  treatment.  Perhaps  the  most  gruesome  of  these 
ceremonies  is  that  j^racticed  in  the  islands  of  Tawitawi  and  South 
Tjbian,  where  the  natives  have  made  little  or  no  progress  in  civiliza- 
tion. The  patient  is  taken  to  some  unfrequented  spot  in  the  woods  or 
mountains,  where  a  bullock  is  slaughtered  and  dressed  up  to  the 
point  of  splitting  the  spine.     The  leper,  perfectly  naked,  is  then 


PUBLIC    HKALTH    AND    MARINE-HOSPITAL    SERVICE.  457 

placed  in  the  body  cavity  and  remains  there  for  twenty-four  hours, 
during  which  time  the  vigorous  "  tom-tom  "  of  his  friends  and  the 
incantations  of  tho  uiediciue  uian  are  suj^posed  to  transfer  to  the 
carcass  all  the  iuii)urities  of  the  individual,  who  is  expected  to  emerge 
from  his  extraordinary  entombment  sound  and  whole.  In  other 
parts  of  the  arc'hii)elago  tuberculous  lepers  are  driven  from  their 
homes  and  usually  find  refuge  in  one  of  the  numerous  uninhabited 
islands  near  at  hand.  The  following  cases  are  presented  to  illus- 
trate the  types  encountered  in  Sulu : 

Case  I. — Filipino  laborer ;  age.  .37 ;  native  of  Pampanga  Province.  Luzon ; 
exhibiting  characteristic  lesions  of  the  combined  antpsthetic  and  tuberculous 
form.  So  far  as  leprosy  is  concerned,  his  family  history  is  clean,  though  the 
man  has  seen  enough  of  the  disease  in  his  native  village  to  recognize  it  when  it 
appeared  on  his  own  person.  In  1893  he  enlisted  in  the  Spanish  army  and  was 
sent  to  garri.son  at  Jolo.  where  he  served  until  the  evacuation  in  1800.  lie 
then  obtained  employment  from  the  American  provost-marshal  and  worked 
steadily  as  a  scavenger  up  to  May.  190:>,  when  my  attention  was  called  to  him 
rather  forcibly  by  encountering  the  leper  in  my  own  bathroom.  He  was  imme- 
diately isolated,  together  with  his  wife  (who  had  for  several  years  borne  her 
share  of  the  family  expenses  by  doing  laundry  work  for  the  troops),  in  a  nipa 
shack  beyond  the  main  gate  of  Jolo,  while  the  house  they  had  occupied  was 
repeatedly  disinfected  and  allowed  to  remain  vacant.  The  patient's  attention 
was  first  attracted  to  the  disease  three  years  ago,  by  perceptible  weakness  of  the 
mu.scles  of  his  right  hand  and  diminished  sensation  along  the  ulnar  side  of 
the  arm. 

Soon  after  a  macular  eruption  appeared  on  the  face,  chest,  and  hips ;  the 
eyebrows  were  lost,  the  ear  lobes  enlarged,  and  nasal  catarrh  developed.  At 
the  time  of  examination  the  man  presented  a  typical  picture  of  leprosy  in  an 
advanced  stage.  The  nerve  involvement  had  gone  on  to  complete  auresthesia  ; 
the  nasal  bones  were  absorbed ;  there  was  alopecia  of  the  ciliary  region,  cloudi- 
ness of  the  cornea,  and  masses  of  lepromata  studded  the  face,  giving  the  char- 
acteristic expression.  The  man's  wife  shows  at  present  no  evidence  of  the 
disease,  but.  as  is  so  frequently  observed  in  these  cases,  the  marriage  has  been 
a  sterile  one. 

Case  II. — Moro  fisherman;  age,  40;  native  of  Panducan  Island;  a  leper  for 
ten  years.  Family  history  not  obtainable.  Through  an  interpreter  the  patient 
expressed  the  belief  that  he  was  infected  by  an  "evil  spirit"  from  a  turtle  he 
captured  one  day  while  out  fishing.  The  following  day  violent  pains  in  both 
arms  were  noted,  succeeded  later  by  a  numbness,  which  has  remained.  I 
assured  him  this  was  the  shortest  incubation  period  on  record,  but  the  Moro 
appeared  to  derive  small  comfort  from  this  somewhat  questionable  distinction. 
Examination  shows  an  almost  classical  case  of  nerve  leprosy,  with  complete 
ansesthesia  below  the  elbows  and  along  the  dorsum  of  the  right  foot.  The  pri- 
mary contractures  have  been  followed  by  mutilations,  resulting  in  the  loss  of 
three  fingers  and  two  toes,  with  stumps  still  showing  extensive  ulceration. 
There  are  no  facial  changes,  no  eruptions  of  any  kind,  and  the  man's  general 
health  is  excellent.  He  is  the  father  of  7  children,  all  born  since  the  onset  of 
the  disease,  but  neither  they  nor  his  wife  are  lepers. 

Segregation  of  Moro  lepers  is  not  practicable  at  this  time  on  account 
of  the  imsettled  conditions,  and  health  officers  at  Philippine  ports 
should  exercise  more  than  usual  vigilance  in  the  inspection  of  steerage 
passengers  from  these  islands. 


Sanitary  Improvements  at  Naples. 
By  Passed  Asst.  Surg.  J.  M.  Eager  (oh  duty  at  Naples,  Italy). 

The  beauty  of  the  villa,  the  handsome  pleasure  ground  extending 
along  the  sea  at  Naples,  was  marred  during  the  height  of  the  tourist 
season  this  year  by  excavations  made  throughout  the  length  of  the 
Riviera  di  Chiaia  for  the  purpose  of  completing  the  extensive  sewer- 
age system  of  the  city.  The  devastating  epidemics  of  which  Naples 
has  so  often  been  the  victim,  and  especially  the  cruel  prevalence  of 
Asiatic  cholera  in  1884,  were  the  prime  movers  in  an  agitation  for 
better  sanitation.  New  streets  have  been  opened,  many  crowded  and 
filthy  buildings  demolished,  thus  admitting  sunshine  and  fresh  air  to 
sections  that  formerly  were  veritable  i:)cst  holes.  One  of  the  most 
conspicuous  results  of  the  sanitary  movement  at  Naples  is  the  perfect- 
ing of  the  water  supply.  In  a  communication  printed  in  the  Public 
Health  Reports  August  29,  1902,  a  history  and  description  of  the 
water  supply  of  Naples  was  given  and  reference  made  to  the  interest- 
ing circumstances  leading  to  the  restoration  and  extension  of  an 
ancient  aqueduct  delivering  water  from  the  same  source  as  that  drawn 
upon  in  the  days  of  Pompeii  and  Ilerculaneum.  This  water  from  the 
springs  of  Seriiio  was  used  by  Caesar's  navy  at  Pozzuoli,  and  undoubt- 
edly St.  Paul  drank  it  when  he  stopped  at  that  place  on  his  journey  to 
Rome. 

An  adequate  sewerage  system  at  Naples  would  have  been  impossible 
without  a  sufficient  water  supply.  These  two  factors  are  of  great 
importance  against  the  inroads  of  future  epidemics  to  which  Naples 
is  particularly  exposed,  not  only  owing  to  the  dense  and  impoverished 
population  but  to  the  direct  communication  of  the  port  with  the 
Orient.  The  sanitary  status  of  Naples  is  extremely  vital  to  the  United 
States  in  view  of  the  almost  daily  intercourse  by  sea  between  this  city 
and  New  York  (215  sailings  during  the  year  1903). 

SEWERS  or  NAPLES. 

The  history  of  sewage  disposal  at  Naples,  which  conveys  n.any 
instructive  hygienic  lessons,  carries  one  back  to  remote  times.  The 
ancient  Greek  settlements  of  Partenope  and  Neapolis,  which  occupied 
part  of  the  present  site  of  Naples,  were  healthful  towns.  They 
undoubtedly  possessed  a  sewerage  system,  but  the  way  in  which  it  was 
constructed  is  totally  unknovvu.  Indeed,  there  is  no  document  set- 
ting forth  information  regarding  the  sewerage  of  Naples  until  the 
year  130.5. 

In  order  to  understand  the  ]:»roblems  which  have  confronted  sani- 
tary engineers  at  Naples  not  only  in  olden  but  in  recent  times  a  slight 

458 


PUBLIC    HEALTH    AND    MARlNP>HOSriTAL    SEKVICK.  459 

knoAvlodao  of  the  t<>j)()OTapliy  of  the  city  is  nocossary-  A  narrow 
rid^c  l)('arin<2;  the  C'astcllo  (U'lT  Ovo  runs  hack  from  the  sea,  broad- 
ening out  into  tli(>  lu'iiihts  of  l^izzofalcone,  Sant'  Elmo,  and  C'apo- 
dinionte,  which  divide  the  city  into  two  nnecjual  ])arts.  In  the 
eastern  division,  extending  as  far  as  the  Sebeto,  lies  the  greater  and 
most  ancient  part  of  Xai:)les,  the  district  where  the  cholera  of  1884 
worked  such  sad  havoc.  In  the  quarter  to  the  west  of  the  ridge  most 
of  the  large  hotels  are  situated.  On  the  hills  in  which  the  ridge  ter- 
minates back  of  the  city  is  a  new  quarter  of  the  town.  The  hill  of 
Posillipo,  bounding  the  city  on  the  west  and  terminating  in  a  promon- 
tory, is  perforated  by  a  tunnel,  the  new  grotto  of  Posillipo,  bored 
twenty  j'ears  ago  to  replace  the  old  grotto,  which  was  constructed 
probably  in  the  reign  of  Augustus.  Both  these  tunnels  are  utilized 
in  the  new  sewerage  system  of  Naples.  The  Avestern  slope  of  the  hill 
of  Posillipo  drains  into  the  Gulf  of  Pozzuoli.  Farther  to  the  west  is 
the  Gulf  of  Gaeta,  which  in  the  future  is  to  receive  the  foulest  part  of 
the  sewage  of  Naples. 

When  the  kingdom  of  Naples  fell  under  the  dominion  of  the  house 
of  Anjou  a  formidable  castle  was  built  on  the  seaside,  the  port  was 
constructed,  and  a  light-house  still  in  use  was  erected.  Planning 
for  the  sanitation  of  the  section  in  which  stood  the  castle,  the  residence 
of  the  king,  Charles  II  called  together  several  public  officers  who 
were  expert  in  constructing  public  Avorks  and  edifices  and  gave  them 
orders  to  do  what  w'as  necessary  to  enlarge  the  port,  to  clean  up  the 
dirt  in  that  part  of  the  city,  and  to  take  opportune  measures  to 
improve  public  sanitation.  Among  other  works  a  large  sewer,  which 
exists  at  the  present  time,  was  constructed.  This  sewer  runs  along 
the  mole.  It  Avas  designed  to  gather  not  only  excrement  but  also  the 
rain  w-ater  Avhich  ran  through  the  streets  and  was  collected  at  inter- 
A^als  by  special  orifices  opening  into  the  scAver. 

Under  the  reign  of  the  Aragonese  a  state  of  war  prevailed  from 
1449  until  1528  and  municipal  sanitation  Avas  neglected  under  stress 
of  the  more  urgent  call  of  arms.  More  placid  days  began  Avhen 
Charles  V  had  succeeded  in  ridding  Naples  of  the  residue  of  the 
French  army.  With  the  definite  establishment  of  the  Spanish 
dominion  steps  Avere  taken  Avith  a  vicAv  to  the  improvement  of  the 
city,  which  had  become  the  capital  of  southern  Italy.  By  increase 
in  population  and  commerce  the  city  has  groAvn  greatly,  especiall}^  the 
eastern  part,  occup3dng  the  slope  of  the  hill  of  Sant'  Elmo,  in  Avhich 
section  the  a^  iceroy,  Don  Pedro  de  Toledo,  built  his  palace.  The  archi- 
tect of  the  palace,  Ferdinand  Manlio,  was  called  upon  to  outline  a 
system  of  sewers  for  Naples,  an  immense  and  difficult  Avork  in  those 
times.  These  seAvers  collected  not  only  the  rain  Avater  of  the  most 
populous  part  of  the  city  but  the  contents  of  the  domestic  drains  and 
consequently  some  excrement.  The  Avater  from  Capodimonte  Avas 
alloAved  to  run  in  a  channel  through  the  streets,  finally  discharging 
into  the  sea  near  the  Sebeto.  So  all  the  seAvage  collected  from  the 
eastern  Avatershed  Avas  cast  on  the  seashore  between  the  Sebeto  and 
the  mole  erected  by  the  Anjou  kings.  The  beach,  from  Avhich  arose 
the  light -house  at  the  foot  of  the  promontory  on  w' hich  stood  the  uni- 
versity, was  pestilential  beyond  measure.  The  draining  from  the 
Avestern  watershed,  including  the  ncAver  part  of  the  city,  was  dis- 
charged by  the  sew^ers,  in  the  beginning,  at  Santa  Lucia,  and,  later. 


460  PUBLIC    HEALTH    AXD    MARINE-HOSPITAL    SERVICE. 

along  the  Kiviera  di  Chiaia.  which  was  then  a  stretch  of  shore  land 
rich  in  gardens,  but  without  habitations  except  a  few  sumptuous  vilhis 
toward  Posillipo  and  some  huts  tenanted  by  fishermen.  This  sewer 
of  the  middle  ages  was  made  with  a  large  central  subterranean  channel 
into  which  emjDtied  branch  sewers  of  diminishing  size  according  to  the 
distance  from  the  main.  The  section  of  these  conductors  was  quad- 
rilateral, the  pavement  made  of  lava  from  Vesuvius  and  the  lateral 
walls  and  arch  of  vulcanic  tufa.  Along  the  course  of  the  sewers 
were  apertures  into  which  the  street  water  flowed.  A  special  corps  of 
guards  was  assigned  to  the  duty  of  watching  the  sewers.  It  is 
remarkable  with  what  precision  the  capacity  of  these  conductors  was 
calculated.  Notwithstanding  the  copious  floods  recorded  in  local 
chronicles,  it  is  noted  that  during  their  early  history  on  one  occasion 
only  was  their  containing  power  exceeded  and  the  contents  thrown 
into  the  streets.  Equally  surprising  is  the  solidity  of  their  construc- 
tion. There  are  points  in  which  for  many  centuries  the  arches  of 
these  old  sewers  have  sustained  without  damage  the  weight  of  huge 
stone  buildings.  Often  in  the  recent  work  of  imj^rovement  at  Naples 
it  has  been  necessary*  to  abandon  the  pick  and  shovel  and  resort  to 
explosives  to  remove  parts  of  the  old  sewers.  Considering  the  scanty 
water  supply  of  Naples  in  those  days,  it  is  easy  to  conceive  the  hor- 
rors that  arose  from  such  sewers  in  seasons  of  scanty  rain. 

For  more  than  two  centuries,  during  which  the  growth  in  popula- 
tion and  area  of  the  city  was  continuous,  this  network  of  sewers  was 
not  extended.  In  later  times,  during  torrential  rains  and  southerh' 
Avinds,  the  sewers  often  vomited  tlieir  filth  into  the  streets. 

In  parts  of  the  town  where  the  sewerage  was  inadequate  the  rain 
water  was  allowed  to  run  along  the  public  highways  to  the  most 
accessible  manhole.  Privy  pits  and  cesspools  received  the  dejections 
and  refuse  water.  At  this  time  the  supply  of  water  which  came  from 
the  former  aqueducts  of  Bolla  and  Carmignano  was  intermittent  and 
stored  in  cisterns  in  the  intervals  of  delivery.  Alongside  these  cis- 
terns, too  often  not  water-tight,  were  the  privv  vaults,  usually  leakv. 
As  far  as  bad  epidemics  are  concerned,  however,  all  went  well  until 
the  invasion  of  Asiatic  cholera  in  1836-37.  In  that  terrible  epidemic 
the  quarters  most  affected  were  in  the  lower  parts  of  the  city,  where 
the  sewers  were  defective,  while  among  the  communities  on  the  hills 
there  were  fewer  victims.  Indeed,  some  sections  were  entirely  exempt 
from  the  scourge.  Years  were  passed  in  the  discussion  of  sanitary 
remedies,  when  in  1854  another  grave  epidemic  of  cholera  spread 
itself  over  precisely  the  same  area  of  stagnant  and  inadequate  sewers. 
The  lesson  was  learned  slowly,  perhaps  in  part  because  of  the  preva- 
lent belief  in  the  transportation  of  cholera  by  the  air.  Light  and  air 
were  demanded,  but  there  were  great  difficulties  in  the  way  of  tearing 
down  blocks  of  buildings.  Sewerage  and  water  were  secondary 
considerations  until  1860,  when  the  municipal  administration  began 
to  work  seriously  on  the  problems  of  water  and  drainage.  The  dis- 
posal of  surface  water  received  the  first  attention.  Canals  for  surface 
water  were  constructed,  but  owing  to  the  difl'erences  in  levels  the  street 
water  in  many  parts  of  the  city  did  not  flow  into  the  new  channels, 
but  was  taken  up  by  the  old  sewers.  A  serious  fault  arose,  however. 
The  ncAv  water  courses,  through  irregular  jjrocedures,  were  used  for 
the  discharge  of  private  cesspools  and  public  urinals  and  as  recepta- 
cles for  street  sweepings  and  rubbish. 


PUHLK^    HKALTH    AND    MAKINE-HOSPITAL    HKRVICP].  461 

With  the  instalhition  of  Scrino  water  the  constnictioii  of  a  satis- 
factory system  of  sewerage  was  seriously  taken  up,  having  the  follow- 
ing ends  in  view:  To  purify  the  seashore,  liberating  it  from  all 
li(pii(ls  containing  putrescible  matter;  to  preserve  the  siibsoil  from 
harmful  infiltration  either' of  matters  transported  by  or  developing 
in  sewers;  to  prevent  the  lower  parts  of  the  city  becoming  more 
unhealthy  through  matters  brought  from  higher  sections;  to  cleanse 
the  subsoil  of  the  lower  sections,  getting  rid  of  the  foulness  already 
therein;  and  to  construct  approj)riate  sewers  in  all  the  streets,  doing 
away  forever  with  cesspools  and  privy  pits  in  all  parts  of  the  city. 
The  single  system,  owing  to  local  topographical  conditions,  has  not 
been  adopted  throughout.  The  continuous  water  carriage  of  all  foul 
matter  in  separate  sewers  was  admitted  to  be  the  only  method  prac- 
ticable for  the  lower  and  middle  levels  of  the  city.  Flood  water  is 
conducted  by  separate  sewers,  except  in  the  higher  section  of  the  city, 
where  the  single  system  has  been  introduced.  The  surface-water 
channels  empty  at  the  two  extremities  of  the  city.  Those  for  filthy 
sewage  have  their  outlets  one  at  the  point  of  Posillipo,  the  other  at 
Licola,  a  desert  beach  of  the  Gulf  of  Gaeta,  15  kilometers  from 
Naples. 

In  regard  to  the  disposition  of  the  new  sewers  the  city  has  been 
divided  into  three  zones,  a  lower,  including  the  stretch  of  the  city, 
having  a  height  of  less  than  12  meters  above  the  mean  level  of  the 
sea,  a  middle  zone  extending  to  22  meters,  and  an  upper  zone  above 
that  level.  So  there  are  three  collectors,  high,  middle,  and  low. 
The  high  collector,  on  the  mixed  system,  begins  at  the  Porta  San 
Gennaro  at  a  level  of  17.09  meters  and  descends  to  Piedigrotta,  the 
Nai)les  end  of  the  tunnel  through  Posillipo  Hill,  where  its  altitude  is 
12.40  meters.  The  fall  is  1  per  cent.  The  middle  collector  begins 
at  the  Corso  Garibaldi  at  a  level  of  8.80  and  descends  with  a  fall  of 
0.75  per  cent  to  Piedigrotta,  where  its  level  is  4.50  meters.  The  low 
collector  is  double,  one  part  serving  for  the  eastern  zone,  the  other 
for  the  western  section.  The  contents  of  the  two  sections  of  the  low 
conductor  are  pumped  into  the  middle  collector  at  appropriate  places, 
and  the  combined  contents  of  the  middle  collector  are  similarly  lifted 
into  the  lower  extremity  of  the  high  conductor  at  Piedigrotta. 

In  the  construction  of  the  conductors  application  has  been  made  of 
material  from  Vesuvius.  The  floors  and  lateral  walls  are  made  of 
lava  and  of  mortar  of  hydraulic  cement  and  volcanic  sand.  The 
vaults  are  built  in  some  places  of  volcanic  tufa  and  in  others  of 
bricks  of  terra  cotta.  Over  the  arch,  which  nearly  reaches  the  street 
level,  is  a  layer  of  concrete  of  scoria?  and  hydraulic  cement.  An  extra 
solid  foundation  of  slag  and  cement  has  been  laid  under  the  low  con- 
ductor in  places  where  it  runs  at  the  level  of  the  sea.  The  internal 
walls  of  the  collectors  are  covered  with  a  layer  of  varying  thickness 
of  hydraulic  cement  and  in  places  are  liberally  plastered  with  a 
mixture  of  mineral  asphalt  and  sea  sand.  Purifying  pits  and 
hydraulic  interception  are  installed  to  reduce  the  quantity  of  organic 
and  solid  matter  entering  the  sewers  from  the  streets  and  to  regulate 
the  ingress  of  surface  water.  To  render  fecal  matter  more  fluid,  use 
is  made  of  water  furnished  by  the  ancient  aqueducts  of  Carmignano 
and  Bolla,  Avhile  in  the  smaller  sewers  there  is  a  special  apparatus 
w^hereby    water   is    automatically    drawn    from    the    Serine    mains. 


462  PUBLIC    HEALTH    AND    MARINP>H()8PITAL    SERVICE. 

Suitable  ventilation  is  also  provided  for  by  appropriate  engineering 
devices.  The  sewer  of  Cinna,  which  is  destined  to  transport  the 
sewage  from  Piedigrotta,  is  15,572  meters  in  length.  The  end  is  pro- 
longed 50  meters  under  the  sea.  The  fall  of  the  terminal  part  is  3 
per  cent,  and  is  constructed  in  such  a  maimer  as  to  be  unaffected  by 
the  action  of  the  waves  even  in  the  most  tempestuous  weather.  The 
current  produced  by  the  rapid  fall  is  of  sufficient  strength  to  over- 
come the  resistance  of  the  waA^es  and  to  sweep  away  from  the  mouth 
all  the  deposits  that  the  sea  may  accumulate. 

The  sewer  of  Corolio,  Avhich  runs  from  Piedigrotta  to  the  point  of 
Posillipo,  is  destined  to  transport  a  large  part  of  the  rain  water  and 
only  a  small  quantity  of  foul  material,  and  that  only  in  case  of  excep- 
tional rain.     Its  length  is  5,248  meters. 


Catheter  in   Hladdeu — Removal  Through  Perineum. 
I'.y  Passed  Asst.  Surg.  J.  A.  Nydeogku. 

This  case  is  rc])ortcd  because  it  is  oiui  of  rather  unusual  occurrence. 
F.  G.,  age  42,  a  French  sailor,  was  admitted  to  the  marine  hospital, 
Baltimore,  Md.,  in  February,  1903;  had  oonorrhcea  in  1901  and 
again  in  May,  1902.  He  was  treated  in  a  hospital  in  October,  1901, 
for  inflammation  of  l)ladder  following  his  last  attack  of  gonorrhfea. 
He  left  the  hospital  improved.  In  November  last  he  Iwgan  the  use  of 
a  rubber  catheter  on-account  of  occasional  retention  of  urine. 

On  January  25,  1903,  he  fell  asleep  in  the  forecastle  of  his  vessel 
with  his  catheter  in  his  urethra.  On  awakening  several  hours  later 
the  catheter  could  nowhere  be  found.  He  believed  it  had  gone  into 
his  bladder. 

About  one  week  later  he  was  seen  for  the  first  time.  His  symp- 
toms were  those  of  an  aggravated  case  of  cystitis.  There  was  fre- 
quent urination.  There  w^as  constant  pain  and  a  burning  sensation 
referred  to  the  head  of  tiie  penis,  urethra,  and  bladder,  all  of  which 
were  increased  after  voiding  urine.  The  urine  had  a  specific  gravity 
of  1.011,  was  strongly  alkaline,  of  a  yellowish  color,  with  an  ammo- 
niacal  odor,  and  contained  rather  a  large  amount  of  mucus. 

At  the  time  not  much  credence  was  given  to  his  statement  as  to  the 
whereabouts  of  the  catheter,  as  the  patient  was  of  a  neurotic  type,  and 
the  catheter  might  have  easily  slipped  out  and  gotten  concealed  under 
some  object  or  hidden  or  thrown  away  by  some  mischievous  shipmate. 
His  bladder  was  explored  with  a  sound,  but  nothing  was  made  out. 

The  patient  was  ordered  in  bed  and  treatment  locally  and  internally 
administered,  but  there  was  no  amelioration  of  his  discomforts.  The 
condition  grew  worse.  Drainage  of  the  bladder  through  the  peri- 
neum was  decided  upon.  Median  lithotomy  was  performed.  Upon 
introducing  a  finger  into  the  bladder  it  came  in  contact  with  a 
somewhat  resistant  roughened  surface.  A  pair  of  long-jawed  artery 
forceps  were  introduced  over  the  finger  and  the  object  grasped  and 
drawn  out.  It  proved  to  be  a  full  length  soft-rubber  catheter,  size 
16,  covered  with  phosphatic  deposits.  The  catheter  was  quite  rotten, 
having  been  in  the  bladder  over  a  month,  and  broke  on  traction  neces- 
sary to  draw  it  through  the  urethra,  and  was  removed  by  piecemeal. 

The  patient  w^as  continued  on  his  former  treatment,  which  con- 
sisted of  urotropin,  salol,  and  boracic  acid  administered  by  turns,  and 
the  bladder  irrigated  twice  daily  with  warm  boracic-acid  solution. 
All  symptoms  subsided  promptly  and  recovery  ensued. 

A  point  of  interest  in  connection  with  the  case  is  the  fact  of  the 
patient  having  carried  the  catheter  about  in  his  bladder  for  over  a 
month  and  the  delay  in  operation  due  to  the  lack  of  belief  in  his 
statement.  The  previous  history  of  a  rather  recent  attack  of  cystitis 
without  complete  recovery  helped  to  mask  the  cause  of  the  aggravated 
symptoms  set  up  in  the  bladder  by  the  presence  of  the  catheter. 

463 


REPORTS  OF  FATAL  CASES  WITH  NECROPSIES. 

Following  are  the  reports  on  cases  d3ang  at  the  marine  hospitals, 
with  necropsic  findings : 

ALCOHOLISM. 


L.  W. ;  white,  male ;  aged,  42 ;  born  in  Tennsylvania  ;  admitted  to  the  United 
States  Marine  Hospital  at  Chicago,  111.,  July  20,  1903,  and  died  .July  25,  1903. 

History. — Patient  states  that  for  twelve  years  he  has  been  a  heavy  drinker. 
He  says  he  started  on  a  spree  on  the  morning  of  July  4,  and  by  noon  was  quite 
intoxicated  and  laid  down  somewhere  to  sleep.  While  lying  there  asleep  some 
one  placed  a  lighted  cannon  cracker  between  his  thighs.  Upon  its  explosion  he 
was  severely  burned  on  the  scrotum  and  inner  aspect  of  the  thighs.  lie  neither 
received  nor  sought  treatment  for  the  burns,  which  are  now  healing.  Since 
that  day  he  has  been  drinking  continuously,  and  now  applies  for  treatment  in 
order  that  he  may  sober  up. 

Present  condition. — Patient  is  in  a  very  nervous  state,  his  hand  shaking 
like  one  with  the  palsy.  Tongue  is  ccited,  eyes  are  red  at  margin  of  lids,  and 
he  has  the  general  appearance  of  one  on  a  protracted  spree.  He  was  ordered 
to  bed  and  on  strictly  milk  diet,  and  was  given  chloral  and  bromides,  followed 
the  next  day  by  castor  oil. 

Jullf  2.i. — Patient  wretchedly  nervous,  and  has  temperature  40.4°.  Looks 
pale;  reports  pain  in  left  cliest  and  cardiac  region ;  says  he  had  a  chill,  but  did 
not  report  it  till  questioned  very  closely.  On  auscultation  a  few  medium  mucous 
rales  can  be  heard  at  base  of  left  lower  lobe;  is  put  on  digitalis. 

July  23. — Patient  in  considerable  delirium  last  night;  is  exceedingly  nervous; 
says  he  saw  devils  and  animals  in  his  delirium.  Physical  signs  improved.  No 
dullness,  crepitating  rales,  or  other  signs  of  impending  or  actual  pneumonia. 

July  2-J. — Patient  is  very  weak  and  tremulous.  Temperature  is  38.4°  ;  pulse, 
146;  respirations,  54.  No  dullness  present  over  the  thorax,  and  heart  sounds 
are  shallow  and  frequent;  some  niles  present  in  all  lobes,  except  left  upper 
lobe,  where  the  sound  is  somewhat  dry  and  tubular  in  character.  The  treat- 
ment now  consists  of  stimulants,  bromides  and  chloral  having  been  discontinued. 
Urinary  analysis  showed  presence  of  albumen  and  casts — epithelial  and  granular. 

July  2.J.— Patient  is  delirious  and  restless,  attempting  to  leave  bed  all  the 
time.  Pulse,  150;  respirations,  58;  very  shallow  and  markedly  diaphragmatic 
in  character.  On  physical  examination,  which  was  very  difficult  on  account 
of  restlessness  and  grunting  expirations,  some  flattening  of  percussion  note 
was  elicited  over  rigiit  lower  lobe,  but  it  did  not  amount  to  dullness.  Mucous 
rales  with  sighing  expiratory  murmur  were  heard  all  over  lungs.  Heart  sounds 
could  not  be  differentiated,  owing  to  noisy  pulmonary  sounds;  passes  plenty  of 
urine. 

Patient  so  restless  that  a  hypodermic  of  hyoscine  hydrobromate  was  given 
with  little  effect.  Patient  gradually  became  unconscious  about  noon  and  has 
remained  so,  but  is  very  restless. 

Despite  active  stimulation  the  patient's  condition  became  more  and  more 
grave.  He  rapidly  weakened,  his  pulse  grew  feebler,  respirations  remained 
quite  rapid,  but  were  shallower.  At  about  5..30  p.  m.  he  had  a  sudden  turn  for 
the  worse,  respirations  finally  ceased,  and  cardiac  action  ended  at  5.40  p.  m. 
Patient  had  not  regained  consciousness  before  death. 

Necropsy  (22  hours  after  death). — Body  that  of  a  well-nourished  male; 
post-mortem  lividity  marked  in  dependent  portions  and  face;  both  orbits  and 
scrotum  edematous;  small  burns  on  inner  sides  of  thighs  and  scrotum  nearly 

464 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  -165 

healed.  Thorax :  The  perieardiimi  contained  about  10  c.  c.  bloody  serum ; 
the  rifiht  lunj;  weij^hed  !IS(»  i^ranis;  markedly  anthraeolio,  lower  part  of  upper 
lobe  in  red  hepatization;  left  lunj:  weighed  1,190  si'ams  ;  upper  portion  of  upper 
lobe  in  hepatization,  lower  part  showed  hypostatic  congestion  ;  anterior  surface 
of  hepatized  portion  showed  frothy,  bloody  tluid ;  a  few  not  very  recent  adhe- 
sions at  base;  heart  weighed  olO  grams,  very  flabby,  and  contained  some  post- 
mortem clots;  nuiscular  tissue  pale,  but  not  especially  frial)le;  all  valves  com- 
petent ;  they  were  all  I'ed  in  color,  the  aortic  and  tricuspid  valves  being  dark 
red.  almost  bluisli ;  the  aorta  was  bright  red  and  velvety  in  appearance.  Abdomen  : 
The  liver  weighed  1,<IT0  grams;  was  pale,  reddish  yellow  in  color,  lobules  not 
differentiated,  doughy  in  consistency;  the  right  iKidney  weighed  200  grams; 
capsule  stripped  off  readily;  tissue  soft  and  flabby;  deeply  congested  exter- 
nally and  on  section;  the  left  kidney  weighed  175  grams,  slightly  congested, 
normal  in  consistency  ;  the  ston)ach  and  intestines  greatly  distended  with  gas, 
and  showed  signs  of  cougestion ;  bladder  contracted  and  empty. 

L.  P.  H.  B. 

C.  E.  B. 
II. 

J.  M. ;  age,  34 ;  nativity,  Michigan ;  admitted  to  the  United  States  Marine 
Hospital,  Cleveland.  Ohio.  April  17,  1904,  and  died  April  19,  1904. 

History. — Brought  into  hospital  suffering  from  a  fracture  of  right  tibia  in 
lower  third.  He  showed  symptoms  of  alcoholism  upon  admission.  He  was  a 
heavy  drinker  and  had  been  on  a  protracted  spree  for  several  weeks.  His  con- 
dition was  such  that  he  could  not  give  an  intelligent  history.  Delirium  tremens 
developed  April  19.  and  he  died  at  8  p.  m. 

Necropsy  (14  hours  after  death). — Body  of  a  large,  well-nourished,  white 
male;  rigor  mortis  well  marked;  considerable  post-mortem  lividity  of  dependent 
parts ;  no  scars ;  lower  third  of  right  leg  considerably  swollen,  marked  ecchymo- 
sis  around  lower  third;  considerable  unnatural  mobility  at  this  place  with  crepi- 
tation ;  an  incision  over  this  point  shows  some  oedema  and  ecchymosis  of  soft 
parts;  the  tibia  shows  a  Y-shaped  fracture;  the  upper  fragment  pointed  and 
held  between  the  two  arms  of  the  lower  fragment ;  fibula  not  fractured.  Brain : 
Convolutions  well  marked,  severe  venous  and  arterial  congestion  with  oedema ; 
brain  wet  and  soggy ;  considerable  increase  of  cerebro-spinal  fluid — typical  wet 
brain  ;  brain  weighed  1,140  grams  ;  spinal  cord  not  examined.  Thorax  ;  Incision 
through  thorax  and  abdomen  shows  subcutaneous  fat  well  marked ;  pleura  free ; 
pericardium  contains  considerable  fat ;  heart  not  enlarged,  walls  rather  thick 
and  show  slight  fatty  change,  valves  normal,  weight  of  heart  450  grams ;  lungs 
show  slight  hypostatic  congestion,  otherwise  normal  in  appearance,  left  lung 
weighs  050  grams,  right  lung  weighs  725  grams.  Abdomen :  Peritoneum  normal 
in  appearance ;  omentum  contains  a  large  amount  of  fat ;  intestines  free,  no 
adhesions ;  stomach  and  intestines  slightly  distended  with  gas ;  liver  is  rather 
large,  exterior  shows  mottled  surface,  on  section  shov\s  fatty  changes  and  weighs 
1,890  grams ;  gall  bladder  is  distended  with  dark-colored  bile ;  great  increase  in 
perinephritic  fat;  capsules  of  kidneys  strip  easily,  on  section  both  kidneys  show 
fatty  changes,  left  weighs  165  grams,  right  weighs  190  grams ;  spleen  is  normal 
in  appearance,  weighs  290  grams ;  in  omentum  are  five  or  six  small  round 
bodies  the  size  of  a  pea,  which  on  section  appear  to  be  accessory  spleens ;  pan- 
creas appears  normal,  weight  85  grams ;  bladder  full  of  urine. 

AnatOxMical  diagnosis. — Fracture  of  right  tibia ;  congestion  and  oedema  of 
brain. 

H.  S.  M. 
BERIBERI. 

B.  O. ;  age.  48  years ;  nativity,  Norway ;  admitted  to  the  United  States 
Marine  Hospital.  San  Francisco,  Cal.,  August  18.  1903 ;  died  October  13,  1903. 

History. — The  patient  stated  that  for  the  past  three  weeks  he  had  been  suf- 
fering from  cough,  dyspnoea,  and  general  dropsy.  Examination  :  Tongue  coated ; 
face  cyanotic ;  many  moist  rales  in  both  lungs ;  area  of  heart  dullness  increased 
toward  the  left  side ;  heart  sounds  very  feeble ;  pulse  163.  weak  and  irreg- 
ular ;  abdomen  and  legs  tense  from  dropsy ;  urine,  specific  gravity,  1.026 ;  dailj^ 
quantity,  1.000  c.  c. ;   no  albumen  present. 

By  the  use  of  stimulants  and  tonics  the  patient  became  much  improved,  his 
dropsy  disappeared  almost  entirely,  and  his  strength  returned.    On  September 

8629—04 30 


466  PUBLrC   HEALTH    AND   MAEIXE-HOSPITAL    SERVICE. 

20  pericarditis  developed  and  bis  old  symptoms  gradually  returned.  He  lost 
his  appetite,  which  had  previously  been  good,  bis  respirations  were  labored, 
and  his  pulse  weak  and  irregular.  He  die*!  from  exhaustion  October  13,  at 
1.20  a.  m. 

Necropsy  (10  hours  after  death). — Height,  o  feet  8  inches:  trunk  and  legs 
very  (edematous;  arms  rather  emaciated:  post-mortem  lividity  and  rigor  mor- 
tis well  developed;  face  of  livid  blue  color;  superficial  ulcerations  on  calves  of 
both  legs;  scrotum  and  penis  ojdematous.  Over  frontal  region  of  skull,  a 
little  to  the  left  side,  exists  a  deep  depression  about  3  inches  long  and  2  wide, 
the  remains  of  an  injury  many  years  ago.  Brain:  On  removal  of  the  calvn- 
rium  it  is  seen  that  the  outer  table  over  the  depressed  area  is  ab.sent,  the  skull 
there  consisting  only  of  the  inner  table;  the  latter  is  not  at  all  depressed,  nor 
are  the  frontal  convolutions,  but  the  bony  plate  is  very  thin  and  transparent 
when  held  up  to  the  light;  brain  weighs  1,333  grams;  cerebral  tissue  is  gen- 
erally very  antemic  in  appearance;  otherwise  the  cranial  contents  are  normal. 
Thorax :  The  anterior  mediastinum  exposed  and  the  margins  of  the  lungs  and 
the  pericardium  found  to  be  strongly  bound  together  by  fibrous  adhesive  bands; 
on  opening  the  pericardium  an  amount  of  serous  fluid  escapes ;  pericardium  is 
so  strongly  adherent  to  neighboring  structures  that  it  can  be  separated  only 
with  great  difficulty ;  its  layers  are  much  thickened  and  of  fibrous  consistency ; 
the  heart  and  pericardium  are  strongly  adherent  in  places,  and  the  inner  sur- 
face of  the  pericardium  is  roughened  and  exhibits  a  "  bread-and-butter  "  appear- 
ance; the  heart  weighs  480  grams,  is  enlarged,  and  the  musculature  is  of  pale 
I'ed  color ;  the  mitral  valve  is  thickened  and  roughened  :  the  other  valves  appear 
normal;  the  left  ventricular  wall  is  1^  cm.  in  thickness,  that  of  the  right  |  cm. 
The  right  lung  adheres  firmly  to  the  diaphragm  and  pericardium  and  weighs 
460  grams ;  the  upper  lobe  is  crepitant,  grayish  red  on  section ;  the  lower 
lobe  is  noucrepitant,  dark  red  in  color,  and  cuts  with  increased  resistance;  the 
section  is  bloody  and  (edematous ;  the  left  lung  is  intimately  bound  to  the  clie.st 
wall  and  diaphragm,  and  weighs  290  grams:  measures  23  by  15  by  5  cm.,  is 
retracted,  and  considerably  smaller  than  the  right  lung :  the  apex  shows  an 
old  .scar  completely  healed :  it  is  generally  crepitant  and  is  of  reddish  gray 
color;  the  great  vessels  and  nerve  trunks  are  normal:  the  diaphragm  adheres 
to  the  bases  of  the  lungs.  Abdomen:  On  opening  the  abdominal  cavity  a  large 
amount  of  clear  serous  fluid  escapes.  The  peritoneum  is  smooth  and  shining. 
The  great  omentum  is  contracted,  contains  very  little  fat,  and  is  of  a  dark 
brownish-red  color.  The  spleen  weighs  29.5  grams,  is  enlarged,  and  cuts  with 
increased  resistance ;  the  pulp  is  firm  and  .somewhat  hard  to  the  touch.  Sev- 
eral interstitial  hemorrhagic  areas  are  present :  cut  section  rather  pale  in 
color.  The  left  kidney  is  2.35  grams  in  weight,  is  enlarged,  and  bound  by 
strong  adhesions  to  the  lumbar  region  ;  it  measures  G  by  12  by  4  cm. ;  it  cuts 
with  increased  resistance,  showing  a  narrow  cortex  (h  cm.  thick),  with  red  and 
yellow  striations  and  some  increase  of  interstitial  tissue:  the  fibrous  capsule 
strips  readily.  The  right  kidney  weighs  200  grams  and  measures  6  by  12  by  3 
cm.;  it  is  not  bound  down  quite  as  firmly  as  is  the  left  organ;  it  presents  a 
nearly  similar  condition  to  that  of  the  left,  except  for  a  somewhat  greater 
increase  of  the  interstitial  connective  tissue.  The  suprarenal  capsules  are  lx)th 
enlarged  and  sclerosed  and  cut  with  increased  resistance.  The  urinary  bladder 
contains  a  moderate  amount  of  clear  urine.  The  organs  of  generation  are  nor- 
mal, except  for  fftdema  of  the  penis.  The  rectum  and  duodenum  are  normal. 
The  stomach  shows  hemorrhagic  areas  throughout  its  mucous  membrane.  The 
gall  ducts  and  gall  bladder  are  normal.  The  liver  weighs  1,800  grams;  its 
external  surface  is  pale  and  streaked  with  whitish  lines;  it  cuts  with  increased 
resistance,  and  the  section  gives  the  typical  nutmeg  appearance :  the  section 
feels  somewhat  greasy  ;  it  measures  22  by  24  by  8  cm.  The  pancreas  is  hard 
and  nodular  and  cuts  with  increased  resistance ;  on  section  it  is  somewhat 
lighter  in  hue  than  normal.  The  solar  plexus  and  mesentery  are  normal.  The 
small  intestines  are  nearly  empty ;  there  is  .some  congestion  of  the  mucous 
membrane  of  the  ileum.  The  large  intestines  are  distended  with  gas;  the 
caecum  is  bound  by  adhesions  to  the  iliac  fossa.  The  vermiform  appendix  is 
long,  free,  and  of  normal  appearance.     The  great  vessels  are  also  normal. 

Anatomical  diagnosis. — Oedema  of  trunk,  legs,  scrotum,  and  penis ;  absence 
of  portion  of  external  table  of  skull ;  chronic  adhesive  pericarditis,  with  effu- 
sion ;  fibrous  adhesions  between  heart,  pericardium,  pleurte,  lungs,  and  dia- 
phragm ;  cardiac  hyr^ertrophy  and  dilatation ;  sclerosis  of  mitral  valve,  with 
insufficiency;    chrouic  fibrous  pleuritis;    passive  congestion  of  lower  lobe  of 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE.  467 

right  lung;  healed  cicatrix  in  left  apex;  chronic  phrenitis ;  ascites;  contrac- 
tion of  omentum;  chronic  splenitis,  with  infarction;  sclerosis  of  kidneys; 
sclerosis  of  suprarenal  capsules;  chronic  gastritis;  hypertrophic  cirrhosis  of 
liver;   sclerosis  of  pancreas ;   chronic  enteritis  ;   remains  of  old  perityphlitis. 

C.  R. 

W.  G.  S. 
CIRRHOSIS  OF  LIVER. 

T.  S. ;  aged,  49 ;  nativity,  Holland ;  admitted  to  United  States  Marine  Hospi- 
tal, Boston,  Mass.,  August  '24,  1!)02;  died  Septemher  10,  1903. 

Family  history. — Father  killed.  Mother  died  of  paralysis.  Otherwise 
negative. 

Pkevious  history. — Beriheri  five  years  ago ;  yellow  fever  ten  years  ago ; 
severe  injuries  three  mouths  ago  to  right  shoulder  and  head,  caused  by  con- 
tact with  machinery;  gonorrhea  four  times,  stricture  at  present;  used  alcohol 
and  tobacco  freely  up  to  six  months  ago. 

Present  history'. — Abdomen  began  to  swell  as  he  was  recovering  from  his 
injuries  three  months  ago;  never  had  any  pain;  has  lost  much  flesh. 

Physical  examination. — Patient  very  thin  and  pale;  chest  hyperresonant 
over  lungs  iu  front  down  to  fifth  rib;  breathing  exaggerated;  apex  and  lower 
border  of  heart  not  determined;  liver  extends  from  fifth  rib  to  two  fingers' 
breadth  below  costal  border;  abdomen  very  tense,  and  tj-mpanitic  over  middle, 
with  dullness  in  flanks,  which  changes  with  position  of  patient.  Abdomen 
tapped  and  10.000  c.  c.  of  fluid  removed,  which  gave  patient  considerable  relief. 
Thereafter  patient  was  tapped  about  once  a  fortnight,  the  amount  of  fluid  vary- 
ing between  10,000  and  12.000  c.  c.  Bowels  kept  active  with  Ext.  Apocyni 
cannabini  fld.  8  c.  c.  t.  i.  d.  Patient's  only  complaint  is  extreme  thirst.  During 
the  month  of  March  patient  very  weak  and  was  obliged  to  stay  iu  bed  most  of 
the  time.  Abdomen  tapped  about  once  a  week.  Elaterium  gm.  0.002  t.  i.  d. 
prescribed  and  continued  for  a  week.  About  the  middle  of  May  patient  began 
to  improve,  became  brighter  and  more  cheerful,  and  was  up  and  about  most  of 
the  time. 

On  June  12  patient  was  tapped  again,  having  been  forty-two  days  without 
tapping,  and  5,000  c.  c.  of  fluid  withdrawn  ;  continued  well  until  tlie  last  of 
July,  when  he  began  to  fail,  requiring  to  be  tapped  with  increasing  frequency. 
Elaterium  was  again  prescribed,  but  it  nauseated  the  patient  and  was  aban- 
doned. On  August  30  patient  took  to  his  bed  and  stayed  there  entirely 
thereafter. 

September  -J. — Patient  only  semiconscious. 

Septemher  5. — Passing  urine  and  faeces  involuntarily;  takes  little  nourish- 
ment. 

September  6. — Somewhat  brighter  to-day  and  responds  when  spoken  to. 

September  S. — Still  holding  his  own,  but  apathetic. 

September  10. — At  sick  call  this  morning  patient  appeared  very  low  and 
death  occurred  at  12.20  p.  m. 

Necropsy  (10  hours  after  death). — Body  ill-nourished  and  emaciated;  post- 
mortem lividity  well  marked;  rigor  mortis  very  slight.  Median  incision 
revealed  peritoneum  as  very  much  thickened  and  fibrous,  while  the  omentum 
appeared  as  a  ver.v  thin  membrane.  Intestines  were  very  much  filled  with  gas 
and  the  abdominal  organs  were  much  displaced.  Pericardium  contained  usual 
amount  of  clear  fluid,  and  heart  contained  a  considerable  quantity  of  blood  and 
both  post  and  ante  mortem  clots.  Weight  of  heart,  320  grams;  valves  appar- 
ently normal.  Left  lung  adherent,  especially  to  diaphragm,  weight  920  grams, 
normal  on  section.  Right  lung  also  adherent,  weight  1.6.50  grams,  and  appar- 
ently normal  on  section.  Enormous  thickened  mesentery ;  intestines  diflScult  to 
remove ;  otherwise  noi-mal.  Pelvic  cavity  very  shallow,  owing  *:o  tb.e  thickening 
and  contraction  of  peritoneum.  Spleen  very  adherent  and  enlarged,  weight 
470  grams,  and  on  section  shows  increase  of  connective  tissue.  Left  kidne.v 
wei.ghs  250  grams,  right  kidney  170  grams;  cortex  of  both  kidneys  deeply  con- 
gested. Liver  very  much  contracted,  firm  and  hard,  showing  great  increase  of 
gray  connective  tissue,  weight  920  grams.     Brain  not  examined. 

Diagnosis. — Cirrhosis  of  the  liver. 

'W.  C.  R. 
R.  M.  W. 


468  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

DISEASES  OF  THE  BRAIN  AND  ITS  MEMBRANES. 

A'bscess  of  brain. 

(Syphilis,  secondary.) 

J.  R. ;  age,  40 ;  nativity,  Finland ;  color,  white ;  admitted  to  the  United  States 
Marine  Hospital,  San  Francisco,  Cal.,  October  15,  1903 ;  died  December  11,  1903. 

History. — Malarial  fever  wlien  a  child ;  gonorrhea  eleven  years  ago ;  chancre 
Ofteen  years  ago,  followed  by  sore  throat  and  vague  symi)toms ;  bad  cold  all 
last  winter,  and  coughing  and  spitting  for  the  last  three  weeks  before  applying 
for  admission  to  the  hospital.  Complained  of  a  steady  pain  in  the  left  side  of 
the  head,  which  began  about  five  months  before  and  gradually  increased  in 
severity.  He  began  to  see  double  about  two  months  ago  and  his  eyes  became 
crossed  at  that  time ;  hearing  was  gradually  lost  in  the  left  ear ;  was  unable  to 
sleep,  digestion  became  poor ;  was  constipated :  got  very  dizzy  on  exertion. 
Examination  showed  internal  squint ;  double  vision  ;  dryness  of  nose ;  coated  and 
ulcerated  tongue;  enlarged  and  tender  liver;  anaesthetic  leucodermic  area  size  of 
nickel  on  left  knee.  The  face  exhibited  a  fairly  typical  leonine  expression. 
Marked  temporary  improvement  was  observed  after  treatment  with  potassium 
iodide,  but  the  old  symptoms  soon  appeared  again.  The  face  became  swollen  on 
the  left  side,  and  the  left  eyeball  bulged  forward.  The  left  eye  gradually  lost  its 
power  of  motion  and  became  fixed  while  the  other  moved,  but  vision  remained 
fairly  good  until  a  late  stage  of  the  case;  ptosis  of  the  left  eyelid  supervened, 
followed  by  mild  conjunctivitis;  pain  became  so  constant  that  morphine  had  to 
be  frequently  given.  The  vision  of  the  right  eye  became  impaired ;  urinalysis 
was  negative;  irregular  fever  began  to  occur.  The  breath  became  exceedingly 
foul  and  mucopurulent  matter  was  ejected  from  the  nose  and  mouth.  The  tongue 
was  fissured,  ulcerated,  and  swollen,  and  the  appetite  failed.  Consciousness  was 
gradually  lost  and  Cheyne-Stokes  respiration  and  stertorous  breathing  occurred, 
the  latter  accompanied  by  a  peculiar,  shrill  sound  during  inspiration.  Opthal- 
moscopic  examination  (earlier  in  the  case)  revealed  choked  disk  in  the  left 
eye.  The  patient  was  taken  to  a  specialist  shortly  after  admission  to  the  hos- 
pital, but  no  certain  diagnosis  was  then  made,  though  the  case  was  deemed  sufii- 
ciently  suspicious  to  warrant  isolation  and  a  provisional  diagnosis  of  leprosy. 
After  a  second  and  later  examination  by  the  same  expert  it  was  concluded  that 
the  case  was  one  of  cerebral  syphilis.  Death  occurred  at  5.55  p.  m.,  December 
11,  1903. 

Necropsy  (10  hours  after  death). — Body  emaciated;  rigor  mortis  and  post- 
mortem lividity  jiresent ;  post-mortem  changes  are  present  in  the  skin  of  the 
abdominal  wall.  The  contents  of  the  left  orbit  project  forward  and  outward 
and  the  left  cheek  is  swollen.  The  left  eyelids  are  gummed  together,  and  the 
right  are  partially  open.  The  left  forefinger  is  tightly  flexed  into  the  palm,  all 
joints  being  anchylosed,  and  the  left  middle  finger  is  rigid  at  the  metatarso- 
phalangeal joint — these  the  result  of  an  old  injury.  On  the  skin  of  the  left 
knee  is  a  whitened  area,  size  of  a  nickel.  The  left  pupil  is  dilated.  The  tongue 
is  eroded  and  swollen,  and  there  is  a  fungous  growth  on  the  dorsal  surface. 
Brain:  The  brain  weighs  1,2.55  grams.  On  removing  it  from  the  skull  a  large 
abscess  cavity  is  found  in  the  middle  fossa  on  the  left  side,  involving  a  large 
portion  of  the  temporo-sphenoidal  lobe,  and  extending  as  far  as  the  median  line 
and  into  the  sphenoidal  fissure.  The  l)ony  floor  of  the  middle  fossa  has  been 
destroyed  and  the  abscess  eomnmnlcates  by  a  large  opening  with  the  naso- 
pharynx, and  with  the  antrum  of  Ilighmore.  Microscopical  examination  of  the 
pus  from  the  abscess  reveals  only  pus  cells  and  broken-down  nerve  tissue.  The 
structures  at  the  base  of  the  brain  are  matted  together  with  inflammatory 
exudate.  The  remainder  of  the  brain  aijpears  normal  externally  and  on  section. 
Thorax:  The  costal  cartilages  of  the  first  ribs  are  ossified.  The  lungs  meet  in 
the  median  line.  The  pericardium  contains  a  small  amount  of  clear  serous 
fluid,  and  its  layers  are  free  all  over.  The  heart  weighs  370  grams.  There  is  a 
moderate  amount  of  fat  on  the  external  surface.  It  is  somewhat  bi'oad  later- 
ally, and  its  tissue  is  soft  and  flabby.  The  myocardium  cuts  with  normal  resist- 
ance, and  is  of  a  x'eddish-brown  color.  The  endocardium  a])i)ears  smooth  and 
shining  all  over.  The  right  auricle  contains  a  large  goose-fat  clot,  which 
extends  into  the  right  ventricle.  There  are  small  clots  in  the  left  auricle,  and 
in  the  pulmonary  artery.    The  aortic  and  pulmonary  valves  are  competent  to 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  469 

the  water  test.  The  mitral  orifice  admits  four  finser  tips;  the  tricuspid  the 
same.  The  riuht  luiic:  is  free  in  tlie  i)Ieural  cavity,  is  of  slate  color  anteriorly, 
darker  posteriorly,  and  shows  several  hardened  yellowish  areas,  size  of  a  hazel- 
nut, hulj^inj:  from  the  surface  of  the  lower  lohe.  It  weighs  9G0  grams  .nnd  is 
enlarged,  ('rei)ltation  is  good  in  the  upper  and  middle  lohes,  and  in  the  lower 
lohe  excei»t  the  yellowish  niasses.  which  on  section  are  found  to  extend  ahout 
half  an  inch  into  the  lung  suhstance,  giving  increased  resistance.  Their  out- 
lines are  irregular.  Section  of  the  posterior  portion  of  the  lower  lobe  is  bloody 
and  (edematous;  on  section  of  the  upper  loi)es  pus  exudes  from  the  smaller 
bronchi.  The  left  lung  is  bound  to  the  chest  wall  at  the  apex  by  sepax'able 
fibrinous  adhesions ;  it  weighs  (UO  grams.  The  external  surface  is  similar  to 
that  of  the  right  lung,  and  on  the  lower  lobe  are  similar  hardened  yellowish 
bodies.  At  the  outer  bni-der  occurs  a  mass  of  the  size  of  a  pigeon  egg.  yellowish 
and  firm  at  the  peripliiny,  but  breaking  down  and  undergoing  liquefaction  necro- 
sis centrally.  Smaller  areas  of  yellowish  deposit  have  invaded  the  interior  of 
the  lower  lobe,  wliich  is  bloody  and  fedematous.  and  shows  pus  in  places.  The 
peribronchial  glands  are  enlarged,  hardened,  and  of  black  color.  The  mucous 
membrane  of  the  lower  part  of  the  trachea  is  congested.  The  esophagus  is 
ai)parently  normal.  Microscopical  examination  of  pus  from  the  necrosed  area 
in  the  left  lung  shows  merely  pus  cells  and  broken-down  lung  tissue.  The  great 
vessels  and  nerve  trunks  are  normal.  The  diaphragm  on  the  right  side  reaches 
to  the  fifth  interspace;  on  the  left  to  the  sixth.  Abdomen:  The  peritoneum  is 
smooth  and  shining.  The  great  omentum  is  retracted  to  the  left,  is  vei'y  thin, 
and  is  adherent  to  the  abdominal  wall  in  the  left  hypochondriac  region.  The 
spleen  weighs  GO  grams,  is  of  slate  color  externally,  wrinkles  easily,  and  is  nor- 
mal on  section.  The  left  kidney  weighs  1S5  grams,  and  is  smooth  externally. 
There  are  minute  subcapsular  hemorrhages.  The  fibrous  capsule  strips  easily, 
and  covers  several  minute  yellowish  nodules  projecting  from  the  cortex.  Sec- 
tion shows  diminished  resistance,  pale  yellowisli  color,  prominence  of  pyramids, 
and  distinct  cortical  markings.  The  right  kidney  weighs  180  grams ;  it  is 
firmly  bound  down  to  the  posterior  abdominal  wall :  its  external  surface  and 
Internal  structure  are  similar  to' those  of  the  left  kidney.  The  suprarenal  cap- 
sules weigh  27  grams,  are  much  enlarged,  and  on  section  appear  congested. 
The  urinary  bladder  contains  a  small  amount  of  turbid  urine,  and  its  mucous 
membrane  is  congested.  The  gastric  mucous  membrane  shows  areas  of  conges- 
tion. The  organs  of  generation,  rectum,  and  duodenum  are  normal.  The  gall 
bladder  is  distended  with  fluid  bile,  and  the  gall  ducts  ai-e  patent.  The  liver 
weighs  1,970  grams,  and  is  enlarged.  The  external  surface  is  smooth  and  mot- 
tled brownish  yellow.  Section  shows  diminished  resistance,  light  color,  and 
darkened  lobular  centers.  The  pancreas  weighs  95  grams,  and  is  slightly  hem- 
orrhagic on  section.  The  solar  plexus,  mesentery,  and  small  intestines  are  nor- 
mal. The  descending  colon  contains  hardened  fecal  matter.  The  great  vessels 
are  normal.     The  vermiform  appendix  is  normal. 

Anatomical  diagnosis. — Syphilis  (gumma)  of  left  tempero-sphenoidal  lobe 
of  cerebral  cortex,  with  abscess  formation,  destruction  of  bone,  and  involve- 
ment of  orbit,  nasopharynx,  and  anti'um  of  Highmore;  ossification  of  costal 
cartilages  of  first  ribs ;  pulmonary  syphilis  (gummata)  and  cedema ;  chronic 
bronchitis;  jieribronchial  adenopathy;  localized,  old  omental  and  peritoneal  ad- 
hesion ;  acute  pleuritis,  left  apex ;  gummata  of  kidneys ;  congestion  of  supra- 
renal capsules ;  congestion  of  liver  with  fatty  degeneration ;  congestion  of 
pancreas. 

C.  R. 

W.   G.   S. 
Cerehral  hemorrhage. 


H.  M. ;  age,  32 ;  nativity,  Illinois ;  admitted  to  the  United  States  Marine  Hos- 
pital, Chicago.  111.,  November  13,  1903;  died  November  25,  1903,  at  9.30  a.  m. 

History. — Patient  entered  hospital  with  a  severe  headache  and  a  history  of 
frequent  attacks  of  epistaxis.  He  was  also  suffering  from  acute  catarrhal 
bronchitis.  His  hearing  had  become  steadily  worse  and  the  left  ear  had  dis- 
chai-ged  freely  through  a  rupture  of  the  membrana  tympani.  The  bronchitis 
under  treatment  soon  disappeared,  but  epistaxis  was  frequent  and  alarming 
at  times,  and  lieadache  was  persistent. 

On  November  22,  patient  went  to  the  toilet  room  at  11.30  p.  m.  and  when 
returning  fell  to  the  floor.     He  was  assisted  to  his  feet  by  a  patient  and  made 


470  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

the  remark  that  he  felt  dizzy  and  that  he  was  losing  his  hearing.  When  seen 
by  the  medical  officer  he  was  lying  partly  prone  on  his  left  side.  His  skin  was 
wet  with  perspiration  and  almost  total  muscular  relaxation  was  present.  He 
made  some  effort  to  answer  questions,  but  soon  lapsed  into  total  unconscious- 
ness. The  head  was  directed  to  the  left  side.  Pupils  not  responsive  to  light; 
right  pupil  dilated :  the  left  c-ontracted.  At  this  time  there  was  no  muscular 
paralysis  in  the  limbs.  Breathing  was  stertorous  and  irregular,  almost  of  the 
Cheyne-Stokes  variety.  Convulsive  twitchings  of  the  muscles  of  the  left  hand 
were  noted.  Temperature  was  .38°  C,  and  the  pulse  of  high  tension,  quick 
and  hard,  indicating  arterio-sclerosis. 

yovemher  2.i. — Patient  paralyzed  in  upper  extremities  and  left  leg.  Patient 
given  nitroglycerin,  hyix)dermatically  (0.(X)1  gram)  every  three  hours. 

yovemljer2S. — Nitroglycerin  given  (O.CHJl  gi-am)  every  four  hours  hyjx)- 
dermatically.  Later  in  day  strychnine  sulphate  was  given  hypodermatic-ally 
every  four  hours,  alternating  with  the  nitroglycerin.  At  that  time  patient  had 
total  paralysis  of  lx)th  arms  and  legs  and  was  unconscious ;  oxygen  was  used 
during  the  day. 

yovemher  25. — Patient  grew  steadily  worse  in  spite  of  stimulation,  and  died 
at  9.30  a.  m.  without  regaining  consciousness. 

Necropsy  (12  houi-s  after  death). — The  body  was  that  of  a  fairly  developed, 
rather  emaciated,  young  white  male.  Rigor  mortis  was  fairly  well  marked. 
Post-mortem  lividity  not  marked.  The  subcutaneous  tissue  was  poorly  devel- 
oped, but  the  muscles  were  healthy  in  appearance  and  well  developed.  The  peri- 
cardium contained  about  20  c.  c.  of  a  clear,  straw-colored  fluid.  The  heart  was 
normal  in  size  and  color.  It  weighed  4.30  grams.  The  muscular  tissue  was 
normal.  All  its  cavities  contained  ante-mortem  clots.  The  aorta  was  smooth 
and  contained  no  calcareous  deposits.  The  coronary  arteries  were  sclerotic  and 
calcareous  deposits  were  found  on  the  pulmonary  valves ;  also  on  the  aortic 
valves,  which  were  partially  destroyed.  The  bicuspid  orifice  admitted  two  fin- 
gei-s.  The  lungs  were  deeply  congested,  especially  at  their  bases.  They  were 
crepitant  however.  The  right  lung  weighed  870  grams,  the  left  6.50  grams.  On 
section  both  lungs  showed  dark  red,  and  dripped  blood.  They  contained  no 
miliary  deposits.  The  liver  was  a  good  example  of  "  nutmeg  liver."  It  weighed 
2,160  grams.  Its  vessels  contained  calcareous  deposits.  The  spleen  was  en- 
larged, and  weighed  825  grams.  The  kidneys  were  normal.  The  right  weighed 
205  grams,  tlie  left  230  grams.  The  stomach  and  intestines  were  normal.  The 
appendix  vermiformis  was  4  inches  long  and  was  normal.  The  bladder  was 
nearly  empty.  The  ureters  were  normal  and  pervious  throughout  their  entire 
length.  The'  calvarium  was  removed  and  the  dura  exposed.  The  latter  was 
apparently  normal.  The  longitudinal  sinus  was  found  empty.  The  pia  mater 
was  deeply  congested  and  adherent  along  the  fissure  of  Sylvius.  An  opening 
was  found  in  the  right  hemisphere  near  the  base  of  the  Sylvian  fissure,  in  the 
ascending  parietal  lobe.  The  brain  substance  was  friable  and  soft  in  this  situa- 
tion. On  making  sections  through  the  lateral  ventricles  the  right  ventricle  was 
found  enlarged  and  contained  about  25  c.  c.  of  blood  clot  The  left  ventricle 
contained  only  a  small  amount  of  blood.  The  brain  substances  around  the 
region  of  the' ventricles  was  disintegrated,  being  very  soft  and  friable.  The 
cerebellum  and  medulla  were  apparently  normal. 

F.  A.  A. 
C.  E.  B. 

IL 

S.  M. ;  age.  31  vears :  nativity.  Austria ;  admitted  to  Marine  Hospital,  Port- 
land, Me..  March  2.5.  1902  :    died  October  12,  1903. 

History. — Patient  had  history  of  an  attack  of  unconsciousness  previous  to 
entering  this  hospital,  followed  by  hemiplegia  of  left  side,  also  loss  of  control 
over  sphincter  of  bladder:  mental  condition  good;  sensation  only  partially 
destroyed.  A  few  hours  before  death  he  began  to  have  attacks  of  convulsions 
every  five  to  ten  minutes,  attended  by  unconsciousness;  between  attacks  was 
cons'cious.     On  day  of  death  temperature  reached  40.1° ;    pulse,  160. 

Necropsy  (13  hours  after  death).— Body  well  nourished;  rigor  mortis  well 
marked ;  post-mortem  discoloration  on  neck  and  right  side  of  head ;  deformity 
of  right  hand  and  foot  from  paralysis  and  contracture.  Scalp  reflected  back  by 
Incision  across  top  of  head:  no  hemorrhage  under  scalp:  circular  incision 
through  muscles  of  skull :  skull  cap  rather  thin  :  dura  separated  easily  :  cere- 
bral vessels  much  degenerated,  hard,  and  tortuous.  Large  hemorrhage  in  right 
cerebrum ;    large  clot  and  extreme  dilatation  of  right  ventricle ;    clot  weighed 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  471 

32  prams.  Sixteon  smius  of  recent  lieniorrliaKe  in  left  ventricle;  dilatation 
much  less  than  on  rijiht  side;  small  hemorrhage  noted  in  pons  and  base  of  cere- 
bellum. Body  opened  by  long  incision  from  chin  to  symi)hysis  pubis,  and  in- 
cision niade  acro.ss  abdomen,  muscles  reflected  back,  and  chest  opened.  Glands 
of  neck  were  noted  to  be  enlarged.  Thoracic  cavity :  Diaphragm  attached  i)e- 
tweeu  eighth  or  ninth  rib;  normal  amount  of  fluid  in  pericardium;  left  ven- 
tricle hyi)ertrophied ;  mitral  valve  incompetent;  aortic  valve  pale  and  flabby, 
but  competent;  small  ante-mortem  clot  noted  in  right  ventricle;  weight  of 
heart,  480  grams.  Lungs  :  Left  lung  much  congested  ;  weight,  4~tO  grams  :  right 
lung  tt'dematous  ;  weight,  T.jO  grams.  Gall  bladder  distended  and  containing 
dark,  almost  black,  fluid;  ducts  patent.  Abdomen:  Liver  congested  and 
bleeds  easily  on  section;  substance  of  liver  firm;  weight,  1,320  grams;  spleen 
is  a  dark-blue  color,  substance  fairly  firm,  capsule  wrinkled  ;  weight,  240  grams; 
small  supernumerary  spleen  on  artery.  Pancreas :  Weight,  (XJ  grams :  sub- 
stauce  firm  and  normal.  Stomach  normal  in  size ;  mucous  membrane  con- 
gested;  stomach  contained  1  ounce  of  a  dark,  sticky  mucus;  pylorous  normal; 
cardiac  opening  normal ;  stomach  chronically  inflamed  and  contained  numerous 
hemorrhagic  spots.  Left  kidney  :  Normal  in  api)earance ;  weight.  135  grams ; 
capsule  separated  easily  ;  line  between  cortical  and  medullary  substance  well 
marked.  Right  kidney :  Weight.  90  grams :  congested  and  bleeds  easily  on  sec- 
tion. Ureters  normal.  Bladder  normal  and  contained  3  ounces  of  urine. 
Intestines:  Appendix  long,  and  contained  a  number  of  concretions.  Cause  of 
death  :  Hemorrhage  in  floor  of  fourth  ventricle,  resulting  in  paralysis  of  respira- 
tion. The  remarkable  thing  in  this  case  is,  though  the  man  was  only  31  years 
old,  his  arteries  were  like  reeds  or  quills ;  they  were  so  hard  as  to  break  when 
pressed  together,  and  were  full  of  small  dilatations. 

W.  P.  M. 
III. 

J.  N. ;  aged  65 :  nativity.  Nova  Scotia ;  admitted  to  the  United  States  Marine 
Ho.spital,  Boston,  >L\ss.,  on  December  13,  1899,  and  died  January  9,  1904. 

History  ;  Family  and  previous  history  negative. 

Present  history. — Patient  was  unable  to  talk,  and  it  was  impossible  to  secure 
any  subjective  symptoms.  The  lower  face,  arm,  and  leg  on  the  right  side  were 
paralyzed,  and  there  was  aphasia  and  rigidity  of  the  muscles  of  the  affected 
side.  Knee  jerk  increased  and  some  ankleclonus  present.  Hearing  seemed  to 
be  good.  Patient  had  the  appearance  of  having  been  at  one  time  a  powerful 
man  and  seemed  to  be  still  very  strong.  At  the  time  of  admission  was  unable 
to  walk  and  was  practically  helpless.  When  questioned  always  answered  by 
holding  up  the  fii"st  and  second  fingers  of  the  left  hand. 

Treatment. — Tonics,  such  as  iodide  of  potassium,  strychnine  sulphate,  and 
the  elixir  of  iron,  quinine,  and  strychnine,  and  an  occasional  cathartic. 

January  5,  190Jf. — Patient  became  unconscious  and  comatose  during  the  night; 
all  the  evidences  of  another  hemorrhage  were  present. 

January  9,  190 'f. — Patient  continued  unconscious,  and  died  at  4.10  a.  m. 

Necropsy'  (6  hours  after  death). — Body  was  that  of  a  well-nourished  man; 
rigor  mortis  well  marked ;  post-mortem  lividity.  slight ;  right  wrist  ankylosed ; 
right  hand,  "  main  en  griffe  ;"  usual  incision  made  in  the  median  line.  Thorax  : 
Pleura  was  nonadherent  and  the  pleural  cavity  contained  small  amount  of 
fluid.  Right  lung  was  normal ;  weight.  700  grams.  Left  lung  was  normal ; 
weight,  870  grams.  Pericardium  contained  50  c.  c.  of  straw-colored  fluid. 
Heart  was  normal :  weight,  550  grams.  Left  ventricle  contained  small  post- 
mortem clot ;  right  ventricle  contained  an  ante-mortem  clot.  Abdomen:  Abdom- 
inal fat  was  9  cm.  in  thicknes.s.  Liver  showed  chronic  passive  congestion ; 
weight,  1,250  grams.  Both  kidneys  were  normal ;  weight,  175  grams.  Stomach 
was  normal.  Large  and  small  intestines  were  normal  except  for  the  fact  that 
the  jejunum  presented  an  invagination,  probably  post-mortem.  Bladder  and 
pancreas  were  normal.  Spleen  was  normal ;  weight.  120  grams.  On  removal 
of  the  calvarium  much  serum  escaped.  Brain  weighed  1,2.50  grams.  The 
cerebrum  presented  on  the  left  side  a  degenerated  area  of  large  size.  It  was  of 
chocolate  color,  and  presented  the  remains  of  an  extensive  blood  clot.  The 
brain  tissue  beneath  it  was  soft  and  semifluid.  The  dura  was  greatly  thickened 
over  the  degenerated  area. 

R.  M.  W. 
W.  C.  R. 
J.  D.  F. 


472  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

DISEASES  OF  THE  HEART  AND  GREAT  VESSELS. 
Acute  endocarditis. 

C.  B. ;  white ;  age,  22 :  admitted  to  the  United  States  Marine  Hospital,  Staple- 
ton,  N.  T.,  September  16.  1903 ;  died  September  22.  190.3. 

History. — Personal  history  and  family  history  negative.  On  admission  the 
principal  symptoms  were  a  dull  pain  in  right  shoulder  joint,  a  feeling  of  general 
weakness,  and  a  temperature  of  38°  C. 

Physical  examination  revealed  slight  swelling  of  right  shoulder  joint  and 
a  systolic  mui-mur  at  apex  of  heart.  Upon  inquiry  it  was  learned  the  patient 
had  previously  had  two  attacks  of  rheumatism.  I^he  usual  remedies  for  rheu- 
matic fever  were  given,  and  a  slight  improvement  noted  on  second  and  third 
days.  Pulse  ranged  from  97  to  118  and  temperature  from  38°  to  39°  C.  Patient 
became  delirious  on  morning  of  September  20  and  grew  gradually  worse  until 
noon  on  the  22d.  At  this  time  oxygen  inhalations  and  venesection  were 
resorted  to  in  order  to  relieve  the  embarrassment  of  the  heart,  but  without 
result. 

Necropsy  (24  hours  after  death). — Body  fairly  well  nourished;  rigor  mortis 
and  post-mortem  lividity  marked ;  small  amount  of  subcutaneous  fat.  On 
opening  the  thoracic  cavity,  the  pleural  surfaces  were  found  adherent  over 
anterior  and  posterior  aspect  of  both  lungs,  and  at  their  bases.  Each  pleural 
cavity  contained  about  4.50  c.  c.  of  serous  fluid.  The  pleural  surfaces  presented 
areas  covered  with  organized  lymph.  The  lobes  of  the  lungs  were  adherent,  and 
the  surface  of  each  presented  nodular  appearances  which  were  found  on  incision 
to  be  filled  with  a  brownish  pus.  Microscopic  examination  of  the  pus  revealed 
the  usual  pus  organisms,  tubercule  being  absent.  Tissues  of  both  lungs 
crepitated,  save  at  above-named  areas,  and  both  floated.  Right  lung  weighed 
770  grams ;  left,  735  grams.  Bronchi  were  filled  with  a  frothy  mucus.  The 
dependent  portions  were  congested.  Pericardial  sac  contained  35  c.  c.  of  serous 
fluid  ;  heart  weighed  285  grams,  contained  no  clots.  The  valves  were  very  much 
congested,  and  vegetations  were  found  on  mitral  and  aortic  segments.  Perito- 
neum showed  no  adhesions ;  omentum  congested,  and  lymph  nodes  of.  mesentery 
enlarged ;  intestines  distended  with  gas.  congested  in  lower  portion  of  jejunum 
and  ileum,  and  presented  areas  of  hemorrhagic  extravasation.  Liver  was 
enlarged  and  weighed  2.250  grams;  gall  bladder  was  distended.  Spleen  was 
adherent  and  weighed  280  grams.  Kidneys  were  apparently  normal,  capsules 
stripped  easily.  Right  weighed  210  grams;  left,  200  grams.  Incision  into 
affected  shoulder  joint  revealed  nothing  of  interest. 

H.  McG.  R. 
P.  H.  B. 

Acute  pericarditis. 

A.  B. ;  color,  brown ;  age,  41  years ;  nativity,  Guam ;  admitted  to  the  United 
States  Marine  Hospital,  San  Francisco,  Cal.,  December  7,  1903;  died  December 
9,  1903. 

History. — Three  days  ago  sickness  began  with  a  cold  and  severe  pain  in  the 
lower  part  of  thorax  and  abdomen.  He  was  short  of  breath ;  had  a  bad  cough 
and  vomited  frequently ;   vomited  matter  contained  blood. 

Examination. — Rough  sounds  heard  over  entire  left  lung  and  base  of  right 
lung ;  dullness  over  whole  of  left  lung  anteriorly  and  posteriorly  and  over  base 
of  right  lung;  area  of  cardiac  dullness  enlarged  and  rough  grating  sounds 
heard  over  heart;  pulse,  120;  respiration,  25;  temperature,  38°  C.  The  tem- 
perature did  not  rise  above  38.2°  and  the  pulse  fell  to  88  and  was  soft  and 
compressible.  He  suffered  greatly  from  dyspncea  and  his  face  was  much 
cyanosed.     He  died  from  exhaustion  9  a.  m.,  December  9,  1903. 

Necropsy  (6  hours  after  death). — Body  large  and  heavy;  very  fat;  length. 
153  cm.  Brain :  Weight,  1,170  grams.,  tissue  apparently  normal.  Abdomen 
swollen,  walls  7  cm.  thick,  organs  covered  with  fat  and  great  lumps  of  fat  in 
omentum;  costal  cartilages  ossified;  mediastinum  contains  much  fat  and  fat 
also  covers  the  pericardium ;  pericardium  attached  to  right  pleura,  on  opening 
its  sac  a  large  amount  of  greenish  fluid  escapes ;  the  sac  is  lined  with  a  thick 
soft  fibrous  exudate.  Heart:  Weight.  010  grams;  valves  normal  except 
mitral,  whose  edges  are  roughened ;  right  side  contains  a  black  clot ;  thickness 
of  wall  of  right  ventricle,  1  cm. ;  of  left  ventricle,  2  cm.  Left  lung :  Weight, 
490  grams;   tissue  crepitant;   color  on  section,  grayish  red;   blood  and  serum 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  473 

oozes  from  its  sui-faco.  Right  lung :  Weight.  ooO  grams ;  the  adherent  pleura 
is  covered  with  a  fibrous  layer,  tissue  is  leathery  to  the  touch,  only  slightly 
irepitant :  color  on  sci-tion.  dark  red  ;  dark  i)lood  oozes  from  its  surface.  Sijleen  : 
Very  small,  apparently  normal.  Left  kidney  weighs  222  grams,  capsule  non- 
adherent, pelvis  filled  with  fat.  cortical  portion  shows  indistinct  yellowish 
striations.  pyramids  prominent.  Right  kidney  weighs  210  grams;  tissue  same 
as  left.  Bladder  empty,  urethra  normal,  stomach  contains  undigested  food,  its 
mucous  membrane  is  covered  with  grayish-brown  mucus;  small  and  large  intes- 
tines normal.  tJall  bladder  filled  with  bile,  ducts  patent.  Liver  weighs  2,820 
grams,  tissue  cuts  with  increasetl  resistance,  center  of  lobules  of  a  dark  color. 

W.  G.  S. 
Aneurism  of  the  aorta. 

J.  M. ;  age,  40 ;  nativity.  Portugal ;  was  admitted  to  the  Unite<l  States  Marine 
Hospital,  Boston,  Mass..  August  7,  1003,  and  died  November  2,  190.3. 

History. — Family  and  previous  history  negative;  was  admitted  to  the  hos- 
pital July  2,  19o3,  .suffering  from  a  cough  of  eight  months'  duration  and  ex- 
pectorating considerable  coal-streaked  sputum.  The  coughing  was  accompanied 
by  some  pain,  but  there  was  no  obtainable  history  of  night  sweats  nor  could 
tubercle  bacilli  be  demonstrated  in  the  sputum.  At  the  time  of  entrance  there 
were  no  marked  physical  findings  except  that  the  left  arm  and  forearm  were 
pulseless.  Later  he  complained  of  pain  in  the  arm  and  thought  he  could  hear 
a  rough  sound  synchronous  with  the  boat  of  his  heart.  Examination  was  made 
from  time  to  time  to  determine  the  presence  of  an  aneurism.  On  July  29,  1903, 
a  slight  tracheal  tug  was  detected  and  a  hitherto  undiscovered  presystolic 
murmur.  By  August  5.  1903,  this  murmur  had  greatly  increased  and  a  systolic 
bruit  was  noted  There  was  a  heaving  sensation  over  the  precordial  area,  and 
as  the  cough  and  expectoration  had  much  diminished  he  was  discharged  to  be 
readmittetl  under  the  diagnosis  of  aneurism. 

Physical  examination. — Well  nourished  ;  somewhat  pale  and  anxious  facies ; 
no  discoveral)le  pulmonary  lesion.  There  was  a  slight  swelling  over  the  manu- 
brium, and  the  superficial  veins  were  dilated.  The  apex  beat  was  displaced 
downward  and  to  the  right.  In  spite  of  all  medical  treatment,  the  swelling 
over  the  manubrium  gi'adually  increased  in  size  until  it  reached  the  size  of  a 
small  orange,  when  the  patient  died  at  6.1.5  a  .m.,  November  3,  1903. 

Necbopsy'  (4  hours  after  death). — Legs  and  feet  greatly  swollen  and  oedem- 
atous ;  rigor  mortis  moderate ;  tumor,  the  size  of  a  cocoanut.  at  the  upper 
part  of  left  chest  between  midsternal  and  anterior  axillary  line.  The  usual 
medium  incision  made,  a  little  to  the  right  of  median  line  in  chest.  No  ab- 
normal fluid  in  the  abdominal  cavitj'.  Small  intestines  removed  first,  followed 
by  large  intestines,  liver,  spleen,  kidney,  stomach,  and  pancreas ;  sternum  and 
costal  cartilage  removed  with  difliculty.  Thoracic  cavity  :  Right  pleural  cavity 
contained  150  c.  c.  of  clear  serum  :  no  particular  adhesions  of  right  lung  to 
pleura  ;  left  pleural  cavity  contained  about  2.50  c.  c.  of  blood-stained  serum, 
whether  stained  ante-mortem  or  post-mortem  could  not  be  determined.  Left 
lung  compressed  into  small  compass  at  lower  i)art  of  pleural  cavity.  Right 
lung  somewhat  congested  but  normal,  weight  7C)0  grams.  Left  lung  very  small 
and  carnified.  weight  285  grams.  In  wall  of  aueurismal  sac  were  found  the 
end  of  left  clavicle,  manubrium  of  sternum,  and  a  portion  of  the  fii-st.  second, 
and  third  ribs  on  left  side,  all  considerably  eroded.  Heart,  aorta,  and  aneu- 
rism with  contents  weighed  2..34ri  grams.  Liver  very  large  and  showed  chronic 
passive  congestion,  typical  "  nutmeg  "  liver,  weight  1.7-40  grams.  Right  kidney 
shows  congestion,  weight  2.50  gi-ams.  Left  kidney  also  shows  congestion, 
weight  255  grams.  Spleen  slightly  enlarged  and  shows  chronic  passive  conges- 
tion, weight  270  grams.  Pancreas  normal,  weight  130  grams.  Brain  normal, 
weight  900  grams. 

J.  D.  F. 
W.  C.  R. 
E.  M.  W. 
Rupture  of  the  heart. 

J.  P. ;  age,  .38 ;  nativitv,  Maine ;  admitted  to  the  United  States  Marine  Hospi- 
tal, Portland,  Me..  December  28,  1903 ;  died  March  25.  i;X>4. 

History. — Patient,  when  admitted,  complained  of  asthma,  with  fluttering  of 
heart,  shortness  of  breath,  vertigo ;  at  times  would  fall  during  attacks ;  patient 
able  to  pass  his  water ;  bowels  open ;  appetite  good.  Examination  showed  a 
diastolic  murmur  at  base  of  heart ;  carotid  pulsation  very  distinct ;  slight 
amount  of  albumin  iu  urine.     Patient  was  put  upon  treatment  of  caffeine  and 


474  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE, 

coiuplete  rest.  Following  this,  sparteine,  digitalis,  and  strychnine  wei'e  tried, 
extending  over  a  period  of  two  weeks :  on  two  or  three  occasions  the  patient  had 
attacks  of  dyspnoea,  with  cyanosis,  and  suffered  extreme  anguish,  the  symptoms 
being  those  of  angina  pectoris.  Salicylate  of  theobromine  (diuretine)  gave  more 
relief  than  anything  else;  morphine  hypodermatically  was  also  of  great  value. 
Death  occurred  very  suddenly  during  one  of  these  attacks.  Previous  to  death 
patient  had  dyspnoea  and  pain,  with  severe  cough.  He  was  unable  to  pass  his 
water.  OEdema  of  lower  extremities  marked,  abdomen  distended ;  died  March 
25,  1904. 

Necropsy  (15  hours  after  death). — Body  that  of  a  strongly  developed,  muscu- 
lar, white  male  adult ;  rigor  mortis  well  marked ;  considerable  oedema  of  feet 
and  legs;  scrotum  and  penis  cedematous  and  contained  extravasated  blood; 
slight  discharge  of  blood  from  penis;  superficial  veins  enlarged;  post-mortem 
ecchymosis  in  dependent  portions  of  body  and  upper  part  of  chest;  first  and  sec- 
ond toe  of  both  feet  webbed.  On  anterior  aspect  of  right  arm  a  design  of  a 
horseshoe  and  a  band  of  stars  at  wrist,  worked  in  red  and  black  ;  on  upper  arm 
that  of  Godde.ss  of  Liberty  and  a  shield;  on  inner  aspect  of  left  arm  was  that  of 
a  musician,  and  at  wrist  a  cloAer  leaf  and  a  5-pointed  star.  Bloody  froth  issuing 
from  mouth;  pupils  moderately  dilated  and  irregular.  Body  opened  by  a  long 
incision  from  chin  to  symphsis  pubis;  muscles  flabby;  considerable  serous  fluid 
escaped  on  opening  the  abdomen.  Chest  contained  a  bloody  serous  fluid  ;  tissues 
of  neck  infiltrated  with  clotted  blood;  trachea  and  bronchi  filled  with  blood; 
thoracic  cavity  contained  about  1.000  c.  c.  of  fiuid.  Lungs  extremely  oedema- 
tons  ;  pleuritic  adhesion  on  left  side  caused  teaiing  of  the  lung  on  removal. 
Weight  of  right  lung.  1.105  grams;  lower  lobe  very  oedematous.  Left  lung, 
weight  770  grams,  oedematous.  and  had  small  area  of  consolidation ;  section  sank 
in  water.  Blood  vessels:  Coronary  arteries  degenerated  but  patulous;  aorta 
dilated  and  degenerated,  containing  numerous  calcareous  plates.  The  vessels, 
heart,  and  pericardium  were  stained  a  deep  pink.  Pericardium  filled  with  dark 
clotted  blood.  Heart  very  large  (so-called  "bovine  heart"),  extremely  hyper- 
trophied  and  dilated ;  weight,  1.000  grams.  Left  ventricle  extremely  hyper- 
trophied  and  dilated.  Right  ventricle  dilated  ;  capacity,  150  c.  c.  of  fluid.  Rup- 
ture in  anterior  wall  of  right  ventricle  about  5  cm.  in  length;  wall  of  ventricle 
extremely  thin.  Aortic,  mitral,  and  tricuspid  valves  incompetent,  admitting 
the  passage  of  three  fingers  through  the  valves.  Small  round  opening  noted  in 
pulmonary  aorta,  about  one-eighth  inch  in  diameter;  appeared  as  if  a  plate  of 
degeneration  had  dropped  out.  There  was  no  way  to  account  for  this  small 
I'onnd  ojiening  in  vessel  wall  except  as  above;  no  one  present  had  observed  any- 
thing of  this  kind  before.  Abdominal  cavity:  Spleen  hypertrophied.  of  a  brown 
color,  and  easily  torn;  pulp  soft;  weight,  450  grams.  Liver  i*ather  small;  of 
chocolate  color;  tissue  soft  and  pulpy;  bleeds  on  section;  weight,  1,560  grams. 
Gall  bladder  distended  and  filled  with  dark  grumous  bile.  Stomach  :  Walls  very 
thin  and  part  of  mucus  membrane  found  to  be  digested;  stomach  contained 
about  .300  c.  c.  of  liquid.  Kidneys  very  large  and  pale  in  color;  large  white  kid- 
ney of  Bright.  Right  kidney  loose  and  movable  over  a  space  of  8  inches;  cap- 
sule peeled  with  difficulty  and  tears  easily;  weight,  270  grams;  left,  in  same 
condition  ;  weight,  .'>oO  grams.  Line  between  the  cortical  and  medullary  sub- 
stance of  both  kidneys  well  marked.  Bladder  contained  about  60  c.  c.  of  fluid. 
Small  intestines  contracted  and  empty.  Brain  and  cord  not  examined.  Points 
of  interest:  infiltration  of  connective  tissue  of  neck  with  blood,  blood  in  thoracic 
cavity,  bronchi,  and  trachea ;  the  heart,  twice  the  normal  size,  was  practically 
an  aneurisnial  sac,  its  walls  very  thin,  with  rupture  of  right  ventricle;  the 
movability  of  both  kidneys,  either  of  which  or  both  could  have  become  floating 
kidneys.  Anatomical  diagnosis:  Valvular  disease  of  heart,  with  hypertrophy, 
dilatation,  and  rupture.     Immediate  cause  of  death,  rupture  of  heart. 

B.  McV.  M. 

W.  P.  M. 
Valvular  disease  of  heart — aortic. 


G.  H. ;  colored;  male;  age.  47;  was  admitted  to  the  United  States  Marine 
Hospital.  Cincinnati.  Ohio,  October  15  and  died  October  16.  1903. 

History. — Complained  of  a  dull  continuous  pain  in  thorax  and  abdomen,  with 
cough,  dyspnoea,  and  a  copious  expectoration  of  viscid  mucopurulent  sputum, 
general  malaise,  and  loss  of  appetite.    Has  had  syphilis. 

Present  condition. — His  temperature  was  37.1°  C. ;  pulse.  82;  feels  weak; 
has  dull,  but  severe  pains  in  abdomen  and  thorax,  with  shortness  of  breath. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  475 

Tongue  coated  witli  heavy  ln-owii  lur,  and  is  deeply  fissured.  Facial  expression 
is  apathetic  and  listless.  Kesi)iratory  movements  ra|)id,  and  a  sense  of  mucous 
rattling  is  conveyed  to  hand.  Percussion  is  negative.  Auscultation:  Moist 
crei)itant  rales  heard  all  over  chest.  Heart  dullness  is  increased  to  left  to  mid- 
clavicular line  and  downward  to  sixth  rih.  Heart  sounds  at  apex  are  distant 
and  feehle;  no  apex  impulse  can  he  felt;  at  aortic  cartilage  a  douhle  murmur 
is  heard  and  is  transmitted  to  vessels  of  neck  and  down  along  the  sternum. 
Ahdomen  distended  and  could  not  be  palpated  on  account  of  tenderness. 
Urinalysis:  Color,  dark  red  ;  reaction,  acid  ;  specific  gravity,  1.0.30  ;  no  albumen 
or  sugar  present.  Was  given  a  saturated  solution  magnesia  sulphate,  30  c.  c. ; 
at  1  p.  m.  an  enema,  after  which  his  bowels  moved  freely.  Patient  died  the 
following  day  at  o.oO  a.  m. ;   death  occurred  suddeidy. 

Necropsy  {'»  hours  after  death). — Body  that  of  a  well-developed  colored  man; 
rigor  mortis  well  marked;  pupils  dilated;  has  a  right  scrotal  hernia  and  areas 
of  copper-colored  discoloration  over  skin  of  both  tibia  (syphilitic).  Calvarium, 
brain,  and  meninges  normal;  no  excess  of  fluid;  ventricles  empty  and  normal; 
slight  congestion  of  cerebral  vessels.  Pleura  normal  in  appearance;  no  adhe- 
sions present  nor  excess  of  fluid.  Left  lung  normal,  crepitates  throughout ;  on 
.section  a  mucous  exudate  is  noted  ;  weight,  4.j0  grams.  Right  lung  normal ; 
weight,  405  grams.  Pericardium  contains  no  excess  of  fluid.  Heart  is  markedly 
enlarged;  ventricles  and  auricles  contain  chicken-fat  clots;  aorta  is  markedly 
atheromatous;  the  aortic  leaflets  are  thickened  and  contracted;  mitral  orifice 
admits  tips  of  two  fingers,  and  valves  are  somewhat  thickened.  Left  ventricle 
is  enlarged,  and  its  walls  are  markedly  hypertrophied,  and  the  muscular  tissue 
shows  fatty  degeneration.  Other  valves  normal.  Weight  of  heart,  015  grams. 
Abdomen:  Peritoneum  presents  nothing  abnormal.  The  liver  is  markedly 
cirrhotic  and  presents  a  distinct  hobnailed  appearance  and  cuts  with  consistency 
of  leather ;  weight,  2,400  grams.  Spleen  somewhat  enlarged  and  is  seat  of 
cloudy  swelling;  weight,  400  gnims.  Pancreas  normal.  The  kidneys  normal; 
capsules  strip  readily;  right  kidney  weighs  200  grams;  left  kidney  weighs  215 
grams.  Stomach,  normal.  Lower  part  of  ileum  is  the  seat  of  a  plastic  inflam- 
matory condition.  The  end  of  the  appendix  is  also  somewhat  inflamed.  Some 
plastic  lymph  and  serum  ai'e  present  in  abdominal  cavity.  No  enlargement  of 
mesenteric  glands. 

J.  H.  G. 
J.  W.  S. 
II. 

A.  K. ;  age,  47 ;  nativity,  England  ;  was  admitted  to  the  United  States  Marine 
Hospital,  Cleveland,  Ohio,  October  10,  1904  ;  died  May  1.  1904. 

History. — Patient  complained  of  cough,  with  little  or  no  expectoration. 
Physical  examination  showed  some  oedema  of  lower  extremities,  veins  of  neck 
distended  and  pulsating,  apex  beat  very  forcible  and  visible  over  a  large  area; 
ends  of  fingers  slightly  clubbed,  but  no  cyanosis  present;  pulse  of  high  tension, 
but  not  a  true  Corrigan  pulse;  over  aortic  area  two  murmurs  were  heard,  the 
systolic  being  louder  than  the  diastolic. 

Necropsy  (14  hours  after  death). — Body  well  nourished,  medium  sized,  white, 
male;  rigor  mortis  medium;  post-mortem  lividity  of  dependent  parts;  con- 
siderable oedema  of  feet  and  ankles;  small  amount  of  subcutaneous  fat. 
Thorax  :  Slight  pleural  adhesions  of  left  side.  Pericardial  sac  contained  about 
400  c.  c.  of  straw-colored  fluid,  containing  no  flakes.  Heart  somewhat  enlarged; 
weight,  610  grams ;  muscular  tissue  of  right  side  of  heart  pale  and  fatty, 
left  side  hypertrophied  and  showed  little  or  no  fat,  valves  of  right  heart  nor- 
mal;  aortic  valves  incompetent  and  covered  with  abundant  vegetations; 
chordea  tendinea  normal,  no  arteritis  present.  Lungs  much  congested,  small 
amount  of  oedema  ;  weight  of  right  lung,  7(X)  grams  ;  left,  490  grams.  Abdomen  : 
Considerable  free  fluid  in  peritoneal  cavity.  Omentum  and  peritoneum  normal. 
Liver  weighed  1,090  grams,  is  congested,  ard  with  fat  infiltrated.  Gall  bladder 
was  normal  and  contained  about  50  c.  c.  dark  bile.  Both  kidneys  congested; 
cortex  and  medulla  well  defined ;  cap.sules  stripped  easily ;  right  weighs  230 
grams;  left  weighs  240  grams.  Spleen  hypertrophied  and  congested,  with  con- 
siderable oedema  ;  weight,  460  grams.  Stomach  normal,  but  filled  with  straw- 
colored  fluid.  Intestines  distended  with  gas.  Bladder  full  of  urine.  Pancreas 
normal ;  weight,  80  grams.     Brain  and  spinal  cord  not  examined. 

Anatomical  diagnosis. — Valvular  disease  of  heart,  aortic;  chronic  conges- 
tion of  kidneys  ;  fatty  degeneration  of  liver  ;  congestion  of  lungs. 

H  S.  M. 


476  PUBLIC    HEALTH    AND   MAEINE-HOSPITAL    SEEVICE. 

III. 

C.  L. ;  white ;  age,  55 ;  nativity,  NoA-a  Scotia  ;  was  admitted  to  the  United 
States  Marine  Hospital,  Boston,  Mass.,  May  19,  1904;  died  INIay  21,  1904,  at 
3.30  a.  m. 

History. — Family  history,  negative. 

Previocs  history. — Severe  rheumatism  seA  eral  years  ago ;  syphilis  fifteen 
years  ago ;  was  treated  in  this  hospital  from  February  20  to  March  7,  1904, 
for  valvular  disease  of  heart  (aortic  regurgitation  and  stenosis)  complicated 
by  pneumonia.  The  patient  was  discharged  recovered  of  his  pneumonia,  and 
heart  lesion  improved.  He  returned  ]March  19,  1904,  with  considerable  aggra- 
vation of  his  cardiac  trouble,  the  heart  being  greatly  dilated.  He  was  treated 
until  May  18,  1904,  when,  as  theurfpuiic  symptoms  began  to  mask  all  the  others, 
he  was  discharged  for  readmission  under  the  diagnosis  of  Bright's  disease, 
granular  kidney.     He  failed  rapidly  and  died  May  21,  1904,  at  3.30  a.  m. 

Physical  examination. — Patient  is  a  fairly  well  developed  man.  Tissues 
about  face  somewhat  o?dematous ;  vessels  on  forehead  stand  out  well  and  are 
sclerosed ;  pupils  respond  only  slightly  to  light  and  accommodation ;  cornea 
shows  well-marked  arcus  senilis ;  tongue  coated  with  whitish  fur :  pulsation  of 
jugular  vein  on  right  side ;  carotid  pulsation  well  marked.  Lungs :  On  inspec- 
tion the  expansion  appears  fair  and  equal  on  both  sides.  Palpation :  Vocal 
fremitus  is  equal  on  both  sides.  Percussion :  Slight  dullness  in  right  apex. 
Auscultation :  Slight  crepitation  on  right  side,  extending  up  to  sixth  interspace. 
A  few  sonorous  rales  in  right  apex.  Heart :  Apex  beat  seen  in  the  seventh 
interspace  about  7  cm.  to  left  of  mammaiy  line.  On  palpation  slight  fremitus 
over  precordial  region  and  point  of  maximum  cardiac  intensity  corresponds  to 
apex  bent.  Percussion  reveals  a  much  enlarged  heart,  extending  from  2i  cm. 
each  side  of  lower  third  of  manubrium  downward  and  outxAard  to  apex  beat,  the 
lower  border  going  below  xiphoid  appendix.  Auscultation  reveals  both  aortic 
systolic  and  diastolic  murmurs  and  also  mitral  systolic  murmur.  Liver :  ^luch 
enlarged ;  lower  border  extends  3  cm.  below  lower  border  of  ribs.  Spleen  not 
palpable,  and  the  rest  of  abdomen  normal.  Genital  organs  normal.  Extremities 
very  (edematous. 

Necropsy  (6  hours  after  death). — Body  well  nourished;  rigor  mortis  well 
marked ;  suggillation  profuse  over  posterior  surface  of  body.  On  opening  the 
abdomen  the  omentum  is  found  adherent  to  the  peritoneum ;  the  peritoneal 
cavity  contains  950  c.  c.  of  clear,  straw-colored  fluid.  In  opening  the  chest 
the  upper  two  and  lower  two  costal  cartilages  are  found  ossified.  The  right 
pleural  cavity  contains  2,600  c.  c.  of  clear,  straw-colored  serum,  which  has 
greatly  compressed  the  right  lung.  The  pleura  is  very  adherent  to  the  apex 
and  posterior  surface  of  the  right  lung.  The  right  lung  weighs  1,040  grams 
and  shows  hypostatic  pneumonia  in  upper  lobes.  The  lower  lobe  is  oedematous ; 
cut  section  sinks  in  water.  The  left  pleural  cavity  contains  normal  amount  of 
straw-colored  fluid;  the  pleura  is  slightly  adherent  to  the  apex  of  the  lung. 
The  left  lung  weighs  1,045  grams  and  is  oedematous.  Pericardium  contains  25 
e.  c.  of  clear,  straw-colored  fluid.  Heart  is  greatly  enlarged  and  weighs  880 
grams ;  both  ventricles  filled  with  post-mortem  clot.  There  is  ante-mortem  clot 
in  right  auricle ;  the  aortic  valve  is  very  largely  destroyed,  and  what  remains 
is  filled  with  calcareous  deposit,  making  the  edges  very  jagged  and  irregular. 
The  aortic  orifice  is  considerably  constricted  and  greatly  stiffened  by  the  calca- 
reous deposits  in  the  valve.  The  mitral  orifice  is  dilated ;  the  mitral  valves 
are  normal.  The  tricuspid  orifice  and  valve  is  normal.  The  liver  weighs  2,430 
grams  and  shows  chronic  passive  congestion  (nutmeg  liver).  The  gall  bladder 
is  15  cm.  in  length  and  contains  bile.  It  extends  4  cm.  beyond  lower  border 
of  liver.  Spleen  weighs  180  grams  and  is  cirrhotic.  Left  kidney  weighs  450 
grams ;  it  presents  late  stages  of  large  white  kidney.  The  capsule  is  thickened, 
but  not  adherent.  Right  kidney  weighs  4.30  grams  and  jiresents  the  same  condi- 
tion as  the  left.  The  bladder  contains  25  c.  c.  of  mine  and  is  normal.  Pancreas 
weighs  135  grams  and  is  normal.  Oesophagus,  stomach,  and  intestines  normal, 
with  the  exception  that  the  vermiform  appendix  is  G  cm.  in  length,  tapering  to 
a  fine  point.  About  its  middle  it  is  bent  at  a  right  angle  by  a  cicatricial  band. 
The  sigmoid  fiexure  is  displaced,  and  instead  of  being  in  the  left  flank  is  in  the 
median  line,  with  convexitj'  toward  umbilicus,  and  fully  distended  with  gas. 
Brain  weighs  1,435  gi'ams  and  is  somewhat  softened.  The  velum  interpositum 
is  adherent. 

R.  M.  W. 
W.  C.  R. 
W.    E.    K. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  477 

Aortic  and  tnitral. 
I. 

J.  T. ;  male;  colored;  age,  3S ;  nativity,  Tennessee ;  admitted  to  the  United 
States  Marine  Hospital,  Cairo.  111.,  October  1."..  1!M»;5;   died  October  14.  190;i 

History. — About  eight  years  ago.  while  suffering  from  an  acute  fever,  his 
attention  was  first  called  to  "  heart  trouble."  Since  that  time  he  has  been  able 
to  follow  his  vocation — firing  steamer — the  major  portion  of  the  time,  being, 
howevei",  disabled  at  intermittent  periods  by  attacks  of  dyspnoea,  pains  of 
minor  severity  in  small  of  back,  palpitation  of  heart,  with  ascites  and  anasarca. 

His  condition  on  admittance  was  that  of  general  functional  inactivity  and 
physical  exhaustion.  He  said  bowels  had  been  moving  very  frequently  during 
preceding  week :  had  obtainetl  very  little  sleep  for  several  days,  and  had 
received  scant  attention ;  was  immediately  put  to  bed ;  bowels  moved  involun- 
tarily :  abdomen  was  distended,  and  he  had  dyspno?a  to  the  extent  that  he  was 
unable  to  assume  recumbent  posture :  extremities  were  cold  and  bloodless ; 
intellect  dull :  pulse  very  rapid,  thready,  and  intermittent ;  respiration  shallow 
and  labored. 

There  was  marked  ascites,  a  large  thorax,  giving  signs  of  considerable  fluid 
within  this  cavity  :  greatly  increased  lateral  heart  dullness :  aortic  and  mitral 
murmurs  and  a  rubbing  apex  sound  simultaneous  with  systole. 

Gave  morphinie  sulphatis,  0.01  gm..  at  once,  aud  following  ordered :  Rx. 
nitroglycerina^,  0.003 :  ext.  digital,  fl..  0.500 ;  tr.  strophanth..  1.500 ;  ferri 
reduct.  0.500.  M.  et  ft.  tabs.  No.  8.  Sig. :  One  eveiy  three  hours.  Patient  did 
not  respond,  and  at  1  a.  m.  on  14th  nurse  found  him  dead. 

Necropsy  (12  hours  after  death). — Body  that  of  a  well-developed,  muscular 
man ;  rigor  mortis  slight,  more  pronounced  in  lower  extremities ;  abdomen  dis- 
tended with  fluid  :  penis  swollen  and  congenitally  phimosed ;  genitalia  other- 
wise normal.  The  face  was  emaciated  :  eyes  partially  closed  and  pupils  dilated. 
On  incision  scant  subcutaneous  adipose  tissue  of  thorax  and  abdomen ;  abdom- 
inal muscles  ill-developed  as  compared  with  other  muscles  of  body.  The  left 
pleural  cavity  contained  600  c.  c.  the  right  400  c.  c.  of  fluid  of  thin  consistency. 
Pericardium  contained  300  c.  c.  of  fluid.  Heart  weighed  653.2  grams,  occupied 
a  great  portion  of  left  chest  cavity ;  cardiac  vessels  engorged ;  fat  deposits 
covered  entire  external  cardiac  surface.  The  walls  of  the  left  ventricle  were 
4  cm.  thick,  containing  ante-mortem  clot ;  walls  of  right  ventricle  1.5  cm.  thick ; 
both  auricles  dilated.  All  valves  were  functionally  inadequate,  owing  to  edges 
of  flaps  being  indurated  and  not  permitting  perfect  closure — this  especially 
true  of  aortic  and  mitral  valves.  Left  lung  displaced  by  heart  to  posterior  part 
of  cavity  ;  weight.  397.6  grams ;  tissue  contained  some  small  caseous  masses ; 
right  lung  presented  numerous  hnemorrhagic  ai-eas  and  tubercular  nodules ; 
weight,  707  grams.  Gall  bladder  distended  and  containing  40  c.  c.  bile,  of  thick 
consistency.  Weight  of  liver.  1.193  grams :  tissue  normal.  Spleen  showed 
chronic  enlargement ;  weight,  441  grams.  Left  kidney  weighed  398  grams ; 
easily  divested  of  capsule,  and  was  histologically  normal,  except  parenchymatous 
enlargements.  After  some  difliculty  the  right  kidney  was  located,  not  lateral  to 
spine,  but  lying  close  to  body  of  vertebrte,  small  (weight  28  grams),  and  evi- 
dently functionless.  Blood  vessels  of  omentum  engorged ;  intestines  and  stom- 
ach were  in  healthy  condition.     Bladder  normal,  and  contained  50  e.  c.  urine. 

T.  H.  D.  G. 
II. 

W.  M. :  age.  20 :  nativity.  England :  admitted  to  marine  ward  of  the  St. 
Francis  Xavier's  Infirmary,  Charleston.  S.  C.  January  26,  1904;  died  February 
10.  1904. 

History. — Had  never  been  seriously  sick  before,  and  had  been  following  his 
usual  avocation  as  ordinaiT  seaman  up  to  a  few  houi^s  before  admission  to  hos- 
pital ;  had  been  suffering  from  shortness  of  breath  on  exertion,  with  weakness 
and  slight  cough,  for  ])ast  t«o  mouths,  and  had  noticed  his  feet  swelling  for  a 
day  or  tRO ;  poor  appetite,  nausea,  and  sleeplessness. 

Physical  examination  showed  enlarged  heart  with  diseased  aortic  and  mitral 
valves ;  face  and  feet  somewhat  swollen ;  gi*eat  antemia.  engorgement  of  lower 
lobes  of  both  lungs,  most  marked  behind,  with  moist  r.ales  over  other  r>ortions 
of  chest.  A  mild  degree  of  dyspnoea ;  paiu  near  left  nipple ;  nausea ;  tempera- 
ture 36.6°,  pulse  102. 


478  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Treatment. — Absolute  rest  in  bed  with  milk  diet;  nitroglycerin  with  strych- 
nine for  cardiac  condition ;  heroin  with  terpin  hydrate  p.  r.  n.  for  cough.  After 
a  few  days  a  light  diet  was  ordered,  but,  owing  to  the  almost  ince.ssant  nausea, 
was  .stopped  and  milk  with  "  Panopepton  "  substituted,  the  milk  being  diluted 
with  Apolinaris  or  lime  water  or  partially  peptonized.  After  a  short  period 
of  improvement,  during  which  time  he  was  able  to  get  up  and  walk  about,  all 
conditions  being  better,  the  swelling  of  face  and  feet  returned,  and  eventually  a 
general  oedema  occurred.  The  usual  remedies  failing  to  give  relief,  he  grew 
rapidly  woi'se  and  died  vei-y  suddenly  on  February  10,  1004.  His  temperature, 
which  had  run  a  very  low  course,  during  the  last  three  days  never  rose  above 
35.5°. 

Necropsy  (14  hours  after  death). — Body  poorly  nourished;  post-mortem  livid- 
ity  marked ;  rigor  mortis  slight ;  pupils  dilated ;  brain  and  membranes,  vessels, 
and  sinuses  appeared  normal,  weight  of  brain  1,500  grams.  Heart  weighed  GOO 
grams,  enlarged ;  aortic  valve  incompetent  and  thickened,  the  edges  being 
bound  down  by  adhesions ;  mitral  valve  incompetent,  both  ventricles  hyper- 
trophied ;  pericardial  sac  contained  200  c.  c.  of  fluid ;  thoracic  aorta  showed 
atheromatous  patches ;  abdominal  aorta  normal ;  general  venous  engorgement. 
Left  lung  weighed  700  grams ;  some  fluid  in  pleural  cavity,  but  no  adhesions. 
Right  lung  weighed  900  gi-ams :  the  pleural  cavity  showed  signs  of  an  old 
inflammation,  the  whole  sac  being  adherent.  Abdominal  cavity  contained  1,500 
c.  c.  of  fluid.  Stomach  small  and  contracted,  walls  thickened,  pyloric  and  car- 
diac orifices  normal.  Small  intestines  distended  with  gas ;  large  intestine 
empty.  Appendix  vermiformis  normal.  Liver  congested,  veiy  dark  in  color, 
weighed  1,.360  grams;  gall  bladder  and  ducts  distended  with  bile  mixed  with 
blood.  Spleen  small ;  capsule  somewhat  thickened ;  weight  110  grams.  Pan- 
creas normal ;  kidneys  appeared  healthy  to  macroscopic  examination ;  each 
weighed  200  grams.  LTreters  normal.  Both  suprarenal  bodies  were  in  a  state 
of  calcareous  degeneration,  all  structural  appearances  being  lost,  so  that  they 
appeared  as  deposits  of  lime  upon  the  kidneys.  Bladder,  prostate,  and  other 
organs  appeared  normal. 


F.  F.  S. 


III. 


A.  F. ;  white ;  male ;  age,  40 ;  born  in  Germany ;  single ;  marine  fireman ; 
admitted  to  the  United  States  Marine  Hospital  at  Chicago,  111.,  August  14 
and  died  August  25,  1903. 

History. — Father  and  mother  had  poor  health,  and  both  dead ;  had  fever 
(malarial)  in  Rio  Janeiro;  had  gonorrhoea  and  symptoms  of  constitutional 
syphilis,  yet  denies  having  ever  seen  a  primary  sore ;  had  subacute  articular 
rheumatism  at  intervals  for  about  eighteen  months.  About  two  months  ago  he 
had  attacks  of  dyspnoea  and  palpitation  of  the  heart.  This  improved  and  got 
worse  at  intervals,  until  on  admission  he  could  scarcely  walk  without  distress. 
At  the  out-patient  office  a  double  murmur  was  heard  at  the  aortic  area  and  a 
systolic  at  the  mitral.  After  a  rest  in  bed  the  mitral  sound  became  approximately 
normal,  but  later  the  nmrmur  reappeared,  and  toward  the  last  all  the  sounds  of 
the  heart  were  replaced  by  loud  murmurs.  On  admission  he  was  at  once  put  to 
bed  and  given :  Tr.  digitalis,  6  c.  c. ;  strych.  sulph.,  0.02  gram ;  aquse  q.  s.  ad 
50  c.  c.  Sig.  5  c.  c.  every  three  hours,  when  awake.  The  next  morning  he  had 
slept  and  his  breathing  was  better.  For  the  next  day  or  so  he  appeared  to  be 
improving.  Then  he  began  to  stay  awake  at  night,  being  awakened  by  a  sense 
of  suffocation  as  soon  as  he  fell  asleep.  This  became  more  marked,  and  was 
not  obviated  by  cautious  use  of  morphine.  The  dyspnoea  progressively  became 
worse,  the  feet  began  to  swell.  At  this  time  albumen  and  casts  appeared  in  the 
urine.  In  twenty-four  hours,  between  morning  sick  call,  August  24  and  August 
25,  a  great  change  for  the  worse  was  noticed.  The  temperature  sank  to  35.4°, 
and  he  was  sweating  and  very  short  of  breath  and  insisted  on  sitting  by  the 
open  window.  The  dyspnoea  continued  to  increase,  and  he  was  ordered  a 
hypodermic  every  hour  of  strychnine  sulphate,  0.001  gram ;  glycerin,  0.0005 
gram;  atropine  sulphate,  0.0005  gram.  By  2  a.  m.  his  suffering  was  intense; 
and  as  a  last  resort  he  was  bled  500  c.  c.  This  appeared  to  relieve  him  for  a 
time,  and  he  fell  asleep.  At  sick  call,  August  25,  he  was  found  propped  up  in 
bed,  half  asleep  and  cyanosed.  He  was  very  restless  and  frequently  changed 
his  position.  About  11  a.  m.,  while  sitting  on  the  side  of  the  bed,  leaning  against 
a  chair,  he  fell  over  backwards,  dead. 

Necropsy  (8  hours  after  death).— Body  of  male;  age,  about  40;  good 
muscular  development;  large  quantity  of  subcutaneous  fat;  marked  hypostatic 


PUBLIC   HEALTH    AND    MARINE-HOSPITAL    SERVICE.  479 

congestion  in  dependent  portions :  a'donia  of  bands,  legs,  and  anliles ;  hernia 
right  side,  tonsiderable  yellow  Hnid  In  tnnica  vaginalis,  hernial  sac  projects 
down  about  4  inebes  below  internal  ring.  Lungs:  Very  black,  a'deniatous, 
fluid  in  the  pleural  cavities.  Post-tracheal  glands  enlarged  and  black.  Right 
lung:  Adherent  all  around;  weight  1,180  grams.  Left  lung:  Adhesions  to 
pleura;  weight  1,1(>0  grams.  Appendix:  About  8  inches  long;  mesoappendix 
short  and  twisted ;  appendiceal  concretion  present.  Right  kidney :  190  grams  in 
weight,  capsule  strips  ofif  readily,  slightly  congested.  Left  kidney:  180  grams  in 
weight,  capsule  strips  off  readily,  slightly  congested.  Liver:  Weigiit  2,020 
grams ;  gall  bladder  adherent  to  colon ;  about  75  c.  c.  of  brownish-green  fluid 
in  gall  bladder.  Bladder :  Contains  about  GO  c.  c.  of  urine.  Spleen  :  Weight  370 
grams;  dark  slate  color,  edge  lobulated.  Heart:  Weight  000  grams;  very  little 
fluid  in  pericardium ;  ante-mortem  and  post-mortem  clots  throughout  heart. 
Pulmonary  semilunar  valve  normal;  vegetations  on  one  leaflet  of  aortic  valve; 
ascending  aorta  and  arch  greatly  dilated ;  wail  1  cm.  thick  in  places. 

N.  R. 

C.  E.  B. 

Mitral. 


A.  O.. ;  age,  42 ;  nativity,  Norway ;  admitted  to  the  United  States  Marine  Hos- 
pital, Boston.  Mass.,  September  9,  190:3,  and  died  October  20,  1903. 

History. — Father  committed  suicide ;  mother  dead,  cause  unknown ;  gonor- 
rhoea and  bubo  once ;  hai-d  chancre  six  years  ago ;  was  treated  in  this  hospital 
on  two  previous  occasions  during  the  last  three  months  for  valvular  disease  of 
heart,  mitral  regurgitation,  and  discharged  improved.  On  September  9,  1903,  he 
returned  to  the  hospital  with  old  heart  trouble  and  in  verj'  bad  condition ; 
very  weak ;  had  a  great  deal  of  pain  anteriorly  and  posteriorly  in  region  of 
heart ;  great  dispnoea ;  legs  were  badly  swollen  and  painful. 

Physical  examination. — Normal  area  of  cardiac  dullness  increased ;  systolic 
murmur  best  heard  at  fourth  interspace  left  side,  transmitted  to  left.  Apex 
beat  forcible  and  diffuse.  Legs,  hands,  abdomen,  feet,  and  external  genitals 
very  oedematous.  Patient  steadily  declined,  oedema  and  dyspnoea  gradually 
increasing,  in  spite  of  all  medication,  and  died  suddenly  October  26,  1903,  at 
4  p.  m. 

Necropsy  (18  hours  after  death). — Body:  Hands,  legs,  feet,  abdomen,  and 
external  genitals  enormously  swollen ;  rigor  mortis  absent ;  no  discoloration  of 
skin.  L'pon  removal  of  calvarium  membranes  were  found  congested ;  brain 
was  normal  and  weighed  1,270  grams.  Tissues  on  section  drip  serum.  Anomaly 
of  round  ligament  of  liver  which  passes  from  left  to  right.  Thorax :  Right 
pleural  cavity  contained  3,200  c.  c.  of  serosanguinoleut  fluid  and  the  remains  of 
a  greatly  shrunken  right  lung.  Left  pleural  cavity  contained  about  100  c.  c.  of 
serous  fluid,  and  pleura  was  very  adherent  throughout.  Right  lung  greatly 
shrunken  and  presents  some  congestion  in  lower  lobe ;  weight  680  grams. 
Left  lung  diminished  in  size  and  presents  some  hypostatic  congestion  in  lower 
lobe ;  weight  480  grams.  Pericardium  was  slightly  thickened  and  adherent 
and  contained  50  c.  c.  of  serous  fluid.  Heart  was  hypertrophied ;  walls  of 
ventricles  very  much  thickened,  especialy  left  ventricle.  Tricuspid  and  mitral 
valve  openings  were  considerably  dilated,  admitting  four  fingers.  INIitral  valve 
thickened  and  incompetent.  Aortic  valve  showed  contraction  of  valvular  seg- 
ments and  patches  of  vegetative  ulcerations ;  deposits  of  lime  salts  both  at  the 
valvular  edges  and  in  forms  of  plaques  in  ascending  portion  of  aorta;  large 
ante-mortem  clot  filled  right  ventricle ;  weight  of  heart  330  grams.  Abdomen : 
Stomach  and  intestines  normal.  Liver  presented  a  "  nutmeg  "  appearance  with 
chronic  hypostatic  congestion;  weight  1.150  grams.  Spleen  presented  hypo- 
static congestion ;  weight  170  grams.  Right  kidney  showed  chronic  productive 
(interstitial)  nephritis;  weight  230  grams.  Left  Ividney  presented  congestion; 
weight  250  grams.  Ureters  were  normal.  Bladder  contracted  and  contained 
small  amount  of  urine.    Pancreas  was  normal.. 

J.  D.  L. 
W.  C.   R. 
R.   M.   W. 


480  PUBLIC   HEALTH    AND   MAEINE-H08PITAL   SERVICE. 

IL 

W.  B. ;  age,  61 ;  nativity,  Germany ;  admitted  to  the  United  States  Marine 
Hospital,  San  Francisco,  Cal.,  Januui-y  15,  1904 ;  died  January  20,  1904. 

History. — Has  not  been  well  for  long  time,  has  dyspnoea,  profuse  expectora- 
tion, weakness,  and  no  appetite;  crepitant  and  sibilant  rales  present  over 
whole  chest ;  area  of  heart  dullness  increased.  A  mitral  systolic  murmur  is 
heard  over  apex  of  heart ;  it  transmitted  toward  the  axilla.  The  liver  is 
enlarged,  extending  two  finger  breadths  below  margins  of  ribs.  The  veins  of 
both  legs  are  dilated.  The  specific  gravity  of  the  urine  Is  1.02G ;  there  is  no 
albumen  or  sugar  present. 

The  patient's  dyspnoea  gradually  became  worse,  cyanosis  was  marked,  and 
there  was  ascites  and  oedema  of  the  lower  extremities.  He  died  from  exhaus- 
tion 2  a.  m.  January  20,  1904. 

Necropsy  (9  hours  after  death). — Length  of  body,  5  feet  4  inches.  Tattoo 
marks  (anchor)  on  right  wrist;  ecchymotic  spots  size  of  a  quarter  dollar  on 
chest;  rigor  mortis  not  well  marked.  Brain:  Weight,  1,400  grams;  tissue 
apparently  normal,  although  it  cuts  with  more  than  normal  resistance.  The 
subcutaneous  fat  is  abundant,  and  there  is  also  a  large  amount  of  fat  in 
the  omentum.  The  peritoneum  is  much  thickened,  strong  fibrous  bands  running 
through  it.  The  abdominal  cavity  contains  considerable  fluid.  The  small  intes- 
tine is  of  grayish-red  color,  the  appendix  is  small  and  has  its  own  mesentery, 
and  its  blood  vessels  are  engorged.  The  transverse  colon  is  small  and  col- 
lapsed. Heart :  Weight,  600  grams ;  the  leaflets  of  the  triscupid  valve  are  thick- 
ened, those  of  the  mitral  valve  are  hard,  nodular,  and  contracted ;  there  is  a 
small  mixed  clot  in  the  left  ventricle.  The  wall  of  the  right  ventricle  is  li  cm., 
of  the  left  ventricle  2  cm.  There  are  a  few  small  atheromatous  spots  in  the 
aorta.  The  left  lung  bound  down  by  separable  adhesions  to  surrounding  struc- 
tures ;  weight,  450  grams ;  it  is  crepitant  throughout,  and  the  tissue  is  normal 
with  the  exception  of  a  slight  congestion  at  the  base.  Right  lung  also  bound 
down  by  separable  adhesions ;  weight,  535  grams ;  condition  of  tissue  resembles 
left  lung.  Spleen  :  Weight,  165  grams  ;  color  of  external  surface,  brown,  mottled 
with  yellowish  white ;  capsule  thickened  and  adherent  to  pulp,  which  is  of  a 
deep-brown  color ;  trabeculjTe  prominent ;  tissue  cuts  with  increased  resistance. 
A  small  supernumerary  spleen  is  found  attached  to  the  lower  surface  of  the 
spleen  by  a  short  mesentery.  The  suprarenal  capsules  are  apparently  normal. 
Left  kidney :  Weight,  200  grams ;  capsule  nonadherent ;  tissue  cuts  with  in- 
creased resistance;  pyramids  prominent;  cortex  narrow,  of  a  reddish  color, 
showing  slight  yellow  striations.  Ptight  kidney :  Weight,  160  grams ;  it  is  simi- 
lar in  every  respect  to  the  other  kidney.  Bladder  empty,  wall  not  thickened ; 
ui'ethral  normal.  The  walls  of  the  stomach  are  thickened,  and  the  mucous 
membrane  presents  minute  hemorrhages.  The  walls  of  the  small  intestines 
are  much  congested.  The  tissue  of  the  pancreas  cuts  with  increased  resistance 
and  small  hemorrhages  are  present  between  its  lobules.  Liver :  Weight,  1,720 
grams ;  color  on  section,  brown,  with  a  bright  yellow  shade ;  tissue  is  greasy 
to  the  touch  and  cuts  with  increased  resistance. 


W.  G.  S. 


III. 


H.  S. ;  age.  21 ;  nativity,  Wisconsin ;  admitted  to  the  United  States  Marine 
Hospital,  Cleveland,  Ohio,  April  4,  1904 ;  died  April  24,  1904. 

History. — Patient  complains  of  malaise  for  past  two  weeks.  April  2,  1904, 
had  severe  headache,  backache,  and  joints  became  painful;  some  nausea; 
but  did  not  vomit ;  acceleration  of  heart  action  bothered  him  considerable ; 
general  chilly  feeling,  with  some  sore  throat  and  cramps  in  bowels ;  severe  pain 
in  cardiac  area. 

Physical  examination  showed  a  body  poorly  nourished ;  apex  beat  visible 
over  a  large  area ;  face  and  lips  somewhat  cyanotic.  On  palpitation  the  cardiac 
impulse  is  strong,  but  pulse  soft  and  easily  compressed.  On  percussion  the 
general  cardiac  dullness  is  increased ;  balance  of  thorax  negative.  A  blowing 
systolic  murmur  is  heard  at  apex  with  accentuation  of  second  pulmonic  sound. 

Necropsy  (6  hours  after  death). — Tall,  while  male;  body  poorly  nourished; 
post-mortem  lividity  of  dependant  parts ;  considerable  oedema  of  feet  and 
ankles;  very  small  amount  of  subcutaneous  fat.  Thorax:  No  pleural  adhesions 
present.  Visceral  and  parietal  pericardium  adherent  throughout  with  fibrous 
plastic  material ;  no  free  fluid  in  sac.    Heart  somewhat  enlarged,  muscles  soft 


PUBLIC    HEALTH    AND    MARINIvHOSPITAL    SERVICE.  481 

ami  ll!il»l).v  :  \v('i.i,'Iit.  570  {irains.  Uijjclit  lu'art  soinowliat  (listended  nnd  filled  with 
post-niorttMii  clots.  Valves  of  ri;;lit  heart  normal.  Mitral  valve  iiicouipeteiit 
and  shows  ealcareous  vej,'etations.  A<.rtic  valves,  normal  ;  chorda'  tendina'. 
normal:  no  arteritis  present.  Lnn,i,'s  con.irestcnl  and  (edematons :  the  rij,'ht 
weijrhs  1,(HM)  grams;  the  left.  l.OOO  grams.  Some  free  Ilnid  In  jieritoneal  cav- 
ity. Omentum  and  peritonium  normal.  Liver  weighs  I'.C.oo  grams.  It  was 
dark  red  on  section,  and  (edematous.  Spleen  weighed  1120  grams  and  was  firmer 
than  normal.  (Jail  bladder  contained  about  75  c.  c.  of  bile.  Kidneys  normal; 
right  weighs  150  grams;  left.  105  grams.  Stomach  apparently  normal.  Intes- 
tines tilled  with  gas.  Bladder  normal,  contained  some  urine.  Pancreas  normal, 
weighs  S5  grams.     P.rain  and  spinal  cord  not  examined. 

AxATo.MicAi,  DIAGNOSIS. — Chroiiic  rheumatism;  valvular  disease  of  heart 
mitral ;  adherent  pericardium  ;  myocarditis. 

II.  S.  M. 
DISEASES  OF  THE  KIDNEYS. 

Chronic  nephritis. 

I. 

F.  J. ;  age,  44 ;  nativity,  Norway ;  color,  white ;  admitted  to  the  United 
States  Marine  Hospital  October  21.  1903;  died  October  24,  1903. 

History. — Family  history  negative ;  syiihilis  twelve  years  ago ;  gonorrhea 
ten  years  ago :  pneumonia  three  years  ago  ;  about  five  months  ago  had  an  attack 
\(-ith  diarrhea,  general  jiains.  chills  and  fever  ;  present  sickness  began  about  three 
weeks  ago  with  symptoms  like  that  last  experienced ;  patient's  mental  condition 
not  clear,  and  histoiy  ditticult  t:)  obtain;  was  treated  in  two  local  hospitals 
before  ai)plying  for  adniission  to  the  marine  hospital. 

CoxDiTio.N-  ox  ARRIVAL. — T'nuble  to  walk;  dyspnoea;  complaint  of  pain  in 
back  and  tliiglis :  diarrhea ;  large  l)ed  sore  over  sacrum ;  indefinite  macidar 
rash  on  back,  sides,  and  extensor  surfaces  of  arms;  small  crusting  lesion  on 
penis;  skin  dry  and  scaling;  moist  raler.  in  bases  of  lungs.  Later  examination 
uf  urine  showed  large  amount  of  albumin. 

All  symptoms  grew  more  pronounced,  except  diarrhea,  and  death  occurred  at 
4.30  p.  m.,  October  24.  The  temperature  was  subnormal  during  the  period  the 
case  was  under  observation. 

Necropsy  (19  hours  after  deatli). — Body  somewhat  emaciated.  Skin  diy, 
rigor  mortis  and  post-mortem  lividity  well  marked;  pupils  moderately  dilated; 
large  decubitus  over  sacrum  :  small  crusted  lesion  on  dorsum  of  penis.  The 
calvarium  removed  and  extensive  adhesions  are  found  between  meninges  and 
inner  table  for  about  3  cm.  on  either  side  of  the  longitudinal  sinus.  The  weight 
of  the  brain  is  1.500  grams.  The  anterior  mediastinum  exposed  by  removal  of 
the  sternum.  The  lungs  do  not  meet  in  the  median  line,  the  left  being  consider- 
ably retracted  to  the  left,  the  right  firmly  attaclied  to  the  lower  part  of  the 
sternum.  The  pericardium  is  strongly  adherent  to  both  lungs,  sternum,  and 
diaphragm.  Its  layers  are  thickened  and  adherent  to  the  heart  superiorly,  and 
there  is  scarcely  any  fluid  in  the  cavity.  The  heart  weighs  322  grams ;  it  cuts 
with  normal  resistance  and  its  muscuhir  tissue  is  pale  brown  in  color.  The 
aortic  and  imlmonary  valves  are  competent  to  the  water  test.  The  mitral  orifice 
admits  three  fingers ;  the  tricuspid  five  finger  tips.  Both  ventricals  contain 
large  goose-fat  clots  which  extend  into  the  aorta  and  pulmonary  artery.  Imme- 
diately above  the  aortic  valves  occurs  a  transverse,  hardened  plaque  in  the  aortic 
wall,  ulcerated  into  the  lumen  and  adherent  to  the  goose-fat  clot.  The  right 
lung  is  strongly  adherent  to  the  parietal  pleura  all  over  by  fibi-ous  material. 
It  crepitates  normally  in  the  upjier  lobes,  and  to  a  lesser  extent  in  the  lower 
lobe.  Section  shows  considerable  bloody  frothy  fluid  in  the  lower  lobe. 
Weight  of  right  lung  705  gi-ams.  The  left  lung  weighs  (580  grams.  It  is 
adherent  to  its  parietal  pleura  by  recent  filirinous  adhesions,  easily  separable. 
Section  similar  to  that  of  right  lung — normal  above,  (Edematous  below.  The 
great  vessels  and  nerve  trunks  are  normal,  except  aorta  previously  described. 
The  diaplu-agm  adheres  to  tlie  bases  of  the  lungs,  to  the  right  by  fibrous,  to  the 
left  by  fibrinous  l)ands.  The  intestines  are  moderately  distended  witli  gas. 
The  peritoneum  is  everywhere  smooth  and  shining;  no  evidence  of  inflamma- 
tion is  present.  The  great  omentum  is  normal.  The  spleen  is  of  normal  size 
and  weight.     The  external  surface  is  bluish  red  and  wrinkles  easily.     It  cuts 

8629—04 31 


482  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

with  slight  increase  in  resistance;  the  section  is  rather  dry  and  shows  some 
increase  of  interstitial  tissue.  The  kidneys  are  enormously  enlarged ;  the  right 
weighs  375  and  the  left  405  grams.  The  perinephritlc  fat  is  much  diminished. 
The  external  surfaces  are  very  pale,  smooth,  and  the  capsules  are  nonadherent. 
There  is  much  diminished  resistance  on  section,  which  is  pale  yellow  in  the  cor- 
tex and  medulla,  except  tlie  pyramids,  which  are  darker.  The  tissue  is  veiy 
friahle  and  soft.  The  urinary  bladder  contains  about  100  c.  e.  of  turbid  urine. 
A  permeable  stricture  is  present  in  the  membranous  urethra ;  the  other  organs 
of  generation  are  normal.  The  rectum  contains  considerable  semifluid  fecal 
matter.  The  duodenum  shows  congestion  and  hemorrhagic  areas  in  the  mucous 
membrane  of  its  ascending  portion.  The  stomach  is  dilated  with  gas,  and  also 
contains  some  liquid  material  of  light  brown  color.  The  mucous  membi'ane 
along  the  greater  curvature  is  congested  and  ecchymotic.  The  gall  ducts  are 
patent  and  the  gall  I)ladder  contains  a  moderate  amount  of  fluid  bile.  The  liver 
weighs  1,970  grams,  is  enlarged,  smooth  externally,  and  rather  pale  in  color.  It 
cuts  with  diminished  resistance,  the  section  being  mottled  red  and  yellow  and 
generally  pale,  with  fatty  areas ;  there  are  no  abnormal  adhesions.  The  pan- 
creas weighs  157  grams.  On  section  the  resistance  is  normal,  but  the  cut  sur- 
face shows  interstitial  hemorrhages  throughout.  The  solar  plexus  is  normal. 
The  mesentery  exhibits  a  few  slightly  enlai-ged  lymph  glands.  The  first  part 
of  the  jejunum  shows  congestion  of  the  mucous  membrane  and  hemorrhagic 
areas.  In  the  last  2  or  .3  feet  of  the  ileum  the  mucous  memlirane  is  greatly 
swollen  and  congested  and  uniformly  hemorrhagic.  No  ulcers  are  present, 
but  there  is  much  semiliquid  fecal  matter.  The  large  intestines  are  normal 
except  for  the  presence  of  the  same  quality  of  fecal  matter.  The  vermiform 
appendix  Is  normal.     The  great  vessels  are  apparently  normal. 

Anatomical  diagnosis. — Decubitus  over  sacrum;  crusted  lesion  on  penis; 
localized  cerebral  pachymeningitis;  acute  myocarditis;  chronic  adhesive  peri- 
carditis; tricuspid  insuflficiency,  slight ;  goose-fat  clots  in  ventricles  ;  retraction 
of  left  lung ;  fibrous  adhesions  between  pericardium,  heart,  lungs,  sternum,  and 
diaphragm ;  arterio-sclerosis  and  ulceration  in  beginning  of  aorta ;  chronic 
fibrous  pleuritis,  right;  acute  fibrinous  pleuritis,  left;  pulmonary  cedema,  bilat- 
eral ;  acute  and  chronic  phrenitis ;  slight  fibrosis  of  spleen ;  chronic  parenchyma- 
tous nephritis  with  large  white  kidneys;  organic  stricture  of  urethra;  acute 
enteritis ;  acute  gastritis ;  acute  hepatitis  with  fatty  degeneration ;  acute 
hemorrhagic  pancreatitis. 


C.  R. 
W.  G.  S. 


II. 


A.  G.  K. ;  age  43 ;  iiatiA'ity,  Finland ;  color,  white ;  admitted  to  the  United 
States  Marine  Hospital,  San  Francisco,  Cal.,  Decemlter  lO,  1903;  died  December 
17,  1903. 

History. — This  patient  was  brought  to  the  hospital  in  the  ambulance,  and 
his  mental  condition  was  such  that  all  that  could  be  gotten  out  of  him  was 
that  he  had  been  sick  two  weeks  and  had  had  a  chill  the  day  before.  Shortly 
after  being  put  to  bed  he  was  seized  with  convulsions  of  epileptiform  character, 
which  lasted  for  several  minutes.  Urinalysis  showed  a  large  amount  of  albu- 
min, about  14  per  cent  by  the  Esbach  test ;  was  unable  to  hold  anything  on  his 
stomach  on  account  of  coughing ;  expectorated  a  large  amount  of  mucopuru- 
lent matter.  Several  other  convulsive  attacks  were  experienced,  followed  by 
jerking  movements  of  the  left  hand  and  arm  and  face.  He  was  given  hot  baths, 
pilocarpine,  and  saline  solution,  but  scarcely  any  benefit  resulted.  Death 
occurred  the  following  day  at  4.25  p.  m.  Owing  to  the  patient's  critical  condi- 
tion it  was  impracticable  to  make  a  complete  physical  examination. 

Necropsy  (18  hours  after  death). — Body  fairly  well  nourished;  rigor  mortis 
and  post-mortem  lividity  present ;  skin  of  face  yellowish  in  color.  The  cal- 
varium  removed,  and  the  condition  of  the  skull  cap.  the  brain  case,  the  sinuses 
and  vessels,  the  brain  and  its  membranes  noted,  and  all  appeared  to  be  nor- 
mal. The  brain  weighs  1,280  grams.  On  removing  the  sternum  the  right  lung 
is  seen  to  come  to  the  median  line,  while  the  left  is  retracted.  The  peribron- 
chial lymph  glands  are  enlarged  and  show  anthracosis.  The  pericardium  is 
strongly  adherent  to  both  lungs.  When  opened  a  large  amount  of  clear  serous 
fluid  escapes.  The  parietal  pericardium  is  thickened  and  adherent  to  the  vis- 
ceral layers  above.  When  the  heart  is  removed  the  blood  is  found  to  be  very 
fluid,  and  the  outer  surface  of  the  heart  anfl  inner  surface  of  the  pericardium 


1»ITHLI(1    HEALTH    AND    M AHINK-HOSriTAL    SKRVICE.  483 

to  have  lost  tlioir  sliinin;^:  a]ipo;iranoo  and  l)Of'oiiio  Rvoatly  roughonod  liy  i)ar- 
tially  orf^aiiizcil  inllaiuiiiatory  exudalc,  tlic  latter  jjivin^  the  "  hrcad-and 
butter"  aitpearaiice.  The  heart  is  ;;reatly  enlarged,  \velt,diiiif^  ;")()()  Ki'aiiis.  It 
is  broad  laterally.  A  ehlckeii-tat  elot  extends  from  the  left  ventrich'  into  the 
aorta.  Tlu'  inycteardiuni  cuts  with  inereased  resistance,  sho\vin;:C  a  i)ale  sur- 
face and  increase  of  eonneetivo  tissue.  The  aortic  and  i)ulnionary  valves  are 
competent  to  th<>  water  test.  The  nutral  orifice  admits  three  fiiifjcers  ;  the  tri- 
cuspid fcmr.  The  endocradium  aj)pears  everywhere  smooth  excei)t  on  the 
nntral  valve,  where  there  are  s(>veral  at  h(>roma tons  patches.  The  tricuspid  valve 
is  normal.  The  myocardium  of  the  left  ventricle  is  nuicli  increased  ;  that  of 
the  right  is  al»out  noi-nial.  The  nuicous  memiu'ane  of  the  trachea  and  bronchi 
is  congested.  Tlie  right  lung  weighs  SSO  grams.  The  external  surface  is  mot- 
tled gray  and  black.  The  layers  of  the  pleura  are  adherent  all  over  l)y  filirin- 
ous  adhesions,  except  at  the  base,  whei'e  firm  fibrous  bands  connect  the  lung 
with  the  diaphragm  and  chest  wall.  There  is  crepitation  in  the  middle  lolje 
and  anterior  portion  of  the  ui)per  loI)e,  Imt  none  in  the  lower  two-thirds  of 
the  upper  i»art  of  the  upi»er  lol)e  posteriorly,  this  being  consolidated.  Crepita- 
tion is  diminished  in  the  lower  lobe.  Section  of  the  consolidated  portion  shows 
increased  resistance  and  a  grayish-red  color.  Section  of  the  lower  lobe  shows 
considerable  bloody,  frothy  fluid.  The  i)osterior  surface  of  the  lower  lobe 
is  dark  grayish  red.  Filirinous  bands  are  i>resent  in  the  interlobular  fis- 
sures. The  left  lung  weighs  ~>'.]T}  grams.  Its  external  surface  resembles 
that  of  the  right  lung.  The  layers  of  the  pleura  are  similarly  adhesed — by 
fibrinous  exudate  superiorly  and  by  organized  fibrous  bands  inferiorly.  Fibrin- 
ous bands  also  occur  in  the  interlol)ular  fissure.  C'repitation  good  through- 
out, except  in  the  posterior  ]K)rtion  of  the  lower  lobe,  where  it  is  diminished. 
Section  of  the  upper  lol)e  is  somewhat  frothy ;  of  the  lower  lobe  very  bloody  and 
oedematous.  On  the  convex  border  of  the  arch  of  the  aorta  there  is  a  saccular 
dilatation,  size  of  small  hen  egg,  the  walls  of  which  are  thinner  than  those 
of  the  aorta  projier,  and  the  endothelium  roughened,  hemorrhagic,  and  in 
places  eroded.  The  ascending  portion  of  the  aorta  contains  a  numl^er  of 
atheronnitons  plaques.  The  descending  portion  and  entire  thoracic  aorta  show 
numerous  atheromatous  i)atches.  the  endothelium  being  hemorrhagic  and  rough- 
ened in  places  and  extensively  ulcerated  in  others.  No  clots  adhere  to  any 
of  these  eroded  areas.  The  intima  of  the  innominate  artery  also  exhibits 
areas  of  atheromatous  change.  The  nerve  trunks  are  normal.  The  diaphragm 
on  the  right  side  reaches  to  the  fifth  rib ;  on  the  left  side  to  the  sixth.  It  is 
firmly  adherent  to  the  bases  of  the  lungs.  AbdomeTi :  The  great  omentum  is 
retracted  to  the  left  and  contains  considerable  fat.  It  is  firmly  adherent  to  a 
portion  of  the  anterior  al)dominal  wall,  also  in  the  left  hypochondriac  region 
and  to  the  spleen,  and  Iiy  a  single  fine  fibrous  l)and  to  the  cfecum.  The  spleen 
is  strongly  lH)und  down  jiosteriorly.  It  weighs  (!<S  grams  and  is  diminished  in 
size.  It  is  hard  in  consistency,  pale  gray  in  color,  somewhat  roughened  on  the 
surface,  and  the  capsule  does  not  wrinkle  easily  and  shows  hemorrhagic  areas 
beneath.  On  section  there  is  considerable  increase  in  resistance,  firmness  of 
pulp,  iiale-cut  surface,  and  proliferation  of  interstitial  fiI)rous  tissue.  The  right 
Kidney  weighs  220  grams  and  is  enlarged.  It  is  surrounded  by  considerable 
fat.  There  is  a  dee])  depression  on  the  convex  border.  The  surface  is  pale, 
and  subcapsular  hemorrhages  and  yellowish  areas  of  large  size  are  present. 
The  fibrous  capsule  strips  with  some  difliculty.  heaving  a  fine  granular  surface. 
Section  shows  increased  resistance,  relative  darkness  of  the  pyramids,  light 
.vellowish  color  of  cortex  and  medulla,  and  fairly  distinct  cortical  markings. 
The  test  for  amyloid  degeneration  was  tried  and  gave  negative  resxdts.  The 
left  kidney  is  very  small  and  embedded  in  a  quantity  of  fat;  it  weighs  only  50 
grams.  The  surface  is  very  nodular  and  irregular.  The  fibrous  capsule  strips 
with  difficult.v  and  shows  a  granular  and  hemorrhagic  surface.  Section  shows 
increased  resistance,  darkened  color  of  the  pyramids,  diminished  cortex,  and 
excess  of  filjrous  tissue.  The  suprarenal  capsules  are  apparently  normal.  The 
urinary  bladder  contains  a  small  amount  of  purulent  fluid.  The'  organs  of  gen- 
eration, rectum,  and  duodenmn  are  normal.  The  stomach  shows  congestion  of 
the  nmcous  membrane,  with  hemoi-rhagic  areas  and  glairy  mucous.  The  gall 
bladder  and  the  gall  ducts  are  normal.  The  liver  weighs  1,0.^).5  grams.  It  is 
enlarged,  and  the  surface  is  somewhat  irregular,  showing  bands  of  white 
fibrous  tissue  and  lighter  areas.  There  are  strong  and  extensive  adhesions 
superiorly.  On  section  there  is  increased  resistance,  pale  surface  with  yellow- 
ish areas,  and  increase  of  fibrous  tissue.  On  the  surface  of  the  left  lobe  there 
occurs  a  large  and  light-yellowish  area,  which  penetrates  deeply  and  cuts  with 


484  PUI?LIC   HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

diminished  i'Osi>;tiince.  The  pancreas  weighs  To  grams  and  is  normal.  The 
solar  plexus,  mesentery,  small  intestines,  and  vermiform  appendix  are  normal. 
The  lumen  of  the  transverse  c-olon  is  much  contracted.  Otherwise  the  large 
intestines  are  normal.  The  abdominal  aorta  is  in  a  condition  similar  to  that 
of  the  thoracic  aorta. 

Anatomical  diagnosis. — Anthracosis  of  peribronchial  lymph  glands ;  peri- 
carditis with  effusion  and  adhesive  inflammation :  hypertrophy  of  the  left 
ventricle;  chronic  myocarditis;  atheroma  of  mitral  valve;  acute  bronchitis; 
acute  and  chronic  pleuritis ;  lobar  pneumonia  of  right  upper  lobe;  imlmonary 
oedema  ;  saccular  aneurysm  of  the  arch  of  the  aorta ;  arterio-sclerosis  of  tho- 
racic and  abdominal  aorta  and  other  large  branches ;  chronic  phrenitis ;  omen- 
tal adhesions;  chronic  splenitis;  chronic  interstitial  nephritis;  acute  ga.stritis ; 
hepatic  hypertrophic  cirrhosis. 


C.  R. 

W.  G.  S. 


TIT. 


J.  D. :  age.  27 ;  nativity,  Massachusetts ;  admitted  to  the  United  States 
Marine  Hospital,  San  Francisco,  Cal.,  November  16,  1903 ;  died  November  27, 
1003. 

History. — The  patient  stated  he  used  alcohol  to  excess;  that  he  had  been 
suffering  from  "  spells."  when  he  would  have  a  headache,  spasms  of  his  arms 
and  legs,  nausea,  and  vomiting.  These  fits  would  end  in  a  state  of  coma,  from 
which  he  could  not  lie  aroused. 

Examination. — Sl<in  pale,  of  yellow  hue;  conjunctiva"  have  a  yellowish  cast; 
rAles  beard  over  the  apex  of  right  lung:  heart  sounds  normal  :  liver  and  spleen 
not  enlarged.  Temperature,  3<;..!i°  C. ;  pulse,  80.  Urine;  Specific  gravity.  1.029  ; 
no  albumen  or  sugar  present:  bile  present  in  large  amount;  Plasmodium  of 
malaria  ;    jpstivo  autumiiial  form  found  in  blood. 

November  24  the  patient  had  delirium  for  several  hours.  The  next  day  he  had 
three  attacks  of  a  semicomatose  nature,  lasting  one-half  hour  each,  during 
which  he  made  much  noise  and  thrashed  around  with  his  arms.  On  November 
2G  he  passed  into  a  state  of  complete  coma,  in  which  he  died  at  1.15  a.  m.  on 
the  27th. 

Necropsy  (10  hours  after  death). — Height,  5  feet  0  inches:  body  fairly  well 
nourished ;  abrasions  on  left  ell)ow  and  hip :  rigor  mortis  present.  Brain : 
Weight,  1.450  grams ;  tissue  apiiarently  normal.  No  gas  escapes  on  opening 
abdomen ;  small  Intestines  stained  a  yellowish  color,  filled  with  gas :  appendix 
long,  has  several  concretions  in  it.  one  at  distal  end,  no  evidence  of  inflammation 
of  its  tissues ;  omentum  contains  considerable  fat :  large  intestines  distended 
with  gas ;  color  grayish.  Liuigs :  Overlap  the  heart ;  pericardial  sac  contains 
a  small  quantity  of  yellowish  fluid.  There  is  a  quantity  of  fat  surrounding  the 
heart;  weight  of  the  heart.  200  grams:  valves  of  right  side  normal:  thick- 
ness of  wall  of  right  side.  *  cm. ;  of  left  side.  1  cm. ;  the  edges  of  the  mitral 
valve  are  roughened ;  aortic  valves  normal :  color  of  heart  muscle  bright  red : 
of  the  endocardium,  reddish  brown.  Right  lung:  Weight,  325  grams;  small 
adhesions  to  chest  wall  at  apex  ;  tissue  crepitant  throughout,  except  at  apex, 
where  there  is  a  small  collection  of  tubercles  and  a  caseous  mass  of  the  size  of 
a  pea.  Left  lung:  AYeight,  285  grams  ;  crepitant  throughout ;  tissue  apparently 
normal.  Spleen :  Weight.  05  grams :  cuts  with  increased  resistance ;  tissue 
very  dark  red:  trabecuhp  well  marked;  pulp  firm.  Left  kidney:  Weight.  110 
grams :  capsule  slightly  adherent  to  kidney  substance :  tissue  cuts  with  in- 
creased resistance;  cortical  layer  very  thin:  color  pale  red.  streaked  with  yel- 
low; pyramids  prominent.  Right  kidney:  Weight.  105  grams;  condition  same 
as  left.  Liver:  Weight.  1.000  grams;  color  dark  red;  cuts  with  increased  re- 
sistance and  dark-red  blood  oozes  out  on  section  ;  gall  bladder  filled  with  dark- 
brown  bile:  gall  ducts  patent.  Stomach  and  small  intestines  normal;  pancreas 
normal ;  bladder  contains  about  250  c.  c.  of  urine ;  tissue  in  good  condition ; 
urethra  normal. 

W.  G.  S. 
IV. 

E.  H. ;  age.  50 ;  nativity,  Germany ;  transferred  to  the  United  States  Marine 
Hosi)ital.  San  Francisco,  Cal.,  from  San  Diego.  Cal.,  January  12,  1904  ;  died 
February  5,  1904. 

History. — Good  health  until  three  months  before  admission.  Sickness  began 
with  shortness  of  breath  and  swelling  of  feet.     He  has  headaches,  loss  of  appe- 


PTTHLIC    HKALTH     AND    MARINE-HOSPITAL    SERVIPE.  485 

lite,  sliglit  riiiiKli.  wciikiioss,  and  froiinoiit  urinalion.  in  nddilion  to  llio  ali<)V(> 
symptoms.  Examination  shows  a  systolic  murmnr  prosont  over  apex  of  heart  : 
nnmcrons  rales  in  both  hniirs  :  aixlonuMi  t.vnii)anitic ;  prostate  enhirtjed  ;  larije 
uleers  in  throat,  whicli  are  apparently  syphilitic  Urine:  Speeilic  Ki'iivity,  l.O'JO; 
lii,'ht  eolor,  stronir  odor,  elondy  sediment  in  larjro  anumnt:  albumen  present 
in  ;;reat  (piantities.  I'ulse.  !>"J :  respiration.  20 ;  temperature,  normal.  The 
jiatient's  condition  improved  and  his  symptoms  disappeared.  January  20,  1004, 
he  left  the  liospitjil  for  a  few  hours,  williout  pernussion,  and  drank  a  large  quau- 
tit.v  of  whisky.  lie  never  r<>covered  from  this  deli.-iuch,  for  his  symptoms  n^ 
turned  in  an  exa.i^s^erated  form  and  he  had  delirium,  nausea,  and  voinitinj;, 
trenil)linfjr  of  the  limbs,  and  finally  died  February  5.  1004.  at  1.20  p.  m. 

Xkckopsy  (22  hours  after  death). — P.ndy  fairly  well  nourished;  leufjth,  5  feet 
7  inches.  Evidence  of  old  fracture  of  the  ninth  rib,  rij^ht  side;  costal  cartilages 
partially  ossified.  Left  lung :  Weight.  470  grams;  tissue  ai)pare!itly  normal, 
liight  lung  strongly  bound  down  to  chest  walls  l)y  adhesions;  weight.  uOO  granis ; 
moderate  crepitation;  lower  lobe  congested  and  o^demntous.  lleart:  Weight. 
800  granis:  nuiscle  walls  thickened;  pale,  with  uiucli  fat  between  fibers;  clots 
in  both  ventricles  ;  leaflets  of  mitral  valve  thickened  :  first  jjortion  of  aorta 
dilated;  walls  show  atheromatous  si)ots.  Omentum  adherent  to  anterior  wall 
of  abdonien.  Spleen  :  Weight.  145  grams  ;  tissue  apparently  normal.  Left  kid- 
ney :  Weight.  220  grams;  capsule  strips  with  difficulty:  cortical  portion  thin; 
color  light  red.  with  indistinct  yellowish  markings ;  pyramids  well  marked  and 
of  a  dark  color.  Right  kidney:  Weight,  250  grams;  tissue  in  similar  condi- 
ton  as  left  kidney.  Suprarenal  capsules  normal.  Bladder  contains  300  c.  c.  of 
turbid  urine ;  mucous  membrane  pale,  with  hemorrhagic  areas.  Prostate  en- 
largetl.  Walls  of  stomach  and  intestines  normal.  Appendix  8  inches  long ; 
has  its  own  mesentery.  Liver:  Weight,  1.850  grams;  color  on  section  light 
reddish-brown,  with  large  areas  of  light  yellow.  Gall  bladder  full  of  bile; 
ducts  patent. 

W.  G.  S. 

V. 

P.  A. ;  coloi'ed :  age,  55 ;  nativity,  Virginia ;  admitted  to  the  LTnited  States 
Marine  Hospital,  San  Francisco.  Cal.,  May  2G,  1903 ;  died  August  31,  1903. 

History. — After  having  an  attack  of  enteric  fever  in  New  Zealand  five  months 
ago,  as  he  was  coa\alescing  he  awoke  one  morning  and  found  he  could  not 
speak  or  move  his  right  arm  and  leg.  Speech  gradually  returned,  so  that  in  one 
and  one-half  months  he  was  able  to  talk.  The  right  side  of  his  body  remained 
paralyzed  for  three  months;  the  patient  then  gradually  recovered  the  use  of  his 
band  and  leg.  About  twenty  days  ago  he  noticed  legs  were  beginning  to  swell, 
and  the  swelling  has  continued  to  increase  up  to  the  time  of  admission.  About 
three  months  ago  he  had  a  number  of  liemorrliages  from  the  nose.  He  now  has 
a  severe  pain  in  the  frontal  region  and  behind  the  right  ear.  For  the  last 
twenty  days  the  patient  has  been  vomiting  after  eating,  and  states  he  can  Iceep 
nothing  but  water  in  his  stomach.  He  has  to  pass  his  urine  four  or  five  times 
every  night.  He  has  considerable  dyspnoea  and  saliva  is  constantly  driveling 
from  his  mouth. 

ExAMiNATiox.— General  anasarca  present ;  tongue  good  color,  broad  and 
thick,  especially  at  tip ;  teeth  decayed ;  the  heart  extends  considerably  beyond 
the  left  border  of  the  nipple  line ;  a  loud  blowing  systolic  murmur  is  heard  over 
the  mitral  area  ;  rales  are  heard  over  the  entire  chest.  Abdomen :  Convex  tym- 
panitic at  dome ;  dull  in  flanks  and  above  pubes  ;  fluctuation  present ;  skin  pits 
on  pressure.  Right  hand  and  arm  cold  and  axlematous ;  great  loss  of  musciilar 
power ;  atrophy  of  muscles ;  patient  can  only  move  arm  by  jerks.  Patellar 
reflex  increased  in  both  legs ;  entire  loss  plantar  reflex  right  foot ;  Babinski's 
reflex  present  left  foot.  Ilyperiiesthesia  over  entire  body  ;  tactile  sense  lost  on 
right  leg  and  arm.  Right  side  of  bod.v  shows  delayed  reaction  to  heat  and  cold. 
Temperature.  37.5°  C. ;  respiration,  24;  pulse  regular,  fairly  strong;  ai-teries 
hard.  Urine;  Specific  gravity,  1.010;  acid  reaction;  color,  light  yellow;  one- 
tenth  of  1  per  cent  albumen  present;  no  sugar  or  bile;  the  microscope  shows 
hyaline  and  granular  casts ;  quantity  of  urine  passed  In  twenty-four  hours, 
600  c.  c.  By  the  administration  of  diajihoretics  and  cathartics  the  drops.y  in 
time  entirely  disappeared.  He  was  then  given  tonics  and  diuretics,  and  by 
June  30,  1903,  his  lu-ine  had  increased  to  1,700  c.  c.  a  day  and  the  albumen 
diminished  to  one-fortieth  of  1  per  cent.  There  was,  however,  very  little 
improvement  in  the  hemiplegia.     About  the  middle  of  August  he  lost  his  appe- 


486  PUBLIC    HEALTH    AND    MAEINE-HOSPITAL    SERVICE. 

tite  and  began  to  fail  rapidly.     lie  became  very   weak,  and  toward  the  end 
became  comatose.     He  died  from  exhaustion  August  31,  1903. 

Necropsy  (1(J  hours  after  death). — Body  emaciated;  scar  on  right  arm  5  cm. 
long;  rigor  mortis  well  marked;  abdominal  wall  1  cm.  thick,  very  little  fat  pres- 
ent; omentum  small  and  retracted.  P>rain :  \Yeight,  1,170  grams;  walls  of 
arteries  at  base  of  brain  hard  and  thickened ;  i)atches  of  yellowish  sclerotic 
material  occur  throughout  these  vessels.  There  is  a  mass  of  degenerated  tissue 
in  the  corpus  striatum.  This  mass  is  of  a  yellowish-black  color,  the  size  of  a 
bean  and  of  a  gelatinous  consistency.  Costal  cartilages  ossified.  The  pericar- 
dial sac  contains  a  small  quantity  of  yellowish  fluid.  The  heart  is  much 
enlarged ;  weight,  780  grams ;  the  right  ventricle  contains  a  white  clot ;  its  wall 
Is  1.2  cm.  thick.  The  wall  of  the  left  ventricle  is  2.5  cm.  thick.  The  mitral 
valve  is  thickened  and  roughened  and  orifice  dilated.  The  heart  muscle  is  of 
a  bright-red  color  and  cuts  with  normal  resistance.  There  are  separable 
fibrous  adhesions  over  pleural  surfaces  of  both  lungs.  Combined  weight  of 
lungs,  1,400  grams ;  tissue  apparently  normal.  Spleen :  Weight,  200  grams ; 
brick-red  color:  trabecuhi?  prominent  Left  kidney:  Weight,  110  grams;  caj)- 
sule  strips  with  diliiculty.  leaving  roughened  and  granular  surface.  The  kidney 
cuts  with  great  resistance;  the  pelvis  is  filled  with  fat;  the  cortex  is  nearly 
obliterated;  connective  tissue  abundant,  fornnng  layers  between  pyramids;  the 
pyramids  are  of  a  red  color,  streaked  with  white.  Itight  kidney:  Weight,  1)0 
grams;  condition  similar  to  left  kidney.  Liver:  Weight,  1,750  grams;  surface 
on  section  shows  a  number  of  pin-head  yellowish  areas;  cuts  with  slightly 
increased  resistance:  gall  bladder  distended  with  bile;  gall  ducts  patent.  Other 
abdominal  organs  are  apparently  in  normal  condition. 

W.  G.  S. 

VI. 

J.  W. ;  age,  59;  nativity,  AMrginia ;  admitted  to  United  States  Marine  Hos- 
pital, Memphis,  Tenn.,  August  18,  1903 ;   died  August  25,  1903. 

History. — Family  history  negative. 

Previous  history. — Has  had  rheumatism  ;  has  used  both  alcohol  and  tobacco ; 
has  had  gonorrhcea  and  chancre  some  time  ago. 

Present  illness. — Complains  of  not  being  able  to  pass  his  urine;  passes 
about  10  c.  c.  at  a  time  with  a  great  deal  of  blood ;  has  a  great  deal  of  pain  in 
abdomen;  feet  and  penis  cedematous  ;  some  discharge  from  penis  of  foul  odor; 
no  history  of  stricture;  on  admission  complained  of  a  catching  pain  under 
heart,  with  labored  respiration  ;  bowels  very  loose  and  passes  a  great  deal  of 
blood  at  each  action  ;  no  ai)petite ;  pains  in  region  of  kidneys ;  pulse  full, 
tense,  bounding,  and  frequent;  cardiac  action  tunudtuous ;  tongue  pale  and 
swollen  ;  some  hemorrhage  from  the  mouth. 

Treatment. — Elaterin,  infu.sion  of  digitalis  and  potassium  citrate,  spirits 
frumenti  and  strychnia. 

August  20. — Urine  analysis:  Specific  gravity,  1.025;  reaction,  acid;  color, 
pale;   albumen  present ;  sugar  absent. 

Patient  died  on  the  morning  of  August  25,  1903. 

Necropsy  (24  hours  after  death). — The  body  fairly  well  preserved,  and  shows 
old  syphilitic  scars  and  pigmentation.  Lymph  glands  enlarged.  Brain: 
Weight,  1,2.50  grams;  syphilitic  deposits  on  dura  mater.  Right  lung:  Weight, 
900  grams;  hyi)ostatic  congestion.  Left  lung:  Weight,  010  grams;  very  much 
smaller  than  right  lung;  hypostatic  congestion:  [)leura  adhered  to  lungs  in  dif- 
ferent places  and  contained  about  1,000  c.  c.  of  fluid.  Heart:  Weight,  310 
grams;  left  ventricle  hypertrophied ;  sclerotic  changes  in  vessels  and  deposits 
on  valves.  Spleen  :  Weight,  80  grams  ;  congested  and  contained  very  dark  spots. 
Liver:  Weight,  1,200  grams;  Gllsson's  capsule  very  much  thickened;  dark  dis- 
coloration over  liver;  gall  bladder  almost  empty;  syi)hilitic  deposits  over  liver. 
Right  kidney :  Weight,  170  grams ;  capsule  adherent.  Left  kidney :  Weight, 
240  grams ;  cai)sule  adherent.  Both  kidneys  contain  deposits,  congested,  and 
show  increased  connective -growth.  Bladder  distended  and  mucous  membrane 
thickened.  Penis  cedematous  and  gangrenous.  Intestines  distended  w'ith  gas, 
yellowish  gray  in  color. 

W.  T.  B. 
VII. 

C.  L. ;  age,  4G ;  nativity,  Finland;  admitted  to  the  United  States  Marine  Hos- 
pital, San  Francisco,  Cal.,  March  3,  1904;  died  March  11,  1904. 


PUBLIC    HEALTH    AND    MARINP>HOSl'lTAL    SERVICE.  487 

History. — Tlio  i)atioiit  had  boon  sick  for  about  a  wook.  He  complained  of 
hoadacho.  diarrbica,  jj:r»>at  weakness,  cramps  in  liis  li'^s,  and  frc(|ucnt  vomiting. 
Kxan)ination  sliowcd  tliat  the  area  of  lieart  dullness  was  increased;  a  systolic 
nun-nuir  was  heard  at  the  ai)ex  ;  i)ulse,  72;  moist  rfiles  were  present  over  ai)ex 
of  left  Inn?:;  e.\i)iration  loud  and  blowins  at  base  of  ri«ht  lunj; ;  abdomen  ten- 
der on  pressure;  skin  cold,  but  not  clannny ;  a  few  eccbymotic  spots  were 
found  over  chest;  urine  small  in  amount,  albumen  present  in  large  (juantity  ; 
microscoi)icaIly  showed  granular,  epithelial,  and  hyaline  casts,  also  large  num- 
ber of  oxal.-ite  crystals;  tempe;-alnr(>  was  subnormal  throughout  his  sickness; 
r(>s|>i  rat  ions  were  normal  until  March  S,  when  a  lerminal  i)neumonia  developed 
in  the  bases  of  both  lungs;  sever(>  cough,  with  prune-juici'  expectoration  con- 
taining dii)lococcus  i)nenmoni:i.  was  present.  There  was  dullness  over  the  base 
of  both  lungs  and  rough  breathing  over  the  whole  chest.  lie  finally  died  from 
exhaustion  at  1.10  p.  m.,  March  11,  1!)04. 

Necropsy  (22  hours  after  death). — Scar  on  nose  extending  from  tii)  to  inner 
angle  of  left  eye;  rigor  mortis  well  marked.  Brain:  Weight,  l,r>2r>  grams;  a 
great  deal  of  congestion  is  present  and  the  large  vessels  at  base  have  numerous 
yellow  atheromatous  jjatches.  Heart :  Weight,  425  grams  ;  right  ventricle  con- 
tains a  goose-fat  clot;  valves  of  right  side  normal;  leaflets  of  mitral  valve 
nuich  thickened  and  several  atheromatous  plaques  present;  aortic  valve  nor- 
mal ;  heart  muscle  pale.  Right  lung  bound  down  by  strong  adhesions  to  chest 
wall,  pericardium,  and  diaphragm;  weight,  755  grams;  tissue  very  soft; 
upper  lobe  crepitant,  very  bloody,  and  has  the  appearance  of  currant  jelly ; 
lower  lobe  noncrepitant,  tissue  pulpy,  tears  easily,  and  cuts  with  diminished 
resistance.  Left  lung  hard  to  remove  on  account  of  adhesions ;  weight,  750 
grams;  tissue  similar  to  right  lobe.  Spleen:  Weight,  115  grams;  pulp  soft, 
color  dark  red ;  suprarenals  apparently  normal.  Left  kidney ;  Weight,  235 
grams;  capsule  strips  easily,  but  takes  a  little  tissue  with  it;  cortical  sub- 
stance congested,  color  reddish  yellow;  pyramidal  portion  pale;  pelvis  contains 
much  fat.  Right  kidney:  Weight,  195  grams;  condition  similar  to  left  kidney. 
Bladder  contains  turbid  urine;  walls  normal.  Urethra  normal.  Stomach: 
Mucous  membrane  shows  minute  hemorrhages.  Intestines  normal.  Appendix, 
4  cm.  long.  Liver ;  W^eight,  1,825  grams ;  cuts  with  diminished  resistance ; 
color  yellowish  brown  ;   section  dry  and  greasy  ;   biliary  ducts  patent. 

W.  G.  S. 

vm. 

H.  W. ;  age,  69  years  ;  nativity,  Massachusetts ;  admitted  to  the  United  States 
Marine  Hospital,  San  Francisco,  Cal.,  January  18,  1904 ;  died  March  22,  1904. 

History. — Uatient  stated  eight  days  ago  he  had  a  severe  chill  after  being  ex- 
posed to  a  cold  fog  while  sweating.  He  now  has  dyspnoea  and  coughs  up  a 
brownish  sputum.     He  has  no  appetite  and  can  not  sleep  at  night. 

Examination.^ — Temperature,  38.2°;  pulse,  88;  respiration,  40.  The  area  of 
the  heart  dullness  is  increased  to  the  left.  A  loud  blowing  murmur  during  the 
entire  systole  and  lasting  into  the  diastole  is  heard  over  the  chest.  There  is 
dullness  over  the  base  of  the  left  lung  and  the  vocal  fremitus  is  increased. 
Rales  are  also  present  at  this  point.  A  petechial  eruption  is  present  on  the  skin. 
Urine;  Only  500  c.  c.  passed  in  twenty-four  hours.  It  contains  albumen  in  large 
quantities.  The  microscope  sIionas  the  presence  of  hyaline,  granular,  and  epi- 
thelial casts.  During  February  dropsy  developed.  His  legs  became  so  large 
the  skin  broke  and  large  quantities  of  water  oozed  out.  Ulcers  formed  and  were 
kept  in  a  clean  condition  with  ditticulty.  The  pulse  was  frequently  intermittent, 
but  the  tension  was  never  great.  He  became  very  feeble  in  March.  His  mind 
wandered,  and  he  was  extremely  weak.  Several  days  before  death  the  dropsy 
entirely  disappeared. 

On  March  22,  1904,  he  passed  into  a  state  of  coma,  the  extremities  became 
cold,  and  he  died  at  7.30  a.  m. 

Necropsy  (3  hours  after  death). — American  eagle  tattooed  on  left  forearm; 
star  on  left  wrist ;  lower  limbs  oedematous  ;  large  superficial  ulcer  on  right  leg ; 
rigor  mortis  not  well  marked.  Brain  :  Weight.  1,325  grams ;  tissue  apparently 
normal,  but  arteries  at  base  show  many  yellowish  atheromatous  patches.  Ster- 
num removed  ;  very  little  ossification  of  costal  cartilages.  Lungs  do  not  meet  in 
the  middle  line ;  pericardium  bound  by  adhesions  to  each  lung.  Pleural  cavities 
contain  fluid  in  small  amount.  Heart :  Weight,  625  grams ;  wall  of  right  ven- 
tricle 1  cm.  thick  ;  valves  of  right  side  normal ;  wall  of  left  ventricle  3  cm. 
thick ;  cavities  of  heart  not  dilated ;  both  leaflets  of  mitral  valve  much  thick- 
ened and  infiltrated  with  calcareous  particles,  one  at  base  of  outer  leaflet  being 


488  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

as  large  as  a  poa  :  inner  leaflet  of  mitral  valve  much  shortened ;  the  aortic 
valves  consist  of  dense  fibrous  tissue,  tilled  with  calcareous  deposit,  covered  by 
thickened  endothelium  ;  the  blood  vessels  of  the  heart  are  dilated,  especially  the 
veins,  and  there  are  large  lumps  of  fat  between  the  muscular  fibers:  a  small 
atheromatous  patch  is  ])resent  in  the  aorta  about  1  inch  above  the  aortic  valve. 
Right  lung:  Adherent  to  diaphragm  by  separable  adhesions:  weight.  390  grams; 
the  upper  and  middle  lobes  are  bound  together  so  tightly  that  it  is  difficult  to 
find  the  spot  where  the  lobes  meet :  the  middle  and  lower  lobes  are  bound  by 
separable  adhesions:  color  of  lung  on  section  grayish  red:  only  a  little  bloody 
fluid  oozes  out;  tissue  crepitant  throughout  and  apparently  normal.  Left  lung: 
Weight,  340  grams;  crepitant,  and  tissue  in  good  condition.  Abdomen  opened 
by  median  incision:  very  little  fat  in  abdominal  walls  or  in  omentum.  Spleen: 
Weight,  145  grams :  cuts  with  increased  resistance :  pulp  hard :  ti-abecul.ie 
prominent:  vessels  dilated:  left  suprarenal  capsule  firm  and  in  good  condition. 
Left  kidney:  Weight.  155  grams:  there  are  5  small  cysts  on  surface  filled  with 
serum  ;  section  shows  that  the  cortical  substance  on  the  border  of  kidney  has 
nearly  disappeared,  so  that  the  capsule  is  ai)i)arently  in  places  attached  directly 
to  the  pyramids  :  these  are  of  a  deep  red  c(»lor.  the  tissue  between  them  being  of 
a  dirty  gray  color:  pelvis  filled  with  fat;  ui'cter  patent;  right  su])rareual  cap- 
sule normal.  Right  kidney:  Weight,  145  grams;  condition  similar  to  left  kid- 
ney. Bladder  contains  2(t()  c.  c.  of  turbid  urine;  walls  normal.  Organs  of  gen- 
eration and  rectum  normal.  Mucous  membrane  of  duodenum  and  stomach  con- 
gested;  gall  ducts  patent:  gall  bladder  contains  a  small  quantity  of  dark  brown 
bile.  Liver:  Weight.  1.705  grams;  section  shows  a  mottled  api)earance,  owing 
to  the  deeply  congested  hepatic  and  anremic  portal  territories ;  the  connective 
tissue  is  increased  and  the  vessels  are  dilated  :  tissue  is  dry  and  greasy  to  the 
touch.  Pancreas,  solar  plexus,  mesentery,  intestines,  and  great  vesseLs  normal. 
Appendix  6  cm.  long.     Blood  vessels  congested,  otherwise  apparently  normal. 

W.  G.  S. 
IX. 

J.  W. ;  colored ;  age,  45 ;  nativity,  Massachusetts ;  admitted  to  United  States 
Marine  Hospital,  Baltimore,  Md.,  February  12.  1!)04 ;  died  February  lO,  1904. 
When  admitted  was  in  a  semiconscious  condition,  with  irregular,  weak  pulse. 
90  per  minute:  respiration.  22  per  minute,  and  of  Cheyne  Stokes  character;  tem- 
perature, subnormal.  This  condition  contituied  during  the  four  days  following 
his  admission  to  the  hospital,  with  suppression  of  urine,  increasing  delirium, 
and  increased  irregularity  of  pulse.  Urine  was  highly  albumenous,  containing 
many  dark,  .granular  casts.  Examination  of  the  heart  elicited  no  murmurs, 
although  there  was  decided  irregularity,  weakness,  and  loss  of  tone  of  the 
heart  sounds.  At  the  base  of  the  left  chest,  in  the  anterior  axillary  line,  many 
distinct,  crepitant  rales  were  heard  at  the  end  of  inspiration. 

Clinical  diagnosis. — I'arenchymatous  nephritis;  chronic  myocarditis;  pneu- 
monia, catarrhal,  left. 

Necropsy. — Body  of  a  poorly  nourished  nuilatto ;  height,  5  feet  7  inches ; 
weight,  approximately  128  to  130  pounds;  section  shows  all  organs  in  normal 
position  and  relation.  The  left  pleural  cavity  is  entirely  obliterated  by  dense 
adhesions.  The  left  lung  is  torn  upon  removal,  and  is  dark,  bluish  red  in 
color.  The  lower  lobe  is  firm  to  the  touch.  The  apex  is  contracted,  and  many 
small  nodules  can  lie  felt  uiiou  pressure.  Section  shows  a  moderately  dissem- 
inated consolidation  of  the  lower  lobe,  which  is  dark  red  in  color.  The  apex 
upon  section  is  grayish  red  in  color,  is  distorted  by  the  contraction  of  fibrous 
trabecula:»,  which  are  evidently  the  result  of  a  chronic  tubercular  process.  The 
right  pleural  cavity  is  normal.  The  lung  is  grayish  pink  in  color,  and  on  sec- 
tion shows  a  cicatricial  contraction  of  the  ai)ex,  which  is  probably  the  result 
of  a  chronic  fibroid  tubercular  process.  The  pericardium  contains  25  c.  c.  of 
clear  serum.  The  heart  is  greatly  enlarged,  reaching  the  size  of  two  adult 
clinched  fists.  The  cardiac  muscle  is  yellowish  red  in  color,  showing  evidences 
of  fatty  change,  iirobably  degenei-ation.  The  left  ventricular  walls  are  3  cm. 
in  thickness,  and  the  left  ventricular  cavity  is  perhaps  slightly  enlarged.  The 
valve  leaflets  appear  slightly  thickened,  but  otherwise  are  normal.  The  walls 
of  the  other  cavities  are  of  normal  thickness.  The  spleen,  of  normal  size  and 
consistence,  is  bound  to  the  diaphragm  and  left  lolie  of  the  liver  by  dense, 
fibrous  adhesions.  The  liver  is  of  normal  size,  is  yellowish  brown,  and  is  mac- 
roscopically  a  fairly  fatty  organ.  The  left  kidney  weighs  100  grams.  It  is 
shrunken,  pale,  grayish  red  in  color,  and  on  section  shows  marked  contraction 


IMrin.lC    IIKALTTI    AND    M  Mil  NK-IK  tSl'ITAL    SKKV1(5K.  489 

of  tiio  corlicnl  sulisliiiicc  The  ciiiisnlc  is  icirlly  adiicrcni.  and  l)oii('a(li  tlic  cap- 
sul(>  arc  s(H'ii  four  iw  live  small  serous  cysts,  raiijiiiiir  in  size  fi'oni  a  niiilol  scod 
to  a  si)lit  pea.  'i'lio  i-i.i,'lit  kidney,  in  addition  (o  I  lie  i-liaractei-istics  presented 
liy  (he  left  or.iian,  shows  pus  in  the  ix'his. 

Anai'omu'ai,  diaonosis. —  rneunionia,  catarrhal;  lihroid  phthisis;  hy))ertroi)hy 
of  left  ventricle;  fatty  dei^eneration  of  heart;  chronle  parenchymatous  and 
interstitial  nei)hritis. 


II.  R.  C. 
('.  VV.  W. 


X. 


A.  W. ;  iiffo,  40;  nativity.  Virginia;  adnnttod  to  United  States  Marine  Hos- 
pital.  .Mobile.  Ala..  October  1.  1!)(t:'. ;  died  Noveml)(>r  12.  l<»(t:',. 

Family  iiisToiiv. — Mother  died  at  1^>  years  of  a.ue,  cause  "old  a^e ;"  father 
died  at  HO  years  of  a.uce.  cause  of  death  unknown;  no  brothers  living;  2  dead, 
1  drowned  at  21»  y(>ars  of  a.iie,  and  1  died  at  .^>.'">  years  of  aj^e,  cause  unknown; 
1  sister  liviiii^,  health  jj;<'Od;  2  sisters  dead;  1  die<l  at  lir>  years  of  aso  from 
smallpox,  and  1  at  r>0  years  of  af;:e,  cause,  cancer  of  uterus. 

Personal  history. — Gonorrhea  seventeen  or  eij^hteen  years  ago;  ulcer  of 
lienis  twenty  years  a.c;o ;  no  secondary  erui)tion  ;  says  never  had  rheumatism; 
when  admitted  was  very  weak  and  unable  to  control  flow  of  urine;  iirinating 
every  few  minutes. 

Patient  v.(>nt  from  bad  to  worse,  dying  November  12,  100.",,  at  il4r>  p.  m. 

Necropsy  (1.">  hours  after  death). — Body  of  a  negro  male,  forty-odd  years  of 
age;  gre.atly  emaciated;  rigor  jnoi'tis  well  marked.  P.ody  opened  by  long  inci- 
sion from  chin  to  syniiihysis  pubis.  Spleen  shriveled,  soft,  and  flabby;  weighs 
125  grams.  Right  kidney  very  much  congested;  impossible  to  i)eel  without 
tearing.  The  line  of  demarcation  between  the  cortical  and  the  medullary 
substance  well  marked  ;  weight  of  right  kidney  is  24.5  grams.  The  whole  of 
the  left  kidney  is  adherent  and  contains  many  calculi,  one  weighing  20  grams, 
and  one  2  grams;  capsule  tears  on  peeling.  Line  of  demarcation  between  the 
cortical  and  the  medullary  substance  not  well  marked.  The  stomach  greatly 
distended  and  cont.nins  about  2150  c.  c.  of  undigested  food.  Aiipendix  is  con- 
gested and  bound  down.  The  urinary  bladder  very  much  congested  and 
contains    a  small  amount  of  urine.     Cause  of  death,  ur«>mia. 

J.  H.  W. 
EMPYEMA. 

M.  D.  ;  mulatto;  age.  32  ;  nativity.  North  Carolina  ;  admitted  to  marine  ward, 
Ilositital  of  St.  Vincent  of  Paul,  Norfolk,  Va.,  February  19,  1904;  died  March 
1.5,  1904. 

Family  history. — Negative. 

Personal  history. — Patient  had  gonorrhea  about  two  years  ago  ;  chills  and 
fever  last  summer ;  recently  he  has  been  exposed  to  an  atmosphere  laden  with 
coal  dust;  now  he  complains  of  shortness  of  breath,  es[)ecially  on  exertion,  and 
slight  cough  with  scanty  expectoration  :  also  from  dull  pains  in  chest  and  lum- 
bar regions;  bowels  costive,  urine  normal,  ajtpetite  good. 

Physical  examination. — Patient  fairly  well  nourished;  tongue  clean:  phar- 
ynx shows  catarrhal  congestion  ;  breathing  distinctly  audible  and  wheezing  in 
character;  heart  sounds  normal.  Lungs:  Sil)ilant  and  sonorous  r.ales  heard  dis- 
tinctly over  entire  lung  surface,  intensified  during  expiration  (an  expiatory 
dyspncea).  Abdomen:  Slight  tenderness  in  right  iliac  region.  Spleen  not 
enlarged. 

Fchniarij  22. — Dyspnoea  much  improved;  a  few  moist  rales  are  heard  in  right 
axillary  line;  cough  is  now  accompanied  by  mucopurulent  expectoration. 

Frhniani  21!. — Since  admission  temi)erature  i-ecord  shows  a  daily  range  from 
?u°  C.  a.  m.  to  H?t°  to  40°  C.  p.  m.  Pulse  88  to  100;  respirations  24  to  .32; 
no  apparent  change  in  patient's  condition  ;   he  suffers  no  pain. 

March  3. — Fever  continues  high,  with  morning  remissions  and  a  rather  pro- 
fuse sweat  this  morning;  patient  is  an;pmic  and  losing  flesh;  examination  of 
sputum  shows  no  tubercle  bacilli,  but  many  staphylocci  and  jjueumococci.  and 
a  few  streptococci  ;    leucocytes  nuuiber  10,-500. 

March  10. — Temperature,  pulse,  and  respiration,  as  above  recorded  ;  patient 
complained  of  chilliness  and  he  perspired  freely  this  morning,  followed  by  nau- 
sea and  vomiting. 

March  12. — Patient  perspired  all  day  yesterday,  and  was  very  restles?  and 
coughed  a  great  deal  last  night ;  he  complains  of  thirst,  but  is  free  from  pain. 


490  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

Leucocyte  count,  18.200.  There  is  sji^litly  diminished  vocal  fremitus  in  thg 
right  axilhiry  region,  but  no  Imlging  or  (edema  of  cliest  wall.  The  percussion 
note  is  not  altogether  clear,  but  there  is  no  distinct  line  of  dullness;  vocal  reso- 
nance is  slightly  diminished. 

March  J '/. — Patient  complains  of  sevei'e  pain  in  right  mammary  and  axillary 
regions  and  this  afternoon  suffers  from  expiratory  dyspnoea,  also  from  muscular 
I)ains  in  arms  and  lumbar  region. 

Murch  1.'),  a.  m. — Patient  rested  fairly  well  last  night.  His  mind  is  clear  and 
he  suffers  no  pain  this  morning.  Tem])erature  at  (J  a.  m.,  3<j.2°  C. ;  pulse,  144; 
respiration,  4S.  At  O.l.j  a.  m.  he  asked  permission  to  smoke,  and  a  few  minutes 
later  he  closed  his  eyes  and  died  without  a  struggle. 

Xkckopsy  (7  hours  after  death). — Height  1.78  meters;  rigor  mortis  moderate; 
general  iHJurishment  i)()or.  Heart:  Weight  (after  opening),  315  grams;  myo- 
cardium, the  cavities  and  thickness  of  walls  are  normal  ;  all  valves  are  compe- 
tent;  ])ericardial  sac  cf)ntains  normal  amount  of  clear  fluid.  Nares,  larynx,  and 
trachea  normal.  Left  hnig:  Weight,  0.30  grams;  the  organ  is  slightly  retracted 
at  the  apex;  color  normal.  The  bronchial  glands  at  the  bifurcation  of  the 
trachea  are  enlarged.  Pleural  cavity  normal.  Right  lung:  Weight,  780  grams; 
the  organ  is  retracted  at  the  apex  and  slightly  comin-essed  at  lower  lobe,  but 
it  crepitates  when  handled;  the  surface  is  smooth  and  mottled:  dark  slate 
color;  on  section  a  frothy  mucopurulent  fluid  exudes;  there  are  no  consolidated 
areas.  I'lural  cavity:  In  the  auxiliary  line,  o|>posite  the  nipi)le,  the  surfaces  of 
the  pleura  are  covered  with  a  thick,  soft  layer  of  lymph,  between  which  a  small 
quantity  (about  00  c.  c. )  of  fibrino-purulent  fluid  has  collected;  directly  below 
this  area  the  lung  is  adherent  to  the  wall  of  the  chest.  Peritoneum  normal. 
Stomach:  The  nmcous  membrane  is  pale;  intestines  are  slightly  distended 
with  gas.  Liver:  Enlarged;  weight,  2.4ij0  grams;  color,  normal,  (iall  bladder 
and  ducts  normal.  Pancreas:  Normal;  weight  75  grams.  Both  kidneys  show 
moderate  congestion;  left,  weight  ISO  grams;  right,  weight  175  grams.  Blad- 
der and  ureters  normal  ;  urethra  and  ])rostate  nonii;il.  Supr.-irenal  bodies 
normal ;  left,  weight  3.5  grams ;  right,  weight  4  grams.  Spleen,  weight  310 
grams.  The  organ  is  slightly  enlarged,  but  otherwise  apparently  normal. 
Other  organs  not  examined. 


J.  B.  S. 


ENTERIC   FEVER. 


A.  I. ;  age,  24 ;  nativity,  Finland  ;  admitted  to  the  United  States  Marine 
Hospital,  San  Francisco,  c'al.,  March  5,  11)04;    died  March  15,  1004. 

History'. — Patient  has  been  sick  seven  days.  He  has  had  headache,  epistaxis, 
diarrhoea,  fever,  and  great  weakness,  with  no  appetite. 

Examination  showed  small  red  papules  scattered  over  abdomen  and  chest. 
Expression  apathetic;  tongue  heavily  coated;  cheeks  flushed;  heart  negative; 
roughened  breathing  over  entire  loft  lung;  abdomen  tympanitic,  tender  on  pres- 
sure ;  si>leen  enlarged ;  stools  of  a  yellowish-green  color.  Temperature,  39.0° 
V. ;  jjulse,  04  ;  respiration,  24.  The  temperature  remained  very  high  until  March 
0.  cold  baths  being  necessary  frequently.  On  that  date  he  had  a  hemorrhage  from 
his  bowels.  After  this  the  temperature  range  was  half  a  degree  lower,  but  still 
continued  high.  He  had  another  slight  hemorrhage  on  the  1.3th,  and  at  that 
time  became  delirious  and  very  restless.  He  died  from  exhaustion  at  2.25  a.  m. 
March  15,  1004. 

Necropsy  (10  hours  after  death). — Length  of  body,  5  feet  11  inches;  rigor 
mortis  marked.  Brain:  Weight,  1.075  grams;  tissue  normal;  color  of  muscles, 
on  section,  very  dark  red  ;  on  renioving  the  sternum  the  thymus  gland  is  found 
to  be  present,  extending  downward  as  far  as  the  second  rib.  Heart:  Weight, 
435  grams ;  a  chicken-fat  clot  is  found  in  the  right  ventricle ;  valves  normal. 
Left  lung:  Weight,  750  grams;  color,  grayish  red;  crepitant  throughout; 
lower  lobe  nmch  darker  red,  especially  at  base  and  on  posterior  surface;  bloody 
frothy  fluid  oozes  out  freely  on  section.  Right  lung:  Weight,  735  grams;  con- 
dition similar  to  left  lung.  Spleen:  Weight.  .355  grams;  tissue,  soft;  section, 
bloody;  pulp,  prominent ;  color,  dark  red.  Suprarenals,  normal.  Left  kidney : 
Weight,  235  grams ;  capsule  strips  easily ;  section,  bloody ;  cortex,  swollen ; 
yellowish-red  markings  ;  pyramids  prominent,  deeply  congested.  Right  kidney  : 
Weight,  275  grams;  condition  similar  to  left  kidney.  Bladder  and  stomach, 
normal.     Appendix  long;    lumen  slightly  constricted   in  places.     The  mucous 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  491 

nuMnbraiit'  of  tlio  ikMiin  for  its  lower  li  feet  shows  uuinerous  small  round  and 
oval  ukers  with  smooth  bases  and  soft  edges.  None  of  these  ulcers  have  per- 
forated the  intestinal  wall.  Liver:  Weij^ht,  2.;!.S<)  j^ranis ;  .section,  jiale  red  with 
yellowish  areas;  tissue  jjrea.sy ;  lobules  not  well  outlined,  on  the  surface 
areas  showing  c(»n;,'ested  lilood  vessels.  (Jail  bladder  contains  about  a  teaspoou- 
fnl  of  bile;  };all  ducts  i)atent.  A  culture  made  from  the  siileen  shows  the  i»res- 
eiice  of  bacillus  typhosu.s. 

W.  G.  S. 
XL 

J.  W. ;  age.  .'^.''> :  native  of  Sweden;  entered  the  marine  division  of  the  Buf- 
falo Hospital  of  the  Sisters  of  Charity  on  Septemlier  0  and  died  Oct()l)er  4,  V.Hy.i. 

History. — The  patient  can  not  s[)eaU  Kiiglish  and  can  give  no  history. 

I'KESE.NT  co.NDrno.N. — Through  an  interpreter,  it  was  with  difficulty  ascer- 
tained that  he  had  been  ill  four  days.  The  face  is  flushed,  eyes  suffused,  and 
tongue  red  and  pointed.  There  is  cough  and  profuse  expectoration;  the  abdo- 
men is  tender  in  the  right  fossa,  and  there  is  diarrhtea  ;  the  apices  of  the  lungs 
are  tuberculai-;  there  are  moist  rales,  prolonged  expiration,  and  high-pitched 
percussion  note.  In  the  middle  and  lower  lo!)es  of  the  right  lung  thei-e  is  well- 
marked  paresis;  the  breath  sounds  enfeebled;  numerous  shrill,  sibilant  i-files 
with  a  few  moist  rales  throughout  this  area;  the  percussion  note  anteriorlj'^ 
full  and  sonorous,  while  posteriorly  it  is  higher  pitched;  the  left  lower  lobe  is 
puerile  in  its  breathing,  percussion  note  loud  and  resonant;  the  spleen  is  at  the 
midaxillary  line,  and  palpable  at  the  costal  border;  the  blood  pressure  is  1G4 
nnu.  of  mercury  ;  the  temperature  is  39°  C.  and  the  pulse  90.  The  course  of  the 
typhoid  fever  ran  smoohly  ;  rose  spots  appeared  on  the  seventh  day,  and  the 
Widal  reaction  was  positive  on  the  ninth  day,  and  the  temperature  became 
normal  on  the  fourteenth  day  of  illness.  On  the  next  day  all  symptoms  became 
worse,  the  left  lung  became  paretic,  and  the  paretic  portions  of  the  right  rapidly 
developed  a'dema  ;  dyspnoea  was  extreme.  From  the  fifteenth  to  the  twenty-tirst 
days  this  paretic  cedema  continued,  and  death  from  failure  of  the  right  heart 
was  inuninent.  but  thereafter  it  improved  with  amelioration  of  all  symptoms 
until  the  morning  of  the  twenty-ninth  day,  when  a  copious  hemorrhage  from  the 
left  apex  occurred,  and  he  died. 

Necropsy  (14  hours  after  death). — Body  of  an  adult  male;  moderately  emaci- 
ated; rigor  mortis  well  marked;  hypostasis  of  the  dependent  portions  of  the 
trunk;  two  slight  echymoses  on  the  chest  wall  at  site  of  saline  injections; 
the  pupils  widely  dilated.  The  abdomen  opened  by  median  incision ;  the  peri- 
toneum is  normal ;  the  mesentery  of  the  small  intestine  is  engorged,  and  its 
glands  enlarged  ;  incision  of  the  lower  portion  of  the  ileum  showed  several 
recently  healed  ulcerations  in  the  Peyer's  glands;  the  spleen  somevrhat  enlarged; 
the  kidneys  congested;  the  liver  normal  macroscopicallj- ;  the  pericardium  nor- 
mal ;  the  right  heart  distended  with  semiclotted  blood,  the  left  contracted,  the 
heart  muscle  pale  and  fatty.  The  right  pleura  is  adherent  at  the  apex  and  pos- 
teriorly over  the  middle  lobe ;  the  left  pleura  is  generally  adherent  over  the  upper 
lobe.  Both  apices  are  in  caseous  degeneration ;  the  right  lower  and  middle 
lobes  are  cedematous,  yet  sections  float  in  water  bath,  and  pressure  shows  the 
pre.sence  of  considerable  quantities  of  air  in  the  lung  spaces ;  the  lower  left  lobe 
is  congested.  In  the  lower  border  of  the  left  upper  lobe  there  is  a  small  cavity, 
2  cm.  in  diameter,  filled  with  recent  blood  clot,  the  seat  of  the  fatal  hemorrhage. 
From  the  tubercular  foci  the  bacillus  tuberculosis  was  readily  stained,  and  in 
the  paretic  areas  on  the  right  side  rounded  rods  in  great  numbers  staining  as 
the  bacillus  of  Eberth  were  found. 

E.  W. 

III. 

J.  W. ;  age.  20 ;  nativity'.  Norway ;  admitted  to  the  United  States  Marine 
Hospital,  Boston,  Mass.,  on  February  28,  1904,  and  died  on  February  29,  1904. 

History'. — Family  and  ])revious  history  were  negative.  Patient  was  brought 
to  the  hospital  iu  the  ambulance ;  complained  of  occipital  headache,  tenderness 
over  the  abdomen,  diarrhoea,  no  appetite,  and  fever.  Temperature  was  39.2°  C, 
spleen  enlarged,  and  the  patient  was  very  weak. 

Treatment. — Patient  was  put  to  bed  and  cold  bath  given  at  once.  This 
was  repeated  every  hour;  ten  grains  of  quinine  and  one  Dover's  powder  were 
also  given. 


492  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

I'chnntnj  2!),  lOOJ/. — Patient  delirious ;  temperature  dropped  suddenly  2°  C. ; 
was  very  weak,  and  stimulants  were  used  every  Lour.  Died  at  1.38  this 
morning. 

Necropsy  (12  hours  after  death). — Body  was  that  of  a  well-developed  but 
much  emaciated  young  man ;  rigor  mortis  well  marked ;  post-mortem  sug- 
gillations  well  marked. 

Thorax  :  Left  pleura  was  adherent  and  showed  some  inflammation,  and  was 
slightly  emphysematous.  Right  pleura  was  normal.  Pleural  cavity  contained 
75  c.  c.  of  serous  fluid.  Right  lung  showed  pneumonic  changes  at  the  apex  and 
middle  lobe ;  was  extremely  oedematous,  and  cut  section  sank  in  water ;  weight, 
1)00  grams.  Left  lung  showed  hypostatic  pneumonia  and  about  the  same 
changes  as  in  the  right  lung;  weight,  500  giams.  Pericardium  contained  05  c.  c. 
of  straw-colored  fluid.  Heart  was  normal ;  weight,  330  grams.  Alxlomen : 
Left  kidney  showed  slight  congestion  and  capsule  stripped  easily  ;  weight,  250 
grams.  There  was  extensive  hemorrhage  into  the  left  perinephritic  tissue,  and 
into  the  left  psoas  muscle.  Right  kidney  was  slightly  congested,  and  capsule 
stripped  easily ;  weight,  220  grams.  Liver  was  normal ;  weight.  2,100  grams. 
Gall  bladder  empty.  Spleen  was  highly  congested  and  considerably  softer 
than  normal ;  weight,  700  grams.  Stomach  was  normal.  Intestines  showed 
enlargement  of  solitary  follicles  and  ulceratir  i  of  Peyer's  patches  in  the  ileum 
and  ascending  colon  ;  mesenteric  glands  were  considerably  enlarged.  Pancreas 
was  normal :  weight.  120  grams.  liladder  was  empty  and  walls  seemed  con- 
siderably thinner  than  normal.  Brain  showed  a  slight  softening  of  cerebellum ; 
weight,  1,220  grams. 

R.  M.  W. 

W.  C.  R. 

J.  D.  F. 
IV. 

N.  N. ;  age.  24 ;  nativity,  Norway ;  admitted  to  the  marine  wards  of  the 
Gei-man  Hospital,  Philadelphia,  Pa.,  .Tanuary  30,  and  died  February  10,  1904. 

Clinical  diagnosis. — Typhoid  fever,  right  pleuro-pneumonia. 

Anatomical  diagnosis. — Typhoid  fever;  acute  splenic  tumor;  catarrhal  pneu- 
monia of  right  base ;    acute  parenchymatous  nephritis. 

Necropsy  (24  hours  after  death). — Body  that  of  a  well-developed  male; 
weight,  180  pounds ;  height,  5  feet  10  inches ;  post-mortem  lividity  present  over 
back  and  buttock.  The  left  pupil  is  slightly  larger;  both  are  dilated.  There 
were  fibrino-plastic  adhesions  anteriorly  and  at  the  apex  between  the  left  lung 
and  pleura.  The  left  pleural  cavity  contained  200  c.  c.  serous  fluid.  Some 
hypostatic  congestion  of  left  lower  lobe.  Fibrinous  adhesions  present  pos- 
teriorly between  the  right  lung  and  pleura.  The  right  pleural  cavity  contained 
300  c.  c.  serous  fluid.  The  right  lung  weighed  .500  grams;  marked  congestion  of 
lower  part  of  lower  lobe;  no  crepitation.  Heart  and  pericardium  were  normal. 
Abdomen  :  Transverse  colon  horseshoe-shaped ;  fibrous  adhesions  around  gall 
bladder;  gall  bladder  and  liver  otherwise  normal.  Spleen:  Weight,  G.55  grams; 
length.  17  cm. ;  width,  12  cm. ;  thickness,  8  cm.  ;  pulp  increased,  consistency 
diminished,  capsule  tense,  follicles  not  prominent.  Right  kidney  weighed  275 
grams;  capsule  strip]x>d  easily;  surfa^'e  smooth  and  yellowish  red;  section 
surface  dull  and  opaque;  color,  reddish  yellow.  Left  kidney:  Weight,  260 
grams;  capsule  stripped  easily;  surface  smooth  and  red;  section  surface  dull 
and  opaque;  color,  red;  the  mesentery  was  fatty  and  shows  enlarged  and 
softened  lymph  glands.  The  Peyer's  patches  in  ileum  were  swollen,  necrotic, 
and  ulcerated.  Brain:  Dura,  smooth  and  glistening:  arachnoid  moist  and 
oedematous  over  convexity ;    consistency,  normal ;    cerebellum  and  cord  normal. 

F.  I. 


C.  R. ;  age,  20;  nativity,  Finland;  admitted  to  the  United  States  Marine  Hos- 
pital, San  Francisco,  C.-^l.,  October  1,  1003;  died  October  3,  100.3. 

History. — The  patient  stated  he  was  taken  sick  eight  days  ago;  his  illness 
began  with  a  chill  and  two  days  later  he  had  pain  in  his  abdomen.  During  the 
last  three  days  he  had  vomited  often. 

Examination. — Patient  very  weak;  covered  with  profuse  sweat;  tempera- 
ture 37.9°  C;  pulse,  0(5,  hardly  perceptible  at  wrist;  respirations,  24;  general 
appearance  good;  very  little  emaciation;  abdomen  tympanitic  and  tender; 
lungs  normal;  heart  sounds  very  weak,  scarcely  audible;  spleen  and  liver  dull- 


I'UHLIC    HKAl/ni     AND    M AKINK-HOSI'ITAL    SKKVICE.  498 

iicss  iiuTc.isod;  \Vi(l;il  ivaction  positive  ;  urine— spocilic  Ki':»vity,  1.02.S ;  acid  reac- 
11(111.  .illiiiiiKMi  aluindaiil  :  bowols  constipated.  .Vt  S  p.  ni.  tlie  same  day  his 
alidoiiicn  was  jircatiy  swollen.  Iheiv  was  tenderness  on  pressure  over  its  wiiole 
surface;  the  i)atient  was  ai»atlietic;  ton.i^ne  dry.  sniall.  iiavin,!;  j^la/ed  appear- 
ance; face  drawn:  jiulse  weak,  conipressihle.  He  complained  very  little  of 
pain.  The  next  afternoon  he  liecanie  worse,  vomited  first  nnicus,  then  bile,  and 
(inally  fecal  matter.  He  !iad  profuse  sweats  and  the  jiain  had  to  he  controlled 
by  morphia.     He  died  from  exh.iustion  at  li.l'O  a.  m.  Octolter  .■>,  lOO:}. 

XKtKorsv  (!)  hours  after  death). — Rody  fairly  well  nourished;  heij,'lit  about 
<>  feet;  dark-brown  lluid  escapes  from  the  mouth  on  raisinj^  the  head.  I'.rain: 
Wei.i,'ht,  l.ri2(»  i^rams:  tissue  aiipareiitly  normal.  When  the  abdomen  is  opened 
;i  foul-smelling  .iras  est-ai)es.  The  entire  surface  of  the  peritoneum,  l»oth  viscera 
and  parietal,  is  covered  with  a  thick  la.\er  of  yellowish  lymph,  and  the  cavity 
contains  1.0(10  c.  c.  of  yellowish,  foul-smellinj;  liiiuid.  The  lymph  has  bound  the 
viscera  into  one  solid  mass,  so  that  it  is  dillicult  to  separate  one  structure  from 
another.  The  omentum  is  of  a  reddisb-f;;ray  color,  lying  on  the  intestines,  to 
which  it  is  intimately  adherent.  The  intestines  are  distended  with  gas  and 
are  of  a  dark  reddish-gray  color.  The  pericardium  is  filled  with  a  straws-colored 
Huid ;  the  right  ventricle  contains  a  small  chicken-fat  clot  extending  into  the 
I)ulmonary  arlery.  The  thickness  of  the  wall  of  the  right  ventricle  is  J  cm.,  of 
the  left  ventricle  Ij  cm.  The  valves  of  the  heart  are  normal.  The  heart  muscle 
is  of  a  bright  red  color.  Left  lung:  Weight,  <'i.'')0  grams;  crepitant;  reddish- 
gray  color ;  tissue  apparently  normal.  Right  lung :  Round  down  by  adhesions 
at  its  upiter  lobe;  weight.  ToO  grams;  tissue  same  as  other  lung.  Spleen: 
Weight.  KiO  grams;  tissue  bright  red  color;  on  section,  consistency  soft;  pulp 
firm,  bloody,  and  prominent.  Left  kidney:  250  grams;  measurement,  1.")  by  9 
by  3  cm.  There  is  a  cyst  size  of  a  pea  filled  with  yellowish-red  fluid  on  its 
anterior  surface;  the  ca])sule  strips  readily;  on  section  the  cortex  shows  marked 
yellowish  striations;  the  pyramids  are  of  deep  red  color.  Right  kidne.v: 
Weight.  250  grams ;  condition  same  as  opposite  kidney.  Stomach :  ^Mucous 
membrane  is  covered  with  a  dark-brown  sticky  sulistance;  on  washing  this  off 
the  membrane  shows  many  small  hemorrhages;  the  duodenum  is  in  the  same 
condition  as  the  stomach,  but  the  hemorrhages  are  more  marked  ;  in  the  wall 
of  the  ileum  are  numerous  ulcers,  two  of  which  have  perforated  the  intestines; 
the  perforations  are  about  ^  cm.  in  diameter,  the  mucous  meml)rane  of  the 
ileum  and  large  intestine  is  congested  and  hemorrhagic;  the  appendix  is  bound 
down  by  the  adhesions  similar  to  the  adhesions  which  bind  the  other  organs 
together;  it  is  slightly  swollen,  but  its  lumen  is  patent.  The  mesenteric  glands 
are  enlarged.  Liver:  Weight.  2,(j70  grams;  cuts  with  slightly  increased  resist- 
ance ;  very  pale ;  red  on  section. 

W.  G.  S. 
VI. 

B.  P.  ;  age,  o8 :  nativity,  Michigan;  was  admitted  to  the  United  States  Marine 
Hospital,  port  of  St.  Louis,  Mo.,  February  28,  and  died  February  29,  1904. 

History. — Patient  was  brought  to  the  hospital  in  a  very  feeble  condition,  and 
respiration  were  .■'>T.2°  C,  00.  and  21,  respectively.  He  was  given  stimulants. 
He  could  give  no  history  of  his  case  olher  than  he  had  been  ill  for  some  time, 
and  had  finally  concluded  to  enter  this  hospital. 

Necropsy  (4  hours  after  death). — Body  that  of  a  young,  adult,  white  male, 
muscular  and  fairly  well  nourished;  skin  somewhat  .laundiced ;  rigor  mortis 
well  pronounced:  pupils  evenly  dilated;  abdomen  slightl.v  distended,  and,  on 
section,  discharging  a  large  quantity  of  purulent  serum  mixed  with  fecal  matter 
and  of  a  markedl.v  fecal  odor;  lungs  collapsed;  no  adhesions  to  chest  wall; 
l>leura  dry;  jsericardial  sac  contains  50  c.  c.  of  clear  fluid.  Heart:  Weight, 
270  grams:  right  auricle  contains  ante-mortem  clots;  left,  fluid  blood;  valves 
normal;  visceral  pericardium  somewhat  thickened.  Left  ventricle  contracted; 
right,  dilated.  Lungs :  Left,  weight,  200  grams ;  ci'epitates  in  all  parts :  on 
section  showing  little  blood;  right,  weight,  320  grams:  some  marginal  emphy- 
sema. Bronchial  nmcosa  slightly  congested.  Intestines  matted  together  by 
recent  fibrinous  material,  particularly  in  lower  abdominal  and  pelvic  cavities. 
Mesenteric  glands  considerably  enlarged,  rather  soft.  Ileum  site  of  perforation  14 
cm.  above  ileo-ca-cal  valve  :  and  two  other  ulcerations,  one  20  cm.  above  that  valve 
and  one  at  its  margin.  Ulcerations  elliptical  in  shape,  long  axis  transverse  to 
gut.  S[>leen  very  nuich  enlarged :  firm  :  pulp  does  not  scrape  off  readily  on 
knife;  like  currant  jelly;  capsule  .strips  readily;  weight,  320  grams.  Gall  duct 
patulous.     Stomach  mucosa  pale,  otherwise  normal.     Kidneys:  Capsules  strip 


494  PUBLIC    HEALTH    AKD   MARINE -HOSPITAL    SERVICE. 

rojulily  ;  cortex  somewhat  mottled  and  thickened,  showing  toxic  pai'enchymatous 
nephritis  witli  fatty  degeneration  somewhat  advanced  in  glomeruli ;  right  some- 
what paler  than  left ;  weight,  right,  105  grams ;  left,  180  grams.  Liver : 
Weight,  1.820  grams;  right  lobe  superior  surface  shows  fibrinous  patches;  on 
section  rather  pale,  with  uniform  yellow  mottling  throughout,  apparently  indi- 
cating ])arenchymatous  hepatitis.  Gall  bladder  contains  100  c.  c.  of  very  dark, 
almost  insi)issated  bile.  I'ancreas  normal.  The  findings  may  be  considered  as 
enteric  fever;  ulceration  of  intestines,  perforating,  with  inflammation,  acute; 
inflammation  of  liver  chronic,  with  chronic  Bright's  disease. 

J.   M.   G. 

VII. 

Seaman  J.  B. ;  age,  19 ;  nativity,  Canada  ;  admitted  to  the  marine  wards  of 
the  German  Hospital,  Philadelphia,  Pa.,  February  24,  and  died  March  5,  1904. 

Clinical  'diagnosis. — Enteric  fever. 

Anatomical  diagnosis. — Typhoid  ulceration  of  ileum,  acute  splenic  tumor, 
focal  necrosis  of  livei",  congestion  of  kidneys. 

Necropsy  (48  hours  after  death). — Body  is  that  of  a  male,  weight  about  140 
pounds,  of  good  musculature.  Post-mortem  lividity  over  buttocks  and  back ; 
fibrous  adhesions  between  left  lung  and  pleura  laterally  and  at  the  apex.  Left 
lung :  Weight,  350  grams  ;  moderate  hypostatic  congestion  of  lower  lobe.  Right 
lung :  No  adhesions ;  weight,  400  grams ;  hypostatic  congestion  present  in  lower 
lobe.  Heart  normal.  Liver :  Weight,  1,820  grams ;  of  soft  consistency ;  on 
section  moist;  smooth  and  opaque  in  spots;  several  small  yellowish  areas  of 
focal  necrosis.  Spleen :  Weight,  320  grams ;  soft  consistency ;  capsule  tense ; 
section  surface  dark  red ;  soft  splenic  pulp  greatly  increased.  Both  kidneys 
normal  macroscopically.  The  intestines  show  different  phases  of  typhoid  pathol- 
ogy, the  Peyer's  ])atcbes  of  upper  portion  of  ileum  are  swollen  and  partially 
necrotic,  in  lower  portion  they  are  deeply  ulcerated.  There  was  no  blood  in  the 
intestines.  The  mesenterit-  glands  are  enlarged,  soft,  dark  red  in  color,  the 
greatest  eidargement  confined  to  those  glands  nearest  the  seat  of  greatest  ulcer- 
ation. Brain :  Vessels  of  base,  convexity,  and  choroid  plexus  injected.  Spinal 
cord  was  normal. 

F.   I. 

INFLAMMATION  OF  CONNECTIVE  TISSUE,  NECK. 
{Liiduuff's  angina.} 

O.  O. ;  age,  29;  nativity,  Norway;  was  admitted  to  the  United  States  Marine 
Hospital,  Boston,  Mass.,  December  15,  1903,  and  died  December  20,  1903,  at 
2.45  a.  m. 

History. — Family  and  previous  history  negative. 

I'besent  history. — On  the  13th  instant  the  patient  went  to  bed  feeling  per- 
fectly well.  The  next  morning  he  felt  sick  and  weak  and  unable  to  work.  He 
noticed  a  swelling  above  the  "Adam's  ap])le"'  which  gradually  increased  in  size 
and  finally  occupied  the  entire  left  side  of  the  face. 

Examination. — There  was  a  small  red  point  beneath  the  chin  over  the  point 
of  greatest  swelling,  which  looks  as  though  an  attenii)t  had  been  made  to  punc- 
ture the  skin  at  this  point.  There  was  very  limited  fluctuation,  and  the  swell- 
ing thick  and  brawny.  The  patient's  skin  was  hot  and  dry,  and  he  says  he  is 
"  freezing."     The  heart  and  lungs  were  normal  and  the  pulse  full  and  rapid. 

DeccTiiJjer  16,  190S. — Under  ether  an;TPstbesia  the  opening  in  the  neck  was 
enlarged  and  the  wound  packed  with  sterile  gauze.  The  patient  was  put  to 
bed  on  milk  diet ;  temperature  very  high  and  general  condition  very  serious. 

Dcccitihrr  17,  lf)03. — Patient  was  delirious,  with  temperature  of  40.2°  C.  An 
injection  of  antistreptococcic  serum  was  given  and  in  the  evening  a  large  dose 
of  quinine. 

December  i(S,  1903. — Temperature  40°  C.  Another  injection  of  antistrepto- 
coccic serum  given.  In  the  evening  the  patient  was  delirious ;  one-half  grain 
of  morphine  given  hypodermatically. 

Decemher  19,  1903. — Patient  was  delirious  and  required  restraint  apparatus 
to  be  kept  in  bed;  pulse,  140;  temperature,  40.(5°  C. 

Deeemher  20,  1903. — Heart  very  weak  and  required  stimulation.  Patient 
failed  rapidly  and  died  at  2.45  a.  m. 

Necropsy  (7  hours  after  death). — Body  was  that  of  a  well-developed  man; 
post-mortem  rigidity  well  marked;  lividity  fairly  well  marked.     There  was  a 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE.  495 

wound  li  iiH'lios  in  lonsth  hoiicath  tlio  chin.  Thore  woro  imiuorous  discoloi-ii- 
tions  on  the  chest.  On  cnttinf^  tlirou^li  tlio  skin  of  tlio  chest  hemorrhages  hito 
the  niusch's  were  seen  and  sernni  esca|)ed.  Thorax  :  Position  of  thoracic  organs 
was  normal.  Pleura  was  nonadherent.  I'leural  cavity  contained  2()0  c.  c.  of 
serous  tiuid.  Lun>:s :  Left  \\\n^  showed  conj^estiou  at  the  liase,  weight  KM) 
grams.  Right  lung  showed  congestion  at  the  ajiex.  weight  470  grams.  Heart 
weighed  o.lO  grams;  right  iieart  contained  dark  unclotted  blood  and  chicken- 
fat  clot.  The  left  h(>art  was  empty  and  contracted.  Liver  was  congested, 
weight  2,2()()  grams.  P.oth  kidneys  were  normal  and  weighed  220  grams  each. 
Spleen  was  engorged,  weight  ;!2.")  grams.  P;iiicreas  was  normal,  weight  150 
grams.     Brain  was  engorgetl  and  on  its  removal  serum  escaped  freely. 

R.    M.    W. 

J.  D.  L. 

W.  C.  R. 
INTESTINAL  OBSTRUCTION. 

Right  oblique  inguinal  hernia  strangulated. 

C.  J.  C. ;  ago,  37 ;  nativity,  Sweden ;  admitted  to  the  United  States  Marine 
Hospital,  San  Francisco,  Cal.,  September  14,  1903 ;   died  September  18,  190.3. 

History. — The  patient  has  been  drinking  heavily  and  trembles  violently  when 
he  tries  to  talk  or  move.  Me  states  he  has  been  on  the  present  spree  about  three 
weeks,  but  gives  a  very  indefinite  account  of  himself.  He  says  last  night  he 
slipped  and  while  trying  to  recover  himself  he  felt  a  pain  in  bis  right  inguinal 
region  and  later  be  noticed  a  swelling  at  this  i)lace.  He  was  taken  to  the 
receiving  hospital  and  this  morning  at  10  a.  m.  was  given  chloroform.  The 
authorities  at  the  hospital  reported  that  when  the  man  was  admitted  there  he 
had  a  hernia  which  was  reduced  when  he  was  under  chloroform. 

Physical  examixation. — The  patient's  right  inguinal  region  is  tightly  ban- 
daged ;  on  removing  the  bandage  a  small  fusiform  swelling  is  found  to  be  pres- 
ent in  the  inguinal  canal.  Tliere  is  great  tenderness  on  pressure  over  and 
around  this  tumor.  Iieart  and  lungs  are  apparently  normal.  lie  has  had  no 
vomiting.  The  abdomen  is  flat,  no  tympanites  being  present.  Temperature 
37.6,  pulse  72,  respiration  28. 

An  ice  bag  was  placed  over  the  swelling,  an  enema  given,  and  his  bowels 
moved  freely.  Next  day  the  swelling  had  somewhat  subsided  and  the  tender- 
ness was  less  marked.  The  morning  temperature  was  37.G°  C. ;  pulse,  84 ; 
respiration,  25.  The  evening  temperature  was  39°  C. ;  pulse,  98 ;  respiration, 
22.  The  patient  was  still  very  nervous.  He  had  no  tymjianites  or  vomiting. 
On  the  lOtli  his  morning  temperature  was  .38.5°  C. ;  pulse,  90 ;  respiration,  24 ; 
evening  temperature,  38.0°  :  pulse.  84 ;  respiration,  24.  Tenderness  over  the 
inguinal  region  was  less.  The  morning  of  tlie  17th  the  swelling  had  increased 
and  there  was  some  oedema  of  the  scrotum  on  the  right  side.  The  patient 
stated  tliat  this  additional  swelling  bad  occurred  after  a  fit  of  coughing.  An 
ice  bag  lias  been  kept  continually  applied  to  the  inguinal  region.  Morning  tem- 
perature. 38.8°  C. ;  ]mlse.  92;  respiration,  23;  evening  temperatui'e,  38.8°; 
pulse,  93;  resitiration.  24.  His  l)()wels  moved  freely  after  an  enema  and  he 
states  that  be  passed  flatus  without  difliculty;  the  abdomen  is  flat  and  he  has 
had  no  vomiting.  The  patient  did  well  through  tlie  day.  but  during  the  night 
between  midniglit  and  daybreak  be  became  suddenly  worse.  The  next  morning 
the  oedema  of  the  tissue  had  greatly  increased  ;  it  extended  over  the  scrotum, 
penis,  and  the  lower  abdomen.  There  was  much  tenderness  on  pressure  and  tlie 
patient  complained  of  severe  pain.  The  abdomen  Avas  still  flat,  there  liad  lieen 
no  vomiting,  and  bis  liowels  moved  twice,  after  an  enema.  Temperature,  37.5° 
C. ;  pulse,  112;  respiration.  31.  The  patient  was  anjipsthetized  with  ether  and 
multiple  incisions  were  made  into  the  oedematous  tissues ;  a  large  quantity  of 
yellowish  fluid  escaped ;  the  urethra  was  opened  in  the  perineum  and  a  soft 
catheter  was  introduced  into  the  bladder.  Some  little  difficulty  was  expe- 
rienced in  finding  the  deep  urethra  on  account  of  the  swelling  of  the  tissues ; 
an  incision  was  then  made  into  the  ti.ssues  over  the  right  testicle  and  the  tunica- 
vaginalis  opened ;  the  incision  was  jirolonged  into  tlie  inguinal  region  and  a  sac 
found  leading  from  the  testicle  into  the  abdominal  cavity.  An  incision  was 
about  to  be  made  into  this  sac  when  the  patient  collapsed.  He  had  been  taking 
the  anresthetic  very  well ;  there  had  been  some  cyanosis,  but  it  was  not  marked. 
His  breathing  had  been  regular  and  his  pulse  good.  For  the  previous  five  min- 
utes he  had  been  given  no  ether,  as  the  nurse  having  been  ordered  to  prepare 


496        rur.Lic  health  and  marine-hospital  service. 

the  patient's  bed.  the  aiuesthetist  thought  the  operation  was  nearly  finished  and 
had  removed  the  ether  cone  from  tlie  patient's  face.  The  patient's  resjyiratious 
l^ecame  sliallow  and  then  stopped  altogether ;  there  was  deep  cyanosis.  His 
head  was  innnediately  lowered,  artificial  respiration  was  connnenced,  and  he 
was  given  oxygen,  nitroglycerin,  and  strychnia,  l)ut  he  did  not  revive.  The 
artificial  resijiration  and  the  oxygen  was  continued  for  forty  minutes;  250 
c.  c.  of  ether  was  used  during  the  ana'sthesia. 

Necropsy  (4  hours  after  death). — Body  of  large,  well-nourished  man,  about  0 
feet  tall.  Anchor  on  hack  of  right  hand.  Operation,  wound  in  perineum  2 
inches  in  length,  also  one  in  the  right  groin  and  scrotum  5  inches  long,  exposing 
testicle.  The  external  surface  of  the  lower  abdomen,  penis,  and  scrotum  exhibit 
a  uniform  yellowish  discoloration.  On  separating  the  lips  of  the  wound  in  the 
groin  a  tumor  is  exposed  extending  from  the  testicle  to  the  external  abdominal 
ring,  where  it  is  constricted.  The  inguinal  canal  is  incised  and  the  abdomen 
opened.  A  sac  extends  from  the  i)eritonenm  through  the  inguinal  canal  and  is 
intimately  adherent  to  the  testicle.  On  opening  this  sac  black  fluid  escapes  and 
the  sac  is  found  to  be  gangrenous  in  si)ots  and  shows  hemorrhagic  infiltration. 
It  contains  bowel  of  black  color  and  gangrenous  odor.  On  following  this  piece 
of  bowel  into  the  abdomen  it  is  found  to  be  a  diverticulum  from  the  caecum.  It 
is  as  thick  as  a  thumb,  4  cm.  long  and  3  cm.  wide,  and  is  attached  to  the  cT'cum 
at  its  lower  posterior  portion,  3  cm.  from  the  root  of  the  api»endix.  This 
diverticulum  is  constricted  at  its  connection  v.ith  the  ctecum.  The  appendix  is 
normal  and  the  c;ecum  is  in  normal  condition,  only  a  few  hemorrhagic  spots 
occuring  on  its  surface  near  the  diverticulum  There  ai-e  no  other  evidences  of 
an  inflammation  of  any  i)art  of  the  peritoneum  with  the  exception  of  a  few  hem- 
orrhagic spots  on  the  coat  of  the  riglit  external  iliac  vein.  A  lymphatic  gland 
found  in  the  inguinal  canal  is  of  a  l)lack  color,  and  on  section  shows  cortical  hem- 
orrhages. The  walls  of  the  abdomen  and  the  tissues  over  the  right  femoral  region 
are  infiltrated  with  gelatinous  exudate.  Brain:  Weight,  1.4(i()  grams;  tissue 
congested.  Heart:  Weight,  415  grams;  a  few  small  clots  are  present  in  the 
right  ventricle:  thickness  of  its  wall,  0.5  cm.  The  left  ventricle  contains  no 
clots :  its  wall  is  2  ciu.  thick  ;  the  edges  of  the  mitral  valves  are  roughened. 
Lungs:  There  are  a  few  adhesions  at  the  ai)ex  of  the  left  lung  and  at  the 
posterior  surface  of  the  base  of  the  right  lung.  The  right  lung  shows  some 
congestion  at  tlie  l)ase,  but  the  tissue  of  both  lungs  is  otherwise  api)arently 
normal.  Spleen:  Color  on  section  very  dark  red;  tissue  soft  and  shows  well- 
marked  hemorrhagic  areas.  Right  kidney:  Capsule  strips  easily;  weight,  1<)5 
grams;  blood  drijis  from  the  kidney  on  section:  the  cortical  portion  is  1  cm. 
thick,  and  shows  marked  hemorrhagic  infiltration.  Left  kidney:  Weight,  175 
grams;  the  tissue  is  in  the  same  condition  as  the  right  kidney.  Bladder  con- 
tracted. Liver:  Weight,  2.170  grams;  on  section  tissue  has  the  so-called 
"nutmeg"  appearance.  Other  abdominal  organs  are  api)arently  in  normal 
condition.  Cultures  were  taken  from  the  Sjjleen  and  from  the  lymphatic  glands 
in  the  groin.     A  bacillus,  resembling  the  colon  bacillus,  was  found  to  be  present. 

W.  G.  S. 
Toll:  111  Its. 

M.  S. ;  age,  50;  nativity,  Ohio;  occupation,  steward;  admitted  to  the  United 
States  Marine  Hospital,  Cleveland,  Ohio.  February  22,  1004;  died  February  25, 
1904.  When  admitted,  patient  complained  of  obstinate  constipation  of  four 
days'  standing,  with  severe  pain  referred  to  abdomen. 

Physical  kxa.mixation. — The  abdomen  was  found  to  be  widely  distended 
and  extremely  tender  all  over.  There  was  fecal  vomiting.  Attemi»ts  to  move 
the  bowels  being  unsuccessful,  a  laparotomy  was  done,  at  10  p.  m.,  February  22, 
twelve  hours  after  admission  to  the  hospital,  and  the  source  of  olistruction  was 
found  to  be  a  volvulus  of  the  small  intestines,  located  1  meter  distant  ffom  the 
caput  coli  iind  involving  aiiout  one-h:iIf  meter  of  gut.  This  was  relieved,  and  as 
the  gut  api)eared  viable  it  was  returned  to  the  abdomen  and  the  wound  closed. 
The  condition  of  the  patient  improved  somewhat  after  the  operation.  Flatus 
was  passed  iier  rectum  and  all  vomiting  ceased.  No  movement  of  the  bowel  was 
obtained,  and  the  patient  gradually  failed  until  his  death,  at  4.30  p.  m.,  on 
the  25th. 

Necropsy  (15  hours  after  death). — The  examination  was  restricted  to  the  ab- 
dominal contents.  There  was  no  i)ei-itonitis.  The  small  intestine  was  markedly 
distended  to  within  1  meter  of  the  caput  coli.     The  lower  one-half  meter  of  the 


PUBLIC    HKALTH    AND    MARINE-HOSPITAL   SERVICE.  497 

(listondod  small  iiitcsliia'  prrsciilcd  ovidciico  of  i)artial  strani^idatioii ;  portions 
of  tlu*  Kut  wore  dark  in  color.  Tlii'so  areas  were  scattered  about  over  the  por- 
tion of  (lie  ;;u(  involved,  and  varied  in  size  from  2  cm.  to  '.\  cm.  in  diameter.  Re- 
cent adhesions  lightly  hound  (cuether  the  coils  of  intestine  near  the  site  of  oh- 
sti'uction.  rpon  openinj^  1h(>  ^nit  then*  was  no  <'vidence  of  ulc(>ration.  The  j^ut 
was  tilled  with  ,s:as  and  feces.  TIk^  rest  of  (he  small  intestine  an<l  the  lar^;e  in- 
testine were  emi»ty  and  contracted.  The  other  abdominal  contents  apiieared 
normal. 

J.  W.  W. 

II.  S.  M. 
Nor  f/nnriJi  of  jxinvrrnfi. 

S.  A.;  age,  r»0;  nativity,  Sweden;  adnntted  to  the  marine  ward  of  the  Los 
Angeles  Intirmary,  Los  Angeles,  Cal.,  April  12,  lOO.'} ;  died  .July  :?,  lOO.'?. 

IIiSTOKY. — Patient  was  operated  upon  at  this  hosi)ital  last  October  for  a]>]ten- 
dicitis,  .-ind  later  a  right-sided  psoas  abscess  developed,  pointed  in  thigh,  was 
opened,  drained,  .-ind  healed.  Left  hospital  apparently  all  right.  Duiing  the 
winter  a  pain  of  indetinite  character  developed  in  abdomen,  which  seemed  to 
radiate  down  into  left  iliac  fossa.  Examination  on  entrance  revealed  nothing 
in  the.se  regions.  Had  been  constipated  for  a  long  time.  Bowels  opened  with 
cathartics,  and  after  fourteen  days  in  hospital  an  enlargement  appeared  in  left 
iliac  fossa.  Operated  in  two  stages  and  found  a  large  psoas  abscess,  and  a  pint 
of  greenish-yellow  pus  drained  off.  Patient  got  much  better,  but  still  consti- 
pated and  ana'uiic,  and  received  treatment  for  both.  Restless  at  times,  and  still 
complained  of  the  obscure  pain  in  the  abdomen.  June  2(\,  had  great  pain  in  ab- 
domen and  commenced  vomiting  up  stercoracious  material.  Could  keep  nothing 
on  his  stomach.  Diagnosis:  Intestinal  obstruction,  and  oiterated  June  ?>0,  lOO.'l 
Found  bowels  distended  and  a  constricting  band  of  adhesions  around  iliuu). 
Stricture  was  incomplete,  however.  Exploration  of  abdominal  cavity  revealed 
hard,  nodular  mass  at  head  of  pancreas,  involving  gall  ducts,  mesenteric  glands, 
pancreas,  and  entirely  surrounding  the  colon.  Patient  very  weak  ;  operation 
hurried.  Gut  was  punctured  and  gas  and  fecal  contents  drained  out  and  sutured 
with  Czerney-Lembert  sutures,  and  all  adhesions  broken  up.  Patient  kept  alive 
next  three  days  by  salt  solution,  striclmia,  stimulating  eneniatas ;  rallied  fairly 
well ;  bowels  moved,  vomiting  ceased,  but  died  July  3,  190.3,  at  7  a.  m. 

Necropsy  (3  hours  after  death). — Rigor  mortis  setting  in,  but  body  still  warm. 
Body  of  a  rather  small  man.  greatly  emaciated.  Skin  of  a  yellowish  tint. 
Nothing  abnormal  externally,  save  scar  of  appendicitis  operation  of  last  October 
and  the  open  wounds  from  his  recent  psoas  abscess  on  the  left  side  and  the 
wound  in  linea  alba,  in  process  of  healing  from  recent  exploratory  operation. 
Hypostatic  congestion  of  lungs  posteriorly  and  a  little  exudate,  showing  pneu- 
monic process.  Coal  pigment,  but  no  evidences  of  tuberculosis.  Heart  is  very 
much  contracted  and  right  ventricle  quite  thin.  LTsual  clots  in  heart.  Valves 
competent.  Pericardial  fluid  increased  about  double.  Diameter  of  the  thoracic 
aorta  greatly  increased  and  a  slight  tendency  to  sacculation.  Other  vessels  and 
thoracic  duct  normal.  Omentum  very  thin  ;  no  fat.  Plastic  adhesions  of  in- 
testines everywhere.  Some  dark  ai'eas  of  congested  capillaries  on  surfaces. 
Operative  wound  of  intestine  healed  beautifully.  Appendix  oi)eration  wound 
showed  beautiful  results  and  adhered  to  abdominal  scar.  Intestine  patulous,  but 
not  greatly  intlated.  Liver  is  very  small  and  shows  nothing  wrong  save  its  size 
and  the  large  size  of  the  full  gall  bladder.  Common  gall  duct  encroached  upon 
by  an  enlarged,  hard,  lymph  gland  pressing  ui)on  it,  thus  narrowing  its  lumen. 
Spleen  is  normal,  save  its  small  size.  Kidneys  showed  healed  scars  externally 
and  a  proliferation  of  white  scar  tissue;  ui)on  section  shows  normal  structure. 
Stomach  shows  no  involvement  at  all  in  the  cancerous  process.  At  head  of 
pancreas  one  lai'ge  tumor  mass,  less  than  size  of  patient's  fist ;  whole  organ  hard 
and  cirrhotic.  Mesenteric  glands  near  by  involved  and  were  also  hard  and 
cirrhotic.  Mesentery  shows  no  acute  inflammatory  process.  The  colon  was 
encroached  upon,  surrounded,  and  embedded  in  the  mass,  and  here  a  stricture 
resulted.  The  mass  was  of  a  whitish  connective  tissue  color.  No  stones  found 
in  pancreas.  Bladder  normal.  Ureters  normal.  No  source  for  the  psoas 
abscess  could  be  found. 

M.  H.  R. 
J.  O.  C. 
8629—04 32 


498  PFBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

MALARIAL    FEVER,    REMITTENT. 
Acute  endocarditis,  collapse  of  right  lung. 

H.  G. ;  age,  30 ;  nativity,  Germany ;  admitted  to  United  States  Marine  Hos- 
pital, New  Orleans,  La.,  January  28,  1904 ;    died  February  6,  1904. 

History. — Previous  illness,  typhoid  fever  in  1898 ;  none  other  of  any 
moment ;  denies  venereal  disease.  Two  days  prior  to  admission  had  a  chill, 
followed  by  fever  and  sweat.  Since  then  has  had  malaise,  headache,  and  fevei*. 
On  admission  has  a  cough  and  slight  coryza.  Some  discon)fort  in  lower  part 
of  right  chest,  but  taking  a  deep  breath  does  not  cause  pain.  Expectoration  is 
scant.  Sputum  white,  frothy ;  is  not  now,  and  has  not  been,  blood  tinged. 
Patient  is  a  strong,  robust-looking  man.  Facies  heavy  and  stupid.  Skin  and 
mucous  membranes  pale.  Tongue  moist,  flabby.  Teeth  indented  and  heavily 
coated,  white.  Temperature  39.8°  C.  Pulse  103,  of  moderate  tension  and  com- 
pressible. 

Physical  examination. — Heart  apparently  normal.  A  few  coar.se  mucous 
rales  heard  over  lower  lobes  of  both  lungs,  more  numerous  over  right ;  otherwise 
examination  was  negative.  The  day  after  admission  patient's  condition  was  im- 
proved. Cough  was  not  troublesome,  headache  was  relieved,  and  be  had  scarcely 
any  pain  in  chest.  A  saline  had  been  administered  in  the  early  morning,  and 
bowels  moved  freely  several  times  during  the  day.  At  0  p.  m.  temperature  was 
38°  C. ;  pulse,  84.  On  the  afternoon  of  .January  30  temperature  began  to  rise, 
and  at  6  p.  m.  was  40.2°  C. ;  pulse,  105;  skin  moist;  face  pale;  respirations  30 
per  minute.  At  9  a.  m.  on  January  31  patient  felt  quite  comfortable.  Tempera- 
ture, 39°  C. ;  pulse,  90 ;  respiration,  28.  Physical  examination  of  heart  was 
negative;  fine  and  coarse  moist  niles  heard  over  bases  of  both  lungs;  more 
numerous  over  right.  Percussion  note  clear  on  both  sides.  On  examining  blood 
a  few  Plasmodia  of  aestive-autumnal  type  were  found.  Quinine  sulphate,  0.6 
gram,  was  given  every  four  hours.  On  February  2  a  loud  blowing  systolic  mur- 
mur could  be  heard  over  apex  of  heart.  Respiration  was  rather  shallow,  and 
averaged  about  30  per  minute;  voice  was  husky.  The  coarse  mucous  rales  over 
lower  lobe  of  right  lung  were  increased,  and  the  respiratory  murmur  over  the 
upper  part  of  the  lung  was  roughened.  Stimulants  were  increased  and  quinine 
continued.  Temperature  began  to  fall  on  February  2,  and  with  slight  evening 
rises  continued  to  fall  until  the  morning  of  February  4,  when  it  was  normal. 
I*atient's  general  condition  seemed  improved.  Pulse  at  9  a.  m.  was  74  and  of 
good  tension.  Cough  was  not  troublesome,  expectoration  free,  and  sputum  was 
mucopurulent  in  character.  Itespiration  deeper  and  free  of  pain — about  30  per 
minute.  In  the  afternoon  of  February  4  temperature  rose  rather  suddenly,  and 
at  G  p.  m.  was  38.8°  C.  The  fever  was  not  preceded  by  a  chill,  but  was  followed 
by  a  profuse  sweat.  February  .5  temperature  was  normal,  patient's  mind  was 
clear,  and  he  complained  of  no  pain.  Improvement  was  indicated  by  all  symp- 
toms except  the  rapid  respiration,  which  continued  about  30  per  minute.  At  9 
a.  m.  February  6  respiration  was  35  per  minute,  wheezy  and  rather  shallow. 
Patient  was  perspiring  freely  and  face  was  pale.  Pulse  was  82  and  of  fair 
tension.  Stimulation  was  increased  and  quinine  reduced  to  0.3  gram  three 
times  a  day.  At  11  a.  m.  patient's  respiration  was  easier  and  deeper.  His 
strength  .seemed  abundant,  and  he  was  able  to  sit  up  in  bed  or  stand  without 
assistance.  At  2  p.  m.  re.spiration  suddenly  became  gasping,  pulse  weak  and 
thready,  face  blanched.  Hypodermic  injections  of  strychnine,  nitroglycerine, 
and  ether  were  given  and  artificial  respiration  used,  but  the  patient  sank 
rapidly  and  died  at  2.40  p.  m. 

Necropsy  (18  hours  after  death). — Body  well  nourished;  rigor  mortis 
marked;  post-mortem  lividity  of  dependent  i)arts.  Mucosanguineous  discharge 
from  mouth  and  nostrils.  Right  pupil  slighty  contracted,  probably  due  to  an 
old  iritis  with  adhesion.s.  Calvarium  nut  removed.  Right  pleural  cavity  con- 
atined  800  c.  c.  of  clear  fluid.  Right  lung  is  collapsed  and  flattened  against 
inner  wall  of  cavity,  covered  posteriorly  with  pla.stic  exudate.  Weight,  650 
grams.  On  section  lung  is  found  to  be  deeply  congested.  Is  not  crepitant  in 
any  part.  Left  pleura  and  lung  normal.  Weight  of  lung  .590  grams.  Pericar- 
dium contains  100  c.  c.  of  clear  fluid.  Fatty  panniculus  marked.  Heart  weighed 
350  grams;  contained  ante-mortem  clots.  Mitral  valve  was  incompetent 
and  the  edges  of  its  anterior  segment  were  thickened,  crumpled,  and  lined 
with  vegetations.  Tricusi)id  valve  also  inconijietent  and  edges  of  two  of  its 
segments  lined  with  fresh  vegetations.     Aortic  and  pulmonary  valves  were  nor- 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  499 

iii.il  ninl  coiiipoteiit.  Liver  was  normal  in  api»earan<(> ;  weight  l.fKX)  grams. 
(Jail  l)la(l(ler  contained  oO  c.  c.  Idle.  Spleen  weiglied  220  grams;  capsule  adhe- 
rent; i>nip  soft.  Uiglit  Ividney  weighed  22(t  gran)s;  left,  250  grams.  P.oth 
were  slightly  congt'sted.  otherwise  normal.  All  other  contents  of  alxlominal 
cavitv  were  apparently  normal. 

L.    I>.    L. 

('.  P.  W. 
M:\V  (JKOWTII.  MALKJ.XANT. 

CairiiKiiiKi  of  iiuhitc  and  fauces. 

J.  A.;  white  male;  age.  45;  born  in  Illinois;  was  admitted  to  the  United 
States  Marine  Hospital,  Chicago,  111.,  on  December  0,  1002;  died  November  25, 

ino:?. 

Fa.mii.y  history. — (jJood. 

Plrsonal  history. — II.ul  measles  and  malaria;  had  gonoiThoea  three  times; 
no  history  of  syphilis. 

I'RESEXT  (ONornoN. — About  March,  19f)2,  patient  began  to  be  troubled  tiy 
dryness  of  throat  and  a  lia(king  cough.  This  was  first  diagnosed  as  bron- 
(liitis.  AI)out  August  1  patient  noted  a  siinill  growth  in  the  posterior  wall 
of  idiarynx,  which  occasionally  bled.  Fi'om  August  1  the  growth  gradually 
enlarged,  but  seldom  bled.  Patient  complained  of  a  constant  dull  pain  in 
throat,  radiating  to  right  ear.  There  was  some  pain  on  deglutition,  and  patient 
said  that  he  could  not  breathe  with  ease.     The  appetite  was  poor. 

Physical  exa  mi  .nation. — Inspection  showed  growth  on  posterior  wall  of 
pharynx  and  right  tonsil ;  right  side  of  face  and  right  shoulder  showed  red- 
ness of  skin,  caused  by  X-ray  Ijurns. 

Januanj  26.  1003. — Patient  has  suffered  more  or  less  since  date  of  admission 
with  severe  neuralgic  pains  in  the  right  side  of  face,  radiating  over  the  scalp 
and  down  the  right  shoulder.  On  examination  it  was  seen  that  the  uvula  had 
become  actively  involved,  and  its  anterior  aspect  showed  an  eroded  surface. 

February  9,  1903. — Patient  continued  to  have  pain,  which  was  greatly  exacer- 
bated at  times,  requiring  the  use  of  analgesics  continually  to  give  comfort.  On 
inspection  it  was  seen  that  the  anterior  pillar  of  the  right  fauces,  right  tonsil, 
and  right  half  of  soft  palate  were  almost  destroyed,  while  the  right  half  of 
uvula  was  partly  destroyed  and  remaining  portion  drawn  to  the  other  side. 
The  buccal  mucous  membrane  was  already  involved. 

February  IS.  1903. — On  this  date  the  uvula  was  found  obliterated,  and  the 
growth  of  the  neoplasm  seemed  to  be  infiltrating  the  surrounding  tissues.  The 
tongue  also  was  involved,  the  site  of  the  neoplastic  formation  being  on  the 
right  posterior  portion. 

July  6.  1903. — Patient's  condition  was  growing  worse.  The  growth  prevented 
opening  of  the  mouth,  necessitating  the  use  of  liquid  food  and  interfering 
greatly  with  deglutition  and  phonation.  The  submaxillary  lymphatics  were 
noted  somewhat  enlarged  and  greatly  indurated.  Cachexia  was  becoming 
marked.  Severe  pains  radiated  from  growth  up  and  down  the  right  side  of 
head  and  face,  and  required  the  use  of  hypodermic  injections  of  morphine 
sulphate  0.015  gram  every  eight  hours. 

July  10,  1903. — Patient  had  quite  a  severe  hemorrhage.  The  loss  of  blood  was 
estimated  at  about  750  c.  c. 

November  6.  1903. — Patient  had  progressed  as  usual  to  date.  Emaciation 
extreme  and  cachexia  marked.  Large  doses  of  morphine  were  required  to 
allay  pain. 

November  21,  1903. — Patient  had  become  very  weak  and  was  delirious  at 
times;  pulse  was  getting  weaker.  He  was  taking  no  food  by  mouth,  necessi- 
tating the  use  of  nutritive  enemata. 

November  23.  1903. — Condition  was  grave,  patient  being  in  a  comatose  state; 
temperature.  30.3°;  pulse.  138.  and  thready;  respirations,  20. 

November  25.  1903. — Despite  active  stimulation  the  patient  grew  gradually 
weaker,  re.spirations  shallower,  and  at  3.45  p.  m.  heart's  action  ceased.  The 
nature,  extent,  and  location  of  the  growth  precluded  any  surgical  interference. 
The  treatment  was  symptomatic.  The  patient  was  very  weak  and  cachectic 
and  the  growth  surrounded  the  right  carotid  and  submaxillary  arteries  be- 
sides other  important  structures.  It  was  feared  that  the  arterial  walls  were 
so  diseased  that  a  fatal  hemorrhage  might  occur  from  the  manipulation  inci- 
dent to  an  oiieration  for  the  removal  of  the  growth.  Coley's  toxines  were 
tried  with  no  apparent  results. 


500 


rUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 


Necropsy  (24  hours  after  death). — Body  that  of  a  poorly  nourished  white 
male;  age.  45;  post-mortem  rigidity  not  well  marlved ;  post-mortem  lividity 
marked ;  subcutaneous  tissues  poorly  developed.  Thorax :  Pericardium  con- 
tained about  10  e.  c.  straw-colored  fluid.  Heart  weighed  250  grams ;  contained 
a  few  ante-mortem  clots;  valves  to  all  appearances  were  normal.  Lungs  were 
bound  down  by  adhesions.  Bronchial  glands  were  enlarged  and  cheesy.  Right 
lung  weighed  570  grams.  Apex  scarred  on  surface.  Left  lung  weighed  5*80  grams. 
It  was  congested  at  base.  Abdomen :  Liver  adherent  to  diaphragm ;  weighed 
1,350  grams ;  on  section  appeared  normal.  Intestines  matted  together  by  adhe- 
sions. Right  kidney  weighed  140  grams ;  was  bound  down  by  adhesions  and 
capsule  stripped  with  difficulty.  Left  kidney  weighed  130  grams;  also  adher- 
ent ;  small  cyst  was  present  on  posterior  surface ;  capsule  adherent.  Both 
kidneys  appeared  normal  on  section.  Spleen  weighed  100  grams,  and  to  all 
appearances  was  normal.  Bladder  was  partially  distended  with  urine.  In 
the  right  submaxillary  region  at  the  angle  of  the  ranms  of  the  inferior  maxil- 
lary bone  was  a  dark  necrotic  mass  of  tissue,  which  on  incising  set  free  a 
quantity  of  very  offensive  material  composed  of  degenerated  cells,  disintegrated 
blood,  and  purulent  material.  The  pathological  processes  had  involved  almost 
the  entire  right  wall  of  the  pharynx,  and  there  was  left  a  free  comnmnica- 
tion  l)etween  the  buccal  cavity  and  the  exterior.  The  patient's  death  was 
proI)al)Iy  due  to  septic  intoxication,  the  result  of  absorption  of  the  septic 
material  into  the  general  systemic  circulation.  The  growth  was  very  malig- 
uant  in  character,  as  is  shown  by  the  clinical  course  of  the  disease. 

F.  A.  A. 

C.  E.  B. 

PNEUMONIA. 
Lobar;  absence  of  right  kidney. 


J.  M. ;  age,  47 ;  nativity,  Massachusetts ;  was  admitted  to  the  United  States 
Marine  Hospital,  St.  Louis,  Mo,,  January  13,  and  died  January  17,  1904. 


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History. — Patient   had   been    ill    for   several    days    and   on    admission    was 
exhausted   from   pain,  sleepless   nights,   and  the  distress  of  his  disease.     On 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  501 

admission  respiratory  sound  was  al)sont  over  ri.i;lil  Innf;  and  faint  over  left, 
'rmiperaturc,  :!!».2°  (.'.  ;  jjuIsc  !•('),  wiry;  r('si)iralion  :'.2,  superficial.  Dysjmijea, 
lividity  of  tlie  prolahia,  and  iirune-.juiee  e.vpectoration.  witii  constant  restless- 
ness and  inability  to  lie  down  completed  the  picture.  lOnertjetic  treatment  of 
quinine,  strychnine,  and  alcohol  were  given  without  effect  and  patient  died 
January  17,  1004,  at  7.40  p.  m. 

Neckoi'sy  (-()  hours  after  death). — Body  that  of  a  very  muscular,  well-nnur- 
ished,  white  adult  male.  Kigor  mortis  and  lividity  of  dependent  parts  well 
marked.  Ahdonien  and  abdominal  organs  loaded  with  fat.  Lungs  closely  adlier- 
(^nt  throughout,  and  inii)()ssil)le  of  removj'.l.  except  in  fragments.  Right,  hepa- 
ti/.ed  :  left,  nodular,  congested.  Heart  full  of  dark-red  clots;  weight,  4120  gi-ams  ; 
hyi»ertroj)hied  throughout;  valves  ai)pear(>d  to  he  comi)etent.  Artei'ies  thick- 
ened and  i)archmeiit  like.  Liver:  Weight,  2,i)00  grams;  very  friable,  hyper- 
iiuiiic.  Kidney:  I^eft.  swollen,  enlarged,  pale;  weight,  IVM)  grams;  capsule  strips 
readily;  loaded  with  fat,  and  pehis  almost  obliterated  with  bright,  yellow  fat. 
No  trace  ceuld  be  found  of  right  kidney,  nor  of  right  uretei",  uor  was  there  trace 
of  a  uephrectomy,     Frjeuum  pryjputii  shows  au  old  scar. 

H.  C.  W. 

J.  M.  G. 
II. 

J.  M. ;  age.  .'7 ;  nativity,  Maryland ;  admitted  to  the  United  States  Marine 
Hospital,  Baltimore.  Md.,  December  7,  1903;  died  December  11,  1903. 

History. — He  ascribes  his  present  condition  to  a  fresh  "  cold  "  engrafted  upon 
a  chronic  cough  of  three  months'  standing.  One  week  ago  his  cough  became 
worse,  he  was  weak  and  feverish,  but  never  had  a  chill  or  pain  in  the  chest. 
On  admission  to  the  hospital  he  complains  of  a  severe  cough  with  very  scanty, 
tenacious,  rusty,  sputum ;  has  no  pain,  but  is  suffering  greatly  with  dyspnoea ; 
temperatux'e,  39°  ;  pulse,  132,  and  respiration,  48  per  minute. 

His  physical  signs  on  admission  are  as  follows :  Dullness  on  percussion  over 
right  lower  half  of  the  chest,  with  vocal  resonance  and  fremitus,  bronchial 
breathing,  and  crepitant  I'ales  on  inspiration  in  this  position.  Urine  is  highly 
albuminous,  with  many  pale,  granular  casts,  red  and  white  corpuscles.  Death 
was  sudden  and  unexpected  eighty-one  hours  after  admission. 

Necropsy  (ir>  hours  after  death). — Post-mortem  rigidity  is  extremely  well 
marked.  The  left  lung  is  not  diseased  beyond  some  swelling  and  injection  of 
the  mucous  membrane  of  the  large  bi'onchial  tubes.  The  right  pleura  contain.s 
100  c.  c.  of  clear  serum.  Laterally  the  upper  lobe  of  the  right  lung  is  tightly 
adherent  to  the  chest  wall.  The  organ  is  uniformly  consolidated.  The  surface 
of  section  of  the  upper  two  lobes  is  grayish  red ;  of  the  lower  lobe,  deep  red  in 
color.  There  is  an  area  in  the  apex,  about  4  cm.  across,  which  is  softer  and 
more  deeply  congested  than  the  surrounding  tissue.  It  is  traversed  by  several 
fibrous  bands  and  is  probably  a  subacute  tubercular  focus.  Many  of  the 
iiiedlum-sized  and  smaller  bronchioles  are  filled  with  fibrino-purulent  material. 
The  organ  is  quite  friable,  the  torn  surfaces  showing  small  fibrinous  plugs, 
which  pi'oject  from  the  finer  bronchial  tubules. 

The  heart  is  of  normal  size ;  its  valves  are  competent  and  its  muscle  yellow- 
ish red,  though  not  fat  streaked.  The  muscle  is  probably  degenerated.  Both 
ventricular  cavities  are  partially  filled  with  mixed  clots,  which  are  entangled 
in  the  meshes  of  the  mitral  and  tricuspid  leaflets  and  extend  through  the  aortic 
and  semilunar  valve  oi)enings  into  the  aorta  and  pulmonary  artery  for  a  dis- 
tance of  7  cm.  There  is  no  pulmonary  embolus,  at  least  in  the  larger  branches 
of  the  vessel. 

The  spleen  is  slightly  enlarged,  swollen,  and  friable.  There  is  a  supernu- 
merary organ,  the  size  of  an  English  walnut,  on  the  splenic  vessel,  7  cm.  from 
the  parent  striicture. 

There  is  but  one  kidney,  the  left.  It  is  quite  large ;  weighs  330  grams  ;  is  lobu- 
lated  and  strips  easily  from  the  capsule.  The  organ  is  soft  and  extremely 
friable  ;  is  pale  grayish  red  in  color ;  the  cortex  is  thickened  and  swollen.  The 
whole  surface  exhibits  that  peculiar,  cloudy,  grayish  cast  which  denotes  a 
parencliymatous  change. 

Anatomical  diagnosis. — Acute  lobar  pneumonia,  which  has  probably  been 
engrafted  upon  a  tuberculosis  of  the  right  luug;  acute  parenchymatous 
nephritis. 

H.  R.   C. 
C.   W.   W. 


502  PUBLIC    HEALTH    AND   MAEINE-HOSPITAL    SERVICE. 

III. 

W.  F. ;  age  27 ;  uativity,  Virgiuia ;  admitted  to  the  Tliiited  States  Marine 
Hospital,  Baltimore,  Md.,  Jamiary  17,  1904,  complaining  of  severe  pain,  in  the 
left  side,  of  one  day's  dnration  ;  severe  cough,  and  scanty,  tenacious  expectoration. 
On  admission  his  temperature  was  40.6°  C,  pulse  120  and  respiration  46  per 
minute.  Physical  examination  showed  breathing  to  be  rapid  and  labored, 
shallow  over  the  bases  and  more  pronounced  than  normal  over  the  apices  of  both 
lungs  anteriorly.  Vocal  fremitus  diminished  over  base  of  left  lung  posteriorly, 
with  dullness  on  deep  percussion  over  an  area  the  size  of  a  silver  dollar  1^ 
inches  below  the  angle  of  the  scapula.  In  this  position  many  fine,  distinct, 
crepitant  rales  were  heard  at  the  end  of  inspiration.  Expiration  was  only 
slightly  prolonged,  though  distinct  bronchial  breathing  was  not  present.  Vocal 
resonance  was  increased  in  this  position.  The  heart  appeared  to  be  normal.  On 
the  second  day  after  admission  the  patient  became  delirious,  which  continued 
until  death  occurred  on  the  fourth  day  after  admission.  Urine  was  scanty  and 
highly  colored  and  was  markedly  albuminous.  Clinical  diagnosis :  Acute  lobar 
pneumonia,  left;  acute  nephritis,  with  partial  suppression. 

Necropsy  (18  hours  after  death). — Body  of  a  poorly  developed  negro;  post- 
mortem rigidity  extremely  well  marked.  The  left  i>leural  cavity  contains  about 
20  c.  c.  of  clear,  straw-colored  serum.  The  left  lung  shows  a  uniform  consolida- 
tion of  the  lower  lobe.  The  surface  of  section  shows  the  lower  lobe  to  be  quite 
solid,  dark  red  in  color,  and  quite  dry.  The  smaller  bronchial  tubules  are  tilled 
with  fibrinous  plugs,  the  mucous  niemlirane  being  swollen  and  injected.  A  torn 
surface  through  this  portion  of  the  lung  shows  many  fine  fibrinous  plugs  pro- 
jecting from  the  fine  bronchioles  and  alveoli.  The  upper  lobe  of  the  left  lung 
shows  some  congestion,  with  swelling  and  injection  of  the  bronchial  mucous  mem- 
branes. Much  blood-stained,  frothy  serum  exudes  upon  section.  The  right  lung 
presents  a  condition  similar  to  the  upper  lobe  of  its  fellow. 

The  heart  and  pericardium  are  normal.  A  chicken-fat  clot  is  found  entangled 
in  the  meshes  of  the  mitral  and  tricuspid  valve  leaflets.  The  left  ventricle  is 
tightly  contracted. 

The  spleen  is  of  normal  size,  but  is  bound  down  to  the  diaphragm  by  dense, 
fibrous  adhesions. 

The  left  kidney  is  of  normal  size,  pale,  grayish  red  in  color.  The  capsule  strips 
readily,  and  on  section  the  organ  shows  a  uniformly  cloudy,  gray  surface.  The 
cortex  is  slightly  thickened  and  swollen.  The  right  kidney  shows  similar  char- 
acteristics to  its  fellow.  The  other  abdominal  organs  appear  normal.  The 
brain :  The  dura  is  found  to  be  tightly  adherent  to  both  hemispheres  for  5  cm. 
at  the  vertex  of  the  superior  longitudinal  fissure.  The  adhesions  are  of  a  fibri- 
nous nature ;  they  are  not  very  recent,  but  can  be  torn  through  readily  with  the 
finger.  The  cerebral  cortical  vessels  are  deeply  congested  and  swollen.  The  pia 
mater,  both  of  the  cortex  and  base  of  the  brain,  is  more  cloudy  and  more  swollen 
than  normal. 

Anatomical  diagnosis. — Acute  lobar  pneumonia,  left  lower  lobe ;  acute  par- 
enchymatous nephritis  ;   meningitis,  cerebral,  acute. 

C.  W.  W. 
H.  R.  C. 

IV. 

J.  McC. ;  white ;  age,  51 ;  born  in  Indiana ;  was  admitted  to  the  United 
States  Marine  Hospital,  Chicago,  111.,  February  18,  1904,  and  died  February  24, 
1904. 

History. — Had  had  usual  diseases  of  childhood  and  two  attacks  of  "  bilious 
fever ;"  for  several  months  had  been  troubled  with  frequent  micturition ;  from 
January  19  to  29,  1904,  was  under  treatment  here  for  influenza  of  mild  type. 
On  February  IG,  1904,  was  suddenly  seized  with  pain  in  region  of  right  and 
then  the  left  scapula  ;  three  hours  later  had  a  moderately  sharp  chill,  followed 
by  fever ;  soon  began  to  cough.  Growing  worse,  he  applied  for  treatment.  On 
admission  had  temperature  of  39.7°;  pulse,  120;  respirations,  24;  breathing 
was  jerky,  with  explosive  expiration,  due  to  the  pain  at  base  of  left  lung.  No 
dullness  present,  nor  could  friction  rub  be  distinguished.  The  next  day  friction 
nib  and  characteristic  pain  showed  presence  of  pleurisy  at  base  of  right  lung ; 
some  pain  was  referred  to  the  right  scapular  region.    Breathing  was  much  less 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL   SERVICE.  503 

distressiiijx.  Sinitum  was  visrid  and  Mood  tinged :  on  examination  showed 
I)re.senc'e  of  i)nennioc'oecM.  No  pliysical  signs  of  pneumonia  present.  In  after- 
noon light,  talkative  delirium  set  in.  and  patient  began  to  perspire  freely.  On 
February  '_"_*  (luiluess  was  lirst  noted  over  entire  riglit  lung  posteriorly,  with 
tyuipano-rt'soMance  anteriorly.  Friction  I'ub  was  also  found  at  base  of  left 
lung  posttMMorly.  Tyiiii-al  pneumonic  breathing  i)res(>nt  on  right  side;  aside 
from  pleurisy  at  l>ase,  the  left  lung  was  (piite  normal.  Heart  action  was  some- 
what weaivened,  and  patient's  condition  not  encouraging.  Deliriinn  constant. 
The  following  day  (li.'id)  stools  were  light  colored,  urine  dark,  and  conjunctiva' 
icteric.  Patient  greatly  prostrated,  constantly  delirious,  and  pulse  luisatisfac- 
tory.  On  February  24  patient  was  weaker  and  gradually  lost  ground;  i)ulse 
was  occasionally  intermittent  and  was  of  low  tensi(»n.  Dullness  was  not  so 
wooden  in  character  and  expectoration  was  quite  copious.  Toward  night  his  c(ui- 
dition  became  very  grave,  and,  although  actively  stimulated,  died  at  Of)()  p.  m. 

Treat.ment. — Abundant  light  nourishing  diet:  exi)ectorants  and  stinnilants 
as  needed  ;  subcutaneous  and  rectal  injections  of  normal  saline  solutions  ;  oxy- 
gen by  inhalation. 

Necropsy  (22  hours  after  <leath). —  Body  that  of  a  moderately  well-nourished 
man;  i)ost-mortem  lividity  moderate;  rigor  mortis  at  a  mininnun.  Thirty-five 
c.  e.  clear  fluid  formed  in  pericardium  ;  heart  weighed  3.10  grams,  had  stopped 
In  sy.stole,  its  muscular  tissue  was  rather  friable,  all  the  valves  were  pinkish  in 
color,  but  otherwise  normal ;  all  chambers  of  heart  contained  ante  and  i)ost 
mortem  clots.  The  right  lung  weighed  1,840  grams,  all  lobes  were  densely 
adherent  to  the  parietal  pleura  and  bathed  in  grayish-yellow  pus.  The  lower 
and  middle  lobes  were  in  the  stage  of  gray  hepatization  ;  the  upper  lobe  was  deep 
bluish-black  in  color,  and  rather  more  friable  than  normal.  The  left  lung 
wei.ghed  490  grams,  was  bound  down  by  moderately  firm  adhesions  to  the  dia- 
phragm and  to  the  posterior  and  lateral  parietal  pleura  ;  otherwise  this  lung 
was  normal.  No  tuberculosis  present,  but  numerous  small  calcified  nodules 
found  in  the  base  of  both  lungs  at  the  surface.  The  liver  weighed  2,215  grams  ; 
the  upper  surface  of  the  right  lobe  and  of  the  right  half  of  the  left  lobe  were 
universally  bound  to  the  lower  surface  of  the  diaphragm  by  an  apparently  single 
adhesion;  the  left  half  of  the  left  lobe  was  greatly  scarred  (hobnailed)  ;  on 
section  the  liver  showed  general  chronic  interstitial  hepatitis.  The  gall  bladder 
was  unusually  small  and  contained  about  10  c.  c.  of  thin  bile.  The  right  kidney 
weighed  IGO  grams,  the  left  205  grams ;  in  both  the  cortex  was  very  narrow 
and  pale ;  in  the  superior  pole  of  the  left  kidney  was  a  small  urinary  retention 
cyst ;  an  accessory  renal  artery,  about  one-third  the  size  of  the  arteria  propria, 
supplied  the  upper  pole  of  the  left  kidney,  entering  at  the  internal  border  about 
1  cm.  above  the  hilus.  The  spleen  weighed  290  grams,  was  deep  bluish  black  in 
color,  and  of  a  consistency  softer  than  normal.  Ajipendix  was  only  8  cm.  long, 
was  normal,  and  had  a  mesentery  for  half  its  length.  The  pancreas  weighed  95 
grams  and  appeared  normal.     Notliing  abnormal  found  in  the  intestinal  tract. 

L.  P.  H.  B. 

L.    D.    L. 

C.  E.  B. 

V. 

W.  S. ;  white  male ;  age,  49 ;  born  in  Ireland ;  admitted  to  the  United  States 
Marine  Hospital,  Chicago,  111.,  March  2,  1904,  and  died  March  9,  1904. 

History. — Patient  stated  that  on  February  27  he  first  felt  headache  and  vague 
thoracic  pain,  that  he  felt  worse  the  next  day,  and  on  February  29  hud  a  chill, 
severe  headache,  fever,  and  began  to  ache  all  over.  On  admission  he  appeared 
to  be  suffering  from  a  severe  neuralgic  attack  of  influenza  with  moderate  diar- 
rhoea. Physical  examination  was  negative.  Magnesium  sulphate  and  phenace- 
tine  were  exhibited ;  on  the  following  morning  his  temperature  was  37.8°  and 
patient  said  he  felt  better  in  all  respects.  That  evening,  however,  his  tempera- 
ture returned  to  40°,  and  free  prespiration  was  present.  On  March  4  slight 
icterus  of  conjunctivte  was  noted,  bowels  were  still  loose,  and  patient  reported 
slight  pain  in  left  hypochondriura,  but  physical  examination  still  proved  nega- 
tive. That  evening  he  reported  dizziness  and  pain  at  base  of  left  lung  in  pos- 
terior axillary  line.  A  few  crackling  rales  could  be  heard  at  this  point,  and 
over  the  tricuspid  area  a  low  blowing  murmur.  No  change  occurred  on  the 
following  day  except  a  decrease  in  thoracic  pain.     On  March  6  signs  of  pleurisy 


504  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

were  jiresent  over  entire  left  lower  lobe  of  luns,  with  dullness  posteriorly,  flat- 
tening laterally,  and  tynipano-resonance  anteriorily  ;  the  !»reatli  sounds  over  this 
area  were  somewhat  tubular.  On  the  following  day  all  the  signs  of  pneumonia, 
with  added  involvement  of  lower  half  of  upper  loi)e,  were  present  in  left  lung. 
Posteriorly  there  was  practically  complete  absence  of  tactile  fremitus  over  this 
lung,  but  anteriorly  there  was  tympano-resonance  atid  slightly  augmented  tactile 
fremitus,  even  when  patient  assumed  various  i)ositions.  The  heart  sounds  were 
normal  and  slightly  subdued  in  intensity.  Delirium  set  in  and  persisted  to  the 
end.  Pro.stration  was  extreme,  the  patient  apparently  laboring  under  i>rof()u:Hl 
toxaemia.  On  the  8th  the  patient's  condition  grew  rapidly  worse,  the  pulse 
growing  feebler  and  more  rapid.  During  the  night  the  patient  fell  into  a  stui)or 
and  toward  morning  failed  rapidly,  dying  at  S.40  a.  m.  without  regaining 
consciousness. 

Treatment. — Counterirritants  were  directed  against  the  pleurisy.  After 
physical  signs  of  pneunionia  v>'ere  detected  stimulants  and  light  nourisliing 
diet  were  given  and  cotton  jacket  a])])lied.  When  tlie  signs  of  toxjpmia  i)re- 
sented,  subcutaneous  injections  of  normal  saline  silution  were  given  and  stimu- 
l;^i^ts — strychnia  and  whisky — were  administered  hypndermically  to  combat  the 
depression.  Ilyoscine  hydrobromate  was  used  to  control  the  active  stage  of 
the  delirium. 

Necropsy  (11  hours  after  death). — P.ody  that  of  a  well-developed  male;  layer 
of  adipose  tissue  thick  ;  usual  amount  of  rigor  UKirtis  and  post-mortem  lividity 
present;  350  c.  c,  milky  fluid,  containing  an  abun.dance  of  fibrin  Hakes,  found  in 
pericardium;  deposit  of  fibrin  upon  both  visceral  and  parietal  pericardium. 
The  heart  weighed  470  grams ;  its  muscular  tissue  was  apparently  normal ; 
the  valves  were  competent.  I)ut  all  were  of  i)ink  color.  The  right  lung  weighed 
TOO  grams,  was  Iwund  down  in  a  number  of  places  by  old  adhesions,  but  was 
otherwise  normal.  The  left  lung  weighed  1,^00  grams;  posteriorly  a  pocket 
had  been  formed  by  recent  pleural  adhesions,  and  this  contained  300  c.  c.  bloody 
purulent  fluid.  In  the  general  pleural  cavity  (left)  was  about  100  c.  e.  milky 
seropurulent  fluid,  containing  many  fibrin  flakes.  The  visceral  and  parietal 
pleura  at  the  base  of  the  left  lung  showed  fibrin  deposits  and  numerous  i-ecent 
adhesions.  The  lower  lobe  and  the  lower  half  of  the  u])i)er  lobe  of  the  left  lung 
were  in  a  stage  of  gray  hepatization.  Remainder  of  upper  IoIjo  was  crepitant.  No 
signs  of  tubercle  present.  The  liver  weighed  2,900  grams  ;  the  capsule  was  greatly 
thickened  and  in  places  cartilaginous,  but  otherwise  ai^parently  normal.  The 
right  kidney  weighed  210  grams;  the  capsule  strii)i)ed  off  readily;  both  organs 
were  congested  and  had  a  narrow  cortex  which  in  places  could  not  be  differen- 
tiated from  the  pyramids.  The  spleen  weighed  3.^0  grams,  was  dark-bluish  in 
color,  and  somewhat  friable.  The  i)ancreas  weighed  00  grr.ms  and  was  normal 
in  its  gross  appearance.  The  bladder  was  empty.  The  stomach  and  intestines 
were  normal. 

L.  P.  H.  B. 

C.  E.  B. 

VI. 

F.  J. ;  age,  41 ;  a  native  of  the  United  States ;  entered  the  marine  ward  of 
the  Buffalo  Hospital  of  the  Sisters  of  Charity  on  the  10th  and  died  on  the  15th 
of  February,  1!)04. 

History. — His  family  history  is  negative.  lie  states  that  he  has  had  the 
ordinary  diseases  of  childhood,  and  had  been  under  treatment  in  this  hospital 
for  typhoid  fever  one  year  ago,  and  the  records  show  that  during  this  attack 
his  lungs  were  the  seat  of  decided  reaction.  He  further  states  that  he  has 
been  ill  for  the  past  two  weeks  with  grippe,  contracted  while  working  on  Long 
Island  Sound,  and  from  which  he  had  not  fully  recovered  when  he  came  to 
this  port.  Three  days  ago,  or  on  the  7th,  he  experienced  a  hard  chill,  with 
pain  in  the  right  side,  and  for  three  days  has  suffered  a  great  deal.  On  admis- 
sion he  is  quite  ill ;  there  is  severe  pain  in  the  right  side,  with  frequent  cough 
and  expectoration  of  ])ronounced  pneumonic  sputum ;  the  face  is  darkly  suf- 
fused, and  the  tongue  furred ;  the  face  is  decidedly  apprehensive ;  the  tempera- 
ture is  37.8°  :  pulse,  102 ;  respiration,  26. 

Physical  examination  shows  the  entii'e  right  lung  in  consolidation ;  a  high- 
pitched  percussion  note,  almo.st  flat,  characterizes  l)oth  the  middle  and  lower 
lobes,  while  the  upper  is  somewhat  emphysematous  anteriorly,  but  dull  pos- 


PTTKLir    IlKALTII    AND    MARTNE-IIOSPTTAL    SERVICp].  505 

torioi'Iy.  AuscuUiitiou  ovor  tlio  lowor  areas  gives  liarsli  luhal  lin-atliiiiR.  with 
iiuiiK'niiis  loud,  moist  rales;  over  the  infrascapular  ref^ion  there  is  a  dry 
I)kniral  friction  rub  extendiufr  over  the  mid  lateral  lobe;  at  the  ujtper  lobe 
there  is  crei'itation,  with  the  line  moist  sounds,  and  conuncncinfx  tubal  breath- 
ing, from  the  extension  of  the  process  upward.  On  the  left  side  there  is  purile 
breathing  over  the  anterior  ehest  wall  and  the  moist  sounds  of  a  commencing 
uedema  in  the  dependent  portions  of  tlie  lung.  At  the  angle  of  the  right  scapula 
there  is  the  most  pronounced  pectoriloquy.  At  this  i)oint  aspiration  is  tried, 
hut  the  needle  fails  to  reacli  tiuid.  To  this  serious  lung  conditi(»n  is  added  a 
marked  paresis  of  the  small  intestine;  the  abdomen  is  greatly  swollen,  the  note 
drumlike,  and  the  distention  is  seriously  impairing  the  heart's  action,  which  is 
at  times  tunuiltuous.  Treatment  to  relieve  the  al)dominal  distention:  Calomel 
and  guiacol  by  mouth,  and  tlu'  high  rectal  tul)e  with  turpentine  enemas,  are 
ordered  and  give  immediate  relief;  the  chest  is  enveloped  in  a  cotton  jacket 
and  heroine  given  to  relieve  ])ain  ;  general  stimulation,  with  close  attention  to 
the  overfull  right  heart  ;  milk  and  broths. 

Fchnntry  11. — The  condition  remains  unchanged;  the  cycle  may  not  be  accom- 
plished until  the  14th  or  l.lth;  the  temperature  is  oS°  ;  pulse,  100;  respiration, 
22.  The  blood  pressure  is  IGO  mm.  of  mercury;  the  al)domen  still  distended; 
the  heart  not  so  tumultuous ;  the  s])utum  contains  numerous  dlplococci  of  pneu- 
monia. 

February  13. — The  temperature  is  38°  ;  pulse,  118 ;  respiration,  52.  The  right 
lung  is  now  solidified  throughout;  the  exploring  needle  again  fails  to  find  pleu- 
ral fluid;  the  left  lung  is  (edematous  throughout  the  lower  lobe;  the  right  heart 
is  improved  under  stimulation  and  nitroglycerin  ;  the  urine  is  scanty  and  albu- 
minous ;  the  abdomen  still  distended ;  a  Widal  reaction  is  positive  from  the  pre- 
ceding typhoid;  there  is  a  leucocytosis  of  17,000.  Suprarenal  extract  is  ordered 
to  relieve  the  paresis  of  the  small  intestine,  with  hypodermatics  of  physostig- 
mine;  also  hot  and  cold  stupes;  firing  along  the  recti  muscles,  and  the  galvanic 
current.  Saline  infusions  under  the  skin  are  ordered  to  influence  the  renal  se- 
cretion. 

Fehruary  l.'i. — All  the  symptoms  are  accentuated ;  there  is  no  sign  of  com- 
mencing resolution  in  the  lower  right  lobe ;  the  oedema  on  the  left  side  is  pro- 
gressing ;  the  heart  is  seriously  compressed  from  the  greatly  distended  abdomen  ; 
the  temperature  is  38°  ;  pulse,  124 ;  respiration,  58. 

Fehruary  15. — Death  at  8  a.  m.  from  heart  failure. 

Necropsy,  (held  9  hours  post-mortem). — The  body  is  emaciated;  the  abdomen 
greatly  distended ;  rigor  mortis  is  marked ;  the  dependent  portions  are  livid ; 
there  are  numerous  puncture  points  upon  the  chest  wall,  the  sites  of  saline  infu- 
sions. On  section  the  contents  of  the  abdomen  are  found  of  normal  appearance 
.save  for  the  distention  of  the  small  intestine,  which  failed  to  contract  when 
incised  freely,  the  escaped  gas  leaving  the  gut  collapsed,  but  widely  distended ; 
the  mucosa  is  clean  and  of  ansemic  appearance,  the  glands  are  normal,  the 
veins  of  the  mesentery  congested.  The  colon  is  also  distended ;  the  kidneys 
are  engorged,  their  capsules  peeling  easily;  section  shows  the  cortex  pale  with 
poorly  defined  markings ;  the  urinary  bladder  contains  200  c.  c.  of  albuminous 
urine ;  the  spleen  is  enlarged ;  the  liver  and  gall  bladder  normal ;  the  pancreas 
is  normal,  as  are  the  adrenals.  The  diaphragm  is  at  the  sixth  left  interspace, 
and  at  the  fourth  on  the  right  side.  On  removing  the  bony  wall  the  left  lung 
retracts,  the  right  is  rigid ;  the  right  pleura  is  Inflamed,  fresh  lymph  binding 
the  layers  and  obliterating  the  pleiu'al  sac  save  at  the  midlobe  posteriorly, 
where  there  is  a  collection  of  250  c.  c.  of  turbid  serum ;  the  lung  is  solidified, 
the  lower  and  mid  lobes  in  gray,  the  upper  in  red  hepatization,  and  there  is 
no  sign  of  resolution.  The  left  pleura  is  adherent  to  the  parietes  and  the 
lung  posteriorly  over  the  upper  lobe ;  the  left  lung  is  oedematous  both  in  the 
vesicles  and  the  connective  tissues ;  sections  float  in  the  bath ;  the  larger 
bronchii  are  inflamed,  the  mucosa  covered  with  glairy  mucus ;  the  pericardial 
fluid  is  increased ;  the  heart  muscle  is  pale ;  the  right  heart  is  distended  with 
semifluid  blood ;  there  is  a  partially  decolorized  clot  from  the  aorta  into  the 
left  heart ;   the  valves  are  efficient.     Brain  and  spinal  cord  not  examined. 

Anatomical  diagnosis. — Acute,  fibrinous,  lobar  pneumonia,  with  acute,  fibri- 
nous, pleuritis  limited  to  the  right  side;  a  left-sided  bronchitis  and  (acute  toxic) 
paresis  of  the  small  and  large  intestine. 

E.  W. 


506  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

VII. 

J.  McL. ;  age,  G5 ;  nativity,  Ireland;  admitted  to  the  United  States  Marine 
Hospital,  San  Francisco.  Cal.,  November  17,  1903 ;   died  November  19,  1903. 

History. — The  patient  uses  alcoholic  liquors  and  tobacco ;  had  pneumonia 
twenty  years  ago,  rheumatism  fifteen  years  ago.  He  was  taken  sick  three 
weeks  ago  with  a  bad  cold,  which  has  grown  steadily  worse.  He  now  has  a 
severe  pain  in  his  left  side,  dyspnoea,  severe  cough,  and  nasty  expectoration. 
Examination  shows  marked  dullness  and  increased  vocal  fremitus  over  the 
whole  of  left  lung  and  base  of  right  lung.  There  are  moist  rales  heard  over 
both  lungs,  but  more  apparent  over  apex  of  right  lung.  Heart  sounds  difficult 
to  distinguish,  on  account  of  noisy  breathing;  pulse,  122,  full  and  strong; 
temperature,  38.G°  ;  respiration,  34.  The  next  morning  the  patient's  condition 
had  slightly  improved,  but  his  strength  gradually  failed,  and  he  died  at  4.15  a.  m. 
November  19,  1903. 

Necropsy  (10  hours  after  death). — Height,  173  cm. ;  rigor  mortis  well  marked; 
post-mortem  lividity  present.  Brain:  Weight,  1,300  grams;  tissue  normal.  On 
opening  abdominal  cavity  intestines  found  to  be  of  a  gray  color  distended  with 
gas.  The  transverse  colon  shows  a  constriction  of  one-half  its  diameter  for  a 
distance  of  7  cm.  near  the  hepatic  flexure.  Appendix  very  small ;  omentum  con- 
tains considerable  fat.  On  opening  the  thorax  the  softness  of  the  bones  is  noted. 
The  fat  in  the  anterior  medeastinum  shows  a  slight  yellow  oedema ;  pericardium 
liound  down  to  both  lungs  l)y  adhesions.  Heart:  Weight,  470  grams.  There 
is  a  "  milk  spot  "  about  the  size  of  a  nickel  on  its  anterior  left  aspect ;  a  number 
of  white  branching  lines  are  also  present  on  its  surface,  which  appear  to  be 
degenerated  lilood  vessels.  There  is  a  large  chicken-fat  clot  in  the  right  ven- 
tricle, extending  through  the  auricular  orifice  into  the  ventricle  and  up  into  the 
pulmonary  orifice.  The  edges  of  the  leaflets  of  the  mitral  valves  are  roughened 
and  thickened  ;  other  valves  normal.  There  are  a  few  atheromatous  spots  at  the 
base  of  the  mitral  valve  and  in  the  aorta  near  the  aortic  valve.  The  wall  of  the 
right  ventricle  is  1  cm.  thick,  the  wall  of  the  left  2  cm.  The  heart  muscle  is  of 
a  bright  red  color,  the  endocardium  a  light  brown.  Left  lung  adherent  to  chest 
wall  throughout;  it  is  removed  with  difficulty  from  the  thoracic  cavity.  The 
whole  lung  is  a  solid  mass,  color  of  tissue  dark  reddish  brown.  Right  lung 
also  bound  down  throughout  to  the  chest  wall.  All  parts  are  solid  except  the 
posterior  part  of  the  lower  lobe,  which  is  crepitant.  Spleen :  Weight,  18.5 
grams;  color,  pale  red;  cuts  with  slight  resistance;  trabeculie  prominent.  Left 
kidney :  Weight,  IGO  grams ;  capsule  nonadherent ;  pelvis  contains  considerable 
fat,  cortical  portion  very  thin,  pyramids  not  prominent.  Right  kidney :  Weight, 
130  grams.  There  is  a  serus  cyst  the  size  of  a  marble  on  external  surface ;  tissue 
cuts  with  greater  resistance  than  left  kidney ;  color,  red,  with  minute  yellow 
markings.  Bladder  empty  ;  mucous  membrane  of  stomach  slightly  congested.  It 
is  covered  with  yellowish-white  mucus.  Small  intestines  normal.  Liver: 
Weight,  2,100  grams  ;  surface  brown,  mottled  with  yellow  areas  ;  cuts  with  slight 
resistance ;  tissue  greasy  to  the  touch. 

W.  G.  S. 

VIII. 

J.  R. ;  age,  .30;  nativity,  Tennessee;  was  admitted  to  the  United  States  Marine 
Hospital,  port  of  St.  Louis,  Mo.,  February  12,  and  died  February  17,  1903. 

History. — This  patient  had  been  evidently,  from  his  extremely  filthy  con- 
dition, lying  in  neglected  quarters  for  some  weeks,  though  he  maintained  he  had 
been  on  a  vessel  within  a  week.  On  admission  he  could  not  give  an  intelligent 
account  of  himself,  other  than  he  had  been  drinking,  had  caught  cold,  was  suf- 
fering much  pain  in  the  chest,  and  was  "  feverish."  Temperature,  40°  C. ;  pulse, 
88,  weak;  respiration,  36  per  minute;  shallow.  Respiratory  murmur  lost  on 
right  side.  He  was  thoroughly  cleaned  in  a  hot  bath,  put  to  bed,  and  a  cotton 
jacket,  covering  entire  chest,  applied.  A  mild  mercurial  purge  was  adminis- 
tered, followed  by  quinine  in  1.33  gram  doses.  Abundant  easily  digestible  food 
(eggs,  milk,  and  the  ordinary  diet)  was  given,  of  which  he  ate  very  freely.  A 
blister  was  applied  over  the  seat  of  pain,  and  with  the  exception  of  this  pain 
the  patient  invariably  declared  that  he  was  perfectly  comfortable.  Prune- 
juice  expectoration  was  observed  from  the  entrance  of  the  patient.  A  tendency 
to  rambling  delirium  was  noticed  early  in  the  case.  On  February  K!  a  free  stimu- 
lation with  strychnine  and  whisky  was  begun  without  apparent  benefit. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE. 


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Necropsy  (14  hours  after  death). — Body  that  of  a  middle-aged,  very  black, 
negro  male,  fairly  well  nourished;  rigor  mortis  marked;  pleura  obliterated; 
periphery  of  lungs  covered  with  exuded  plastic  lymph ;  pericardium  thickened 
and  showing  signs  of  old  inflammatory  action ;  heart  hypertrophied  concen- 
trically ;  filled  with  chicken-fat  clots ;  valves  apparently  normal ;  weight,  430 
grams.  Lungs :  Right,  hepatized  throughout,  adherent  strongly  to  anterior 
chest  wall  by  old  and  by  recent  exudations  of  lymph ;  weight,  1,650  grams ; 
middle  and  inferior  lobes  breaking  -down,  cavities  filled  with  seropurulent  mat- 
ter. Left :  Closely  adherent  by  old  exudations  laterally  and  posteriorly  to 
chest  wall ;  weight,  800  grams ;  slightly  congested,  and  friable  under  the  knife. 
On  removal  indentation  of  ribs  visible.  Liver  somewhat  cirrhosed ;  vessels 
dilated;  weight,  2,200  grams.  Kidneys:  Right,  capsule  adherent ;  rather  pale 
and  shriveled;  weight,  150  grams.  Left,  apparently  normal;  weight,  200  grams. 
Stomach,  intestines,  bladder,  and  urethra  normal.     Brain  not  examined. 

H.  C.  W. 

J.  M.  G. 
IX. 


C  E. ;  age,  53 ;  nativity,  England ;  admitted  to  United  States  Marine  Ho.-s- 
pital,  Baltimore.  Md.,  February  27,  1904 ;  died  March  2,  1904. 

History. — Admitted  to  the  wards  complaining  of  pain  in  the  right  chest ; 
cough,  with  blood-stained,  tenacious,  rusty  sputum ;  had  a  severe  chill  three 
days  before  admission. 

Physical  examination  showed  impaired  resonance  on  percussion  over  the  base 
and  side  of  the  right  lung.  There  was  increa.sed  vocal  fremitus  and  resonance, 
also  crepitant  riiles  heard  on  inspiration  along  the  right  anterior  axillary  line 
below  the  axillary  fold.  On  admission  the  patient  gave  evidence  of  a  previous 
alcoholic  history ;  was  nervous  and  tremulous ;  skin  was  jiale  and  leaky,  and 
there  was  considerable  dyspnoea.  The  urine  was  slightly  albuminous  and  con- 
tained pale  granular  casts  in  moderate  amount. 

Clinical  diagnosis. — Lobar  pneumonia  in  the  eighth  day  of  the  disease; 
nephritis,  paremchymatous. 

Necropsy  (14  hours  after  death). — Body  of  a  well-developed  white  man; 
weight,  about  170  pounds ;  height,  about  5  feet  9  inches.  The  skin  is  pale  lemon 
yellow  in  color.  There  is  a  large  ulcer  2  inches  in  diameter  on  the  right  leg  just 
above  the  ankle.  The  panniculus  adiposus  is  extremely  well  marked ;  is  pale 
lemon  yellow  in  color.  Section  of  the  body  shows  all  organs  in  normal  position. 
The  left  pleural  cavity  and  corresponding  lung  are  quite  normal,  barring  some 


508  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

slight  hypostasis  in  the  jiostorior  portion  of  the  lun?;.  The  riirht  jilennil  cavity 
fontains  aix)ut  4(K>  c.  e.  of  clear  yellow  serum.  The  visceral  layer  of  the  nieni- 
hrane  covering  the  anterior  and  lateral  aspects  of  tlie  lung  is  cviated  here  and 
there  by  irregularly  shaped  patches  of  fibrinous  exudate.  The  lung,  e.xcepting 
the  lower  lobe,  is  completely  solidified  and  is  adherent  at  its  apex.  Section 
of  the  organ  shows  an  irregularly  grayish  red  surface  of  section.  The  organ 
is  quite  friable,  and  both  cut  and  torn  surfaces  show  the  gaping  orifices  of  the 
smaller  bronchioles  containing  a  central  projecting  fibrinous  plug.  The  mucous 
membrane  of  the  larger  bronchial  tubules  is  swollen  and  its  capillaries  deejily 
injected.  There  is  a  scar  in  the  right  a])ex.  the  result  of  a  chronic  tubercul:;r 
process.  The  pericardium  is  normal.  The  heart  is  somewhat  enlarged.  Th!> 
left  ventricular  wall  is  thickened  and  reddish  yellow  in  color,  showing  evi- 
dences of  fatty  change  in  the  muscular  tissue.  The  auricles  and  left  ventricle 
are  dilated  and  filled  with  a  mixed  currant-jelly  and  chicken-fat  clot.  The 
mitral  valves  are  competent :  the  valve  leaflets  are  considerably  thickened. 
The  aortic  and  pulmonary  semilunar  valve  leaflets  are  slightly  thickened,  but 
are  competent.  The  spleen,  liver,  and  other  abdominal  viscera,  excepting  the 
kidneys,  are  apparently  normal.  The  left  kidney  weighs  180  grams.  It  is 
enlarged,  soft,  and  pale  grayish  red  in  color.  The  capsule  strips  readily,  dis- 
closing a  yellowish  red  mottling  of  the  surface  of  the  kidney.  Upon  section 
the  organ  presents  a  clouded  grayish-red  appearance,  but  upon  close  examina- 
tion there  is  seen  a  decidetl  general  yellowish  mottling  of  the  grayish-red  sur- 
face of  section.  The  right  kidney  weighs  190  grams  and  presents  character- 
istics similar  to  its  fellow  of  the  opposite  side. 

Anatomical  diacnosts. — Lobar  pneumonia,  right,  upper,  and  middle  lobes; 
chronic  myocarditis,  with  moderate  sclerosis  of  the  mitral  and  aortic  valve 
leaflets ;  chronic  parenchymatous  nephi'itis,  with  fattv  change. 

H.  R.  C. 

C.  W.  W. 
X. 

J.  P.;  age,  4.5;  nativity,  Greece;  admitted  to  Marine  Hospital,  Mobile,  Ala., 
July  20,  190.3 ;  died  July  31,  1903. 

History. — Father  died  at  Gli  yeai-s  of  age ;  cause,  fever ;  mother  died  at  7."> 
years  of  age.  drowned;  one  brother  and  one  sister  living,  both  in  good  health; 
had  fever  about  twenty  years  ago ;  lias  never  had  any  venereal  disease. 

Present  illness. — Suffered  injury  to  palm  of  right  hand  while  performing 
heavy  labor.  Hand  became  swollen  and  painful  ;  has  small  abrasion  on  back 
of  same  which  contains  pus.  States  had  two  chills — one  Monday  and  one  Tue.s- 
day — followed  by  fever. 

July  31,  1903  (two  days  after  admission). — Complains  of  pain  in  right  side: 
referred  to  right  mammary  region.  Physical  examination  elicited  dullness  over 
this  area;  crepitant  rales  present:  a  considei-able  portion  of  upper  and  middle 
lobes  seem  to  be  involved.  Patient  was  given  ammonium  chloride,  aromatic 
spirits  ammonia,  and  strychnine  hypodermically  in  large  doses,  also  nitro- 
glycerine and  normal  salt  solution,  without  effect.  Died  8.45  p.  m.  July  31, 
1903.    Temperature  at  this  time  .39°  C. ;  pulse.  140:  respiration,  42. 

Necropsy  (11  hours  after  death). — Body  of  a  white  male,  apparently  about 
40  years  of  age :  rigor  mortis  fairly  well  marked ;  post-mortem  discolorations 
on  back,  buttocks,  legs,  scrotum,  back  of  neck,  and  head ;  eyes  open,  pupils 
dilated,  mouth  closed  ;  coagulated  blood  in  left  nostril ;  froth  in  mouth ;  left 
hand  slightly  swollen  ;  abdomen  distended.  Body  opened  by  long  incision,  reach- 
ing from  chin  to  symphisis  pubis.  Diaphragm  attached  between  eighth  and 
ninth  ribs.  Heart  normal;  post-mortem  clot  in  right  auricle;  weight,  335 
grams.  Lungs  very  dark  in  appearance:  bleed  easily  on  section:  weight  of  left 
lung  is  700  grams.  The  entire  right  lung  is  very  mucli  congested,  the  upper 
lobe  containing  pus;  weight  of  right  lung,  1,1.30  grams.  A  hard  calcareous 
deposit,  about  the  size  of  end  of  little  finger,  found  between  trachea  and  esopha- 
gus. Liver  normal  in  apjiearance,  bleeds  easily  on  section,  and  weighs  1,715 
grams.    Gall  bladder  contains  about  15  c.  c.  of  bile. 

J.  H.  W. 
XL 

A.  P. ;  age.  59 ;  nativity,  California ;  admitted  to  the  United  States  Marine 
Hospital.  Baltimore.  Md.,  May  9,  1904,  with  a  history  of  chills,  cough,  and  pain 
in  the  left  chest. 

Physical  examination  showed  dullness  on  percussion  over  the  upper  half  of 


PUBLIC    HEALTH    AND    MARINK-HOSPITAL    SERVICE.  5U9 

tlio  left  clii'sl  :  rntlior  fonrso  suhorcpitiint  rales  licard  tliroui^lioiit  inspiration 
ill  tliis  location.  Sputum  tenacious  and  faintly  rust  slroaUcd.  I'rinc  albumin- 
ous. Si.\  days  after  admission  tlicro  was  noticed  some  pitting  over  the  pre- 
cordia.  with  some  iiicreas(>d  an>a  of  cardiac  dullness;  heart  sounds  distant. 
Death  May  17,  S  days  after  admission. 

Cm-mcaf,  ihacnosis. — rneumonia,  acute,  lobar  (left)  ;  pericardial  effusion; 
Itarenchyinatous  nephritis. 

Anatomuai,  diagnosis. — Pneumonia,  lobar  left;  librino-i)urul<'iit  pericarditis; 
chronic  i»arenchymatoiis  neiihritis. 

XKcijoesY  (18  hours  after  death). — Kody  of  slightly  built  Mexican;  i)ost- 
iiiortem  rigidity  present.  Section  shows  little  subcutaneous  fat,  with  all  organs 
in  norm.-il  position.  The  left  pleural  cavity  is  normal.  The  corresponding 
lung  shows  uniform  solidification  of  the  upper  lobe.  Section  of  the  organ 
reveals  a  typical,  gray  heiiatization  of  the  upper  lolie,  with  bronchial  tubules 
lillcMl  with  a  semifluid,  thick,  inirulent  material.  The  larger  bronchi,  as  they 
iiciir  the  trachea,  show  extreme  injection  and  swelling  of  their  mucous  mem- 
brane. The  lower  lobe  is  dark  red.  containing  much  blood,  and  is  somewhat 
cedamatous.  A  similar  condition  of  pulmonary  congestion,  with  oedema,  pre- 
vails throughout  the  ojiposite  lung  structure.  The  right  pleural  cavity  is 
normal.  The  pericardium  is  moderately  adherent  to  the  pleura  on  either  side. 
It  is  distended  and  enlarged  fully  one-fourth  its  normal  size.  Section  reveals 
an  extremely  interesting  condition.  The  cavity  is  filled  partly  by  about  200 
c.  c.  of  thin,  cloudy,  yellowish,  purulent  fluid,  and  partly  by  a  well-organized 
fibrinous  exudate  which  co\ers  completely  the  visceral  and  parietal  layers  of 
the  structure.  This  fibrinous  structure  varies  from  0.3  to  0.4  cm.  in  thickness; 
is  yellow,  firm,  and  is  readily  detached  from  tlie  underlying  pericardium.  The 
attached  surface  is  smooth ;  its  free  surface  rough,  with  innumerable  freely 
projecting  fibrinous  shreds.  It  is  to  be  regretted  that  inoculations  on  culture 
media  were  not  made  from  the  pericardial  contents,  since  it  is  thought  that 
the  condition  might  possibly  have  been  the  result  of  a  pneumococcus  infection  of 
this  structure.  The  heart,  beyond  some  slight  hypertrophy  of  the  left  ven- 
tricular wall,  which  is  2.5  cm.  in  thickness,  is  normal  and  its  valves  are  com- 
petent. The  liver,  which  weighs  2,270  grams,  is  enlarged  and  swollen.  Other- 
wise it  shows  no  further  pathological  change.  The  spleen,  weight  205  grams, 
though  slightly  enlarged  and  swollen,  does  not  dejiart  much  from  the  normal 
appearance.  The  kidneys  present  a  similar  condition  and  may  be  discussed 
together.  They  are  slightly  enlarged  (right  weighs  230;  left,  220  grams),  their 
capsules  strip  readily,  and  on  section  they  show  a  grayish-pink,  cloudy  surface 
of  section.  The  cortex  measures  1  cm.,  is  thickened,  pale  and  clordy  in  appear- 
ance. The  organs  are  tyiiical  examples  of  a  chronic  parenchymatous  inflam- 
matory process.  The  suprarenal  capsules  are  normal,  as  are  also  the  other 
abdominal  organs, 

H.  R.  C. 
C.  W.  W. 
Lobular. 

P.  M. ;  age,  58 ;  nativity,  Ireland ;  entered  United  States  Marine  Hospital, 
Baltimore,  Md..  September  21,  1003;  died  October  11,  1903. 

Came  in  suffering  with  intense  dyspnoea  ;  unable  to  lie  down  and  scarcely  to 
stand:  dyspnoea  asthmatic  in  character,  relieved  by  hypodermic  injection  of 
morphia  and  atropia.  Gives  history  of  such  attacks  at  intervals  for  some  years, 
but  recently  has  had  them  oftener  and  more  severely,  and  has  pain  over 
praecordia  and  "  all  over."  Temperature,  39.6°  ;  pulse,  140  (taken  after  par- 
oxysm had  passed). 

Examination  of  thorax  shows  heart  enlarged,  apex  to  near  midaxillary  line, 
and  impulse  weak;  quick  and  irregular;  no  valvular  lesion  made  out;  lungs 
give  signs  of  general  bronchitis,  with  emphysema  about  apices ;  there  are  a 
number  of  very  small  rales  and  some  "wheezing;"  examination  of  urine  nega- 
tive. The  case  did  badly  from  the  beginning ;  there  \Aere  recurrent  attacks  of 
dyspnoea,  and  the  heart  was  always  very  weak.  During  the  attacks  of  dyspnoea 
the  intercostal  spaces  would  sink  in  as  in  asthma.  Albuminuria  appeared  later 
and  the  urine  became  scanty.     He  died  of  cardiac  weakness. 

Necropsy  (30  hours  after  death). — Man  of  medium  build:  marked  hypostatic 
congestion  of  neck  and  face,  also  some  cutaneous  congestion  on  lateral  and 
posterior  surfaces  of  body  and  legs:  hairy  development  excessive:  normal  fat 
on  chest  and  abdomen;  intestines  distended  witli  gas;  omentum  normal,  almost 
entirely  free  from  fat;  cartilages  of  ribs  soft,  and  but  little  changed  by  age. 


510  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

On  opening  thorax  the  left  hiui;  coUapsed ;  the  rii^ht  hiiiy  collapsed  but  little, 
being  held  by  adhesions  in  fnjnt.  Left  lung  presents  no  adhesions;  i)assi^e  con- 
gestion in  postei'ior  part;  cniphysenjatoiis  on  front  edges,  with  many  spots  of 
consolidation:  lohnlar  imennionia  :  apices  very  eni])hyseniatous.  Right  lung 
adheres  to  anterior  wall  aii<l  none  other;  both  lungs  niarlvedly  emphysematous, 
especially  at  apices  and  on  front  edges,  with  many  and  considerable  patches  of 
lobular  pneumonia ;  nnicous  membrane  of  bronchi  swollen  and  bronchi  contain 
tenacious  mucus ;  hypostatic  congestion  in  posterior  portion  of  neither  linig  is 
marked;  this  congestion  only  at  lower  end  of  posterior  portion.  Area  of  heart 
uncovei'ed  l)y  lung  above  normal ;  pericardium  contains  50  c.  c.  of  clear  fluid ; 
heart  in  diastole  widely  dilated,  is  large;  aorta,  pulmonary  vessels,  superior  and 
inferior  vena  cava  normal  in  size;  ante-mortem  clot  in  right  auricle;  right 
auricle  distended  and  has  rather  thin  walls;  walls  of  left  ventricle  extremely 
thin,  al)ont  1  cm.  thick  above  and  at  lower  part  0.5  cm.,  no  more;  cavity  enor- 
mously dilated;  right  ventricle  also  dilated,  but  not  markedly  so;  mitral  valves 
are  not  competent,  but  are  normal ;  aortic  valves  normal ;  heart  weights  380 
grams.  Abdomen:  Intestines  empty,  distended  with  gas;  gall  bladder  nearly 
empty ;  it  contains  a  small  amount  of  very  dark-brown  bile.  Liver  weighs 
1,770  grams;  it  has  a  scar  on  lower  part  of  right  lobe;  on  section  it  is  normal, 
except  at  scar,  which  shows  increased  connective  tissue  from  surface  to  deeji 
down  in  liver.  Kidneys:  Kiglit  weighs  1(!5  grams;  it  is  large,  congested,  and 
capsule  rather  adherent ;  on  section  marked  cong(>stion,  passive ;  cortex  well 
marked;  kidney  is  soft  and  friable.  Left  weighs  190  grams;  it  is  large,  con- 
gested, and  has  on  section  same  appearance  as  right,  only  more  marked;  capsule 
mainly  not  adherent.  Both  kidneys  i)resent  marks  of  intense  passive  congestion. 
Appendix  normal  in  position  and  size;  It)  cm.  long:  meso  appendix  within  1  cm. 
of  tip.  Spleen  weiglis  215  grams;  it  is  hard,  about  normal  in,  size,  and  normal 
on  section.     Other  viscera  not  examined. 

H.  R.  C. 

PULMONARY  HEMORRHAGE. 

J.  U. ;  age,  48 ;  born  in  Germany ;  was  aduiitted  to  United  States  Marine 
Hospital,  Stapleton,  N.  Y.,  September  15,  190.3,  and  died  October  8,  1903,  at 
6.30  a.  m. 

History. — Had  the  usual  diseases  of  childhood ;  malaria  four  years  ago  and 
syphilis  in  1893.  Pi-esent  illness  began  about  six  weeks  previous  to  his  admis- 
sion to  hospital.  First  symptom  noted  was  hoarseness,  which  was  marked  and 
persistent.  This  came  on  rather  suddenly.  For  three  weeks  jirior  to  admis- 
sion patient  was  treated  at  the  city  office,  New  York,  as  an  out-])atient,  for 
the  above  condition.  As  no  improvement  was  ob.served  he  was  sent  to  hos- 
pital on  September  15.  In  addition  to  the  hoarseness,  a  soreness  in  the  larynx 
and  pain  in  right  lung  developed.  This  pain  was  deep  seated  and  was 
descril)ed  as  beginning  about  the  region  of  the  diaphragm  anteriorly  and  extend- 
ing to  a])ex.  Patient  slept  well  and  had  a  fairly  good  appetite.  General  condi- 
tion was  very  good.     Temperature  and  pulse  were  normal. 

Physical  examination. — Palliation  and  ])ercnssion  negative.  Ausculta- 
tion revealed  harsh  bi-eathing  over  whole  of  anterior  surface  of  right  lung. 
No  moist  rales.  Left  lung  normal.  Heart  sounds  normal.  Patient  expectorated 
freely  a  frothy  mucus.  ^licroscopic  examination  of  sputum  showed  no  tuber- 
cle bacilli,  though  repeated  and  careful  examinations  were  made.  Laryn- 
goscopic  examination  revealed  no  ulcers.  Tov.ard  the  last  the  hoarseness 
became  worse,  and  i^atient  was  unable  to  sleep.  On  October  5  patient  fainted 
while  in  water-closet  and  said,  on  I)eing  revived,  that  his  nose  had  bled  some  a 
short  while  previously.  Treatment  consisted  of  inhalations  of  medicated 
vapors,  cough  mixtures,  and  the  iodides,  together  with  stimulants  and  a  gen- 
erous diet.  The  usual  counterirritants  were  applied  both  over  the  larynx  and 
over  the  right  lung.  On  the  morning  of  October  8,  while  attempting  to  go  to 
the  bathroom,  patient  died  suddenly  with  hemorrhage  from  the  lungs. 

Necropsy  (24  hours  after  death). — Pupils  eriually  dilated;  rigor  mortis  and 
post-mortem  lividity  marked;  body  well  developed  and  nuiscular;  subcuta- 
neous fat  abundant.  The  larynx  was  dissected  out  and  divided  from  trachea 
down  to  about  one-half  inch  below  the  cricoid  cartilage.  Examination  of  the 
interior  of  the  larynx  showed  slight  erosion  of  mucuous  membrane,  but  no  ulcers 
or  cicati'ices.  Vocal  cords  i)ale  and  somewhat  atroi)hied.  Dissection  of  the 
neck  gave  no  evidence  of  any  tumor  having  i)ressed  on  recurrent  laryngeal 
nerves.     Upon  incising  the  trachea  below  cricoid  cartilage  it  was  found  to  be 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  511 

filled  with  dark  fluid  blood,  which  poured  out  when  trachea  was  allowed  to 
retract  into  thoracic  cavity.  Inspection  of  the  orf?ans  within  thorax  showed 
that  both  lung's  collapsed  slijrhtly  when  jdeural  (-avities  were  opened  and  that 
the  heart  and  Iarj,'e  vessels  w(>re  in  a  normal  condition.  No  fluid  was  found  in 
either  pleural  sac  or  in  tlu>  pericardial  sac.  Lunf,'s  mottled  and  darlv  ; 
ri.i,'!it  lunuc  weifihed  ")"()  tjrams;  left.  r»4()  ,i,'rams.  On  section,  all  ramifica- 
tions (if  bronchi  and  bronchioles  of  both  lunj^s  were  found  to  contain  frothy 
fluid  blood.  No  cavities  or  areas  of  consolidation  were  found,  and  although  a 
tliorou.uh  search  was  made  the  vessel  from  whicli  the  lieniorrhaKe  proceeded 
could  not  be  found.  Mucous  menil»ran(>  of  trachea  and  bronchi  not  congested. 
The  heart  was  normal  on  section  ;  weiglit.  ?,2r>  grams.  The  abdominal  cavity 
was  ojtened  and  all  the  org:\ns  inspected  in  their  normal  positions.  No  jieri- 
toneal  adhesions;  lym])h  nodes  of  mesentery  not  enlarged.  All  organs  appear- 
ing in  a  perfectly  normal  state,  they  were  not  removed.     P.rain  not  examined. 

11.  McG.  R. 
P.  II.  K. 
PY.^MIA, 

M.  M.  :  age.  30 ;  nativity.  Clermany ;  admitted  to  the  United  States  Marine 
Hospital.  Stapleton,  N.  Y..  September  15.  1;h)3  ;  died  October  '5.  1903. 

History. — Family  and  personal  history  were  negative.  For  three  weeks  jirevi- 
ous  to  admission  t  >  hosjiital  jiatient  had  been  ill  on  board  ship.  The  trouble 
began  with  a  feeling  of  weakness,  followed  by  chills  and  sweats.  At  the  time 
of  admission  patient  appeared  profoundly  an:eniic  and  was  extremely  weak. 
Had  bedsores  on  posterior  aspect  of  right  elbow  joint  and  over  sacral  region. 
Examination  of  l)lood  sliowed  no  malarial  organisms.  Only  .3(»  jier  cent  haemo- 
globin present.  I'.lood  count  gave  an  enormous  increase  of  white  blood  cells, 
and  a  diminution  to  nearly  half  the  normal  number  of  the  reds.  p]xaminations 
of  urine  and  sputum  were  negative.  Temperature  of  patient  varied  from  36.4°  C. 
to  38°  C.  Pulse  ranged  from  78  to  100,  and  was  always  weak.  Discharge  of 
l)us  from  region  of  anus  indicated  an  ischio-rectal  abscess,  but  patient  was  too 
weak  to  undergo  operation.  Patient  was  delirious  nearly  all  the  time,  and 
failed  to  respond  in  any  way  to  treatment. 

Necropsy  (18  hours  after  death). — Body  markedly  emaciated  and  presented 
bedsores  on  right  elbow  and  over  sacral  region  ;  ankylosis  of  right  elbow ; 
rigor  mortis  marked :  cadaveric  lividity  slight ;  practically  no  subcutaneous 
fat  on  incision  ;  pleural  surfaces  adherent  over  greater  portion  of  Ijoth  lungs, 
but  no  fluid  in  pleural  sacs.  Lungs  very  small,  and  present  dark,  nearly  black 
spots  upon  gray  surface ;  both  crepitate  and  float ;  hypostatic  congestion 
marked  :  right  lung  weighed  370  grams  ;  left.  390  grams.  Pericardial  sac  con- 
tained small  amount  of  fibrinous  exudate.  Ileai-t  soft  and  flabby,  filled  with 
dark  fluid  blood,  apparently  fatty ;  weight,  320  grams.  Peritoneum  showed 
extensive  adhesions  in  posterior  i)ortion  of  abdominal  cavity.  Intestines  dis- 
tended with  gas  ;  small  amount  of  fat  in  mesentei-y  and  omentum.  Mesenteric 
lymph  nodes  not  enlarged.  Spleen  was  adherent  to  abdominal  wall  on  convex 
surface :  on  inner  side  it  was  covered  with  a  filn-inous  exudate.  Weight  of 
spleen,  100  grams ;  on  section  was  dark,  almost  black.  Liver  relatively  large ; 
weight,  1.400  grams :  apparently  normal.  Capsules  of  kidneys  strip  easily ; 
both  normal  in  appearance  on  section.  Stomach  small.  On  examination  of 
ischio-rectal  fossa  pus  was  found  in  abundance,  having  burrowed  about  in  ischio- 
rectal region.  An  interesting  feature  of  the  case  was  the  very  small  amount  of 
blood  found  in  the  body  while  performing  the  autopsy — very  little  even  in  the 
veins  and  large  arteries. 

H.  McG.  R. 

T>       TT       TD 

TUBERCULOSIS. 

Luriys. 
I. 

G.  W.  H. ;  age,  52;  nativity,  Michigan;  color,  white;  admitted  to  the  United 
States  Marine  Hospital,  San  Francisco,  Cal.,  February  10,  1904 ;  died  February 
29,  1904. 

History. — Had  a  chancre  nine  years  ago;  African  fever  thirty  years  ago; 
family  history  negative ;  diarrhea  more  or  less  steadily  for  about  four  .vears, 
which  has  gi'owu  much  worse  in  the  last  three  months ;   now  has  to  go  to  stool 


512  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

many  times  daily ;  has  lost  greatly  in  weight  and  is  very  short  of  breath ;  very 
weak  and  emaciated ;  dullness  over  both  lungs ;  vocal  and  tactile  fremitus 
much  increased,  particularly  over  right  luug ;  cogwheel  respiration  over  right 
lung:  few  large  dry  rales  heard  over  apices  and  base  of  left  lung;  heart  action 
regular;  skin  very  antemic;  cough  and  considerable  purulent  expectoration  con- 
taining numerous  tubercle  bacilli ;  trace  of  albumen  in  the  urine ;  irregular  tem- 
perature. The  patient's  condition  rapidly  became  worse,  delirium  supervening. 
The  diarrhea  did  not  abate,  but  the  expectoration  diminished.  Death  occurred 
as  stated  above. 

Necropsy  (27  hours  after  death). — Body  emaciated;  rigor  mortis  and  post- 
mortem lividity  present ;  left  pupil  widely  dilated.  A  urethral  discharge  is 
present.  Brain :  Weight.  1.305  grams ;  on  removing  the  calvarium  the  condition 
of  the  skull  cap,  the  brain  case,  the  sinuses  and  vessels  and  the  brain  and  its 
membranes  noted  ;  the  arachnoid  and  pia  are  congested.  Thorax  :  The  inner  bor- 
ders of  the  lungs  are  retracted ;  the  pericardium  is  strongly  bound  to  the  left 
lung ;  its  cavity  contains  a  moderate  amount  of  clear,  yellovrish  tluid.  The 
heart  is  small,  weighing  215  grams ;  on  the  surface  of  the  right  ventricle  is 
a  whitish  plaque  size  of  a  nickel ;  the  surface  is  pale  brown  in  color  and  the 
heart  substance  is  flabby,  and  cuts  with  the  usual  resistance  showing  a  i)ale- 
brown  cut  surface ;  the  left  ventricle  contains  a  white  clot ;  the  right  auricle 
and  ventricle  contain  mixed  clots ;  the  endocardium  is  smooth  in  all  the  cavi- 
ties;  the  aortic  and  pulmonary  v.-ilves  are  competent  to  the  water  test;  the 
mitral  orifice  admits  three  fingers,  the  tricuspid  four ;  the  mitral  valve  con- 
tains several  hardened  yellowish  plaques ;  the  tricuspid  valve  is  thickened 
and  somewhat  atheromatous ;  the  thoracic  aorta  contains  atheromatous  patches. 
The  left  lung  is  adherent  Ity  a  few  bands  posteriorly  and  at  the  apex,  and  weighs 
725  grams;  crepitation  is  fairly  good  throughout;  the  surface  is  of  slate-gray 
color  above,  dark  red  below ;  hardened  nodules  are  felt  in  the  apex  and  in  other 
places ;  section  of  the  upper  lobe  is  purulent  and  frothy,  showing  hardened, 
yellowish  masses ;  section  of  the  lower  lobe  is  bloody  and  frothy ;  the  right  lung 
weighs  1,150  grams ;  it  is  strongly  bound  down  posteriorly  and  about  the  apex 
and  by  one  band  to  the  diaphragm ;  the  surface  is  mottled  red  and  black  ;  there 
is  a  circumscribed  pleural  effusion:  the  entire  lung  is  solidly  infiltrated  except 
for  a  small  crepitant  area  in  the  middle  lobe  and  a  large  fluctuating  mass  in  the 
apex ;  section  of  the  lung  shows  it  to  be  a  mass  of  caseous  material  except  for 
the  presence  of  large  cavities  in  the  a])ex  and  middle  lobe;  the  right  pleural 
cavity  is  obliterated:  the  nerve  trunks  are  normal:  the  diaphragm  is  adherent 
to  the  base  of  the  right  lung  all  over  and  to  the  left  base  by  a  fibrous  band. 
Abdomen  :  The  great  omentum  is  thin,  retracted,  and  contains  almost  no  fat. 
The  si)leen  weighs  85  grams ;  it  is  small,  the  surface  wrinkles  easily,  and  is 
mottled  blue  and  bi-own ;  there  are  several  fine,  fibrous  plaques  in  the  capsule; 
section  gives  about  normal  resistance,  is  bloody,  and  the  pulp  is  prominent.  The 
left  kidney  weighs  120  grams ;  the  external  surface  is  smooth  and  pale  and  the 
fibrous  capsule  strips  readily ;  section  gives  normal  resistance  and  a  pale  color, 
showing  fatty  change.  The  right  kidney  weighs  110  grams  and  is  in  a  condition 
similar  to  that  of  the  left :  the  suprarenal  capsules,  urinary  bladder,  organs  of 
generation,  rectum,  and  duodenum  are  normal.  The  stomach  contains  a  quan- 
tity of  dark,  liquid  material ;  the  mucus  membrane  is  very  auipmic  and  shows 
hemorrhagic  areas:  the  gall  ducts  are  patent.  The  gall  bladder  is  distended 
with  bile  and  contains  four  gall  stones  of  pea  size  and  of  irregular  conformation. 
The  liver  weighs  1..320  grams :  the  external  surface  is  pale  and  mottled  with  yel- 
lowish areas;  it  cuts  with  slightly  diminished  resistance,  showing  a  pale  sur- 
face and  extensive  fatty  change.  The  pancreas  and  solar  plexus  appear  normal. 
The  mesentery  is  filled  with  enlarged,  hardened,  yellowish  lymph  glands.  The 
walls  of  the  small  intestine  show  extensive  ulceration  opposite  the  mesenteric 
attachment.  A  few  small  areas  of  ulceration  are  present  in  the  ascending  colon. 
The  vermiform  appendix  is  very  small  and  contains  in  its  wall  a  small,  localized 
abscess,  which  does  not  occlude  the  lumen.  The  great  vessels  are  apparently 
normal. 

Anatomical  diagnosis. — Congestion  of  arachnoid  and  pia  mater;  adhesions 
of  pericardium  and  left  lung ;  brown  atrophy  of  heart ;  arteriosclerosis  ;  chronic 
obliterative  i»leuritis  ;  circiunscribed  pleural  effusion  :  chronic  pulmonary  tuber- 
culosis ;  renal  and  hepatic  fatty  degeneration:  nonobstructive  gall  stones; 
tubercle  of  mesenteric  lymph  glands ;  tubercular  ulceration  of  small  and  large 
intestines ;  abscess  of  vermiform  appendix. 

C.    R. 

W.  G.  S. 


PUBLIC    HKALTH    AND    MARINE-HOSPITAL    SERVICE.  513 

II. 

S.  W.  W..  ago,  4(i;  horn  in  .Now  York  ;  julinittcd  to  T'nitcd  States  Marine  Hos- 
pital, C'liicago,  111..  .Inly  4,  IIKK!;   died  AujU'iist  20,  IIKKJ. 

History. — Has  always  boon  o.xcoptionally  rol»ust,  in  spito  of  continuod  dissi- 
pation, until  last  sprinj?.  At  that  timo  ho  ho^an  to  fool  languid  and  va^^noly 
nncoinforl.-iltle,  and  for  soino  time  ho  was  in  another  marine  hosi)ital,  according; 
to  another  patient,  in  a  condition  of  talkative  delirium.  P.efore  admission  he 
had  lieen  drinkin.t,'  heavily  to  for^^et  his  discomfort.  The  week  before  .admission 
he  had  sweats  and  p:iin  in  tlie  left  chest.  On  aihnission  he  was  filthy  from 
no^loct,  and  was  sleeidess,  tremblin,!,',  and  on  the  vorj^o  of  delirium  treiiiens. 
Thoro  wore  no  sij;ns  or  symptoms  i-oforahle  to  anything  but  alcoholism.  During 
his  stay  in  the  hospital  ho  was  in  a  condition  of  nervousness  and  o.xcitement. 
At  first  ho  did  not  sle(>i>  at  all  without  the  use  of  hypnotics,  and  at  no  time  were 
these  effectual  in  (piieting  him  entirely.  Later  ho  fell  into  a  state  of  continued 
talkative  dreams,  from  which  ho  could  bo  roused  at  any  time,  but  relapsed  aftei- 
a  few  nnnutos  and  toward  the  last  immediately.  lie  was  on  one  or  two  occa- 
sions awake  and  (luiot,  but  oidy  for  an  hour  or  so,  and  occasionally  asleej)  ;ind 
quiet;  but  as  a  general  rule  he  was  twitching,  tossing,  and  trying  to  get  out  of 
bed,  and  making  some  kind  of  noise  all  the  time.  One  night  he  had  to  be 
removed  from  the  ward  to  allow  the  other  ])atients  to  sleep. 

On  admission,  and  until  August  2,  no  signs  of  pulmonary  disease  were  dis- 
coverable except  occasionally  cough  and  mucopurulent  sputum,  and  mucous  rales 
over  the  left  apex  in  front,  with  an  occasional  whistling  rale  on  the  right  side. 

There  was  some  expectoration,  but  reiieated  staining  showed  no  tubercle 
bacilli  until  August  4.  On  the  dates  mentioned  dullness  on  percussion  was  dis- 
covered over  the  left  ape.x,  and  tubercle  bacilli  in  the  sputum.  The  consolida- 
tion increased,  and  also  the  expectoration,  from  that  time  until  death. 

At  first  the  bowels  were  constipated,  requiring  frequent  cathartics.  Later 
thoro  was  diarrhoea,  the  stools  at  first  being  voluntary,  later  involuntary.  They 
were  frequent.  co])ious,  and  watery.  For  a  few  days  before  death  tlie  stools 
showed  an  increasing  tendency  to  become  normal.  After  the  inunodiate  effects 
of  the  alcohol  wore  off  the  stomach  became  efflcient  and  remained  so  until 
death.  As  the  symptoms  suggested  some  form  of  autointoxication,  normal  salt 
solution  was  given  by  the  rectum  in  doses  of  1,000  c.  c.  from  .July  l.*^  to  24.  At 
first  this  was  well  borne,  but  later  had  to  be  discontinued  liocause  it  produced 
severe  pain  in  spite  of  large  quantities  (4  c.  c. )  of  tincture  of  opium. 

The  urinary  apparatus  acted  normally  throughout  the  course  of  the  disease. 
The  treatment  was  principally  symptomatic.  Alcohol  was  administered  through- 
out the  disease  in  considerable  doses  in  the  form  of  sherry  wine  or  brandy. 

Necropsy  (10  hours  after  death). — Body  that  of  a  poorly  nourished  male, 
about  45  years  old.  Small  bed  sore  over  the  sacrum  ;  hypostatic  congestion 
marked  in  dependent  portions ;  scar  in  left  umbilical  region  about  2  inches  long ; 
subcutaneous  fat  almost  absent;  muscles  wasted  but  normal  in  color.  About 
100  c.  c.  clear  fluid  in  pericardium.  No  fluid  in  right  pleural  cavity.  Right  lung 
weighs  810  grams;  deeply  pigmented;  no  cavities  foMud  in  apex;  a  few  solid 
nodular  masses  are  noticed  iu  apex ;  sections  of  the  lung  from  every  portion 
floated  iu  water.  Left  lung  weighed  1,850  grams;  deeply  pigmented  and  lunisu- 
ally  adherent,  the  adhesions  being  recent,  easily  looseno(l.  Large  cavity  iu  mid- 
dle of  upper  lobe  containing  about  80  c.  c.  of  greenish-yellow  muco-ims.  On  sec- 
tion the  inner  part  of  the  upper  lobe  is  full  of  small  cavities,  discharging  a 
greenish-yellow  fluid.  Sul)stance  of  the  upper  lobe  sinks  in  water.  Lower  lobe, 
the  entire  substance  is  full  of  tubercles,  some  solid,  some  broken  down.  Small 
sections  sink  in  water.  Liver  weighs  2.070  grams ;  nonadherent ;  subs-tance 
pale  and  rather  tough ;  lobules  well  defined.  Bladder  contains  about  50  c.  c. 
of  urine.  Stomach  and  intestines  slightly  congested,  otherwise  normal.  Heart 
weighs  300  grams ;  contains  post-mortem  clots ;  nuiscular  tissue  not  friable, 
and  the  valves  to  all  appearances  are  normal.  Spleen  weighs  140  grams;  nor- 
mal in  appearance  and  consistency.  Left  kidney  weighs  170  grams ;  capsule  is 
adherent  in  idaces.  Right  kidney  weighs  180  grams;  capsule  strips  off  readily, 
and  organ  is  to  all  appearances  normal.  Pancreas  weighs  90  grams;  Brain 
weighs  1,300  grams.  There  is  a  slight  adhesion  of  dura  to  brain  substance  at 
the  upper  end  of  the  Rolandic  area.  No  tubercles  are  found  on  the  membranes 
and  the  brain  substance  is  to  all  appearances  normal. 

N.  R. 
C.  E.  B. 

8629—04 33 


514  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVIOE. 

III. 

N.  F. ;  age,  45;  nativity,  Nova  Scotia;  admitted  to  the  United  States  Marine 
Hospital.  Boston,  Mass..  on  January  lio.  19(»4.  and  died  January  21,  1!K)4. 

IIiSTOKV. — Family  history — father  and  two  hrothers  died  of  consumption, 
mother  of  old  age;  three  hrothers  alive  and  well;  paternal  grandparents  lived 
to  an  old  age. 

Previous  history. — Soft  chancres  one  year  ago;  moderate  drinker  and 
smoker.  History  very  unsatisfactory,  as  patient  was  very  nervous  and  evi- 
dently hadly  frightened ;  admitted  night  s\^  eats,  cough,  loss  of  weight,  and  ex- 
pectoration of  yellow  material,  hut  statements  were  contradictory  and  variable. 

Present  history. — Patient  complained  of  pain  in  right  side  and  soreness  in- 
chest and  limbs. 

Physical  examinaiion. — On  inspection  the  patient  showed  marked  emacia- 
tion, and  both  clavicles  were  very  prominent.  On  auscultation  there  were  crack- 
ling rales  and  friction  sounds  over  the  entire  left  lung  and  right  upper  lobe. 
On  percussion  there  was  dullness  over  both  apices.  Vocal  fremitus  increased 
on  both  sides.     Dyspnoea  marked  and  patient  very  weak. 

Treatmext. — Patient  put  to  bed  and  given  heroin  cough  mixture,  ~^  c.  c. 
every  four  hours ;  also  the  elixir  of  iron,  quinine,  and  strychnine,  5  c.  c,  t.  i.  d. 

Jamtarii  .21,  IDO.'/. — Patient  was  a  little  better  this  morning  and  seemed  a  little 
stronger.  When  seen,  at  2  p.  m..  was  feeling  a  little  stronger  than  in  the 
morning.     He  suddenly  died,  however,  at  ,3..W  p.  in. 

Neckopsy  (14  hours  after  death). — Body  was  that  of  a  well-developed,  but 
emaciated,  man.  Tattooed  with  star,  si)read  eagle,  stars,  shield  and  flag  on 
back  of  right  hand,  and  two  hearts  pierced  by  an  arrow  on  back  of  left  hand. 
There  was  a  small  scar  on  the  glans  penis,  just  above  the  fmenum ;  post-mortem 
rigidity  well  marked;  jwst-mortein  lividity  fairly  well  m.arked.  Usual  incision 
was  made  in  the  median  line.  Thorax :  Pleura  was  adherent,  and  the  pleural 
cavity  was  filled  with  a  grumous  fluid  containing  many  shreads.  Right  lung 
presented  a  shaggy  appearance,  especially  at  the  apex;  at  its  base  was  a 
large  cavity,  and  in  the  interior  of  lower  lobe  were  numerous  small  cavi- 
ties and  many  tubercles.  The  anterior  mediastinal  and  the  midperibronchial 
glands  showed  tubercular  processes;  weight.  1,790  grams.  Left  lung  was 
firmly  adherent  to  the  ribs  and  presented  numerous  miliary  tubercles.  The 
upper  lobe  showed  large  cavity ;  weight,  550  grams.  Pericardium  contained  75 
c.  c.  of  straw-colored  fluid.  Heart  was  normal  and  weighed  440  grams.  Left 
ventricle  contained  small  post-mortem  clot ;  right  ventricle  contained  an  ante- 
mortem  clot.  Abdomen  :  I.,iver  showed  chronic  passive  congestion  ;  weight.  1.G70 
grams.  Both  kidneys  were  normal ;  weight,  220  grams  each.  Stomach  greatly 
dilated  and  itre.sented  marked  diminution  in  thickness  of  its  coats.  Large  and 
small  intestines  were  normal.  Bladder  was  normal.  Pancreas  was  normal ; 
weight,  90  grams.  Spleen  was  normal ;  weight,  150  grams.  Brain  was  con- 
siderably injected,  but  otherwise  normal ;  weight,  1,470  grams. 

R.  M.  W. 
J.  D.  F. 
W.  C.  R. 

IV. 

A.  J.  K. ;  age,  .32 :  nativity.  Nova  Scotia ;  was  admitted  to  the  United  States 
Marine  Hospital,  Boston,  Mass.,  on  April  G,  1904,  and  died  April  18,  1904,  at 
10.35  p.  m.      . 

History. — Family  history :  Father  died  of  old  age  and  mother  died  of  cancer. 

Previous  history. — Had  influenza  once;  otherwise  had  always  been  well. 

Present  history. — Has  been  sick  for  the  past  month;  lost  much  weight, 
coughs  much,  and  expectorates  a  yellowish  material ;  has  had  two  hemorrhages 
from  the  lungs,  and  feels  weak  all  over ;  has  some  headache,  bowels  irregular, 
and  appetite  poor. 

Physical  examination.^ — Patient  was  extremely  emaciated.  There  was  dull- 
ness over  both  apices  and  entire  left  lung;  over  left  apex  large  and  small  moist 
rales.  Heart  and  abdominal  organs  normal.  Sputum  contained  the  tubercle 
bacillus. 

Treatment. — Heroin  cough  mixture,  5  c.  c,  t.  i.  d.,  and  during  the  night ; 
elixir  of  iron,  quinine,  and  strychnine,  5  c.  c,  t.  i.  d. ;  nutritious  diet  and  rest 
in  bed. 

April  9,  J90.'f. — Felt  much  better  to-day ;  not  so  much  cough  and  stronger. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SKRVICE.  515 

April  12,  190.li. — Had  a  sovciv  lu'iiiorrlingo  from  the  hint's  this  niorniuK.  The 
homorrh.-is^o  \v:is  controlled  hy  the  use  of  salt  and  crac-lud  ice  and  a  liypodermic 
of  Mioriihine:  imtient  was  very  weak,  and  it  was  necessary  to  stimulate  him 
with  strychnine  and  whisky. 

Ainil  l-'i,  litti). — Patient  very  weak  and  rapidly  failing';  stinmlants  used  daily. 

April  10,  UXl.'i. — Very  weak;  stays  in  bed  all  the  time;  apt  to  pass  away  any 
hour. 

April  IS,  i.Ory/,.— Died  to  day  at  1  (».:'.">  ]».  m. 

XiHuoi'SY  (11'  hours  after  death). — P.ody  that  of  a  poorly  nourished,  much 
emaciated  younj:  man  ;  i)ost-mortein  lividity  and  rii,'idity  well  marked.  Thorax: 
Heart  and  i)ericardium  were  normal;  heart  wei^du'd  4l'()  <;rams.  Lunj.cs:  Right 
Inn.t:  showed,  near  the  base,  an  old  scar;  wei.s^ht,  STO  f^rams.  Left  lung  was 
adherent  throughout,  and  presented,  near  the  apex,  a  large  cavity  and  numerous 
smaller  cavities;  weight.  (iOO  grams.  Throughout  the  entire  lung  were  nnliary 
tubercles.  The  anterior  and  i)osterior  mediastinal  glands  were  greatly  enlarged. 
Abdomen:  Liver  presented  chronic  i)assive  congestion;  weight,  l,:iOO  grams. 
Spleen  was  uormal ;  weight,  17(»  grams.  Right  kidney  was  normal;  weight,  220 
grams.  Left  kidney  was  normal  ;  weight,  180  grams.  Intestines  were  normiil. 
I'iincreas  was  normal;  weight.  1(50  grams.  Brain  was  noi-mal ;  weight,  1,400 
grams. 

R.  M.  W. 
W.   C.    R.        ' 
J.   D.   F. 

V. 

J.  M. ;  age.  20 ;  nativity.  Russia  :  color,  white ;  admitted  to  the  United  States 
Marine  Hospital.  San  Francisco.  Cal..  July  27,  1003 ;  died  February  2,  1004. 

History. — Family  history  negative,  (jonorrboea  live  or  six  times,  the  last 
about  six  years  ago;  chancres  about  ten  years  ago;  m.'ilarial  fever  three,  and 
rheumatism  eight  years  ago.  About  18  months  ago  he  contracted  a  severe  cold 
which  never  left  him.  This  was  accompanied  by  i)rofuse  expectoration,  and  fol- 
lowed by  loss  of  weight,  night  sweats,  haemoptysis,  and  involvement  of  both 
testicles ;  the  latter  were  subsequently  removed  by  operation.  He  was  trans- 
ferred to  Fort  Stanton,  N.  Mex..  where  he  remained  some  time  but  failed  to 
improve,  and  in  consequence  left  that  station  of  his  own  accord.  After  arriving 
in  San  Francisco  he  applied  for  and  was  granted  admission  to  this  hospital, 
where  he  stayed  until  the  day  of  his  death.  Immense  numbers  of  tubercle 
bacilli  present  in  sputum. 

Necropsy  (21  hours  after  death).  Body  greatly  emaciated;  rigor  mortis  not 
marked  ;  post-mortem  lividities  present ;  anchor  tattooed  on  right  forearm  ;  skin 
dry  and  somewhat  scaly  ;  clavicles  and  ribs  esj^ecially  prominent.  Brain :  The 
caivarium  was  removed,  and  the  skull  cap,  brain  case,  sinuses  and  vessels,  and 
the  brain  and  its  membranes  \^'ere  apparently  normal ;  all  are  apparently  nega- 
tive;  weight  of  brain,  1,555  grams.  Thorax:  The  anterior  mediastinum  con- 
tains a  mass  of  enlarged  and  caseous  lymph  glands.  The  heart  weighed  270 
grams.  Its  muscular  tissue  was  soft  and  flabby,  pale  in  color,  and  cut  with 
normal  resistance.  The  ventricles  contained  small  white  clots  extending  up 
into  the  aorta  and  pulmonary  artery ;  the  auricles  were  empty.  The  mitral 
orifice  admitted  three  fingers,  the  tricuspid  four ;  botli  of  these  valves  appeared 
normal.  The  endocardium  throughout  appeared  smooth  and  shining.  The 
aortic  and  pulmonary  valves  were  competent  to  the  \\-ater  test.  The  pericar- 
dium was  strongly  adherent  to  both  lungs,  and  its  cavity  contained  a  moderate 
amount  of  clear, '  straw-colored  fluid.  The  right  lung  was  strongly  bound  by 
fibrous  bands  to  the  pericardium,  and  the  lajers  of  the  pleura  were  adherent 
about  the  upper  lobe  and  the  iiosterior  border ;  there  was  one  fibrous  band 
attached  to  the  diaphragm.  The  right  lung  weighed  1,570  grams ;  did  not  col- 
lai)se ;  the  external  surface  was  of  mottled  slate  coloi-,  and  there  were  firm 
adhesive  bands  in  the  interlobular  fissures.  In  the  lower  part  of  the  upper 
lobe,  and  in  the  middle  and  lower  lobes,  were  numerous  hard  nodules  and 
between  them  some  crepitant  tissue.  The  upper  portion  of  the  upper  lobe  was 
a  fluctuating  mass,  found  on  section  to  contain  about  300  e.  c.  of  thick  pus. 
Section  of  the  rest  of  the  upi^er  lobe  and  the  middle  lobe  showed  a  mass  of 
caseous  nodules  and  many  small  ca^-ities  filled  with  pus.  Section  of  the  lower 
lobe  showed  nodules  of  various  sizes.  The  left  lung  was  bound  to  the  pericar- 
dium and  chest  wall  in  a  manner  similar  to  the  right  lung.  Its  weight  was 
1,000  grams.    There  was  present  in  the  upper  lobe  a  cavity  of  nearly  the 


516  PUBLIC    HEALTH    AND   MAKINE-HOSPITAL    SERVICE. 

same  size  as  that  described  in  the  right,  which  cavity  was  ruptured  on  remov- 
ing the  lung  from  the  body.  Many  yellowish,  caseous  nodules  occurred  through- 
out the  remainder  of  the  lung,  which  contained  more  crepitant  tissue  than 
did  the  right  lung.  The  great  vessels  and  nerve  trunks  were  normal.  The 
diaphragm  on  the  right  side  i-eached  to  the  lower  border  of  the  fifth  rib ;  on  the 
left  to  the  upper  border  of  the  sixth.  Abdomen  :  The  peritoneal  cavity  contained 
a  considerable  quantity  of  clear,  straw-colored  fluid :  its  layers  were  smooth 
and  free  except  about  the  spleen,  where  there  were  adhesions  involving  also  the 
splenic  flexure  of  the  colon.  The  great  omentum  was  very  thin,  friable, 
retracted  to  the  left,  and  contained  almost  no  fat.  The  spleen  weighed  225 
grams.  It  was  strongly  adhei-ent  to  the  stomach  and  colon.  It  was  much 
enlarged,  hardened,  and  of  mottled  black  and  brown  color  externally,  with 
roughened  surface.  The  capsule  was  rather  tense  and  wrinkled.  On  section 
increased  resistance,  reddish  cut  surface,  firmness  of  pulp,  and  increase  in 
interstitial  fibrous  tissue  were  noted.  Left  kidney  weighed  220  grams,  was 
enlarged,  very  pale  and  smooth  externally  ;  no  perinephritic  fat  present ;  the 
fibrous  capsule  stripped  easily,  leaving  a  smooth  surface.  On  section  there  was 
diminished  resistance,  light  yellowish  color  of  cortex  and  medulla  with  reddish 
transverse  striations,  and  dark  color  of  the  pyramids.  The  right  kidney 
weighed  230  grams,  and  was  in  a  condition  similar  to  that  of  the  left  one.  The 
suprarenal  capsules  were  normal.  The  urinary  bladder  contained  about  150  c.  c. 
of  clear,  yellowish  urine,  and  was  normal.  The  organs  of  generation  were  nor- 
mal, except  the  testicles,  which  are  absent,  and  the  presence  of  a  phimosis.  The 
rectum  was  normal,  also  the  duodenum.  The  stomach  was  moderately  dis- 
tended with  gas  and  liquid  matter :  the  cardia  was  adherent  to  the  splenic  flex- 
ure, spleen,  and  abdominal  wall.  The  gall  ducts  were  patent,  and  the  gall 
bladder  contained  liquid  bile.  The  liver  weighed  1,G00  grams.  The  surface  was 
pale,  roughened  and  granular.  The  hepatic  tissue  cut  with  increased  resistance, 
and  showed  a  pale  surface  with  increase  of  fibrous  tissue.  The  pancreas,  solar 
plexus,  mesentery,  and  small  intestines  were  normal.  The  large  intestines  were 
normal  except  for  the  presence  of  filirous  adhesions  at  the  splenic  flexure  of  the 
colon.  The  vermiform  appendix  and  the  great  vessels  were  apparently  normal. 
Anatomical  diagnosis. — Tubei-cle  of  bronchial  lymph  glands;  pericardial 
and  pleural  adhesion ;  chronic  fibrous  pleuritis ;  chronic  bilateral  pulmonary 
tuberculosis ;  moderate  ascites ;  old,  localized  peritoneal  adhesions ;  atrophy  of 
great  omentum  :  chronic  splenitis ;  subacute  nephritis  with  fatty  degeneration ; 
absence  of  testicles  ;  phimosis  ;  hepatic  cirrhosis. 

C.  II. 

W.  G.  S. 

VI. 

J.  B. ;  age,  5<i ;  nativity,  Ohio :  was  admitted  to  the  United  States  Marine 
Hospital,  St.  Louis,  Mo..  September  10,  1!»03,  and  died  January  30,  1904. 

History. — The  history  was  that  of  years  of  bard  work  and  alcoholism 
with,  latterly,  complete  breakdown  and  helplessness.  He  sought  relief  from  an 
annoying  cough  which  he  deemed  the  cause  of  his  debility.  On  admission  his 
temperature  was  37.6°  C. ;  respiration,  24 ;  pulse,  80.  These  were  the  average 
records  throughout  his  stay.  On  auscultation,  moist  rales  were  found  thi-ough- 
out  both  lungs.  He  was  vex-y  pale  and  very  feel)le.  Treatment  was  supi)ortive, 
stimulating,  and  nourishing. 

Necropsy  (10  hours  after  death). — Body  that  of  a  fairly  muscular,  but  greatly 
emaciated,  elderly  white  male ;  rigor  mortis  well  established.  Right  lung 
adheres  to  thoracic  wall  throughout,  and  it  can  not  be  removed.  On  section 
(in  place)  find  nearly  entire  superior  lobe  occupied  by  large  cavity;  entire  lung 
very  much  conti-acted ;  weight  (estimated),  250  grams.  Left  lung  adheres 
posteriorly  and  latterally  to  thoracic  wall ;  very  much  contracted ;  nodular ; 
apex  contains  abscess  of  60  grams  capacity.  Inferior  lobe  contains  many 
minute  cavities  ;  weight,  720  grams.  Bronchial  tui>es  are  thickened  and  contain 
large  amount  of  muco-purulent  matter.  Heart :  Surface  pale  and  covered  with 
thin  layer  of  fat ;  wall  thin  and  flabby ;  valves  normal ;  weight,  245  grams. 
Liver  slightly  enlarged;  weight,  1,170  grams;  capsule  somewhat  thickened. 
Gall  bladder  normal,  contains  about  15  c.  c.  of  pale  yellow  bile.  Kidneys :  Cap- 
sule adherent;  pelvis  contracted;  weight,  l.lfi  grams.  Left  kidney:  Capsule 
adherent  and  somewhat  thickened;  j>elvis  distended  and  containing  about  25 
c.  c.  of  limpid  fluid ;    weight,  195  grams.     Stomach  uoiunal.     Spleen  soft ;    cap- 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE.  517 

siilc  .•ulIirrtMit  :  wfijilil,  170  m'Miiis.  Appciidix  noniiMl  :  IciiKtli,  10  vn\.  P.liuMor 
very  imicli  tlistciidcd.  coiitaiiiiiij;  Mlioiit  -"(Id  c.  <•.  ol'  pale  uriue.  Mest'iilci-ie 
j^laiuls  vorv  iiurIi  eiihirgeil.     Other  organs  normal. 

IL  C.  \V. 

J.  M.  a. 
vn. 

L.  M. ;  colored ;  age.  r>2 :  admitted  to  United  States  Marine  Hospital,  Cincin- 
nati. Ohio,  December  15.  I'.HKi,  died  January  12,  1!X)4. 

History. — Patient  entered  complaining  of  shortness  of  breath,  cough,  pain  in 
back,  and  a  "  heavy  feeling "  over  the  chest.  Family  history  negative ;  has 
always  been  well  with  the  exception  of  a  severe  cough,  which  he  has  had  for 
some  time ;  denies  syphilis ;  was  circumcised  for  paraphimosis  at  this  hospital 
one  mouth  ago. 

I'resent  state. — The  cough  is  severe  at  times  and  accompanied  by  a  purulent 
viscid  sputum  ;  has  fever  every  afternoon  and  night  sweats  ;  shortness  of  breath 
is  marked  with  an  oppressive  feeling  over  chest. 

Physical  examination. — Poorly  nourished  man ;  has  an  anxious  facial 
expression ;  pupils  equal  and  react  normally  to  light  and  acconunodation.  The 
tongue  is  covered  with  a  thick  white  coating :  no  marks  of  syphilis  on  skin. 
Apex  impulse  is  seen  below  sixth  rib  and  one  inch  external  to  midclavicular 
line.  Palpation  reveals  increased  tactile  fremitus  over  entire  right  lung,  with 
absence  of  tactile  fremitus  over  lower  left  lung.  Dullness  is  marked  over  right 
upper  thorax.  Moist  and  coarse  rales  of  various  kinds  are  heard  over  both 
lungs,  with  bronchial  breathing  and  increased  vocal  fremitus.  Expiration 
lengthened.  A  diastolic  murmur  is  heard  over  aortic  cartilage,  harsh  in  char- 
acter. The  heart  dullness  is  increased  downward  and.  toward  the  left  and  is 
continuous  with  a  flatness  in  left  lower  thorax.  Abdominal  organs  appear  nor- 
mal under  examination. 

December  16. — Patient  had  several  free  actions  of  the  bowels.  Feels  very 
weak  ;  breathing  is  labored.  Urine  had  specific  gravity  of  1.015,  was  acid  in 
reaction,  light  amber  in  color,  and  contained  traces  of  albumin.  Sputum 
examination  showed  abundant  tubercle  bacilli.  In  spite  of  tonics  and  creosote 
patient  grew  steadily  worse  and  died  at  4..50  a.  m.  January  12,  1904. 

Necropsy  (5  hours  after  death). — Post-mortem  rigidity  well  marked;  body 
that  of  a  i)oorly  developed,  emaciated  negro.  Opening  the  thorax,  the  peri- 
cardium was  incised  and  about  40  c.  c.  of  a  sti*aw-colored  fluid  was  found  therein. 
The  heart  was  markedly  enlarged ;  its  muscular  tissue  was  pale  and  degenerated. 
The  aortic  leaflets  were  thickened  and  somewhat  retracted,  which  caused  a 
slight  insufficiency.     Other  valves  normal.     Weight  of  heart.  4.50  grams. 

The  right  lungVas  free  from  adhesions.  It  was  heavy  and  did  not  float  in 
water.  On  section  one  large  cavity  the  size  of  a  walnut  was  found  in  apex,  the 
whole  lung  was  in  a  stage  of  hepatization,  and  a  dark  sanguineous  fluid  exuded. 
Many  miliary  tubercles  were  noted  scattered  throughout  the  lung  tissue. 
Weight  of  right  lung.  1.020  grams.  The  left  lung  was  retracted  upward,  back- 
ward, and  inward  toward  the  spine.  It  contained  no  cavities,  but  otherwi.se  was 
in  same  state  as  right  lung.  The  visceral  and  parietal  pleura  were  adherent 
almost  throughout.  Weight  of  left  lung,  975  grams.  Abdomen:  Stomach  was 
smaller  than  normal.  Intestines  normal,  except  the  descending  colon,  which 
was  elongated  and  thickened.  Some  enlargement  of  mesenteric  glands  was 
noted.  Liver  normal ;  weight.  1.975  grams.  Gall  bladder  free  from  calculi 
and  apparently  normal.  Kidneys  were  to  all  appearances  unaffected,  except  the 
right  kidney,  which  had  in  its  cortex  a  large  cyst  the  size  of  a  filbert.  Capsules 
stripped  readily;  right  kidney  weight.  210  grams;  left  kidney  weight.  220 
grams.  The  spleen  gave  appearances  of  cloudy  swelling  and  its  surface  was 
studded  with  small  calcareous  nodules;  weight,  270  grams.  Appendix  not 
inflamed  and  was  free  from  concretions ;   length,  8  centimeters. 

J.  W.  S. 

VIII. 

8.  P. ;  age,  6.3 ;  nativity.  England ;  color,  white :  admitted  to  the  United 
States  Marine  Hospital,  San  Francisco,  Cal..  August  15,  1903;  died  November 
27,  1903. 

History. — Was  previously  under  treatment  in  this  hospital  for  paralysis  of 
the  right  arm  and  leg.  Later,  signs  of  pulmonary  disease  appeared.  Dis- 
charged August  14,  1903,  improved  as  regarding  the  former  trouble ;  readmitted 


518  PUBLIC    HEi^LTH    AND    MAEINE-HOSPITAL    SERVICE. 

on  the  followiug  day  for  treatmeut  of  the  hittei-  disease.  The  signs  and  symp- 
toms present  were  severe  cough,  profuse  expectoration,  night  sweats,  loss  of 
weight,  increasing  dyspnoea  and  weakness,  retraction  of  the  left  chest,  dullness 
in  left  upper  lobe,  tenderness  over  right  apex,  numerous  moist  rales  in  left 
lung,  heart  to  left  of  mammary  line.  Tubercle  bacilli  could  not  be  demonstrated 
in  the  sputum.  Urinalysis  showed  nothing  except  low  specific  gravity.  Sep- 
tember 25  an  apoplectic  attack  was  experienced,  with  return  of  paralysis  and 
loss  of  consciousness ;  the  latter  was  ]>artially  recovered  later.  Feces  and 
urine  were  passed  involuntarily,  the  pupils  became  uneven,  he  groaned  and  mut- 
tered and  rolled  from  side  to  side.  Incontinence  of  feces  was  followed  by 
obstinate  constipation,  followed  again  by  diarrha»a ;  appetite  returned  and 
became  ravenous ;  expectoration  ceased  entirely.  Novemlier  25  he  suddenly 
lost  power  to  swallow  food  and  there  was  a  recurrence  of  the  paralytic  phenom- 
ena. His  condition  became  rapidly  worse.  Shortly  before  death  ti'emors  and 
occasional  decided  movements  were  observed  to  occur  in  the  affected  right  arm. 
Death  took  place  November  27  at  9.30  a.  m. 

Necropsy  (5  hours  after  death). — Rigor  mortis  and  post-mortem  lividity  pres- 
ent :  right  pupil  larger  than  left ;  the  mouth  contains  frothy  fluid ;  over  the  left 
shoulder  blade  and  on  the  left  ankle  are  several  abraded  areas.  The  left  chest 
is  depressed.  General  emaciation  is  present.  There  is  moderate  scoliosis. 
Brain  :  The  dura  mater  is  adherent  to  the  brain  along  the  margins  of  the  supe- 
rior longitudinal  sinus.  In  the  internal  capsule  and  optic  thalamus  of  the  left 
side  there  are  hemorrhagic  areas  and  softening.  The  walls  of  the  left  middle 
cerebral  artery  are  rigid  and  calcareous.  The  weight  of  the  brain  is  1,230 
grams ;  the  remainder  of  the  brain  is  normal.  The  body  opened  by  a  long 
median  incision  extending  from  the  chin  to  the  pubes.  The  larynx,  tongue, 
fauces,  tonsils,  and  beginning  of  a?sophagus  and  trachea  removed  and  examined. 
All  are  coated  with  frothy,  foul-smelling  uuicus.  The  larynx  was  divided  pos- 
teriorly by  scissors.  The  false  vocal  cords  ai"e  normal.  The  ventri'^le  of  the 
larynx  contains  the  before-mentioned  mucus.  The  true  vocal  cords  are  slightly 
hemorrhagic  at  their  inner  borders.  Thorax :  On  removing  the  sternum  the 
costal  cartilages  of  the  first  ribs  are  found  ossified.  The  right  lung  extends 
across  the  median  line  about  three  inches,  covering  the  pericardium.  The  entire 
lung  is  emphysematous.  It  adheres  to  the  diaphragm  by  one  fibrous  band. 
Elsewhere  the  lung  is  fi'ee  in  the  pleural  cavity.  The  weight  is  970  grams. 
The  anterior  surface  is  mottled  gray  and  black  :  the  posterior  surface  is  dark  red 
in  color.  Crepitation  is  good  in  the  lung  except  in  the  posterior  portion  of  the 
lower  lobe,  where  it  is  somewhat  diminished.  On  the  anterior  surface  of  the 
upper  lobe  is  seen  a  large  healed  scar,  beneath  which  section  reveals  a  calcare- 
ous nodule.  Section  of  the  posterior  part  of  the  lower  lobe  is  bloody  and  frothy 
and  gives  increased  resistance ;  otherwise  examination  is  negative.  The  left 
lung  is  greatly  retracted,  and  the  layers  of  the  pleura  are  adherent  all  ovex*. 
There  are  strong  adhesions  to  the  pericardium,  and  when  the  lung  is  removed 
the  parietal  pleura  is  torn  off  with  it.  The  weight  is  680  grams.  The  tissue 
as  a  whole  is  much  denser  than  that  of  the  right  lung,  but  it  floats  in  water. 
The  external  surface  is  dark  and  mottled,  and  there  is  very  little  crepitation. 
Section  of  the  upper  lobe  resembles  boiled  meat  and  is  very  frothy  and  bloody — 
this  in  the  upper  half ;  the  lower  half  of  the  lobe  contains  some  crepitant  tissue 
in  a  kind  of  network  of  healed  scar  tissue  and  hardened  yellowish  masses,  the 
section  cutting  with  much  increase  in  resistance ;  essentially  the  same  may  be 
said  of  the  lower  lobe.  The  heart  weighs  325  grams :  its  external  surface  is  cov- 
ered with  fat :  it  cuts  with  increased  resistance.  The  walls  of  the  left  ventricle 
are  thickened,  and  the  cardiac  muscle  is  pale  and  shows  considerable  increase 
of  interstitial  tissue.  The  left  ventricle  is  empty  of  clots.  The  right  ventricle 
contains  a  small  dark  clot.  The  aortic  and  pulmonary  valves  are  competent  to 
the  water  test.  The  mitral  and  tricuspid  valves  are  normal,  though  the  mitral 
valve  is  rather  firmly  related  to  a  dark  clot,  which,  however,  can  be  separated 
from  it  without  leaving  a  denuded  surface.  The  right  auricle  contains  a  similar 
clot.  The  great  vessels  and  nerve  trunks  appear  normal.  The  diaphragm  on 
the  right  side  extends  to  the  fifth  interspace ;  on  the  left  side  to  the  sixth  rib. 
The  pericardiinn  is  covered  by  the  overlapping  portion  of  the  right  lung,  and 
is  adherent  to  the  left  lung.  Abdomen :  The  peritoneum  appears  everywhere 
smooth  and  shining.  The  great  omentimi  is  normal.  The  spleen  weighs  only  85 
gi-ams,  and  is  adherent  to  the  diaphragm.  The  surface  is  of  lead  color  and 
wrinkles  easily.  Section  shows  increase  of  interstitial  fibrous  tissue  and  firm- 
ness of  pulp.  The  left  kidney  weighs  Kio  grams,  is  smooth  externally  and  dark 
in  color.     The  fibrous  capsule  is  adherent  in  places  and  strips  off  with  some  diffi- 


PUBLIC    HEALTH    AND    MAKINE-IIOSPITAL    SERVICE.  519 

ciiKy.  Soction  shows  incroasod  resistance  and  a  dark  and  l>l()ody  surface.  The 
(•(irtical  iiiarUinj,'s  are  fairly  distinct,  and  liie  ])yraniids  are  not  itroinineiit.  Tlie 
rif^ht  kiiUu'y  weij^hs  i:!(>  Ki'anis,  and  its  condition  is  similar  to  that  of  the  left 
organ  except  that  the  cortex  is  thinner  and  the  niarkin;;s  are  less  distinct.  The 
suprarenal  capsules  are  enlarged,  cut  with  Increased  icsistance,  and  show 
increase  (»f  tihrous  tissue.  The  urinary  hladder  contains  about  To  c.  c.  of  turbid 
urine,  and  is  otherwis»>  normal.  The  organs  of  fjeneration  are  normal.  The 
rectum  contains  a  nmderate  amount  of  solid  fecal  matter.  The  duodenum, 
stomach,  and  ^all  ducts  are  normal.  The  liver  weif^hs  1,2:1")  grams.  The  exter- 
n.-il  surface  is  smooth  and  uniform  in  color.  It  cuts  with  some  increase  in 
i-esistance.  showing  a  yellowish  surface  with  increase  of  iibrous  tissue  and  areas 
of  fatty  change.  The  gall  bladder  Ci)ntains  a  moderate  amount  of  viscid  bile. 
The  pancreas  weighs  SO  grams,  and  is  normal  on  section.  The  solar  jilexus  is 
normal.  The  niesei:tery  is  dark  iu  color  and  much  congested.  Meckel's  diver- 
ticulum is  pres(>nt  about  two  feet  above  the  termination  of  the  ileum.  It  is  a 
blind  ])!nich  about  three  inches  long.  At  its  junction  with  the  gut  the  lumen  is 
about  eijual  to  that  of  the  latter,  but  it  expands  somewhat  toward  the  blind 
extrenuty.  It  has  no  mesentery  of  its  own,  and  its  contents  are  the  same  as 
tho.se  cf  the  ihnnn,  with  which  it  conuuunicates.  The  vermiform  ai)pendix  is 
short,  has  a  mesentery  of  its  own,  and  appears  normal.  The  small  intestines 
contain  liciuid  fecal  matter,  and  the  large  intestines  semisolid  material.  The 
great  vessels  are  normal. 

Anatomical  diagnosis. — Inequality  of  pupils;  scoliosis;  hemorrhage  and  soft- 
ening of  left  internal  capsule  and  optic  thalanms ;  atheroma  of  left  middle 
cerebral  artery  ;  congestion  of  true  vocal  cords ;  ossification  of  costal  cartilages 
of  first  ribs ;  emphysema  of  right  lung  anteriorly,  and  oedema  posteriorly ; 
healed  scar  and  calcareous  nodule  of  right  upper  lobe ;  partial  adhesion  of 
lower  lol)e  and  diaphragm ;  chronic  tuberculosis  and  obliterative  pleuritis, 
with  contraction  of  left  lung;  adhesion  of  left  lung  and  pericardium;  chronic 
myocarditis;  hypertrophy  of  left  ventricle;  chronic  phrenitis ;  atrophy  and 
fibrosis  of  spleen  ;  chi'onic  interstitial  nephritis  ;  sclerosis  of  suprarenal  capsules  ; 
cirrhosis  and  fatty  degeneration  of  liver ;  congestion  of  mesentery ;  the 
presence  of  Meckel's  diverticulum. 

C.  R. 

W.    G.    S. 
IX. 

F.  D. ;  age,  29 ;  nativity,  Maine ;  admitted  to  the  United  States  Marine  Hos- 
pital, Boston,  Mass.,  January  9,  1903;  died  February  2,  1903. 

Pkeviois  history. — Had  usual  diseases  of  childhood,  but  has  always  in 
adult  life  been  a  healthy  man. 

Present  history. — Has  had  hernia  for  seven  or  eight  years.  He  has  worn  a 
truss  almost  continuously. 

Exaj[ination. — Heart  and  lungs  normal.  Abdomen  normal.  In  right  groin 
has  large  oblique  inguinal  hernia.  Left  groin  presents  a  small  oblique 
inguinal  hernia. 

On  January  11,  1903,  ether  was  administered  and  patient,  having  been 
properly  prepared,  was  operated  upon,  a  Bassini's  operation  being  performed 
on  the  left  side  and  a  Kocher's  on  the  right.  Before  the  operation  the  tem- 
perature was  normal  and  patient  showed  no  sign  of  any  disease  nor  did  he 
give  any  such  history.  After  the  operation  patient  did  not  seem  to  do  well 
and  his  temperature  rose  to  a  considerable  height.  He  had  no  chills  or  sweats, 
and  an  examination  of  the  lungs  revealed  nothing  of  note.  His  eyes  became 
sunken  and  extreme  emaciation  made  its  appearance.  Patient  became  weaker 
and  his  temperature  was  so  high  and  showed  such  marked  remissions  that  at 
first  an  infection  of  the  wound  was  suspected.  This,  however,  was  not  found 
to  be  so  on  dressing  the  wound.  Typhoid  fever  being  suspected  blood  tests 
were  made  for  the  Widal  reaction,  but  with  negative  results.  Tuberculosis 
was  suspected  and  several  examinations  of  the  sputum  were  made,  but  without 
finding  the  bacilli.  Before  his  death  an  exploratory  search  for  any  trouble 
in  the  wound  was  made,  but  nothing  was  found  to  account  for  the  patient's 
symptoms.  He  died  very  suddenly  on  February  2,  1903.  During  the  latter 
part  of  his  sickness  stimulants  were  employed. 

Necropsy  (4  hours  after  death). — Rigor  mortis  absent.  The  right  rectus 
muscle  in  the  lower  3  inches  showed  signs  of  intestinal  hemorrhages,  the  same 
as  found  at  the  exploratory  laparotomy.  The  left  pleural  cavity  contained 
150  e.  c.  of  fluid,  the  right  75  c.  c.     The  pericardium  contained  25  c.  c.  of 


520  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

clear  fluid.  Slight  adhesions  \yere  found  at  apex  of  left  lung.  This  lung 
weighed  o75  grams.  Tliree-fifths  of  the  right  lung  and  the  apex  of  the  left 
lung  showed  innumerable  uiiliai-y  tul)ercles.  The  right  lung  weighi'il  810 
grams.  The  heart  weighed  285  grams.  The  right  heart  contained  one  veiy 
small  ante-mortem  clot.  The  left  ventricle  contained  a  similar  clot.  The  heai-t 
was  extx-emely  flabby.  The  auricles  w^ere  normal.  The  tricuspid  orifice  ad- 
mitted four  fingers.  The  other  valves  were  normal.  The  liver  was  slightly 
congested.  It  weighed  1,080  grams.  The  spleen  weighed  220  grams  and  was 
normal.  The  pancreas  was  also  normal,  and  weighed  00  grams.  The  kid- 
neys, except  for  slight  congestion,  were  normal.  Each  kidney  weighed  2.")() 
grams.  Bladder  was  normal  and  contained  20  c.  c.  of  urine.  The  lower  ]»;)rti;)n 
of  the  ileum  showed  marked  injection.  The  mesenteric  glands  were  slightly 
enlarged.  There  was  interstitial  hemorrhage  into  the  right  iliac  muscle.  The 
brain  was  normal  and  weighed  1,880  grams. 
Cause  of  death. — Tubercle  of  lung,  miliary. 

F.  A.  A. 

W.  C.   R. 

R.  M.  W. 


T.  M. ;  age,  56 ;  nativity.  New  .lersey ;  color,  white ;  admitted  to  the  United 
States  Marine  Hospital,  San  Francisco,  Cal.,  October  31,  1003 ;  died  November 
22,  1903. 

History. — Family  history  negative.  Personal  history  of  rheumatism  and 
vesicular  emphysema.  Transferred  from  marine  hospital  at  Port  Townsend, 
Wash.,  to  this  ho.spital  for  his  i)resent  disease,  which  began  as  near  as  the 
patient  can  tell  about  ten  months  ago.  Has  had  constant  cough,  expectora- 
tion, fever,  loss  of  weight,  night  sweats,  and  dyspna?a  ever  since,  and  has  been 
growing  steadily  worse.  Received  in  very  bad  condition.  Both  lungs  give  out 
numerous  moist,  crackling,  and  bubbling  rales  all  over.  He  is  very  weak  and 
suffers  from  dyspnoea.  Became  rapidly  worse  and  was  delirious  at  night. 
Expectorated  tubercle  bacilli  and  had  more  or  less  diarrhea.  Cheyne-Stokes 
respiration  began  to  develop  November  18.  Death  occurred  November  22.  1903, 
at  1.30  a.  m. 

Necropsy  (9  hours  after  death). — Body  emaciated.  Rigor  mortis  and  post- 
mortem lividity  marked.  Brain :  The  calvarium  removed.  On  removing  the 
dura  mater  the  pia  mater  is  seen  to  be  somewhat  distended  with  clear  serous 
fluid.  Along  the  superior  longitudinal  sinus  and  in  the  sulci  between  the  con- 
volutions there  are  signs  of  acute  plastic  inflnnnnation.  The  number  of  convolu- 
tions is  exceedingly  small.  On  section  the  brain  is  seen  to  be  very  pale,  and  the 
ventricles  contain  considerable  clear  serous  fluid.  The  cerebellum  and  the 
structures  of  the  base  of  the  brain  are  normal.  The  weight  of  the  brain  is  1,070 
grams.  Thorax :  The  costal  cartilages  are  lai-gely  ossified.  The  anterior 
mediastinum  contains  a  moderate  amount  of  fat.  The  right  lung  extends  across 
the  median  line  and  the  left  lung  is  retracted.  The  left  lung  is  adherent  to  the 
costal  cartilages.  The  right  lung  is  firmly  adherent  about  the  apex  and  poste- 
riorly and  to  the  diaphragm,  and  on  removing  the  lung  a  portion  of  the  parietal 
pleura  is  torn  off  with  it.  It  weighs  980  grams.  The  upper  lobe  is  one  solid 
mass  of  caseous  material,  and  the  middle  lobe  is  nearly  as  bad,  though  there  is 
a  small  amount  of  tissue  that  crepitates.  The  lower  lobe  contains  large  caseous 
masses  centrally  and  miliary  tubercles  elsewhere;  there  is  crepitation  in  a 
p(n-tion  of  this  lobe,  and  the  section  is  very  bloody  and  frothy.  The  external 
appearance  of  the  lung  is  mottled  bluish  red  and  uneven.  The  left  is  so  strongly 
bound  to  the  chest  wall  that  it  can  not  be  removed  except  in  sections,  and  it 
is  therefore  examined  in  situ.  The  upper  lobe  and  upper  portion  of  the  lower 
are  in  similar  condition  to  that  of  the  right  upper  lobes ;  there  is  crepitation  in 
a  small  part  of  the  lower  lobe,  and  the  section  is  bloody  and  frothy.  The  heart 
weighs  285  grams.  Its  outer  surface  is  covered  with  considerable  fat.  The 
pericardium  is  suri-ounded  by  an  amount  of  fat,  and  its  cavity  contains  a 
small  amount  of  serous  fluid ;  it  is  strongly  adherent  to  the  left  lung.  The 
heart  cuts  with  increased  resistance;  its  muscular  tissue  is  pale  in  color 
and  shows  excess  of  interstitial  tissue.  The  right  auricle  contains  a  large, 
nonadherent,  mixed  clot.  The  aorta  and  pulmonary  artery  contain  goose-fat 
clots.  The  aortic  and  inilmonary  valves  are  competent  to  the  water  test,  and 
the  mitral  and  tricuspid  valves  are  normal.  The  great  vessels  and  nerve 
trunks  are  apparently  normal.     The  diaphragm  reaches  to  the  fifth  rib  on  the 


PFBLTC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  521 

right  sido  an<l  to  tho  sixth  on  the  loft;  it  is  lulliorcnt  to  tiio  i)asf's  of  l)otb 
liin.us  liy  Jiliious  hands.  Aixlonicn  :  Tliore  is  a  lar^o  amount  of  snlicntancous 
fat  considcrini,'  tiio  general  emaciation  externally.  The  suliperitonial  fat  is 
also  i>rominent.  The  great  omentmn  is  retracted  to  tlie  left  and  contains  con- 
siderahle  fat  ;  it  is  free  all  ovi'r.  The  peritonenm  is  everywhere  smooth  and 
shining,  and  the  intestines  move  freely.  The  spleen  weighs  .">(i(»  grams  and  is 
enlarged.  It  is  strongly  adherent  posteriorly,  wrinkles  easily,  is  soft  in  con- 
sistence, and  jiale  hluisli  red  in  color,  with  lighter  areas.  It  cuts  with  dimin- 
ished resistance,  the  pvdj)  is  very  soft  and  iironiinent.  and  there  appears  to  he 
slight  proliferation  of  interstitial  tissue.  The  external  surface  is  smooth.  The 
left  kidney  is  surnuuided  with  a  large  amount  of  fat  and  weighs  1U.~»  grams.  It 
is  smooth  externally,  and  the  fihrous  capsule  strips  readily,  showing  hemorrhagic 
areas  along  the  convex  border.  It  cuts  with  increased  resistance,  showing  a 
pale  surface  with  yellowish  striations.  The  cortic.il  markings  are  fairly  dis- 
tinct, and  the  i)yranuds  are  pale  in  color.  The  right  kidney  weighs  10;")  grams 
and  is  similar  to  the  left  as  regards  surrounding  fat  and  general  condition,  hut 
beneath  the  capsule  occurs  a  small  yellowish  nodule  of  ])in-head  size.  The  left 
suprarenal  capsule  is  deeply  embedded  in  the  surrounding  fat  and  is  enlarged 
and  bloody  on  section.  The  same  conditions  are  present  in  the  right  suprarenal 
capsule.  The  urinary  bladder  is  encompassed  by  a  quantity  of  fat.  It  contains 
about  !()(•  c.  c.  of  cloudy  urine.  The  mucous  meml)r:uie  is  normal.  The  prostate, 
seminal  vesicles,  testicles,  and  penis  are  normal.  The  urethra  contains  a  slight, 
permeable  stricture  in  the  prostatic  portion.  The  rectum  contains  a  small 
amount  of  soft  fecal  matter.  The  first  portion  of  the  duodenum  shows  consid- 
erable congestion  of  the  mucous  membrane.  The  stomach  is  slightly  distended 
with  gas  and  contains  a  small  amount  of  liquid  material.  The  mucous  mem- 
brane is  mottled  and  shows  hemorrhagic  areas.  The  gall  ducts  are  patent.  The 
gall  bladder  is  moderately  distended  with  fluid  bile.  The  liver  weighs  1,015 
gi'anis.  The  external  surface  is  smooth,  pale  yellowish,  and  mottled  with  numer- 
ous minute  reddish  points.  On  section  it  is  soft  and  frialtle,  and  the  cut  surface 
is  very  pale.  The  centers  of  the  lobules  are  dark  and  prominent.  The  pancreas 
is  surroiuided  by  fat :  it  weighs  (!.">  grams  and  is  negative  on  examination.  The 
solar  plexus  is  normal.  The  mesentery  contains  a  large  amount  of  fat.  In  the 
wall  of  the  ileum,  about  0  inches  from  the  ciecum,  occurs  a  large  transverse 
ulceration  ei'oding  the  mucous  membrane.  The  large  intestines,  the  great 
vessels,  and  the  vermiform  appendix  are  apparently  normal. 

Anatomical  diagnosis. — Acute  leptomeningitis ;  ossification  of  costal  carti- 
lages ;  chronic  bilateral  pulmonary  tuberculosis  and  pleuritis ;  chronic  myocar- 
ditis :  chronic  phrenitis ;  excessive  adipose  formation  about  abdominal  viscera ; 
subacute  splenitis :  chronic  interstitial  nephritis :  stricture  of  urethra  :  chronic 
gastritis ;  tubercle  of  suprarenal  capsules ;  fatty  degeneration  of  liver ;  tuber- 
cular ulceration  of  ileum. 

C.    R. 

W.  G.   S. 

■  XL 

A.  D.  M. ;  age,  4.3 ;  nativity,  New  York ;  color,  white.  Admitted  to  United 
States  Marine-Hospital  Sanatorium.  Fort  Stanton,  N.  Mex.,  July  20,  1903.  and 
died  August  8,  1903. 

History. — Had  typhoid  fever  twentj'-one  years  ago.  Has  Bright's  disease, 
and  a  severe  cough  for  five  years,  dating  from  an  attack  of  la  grippe ;  has'  lost 
in  weight,  and  has  had  i)ain  in  chest,  and  night  sweats  for  two  years  ;  is  weak 
and  dyspnceic  on  slight  exertion  ;  has  suffered  from  hemoptysis  on  several 
occasions. 

Necropsy  (7  hours  after  death). — Body  that  of  a  fairly  well-nourished  man 
of  medium  build,  skin  slightly  inelastic  and  of  a  sallow  color,  abdomen  and  chest 
hairy.  Upon  section  of  the  abdominal  wall  the  panniculus  was  found  fairly 
abundant,  but  the  muscles  poorly  developed.  Omentum  was  fairly  rich  in  fat, 
but  pale.  Upon  removal  of  the  sternum  and  costal  cartilages  the  anterior  medi- 
astinum was  found  normal.  The  larynx  and  trachea  were  apparently  normal. 
Left  lung  adherent  to  thoracic  wall  at  apex  and  inferior  angle  of  scapula. 
Weight.  3t;,'5  grams.  Part  of  upper  lobe  contracted  and  indented:  hard  nodules 
could  be  felt  in  the  tissue  of  the  upper  lobe,  and  smaller  nodules,  size  of  pea  and 
smaller,  felt  in  tissue  of  lower  lobe.  On  section  the  upper  lobe  was  found  to 
contain  a  cavity  the  size  of  a  walnut  beneath  the  contracted  area  previously 
described.     Both  lobes  containetl  tubercles  scattered  throughout.     Right  lung: 


522  PUHLIC    HEALTH    AND    MARINl':-HOSPITAL    SERVICE. 

Weight,  340  grams,  not  adhei'ent  to  thoracic  wall ;  tubercles  varying  in  size 
from  a  millet  seed  to  a  pea  were  scattered  throughout  the  lung.  Right  ven- 
tricle slightly  dilated,  walls  of  ventricle  slightly  atrophic ;  weight,  oSo  grams ; 
the  pericardial  sac  contained  25  c.  c.  of  a  clear  serous  fluid.  I^iver  extended  to 
costal  in;irgin  in  right  nipple  line.  Olisson's  capsule  was  adherent  by  fresh, 
easily  torn  adhesions  to  the  parietal  ]»eritoneum  and  to  the  diaphragm.  Weight 
of  liver,  2,105  grams.  Surface  of  liver  was  rough,  with  a  very  slight  hobnail 
appearance.  Glisson's  capsule  was  thicliened  and  contracted  in  areas.  The 
whole  organ  was  enlarged  and  of  firm  consistency,  (iall  bladder  filled  with 
yellowish-gi'een  bile ;  cystic  duct  patent.  Spleen  weiglis  42.j  grams,  was  en- 
larged, and  had  four  distinct  notches ;  cuts  like  cheese  and  was  pale  and 
antemic.  The  follicles  were  easily  seen,  and  constituted  the  greater  part  of  the 
cut  surface.  Left  kidney:  Weight,  490  grams;  fatty  cajisule  small  in  amount; 
stellate  veins  injected  ;  fibrous  capsule  contracted  and  adherent  in  areas  ;  be- 
tween the  injected  stellate  veins  the  cortex  is  very  pale.  On  section  the  kidney 
is  very  i)ale,  of  a  yellowish-white  color,  and  cuts  with  resistance.  The  cortex 
seems  devoid  of  blood  and  the  pyramids  are  few  and  scattered.  The  glomeruli 
ave  few,  scattered,  and  hard  to  make  out.  The  kidney  measured  7i  inches  long, 
4  inches  wide,  and  2i  inches  thick,  with  cortex  from  three-eighths  to  one-half 
Inch  thick.  Right  kidney  was  smaller  than  left,  cortex  thicker,  and  the  pyra- 
mids fewer,  but  similar  in  all  other  respects.  Weight,  4()0  grams.  Bladder  was 
small  and  contracted  down  to  size  of  golf  ball.  The  walls  wore  thick  and  the 
mucous  membrane  pale.  Prostate  api)arently  nomnal.  Testes  soft,  but  other- 
wise apparently  normal.  Stomach  was  emi)ty  and  the  walls  covered  with  a 
greenish,  thick,  tenacious  mucus.  I'ylorus  was  patent.  Duodenum  contained 
considerable  dark-green  tenacious  nnicus.  Its  walls  were  stained  green  and 
brown,  and  showed  passive  congestion.  Jejunum  showed  condition  similar  to 
duodenum.  The  ileum  contained  some  feces.  Entire  intestines  showed  passive 
congestion. 

Microscopical  examination. — Lung  tissue  contained  typical  tubercles  with 
necrotic  centers,  epithelioid,  and  giant  cells.  Blood  vessels  dilated  with  blood 
and  the  pulmonary  connective  tissue,  especially  the  interalveolar,  was  much 
increased.  ^lany  of  the  alveoli  were  filled  with  debris  which  stains  faintly,  red 
blood  cells,  and  a  few  leucocytes.  Anthracosis  throughout  in  moderate  amount ; 
pleura'  were  thickened  and  congested  ;  alveoli,  where  not  in\olved,  were  much 
distended.  Interstitial  connective  tissue  of  the  kidney  was  much  increased 
throughout.  In  cortex  there  were  many  obliterated  glomeruli,  some  small  cell 
infiltration,  the  convoluted  tubules  were  distended  and  filled  with  plugs  of 
hyaline  and  fat  droplets.  The  epithelium  was  flattened  and  showed  cloudy  swell- 
ing. In  pyramids  straight  tubules  were  filled  with  liy.-iline  jdugs.  The  glome- 
ruli which  were  not  entirely  obliterated  showed  hyaline  deposits.  There  was 
arterio-sclerosis  of  blood  vessels. 

Pathological  diagnosis. — Tuberculosis  of  the  lungs;  chronic  adhesive  pleu- 
ritis ;  dilation  of  right  heart;  old  adhesive  peritonitis;  chronic  parenchymatous 
nephritis  ;  passive  congestion  of  intestine. 


J.  W.  T. 
P.  M.  C. 


XII. 


J.  M.  M. ;  age,  42  years ;  nativity.  New  York  ;  color,  white ;  was  admitted  to 
the  United  States  Marine  Hospital  Sanatorium,  Fort  Stanton.  X.  Mex.,  March 
2,  1902,  having  been  transferred  from  Baltimore.  Ilis  history  and  examination, 
made  at  Baltimore,  showed  the  following: 

His  family  history  Avas  negative  as  regards  tuberculosis.  His  statement  as 
to  his  personal  history  was  that  he  had  always  enjoyed  good  health,  that  he 
had  had  gonorrhtea,  that  one  year  ago  he  was  shipwrecked,  and  subsequently 
began  to  cough,  have  night  sweats,  anorexia,  and  loss  of  weight. 

Examination  showed  increased  tactile  fremitus  and  duUness  on  percussion 
over  both  apices  and  hyitoresonance  over  remainder  of  botli  lungs.  Numerous 
rales  were  heard  over  entire  chest.  Tubercle  bacilli  were  found  in  his  sputum. 
His  weight  was  133  pounds.  While  at  Baltimore  he  had  several  attacks  of 
hemoi)tysis. 

Examination  upon  admission  to  Fort  Stanton  revealed  the  following:  Chest 
expansion  equal  on  both  sides,  vocal  fremitus  negative,  abdomen  tender  on  right 
side,  liver  palpable  below  right  costal  margin,  hard  and  tender,  diminished  reso- 
nance in  both  apices,  dullness  in  left  base,  tenderness  ou  deep  percu.ssion  in  left 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  523 

axillary  roRion.  crack linj;  ralos  hoard  at  base  of  ri^lit  luii.!:;  laterally,  loft  lung 
ooutainod  cracUliii.u  rales  from  apox  to  baso,  bronchial  hroathiiii:  in  loft  apex, 
heart  oxtondod  to  tlio  loft  of  the  loft  nipple  lino,  cardiac  sounds  seemed  normal. 
Albumen,  hyaline,  and  fatty  casts  wi're  present  in  urine. 

After  arrival  he  had  repeated  attacks  of  homoi)tysis,  occasional  diarrhoea, 
increased  dyspiKoa.  Durinf^  latter  part  of  May  had  several  convulsions,  was 
restless,  with  coma  at  intervals.     Died  ]May  .">1,  IDOli,  at  7.2.j  p.  ni.   • 

Necuopsy. — Body  emaciated,  abdomen  distended;  potechijo  on  anterior  sur- 
faces (if  jirms,  loj;s.  and  chest  ;  ri,i;or  mortis  and  post-nu)rtem  lividity  present. 
Brain:  The  extorn;tl  dura  mater  is  stronj^ly  conj^osted,  and  there  is  a  slight 
sub<lural  layer  of  librinons  blood;  the  base  of  the  brain  is  bathed  in  clear 
serous  liuid ;  the  moninjxoal  arteries  and  the  circle  of  Willis  are  stronjjly  con- 
gested ;  the  lateral  ventricles  contain  clear,  straw-colored  fluid ;  the  condition 
is  that  of  typical  "wet  brain."  Thoi-ax  :  Ossification  of  the  sixth  costal  car- 
tilaire  on  the  left  side;  same  of  cartilages  of  first  ribs.  The  lungs  do  not  meet 
in  the  median  line.  The  pericardium  contains  a  small  amount  of  clear  straw- 
colored  fluid.  The  visceral  layer  of  the  pericardium  shows  "  soldier  spots." 
The  heart  is  small,  flabby,  and  contains  no  blood;  it  exhibits  the  ordinary, 
amount  of  sui)orficial  fat.  The  aortic  and  pulmonary  valves  are  competent  to 
the  water  tost.  The  mitral  orifice  admits  throe  finger  tips  loosely ;  the  tri- 
cuspid admits  four  loosely.  The  left  heart  is  slightly  enlarged,  the  myocar- 
dium being  increased.  The  right  heart  is  normal.  The  myocardium  of  the 
interventricular  septum  is  dark  brown  in  color ;  increase  of  connective  tissue 
around  the  coronary  arteries  and  beginning  of  the  aorta,  though  the  endo- 
cardium of  the  latter  is  smooth  and  shining.  Both  pleural  cavities  are  oblit- 
erated by  firm  adhesions.  The  right  lung  shows  a  considerable  infiltration  in 
the  upper  lobe;  the  lower  lobes  also  show  infiltrated  areas,  though  compara- 
tively free.  The  left  lung  is  solidly  infiltrated  in  the  upper  lobe ;  the  lower 
lobe  has  areas  of  consolidation  posteriorly  and  laterallj',  the  most  of  the  lobe 
crepitating,  however.  The  great  vessels  and  nerve  trunks  are  normal.  The 
diaphragm  on  the  right  side  extends  to  the  upper  border  of  the  fifth  rib ;  on 
the  left  side  it  extends  to  the  fourth  interspace.  Abdomen :  A  small  amount  of 
subcutaneous  fat.  The  peritoneal  cavity  contains  a  large  amount  of  clear, 
straw-colored  fluid.  The  folds  of  the  lesser  peritoneal  cavity  are  small  and 
thickened.  The  omentum  is  retracted  and  adherent  to  the  large  intestine, 
liver,  and  gall  bladder.  The  spleen  is  adherent  posteriorly  and  inferiorly. 
It  is  about  six  times  the  normal  size  and  cuts  with  slightly  increased  resist- 
ance. The  external  surface  shows  several  elevated,  light-colored,  nodular 
excrescences,  which  in  the  section  appear  on  the  surfaces  and  are  nearly  car- 
tilaginous in  consistency.  These  areas  in  the  spleen  are  irregularly  distrib- 
uted and  not  very  well  defined  in  outline.  There  is  some  increase  of  fibrous 
tissue  in  places.  The  kidneys  are  surrounded  by  much  perinephritic  fat,  are 
large  and  pale,  cut  with  slightly  increased  resistance,  and  show  congestion  of 
the  stellate  veins.  The  fibrous  capsule  strips  readily.  Beneath  the  capsular 
surface  are  numbers  of  small,  nodular,  yellowish,  hardened,  pea-sized  bodies, 
which  also  occur  in  the  cortex  and  medulla.  The  cortex  is  swollen  and  the 
glomeruli  not  prominent.  The  cortical  markings  show  fatty  change.  The 
suprarenal  capsules  exhibit  the  same  nodular  formation  as  do  the  kidneys. 
The  urinary  bladder  is  normal.  The  right  testicle  is  enlarged  and  contains 
nodules  of  large  pea  size,  which  show  gumatous  formation  with  liquefaction  in 
the  center  in  some  nodules ;  these  occur  in  the  testicular  substance  proper.  The 
other  organs  of  generation  appear  normal.  The  rectum,  duodenum,  and  stom- 
ach are  normal.  The  gall  ducts  are  patent.  The  gall  bladder  is  nearly  oblit- 
erated and  bound  firmly  by  adhesions  to  the  border  of  the  liver  and  omentum. 
The  right  lobe  of  the  liver  is  adherent  to  the  hepatic  flexure  of  the  colon  and 
omentum  and  also  to  the  diaphragm.  The  liver  itself  is  enlarged  and  hardened, 
holds  it  shape  rigidly  on  the  flat  surface,  roughened  externally.  There  are 
numerous  divisionary  segments  to  the  lobus  Spigelius  and  adhesions  between 
the  liver  and  inferior  vena  cava.  A  strong  band  of  adhesions  extends  from 
between  the  lobes  over  the  round  ligament.  In  addition  the  surface  of  the 
liver  wrinkles  with  difficulty  and  is  of  a  mottled  brownish-gray  color.  It 
shows  many  elevated  and  light-colored  nodules  of  pea  size  over  the  entire 
surface.  The  consistency  of  those  is  hard,  and  they  extend  downward  into 
the  liver  substance.  The  liver  cuts  with  much  increase  of  resistance,  and  the 
cut  surface  is  roughened  and  uneven  and  shows  considerable  excess  of  fibrous 
tissue,  i)rincipally  around  the  portal  spaces.  The  nodular  bodies  are  uniformly 
distributed    internally.     The    pancreas    shows    nodular    formation    similar    to 


524  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

that  in  the  liver  and  the  other  organs.  The  sohir  plexus  appears  to  be  normal. 
The  mesenteric  l.yui|)h  glands  are  enlarged,  hardened,  and  caseous.  The 
vermiform  ai»i)endix  is  small  and  normal.  In  the  small  intestines  on  the 
external  border  of  the  ileum  occur  trans'x-erse  areas  of  congestion,  which  on 
section  are  seen  to  involve  the  mucosa,  and  are  ulcerative  in  character.  The 
large  intestines  and  the  great  vessels  are  normal. 

Anatomical  diagnosis. — Right  ischial  decubitus;  congestion  of  meninges  of 
brain;  tricuspid  insutticienc.v  (slight);  hypertrophy  of  left  ventricle  (slight); 
incipient  arterio  sclerosis  of  coronary  arteries  and  commencement  of  aorta ; 
chronic  fibrous  pleuritis;  chronic  pulmonary  tuberculosis;  chronic  peritonitis; 
fibrous  adhesion  between  liver,  colon,  gall  bladder,  and  omentum;  gummata  of 
parenchymatous  abdominal  organs;  enlargement  and  fibrosis  of  spleen: 
chronic  parenchymatous  nephritis:  gummata  of  right  testicle;  contraction  of 
gall  bladder ;  hypertrophic  cirrhosis  of  liver ;  tubercular  adenitis  and  ulcera- 
tion of  small  intestine. 

H.  K.  P. 

P.   M.  C. 
XIII. 

C.  R. ;  aged  42  years ;  nativity,  England :  color,  white ;  was  admitted  to 
United  States  Marine  Hospital  Sanatorium,  Fort  Stanton,  N.  Mex.,  January 
25,  1902,  and  died  April  5,  190.^. 

History. — Had  been  in  hospital  at  Honolulu  witli  enlarged  cervical  glands  in 
July,  1901.  December  28,  1901,  he  was  admitted  to  the  United  States  Marine 
Hospital  at  San  Francisco,  complaining  of  dyspna'a,  cough,  expectoration  of 
frothy  siiutum,  pain  in  chest  after  coughing,  and  gradual  loss  in  weight. 
Examination  revealed  a  hard  circumscribed  tumor  over  the  upper  part  of  the 
sternum.  It  had  grown  gradually  and  was  occasionally  iiainful.  Arrived  at 
Fort  Stanton  January  25,  1902,  where  examination  revealed  enlarged  cervi- 
cal axillary,  and  epitroclear  lymph  glands,  and  a  small,  hard,  nonfluctuating 
tumor  at  seat  of  left  sterno-elavicular  articulation.  The  tumor  was  not  adher- 
ent to  the  skin  and  was  of  bony  consistency.  Upon  auscultation  rales  were 
heard  in  the  form  of  small  moist  clicks  over  right  lung  from  apex  to  fourtli 
intercostal  space  anteriorly  and  in  the  interscapulary  si)ace  and  base  posteri- 
orly. In  the  left  lung  bronchial  breathing  was  well  marked  from  clavicle  to 
fourth  rib  in  front,  with  a  few  moist  clicks  in  the  extreme  aiiex  and  ba.se. 
Examination  of  sputum  was  negative.  The  urine  gave  a  marked  diazo  reac- 
tion. For  the  next  three  months  he  had  a  chill,  followed  by  a  run  of  fever 
about  every  second  week.  The  temperature  would  mount  higher  and  higher 
each  evening  until  it  reached  40°  C,  then  it  would  fall  lower  and  lower  each 
morning  until  it  reached  35^  or  34^  C.  It  would  thus  remain  subnormal  for 
a  week  or  two,  being  as  a  rule  about  3.j"  C.  in  the  morning  and  30°  C.  in  the 
evening.  Examination  of  blood  showed  a  great  increase  in  the  number  of 
the  polymorphoneutrophiles.  In  April  lie  began  to  complain  of  pain  and  ten- 
derness in  the  abdomen.  By  July  cough  and  expectoration  were  much  dimin- 
ished. The  febrile  attacks  had  ceased  and  the  patient  gained  8  pounds  in 
weight.  In  August  the  febrile  attacks  returned.  In  January,  1903.  pains 
became  more  continuous  and  troublesome  over  the  abdomen  and  a  severe 
diarrhopa  with  foul-smelling  watery  stools  set  in.  Liver  was  enlarged  and 
tender  on  pressure.     Died  of  exhaustion  April  5,  1903. 

Necropsy  (3*  hours  after  death). — Skin  bronzed  yellow,  dry,  and  inelastic. 
Emaciation  extreme.  Some  hypostasis  over  back.  Excoriations  uiton  legs  and 
abdomen.  White  atrophic  scars  about  knees.  Cervical,  axillary.  Jind  inguinal 
glands  were  all  enlarged.  Right  thorax  more  prominent  than  left.  Abdominal 
walls  very  thin.  Upon  section  abdomen  contained  a  liter  of  clear  greenish 
fluid;  omentum  poor  in  fat:  c:ecum  had  sraall  areas  whitish  in  color.  Sur- 
face of  liver  was  studded  with  small  white  pin-bead  areas,  some  of  which 
have  a  darker  central  dot.  Uiton  removing  the  sternum  there  was  found  a 
tumor  on  the  under  surface  of  the  manul)rium  about  the  size  of  a  hen's  egg 
and  of  the  consistency  of  librous  tissue.  On  section  it  was  yellow  with 
brownish  areas.  This  tumor  formed  a  part  of  the  liianubrium  and  was  clearly 
an  outgrowth  from  it.  It  was  also  adherent  to  the  left  lung.  The  retroperi- 
toneal and  mesenteric  glands  were  all  enlarged,  some  to  the  size  of  hen's  eggs 
and  upon  section  showed  the  same  structure  as  did  the  tumor  just  mentioned. 
The  left  lung  was  adherent  to  the  pericardium,  to  the  thoracic  wall  in  the 
neighborhood  of  the  tumor,  and  to  the  tumor  itself.  All  the  mediastinal  glands 
were  enlarged  and  on  section  showed  an  appearance  similar  to  that  of  the 


PUBLIC    IIKALTH    AND    M AIUNE-IIOSI'ITAL    SERVICE.  525 

luesentorif  f,M:uuls.  TlirouKliont  tlio  loft  lung  witc  liiinl  iiodulos,  varying  in 
size  from  a  niilU't  sood  to  a  Lima  boan.  One  larno  nodule  was  exf-avatcd  and 
contained  a  purulent  fluid  in  the  center.  Lung  contained  air  thiv)UKliout.  The 
nodules  were  firm  and  had  the  apitearanco  of  connective  tissue.  The  right 
lung  was  adherent  slightly  at  the  ape.x.  On  section  a  few  nodules  similar  to 
those  found  on  the  left  were  seen  in  the  ai)e.\'.  No  sign  of  tuberculous  involve- 
ment in  either  lung.  Heart  apparently  normal.  Kidneys:  Fibrous  capsule 
ea.sily  strippi'd :  in  cortex  were  seen  small  pin-head  nodules  of  firm  consis- 
temy  and  yellow  <-olor.  Adrenals  containtul  a  few  pin-point  whitish  areas. 
Spleen  was  large  and  friable  and  tilled  with  nodules  the  size  of  peas  through- 
out. The  follicles  w(>re  visible,  and  the  connective*  tissue  was  increased.  Liver 
was  firm.  Th(>  lobules  were  indistinct  and  througlnmt  were  yellowish  nodules 
varying  in  size  from  a  pin-point  to  a  French  pea.  I'ancreas  was  normal. 
Examination  of  bladder,  prostate,  penis,  and  testicl(>s  was  negative.  Small 
intestines  were  pale,  thin  as  tissue  paper  and  transparent.  One  yellowish 
nodule  was  found  in  the  ileum. 

INIicposcoiMcAL  KXAMiNATio.x. — Primary  tumor  was  a  small  spindle  cell  fibro- 
myxo-sarcoma.  Secondary  tumors  were  foiuid  in  lung,  lymph  glands,  and 
spleen.  laver  showed  great  increase  in  the  intralobular  connective  tissue, 
showed  some  small  cell  infiltration  and  contained  many  miliary  tubercles. 
Spleen  was  congested  and  contained  secondary  sarcomata  and  miliary  tuber- 
cles. Kidney  congested,  comiective  tissue  increased,  some  cloudy  swelling,  a 
few  obliterated  glomeruli.     Small  abcess  in  cortex. 

Pathological  diagnosis. — Small  spindle  cell  fibro-myxo-sarcoma.  The  pri- 
mary tumor  was  located  in  the  anterior  mediastinum  and  was  firmly  attached 
to  and  grew  from  the  inner  surface  of  the  manubrium.  Secondary  tumors  were 
found  in  the  lung,  spleen,  and  cervical,  supra  and  infra  clavicular,  axillary, 
mesenteric,  and  retroperitoneal  lymph  glands;  atrophic  cirrhosis  of  liver; 
miliary  tuberculosis  of  liver  and  spleen;  metastatic  abscess  in  kidney;  chronic 
congestion  of  Ividney :  chronic  librous  pleuritis,  and  pericarditis. 

J.    W.   T. 
P.  M.  C. 
XIV. 

E.  G. ;  age,  21 ;  nativity,  Norway ;  color,  white ;  admitted  to  United  States 
-Marine  Hospital  Sanitorium,  Fort  Stanton,  N.  Mex.,  December  16,  1902.  giving 
a  history  of  pulmonary  tuberculosis  dating  back  four  years.  Tubercle  bacilli 
were  found  in  his  s])utum  and  physical  examination  showed  advanced  disease 
in  both  lungs.  Htemoglobin  percentage  was  between  70  and  80,  as  estimated  by 
Tallquist's  method  ;   died  September  18,  1903. 

Necropsy  (TJ  hours  after  death). — Tlie  findings  were  as  follows:  Hypostasis 
over  back  of  neck,  trunk,  and  thighs ;  blue  tliscoloration  over  left  inguinal 
region;  skin  of  abdomen  mottled  with  patches  of  yellow  (Tinea  Versicolor)  ; 
skin  dry,  inelastic,  and  yellowish  in  color;  nutrition,  poor;  panniculus,  small; 
no  scars,  no  deformities  ;  rigor  mortis  present ;  body  heat,  mere  trace.  Brain  : 
Dura  was  congested  and  contained  bluish,  roughened  areas  varying  in  size  from 
a  pea  to  a  nickel,  along  each  side  of  longitudinal  sinus  in  usual  region  of 
pacchionian  bodies.  The  pia  was  also  congested ;  likewise  the  choroid  plexus 
and  the  cerebral  vessels  in  each  hemisphere.  Examination  of  the  larynx  was 
entirely  negative.  Pericardium  contained  40  c.  e.  of  clear  serous  fluid.  Heart 
weighed  350  grams  and  was  apparently  normal.  Right  lung  adherent  to  tho- 
racic wall  from  apex  to  base  by  strong  adhesions ;  weight,  (>10  grams.  Upper 
lobe  was  contracted  and  contained  many  small  cavities.  The  lower  lobe  con- 
tained many  tubercles  scattered  throughout.  Left  lung  weighed  470  grams,  had 
small  cavity  in  apex  ;  upper  half  of  upper  lobe  was  consolidated ;  many  miliary 
tubercles  were  scattered  throughout  rest  of  lung.  Omentum  normal.  Appendix 
adherent  and  club  shaped.  Liver  weighed  1,855  grams,  and  was  slightly  con- 
gested. Spleen  weighed  380  grams,  and  was  enlarged,  of  firm  consistency,  and 
the  follicles  could  be  easily  seen.  Left  kidney  weighed  220  grains,  and  was  con- 
gested ;  glomeruli  were  visible  as  small  pin-point  dots  in  cortex.  Fibrous  cap- 
sule stripped  easily.  Stellate  veins  were  congested.  Right  kidney  weighed  200 
grams  and  was  in  all  respects  similar  to  the  left.  Panci-eas,  stomach,  urinary 
bladder,  prostate,  and  testes  were  normal.  Intestines  contained  small,  shallow 
ulcers. 

MicROBcopicAL  EXAMINATION. — Lungs  Contained  typical  tubercles,  with  giant 
and  epitheloid  cells  and  necrotic  centers.  Brain  contained  a  few  small  tuber- 
cles, containing  giant  and  epitheloid  cells.     Vessels  showed  moderate  congestion. 


526  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Pia  contained  a  few  small  tubercles  with  epitheloid  and  giant  cells  and  necrotic 
areas.  Spleen  sIlo^Yed  moderate  congestion,  increased  connective  tissue,  many 
small  tubercles,  and  arterio-sclerosis.  Kidneys  showed  moderate  congestion,  a 
few  obliterated  glomeruli,  small  miliary  tubercles  scattered  throughout  cortex 
and  medulla,  slight  increase  of  connective  tissue,  and  some  cloudy  swelling  in 
convoluted  tubules.  Intestines  showed  congestion  and  ulceration  extending  to 
submucosa. 

Pathological  diagnosis. — Tinea  versicolor  over  abdomen ;  chronic  adhesive 
pleuritis  ;  chronic  tuberculosis  of  lungs;  acute  miliary  tuberculosis  of  brain 
and  its  membranes  and  of  the  spleen  and  kidneys ;  ulceration  and  congestion 
of  intestines. 

J.  W.  T. 
P.  M.  C. 
XV. 

II.  C.  W. ;  age,  41;  male;  nativity,  Ohio;  color,  white;  was  admitted  to  the 
United  States  Marine  Hospital  Sanatorium,  Fort  Stanton,  N.  Mex.,  July  17, 1!»0."5, 
giving  a  clear  history  of  pulmonary  tuberculosis.  Examination  revealed  the  dis- 
ease to  be  in  an  advanced  stage.  After  arrival  his  temjicrature  ranged  from  38° 
C.  to  41°  C.  and  he  had  an  annoying  diarrhoea.  His  spleen  was  enlarged  and  his 
urine  gave  Ehrlich's  diazo  reaction.     He  died  July  28,  1003. 

Necropsy  (23  hours  after  death). — Hair  scant;  beard  thin;  skin  of  face 
sallow ;  body  emaciated ;  back  of  trunk,  arms,  and  legs  covered  with  hypo- 
static areas  ;  body  heat  absent ;  rigor  mortis  present ;  vaccination  scar  at  inser- 
tion of  left  deltoid ;  copper-colored  atrophic  scars  over  anterior  aspects  of  both 
tibije ;  scar  1*  inches  long  to  left  of  and  beneath  left  eye ;  abdomen  distended 
and  tympanitic,  panniculus  very  scant.  Upon  section  of  the  abdominal  wall 
the  intestines  ])rotruded  and  were  distended  with  gas ;  abdomen  contained 
some  serous  fluid.  Muscles  of  abdomen  pale.  Upon  removal  of  the  sternum 
the  veins  of  the  anterior  mediastinum  were  found  congested.  Pericardium 
normal.  Heart  weighed  240  grams  ;  myocardhun  was  pale,  flal)by,  and  atrophied  ; 
right  ventricle  dilated ;  subpericardial  fat  slightly  increased ;  slight  sclerosis 
in  c-ommencement  of  ascending  limb  of  arch  of  aorta.  Left  lung  was  adherent 
to  thoracic  wall  at  apex ;  studded  throughout  with  tubercles  and  consolidated 
nodules ;  had  many  small  cavities  in  apex ;  base  showed  marked  hypostatic 
congestion.  Weight  of  liuig,  1,150  grams.  Right  lung  was  not  adherent;  was 
filled  with  tubercles  and  consolidated  nodules  throughout;  contained  severtil 
small  cavities  in  the  lower  lobe.  Weight  of  lung,  1,775  grams.  The  peri- 
bronchial lymph  glands  were  enlarged  and  one  of  the  glands  close  to  the  right 
bronchus  was  completely  calcified.  The  lymph  glands  around  the  oesophagus 
and  thoracic  aorta  were  also  enlarged.  Kidneys :  Fatty  capsules  of  both  kid- 
neys were  scant,  the  fibrous  capsules  adherent,  and  the  parenchyma  pale ; 
Aveight  of  right  kidney  160  grams ;  of  left,  170  grams.  Liver  weighed  1,540 
gnims;  was  very  pale  and  of  normal  consistency.  Spleen  weighed  400  grams; 
was  nuich  congested,  connective  tissue  was  increased,  ])arenchyma  was  friable, 
and  the  follicles  were  easily  seen.  Pancreas  was  soft  and  showed  passive  conges- 
tion. Urinary  l)ladder  was  filled  with  clear  amber  urine  ;  the  walls  were  atrophic. 
Prostate  normal  in  size,  Init  fiabby.  Intestines  contained  undigested  milk.  In 
the  ileum  and  (-ecum  were  found  ulcers  scattered  at  irregular  distances.  They 
varied  in  size  from  a  i)in  head  to  a  dime.  They  had  depressed  centers  and  raised 
edges,  antl  in  the  ca-cum  ])enetrated  to  the  muscularis  mucosae.  They  were 
pale,  excepting  in  the  lower  ileum,  where  they  were  tjugested.  Stomach  con- 
tained considerable  inuligested  milk.  The  mesenteric  and  retroperitoneal  lymi)h 
glands  were  not  enlarged. 

Pathological  diagnosis. — Dilation  of  right  heart;  slight  arterio  sclerosis; 
chronic  adhesive  pleuritis;  chronic  pulmonary  tuberculosis;  lymphadenitis  of 
thoracic  glands ;  chronic  nephritis ;  chronic  congestion  of  spleen ;  chronic 
ulcerative  entero-colitis  (tuberculous). 

J.  W.  T. 
P.  M.  C. 
XVI. 

W.  W. ;  age,  24  years ;  nativity,  Tennessee ;  was  admitted  to  the  United  States 
Marine  Hospital,  St.  liouis.  Mo.,  July  30  and  died  August  17,  1903. 

History. — Patient  was  admitted  to  the  hospital  on  account  of  an  oedema  of 
the  ankles  and  face,  with  cough  and  shortness  of  breath.     The  urine  on  exami- 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  527 

nation  was  small  in  amount  and  contained  considerable  albumen  and  granular 
casts.     Tlicr(>  was  jn-ofuse  (>xi)ectoration  of  nuicopurnlent  sputum. 

NKCRorsY  (4  hours  after  death ).—  l?o(l.v  that  of  a  youuK  adult  negro;  rigor 
mortis  present  in  lower  limbs  and  cedema  of  the  face  and  eyelids;  muscles 
poorly  developed  and  subcutaneous  fat  small  in  amount.  Pericardium  normal  ; 
contained  a  very  small  amount  of  fluid.  Heart  is  bypertroi)bied.  weight  310 
grams;  both  auricles  tilled  with  white  clot  :  valves  normal.  Pugbt  lung  slightly 
adherent  at  the  base  posteriorly  ;  weight,  (>70  grams.  On  section  the  upper  lobe 
contained  cavity  filled  with  pus,  which  was  about  the  size  of  a  hickory  nut. 
The  middle  and  lower  lobes  contained  a  number  of  calcified  areas.  Left  lung  is 
adherent  throughout;  weight,  1,(1.10  grams.  The  surface  is  covered  with  large 
mnnber  of  miliary  tul>ercles;  on  s(H-tion  there  is  found  a  large  cavity  filled  with 
pus  which  is  of  the  size  of  a  hen's  egg.  Tlie  lower  lobe  also  contains  a  few 
small  pus  cavities.  Liver:  Weight,  1,S:",()  grams  ;  surface  is  studded  with  small 
tubercular  nodules.  S])leen  weighs  220  grams,  found  to  be  normal.  Mesenteric 
lymph  glands  are  much  enlarged.  Stomach  is  found  to  be  empty  and  the 
iuuct)sa  of  normal  appearance.  Small  and  large  intestines  are  normal.  Appen- 
dix 17f  cm.  in  length ;  lumen  of  the  appendix  is  open.  Right  kidney :  Weight, 
130  grams ;  smaller  than  normal ;  cajisule  is  adherent ;  surface  of  the  kidney 
nodular ;  cut  section  shows  snnill  i)eh'is ;  cut  surface  is  pale.  Left  kidney : 
Weight,  100  grams :  capsule  is  adherent,  otherwise  same  as  right  kidney. 
Bladder  contains  small  amount  of  urine  mixed  with  pus;  the  mucosa  is  pale 
and  slightlv  thickened.     Urethra  is  pervious. 

II.  C.  W. 
A.  D.  F. 
XVII. 

J.  C. ;  age,  20;  nativitv,  Chile;  color,  white;  adnatted  to  the  United  States 
]\Lirine  Hospital,  San  Francisco,  Cal.,  April  23,   1003 ;  died  July  21,  1903. 

History. — Previous  personal  and  fannly  history  negative. 

Present  history. — For  ten  days  lie  has  not  felt  well,  and  A'ery  bad  for  the 
last  four  days;  has  pain  in  back  and  belly  and  in  head;  he  had  a  chill  and  sweat 
yesterday;  bowels  regular,  appetite  poor,  sleeps  very  poorly;  has  coughed  for 
(>leven  days  and  raised  a  good  deal. 

Examination  shows  coated  tongue,  diminished  expansion  of  left  chest  with 
increased  vocal  fremitus  to  fourth  ril),  and  dullness  over  whole  of  left  side; 
flatness  laterally;  absence  of  resi)iratory  murnuir  laterally  and  below,  and 
small  mucous  rales  throughout  ui)per  lobe.  Heart  action  rapid,  with  heavy 
beats. 

May  2. — Is  about  the  same,  coughs  very  badly,  eats  and  sleeps  fairly  well, 
bowels  very  loose,  sweats  profusely  all  the  time  and  temperature  remains  high. 

Mau  ii.— Somewhat  better,  though  the  temperature  continues  above  the  nor- 
mal ;   the  appetite  is  slightly  improved. 

May  2.1. — Examination  shows  bulging  in  left  axilla  and  hy])ochondrium,  and 
dyspiKpa,  almost  amounting  to  ortiiopurea  ;  increased  vocal  fremitus  in  right 
supraclavicular  region,  diminished  in  left  base ;  slight  loss  of  resonance  in 
a])ices  and  infraclavicular  regions,  and  also  in  supraclavicular  regions  on 
right  side;  over  left  side  dullness  (absolute)  from  third  interspace  up  and  into 
axilla  ;  dullness  from  eighth  rib  downward  on  the  left  side ;  cardiac  dullness 
extending  about  three  cm.  to  the  right;  liver  dullness  about  two  fingers' 
breadth  below  costal  margin ;  bronchophony  in  right  supra  and  inter  scapular 
regions ;  bronchial  breathing  on  right  side  ])osteriorly ;  harsh  breathing  all  over 
rest  of  chest  except  in  a  few  places.  Heart:  Diffuse  pulsation  in  epigastrium 
and  ri.ght  hyjiocliondrium. 

May  26. — Physical  examination:  Movements  of  left  chest  slightly  limited, 
left  chest  bulging  below;  vocal  fremitus  absent  over  lower  half  of  left  chest 
posteriorly  and  dimiinshed  over  same  anteriorly  and  in  extreme  right  base; 
tone  of  entire  left  lung  higher  than  that  of  right,  and  dullness  above  poste- 
riorly, with  flatness  below  ;  liver  dullness  increased  below  and  liver  is  tender ; 
cracking  rales  in  right  apex,  but  of  a  rather  dry  character  and  mostly  inspira- 
tory ;  right  residratory  murmur  generally  exaggerated,  except  in  base,  where 
occur  dry  rales  on  inspiration  and  expiration  :  In  the  left  lung  many  large,  moist, 
crackling  rales  in  the  upper  half,  which  become  metallic  at  the  level  of  the 
nipple  and  fewer  in  number,  the  character  of  the  sound  being  that  of  "  metallic 
tinkling;"  absence  of  rales  and  breath  sounds  over  lower  fourth  of  left  lung; 
splashing  sounds  elicited  when  succussion  is  employed;  bronchial  breathing 
between  nipple  and  left  axilla. 


528  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

May  21. — Aspiration  performed  at  left  lateral  border  of  chest  in  the  eighth 
interspace,  and  about  400  c.  c.  of  yellowish  pus  removed,  air  bubbles  being  mixed 
with  the  pus. 

May  30. — Pain  in  left  chest  about  first  and  second  ribs  since  operation,  though 
breathing  is  nuich  easier ;  expectoration  has  almost  ceased ;  bowels  regular, 
appetite  fair,  sleep  intei-rupted. 

June  1. — An  attempt  made  to  do  a  thoracotomy.  Found  unable  to  give  a  gen- 
eral anaesthetic,  as  patient  was  plunged  into  violent  fits  of  coughing  at  each 
attempt  at  a  recumbent  posture. 

June  2. — Under  spinal  am^sthesia  by  means  of  cocaine  the  thorax  was  opened 
in  the  intercostal  spaces,  one  opening  anteriorly  and  the  other  posteriorly,  both 
being  then  connected  by  a  large  double  drainage  tube.  About  1,500  c.  c.  of 
greenish,  bad-smelling  pus  evacuated.  Great  relief  experienced  by  the  patient, 
and  cough  and  expectoration  ceased. 

June  .5. — Condition  nuich  improved,  no  cough ;  a  large  amount  of  pus  drains 
out  daily. 

June  12. — Condition  generally  about  the  same;  there  is  a  lessened  discharge 
of  pus. 

June  22. — Feels  about  the  same.  Considerable  pus  still  discharges.  Seems 
thinner  and  more  cachectic  than  formerly. 

June  26. — Continues  to  be  bright  and  maintains  a  good  appetite,  notwithstand- 
ing the  fact  that  there  is  a  free  discharge  of  pus  daily  and  that  he  is  growing 
more  wasted  every  day. 

July  3. — Not  much  improvement ;  has  an  enormous  appetite  and  more  or  less 
digestive  disturbance. 

July  10. — Digestive  system  causing  no  further  trouble.  Patient  still  main- 
tains a  ravenous  appetite.     General  condition  about  as  usual. 

July  17. — No  improvement ;  still  maintains  a  hectic  temperature ;  very  nuich 
emaciated  ;   a  free  discharge  of  ]nis. 

July  21. — Estlander's  operation  performetl.  An;esthetic,  chloroform,  later 
changed  to  ether.  During  the  operation  strychnine  sulphate,  one-tenth  grain, 
given  in  divided  doses ;  also  ether,  00  m. ;  brandy,  240  m.,  and  480  c.  c.  of  nor- 
mal saline  solution  hypodermatically.  Oxygen  given  for  ten  minutes.  The 
patient  survived  the  profound  shock  of  the  operation,  and  when  returned  to  bed' 
was  given  an  enema  of  coffee,  whisky,  and  \^ater  at  37°  C.  Later  was  resting 
easily  and  partially  returned  to  consciousness ;   died  at  1.15  p.  m. 

Necropsy  (4  hours  after  death). — Body  emaciated.  A  prijfuse  scaly  eruption 
on  the  dorsum  of  the  penis,  the  scales  being  dirty  gray  in  color,  coarse,  and 
strongly  adherent  to  the  underlying  skin  (this  had  been  present  for  more  than 
a  month).  Chilean  flag  tattooed  on  left  forearm.  On  the  left  side  of  the  chest 
an  operation  wound  extending  from  the  seventh  to  the  ninth  rib,  inclusive,  and 
entering  the  left  pleural  cavity.  A  portion  of  each  of  the  ribs  resected.  P>rain : 
Weight,  1,410  grams.  The  veins  of  the  pia  mater  are  engorged.  The  structures 
at  the  base  and  the  remainder  of  the  brain  do  not  show  anything  pathological. 
Thorax :  In  the  anterior  mediastinum  the  right  liuig  is  seen  to  extend  beyond 
the- median  line.  The  heart  is  small  and  pale  and  weighs  "200  grams.  On  sec- 
tion the  tissue  is  pale  brown  in  color,  greasy  to  the  touch,  and  shows  areas  of 
lighter  color.  No  blood  clots  are  present  in  the  heart.  All  the  valves  apjiear  to 
be  normal.  The  pericardium  is  thickened  and  strongly  adherent  to  the  left 
lung.  The  bronchial  and  posterior  mediastinal  lymph  glands  are  enlarged  and 
hardened.  The  right  lung  is  adherent  to  the  pknu-a  all  over  by  separable  fibri- 
nous adhesions.  The  lung  contains  nunjcrous  small  tubercles  in  the  middle  and 
lower  lobes,  and  the  apex  is  nearly  solid.  Section  of  the  apex  shows  caseous 
masses  and  small  cavities;  very  little  functional  tissue.  The  lower  lobes, 
while  containing  many  small  tubercles,  have  also  nmch  fvuictional  tissue  remain- 
ing. The  left  lung  is  shrunken  to  about  the  size  of  a  man's  closed  fist.  It 
adheres  so  strongly  to  the  upper  part  of  the  pleural  cavity  that  it  can  not  l;e 
separated  and  removed.  Section  in  situ  shows  the  lung  to  be  merely  a  mass  of 
tuberculous  material,  no  functional  tissue  remaining  that  can  be  seen.  The 
pleura  is  greatly  thickened  and  is  coated  with  a  prominent  white  pyogenic  mem- 
brane. The  great  vessels,  nerve  trunks,  and  diaphragm  are  normal.  Abdomen : 
About  3  inches  above  the  umbilicus  in  the  median  line  occurs  a  small  abscess 
of  bean  size  in  the  subcutaneous  tissue.  The  i)eritoneum  is  white  and  some- 
what thickened,  and  there  is  a  considerable  amount  of  serum  in  the  peritoneal 
cavity.  Inflanunatory  lymph  is  ])resent  on  tlie  peritoneal  coat  of  the  intestines. 
The  omentum  contaiTis  very  little  fat.  The  sjileen  is  loosely  adherent  to  the 
neighboring  structures,  is  soft  in  consistency,  and  wrinkles  easily ;   weight,  165 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE.  529 

grams.  Section  shows  prominonoo  of  tlio  pulp  and  is  quite  bloody ;  there  is 
some  increase  (»f  interstitial  connoftive  tissue.  Tlie  Jcidneys  are  large,  soft,  and 
very  pallid  in  hue.  The  capsules  strip  readily.  Section  shows  no  increase  in 
resistance,  the  cut  surface  being  very  pale  and  the  pyramids  faintly  outlined. 
The  cortex  is  made  up  of  tissue  of  a  light-yellow  color,  as  is  also  the  medulla. 
The  right  suprarenal  capsule  is  yellowish  in  color,  enlarged,  and  of  doughy 
consistency;  it  cuts  with  increased  resistance.  Examination  of  the  left  supra- 
renal is  negative.  The  urinary  bladder  contains  a  small  anumnt  of  turbid  urine. 
The  organs  of  generation  are  normal,  except  tlie  penis,  wliicli  shows  the  erup- 
tion before  descril)ed.  The  rectum  and  duodenum  are  normal.  The  stomach 
is  distended  with  gas.  The  gall  ducts  are  patent  and  the  gall  bladder  contains 
viscid  bile.  The  liver  shows  masses  of  inflammatory  lymph  on  its  convex 
border,  also  a  semilunar  depression.  It  weighs  1.220  grams.  On  section  the 
cut  surface  is  very  bloody  and  when  scraped  off  with  a  knife  is  seen  to  be  of  a 
light  yellowish  color.  The  centers  of  the  lobules  show  darker  than  the  periph- 
ery. The  pancreas  is  very  anaMuic,  the  color  being  pale  yellow.  The  solar 
plexus  is  normal.  The  small  and  large  intestines  are  coated  externally  with 
inflammatory  lymph  and  the  small  intestines  show  a  number  of  transverse 
ulcerations.  The  great  vessels  are  normal.  Enlarged  mesenteric  lymph  glands. 
Anatomical  diagnosis. — Lichen  rul)er  planus  of  penis ;  operative  wound  in 
left  axilla  from  second  to  ninth  ribs,  inclusive,  with  resection  of  portion  of  each 
rib ;  engorgement  of  vessels  of  pia  mater ;  emphysema  of  right  lung ;  acute 
myocarditis  with  fatty  infiltration ;  localized  pericarditis ;  tubercular  adeno- 
pathy;  acute  fibrinous  i)leuritis  (right);  pulmonary  tuberculosis  (bilatei'al)  ; 
complete  contraction  of  left  lung;  chronic  pleuritis  (left),  obliterative  above, 
with  empyema  below ;  abdominal,  subcutaneous,  bean-size  abscess ;  chronic 
tubercular  peritonitis  ;  chronic  splenitis  ;  acute  nephritis  with  fatty  infiltration  ; 
chronic  adrenitis  (right)  ;  acute  hepatitis  ■«  ith  fatty  degeneration;  fatty  degen- 
eration of  the  pancreas ;  tubercular  ulceration  of  small  intestines.  Note. — 
Tubercle  bacilli  were  never  found  in  this  case. 

C.   R. 

W.  G.   S. 
XVIIL 

T.  T. ;  age,  45;  nativity,  New  York;  color,  white;  admitted  to  the  United 
States  Marine  Hospital  Sanatorium,  Fort  Stanton,  N.  Mex.,  June  27,  1903 ;  died 
July  10,  1903. 

History. — His  mother  had  died  of  some  form  of  lung  trouble.  He  gave  a 
history  of  gonorrhoea,  cliancroid,  and  syphilis,  and  claimed  to  have  had  a  cough 
for  fifteen  years,  but  stated  tliat  it  became  much  more  severe  six  months  ago, 
and  that  he  was  compelled  at  that  time  to  give  up  work  on  account  of  weakness, 
loss  in  weight,  cough,  and  dyspnoea.  Upon  arrival  lie  waS  in  a  very  weak  con- 
dition ;  his  pulse  was  110  and  his  respiration  2(i  per  minute ;  he  was  an  anaemic 
and  dyspnceic.  While  at  the  sanatorium  lie  remained  in  a  semicomatose  condi- 
tion most  of  the  time. 

Necropsy  (4  hours  after  death). — Body  heat  present  in  small  amount; 
rigor  mortis  absent ;  emaciation  extreme ;  hair  gray  ;  chest  hairy  ;  hypostasis 
over  back ;  upon  section  the  abdominal  walls  were  found  to  be  thin ;  the  pau- 
niculus  very  scant  and  the  muscles  pale.  The  liver  extended  from  1  inch  in  the 
anterior  axillary  line  to  2^  inches  in  the  parasternal  line  below  the  right  costal 
margin.  The  abdomen  was  comparatively  dry.  The  sternum  was  removed  witli 
ease,  the  costal  cartilages  being  easily  cut.  Upon  opening  the  pericardial 
sac,  the  visceral  and  parietal  pericardia  were  found  adherent  over  their 
entire  extent  by  adhesions  which  were  torn  witli  comparative  ease.  The  visceral 
pericardium  was  found  much  tliickeued,  the  heart  muscle  pale,  the  right  ven- 
tricle filled  with  mixed  clots,  the  left  ventricle  filled  with  currant-jelly  clots. 
The  ascending  limb  of  the  arch  of  the  aorta  was  enlarged  and  bulged  on  its 
convex  side.  Its  entire  inner  surface  was  covered  with  liard,  glistening,  brittle, 
bony  plates,  which  extended  as  far  as  the  end  of  the  descending  limb  of  the  arch. 
All  the  valves  were  apparently  normal.  Both  lungs  were  adherent  to  the 
thoracic  wall  over  their  entire  surface.  The  left  lung  contained  a  cavity  the 
size  of  a  small  apple  in  the  apex.  Elsewhere  it  was  consolidated  by  closely 
crowded  tubercles  and  infiltrated  areas,  except  at  the  base,  where  there  was  a 
small  amount  of  air-containing  lung.  The  right  lung  contained  a  cavity  the  size 
of  a  large  apple  in  the  apex.    Elsewhere  it  was  consolidated,  with  but  traces  of 

8629—04 34 


530  PUBLIC    HEALTH    AND    MARINP>HOSPITAL    SERVICE. 

air-contaiuing  lung  here  and  there.  Spleen  was  pale  and  had  an  increase  of 
connective  tissue.  Kidneys  were  pale  and  showed  an  increase  of  connective 
tissue.  Liver  showed  passive  congestion.  The  small  intestines  were  contracted 
and  of  small  caliber.  There  was  an  old  fistula  in  ano.  Pancreas,  lymph  glands, 
urinary  bladder,  i)rostate,  seminal  vesicles,  penis,  and  testicles  were  normal. 
The  brain  was  not  removed. 

J.  W.  T. 

XIX. 

T.  M. ;  colored;  age,  40;  native  of  Ohio;  unmarried;  admitted  to  United 
States  Marine  Hospital,  Cairo,  111.,  August  29,  1003;   died  September  5,  1903. 

Family  history. — Unknown  to  patient. 

Previous  history. — Has  been  sailing  on  vessels  of  the  United  States  for  about 
twenty-three  years,  usually  employed  as  cabin  boy.  Health  excellent  until 
three  years  ago,  when  he  had  an  attack  of  smallpox,  from  which,  apparently,  he 
made  a  good  recovery.  About  a  year  later,  however,  he  began  to  complain  of  an 
occasional  hacking  cough,  which  gradually  became  more  persistent.  At  no 
time  has  he  suffered  from  pain  or  much  discomfort,  but  his  general  health 
gradually  became  impaired.  Six  months  ago  had  two  hemorrhages  within  a 
short  Interval,  both  occurring  during  a  coughing  spell.  Two  weeks  ago  haemop- 
tysis again  occurred  and  he  applied  at  this  office  for  out-door  treatment.  He 
was  then  advised  to  remain  in  hospital  until  the  necessary  steps  were  taken  to 
transfer  him  to  the  marine  .hospital  sanatorium,  but  he  stated  that  it  was 
imposible  for  him  to  do  so  at  that  time. 

Present  history. — Patient  somewhat  emaciated ;  short  in  stature  and  weighs 
120  pounds,  having  lost  15  pounds  in  the  last  six  months;  complains  of  little 
or  no  pain ;  has  a  short,  hacking,  persistent  cough,  accompanied  by  abundant 
expectoration ;   sputum  tenacious  and  blood  tinged  and  full  of  tubercle  bacilli. 

Physical  examination. — On  inspection  diminished  expansion  of  chest  is 
noted,  especially  marked  on  left  side,  and  accompanied  with  some  flattening. 
Percussion  reveals  dullness  over  lower  two-thirds  of  left  lung.  Over  this  area 
there  is  also  prolongation  of  the  expiratory  murmur  and  numerous  small  sibi- 
lant and  large  moist  rales.  Signs  of  cavity  are  elicited  in  the  mid-axillary  line 
on  thfe  left  side  on  a  level  with  the  fifth  rib.  The  right  and  left  apices  also  show 
signs  of  extensive  infiltration. 

While  under  treatment  the  symptoms  above  mentioned  persisted.  The  sputum 
was  constantly  tinged  with  blood  and  severe  hemorrhages  occurred  on  three 
occasions.  The  last  one  was  very  profuse  and  proved  fatal  at  7  a.  m.,  Septem- 
ber 5. 

Necropsy  (3i  hours  after  death). — The  cadaver,  that  of  a  small-sized  spare 
man,  somewhat  emaciated.  There  is  some  oedema  of  legs ;  pupils  dilated ;  scar 
iu  left  inguinal  region ;  nearly  all  teeth  decayed ;  flattening  of  left  thoracic 
region  ;  rigor  mortis  not  perceptible  except  in  muscles  of  back  of  neck.  On 
incision  adipose  tissue  is  seen  to  be  scant ;  all  the  tissues  are  dry  and  bloodless ; 
lungs  pale  gray  and  emphysematous;  old  pleural  adhesions  on  both  sides, 
especially  about  base  and  apex ;  a  number  of  old  cicatrices  seen  on  lung  sur- 
face ;  right  lung  weighs  495  grams ;  large  cavity  in  apex,  partly  cicatrized ; 
numerous  tul)ercular  nodules  present.  Left  lung  weighs  528  grams ;  it  is  com- 
pletely infiltrated  with  tubercular  products ;  in  the  lower  lobe  there  is  a  large 
cavity  filled  with  clotted  blood,  evidently  the  seat  of  the  fatal  hemorrhage. 
Pericardium  normal.  The  sac  contains  about  15  c.  c.  of  straw-colored  serous 
fluid.  Heart :  Weight,  232  grams  ;  walls  fatty,  pale,  and  bloodless  ;  a  few  small 
currant-jelly  clots  in  ventricles ;  tricuspid  valve  slightly  thickened.  All  other 
valves  normal.  Liver :  Weight,  1,518  grams ;  pale,  and  showing  signs  of  fatty 
degeneration ;  capsule  strips  off  easily ;  gall  bladder  normal  and  containing 
about  30  c.  c.  of  rather  dark-colored  bile.  Spleen:  Weight,  231  gi'ams ;  very 
friable,  breaking  up  on  removal.  Kidneys  normal ;  right  weighs  181  grams,  the 
left  188  grams.  Stomach  and  intestines  normal ;  bladder  normal  and  containing 
about  100  c.  c.  of  urine.     Brain  normal,  weight  1,452  grams. 

G.   M.   G. 
XX. 

R.  D. ;  age,  57 ;  nativity,  Ireland ;  color,  white ;  admitted  to  the  United 
States  Marine  Hospital,  San  Francisco,  Cal.,  April  4,  1904;   died  May  2,  3904. 

History. — Family  history  negative ;  personal  history  of  pneumonia  in  1872, 
gonorrhoea  twenty  years  ago,  and  cough  for  fifteen  years.     One  week  ago  was 


PTTBLIO    HEALTH    AND    MARINE-HOSPITAL   SERVICE.  531 

taken  sick  witli  cliills  and  fevor.  Also  had  pain  in  stomach,  was  constipated, 
and  was  dolirions  some  of  the  time.  Had  consideral)le  cough  and  ex|>ectora- 
lion.  Examination  showed  fever,  coated  tongue,  empliyseniatons  lireatliing. 
(ItisUy  Ime  of  face,  rougliened  breathing  over  whole  riglit  lung  with  moist  crack- 
ling rales  in  1)ms(\  Tubercle  bacilli  were  found  in  the  sputum,  and  a  small 
amomit  of  alhuniin  in  the  urine.  Heart  action  rai)id  and  faint,  and  first  sound 
accentuated.  Tain  in  median  line  of  thorax.  Condition  became  rapidly  worse. 
Had  a  severe  pulmonary  hemorrhage  a  few  days  before  his  death.  During  the 
last  two  days  no  sputum  was  raised,  and  patient  was  unconscious.  Death 
occurred  May  2,  1904. 

Necropsy  (18  hours  after  death). — Body  emaciated;  rigor  mortis  and  post- 
mortem lividity  present;  bruise  over  the  left  temple.  Body  opened  by  long 
median  incision.  The  calvarium  removed  and  the  brain  taken  out  and  found  to 
weigh  ],.")40  grams.  The  condition  of  the  skull  car),  the  brain  case,  the  sinuses 
and  vessels,  and  the  brain  and  its  membranes  noted  and  all  found  to  be  normal. 
Thorax  :  The  costal  cartilages  are  ossified.  The  anterior  mediastinum  contains 
several  enlarged  lymph  glands.  The  pericardium  is  distended  with  fluid  which 
on  section  is  found  to  consist  of  thick,  yellowish-green  pus.  The  pus  is  circum- 
scribed anteriorly.  The  pericardium  is  firmly  adherent  to  the  heart  posteri- 
orly, the  cavity  there  being  obliterated.  The  portion  covering  in  the  pus  collec- 
tion shows  great  thickening  of  its  layers.  The  heart  removed  with  the 
pericardium,  it  being  impossible  to  separate  them,  and  both  together  weigh 
904  grams.  The  anterior  surface  of  the  heart  has  the  "  bread-and-butter " 
appearance,  while  the  posterior  surface  is  inseparable  from  the  pericardium. 
The  myocardium  of  the  ventricles  is  increased,  the  thickness  of  the  left  being 
3  cm.  and  that  of  the  right  2  cm.  Section  gives  the  usual  resistance  and  a 
light-brown  color.  The  tricuspid  valve  is  normal.  The  mitral  valve  is  thick- 
ened and  calcareous  at  its  edges.  The  aortic  valves  are  competent  but  show 
yellowish  plaques.  The  pulmonary  valve  is  normal.  The  right  lung  is  so 
strongly  bound  down  that  it  is  impossible  to  remove  it  except  in  pieces.  A  sec- 
tion through  it  is  very  bloody  and  frothy  in  the  lower  lobe,  and  encounters 
areas  of  hardened,  yellowish,  and  caseous  masses  in  the  upper  lobe  and  apex. 
The  left  lung  weighs  623  grams.  The  surface  of  the  lower  lobe  is  dark  red,  and 
the  lobe  shows  diminished  crepitation  ;  on  section,  it  is  bloody  and  frothy.  The 
upper  lobe  is  in  fairly  good  condition,  though  section  reveals  a  cavity  of  moder- 
ate size  containing  caseous  material.  The  right  pleural  cavity  is  obliterated; 
the  left  is  normal  except  where  the  lung  and  pericardium  are  adherent.  The 
thoracic  aorta  and  the  arch  show  many  hardened,  calcareous  areas,  some  of 
which  are  ulcerated,  while  a  few  present  vegetations.  The  arch  is  especially 
affected,  the  first  portion  being  considerably  dilated  and  aneurismal  in  character. 
The  nerve  trunks  appear  normal.  The  diaphragm  on  the  right  side  extends  to 
the  upper  border  of  the  seventh  rib ;  on  the  left  side  to  the  lower  border  of  the 
same.  Abdomen  :  The  layers  of  the  peritoneum  appear  smooth  and  shining. 
The  spleen  weighs  177  grams  and  is  enlarged.  The  external  surface  is  normal. 
Section  shows  prominence  of  the  trabecula>.  The  right  kidney  weighs  177 
grams,  surface  pale,  fibrous  capsule  strips  readily.  Section  gives  diminished 
resistance,  pale  color,  and  prominence  of  pyrandds.  The  left  kidney  weighs  183 
grams  and  is  in  other  respects  similar  to  the  right.  The  suprarenal  capsules, 
urinary  bladder,  organs  of  generation,  and  rectum  are  normal.  The  duodenum 
is  bile-stained  and  shows  areas  of  slight  congestion.  The  stomach  contains  a 
small  amount  of  liquid  material,  the  mucous  membrane  is  ana>nnc,  and  there  are 
congested  areas  present.  The  gall  ducts  are  patent  and  the  gall  bladder  is 
normal.  The  liver  weighs  1,620  grams ;  the  surface  is  dark  in  color,  smooth,  and 
the  lower  portion  is  bile-stained.  Section  gives  diminished  resistance,  a  pale 
color,  areas  of  fatty  change,  darkened  lobular  centers,  and  is  greasy  to  the 
touch.  The  pancreas  weighs  132  grams  and  is  normal,  as  are  also  the  solar 
plexus  and  mesentery.  The  small  intestines  show  signs  of  subacute  inflamma- 
tion. The  large  intestines  and  vermiform  appendix  are  normal.  The  abdominal 
aorta  resembles  the  thoracic  aorta  in  pathological  conditions. 

Anatomical  diagnosis. — Ossification  of  costal  cartilages ;  enlarged  medias- 
tinal lymph  glands ;  purulent  pericai'ditis  with  effusion ;  cardiac  hypertrophy  ; 
arteriosclerosis;  chronic  pleuritis  and  pulmonary  tuberculosis;  incipient  aortic 
aneurism ;   renal  and  hepatic  fatty  degeneration. 

C.  R. 

W.  G.  S. 


532  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SEKVICE. 

XXI. 

J.  H. ;  male  ;  color,  white ;  age,  27  years  ;  nativity,  Massachusetts  ;  arrived  at 
United  States  Marine  Hospital  Sanitorium,  Fort  Stanton,  N.  Mex.,  July  30,  1903, 
with  typical  signs  and  symptoms  of  tuberculosis  of  the  lungs.  Sputum  contained 
typical  signs  and  symptoms  of  tul)erculosis  of  the  lungs.  Sputum  contained 
tubercle  bacilli  September  30,  1003.  His  urine  showed  a  specific  gravity  of 
1.032,  much  albumen,  compound  hyaline,  granular  and  leucocyte  casts,  as  well  as 
free  leucocytes.    Died  October  7,  1903,  at  4.45  a.  m. 

Necropsy  (10  hours  after  death). — Medium  build;  emaciated;  skin  dry  and 
inelastic;  hypostasis  over  back  of  trunk;  skin  and  face  yellow;  rigor  mortis 
present ;  body  heat  absent ;  ankles  and  legs  pit  slightly  on  pressure  ;  panniculus 
and  musculature  scant ;  omentum  scant  in  fat  and  blood  contents ;  abdominal 
contents  pale  and  anjemic.  Abdominal  cavity  contained  700  c.  c.  of  amber-colored 
fluid.  Liver  comes  to  costal  margin  in  right  nipple  line.  Mesenteric  lymph 
glands  enlarged.  Anterior,  middle,  and  posterior  mediastinal  lymph  glands  all 
enlarged.  Larynx  :  Epiglottis  ulcerated  away  ;  ventriculse  Morgagni  also  ulcer- 
ated ;  vocal  cords  uninvolved ;  stump  of  epiglottis  covered  with  small  pin-head 
granular  nodules  of  a  yellowish  white  color  and  firm  consistency.  In  larynx 
below  epiglottis  was  a  thick,  tough,  white,  Y-shaped  scar.  Left  lung :  Adhei'ent 
to  thoracic  wall  from  apex  to  base ;  weight,  915  grams  ;  several  cavities  at  apex 
ranging  in  size  from  a  pea  to  a  walnut ;  lung  where  not  occupied  by  cavities  was 
thickly  studded  with  large  and  small  tubercles.  Right  lung:  Adherent  to  tho- 
racic wall  at  apex  and  base ;  weight,  1,125  grams ;  similar  in  all  other  respects 
to  left.  Pericardial  sac  contains  15  c.  c.  of  serous  fluid.  Heart  weight,  240 
grams ;  both  ventricles  contain  white  clots ;  all  valves  apparently  normal. 
Liver :  Weight,  1,540  grams  ;  lobules  stand  out  distinctly,  giving  slightly  nutmeg 
appearance;  gall  bladder  filled  with  bile.  Spleen:  ^Yeight,  270  grams  ;  friable; 
connective  tissue  increased ;  follicles  stand  out  like  kernels  of  boiled  sago. 
Right  kidney :  Weight,  200  grams ;  fibrous  capsule  strips  easily  ;  cortex  pale ; 
glomeruli  visible  as  pin-point  dots.  Left  kidney:  Weight,  200  grams;  fibrous 
capsule  adherent  at  one  or  two  points ;  similar  in  other  respects  to  right.  Adre- 
nals, pancreas,  and  stomach  apparently  normal.  Intestines  contain  ulcers  with 
raised  undermined  edges  varying  in  size  from  a  pin  head  to  a  half  dollar  and 
extending  from  upper  part  of  jejunum  to  ileo-cfecal  valve.  The  ca?cum  is  one 
mass  of  ulcerations.  The  colon  contains  similar  ulcers  fi'om  csecum  to  sigmoid 
flexure.  Urinary  bladder,  small  and  contracted  ;  mucous  membrane  pale ;  con- 
tains small  amount  of  turbid  urine.  Prostate,  testes,  and  penis  apparently 
normal. 

Microscopical  examination. — Spleen  showed  a  passive  congestion.  The  blood 
spaces  were  filled  with  blood ;  the  connective  tissue  was  much  increased ;  the 
follicles  had  almost  entirely  undergone  amyloid  degeneration ;  the  follicles  ap- 
peared as  masses  of  amyloid  with  an  artery  in  the  center  and  a  few  stained  nuclei 
scattered  throughout.  A  few  miliary  tubercles  were  found  containing  giant  and 
epithelioid  cells.  Liver  showed  some  increase  in  Glisson's  capsule;  the  lobules 
were  smaller  than  normal ;  the  columns  of  liver  cells  were  atrophic ;  the  portal 
and  intralobular  veins  were  distended  with  blood ;  areas  of  amyloid  were  found 
in  the  central  and  outer  zones  of  the  lobules ;  many  small  miliary  tubercles  con- 
taining giant  and  e[)ithelioid  cells  were  found  scattered  throughout.  Kidney 
showed  perceptible  general  increase  of  connective  tissue,  considerable  cloudy 
swelling  in  the  convoluted  tubes,  a  considerable  amyloid  deposit  in  the  glomeruli, 
and  congestion  of  both  veins  and  arteries.  Intestine  contained  ulcers  with 
raised  undermined  margins.  In  places  the  ulcers  had  eroded  down  through  the 
muscular  coat  to  the  serosa,  which  was  thickened.  Beneath  the  ulcers  were 
many  small  abscesses,  much  small  cell  infiltration,  some  necrotic  areas,  and  an 
occasional  giant  cell. 

Pathological  diagnosis. — Chronic  pulmonary  tuberculosis ;  chronic  adhesive 
tuberculous  pleuritis  ;  chronic  tuberculous  laryngitis  ;  beginning  atrophic  cirrho- 
sis of  liver  ;  amyloid  degeneration,  miliary  tuberculosis,  and  passive  congestion  of 
liver;  amyloid  degeneration,  chronic  passive  congestion  and  miliary  tuberculosis 
of  spleen  ;  amyloid  degeneration,  subacute  parenchymatous  nephritis,  and  chronic 
congestion  of  kidney ;   chronic  tuberculous  entero-colitis. 

J.  W.  T. 
P.  M.  C. 


PUBLIC    HEALTH    AND    MARTNE-HORPITAL    SERVICE.  583 

XX]]. 

J.  C. ;  ase.  .12;  nativity.  New  York;  adinittod  to  the  T'nitod  States  Marine 
Hospital  Sanatorium,  Fort  Stanton,  N.  Mex.,  October  (>,  1000;  died  December 
9.  1!KX). 

PRE^^ous  iiiSTOKY  (cx>ndensed  from  clinical  notes  of  medical  officer  in  com- 
m.and  at  New  York.  N.  Y.). — Admitted  to  tlie  TTnited  States  Marine  Hospital, 
New  York.  N.  Y.,  May  14,  lOOO. 

Family  histouy. — Nejiative. 

Pkrsonal  history. — Cholera  morbus  and  KonnorlKca  six  years  ago;  chancre 
last  fall  ;  has  secondary  rash  now.  Present  sickness  begaii  in  .Tanuary  with 
coush  which  steadily  gi-ew  worse,  along  with  exj)ectoration.  Lost  '.'>()  pounds 
in  last  year.  Night  sweats  for  past  week.  Diarrhcea  occasionally.  Pain  in 
low(>r  j)art  of  chest  occasionally.  Examination  revealed  a  flat  chest,  and 
depressed  supra  and  infra-clavicular  spaces.  Trunk  exhil)its  disseminated 
papular  syphilides.  Fremitus  marked  on  right  side  posteriorly.  Apices  dull. 
Proncho-vesicular  breathing  over  left  apex,  with  whispered  voice  sounds  and 
mucous  rales.  Heart  negative.  Sputum  contains  tu!)ercle  bacilli.  Syphilitic 
treatment  and  creosote  given.  Slight  improvement  re.sulted.  One  brief  febrile 
attack  occurred,  and  slight  haemoptysis  was  noted  occasionally. 

Condition  as  noted  on  arrival  at  Fort  Stanton  was  as  follows :  Emaciation 
and  weakness;  typical  chest,  nails,  and  gums.  Vocal  fremitus  greater  over 
right  chest;  cervical  and  post-occipital  glands  enlarged.  Entire  left  lung 
slightly  dull;  marked  dullness  in  left  base.  Left  lung:  Numerous  crackling 
rales  throughout.  Right  lung :  Same  in  upper  lobes.  Heart  apparently  normal. 
Urinalysis  showed  Indican  and  strong  diazo  reaction.  Sputum  contained  many 
typical  tubercle  bacilli.  This  was  a  very  serious  case  on  arrival  here,  and  his 
condition  grew  steadily  worse,  death  occurring  on  December  9,  1000. 

Nkcropsy  (7  hours  after  death). — Emaciation;  rigor  mortis  well  marked. 
Calvarium  not  removed.  Thorax  :  Anterior  mediastinum  normal.  Heart  and 
pericardium  normal.  Left  lung  had  large  cavity  in  apex ;  right  lung  several 
small  cavities  in  apex.  Both  had  scattered  tubercles  throughout ;  consolidation  in 
apices  surrounding  cavities,  especially  left.  Layers  of  pleune  adherent  at  apices, 
so  much  so  that  when  left  lung  was  removed  the  large  cavity  in  apex  was  torn 
open.  The  great  vessels,  nerve  trunks,  and  diaphragm  were  normal.  Abdomen : 
Omentum  and  spleen  normal.  Kidneys  enlarged  and  congested ;  capsules  not 
adherent.  Supra-renal  capsules  enlarged.  Urinary  bladder,  organs  of  genera- 
tion, rectum,  duodenum,  stomach,  gall  ducts,  liver,  and  pancreas  normal. 
Mesentery  had  a  few  tuberculous  glands.  Small  intestines,  large  intestines, 
and  the  great  vessels  normal.  Vermiform  appendix  very  long,  extending  to 
mesentery  beneath  gall  bladder,  and  attached  thereto. 

Microscopical  examination  :  Stained  sections  of  kidneys  and  supra-renal 
capsules  demonstrated  many  tubercle  bacilli  in  the  former,  and  a  few  in  the 
latter. 


XXIII. 


C.  R. 
J.  O.  C. 


P.  T. ;  age,  27 ;  nativity.  New  York ;  admitted  to  United  States  Marine  Hospi- 
tal Sanatorium,  Fort  Stanton,  N.  Mex.,  December  l(j,  1899;  died  December  8, 
1900. 

Previous  history  (condensed  from  clinical  notes  of  medical  officer  in  com- 
mand at  Baltimore,  Md.)  :  Admitted  to  United  States  Marine  Hospital.  Nor- 
folk, Va.,  November  11,  1899. 

Family"  history. — Negative. 

Personal  history. — Acute  bronchitis,  in  March,  1898,  from  which  present 
sickness  dated ;  much  cough  and  expectoration  ever  since ;  chagres  fever  in 
May,  1898;  transferred  to  Marine  Hospital,  at  Baltimore,  Md.,  November,  15, 
1899.  Physical  examination  there  showed  emaciation,  prominent  clavicles  and 
scapuliE  and  alar  chest ;  dullness  over  both  lungs,  most  marked  in  supra  and 
infra  clavicular  and  scapular  regions ;  circumscribed  tympanic  area  in  right 
mammary  region ;  bronchial  breathing  all  over,  but  most  marked  in  dullest 
areas ;  cavernous  voice  over  cavity,  and  some  moist  rales ;  bronchophony  over 
dull  areas ;  cough,  worse  at  night,  with  profuse  expectoration ;  November  16, 
tubercle  bacilli  found  in  sputum.  While  in  this  hospital  the  patient  has  gained 
about  10  pounds  and  improved  generally. 


534  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

PLysieal  conditidii  ns  noted  on  arrival  at  Fort  Stanton  was  as  follows:  Infec- 
tion ;it  apices  and  small  foci  scattered  throughout  lungs.  Little  tissu(>  broken 
down.  Some  cough  and  expectoration;  appetite  fair.  Subsequently  his  con- 
dition underwent  improvement  to  a  certain  extent,  and  then  became  stationary 
for  a  considerable  time.  Then  retrogression  began,  slowly  but  surely.  Exam- 
ination April  21  showed  emaciation,  typical  chest  and  nails,  increased  vocal 
fremitus  superiorly,  enlargement  and  tenderness  of  liver,  dullness  in  apices  and 
left  base,  crackling  I'Ales  in  upper  ]>arts  of  lungs,  and  accentuation  of  pulmonary 
second  sound.  Many  tubercle  bacilli  demonstrated  in  the  sputum.  The  patient 
gradually  lost  ground  in  every  way.  The  liver  continued  to  enlarge,  giving 
great  distress.  Vomiting  became  very  severe  and  was  experienced  almost 
daily.  In  the  lungs  more  and  more  tissue  became  involved.  Emaciation 
became  extreme.  Was  bedridden  for  the  last  two  or  three  months,  and  con- 
stantly asked  for  morphine  to  relieve,  abdominal  ])ain.  Distilled  water  was 
administered  hypodermatically  when  pain  was  severe,  the  patient  being  told  that 
it  was  morphine.  Relief  from  pain  always  resulted.  Death  occurred  early  in 
the  morning  of  December  8,  1900. 

Necropsy  (9  hours  after  death). — Emaciation;  partial  rigor  mortis.  Cal- 
varium  not  removed.  Thorax :  Anterior  mediastinum  contained  enlarged 
glands.  Heart  was  normal  in  size,  but  mitral  valve  slightly  incompetent  to 
water  test.  I'ericardimn  contained  about  50  c.  c.  of  serous  fluid.  Left  lung 
almost  entirely  consolidated.  Right  same  in  upper  lobe,  with  many  separate 
tubercles  in  lower  lobe,  which  contained  all  functional  lung  tissue  remaining. 
Layers  of  left  pleura  adherent  nearly  all  over.  Right  same  superiorly.  Great 
vessels  and  nerve  trunks  normal.  Diaphragm  adherent  to  left  lung.  Abdomen : 
Omentum  normal.  Spleen  enlarged.  Kidney^  had  adherent  capsules ;  were 
slightly  congested  and  showed  several  bands  of  connective  tissue  at  periphery. 
Supra-renals  enlarged  and  contained  many  minute  tubercles.  Urinary  bladder 
distended  with  urine.  Organs  of  generation  normal.  Rectum  and  duodenum 
in  a  normal  condition.  Stomach  showed  great  anseniia  of  its  mucous  membrane. 
Gall  ducts  normal ;  gall  bladder  distended  with  bile.  Liver  much  enlarged, 
weighing  ten  pounds ;  a  passive  congestion.  Pancreas  enlarged.  Mesentery 
contained  large  numbers  of  enlarged  tuberculous  glands.  Small  intestines, 
large  intestines,  and  the  great  vessels  normal. 

Microscopical  examination. — Tubercle  bacilli  demonstrated  in  tissue  of 
supra-renal  capsules. 


C.  R. 
J.  O.  C. 


XXIV. 


J.  H. ;  age,  2.5 ;  nativity,  Tennessee ;  color,  black ;  was  admitted  to  United 
States  Marine  Hospital  Sanatorium.  Fort  Stanton.  N.  Mex.,  February  ^^,  1903.  with 
signs  and  symptoms  of  far-advanced  tuberculosis  of  the  lungs.  Died  October 
27,  1903. 

History. — During  the  night  of  April  16  was  seized  with  sudden  pain  in  right 
side,  dyspnoea,  and  general  distress.  Upon  examination  a  right  total  pneumo- 
thorax was  found.  Later  fluid  collected  in  the  cavity  thus  formed.  It  was 
aspirated  repeatedly  at  intervals  of  about  two  weeks.  At  first  the  fluid  with- 
drawn was  sero-fibrinous,  then  at  later  aspirations  it  was  sero-purulent,  and 
later  on  purulent.  The  collection  of  fluid  added  to  the  patient's  distress,  and 
its  removal  gave  marked  relief.  In  May  he  began  to  have  attacks  of  hemoptysis, 
which  were  repeated  at  intervals  for  the  next  few  n)onths. 

Necropsy  (6  hours  after  death). — Body  heat,  present;  rigor  mortis,  absent; 
panniculus,  scant ;  musculature,  fair ;  hypostasis  beginning  over  back  ;  omentum, 
scant  in  fat ;  peritoneum  glistening  and  moist.  Liver  extended  two  finger 
breadths  below  right  costal  margin  in  nipple  line.  Small  amount  of  serous 
fluid  in  abdomen.  Right  chest  more  prominent  than  left.  Right  costal  margin 
protrudes.  Right  intercostal  spaces  less  distinct  than  those  on  the  left.  Right 
pleural  cavity  was  distended  and  partly  filled  with  a  foul-smelling  pus.  Except 
at  the  apex  the  right  lung  was  collapsed  against  the  spinal  column  and  carnified. 
At  apex  it  was  adherent  to  the  thoracic  wall  and  contained  a  cavity  the  size  of 
a  large  walnut.  The  lung  contained  many  tubercles  and  consolidated  nodules  and 
some  small  cavities.  Left  lung  was  adherent  to  thoracic  wall  from  apex  to  base ; 
weight,  570  grams ;  contained  two  small  cavities  in  lower  part  of  upper  lobe 
and  a  few  tubercles  scattered  throughout  the  lung.  For  the  most  part  the  lung 
was  air  containing.  Pericardial  sac  contained  30  c.  c.  of  a  clear  serous  fluid. 
Pericardium  was  smooth  and  apparently  normal.     Heart  was  much  larger  than 


PUBLIC    HEALTH    AND    MARINE-HOSPIT  \L    SERVICE.  535 

patient's  ripht  fist.  Tho  vontriolos  wore  dilated  and  tlio  imisclo  atropliied.  Left 
ventricle  was  filled  with  a  lar^e  white  clot.  Valves  were  apparently  normal. 
Wei;;lit  of  heart,  'AW  j^rauis.  Liver:  Weisjjht,  L-lliO  grains;  (Jlisson's  capsule 
thicla'iied ;  liver  couj^ested ;  lobules  made  out  with  some  difiiculty.  Spleen: 
Connective  tissue  increased;  follicles  few  and  indistinct;  weij^ht,  800  j^rams. 
Left  kidney:  Weifjht.  100  fj;rams  ;  fibrous  capside  stripped  with  difiiculty;  small 
yellowish-white  nodule  in  medulla  ;  pyramids  pale.  Kifjjht  kidney  :  Weight,  150 
grams ;  similar  to  left.  I'ancreas  and  adrenals  apparently  normal.  Urinary 
bladder  filled  with  clear  amber  urine;  walls  smooth  and  ap])arently  normal. 
Testes  apparently  normal.     Aorta  normal.     Stomach  and  intestines  normal. 

MiCROScopicAi.  EXAMINATION. — Liver :  (Jlisson's  capsule  considerably  in- 
creased: portal  vein  much  congested:  intralobular  veins  somewhat  congested; 
some  small  cell  infiltration;  .a  few  miliary  tubercles,  with  giant  and  epithelioid 
cells  scattered  throughout.  Spleen:  Connective  tissue  nuich  increased;  blood 
vessels  and  spaces  congested  ;  follicles  atrophic ;  miliary  tubercles,  with  epithe- 
lioid and  giant  cells  scattered  throughout;  arteries  sclerotic.  Kidney:  Moder- 
ate congestion;  some  cloudy  swelling  in  convoluted  tubules;  increase  of  con- 
nective tissue  between  tubules  ;  miliary  tubercles  of  large  size  scattered  through- 
out cortex  and  medulla. 

Pathological  diagnosis.— Right  total  pyo-pneumothorax ;  pulmonary  tuber- 
culosis; chronic  adhesive  tuberculous  pleuritis  ;  dilatation  of  the  heart;  chronic 
congestion,  cirrhosis  and  miliary  tuberculosis  of  liver;  chronic  congestion, 
arterlo  sclerosis  and  miliary  tuberculosis  of  spleen;  miliary  tuberculosis  of 
kidneys. 

J.  W.  T. 

P.  M.  C. 
XXV. 

G.  S. ;  age,  28 ;  nativity,  Sweden ;  color,  white ;  clinical  diagnosis,  tubercu- 
losis of  the  lungs;  complications,  tuberculous  laryngitis;  admitted  to  United 
States  Marine  Hospital  Sanatorium,  Fort  Stanton,  N.  Mex.,  June  24,  1903,  com- 
plaining of  occasional  fever,  cough,  dyspnoea,  expectoration,  and  Loss  of  weight ; 
mother  died  of  tuberculosis ;  had  malaria  five  years  ago,  and  pneumonia  three 
and  one-half  years  ago ;  present  illness  began  fourteen  months  before  admission ; 
after  arrival  he  declined  steadily,  his  voice  became  husky,  and  later  he  was 
unable  to  speak  above  a  whisper ;  died  October  6,  1903,  at  G.45  a.  m. 

Necropsy  (30  hours  after  death). — Emaciation  extreme,  rigor  mortis  present, 
body  lieat  absent,  hypostasis  over  back  of  trunk  and  legs,  larynx  abnormally 
large  and  prominent,  skin  dry  and  inelastic,  panniculus  and  musculature  scant. 
Contents  of  abdomen  moist  and  glistening.  Omentum  scant  in  fat,  shows 
passive  congestion.  Liver  extends  three  finger  breadths  below  right  costal 
margin  in  nipple  line.  Omentum  adherent  to  parietal  peritoneum  in  several 
places.  Costal  cartilages  soft ;  intercostal  spaces  wide,  ribs  narrow ;  internal 
mammary  veins  congested ;  anterior  mediastinum  otherwise  negative.  Peri- 
cardial sac  contained  about  10  c.  c.  straw-colored  fluid ;  both  pleural  cavities 
obliterated ;  visceral  and  parietal  pleurje  bound  throughout  entire  extent  by 
firm  adhesions.  Heart :  Weight,  200  grams ;  much  below  normal  in  size ;  one  or 
two  pin-head  sclerotic  patches  just  above  aortic  semilunar  valves.  Heart  other- 
wise normal.  Left  lung  contains  in  upper  lobe  two  cavities,  each  the  size  of  an 
apple.  The  cavities  are  traversed  by  thrombosed  blood  vessels  and  contain  much 
mucopurulent  fluid.  The  walls  consist  of  infiltrated  lung  tissue  and  vary  in 
thickness  from  1  to  30  mm.  The  cavities  fill  practically  the  entire  upper  lobe. 
Lower  lobe  contains  tubercles  scattered  throughout  and  is  congested  and  oedema- 
tons.  Right  lung :  Upper  lobe  consists  of  one  large  cavity  similar  in  all  respects 
to  those  in  the  left.  Middle  lobe  contains  tubercles  scattered  throughout.  Lower 
lobe  contains  cavity  the  size  of  walnut  and  tubercles  scattered  throughout. 
Both  lower  lobes  congested.  Larynx  :  Epiglottis  ulcerated  over  both  anterior  and 
posterior  surfaces ;  is  bound  to  root  of  tongue  by  adhesions ;  is  contracted  and 
curled  outward;  tnie  and  false  cords  (vocal)  and  ventriculi  Morgagni  uleeratde. 
Liver :  Weight,  1 ,835  grams ;  slightly  larger  than  normal  for  size  of  patient ; 
consistency,  firm  ;  impression  of  ribs  show  on  anterior  surface ;  on  section  pale, 
and  lobules  distinct.  Gall  bladder  filled  with  bile.  Spleen :  Weight,  147 
grams ;  smaller  than  normal ;  follicles  exceedingly  prominent,  standing  out  like 
well-cooked  sago ;  connective  tissue,  increased ;  color  lighter  than  normal.  Kid- 
neys :  Right,  weight  110  grams  ;  cortex,  pale  ;  glomeruli  seen  with  difficulty  ;  con- 
sistency, softer  than  normal ;  fibrous  capsule  peels  with  ease.  Left,  weight  147 
grams,  larger  than  right ;  fibrous  capsule  adherent  at  one  or  two  points ;  similar 


536  PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 

in  other  respects  to  right  Suprarenals  apparently  normal.  Stomach  walls 
pale  and  atrophic.  Intestines :  Jejunum  congested  over  area  size  of  hand. 
Lower  jejunum,  ileum,  and  cjecum  contain  ulcers  varying  in  size  from  pin  head 
to  a  quarter,  with  raised  undermined  margins.  These  ulcers  extend  in  places 
through  to  the  serosa.  Pancreas  apparently  normal.  Urinary  bladder  filled 
with  turbid  yellow  urine,  walls  smooth,  thin,  and  pale.  Testes,  prostate,  and 
penis  apparently  normal. 

Microscopical  examination. — Liver  contains  miliary  tubercles  devoid  of 
blood  vessels  and  containing  giant  and  epitheloid  cells.  It  also  contains  a  mod- 
erate amount  of  amyloid  tissue  located  chiefly  in  the  middle  zone  of  the  lobule. 
The  columns  of  liver  cells  are  small  and  atrophic.  Fatty  droplets  are  seen 
throughout  the  lobules.  Spleen :  Follicles  are  enlarged  and  transformed  into 
amyloid  tissue.  A  few  miliary  tubercles  with  giaiit  and  epitheloid  cells  and  no 
blood  vessels  are  found. 

Pathological  diagnosis. — Tuberculous  laryngitis  ;  chronic  adhesive  pleuritis ; 
chronic  pulmonary  tuberculosis;  small  heart;  amyloid  liver;  fatty  degenera- 
tion of  liver;  miliary  tuberculosis  of  liver;  amyloid  spleen  ;  miliary  tuberculosis 
of  spleen;  chronic  adhesive  peritonitis;  chronic  enterocolitis  (tuberculous). 

J.W.  T. 


P.   M.   C. 


XXVL 


G.  A. ;  age,  21 ;  nativity,  California ;  color,  white ;  admitted  to  the  United 
States  Marine  Hospital,  San  Francisco,  Cal.,  January  16,  1903 ;  died  May  5, 
1904. 

HisTOKY. — Family  historj-  negative.  Previous  history  of  measles  when  a  boy 
and  typhoid  fever  three  years  ago.  Present  sicliuess  apparently  began  a  long 
time  ago,  with  vague  pains  in  right  side  of  abdomen,  along  with  gastro- 
intestinal disturbance  and  more  or  less  fever.  One  month  ago  began  to  have 
severe  attacks  of  pain  across  abdomen,  which  are  growing  more  and  more  severe. 
Unable  to  sleep  on  account  of  pain.  Sharp,  shooting  pains  on  urination.  Dull- 
ness and  tenderness  over  lower  i)art  of  abdomen.  No  leucocytosis  present. 
Urinalysis  negative.  Moderate,  irregular  fever.  A  large,  hardened  mass  has 
developed  in  the  left  side  of  the  abdomen  below  the  umbilicus.  January  29, 
laparotomy  performed  below  umbilicus  to  left  of  median  line.  A  large  amount 
of  foul-smelling  pus  evacuated  and  drainage  tubes  inserted.  Wound  dressed 
daily.  Great  impi'ovement  at  first,  followed  later  by  development  of  symptoms 
on  right  side.  March  17,  laparotomy  over  McBurny's  point.  Large  quantity 
of  foul  pus  evacuated.  Wound  dressed  daily.  Great  improvement,  followed 
again  by  recurrence  in  right  side.  xVpril  29,  lapai'otomy  performed  in  same 
situation.  A  large  pus  sac  opened  into  and  vermiform  appendix  I'emoved. 
After  transitory  improvement  patient  again  became  worse.  June  2,  operated  on 
again,  enlarging  old  wounds  and  exposing  several  cavities  filled  with  pus. 
Cavities  flushed  out  and  paclvcd.  Improvement  followed  by  relapse.  Pain  this 
time  in  the  right  hypochondrium.  July  3,  superficial  incision  made  in  abdomi- 
nal wall  evacuating  about  200  c.  c.  of  pus.  Improved  at  first,  then  pains  again. 
July  10,  operated  on  in  right  lumbar  region  and  about  100  c.  c.  of  pus  removed. 
Some  improvement.  July  30,  a  small,  superficial  pus  pocket  Incised  in  abdom- 
inal wall.  Later  all  sinuses  made  to  communicate.  Much  discharge  from  the 
lumbar  wound.  Considerable  improvement  in  the  general  condition.  Septem- 
ber 18,  contracted  acute  follicular  tonsilitis  which  lasted  until  September  25. 
Pain  complained  of  in  back  and  lower  part  of  right  chest,  though  some  general 
improvement  continues.  Temperature  runs  above  normal.  October  16,  began 
to  use  Steam's  antistreptolytic  serum.  Considerable  reaction,  followed  by 
improvement.  November  9,  an  abscess  opened  in  the  right  side  discharging  a 
quantity  of  pus.  November  10,  gas  bubbled  through  the  lumbar  sinus  having 
a  ftecal  odor,  followed  later  by  fipcal  matter.  General  condition  good,  very 
little  pain.  Had  to  stop  serum  treatment  as  reaction  always  left  patient  very 
weak.  During  January,  1904,  a  cough  developed,  with  watery  expectoration 
and  occasional  laryngeal  spasms.  February  3  lungs  showed  moist  rales,  mostly 
during  inspiration,  in  dependent  portions.  Expectoration  became  purulent  and 
more  abundant,  with  occasional  hemoptysis.  Tubercle  bacilli  could  not  be 
demonstrated  in  the  sputum.  Severe  night  sweats  and  septic  temperature. 
Diarrhoea  often  present  and  general  condition  growing  gradually  worse.  Pus 
burrows  under  the  skin  in  various  places  and  is  evacuated  wherever  found.  The 
fsecal  fistula  discharges  more  profusely,  both  pus  and  faeces.    April  29,  a  final 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  537 

surgical  operation  was  perionnotl  under  chloroform  anrestbesia.  The  main 
fistulous  tract  in  tlie  rij^ht  luiiihar  ^e^'ion  was  enlarged  toward  the  abdomen, 
and  the  anterlDi-  l)()nler  of  the  (luadratus  luniborum  muscle  exi)osed,  under 
which,  for  some  distance  posteriorly,  the  general  pus  cavity  was  found  to 
extend.  The  abdominal  nuiscles  were  divided  forward  until  the  fa'cal  fistula 
was  traced  to  its  origin  in  the  outer  surface  of  the  ascending  colon,  just  below 
the  hei)atie  flexure.  The  gut  was  very  strongly  adherent  to  the  neighboring 
structures.  The  pus  cavity  seemed  to  extend  between  the  liver  and  the  dia- 
phragm. The  gut  was  freed  for  a  short  distance  above  and  below  the  fistulous 
opening,  and  the  opening  was  found  to  measure  ai)out  2  cm.  in  the  long  axis  of 
the  bowel.  The  opening  was  first  closed  by  the  Ford  inversion  stitch,  employ- 
ing No.  2  silk,  and  including  only  the  mucous  and  subnuicous  coats.  Over  this 
was  sewed  a  continuous  catgut  suture,  completely  burying  the  Ford  suture. 
When  the  fistula  was  entirely  closed  another  large  collection  of  pus  was  then 
discovered  between  the  ascending  colon  and  the  right  pelvic  wall,  but  as  the 
patient's  condition  did  not  then  warrant  further  operative  measures  the  upper 
opening  was  merely  dilated  to  allow  drainage.  The  skin  wound  was  partially 
closed  with  silk  and  the  cavity  was  packed  with  gauze.  Several  fistulous  open- 
ings in  the  neighborhood  were  connected  by  incisions  and  packed.  The  opera- 
tion consumed  two  hours,  but  only  half  an  ounce  of  chloroform  was  used. 
Salines  and  stinmlants  were  given  when  Indicated.  Consciousness  was  rapidly 
regained  and  great  pain  complained  of.  Morphine  and  atropine  were  given. 
During  the  first  three  days  the  discharge  from  the  wound  was  sero-purulent, 
but  after  that  time  it  again  became  ftecal.  The  temperature  at  first  fell  to  nor- 
mal, then  became  subnormal.  There  was  profuse  expectoration,  i)urulent  and 
bloody  in  character.  On  the  fifth  day  he  began  to  weaken  rapidly,  and  there 
was  relief  from  pain.     Death  occurred  on  the  following  day  at  0.10  p.  m. 

Necropsy  (1G  hours  after  death). — Body  greatly  emaciated,  pupils  dilated, 
rigor  mortis  and  post-mortem  lividity  present.  There  is  a  large  incision 
extending  from  the  right  lumbar  region  forward  into  the  abdomen,  The 
stitches  are  still  in  the  forward  portion :  the  edges  of  the  back  part  are  open. 
Scars  of  seven  other  incisions  are  plainly  visible  in  the  right  lumbar  region 
and  over  the  lower  portion  of  the  abdomen.  There  is  practically  no  subcu- 
taneous fat.  The  lower  margin  of  the  ribs  on  the  left  side  projects  prominently. 
The  calvarium  not  removed,  the  relatives  having  made  a  request  to  that  effect. 
The  right  thigh  can  not  be  completely  extended,  owing  to  contraction  of  the 
sartorius  tendon.  Thorax  :  The  anterior  mediastinum  contains  several  enlarged 
lymph  glands.  The  lungs  do  not  meet  in  the  median  line.  The  right  pleural 
cavity  is  obliterated  and  the  right  lung  is  bound  strongly  to  the  thoracic  wall 
all  over,  including  the  diaphragm.  It  is  removed  with  difficulty  and  is  found 
to  weigh  800  grams.  The  lung  does  not  collapse,  is  only  slightly  crepitant,  and 
the  interlobular  fissures  are  nearly  obliterated  by  adhesions.  The  external  sur- 
face is  roughened  and  mottled.  At  the  base  is  a  small  abscess  cavity  which 
connects  with  the  diaphragm.  On  section  there  is  increased  resistance  and  the 
entire  lung  is  seen  to  be  infiltrated  with  hardened,  yellowish  masses,  some  of 
them  showing  caseation.  Between  these  areas  the  tissues  are  very  bloody  and 
frothy.  The  left  pleural  cavity  is  also  obliterated,  but  by  more  easily  separable 
adhesions.  The  left  lung  weighs  790  grams,  does  not  collapse,  crepitates  very 
little,  the  interlobular  fissure  is  obliterated,  and  on  section  is  seen  to  be  nearly 
similar  to  the  right  lung.  The  pericardium  contains  a  moderate  amount  of 
clear,  serous  fluid.  It  is  adherent  to  both  lungs  by  firm  bands.  The  heart 
weighs  280  grams,  is  pale  in  hue,  and  the  surface  is  smooth.  The  right  auricle 
and  ventricle  contain  chicken-fat  clots,  as  do  also  the  left  cavities,  all  clots 
being  separable.  The  aortic  and  pulmonary  valves  are  competent  to  the  water 
test,  and  the  tricuspid  and  mitral  valves  are  normal.  The  myocardium  is  very 
pale  in  color  and  cuts  with  normal  resistance.  The  wall  of  the  right  ventricle 
is  1.5  cm.  in  thickness ;  that  of  the  left  ventricle  is  2  cm.  There  are  yellowish 
areas  about  the  sinuses  of  Valsalva.  The  great  vessels  and  nerve  trunks  are 
normal.  The  diaphragm  on  the  right  side  extends  to  the  lower  border  of  the 
seventh  rib :  on  the  left  side  to  the  upper  border  of  the  seventh.  It  is  strongly 
adherent  to  the  bases  of  the  lungs  and  to  the  entire  posterior  surface  of  the 
liver.  On  the  right  side  there  is  an  opening  which  connects  the  right  lung 
and  the  liver.  Abdomen :  First  opened  by  an  incision  in  the  median  line,  then 
the  operation  wound  is  opened.  The  great  omentum  is  very  thin,  contains 
almost  no  fat,  and  is  adherent  to  the  abdominal  wall  in  places.  The  spleen 
is  enlarged,  soft  and  pale,  and  weighs  275  grams.  On  section  there  is  nor- 
mal  resistance,   pale  color,   firm   puli),   and  slight   increase  of   fibrous   tissue. 


538  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

TLe  loft  kidney  Aveighs  175  grams.  The  surface  is  smooth,  pale  in  color, 
and  shows  yellowish-white  areas.  The  fihrous  capsule  strips  easily.  Section 
seems  to  give  ahout  normal  resistance.  The  cut  surface  is  pale,  and  shows 
areas  of  fatty  and  amyloid  change ;  the  pyramids  are  rather  prominent.  The 
right  kidney  is  removed  with  difficulty.  Its  anterior  surface  forms  a  part 
of  wall  of  the  large  abscess  cavity.  It  weighs  only  130  grams,  and  the  general 
appearance,  except  anteriorly,  resembles  that  of  the  left  organ.  Section  gives 
normal  or  slightly  increased  resistance  and  very  pale  color.  The  cortical  mark- 
ings are  almost  obliterated  and  there  is  present  extensive  iunyloid  and  fatty 
change.  The  fibrous  capsule  is  adherent  on  the  anterior  surface,  and  there 
are  small  subcapsular  hemori'hages.  The  suprarenal  capsules  appear  normal. 
The  urinary  bladder  contains  a  small  amount  of  clear  urine.  The  organs  of 
generation  are  normal.  The  rectum  contains  a  small  amount  of  solid  fjiecal  mat- 
ter. The  duodenum  and  stomach  are  normal.  The  gall  ducts  are  patent,  and 
the  gall  bladder  contains  a  moderate  amount  of  fluid  bile.  The  liver  is  firmly 
bound  to  the  diaphragm  over  its  posterior  surface.  Its  anterior  border  is  adhe- 
rent to  the  costal  margin,  the  heptio  flexure  of  the  colon  and  the  peritoneum 
lining  the  anterior  abdominal  wall.  The  liver  is  very  difficult  to  remove.  It 
weighs  1,025  grams.  The  external  surface  is  roughened  where  adhesions  were 
present,  especially  over  the  quadrate  lobe.  On  the  outer  border  of  the  right 
lobe  there  are  several  yellowish-white  nodules  of  pea  size.  The  surface  of 
the  left  lobe  is  pale  and  smooth.  In  the  right  lobe  is  an  abscess  which  occupies 
the  greater  portion  of  the  lobe.  It  is  pyramidal  in  shape,  the  apex  communicat- 
ing through  the  diaphragm  with  the  base  of  the  right  lung,  while  the  base  arises 
from  the  general  pus  cavity  between  the  ascending  colon,  right  kidney,  liver, 
and  abdominal  wall.  The  contents  of  the  liver  abscess  consist  of  dark,  puru- 
lent, broken-down  liver  tissue.  The  line  of  demarcation  between  the  abscess 
wall  and  the  surrounding  hepatic  tissue  is  very  sharply  defined.  The  liver 
tissue  iH'oper  is  pale  and  shows  light-colored  areas.  On  section  there  is  dimin- 
ished resistance,  pallor,  friability,  and  patches  of  light  yellowish  color  which 
impart  a  greasy  feeling.  External  to  the  ascending  colon  there  occurs  a  large 
cavity,  measuring  10  cm.  in  length,  which  is  filled  with  greenish,  creamy  pus. 
The  pancreas  and  the  solar  plexus  appear  normal.  The  mesentery  contains 
several  enlarged  lymph  glands.  The  small  intestines  are  partially  bound  to  the 
pelvic  wall  in  the  right  inguinal  region  by  separable,  fibrinous  adhesions ; 
otherwise  they  are  normal.  The  vermiform  appendix  is  absent,  having  been 
removed  at  a  former  surgical  operation.  The  coecum,  ascending  colon,  and 
hepatic  flexure  are  very  strongly  attached  to  the  abdominal  wall.  An  irregular 
opening  in  the  outer  side  of  the  ascending  colon  communicates  with  the  abscess 
cavity  in  the  lumbar  and  right  hypochondriac  regions.  On  dissecting  out  this 
portion  of  the  bowel  it  is  seen  that  the  before-mentioned  opening  is  not  the 
fistulous  opening  that  was  sewed  up  during  the  surgical  operation  five  days 
before,  but  a  new  lesion  formed  since.  No  trace  can  be  found  of  the  external 
catgut  suture,  but  the  internal  Ford  inversion  stitch  is  present  and  still  holds 
in  apposition  the  edges  of  the  original  fistulous  opening.  The  aperture  now 
present  was  apparently  formed  later  by  tearing  of  the  tissue  immediately  in 
front  of  the  sutures,  owing  to  impaired  vitality,  peristalsis,  and  constant  pres- 
ence of  pus,  which  it  was  impossible  to  prevent.  Semisolid  fsecal  matter  Is 
present  in  all  the  large  intestines.     The  great  vessels  are  noi'mal. 

SuMMAEV. — Large  abdominal  surgical  wound  on  right  side;  scars  of  seven 
previous  incisions;  contracture  of  sartorius  tendon;  chronic,  bilateral,  oblitera- 
tive  pleuritis  complete;  pulmonary  tubercle,  bilateral;  perforation  of  dia- 
phragm ;  peritoneal  and  omental  adhesions ;  fatty  and  amyloid  degeneration  of 
kidneys ;  abscess  of  right  lobe  of  liver ;  fatty  degeneration  of  liver ;  adiiesions 
between  liver,  colon,  diaphragm,  abdominal  wall,  and  right  kidney ;  large  pus 
cavity  in  right  lumbar  and  hypochondriac  regions ;  pelvic  abscess ;  enlarged 
mesenteric  lymph  glands;  fibrinous  pelvic  adhesions  of  small  intestines;  absence 
of  the  vermiform  appendix  ;  perforation  of  ascending  colon ;  wound  in  ascend- 
ing colon  showing  a  Ford  stitch  holding  the  edges  in  apposition. 

C.   R. 

W.  G.  S. 
XXVIL 

H.  W. ;  age,  29 ;  nativity,  Ireland ;  admitted  to  the  United  States  Marine 
Hospital,  San  Francisco,  Cal.,  December  30,  1903,  died  January  12,  1904. 

History.— Transferred  from  the  United  States  Marine  Hospital  at  Port 
Townsend,  Wash.,  to  this  hospital  for  his  present  disease,  which  began  about 


PUBLIC    HEALTH    AND    MARTNE-HOSPITAL   SERVICE.  539 

seven  niontlis  ago.  Recoivod  in  liad  oondition.  Family  liislory  noRativo.  Per- 
sonal history  of  clironic  supiturativc^  otitis  nunlia,  four  attacks  of  gonorrhfea,  and 
for  last  three  years  has  had  freciuent  attacks  of  "  colds."  lias  had  constant  cough, 
expectoration,  fever,  loss  of  weight,  night  sweats,  and  dyspna-a  ever  since.  In 
addition  to  the  ahove  he  had  nuineroiis  hemorrhages,  some  of  whi<ii  were  (|uite 
severe.  lioth  lungs  gave  out  numiM-ous  moist,  crackling,  and  hulihling  rales  all 
over.  Very  weak,  and  suffers  from  dysjincea  and  sweats.  lie  reipiires  daily 
ahout  one-fourth  gr.iin  of  morpliia  hy]todermatically,  having  heen  addicted  to 
the  hahit  fi>r  several  months.  During  his  stay  at  this  hospital  he  gained 
strength  rapidly,  walking  about  with  ease  and  eating  very  well.  A  severe  hem- 
orrhage from  the  lungs,  amounting  to  about  'JUO  c.  e.,  occurred  on  January  12, 
19(»4,  from  which  he  died  at  12  m.  the  same  daj'. 

NECROP.SY  (2.'>  hours  after  death). — Body  much  emaciated;  rigor  mortis  and 
lK)st-mortem  lividity  marked  ;  height.  5  feet  4  inches.  Brain  :  Weight,  14G  grams. 
Upon  opening  the  dura  mater  the  pia  mater  is  seen  to  be  somewhat  distended 
with  a  clear  serous  fluid.  The  number  of  convolutions  are  exceedingly  small. 
The  tissues  are  api)arently  normal.  Thorax:  The  costal  cartilages  are  not  ossi- 
fied. No  fat  is  found  in  the  anterior  mediastinum.  The  right  lung  extends 
slightly  across  the  median  line.  The  left  lung  is  somewhat  retracted.  The 
right  lung  is  adherent  to  the  costal  cartilages  at  the  base,  and  also  firmly  adhe- 
rent to  the  diaphragm.  The  right  lung  weighs  1,250  grams.  The  entire  lung  has 
a  leathery  feel,  and  does  not  crepitate  except  over  a  small  amount  of  tissue  in 
middle  lobe.  On  section  all  lobes  found  to  be  full  of  tubercles  and  small  cavi- 
ties containing  pus  and  cheesy  masses.  The  external  appearance  of  the  lung 
is  mottled  bluish  red.  Tlie  left  lung  weighs  1.020  grams.  The  external  apijear- 
ance  and  the  tissue  on  section  present  the  same  appearance  as  the  right  lung. 
The  heart  weighs  .370  grams.  The  outer  surface  is  covered  with  a  very  small 
amount  of  fat.  The  pericardium  contains  a  large  amount  of  serous  fluid;  it  is 
strongly  adherent  to  the  left  lung.  The  muscular  tissue  is  pale  in  color.  Thick- 
ness of  the  wall  of  the  right  ventricle  is  i  cm.  The  right  auricle  contains  a 
large  nonadherent  mixed  clot.  The  pulmonary  artery  is  empty.  The  left  ven- 
tricle contains  a  large  currant-jelly  clot  extending  into  the  aorta.  Thickness  of 
the  wall  of  the  left  ventricle,  li  era.  Valves  of  right  side  of  heart  normal.  Mitral 
valves  show  thickened  atheromatous  patches  at  the  base  of  the  leaflets.  A  simi- 
lar condition  exists  at  the  base  of  the  aortic  valves.  The  aorta  shows  numerous 
small  atheromatous  patches  throughout  its  extent.  The  diaphragm  reaches  to 
the  fifth  rib  on  the  right  side  and  to  the  sixth  on  the  left ;  it  is  adherent  to  the 
base  of  the  left  lung  and  to  the  pericardium.  Abdomen  :  There  is  very  little  sub- 
cutaneous fat.  Upon  opening  the  abdominal  cavity  the  intestines  are  seen  to  be 
distended  with  gas.  The  omentum  and  mesentery  contain  practically  no  fat. 
The  spleen  weighs  1.50  grams  and  is  of  a  dark  brown  color.  On  section,  tissue 
found  to  cut  with  diminished  resistance,  the  pulp  being  soft.  The  liver  weighs 
1,500  grams.  The  surface  is  pale  in  appearance.  On  section,  tissue  found 
to  cut  with  diminished  resistance ;  appearance  pale  and  slightly  "  nutmeg." 
The  left  kidney  weighs  140  grams.  The  capsule  strips  easily.  On  section,  tis- 
sue cuts  with  slightly  increased  resistance,  cortex  swollen,  pale,  and  the  pyra- 
mids injected.  The  right  kidney  weighs  140  grams.  The  capsule  strips  easily. 
On  section  tissue  reveals  a  similar  appearance  to  the  left.  Pancreas  weighs 
40  grams,  and  its  tissue  is  apparently  normal.  Suprarenal  capsules  are  en- 
larged and  cut  with  increased  resistance.  The  stomach  is  distended  with  gas; 
found  to  contain  coffee-colored  fluid.  Walls  very  anjemic.  The  small  intestine 
is  distended  with  gas  and  is  for  the  most  part  empty.  The  walls  are  anjemic. 
The  appendix  is  about  7  cm.  long,  very  narrow,  and  empty.  The  csecum  is 
bound  down  with  adhesions  to  the  abdominal  wall.  The  large  intestine  con- 
tains a  small  amount  of  fecal  matter,  but  is  otherwise  normal.  The  urinary 
bladder  contains  about  100  c.  c.  of  turbid  urine.  Tlie  generative  organs  are 
normal. 

H.  F.  T. 

W.  G.  S. 
XXVIII. 

N.  A. ;  aged  2.3 ;  nativity,  Norway ;  color,  white ;  admitted  to  the  United  States 
Marine  Hospital,  San  Francisco,  Cal.,  September  20,  1903 ;  died  October  8.  1903. 

History. — The  patient  complained  of  pain  in  the  abdomen,  diarrhoea  and  loss 
of  appetite.  Body  emaciated,  face  drawn,  eyes  bright,  tongue  moist,  coated 
at  center,  dullness  and  increased  vocal  fremitus  over  apex  of  right  lung,  heart 
normal,  tenderness  on  pressure  over  all  parts  of  abdomen,  temperature  87.8°  C. ; 


540  PUBLIC    HEALTH    AND   MARINE-HOSPITAL   SERVICE. 

pulse,  88;  respiration,  22.  After  the  first  two  days  his  temperature  rose  and 
stayed  above  39°  C.  until  his  death.  His  bowels  were  very  irregular,  at  one 
time  constipated  and  at  another  very  loose.  October  2  he  passed  a  large 
stool  of  a  chocolate  color,  lie  would  eat  but  little  and  his  food  had  to  be  forced 
upon  him.  October  7  he  complained  of  severe  pains  in  his  abdomen,  which  was 
tympanitic  and  tender  on  pressure.  He  also  vomited  a  quantity  of  greenish 
matter.  These  symptoms  continued  throughout  the  day,  and  he  died  at  11 
a.  m.  oh  the  following  day. 

Necropsy  (0  hours  after  death). — Post-mortem  lividity  marked  on  back  and 
chest,  especially  the  latter.  Weight  of  brain,  1,480  grams;  tissues  apparently 
normal.  Thorax:  The  anterior  mediastinum  is  normal.  The  pericardium  con- 
tains a  small  quantity  of  yellowish  fluid.  The  heart  weighs  285  grams.  A 
small  chicken-fat  clot  extends  from  the  right  auricle  through  the  right  auriculo- 
ventricular  opening  into  the  right  ventricle,  and  from  there  reaches  into  the  pul- 
monary artery.  The  valves  of  the  heart  are  normal;  the  tissue  is  of  a  pale 
reddish  color.  The  left  lung  weighs  4.50  grams.  On  section  the  apex  is  found 
to  contain  numerous  caseous  tubercles ;  no  tubercles  are  found  in  the  rest  of 
the  lung,  but  its  tissue  is  congested.  The  right  lung  weighs  482  grams ;  tissue 
congested,  but  otherwise  apparently  normal.  The  great  vessels,  nerve  trunks, 
and  diaphragm  are  normal.  Abdomen  :  Gas  escapes  from  the  peritoneal  cavity 
when-  it  is  opened,  and  about  500  c.  c.  of  yellowish,  bad-smelling  fluid  is  found  in 
it.  The  viscera  are  covered  with  a  thick,  yellowish-white  lymph  which  binds 
them  together  in  one  mass.  The  omentum  is  dark  red  in  color,  retracted,  and 
adherent  to  the  intestines,  which  are  distended  with  gas.  The  spleen  weighs 
330  grams,  the  pulp  is  soft  and  of  reddish-brown  color,  and  blood  escapes  on 
section.  A  supernumerary  spleen  the  size  of  a  large  marble  is  present.  The  left 
kidney  weighs  187  grams,  capsule  strips  easily,  cortical  pale  and  shows  yellowish 
striations,  pyramids  of  deep  red  color.  The  right  kidney  weighs  180  grams ;  tis- 
sue in  same  condition  as  other  kidney.  The  suprarenal  capsules  are  normal.  The 
urinary  bladder  contains  a  small  quantity  of  urine.  The  organs  of  generation, 
rectum,  and  duodenum  are  normal.  The  stomach  contains  a  small  quantity  of 
dark  brown  fluid  and  mucus,  and  its  walls  are  congested.  The  gall  ducts  arc 
patent.  The  liver  weighs  2,080  grams;  tissue  cuts  with  increased  resistance; 
section  of  pale  reddish  color;  centers  of  lobules  dark  and  prominent.  The 
pancTcas  and  solar  plexus  are  normal.  The  mesenteric  lymph  glands  are 
enlarged  and  hardened,  but  not  caseous.  The  mucous  membrane  of  the  lower 
portion  of  the  ileum  is  congested  and  hemorrhagic,  and  shows  a  number  of 
deep  transverse  ulcers  extending  to  the  serous  coat;  one  of  these  has  in  its 
base  a  perforation  of  goose-quill  size.  The  large  intestines  and  great  vessels 
are  normal.     The  vermiform  appendix  is  normal. 

Anatomical  diagnosis. — Tubercle  of  left  lung;  passive  congestion  of  right 
lung;  acute  exudative  peritonitis;  omental  and  intestinal  adhesion;  acute 
splenitis ;  supernumerary  spleen  ;  acute  nephritis ;  acute  gastritis ;  acute  hepa- 
titis ;  tubercle  of  mesenteric  lymph  glands ;  tubercle  of  ileum  with  perforation. 

W.  G.  S. 

XXIX. 

G.  H. ;  age,  30  years ;  nativity,  Norway ;  admitted  to  the  United  States 
Marine  Hospital,  San  Francisco,  Cal.,  November  25,  1903,  died  December  8,  1903. 

History. — Patient  stated  he  caught  a  severe  cold  ten  days  ago.  He  is  now 
extremely  weak,  has  no  appetite,  is  short  of  breath,  has  bad  cough  and  pain  on 
left  side. 

Examination. — Roughened  breath  sounds  heard  over  both  lungs,  dullness 
with  tympanitic  resonance  over  left  lung,  rales  heard  at  base  of  left  lung,  abdo- 
men fiat,  tympanitic,  not  tender  on  palpation,  bowels  constipated,  face  red, 
tongue  coated.  Temperature,  .39.4°  C. ;  respiration,  25;  pulse  soft;  sputum  con- 
tains no  tubercle  bacilli ;  urine,  specific  gravity  1.026,  no  albumen  or  sugar 
present.  On  the  30tli  the  patient  coughed  up  considerable  blood,  and  he  con- 
tinued to  have  hemorrhages  until  his  death;  his  temperature  remained  high 
throughout  his  sickness ;  he  died  from  exhaustion  at  4.45  p.  m.  December  8, 
1903. 

Necropsy  (12  hours  after  death). — Height,  5  feet  8  inches;  mole  on  left 
forearm.  Brain :  Weight,  1,575  grams ;  tissue  normal.  Intestines  filled  with 
gas,  lower  end  of  small  intestine  congested,  appendix  small,  no  evidence  of 
inflammation  of  its  tissues.  Omentum  contains  a  small  quantity  of  fat.  Peri- 
toneum thickened,  tissue  of  yellowish  slate  color;    csecum,  lower  portion  of 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  541 

descending  colon  and  sigmoid  ttoxuro  bonnd  down  to  abdominal  wall  by  strong 
adhesions.  Pericardial  sac  adiicrciit  to  left  pleura,  with  only  a  small  quantity 
of  yellow  fluid  present  in  the  sac.  Valves  of  heart  normal ;  nniscular  tissue  of 
bright  red  color.  Left  pleural  cavity  contains  about  250  c.  c.  of  I)loody  fluid;  it 
is  lined  with  a  thick  soft  fibrous  membrane  and  comnuniicates  with  one  of  the 
bronchial  tubes  which  oi)ens  directly  into  it;  the  pleura  is  bound  down  on  all 
sides  by  strong  adhesions;  the  lung  is  collapsed  and  pushed  over  toward  the 
right.  The  lung  is  reached  by  tearing  through  the  dense  pleura  ;  weight,  490 
grams;  tissue  crepitates  at  apex,  but  is  hard  and  dense  in  all  other  portions; 
color  on  section  dark  red,  no  tul)ercle  present.  Right  lung :  Weight,  G70  grams ; 
upper  lobe  crepitant,  lower  lobe  slightly  crepitant  and  feels  leathery  to  the 
touch ;  tissue  cuts  with  increased  resistance,  and  blood  exudes  from  the  cut 
surface ;  no  tubercles  found.  Spleen  :  Weight,  187  grams  ;  pulp  very  soft,  color 
deep  red.  A  superiuunerary  spleen  size  of  a  marble  is  found  attached  to  the 
spleen  at  its  lower  portion  by  a  small  mesentery.  Left  suprarenal  capsule  nor- 
mal. Left  kidney :  Weight,  200  grams ;  capsule  strips  readily,  cortical  portion 
swollen,  i)yramids  prominent.  Right  kidney:  Weight,  175  grams;  tissue  in 
same  condition  as  other  kidney.  Stomach  contains  undigested  milk  ;  numerous 
small  round  ulcers  found  in  the  lower  2  feet  of  ileum  ;  borders  of  ulcers,  red  and 
indurated ;  ulceration  does  not  extend  through  serous  coat.  Cultures  taken 
from  spleen  show  no  growth. 

W.  G.  S. 

XXX. 

G.  B. ;  aged  45;  nativity,  Sweden;  admitted  to  the  United  States  Marine  Hos- 
pital, San  Francisco,  Cal.,  January  22,  1904 ;  died  E'ebruary  29,  1904. 

History.  Has  been  sick  for  over  a  month,  feels  drowsy  all  the  time,  appetite 
poor,  has  pain  in  bowels,  gets  short  of  breath  on  exertion,  cough  is  bad  at  times, 
has  had  hemorrhages  from  his  nose  for  two  weeks. 

Physical  examination. — Slightly  deaf  in  both  ears.  Dullness  over  base  of 
both  lungs  and  the  breath  sounds  are  harsh  over  these  regions.  A  loud  systolic 
murmur  is  heard  over  the  whole  cardiac  area ;  the  liver  and  spleen  are  en- 
larged. A  number  of  petechiie  are  present  over  the  body.  The  legs  are  swollen 
and  the  veins  enlarged.  Tubercle  bacilli  are  present  in  the  sputum.  Urine, 
specific  gravity  1.018,  acid  reaction ;  dark  yellow  color ;  albumen  is  present  in 
hirge  quantities  and  the  microscope  shows  granular  and  hyaline  casts.  Tem- 
perature 37.6°,  pulse  104,  respiration  24.  The  patient  had  repeated  hemorrhages 
from  his  nose.  The  dyspnoea  was  so  bad  that  he  could  not  sleep  except  in  a 
sitting  posture.  Ascites  developed  and  3,100  e.  c.  of  fluid  was  drawn  off.  He 
had  dilBculty  in  passing  his  water  and  frequently  the  catheter  bad  to  be  used. 
Fever  of  an  irregular  type  was  present  throughout  his  illness.  He  finally  died 
from  exhaustion  at  4.30  a.  m.,  February  29,  1904. 

Necropsy"  (6  hours  after  death). — Rigor  mortis  marked;  length  of  body  5 
feet  7  inches  ;  tattoo  marks  on  arms  ;  scrotum  and  legs  oedematous.  Peritoneum 
much  thickened,  I)ladder  filled  with  urine  although  patient  was  catheterized  four 
hours  before  death.  There  is  an  abnormal  amount  of  fluid  in  the  abdominal 
cavity.  Brain :  Weight  1,270  grams ;  tissue  soft.  Costal  cartilages  are  cut 
through  with  some  difficulty  owing  to  their  being  partially  ossified.  The  cavity 
of  the  pericardium  is  obliterated,  the  two  layers  of  the  pericardium  being 
adherent  to  each  other  throughout ;  this  adhesion,  however,  is  slight  and  the  lay- 
ers are  easily  separated.  Heart :  Weight  400  grams ;  valves  of  right  side  nor- 
mal, but  the  leaves  of  the  mitral  and  aortic  valves  are  greatly  thickened  and  hard 
calcareous  nodules  as  large  as  peas  are  present  on  their  edges.  The  thickness 
of  the  wall  of  the  right  ventricle  is  i  cm.,  of  the  left  ventricle  li  cm.  Left 
lung  is  bound  down  to  the  chest  wall  by  separable  adhesions ;  w^eight  800  grams  ; 
a  milk  spot  is  present  at  apex  of  lov\  er  lobe ;  the  lung  is  crepitant  throughout ; 
the  tissue  on  section  is  reddish  gray  in  color  and  is  slightly  (edematous.  No 
tubercles  are  demonstrable  nor  are  any  tubercles  present.  Right  lung :  Weight 
880  grams ;  condition  of  tissue  same  as  left  lung.  Bronchial  glands  are  slightly 
enlarged  and  the  tissue  is  hard  on  section.  Spleen  is  torn  on  being  removed, 
due  to  the  fact  that  the  upper  portion  is  bound  down  to  the  surrounding  struc- 
tures by  strong  adhesions ;  weight  GOO  grams ;  upper  portion  hard,  tissue  dense, 
trabeculse  prominent ;  lower  portion  soft  and  mushy ;  pulp  oozing  out  when 
capsule  is  broken.  A  small  supernumerary  spleen,  weight  10  grams,  of  normal 
tissue  is  present.  Suprarenal  capsules  are  softened  and  their  interior  is  broken 
down.    Left  kidney :    Weight  330  grams,  cortical  substance  greatly  increased, 


542  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

color,  dirty  reddish  white  with  miniito  yellow  striations.  Right  kidney  :  Weight 
265  grams ;  tissue  in  same  condition  as  left  kidney.  Bladder  walls  thickened ; 
small  submucous  hemorrhages  are  present ;  urethra  normal ;  stomach  small ; 
large  intestines  and  appendix  are  normal.  Liver:  Weight  2,915  grams;  numer- 
ous light  yellow  elevated  spots  size  of  a  small  pea  are  present  over  its  whole 
surface  and  section  shows  that  these  yellowish  areas  are  present  throughout  the 
substance  of  the  whole  organ  ;  the  tissue  cuts  with  increased  resistance,  and  a 
dark  nutmeg  condition  is  found  to  be  present.  Gall  bladder  contains  a  small 
quantity  of  bile ;  bile  ducts  patent. 

W.  G.  S. 

XXXI. 

J.  C. ;  age  37 ;  nativity  New  York ;  color  white ;  admitted  to  United  States 
Marine-Hospital  Sanatorium,  Fort  Stanton,  N.  Mex.,  October  3,  1903. 

HiSTOEY. — Always  enjoyed  good  health,  except  for  bad  colds  during  the  winter 
months.  Had  night  sweats,  cough,  expectoration,  and  loss  in  weight.  Gave  his- 
tory of  syphilis.  Haemoglobin  was  .50  per  cent  as  estimated  with  Tallquist's 
haemoglobin  scale.  Tubercle  bacilli  were  present  in  sputum.  Died  October  12, 
1903,  at  1  a.  m. 

Necropsy  (12  hours  after  death). — Medium  build,  skin  dry  and  inelastic, 
panniculus  scant,  musculature  medium,  small  copper-colored  pigmented  spots 
over  abdomen.  Head  partially  bald,  mustache  reddish,  beard  fairly  thick, 
hair  over  chest,  pubic  hair  fairly  abundant.  Upper  incisors  and  first  molars 
gone,  other  teeth  in  fairly  good  condition.  Rigor  mortis  slight  in  arms,  pres- 
ent in  jaws,  eyelids,  legs,  abdominal  muscles,  and  neck.  Body  heat  absent. 
Hypostasis  over  back  of  thorax,  arms,  and  legs.  Side  of  face  soiled  with  small 
amount  of  di*y  vomitus.  Veins  of  forehead  and  scalp  dilated.  Pupils  slightly 
dilated;  ears  cyanotic;  scrotum  shows  hypostatic  congestion.  Upon  turning 
body  upon  face  vomitus  ran  from  mouth.  Spinal  cord  normal.  Brain  :  Weight 
1,560  grams.  Vessels  of  dura  slightly  injected ;  pia  vessels  also  injected ;  sur- 
face of  brain  moist  and  glistening;  small  amount  of  fluid  in  lateral  ventricles; 
brain  otherwise  normal.  Abdominal  section :  Panniculus  of  light-orange  color, 
small  in  amount;  muscles  pale  but  fairly  well  developed;  vessels  of  omentum, 
intestines,  and  peritoneum  slightly  congested ;  abdomen  contained  500  c.  c.  of  a 
clear  serous  fluid  containing  a  few  floccules  of  fibrin.  Liver  comes  to  right  cos- 
tal margin  on  nipple  lino.  Lower  margin  of  liver  stained  a  greenish  blue  (bile). 
Thoracic  section  :  Anterior  mediastinum,  thymus  fat  somewhat  persistent;  lymph 
glands  enlarged  to  size  of  beans.  Pericardium  contains  40  c.  c.  of  slightly  turbid 
serous  fluid.  Heart :  Weight,  325  grams ;  subpericardial  fat  quite  abundant. 
Valves  and  walls  of  heart  apparently  normal.  Arch  and  valves  of  aorta 
stained  a  pink  color.  Glands  in  middle  and  posterior  mediastina  considerably 
enlarged.  Larynx  apparently  normal.  Left  lung  adherent  to  thoracic  wall  from 
apex  to  base  and  to  diaphragm;  weight,  1,1.30  grams;  consolidated  and  firm  to 
the  feel ;  apex  contained  cavity  size  of  an  apple,  besides  small  cavities  in  ui)per 
lobe.  Lower  lobe  contained  tubercles  scattered  throughout  with  many  small  cavi- 
ties ranging  in  size  from  a  pea  to  a  walnut.  Upper  lobe,  where  not  occupied  with 
cavities  or  connective  tissue,  was  hepatized.  Right  lung:  Adherent  to  thoracic 
wall  at  apex  laterally  and  posteriorly  ;  weight,  050  grams;  contained  in  apex  sev- 
eral cavities  size  of  hickory  nuts;  entire  upper  lobe,  where  not  occupied  by  cavi- 
ties or  connective  tissue,  was  hepatized.  Middle  and  lower  lobes  contained  infil- 
trated areas  and  tubercles  scattered  throughout.  Liver :  Weight,  2,370  grams ; 
gall  bladder  filled  with  a  clear  golden  bile.  On  section  the  lobules  stood  out  dis- 
tinctly. No  pathological  changes  found.  Spleen  :  Weight,  310  grams  ;  consistency 
soft ;  capsule  adherent  to  surrounding  peritoneum  and  viscera  ;  parenchyma  con- 
gested and  friable  ;  follicles  seen  with  some  difficulty.  Connective  tissue  increased. 
Left  kidney:  Weight,  205  grams;  fatty  capsule  fair  in  amount;  stellate  veins 
injected  ;  fibrous  capsule  peeled  easily.  Small  urinary  cyst  in  cortex  ;  kidney 
slightly  congested;  glomeruli  easily  visible.  Right  kidney:  Weight,  205  grams. 
Similar  in  all  respects  to  left.  Pancreas  apparently  normal.  Suprarenals 
apparently  normal.  Mesenteric  and  x'etroperitoneal  glands  all  enlarged.  Aorta 
apparently  normal,  except  for  a  few  small  sclerotic  plaques  just  above  aortic 
semilunar  valves.  Mucosa  of  esophagus  roughened  with  small  pin-head 
raised  areas  having  appearance  of  old  granulations.  Stomach  contained  500 
c.  c.  of  sour-smelling  .sero-mucoid  fluid,  containing  particles  of  undigested  milk. 
Intestines:  Ileum  contained  ulcers  varying  in  size  from  a  pin  head  to  a  half 
dollar,  with  elevated,  undermined  edges,  and  extending  through  the  submucosa. 


riTBLlC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  543 

Lower  part  of  ilouiii  imich  coiiRostod.  Urinary  bladder  distended  with  clear 
urine.  INIucosa  of  iiladder  Kli)j;litl.v  injected.  Walls  apparently  normal,  except 
for  small  ba>uiatoma  size  of  pea  beneath  mucosa.  Prostate  and  testes  appar- 
ently normal. 

MuuoscoiucAL  EXAMINATION. — Livcr  sbowcd  small  cell  infiltration,  congestion 
of  intralobular  cai)illaries.  siij^bt  increase  of  intralobular  connective  tissue. 
Colunnis  of  liver  cells  in  many  places  atrophic;  many  hypertrophic,  deeply 
stainetl  nuclei,  also  many  small  and  many  faintly  staining  nuclei.  Connective 
tissue  of  si>leen  much  increased;  follicles  were  few  and  small  ;  arteries  showed 
sclerosis ;  considerable  black  pigment  scattered  throughout,  but  especially 
located  around  the  t.rabecula\  Kidneys:  A  few  obliterated  glomeruli;  some 
cloudy  swelling  in  convoluted  tnbules ;  very  slight  increase  In  connective  tissue; 
many  small  calcareous  deposits  scattered  throughout  medulla.  Lymphatic 
glands  in  middle  and  posterior  mediastinum  contained  tubercles  with  epithe- 
lioid and  giant  cells.  Intestines  contained  many  ulcers  extending  into  submu- 
cosa.  In  base  of  ulcers  and  at  other  points  in  the  intestines  were  found  tuber- 
cles devoid  of  blood  vessels  and  with  epithelioid  and  giant  cells  and  necrotic 
areas.  In  the  neighborhood  of  the  ulcers  the  intestines  showed  marked 
congestion. 

Pathological  diagnosis. — Partial,  acquired,  symmetrical  alopecia ;  acute  con- 
gestion of  meninges ;  healed  pericarditis ;  chronic  pulmonary  tuberculosis ; 
chronic  adhesive  tuberculous  pleuritis :  tuberculosis  of  lymph  glands ;  chronic 
ulcerative  tuberculosis  of  intestines ;  urinary  cyst  of  kidney ;  hacmatoma  of  uri- 
nary bladder  ;  calcareous  deposits  in  medulla  of  kidney. 

J.   W.   T. 

P.   M.   C. 
XXXII. 

J.  A. ;  age,  20 ;  nativity.  Newfoundland ;  admitted  to  United  States  Marine 
Hospital,  Boston,  Mass.,  April  28.  1903 ;  died  September  1,  1903. 

Family  history. — Father  and  mother  both  dead,  causes  unknown  ;  four  broth- 
ers living  and  in  good  health. 

Previous  history. — Always  well  previous  to  present  illness. 

Present  history. — Began  to  have  a  bad  cough  about  one  month  ago.  Went 
out  to  sea  and  caught  cold  and  has  felt  worse  ever  since.  Expectorates  freely. 
Has  night  sweats,  and  has  been  losing  weight.  Pain  in  right  che.st  on  coughing. 
Appetite  poor.  Bowels  regular.  Sleeps  poorly,  chiefly  on  account  of  the 
troublesome  cough. 

Physical  exa.nhnation. — No  areas  of  dullness  found  on  percussion.  Respira- 
tory sounds  harsh ;  respiration.  .30.  Heart  sounds  normal ;  pulse,  SO,  soft  in 
quality.  Abdomen  normal.  Urinalysis  negative.  Tubercle  bacilli  found  in 
sputum. 

Treatment. — Elixir  iron,  quinine,  and  strychnine  and  heroin  cough  mixture. 
Patient  seemed  to  improve  somewhat,  although  never  strong  enough  to  leave  the 
hospital.  On  .July  30  patient  had  a  sinking  spell,  in  which  his  mind  frequently 
wandered,  but  he  seemed  to  pick  up  again  for  a  few  days,  after  which  he  pro- 
gressively weakened  until  death  occurred,  September  1,  at  G.Oo  p.  m. 

Necropsy  (15  hours  after  death). — Rigor  mortis  and  post-mortem  lividity 
both  slight.  Body  very  much  emaciated.  Subcutaneous  fat  over  abdomen,  as 
revealed  by  median  incision,  very  slight  in  amount.  Position  of  abdominal  con- 
tents normal.  Pericardium  contained  60  c.  c.  of  straw-colored  fluid.  Heart 
weighed  240  grams,  and  contained  both  post  and  ante  mortem  clots.  Its  walls 
were  thin  and  flabby,  but  its  valves  appeared  to  be  normal.  Pleural  cavities 
contained  small  amount  of  fluid,  and  lungs  were  very  adherent.  Left  lung 
weighed  1.150  grams,  right  1,000  grams.  Both  present  numerous  miliary  tuber- 
cles and  several  large  cavities  in  upper  lobes.  Peritoneum  contained  1.50  c.  c.  of 
clear  fluid.  Liver  apparently  normal,  weight  1,4.30  grams.  Spleen  much  en- 
larged and  of  firm  consistency,  weight  270  grams.  Mesentery  shows  many  tuber- 
cles, and  small  intestines  show  numerous  ulcers  the  size  of  a  10-ceut  piece, 
some  of  them  extending  around  the  entire  circumference.  The  edges  and  base 
of  the  ulcer  were  thickened  and  indurated,  and  the  floor  presents  caseous  nod- 
ules. Kidneys  each  weigh  175  grams  and  are  apparently  normal.  Suprarenal 
bodies  greatly  enlarged,  weight  of  each  15  grams.  Pancreas  normal,  weight  85 
grams.    Brain  weighs  1,190  grams,  and  on  section  appears  normal. 

C.  H.  D. 
W.  C.  R. 
R.  M.  W. 


544  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Psoas  abscess. 

C.  E. ;  colored ;  age,  30 ;  nativity,  Kontnolvy ;  admitted  to  United  States  Marine 
HospitaJ,  Louisville,  Ky.,  Ar»ril  30,  lOO:? ;  died  Aiignist  20,  1003. 

History. — Patient  was  operated  on  for  a  tubercular  abscess  pointing  in  right 
iliac  region  in  Decemi)er,  1002,  at  the  Evansville  marine  hospital,  staying  there 
only  three  weeks  after  the  operation.  The  wound  discharged  freely  for  a  while, 
after  which  discharge  stopped  and  he  began  to  suffer  a  great  deal  of  pain,  lost 
his  appetite,  had  chills,  fever,  and  night  sweats.  About  three  weeks  before  ad- 
mission it  began  discharging  freely  again. 

Physical  EXAiiiNATioN.^I'atient  is  a  very  black  negro  of  medium  stature. 
Very  much  emaciated ;  has  a  kyphotic  curve  in  the  lumbar  spine.  Two  inches 
to  the  right  of  this  is  a  small  sinus,  discharging  slightly ;  the  anterior  opening  is 
about  an  inch  internal  to  the  anterior  superior  spine  of  the  ileum  on  the  same 
side.  Patient  was  i)laced  on  supportive  treatment  and  sinuses  irrigated  daily. 
His  temperature  ran  the  course  of  a  hectic  fever  and  was  usually  38°  C.  or  over 
in  the  evenings.  On  July  17  a  bulging  of  the  left  gluteal  region  was  tapped  and 
about  2  litei's  of  greenish  pus  drained  .off.  Temperature  following  operation, 
however,  ranged  much  higher  than  before.  On  August  ^~)  a  severe  diarrhea 
began,  the  stools  containing  quantities  of  bloody  pus.  That  the  pus  came  from  the 
lumbar  abscess,  which  had  ruptiu-ed  into  the  intestines,  was  proved  by  the  in- 
jection of  niethylene  blue  solution  into  the  anterior  opening  and  its  subsequent 
appearance  in  the  stools.  Diarrhea  soon  became  uncontrollable,  and  in  an  effort 
to  promote  freer  drainage  a  Treves  operation  was  done,  opening  into  the  right 
psoas  uniscle  from  the  outer  edge  of  the  erector  spinre.  Although  fairly  free 
through-and-through  drainage  was  secured  by  this,  it  made  no  difference  in  the 
amount  of  pus  coming  out  with  tlie  stools.  On  August  27,  after  com])laiiiing  of 
a  sever  headache  for  several  days,  patient  became  suddenly  maniacal.  Patient 
lingered  on,  dying  at  3  p.  m.  on  August  20,  1003. 

Necropsy  (18  hours  after  death). — Body  extremely  emaciated,  there  being 
absolutely  no  subcutaneous  or  visceral  fat.  Heart  small,  contracted ;  valves 
normal ;  weight,  140  grams.  Lungs  contained  no  tubercular  foci.  The  intestines 
were  then  removed  to  ascertain  opening  ])osition  of  the  abscess  into  them.  This 
was  found  in  the  duodetmm. 

The  .original  tubercular  focus  was  in  the  body  of  the  first  lumbar  vertebra, 
which  was  completely  eroded,  so  that  a  probe  was  thrust  throu.gh  the  slight 
remnant  of  necrotic  material  into  the  canal  of  the  cord.  From  this  original 
focus  there  was  a  pus  tract  on  each  side.  That  on  the  right  followed  the  psoas 
muscle  on  the  same  side  to  the  anterior  superior  spine.  From  this  main  tract 
there  was  a  sinus  leading  into  the  lumbar  region  and  an  anterior  one  discharg- 
ing through  thick  adhesions  into  the  duodenum.  On  the  left  side  the  tract  had 
followed  the  corresponding  psoas  muscle  to  its  insertion  into  the  lesser  tro- 
chanter of  the  femur  and  had  there  spread  out,  baring  the  neck  and  a  part  of 
the  shaft  of  the  bone  and  forming  a  large  pus  cavity. 

T.  D.  B. 

Tubercular  leptomeningitis. 

W.  B. ;  colored ;  age,  23 ;  nativity,  United  States ;  admitted  to  United  States 
Marine  Hospital,  Louisville,  Ky.,  June  3,  1003 ;  died  July  23,  1003. 

History. — Present  illness  began  two  months  ago  with  cough,  pain  in  side,  and 
general  weakness.  Applied  at  out-patient  office  about  three  weeks  before 
admission  to  hospital,  because  of  this  i)ain  in  left  side.  Is  lame  in  left  hip, 
and  right  hip  is  tender,  patient  says  because  of  lying  on  it.  Patient  is  a  very 
black  negro,  not  very  intelligent,  of  about  medium  height  and  weighing  about 
120  pounds.  His  face  and  chest  show  emaciation  and  his  nmcous  membranes 
are  pale.  Percussion  and  palpation  do  not  show  consolidation,  and  no  rales 
are  heard,  but  the  apical  sounds  were  high  pitched  and  bronchial.  The  skin 
over  left  trochanter  is  reddened  and  pressure  over  trochanter  causes  pain  in 
joint.  On  admission  patient's  temperature  ranged  around  38°  and  30°  C. ;  it 
gradually  approached  normal  in  about  three  weeks  and  after  staying  so  a  few 
days  rose  again  and  continued  febrile  till  death.  About  July  0  began  to  have 
nosebleed  daily  and  to  complain  of  severe  headache,  and  temperature  began  to 
rise  quite  high.  The  epistaxis  stopped  in  a  few  days,  but  the  headaches  con- 
tiuued  and  required  daily  doses  of  acetanilid  to  control ;  was  very  constipated 
about  this  time. 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE.  545 

Jul!/  16. — About  S  a.  m.  was  foiiiul  by  tbo  nurso  crying  bitterly;  on  being 
questioned  be  would  ^ive  no  answer;  ten  minutes  later  be  bad  a  bard  convul- 
sion; never  regained  eonseiousnoss  after  convulsion:  would  turn  bead  some- 
times wben  spoken  to.  but  woulil  not  answer  (luestions,  and  would  not  take 
food,  water,  or  medicines;  also  bad  to  be  catberized  for  tbe  first  tbree  days, 
after  wbicli  be  would  pass  bis  evacuations  in  bed;  was  fed  tbrougb  stomacb 
tube  tbree  times  daily,  being  given  beef  brotb.  eggs,  and  wbisky. 

Jul)/  18. — Had  several  rigbt-sided  convulsions  yesterday  and  tbe  rigbt  side 
of  face  was  constantly  twitcbing.  tbe  process  seeming  to  be  localized ;  prepara- 
tions were  made  for  a  trepbine  to-day  ;  bowever.  as  all  convulsions  and  twitcli- 
ings  bad  stopped,  and  as  patient  seemed  to  be  brigliter,  tbe  operation  was  post- 
poned. 

./(////  20. — Had  tbree  bard  convulsions  to-day :  began  in  face.  Patient's  pulse 
is  bolding  up  well,  but  tbe  respiration  is  too  rapid. 

Jul)/  28. — Patient  is  failing  rapidly,  tbe  focal  symptoms,  referable  to  the  right 
side  of  face  contimie.  and  as  a  '"  dernier  ressort "  a  trepbine  was  performed. 
Patient's  bead  was  sbaved  several  days  previous,  and  on  tbe  scalp  tbe  fissures 
of  Rolando  and  Silvins  and  tbe  face  center  were  outlined.  Patient  was  chlo- 
roformed and  tbe  button  of  bone  removed,  and,  as  was  suspected,  tubercular 
meningitis  was  found.  Several  tubercles  were  seen  on  tbe  pia ;  a  probe  was 
thrast  a  short  distance  in  tbe  brain  substance  to  evacuate  any  abscess  that 
there  might  be.  Prior  to  this  the  sterilized  electrodes  of  a  galvanic  battery 
were  placed  on  brain  substance  directly  under  trepbine  opening  and  tbe  spot 
proved  to  be  the  face  center  by  connecting  up  tbe  battery  and  causing  the  right 
side  of  face  to  twitch.  Patient  reacted  from  operation  well  as  regards  shock, 
but  resi)iration  continued  \ery  rapid,  and  both  lungs  were  full  of  rales.  Late 
in  the  afternoon  a  good  deal  of  mucus  began  to  form  in  bis  throat,  which  rap- 
idly increasing,  soon  caused  bis  death,  at  11  p.  m. 

Necropsy  (12  hours  after  death). — Body  male,  black,  much  emaciated. 
Heart  small,  pale,  all  valves  normal.  Universal  old  adhesion  bound  left  lung 
to  pleura.  Left  lung  i)artly  hepatized  in  upper  portion,  completely  so  in  lower 
poi'tion ;  weight,  025  grams.  Hepatization  of  the  lower  lobe  of  right  lung ; 
weight.  750  grams.  Small  miliary  tubercles  scattered  over  tbe  pleural  surfaces 
of  both  lungs,  but  no  evidence  of  more  extensive  process.  A  mass  of  caseating 
tubercular  glands  at  tbe  bifurcation  of  trachea  and  about  the  roots  of  lungs. 
Liver  enlarged,  and  scattered  throughout  its  substance  were  tubercles  varying 
in  size  from  a  millet  seed  to  that  of  a  buckshot ;  weight  of  liver,  1,400  grams. 
Spleen  enlarged  and  a  mass  of  large  caseating  tubercles.  Brain  deeply  con- 
gested, and  tubercles  scattered  throughout  the  pia,  not  only  ou  the  base  but  also 
on  the  convexitj'. 

T.  D.  B. 

NECROPSIES  OF  PLAGUE  CASES. 

The  following  records  of  necropsies  refer  to  plague  cases  which 
occurred  in  San  Francisco,  Cal.,  during  the  period  from  July,  1903, 
to  February,  1904,  since  which 'latter  month  no  cases  have  been 
reported.  The  diagnosis  of  plagiie  in  these  cases  was  made  provi- 
sionally from  the  necropsic  findings  and  subsequently  confirmed  by 
bacteriologic  investigation. 

I. 

C.  J. ;  age,  62 ;  male ;  death  occurred  July  14 ;  necropsy  July  15  by  Asst. 
Surg.  Donald  H.  Currie.  Present :  Passed  Asst.  Surg.  Rupert  Blue,  Asst. 
Surgs.  B.  J.  Lloyd  and  C.  W.  Vogel,  Doctors  Woolsey,  Mathewson,  Laughliii, 
Morrow,  and  Hopper. 

Necropsy. — Body  that  of  a  well-developed,  well-nourished  Chinese  male  about 
50  years  of  age.  The  body  has  progressed  to  beginning  putrefaction,  so  that  it 
has  probably  been  dead  two  or  three  days.  Blebs  putrefactive  in  character,  for 
they  were  not  present  yesterday  at  4  p.  m.  about  tbe  right  inguino-femoral 
region.  Post-mortem  lividity  well  marked,  the  face  being  almost  black.  Scleme 
very  much  injected.  No  signs  of  trauma.  Blood  exudes  from  nose  and  mouth. 
Long  median  incision  made.  Large  quantities  of  gas  escape  from  the  perito- 
neal cavity  when  the  latter  is  opened.     Subcutaneous  fat  unusually  well  pre- 

8629—04 35 


546  PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE. 

served.  Incisions  made  over  the  right  inguino-femoral  region  show  neither 
oedema  nor  glandular  enlargement.  The  same  made  over  the  left  shows  mod- 
erately enlarged  hemorrhagic  gland,  which,  when  removed  and  the  incision 
made  crucial  in  shape,  exposes  another  similar  gland.  Incision  made  in  the 
right  axillar  region  ;  tissues  found  to  be  somewhat  moist  and  the  glands  similar 
to  the  others,  only  slightly  smaller.  Smears  from  gland  show  numerous  organ- 
isms, among  which  are  some  taking  a  bipolar  stain.  Spleen  removed  without 
difficulty ;  enlarged  to  nearly  twice  its  normal  size,  showing  numerous  pig- 
mented areas.  These  are  probably  hemorrhages  which  have  undergone  post- 
mortem change.  Organ  very  soft  in  consistency.  Capsule  tense,  showing  some 
nodules  on  its  surface.  Organ  cuts  very  easily ;  cut  surface  shows  the  pulp  to 
be  confluent  and  bulging ;  of  a  dark  red  color,  the  darkness  probably  being  post- 
mortem. Everywhere  the  tissues  are  found  infiltrated  with  gas  and  fluids  under- 
going putrefactive  change.  Smear  made  from  the  sple>3n  shows  a  number  of  round 
bodies, some  with  slightly  clear  centers,  taking  the  stain  very  indistinctly  and  bear- 
ing some  resemblance  to  doughnut  types  of  B.  pest  is.  Thorax  opened  by  removal 
of  sternum.  Putrefactive  gases  escaj)e.  Lungs  collapse  anteriorly.  Right  lung 
extends  two  finger  breadths  beyond  the  cut  border  of  the  ribs.  Left  lung  re- 
tracted behind  the  cut  border  of  the  ribs.  Pleural  cavity  shows  one  adhesion  of 
the  pleura  near  the  apex  of  the  upper  lobe  of  the  left  lung.  Otherwise  lung  is 
free.  Organ  crepitates  throughout.  Odor  emitted  from  the  pleural  cavity  is 
hardly  bearable.  The  lungs  and  heart  are  not  removed  from  their  cavities  owing 
to  the  putrefactive  state  of  these  organs.  Left  kidney  removed.  Fatty  capsule 
very  rich.  When  removed  shows  the  organ  increased  in  size.  Its  original  con- 
sistency can  not  be  ascertained  owing  to  the  putrefactive  changes.  Cuts  very 
easily.  Characteristic  appearances  of  its  cut  surface  are  lost,  but  in  spite  of 
this,  from  the  color  and  general  appearance  of  the  organ,  there  is  a  possibility 
that  it  is  a  moderately  large  white  kidney.  Liver  appears  normal  in  size,  very 
soft  in  consistency.  Organ  greenish  black  owing  to  post-mortem  change.  Incis- 
ion through  its  substance  shows  that  it  has  advanced  so  far  that  it  is  impossible 
to  form  any  idea  as  to  the  original  appearance.  Intestines  were  probably  about 
normal,  except  that  at  present  they  are  distended  with  putrefactive  gases.  The 
enlarged  glands  mentioned  are  removed,  together  with  a  portion  of  the  spleen, 
but  a  more  complete  autopsy  than  that  described  in  the  preceding  notes  is  impos- 
sible owing  to  the  condition  of  the  cadaver. 

Provisional  anatomical  diagnosis. — Acute  polyadenitis;  acute  splenitis,  pos- 
sibly due  to  infection  with  a  bipolar  organism,  the  nature  of  which  is  to  be 
ascertained  by  bacteriological  examination.  Another  smear  made  from  the 
spleen  stained  for  a  long  time  with  carbothionin,  and  the  organisms  met  with 
previously  described  bear  a  much  stronger  resemblance  to  the  doughnut  type  of 
B.  pestis  than  the  preceding  slide. 

IL 

P.  S. ;  age,  35;  male;  died  Southern  Pacific  Railroad  Hospital,  July  19; 
necropsy  July  20  by  Asst.  Surg.  P..  J.  Lloyd.  Present:  Passed  Asst.  Surg. 
Rupert  Blue,  Asst.  Surgs.  Donald  II.  Cufrie  and  C.  W.  Vogel,  Doctors  Woolsey, 
Dickie,  Laughlin,  Buckley,  Hassler,  Morrow,  Hopper,  Coffey,  Gardner,  Carson, 
and  Schmitt. 

Necropsy. — Body  that  of  a  male  about  32  years  of  age;  Italian  race.  Body 
is  fairly  well  nourished  and  fairly  well  developed.  Rigor  mortis  is  present  and 
ratlier  marked.  Eyes  are  partially  open;  pupils  are  slightly  dilated;  there  is 
slight  injection  only  of  the  scler.'e.  Post-mortem  lividity  in  dependent  parts. 
No  marks  of  violence.  There  are  moderately  enlarged  lymph  nodes  in  the  left 
axilla.  The  tissues  surrounding  these  are  soft.  More  especially  on  the  surface 
of  the  right  arm  and  forearm,  and  to  some  extent  on  the  sides  of  the  chest 
and  abdomen,  there  are  a  number  of  small  dark  red  spots  which  are  subcu- 
taneous and  apparently  minute  hemorrhages.  The  lymph  nodes  in  the  left 
inguino-femoral  region  ""  not  palpable.  In  the  right  inguino-femoral  region 
is  a  large  mass  surrounded  by  an  area  which  superficially  is  soft  in  consistency 
but  not  fluctuating.  I'pon  making  deep  pressure  the  tissues  are  firmer,  and  alto- 
gether this  swelling  is  suggestive  of  enlarged  lymph  nodes  surrounded  by  an 
area  of  inflammation,  in  which  process  oedema  and  infiltration  are  marked 
features.  There  is  present  over  this  mass  a  small  preliminary  incision.  An 
extension  of  this  incision  reveals  a  number  of  enlarged  lymph  nofles,  with  hem- 
orrhage into  the  surrounding  tissues.  Section  of  these  nodes  shows  necrotic 
areas,  and  smears  from  them  with  the  ordinary  stains  show  doughnut-shaped 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  547 

bacteria  and  also  oocco-bacilli  which  take  a  bipolar  stain.  Body  is  opened  by 
long  median  incision.  Subcutaueons  fat  is  fairly  well  preserved.  Abdominal 
mnscles  are  apple  red  in  color  and  moist.  Abdominal  cavity  opened.  The  intes- 
tines are  not  distended.  Omentum  does  not  entirely  cover  intestines.  The 
vessels  of  the  intestinal  walls  are  prominent.  The  peritoneum  is  smooth  and 
jllistcnin;:.  and  beyond  injection  of  its  vessels  presents  nothing  unusual.  Appen- 
dix is  normal.  Si)leen  is  slightly  adherent  above  and  behind,  i)ut  is  removed 
without  difliculty.  The  organ  is  enlarged,  the  capsule  is  tense,  and  there  is 
an  area  of  partially  organized  lymph  corresponding  in  position  to  the  adhesions 
mentioned.  The  surface  Is  reddish  in  color,  but  uniformly  distributed  through- 
out are  very  small  whitish  areas,  which  ai-e  probably  beginning  sul)capsular 
nodules.  The  organ  is  only  fairly  firm  in  consistency.  Cuts  easily.  The  cut 
surface  is  rich  in  blood,  and  is  of  a  dark  reddish  color,  marked  by  minute 
whitish  points  throughout.  There  is  a  slight  bulging  of  the  pulp.  Just  above 
Poupart's  ligament,  on  the  right  side  of  the  body,  there  are  a  number  of  enlarged 
lymph  nodes  in  close  proximity  to  those  already  described;  further  no  nodular 
enlargement  is  noted.  Sternum  is  removed.  The  lungs  do  not  collapse  com- 
pletely when  thorax  is  opened.  The  left  lung  is  slightly  adherent  near  the 
apex  anteriorly.  The  right  is  apparently  free.  The  pericardium  is  opened 
and  is  found  to  contain  about  10  c.  c.  of  pale  straw-colored  fluid.  The  peri- 
cardial surfaces  are  normal  in  appearance,  except  that  the  blood  vessels  are 
prominent  and  somewhat  distended.  There  is  considerable  subpericardial  fat. 
The  heart  is  very  slightly  enlarged,  if  at  all,  and  the  left  side  of  the  heart, 
more  especially  the  left  ventricle,  is  firm  and  contracted.  The  left  lung  is 
removed ;  about  normal  in  size.  The  pleura  is  smooth  and  glistening.  The 
crepitation  is  diminished,  more  especially  in  the  upper  lobe  and  in  the  middle 
portion  of  the  lower  lobe.  On  section  the  cut  surface  is  bright  red  in  color,  and 
upon  pressure  there  is  a  thick,  viscid,  muco-serous  exudate ;  but  this  is  very 
small  in  amount  and  there  is  very  little  air  present.  The  right  lung  is,  perhaps, 
slightly  enlarged,  and  there  is  hypercrepitation  in  the  upper  and  what  there 
is  represented  of  the  middle  lobe.  In  the  lower  lobe  crepitation  is  diminished. 
Upon  section  the  upper  lobe  of  the  right  lung  is  dark  in  color,  (Edematous; 
pressure  cau.ses  serum  mixed  with  blood  and  a  large  quantity  of  air  to  exude; 
presents  contrast  to  the  condition  of  the  corresponding  lung  on  the  opposite  side. 
In  the  lower  lobe  pressure  causes  a  dark  fluid  to  exude  mixed  with  a  small 
quantity  of  air.  This  fluid  is  viscid  in  character  and  approaches  the  type  of 
fluid  which  exuded  from  the  upper  lobe  of  the  left  lung,  but  is  darker  in 
color.  Heart  is  removed.  The  right  ventricle  contains  a  considerable  quantity 
of  fluid  blood  and  a  few  small  post-mortem  clots.  The  left  ventricle  is  empty. 
There  is  a  small  mixed  clot  in  the  left  auricle.  The  semilunar  valves  of  the 
aorta  present  nothing  beyond  possibly  slight  roughening.  The  mitral  valve  is 
apparently  normal.  The  left  kidney  is  removed.  The  fatty  capsule  is  fairly 
rich  in  fat.  The  organ  is  slightly  enlarged,  firm  in  consistency.  The  surface 
is  of  a  reddish  color.  The  capsule  strips  readily.  The  organ  cuts  easily.  The 
relation  between  the  cortex  and  the  pyramids  is  well  retained.  The  cortex  is 
swollen  and  cedematous,  presenting  the  appearance  of  boiled  flesh.  Right 
kidney  removed.  Presents  about  the  same  general  appearance  as  the  left;  is 
even  a  better  picture  of  a  cloudy,  swollen  organ  than  is  the  left.  The  liver  is 
examined  in  situ.  The  cut  surface  is  of  a  light  reddish  color,  poor  in  blood, 
presenting  the  appearance  of  a  cloudy  swelling. 

Anatomical  conditions  noted. — Congestion  throughout  the  greater  part  of 
the  left  lung  marked  in  character,  the  air  vesicles  being  filled  with  a  viscid, 
muco-serous  exudate,  but  containing  air,  the  organ  not  consolidated.  The 
upper  and  middle  lobes  of  the  right  lung  are  in  a  condition  of  emphysema. 
Lower  lobe  presents  practically  the  same  appearance  as  the  left  lung  except  that 
the  exudate  is  of  a  darker  color  and  the  fluid  is,  perhaps,  slightly  more  viscid 
in  character.  There  is  cloudy  swelling  of  the  kidneys  and  of  the  liver;  pulpitis 
of  the  spleen  ;  polyadenitis  with  primary  bubo  in  the  right  inguino-femoral 
region.     Cause  of  death  to  be  determined  by  bacteriological  examination. 

III. 

P.  B. ;  age,  62;  female;  died  19  Jasper  place;  necropsy,  July  21,  by  Asst. 
Surg.  Donald  H.  Currie.  Present :  Passed  Asst.  Surg.  Rupert  Blue,  Asst.  Surgs. 
B.  J.  Lloyd  and  C.  W.  Vogel,  Doctors  Woolsey,  Dickie,  Mathewson,  Laughlin, 
O'Brien,  Hopper,  Morrow,  and  Schmitt. 


548  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Neceopsy. — Body  that  of  a  poorly  developed,  fairly  well-nourished  Italian 
female  about  70  years  of  age.  Rigor  mortis  well  marked.  Post-mortem  lividity 
slight.  Numerous  petechial  hemorrhages  scattered  over  lower  and  upper 
extremities.  Quite  general  oedema  of  a  moderate  extent.  Pupils  midway 
between  dilatation  and  contraction ;  sclerfe  slightly  injected,  showing  no  hemor- 
rhages. A  mass  of  glands  palpable  in  the  right  femoral  region  extending  into 
the  inguinal  region.  Another  mass  just  under  the  angle  of  the  inferior  maxilla 
(right  side).  No  glandular  enlargement  palpable  in  either  axilla.  No  signs  of 
trauma.  Incision  made  in  the  right  inguino-femoral  region,  crucial  in  shape. 
Subcutaneous  fat  unusually  well  preserved.  Flap  dissected  back  in  this  inci- 
sion, exposing  a  mass  of  glands.  There  is  very  little  surrounding  oedema  of  the 
tissues,  possibly  a  slight  increase  above  the  normal  moisture.  Glands  are  dis- 
sected out  en  masse,  together  with  the  adipose  tissue,  and  the  mass  incised, 
exposing  a  gland  enlarged  to  four  times  its  normal  size,  injected,  hemorrhagic, 
necrotic.  Incision  is  next  made  over  the  cervical  glands  mentioned.  Here  a 
mass  of  swollen,  injected,  partially  necrotic  glands  is  found  very  similar  in 
appearance,  but  larger  in  size,  than  those  in  the  inguino-femoral  region.  This 
swelling  is  found  to  consist  of  numerous  moderately  enlarged  glands,  together 
with  infiltration  in  the  surrounding  muscular  and  connective  tissue.  A  chain  of 
enlarged  lymphatics  is  followed  forward  almost  to  median  line.  Long  median 
incision  made.  Subcutaneous  fat  well  preserved.  Abdominal  muscles  very 
poorly  developed  and  of  a  lightish  red  color,  moderately  moist.  Smear  made 
from  the  first  gland  incised  in  the  inguino-femoral  region  stained  with  carbo- 
thioniu  shows  a  doughnut-shaped  organism,  also  a  few  bipolar  bacilli.  Peri- 
toneal cavity  opened.  Intestines  moderately  distended,  bulge  through  the 
abdominal  incision.  Peritoneal  coats  moist,  glistening,  very  slightly  injected, 
although  the  general  appearance  is  pale.  The  liver  is  visible  for  three  finger 
breadths  in  the  median  line  and  one  and  one-half  in  the  umbilico-maramary  line. 
The  peritoneal  cavity  is  very  moist  throughout.  In  the  pelvis  there  are  found 
possibly  10  c.  c.  of  clear  serum.  In  the  posterior  abdominal  region  in  line  with 
the  inflamed  glands  incision  is  made  into  the  muscles,  but  contrary  to  the  rule 
in  such  cases,  no  chain  of  inflamed  lymphatics  extend  upward  in  this  region. 
The  spleen  is  removed  without  difficulty,  being  nowhere  adherent.  The  organ 
is  found  to  be  enlarged  (taking  into  consideration  the  age  and  appearance  of 
the  woman)  possibly  three  times  its  normal  size.  It  is  very  soft  in  consistency. 
Its  capsules  show  many  areas  of  irregular  thickening,  together  with  numerous 
white  nodules  resembling  those  met  with  in  these  cases.  Capsule  is  slightly 
wrinkled.  Organ  cuts  very  easily.  The  pulp  flows ;  almost  comi)letely  disin- 
tegrated. The  fatty  cai)sule  surrounding  the  left  kidney  is  unusually  rich,  inter- 
fering in  the  removal  of  the  organ.  This  when  removed  shows  an  organ  about 
normal  in  size,  possibly  slightly  increased  (considering  the  age  of  the  patient), 
and  very  soft  in  consistency.  The  superficial  blood  vessels  over  the  capsule  are 
dilated.*  The  fibrous  capsule  strips  with  difficulty,  being  adherent  in  many 
places.  The  breaking  up  of  these  adhesions  causes  tearing  of  the  substance  of 
the  organ.  This  when  removed  exposes  a  granular,  yellowish  red  surface,  in 
which  the  stellate  veins  are  very  prominent.  Organ  cuts  easily,  but  with  slight 
grate.  Its  cut  surface  is  moderately  rich  in  blood.  Contrast  between  cortex 
and  pyramids  is  lost  in  areas  or  very  much  diminished.  The  cortical  border 
is  probably  about  two-thirds  the  original  breadth.  The  organ  has  a  general 
whitish  light  yellowish  color,  with  numerous  small  reddish  dots  scattered  over 
its  surface ;  probably  represents  an  old  interstitial  nephritis  on  which  an  acute 
cloudy  swelling  has  been  engrafted.  Thorax  is  opened  by  removal  of  sternum. 
The  costal  cartilages  show  very  little  ossification,  considering  the  age  of  the 
cadaver.  The  lungs  almost  meet  in  the  median  line,  only  partially  collapse 
anteriorly,  and  are  not  adherent  anteriorly.  The  left  lung  is  removed  easily,  not 
being  adherent  in  any  portion  of  the  pleural  cavity.  Spleen  shows  a  cocco- 
bacillus  taking  the  bipolar  stain.  The  lower  lobe  almost  completely  collapses 
in  its  central  two-thirds.  The  pleura  of  this  lobe  has  lost  some  of  its  glisten- 
ing, shows  numerous  subpleural  hemorrhages,  does  not  crepitate,  is  very  firm 
in  consistency.  Cuts  with  slight  resistance.  Its  cut  surface  shows  lobular 
pneumonia  involving  the  whole  lower  half  of  the  upper  lobe.  About  a  third  of 
this  lobe  situated  about  the  apex  is  not  involved.  The  lower  lobe  crepitates 
fairly  well  throughout,  though  less  so  than  the  normal  lung.  It  does  not  pit 
on  pressure.  Its  pleura  shows  the  subcapsular  hemorrhage  noted  in  the  other 
lobe,  but  the  luster  is  retained.  Incises  easily ;  cut  surface  rich  in  blood,  pres- 
sure causing  blood,  air,  and  serum  to  exude,  the  blood  being  in  rather  larger 
than  normal  proportion,  the  condition  being  hypostasis.    The  pericardial  sac  is 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  549 

surrounded  liy  fat;  opened,  found  to  contain  a  small  amount  of  blood-stained 
fluid.  Tbe  heart  itself  shows  n  considerahlo  enlargement,  probably  a  third  above 
the  normal,  compared  with  the  flst  of  the  individual.  It  is  surrounde<l  by  a 
heavy  layer  of  fat  which  shows  a  deep  lemon  color.  The  apex  of  this  organ  is 
foruKHl  almost  altogether  by  the  left  ventricle.  The  right  ventricle  is  opened 
and  found  almost  empty,  the  exception  being  a  small  amount  of  fluid  blood. 
The  right  auricle  is  opened ;  contains  a  few  dark  clots  and  moderate  amount  of 
fluid  blood  oidy.  The  left  ventricle  opened,  contains  post-mortem  clots,  one 
small  white  clot,  and  fluid  blood.  Smears  from  the  lungs  show  cocco-bacillus 
taking  a  bipolar  stain  and  a  doughnut-shaped  organism.  Left  auriculo- 
ventricular  opening  admits  two  gloved  fingers  easily  and  another  with  difliculty 
and  slight  stretching.  Right  auriculo-ventricular  opening  admits  five  gloved 
fingers  easily.  Heart  opened  throughout  and  washed.  There  is  one  rather- 
large  hemorrhage  situated  just  below  the  aortic  valve,  being  about  one-half 
inch  long  and  one-eighth  inch  in  width.  The  mitral  valve  shows  a  diffuse,  uni- 
form thickening  throughout,  the  finger  not  being  visible  through  it.  This, 
taken  in  connection  with  the  fact  that  only  two  fingers  passed  through  its 
orifice,  is  probably  stenosis.  The  aortic  valves  show  a  very  slight  thickening, 
no  adhesions  or  contractions.  The  aortic  surface  is  stained  a  deep  yellow, 
shows  very  few  Irregularities,  these  being  confined  to  two  or  three  plaques  a 
pin  head  in  size  and  very  slightly  raised.  Other  than  that  already  described, 
the  endocardium  itself  appears  transparent  and  normal.  Heart  muscle  shows 
neither  fatty  nor  fibroid  change  and  there  is  a  fair  degree  of  thickness  and 
consistency.  The  right  lung  is  removed  from  its  cavity  easily,  being  nowhere 
adherent.  Its  upper  and  middle  lobes  pit  on  pressure ;  the  lower  lobe  does  not 
pit  and  does  not  completely  collapse,  there  being  rather  a  firm  central  area  in 
this  latter  lobe.  The  upper  lobe  crepitates  fairly  well  throughout,  except  about 
its  lower  third,  where  there  is  a  long,  nari'ow,  centrally  located  area  of 
increased  consistency.  The  upper  lobe  cuts  rather  easily  ;  its  cut  surface  is  rich 
in  blood  and  deeplj'  blood-stained.  The  centrally  located  firm  area  mentioned  is 
devoid  of  air,  and  represents  an  early  stage  of  the  same  pneumonic  process  of 
the  opposite  lung,  differing  only  in  color  and  friability.  Sinks  wlien  thrown  into 
fluid.  The  lower  lobe  incised ;  its  cut  surface  is  found  to  be  deeply  injected 
and  rich  in  blood.  A  large  nodule,  about  as  large  as  the  last  joint  of  the 
thumb,  springs  up  mushroom-like,  being  raised  above  the  surrounding  surface 
in  the  form  of  a  flat,  circular  plaque.  This  is  incised  through  crosswise  and  at 
right  angles  to  the  original  incision,  and  an  area  of  pneumonia  in  the  stage  met 
with  in  the  left  lung,  as  determined  by  its  color  and  friability,  is  met  with.  Liver 
removed.  Probably  slight  increase  above  the  normal  size,  which  supposition  is 
carried  out  by  the  rounding  of  the  lower  border.  The  organ  is  of  a  chocolate 
brown  color  mixed  witli  areas  of  lighter  yellow  and  areas  of  a  brownish  purple; 
is  very  soft  in  consistency.  Capsule  very  transparent  and  smooth.  Cuts  easily; 
cut  surface  is  moderately  rich  in  blood  and  friable.  The  connective  tissue 
shows  up  rather  more  prominently  than  normal  and  there  is  possibly  some 
cloudy  change.  Except  for  the  general  anaemic  appearance,  the  intestines  point 
to  nothing  abnormal  so  far  as  external  examination  would  show,  and  are  not 
opened.     The  mesenteric  glands  are  not  enlarged. 

Anatomical  diagnosis. — Pneumonia,  acute  lobular;  acute  polyadenitis;  mitral 
stenosis ;  acute  pulpitis  of  spleen  ;  chronic  interstitial  nephritis,  acute  cloudy 
swelling:  cloudy  swelling  of  liver;  the  adenitis,  the  pulpitis  and  the  pneumonic 
process  due  to  infection  with  a  bipolar  bacillus,  the  nature  of  which  is  to  be 
determined  by  bacteriological  examination.  The  pneumonic  process  is  lobular 
in  character  and,  owing  to  the  necrotic  appearance  of  the  glands  on  the  one 
hand  and  the  comparatively  recent  appearance  of  the  pneumonia,  even  that  of 
the  left  lung,  on  the  other,  it  is  thought  that  the  adentis  is  primary  and  the 
pneumonia  is  secondary. 

IV. 

Y.  K.  J. ;  age,  44 ;  male ;  died  722  Jackson  street ;  death  occurred  9  a.  m.,  July 
29;  necropsy  same  day  by  Asst.  Surg.  B.  J.  Lloyd.  Present:  Pas.sed  Assistant 
Surgeon  Blue,  Assistant  Surgeons  Currie  and  Vogel,  Doctors  Morrow,  Hopper, 
Woolsey,  Laughlin,  Dickie,  and  Mathewson. 

Necropsy. — Body  that  of  Chinese  male  aliout  40  jears  of  age,  fairly  well 
nourished,  moderately  well  developed.  Post-mortem  rigidity  present ;  thumbs 
flexed  on  palm  and  fingers  flexed  over  thumbs.  Lividity  indepedent  parts. 
Pupils  slightly  contracted,  sclerre  .^somewhat  injected.  No  marks  of  violence,  no 
nodular  enlargement  in  the  right  axilla  or  right  inguinal  region.     In  the  left 


550  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

axilla  thero  ii=!  slicrht  enlargement  of  the  nodes.  In  the  left  inguino-femoral 
region  there  is  a  swelling  about  3*  inches  long  by  2  inches  broad,  and  over  this 
region,  \Ahich  is  cedematous,  there  are  a  number  of  well-marked  petechial  hem- 
orrhages. Petechi.ie  are  also  present  on  the  skin  of  the  forearms,  chest,  abdo- 
men, and  lower  limbs.  An  incision  is  made  into  the  swollen  tissues.  The 
lymphatics  in  both  the  inguinal  and  femoral  regions  are  enlarged,  the  individual 
nodes  being  from  two  to  several  times  as  large  as  normal :  the  tissues  composing 
them  are  hemorrhagic,  and  are  beginning  to  be  necrotic.  There  are  well-marked 
hemorrhages  into  the  tissues  surrounding  the  lymph  nodes,  extending  well  into 
the  muscles.  Smears  made  from  one  of  the  enlarged  nodes  and  stained  with 
carbothionin  shows  a  cocco-bacillus  taking  a  bipolar  stain  morphologically  indis- 
tinguishable from  B.  pestis.  Body  is  opened  by  a  long  median  incision.  Subcu- 
taneous fat  well  preserved.  Abdominal  muscles  are  red  in  color  and  moist. 
Abdominal  cavity  opened.  There  is  considerable  exudate  in  the  peritoneal 
cavity,  serous  in  character.  The  peritoneum  is  normal  in  appearance  except 
that  its  vessels  are  unduly  prominent.  Omentum  is  fairly  rich  in  fat ;  does  not 
completely  cover  the  intestines.  Appendix  normal.  The  tissues  of  the  meso- 
colon are'  hemorrhagic.  The  spleen  is  removed  without  difficulty,  is  somewhat 
enlarged,  and  the  capsule  is  fairly  tense.  On  the  posterior  surface  are  a  num- 
ber of  flaky  deposits  of  lymph ;  several  similar  whitish  patches  are  seen  beneath 
the  fibrous  capsule.  The  surface  is  of  a  light  bluish  color  fading  into  pink. 
The  organ  cuts  easily.  The  cut  surface  is  rich  in  blood,  dark  in  color,  the  pulp 
bulging,  the  jNIalpighian  corpuscles  prominent  as  whitish  spots.  Smears  from 
the  cut  surface  stained  with  thionin  show  cocco-bacilli,  some  of  which  are  bipo- 
lar as  in  the  lymph  nodes.  Sterniun  is  removed.  The  left  lung  is  visible  for 
about  one  finger-breadth  beyond  the  cut  border  of  the  cartilages.  Right  lung 
about  the  same.  Pericardium  is  opened;  the  cavity  contains  about  35  c.  c.  of  a 
pale  straw-colored  fluid.  Left  lung  is  removed ;  about  normal  in  size ;  crepi- 
tates throughout;  cuts  fairly  easily;  cut  surface  is  poor  in  blood.  Pressure 
causes  small  quantities  of  blood  and  serum  and  the  usual  quantity  of  air  to 
exude.  Right  lung  is  removed;  normal  in  size;  cuts  fairly  easily,  and  presents 
about  the  same  general  ap])earance  as  the  left.  Left  kidney  removed;  slightly 
enlarged.  Fatty  capsule  almndant.  Fibrous  capsule  strips  off  easily.  Surface 
of  kidney  pinkish  in  color.  Organ  cuts  easily ;  cut  surface  drips  blood.  Rela- 
tion between  cortex  and  pyramitls  well  retained.  After  pressing  out  the  excess 
of  blood  the  tissues  have  the  appearance  of  boiled  flesh.  Right  kidney  removed ; 
is  smaller  than  its  fellow  ;  fibrous  capsule  strips  readily ;  organ  cuts  easily ; 
presents  same  appearance  as  that  of  the  left.  The  heart  is  removed.  Subperi- 
cardial  fat  abundant.  Hemorrhages  are  present,  especially  in  the  wall  of  the 
left  ventricle.  Organ  is  firm  in  consistency.  Left  ventricle  contracted.  Right 
ventricle  contains  a  small  amount  of  semicoagulated  blood.  The  valves  are 
normal  in  appearance.  The  heart  muscle  has  the  appearance  of  boiled  flesh. 
Liver  removed ;  is  uniformly  enlarged ;  margins  rounded,  but  well  defined. 
Organ  cuts  easily.  Cut  surface  is  poor  in  blood  and  of  a  light  yellowish  color 
with  reddish  tint. 

Anatomical  conditions  noted. — Polyadenitis ;  hemorrhagic  septicaemia  due 
to  infection  by  an  organism  morphologically  identical  with  B.  pestis;  cloudy 
swelling  of  the  heart,  liver,  and  kidneys;  acute  pulpitis  of  the  spleen,  hydro- 
pericardium  and  hydro-peritoneum.  Cause  of  death  awaiting  bacteriological 
investigation. 

Provisional  diagnosis. — Bubonic  plague. 

V. 

C.  B. ;  age,  33  ;  male ;  died  at  German  Hospital. 

Necropsy. — Strongly  built,  well  nourished,  middle-aged  man  ;  marked  cyanosis 
of  face,  upper  half  of  trunk,  and  upper  extremities  ;  numerous  small  hemorrhages 
in  skin  in  upper  part  of  both  arms,  on  right  side  of  thorax,  and  over  abdomen. 
Hemorrhages  vary  in  size,  the  largest  ones  about  3  mm.  in  diameter.  Moderate 
oedema  of  subcutaneous  fatty  tissue  over  chest.  Muscle  normal.  Loose  areolar 
tissue  back  of  pectoralis  major  muscle  on  right  side  very  cedematous  and  full  of 
small  hemorrhages.  Small  hemorrhages  in  the  capsule  of  the  liver,  especially 
along  the  free  margin.  Some  adhesions  between  omentum  and  anterior  abdomi- 
nal wall.  Few  drops  of  blood-stained  fluid  in  recto-vesical  pouch.  Appendix 
normal.  Strong  adhesions  between  liver  and  diaphragm.  Diaphragm  on  right 
side,  fourth  rib ;  on  left  side,  fifth  rib.  Chest  well  formed ;  all  muscles  on  right 
side  of  thorax  cedematous.     Hemorrhage  about  size  of  silver  dollar  in  the  lower 


PUBLIC    HEALTH    AND    MARINK-HOSPrTAL    SERVICE.  551 

part  of  inodiastinum.  Tnblespoonful  of  hlood-stainod  fluid  in  loft  ploural  cavity. 
Stronji  adlu'sions.  Cupful  of  blood-stained  fluid  in  iicricardial  cavitj'.  Fow 
Lemorrlia^'cs  in  visceral  layer  of  ))ericardiuni  ;  more  in  jiarietal  layer.  Post- 
mortem clot  in  pulmonary  artery.  Heart  normal  in  size  and  form.  Endocar- 
dium diffusely  stained  with  liemajxlobin.  Valves,  aorto.  coronary  arteries  and 
heart  nmscle  normal.  Easily  broken  adhesions  in  upper  part  of  left  pleura. 
Left  luuK :  A  superficial  scar  a  little  below  apex,  pulmonary  tissue  (edematous 
and  hyi»erjemic.  Bronchial  tubes  filltHl  with  blood-stained  fluid.  Right  lung: 
Ailhesions  easily  broken,  except  those  between  diaphragm  and  lung — these  are 
strong.  Right  lung  same  condition  as  left,  even  more  a^dematous.  I'eribronchial 
Ij'uiph  glands  on  botli  sides  normal.  Spleen  enlarged — IS*  by  13*  by  7  cm. 
Easily  broken  adhesions  between  upper  surface  and  diaphragm.  Cut  surface  is 
dark  red.  opaque,  full  of  grayish-white  opaque  spots  about  1  mm.  in  diameter. 
The  spots  vary  in  diameter  from  those  scarcely  visible  to  aliove  size,  fairly 
regular  in  outline.  Left  adrenam  small,  otherwise  normal ;  loose  fatty  tissue 
around  kidney  is  a?dematous ;  part  of  adrenal  is  directly  attached  to  upper  pole 
of  kidney.  A  few  large  hemorrhages  in  the  sujxM-ficial  layers  over  capsule. 
Left  kidney  13i  by  0  by  3  cm.  Cortex  is  swollen,  little  opaque.  Numerous 
hemorrhages  in  fatty  tissue  around  renal  pelvis,  and  also  in  mucous  membrane 
of  calyces,  not  in  renal  pelvis  itself.  No  visible  nodules  in  kidney.  Right  kidney 
and  adrenal  exactly  same  as  left.  Glomeruli  in  both  kidneys  hyiiertemic.  Testi- 
cles cyanotic,  little  (edematous,  otherwise  normal.  Considerable  number  of 
small  hemorrhages  in  peritoneum.  Blood-stained  urine,  tablespoonful.  in  blad- 
der containing  hemorragic  flakes  floating  in  it.  Mucous  membrane  of  bladder 
cyanotic;  no  hemoiThages.  Many  small  hemorrhages  in  mucous  membrane  of 
rectum.  Stomach  contains  little  dark-brown  mucous  and  few  remnants  of  vuidi- 
gested  food.  Mucous  membrane  full  of  hemorrhages,  the  largest  about  3  mm.  In 
diameter.  Rest  of  mucous  membrane  is  swollen  and  opaque.  Loose  connective 
tissue  around  head  of  pancreas  shows  diffuse  hemorrhagic  infiltration.  No 
thrombosis  in  vessels.  Bile  duct  is  open.  Gall-bladder  shows  hemorrhagic  infil- 
tration of  wall  at  apex  of  bladder.  Mucous  membrane  and  contents  normal. 
Liver  large — 254  by  244  by  04  cm.  Some  hemorrhages  in  the  adhesions  between 
liver  and  diaphragm.  Cut  surface  opaque,  light  brown,  shows  few  small  irregu- 
lar opaque  spots.  Large  hemorrhage  near  the  hylus  of  liver,  extending  along  the 
loose  connective  tissue  around  portal  vein  to  the  connective  tissue  accompanying 
the  larger  branches  of  the  portal  into  the  liver  substance.  No  visil)le  changes  in 
the  veins  themselves.  Hemorrhagic  infiltration  behind  the  right  pectoral  muscle 
extends  into  pectoralis  minor.  That  muscle  shows  diffuse  infiltration.  Some  of 
the  vessels  that  pass  through  and  underneath  are  filled  with  red  clots,  which 
adhere  to  the  wall  of  the  blood  vessel.  Lymph  glands  in  right  axila  moderately 
enlarged,  hypertemic,  (edematous,  and  full  of  hemorrhages.  Slight  enlargement 
and  congestion  of  femoral  glands  on  both  sides.  Moderate  enlargement  and 
hyperjemia  of  lymph  glands  of  right  side  of  neck.  Hemorrhagic  infiltration  of 
loose  connective  tissue  and  muscle  above  right  clavicle.  Tonsils,  both  sides, 
slightly  enlarged:  right  one  shows  small  hemorrhage  at  upper  half;  the  left 
one  shows  hemorrhage  at  lower  half.  Small  hemorrhages  in  mucous  membrane 
of  the  base  of  tongue,  on  left  side.  Post-mortem  softening  of  lower  third  of 
esophagus.  The  mucous  membrane  of  lower  part  of  larynx  very  hji^eriemic; 
shows  small  hemorrhages.  Mucous  membrane  of  ti'achea  vei*y  much  roughened, 
covered  in  places  with  thin  grayish-white  pseudo-membrane ;  the  membrane 
is  quite  superficial  in  most  places.  Aorta  normal.  Thyroid  normal ;  lymph 
glands  of  mesentery  slightly  enlarged,  showing  hypersemia.  Numerous  hem- 
orrhages in  mucous  membrane  of  ileum,  especially  in  Peyer's  patches.  Solitary 
(lymph  glands)  follicles  in  lowest  part  of  ileum  are  considerably  swollen,  about 
size  of  millet  seed,  grayish  white  in  color,  rather  opaque.  Many  small  hemor- 
rhages in  the  mucous  membrane  of  the  large  intestine,  which  is  otherwise  normal. 
Diagnosis. — L'lcerated  pseudomembranous  inflammation  of  trachea  :  inflam- 
matory enlargement  of  spleen,  with  numerous  necroses ;  parenchymatous  degen- 
eration of  kidneys  and  liver;  congenital  misplacement  of  adrenals;  hemorrhagic 
septicfemia  ;  hypersipmia  and  oedema  of  both  lungs ;  old  scar  at  left  apex ;  adhe- 
sions in  both  pleural  cavities ;  perihepatitis,  chronica  adhaesiva. 

VL 

W.  C.  C. ;   age,  44  ;  male ;  died  735  Commercial  street ;   death  occurred  7  a.  m. 
August  21 ;    necropsy  same  day  by  Asst.  Surg.  B.  J.  Lloyd.     Present :    Passed 


552  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Asst.  Surg.  Rupert  Blue,  Assistant  Surgeon  Vogel,  Doctors  Morrow,  O'Brien, 
Hopper,  Dickie,  Mathewson,  O'Neill,  and  Laughlin. 

Necropsy. — Body  that  of  a  Chinese  male  about  38  years  of  age,  moderately 
well  nourished,  fairly  well  developed.  Post-mortem  rigidity  is  present  and  not 
very  easily  broken  up.  There  is  no  injection  of  the  sclerte.  The  pupils  are  mid- 
way between  dilatation  and  contraction.  There  is  sordes  on  the  teeth ;  a  small 
area  of  the  mucous  membrane  of  the  lower  lip  is  almost  abraded.  Post-mortem 
lividity  is  slight.  On  the  chest  wall  opposite  the  lower  margin  of  the  libs  are 
two  dark-colored  areas  about  2*  inches  long  by  one-fourth  of  an  inch  broad  that 
are  apparently  the  result  of  a  form  of  counter  irritation  known  as  Chinese 
"  black  san  treatment."  Upon  the  right  arm  and  forearm,  and  to  a  less  degree 
upon  the  left  arm,  are  a  number  of  ecchymoses.  Two  similar  areas  are  noted 
a  little  below  the  internal  condyle  of  both  lower  limbs.  There  is  no  nodular 
enlax'gement  in  the  left  axilla  nor  in  the  inguinal  or  femoral  regions.  The 
right  axillary  region  is  bulging ;  the  tissues  composing  the  swelling  in  this 
region  are  firm  on  deep  pressure,  but  superficially  they  are  cedematous.  On  mak- 
ing an  incision  into  this  apparently  swollen  mass  there  is  considerable  fat;  the 
tissues  are  blood  stained,  but  the  general  appearance  .suggests  more  a  post- 
mortem infiltration ;  upon  deeper  section  several  moderately  enlarged  nodes  are 
revealed.  The  tissues  surrounding  these  are  hemorrhagic,  and  the  parenchyma 
of  the  nodes  removed  is  necrotic.  Smears  from  these  necrotic  areas  stained 
with  carbo-thionin  show  cocco-bacilli  and  doughnut-shaped  bacteria.  Body  is 
opened  by  a  long  median  incision.  There  is  considerable  fat  in  the  subcutaneous 
tissues ;  muscles  are  dry,  red  in  color.  The  omentum  forms  an  apron,  covering 
about  two-thirds  of  the  exposed  intestines.  The  liver  is  barely  visible  below  the 
costal  borders.  The  intestines  are  normal  in  appearance ;  the  colon  is  slightly 
distended ;  the  appendix  points  downward  and  to  the  right.  Spleen  is  removed, 
is  uniformly  enlarged,  of  a  slatish  color,  fading  into  pink ;  the  capsule  is 
slightly  wrinkled,  but  as  a  matter  of  fact  is  fairly  well  filled  with  tissue  sub- 
stance, the  organ  being  considerably  enlarged ;  it  is  soft  in  consistency ;  cuts 
easily ;  cut  surface  is  rather  poor  in  blood ;  pulp  is  slightly  bulging  and  very 
soft.  There  is  a  slight  increase  in  the  connective  tissue.  The  lungs  collapse  on 
removal  of  the  sternum.  The  left  lung  is  removed  ;  crepitates  throughout ;  the 
lower  lobe  is  slightly  enlarged  and  crepitation  is  diminished ;  the  pleural  sur- 
faces ai'e  normal  in  appearance ;  the  organ  cuts  fairly  easily ;  the  cut  surface 
in  the  upper  lobe  of  the  lung  is  pale  red  in  color ;  pi'essure  causes  air,  serum, 
and  a  small  amount  of  blood  to  exude ;  in  the  lower  lobe  the  cut  surface  is 
darker  in  color,  is  cedematous ;  pressure  causes  serum,  blood,  and  air  to  exude. 
The  right  lung  is  removed  ;  is  about  normal  in  size  ;  crepitates  thi'oughout ;  the 
lung,  especially  the  lower  lobe,  is  cedematous ;  the  cut  surface  presents  about 
the  same  appearance  as  that  of  the  left.  Left  kidney  is  removed :  Organ  is 
slightly  enlarged ;  capsule  strips  readily.  I'he  surface  exposed  by  removiug 
the  capsule  is  of  a  light  pink  color,  with  areas  of  a  deeper  red ;  organ  cuts  fairly 
easily.  The  relation  between  the  cortex  and  the  pyramids  is  well  retained.  The 
cortex  is  swollen  and  is  of  a  light  pinkish-yellow  color.  Left  kichiey  removed ; 
there  are  a  number  of  small  hemorrhages  beneath  the  capsule  of  this  organ, 
otherwise  organ  presents  about  the  same  general  appearance  as  the  left,  being 
typically  cloudy  swollen.  Pericai-dium  is  opened  ;  cavity  contains  a  small  quan- 
tity of  fluid ;  the  veins  of  the  heart  are  somewhat  tortuous ;  subpericardial  fat, 
moderate  in  amoiuit.  Heart  is  removed ;  is  firm  in  consistency ;  the  left  ven- 
tricle is  empty ;  the  left  auricle  contains  a  small  post-mortem  clot ;  the  valves 
of  the  heart  are  normal  in  appearance ;  the  heart  muscle  is  cloudy  swollen ;  the 
right  ventricle  contains  a  few  post-mortem  clots ;  the  right  auricle  contains  a 
large  post-mortem  clot.  The  liver  is  enlarged ;  cuts  easily  and  is  moderately 
rich  in  blood ;  cut  siu-face  is  yellowish  red  in  color  and  presents  the  appearance 
of  cloudy  swelling.  Stomach  and  Intestines  not  examined.  Anatomical  condi- 
tions noted :  Terminal  oedema  of  the  lungs  ;  cloudy  swelling  of  the  heart  muscle, 
liver,  and  kidneys ;  acute  pulpitis  of  the  spleen,  with  slight  increase  of  its 
connective  tissue ;  petechial  hemorrhages,  subcutaneous  and  visceral ;  an  aden- 
itis not  vei'y  marked  in  character,  confined  to  the  lymph  nodes  in  the  right 
axilla ;  septicaemia  due  to  infiltration  by  a  cocco-bacillus  morphologically  re.sem- 
bling  B.  pestis. 

YII. 

E.  T.  S. ;  male ;  died  Southern  Pacific  Hospital ;  death  occurred  September  13 ; 
necropsy  September  14  by  Asst.  Surg.  B.  J.  Lloyd.  Present :  Passed  Asst.  Surgs. 
Rupert  Blue  and  M.  J.  TVhite,  Asst.  Surgs.  Donald  H.  Currie  and  C.  W.  Vogel, 


PUBLIC   HEALTH    AND    MARINE-HOSPITAL    SERVICE.  553 

Doctors  Morrow.  Ilopiu'r,  Woolscy,  Ellis.  Schiuitt,  McCarthy,  Hamilton,  Blue, 
Mathowsou.  Uossoii,  and  TlK)ni])son. 

Necroi'sy. — Body  that  of  a  fairly  wi'll-dovelopod.  wcll-nourlshod  male;  Ameri- 
can; about  ^8  years  of  ai?e.  I'ost-mortem  lividity  is  present,  rather  marked; 
post-mortem  rij,'idlty  well  niarkod  in  the  upi)er  and  lower  limbs,  including 
marked  contractions  of  the  muscles  of  the  extremities.  Sclerje  are  injected; 
pupils  are  slif,'litly  dilated.  There  is  a  blood-stained  discharge  from  the  nose; 
lips  are  blue.  There  are  petechial  hemorrhages  in  the  skin  over  the  side  of  the 
chest,  extending  into  the  axillary  region  on  the  left  side.  There  are  no  marks 
of  violence;  there  is  some  enlargement  of  the  lymph  nodes  in  the  axillary  and 
ingulno-femoral  regions  on  the  left  side.  There  has  been  a  preliminary  inci- 
sion over  a  mass  of  enlarged  glands  in  the  left  axilla,  and  smears  from  the  gland 
removed  show  an  organism  which  morphologically  has  the  appearance  of 
B.  pestis.  Examination  of  the  structures  revealed  by  this  incision  shows 
enlarged  lymph  nodes,  the  tissues  surrounding  these  nodes  being  edematous 
and  hemorrhagic.  One  of  tliese  lymph  nodes  is  removed,  and  upon  section 
shows  beginning  necrotic  areas,  with  cortical  injection.  An  incision  is  made 
into  the  left  femoral  region,  and  an  enlarged  lymph  node  about  two-thirds  the 
size  of  the  last  joint  of  tlie  little  finger  is  removed.  This  node  is  incised ; 
presents  cortical  injection.  Incision  into  the  right  femoral  region  reveals  a 
number  of  enlarged  lymph  nodes  wliich  have  the  same  appearance  as  the  other 
nodes  removed.  Body  is  opened  by  a  long  median  Incision.  The  subcutaneous 
fat  is  moderate  in  amount.  The  muscles  of  the  chest  and  abdominal  wall  are 
red  in  color  and  moist.  Abdominal  cavity  is  opened ;  the  omentum  almost 
entirely  covers  the  intestines ;  intestines  do  not  protrude  through  the  incision. 
Stomach  is  distended  with  gas.  On  laying  back  the  omentum  the  intestines  are 
seen  to  have  lost  their  glistening  appearance,  but  not  entirely.  The  vessels  of 
the  intestinal  wall  and  of  the  mesentery  are  prominent ;  the  mesenteric  lymph 
nodes  are  enlarged  throughout  the  greater  part  of  the  length  of  the  small  intes- 
tine. Appendix  is  normal  in  appearance  and  points  downward  into  the  pelvis. 
The  arch  of  the  diaphragm  on  the  right  side  is  fourth  interspace ;  left  fifth 
rib.  Spleen  is  easily  removed ;  capsule  tears  on  removal ;  organ  is  enlarged ; 
capsule  is  tense.  The  surface  of  the  spleen  is  of  a  light  bluish  color,  fading  into 
pink.  Beneath  the  capsule  are  a  number  of  small  hemorrhages.  Organ  cuts 
fairly  easily ;  the  cut  surface  is  red  in  color ;  fairly  rich  in  blood.  The  pulp  of 
the  spleen  bulges.  The  tissue  is  soft  and  friable,  the  condition  being  an  acute 
pulpitis.  Sternum  is  removed ;  tlie  lungs  do  not  entirely  collapse.  The  right 
lung  presents  for  about  two  linger  breadths  beyond  the  cut  border ;  the  left 
lung  is  barely  visible.  Pericardial  area  is  somewhat  increased  in  size.  Peri- 
cardium is  opened.  There  are  about  4  ounces  of  a  blood-stained  fluid  in  the 
pericardium.  There  are  pleuritic  adliesions  on  the  left  side  extending  posteri- 
orly, and  also  to  some  extent  on  to  the  diaphragm.  In  the  left  pleural  cavity  is 
a  small  quantity  of  blood-stained  fluid.  The  right  lung  is  free  from  adhesions. 
Left  lung  is  removed ;  is  slightly  enlarged ;  there  is  some  thickening  of  the 
pleura ;  organ  is  fairly  firm  in  consistency,  but  crepitates  throughout,  crepita- 
tion being  somewhat  diminished  in  the  lower  lobe.  The  organ  cuts  fairly 
easily ;  cut  surface  is  fairly  ricli  in  blood.  Pressure  causes  serum,  mixed  with 
blood  and  a  small  quantity  of  air,  to  exude.  The  organ  is  cedematous.  A  por- 
tion of  the  lung  when  placed  in  water  floats.  The  right  lung  is  removed. 
Organ  crepitates  throughout.  On  section  the  lung  is  only  fairly  rich  in  blood ; 
pressure  causes  a  muco-serous,  blood-stained  fluid  and  air  to  exude.  Left  kid- 
ney is  removed ;  fatty  capsule  is  abundant.  The  organ  is  very  much  enlarged. 
The  surface  of  the  kidney  is  pink  in  color ;  beneath  the  capsule  are  a  number  of 
small  hemorrhages.  The  fibrous  capsule  strips  readily,  exposing  a  surface 
which  is  red  or  pinkish  in  color,  and  presenting  both  the  appearance  of  capillary 
injection  (judging  from  the  color)  and  hemorrhagic  areas.  Organ  cuts  easily; 
cut  surface  light  red  in  color.  The  contrast  between  the  pyramids  and  the 
cortex  is  very  w'ell  retained.  Cortex  is  swollen  and  the  organ  generally  has 
the  appearance  of  boiled  flesh,  the  condition  being  that  of  cloudy  swelling,  with 
perhaps  degenerative  changes.  The  right  kidney  is  removed ;  presents  large 
hemorrhages  under  the  capsule.  Organ  is  about  the  same  size  as  the  left.  The 
capsule  strips  readily.  Organ  cuts  easily.  Presents  the  same  general  appear- 
ance as  that  of  the  left  kidney.  Heart  is  removed ;  is  about  normal  in  size. 
The  superficial  vessels  are  prominent.  Subpericardial  fat  is  moderate  in 
amount.  Right  ventricle  is  opened ;  contains  fluid  blood.  The  tricuspid  orifice 
admits  tn'o  gloved  fingers.  The  left  ventricle  is  opened  and  contains  a  quan- 
tity of  semicoagulated   blood.     The  auricles   contain   post-mortem   clots.     The 


554  PUBLIC   HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

aortic  valves  are  normal  in  appearance.  The  heart  muscle  is  pale  red  in  color. 
Liver  is  slightly  enlarged.  The  margins  of  the  organ  are  clear-cut ;  it  is 
fairly  soft  in  consistency.  The  gall  bladder  is  distended ;  there  are  no  evidences 
of  anything  but  bile  in  the  gall-bladder.  The  surface  of  the  liver  is  pale  and 
there  are  discolored  areas  corresponding  to  the  impressions  of  the  ribs.  These 
areas  are  dai'k  red  in  color,  and  are  almost  ecchymotic  in  character.  Organ  cuts 
easily ;  the  cut  surface  is  pale  yellowish  in  color,  is  poor  in  blood ;  there  is  no 
increase  in  the  connective  tissue.  The  stomach  and  the  pancreas  are  not 
removed. 

Anatomical  conditions  noted  :  Polyadenitis,  the  lymph  nodes  showing 
necrotic  areas  and  cortical  hemorrhages ;  an  acute  myocarditis ;  acute  pulpitis 
of  the  spleen ;  cloudy  swelling  of  the  kidneys ;  acute  fatty  degeneration  of  the 
liver.  Septicaemia  due  to  the  presence  of  an  organism  morphologically  indis- 
tinguishable from  B.  pestis. 

Cause  of  death, — Bubonic  plague  (provisional  diagnosis), 

VIII. 

K.  I. ;  age,  2G ;  male ;  died  505  Dupont  street ;  death  occurred  October  7 ; 
necropsy  October  9  by  Asst.  Surg.  B.  J.  Lloyd.  Present:  Passed  Asst.  Surg. 
Rupert  Blue,  Drs.  Howard  Morrow,  William  C.  Hopper,  Caiietou  Mathewson, 
and  Chester  H.  Woolsey. 

Neckopsy. — Body  that  of  a  Japanese  male  about  33  years  of  age ;  fairly  well 
developed,  moderately  well  nourished.  Post-mortem  rigidity  has  passed  away, 
except  for  a  very  slight  stiffening  in  the  lower  extremities.  Post-mortem 
lividity  is  present  and  is  peculiar  in  that  the  courses  of  the  superficial  veins  are 
very  clearly  mapped  out  over  the  greater  part  of  the  entire  body.  There  are 
moderately  enlarged  lymph  nodes  in  the  left  axilla  ;  and  to  a  very  slight  extent 
in  the  right.  There  is  a  slight  nodular  enlargement  in  the  right  femoral  and 
inguinal  regions  and  also  the  left.  On  the  side  of  the  chest,  upon  the  right  side 
of  the  body,  the  epidermis  is  peeled  off  in  three  patches  about  the  size  of  a 
dollar.  Pupils  are  midway  between  dilatation  and  contraction ;  sclene  are  not 
injected.  Lips  have  a  bluish  discoloration ;  slight  discharge  from  the  mouth, 
mucous  in  character.  Incision  is  made  into  the  left  axilla.  Tissues  here  are 
moist.  An  enlarged  lymph  node  is  removed.  The  surface  of  this  node  is  red- 
dish, substance  is  soft ;  fairly  rich  in  blood.  Smears  made  from  this  node  show 
oi-ganisms  morphologically  identical  with  B.  pcsti-s.  Incision  is  made  into  the 
right  axilla,  and  similar  enlarged  lymph  nodes  are  revealed.  The  lymph  nodes 
in  the  inguinal  regions  are  very  small.  Body  is  opened  by  a  long  median  inci- 
sion. Subcutaneous  fat  is  moderate  in  amount.  Abdominal  muscles  are  bright 
red  in  color,  moist.  The  intestines  do  not  protrude  through  the  incision.  The 
omentum  almost  completely  covers  the  intestines.  The  stomach  is  somewhat 
distended  with  gas  and  is  visible  for  about  a  hand's  breadth  in  the  median 
line.  The  arch  of  the  diaphragm  on  the  right  side  is  opposite  the  fifth  rib ;  on 
the  left  side  is  opposite  the  sixth  interspace.  The  appendix  is  normal ;  points 
downward;  curved  upon  itself.  Spleen  is  removed;  is  enlarged;  capsule  is 
tense ;  surface  is  of  a  uniform  pinkish  color.  The  consistency  is  soft.  Organ 
cuts  very  easily ;  cut  surface  is  bright  red  in  color  and  there  is  bulging  of  the 
pulp.  Sternum  is  removed.  The  right  lung  is  rather  unduly  prominent.  The 
lungs  do  not  quite  meet  in  median  line.  There  is  a  l)lood-stained  fluid  in  both 
pleural  cavities.  The  pericardial  area  is  increased  in  size.  The  heart,  as  felt 
through  the  pericardial  sac,  is  soft  and  flabby.  On  opening  the  pericardium  we 
find  about  .30  c.  c.  of  blood-stained  serum.  The  vessels  are  tortuous.  Beneath 
the  capsule  over  the  lower  portion  of  the  right  ventricle  and  also  on  the  poste- 
rior wall  of  the  left  ventricle  are  a  number  of  very  small  hemorrhages.  The 
right  ventricle  is  opened;  contains  post-mortem  clot.  The  left  ventricle  is 
opened;  contains  both  fluid  blood  and  post-mortem  clots.  There  are  enlarged 
lymph  nodes  in  the  mesentery.  The  left  lung  is  removed.  The  organ  is  a 
little  larger  than  normal ;  it  is  cedematous ;  pits  on  pressure.  The  pleural 
surfaces  are  slightly  roughened.  Crepitation  is  well  marked  over  the  upper 
lobe.  It  is  also  present  in  the  lower  lobe,  but  somewhat  diminished,  espe- 
cially near  the  central  portion.  The  organ  cuts  easily ;  the  cut  surface  is 
rich  in  blood  and  is  of  a  reddish  color,  which  color,  however,  is  broken  by  a 
number  of  areas  of  lighter  appearance.  Pressure  causes  large  quantities  of 
blood  and  serum  and  a  diminished  quantity  of  air  to  exude.  The  right  lung  is 
removed.  Organ  is  heavier  than  normal ;  crepitates  throughout ;  pits  on  pres- 
sure.    Pleural  surfaces  are  slightly  roughened.     The  cut  surface  of  this  organ 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  f)55 

presents  about  the  same  general  appearance  as  that  rtescribed  In  the  left.  The 
left  kidney  is  removed.  The  orfrau  is  somewhat  enlarged:  fatty  capside  not 
very  ahiUKhuit.  There  are  several  small  hemorrhages  beneath  the  capsnle. 
Capsule  strips  fairly  easily,  exposing  a  surface  which  is  i)ale  yellowish,  almost 
whitish,  in  color.  The  contrast  between  the  cortex  and  the  pyramids  is  fairly 
well  retained.  The  pyramids  stand  out  prominently  and  are  injected.  Right 
kidney  is  removed;  is  enlarged.  There  are  a  few  subcapsular  hemorrhages. 
The  contrast  between  the  cortex  and  the  pyramids  is  only  fairly  well  retained. 
The  cortical  border  is  whitish,  somewhat  mottled,  in  appearance,  and  the  pyra- 
mids are  prominent.  The  liver  is  slightly  enlarged.  Its  margins  are  some- 
what roiuided.  The  surface  is  pinkish  in  color,  with  areas  of  a  darker  hue. 
The  organ  is  soft;  cuts  fairly  easily;  cut  surface  is  pale  yellowish  in  color, 
presenting  the  appearance  of  boiled  tlesh.  The  heart  is  removed  by  severing  the 
vessels.  Its  cavity  is  laid  open.  The  valves  are  fairly  normal  In  appearance. 
The  heart  muscle  is  pale  red  in  color. 

Anatomical  conuitioxs  noted. — Acute  myocarditis,  with  hydropericardium ; 
terminal  anlenia  of  the  lungs ;  acute  pulpitis  of  the  spleen ;  cloudy  swelling  of 
the  liver;  acute  ])arenchymatous  degeneration  of  the  kidneys;  polyadenitis; 
septicaemia  due  to  infection  with  an  organism  morphologically  identical  with  B. 
pest  is.  which  organism  is  associated  with  a  diplococcus. 

IX. 

J.  M.  T.  S. ;  age,  23  ;  female ;  died  30  Fish  alley ;  death  occurred  3..30  p.  m. 
October  20.  1003 ;  necropsy  October  21  by  Asst.  Surg.  B.  ,T.  Lloyd.  Present : 
Passed  Asst.  Surg.  Rupert  Blue,  Asst.  Surg.  Donald  H.  Currie,  Doctors  Howard 
Morrow.  William  C.  Hopper,  W.  M.  Dickie,  Carleton  Mathewson,  and  Arthur 
A.  O'Neill. 

Necropsy. — Body  that  of  a  Chinese  female  about  23  years  of  age ;  fairly  well 
developed,  well  nourished.  The  lymph  nodes  in  the  axillaiy  and  inguino- 
femoral regions  can  be  made  out  on  palpation.  Post-mortem  lividity  is  pres- 
ent, but  slight.  Rigor  mortis  present  in  the  lower  extremities.  Pupils  are 
slightly  dilated.  The  teeth  are  covered  with  sordes,  and  the  lips  have  a  brownish 
discoloration.  There  are  no  petechia?  present.  Abdomen  is  slightly  distended. 
An  incision  is  made  into  the  right  axillary  region,  and  a  small  lymph  node  Is 
removed.  The  tissues  in  the  immediate  vicinity  are  moist  but  not  (edematous. 
This  node  is  of  an  ordinary  flesh  coloi*.  Cut  section  is  normal  in  appearance. 
Smears  made  from  the  cut  surface  stained  with  carbo-thionin  show  a  few 
organisms  which  morphologically  resemble  B.  pcstis.  Body  is  opened  by  a 
median  incision.  The  subcutaneous  fat  is  unusually  large  in  amount  for  one 
of  this  race.  The  abdominal  muscles  are  red  in  color  and  moist.  Intestines 
bulge  slightly  through  the  opening.  The  omentum  does  not  cover  the  intestines ; 
is  quite  rich  in  fat.  The  intestines  are  normal  in  appearance;  have  not  lost 
their  glistening.  Appendix  points  toward  the  pelvis,  is  quite  long,  and  except 
for  the  prominence  of  its  vessels  there  is  nothing  unusual  in  its  appearance. 
On  the  right  side  the  arch  of  the  diaphragm  is  at  the  level  of  the  fifth  rib ; 
left,  fifth  interspace.  Spleen  is  removed.  The  organ  is  almost  pink  in  color,  is 
uniformly  enlarged,  and  the  lower  border  presents  four  distinct  notches. 
It  is  soft,  cuts  easily ;  the  cut  surface  is  very  dark  in  color,  quite  rich  in  blood. 
There  is  bulging  of  the  pulp  and  the  organ  is  somewhat  friable.  Smears  made 
from  the  spleen  show  a  diplococcus  and  a  cocco-bacillus  morphologically  iden- 
tical with  B.  ijrstis.  Sternum  is  removed.  The  lungs  do  not  collapse.  The 
right  is  visible  for  barely  two  finger  breadths  beyond  the  cut  border.  The  left 
is  just  visible.  The  pericardial  area  is  slightly  increased  in  size.  The  vessels 
on  the  external  surface  of  the  pericardium  are  rather  prominent.  There  are  no 
adhesions  of  the  pleume.  Pericardial  sac  is  opened ;  contains  about  30  c.  c. 
of  a  pale  straw-colored  fluid.  The  subpericardial  fat  is  fairly  abundant. 
There  are  one  or  two  small  bright  red  spots  under  the  surface  of  the  pericardiiim, 
which  are  apparently  small  hemorrhages.  The  substance  of  the  heart  is  not 
A-ery  firm  in  consistency.  The  heart  is  removed ;  is  slightly  enlarged.  The 
apex  is  formed  almost  entirely  of  the  left  ventricle.  The  right  ventricle  is 
opened  and  contains  fiuid  blood.  Left  ventricle  opened  ;  is  found  to  contain 
a  small  quantity  of  fluid  blood.  The  aortic  and  mitral  valves  are  normal  in 
appearance.  The  surface  of  the  endocardium  is  smooth.  The  heart  muscle  has 
the  appearance  of  boiled  flesh.  The  left  lung  is  removed.  The  organ  is  perhaps 
slightly  enlarged  and  is  somewhat  (edematous ;  crepitates  throughout.  The  ves- 
sels of  the  lung  underneath  the  pleura  are  prominent ;  the  pleura  is  glistening. 


556  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

Organ  cuts  fairly  easily ;  cut  surface  is  rich  in  blood.  Pressure  causes  a  large 
quantity  of  serum,  mixed  with  some  blood  and  air  to  exude.  Left  lung  is  re- 
moved ;  crepitates  throughout,  but  crepitation  is  diminished  in  the  lower  lobe. 
The  cut  surface  is  very  dark  in  color.  Large  quantities  of  serum  pour  out  of  the 
vesicles,  and  the  amount  of  air  contained  is  less  that  normal.  A  portion  of  the 
lung  excised  just  floats  when  placed  in  water.  Smears  from  the  lung  stained 
with  carbo-thioniu  show  organisms  resembling  B.  pcsti'<.  Left  kidney  is  removed. 
The  fibrous  capsule  strips  easily.  Beneath  the  capsule  are  a  number  of  hem- 
orrhages. Organ  is  pink  in  color.  Cuts  fairly  easily ;  cut  surface  is  light 
yellow  in  color,  and  the  contrast  between  the  cortex  and  pyramids  is  fairly 
well  retained,  the  appearance  being  that  of  boiled,  flesh.  The  right  kidney 
presents  about  the  same  general  appearance  as  the  left,  both  as  to  external  sur- 
face and  cut  section.  The  liver  is  examined  in  situ.  Its  surface  is  light  red 
in  color.  There  are  one  or  two  small  hemorrhages  beneath  the  capsule.  The 
cut  surface  of  the  liver  is  not  very  rich  in  blood,  and  presents  the  appearance  of 
cloudy  swelling.  The  pelvic  organs  are  examined  in  situ  and  nothing  abnormal 
is  found. 

Anatomical  conditions  noted. — Cloudy  swelling  of  the  heart  muscle,  liver, 
and  kidneys  (in  the  kidneys  amounting  practically  to  parenchymatous  degenera- 
tion) ;  acute  oedema  and  congestion  of  the  lungs;  aciite  pulpitis  of  the  spleen. 
There  are  hemorrhages  beneath  the  pleura  and  beneath  the  pericardium  and 
the  fibrous  capsule  of  the  kidney.  There  is  a  polyadenitis  of  very  insignificant 
type.  Septicaemia  due  to  the  presence  of  an  organism  morphologically  identical 
with  B.  pestis. 

Cause  of  death. — Bubonic  plague  (provisional  diagnosis). 

X. 

C.  L. ;  age,  54 ;  male ;  died  32  Fish  alley  ;  death  occurred  4.30  p.  m.,  October 
22 ;  necropsy  October  23,  by  Asst.  Surg.  Donald  H.  Currie.  I'resent :  Passed 
Asst.  Surgs.  Rupert  Blue,  W.  G.  Stimson,  and  Hugh  S.  Cumming;    Asst.  Surgs. 

B.  J.  Lloyd,  C.  E.  D.  Lord,  and  W.  M.  Wightman ;  Surg.  W.  F.  Arnold,  U.  S. 
Navy ;  Dr.  S.  J.  Call,  of  the  Revenue-Cutter  Service ;  Doctor  McDonald,  bac- 
teriologist to  the  board  of  health  at  Honolulu ;    Drs.  Howard  Morrow,  William 

C.  Hopper,  W.  M.  Dickie,  Carletou  Mathewson,  Arthur  A.  O'Neill,  and 
Bellinger,  of  Omaha. 

Necropsy. — Body  that  of  a  fairly  well  nourished,  moderately  well- 
developed  Chinese  male  about  50  years  of  age.  Sclerse  very  slightly  injected, 
showing  no  hemorrhages ;  pupils  contracted  moderately.  Post-mortem  lividity 
moderate  over  dependent  parts,  especially  about  the  shoulders  and  neck.  Two 
hemorrhages  due  to  Chinese  counter  irritation  just  above  the  inner  end  of 
either  clavicle.  A  Chinese  ointment  on  the  skin  over  the  lower  portion  of  the 
sternum.  Rigor  mortis  almost  absent.  Muscles  of  calves  of  legs  contracted. 
Fingers  flexed  only  moderately  on  palms  of  hands ;  thiimbs  not  flexed.  A 
swelling  in  the  left  inguino-femoral  region  is  noted ;  is  covered  with  some 
Chinese  medicine.  This  swelling  extends  from  about  the  level  of  Poupart's 
ligament  to  the  beginning  of  the  middle  third  of  the  thigh,  anterior  aspect. 
There  is  oedema  in  this  region  and  examination  by  palpation  shows  that  appar- 
ently the  enlargement  is  due  to  a  mass  of  glands  which  are  matted  together  by 
surrounding  oedema.  Incision  is  carried  through  this  area.  Tissues  are  found 
to  be  injected  and  oedematous,  and  about  one-half  inch  beneath  the  surface  of 
the  skin  a  large  mass  of  very  hemorrhagic  glands  is  found.  The  surrounding 
tissue  appears  very  moist,  the  oedema  is  not  sufficient  to  cause  a  flow  of  serum 
from  the  dependent  portion  of  tlie  incision.  Smear  made  from  this  mass  of 
inflamed  glands.  This  infiltration  is  found  extending  over  the  subcutaneous 
and  periglandular  tissue  down  to  the  nmscle.  The  glands  incised  through  and 
show  hemorrhage  and  intense  injection,  there  being  little  or  no  necrosis.  After 
this  mass  has  been  excised  tlie  space  left  by  its  removal  fills  up  with  a  sero- 
hemorrhagic fluid,  but  less  tlian  is  usually  the  case  in  plague.  Incision  carried 
over  the  right  inguino-femoral  region.  From  under  the  foreskin  of  the  penis  is 
noticed  a  discharge  of  a  purulent  fluid.  It  is  found  to  be  in  a  state  of  balanitis. 
Smear  made  from  this  fliiid  shows  that  an  organism  in  every  respect  identical 
with  B.  pestis  is  present  in  large  nmnbers.  There  are  also  other  organisms 
present,  but  the  latter  are  greatly  in  the  minority.  From  this  we  are  led  to 
infer  (if  this  organism  prove  to  be  pest)  that  we  have  here,  among  other  things, 
a  plague  balanitis.  Smears  from  the  gland  show  a  pest-like  organism  in 
almost  pure  culture,  the  exception  being  a  few  diplocoeci.    The  smears  from 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  557 

the  splcon  show  only  saprophytic  rods.  Incision  is  made  in  the  right  axillary 
region,  but  neither  nedenia  nor  glandular  enlargement  is  found.  Incision  is 
made  in  the  left  axillary  region,  but  nothing  is  notwl.  Long  median  incision 
made.  Subcutaneous  fat  well  preserved  and  i-ather  moist.  Muscles  about  normal 
in  color,  moist  and  fairly  well  developed.  The  intestines  do  not  bulge  through 
the  abdominal  opening  and  are  only  partially  covered  by  omentum.  Omentum 
rich  in  fat ;  intestinal  coats  moist,  smooth,  and  glistening.  The  abdominal  cavity 
contains  no  free  fluid,  although  there  is  an  excess  of  moisture  on  the  intestinal 
coats.  The  ai)pendix  is  rather  larger  in  circmuference  than  is  usually  the  case; 
it  points  toward  the  umbilicus,  upward  and  slightly  backward.  It  is  filled  with 
fluid  faves,  and  is  normal  in  appearance.  The  liver  is  visible  for  less  than  two 
gloved  fingers  in  the  median  line,  not  visible  at  all  in  the  innbilico-mammary 
line.  It  is  reddish  yellow  in  color,  the  latter  predominating.  There  are  several 
stains  just  beneath  the  capsule,  apparently  hemorrhagic  in  character.  The 
spleen  is  bound  by  a  few  soft  adhesions  to  the  abdominal  wall  and  the  viscera, 
but  is  removed  without  difficulty.  Organ  about  normal  in  size :  its  capsule 
wrinkled ;  extremely  soft  in  consistency.  In  that  portion  which  has  not  under- 
gone post-mortem  change  it  is  of  a  reddish-gray  color.  The  organ  shows  no 
subcapsular  nodules.  It  cuts  easily :  cut  surface  shows  pulp  bulging  and 
diffluent.  The  surface  is  rather  poor  in  blood.  The  thorax  is  opened  by  removal 
of  sternum,  and.  with  the  exception  of  the  cartilage  of  the  first  rib,  shows  no 
ossification.  The  right  lung  collapses  completely  anteriorly,  and  extends 
toward  the  median  line  for  one  finger  breadth  beyond  the  cut  border  of  the 
cartilages.  The  left  lung  almost  completely  collapses  anteriorly,  and  extends 
for  about  the  same  distance  toward  the  median  line.  The  pericardial  area  is 
apparently  slightly  increased  in  size.  The  pericardial  sac  is  opened  and  the 
heart  lifted  out.  The  sac  is  found  to  contain  probably  2o  or  30  c.  c.  of  clear 
blood-stained  serum.  The  apex  of  the  heart  is  formed  about  equally  by  the 
right  and  left  ventricles.  The  superficial  vessels  ai-e  very  slightly  engorged  and 
tortuous,  some  of  them  showing  an  early  sclerotic  change  in  their  coats.  There 
are  several  very  small  milk  spots  over  the  surface  of  the  right  ventricle.  There 
are  no  hemorrhages  beneath  the  pericardium.  The  left  ventricle  is  opened ; 
contains  fluid  blood  with  a  few  very  small  post-mortem  clots.  The  right  ven- 
tricle is  opened :  contains  fluid  blood  and  gas.  The  left  auricle  is  opened ;  con- 
tains fluid  blood  and  post-mortem  clots.  The  right  auricle  contains  a  large  ante- 
mortem  clot,  also  post-mortem  clots  and  fluid  blood.  The  right  auriculo- 
ventricular  opening  admits  six  gloved  fingers  easily.  The  left  auriculo- 
venti-icular  opening  admits  two  gloved  fingers  easily  and  three  with  slight 
stretching.  The  left  lung  is  removed  from  its  cavity,  is  found  to  be  adherent 
over  posterior  portion  of  its  lower  lobe,  the  adhesions  apparently  of  rather  long 
standing.  The  lung  is  removed  by  excising  its  bronchial  connection  and  the 
pleural  surface  washed.  The  organ  is  about  normal  in  size  for  the  individual. 
The  upper  lobe  has  not  completely  collapsed.  The  pleural  surface  of  the  upper 
lobe  has  not  lost  its  luster  and  glistening.  It  shows  one  or  two  subpleural 
hemorrhages.  Organ  pits  on  pressure,  shows  rather  deficient  crepitation,  the 
latter  being  due  to  the  (edematous  fluid.  The  surface  of  the  lower  lobe,  except 
for  a  few  hemorrhages  underneath  its  i^leura,  apiiears  normal.  Fits  to  a  less 
extent  than  the  upper  lobe  and  crepitates  rather  deficiently.  The  incision  is 
carried  through  both  upper  and  lower  lobes.  The  siu'face  of  the  upper  lobe  is 
of  a  dark  red  color,  and  contains  a  rather  large  quantity  of  serum  and  blood. 
Pi-essure  causes  a  large  quantity  of  blood-stained  serum  and  a  moderate  quan- 
tity of  air  to  exude.  A  portion  of  this  is  excised  and  thrown  into  water  and 
found  to  float  fairly  high.  The  surface  of  the  lower  lobe  is  of  the  same  deep 
reddish  color :  contains  a  large  per  cent  of  lilood,  though  the  upper  lobe  also 
contains  less  air.  A  piece  of  the  lower  lobe  is  excised,  thrown  into  water,  and 
found  to  float  lower  than  that  of  upper  lobe.  The  left  lung  is  removed :  it  is 
found  to  be  firmly  adherent  on  its  diaphragmatic  surface  to  the  lower  lobe.  In 
excising  the  bronchial  couuec-tions  of  this  lobe  it  is  found  that  the  mediastinal 
glands  show  calcareous  degeneration,  probably  the  result  of  degenerated  tuber- 
cular processes.  The  organ  is  apparently  somewhat  subnormal  in  size  for  the 
individual ;  collapsed  almost  completely.  Slight  pitting  over  the  middle  and 
lower  lobes  alone  is  noted.  The  pleural  surface  appears  normal.  The  organ  is 
about  normal  in  consistency  and  resistance ;  cuts  rather  easily ;  its  cut  surface 
is  of  a  rather  dark-reddish  color.  Pressure  causes  some  blood,  serum,  and  air 
to  exude.  Portion  of  this  lung  thrown  into  water  floats.  The  heart  is  removed 
by  excising  the  vessels  at  its  base,  washed,  and  it  is  found  that  the  mitral  valve 
shows  a  very  slight  thickening ;  aortic  valves  very  slightly  about  their  connection 


558  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

only ;  none  of  these  conditions  being  sufficient  to  be  of  any  practical  importance. 
There  is  one  hemorrhage  under  the  endocardium.  The  aortic  surface,  however, 
shows  numerous  depressions  and  raised  plaques :  these  do  not  obstruct  the 
coronary  openings.  The  heart  muscle  is  of  a  brownish-red  color,  about  normal 
in  thiclcness,  and  fairly  normal  in  consistency.  It  is  probable  that  there  were 
no  inflammatory  or  degenerative  changes  of  any  importance.  The  left  kidney  is 
removed.  The  fatty  capsule  is  found  to  be  very  well  preserved.  In  removing 
it  the  fibrous  capsule  strips  off.  exposing  a  very  granular,  light-mottled  surface, 
being  a  mixture  of  areas  of  light  yellow  and  purplish  blue.  The  surface  also 
shows  prominent  stellate  veins.  Organ  is  smaller  than  normal ;  rather  firm  in 
consistency ;  cuts  with  considerable  resistance :  the  cut  surface  shows  a  much 
diminished  cortical  border,  with  the  contrast  between  the  cortex  and  the  pyra- 
mids fairly  well  retained.  The  surface  is  very  poor  in  blood.  Liver  is  removed ; 
is  found  to  be  subnormal  in  size,  probably  a  third  below  the  normal.  It  is  of  a 
general  yellowish-brown  color,  with  large  areas  of  lighter  yellow,  small  areas  of 
bluish  black.  The  lower  border  of  the  organ  is  thin.  It  is  rather  soft  in  con- 
sistency. Cuts  with  a  moderate  amount  of  resistance ;  its  cut  surface  is  rather 
poor  in  blood,  presenting  a  general  boiled  appearance  and  giving  a  slight  grate 
when  the  knife  is  drawn  across  its  surface.  There  is  considerable  staining 
about  the  bile  ducts.  A  specimen  of  the  distomum  sinense  is  fovmd  in  the  bile 
passages.  The  mesentery  is  rather  rich  in  fat.  but  its  lymph  nodes  show  no 
enlargement.  So  far  as  external  inspection  shows  there  is  nothing  to  indicate 
any  abnormality  in  the  intestines,  so  they  are  not  opened. 

Anatomical  diagnosis. — Acute  hemorrhagic  adenitis ;  acute  pulpitis  of  the 
spleen ;  chronic  interstitial  increase  of  liver  plus  cloudy  fatty  degeneration ; 
chronic  interstitial  increase  of  kidneys ;  chronic  cedema  of  the  lungs ;  chronic 
arteritis  of  the  ascending  aorta.  The  acute  conditions  are  due  to  infection  with 
a  bipolar  bacillus  having  all  the  appearance  morphologically  of  B.  pcstis,  the 
nature  of  which  is  to  be  determined  by  bacteriological  investigation. 

XI. 

H.  I. ;  age,  16 ;  male ;  died  334  Bush  street ;  death  occurred  2  a.  m..  October 
24 ;  necropsy  same  day  by  Asst.  Surg.  B.  J.  Lloyd.  Present :  Passed  Asst.  Surg. 
Rupert  Blue.  Asst.  Surgs.  Donald  H.  Currie,  C.  E.  D.  Lord,  and  W.  M.  Weight- 
man,  Drs.  Howard  Morrow,  William  C.  Hopper,  Carleton  INIathewson,  W.  M. 
Dickie,  and  L.  S.  Schmitt. 

Necropsy. — Body  that  of  a  Japanese  male  about  18  yeai's  of  age.  rather 
poorly  nourished,  moderately  well  develojied.  Thumbs  are  flexed  on  palms  and 
fingers  over  thumbs.  Rigor  mortis  present  and  well  marked.  Pupils  are  some- 
what dilated,  sclerie  are  not  injected.  There  are  a  few  small  petechite  on  the 
forearms,  arms,  and  on  the  lower  part  of  the  abdomen.  Post-mortem  lividity 
is  fairly  well  marked.  No  nodular  enlargement  can  be  made  out  in  the  axillary 
regions.  In  the  left  inguino-femoral  region  is  a  large  swelling  ovoid  in  shape. 
Over  this  swelling  the  skin  is  ecchymotic.  An  incision  reveals  a  large  lymph 
node,  the  tissues  surrounding  it  being  oedematous  and  infiltrated  with  blood,  the 
node  itself  being  markedly  hemorrhagic.  This  node  is  removed  with  two  or 
three  other  smaller  ones  in  the  immediate  vicinity,  and  smears  made  from  it 
stained  with  carbo-thionin  show  a  very  few  cocco-bacllli.  The  tissues  upon 
which  this  gland  was  lying  are  quite  cedematous  and  hemorrhagic.  A  smaller 
and  de?per  node  is  removed  which  is  necrotic  and  smears  from  this  show  a 
considerable  number  of  organisms  morphologically  resembling  B.  pcstis.  Inci- 
sion into  the  right  inguino-femoral  region  also  shows  enlarged  nodes,  but  the 
enlargement  is  not  very  marked.  In  the  right  axillary  region  we  find  enlarged 
nodes  which  are  hemorrhagic.  Body  is  opened  by  a  median  incision.  Subcu- 
taneous fat  is  small  in  quantity.  Abdominal  muscles  are  red  in  color  and  moist. 
The  peritoneum  is  somewhat  duller  than  normal ;  its  vessels  are  quite  promi- 
nent. The  appendix  is  normal  in  appearance :  points  downward  and  to  the 
right.  The  spleen  is  removed ;  is  a  little  enlarged.  The  capsule  is  tense.  The 
surface  of  the  organ  is  almost  pink.  The  organ  is  not  very  firm  in  consistency. 
Cuts  easily ;  cut  surface  dark  red  in  color,  fairly  rich  in  blood.  Sternum  is 
removed.  The  lungs  almost  completely  collapse  on  the  removal  of  the  sternum. 
There  are  no  adhesions  on  either  side  of  the  pleura.  The  pericardial  area  is 
about  normal  in  size.  The  pericardium  is  opened,  and  contains  a  small  quantity 
of  clear,  straw-colored  fluid,  probably  a  little  in  excess  of  the  normal  in  amount. 
There  are  no  hemorrhages  under  the  pericardium.  The  apex  of  the  heart  is 
made  up  almost  entirely  of  the  left  ventricle  which  is  firmly  contracted.    The 


I'UBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE.  559 

right  vontriolo  is  oponod  aiul  contains  fluid  blood.  The  loft  vontricle  is  empty. 
The  lelt  hins;  is  removed ;  is  jd)out  nonnal  in  size.  I'leural  surfacH^s  have  not 
lost  their  ^xiisteniii};.  The  lunp:  presents  a  very  small  quantity  of  external  pig- 
ment. Tlie  orsan  crepitates  tlironsliont,  but  crepitation  is  diminished.  Cuts 
fairly  easily;  cut  surface  is  hrisjlit  red  in  color,  not  very  rich  in  blood.  Pressure 
causes  a  small  quantity  of  a  thick,  viscid,  muco-serous  fluid  to  exude  mixed  with 
a  very  little  air.  A  portion  of  the  lun^  excised,  floats.  Ki^lit  lung  is  removed; 
presents  about  the  same  general  appearance  as  noted  in  the  left.  There  are 
two  or  three  small  hemorrhages  under  the  pleural  surface.  The  organ  cuts 
with  slight  resistance;  cut  surface  is  dark  in  color,  moderately  rich  in  blood. 
There  is  a  marked  diminution  in  the  amount  of  air  normally  contained  in  the 
air  vesicles,  but  there  is  no  attempt  at  consolidation.  Left  kidney  removed. 
Fatty  capsule  is  not  very  abun<lant.  Oi'gan  is  normal  in  si/e.  Fibrous  cai)sule 
slightly  adherent.  The  cut  surface  of  the  kidney  is  apple  red,  almost  yellow 
in  color;  the  cortex  is  swollen;  the  contrast  between  the  cortex  and  pyramids 
is  fairly  well  retained,  the  organ  being  in  a  condition  of  cloudy  swelling,  prac- 
tically amounting  to  parenchymatous  degeneration.  The  right  kidney  is 
removed;  presents  about  the  same  external  apjiea ranee  as  the  left.  The  ves- 
sels in  several  places  under  the  capstde  are  somewhat  injected,  but  there  are 
no  distinct  hemorrhages.  The  cut  surface  presents  the  same  general  appear- 
ance as  in  left  kidney,  but  is  perhaps  a  better  picture  of  cloudy  swelling  than 
the  left.  The  bladder  is  distended  with  urine.  The  liver  is  about  normal  in 
size;  is  examined  in  situ.  The  surface  is  perhaps  a  little  lighter  than  normal 
in  color.  Cuts  fairly  easily;  fairly  rich  in  blood.  The  cut  sui'face  is  slightly 
mottled  in  appearance.  There  is  no  increase  in  connective  tissue.  Organ  has 
the  appearance  of  boiled  flesh. 

Anatomical  conditions  noted. — Cloudy  swelling  of  the  heart  muscle,  kid- 
neys, and  liver ;  acute  pulpitis  of  the  spleen ;  polyadenitis ;  septicaemia  due  to 
an  organism  morphologically  indistinguishal)le  from  B.  pcstis. 

Cause  of  death. — Bubonic  plague   (provisional  diagnosis). 

XII. 

L.  S. ;  age,  57 ;  male ;  died  G27  Jackson  street ;  death  occurred  12.30  p.  m., 
October  29;  necropsy  October  30  by  Asst.  Surg.  Donald  H.  Currie.  Present: 
Passed  Asst.  Surg.  Rupert  Blue,  Asst.  Surgs.  B.  J.  Lloyd  and  C.  E.  D.  Lord, 
Doctors  Howard  Morrow,  William  C.  Hopper,  Carleton  Mathewson,  W.  M. 
Dickie,  Chester  II.  Woolsey,  Arthur  A.  O'Neill,  and  J.  T.  McDonald,  of  Hono- 
lulu. 

Necropsy. — Body  that  of  a  fairly  well-developed,  moderately  well-nourished 
Chinese  male  about  57  years  of  age.  Pupils  moderately  dilated  ;  sclenie  slightly 
injected,  showing  no  hemorrhages.  Post-mortem  rigidity  and  lividity,  the  latter 
over  the  dependent  parts,  fairly  well  marked.  A  swelling  in  the  left  inguino- 
femoral region  roughly  about  7  inches  by  3  inches  in  size.  The  lower  portion 
of  it  is  covered  by  black,  tarry  Chinese  ointment.  About  4  .inches  above  the 
knee,  on  the  inner  aspect  of  the  thigh,  there  is  a  hemorrhage  about  half  the 
size  of  a  10-cent  piece,  surrounded  by  a  zone  of  injection.  Smear  made  from 
this,  stained  with  carbo-thionin,  shows  typical  pest-like  organisms.  Scattered 
over  the  abdomen  are  numerous  petechial  hemorrhages,  which  do  not  disappear 
in  the  least  on  pressure.  No  glandular  enlargement  is  noted  on  palpation  in 
the  right  inguino-femoral  region  nor  in  either  axilla.  The  muscles  of  the 
calves  are  firmly  contracted.  The  arch  of  the  foot  is  increased  and  the  foot 
turned  inward.  The  fingers  are  slightly  flexed ;  thumbs  drawn  a  little  toward 
the  median  line.  Incision  made  over  the  swelling  in  the  left  inguino-femoral 
region.  Tissues  in  this  region  found  to  be  extremely  hemorrhagic.  There  is  a 
moderate  amount  of  moisture,  iait  less  oedema  than  is  usually  seen  in  cases  of 
this  type.  This  mass  of  hemorrhagic,  infiltrated  tissue,  amounting  to  prob- 
ably 2  or  3  ounces  or  more,  is  dissected  out  en  masse  and  incised  through. 
It  is  found  to  be  composed  chiefly  of  glandular  tissue,  the  cut  surface  of  which 
shows  numerous  hemorrhages  of  a  dark  reddish,  mottled  color ;  is  moderately 
moist,  but  shows  no  necrosis  or  tendency  to  break  down.  Incision  is  made  in 
the  right  inguino-femoral  region.  One  small  gland  found,  showing  distinct  cor- 
tical injection.  Incision  made  in  the  right  axilla.  One  gland  is  found  very 
slightly  enlarged,  showing  cortical  injection.  Incision  is  made  in  the  left  axil- 
lary region.  Neither  oedema  nor  glandular  enlargement  is  found.  Long  median 
incision  made.  Subcutaneous  fat  is  very  well  preserved,  remarkably  well  for 
an  individual  of  this  build  and  external  appearance.    Muscles  rather  dry  and 


560  PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 

of  a  deep  reddish  color.  Peritoneal  cavity  opened.  Intestines  do  not  bulge 
through  the  incision ;  are  only  partially  covered  by  omentum,  which  is  very 
rich  in  fat.  Intestines  collapse;  their  coats  of  normal  appearance,  not  injected, 
rather  moist,  but  no  free  fluid  in  the  peritoneal  cavity.  The  appendix  is  rather 
long,  is  normal  in  appearance,  points  toward  the  true  pelvis.  The  liver  is  not 
visible  below  the  costal  border  in  either  median  or  umbilico-mammary  line. 
The  stomach  is  in  al^out  normal  position.  The  spleen  is  removed  without  diffi- 
culty ;  is  very  slightly  enlarged  as  compared  with  what  would  be  expected  in 
an  individual  of  this  size;  its  capsule  is  quite  tense;  organ  of  a  bluish-lilac 
color,  showing  numerous  small  hemorrhages  under  its  capsule.  The  organ  is 
rather  firm  in  consistency ;  cuts  very  easily ;  its  cut  surface  is  only  moderately 
rich  in  blood ;  shows  a  very  slight  bulging  of  the  pulp ;  no  connective  tissue 
increase.  Thorax  opened  by  removal  of  sternum.  The  muscles  over  the  ante- 
rior portion  of  the  thorax  found  to  be  about  as  those  described  in  opening  the 
abdomen,  except  possibly  they  are  a  little  lighter  in  color.  They  are  unusually 
dry  for  an  individual  dead  of  an  acute  disease.  The  costal  cartilages  are  some- 
what ossified,  especially  on  the  right  side.  The  lungs  are  found  to  almost  meet 
in  the  median  line,  lacking  about  one  finger  breadth.  They  do  not  completely 
collapse  anteriorly.  When  the  lungs  are  laid  back  the  pericardial  area  is  found 
to  be  probably  slightly  increased,  but  such  increase  is  apparently  due  to  increase 
in  the  size  of  the  heart  muscle.  The  right  luug  is  lifted  out  of  its  cavity  and 
found  to  be  nonadherent.  The  right  pleural  cavity  is  found  to  contain  prob- 
ably half  a  pint  of  blood  and  serum.  The  left  lung  is  lifted  out  of  its  cavity 
and  the  same  hydrothorax  is  found  to  exist.  The  pericardial  sac  is  opened  and 
the  heart  lifted  out.  It  is  found  to  contain  very  little  fluid,  but  what  there  is 
is  decidedly  blood  tinged.  The  apex  of  the  heart  is  formed  about  equally  by 
the  right  and  left  ventricles.  The  superficial  arteries  show  thickening  of  their 
coats.  There  are  several  small  milk  spots  over  the  surface  of  the  heart.  The 
veins  are  very  slightly,  if  at  all,  tortuous  aud  somewhat  engorged.  The  organ 
is  very  soft  in  consistency.  The  terminal  veins  along  the  main  trunks  are 
found  to  be  very  much  dilated  and  there  is  a  diffuse  redness  extending  into  the 
surrounding  tissue,  but  aside  from  this  there  is  no  evidence  of  any  tendency  to 
hemorrhage  into  the  pericardial  surface.  The  left  ventricle  is  opened  ;  is  found 
to  contain  a  small  amount  of  gas,  semifluid  blood,  and  post-mortem  clots.  The. 
light  ventricle  is  opened  and  the  same  contents  in  the  same  proportions  are 
found'.  The  left  auricle  is  opened  ;  the  same  contents  found.  The  left  auriculo- 
ventricular  opening  is  found  to  admit  three  gloved  fingers  with  slight  difficulty. 
The  right  auricle  is  opened ;  found  to  contain  large  quantities  of  fluid  blood 
and  post-mortem  clots.  The  right  auriculo-ventricular  opening  admits  five 
gloved  fingers  easily.  The  heart  is  removed  by  severing  the  vessels  at  its  base. 
It  is  found  that  this  muscle  is  so  soft  that  the  stretching  necessary  to  make  the 
incision  causes  tearing  of  its  substance.  The  heart  is  washed  and  the  organ  laid 
open.  It  is  found  that  the  aortic  valves,  the  surface  of  the  ascending  aorta, 
and  the  mitral  valve  are  in  a  state  of  acute  arteritis  and  endocarditis.  There 
is  one  rather  large  hemorrhage,  half  the  diameter  of  a  10-cent  piece,  at  the  base 
of  one  of  the  aortic  valves.  The  left  ventricle  muscle  itself  is  very  thin,  of  a 
grayish,  reddish  color,  the  latter  color  predominating;  very  soft  in  consistency, 
friable.  The  whole  endocardium  shows  the  same  injection  described.  The  right 
heart  shows  the  same  diffuse  inflammation  of  the  endocardium.  The  left  lung 
is  removed  from  its  cavity.  It  is  found  to  be  about  normal  in  size,  pits  very 
slightly  on  pressure;  its  pleural  surface  has  not  lost  its  smooth,  glistening 
appearance,  showing  that  the  exudation  found  within  the  pleural  cavity  was 
not  inflammatory.  There  are  no  hemorrhages  noted  luider  the  ])leura.  The 
organ  crepitates  fairly  well  throughout ;  is  about  normal  in  consistency ;  cuts 
easily ;  its  cut  surface  is  rather  dark  in  color,  pressure  causing  a  large  quan- 
tity of  blood  aud  a  rather  deflcient  amount  of  air  to  exude.  This  is  probably 
only  due  to  congestion.  A  portion  of  the  lung  excised  is  thrown  into  water ; 
found  to  float  fairly  high.  This  is  for  the  lower  lobe.  The  cut  surface  of  the 
upper  lobe  is  of  a  fairly  normal  appearance,  considering  the  length  of  time 
since  death.  The  right  lung  is  removed.  It  is  found  to  be  about  normal  in 
size,  possibly  slightly  enlarged ;  pits  on  pressure  rather  more  than  its  fellow  of 
the  opposite  side ;  crepitates  well  throughout,  though  a  considerable  amount  of 
fluid  can  be  felt  within.  The  organ  is  about  normal  in  consistency ;  cuts  easily ; 
its  cut  surface  is  of  a  moderately  dark  reddish  color.  Pressure  causes  about 
the  same  amount  of  blood,  more  air,  and  serum  to  exude  than  its  fellow  of  the 
opposite  side.  Left  kidney  removed.  Its  fatty  capsule  is  found  to  be  fairly 
well  preserved ;  strips  off  rather  easily  and  without  tearing  off  the  fibrous  cap- 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  561 

siile  with  it.  Tho  liltrous  capsnlo  strips  off  rather  roadily,  oxposliif;  a  smooth, 
yellowisli-rod  surface,  in  which  tho  stellate  veins  siiow  up  prominently.  The 
organ  is  ahout  normal  in  size  and  consistency;  cuts  with  ahout  the  normal 
resistance:  its  cut  surface  is  vather  rich  in  blood.  The  contrast  between  the 
cortex  and  th(>  i)yramids  is  fairly  well  retained.  Tlu>  cortical  border  is  very 
slightly  diminished  in  breadth  api)arently  in  places.  Tho  vessels  show  consid- 
erable injection  and  the  color  of  the  organ  is  rather  more  of  a  lightish  yellow 
(as  seen  through  the  pink)  than  normal.  The  liver  is  probably  subnormal  in 
size.  Its  lower  border  is  ahout  normal  in  shape.  Tho  organ  is  of  a  light 
lemon-yellow,  mixed  with  a  chocolate-brown  color,  interspaced  with  areas  show- 
ing venous  engorgement  in  tho  terminal  vessels.  The  organ  is  rather  soft  in 
consistency;  pits  on  i)ressuro;  cuts  easily;  its  cut  surface  is  about  the  same 
color  as  seen  through  the  cai)sule  and  possibly  even  more  yellowish  in  appear- 
ance. The  whole  structure  of  the  organ  has  a  boiled  ai)pearance  and  rei)re- 
sents  the  late  stage  of  cloudy  swelling  going  into  fatty  degeneration.  The 
organ  is  rather  poor  in  blood.  Two  specimens  of  Distomum  Sinense  are  foinid 
in  one  of  the  bile  ducts  when  the  organ  is  squeezed.  The  intestines,  partially 
describetl  before,  are  normal  in  appearance  externally.  The  mesenteric  glands 
are  not  enlarged ;  the  intestines  are  not  opened. 

Anatomical  diagnosis. — Acute  endocarditis;  aqute  fatty  change  of  myocar- 
dium ;  moderate  pulmonary  emphysema  ;  acute  renal  congestion  ;  cloudy  swell- 
ing, going  on  to  fatty  change  of  liver ;  moderate  acute  pulpitis  of  spleen ;  acute 
hemorrhagic  adenitis,  especially  in  the  right  inguino-femoral  region.  The  acu^^o 
processes  mentioned  appear  to  be  due  to  infection  with  a  pest-like  bacillus,  the 
exact  nature  of  which  is  to  be  determined  by  bacteriological  examination. 
Smears  from  the  glands  and  the  hemorrhage  mentioned  on  the  inner  aspect  of 
the  thigh,  from  the  spleen,  from  the  lung,  show  a  bipolar  cocco-bacillus,  occur- 
ring sometimes  with  doughnut  forms,  indistinguishable  from  B.  pestis. 

XIII. 

S.  C. ;  age,  7 ;  female ;  died  742  Washington  street ;  death  occurred  4  a.  m., 
November  4 ;  necropsy  same  day  by  Asst.  Surg.  Donald  II.  Currie.  Present : 
Passed  Asst.  Surg.  Rupert  Blue,  Asst.  Surgs.  B.  J.  Lloyd  and  H.  A.  Stansfield, 
Drs.  Arthur  A.  O'Neill,  Chester  H.  Woolsey,  Carleton  Mathewson,  W.  M. 
Dickie,  Howard  Morrow,  and  William  C.  Hopper.  Body  that  of  a  Chinese 
female  about  7  years  of  age. 

Necropsy. — Body  well  nourished,  fairly  well  developed  for  a  child  of  this 
age.  Post-mortem  lividity  moderate  over  dependent  parts.  Post-mortem  rigid- 
ity almost  absent.  Sclenii  very  slightly  injected ;  pupils  moderately  dilated. 
Hemorrhage  over  right  eyebrow,  possibly  due  to  contusion.  Similar  hemor- 
rhagic conditions  between  the  inner  portion  of  the  orbit  and  the  nose  on  either 
side.  Some  glandular  enlargement  palpable  at  the  angle  of  the  jaw,  left  side, 
and  there  is  prominence  in  this  region.  There  is  a  swelling  extending  from 
the  left  clavicle  down  to  the  ninth  or  tenth  rib  and  its  anterior  aspect  bounded 
by  a  line  running  from  the  inner  aspect  of  the  left  clavicle.  It  extends  down- 
ward and  backward  to  the  posterior  axillary  line  to  the  shoulder  joint,  extend- 
ing up  to  the  axilla,  in  the  axilla  considerable  glandular  enlargement  can  be 
noted.  No  glandular  enlargement  palpable  in  either  of  the  inguino-femoral  re- 
gions. A  subcutaneous  liemorrhage  or  area  of  discoloration  in  the  inner  aspect 
of  the  left  femoral  region.  The  muscles  of  the  calves  are  somewhat  contracted. 
The  arch  of  the  foot  is  higli,  the  toes  turned  inward.  The  thumbs  are  flexed  in 
toward  the  median  line  of  the  palms  and  the  fingers  are  flexed  over  them.  Inci- 
sion made  over  the  swelling  in  the  angle  of  the  left  side  of  the  jaw  and  very 
much  enlarged,  hemorrhagic  glands  found  in  this  region.  Tliis  gland  is  dis- 
sected out  and  incised  through.  Cut  surface  is  found  to  be  very  much  injected 
and  its  cut  surface  moist.  Incision  is  made  in  the  inner  aspect  of  the. clavicle 
over  the  swelling  noted  in  this  region.  The  muscles  are  found  to  be  swollen, 
(Edematous,  of  a  light  brownish-red  color,  the  subcutaneous  tissue  showing  the 
gelatinous  oedema.  Incision  is  carried  upward  into  the  axilla  and  serum  flows 
freely  from  this  region.  The  tissue  in  the  axillary  region  is  removed  en 
masse ;  is  found  to  be  very  deeply  injected.  Glands  show  considerable  enlarge- 
ment, four  or  five  times  their  normal  size  or  more.  Incision  made  in  the  right 
axillary  region  and  a  few  very  sliglitly  enlarged  and  deeply  injected  glands 
are  found.     One  of  these  is  cut  open  and  a  hemorrhage  found,  plus  the  deep 

8629—04 36 


562  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

injection.  Incision  made  in  tlio  right  inguino-feniornl  region  and  a  gland 
similar  to  that  in  the  right  axilla  found.  Incision  made  over  the  left  inguino- 
femoral region ;  same  condition.  Long  median  incision  made.  Subcutaneous 
fat  fairly  well  preserved.  Muscles  of  a  dark  reddish  color,  moderately  dry. 
Smears  from  the  glands  at  the  angle  of  the  jaw,  stained  with  cai-bo-thionin, 
shows  :i  pest-like  bacillus  ai)pai-eutly  in  pure  culture.  Abdomen  opened. 
Intestines  bulge  slightly  through  the  opening.  The  omentum  is  rather  poor 
in  fat,  only  partially  (about  two-thirds)  covering  the  anterior  aspect  of  the 
intestines.  Intestinal  coats  are  very  moist,  glistening;  vessels  not  injected,  but 
show  numerous  hemorrhages  under  the  peritoneum.  ]Most  of  these  hemor- 
rhages are  bright  red  in  color  and  recent.  There  are  several  of  a  bluish-black 
color.  The  whole  peritoneal  cavity  is  very  moist  and  there  is  about  30  c.  c.  of 
fluid.  The  appendix  is  normal  in  ai^pearance,  quite  long,  recun-ed  u])on  itself, 
pointing  ui)ward  and  forward.  The  liver  is  barely  visible  below  the  costal 
border  in  the  umbilico-mammary  line  and  not  visible  at  all  in  the  median  line. 
The  stomach  is  in  about  normal  position.  Stand  of  the  diaphragm,  left, 
fourth  interspace ;  right,  fifth  interspace.  Spleen  is  removed  without  difficulty, 
being  nowhere  adherent,  except  at  the  upper  portion  where  the  adhesion  is 
very  fresh,  soft,  and  easily  broken.  The  organ  is  enlarged  to  i)ossil)ly  one-third 
above  the  normal  size;  it  is. tense,  its  capsule  not  wrinkled.  Capsule  covered 
with  lymph  deposit,  which  has  undergone  very  little  organization.  Under  the 
capsule  there  are  numerous  hemorrhages  varying  from  almost  microscopical. 
The  organ  is  firm  in  consistency,  but  easily  pliable  to  pressure  exerted  through 
its  capsule.  It  cuts  very  easily ;  its  cut  surface  is  not  very  rich  in  blood, 
shows  a  very  slight  bulging  of  the  pulp,  no  connective  tissue  increase.  It  has 
a  mottled  appearance,  being  made  up  of  very  small  areas  of  red  and  light  pink- 
ish yellow.  Thorax  opened  by  removal  of  sternum.  The  muscles  over  the 
thorax  present  the  same  rather  dry.  deep  reddish  appearance  as  those  noted  in 
opening  the  abdomen.  Costal  cartilages  show  no  ossification.  The  lungs  almost 
meet  in  the  median  line,  lacking  only  about  half  a  finger  breadth.  They  do 
not  collapse  completely  anteriorly.  They  are  not  adherent  anteriorly.  When 
laid  back  the  pericardial  area  is  exposed.  It  is  found  that  the  pericardial  area 
is  about  normal  in  size,  possibly  very  slightly  increased.  There  is  one  hemor- 
rhage on  the  mediastinum  just  overlying  the  pericardium.  The  pericardium  sac 
is  opened  and  the  heart  lifted  out.  The  sac  is  found  to  contain  probably  25  or 
30  c.  c.  of  a  clear,  strav,-  colored  serum.  The  apex  of  the  heart  is  formed  almost 
equally  by  right  and  left  ventricles.  The  left  plays  a  slightly  greater  part 
than  the  right.  There  are  numerous  hemorrhages  scattered  over  the  peri- 
cardial surface.  The  vessels  are  engorged,  and  along  the  terminal  vessels 
is  seen  the  redness  mentioned  in  the  two  i)receding  pest  necropsies,  gradually 
fading  into  the  normal  tissue.  Right  ventricle  opened ;  found  to  contain  fluid 
blood  only.  The  left  ventricle  opened;  almost  empty,  the  exception  being  a  few 
drops  of  clear  fluid.  The  left  auricle  is  opened ;  contains  fluid  blood,  some  gas, 
and  a  few  post-mortem  clots.  Right  auricle  opened  ;  contains  fluid  blood  and 
post-mortem  clots.  Left  auriculo-ventricular  opening  admits  one  gloved  flnger 
easily.  Right  auriculo-ventricular  opening  admits  two  gloved  fingers  with  slight 
stretching.  Left  lung  lifted  out  of  its  cavity.  The  left  pleural  cavity  is  found 
to  be  dry.  The  organ  is  removed  by  excising  the  bronchial  connections.  It  is 
possibly  slightly  increased  in  size;  does  not  completely  collapse;  pits  on  pre.s- 
sure.  Pleural  surface,  after  the  organ  has  been  washed,  is  normal  in  appear- 
ance. Aside  from  the  fact  that  there  are  numerous  small  gas  bubbles  between 
the  pleura  and  the  lung,  possibly  due  to  post-mortem  change,  possibly  to  the 
rupture  of  an  air  vesicle,  the  pleura  appears  normal.  The  organ  is  rather  firm 
in  consistency ;  crepitates  throughout ;  cuts  easily ;  its  cut  surface  is  rather 
deeply  injected,  rather  rich  in  blood ;  pressure  causes  blood,  air.  and  serum  in 
about  the  usual  proportions  to  exude.  When  the  blood  is  removed  from  the  cut 
surface  of  the  organ  there  is  noticed  in  several  places  a  slight  mottling,  but 
apparently  it  is  not  pneumonic.  However,  a  poriton  of  it  is  excised  and  tlu-own 
into  water;  is  found  to  float.  From  the  middle  of  one  of  these  lighter  areas  a 
vei-y  small  i)iece  of  lung  about  the- size  of  an  ordinary  pin  head  is  thrown  into 
the  water;  it  is  found  to  sink.  Several  others  are  tried  in  the  same  way.  but 
they  all  float.  If  any  pneumonic  areas  exist,  they  are  extremely  small  and  few. 
The  right  lung  is  removed  from  its  cavitv  and  the  bronchial  connections  severed. 
The  organ  is  found  not  to  collapse;  to  be  larger  than  normal  in  size;  its  pleura 
to  be  normal  in  appearance,  of  bluish-red  color.  The  organ  pits  slightly  on 
pressure.  The  consistency  is  possibly  slightly  increased.  The  organ  cuts  easily ; 
its  cut  surface  is  moderately  rich  in  blood.     Pressure  causes  blood,  air,  and 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    RERVICE.  563 

serum  to  oxiulo,  the  air  beinj:  in  slightly  doficiont  nniount.  The  heart  is 
removed;  the  organ  washed  and  laid  oi)en.  The  endocardium  shows  as  the 
most  i)r(>unnent  thing  numerous  hemorrhages  under  tlie  endocardium  varying 
in  size  from  a  pin  point  to  as  lai-ge  as  a  dime.  The  endocardium  itself  is  trans- 
panMit.  The  aortic  valvt>s  are  perfeclly  soft  and  pliable.  The  surface  of  the 
aorta  is  smooth,  normal  in  color  and  appearance.  The  heart  muscle  is  of  a 
fairly  normal  color,  probably  a  little  more  nnxture  of  brown  than  is  usual; 
normal  in  thickness  and  consistency.  The  left  kidney  is  removed.  The  fatty 
capsule  is  only  fairly  well  retained.  The  organ  is  alxnit  normal  in  size  and 
consistency.  Its  fibrous  capsule  strips  off  readily,  exposing  a  smooth,  mottled, 
yellowish-red  surface,  in  which  the  stellate  veins  are  fairly  prominent.  The 
organ  cuts  easily,  with  a  rather  soapy,  greasy  feel.  Its  ciit  surface  is  very 
moist,  but  only  moderately  rich  in  blood.  The  contrast  between  cortex  and 
pyramids  is  all  but  completely  lost.  Cortical  border  is  about  normal  in  breadth. 
The  organ  has  a  boiled,  light  yellowish  appearance,  and  shows  injection  of  its 
blood  vessels.  Liver  removed  without  difiiculty.  The  liver  is  adherent  to  the 
diaphragm  for  a  quite  considerable  area,  the  adhesions  being  soft  and  fresh  in 
character.  The  organ  is  about  normal  in  size  and  color,  although  its  lower 
border  is  slightly  rounded.  Its  surface  shows  numerous  areas  of  lymph 
deposit,  some  of  which  have  already  been  mentioned  as  binding  it  to  the  dia- 
phragm. Moderate,  recent  perihepatitis.  The  organ  cuts  with  considerable 
resistance;  its  cut  surface  is  moist,  but  rather  poor  in  blood.  Its  structure  is 
fairly  well  retained.  The  color  is  made  up  of  islands  of  normal,  or  possibly  more 
yellow  than  normal,  liver  tissue  and  areas  of  venous  congestion.  It  is  possible 
that  there  is  some  acute  change  in  the  organ,  but  very  little.  The  intestines, 
as  before  mentioned,  show  hemorrhages  into  the  peritoneal  coats.  The  mesen- 
teric glands  are  enlarged  and  the  mesenteric  vessels  engorged.  The  intestines 
are  not  opened.  From  the  fact  that  a  dii)lococcus  is  mixed  with  the  pest-like 
rod  iu  the  smears  and  that  one  of  the  buboes  is  found  at  the  angle  of  the  jaw, 
the  possibility  of  there  being  a  throat  infection  is  to  be  investigated.  The 
child's  head  is  put  on  a  block  and  incision  made  of  the  jaw  under  the  symphisis, 
so  as  to  join  the  long  median  incision  before  described.  Trachea  removed. 
Hemorrhage  found  in  the  tissue  around  the  epiglottis,  together  with  hypertrophy 
of  the  papilla  in  this  region.  The  tonsil  is  enlarged  on  the  left  side.  This  is 
excised;  it  is  found  to  be  very  deeply  congested;  is  incised,  very  soft  in  con- 
sistency, showing  a  deep,  almost  hemorrhagic  condition  throughout  the  sub- 
stance, and  a  smear  from  it  shows  large  number  of  pest-like  rods  and  diplococci. 
Inspection  of  the  external  genitalia  shows  nothing  abnormal. 

Anatomical  diagnosis. — Acute  tonsilitis ;  acute  polyadenitis,  especially  of 
the  left  axillary  and  left  cervical  glands ;  acute  moderate  pulpitis  of  spleen ; 
acute  nephritis ;  acute  congestion  of  lungs ;  hemorrhages  into  the  various  serous 
surfaces.  All  the  conditions  noted  are  probably  due  to  infection  with  a  bipolar, 
pest-like  bacillus,  which  is  to  be  carried  through  the  usual  bacteriological  tests 
to  determine  its  nature. 

XIV. 

J.  S. ;  age,  7;  female;  died  844  Washington  street;  death  occurred  5  a.  m. 
November  7 ;  necropsy  same  day  by  Asst.  Surg.  B.  J.  Lloyd. 

Necropsy. — Body  that  of  a  Chinese  female  child  aged  7  years ;  fairly  well 
developed,  fairly  well  nourished.  A  partial  necropsy  revealed  the  following 
anatomical  lesions :  Acute  parenchymatous  degeneration  of  the  kidneys ;  poly- 
adenitis ;  hemorrhagic  diathesis ;  acute  pulpitis  of  the  spleen  ;  septiciiemia  due 
to  the  presence  in  the  glands  and  spleen  of  a  bacillus  morphologically  indis- 
tinguishable from  B.  jicstis. 

XV. 

C.  M.  T.  S. ;  age,  54 ;  female :  died  lOlG  Stockton  street ;  death  occurred  11 
p.  m.  November  11 :  necropsy  November  13  by  Asst.  Surg.  B.  J.  Lloyd.  Present: 
Asst.  Surg.  C.  E.  D.  Lord,  Doctors  Howard  Morrow,  William  C.  Hopper,  Chester 
II.  Woolsey,  Arthur  A.  O'Neill,  W.  M.  Dickie,  and  Carleton  Mathewson. 

Necropsy. — Body  that  of  a  Chinese  female  about  54  years  of  age,  fairly  well 
developed,  well  nourished.  Post-mortem  rigidity  is  almost  absent.  There  is 
lividity  over  the  dependent  parts,  and  to  a  moderate  extent  generally.  A  few 
small  petechial  spots  are  noted  over  the  limbs.  A  preliminary  incision  over  a 
moderately  enlarged  node  in  the  left  inguino-femoral  region  was  made  yesterdaj 
when  the  body  was  brought  to  the  morgue,  and  smears  from  an  enlarged  lymph 


564  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

node  showed  a  number  of  organisms  wLioh  wore  morpboloRically  indistiu- 
guisbal)le  from  B.  pcstis.  Pupils  are  midway  between  dilatation  and  contrac- 
tion ;  the  sclera'  are  slightly  injected.  There  is  slight  nodular  enlargement  in 
the  axillary  and  l)oth  femoral  regions.  Body  is  opened  by  a  median  incision. 
The  subcutaneous  fat  is  very  unusual  in  antount  for  one  of  this  race.  The 
abdominal  muscles  are  red  in  color  and  moist.  The  omentum  almost  com- 
pletelj-  covers  the  intestines  and  is  very  rich  in  fat.  The  intestines  do  not 
bulge  through  the  incision,  and  the  stomach  is  slightly  distended  with  gas. 
The  liver  is  barely  visible  below  the  costal  mai-gins.  Intestines  are  normal  in 
appearance.  In  tlie  i^soas  muscle  on  the  right  side  are  numerous  hemorrhages. 
The  appendix  is  normal  in  ai*pearance  and  points  downward  and  to  the  right. 
I'he  spleen  is  removed;  is  about  normal  in  size,  perhaps  a  little  enlarged;  the 
surface  is  light  red,  almost  pink  in  color.  The  consistency  is  quite  soft.  The 
capsule  is  tense  and  smooth.  Organ  cuts  easily ;  cut  surface  is  ^  ery  rich  in 
blood.  There  is  marked  bulging  of  the  pulp.  Smears  made  from  the  cut  sur- 
face of  the  spleen  show  cocco  bacilli  I'esembling  B.  pestisi.  Sternum  is  removed. 
The  lungs  do  not  collapse  on  removal  of  the  sternum  The  right  lung  is  visible 
for  about  one  finger  breadth  beyond  the  cut  border  of  the  cartilages ;  the  left 
is  flush  with  this  border.  The  pericardial  area  is  slightlj'  increased  in  size. 
There  are  numerous  adhesions  of  the  pleura  anteriorly  on  the  left  side,  which 
are  fairly  easily  broken  up.  Similar  adhesions  are  noticed  on  the  right  side  to 
a  less  marked  extent.  Pericardium  is  opened,  and  contains  about  20  c.  c.  of 
blood-stained  serum.  Upon  the  posterior  surface  of  the  heart  are  seen  a  num- 
ber of  rather  diffuse  subpericardial  hemorrhages.  The  left  lung  is  i-emoved. 
The  pleura  is  thickened  ;  the  organ  crepitates  throughout.  Cuts  fairly  easily ; 
cut  surface  is  dark  in  color,  moderately  rich  in  blood.  Smears  show  a  few 
cocco  bacilli  with  some  diplococci.  In  the  upper  lobe  is  a  small  area  which  is 
apparently  the  seat  of  calcareous  change.  Pressure  causes  serum,  a  large 
amount  of  blood,  and  a  diminished  quantity  of  air  to  exude.  Necropsy  discon- 
tinued on  account  of  an  accident. 

Anatomical  conditions  (additional  note). — Congestion  of  lungs,  pleuritis, 
acute  pulpitis  of  spleen,  acute  parenchymatous  degeneration  of  kidneys,  septi- 
caemia.    Cause  of  death  to  be  determined  by  bacteriological  investigation. 

XVI. 

II.  M.  C.  S. ;  age,  20;  female;  died  G28  Jackson  street;  death  occurred  0 
a.  m.,  January  10;  necropsy  same  day  by  Asst.  Surg.  B.  J.  Lloyd.  Present, 
Drs.  Chester  H.  Woolsey  and  William  C.  Hopper. 

Necropsy. — Body  that  of  a  Chinese  female  about  32  years  of  age;  fairly  well 
nourished,  rather  poorly  developed.  There  is  a  nodular  enlargement  in  the 
right  inguinal  region  extending  above  Poupart's  ligament,  also  in  the  left  axil- 
lary region.  There  are  several  small  points  of  counter  irritation  on  various 
parts  of  the  body.  Post-mortem  lividity  and  rigor  mortis  fairly  well  marked. 
The  sclera>  are  not  injected.  An  incision  is  made  into  the  left  axilla  and  a 
quantity  of  fat  with  an  enlarged  lymph  node  about  the  size  of  an  almond  is 
removed.  The  cortex  of  this  node  shows  some  injection  and  there  is  one  area 
about  the  size  of  a  split  pea  which  is  apparently  beginning  to  be  necrotic. 
Incision  is  made  into  the  right  inguinal  region  and  two  or  three  small  lymph 
nodes  are  removed.  An  incision  into  these  nodes  shows  nothing  beyond  injec- 
tion. Body  is  opened  by  a  median  incision.  Subcutaneous  fat  is  fairly  well 
preserved.  The  al)dominal  cavity  is  opened.  There  is  some  dilatation  of  the 
vessels  of  the  peritoneum.  The  omentum  almost  entirely  covers  the  intestines, 
and  is  adherent  to  the  upper  border  of  the  uterus  and  to  a  less  extent  to  the 
fallopian  tubes.  The  ovary  on  the  left  side  is  enlarged.  The  stomach  extends 
for  a  hand's  breadth  below  the  xiphoid  cartilage ;  liver  for  about  two  finger 
breadths  in  the  median  line.  Spleen  is  removed  ;  is  enlarged.  The  surface  is  of 
a  reddish,  more  nearly  pinkish  color.  Capsule  is  tense.  The  organ  is  not  very 
firm  in  consistency  ;  cuts  easily ;  the  cut  surface  is  light  red  in  color,  not  very 
rich  in  blood,  but  quite  moist.  There  is  bulging  of  the  pulp.  There  are  numer- 
ous pin-point,  whitish  areas  uniformly  distributed  over  the  cut  surface.  Peri- 
cardium is  opened.  The  heart  contains  a  considerable  quantity  of  blood  and 
is  somewhat  flabby.  The  left  lung  is  lifted  out  of  its  cavity ;  is  about  normal  in 
size;  crepitates  throughout.  The  pleural  surfaces  are  fairly  normal  in  appeax'- 
ance.  Organ  cuts  fairly  easily:  the  cut  surface  is  red  in  color,  in  some  places 
dark,  in  some  places  briglit  red ;  fairly  rich  in  blood  and  quite  moist.  Pressure 
causes  serum  tinged  with  blood,  with  a  diminished  quantity  of  air,  to  exude. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  565 

The  riRlit  liiuf;  is  removed:  presents  about  the  same  general  appearances  as 
the  left.  Crepitation  is  somewhat  diminished,  hut  is  f^eueral  tlirouf^hout. 
Organ  cuts  lairly  «'asil.v  :  the  eut  surface  is  not  very  rich  in  blood.  l)ut  (luite 
iiioist,  dark  red  in  color.  Pressure  causes  a  large  (juantity  of  serum  mi.xed 
with  air  to  exude.  Heart  is  rvMuoved.  The  right  ventricle  is  opened;  contains 
lluid  blood,  with  a  few  small  clots.  Left  ventricle  is  opened;  contains  a  very 
small  (piantily  of  clotted  blood.  The  surface  of  the  aorta  and  the  endocardium 
are  normal  in  api»earance.  The  he.-irt  muscle  is  p.aler  than  normal.  The  left 
kidney  is  removed.  Organ  is  slightly  enl.arged.  Fibrous  capsule  strips  off  very 
easily,  leaving  a  surface  which  is  light  red  in  color.  The  contrast  between 
the  cortex  and  the  i)yramids  is  well  retained.  Cortical  portion  is  swollen  and 
the  surface  of  the  kidney  is  very  moist.  The  left  kidney  is  removed.  There  is 
a  small  hemorrhage  under  the  capsule.  Organ  jiresents  the  same  external 
appearance  as  that  of  the  left.  Capsule  strips  off  readily.  The  organ  cuts 
fairly  easily.  The  contrast  between  the  cortex  and  the  pyramids  is  very  well 
retained;  the  cortex  is  swollen  ;iiid  o^dematous,  resembling  boiled  flesh  in 
ai)pearance.  The  liver  is  examined  in  situ  ;  cuts  easily,  is  rather  poor  in  blood, 
but  moist,  fairly  normal  in  ai)i)earance.  Ai)i)endix  is  normal.  The  adhesions 
mentioned  between  the  pelvic  organs  and  the  omentum  present  the  appearance 
of  rather  long  standing.  The  tubes  are  thickened.  The  tube  on  the  left  side 
is  removed  and  opened;  is  found  to  contain  a  small  quantity  of  pus.  The  ovary 
is  sclerotic  in  appearance.  The  right  ovary  is  cystic  (the  cysts  are  not  very 
large)  and  is  also  sclei'otic. 

Anatomical  conditions  noted. — Acute  congestion  of  the  lungs,  with  slight 
oedema  :  acute  pulpitis  of  the  spleen  ;  jwlyadenitis  (slight),  involving  the  lymph 
nodes  of  the  axillary  and  inguinal  regions ;  acute  cloudy  swelliug  of  the  kid- 
neys ;  double  oophoritis ;  pyosalpinx.  There  is  present  in  the  glands  removed, 
in  the  siileen  and  in  the  lungs,  an  organism  which  is  morphologically  indis- 
tinguishable from  B.  i}estis. 

XVII. 

L.  W.  W. ;  age,  62 ;  male ;  died  624*  Jackson  street ;  death  occurred  9  p.  m., 
January  11;  necropsy  January  12  by  Asst.  Surg.  Donald  H.  Currie.  Present; 
Passed  Asst.  Surg.  Rupert  Blue,  Asst.  Surg.  B.  J.  Lloyd,  Doctors  F.  G.  Canney, 
Arthur  A.  O'Neill,  Chester  H.  Woolsey,  and  Carleton  Mathewson. 

Necropsy. — Body  that  of  a  poorly  nourished,  poorly  developed  Chinese  male, 
about  do  years  of  age.  Sclerie  very  much  injected;  pupils  contracted.  Body 
still  slightly  warm.  Rigor  mortis  present;  post-mortem  lividity  all  but  absent, 
although  there  is  a  general  darkish  appearance  of  the  body  from  the  waist 
line  up  as  compared  with  the  lower  extremities.  There  are  a  few  possibly 
slightly  enlarged  lymph  nodes  in  both  inguino-femoral  regions,  and  some  dis- 
tinctly enlarged  ones  in  either  axilla  ;  they  are,  however,  firm  and  movable. 
Incision  made  in  the  right  Inguino-femoral  region  and  the  lymph  nodes  men- 
tioned found  to  show  cortical  injection,  to  be  slightly  larger  than  the  usual 
normal.  One  of  them  is  removed,  incised,  and  a  smear  made  from  it.  Incision 
made  in  the  left  inguino-femoral  region,  and  a  lymi)h  node  fully  twice  its 
probable  normal  size  is  found  :  shows  c-onsiderable  injection  ;  is  incised  through ; 
its  cortex  is  found  to  be  deeply  injected  and  a  smear  taken  from  it.  In  this 
latter  region,  while  there  is  not  enough  oedema  to  flow  from  the  knife  point, 
the  tissues  are  decidedly  moist  and  cedematous.  Incision  made  in  the  right 
axillary  region.  The  same  condition  of  the  lymph  nodes  noted  in  the  left 
inguino-femoral  is  found  here.  The  larger  of  these  is  removed.  It  is  found  to 
show  injection ;  incised  through  and  its  cut  surface  is  found  to  show  consider- 
able injection.  The  left  axillary  region  is  next  incised  into  and  the  same  con- 
dition of  the  lymph  nodes  noted.  One  of  these  incised  through  presents  the 
same  ai)pearauce  to  a  less  degree,  its  cut  surface  found  to  be  quite  moist  as 
well  as  injected.  Long  median  incision  made.  The  subcutaneous  fat  is  all  but 
absent.  Subcutaneous  vessels  show  marked  injection.  (Smears  made  from 
the  right  inguino-femoral  gland,  stained  with  carbo-thionin,  show  a  few  cocco- 
bacilli  taking  the  bipolar  stain,  closely  resembling  B.  pcsiis  in  morphologj'.) 
The  muscles  found  to  be  of  a  dark-red  color,  rather  dry.  Peritoneal  cavity 
is  opened.  The  omentum  found  to  all  but  completely  cover  the  intestines. 
Gland  removed  from  the  left  inguino-femoral  region,  stained  with  carbo-thionin, 
shows,  as  far  as  morphology  goes,  typical  pest-like  bacilli  in  large  numbers. 
One  process  of  the  omentum  is  i>ushed  downward  and  to  the  right,  and  is 
adherent  to  a  swollen  appendix.     The  vessels  in  this  region  show  considerable 


566  PUBLIC    HEALTH    AND    MABINE-H08PITAL    SERVICE. 

injection.  Tlie  adhesions  uiv  (juite  firm  in  charactor  and  completely  surround 
and  encapsulate  the  organ.  The  ajiiiendix  is  removed  and  is  found  to  con- 
tain a  semifluid  mass  of  faves.  The  ai)pendix,  which  is  cjuite  short,  is  oi)ened. 
The  surface  of  the  nuicosa  is  found  to  be  somewhat  injected,  and  shows  several 
slight  erosions,  but  is  otherwise  fairly  normal.  Its  walls  are  thickened 
and  infiltrated,  but  there  is  no  evidence  anywhere  of  perforation  or  any- 
thing api)roaching  it.  There  is  nothing  except  the  slight  injection  of  the 
vessels  resembling,  in  any  way,  beginning  peritonitis.  The  spleen  is  removed 
without  difficulty.  The  organ  is  fouud  to  be  slightly  enlarged,  possibly  one- 
fourth  above  its  normal  size.  The  enlargement  is  chiefly  in  length  and  thick- 
ness. The  capsule  is  not  thickened  except  for  the  fresh  lymph  deposits  between 
some  of  the  lobes,  the  organ  being  quite  lobulated.  Under  the  capsule  are 
distinctly  seen  numerous  hemorrhages,  and  in  the  center  of  some  of  these  hem- 
orrhages is  noted  the  small  white  subcapsular  nodules.  The  organ  is  quite 
soft  in  consistency  ;  its  capsule  is  fairly  tense ;  it  cuts  with  very  slight  resist- 
ance; its  cut  surface  is  moderately  rich  in  blood,  showing  a  very  slight  bulging 
of  the  pulp.  Stand  of  the  diaphragm  on  the  right  side  fifth  interspace ;  on  the 
left  side,  sixth  rib.  The  liver  extends  for  about  four  finger  breadths  below 
the  costal  border  in  the  median  line,  and  two  and  a  fraction  in  the  umbilico- 
mammaiy  line.  The  peritoneal  cavity  contains  no  free  fluid.  The  peritoneal 
coat  of  the  intestines  shows  slight  general  injection,  especially  in  the  pelvic 
region,  but  there  is  nowhere  a  loss  of  luster.  The  mesenteric  glands  show  a 
slight,  moderate,  general  enlargement.  The  thorax  is  opened  by  removal  of  the 
sternum.  The  costal  cartilages  show  practically  no  ossification,  which  is  rather 
remarkable  for  a  man  of  this  age.  Lungs  overlap  in  the  median  line,  the  upper 
half  and  within  a  finger  breadth  of  the  lower  half;  they  are  laid  back.  Peri- 
cardium brought  into  view.  The  external  vessels  of  the  pericardial  sac  show 
some  slight  engoi'gement ;  the  sac  is  about  normal  in  size.  Neither  lung  col- 
lapses completelj'  anteriorly.  The  left  one  is  lifted  out  of  its  cavity ;  found 
to  be  nowhere  adherent.  Organ  removed  by  incising  through  the  bronchi. 
(Smears  from  the  spleen,  stained  with  carbo-thionin,  show  organisms  of  the 
same  ai^pearance  as  noted  in  the  glands,  also  a  coarser  rod.)  The  left  lung 
found  to  be  considerably  enlarged ;  its  pleura  has  not  lost  its  luster,  is  of  a 
pinkish  gray  color,  interspaced  with  areas  of  bluish  black  pigmentation ;  it 
pits  very  much  on  pressure ;  shows  hypercrepitation  throughout ;  cuts  easily ; 
cut  surface  rather  poor  in  blood.  Pressure  causes  some  blood,  a  large  amount 
of  air,  and  a  moderate  (piantity  of  serum  to  exud(>.  the  condition  approaching 
emphysema  with  terminal  oedema.  The  right  lung  found  to  be  bound  ante- 
riorly ;  has  some  rather  soft  adhesions,  also  a  small  area  at  the  diaphi-agm  of 
the  same  kind ;  organ  removed.  The  condition  of  the  organ  is  found  to  be 
the  same  as  its  fellow  of  the  opposite  side,  only  with  more  oedema.  The  pericar- 
dial sac  is  next  opened,  and  is  found  to  contain  a  considerable  quantity  of  clear 
serum.  The  heart  is  lifted  out ;  its  apex  is  found  to  be  formed  by  the  right 
and  left  ventricles,  possibly  the  left  playing  somewhat  the  larger  part.  There 
is  one  milk  spot  over  the  right  ventricle  and  some  small  opacities  scattered  over 
the  left.  The  superficial  vessels  show  some  thickening  of  their  coats ;  they 
are  slightly  tortuous  and  very  slightly  engorged.  The  right  ventricle  is  opened; 
found  to  contain  post-mortem  clots  and  fluid  blood.  The  left  ventricle  is 
opened ;  is  found  to  contain  fluid  blood  and  a  few  post-mortem  clots.  Right 
auricle  opened ;  found  to  be  filled  to  its  full  cai^acity  with  post-mortem  clots 
and  some  fluid  blood.  The  left  auricle  opened ;  found  to  contain  some  fluid 
blood.  The  heart  removed  and  organ  washed  and  cavities  laid  open.  The 
mitral  valve  itself  shows  a  very  slight  thickening  at  its  base.  The  aortic  vah^es 
are  perfectly  normal.  The  coronary  openings  are  patulous.  There  is  a  plaque 
about  the  size  of  the  distal  j)halanx  of  the  middle  finger  just  above  the  middle 
aortic  valve.  The  aorta  has  a  general  creamy,  ivory-white  color ;  shows  a 
slight  general  dilatation,  but  not  sufficient  to  be  of  any  importance  during  life. 
Left  kidney  removed;  fatty  capsule  poorly  preserved;  when  strii)i»ed  off 
it  is  found  that  the  organ  is  decidedly  smaller  than  normal,  even  when  the  age 
and  size  of  the  individual  are  taken  into  account.  There  are  numerous  small 
cysts  visible  through  the  capsule.  The  organ  is  quite  firm  in  consistency.  The 
fibrous  capsule,  outer  layer,  also  strips  off  fairly  readily,  but  the  inner  layer 
is  adherent,  being  imi)ossible  to  remove  without  tearing  the  organ.  The  organ 
cuts  with  quite  moderate  increase  in  resistance;  cut  surface  moderately  rich 
in  Itlood.  Decided  diminution  in  the  breadth  of  the  coi'tex,  proliably  reduced 
to  three-fifths  its  normal  size.  Contrast  between  cortex  and  pyramids  i)erfectly 
retained.     Cortex  is  of  a  pale  yellowish-red  color.     Pyramids  about  normal  iu 


P[TBLIC    HEALTH    AND    MARTNE-IIOSPITAL    SKKVICE.  5()7 

color.  Livor  cxainiiiod  in  situ.  Tiic  <)rj;:ui  is  fouiul  to  be  soniowli;it  smaller 
than  normal;  its  lower  border  is  tliin  and  slu'.rp;  its  capsule  is  transi)arent ; 
or^an  is  of  a  f^eneral,  brownish,  yellowisli-red  color;  rather  lirm  in  consist- 
ency; cuts  easily;  cut  surface  exceedingly  I'ich  in  l)lo(id,  which  is  mixed  with  a 
lar.ue  ([uantity  of  bile,  jxissibly  due  to  the  occlusion  of  a  duct  by  Distoinniii 
sUiciixr.  A  search  is  made  for  this  parasite,  but  none  are  found.  The  ^all 
bladder  is  opene<l ;  tilled  with  a  rather  clear,  thin,  yellowish  bile.  The  intes- 
tines are  not  opened. 

Anwtomu'ai-  di.vcnosi.s. — I'ulmonary  emphysema  ;  ternunal  a>dema  ;  chronic 
interstitial  nei)hriti.s  (small  red  kidney)  ;  acute  pulpitis  of  the  spleen;  acute 
treneral  .-idenitis;  the  latter  two  conditions  probably  beiuf;  due  to  infection  of 
a  biiiolar  bacillus,  the  nature  of  which  is  to  be  deternuned  by  bacteiaolof^ical 
examination;  acute  catarrhal  apitendicitis  of  some  duration.  Probable  cause 
of  death ;    Septieiemia  from  the  before-meutioued  bacillus. 

XVIII. 

L.  N.  L. ;  ago.  (!1 ;  male ;  died  at  Oriental  Dispensary ;  death  occurred  7  a.  m., 
.January  l.t;  necropsy  same  day  by  Asst.  Surg.  r>.  J.  Lloyd.  Present:  Passed 
Asst.  Surg.  Rui)ert  lUue.  Asst.  Surg.  Donald  H.  Currie,  Drs.  \Yilliam  C.  Hopper, 
F.  (}.  Cauney.  Chester  II.  Woolsey.  Carleton  Mathewsou,  and  Arthur  A.  O'Neill. 

Xecuopsv. — P.ody  that  of  a  Chinese  male  about  GO  years  of  age ;  moderately 
well  developed,  fairly  well  nourished.  Sclera'  slightly  injected.  Rigor  mortis 
is  present,  moderately  well  marked.  I'ost-mortem  lividity  slight;  in  dependent 
parts.  In  Scarpa's  triangle  on  the  left  side  is  a  swelling  which  is  easily  seen 
on  inspection.  The  skin  over  this  swelling  and  in  the  vicinity  as  high  as 
Poupart's  ligament  and  extending  downward  for  two  or  three  inches  below  the 
swelling  is  of  a  mottled  purplish  color.  There  is  oedema  over  and  surrounding 
the  enlargement.  There  is  a  nodular  enlargement  iu  both  axillary  regions.  A 
very  small  nodular  enlargement  can  also  be  felt  in  the  right  femoral  region. 
An  incision  is  made  over  the  swelling  in  the  left  groin.  The  tissues  are 
fjedematous  and  the  vessels  are  injected ;  hemorrhages  surround  the  enlarged 
lymph  nodes.  A  lymph  node  about  as  large  as  a  pigeon's  egg  is  removed.  An 
incision  into  this  node  shows  hemorrhages ;  the  surface  is  quite  moist  and  in 
the  central  part  are  a  number  of  necrotic  foci.  An  incision  into  the  left  inguino- 
femoral region  sliowvs  a  few  very  small  nodes,  the  size  of  a  pea.  An  incision  into 
the  right  axillary  region  does  not  reveal  any  enlarged  nodes.  An  incision  into 
the  left  axilla  shows  a  few  very  slightly  enlarged  lymph  nodes.  Body  is  opened 
by  a  median  incision.  .  The  subcutaneous  fat  is  moderate  in  amount.  The 
abdominal  muscles  are  red  in  color  and  moist.  The  omentum  does  not  entirely 
cover  the  intestines.  The  intestines  do  not  bulge  through  the  incision,  and 
are  normal  in  appearance.  The  appendix  is  normal  in  appearance;  points 
downward  toward  the  pelvis.  Spleen  is  removed ;  is  very  much  enlarged. 
Capsule  is  tense.  There  are  several  flaky  deposits  of  lymph  on  the  surface. 
The  surface  presents  a  light  bluish,  somewhat  pinkish  color,  broken  by  a  nmuber 
of  decidedly  brighter  reddish  areas.  It  is  soft  in  consistency;  cuts  easily;  cut 
surface  is  moist,  fairly  rich  in  blood.  There  is  bulging  of  the  pulp.  The  color 
is  a  medium  dark  red  and  is  uniform.  There  is  possibly  a  very  slight  increase 
in  the  connective  tissue  of  the  organ.  Sternum  is  removed.  Cartilages  are 
very  slightly  ossified  for  a  man  of  this  age.  The  lungs  do  not  collapse  on 
removal  of  the  sternum.  The  right  lung  presents  for  three  gloved  fingers 
beyond  the  cut  border ;  the  left  for  almost  the  same.  Pericardial  area  is 
.slightly  increased  in  size.  Pericardium  is  opened.  The  cavity  contains  a  small 
quantity  of  pale,  straw-colored  tluid.  The  heart  is  lifted  out.  The  surfaces  of 
the  pericardium  are  normal  in  appearance,  except  that  beneath  the  visceral 
layer  are  a  number  of  small  hemorrhages  from  about  the  size  of  a  pin  head  to 
half  as  large  as  a  pea.  The  left  lung  is  lifted  out  of  its  cavity.  The  pleural 
surfaces  are  fairly  normal  in  apjiearance.  There  are  present  under  the  sur- 
face of  the  pleura  small  collections  of  air  (interstitial  emphysema).  The  left 
lung  is  removed.  The  organ  is  hypercrepitant,  (edematous,  pits  on  pressure; 
cuts  fairly  easily  ;  cut  surface  is  darii  red  in  color,  is  not  very  rich  in  blood ; 
I)ressure  causes  serum  mixed  with  blood  and  air  to  exude.  A  portion  of  the 
lung  when  placed  in  water  floats  high.  Right  lung  i>resents  a  slight  adhesion 
at  the  base;  is  removed;  is  (edematous  and  hypercrepitant;  organ  cuts  fairly 
easily.  Heart  is  examined  in  situ.  The  left  ventricle  contains  a  small  quan- 
tity of  fluid  blood.  Right  ventricle  is  opened;  is  found  to  contain  a  consideraI)le 
quantity  of  fluid  blood  with  some  fairly  recent,  though  possibly  ante-mortem, 


568  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

clots.  The  left  auricle  is  opened,  and  is  found  to  be  practically  empty.  The 
right  auricle  is  opened,  and  contains  a  considerable  <iuantity  uf  tiuid  blood. 
Heart  is  removed  by  severing  its  vessels.  The  surface  of  the  aorta,  with  the 
aortic  valves  and  the  mitral  valves,  is  normal  in  appearance.  The  heart 
muscle  is  dark  red  in  color.  The  surface  of  the  endocardium  is  smooth.  Left 
kidney  is  removed.  Fatty  capsule  is  very  abundant.  The  kidney  is  perhaps 
slightly  diminished  in  size,  and  presents  numerous  cysts.  The  capsule  does  not 
strip  readily.  Organ  cuts  with  increasetl  resistance.  There  is  a  small  calculus, 
which  is  easily  broken  up.  The  contrast  between  the  cortex  and  the  pyramids 
is  almost  entirely  lost. 

Anatomical  conditions. — Polyadenitis;  acute  congestion,  with  oedema  and 
emphysema,  of  the  lungs  :  acute  pulpitis  of  the  spleen  ;  chronic  diffuse  nephritis ; 
nephrolithiasis :  seiitic;emia  probably  due  to  infection  by  an  organism  morpho- 
logically resembling  B.  pcstis. 

XIX. 

I.  R. ;  age,  18;  female;  died  (>  Verraness  street;  death  occurred  February  S; 
necrop.sy,  same  date,  by  Asst.  Surg.  Donald  H.  C'urrie.  Present :  Asst.  Surg. 
B.  J.  Lloyd  and  Dr.  Carleton  Mathewson.  the  undertaker,  and  the  father  of 
the  girl. 

Necropsy. — Body  brought  down  late  at  night.  A  small  incision  about  one- 
half  an  inch  in  length  made  in  the  right  inguino-femoral  region  and  a  small 
gland  removetL  Smears  made  from  it,  stained  with  carlio-thioniu,  showed  three 
bacilli  bearing  some  resemlilance  to  pest.  A  small  incision  was  then  made  in 
the  median  line  in  the  epigastric  region,  an  incision  just  large  enough  to  intro- 
duce the  hand.  A  knife  introduced  through  this  incision  and  another  incisio'.i 
made  through  the  diaphragm.  Through  these  two  incisions  the  hand  and  arm 
are  introduced  and  the  base  of  the  lower  lobe  of  the  left  lung  was  removed. 
Showed  brouchopueuinouia.     Smears  made  from  it  showed  typical  pest  bacill). 

XX. 

G.  R. ;  age,  54 ;  male ;  died  0  Verraness  street :  death  occurred  February  V2 ; 
necropsy,  same  day,  by  Asst.  Surg.  B.  J.  Lloyd.  Present :  Passed  Asst.  Surg. 
Rupert  Blue,  Asst.  Surg.  Donald  II.  Currie,  Drs.  Carleton  Mathewson.  Ches- 
ter H.  Woolsey,  Arthur  A.  O'Neill.  L.  D.  Bacigalupi,  Weeks,  Snow,  Gross,  I^.  F. 
Ragan,  F.  G.  Canney.  Howard  Morrow,  and  W.  J.  Jackson. 

Necropsv. — Body  that  of  a  moderately  well  developed,  fairly  well  nourished 
white  male  about  54  years  of  age.  Post-mortem  rigidity  is  present  and  quite 
marketl.  Post-mortem  lividity  is  fairly  well  marked,  especially  in  de]>endent 
parts.  Scleme  are  injected.  There  is  slight  nodular  enlargement  in  the  left 
inguino-femoral  region,  to  a  less  extent  in  the  right  and  also  in  the  left  axillary 
regions.  An  incision  is  made  into  the  left  inguino-femoral  region  and  a  mod- 
erately enlarged  lymph  node  is  removed.  I'i)on  incision,  this  is  found  to  be 
slightly  hemorrhagic,  but  is  otherwise  normal  in  appearance.  Another  lymph 
node  removed  from  this  region,  which,  besides  being  quite  markedly  injected, 
shows  a  necrotic  area  in  the  center.  Smears  made  from  these  nodes  stained 
with  corbo-thionin  show  organisms  morphologically  indistinguishalile  from 
B.  pestis.  Body  is  opened  by  median  incision.  The  intestines  are  slightly 
distended  with  gas.  but  are  otherwise  normal  in  appearance.  Spleen  is 
removed ;  is  enlarged :  the  capsule  is  unevenly  thickened.  Thei'e  are  a  number 
of  whitish  subcapsular  nodules,  ^^•hich  are  proI)al)ly  necrotic  areas.  Except  for 
these  areas  and  portions  where  the  caiisule  is  decidely  thickened  the  organ  is  of 
a  light  bluish,  somewhat  jyinkish,  color.  It  is  soft  in  consistency:  cuts  easily; 
cut  surface  is  medium  dark  red  in  color :  not  very  rich  in  blood.  There  is  i)er- 
hai)s  a  slight  increase  in  connective  tissue.  The  pulp  is  slightly  bulging. 
Smears  from  the  spleen  show  organisms  resembling  B.  jtcstis.  Sternum  is 
removed.  The  lungs  do  not  collapse  on  removal  of  the  sternum.  The  right 
lung  presents  for  about  3  finger  breadths  beyond  the  cut  border ;  the  left  for 
about  IJ.  Beneath  the  pleura.  esi)ecially  of  the  right  lung,  there  are  extensive 
areas  of  small  hemorrhages.  The  pericardial  are.i  is  slighly  increased.  Peri- 
cardium is  opened,  and  contains  perhai)s  a  little  in  excess  of  the  normal 
amount  of  clear  serum.  The  heart  is  enlarged  slightly.  There  is  one  small 
subpericardial  hemorrhage  on  the  upi)er  surface  of  the  right  ventricle.  There 
is  a  slight  increase  in  the  subpericardial  fat.  Left  ventricle  is  opened  ;  contains 
a  very  small  quantity  of  fluid  blood.     Left  auricle  contains  post-mortem  clots. 


PUKLIO    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  569 

Rifrlit  voiitriclo  contains  fluid  blood.  Kislit  auricle  contains  a  larjio  ijuantity  of 
post-niortt'Ui  clot.  The  loft  lun^r  is  lifted  out  of  its  cavity  ;  is  nowhere  adherent ; 
crei)itates  tlnH)Uj:hout ;  is  a'deniatous;  pits  on  pressure,  especially  in  the  ui)per 
lolie.  where  crei>itation  is  diminished.  Tlie  pleural  surfaces  are  jilistening. 
The  or;:an  cuts  fairly  easily.  There  is  an  area  n<'ai'  the  central  portion  of  this 
upper  h'ft  lolie  wliicli  grossly  has  the  ciiaracteristic  appearance  of  hroncho- 
jHieunionia.  A  portion  of  huij;  tissue  removed  from  this  area  when  i)laced  in 
water  sinks.  The  lower  lohe  is  congested  and  c(jntains  a  smaller  (|uantity  of 
air  than  normal.  The  right  lung  is  removetl ;  is  markedly  ofdematous  :  i»its  on 
pressure;  is  (juite  hoggy.  Crepitation  is  diminished,  and  in  upiter  lohe  is 
almost  entirely  absent.  Organ  cuts  with  slight  resistance.  Cut  surface  is 
paler  than  normal,  moist,  and  shows  almost  comjilete  consolidation,  jiressiu'e 
causing  a  large  (piantity  of  serum  tinged  with  blood  and  jiractically  no  air  to 
exude.  This  involves  nearly  the  whole  of  the  upper  lobe  on  the  right  side.  A 
iwrtion  of  the  lung  excised  and  placed  in  water  sinks  readily.  Liver  is  exam- 
ined in  situ  :  is  cloudy,  swollen.  The  left  kidney  is  removed.  The  organ  is 
enlarged,  perhaps  one-fourth  or  one-third  as  large  again  as  normal.  The  fatty 
capsule  is  not  very  conspicuous.  The  fibrous  capsule  strips  readily,  exposing  a 
surface  whic-li  is  paler  than  normal,  but  there  is  injection  of  some  of  the  venre 
stellatje.  Organ  cuts  fairly  easily.  The  contrast  between  cortex  and  pyramids 
is  well  retained.  The  cortex  is  swollen  and  the  cortical  markings  are  some- 
what obscured.     The  necropsy  is  discontinued. 

Anatomical  conditions  noted. — A  I)ronchopneumonia  involving  almost  the 
entire  portion  of  the  right  ui)per  lobe  and  a  small  poi-tion  of  the  left  upper 
lobe:  subpleural  hemorrhages:  cloudy,  swelling  of  the  kidneys  and  liver:  acute 
pulpitis,  with  slight  increase  in  the  connective  tissue  of  the  spleen  :  septic-pinia 
due  to  au  organism  which  is  morphologically  indistinguishable  from  B.  pestis. 

XXI. 

F.  B. ;  age,  40  :  male  :  died  714*  Jackson  street :  death  occurred  February  14 ; 
necrop.sy  February  1.1  by  Asst.  Surg.  Donald  II.  Currie.  Present :  Passed  Asst. 
Surg.  Rupert  Blue,  Asst.  Surg.  B.  J.  Lloyd,  and  Drs.  Carloton  Mathewson, 
Chester  H.  Woolsey.  and  Frederick  G.  Canney. 

Necropsy. — Body  that  of  a  rather  poorly  developed,  fairly  well-nourished. 
Chinese  male,  about  40  years  of  age.  Rigor  mortis  and  lividity  well  marked,  but 
the  latter  confined  to  the  deiiendent  parts.  Sliglit  anlema  over  the  lower  ex- 
tremities. Muscles  of  the  calves  moderately  contracted.  Pupils  midway  be- 
tween contraction  and  dilatation.  Sliglit  oedema  over  the  malar  regions.  Long 
median  incision  made.  Subcutaneous  fat  is  quite  well  preserved.  The  muscles 
of  a  dark-red  color,  moderately  moist.  Peritoneal  cavity  opened :  tlie  omentum 
almost  completely  covers  the  intestines  :  intestines  do  not  bulge  through  the 
opening :  the  liver  is  visible  for  four  finger  breadtlis  in  tlie  median  line.  The 
omentum  is  laid  back  and  exposes  the  intestines,  \\bicli  are  abnormally  moist. 
Their  coats  are  somewhat  injected,  but  smooth  and  glistening.  The  appendix 
is  curved  twice  upon  itself,  the  distal  end  finally  pointing  toward  pelvis.  A 
very  mucli  injected,  almost  liemorrliagic  gland  is  found  in  the  mesentery  about 
14  inches  above  tlie  ileo-C(Pcal  valve.  This  is  incised  and  a  smear  made  from 
it.  Looking  througli  tlie  posterior  peritoneal  coat,  the  tissue  l)eneath  appears 
to  be  injected,  so  the  peritoneum  is  cut  tlirougli  and  examined.  Some  enlarged 
glands  are  found  in  the  center  of  tliis  injected  area.  A  smear  from  tlie  first 
mesenteric  gland  mentioned,  stained  with  carbo-thionin,  shows  pest-lilce  organ- 
isms. A  section  of  the  intestines  lying  nearest  to  this  mesenteric  gland  opened 
and  the  mucosa  examined.  The  blood  vessels  are  found  to  show  a  moderate 
general  injection.  Intestinal  follicles  are  a  little  prominent :  this  injection 
increases  as  you  descend :  however,  there  is  nothing  sufficiently  definite  to 
make  it  even  probable  that  this  was  the  site  of  inoculation.  The  s])leen  is 
next  removed.  The  organ  is  enlarged  to  probably  three  times  its  normal  size. 
The  capsule  is  very  tense :  there  are  some  patches  of  jiartially  organized  lymph 
on  its  external  surface :  there  are  no  white  subcapsular  nodules  noted :  the 
organ  is  of  a  uniform  purplish,  reddish-lirown  color :  (piite  firm  in  consistency 
when  light  pressure  is  exerted,  but  when  firm  pressure  is  used  it  can  be  felt 
to  break  under  the  capsule.  It  cuts  almost  without  resistance.  Its  cut  sur- 
face is  very  rich  in  blood :  shows  a  slight  bulging  of  the  pul]i.  The  stand  of 
the  diaphragm  on  the  right  side  is  the  fourth  interspace  and  on  the  left  side 
fifth  rib.     The  thorax  is  opened  by  removing  the  sternum.     The  left  lung  com- 


570  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

pletely  collapses;  is  not  visible  anterioiiy.  The  right  lung  extends  toward  the 
niedinn  line  beyond  the  cut  l)order  for  one  and  one-half  finger  breadths.  It  is 
bound  anteriorly  in  the  lower  portion  opposite  the  middle  lobe  by  a  small  but 
rather  firm  adhesion.  The  lung  is  laid  back.  Pericardial  area  examined; 
found  to  be  enlarged;  the  enlargement  apparently  due  to  increase  in  the 
size  of  the  heart  muscle.  The  adhesion  mentioned  over  the  right  lung  is 
cut  and  the  organ  is  found  to  be  further  adherent  at  the  apex  of  the  upper 
lobe.  These  adhesions  are  quite  firm  in  character.  After  being  cut  and 
broken,  the  organ  is  lifted  out  of  its  cavity.  The  pleura  retains  its  normal 
luster.  Al>out  the  apex  of  the  upper  lobe  are  nodules  the  shape  of  which  is 
visible  through  the  pleura  and  on  palpation  these  are  found  to  be  firm,  hard 
masses  about  the  apex  of  this  lobe.  Eight  of  ten  of  these  circumscribed  masses 
can  be  palpated.  Incision  is  made  through  these  and  they  are  found  to  bo 
tubercles  which  have  undergone  degenerative — chiefiy  caseous — changes.  The 
surrounding  lung  substance  in  this  region  is  congested,  and  shows  consider- 
able (edema.  Tlie  lower  lobe  crepitates  throughout ;  fairly  resistant  to  pres- 
sure when  the  knife  cuts.  The  surface  is  dark  in  color ;  contains  a  moderate 
amount  of  blood.  Pressure  causes  blood,  serum,  and  air  to  exude  in  about  the 
usual  proportions,  probably  the  blood  being  a  little  in  excess.  The  whole 
organ,  however,  has  rather  a  leathery  resistance  when  firm  pressure  is  exerted 
upon  it.  The  left  lung  is  removed.  Its  pleura  is  found  to  be  normal  in  appear- 
ance, not  even  showing  subpleural  hemorrhages.  Organ  crepitates  fairly  well 
throughout ;  is  rather  resistant  to  knife  cut.  Its  cut  surface  is  lighter  than 
its  fellow  of  the  opposite  side,  being  a  brown  red,  which  is  quite  resistant  to 
pressure,  and  pressure  causes  blood  in  excess,  some  serum,  and  about  the 
usual  amount  of  air  to  exude.  It  has  the  same  elastic,  leathery  feel  that  the 
other  one  has  and  which  is  met  with  not  infrequently  in  pest  independent  of 
any  pneumonic  condition ;  when  i)resent  is  usually  more  marked  than  in  this 
case,  and  may  possibly  be  due  to  involvement  of  the  lymphatics  of  the  lung. 
A  portion  of"  the  organ  is  preserved  for  section  and  examination  under  the 
luicroscope.  The  heart  is  lifted  out  of  its  cavity.  Its  surface  shows  several 
small  hemorrhages  under  the  pericardium  and  one  small  milk  spot.  The  ves- 
sels are  not  especially  engorged  except  on  the  posterior  side,  uor  are  they  tor- 
tuous. The  apex  is  formed  equally  by  right  and  left  ventricles.  The  organ 
is  somewhat  enlarged  as  compared  to  the  fist  of  the  individual.  The  left  ven- 
tricle is  firm,  and  apparently  hypertrophied ;  the  right  ventricle  moderately 
firm.  The  left  ventricle  is  opened ;  found  to  contain  both  fluid  blood  and 
post-mortem  clots.  The  right  ventricle  is  oi)ened:  same  contents,  only  more. 
The  left  ain-icle  is  cut  into  and  found  to  be  almost  empty.  The  left  ain-iculo- 
ventricular  opening  admits  three  gloved  fingers  easily,  four  with  slight  stretch- 
ing. The  right  auricle  is  opened  and  found  to  contain  a  similar  quantity  of 
fluid  blood  and  post-mortem  clots.  The  right  auriculo-ventricular  opening 
admits  four  fingers.  The  heart  is  removed  by  excising  the  vessels  at  its  base. 
Left  heart  is  next  laid  oi)en  and  the  organ  washed.  The  aortic  siu-face  shows 
numerous  corrugations,  the  result  of  chronic  endarteritis.  The  aortic  valves 
are  normal.  Tlie  coronary  openings  are  patulous.  The  mitral  valves  are 
transparent.  Probably  there  is  a  slight  thickening  of  the  endocardium  over 
the  columna  carnea,  but  the  substance  appears  normal  in  color  and  consistency. 
The  left  ventricle  wall  is  a  little  thickened,  but  otherwise  appears  normal. 
Left  kidney  is  removed.  Its  fatty  capsule  is  fairly  well  preserved.  Its 
fibrous  capsule  removes  very  easily,  excei)t  in  places  where  it  shows  adhesions. 
The  surface  is  for  the  most  part  smooth,  but  there  are  patches  in  which  there 
is  a  suspicion  of  granulations,  especially  along  the  convex  border.  The  organ 
is  incised  through.  It  cuts  with  a  moderate  amount  of  resistance ;  its  cut 
surface  is  rather  rich  in  blood.  The  contrast  between  the  cortex  and  the  pyra- 
mids is  poorly  retained.  The  cortical  margins  are  normal  in  l)readth.  The 
whole  organ  has  a  very  slight  yellowisli  color.  Collections  of  the  blood  vessels 
in  places  can  be  noted  as  red  points  or  fine  lines.  The  condition  is  probably  an 
acute  nephritis  of  several  days  duration.  A  section  of  it  is  taken  for  micro- 
scojtical  examination.  The  liver  is  next  removed.  The  organ  is  smaller  than 
normal.  Its  surface  is  of  a  general  mottled  yellowish  pink  chiefly,  with  areas 
of  venous  engorgement.  Besides  this  there  are  numerous  black  spots  scattered 
over  its  surface.  These,  in  some  cases,  show  a  slight  de])ression  of  the  capsule 
dipping  down  into  them,  but  are  mostly  on  the  same  level  with  the  rest  of  the 
organ.  These  spots  vary  in  size  from  a  pin  point  to  a  split  pea,  and  are 
numerous  on  the  whole  surface  of  the  right  and  left  lobes.  Some  of  these 
are  incised  into  and  found  to  be  cystic  in  character ;  they  contain  a  small 


I'UHLIO    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  571 

iUiKHint  of  <-l0iir  Ihiid  :  tlioy  are  unilocular  and  arc  not  due  to  liydaliil.  The 
orjxan  is  n'sistant  to  ])rrssuri'.  cuts  with  rcsistanc(>,  and  its  cut  surface  shows 
a  uicdhuu  advanced  sta.^e  of  La-nnec's  cirrhosis.  These  cysts  are  in  some 
cases  even  nunid  in  the  center  of  the  or^an.  and  whili'  the  condition  is  a  rather 
IHH'uIiar  one.  it  is  prohable  that  they  are  due  to  lynii)hatic  obstruction  from  the 
contracted  c(Hinective  tissue.  However,  section  is  taken  for  niicrosco]iical 
examination.  An  incision  is  made  into  the  ri;iht  in;,'uino-fcmoral  re;;ion.  One 
small  ;;land  found,  which,  while  not  specially  enlarj^ed,  showed  a  small  hemor- 
rhaj^e  in  the  central  jxirtion.  A  smear  made  from  this  shows  a  pest-like 
bacillus.  An  incision  made  in  the  left  iufiuino-femoral  rej^ion  and  nothintc 
fouud.  Incision  made  in  the  ritjht  a.xillary  rej^ion  and  a  bunch  of  three  glands, 
enlarged  to  probably  twice  their  normal  size,  are  found.  One  of  the  largest 
of  these  cut  through  is  found  to  be  d(>eiily  congested.  An  incision  made  below 
the  angle  of  the  jaw  on  the  right  side  and  a  very  much  injected  and  enlarged 
gland  is  found,  typically  pest-like  in  character  and  probably  the  primary  bubo. 
The  gland  is  found  just  internal  to  the  carotid  artery.  The  right  tonsil  is 
removed  and  it  is  found  to  be  enlarged  and  congested:  is  incised  through  and 
a  smear  made  from  it.  Sni(>ar  made  from  the  gland  foiuid  in  the  triangle 
shows  numerous  "  doughnut  "  forms,  which  stain  poorly,  indicating  that  it  is 
probably  the  primary  bubo.  The  tongue  is  removed.  The  villi  at  its  po.sterior 
portitm  appear  normal,  as  tloes  the  organ  throughout  except  the  anterior  por- 
tion, which  has  a  darkish  streak.  The  larynx  and  epiglottis  are  next  removed. 
A  large  hemorrhage  is  found  on  the  surface  of  the  epiglottis.  The  larynx  is 
very  much  congested  and  covered  with  blood.v  mucus. 

Anatomical  niAiiNosis. — Acute  adenitis  of  the  right  inguiuo-femoral,  both 
axillary.  retro-perit(meal,  anterior  cervical,  and  the  glands  situated  just  under 
the  tonsil :  acute  tonsilitis :  acute  inflammation  of  the  spleen ;  acute  nei)hritis. 
These  acute  conditions  are  probably  due  to  the  infection  with  a  bipolar  pest-like 
bacillus,  the  nature  of  which  is  to  be  determined  l)y  bacteriological  examination. 
Besides  this,  there  is  a  hypertrophy,  moderate  in  character,  of  the  left  heart, 
and  tubular  infiltration  of  the  apex  of  the  upper  lobe  of  the  right  lung. 

XXII. 

L.  R. ;  age,  33 ;  female ;  died  City  and  County  Hospital ;  death  occurred  Febru- 
ary 10;  necropsy  February  20,  l)y  Asst.  Surg.  Donald  II.  Currie.  Present: 
Passed  Asst.  Surg.  Rupert  Blue.  Asst.  Surg.  B.  J.  Lloyd,  Doctors  Chester  II. 
Woolsey,  Carleton  Mathewson,  D.  F.  Ragan,  F.  G.  Canney,  L.  D.  Bacigalupi, 
Drew,  Weeks,  Trotter,  Clark,  and  McXutt. 

Necropsy. — Body  that  of  a  well-developed,  unusually  well-nourished  white 
female  about  45  years  of  age.  Muscles  of  calves  moderately  contracted ;  arch 
of  foot  somewhat  raised.  Post-mortem  rigidity  marked  in  the  extremities; 
absent  in  the  neck.  Post-mortem  lividity  in  dependent  parts  very  well  marked; 
slight  on  the  anterior  aspect  of  the  liody.  Scleme  show  slight  injection  but  no 
hemorrhages.  The  pupils  are  midway  betAA-een  dilatation  and  contraction.  There 
is  post-mortem  lividity  over  the  right  cheek  and  some  cedema  in  this  region.  No 
glandular  enlargement  noted  on  palpation.  Long  median  incision  made.  Sub- 
cutaneous fat  unusually  well  preserved,  being  probably  2  inches  in  thickness  on 
an  average.  Muscles  of  abdomen  poorly  developed,  of  a  light,  reddish-brown  color. 
Peritoneal  cavity  opened.  The  omentum  bulges  slightly  through  the  incision ; 
completely  c:)vers  anterior  aspect  of  the  intestines  ;  is  very  rich  in  fat.  This 
laid  back,  the  intestinal  coats  are  found  to  be  normal  in  apiiearance  and  moder- 
ately moist.  The  peritoneal  cavity  contains  practically  no  free  fluid.  The  appen- 
dix is  a  little  over  an  inch  long,  straight,  points  toward  the  true  i)elvis.  Stand  of 
the  diaphragm  on  the  right  side  fourth  interspace,  left  side  fifth  rib.  The  liver 
is  visible  for  aI)out  2  finger  I)readths  in  tlie  median  line  and  about  the  same  dis- 
tance in  the  umbilico-manimary  line.  The  stomach  is  in  normal  position. 
Spleen  is  pushed  downward  and  forward ;  not  adherent ;  removed  without  diffi- 
culty. The  organ  is  enlarged  to  twice  its  normal  size ;  the  enlargement  is 
chiefly  in  length  but  somewhat  in  thickness.  The  capsule  is  wrinkled.  Fibrous 
capsule  has  been  i)artially  torn  off  in  the  removal.  Capsule  is  transparent,  and 
through  it  can  be  seen  an  organ  of  a  pinkish  blue  color.  There  are  none  of  the 
white  subcapsular  nodules  sometimes  met  with  in  pest,  but  there  are  flakes  of 
more  or  less  organized  lymph  deposits  scattered  over  its  surface.  Organ  is  quite 
soft  in  consistency  :  cuts  easily ;  its  cut  surface  shows  a  decided  bulging  of  the 
imlp.  Surface  is  not  very  rich  in  blood  and  thei'e  is  apparentl.v  no  coiniective 
tissue    increase.     Smear    made    from    this    organ,    stained    with    carbo-thionin, 


572  PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 

shows  an  absence  of  all  bacteria.  The  thorax  is  next  opened  by  removal  of 
sternum.  Costal  cartilages  show  no  ossification  on  the  rij^lit  side :  moderate 
ossification  on  the  left,  especially  the  upper.  The  lungs  do  not  meet  in  median 
line.  The  right  lung  extends  al)out  half  a  finger  breadth  toward  the  median 
line  l)eyoud  the  cut  border,  which  is  the  juncture  of  the  cartilage  and  rib.  The 
left  lung  extends  toward  the  median  line  foi-2  finger  breadths  beyond  the  cos- 
tal articubition.  The  left  lung  is  lifted  out  of  its  cavity.  The  organ  is  not  col- 
lapsed, and  the  lower  jwrtion  of  the  upper  lobe  shows  consolidation.  The  right 
lung  is  lifted  out  of  its  cavity ;  found  to  be  free  from  adhesions,  except  a  slight 
one  at  the  base,  fresh  and  soft  in  character.  The  upiter  lobe  of  this  organ  prob- 
ably also  shows  consolidation.  The  pericardial  area  is  inereased  in  size  and  its 
surface  covered  with  fat.  Pericardial  sac  is  opened  and  the  heart  lifted  oiit.  It 
is  found  that  the  sac  contains  about  ijO  c.  c.  of  a  slightly  blood-stained  serum. 
The  heart  is  enlarged  to  probal)ly  one-third  above  its  normal  size  as  comi>ared 
with  the  fist  of  the  individual.  The  apex  is  formed  chiefly  by  the  left  ventricle. 
Its  surface  shows  considerable  increase  in  fat.  Its  veins  are  engorged  but  not 
tortuous.  A  close  inspection  shows  that  the  terminal  venules  are  dilated  every- 
where (as  is  frequently  seen  in  cases  of  pest"),  and  in  some  of  these  there  are 
small  hemorrhages  at  the  distal  ends.  The  left  veiitricle  is  opened  ;  found  to  con- 
tain fluid  blood  only.  The  right  ventricle  opened  ;  found  to  be  practically  empty. 
The  left  auricle  opened ;  contains  fluid  blood  and  one  moderate-sized  white  clot. 
The  left  auriculo-ventricular  opening  admits  four  fingers  with  difliculty.  three 
easily.  The  right  auricle  opened ;  almost  filled  with  white  clot,  some  fluid  blood. 
Right  auriculo-ventricular  opening  admits  four  gloved  fingers  with  slight  stretch- 
ing. The  left  lung  is  now  removed  by  severing  the  bronchi.  The  organ  is 
enlarged.  It  hardly  collapses  at  all.  The  pleura  over  the  lower  lobe  has  not 
lo.st  its  luster;  is  normal  in  appearance.  The  pleura  of  the  upper  lobe,  lower 
half,  is  of  a  light  grayish-red  color;  has  lost  its  luster  comi)letely.  The  lower 
lobe  crepitates  moderately.  Init  the  resistance  is  very  much  increased,  especially 
in  the  central  portion.  The  crejtitation  about  the  base  is  fairly  normal.  In  the 
upper  lolie  the  consolidated  area  is  represented  in  the  lower  half  of  the  lung. 
It  is  completely  consolidated,  while  the  upper  half  still  crepitates.  Incision  is 
made  through  the  consolidated  portion  of  the  upper  lobe  and  the  most  resist- 
ant portion  of  the  lower  lobe.  The  area  of  consolidation  in  the  upper  lobe  is 
found  to  be  alxjut  3  fingers  long  Ijy  2  in  bi'eadth.  It  is  completely  airless.  The 
color,  when  the  blood  is  removed  from  the  surface,  is  a  general  yellowish  red, 
with  here  and  there  areas  of  a  darker  red  hue.  The  condition  met  with  in  the 
more  solid  portion  of  the  upjier  lobe  is  an  increased  amount  of  bloody  senna  on 
the  surface,  which,  on  being  removed,  exposes  a  dark-red  surface,  all  but  air- 
less. Pressure  in  this  area  causes  blood,  some  sermn.  and  a  A-ery  little  air  to 
exude.  Incision  is  now  made  through  the  upper  loI)e  at  right  angles  to  the  other 
incision  and  toward  its  apex.  The  same  condition  to  a  less  extent  is  met  with. 
Portion  of  this  consolidated  area  is  excised  and  floats  very  low,  finally  sinking, 
the  upper  portion  of  the  piece  being  l)elow  the  surface  of  the  water.  A  portion 
of  the  more  solid  area  of  the  the  lower  lobe  sinks,  condition  being  broncho- 
pneumonia sinudating  the  pseudo-lobar  type.  The  right  huig  is  removed  from 
its  cavity.  The  middle  lobe  collapses  almost  completely.  The  lower  lobe  col- 
lapses to  a  less  extent,  and  the  upper  lobe  probably  collapses  to  one-half  its 
normal.  The  pleura  of  the  lower  lobe,  except  in  one  area  about  the  size  of  a 
25-cent  piece,  has  still  retained  its  luster  and  shows  nothing  abnormal.  In  the 
area  mentioned,  which  is  of  a  lightish  red  color,  the  pleura  has  lost  its  luster.  The 
organ  in  this  region  is  (iiiite  firm  and  resistant  to  pressure.  Incision  carried 
through  it  shows  the  same  condition  as  met  in  the  opr)osite  lung,  as  far  as  the 
naked-eye  inspection  shows,  but  from  its  wedge  shajjc  it  is  prol)ably  due  to  an 
infarct.  The  ui)per  lol»e,  except  for  this  area  .iust  described,  shows  a  deficient 
crei)itation  throughout,  esi)ecially  marked  about  its  l)ase.  Incision  is  carried 
through  it.  It  is  found  to  be  in  the  same  condition  as  the  upper  lobe  of  the  left 
lung.  The  consolidation  varies  in  extent  in  different  areas  of  the  lung,  but  in 
no  portion  of  this  lobe  is  the  organ  normal.  Incision  is  carried  through  the 
lower  lobe.  This  portion  of  the  organ  is  found  to  be  congested,  although  it  still 
contains  a  considerable  quantity  of  air.  A  portion  is  thrown  into  water  and 
floats  fairly  high.  The  left  kidney  is  next  removed.  Fatty  capsule  is  found  to 
be  well  preserved.  When  stripped  off,  exposes  organ  about  normal  in  size. 
Its  blood  vessels  distrilmted  sui)erficially  over  its  capsule  show  consolidation. 
The  organ  is  rather  soft  in  consistenc.v.  Its  filirous  capsule  strips  off  very  easily, 
exposing  a  moist,  light  yellowish-red  surface  in  which  the  stellate  veins  are  very 
promiuent.     The   surface   is  perfectly    smooth.     Incision   carried   through   the 


PITHLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE.  573 

orjiiin.  Cut  snrfiicc  fouiul  to  ho  (|uito  ricli  in  l)loo(l.  Tlio  fontr;ist  between  cor- 
tex and  pyraiiiids  is  fairly  w(»!i  retained  in  areas  and  (|"ite  dinunislied  in  others. 
The  cortical  niar.uin  is  proitahly  about  normal  in  breadth.  'I'he  j^eneral  color  of 
the  cortical  portion  of  the  oi'^an  is  a  yellowish  red.  in  which  red  s|)(»ts  show  up 
prondneidly,  rejiresentini;  the  congested  nialpi.:,diian  bodies.  The  i)yrandds  are 
about  normal  in  ai»pearance.  The  condition  is  probably  an  early  sta^e  of  acute 
nepliritis.  The  rij,'ht  kidney  is  ne.xt  removed.  Its  attachments  are  found  to  be 
very  loose.  Its  fatty  ca|)sule,  like  its  felhw  of  the  oi)posite  side,  is  unusually 
well  preserved.  The  orjian  is  about  the  same  size  as  its  fellow.  Its  fibrous 
capsule  strips  ofT  very  easily,  exitosintc  a  very  smooth,  yellowish-red  substance. 
Orjian  cuts  «'asily  ;  its  cut  snrf;ice  is  moderately  rich  in  blood.  An  incision  is 
made  in  tli(>  rii^lit  in.ijuino-fenioral  rej^ion  to  ascertain  if  there  are  any  enhwiu'eil 
nodes.  One  slij,ditly  (>nlar,i:e(l  lymi)h  node  showiuf;  cortical  injection  is  foinid, 
and  a  smear  made  from  it.  Anotlu>r  incision  is  made  in  the  left  inj^uino-femoral 
region.  Incision  is  made  at  the  anj^le  of  the  .jaw,  right  side.  A  very  much 
eidarged,  broken-down  gland  is  found,  and  a  smear  is  made  from  it.  The  liver 
is  exanuned  in  situ.  The  organ  is  soiuewhat  deformed,  possibly  from  pressiu'c 
of  tight  clothing.  The  lower  border  is  very  slightly  rounded.  The  organ  is 
probably  enlarged.  Its  surface  Is  smooth.  Capsule  is  not  thickened.  The  color 
of  the  oi'gan,  us  seen  through  the  capsule,  is  a  chocolate  brownish  red  with  areas 
of  lightish  red  and  areas  of  venous  dilatation.  Organ  is  very  soft  in  consist- 
ency;  pits  on  pressure;  cuts  easily;  its  cut  surface  is  moderately  rich  in  blood. 
Structural  appearance  is  rather  lost,  showing  a  slightly  "boiled  appearance;" 
it  is  very  soft  and  friable.  There  is  probably  some  acute  degenerative  condi- 
tion, probably  cloudy  swelling;  is  not  examined  furtlier.  The  mesentery  is 
gone  over  and  is  found  to  be  very  rich  in  fat,  but  its  glands  are  not  visible. 
The  uterus  is  probably  slightly  enlarged,  firm,  in  normal  position ;  is  not  ex- 
amined further.  The  bladder  is  empty  and  collapsed.  The  heart  is  removed 
by  severing  the  vessels  at  its  base,  the  organ  washed,  and  its  left  cavity  is 
laid  open.  The  aorta  is  almost  smooth,  showing  a  few  corrugations,  which  have 
not  interfered  with  the  coronary  openings.  The  aortic  valves  are  slightly 
blood  stained,  but  are  thin  and  transparent.  IMitral  valve  is  normal  in  appear- 
ance. The  heart  muscle,  as  seen  in  the  wall  of  the  left  ventricle,  has  a  rather 
brownish,  yellowish  color,  probably  due  to  some  acute  febrile  degeneration. 
The  endocardium  generally  is  smooth  and  transparent. 

Anatomical  diagnosis. — Lobular  pneumonia  ;  acute  adenitis  of  right  cervical 
glands  ;  acute  pulpitis  of  spleen  ;  acute  nephritis  ;  acute  degeneration  of  liver  and 
heart  muscle,  the  conditions  i)robably  being  due  to  infection  with  an  organism 
which  is  found  in  considerable  number  in  the  smears  from  the  lungs,  the  nature 
of  which  is  to  be  determined  by  bacteriological  examination. 


STATISTICAL  TABLES. 


575 


STATISTICAL  TABLES. 


The  following  statistical  tables  are  self-explanatory: 

TaHI.K    I. — COMPAKATIVE    TaUI.E    OV    XlMUKK    TkEATEI) 1868    TO    1904. 


Tlie   following  tabular  statement   will  .serve   to   illustrate  its  growth   aince  the 
reorganization  of  the  Marine-Hospital  Service  in  1871: 

Operations  of  the  Marine  Hospital  Service  from  July  1,  1868,  to  June  SO,  1904. 


Fiscal  year. 

Number  of   ""."l^l'^f 

Prior  to  reorganization: 

1868 

64              11..t3.'5 

1869 

64 

74 

72 
81 
91 
91 
94 

11,356 

1870 

10,560 

After  reor£;ani7.ation: 
1871.. 1 

14,256 

1872 

13, 156 

1873 

13,529 

1874..                 ... 

14,356 

1875 

15.009 

1876. 
1877. 
1878. 
1879. 
1880. 
1881. 
1882. 
1883. 
1884. 
1885. 
1886. 
1887. 
1888. 
1889. 
1890. 
1891. 
1892. 
1893. 
1894. 
1895. 
1896. 
1897. 
1898. 
1899. 
1900. 
1901. 
1902. 
1903. 
1904. 


94 
100 
210 
210 
210 


16,808 
15. 175 
18,223 
20,922 
24,860 
32, 613 
36,184 
40, 195 
44,761 
41,714 
43,822 
45, 314 
48,203 
49, 518 
50,671 
52.992 
.53,  610 
53,317 
52,803 
52,643 
53,804 
54,477 
.52,  709 
.55,489 
56,355 
.58, 381 
56, 310 
58,573 
58,556 


8(529—04- 


-37 


578 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Amount          Tonnage  tax 
expended,     j      collected. 

8  : 

00      '■ 

CO 

i 

5,90.5.74 

45, 464. 91 

440.70 

33. 15 

116. 10 

MOO 

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210.  72 

24.87 

1,774.80 

4,520.94 

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IN       CO 

274.88 
685.00 
962. 80 
583. 00 
1, 538. 49 
24, 665. 87 
602.00 
340.20 
302.60 
405.40 
130.00 

372. 87 

197. 83 

510. 85 

23,575.39 

... 

Mi 

2^ 

25.00 
283. 86 
2,  799. 16 
275. 60 
28, 715. 74 
11, 335.  78 
16,091.03 

CO 

Number  of 
persons 

examined 
physic- 
ally, in- 
eluding 
pilots. 

OS 

cc 

i-H  t^  <M  00 

lO  -jh 

COI^ 

CO 

g 

g^?§ 

N 

Number 
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lief was 

fur- 
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co-^-o^ioo-.  trscqooio 

05  -* 
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CO 

CO 

CO 

IS 

28 

423 

945 

13 

2,901 

671 

2,402 

■^ 

Number 
of  sea- 
men fur- 
nished 
office 
relief. 

11 

OOCMOOOir^Ot^QOl^CvD 

CC^iO  —  O00iO(M--C0 

CO  -^ 

2S 

CO 

OS  »0  CD  .<J^  00  CO  ^ 
INCD        ^'J'OO 

c-i      i-T 

^ 

Number 
of  days' 
relief  in 
hospital. 

a: 

151 
268 
706 
233 
363 
18, 350 
67 

CO 

CO 

oo" 

i 

o5<oo 

COt^  w 

f 

15 

1,448 

104 

17, 162 

5,911 

13,  754 

IM 

Remain- 
ing in 
hospital 
June  30, 
1904. 

© 

n 

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^ 
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Dis- 
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Patients 
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July  1, 
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Total 
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a    .1—  -<( 


©■^OJ-^Ol 


-HOOtOt^^ 


r,  Q  r- -- o -- o 
M  uS  ^i  r~  CO  CO  CO 


o>  0-.  <r  o  o 

IM  C-.  >C  O!  00 


Q'*00Q0O«O» 
NC'lO-iCOt^M 

.-1U510  —I 


coMcooor^ 


(N  N  00  CO  t^  -^  CO 

■^  UO  00  »o  c  —  o 


O  CO         »-*  CO 


C2  CO  05  O  CO  (N  lO 

—  r^  CO  r^r^  ^  ^ 

-i-         (N         ^  UO  O 


^  t^  -rj*  ^?o 

lO  CO  t^  0>  IM 

(NOiC  (Nrt 


»0  CO  W  lO  (M  •*  (N 
M        N        O  LO  »o 


1.0  r^  «3  c-1  o 


'ocooi^o^ 

.-lOlCO— <ooo 


lO  CO  (N  lO  »0  ^-  ^H 


i^  -<^  05  o  o 


CO  O  CO  LO  O  LO  -^ 
—  I^  CO  "  t~  t- 


>.0  (M  M  O  O  O  Ol 
CI        (N        to  >f5  UO 


-1"  O  IM  "  "O 


O  ■*  —  >-o  O 


-H  «  t^   C.   '^ 


S-^  >-i  t^  ^  »/^  CO 
COOiO-*  "CCO 
>-100«5        "-OO 


05C0000000O*-^t^O 

r^      »o  (M  05 -^  c;  o  CO 


M  1^  00  1^  lO 


C  t-t  ^  I 
o  o  o  ^ 


^^ 


5  2  s  y' 


2>Z 


5  L-  r^  ^  f  ci  o  hr'r"r  ^  c  c:  c  e 
-  r  c;  cj  «  c  o  Si'  ^"^  ^  tii  "  b 


i^s 


J  OJ  -^'^  c^     ^  ^  r*  -^  '^ 


CO  K  « 'X  ^  r^  £-  £-■  f  ^  I-' 


582 


PUBLIC    HEALTH    AND   MAEINE-HOSPITAL   SERVICE. 


Tonnage  tax 
collected. 

00 

Amount 
expended. 

Number  of 

persons 

eximiined 

pliysic- 
!iMy.  in- 
cluding 
[lilots. 

o 

Number 
of  times 
office  re- 
lief was 

fur- 
nished. 

:S 

Number 
of  sea- 
men fur- 
nished 
office  re- 
lief. 

•<M 

Number 
of  (lays' 
relief  in 
hospital. 

s 

-S<  t^  115  00  O  O — 

->oc  — oc^"*;; 

Remain- 
ing in 
hos|)ital 
.Tune  30, 
1904. 

Died. 

(N 

^~' 

'"' 

Dis- 
charged. 

OC 

.-.  CO  .-*  PC  t^  f-H  00 

Total 
number 
treated 
in  hos- 
pital. 

00 

-HOOrt  moorHos 

Admit- 
ted dur- 
ing the 
year. 

—  00 

t<;io-.Jo5 

Patients 
in  hos- 
pital 
July  1, 
1903. 

n 

Total 
number 
of  sen- 
men 
treated. 

°  ! 

^oc  —  re  X  rJ02 

o 

£ 

1 

2 

& 

ft 

03 

O 

c 
c 

5 

c 

d 

c 

1 

1 

5 

5 
5 

c 
£ 

& 

c 
E- 

c 

ft- 

C 
C 

£ 

S 

d 

c 

c 

c 

c 

03 

4= 
o: 
C 
C 

> 

c 
c 

g 

S 

i 

o 

n 
a: 

1 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


583 


T.\BLE    III. — Sr.MM.VRY    OF     rilYSUAI,     K.V AMINATIONH   OF    SeAMK.V    MADE    BY    OfFKERH 
OF     THE    Pl'BLIC     HeALTII     AND      M  AKl.NE-IIo.SI'ITAL     SERVICE     DURING     THE      FlMCAL 

Year  ended  June  30,  1904. 


Summary  of  examinations  and 
causes  of  rejection. 

"3 
*^ 
o 

o 

> 

t 
b£  ■ 

SS 

2 

•43 

a> 

O   0) 

to 

03 
O 
O 

i 

CO 

a> 

is 

a 

i 

3 

e 

a 

ca 
.a 

Foreign  seamen. 

Immigration  Serv- 
ice. 

i 

II 

o 

a 

a'm 

03  .S 

■-a 

J5  P 
l-l 

Simimnrv  of  examinations: 

5,783 

5,30,3 

480 

1,812 

1,686 

126 

728 
600 
128 

1,161 

1,124 

37 

.53 
47 
6 

12 
9 
3 

604 
516 

88 

6      2 
3      2 
3  .... 

1,403 

1,314 

89 

2 

Xiiuil)or  passed 

2 

Causes  of  rejection: 

1 

1 
2 
2 
2 

2 

68 
125 

U 

3 
30 

1 

2 
5 
3 

i 

3 
1 

5 

1 
1 

1 
1 

Alcoliolisiii 

1 

1 

2 

1 

1 

2 

Atrophy,  leg             . .             .... 

1 

Bronchitis              

i' 

45 

4 

'\ 

2 

Color  blindness 

12 

'\ 

1 

7 

i  

1 

Coryza  

i' 

1 
2 

1 

Deafness 

Debility 

1 
2 
4 

Deformity,  amputartions 

1 

53 
1 

1 
28 

Defective  \nsion 

9 

' 

27 

Degeneration  of  arteries,  aorta. . 
Dysentery 

1 

Eczema 

...... 

8 
4 

1 

1 
1 
3 

] 

Flatfoot 

General  eruption 

. 

Gonorrhea    

1 
2 

Heart- 

3 

... 

1 

Fatty  degeneration 

Disease  of— 
Mitral 

8 
4 

4 

17 
1 
1 

39 
2 

Aortic 

Aortic  and  mitral 

Pulmonary 

3 
13 

Hernia 

4 

8 
1 

2 
3 
2 

1 

4 

Impetigo  contagiosa 

Inflammation  of— 
Larynx 

2 

Tonsils 

1 

Injured  shoulder 

1 

Insubordination . . . 



1 

Jaundice 

Malarial  feyer,  intermittent 

1 

1 

Myelitis,  diffuse 

1 
1 

2 



CEdema 

Old  age 

Otitis  media,  suppurative 

Paralysis,  hemiplegia 

1 

1 

Paresis 

2 

Pediculosis 

1 
1 
4 
1 

1 

Piles 

2 
3 
2 

i' 

Poor  physical  condition 

4 

Psoriasis 

Refused  examination 

1 

Retention  of  urine 

Rheumatic  fever 

1 

Rheumatism 

1 

Scabies 

1 

Scoliosis 

1 
1 

Senility 

1 

Soft  chancre 

4 

Stricture  of  urethra 

1 

SypMUs— 

Primary 

1 
2 

1 

Secondary 

1 

1    ... 

Talipes,  valgus 

1 

Temperature,  abnormal. 

r 

1 
1 

2 

4 

7 

Tubercle 

19            2 

8 

1 

1 

584 


PUBLIC    HEALTH    AND    MAEINE-HOSPITAL   SERVICE. 


Table  III. — Summary  of  Physical  Examinations  of  Seamen  made  by  Officers 
OF  the  Public  Health  and  Marine-Hospital  Service  during  the  Fiscal 
Year  ended  June  30,  1904 — Continued. 


0) 

& 

a 

> 

aJ 

^ 

a 

"3 

+J 

■a 

m 

K 

g 

02 

o 

5« 

3ffl 

;'?'»=-• 

S 

CS 

d 

a 

SS 

0  m 

03-2 

Summary  of  examinations  and 

o.y 

S3 

03 

O  01 

oScc 

p^ 

d 

03 

.y^ 

causes  of  rejection. 

w'" 

J3 

a 

03  •'-' 

CO  a 

C 

o 

^ 
® 

s 

o 

.15 

u 

0) 

o 

> 

+^o 

H 

PM 

rt 

►^ 

o 

1-1 

;^ 

(X, 

o 

M 

1 

1 

Ulcer  of — 

2 
1 

2 

1 

1 

1 

11 

10 

1 

9 
2 
1 

■     2 

1 

1 

6 

2 

2 

1 

Table  IV.- 


-Statement,  by  Districts,  of  the  Number  of  Patients  Treated  during 
the  Year  ended  June  30,  1903. 


District. 

Total 
cases. 

Pa- 
tients 
in  hos- 
pital 
Julyl, 
1902. 

Ad- 
mitted 
during 
the 
year. 

Total 
num- 
ber 
cases 
treated 
in  hos- 
pital. 

n3 

03 
o 

5 

Died. 

Pa- 
tients 
in  hos- 
pital 
June 
30, 1903. 

Numlier 
of  days 
relief  in 
hospital. 

Num- 
ber of 
seamen 

fur- 
nished 

office 
reUef. 

Num- 
ber of 
times 
office 
relief 
was  fur- 
nished. 

Total 

Atlantic 

58,556 

20,  797 

131 

7,329 

4,441 

4,419 

13,290 

7,512 

555 

82 

902 

273 
6 

87 
58 
42 
133 
289 
9 
5 

13,401 

4,603 

59 

1,271 

1,004 

1,305 

2,640 

2,299 

166 

54 

14,303 

4,876 

65 

1,358 

1,062 

1,347 

2,773 

2,588 

175 

59 

12,776 

4,382 

58 

1,221 

971 

1,258 

2,584 

2,091 

155 

55 

491 

155 

2 

40 

40 

36 

73 

137 

4 

4 

1,037 

339 

5 

97 

51 

53 

116 

360 

16 

415,292 

134,037 

1,554 

37,  391 

22, 816 

22, 361 

65, 434 

126, 524 

4,569 

606 

44,263 

15, 921 

66 

5,971 

3,379 

3,072 

10,517 

4,924 

380 

23 

72,987 
25,  270 

West  Indies 

Gulf 

79 
10, 295 

Ohio 

5,146 

Mississippi 

4,396 

Great  Lakes 

16,079 
10,991 

Pacific  islands 

Quarantine  stations 

705 
26 

Table  V. — Katio  of  Patients  Treated  in  Hospital  in  Each  District. 


District. 

Per  cent  of 
patients 
treated  in 
hospital. 

District. 

Per  cent  of 
patients 
treated  in 
hospital. 

Atlantic .• 

23.44 
49.61 
18.52 
23.91 
30.48 

20. 85 

West  Indies 

Pacific 

34.31 

Gulf 

31.53 

Oh^o 

71.70 

Mississippi 

Table  VI. — ^Average  Duration  op  Treatment  in  Hospital  in  Each  District. 


District. 


Atlantic 

West  Indies 

Gulf 

Ohio 

Mississippi . 


Average 

number  of 

days'  relief 

furnished 

to  each 

patient. 


27.48 
23.90 
27.52 
21.48 
16.62 


District. 


Great  Lakes 

Pacific 

Pacific  islands 

Quarantine  stations 


Average 

number  of 

days'  relief 

furnished 

to  each 

patient. 


23.61 
50.81 
26.10 
10.28 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


581 


Tahi.k    VII. — Tahular    Statement,    by     Districts,    of     Diseases    and 
Treated  durin(}  the  Fiscal  Year  ended  June  30,  1904. 


In.iikies 


DISTRICT  OF  THE  ATLANTIC. 


Number  of  cases 

Diseases. 

it 

c  o  * 

lis 

(JO 

a; 

-a 

■6 
£ 

> 
0 

2 

> 

2 
a 

a 

■6 

% 
2 

a. 
S 

0 
1^ 

•d 
a. 

(5 

1° 

s 

0. 
•3  . 

<a 

11. 

•as 

Total  Cases 

273 

87 

4,603 

1,888 
1 

2,967 
1,070 

1,559 

«7S 

126 

49 

1 

155 

5(i 

339 
122 

15,921 
6,050 

20,797 

(•fiu'ral  Itisciisos 

Smallpox 

8,025 

1 

15 

15 

1 
22 

1 

128 

18 

12 

1 

6 
152 

3 

1 
21 

"'163' 
17 
12 

1 

Measles 

Rubella 

2 

'  i 

26 

1 

1 

2 

7 

1 

433 

25 

1 

31 
2 

Influen/.ii 

2 

1  

563 
43 

13 

Cerebro-spiBal  fever 

Simple  continued  fever. . .                   - 

1 

1 

4 

115 

1 

2 

17 
2 

4 
14 
13 

1 
49 

10 

Enteric  fever 

5 

8  ,       17 

171 
16 

Epidemic  diarrhea 

1 

Dysentery 

1 

33 
9 

256 

96 

12 

2 

1 

1 

194 

22 

218 

6 

237 

4 

1 

28 
5 

230 
76 
10 

i' 

6 

4 

25 
17 
3 
1 



83 

9 

Malarial  fever: 

Intermittent 

Remittent 

E  rysipelas 

Phlegmonous 

12 
2 
1 

3 

4 
3 

6 
2 

718 
42 
9 

i' 

986 
140 
22 

1 

2 

2 

Tetanus  . 

1 
31 

1 

Tubercle 

1.5 

6 

2 
6 

""ui 

5 

1 

128 

15 

209 

3 

91 

25 

2 
3 

19 

3 
17 
3 

15 

74 

143 

843 

12 

1,947 

4 
1 
1 
1 
4 

15 
142 

1 
18 
2 

2 
4 
4 

2 

283 
165 

Secondary 

17 

1.078 
18 

Diseases  dependent  on  animal  parasites: 
Taenia  solium . . 

12 
1 

1 

1 

2,196 
9 

Taenia  mediocanellata . . 

2 

Ascaris  lumbricoides .... 

1 

1 

1 

2 

Pediculis  vestimenti 

4 

Phthirius  inguinalis ... 

15 

12 
1 

1 
1 

12 

154 

Uncinariasis 

1 

1 

Diseases  dependent  on  vegetable  para- 
sites: 
Achorion  Rchi'inleinii 

i' 

1 

2 



19 

Microsporon  furfur 

2 

Effects  of  Vegetable  Poisons: 
Tobacco 

1 

2 

Rhus  toxicodendron 

4 

Coal  gas ... 

.    .      . 

1 

1 

1 
2 
5 

1 

1 

i' 

1 
2 
1 

1 

5 

Effects  of  inorganic  poisons: 

Mercury 

1 

3 

Iodine 

1 

Effects  of  the  presence  of  foreign  bodies. . . 

2 

1 
1 

9 
6 
2 
1 
2 

74 
1 

16 
1,121 

13 

2 
1 

11 

11 

3 

1 

Scurvy 

AlcohoUsm 

1 

1 
48 

1 
66 
252 

3 

1 

2 
39 

1 

42 
156 

4 

7 

1 

1 

122 

Delirium  tremens 

2 

3 
10 

16 
83 
3 



10 
17 

85 

Rheumatism 

1.383 

Gout .   . 

16 

1 

1 

Cyst: 

Serous 

2 

Mucous 

3 

3 



4 

586 


PUBLIC    HEALTH    AND   MARHSTE-HOSPITAL    SERVICE. 


Table    VII. — Tabular    Statement,    by    Districts,    of     Diseases     and    Injuries 
Treated  diring  the  Fiscal  Year  ended  June  30,  1904 — Continued. 


DISTRICT  OF  THE  ATLANTIC— Continued. 


Number  of  cases. 

Diseases. 

si 

•3  a 

cog 

g 

> 

o 

g 

■6 

o 
u 

ft 
S 

■d 
> 

P- 

s 

0 

•6 
5 

a  0 
.3  oj 

all 

&3 

Cyst— Continued. 

7 
1 
2 

7 
1 

22 

29 

1 

2 

4' 

7 
1 
1 
1 

2 

4 

New  Growth,  Nonmalignant: 

Lipoma 

1 

1 

2 

9 

1 

1 

1 

1 

2 

1 

1 
1 
3 
1 

3 

1 
2 
2 
4 

1 

1 

1 

1 

1 

10 

45 
5 

3' 

4 

1 
11 

11 

2 

48 

1 

6 

New  Growth,  Malignant: 

2 

1 
1 

3 

1 

i' 

1 

1 

1 

1 

6 

9 

1 

4 
2 
1 
13 

2 
2 

1 

1 

15 

2 

1 

2 

2 

137 

1 

3 

Debility 

1 

1 

6 

5 

1 
1 

151 

2 

Diseases  of  the  Nervous  System 

Of  the  nerves — 

55 
2 

111 

14 
5 

1 

30 

7 
2 

44 
9 

'"'i' 

10 

16 

66 

453 

15 
1 

619 
31 

1 

2 

6 

1 

Of  the  spinal  cord  and  membranes- 
cord- 
Inflammation — 

Anterior  poliomyelitis 

1 
2 

1 

1 

2 

0 

Degeneration— 

1 
3 
4 

1 
3 
3 

1 
2' 

2 

5 
1 

3 

4' 

11 
4 
5 
3 

2 

Of  lateral  columns 

2 
2 

1 

3 

1 

5 

Of  posterior  columns 

8 

Of   the  brain  and  its  membranes- 
brain— 
Inflammation 

2 

Sclerosis 

2 

1 

2 

7 

2 

"2 

2 

4 

6 

13 

Hvpersemia 

1 

Functional   nervous    disorders    with 
other  diseases  of  undetermined  na- 
ture- 
Apoplexy 

2 

1 

1 

3 

S 
1 

5 

Paralysis- 
Paraplegia  

.3 

4 

3 

Henuplegia 

12 
4 
1 

i" 

2 
2 

6 

20 

Local  paralysis 

15 

Incomplete  paralysis 

1 

5 

Spasm 

5 

Torticollis 

1 
1 
4 
5 
1 

1 

4 

Eclampsia 

1 
i' 

I 

1 

Epilepsy 

2 
4 

1 

1 

14 

10 

55 

2 

241 

18 

Vertigo 

15 

Headache 

1 

56 

Hypersesthesia 

1 

Neuralgia 

IS 

10 

7 

1 

259 

PUBLIC    HEALTH    AND   MARINP>HOSPITAL    SERVICE. 


587 


Taki.k    til — Tabular    Statement,    by     Districts,    of    Diseases    and     Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  ATLANTIC— Continued. 


Ntunber  of  cases. 

Diseases. 

.ae- 

III 

CUD 

•g 

-o  >. 

a*" 

•a 
< 

i 

o 

73 

0) 

> 

2 
p. 

a 

•6 

I 

a 
.| 
o 

i 

5 

■*  s 

.a  .2 

< 

'i  * 

a-tn  O 
« 

s 

p. 

.9.3 
■3 

•as 

cJ=P. 

Diseases  of  the  Nervous  System— Con. 
Functional    nervous    disorders  with 
other  c^iseases  of  undetermined  na- 
ture—Continued. 

1 

1 

81 

1 
1 

1 

1 

11 

3 
2 
3 

i' 

5 

34 

2 
6 
2 
1 

4 

5 

1 

1 

1 



13 
14 
8 

92 

Mental  diseases- 

11 

14 
8 

1 

2 

15 

2 
1 
1 

17 

2 

11 

1 

General  paralysis  of  the  insane 

1 

2 

1 

6 

195 

3 

17 

2 
3 

! 

1 
11 

3 

4 

5 

4 

233 

Conjiuictivitis- 

2 

2 



125 
3 

1.30 

5 



1 

1 

1 

1 
1 

1 
5 

1 
1 

1 
1 

1 
6 

1 
19 

3 

3 

1 

12 

1 

Intls                                                 

10 
1 
1 

2 

1 
1 

5 

3 

2 

29 

1 
1 

1 

1 

1 

1 

1 

1 

4 
2 
2 
2 
2 
6 
2 
2 

■1 

1 

1 

99 

5 
1 

3 

Atrophy   and   degeneration   of  optic 

1 

6 

3 

1 

2 

4 

2 

2 

6 

2 

2 

1 

1 

3 

Sty 

12 

1 

1 

2 

1 

21 

3 

1 
1 

1 

i' 

9 

2 
1 

3 

2 

120 

Inflammation  of  the  external  meatus— 

8 

2 

1 

Accumulation  in  external  meatus  of 

34 

16 
22 
2 
4 
3 
3 
2 
7 

151 

130 

1 

8 

2 

10 

34 

Inflammation  of  the  middle  ear- 

16 

12 

1 

5 

4 

1 

1 

2 

34 

3 

4 

Perforation  of  membrana  tympani. .  . 

2 

1 

1 

5 

3 

1 

1 

3 

( 

5 
2 

1 
2 

4 
1 
1 
2 

1 
1 

156 

1.32 

2 

10 

2 

Inflammation  of  the  naso-phar>mx 



10 

588 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Tabi.k    VIL— Tabulak    Statement,    by     Districts,    of     Diseases    and    Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  ATLANTIC— Continued. 


Number  of  cases. 


Diseases. 


D3 


Diseases  of  the  Circulatory  System  . .  . 

Pericarditis 

Valvular  disease- 
Aortic  

Mitral 

Aortic  and  mitral 

Degeneration  of  heart,  fatty 

Hvpertrophy  of  heart 

Dilatation  of  heart 

Calcareous  degeneration  of  coronary 

artery 

Angina  pectoris 

Syncope 

Disordered  action  of  the  heart 

Abnormal  slowness 

Abnormal  rapidity 

Irregularity 

Arteritis 

Degeneration  of  arteries 

Arterio-capillary  fibrosis 

Aneurism  of  arteries 

Obstruction  of  arteries,  thrombosis 

Phlebitis 

Varix 

Arterio-venous  aneurism 


115 
1 

9 
40 
22 


Diseases  of  the  Respiratory  System.  . . 
Inflammation  of  mucous  membrane 
of  larynx— 

Catarrhal,  acute 

Catarrhal,  chronic 

Bronchitis— 

Catarrhal,  acute 

Catarrhal,  chronic 

Dilatation  of  bronchi 

Spasmodic  asthma 

Haemoptysis 

Pneumonia 

Broncho-pneumonia 

Abscess  of  lung 

Gangrene 

Chronic  interstitial  inflammation 

Phthisis- 
Acute  

Chronic 

Tubercular 

Emphysema,  vesicular 

Collier's  phthisis 

Pleurisy— 

.\cute 

Chronic 

Empyema 


353 


86 
67 

1 
34 

1 
101 


Diseases  of  the  Digestive  System.. 

Inflammation  of  the  lips 

Ulceration  of  the  lips , 

Inflammation  of  the  mouth , 

Ulceration  of  the  mouth 

Inflammation  of  the  dental  pulp 

Suppuration  of  the  dental  pulp 

Caries  of  dentine  and  cementum 

Inflammation  of  dental  periosteum. 

A  bscess  of  dental  periosteum , 

Inflammation  of  gums  and  alveoli. . 

Suppuration  of  alveoli , 

U  Iceration  of  gums  and  alveoli 

Necrosis  of  the  alveoli 

Toothache 


1 
1 

i 
.1  I 
3 
1 
1 
1 

40 
5 
3 


|j3  a> 

\b  o 


fi  i« 


2   .... 

14  I  14 


151 


1.036 

289 

1 

33 

7 

6 


54 
7 
1 

2.1.36 
2 
4 
9 
4 
1 
1 

52 
1 

12 
7 
1 
4 
1 

46 


I'UULIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


589 


Taulk    VII. — Tabular    Statement,    by     Distkicts,    of     Diseases    and     Inmukies 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  ATLANTIC— Continued. 


Number  of  cases. 

Diseases. 

HO. 
ea  oj  „ 

an 

a 
•c 

3    . 

•a  >, 

■r 

< 

Recovered. 

■a 

(p 
t> 
2 
a 

a 

1— 1 

•0 
<u 
t> 

2 

a 

0 

■6 

5 

60" 

Treated  at  dispen- 
sary. 

•9 .3 

■0 

CO  *    . 

■as 

^x5a 

Diseases  of  the  Digestive  System— Con. 
Inflammation  of  the  tongue 

2 

2 

2 

ini'oration  of  the  tongue 

06 

7 

4 
1 

61 

20 

2 

2 

1 

54 
17 
2 

2 

70 

1 

Inflammation  of  tonsils— 

FolUcular 

6 
2 

1 

180 
13 
2 
3 
1 

241 

1 

33 

4 

Elongated  uvula 

3 

1 
1 

5 

1 

2 



5 

1 

1 

Inflammation  of  the  pharynx— 

Catarrhal 

126 
2 
15 

131 

Granular 

2 

Follicular 

4 
1 

4 
1 

19 

Ulceration  of  pharynx 

1 

1 

2 

Stricture  of  esophagus 

1 

107 
2 

1 

Inflammation    of   the    stomach,    ca- 

2 

63 
3 
1 
1 

17 
2 

39 

1 
1 

19 
1 

i 

2 

5 

172 

Ulceration  of  the  stomach,  superficial. 

5 

Hemorrhage  of  the  stomach 

1 

Dilatation  of  the  stomach  

1 

1 

536 
9 
5 

56 
5 
6 

28 
1 

2 

Indigestion 

13 

4 
2 

553 

Gastralgia.          

11 

Loss  of  a  ppetite 

5 

Inflammation  of  the  intestines — 

Enteritis 

28 
22 

23 

15 

3 
5 

2 
3 

84 

Typhlitis 

4 

2 

31 

Colitis.... 

6 

Catarrhal 

5 

4 

1 

33 

Hemorrhage  of  the  intestines 

1 

Concretions 

1 
3 

54 
2 
2 
1 

12 
5 

28 

1 
3 

46 
1 

1 

'    "12' 
5 
22 

1 

Fecal  accumulation 

28 
262 

31 

Hernia 

6 

6 

5 

2 

322 

Voloulus 

2 

Obstruction  of  the  intestines  . 

1 

3 

Intestinal  dyspepsia 

1 

9 

264 

15 

87 

3 

1 
7 

10 

Constipation 

276 

Colic 

20 

Diarrhea 

3 

3 

115 

Enteralgia 

3 

Inflammation  of  the  rectum 

2 
5 
6 

2 

1 
3 

4 
6 
2 

1 
2 
2 
3 

3 

Periproctitis,  abscess •. .  . 

2 

1 

14 

Fissure  of  the  anus 

6 

Fistula  in  ano 

2 

12 

21 

Prolapse  of  the  rectum 

2 

Ulceration  of  the  anus 

1 
2 

19 

57 

4 

1 

2 

6 

23 

1 

1 

Hemorrhage  of  rectum 

2 

Piles- 
Internal  

10 
10 

8 

7 
5 
7 

1 
2 
1 

2 

29 

External 

3 

67 

Mixed 

12 

Pruritus  ani 

1 

Inflammation  of  the  liver- 
Acute  

1 

4 
4 
1 
1 
3 
4 

9 

1 
1 
3 

1 

i' 

2 

1 

1 

""2 

7 

Chronic 

10 

Hypersemia  of  the  liver 

24 

Atrophy  of  the  liver. 

1 

2 

Hypertrophy  of  the  liver. . 

3' 

7 

i 

2 

1 
1 

3 

1 

1 

3 

Jaundice 

8 

1 
2 
1 
1 
2 

12 

Inflammation  of  hepatic  ducts  and 
gallbladder ... 

1 

11 

Calculi 

3 

Biliary  colic 

2 

4 

Accumulation  of  bile 

2 

590 


PUBLIC    HEALTH    AND    MAEINE-HOSPITAL    SERVICE. 


Table    VII. — Tabular    Statement,    by     Districts,    of     Diseases    and    Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  ATLANTIC— Continued. 


Number  of  cases. 

Diseases. 

o  > 
*£ 

BO- 

=  2^ 

.g—   >. 

*  *  m 

C>0 

c 

3     . 

o 

< 

•6 
> 

O 

i 
> 

2 

a 

> 

2 

o, 

B 
o 

5 

la's 
So 

c  0 
'^■^ 
"S*  . 

£.-  oj 

a 
a. 

^   . 

oi 
t-. 

.9  m 

gas    . 

-■|i 

Diseases  of  the  Lymphatic  System..  . 

12 

185 

139 

42 

6 

....     10 

307 

1 

2 

270 

32 

504 
1 

2 

Inflammation  of  lympli  glands 

10 
2 

140 
42 

1 
1 

1 

108 
30 

i' 

31 
10 

1 

5 

1 

6 
3 

420 
76 

1 

2 

3 
3 

3 

1 

1 

3 

Goiter 

3 

Diseases  of  the  Suprarenal  Capsules 

1 
1 

89 
10 

7 
26 
18 

1 

1 

1 

10 
1 

"4' 
5 

1 

1 

Diseases  of  the  Urinary  System 

Acute  nepliritis 

12 

18 
2 

55 
6 
5 
19 
13 

4 

""2 
2 



14 

1 
2 
5 
4 
1 

229 
4 
6 
12 
3 

i' 

4 
1 
3 
2 
8 
1 
2 

75 
65 
15 
6 
13 
2 
6 

1,160 
42 
23 

1 
1 

84 

] 
1 

330 
14 

Bright's  disease 

Chronic  nephritis 

Granular  kidney 

Lardaceous  kidney .... 

2 

4 
4 

15 

42 

25 

1 

1 

Calculus  in  kidney.  ..                              1 

2 
1 

1 
1 

1 

6 

Calculus  in  ureter ' 

2 

Glycosuria 1 

3 

Suppression  of  urine ' 

0 

Hematuria 1 

3 

3 

11 

Albuminuria .  . 

1 

Lithuria ' 

2 

Inflammation  of  bladder—                     1 
Acute 1 . 

10 

1 
6 

6 

1 

4 

85 

Subacute 

■" 

66 

Chronic 

1 

6 

1 

22 

Calculus  of  bladder 

6 

Irritability  of  bladder i  . 

2 
2 

1 
3 

1 

15 

Retention  of  urine 

1 

5 

Incontinence  of  urine 

6 

Diseases  of  the  Generative  System... 
Urethritis 

13 

331 
1 
2 

198 
2 

112 
1 

7 

1 

26 

1,.504 
43 

Gleet 

25 

Ulcer  of  the  urethra 

1 

Hemorrhage  of  the  urethra 

1 

Stricture  of  urethra — 

Organic 

1 

53 
1 
3 
1 
2 
1 
5 

19 
1 

i' 

27 

1 

1 

6 

l.'?8 

Spasmodic 

9 

Urethral  fistula 

2 
1 
2 
1 
6 

1 

4 

1 

2 

Inflammation  of  the  prostate, acute... 

::::::::;;:::: 

9 

Prostatorrhea  

1 
13 

3 
18 
10 
23 

1 
•118 

1 
643 

4' 

3 

38 
9 

2 

Hypertrophy  of  the  prostate 

1 

1 

19 

Posthitis 

1 

3 

Phimosis 1 

14 
9 
3 

12 
6 
2 

2 
3 
1 

32 

Paraphimosis 1.     ... 

19 

Inflammation  of  the  glans  of  the  penis .1 

Abscess  of  penis 

26 

1 

Ulcer  of  penis 

2 

57 

34 

23 

2 

177 

CEdema  of  penis 

1 

Soft  chancre 

Abscess  of  the  scrotum 

4 

121 
2 
1 
2 

12 
7 
4 

18 
1 

11 

81 

2 

8 
6 
3 
14 

Y 

27 
1 

1 

4 

13 
1 

768 
2 

Inflammation  of  the  spermatic  cord...  1 

5 

Hydrocele  of  the  spermatic  cord 

5 

Varicocele 

Hydrocele  of  tunica  vatrinalis 

1 

1 

1 
2 
1 
3 
1 
6 

2 

2 

51 
17 

Inflammation  of  the  testicle 

4 

Acute  orchitis 

1 

74 

3 

27 

1 

92 

Chronic  orchitis 

4 

Epididymitis 

2 

40 

Abscess  of  testicle 

1 

1 

I'UHLIC    HKALTII    AND    MAKINE-HOlSriTAL    SKKVICE. 


591 


Table    VII. — Taui'lak    Statement,    by    Distkictk,    of     1)i8k;a8Es     and     In.uiueh 
TuEATED  DURING  THE  FiscAi,  Ykak  ENDED  JuNE  SO,  1904 — Continued. 

DISTRICT  OF  THE  ATLANTIC— Continued. 


Number  of  cases. 

Diseases. 

eft 

iftO 

bo 

a 
•c 

3    . 

2 

> 

o 

i 
> 

2 
ft 
s 

l-H 

a 

>■ 

2 
E 
0 

■6 

5 

§0 

a  0 

gft?i> 

0 

II 

•3.2 

Sab 

-&« 
«gg 

^J5ft 

Diseases  of  the  Generative  System— 
Continued. 

10 
3 
1 

10 

3 

1 

1               1 

1               1 

1 
551 

1 

Diseases  of  the  Organs  of  Locomo- 
tion   

6 

1 

109 

1 
2 
8 
4 
7 
2 

17 
2 

1 

71 

2 
1 
5 

4' 

2 

9 

33 

4 

2 

5 

666 

Inflammation  of  the  bones- 

2 

Chronic  osteo-myelitis 

1 

7' 

2 

1 

4 
2 
3 
1 

8 

16 

I     ' 

4 

1 

1 

8 

16 
3 

61 

Ununited  fracture  or  false  joint 

Inflammation  of  joints- 

\ 

44 

Chronic  synovitis.. 

2 

6              8 

1 

1 

2 

2 

Dislocation  of  articular  cartilage 

I"" 

1               1 

Loose  body  in  joint 

2 

1 

1 

1 

2 

Caries  of  the  spine 

1 
1 

1 

1 



i' 

1 

1 

1 
1 

1 

2  1            2 

Myalgia          

35 

10 

1 

1 

29 

7 

4 
2 

1 
1 

2 

426          461 

1 

10 



1 

1 

1 

\ 

2 
9 
3 

13 
4 

2 

9 

Thecal  abscess                         

3 

Inflammation  of  bursae- 

Acute 

5 
1 
4 

5 

1 
4 

18 

Chronic           .                           

5 

4 

Bunion 

5 

11 

1 

1 
5 

257 

99 

154 

4 

915 

7 

Bursal  cyst 

1 

1 

12 

1 

Club  foot     . 

1 

Flat  foot 

3 

98 
41 
56 

i 

145 
2 

1 

17 
I 

71 
31 
39 

1 

S3 
2 
1 

3' 

5' 

2 

30 
9 
21 

1 

4 
3 
1 

8 

Diseases  of  the  Connective  Tissue 

Inflammation 

10 
3 

7 

2 
""2 

1 
1 

365 
143 

217 

5 

Diseases  of  the  Skin 

6 

60 

1 

1 

6 

1,066 

Erythema                                      

9 

.... 

1 

1 

1 

38 
6 
171 
3 
4 
6 
2 
11 
39 
9 
3 
1 

41 

1 

11 

7 



1 

1 

188 

Impetigo 

Pityriasis  rubra 

4 

1 

5 

6 



1 

3 
5 
2 
1 

2 

5 
1 

1 

4 
1 

3 

15 

Herpes 

42 

14 

Pemphigus 

Dermatitis  herpetiformis 

1:::::: 

1 

5 

i 

2 

592 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 


Table    VII. — Tabular    Statement,    by    Districts,    of    Diseases    and    Injuries 
Treated  during  the  Fiscal  Year  ended  June  80,  1904 — Continued. 

DISTRICT  OF  THE  ATLANTIC— Continued. 


Number  of  cases. 

Diseases. 

Mi 

.B~>, 

a 

3    . 

^S 

<s 
■S  >> 

a*' 

•a 

< 

i 

o 

13 
o 

s 

E 
1— 1 

i 

p. 

a 

o 

5 

•eg 
c  o 

c 

o 

.2 

-3  . 

•O  CO 

.5  m 

■5 

=3  O    . 

"•Eg 

C—  2. 

Diseases  of  the  Skin— Continued : 

1 

1 

19 

9 

2 

1 

2 

300 

2 

171 

19 

37 

19 

1 

8 

1 

17 

1 

3 

3 

48 

20 

9 

1 

1 

3 

1 

Chilblain 

3 

1 

59 

1 

31 

3 

Ulcer 

29 

2 

362 

2 

Boil                         ... 

1 
1 
1 

16 
9 
11 

13 

7 
9 

4 
2 
3 

188 

1 

29 

Whitlow                  .             .  . 

49 

Onychia 

19 

Tylosis 

1 

1 

Corn 

2 

1 

1 

10 

Cheloid 

1 

Wen 

1 

1 

1 

18 

1 

1 

Pruritus 

1 

3 

1 
38 

28 

1 
7 

1 

4 

Injuries 

2 

1 

86 

General  Injuries 

Effects  of  heat- 

15 
5 
1 
6 

2 
8 

1 

15 
3 

25 
10 

40 

Heat  stroke 

2 

15 

1 

1 

Effects  of  cold 

5 

1 
4 

1 

4 

1 
6 

10 

Effects  of  chemical  irritants  and  cor- 

1 
3 

1 

3 

Multiple  injury 

1 

14 

1 

2 
1,590 

2 

Local  Injuries 

33 

643 
1 
2 
1 
2 
1 
7 
2 
56 
31 

450 
2 

i" 

5' 

2 
37 
27 

190 

1 

2 

4 

30 

2,266 

1 

Wound  of  artery 

2 

2 
41 

4 
11 

5 
84 
41 

2 

1 

3 

73 

4 

1 

1 
1 
3 

3 

1 

43 

Contusion  of  skin . . 

1 

5 

1 

19 

7 

2 

16 

4 

0 

142 

72 

Effects  on  the  skin  of  irritants  or  cor- 
rosives   

•) 

Bum  or  scald  of  mucous  membrane 

:::::::  ::;:;i:::::: 

1 

1 

21 

1 

2 

1 
19 

1 
2 

4 

Wound  of  scalp 

2 

94 

1 

With  injury  to  the  pericranium 

2 

1 

1 

Fracture  of  the  vault  of  skull 

3 

1 
3 
7 
11 
8 
1 
5 

1 

2 

3 

::::;:::::: 

1 

Concussion  of  brain 

1 
5 
7 
1 

1 
2 

2 
1 

1 

14 
55 
5 
5 
4 
1 

4 

1 
3 

8 

21 

Wound  of  face  and  mouth 

1 

66 

Fracture  of  facial  bones 

1 

14 

Contusion  of  eyelid 

6 

Wound  of  evelid.            

3 

9 

Wound  of  conjunctiva 

1 

2 

1 

1 

2 

Foreign  bodies  in  the  conjunctiva  or 
cornea 

27 
3 
2 
2 
4 
1 
2 

27 

Foreign  bodies  in  the  eyeball 

I 

3 

Wound  of  orbit   .. 

1 

2 

2 

Foreign  bodv  in  external  meatus 

4 

1 

Gunshot  wound 

2 

1 

1 

1.... 

4 

IMBLIC    IIKALTII    AND    MARINK-JIOSl'ITAL    SKUVICK. 


593 


T.Mil.K      \'II. — TaIU'L.XU      StATKMKNT,       IIV        Dl-STKICTS,      Ol'       L)l8KASK,S       AND       I.S.HUIEH 

TuEATEi)  DPRiNd  TiiK  FisiAi,  Ykak  iCNDEi)  Ji'Nio  :50,  1904 — Coiitiuued. 
DISTRICT  OF  THli  ATLANTIC-Continued. 


Number  of  cases 

. 

Diseases. 

i'3,o 

60 

c 
•c 

u 

a 
< 

■6 

> 
o 

« 

■6 
o 

u 

a 

■6 
o 

a 

o 

■6 
5 

1    "M 

go 

lis 

Treated  at  dispen- 
sary. 

Total    treated    in 
hospital  and  dis- 
pensary. 

Local  Injuries— Continued. 

Fracture  of  sacriiin 

1 

1 

1 

Wound  of  kidney 

1 
1 

1 

Contusion  of  neck ' 

1 

2 

1 

2 

Wound  of  neck 1 

2 

2 

Foreign  l)od\'  in  tlie  food  passages .1 

1 
58' 

1 

Dislocation  of  spine 

1 
16 

1 
30 

2 
19 
11 

1 

1 

Contusion  of  chest 

13 

1 
20 

2 
14 
11 

3 

7t 

Di.'^locution  of  costal  cartilages 

1 

1 

9 

1 

1             20 

51 

Wound  of  parietes  of  chest 

2 

Contusion  of  back 

2 

7 

:<,"> 

56 

Sprain  of  back 

1 

21 
15 

32 

Wound  of  back 

15 

Fracture  of  spine             .          .   . 

3 
2 
3 

1 
2 

1 

1 
1 

1 
1 
1 
16 
3 
2 
7 
1 

i' 

1 

1 
1 

1 
1 

2 
2 
2 

1 

3 

Concussion  of  cord 

2 

5 
3 

8 

Wound  of  parietes  of  abdomen 

4 

Contu.sion  of  the  pelvis 

1 

2 

Contusion  of  the  perinfeum,  scrotum, 
or  penis 

1 

Wound  of  the  male  urethra,  perinseum. 

8 

9 

1 

1 

1 

1    

1 

1 

12 

1 

5 

1 

2 

Contusion  of  ujjper  extremities 

2 

6 
2 
2 
2 
1 

109 
21 

7 

37 

3 

8 

127 

24 

9 

Sprain  of  wrist 

44 

4 

8 

U 

11 

Wound  of  upper  extremities 

6 

94 
9 
1 
1 

6 

1 
2 

15 
1 

7 

73 

7 

i" 

4 
1 
1 

^? 

4 

21 
2 
1 

3 

490 

1 
1 

.590 

10 

Fracture  of  scapula 

2 

1 

Fracture  of  bones  of  forearm — 

2 

2 

1 
6 

12 

8 

Ulna 

2 

2 
1 

3 
6 

10 

Frafcture  of  carpus,  metacarpus,  or 

28 

1 

3 

8 
1 

15 

1 

Dislocation  of  carpus 

1 
1 

58 
1 
8 

28 
1 

50 
4 
6 
1 
5 

13 

14 
8 

1 
3 
1 

i' 

] 
1 

40 
1 
6 

20 
1 

31 
2 
5 

1 

■' 

1 

Contusion  of  lower  extremities 

2 

17 

1 

2 

93 
3 
21 
54 
4 
128 

153 

1 
2 

3 
10 

30 

84 

5 

1 

17 
2 
3 



^ 

2 

179 

4 

4 

2 

1 

10 

1 

1 

4 
10 
11 

6 

i' 

1 
1 

2 

6 

] 
1 

3 
3 

4 

2 
2 

16 

2 
3 

1 
2 

17 

3 

1 

15 

Fracture  of  bones  of  foot— 

3 

5 

1 

1 

1 

i 

1 

2 

8629— 0-J 


594 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Table    VII. — Tabular    Statement,    by    Districts,    of     Diseases     and     Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 


DISTRICT  OF  THE  GULF. 


Number  of  cases. 

Diseases. 

eft 

3    . 
o 

< 

•6 
£ 

> 

o 

P5 

i 

> 

2 

S 

•0 
0 
> 

0 

a. 
c 

•6 
2 
5 

Xi  g 

g 
0. 

■3  . 

^^ 

T!  en 

.H  m 

•3 

•§•0 

Total  Cases  

87 
35 

1,271 

550 

761 
325 

428 
197 

32    40 
11     16 

97 
36 

5,971 
2,612 

38 

1 

7,329 

General  Diseases 

3,199 

Cowpox 

38 

:::::::::::;;::::  r: ::;;;. 

1 

7 
17 

I 
27 

6 
17 
7 
2 
18 

1 

7 

67 

1 

84 

8 

Simple  continued  fever                   

2 

Enteric  fever 

3 

2 

4 



5' 

27 

5 

1 
16 

89 

82 

3 

35 

4 
% 

3 
51 

1 

1 
14 

86 

75 

1 





""39" 
1 

.........._.. 

1 

1 

3 

3 
5 

20 

375 
30 
4 
55 

53 

480 

2 

618 

37 

Malarial  fever: 

1 

1 

1 
1 

2 
2 
2 
3 

468 

Remittent 

114 

7 

23 

5 
98 

2 
13 

1  i     8 

PC 

Syphilis : 

Primary 

1 
12 

58 

2    .... 

8 

1 
1 

588 

Tertiary 

5 

3 

1    

672 

Diseases  dependent  on  animal  parasites: 
Tienia  soUum 

2 

1 
1 
1 
11 

8 
16 
2 
2 

2 

2 

1 

1 

2 

1 

Phthirius  ingiiinalis 1 

1 

Sarcoptes  scabiei 

1 

1 

12 

Diseases  dependent  on  vegetable  para- 
sites: 
Trichophyton  tonsurans 

I 

8 

Tinea  circinati 

16 

1 

2 

Effects  of  animal  poisons,  insect 

1 

2 

Ivy 

1 

2 

Opium 

1- 

3 

1 

Alcohol 

4 
2 

4 

1 
1 

1 

1 

3 

1 

Effects  of  inorganic  poisons: 

Lead 

1 
2 

1 
1 
2 
11 
5 
782 
2 

6 
I 

2 

1 

Mercury 

2 

Ammonia 

1 

Effects  of  the  presence  of  foreign  bodies. . . 

1 

Effects  of  chemical  agents 

2 

1 

8 
11 
59 

7 

5 

30 

""4 

27 

2 

20 

Rheumatic  fever 

2 
8 

16 

9 

2 

1 

850 

Gout 

2 

Cyst: 

Sebaceous 

1 

6 

Chalazion 

1 

1 

New  growth,  nonmalignant: 

Lipoma 

1 

1 
1 
1 
1 
1 

1 
2 

1 

1 
1 

i" 

1 

3 

Fibroma 

. 

1 

Pterygium 

1 

Lymphadenoma 

1 

1 

1 

4 
2 

5 

Condvloma 

1 
1 

3 

New  growth,  malignant: 

Sarcoma 

1 

, 

Carcinoma 

1 

1 



4" 

2' 

•> 

Squamous  carcinoma 

4 

EpitheUoma 

1 

1 

1 

Myxoedema 

1 

2 

PUBLIC    HKALTH    AND    MARINE-HOSPITAL    SERVICE. 


5'.)5 


Tablk    VII. — Taiutlak    Statement,    uy     Districts,    ok    Diseases    and     Injikies 
Treated  di'rinc  the  Fiscal  Year  ended  June  80,  1904 — Continued. 

DISTRICT  OF  THE  GULF— Continued. 


Number  of  cases 

Diseases. 

ah 

n 
•E 

1 

iisi 

i 

o 

1 

a 

1 

£ 

a. 

.§ 
o 

•6 

Q 

lis 

a 
t 
.2 

•3  . 
+j  >• 

^« 

^« 

03 

a: 

ail 

oj  <s   . 
SI  J? 

Ansemia 

1 
1 

1 

1 
1 
2 

1 

Diabetes  mellitus 

9. 

Diabetes  insipidus 

1               1 

Debility 

Old  age 

1 

14 

6 

7 

2 

68 
2 

;3 

2 

Diseases  of  the  Nervous  System 

Of  the  nerves — 

Inflammation,  neuritis 

5 

27 
1 

4 

18 

2 

3 

5 
1 

219 
3 

4 

2.n 

4 

Of  the  spinal  cord  and  membranes, 
cord- 
Inflammation,  diffuse 

4 

Hemorrhage 

2 
1 



"i        1 

2 

Degeneration  of  lateral  columns . . . 
Of  the  brain  and  its  membranes,  mem- 

1 
2 

1 
2 

1 

1 

2 

2 

Of    the   brain    and    its    membranes, 
brain- 
Sclerosis 

1 

1 

Softening . .          



1 
1 

2 

1 

1 

1 

1 

Functional  nervous    disorders    with 
other  diseases  of  undetermined  na- 
ture- 

2 

Paralysis— 

Hemiplegia 

2 

4 

2 

1 

3 

1 

1 

1 

1 

Spasm ". 

1 
3 
2 
4 
3 
179 
12 

1 

1 

1 

Torticollis 

3 

Epilepsv.. 

.3 
1 

i' 

3 

5 

5 

Headache 

3 

6 
2 

2 
] 
1 

1 

14 

4 

2 

3 

3 
2 

2 

185 

14 

Mental  diseases- 
Mania  

3 

Melancholia 

1 

2 

Dementia 

1 

1 

1 
3 

1 

Diseases  of  the  Eye 

3 

1 

7 

4 

1 

5 

1 
1 

2 

62 
44 

79 

Conjunctivitis — 
Catarrhal,  acute 

49 

2 

2 

1 
4 
1 

2 

Keratitis 

2    -- 

1 

1 
1 

3 

Ulceration  of  cornea 

1 
1 

5 

Iritis 

1 
1 

2 

3 

Choroiditis 



1 

1 

lenticular  cataract 

1    1 

5 

1 

6 

1 
2 

1 

2 

Ametropia 

2 

2 

1 
2 

1 

1 

Chronic  dacryo  cvstitis 

2 

Sty "           

1 

Diseases  of  the  Ear 

5 

3 

1    .... 

1 

57 

7 
5 

21 

62 

Inflammation  of  the  external  meatus— 

7 

Abscess 

5 

Accumulation  in  external  meatus  of 
wax  or  epidermis 



1 

1 

22 

596 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE 


Table    VII. — Tabular    Statement,    by    Districts,    of    Diseases    and    Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  GULF— Continued. 


Number  of  cases. 

Diseases. 

oj  iS  aj 

a 

< 

■6 

u 

ID 
> 

o 

s 

■a 
> 
£ 

•6 

m 
% 
P. 

B 

o 

S 

1    4H 
-J 

a 

K 
.2 

-S  . 

1 

Total    treated    in 
hospital  and  dis- 
pensary. 

Diseases  of  the  Ear— Continued. 
Inflammation  of  the  middle  ear — 

1 

1 
1 

1 

10 
9 

11 

Suppurative 

1 
1 

10 

Within  the  mastoid  cells 

1 

3 

2 

17 
15 

1 
1 

43 
3 

3 
9 
3 
3 
2 

2 
2 

7 

3 

Deafness 

1 

1 

3 

Diseases  of  the  Nose 

17 

Inflammation  of  soft  parts 

15 

Inflammation  of  framework,  caries 

1 

Epis  taxis 

1 

Diseases  of  the  Circulatory  System  . 

2 

25 
2 

7 
10 

1 

2 

1 

12 
1 

4 
3 

2 

5 

6 

70 

Valvular  disease- 
Aortic 

""2 

2 
2 
1 

1 
3 

10 

Mitral 

19 

Aortic  and  mitral 

4 

Dilatation  of  heart 

...i 

3 

Angma  pectoris 

3 

3 

5 

Disordered  action  of  the  heart — 

Abnormal  slowness 

2 

Abnormal  rapidity 

2 

Irregularity 

.J 

7 

Degeneration  of  arteries 

2 



1 
1 

.     .. 
' 

1 

2 

8 

Aneurism  of  arteries 

1 

Varix 

4 
527 

9 
1 

470 
9 
8 

4 

Diseases  of  the  Respiratory  System. 
Inflammation  of  mucous  membrane 
of  larynx— 
Catarrhal,  acute 

1 

63 

41 

16 

2 

4 

1 

591 
9 

Catarrhal,  chronic 

1 

26 

4 
1 
1 

20 

i' 

1 

5 

1 
2 

2 

Bronchitis— 

Catarrhal,  acute 

1 
1 

496 

Catarrhal,  chronic 

1 

1 

13 

Spasmodic  asthma 

i 

10 

Hemorrhage  of  lung 

1 

Hsemoptysis 

i 

1 

Pneumonia 

17 
2 

13 

2 

1 

2 
1 

17 

Phthisis — 

Acute 

6 
1 

22 

8 

Chronic 

1 

Pleurisy- 
Acute  

10 
1 

105 

7 
81 

3 

1 

21 

.32 

Chronic 

1 

Diseases  of  the  Digestive  System 

Ulceration  of  the  lips 

10 

2 

4 

7 

799 
3 
3 

894 
3 

Inflammation  of  the  mouth 

3 

Ulcera  tion  of  the  mouth 

1    

1 

1 

Caries  of  dentine  and  cementum 

30 

30 

Inflammation  of  dental  periosteum . . . 

1 

1 

1 

1 

2 

Abscess  of  dental  periosteum 

4 
1 

10 

22 

1 

18 

23 
6 

4 

Inflammation  of  gums  and  alveoli .... 

1 

Caries  of  the  alveoli 

10 

Toothache 

22 

Impaction  of  teeth 

1 

Sore  throat 

18 

Inflammation  of  tonsils — 

Folhcular 

3 

3 

26 

6 

Hypertrophy  of  tonsils 

1 

1 

1 

Elongated  uvula 

1 

1 

Inflammation  of  salivarj'  glands 

1 

1 

1 

Salivation 

6 

20 
6 

6 

Inflammation  of  the  pharynx— 

Catarrhal 

20 

Follicular 





6 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


597 


Table    VII.— Tabular    Statemknt,    hv     Districts,    of    Diseases    and     In.hkies 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  GULF— Continued. 


Number  of  cases. 

Diseases. 

It 

< 

■6 

S 
o 

•6 

a 

T3 

> 
2 
ft 

a 

o 

2; 

■6 
5 

43  g 

e  o 

•1!. 

3  *  S 

g  ftt>. 

0 

1 

'■5  . 
=** 

oS(J3     . 

ftco 

o.a  ft 

Diseases  OF  THE  DiGEbXiv  E  SYSTEM— Con. 

1 

1 

9 
2 

7 
2 

9 

7 
1 

9 

1 

2 
15 

1 
12 

i 

2 

2 

293 
1 

7 

308 

1 



7 

1 

6 

7 
1 
7 
5 
5 
1 
1 
4 

1 

1 

Inflammation  of  tlie  intestines- 

5 
8 

1 
4 
4 
4 

1 

8 
3 

14 

Typhlitis  

3 

2 

13 

1 

2 

1 

2 

1 

1 

1 

94 

8 

6 

Hernia 

3 

1 

102 

1 

23 

24 

4 

4 

Colic.      .                                        

4 

103 

2 

3 

4 

2 

7 
1 

8 

::::;::: 

112 

1 
1 

3 

Periproctitis,  abscess 

1 

4 

2 

7 

1 
2 
1 

2 

5 

1 
1 
1 

2 

1 

1 

3 

7 
15 
12 

2 

4 
1 

19 
3 

10 

Piles- 
Internal 

8 

External 

1 

17 

13 

2 

Inflammation  of  the  Uver— 

2 

1 
4 
3 
1 

2 

2 

1 

2 
1 

2 

1 

6 

2 

Hypersemia  of  the  liver. 

23 

Jaundice 

6 

1 

2 

59 

56 

2 

1 

71 
7 
5 
6 
1 
1 
1 

32 

10 

6 

1 

1 

344 
3 
56 

2 

Diseases  of  the  Lymphatic  System 

6 
6 

54 
48 
6 

29 
25 
4 

25 
24 

1 

6 
5 
1 

119 

Suppuration 

110 

8 

Inflammation  of  lymphatics 

1 

Diseases  of  the  Urinary  Sy'stem 

17 

4 

10 

2 

1 


88 

Acute  nephritis 

7 

Bright's  disease 

6 
5 

5 

4 

1 

11 

Chronic  nephritis 

1 

11 

1 

1 

1 

2 

1 

Inflammation  of  bladder- 
Acute  

5 

4 

1 

37 

Chronic 

10 

6 

Retention  of  urine 

1 

Incontinence  of  urine 

1 

Gleet 

9 

115 

66 

44 

2 

12 

468 
3 

Stricture  of  urethra,  organic 

2 

18 

1 

5 

12 
1 

3 

76 

1 

3 
3 

8 

1 

1 

120 

3 

1 
3 

2 

1 
1 

4 

1 

1 

12 

1 

1 

Ulcer  of  penis 

2 

3i 

14 

17 

i 

i 

153 

598 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Table    VII. — Tabular    Statement,    by    Districts,    of    Diseases    axd    Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  GULF— Continued. 


Number  of  cases. 

Diseases. 

H 

c  — 

.S£« 
S—  ^ 

3'S.o 

6f 
o 

•a 
< 

1 
§ 
Pi 

> 

£ 

p. 
S 

2 

P. 
S 

o 

5 

P 

"a  * 

Hi 

n 

<s 
Eh 

Total    treated    in 
hospital  and  dis- 
pensary. 

Diseases  of  the  Geneeative  System— 
Continued. 

1 
41 

1 

26 

1 

95 
1 

2 

Soft  chancre    .          

3 

10 

1 

7 

139 

1 

2 

1 

1 

o 

2 
6 
4 

22 
2 
8 
5 
3 

183 

2 

1 
1 

8 
1 
6 

1 
1 

8 
1 
6 

Inflammation  of  the  testicle- 
Acute  orchitis ... 

1 

1 

31 

3 

Epididymitis 

14 

Spermatorrhea 

5 

Impotence 

3 

Diseases  of  the  Organs  of  Locomotion. 
Inflammation  of  the  bones,  periostitis 

3 

15 

1 
2 

4 

1 

2 

11 

2 

3 

5 
1 

1  .... 

1 

206 
1 

Caries 

2 

Necrosis 

1 

2 

6 

Ununited  fracture,  or  false  joint 

1 

1 

Inflammation  of  joints — 

Acute  synovitis 

1 

3 

21 
1 
2 

1 

i' 

1 

147 

24 

Suppuration 

1 

Ankylosis 

2 

Dislocation  of  joint 

1 

Caries  of  the  spine 

1 

1 

1 

1 

2 

Posterior  curvature  of  spine . . . 

1 

Inflammation  of  muscles 

1 

Mvalgia 

1 

2 
1 

2 

1 
1 

150 

Hypertrophy  muscles  of  leg. 

1 

Inflammation  of  sheaths  of  tendons. 

2 
4 

1 

88 
19 
65 

4 

287 

1 
6 
4 
83 

1 
1 
1 
6 
2 
3 
4 

2 

Thecal  abscess 

1 

1 

5 

Inflammation  of  bursae,  acute... 

1 

Diseases  of  the  Connective  Tissue  .. 
Inflammation 

2 

40 
5. 
34 

1 

41 

18 

1 

17 

25 

20 
2 

17 
1 

15 

2 

2 
2j 

130 
24 

Abscess 

2 

2 

101 

(Edema 

5 

diseases  of  the  Skin 

3 

2 

2 

331 

I.  ry  thema 

1 

Urticaria 

6 

Prickly  heat 

4 

Eczema 

6 

1 

2 

3 
1 

1 

89 

Impetigo 

2 

Pityriasis  rubra 

1 

Psoriasis 

2 

1 

1 

3 

Herpes 

6 

Zona 

2 

Pemphigus 

1    

1 

4 

Acne 

4 

Sycosis 

1 

1 

1 

Seborrhea 

::::::;:;: 

t 

1 

1 

72 

58 

5 

21 

4 

4 

2 

2 

3 

1 

9 

1 

Chloasma 

1 

Alopecia 

1 

Ulcer 

2 

21 

1 
3 

2 

1 

15 

7 

1 

95 

Boll 

1 

59 

CB.rhiinrlfi 



1 

2 
1 

1 

1 

8 

Whitlow 

23 

Onychia 



5 

Com 

4 

Wen 

2 

2 

3 

1 

1 



1 

16 

2 
12 

3 

Injuries 

2 



1 

2 

26 

ITBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE, 


599 


Tablk    VII. — Taiui.au 

TkKATKI)    DIKINC 


SiAiicMKNT,    n\     Districts,    of    Diseases    and    Injuries 
THE  Fiscal  Year  ended  June  30,  1904 — Continued. 


DISTRICT  OF  THE  GULF— Continued. 


Number  of  cases. 

Diseases. 

gfto 
P3 

Admitted    during 
the  year. 

u 

o 

"6 

1 
p. 

a 

1 

P< 

a 

*^ 

o 

•6 

s 

m  o 
O 

tn 

a  o 

c 
a. 

.Si 

Jit 

6^ 

General  Injuries: 
Effects  of  heat- 

4 
7 
4 

4 
6 
1 

1 

4 
2 
1 

1 

614 

1 

1 

23 

2 

14 

24 

47 

2 

i 

5 

Heat  stroke , 

1 
1 

11 

Simstrnlfp                                 , 

1 

1 

6 

Effects  of  cold 

1 

Multiple  injury 

1 
7 

1 
184 

1 
133 

1 

13 

3 

Local  Injuries 

38 

2 

5 

805 

Contusion  of  liver 

1 

1 

1 

2 

Strain  of  muscles 

23 

Strain  of  tendons .... 

: :::; 

2 

Abrasion  of  skin 

•1 

1 

10 
1 

1 

8 

1 
1 

16 

Bum  or  scald  of  skin 

1  I 

34 

Frostbite : . . . 



1 

48 

Abrasion  of  mucous  membrane 

2 

Bum  or  scald  of  mucous  membrane 

■...:.! 

1 

Contusion  of  scalp 

1 
2 

1 
1 
1 

4 
1 
1 

i' 

1 

1 

1 

Wound  of  scalp 

1 

14 

16 

Contusion  of  skull 

1 

Fracture  of  the  vault  of  skull 

4 
2 
15 

Contusion  of  face 

1 

7 
2 

1 

3 

AVound  of  face  and  mouth 

22 

Fracture  of  facial  bones 

2 

4 

Dislocation  of  lower  Jaw 

1 
1 
1 

2 

Contusion  of  eveUd 

1 

2 

Wound  of  e velid 

1 

Subconjunctival  hemorrhage 

Contusion  of  eveball 

1 

1 

1 

1 

3 

7 
1 
3 
2 
1 
4 
2 
27 
5 

3 

Foreign  bodies  in  the  conjimctiva  or 
cornea 

7 

Foreign  bodies  in  the  eyebaU 

1 

Wound  of  eveb«"    

1 

1 

1 

4 

Wound  of  pinna 

2 

Foreign  body  in  external  meatus 

1 

1 

Contusion  of  neck 

i 

4 

Wonnd  of  neck 

1 
5 
8 

1 
1 

5 
1 
2 

1 
3 

1 

1 

3 

Contusion  of  chest 

5 

7 
1 

h' 

6 



32 

Fracture  of  ribs •. 

1 

13 

Wound  of  pflriptps  of  chest 

1 

1 

Penetrating  wound  of  pleura  or  lung. . 



1 

3 
2 
15 

27 

1 

4 

1 

1 

9 

Contusion  of  back 

2 

1 

22 

Sprain  of  back 

1 

28 

Wound  of  back 

2 
1 
2 
1 

3 

Concussion  of  cord 

1 

Contusion  of  abdomen 



1 

4 
1 

1 

1 

2 

1 

2 

19 

21 

2 

6 

2 

1 

180 

1 

7 

Wound  of  parietes  of  abdomen 

1 

3 

Contusion  of  the  pehns 



1 

2 

Contusion  of  the  perinseura,  scrotum, 
or  penis 

1 

Woimd  of   the   male   urethra,  peri- 
naeum,  scrotum,  testis,  or  penis 

1          2 

1 

1 

4 

Laceration  of  bladder 

1 

Contusion  of  testicle 

1 

10 

i 

7 

1 

3 

Contusion  of  upper  extremities 

2 

1 

29 

Sprain  of  shoulder 

21 

Sprain  of  elbow 

2 

Sprain  of  wrist 

4 

4 

1 1 

10 

Sprain  of  thumb 

2 

Sprain  of  fingers 

..    .    . 

i 

1 

Wound  of  upper  extremities 

18 
3 
2 

3 

1 
3 

12 
3 

1 

2 
2 

5 

1 

198 

Fracture  of  clavicle 

1 

4 

Fracture  of  scapula 



1 

1 

1 
1 

2 

Fracture  of  bones  of  forearm- 
Radius  

2 
1 

5 

Ulna 

2 

Both  bones 

3 

600 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Table    VII. — Taiuilak    Statement,    by     Districts,    of     Diseases     and     Injuries 
Treated  durincj  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTKICT  OF  THE  GULF— Continued. 


Number  of  eases. 


Local  Injueies — Continued 

Fracture  of  carpus,    metacarpus,   or 

phalanges  

Dislocation  of  clavicle 

Dislocation  of  phalanges  of  lingers 

Contusion  of  lower  extremities 

Sprain  of  hip 

Sprain  of  knee 

Sprain  of  ankle 

Sprain  of  foot 

Wound  of  lower  extremities 

Woimd  of  joint,  lower  extremities 

Fracture  of  femur 

Fracture  of  tibia 

Fracture  of  fibula 

Fracture  of  tibia  and  fibula 

"  Observation  " 


a 

3  . 
'I 
Ha, 


B  03 

lis 


DISTRICT  OF  THE  OHIO. 


Total  Cases                                   

58 
29 

1,004 
396 

7 

611 
•231 

5 

838 
146 

22 
11 

2 

40 
17 

51 
20 

3,379 

1,280 

2 
54 

4,441 

General  Diseases       ...            

1,705 

9 

7 

48 

2 

3 

7 
39 
2 
3 

7 

2 

80 
1 

88 

Mumps.   . 

3 

Diphtheria 

Cerebro-spinal  fever           ... 

3 



1 

1 

15 

137 

25 

1 

1 

Enteric  fever 

2 
2 

2 

1 
2 

23 
23 

43 
22 
5 

1 
40 

20 
47 

16 

18 

36 
21 
5 

1 
5 

7 
2 
2 

1 

6 

1 

2 
1 

1 

26 

Dysentery 

Malarial  fever — 

Intermittent 

40 

182 
48 

Erysipelas 

8 

1 

7 



1 

Tubercle 

5 

1 
8 

2 

9 
1 

27 

11 
48 

2 

7 

1 
3 

45 

15 
279 

13 
304 

90 

Syphilis- 
Primary 

3S 

Secondary 

2 

' 

334 

Tertiary 

13 

Gonorrhea 

1 

19 

1 

10 

1 

9 

1 

324 

Diseases  dependent  on  ariiinal  parasites — 
Taenia  mediocaneUata.   . 

1 

Pediculi.s  vcst.imenti 

1 
6 
2 
12 

2 

1 

1 
1 

13 

9 

214 

1 
] 

3 

1 
1 

1 

Phthirius  inguinaUs 

6 

Rhinoscleroma 

2 

Sarcoptes  scabiei 

2 

2 

14 

Diseases  dependent  on  vegetable  para- 

i 

2 

Eflects  of  animal  poisons,  decayed  and 
poisonous  food 

1 

1 

9 

Effects  of  vegetable  poisons- 
Poison  oak 

1 

Patent  medicine 

1 

Alcoholism 

1 
4 

11 
19 
40 

1 

11 
16 
23 

1 

1 

""2 
3 

25 

Rheumatic  fever 

5 
13 

""i' 

32 

Rheumatism 

254 

Cyst— 

Chalazion 

Tubo-ovarian 

:::;::::: 

1 

New  growth,  nonmalignant — 

Lipoma 

2 

2 

5 

Fibroma 

1 

Chrondroma 

1 

1 

::;::::;:: 

2 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


601 


Tahle    Vll. — Tabulak    Statemknt,     hy     Distkkts,    ok     DiHEAsiis     AND     In.h:kies 
Treated  diirinc!  the  Fiscai,  Year  i:nded  June  80,  ltH)4 — Continued. 

DISTRICT  OF  THE  OHIO— Continued. 


Number  of  cases. 

Diseases. 

a 
•c 
s  . 

-a  >. 

13 

£ 

> 
o 
o 

•a 

a) 
> 

o 

u 
ft 

S 

> 
o 
u 
ft 

V 

o 

■6 

s 

lis 

ft 
T3 

an 

•Si 
£«>. 

New  growth,  nonmalignaiit— Continued. 

1 

5 
2 

2 
4 

1 

I'apillonia     

5 

2 

New  growth,  malignant- 

2 

i 

4 

1 

2 
5 

1 

L.   . 

1 

2 
5 

1 
23 

3 

Debility  

28 

Diseases  of  the  Nervous  System 

Of  the  nerves- 
Inflammation— 

Neuritis       

6 

6 

1 

3 

4 

1 
1 

4 

61 
8 

73 
9 

i 

2 
3 

1 

1 

Of  the  spinal  cord  and  membranes, 
cord— Degeneration  of  posterior  col- 

2 
2 

1 

3 

Functional    nervous    disorders    with 
other  diseases  of  undetermined  na- 
ture— 
Paralysis — 
Hemiplegia 

2 

3 

5 

Monoplegia 

1 

1 
3 
5 
24 
18 

57 

46 
5 

1 

1 

3 

Headache 

5 

2 
I 

11 
3 

1 
1 

6 
1 

1 



26 

Nervous  weakness 

19 

Diseases  of  the  Eye 

2 

6 
2 

1 

70 

Conjunctivitis — 
Catarrhal  - 

49 

5 

1 
2 
2 
1 
1 

2' 

3 

1 

1 

Ulceration  of  cornea 

2 

1 

1 
2 

4 

1 

3 

1 

2 

2 

Panophthalmitis 

1 

1 
1 

8 

2 
2 

1 

1 

Dacryo-cystitis 

1 
2 

1 

1 
1 

2 

Diseases  OF  the  Ear 

10 

Inflammation  of  the  external  meatus— 
Acute 

2 

Abscess 

2 

Inflammation  of  the  middle  ear— 
Nonsuppu  rative . 

1 

1 

i 

1 

1 

Suppurative 

4 

26 

20 

4 

2 

60 

6 

20 

1 

5 

Diseases  of  the  Nose 

26 

Inflammation  of  soft  parts.          

20 

4 

Inflammation  of  the  naso-pharynx 

2 

Diseases  of  the  Circulatory  System 

Valvular  disease- 
Aortic 

1 

21 

3 
8 

18 

1 

8 

2 
2 

2 
...... 

82 
9 

Mitral                                                        1 

29 

Aortic  and  mitral 

1 

1 

1 

1 

2 
4 
4 
ID 

2 

1 
2 
3 

1 

2 
3 

5 

6 

Dilatation  of  heart ' 



13 

()02 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Table    VII. -^Tabular    Statement,    by    Districts,    of    Diseases    and     Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  OHIO— Continued. 


Number  of  eases. 

Diseases. 

■a  a 

-0 
a--  3 

S  no 

•c 

H 

'a  >> 

> 

i 
> 

2 
ft 

a 
1— 1 

•a' 

> 
0 

u 

p. 

a 

0 

i 

M   0 
0 

^^ 

«.!  . 

as  a- 

a 
p, 
-3  . 

^^ 

•V  to 

Eh 

'"■■3 
hit 

__  D.CO 
'1  0  § 

0^  a 
en 

Diseases  of  the  Circulatory  System— 
Continued. 
Disordered  action  of  the  heart,  irregu- 
larity                 

1 

2 
4 

1 

Degeneration  of  arteries,  arterio  capil- 

2 

1 

1 
1 

1      I 

■    1 

5 

Phlebitis                  

1 

i 

1 

1 

391 
2 

12 
2 

301 
8 
41 

6' 

2 

12 
2 
2 

1 

Phlegmasia  dolens 

Diseases  of  the  Respiratory  System  . . 
Hay  fever 

1 

69 

42 

13 

1 

12 

2 

461 
2 

Inflammation  of  mucous  membrane 
of  larynx— 
Catarrhal,  acute 

1 

1 

13 

Tracheitis 

2 

Bronchitis — 

Catarrhal,  acute 

25 

22 

3 

326 

Catarrhal,  subacute 

8 

Catarrhal,  chronic 

4 

1 

3 

20 

1 

1 

3 

45 

Ulceration  of  bronchi 

1  _ 

1 

Spasmodic  asthma 

2 
11 

1 

8 
1 

'""i' 

9 

20 

Phthisis- 
Acute  

1 

Tubercular 

2 

Pleurisy — 

Acute 

1 

11 

6 

5 

1 

'24 

Subacute 

2 

Chronic 

2 

Hydrothorax 

1 

2 

111 

1 

2 

Emphysema 

79 

2 

24 

2 

Diseases  of  the  Digestive  System 

Fissure  of  the  Ups 

4 

4 

4 

4 

1 
2 
2 

7 
2 
1 
1 

1 
5 

1 

35 
3 
2 
2 

4 
2 
1 
1 

25 
2 
1 
135 
4 
1 
1 

15 

663 
1 

Inflammation  of  the  mouth 

2 

Ulceration  of  the  mouth i 

2 

Caries  of  dentine  and  cementum.           ' 

7 

Inflammation  of  dental  periosteum 

1 

2 

Abscess  of  dental  periosteum 

1 

1 

Caries  of  the  alveoli 

1 

Toothache 

1 

Sore  throat 

5 

Ulceration  of  tonsils 

1 

Inflammation  of  tonsils— 

Folhcular 

9 
2 

8 
2 

1 

44 

Suppu  ration 

5 

Hypertrophy  of  tonsils 

2 

Salivation 

2 

Inflammation  of  the  pharynx— 
Catarrhal 

1 

1 

2 

i 

■ 

6 

Granular 

2 

Follicular 

1 

Ulceration  of  pharynx 

1 

Inflammation    of   the   stomach,   ca- 
tarrhal   

8 
1 

8 

33 

Ulceration  of  the  stomach,  superficial 

1 

3 

Dilatation  of  the  stomach 

1 

Indigestion 

1 

11 

8 

2 

1 

147 

Pyrosis 

4 

Gastralgia. 

2 

1 

1 

3 

1 

Inflammation  of  the  intestines— 

1 
1 

2 

7 

25 

2 

4 

20 

'""3" 

1 

1 

18 

1 

7 

Catarrhal 

2     1 

i 

24 

49 

PUBLIC    HP:ALTH    and    MARINE-HOBPITAL    SERVICE. 


603 


Tablk     \11.— Tabular    Statement,    hy    Districts,    f)K     Di.seasks    and     Injukieh 
Treatki)  DiKiNc)  THE  FisCAL  Year  ENDED  JuNE  oO,  1904 — Contir\ued. 

DISTRICT  OF  THE  OHIO— Continued. 


Number  of  cases. 

Diseases. 

si 

lis 

m 

a 
•t; 

Si  oj 

a 
< 

■6 

0 
0 

13 

0 
u 

ft 

a 

■6 

I 
0. 

0 

■6 

s 

.a  a) 

d  *^ 
d  * 

as* 

K 

a 

K 
'■B 

OS 

73 

0/ 

Diseases  of  the  Digestive  System— 
Continued. 

1 
3 

2' 

1 

1 

45 

7 
84 

1 
77 

1 

2 

1 

48 

7 

84 

Colic 

1 

16 
3 

1 
4 

1 
3 

1 

11 
1 

2' 

1 

2 

2 

4 
2 
1 

2 

1 

93 

Periproctitis,  abscess 

4 

1 

0 

2 
14 

1 
1 

35 
1 
5 
6 
1 
1 

2 

10 

Piles- 
Internal  

3 

1 

17 

1 

1 

Inflammation  of  the  liver- 

2 

1 

1 

37 

1 

Chronic  

Hyperaemia  of  the  liver 

3 

2 

1 

8 
6 

1 

2 

2 
]" 

3 

Inflammation  of  hepatic  ducts  and 
gall  bladder.          .                   ... 

1 
2 

1 
1 

3 

Calculi 

2 

1 

1 

32 

25 

3 

4 

1 

1 

24 

1 

Diseases  of  the  Lymphatic  System 

Inflammation  of  lymph  glands 

1 
1 

.34 
27 

7 

22 

18 
4 

11 

8 
3 

1 

1 
1 

67 
53 
10 

Inflammation  of  lymphatics . 

4 

Diseases  of  the  Thyroid  Body 

1 

1 

2 

Goitre 

1 

Diseases  of  the  Urinary  System 

Acute  nephritis 

1 

12 
2 
1 

4 
1 

1 
1 

3 
1 

6 

1 

3 

1 
1 
1 

37 
2 

Bright's  disease 

3 

1 
2 

4 

Chronic  nephritis 

1 

1 

2 
1 
1 

1 

6 

3 

1 

4 

5 
4 
2 
1 

5 

Inflammation  of  bladder- 

5 

1 

1 

5 

Chronic 

2 

1 

1 

1 

1 

Incontinence  of  urine 

2 

228 
2 

1 

2 

Diseases  9F  the  Generative  System  . . 

2 

80 

46 

33 

1 

2 

310 
2 

Gleet 

1 

1 
2 

12 

1 
1 

1 

1 

1 

1 

5 
1 
1 

1 

7 

1 

2 

Organic        

29 

41 

1 

1 

Inflammation  of  the  prostate- 

1 

Chronic  

2 

2 

Phimosis . . 

3 
1 
6 
24 
16 

2 

1 
4 
7 
15 

1 

1 

3 

1 

inflammation  of  the  glands  of  the  penis 

"  'i' 

1 

2 
17 
2 

10 

86 

52 

2 

16 

1 

111 

69 

Hydrocele  of  the  spermatic  cord 

2 

604 


PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 


Taule    VII. — Tabular    Statement,    by    Districts,    of    Diseases    and    Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 


DISTRICT  OF  THE  OHIO— Continued. 


Number  of  cases. 

Diseases. 

|li 

c 

•c 

1 

<! 

i 
i 

i 

a 

■6 

1 
p. 

.| 

o 

'A 

s 

1  (i-< 

c 

p. 

■-3  . 
+^  >. 

%\ 

Eh 

Diseases  of  the  Generative  System— 
Continued.    • 

1 
1 

1 

11 
3 

14 

12 

1 

4 

Inflammation  of  the  testicle—                | 

4           1 
.   ...          1 

19 

1 
2 
2 

9 

2 

1 



1 

2 

6              6 

1              1 

1 

1 

1 

1 
1 

2 

1 

i 

2 

1 
4 

166 

1 

1 

Leucorrhea 

;:::::::::::: 

4 

Diseases  of  the  Organs  of  Locomotion. 
Inflammation  of  tlie  bones- 
Osteitis          ....         

3 

26 

18 

7           1 

1 

2 

195 
1 

2 



2 

2 

1 

1 

Necrosis 

•  2 

1 

1 

1 

2 

Inflammation  of  joints- 
Acute  sjTiovitis 

2 
2 

3 

Chronic  synovitis 

2 

Hydrops  articuli 

1 



1 

1 

Psoas,  lumbar,  and  other  abscesses 

1 

1 

1 

Suppuration  of  muscles 

1 
18 

i 

15 

1 

Myalgia 

Lumbago 

i 
1 

2 

1 

1 

.... 

1 

151 

170 
1 

Contraction  of  tendons 

1 

1 

..   1...... 

1 
3 
1 

2 

Inflammation  of  sheaths  of  tendons. . . 

3 

Bunion 

1 

Flat  foot 

4              4 

Diseases  of  the  Connective  Tissue... 

15 
1 
14 

11           3 

1 

37 
4 

32 
1 

188 
2 

52 

Inflammation 

1 
10 

5 

Abscess 

3 

1 

46 

CEdema 

1 

Diseases  of  the  Skin 

3 

33 

23         10 

3 

224 

Erv'thema 

2 

Uticaria 

7  '            7 

Prickly  heat 

2              2 

Eczema 

1 

4 

2          2 

1 

54            59 

Herpes 

5              5 

Zona 

2              2 

Acne 

■   ■ 

6              6 

Sycosis 

2              2 

Sudamina 

1               1 

Ulcer 

2 

24 
2 

18          7 

1 

78           104 

Boil 

2 

12             14 

Carbuncle 

5               5 

Whitlow 

1 
2 

1 

4              5 

Onychia 

1 

1 

4              6 

Com 

2              2 

Hjrperidrosis 

1 

1               1 

Bromidrosis 

1 

1              1 

InJurleK 

General  Injuries 

9 
5 

5 

3 

1  

5 
3 
1 

14 

Effects  of  heat,  bums  and  scalds 

5 

8 

Effects  of  cold 

1 

Multiple  injury 

1 

1 

1 

Exhaustion 

1 

1 

Shock 

3 

3 

j 

3 

PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 


605 


Tarlr     VII. — Tahilau    Statement,    by    Districts,    of    Diseases    and     Injuries 
Treated  durikc  the  Fiscal  Year  ended  .Tine  30,  1904 — Continned. 

DISTRICT  OF  TIIK  OHIO -Contiiiticd. 


Number  of  cases. 

Diseases. 

ii 

iis 

§  CO 

60 

•§ 
3    . 

•a  >; 

< 

•d 

0 

K 

i 
> 

2 
a 

h-4 

i 
> 
0 

u 

a 

a 

0 

■6 

(3 

Si  % 

■H 
1.11 

1 

OS  oj 

^  '^  C' 
2og 

Local  Injuries 

5 

178 

121 

53 

1 

8 

367 
1 
3 
1 
29 
2 

1 
3 
12 

550 

1 

3 

Wound  of  skill 

1 

Bum  or  sr-alii  of  skin 

5 
2 

4  ;        1 

34 

Frostbite 

2 

4 

Effects  on  tlie  skin  of  irritants  or  cor- 
rosives   

1 

3 

Wound  of  scalp 

7 
1 
1 
4 
4 
1 

5           2 

19 

Concussion  of  brain 

1 

1 

Contusion  of  face 

1 

i 

5 

7 

6 

Wound  of  face  and  mouth 

3 
2 

1 
2 
1 

11 

Fracture  of  facial  bones 

4 

1 

Contusion  of  eyelid 

2 

1 

2 

Wound  of  eyelid 

;::;::::::::::;::: 

1 

2 

2 

2 

Foreign  bodies  in  the  conjunctiva  or 
cornea 

5 

5 

1 

1 

1 

Wound  of  pinna 

1 

1 

Contusion  of  neck 

1 

1 

1 

Wotmd  of  neck 

4 

4 

Gunshot  wound 

::::::      1 

8' 

5 
2 

1 
1 
1 

2 ;        3 

Contusion  of  chest 

9 
6 
3 

15  i          24 

8             14 

Wound  of  parietes  of  chest. . 

1 

4              7 

Contusion  of  back 

3             2 
0             3 

1 

21             24 

8.           13 

Wound  of  back 

1               1 

Contusion  of  abdomen 

1    ;             1 

1              2 

2  1            2 

Contusion  of  the  pelvis 

2  j          2 

2              4 

Wound   of   the   male   urethra,   peri- 
naeum,  scrotum,  testis,  or  penis 

1               1 

Contusion  of  testicle 

2              2 

Contusion  of  upper  extremities 

12            8 

4 

35             47 



5              5 

Sprain  of  elbow 



4  '            4 

Sprain  of  wrist 

1             1 

14             15 

1               1 

Wound  of  upper  extremities 

Fracture  of  clavicle 

1 

13             9 
3  !          3 

i 

4 

1 

7.T               80 

3 

1 

1 

Fracture  of  humerus            

2  1 

3  1 
2             1 
2    

1  '          1 

1 

2 

Fracture  of  bones  of  forearm- 
Radius  

2 
1 
2 

3 

Ulna 

1 

3 

2 

Fracture  of  carpus,  metacarpus,  or 
phalanges 

1 

1 

6 

a 

Dislocation  of  humerus 

2             2 
2             2 
1             1 
.30           17 
6  ;         4 

* 

1               3 

Dislocation  of  radius  and  ulna 

2 

1 

fi9 

Dislocation  of  phalanges  of  fingers 

Contusion  of  lower  extremities 

13 
2 
5 
5 

39 

5  1          11 
14  '            29 

Sprain  of  ankle 

1 

14!           8 

2 

Wound  of  lower  extremities 

13 

7 
2 
1 
2 
1 
2 

1 

1             20             33 

2 

2' 

4 
1 
2 

1 



2 
2 
4 
1 

Fracture  of  patella 

1 

1 

1    

Fracture  of  fibula 

1 

1              2 

5 

Fracture  of  bones  of  foot,  dislocation 
of  scapho-astrogaloid  joint 

1 

1 
1 

1 

1 

1 

1 

Malingering 



1 

606 


PUBLIC    HEALTH    AND    MAEINE-HOSPITAL    SERVICE. 


Table     VII. — Tahulak    Statement,    by    Districts,    op    Diseases    and     Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  MISSISSIPPI. 


Number  of  cases. 

Diseases. 

■3  a 

gfto 

be 

.g 

■< 

■6 

0) 

o 

13 

> 
O 

a 

13 
t> 

2 
S 

o 

2; 

■6 

5 

OQ   O 

o 

•a  g 
•9-1 

M 

'a  °* 
'gli 

a 

K 

m 

TJ   CO 

o 

^1 

""•as 
3§g 

Total  Cases 

42 
•21 

1,305 
(t7(i 

5 

815 
474 

3 

414 
1(5S 

29 
•21 

2 

36 
11 

53 
•23 

3.072 
1,540 

4,419 

2,  •2,".  7 

5 

44 
4 

66 
1 
1 
2 

23 

466 

15 

44 

9 
35 
5 
2 
19 
10 

285 
35 

1 
4 
29 

68 
29 

9 
29 

5 

2 
14 

8 

262 

36 

1 

4 

1 

i" 

19 

13 

5 

1    

101 

6 

3 

1 
1 

4 
2 

1 
3 

11 
1 

4 

1 

22 

34 

Malarial  fever — 

3 

2 

11 

755 

52 

1 

4 

Tubercle t 

3 

1 

1 

17 

8 
64 
10 

8 

4 

2 

40 

27 
237 
257 

1 
1 
6 
1 
6 

72 

Syphilis — 

35 

1 

3 

306 

286 

Diseases  dependent  on  animal  parasites- 

1 



1 

6 

1 

1 

2 

6 

1 
1 

1 

1 

1 

1 

1 

1 

Diseases  dependent   on  vegetable  para- 

1 

1 

2 

Eflfects  of  animal  poisons- 

1 

1 

1 

1 

1 
1 

1 

Effects  of  vegetable  poisons,  rhus  toxico- 

1 

1 

1 

Eflects  of  heat 

1 
1 

27 
2 
9 

77 

1 

1 

21 

2 

7 

43 

1 

Effects  of  chemical  agents 

1 
10 

2 

4 

1 

1 

37 

2 

2 
35 

9 

Rheumatism 

6 

1 

4 

252 

1 

1 
10 

335 

Gout 

1 

New  growth,  nonmalignant — 
Fibroma 

1 

10 

New  growth,  malignant- 

1 

1 

3 

1 

] 
1 
1 
3 

1 

i" 

2 
...... 

2 

1 

4 

2 

Hodgl'm's  disease .,  . . 

3 

2 

4 

1 

3 

2 

1 

1 

DeMlity 

1 

57 

60 

1 

1 

Local  Diseases 

Diseases  of  the  Nervous  System 

Of  the  nerves — . 

4 

21 

1 
1 

8 
1 

11 

3 

3 

41 

4 
3 

1 
1 

66 

1 

4 

Of  the  spinal  cord  and  membranes, 
cord- 

1 

Degeneration  of  posterior  columns. 
Hsemorrhage 

...... 

2 

1 



1 

1 

1        1 

1 

1 

3 

1 

1 

2 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


607 


T.VBLE     VII. — Tabul.vr    State-mknt,    hy    Districts,    of     Disea.ses    and     I.njuries 
Treated  durinc;  the  F'iscal  Year  ended  June  SO,  1904 — Continued. 

DISTRICT  OF  TIIK  MlSSISSIPPI-Continucd. 


Number  of  cases. 

Diseases. 

go. 

Mi 

S'0.0 

•a  f». 

-a 
< 

■6 

> 
0 

■6 

> 
0 

u 

a 
E 

i 

u 

0. 

.a  '^ 
a  0 

"^ 

■a*  . 

a 

a 

•S  . 

« 

Total    treated    in 
hospital  and  dis- 
pensary. 

Diseases  of  tue   Nervous    System— 
Continued. 
Functional    nervous   disorders    with 
other  diseases  of  undetermined  na- 
ture- 
Apoplexy 

Paralysis,  hemiplegia 

1 

I 

I 

1 

2 

1 
1 

3 

4 

1 

1 
1 
1 

5 

Incomplete  paralvsis 

1    2 

3 

Torticollis ". 

1 

Epilepsy 

2    - 

9. 

3 

Vertigo 

3 

3    .- 

3 

Headache 

5 
20 

5 

Neuralgia 

4 
1 

3 

1 

24 

Hysteria 

1 

1 

Nervous  weakness 

3 

3 

Mental  diseases,  mental  stupor 

1 
7 

5 

1 
3 

2 

1 

Diseases  of  the  Eye 

1 

5 
3 

29 
25 

37 

Conjunctivitis — 
Catarrhal— 

Acute 

30 

Ch  ronic 

1    

1 
1 



1 

Purulent 

1 

i' 

::::::;: 

1 

Iritis 

1 

1 

Lenticular  cataract 

2 

1 
1 

12 

6 
1 

1 

2 
2 

13 
13 

2 

CEdema  of  eyeUd 

1 

Ptosis 

1 

Diseases  of  the  Ear 

1 
5  ■          1 

4 

17 

Inflammation  of  the  external  meatus— 
Acute 

6 

Abscess 

1 

Accumulation  in  external  meatus  of 
wflTc  or  ppidprmis 

1 

Inflammation  of  the  middle  ear — 

3     .       1 
2    

2 
2 

5 

4 

Diseases  of  the  Nose 

1 

1 
1 

34 
3 

1 

2 
1 
1 

2 

15 

Inflammation  of  soft  parts 

14 

Inflammation  of  the  accessory  sinuses. 

Diseases  of  the  Circulatory  System  . 
Pericarditis 

1 
2 

1 

26 
3 

2 
9 
2 

3 

5 

43 
1 

3 
28 

79 
4 

Aortic 

1 

5 

13    

2    

2 

2 

41 

2 

1 

1 

1 

Dilatation  of  heart. 

1 
1 

1 
1 

1 

1 

\ 

2 

,  _   . 

5 

1 
3 
1 
3 

2 

54 
2 

1 
1 

1 

1 

Aneurism  of  arteries 

2 

3 

1 

Phlebitis 

1 

4 

7 

5 

91 
2 

2 

1 

28 
6 
5 

34 

5 

25 
2 

5 

Diseases  of  the  Respiratory  System 

1 

9 

2 

223 

314 

2 

Inflammation  of  mucous  membrane  of 

3 
1 

201 
6 

4 

1 

5 

1 

2 

Bronchitis- 

19 

1 

...... 

9 
4 
5 
1 

229 

1 

12 

9 

Pneumonia 

8 

1 

35 

608 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


TAJiLK     VII. — Tabular    Statement,    by    Districts,    of     Diseases    and    Injuries 
Treated  utring  the  Fiscal  Year  ended  June  30,  1904 — Continue(L 

DISTRICT  OF  THE  MISSISSIPPI— Continued. 


Number  of  cases. 

Diseases. 

go. 

c 

a*" 

-a 

< 

'6 
2 

o 
B 

i 
> 

2 
a 

e 

1 

6 

+^ 
c 

■6 

5 

go 
c  o 

1 

en 

Diseases  of  the  Respiratory  System— 
Continued. 
Phthisis- 

1 
1 

8 
3 

106 

1 

1 

! 

1 

1 

7 

1 

Pleurisy— 

8 
71 

15 

3 

26 

3 

Diseases  of  the  Digestive  System 

Inflammation  of  the  mouth . . . 

1 

4 

3 

3 

456 
3 
3 

563 
3 

Caries  of  dentine  and  cementum. 

3 

Necrosis  of  cementum 

1 

1 

1 

Abscess  of  dental  periosteum. . . 

2 
2 
1 
19 

34 
3 
4 

8 

24 

2 

2 

Inflammation  of  gums  and  alveoli 

2 

Toothache 

1 

Sore  throat 

3 

4 
2 

2 

4 
1 

1 

1 

1 

22 

Inflammation  of  tonsils— 
Follicular 

1 

39 

Suppuration 

1 

Salivation 

!■"■■; 

4 

Inflammation   of   the   pharynx,   ca- 
tarrhal   

1 
10 

1 

1 
1 
8 

1 

9 

Inflammation    of    the   stomach,    ca- 
tarrhal  

9 

i' 

1 
4 

1 
1 

34 

Ulceration  of  the  stomach — 

Superficial 

3 

Perforating 

1 

Haemorrhage  of  the  stomach 

1 

Indigestion 

3 

; 

1 

91 

1 

5 

2 

3 

46 

1 

88 
74 

99 

Gastralgia 

1 

Inflammation  of  the  intestines — 
Enteritis 

7 
5 
3 
2 
4 

7 
2 
2 
2 
3 

12 

Typhlitis 

2 

1 

1 

5 

Colitis 

5 

Catarrhal 

Hernia 

50 

Intestinal  dyspepsia 

1 

Constipation 

4 
25 
1 
2 
3 
1 

4 
4 

4 
18 
1 
1 
3 

92 

4 

1 

1 

99 

Inflammation  of  the  rectum 

1 

Periproctitis,  abscess 

1 

1 

1 

3 

Fistula  in  ano 

4 

Prolapse  of  the  rectum 

1 

1 

Piles- 
Internal  

2 
2 

2 
2 

2 
20 

1 

4 

6 

External 

24 

Mixed 

1 

Inflammation  of  the  liver- 
Acute 

1 
1 
5 

1 

1 
.5 

5 

Abscess 

1 

Chronic 

2 
6 

1 
1 

Hyperaemia  of  the  liver 

6 

Hypertrophy  of  the  liver 

1 

Calculi 

1 
1 

1 

9 

Inflammation  of  the  peritonaeum 

1 

Dilatation  of  gall  bladder 

. 

1 

11 
1 

4 
6 

1 

Diseases  of  the  Lymphatic  System.  ... 

1 

32 

10 

19 

4 

44 

Splenitis 

1 

Inflammation  of  lymph  glands 

1 

26 
5 
1 

19 
6 

9 

1 

2 
1 

15 
3 

1 

14 
4 

3 
1 

31 

Suppuration 

11 

Dilatation  of  lymphatics  of  scrotum  .. 

1 

1 

Diseases  of  the  Urinary  System 

Acute  nephritis 

4 
1 

39 

4 
3 

4 

1 

59 
10 

Bright's  disease 

3 

Chronic  nephritis 

8 
2 



6 
1 



i 

12 

Granular  kidney 

3 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


(i09 


Tahi.k     VII. — Taih-lar    Statement,    by    Districts,    ok     Diseases    and     Ln.iikies 
Tkeated  i)i-KiX(i  THE  Fiscal  Year  ended  June  80,  1904 — Continued. 


1)1^^TU1(•T  OF  THK  MISSISSIPPI  -("oiitinued. 


Number  of  cases. 

Diseases. 

•1 

■a  >. 

ii.a 

a*" 
< 

■6 
2 

> 
o 

> 
£ 

E 

o 
> 

2 
c 
S 

o 

1 

5 

IS. 

a.-  « 
a; 

- 

•V  w      1 
<s 

=3 

•3 

...   03 

Diseases  of  the  Urinary  System— Con. 

1 

.. 

1 
2 

1 

2    

:::;;. ::::i 

2 

nflamraation  of  bladder- 

1 

1 

i 

17 

18 

2 
4 
1 
2 
1 

131 
7 

2 

4 

1 

2 

1 

1 

1 

89 
1 

1 

13 

1 

43 

1 
1 

6 
1 

45 

2 

221 

8 

1 

Stricture  of  urethra- 
Organic            ... 

7 

18 

31 

1 

1 

1 

1 



1 

1 

4 

4 

1 

1 
3 

1 

2 

1 

5 

1 

1 
3 
1 
6 
66 

1 

1 

3 

1.   .     . .' 

1 

Ulcer  of  penis 

[651 

12 

]              45             14 

28 

1 

109 

1 

1 

1 

2 
5 

1 

12 
1 

2 

5 

Hydrocele  of  tunica  vaginalis 

Inflammation  of  the  testicle— 

1 

I 

8 

2 

12 

3 

1 

24 

1 

Epididymitis 

3 

1 

2 

i 

3 

1 

1 

i 

1 
1 

73 

4 
2 
2 

1 

1 



1 

1 

1 

15 

1 

11 
1 

4 

1 

89 

Inflammation  of  the  bones- 

5 

2 

3 

2 

1 

5 

Inflammation  of  joints— 

1 

1 

1             1 

1 

2 

1 
1 
8 

1 

63' 

] 

Y 

1 
1 

6i 

i 

1 

33 

17 
16 

125 

2 

12 

18 

1 

1 

1 

10 
5 
5 

33 

9 
5 

4 

14 

1 

1 

43 

22 

1 
20 

2] 

3 

2 

1        161 

1            2 

2 
3 
1 

1 
2 



1 
1 

1 

1          1' 

2: 

2 

1 

: 

1 

i 

1 

1 

1 1.... 

: 

2 

6 

2 

1 

1 

1 

1 

1 

7 

1 

[■■■    ■ 

: 

1      1 

2 

Scleroderraia 

1 

I 

1 

1 

i::::: 

1 

1           2 

8629—04- 


-39 


610 


PUBLIC   HEALTH    AND   MARINE-HOSPITAL    SERVICE. 


TaHLE      VII. — T.VBLLAR      STATEMENT,      BV     DISTRICTS,      OF      DISEASES     AND      I.NJURIES 

Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 
DISTRICT  OF  THE  MISSISSIPPI— Continued. 


Number  of  cases 

Diseases. 

a  A 

C  O  o3 

1 

< 

•6 
£ 

> 
0 

■6 
> 
£ 

a 

Not  improved. 
Died. 

III 

1 
'■5  . 

S 

a  i 

■3 

Bst- 

III 
6-1 

Diseases  of  the  Skin— Continued. 

Ulcer                                       

2 


15 
4 
3 
1 

4 
3 

1 
1 

11 
1 
2. 

2 

29 
31 
n 
5 
2 
2 
1 
1 
2 
1 

8 

1 
1 
I 
3 
2 

46 

Boil                          

35 

8 

Whitlow                  

6 

1 

2 

1            ' 

2 

Wen         

1 

1 

2 

1 

1 

1 

2 

1 

1 
1 

: ■....!     , 

2 

6 

1 
2 

1 
1 

5 

1 
2 

1 

14 

General  Injuries: 
Effects  of  heat- 
Burns  and  scalds 

2 

3 

Sunstroke  

2 

1 

4 

2 

Shock 

1 

160 

1 

1 
106 

1 

Local  Injuries 

5 

45 

3 

3  i        8 

295 

460 

1 

1 

Contusion  of  muscles 

2 
26 

2 

1 
1 
1 
4 
7 

1 

i' 

4 
4 

27 

i 

1 

W  ound  of  skin 

1 
11 
2 
2 
21 

2 

Bum  "'■  sfnld  of  skin 

1 

1 
3 

16 

Frostbite        

9 

2 

Wound  of  scalp 

5 
2 
1 

1 
1 
2 

T 

2 
2 

5 
2 

i 

26 

1 

2 

1 
1 

/     1 

1 

1 

2 

1 

1 

Concussion  of  brain 

1 

2 

3 

7 

4 

Wound  of  face  and  mouth 

1 
2 

9 

1 

2 



1 

1 

1 
1 
4 

4 

1 

Contusion  of  eveUd 

1 

1 

Wound  of  eveUd 

1 
3 

1 
1 

2 

Contusion  of  eyeball 

2 

7 

Foreign  bodies  in  the  conjunctiva  or 
cornea 

4 

Contusion  of  lung  .   

1 

4" 

1 

1 

1 

Gunshot  wound 

2  

1 

1 
3 

5 

Contusion  of  neck 

3 

1 

1 

1 

1 

Foreign  body  in  the  air  passages 

1 
2 
5 

1 

Contusion  of  chest 

3 
5 

1 
2 
2 
4 
2 
1 

2 
4 

i' 

1 
3 
1 
1 

1 

5 

Fracture  of  ribs 

...... 

1 

10 

1 

Penetrating  wound  of  pleura  or  lung. . . 

1 

2 

1 

4 
6 

1 

6 

Sprain  of  back 

1 
1 



10 

3 

Concussion  of  cord  .       .                 .  . 

1 

Contusion  of  abdomen 

1 

1 
1 
1 
22 
1 
1 
6 
1 
1 

1 

Wound  of  parietes  of  abdomen 

1 

1 

2 

3 

Contusion  of  testicle 

1 

Contusion  of  upper  extremities 

3 

2 

1 

25 

Sprain  of  shoulder 

1 

1 

1 

Sprain  of  wrist 

1 

1 

1 

7 

Sprain  of  hand 

1 

Sprain  of  thumb 



i 1 



1 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


611 


T\ULE     VII. — T.MU-L.VR    St.\ti:.ment,    by    Dlstricts,    of     Diseases    and     Injuries 
Tre.\ted  DiRiNG  THE  FiscAL  Year  ENDED  JuNE  30,  1904 — Continued. 

DISTRICT  OF  TIIK  MISSISSIPPI— Continued. 


Number  of  cases 

. 

Diseases. 

«£: 
50. 

3-::^ 

i'5,o 

c 
0 

< 

! 

1 

0, 

1 

6 
0 

■6 
5 

Remaining  in  hos- 
pital at  close  of 
year. 

Treated  at  dispen- 
sary. 

Total    treated    in 
hospital  and  dis- 
pensary. 

Local  Injuries— Continued. 

Wound  of  upper  extremities 

22 
2 

2 

1 
1 

2 
1 

20 
2 
10 

11 

11 

80 

102 

Fracture  of  clavicle 

1  :       1 

'       1 

'       1 

1 

1         1 

1 

3 

Fracture  of  bones  of  forearm- 
Radius  

1'           1 

3 

Ulna 

1 

Both  bones 

1 

Fracture  of  carpus,  metacarpus,  or 
phalanges 

1 

3 

Dislocation  of  humerus 

1 

13 
2 
8 

1 

Contusion  of  lower  extremities 

5 

2            15 
6 

35 

Sprain  of  knee 

8 

Sprain  of  ankle 

1 

3 

1           9 

20 

Sprain  of  foot 

2 

2 

Wound  of  lower  extremities 

1 

22 
3 
2 
2 

1 

19           3 

1  i          34 

57 

Fracture  of  tibia 

3 
2 

3 

Fracture  of  fibula 

2 

Fracture  of  tibia  and  fibula 

2    

2 

Fracture  of  bones  of  foot,  of  the  meta- 
tarsus  

1 

1 

Dislocation  of  tibia 

1 

1 

MaUngering 

1 

1 

1 

DISTRICT  OF  THE  WEST  INDIES. 


Total  Cases 

6 

1 

59 

24 

1 
1 

7 

39 

18 

19 
4 

2 

1 
1 

5 
2 

66 

18 

131 

(jeneral  Diseases 

43 

Enteric  fever 

1 

Dysentery 

1 
7 

1 
1 

3 
4 
3 

2 

Malarial  fever,  intermittent 

8 

Syphilis: 

Primary 

3 

1 
4 

4 
2 

3' 

4 

I 

5 

G  onorrhea 

1 

8 

Diseases  dependent  on  animal  parasites: 
Strongylus  duodenaUs 

4 

Uncinaria  Americana 

2 

2 

Scurvj' 

1 

Alcoholism 

1 

1 

Rheumatic  fever 

2 
3 

1 

2 

Rheumatism 

2 

2 

5 

Cyst,  serous 

1 

New  growth,  nomnalignant,  Upoma 

1 

1 

1 

Local  Diseases 

Diseases  of  the  Nervous  System 

2 

1 
1 

1 
1 

1 

2 

Neuralgia 

1 

Nervous  weakness 

1 

Diseases  of  the  Eye 

1 

Iritis 

1 

Diseases  of  the  Circulatory  System.. 

2 

1 

1 

1 
1 

3 

Valvular  disease,  mitral 

1 

Disordered  action  of  the  heart,  irreg- 
ularity   

1 

1 

Vartx 

i 

1 

1 

Diseases  of  the  Respiratory  System  . . . 

3 
3 

3 

inflammation  of  mucous  membrane  of 
larynx,  catarrhal,  acute 

'.'.'.. ..\ 

3 

612 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Table     VII. — Tabular    Statement,    by    Dlstricts,    of    Diseases    and    Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  WEST  INDIES— Continued. 


Number  of  cases. 

Diseases. 

o  £  ce 

Oj  ^   K 

■g 

•S  ® 
•a 

•6 

> 

o 

s 

■6 

o 
u 

ft 

a 

■a 
> 
2 
o. 
6 

o 
25 

5 

•ag 
c  O 

lis 

a 

1 

'■B  . 
*^  h 

2 

a  i 

•3 

as  03    . 

•as 

Eh 

Diseases  of  the  Digestive  System 

6 

6 

15 

3 
6 
1 

1 

21 

Inflammation    of    the    stomach,   ca- 

3 

Indigestion 

2  '          2 

8 

Heartburn 

1 

Hernia 

1 

1 
2 

4 
2 
2 

1 

1 

8 
8 

1 
1 
2 

2 

1 
1 

1 
1 

3 
3 

2 

Colic 

1 

Diarrhea 

3 

1 

5 

Diseases  of  the  Lymphatic  System 

1 
1 

1 

5 

Inflammation  of  lymph  glands 

2 

Suppuration 

1 

2 

Diseases  OF  the  Urinary  System 

1 

Retention  of  urine 

1 

Diseases  of  the  Generative  System.  . . 

4 
4 

9 
9 

8 
7 

1 

1 

1 

20 

19 

Inflammation  of  the  testicle,  acute 
orchitis 

1 

Diseases  of  the  Organs  of  Locomotion. 

1 

Inflammation  of  joints,  acute  synovitis 
Diseases  of  the  Connective  Tissue 

1 

1 

2 

1 
1 

1 
1 

2 
1 

1 

1 
1 

0 

Inflammation 

1 

Abscess 

1 

Diseases  of  the  Skin 

1 

2 

Boil 

1 

Whitlow 

1 
2 

2 

1 

2 

1 

1 

1 
1 

■  4 

General  Injuries: 

Effects  of  heat,  bums,  and  scalds 

3 

1 

9 
1 

1 

6          3 
1 

1 

Local  Injuries 

1 

1             13 

23 

Strain  of  muscles 

1 

1 
1 

1 

2 

Burn  or  scald  of  skin 

1 

Wound  of  pinna 

1 

Foreign  body  in  the  food  passages 

1 

Fracture  of  ribs 

1 
1 

1 

1 

Contusion  of  back 

1 

;:;:::; 

1 

Contusion  of  upper  extremities 



3 
2 
2 
2 



3 

2            2 

1  1 

2    

1             1 
1 

4 

Contusion  of  lower  extremities 

3 

2 

4 

Wound  of  joint,  lower  extremities 

1 

Fracture  of  tibia  and  fibula 

1 



1 

DISTRICT  OF  THE  GREAT  LAKES. 


Total  Cases 

133 

54 

2 

2,640 
1,997 

1,762 
655 

2 

768 
310 

64 
18 

73 
33 

116 
36 

10,617 
4,053 

16,079 

General  Diseases 

6,104 

Smallpox 

2 

Cowpox 

335 
1 

335 

Measles 

12 

1 

96 

10 

7 

3 

174 

10 

1 
88 
9 
7 
3 
151 

1 

1 

13 

Scarlet  fever 

1 

Influenza 

6 

1 

1 

204 

7 

5 

6 

21 

300 

17 

Dinhtheria 

1 

1 

13 

Simple  continued  fever 

9 

Enteric  fever 

20 

19 

4 

11 

9 

215 

Pl^KLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


613 


Table    VII. — Tabular    Statement,    by    Districts,    of    Dlseases    and     Injuries 
f  Treateu  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  GREAT  LAKES— Continued. 


Number  of  cases. 

Diseases. 

cd  °i  n 

§-a§ 

a 
•c 

m 
T3  >> 

tiS3 

< 

73 

i 

> 

O 
O 

i 
> 
2 

Q. 

B 

■2 
t> 

S 
ft 

a 
0 

■d 

5 

be" 

s. 

.2 

■B  . 

^* 
1 

.a<2 

'•3 

Choleraic  diarrhea 

10 
1 

7 

22 
5 
1 

10 
1 
1 

86 

7 
83 

2 
93 

9 

1 
5 

18 

4 

■■■■-■ 

1 
7 
2 

1 

58 

1 

9 

17 

8 

92 
2 
1 
6 

19 

Epidemic  diarrhea 

18 

Dysentery 

2 

7 
1 

1 

15 

Malarial  fever- 
Intermittent 

3 

1 

117 

Remittent 

1 

8 

Phagedaena,  sloughing  phagedena 

2 

Erysipelas 

1 

1 

17 

Pyajmia 

1 

Septicaemia 

1 
67 

6 
69 

1 
31 

1 

47 

91 

806 

47 

1,299 

1 

9 
3 
1 
1 
3 
1 
156 

2 

Tubercle 

6 

1 
2 

2 

11 

5 

139 

Syphilis  — 

Primary 

99 

Secondary...             .                 

3 

2 

4 

891 

Tertiary 

49 

Gonorrhea 

2 

2 

4 

1,394 

Actinomycosis 

1 

Diseases  "dependent  on  animal  parasites- 
Taenia  solium 

6 

3 

1 

2 

15 

Taenia  mediocanellata 

3 

Pediculis  pubis 

1 

Pediculis  vestimenti 

1 

Phthirius  inguinalis 

3 

Ascarix  mystax 

1 

1 

Sarcoptes  scabiei 

9 
3 

2 
5 

6 
2 

3' 

3 

1 

2 
2 

165 

Taenia  Saginata 

3 

Diseases  dependent  on  vegetable  para- 
sites— 
Achorion  Schonleinii 

2 

Trichophyton  tonsurans 

39 

4 

44 

Microsporon  furfur 

4 

Effects  of  vegetable  poisons- 
Ivy  

...... 

2 
1 
4 
1 

1 
1 
3 

1 

1 

2 

Opium 

1 

Tobacco 

2 

9 

14 

Atropia 

1 

Rhus  toxico  dendron 

2 

1 
1 
3 
2 

2 

Effects  of  inorganic  poisons- 
Mercury 

. 

1 

Potassium  iodide 

1 

Effects  of  the  presence  of  foreign  bodies.  .. 

3 

Effects  of  mechanical  injuries 

2 
2 

2 

2 

4 

Effects  of  heat 

2 

Effects  of  chemical  agents 

1 

87 

1 

595 

2 

8 
2 

4 

1 

1 

4 
2 
7 

111 
20 
162 

1 

4 

101 
14 

108 
1 

4 

8 

7 

54 

5 
1 

1 

202 

Rheumatic  fever 

23 

Rheumatism 

764 

Gout 

3 

Cyst- 
Sebaceous  

12 

2 

Chalazion 

4 

New  growth,  nonmalignant— 

Lipoma 

2 
2 

1 
2 

1 

3 

Fibroma 

2 

Chondroma 

2 

1 

31 

2 

2 

1 

4 

11 

2 

Pterygium 

.. 

1 

Papilloma 

31 

1 

3 
1 

1 
1 
1 
1 
1 
5 
1 

1 
1 
1 

1 
1 

3 

New  growth,  mahgnant— 

Sarcoma 

1 

5 

Epithelioma 

2 

Squamous  carcinoma 

5 

Anaemia 

1 

12 

Idiopathic  anaemia 

1 

1 

Purpura 

1 
1 
3 
1 

1 

Haemophilia 

1 

Diabetes  mellitus 

1 

1 

3 
3 

8 

Diabetes  insipidus 

4 

614 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Table    VII. — Tabular    Statement,    by    Districts,    of    Diseases     and     Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  GREAT  LAKES— Continued. 


Number  of  cases. 

Diseases. 

11 

oft 

lis 

.5—  ?-> 

oj  ftO 

OS 

a 
•c 

H 

■a  >. 

a*' 
< 

£ 

0 
O 

-2 
> 

2 

p. 

a 

■6 
o 

Q. 

a 

o 

12; 

5 

1  **~i 

.si 

Ill 

'•3  . 

■5 

2 
5 

1 
5 

1 

2 

61 

4 

Debility     

66 

Local  Diseases 

Diseases  of  the  Nervous  System 

Of  the  nerves,  inflammation — 
Neuritis 

9 

59 

5 

1 

25 

4 
1 

24 

1 

7 

12 

286 

8 
2 

354 
13 

Multiple  neuritis ••' 

...... 

3 

Degeneration  of  nerves 

1 
1 

i 

1 

Of  the  spinal  cord  and  its  membranes- 
Cord— 
Degeneration— 

Of  anterior  cornua 

1 

1 

Of  lateral  columns 

1 
9 
1 

2 

i 

1 

2 

1 

Of  posterior  columns 

4 

8 

3 

3 

6 

21 

Syringomyelia 

1 

Of   the  brain  and  its  membranes — 
Brain- 
Hemorrhage 

1 

1 

1 

1 

2 

Hvpereemia 

2 

Functional    nervous    disorders    with 
other  diseases  of  undetermined  na- 
ture- 
Paralysis- 

Paraplegia 

1 

Hemiplegia 

1 
1 

6 
2 

i 

4 
1 

1    .... 

2 

1 

17 

Local  paralysis 

7 

1 

Paralysis  from  acute  disease 

1 

Spasm 

1 

Facial  spasm 

2 

Eclampsia 

1 
7 
1 

1 

2 

1 

1 

Epilepsy 

1 

5 

1 

5 

13 

Tetany 

1 

Vertigo 

4 

28 

145 

1 

60 

4 

Headache 

5 
13 

4 
9 

1 
4 

33 

Neuralgia 

158 

Hiccough 

1 

Nervous  weakness 

4 

1 
3 

10 

2 

1 

2 

1 

1 
1 

64 

Mental  diseases- 
Mania  

1 

Melancholia 

5 
2 

1 
6 

1 

134 

95 
2 
3 

5 
6 

1 

Diseases  of  the  Eye 

1 

145 

Conjunctivitis,  catarrhal- 

Acute 

1 

97 

Chronic 

2 

Keratitis 

3 

Ulceration  of  cornea 

2 
1 
1 

2 

1 

1 
2 

1 
2 

Iritis 

1 

8 

Choroiditis 

2 

Retinitis 

2 

Lenticular  cataract 

3 

3 

Panophthalinitis 

1 

1 

1 

Amblyopia 

6 

1 
1 
1 
1 

6 

Temporary  blindness 

1 

Ametropia 

1 

Diplopia 

1 

Abscess  of  lachrymal  sac 

1 

Blepharitis  marginalis 

1 

1 

1 

Sty 

3 
3 
1 
1 
1 

3 

Abscess  of  eyeUd 

3 

Trichiosis 

1 

CEdema  of  eyelid 

1 

Ptosis 

1 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


615 


Tahi.k    VII.— Taiuh.ak    Statkmknt,    hy    Districts,    av     Diseases     and     Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  GREAT  LAKES-Continued. 


Number  of  cases. 

Diseases. 

il 

Mia  h 
.S2g 

'3  "3  to 
X 

bo 
a 
•c 

■a 

i 

> 

1 

S 

•2 
> 
2 

.I 

o 

i 
s 

55  o 
a  o 

II  2 

g 

m 

'■B  . 
Si 

03 

a 

48 

7 
2 
1 

18 

Total    treated    in 
hospital  and  dis- 
pensary. 

Diseases  of  the  E\k 

8 
3 

4 
2 

2 
1 

1 

1 

56 

Inflammation  of  the  external  meatus— 
Acute     

10 

Chronic 

2 

1 

Accumulation  in  external  meatus  of 

18 

Inflammation  of  the  middle  ear— 

1 
4 

1 

1 

Suppurative 

2 

1 

1 

is 
1 

2 
1 
3 

120 

60 

2 

1 

1 
56 

125 

1 

5 

45 

3 

1 

1 
1 
1 

1 

1 

1 

27 

1 

17 

Within  the  mastoid  cells 

1 

Perforation  of  membrana  tympani 

o 

Tinnitus 

1 

Deafness 

3 

Diseases  of  the  Nose 

1 

■1 

3 

2 

!:5 

Inflammation  of  soft  parts 

10 

Diseases  of  septum,  deviations 

2 

1 

11 

37 

i 

1 
1 

10 
2 

2 

Inflammation    of    the    accessory  si- 
nuses    ... 

1 

2 

4 

Inflammation  of  the  naso-pharynx .... 

:7 

Diseases  of  the  Circulatory  System  . 
Pericarditis 

9 

59 

1 

9 
3.5 
5 
3 

3 

8 

2 

■07 
2 

Valvular  disease- 
Aortic 

2 
5 

1 

1 
1 

3 
3 
1 

...... 

18 

Mitral 

7 

Aortic  and  mitral .    ... 

9 

Inflammation  of  muscular  tissue      .   . 

4 

1 

Hypertrophy  of  heart 

1 

Dilatation  of  heart 

1 

Angina  pectoris 

1 

2 

Disordered  action  of  the  heart- 

1 

Abnormal  rapidity. .      .  . 

1 

Irregularity 

i7 

Arteritis 

\ 
3 

8 

1 

2 

1 

1 

Aneurysm  of  arteries 

1 

1 

1 

3 

Obstruction  of  arteries,  thrombosis. . . 

1 
2 
5 

1 

Phlebitis 

I 

3 

6 

27 

2 

1.092 
2 

1 

25 

2 

27 

669 

252 

1 

40 

20 

1 

2 

2 

9 

.?5 

Dilatation  of  capillaries  . 

2 

Diseases  of  the  Respiratory  System  . . . 

7 

191 

119 

58 

5 

10 

6 

1,290 
2 

Spasm  of  larynx 

1 

Inflammation  of  mucous  membrane  of 
larynx — 
Catarrhal,  acute           .  .. 

•J 

4 

29 

2 

27 

Bronchitis- 

1 
1 

44 
27 

37 
12 

14 

1 

714 

2 

280 

Membranous           

1 

1 

10 

2 
1 

47 
f. 

4 
1 
3 
2 

4 

"'ih' 
1 

2 

2 

.    13 

51 

22 

Hemorrhage  of  lung,  haemoptysis 

1 

2 

3 

10 

1 

51 

8 

Phthisis- 

1 
1 

1 
1 

2 

4 

3 
2 

1 

4 

2 

5 

Emphysema 



i 

3 

010 


PUBLIC    HEALTH     AND    MARINE-HOSPITAL    SP:RVI(^E. 


TAiiiJ-:    \'II. — Tahim-ak     Staticmknt,     hy     Distkici'.s,    ok     Dijskahes     and     Injuries 
Tkkatioi)   DUKiNi;  THK  Fisc'A  1-  YicAH  ENDED  JuNE  30,  1904 — Continued. 

DISTRICT  OF  THE  GREAT  LAKES— Continued. 


Number  of 

3ases. 

Diseases. 

ah 

Admitted    during 
the  year. 

■6 
S 

1 

i 

Q, 

a 

•6 
> 
g 

a 

o 

Died. 

Remaining  in  hos- 
pital at  close  of 
year. 

■3  . 

•S.S 

•S 

"  S 

cci  *    . 
a>— '  . 

use- 
■as 

Eh 

Diseases  of  the  Respiratory  System— 
Continued. 
Pleurisy— 

30 
7 
3 

385 

26 
3 

1 

303 

4 
4 

1 

67 

31 
11 
1 

1,783 
2 
1 
5 
3 
1 
1 
1 
1 
8 
1 
3 
2 
3 
1 
1 
9 
3 
35 

144 
7 
1 
2 
1 
1 

60 
6 
1 

150 

9 

61 

18 

Empyema 

Diseases  of  the  Digestive  System 

1 
11 

2 
10 

5 

7 

9 

2,179 
2 

1 

5 

1 

3 

1 

1 

1 

1 
2 

i 

1 

1 

1 

2 

10 

1 

3 

2 

1 

1 

4 

1 

3 

1 

1 

1 

9 

3 

3 

60 
4 

2 

55 
4 

1 

38 

Inflammation  of  tonsils — 

204 

11 

1 

1 

I....-.J  .   . 

0 

1 

1 

Inflammation  of  the  pharvnx— 

60 

2 

1 

44 

3 

1 

2 
31 

.     . 

1 

8 

1 

12 

3 
1 

2 

Inflammation    of   the   stomach,    ca- 
tarrhal   

1 

1 

1 

195 

Ulceration  of  the  stomaeh — 
Superficial 

12 

1 

Displacement  of  stomach 

1 

1 
1 

1 

1 

1 

2 

Contraction  of  tendons 

1 

Stricture  of  pylorus 

1 
27 

1 
1 

1 

2 

21 

4 

2 

402 
27 

1 

n 

26 

55 
6 

431 

Pyrosis 

27 

Vomiting 

::::::::::: 

1 

11 

Loss  of  appetite 

26 

Inflammation  of  the  intestines — 
Enteritis 

.55 

13 
2 
4 
1 
1 
2 

27 
1 
1 
5 
5 

49 
3 
9 
1 

10 

46 
9 
2 
4 

2 

24 

6 
1 

3 

1 

110 

Typhlitis 

1 

3 

20 

2 

Catarrhal . 

1 

1 
1 

1 

12 

1 

17 

2 

Hemorrhage  of  the  intestines 

1 

Faecal  accumulation 

2 

Hernia 

2 

1 

1 

104 

131 

Obstruction  of  the  intestines 

1 

Intestinal  dyspepsia 

4 

5 

45 

1 

7 

e' 

1 
1 
2 
3 
1 
3 
1 
4 

19 
275 
13 
195 
7 
1 
3 
4 

20 

Constipation 

280 

Colic 

2 

20 

Diarrhea 

1 
1 
1 

244 

Periproctitis.. 

10 

2 

12 

4 

Fistula  in  uno 

14 

PITBLIC    lIKyVl/lH     AND    MAHINK-II<»S1>ITAL    SERVICE. 


617 


T.\iti,i-:    \'I1. — Taiui.ai;     Statkmknt,     hy     Distkici's,    ok     Dihkases     and     lN.iii{if>t 
Tkkatki)  di  itiNc;  thk  Fiscal  Ykak  ended  Jine  80,  1904 — Continued. 

DISTKICT  OF  THE  GREAT  LAKES— Continued. 


Number  of  cases 

Diseases. 

H 

c  — 

a- p. 

ai  *  M 
a>  CO 

Admitted    during 
the  year. 

•a 
S 

1 

i 
> 

2 
a 

> 
s 

a 

0 
2; 

i 

5 

a 

1 
■3  . 

I 

.S<i> 

•as 

Disease  of  the  Digestive  System— Con. 

1 
1 

1 

1 

Rectocele 

1 

2 
1 

1 

I'iles— 

Internal 

5            3 

11 
61 
12 
9 
3 
1 
2 
54 

16 

Kxtemal 

16 
1 

13 

1 

2 

Mixed 

13 

Pruritus  ani                                                

9 

Inflanunntion  of  tlie  liver,  acute 

.3             1 

1 

1 

6 

1 

1 

1 

4 

Hvperaemia  of  the  liver                 - 

2 

1 

1 

56 

1 

1 

Stricture  of  the  rectum 

1    

1 

1 

Ulceration  of  the  rectum 

1 

1 

1 

Jaundice 

3 

4 
3 

3 
3 

9 

5 

1 
1 

12 

Inflammation  of  hepatic  duct.s  and 

1 

1 

9 

Calculi. 

' 

4 

Bilarv  colic . .                                     





1 

1 

1 
1 

1 

Dropsy                                                                1 

...... 

1 

Accnmnlatinn  of  hilp 



4 
108 

4 

Diseases  of  the  Ly-mphatic  System  . . . 

Hypertrophy  of  spleen 

Inflammation  of  the  Ivmph  glands  .  . 

3 

52 

1 

28 

18 

37 

"'"22" 
11 

15 
1 
4 
9 

2 

1 

163 

1 

1 
1 

1      73 

101 

Suppuration "...'...  7 

3 

28 
1 
4 
2 

8 
1 

49 

Hypertrophy  of  Ivmph  glands 

1 

Inflammation  of  iymphatics 

Dilatation  of  lymphatics 

r^ 

4 

1 

9 

1 

2 

Diseases  of  the  Thyroid  Body  . .   . 

8 

1 

Goitre 

7 

125 

8 
3 
6 

1 

1 

i 

7 

Diseases  of  the  Urinary  System 

6 

46 
2 
6 

11 
4 

1 
1 
1 

19         22 
1 

2 
1 

6|        3 

179 
10 

Brlght's  disease 

1 

4 
1 

1  '        1 

9 

Chronic  nephritis : . 

Granular  kidney 

Abscess — 

Of  kidney   . 

2 
1 

4 

1   1 

1 

19 
6 

2 

Perlnephiitic 

Pyelitis : 

Congestion  of  kidney.. 

1 

i    

;       1 

1 

2 
1 
1 

Movable  klndey . . . ." 

1 

1 
2 

1 

1 
2 

1 

Calculus  in  kidney 

1 

2 

Glycosuria 

2 

2 

Haematuria 

1 



2 

3 

3 

1 
7 

40 

17 

25 

1 

Llthuria 

1 
6 

1 

4 

1 
2 

1 

8 

Inflammation  of  bladder- 
Acute 

2 

1 

46 

Subacute 

Chronic 

2 

2 

1    

19 

27 

Calculus  of  bladder 

1 

Irritability  of  bladder 

4 

4 

1 

i 

1 

96 

1 

Incontinence  of  urine 

2 
138 

1 
2 

9 

651 
3 

11 

Diseases  of  the  Generative  System.. 
Urethritis..                    

o 

44 

1 

794 
3 

Gleet 

I 

3 

2 

100 

3 

1 

2 

Stricture  of  urethra,  organic 

18 



6 

12 



[ 

118 

G18 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Tahi.I':    VII. — Taijui.ak     8T.\TKMt:.\T,     hy    Distkictk,    ok     Diseases     and     I.\.u!kie.s 
Tkeatki)  dihim;  tfie  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  GREAT  LAKES— Continued. 


Number  of  cases 

. 

Diseases. 

.§2 
n  o  oi 

1 

H 
< 

•d 

> 
0 
u 
a) 
« 

■6 

a) 

a 

■0 
e 
(► 
S 

a 

0 

•d 
S 

m  0 
0 

■eg 
B  0 

as  a> 
g  o.t>. 

a 

1 
'■B  . 

i 

Total    treated   in 
hospital  and  dis- 
pensary. 

Diseases  of  the  Generative  System— 
Continued. 
Urethral  fever ; 

1 
1 

1 

Inflammation  of  the  prostate- 

1 

1 

2 
5 

6 

1 

25 

3 

Chronic 

1       < 

5 

Hypertrophy  of  the  prostate 

3 

1 

14 
7 
1 
9 

.32 
1 

11 
16 

2 

1  

9 

Posthitis 

2 

Phimosis 

Paraphimosis 

1 

4 

40 
7 

Inflammation  of  the  glands  of  the  penis 

Ulcer  of  penis 

Soft  chancre 

Soft  chancre  of  scrotum 

""2 

1 

"3' '.'.'.'.'.'. 

16    

3 

102 
281 

4 
113 
314 

1 

Pruritus  of  the  scrotum i 

1 
6 
27 
18 

1 

Hydrocele  of  the  spermatic  cord ' 

2 
10 

7 
4 
15 

9 
5 
5 
13 

1    

1    

2    

8 

Varicocele 1 

37 

Hydrocele  of  tunica  vaginalis 



25 

Inflammation  of  the  testicle 

1 

5 

Acute  orchitis 

2 

34 
1 

10 
6 
2 
1 
1 
1 
1 
4 
1 
2 

49 

Chronic  orchitis t 

1 

Epididymitis 

6 



5 

1 

16 

Spermatorrhoe 

6 

Impotence 

1 

2 

Inflammation  of  the  ovary 

1 
1 

2 

1 

1 
2 

1 

2 

Inflammation  of  the  fallopian  tube 

I 

2 

Inflammation  of  the  uterus 

1 

3 

Atrophv  of  testicle 

1 

Laceration  of  cervix  uteri 

1 

4 

Amenorrhea 

^1          ' 

2 

Menorrhagia 

2 

Metrorrhagia 

i         i 

1 



1 

Mastitis 

1 

372 
4' 

1 

Inflammation  of  breast,  male 

1 

Diseases  of  the  Organs  of  Locomo- 
tion   

4 

49 

1 
3 
1 
2 
3 

33 

18 

1' 

- 

1 

1 

425 

Inflammation  of  the  bones- 
Osteitis  

1 

Periostitis 

1 

2 

3 

1 
1 

1 

Chronic  abscess 

1 

Caries 

2 

Necrosis 

1 

1 

3 

1 

9 

1 
1 
1 

1 

Hypertrophy  of  the  bones 

1 

Inflammation  of  joints- 
Acute  synovitis  

7 
2 

5 

2 
2 

16 

Chronic  synovitis 

3 

Ankylosis 

1 

Dislocation  of  articular  cartilage 

1 

1 

2 

Loose  body  in  joint 

1 

Caries  of  the  spine 

1 

8 

10 

1 
5 
11 

1 

Myalgia 

3 

329 

337 

Lumbago 

1 

11 

Inflammation  of  tendons 

1 
2 

4 

I 
7 

2 

1 

Contraction  of  tendons 1 

2 

Inflammation  of  sheaths  of  tendons  . . 

...... 

1 
2 
5 

i' 

1 

1 
2 

4 

5 

Thecal  abscess 

4 

Inflammation  of  bursae,  acute 

12 

Abscess  of  bursae 

2 

Bunion 

1 

1 

1 
1 

4 

Bursal  cyst 

1 

Flat  foot 

1 

1 

Hammer  toe 

1 

52 
14 
38 

1 

43 
10 
33 

1 

Diseases  of  the  Connective  Tissue... 

Inflammation 

Abscess 

6 
2 
4 

1 
1 

2 

1 
1 

99 

54 
45 

151 
68 
83 

PUBLTC    HKALTH    AND    MARINE-HOSPITAL    SERVICE, 


019 


T.Mti.K    \11. — Tabilak    Statement,    hv    Districts,    oe    Diseases     and     In.iikies 

TkEATEI)    nilKING    THE   FiSCAL    YeaK   ENDED  JuNE   30,   1!>04 — CoiltiniK'il. 
DISTRICT  OF  THE  GREAT  LAKES-Continued. 


Diseases. 


Number  of  cases. 


Diseases  of  the  Skin 

Erythema 

Pityriasis  rosea 

Urticaria 

Prickly  heat 

Eczema 

Impetigo 

Psoriasis 

Herpes 

Zona 

Pemphigus 

Dermatitis  herpetiformis. 
Acne 


Gutta  rosea. 

Sycosis 

Area 

Ulcer 

Boil 

Carbuncle... 

Whitlow 

Onychia 

Com 


Wen 

Hyperidrosis 

Pruritus 

Lupus 

Atrophy  of  skin. 

InJarIeK 


•6 

> 

o 

u 

o. 

B 

o 

a 

:^ 

5 

tn  o 

,  o 
a  o 


«  si 


2  1 


General  Injuries: 
Effects  of  heat- 
Bums  and  scalds 

Heat  stroke 

Effects  of  chemical  irritants  and  cor- 
rosives   

Multiple  injury 


Local  Injuries 

Compression  of  nerve 

Contusion  of  muscles 

Strain  of  muscles 

Strain  of  tendons 

Contusion  of  skin 

Abrasion  of  skin.. 

Wound  of  skin 

Bum  or  scald  of  skin 

Frostbite 

Wound  of  mucous  membrane 

Contusion  of  scalp 

Wound  of  scalp 

With  injury  to  the  aponeurosis.. . 

Contusion  of  skull 

Fracture  of  the  vault  of  skull 

Fracture  of  the  base  of  skull 

Concussion  of  brain 

Contusion  of  face 

Wound  of  face  and  mouth 

Fracture  of  facial  bones 

Injuries  of  alveoli  and  teeth 

Burn  or  scald  of  mouth 

Contusion  of  eyelid 

Wound  of  eyelid 

Wound  of  conjunctiva 

Foreign  bodies  in  the  conjunctiva  or 

cornea 

Wound  of  eyeball 

Contusion  of  pinna 

Haematoma  of  pinna 

Wound  of  pinna 


18 


23 


1 
2 

459 


16 


333 


100 


■2 

c 

X 

OS 

^ 

~  >> 

w 

•5.^ 

OS 

2« 

O  o 

o 

.a  D. 

^ 

521 

620 

a 

6 

0 

2 

25 

26 

1 

1 

72 

80 

6 

7 

21 

22 

24 

24 

X 

13 

12 

12 

6 

6 

26 

26 

I 

1 

33 

35 

4 

4 

127 

179 

110 

119 

8 

18 

9 

14 

5 

8 

1 

1 

0 

5 

1 

1 

6 

6 

2 

2 

1 

1 

17 


075 
I 
2 

1 
5 

26 
4 
59 


40 


25 

12 

1 
2 

1.452 

1 

2 

7 

1 

5 

28 

6 

75 

6 

1 

5 

47 

2 

1 

2 

3 

7 

12 

37 

15 

2 

1 

4 

4 

4 


620 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Tablk    VII. — Tabular    Statement,    by    Districts,    of    Diseases     and     Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  GREAT  LAKES— Continued. 


Number  of  cases. 

Diseases. 

S'ftO 

a 

•c 

H 
1- 

a"" 
< 

T3 

> 
o 

i 
> 
2 

s 

> 

2 

0 
0 

i 
5 

c  0 
Ill 

a 
p. 
.2 

-M 

OS 

"S 

&3 

Total    treated    in 
hospital  and  dis- 
pensary. 

Local  Injuries— Continued. 

1 

1 

1 
1 
1 

34 
1 

26 
2 

2 

1 

1 

15 

9 

6 

49 

1 

Fracture  of  ribs   .... 

21 
1 
1 

16 
7 
1 
2 
2 
1 

1 

1 
16 
2 
1 
5 
1 
2 

12 
1 
1 
9 
3 
1 
2 
2 
1 

1 

6 

1 

2 

47 

3 

1 

6 

1 

1 
3 

18 
31 

34 

Sprain  of  back 

38 

1 

2 

2 

4 

1 

Contusion  of  the  perinaeum,  scrotum, 

1 

2 

6 

88 
7 
5 

28 

3 

Wound  of  the  male  urethra,  perinaeum,  1 

1 

1 
1 

11 

2 

2 

1 
1 

4 

104 

9 

1 
2 

6 

1 

33 

1 

1 

1 
3 
262 
1 
3 

3 

3 

2 

59 

45 

ii 

1 

4 

323 

1 

1 

4 
3 
2 

5 
2 

7 

13 
6 

2 
2 
1 

6 

1 
4 

5 
6 

1 

1 

7 

3 

2 
3 

4 

Fracture  of  bones  of  forearm- 

1 

9 

Ulna 

...... 

6 

1 

2 

Both  bones 

2 
2 

2 

18 
4 
3 

2 
10 
52 

3 

2 

71 

2 

1 

9 

Fracture  of  carpus,  metacarpus,  or 

1 
31 

10 

3 

Contusion  of  lower  extremities 

Sprain  of  hip 

2 

51 

41 

10 

1     .... 

1 

130 
2 

1 
2 

8 
41 

4 
37 

4 
5 

i 
1 

19 

Sprain  of  ankle 

95 

3 

Internal  derangement  of  joints                         ' 

• 

2 

3 

40 

27 

12 

4 

114 

Wound  of  joint,  lower  extremities 

2 

1 

5 
2 
3 

7 
12 

I 
4 

5 

1 

Fracture  of  patella 

I""' 

2 

2 

3 

7 
3 

5' 

3 

1 

L... 

1 
5 

8 

4 

1 

12 

Fracture  of  bones  of  foot— 

1 

1 
1 

5 

Of  the  phlanges  of  the  toes 

■ 

1 

1      1 

1 

1      i 

DISTRICT  OF  THE  PACIFIC. 


Total  Cases 

289 
198 

a,  299 
932 

1 

1,213 
307 

913 
427 

55 
31 

1 

13V 
103 

360 
262 

4,924 

1,719 

2 
2 
3 

1 

7,512 

General  Diseases 

2,849 

Smallpox 

3 

Chicken  pox 

2 

Measles.        

2 

4 

5 

1 

9 

Rubella 

1 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


621 


Tahlk    VII. — T.\iui-AK    Statement,    hy    Distkicts,    of     Disea.se.s    and.    In.hiuk.s 
Tre.\ted  during  the  Fiscal  Year  ended  Jtne  30,  1904 — Continued. 

DISTRICT  OF  THE  PACIFIC— Continued. 


Number  of  cases. 

Diseases. 

si 

00 

a 
■c 

o 
■O  >> 

■2  <» 

T3 

< 

■6 
o 

■6 

> 

0 

a. 
E 

■a 

1 

0. 

a 

0 
2; 

Died. 

Remaining  lil  hos- 
pital at  close  of 
year. 

a 

(S 

0. 
•3  . 

^^ 

e 

Total    treated    In 
hospital  and  dis- 
pense ry. 

Scarlet  fever 

1 

32 

1 
24 

1 

1 

Influenza 

6    

1  1       1 

80 
3 

112 

Mumps 

3 

Diphtheria 

9 

2 

46 

8 

2 

32 

1 

9 

Simple  continued  fever 

2 

Enteric  fever 

6 

2 

9  1        9 

7 
1 
6 

59 

Epidemic  diarrhea 

1 

D  vsenterv 

1 

6 
2 

40 
3 

12 
3 
3 
354 
1 

9 

88 

3 

35 
3 
10 
3 
■-■--■ 

3    

1  ; 

^1 

"i"' 

13 

Berilieri 

1 

2 

Malarial  fever— 

Intennittent 

Remittent .  . 

2 

1 

3 

64 

1 
5 

106 
4 

Erysipelas 

Phlegmonous 

1 

2 

....... 

18 
3 

Pyaemia 

3 

178 

1 

11 
43 

14 

Tubercle 

158 

29 

81 
1 

208 

555 
1 

Syphilis— 

Primarv 

3' 

9 
86 

30 

370 

4 

683 

3 

."^9 

Secondarv 

14 

13 

472 

Tertiary 

4 

Gonorrhea .... 

7 

130 

3 

2 
1 

46 

2 
2 
1 

78 
1 

13 

820 

Diseases  dependent  on  animal  parasites— 
Taenia  soUum 

6 

Taenia  mediocanellata 

2 

Ascaris  lumbricoides 

1 

2 

1 

29 

4 

1 

1 
4 

1 

2 

Pediculis  vestimenti.  . 

2 

Phthirius  inguinalis 

1 

:::;:::: 

1 

Sarcoptes  scabiei 

2 
2 

1 

1 
2 

31 

Diseases  dependent   on  vegetable   para- 
sites— 
Trichophvton  tonsurans 

6 

1 

1 

Effects  of  vegetable  poisons- 

3 


1 

9 

4 

4 

Effects  of  the  presence  of  foreign  bodies 

1 

[ 

1 

Effects  of  heat 



2 

1 

1 

2 

Effects  of  cold 

1 

1 
1 

2 

Effects  of  chemical  agents 

:::::;:::: 

1 

Scurvy 

2 
17 
28 
92 

1 

12 
22 
58 

1 
4 
9 

27 

2 

AlcohoUsm 

. 

-r 

.... 

\ 

7 

1 

32 
3 

287 

1 

12 
3 

49 

4 

1 
1 

35 

Rheumatism   .       .                

380 

1 

Cyst- 
Mucous  . 

1 

Sebaceous 

2 

2 

14 

3 

Degenerative 

1 

3 
2 
1 

1 

3 
2 

1 

1 

New  growth,  nonmalignant— 

3 
4 

6 

6 

1 

10 

10 

2 

1 

1 

I 

1 

7 

2 

2 

New  growth,  malignant— 

1 

1 

1 
3 

1 

Squamous  carcinoma -  

1 
2 

1 

1 

1 

2 

6 
4 

13 

1 

7 

1 

Diabetes  mellitus  

4 

3 

4 

•       1 

6 

11 

1 

DebiUtv ' 

1 



1 

7 

622 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Tablk    VII. — Tabular    Statement,    by    Districts,    of    Diseases    and    Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 


DISTRICT  OF  THE  PACIFIC— Continued. 


Number  of  cases. 

Diseases. 

«  03  m 

la 
■c 

a*" 

T3 

o 

s 

> 

s 

a 

T3 
0) 

> 
2 

s 

O 

12; 

'6 

5 

8° 

•a  m 

a  °* 

si 

b 
a 

Diseases  of  the  Nervous  System 

Of  the  nerves — 
Inflammation- 

16 

1 

53 

8 
1 

1 

18 
5 

28 
4 

2 

4         17 

1 

78 

8 
1 

147 

17 

Multiple  neuritis 

1 

1 

1 
1 

1 

2 

Of  the  spinal  cord  and  membranes — 
Cord- 
Inflammation,  diffuse 

1 

Degeneration — 

Of  anterior  comua 

1 

1 
1 

1 

"l 

1 

1 

Of  lateral  columns 

2 
2 

2 
2 

4 

Of  posterior  columns 

4 

1 

1 

Of  the  brain  and  its  membranes— Mem- 
branes- 
Hemorrhage ' 

4 
3 

4 

5 

i' 

3 
3 

5 
6 

1 
1 

2 

4 

Of  the  brain  and  its  membranes- 
Brain- 

Hemorrhage 1 

Functional   nervous    disorders    with 
other  diseases  of  undetermined  na- 
ture- 
Paralysis,  hemiplegia 4 

Epilepsy 2 

4 

1 

9 
3 

1 

i 

3 
10 

17 
10 

Vertigo 

1 

Headache * 

1 
6 
4 

1 

3 
1 

1 
2 
4 

16 

1 
5 
1 
2 
3 

1 

4 
4 

2 

::::::::::: 

4 

Neuralgia 

1 

1 

44 

Hiccough 

7 

Nervous  weakness 

1 

.         11 

Mental  diseases- 
Mania  1 

2 

4 

Melancholia 1 

1 

1 

1 
1 

1 

2 

Mental  stupor 

1 

General  paralysis  of  the  insane 

1 
4 

4 

2 

Delusional  insanity 

2 
,3 
1 

1 
5 

4 

i' 

9 

2 
1 

1 

6 

Diseases  of  the  Eye... 

42 

61 

Conjimctivitis— 

Catarrhal 

2 

Acute 

22 

27 

Chronic 

1 

Purulent 

1 

2 

Ulceration  of  cornea 

2 

1 

3 
4 
2 

6 

Iritis 

4 

Congestion  of  optic  disk 

2 

Choroiditis 

1 
1 

1 

1 

Glaucoma 

1 

1 

Detachment  of  retina 

1 

1 

Lenticular  cataract 2 

1 

1 

1 

2 

Panophthalmitis 

2    

2 

2 

Blepharitis  marginahs 

4 
2 

2 
1 
1 

58 

4 

3 

21 

9 
13 
1 
5 
2 

4 

Sty 

1 

2 

Trichiasis 

2 

Ectropian 

1 

Oedema 

1 

1 

Diseases  of  the  Ear 

10 

5 

3 

1 

1 

1 

68 

Inflammation  of  the  external  meatus— 
Acute 

4 

Abscess 

i 

3 

Accumulation  in  external  meatus  of 
wax  or  epidermis ' 

21 

Inflammation  of  the  middle  ear — 

Nonsuppura  live ' 

9 

Suppurative i 

10 

1          5 

3    

1 

1 

23 

Ulceration  of  membrana  tympani ' 

1 

Perforation  of  membrana  tympani 

5 

Deafness 1 

:;:;;:;:;;::;; 

2 

PUBLIC    HKALTH    AND    MARINE-HOSPITAL    SERVICE. 


023 


Taiii.i-:    VII. — Taiular     Statkment,    hy    Distuictk,    ok     Diheasew     and     Ixjukies 
TuEATED  DURING  THE  FiscAL  Year  exdei)  JixE  80,  1904 — Continued. 

DlSTltlC'T  OF  TIIK  PACIFIC— Continued. 


Diseases. 


Number  of  cases. 


•pi:  Oi 

.5—  >■. 

50    =S    „_ 


60 


Diseases  of  the  Nose , 

Inflammation  of  soft  parts 

Kpistaxis 

Inflammation  of  the  accessory  sinuses  . 
Inflammation  of  the  naso-pharynx — 


Diseases  of  the  Circitlatort  System... 

Pericarditis 

Endocarditis 

Vajvular  disease — 

Aortic 

Mitral 

Aortic  and  mitral 

Tricuspid 

Inflammation  muscular  substance  of 

heart 

Hypertrophy  of  heart 

Angina  pectoris 

Disordered  action  of  the  heart- 
Abnormal  rapidity 

Irregularity 

Degeneration  of  arteries 

Arterio-capillary  fibrosis 

Ajieurism  of  arteries 

Obstruction  of  arteries,  thrombosis. . . 

Phlebitis 

Varix 

Obstruction  of  veins 


rt 


Diseases  of  the  Respiratory  System  . . 

Perichondritis 

Inflammation  of  mucous  membrane 
of  larynx — 

Catarrhal,  acute 

Catarrhal,  chronic 

Tracheitis 

Bronchitis — 

Catarrhal,  acute 

Catarrhal,  chronic 

Spasmodic  asthma 

Congestion  of  lung 

Hemorrhage  of  lung,  hemoptysis 

Pneumonia 

Gangrene 

Chronic  interstitial  inflammation 

Phthisis — 

Acute 

Chronic 

Tubercular , 

Emphysema  of  lungs , 

Pleurisy — 

Acute 

Chronic , 


133 


85 


Diseases  of  the  Digestive  System... 

Ulceration  of  the  hps 

Inflammation  of  the  mouth 

Ulceration  of  the  mouth 

Caries  of  dentine  and  cementum 

Inflammation  of  dental  periosteum. . 

Abscess  of  dental  periosteum 

Inflammation  of  gums  and  alveoh . . . 

Suppuration  of  alveoli , 

Ulceration  of  gums  and  alveoh 

Toothache 

Ulceration  of  the  tongue 

Sore  throat 

Inflammation  of  tonsils — 

FolUcular 

Suppuration , 


39 


*< 

m  o 

O 

■^o 

c  o 

ht^ 

C*" 

3-  • 

S3  *  ! 

a        I 


1  ,  1 


153  i   62    5   2 


2    3 

1  

1  


22  I   5 
10  I   5 


359 
1 


15 
6 
2 

249 
31 
14 
1 
2 
5 
1 


573 
1 


624 


PUBLIC    HEALTH    AND    MARHSTE-HOSPITAL    SERVICE. 


Table    VII. — Tabular    iStatemext,    by    Districts,    of    Diseases    and    Injuries 
Treated  durinc;  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  PACIFIC— Continued. 


Number  of 

3ase£ 

. 

Diseases. 

go. 

a 
•c 

< 

> 

o 

S 

■6 

> 

0 

> 
0 

c 
E 

+^ 
0 

5 

go 

*  S 
c  0 

Hi 

a 

.1 
■c  . 

^^ 

Total    treated    in 
hospital  and  dis- 
pensary. 

Diseases  of  the  Digestive*  System— 
Continued. 
Inflammation  of  saUvary  glands   . . 

1 

1 

1 

22 

2 

i         : 

22 

Catarrhal 1 

1 

1 

i 

1 

FolUcular ! 

3 

3 

Stricture  of  oesophagus 

1 

18 
1 
1 

1 
8 
1 

4 
2 

'S 

1 

Inflammation    of  the    stomach,   ca- 
tarrhal  

4 

58 

76 

Ulceration  of  the  stomach 

1 

1 



1 

"'"120" 

1 
5 

1 

5 
3 

3 

Dilatation  of  the  stomach 

1 

1 

4 
1 



3 

1 

128 

Vomiting 

1 

2 

Gastralgia 

1 

5 

Loss  of  appetite 

1 

Inflammation  of  the  intestines- 
Enteritis  

1 

3 

14 
2 
4 
1 

45 
3 
1 

2 
8 
2 
4 

'   "37' 

1 

2 
5 

9 

TvphUtis 



1 

17 

Colitis . 

2 

Catarrhal 

1 

1 
1 
3 
2 

3 

8 

1 

Hernia 

Obstruction  of  the  intestines 

3 

2 

1 

5 

67 

115 
3 

1 

66 

1 
.39 

67 

CoUc -  - 

1 

Diarrhea 

12 
6 

1 
5 
1 

5 
10 
6 

9 
4 
1 
3 
2 

5 
11 
3 

3 
3 

51 

Periproctitis,  abscess 

1 

TTlcprfltion  of  rpctiim 

1 

1 
1 

2 

1 

8 

14 

Proliipse   of  the   rectum 

2 

Piles- 

4 
11 
14 

1 

1 

9 

External  

1 

22 

Mixpfl 

2 

1 

20 

Pruritus  ani 

1 

Inflammation  of  the  liver — 

Acute 

1 
4 

1 

1 

2 

Chronic 

3 

1 

1 

4 

Hjrperaemia  of  the  liver 

1 

Hypertrophy  of  the  Uver 

3 
5 

3 

Jaundice 

3 
9 

2 

7 

1 
1 

8 

Inflammation  of  hepatic  ducts  and 
gaU  bladder 

1 

9 

CalcuU 

2 

2 

Inflammation  of  the  peritoneum 

3 

1 

45 
29 
15 

1 

1 

29 

18 

10 

1 

2 
1 

14 
8 
6 

3 

Dropsy '. 

1 ... 

1 

Diseases  of  the  Lymphatic  System 

Inflammation  of  lymph  glands 

1 

1 
1 

2 
2 

61 
53 
6 

1 
1 

107 
82 

1 

22 

Inflammation  of  lymphiitics , 

2 

Elephantiasis 

1 

Diseases  of  the  Thyroid  Body 

1 

1 

43 
10 
5 
14 
3 
2 

3 

1 

1 
1 

26 
5 
3 

7 
3 

1 

Goitre 

1 

Diseases  of  the  Urinary  System 

Acute  nephritis 

3 

A 

10 
2 
3 
5 

5 

1 

""2 

76 
2 
4 

4 

1 

122 
12 

B  right's  disease 

1 

10 

Chronic  nephritis 

18 

Granular  Icidney 

4 

1 

I 

2 

Mova  ble  kidney 

1 

1 

1 

1 

1 

1 

1 

Albuminuria 

1 

1 

1 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


625 


Table    VII.— Tabulak    Statement,    by    Districts,    of    Diseases    and     Injuuies 
Treated  durinc;  the  Fiscal  Year  ended  June  80,  1904 — Continued. 

DISTRICT  OF  THE  PACIFIC— Continued. 


Diseases. 


Diseases  of  the    Urinary   System- 
Continued. 
Inflammation  of  bladder- 
Acute  

Subacute 

Chronic 

Retention  of  urine 

Incontinence  of  urine 


Diseases  of  the  Generative  System.. 

Uretliritis 

Gleet 

Hemorrhage  of  the  urethra 

Stricture  of  the  urethra,  organic... 
Inflammation  of  the  prostate,  acute 

Hypertrophy  of  the  prostate 

Phimosis 

Paraphimosis 

Inflammation  of  the  glans  of  the  penis 

Ulcer  of  penis 

Soft  chancre 

Hydrocele  of  the  spermatic  cord 

Varicocele 

Hydrocele  of  tunica  vaginaUs 

Inflammation  of  the  testicle — 

Acute  orchitis 

Chronic  orchitis 

Epididymitis 

Spermatorrhoea 

Inflammation  of  the  vaguia 


Diseases  of  the  Organs  of  Locomo- 
tion   

Inflammation  of  the  bones — 

Osteitis 

Periostitis 

Necrosis 

Ununited  fracture  of  false  joint 

Inflammation  of  joints,  acute  syno- 
vitis   

Ankylosis 

Loose  body  in  joint 

Dislocation  of  joint 

Inflammation  of  spine 

Psoas,  lumbar,  and  other  abscesses.. 

Posterior  curvature  of  spine 

Contracture  of  muscle 

Myalgia 

Lumbago 

Inflammation  of  sheaths  of  tendons 

Inflammation  of  bursse,  acute 

Bunion 

Bursal  cyst 

Flat  foot 

Hammer  toe 


Diseases  of  the  Connective  Tissue 

Inflammation 

Abscess 

Gangrene 

CEdema 


Diseases  of  the  Skin. 

Erythema 

Untcaria 

Prickly  heat 

Eczema 

Impetigo 


8629— 0-i- 


40 


626 


PUBLIC    HEALTH    AND    MAEINE-HOSPITAL    SERVICE. 


Table    VII. — Tabular    Statement,    by    Districts,    of    Diseases     and    Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

DISTRICT  OF  THE  PACIFIC— Continued. 


Number  of  cases. 

Diseases. 

aft 

.S-H    i>l 

**« 

p.t;  a 
Sfto 

< 

1 
§ 

1 

s 

i 
> 

g 
ft 

0 
2 

Died. 

Remaining  in  hos^ 
pital  at  close  of 
year. 

II 
1 

.2  to 

ej  OS 
_  P-m 

p-a  ft 

Diseases  of  the  Skin— Continued. 

1 

6 
4 
6 

4 
2 
1 
7 

1 

1 

1 

7 

1 

4 

1 

( 

6 

2 

2 

1    .  .. 

6 

Pemphigus 

1 

3 

1 

1 

Acne         .     .                              - 

! 

Gutta  rosea 

1 
1 
1 

i' 

1 

1 

1 

Sycosis 

Seborrhcea 



3 
5 

1 
92 
117 
3 
4 
4 
2 
1 
1 

4 

1             1 

6 

1 

1 

Ulcer 

Boil 

4 

25 
21 
5 
2 

15 

19 

2 

1 

10 

2 
3 

1 

i  I....I      3 
1    .  1 

121 
138 

Carbuncle                                       1 

8 

^^hitlow 

1 

6 

4 

Tylosis i 

1 

1 

3 

Com 1 

1 

Hyperidrosis i 

1 

1 

Injuries 

General  Injuries. 

2 

1 

14 
11 

11 
10 

3 
1 

1 
1 

31 

29 
1 

47 

Effects  of  heat- 
Bums  and  scalds 

41 

Heat  stroke 

1 

sives 

1 
2 

601 

1 

i' 

318 

1 
1 

178 

1 

1 

Multiple  injury 

Local  Injuries 

1 

29 

5 

28 

1 
845 

4 
1.375 

Contusion  of  nerves 

1 

1 

2 
1 

1 
1 
1 
3 
3 
2 
25 
1 

3 

2 

Vi'ound  of  veins 

1 

1 

Wound  of  gland 

1            i 

1 

Wound  of  secreting  gland 

i            1 

1 

Contusion  of  muscles 

1 
4 

3' 

1 

1 

2 

1 

Ahrnsinn  of  sicin 

3 

Woimd  of  skin 

1              9 

::::::i    12 

2 
6 

4 

Bum  or  scald  of  skin 

' 

2 

37 

Frostbite 

1 

Effects  on  the  skin  of  irritants  or  cor-  ; 

i 

1 
10 
6 

1 

i' 

7 

6 

1 

4 

Bum  or  scald  of  mucous  membrane 

1 

1 

Contusion  of  scalp 

2 
38 
3 

1 

3 

Woimd  of  scalp 

1 

4 

49 

With  injurv  to  the  aponeurosis ' 

9 

Contusion  of  skull 

........ ...... 

1 

Fracture  of  the  vault  of  skull ' 

3 

1 

1 
1 

1  1 

1 

1 



4 

Fracture  of  the  base  of  skull 1 

1 

Wound  of  skull ' 

1 

1 
1 
11 
29 
3 
1 
7 
3 
2 
1 
2 

12 

1 

1 

Concussion  of  brain 1 

2  I 
4 

12 

2 
1 

1 

3 

Contusion  of  face 1 

3 

15 

Wound  of  face  and  mouth 

34 

Fracture  of  facial  bones 

1 

6 

1 

2 

16 

Dislocation  of  nasal  cartilages 

1 

Contusion  of  evehd 



3 

2 

1 

1 

10 

Wound  of  evcUd 

3 

Subconjunctival  hemorrhage 

2 

Wound  of  conjunctiva - 

1 

1 

Contusion  of  eveball 

2 

comea 

2 

1 

1 

14 

Wound  of  eveball 

1 

Fracture  cartilage  of  larynx 

M 

1 

1 

Wound  of  neck i 

2 

-2 

PUBLIC    HEALTH    AND    MARINE-PIOSPITAL    SERVICE. 


627 


Taule    VII. — Taiu-l.\r    Statement,    by    Districts,    of    Diseases     and     Ix.il-kie8 
Treated  during  the  Fiscal  Year  ended  .Ttne  30,  1904 — Continued. 

DISTRICT  OF  THE  PACIFIC— Continued. 


Number  of  cases. 

Diseases. 

60 

•o 
< 

■6 

i 

■6 
> 
2 

a 

> 

2 

ft 

o 

2; 

Died. 

"liemaining  in  hos~ 
pital  at  close  of 
year. 

1 

00 

■■3  . 
1 

Total    treated    in 
hospital  and  dis- 
pensary. 

Local  Injuries — Continued. 
Dislocation  of  spine     .  . 

1 

9 

34 

1 

6 

22 

21 

3 
13 

14 
12 
1 

24' 

23 

1 

23 

Fracture  of  ribs 

1 

47 

1 

1 

Penetrating  wound  of  pleura  or  lung. . 

3 

17 
11 

1 
11 
6 

1 
6 

4 

i        ' 

3 

41 

Sprain  of  back 

1 

1 

34 

Wound  of  back. .      .                       ... 

1 

1 

Fracture  of  spine. .     ..          

1 

1 

1 
1 

! 

1 

1 



1 

1 

Compression  of  spinal  cord 

1 

1                  1 

1 

1 
2 
1 

1 

1 
1 
1 

1 

::::i  :::: 

3 
3 

4 

Wound  of  parietes  of  abdomen 

1 

....1  .... 

5 

Rupture  of  viscera 

1 

Woimd  of  the  male  urethra,  perinseum, 
scrotum,  testis,  or  penis 

6 
1 

7 

Foreign  bodv  in  the  rectum 

t 

I 

i^racture  or  dislocation  of  pelvic  bones 

3 
1 

3 

1 

1 

3 

1 

1 

Diffused  hsemotocele  of  cord 

1 

46 
4 
2 

39 
6 
2 
2 

288 
1 

1 

Contusion  of  upper  extremities 

Sprain  of  shoulder 

1 

12 
1 
1 
3 

i 

1 

6 
1 

1 

59 

5 

Sprain  of  elbow 1 

3 

1 

1 

42 

Sprain  of  hand 



6 

Sprain  of  thumb 

3 

3 

5 

Sprain  of  fingers 

2 

Wound  of  upper  extremities 

1 

63 

37 

23 

4 

352 

Wound  of  joint,  upper  extremities 

1 

Injur\'  of  thecae 

1 
6 
1 
8 

8 
5 
1 

6 
2 
4 

1 
2 

1 
78 

1 
5 

4" 

10 
4 
1 

1 
2 
3 

......... 

— 

1 

1 
1 
3 

2 
1 

6 

3 
1 

4 

1 

4 

1 

9 

Fracture  of  bones  of  forearm- 
Radius  

4 

16 

Ulna 

6 

1 

Fracture  of  carpus,  metacarpus,  or 
phalanges 

3 

1 

....     1 

10 

16 

Dislocation  of  cla^'icle . 

2 

Dislocation  of  humerus 

1 

2 

4 

7 

Dislocation  of  radius  and  ulna 

1 

1 

2 

1 

54 

6 

! 

1 

Contusion  of  lower  extremities 

Sprain  of  hip 

2 

19  1        1 

....         6 

80 
1 

13 
25 
2 

56" 

3 

i' 

160 

1 

Sprain  of  knee. 

1 
1 

4 

42 

1 

2 

35 

1 

7 

5 

7 

6 

17 

2 
5 

•    1 

i" 

2 

21 

1 

■■■■-■ 

3 

18 

Sprain  of  ankle 

21 

1 

68 

3 

1 
13 

i 

2 

1 
1 
1 
1 

2 

Wound  of  lower  extremities 

1 

92 

Wovmd  of  joint,  lower  extremities    . 

4 

Fracture  of  femur 

4 

7 
4 
7 
6 
11 

i' 

1 
1 
1 

2 

1 

11 

5 

3 

1 
3 

2 

11 

1 
8 

2 
4 

7 

Fracture  of  tibia  and  fibula 

1 

1 

21 

Fracture  of  bones  of  foot- 

2 

2 
2 

/ 

3 

1 

1 

1 

1 

2 

2 

_. 

1 

1 

1 

' 

1 

1 

628 


PUBLIC    HEALTH    AND    MAEINE-HOSPITAL    SERVICE. 


Table    VII. — Tabular    Statement,    by    Districts,    op    Diseases    and    Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 


PACIFIC  ISLANDS. 


Num 

Der  of  cases. 

Diseases. 

gi 

■a  2 

aj  oj  ca 

-a 
< 

g 
1 

a 

■6 

g 
a 

a 

o 

1? 

■6 
S 
P 

g° 

|! 

•a  03 

as  01 
o  a>> 

35 

a 

K 

•S 

03 

Total  cases 

9 
8 

166 

48 
9 

87 

19 

9 

67 
25 

1- 

4 

16 
5 

380 

89 

3 
1 

554 

139 

Dengue.   . 

12 

1 

Enteric  fever  . . 

1 

5 

1 

1 

1 

2 

2 

1 

1 

5 

Malarial  fever: 
TntermittRnt. 

1 

Remittent 

1 

8 

1 
2 
13 

1 

1 

i 

1 
1 

1 

5 

1 

2 
13 

1 

Tubercle. 

1 

2 

2 

10 

SyphlUs: 

Primary 

1 

10 

44 

12 

Gonorrhea 

2 

1 

59 

Diseases  dependent  on  animal  parasites: 
Taenia  mcdiocanellata 

1 

Tcenia  saginata 

1 

Sarcoptes  scabiei 

2 
1 

1 
1 
1 
2 
1 

2 

Culix  pipiens 



1 

Diseases  dependent  on  vegetable  para- 
sites: 
Trichophyton  tonsurans 

1 

Microsporon  furfur.. 

1 

Effects  of  vegetable  poisons,  alcohol 

1 

P2ffects  of  the  presence  of  foreign  bodies... 

2 

Effects  of  chemical  agents 

1 

1 

1 
2 
1 

2 
.1 

2 

Rheumatic  fever 

1 

is' 

1 
1 

2 

2 

Rheumatism 

i 

16 

Gout 

1 

Congenital  malformations 

1 

1 

Debility 

2 

Local  Diseases 

Diseases  of  the  Nervous  System 

5 
1 

1 

1 
1 

2 

1 

1 

1 

9 
1 

14 

Of  the  spinal  cord  and  membranes, 
cord — 

2 

Functional    nervous   disorders    with 
other  diseases  of  undetermined  na- 
ture— 
Torticollis 

1 

Headache 

5 
2 

5 

Neuralgia 

1 

2 

Hysteria 

1 

1 
1 

1 

1 

Mental  diseases — 

Melancholia 

1 

1 

1 

6 

2 
3 

1 

5 

1 

Diseases  of  the  Eye ' 

6 

Conjunctivitis— 

Catarrhal,  acute 

2 

Sty 

i 

3 

CEdema  of  eyelids 

1 

1 

Diseases  of  the  Ear 

3 

1 

1 
1 

2 

8 

Accumulation  in  external  meatus  of 
wax  or  epidermis 

1 

Inflammation  of  the  middle  ear — 

Supourative 

! 

1 
4 

4 
4 

2 

Perforation  of  membrana  tympani 
Diseases  of  the  Nose  .          

2 

2 

6 

4 

Inflammation  of  soft  parts 

4 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


629 


Table    VII. — Tabular    Statkmknt,    by    Districts,    of    Diseases     and    Inmuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

PACIFIC  ISLANDS— Continued. 


Number  of  cases. 

Diseases. 

it 

as  3 

•< 

■6 

o 
u 

■6 
o 

M 

P. 

a 

■6 
o 

a 

o 

■6 

s 

■9'S 

m 

35 

Treated  at  dispen- 
sary. 

a  a 

Diseases  of  the  CiRruLATORY  System  . 

3 
1 

!  ' 

1 

2 

5 

Valvular  disease- 
Aortic ..                     

1 

1 

Mitral 

1 
1 

1 

Disordered  action  of  the  heart— 
Irregularity 

1 

1 

1 
1 

1 
1 

5 

1 

Phlebitis 

1 

Diseases  of  the  Respiratory  System  . 
Inflammation  oi  raucous  membrane  or 

1 

4 

21 

1 
20 

26 

1 

Bronchitis- 

1 
1 

1 
1 

20 

15 

1 
1 

2 

1 

5 

21 

1 

Spasmodic  asthma 

1 

2 

I 

Diseases  of  the  Digestive  System 

65 
2 
2 

2 
1 

1 

85 

Caries  of  dentine  and  cementum            ' 

2 

Sore  throat 

2 

Inflammation  of  tonsils — 
Follicular 

1 
1 

1 
1 

3 

2 

Catarrhal 

1 

1 

Ulceration  of  the  stomach 

1 

2 

2 

Indigestion 

7 

1 

Vomiting 

Inflammation  of  the  intestines— 

1 

1 

CoUtis  .. 

1 

3 

3 

Hernia 

7 
18 
1 

15 
1 
3 
1 
1 

Constipation . 

4 

4 

22 

Colic 

4 

4 

19 

Enteralgia 

1 

1 

Piles,  external 

i 
1 

7 

7 

4 
3 

7 
7 

1 

1 
1 

2 

Jaundice 

1 

Diseases  of  the  Lymphatic  System 

8 
8 

4 

15 

Tnflflmmfltion  of  lymph  glands 

15 

Diseases  of  the  Urinary  System 

3 
3 

8 

Bright's  disease,  chronic  nephritis        ! 

3 

Haematuria 1 

2 

1 
1 

24 
3 

2 

Inflammation  of  bladder- 
Acute  

1 

Chronic 

1  1 

8            4 

2  1 

i  ::::::: 

2 

Diseases  of  the  Generative  System 

4 
1 
1 

1 

32 

Stricture  of  urethra,  organic 

5 

Urethral  fistula 

1 

Hypertrophy  of  the  prostate 

1 

Paraphimosis 

1 
1 

16 
1 

1 
1 

1 

i 

1 

Soft  chancre.. 

4 

3 

1 

20 

Varicocele 

1 

Inflammation  of  the  testicle,  acute  or- 
chitis   

1 

(Edema  of  prepuce 

::::;;:::;;:;: 

1 

630 


PUBLIC    HEALTH    AND    MARINE-HORPITAL    SERVICE. 


Table    VII. — Tabular    Statement,    by    Districts,    of    Diseases    and    Injuries 
Treated  during  the  Fiscal  Year  ended  June  30,  1904 — Continued. 

PACIFIC  ISLANDS— Continued. 


Number  of  cases. 

Diseases. 

CP. 

lis 
ill 

i'p.o 

•9 

■a  >> 

!_§ 

•a 
< 

■6 

o 

> 
o 

a/ 

i 

B 

■6 
> 
2 
p< 
.6 

o 

•d 

s 

■Sts 

33 

to 
1 

^ 

^ 

.3   M 

11 

ill 

in 

4 
2 

2 
1 

2 

1 

18 

1 

1 

1 

12 

1 

22 

Inflammation  of  joints- 

3 

1 

1 

12 

1 
1 

1 

1 

2 

1 

1 

1 

Flat  foot               .                      

2 

8 
7 
1 

27 

1 

2 

Diseases  of  the  Connective  Tissue... 

6 
6 

1 

1 
1 

.  1 

14 

1 

13 



1 

5 

3 

1 

1 

32 

1 

1 
2 
1 

1 
1 

1 

Uli-er 

1 

12 

13 

1 

14 

Boil                                         

1 

14 

1 

Wen 

1 

1 

1 

1 

1 

3 

4 

General  Injuries 

1 

48 
1 

29 

1 

1 

14 

3 

86 
1 
1 

4 

4 

Local  Injuries 

5 

1 

9 

139 

2 

1 

J.    :: 

..!.... 

4 

1 

1 

1 

1 

6 

6 

2 

1 

1 

..    1 

2 

1 

1 

1 

2 

1       1 

2 

3 

3 

Dislocation  of  costal  cartilages 

Contusion  of  back 

1 

1 
2 
3 

1 
1 

i' 

1 

1 

2 
2 

2 

2 

12 

4 

Sprain  of  back 

1 

1 

15 

1 

Fracture  or  dislocation  of  peUnc  bones. 
Injury  to  back  with  compression  of 

1 

1 
1 

1 

1 

1 

1 

2 

1 

1 

1 

20 

3 

Sprain  of  wrist  .   . 

1 

1 

Sprain  of  hand 

1 

1 

1 

2 

Sprain  of  fingers 

1 

1 

Wound  of  upper  extremities 

5 

1 

2 
1 

4 
1 

4 

3 

1 

2 
3- 

1 

1 

25 

1 

Fracture  of  carpus,  meta/'arpus,  or 
phalanges 

2 

4 

Dislocation  of  clavicle 

i 
1 

1 

Contusion  of  lower  extremities 

12 
6 
3 

1 
7 

16 

Sprain  of  knee 

1 

7 

Sprain  of  ankle 

2 

2 

7 

Sprain  of  foot 

1 

Wound  of  lower  extremities 

6 

1 
3 
2 
2 

1 

5 
2 
2 

1 
2 

' 

13 

1 

2 

1 
1 

3 

Fracture  of  fibula 

1 

2 

1 

1 

1 

3 

Fracture  of  bones  of  foot,  of  the  tarsus. 

1 

1 

1 

1 

PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 


631 


Table    VII. — Tahul.vr    Statement,    by    Districts,    ok     Diseases    and     iN.irniEf- 
Treated  durino  the  Fiscal  Year  ended  June  80,  1904 — Continued. 

QUARANTINE  STATIONS. 


Number  of  cases 

Diseases. 

•ag 

.3-2  t». 

a 
■a  t» 

<1 

■6 

> 
o 

■6 

1 

•a 

1 

o 

■6 

a> 
ft 

Remaining  in  hos- 
pital at  close  of 
year. 

Treated  at  dispen- 
sary. 

Total    treated    in 
liospital  and  dis- 
pensary. 

Total  Cases 

5 
5 

5 

54 
49 

9 

47 

44 

14 

8 
5 

3 
1 



4 
4 



23 
10 

82 

General  Diseases 

64 

Smallpox.. 

14 

3 

3 

3 
.5 
2 

23 

2 
1 
1 

1 
2 

2 



3 

Yellow  fever 

3 

5 

2 

.      2 

Malarial  fever— 

23 

1 
1 

23 

Remittent 

1 

1 

2 

Septicaemia..                                            

1 

1 

1 

1 

1 

Syphilis- 

1 

1 

1 

1 

...      ^ 


1 

3 

3 

Diseases  dependent  on  animal  parasites- 

1 

1 

1 

1 

1 

1 

1 

1 

1 

1 

1 

1 

2 

1 
1 

2 

1 
1 

2 

Functional    nervous    disorders   with 
other  diseases  of  undetermined  na- 

1 

! 

1 

2 
1 
1 

1 
1 

8 
3 
1 

1 
1 

1 

2 

1 

1 

2 
2 

2 
2 

3 

3 

8 

1 

3 

1 

1 

1 

Inflammation  of  hepatic   ducts   and 

1 

3 

2 
1 

1 
1 

1 

1 

3 
2 
1 

■ 

3 

2 

1 

1 
1 

2 
1 

1 

2 

2 

2 

1 

Ulcer                                               

1 

1 

1 

1 

1 

632 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Table  VIII. — Tabulated  Statement,  by  Districts,  op  Causes  of  Mortality  among 
Patients  of  the  Service  during  the  Year  ended  June  30,  1904. 


"3 
+^ 
o 

Districts. 

Cause  of  death. 

6 
1 

M 

■a 

13 

S 

"3 

6 
o 

a, 
1 

'3 
a 

73 

a 
o 

1 

Ph 

4 

1 
3 

ai 

•  CO 

®  ,;; 

.So 

& 

Total  deaths  from  all  causes 

491 

25 
466 

155 

6 
149 

2 

0 
2 

40 

6 
34 

40 

2 

38 

36 

3 
33 

73 

5 

G8 

137 

2 
135 

4 

J<'ROM  Injuries 

0 

4 

General  Diseases 

243 

4 
1 
42 
2 
3 
1 

8 
5 
1 
1 
142 
1 
3 
1 
1 
1 
6 

} 

1 

2 
3 
3 
2 

4 

1 
1 

56 

1 
1 
8 

1 

16 

17 

19 

1 

25 

1 

103 

1 

2 

4 

Cerebrospinal  fever 

1 

2 

6 
1 

4 

11 

9 
'  1 

1 

Dysentery 

3 

Beriberi               

1 
1 

Malarial  fever: 

Intermittent      

4 
3 

1 
1 

2 

1 

Septicsemia 

1 



Tetanus 

1 
31 

1 

8 

7 

4 

11 

81 
1 

1 

Leprosy 

Syphilis,  secondary 

^' 

2 

Gonorrhea 

1 

Kflects  of  vegetable  poisons,  opium 

1 

1 

Effects  of  heat 

1 

Alcoholism 

1 

5 

Delirium  tremens 

1 

Kheumatic  fever 

1 

i 

Rheumatism 

1 

New  growth,  mahgnant: 

Sarcoma 

2 

Carcinoma 

1 

1 

1 

3 

Squamous  carcinoma 

Anaemia,  idiopathic 

1 

1 

Diabetes  mellitus 

1 
1 
1 

3 

Debility 

Old  age 

Local  Diseases 

Diseases  of  the  Nervous  System 

26 

3 

1 
1 

2 

2 

7 
2 
1 

2 
2 

1 
2 

1 
1 

2 

1 
1 

16 
2 

3 
1 
1 

3 

4 

Of  the  spinal  cord  and  membranes,  cord— 
Heemorrhage 

Degeneration— 

Of  lateral  columns 

Insular  sclerosis 

1 

Of  the  brain  and  its  membranes,  mem- 
branes— 
llEemorrhage 

2 

1 
6 

1 

1 

Functional  nervous  disorders  with  other 
diseases  of  undetermined  nature — 
Apoplexy 

] 

1 

Paralysis,  hemiplegia 

1 

Epilepsy 

2 

Nervous  weakness 

1 

1 
2 

1 

1 

Mental  diseases- 
Melancholia  

1 

Dementia 

Mental  stupor 

i 
1 

1 
1 

1 

General  paralysis  of  the  insane 

1 

Diseases  of  the  Eye 

Lrcnticular  cataract 

Diseases  of  the  Ear 

1 

1 

Inflammation  of  the  middle  ear— 

Nonsuppurative 

1 

Suppurative 



1 

PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


633 


Table  VIII. — Taiutlated  Statement,  hy  Districts,  of  Causes  of  Mortality  among 
Patients  of  the  Service  during  the  Year  ended  June  30,  1904 — Continued. 


o 

Districts. 

Cause  of  death. 

6 

a 

oa 

3 

o 

o 
2 
o 

1 

<u 

S3 
►J 

0 

6 

a 

■0 
c 
_2 

0 

a 

to 

11 
2 

3 

Diseases  of  the  Circulatory  System.... 
Pericarditis 

•13 
1 
1 

13 
19 
3 
1 

1 
2 
1 
1 

72 

1 

2 
1 

13 

1 

5 

2 

3 

8 

16 
1 

1 

'"'h' 
1 

1' 

Endocarditis 

ValvTJlar  disease- 

6 

..... 

2 
2 
1 

2 

'"2 

3 
3 

1 

1 

Mitral 

Aortic  and  mitral 

Degeneration  of  heart,  fatty 

1 

Degeneration  of  arteries,  arterio-capil- 
larj'  fibrosis 

1 

Aneurysm  of  arteries 

1 
1 

1 

Obstruction  of  arteries,  thrombosis 

Phlebitis 

1 
3 

Diseases  of  the  Respiuatoky  System 

34 

4 
1 

12 

9 

10 

Inflammation  of  mucous  membrane  of 
larynx,  catarrhal,  chronic 

Bronchitis— 

Catarrhal,  acute 

2 

Catarrhal,  chronic 

1 

Ulceration  of  bronchi 

1 

1 

1 
8 
1 
1 

4 

Spasmodic  asthma 

2 

Pneumonia 57  i      28 

2 

1 

8 

10 

1 

Phthisis,  acute 

0 

Pleurisy,  acute 

5 

2 

2 
2 

Diseases  of  the  Digestiye  System 

36 

14 

4 
1 

3 

9 

Inflammation  of  dental  periosteum '        1 

Inflammation  of  tonsils,  suppuration 

1 

i 

Inflammation  of  salivary  glands 

1  i         1 
3           2 

Inflammation  of  the  stomach,  catarrhal. . 

1 

Hyppfflpniifl  of  stomach    . 

1 

1 

2 

1 
1 
1 

1 
3 

Inflammation  of  the  intestines,  typhlitis. 

8 
1 
3 
3 
1 
1 
1 

2 

1 

2 

1 

Hernia 

1 

3 

1 

1 

Obstruction  of  the  intestines,  volvulus 

Diarrhea 

1 

Periproctitis,  abscess 

1 

Prolapse  of  the  rectum 

1 
1 

Inflammation  of  the  liver- 
Acute ... 

1 
1 

1 

Chronic 

2 

1 

"■ 

Hypertrophy  of  the  liver 

1 

1 
1 

Inflammation  of  hepatic  ducts  and  gall 
bladder 

1 
1 

Calculi 

Inflammation  of  the  peritohaeum 

9 

1 

1 

Diseases  of  the  Lymphatic  System 1       1 

1 

1 

Inflammation  of  lymph  glands ' 

Diseases  of  the  Supraren.\l  Capsules...        1 

1 
1 

10 

1 

4 
5 

Addison's  disease 

Diseases  of  the  Urinary  System ^^ 

2 

1 

4 
1 

2 
1 

6 

5 
1 

10 
2 

8 

Acute  nephritis .   .   . 

4 
21 

Bright's  disease — 

Chronic  nephritis 

1 

1 

Granular  kidney i        7 

Inflammation  of  bladder,  acute 1 

1 

Diseases  of  the  Generative  System...  .        2 

1 

1 

1 

Stricture  of  urethra,  organic '        1 

H5T)ertrophy  of  the  prostate 

1 

1 

Diseases  of  the  Organs  of  Locomotion.. 

4 
1 
1 

2 
1 

1 

1 

1 



Caries 

Psoas,  lumbar,  and  other  abscesses 

2 

1 



1 



634 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


Table  VIII. — Tabulated  Statement,  by  Districts,  of  Causes  of  Mortality  among 
Patients  of  the  Service  during  the  Year  ended  June  30,  1904 — Continued. 


"3 
o 

Districts. 

Cause  of  death. 

a 

+3 

i 

a 

s 

3 

o 

6 
o 

■ft 
ft 

i 

09 

o 

o 
ta 

u 

1 

o 

ca 

•§ 
Ah 

Dlseases  of  the  Connective  Tissue 

1 
1 

1 
1 

6 

1 
1 

1 
1 

2 

Inflammation 

Diseases  of  the  Skin 

Com 

Injuries 

1 

1 

1 

1 

General  Injuries 

Effects  of  heat- 
Burns  and  scalds 

1 

1 
3 

1 

19 
1 
2 

1 
3 
1 

1 
2 
1 
2 
2 
1 
1 
1 

1 

Sunstroke 

1 

Multiple  injury 

1 
1 

4 

1 

1 

Heat,  apoplexy 

Local  Injuries 

5 

1 

3 
1 

4 

1 

1 

Wound  of  internal  viscera 

Bum  or  scald  of  skin 

1 

1 

1 

1 

Wound  of  scalp,  with  injury  to  the  apon- 
eurosis         .  . 

Fracture  of  the  vault  of  skull 

1 

1 

1 

Fracture  of  the  base  of  skull. .   . 

Wound  of  skull 

1 

Concussion  of  brain 

1 

1 

Contusion  of  neck 

1 

Wound  of  neck 

1 
1 

1 

Gunshot  wound 

1 

Wound  of  upper  extremities 

1 

Wound  of  lower  extremities 

1 

1 

Fracture  of  tibia  and  fibula 

Table  IX. — Ratio  of  Deaths  from  Specific  Causes. 


Deaths  from— 

Per  100 
from  all 
causes. 

Deaths  from— 

PerlOO 
from  all 
causes. 

General  diseases 

49.49 
5.30 
8.76 

14.66 

Diseases  of  the  digestive  system 

7.33 

Diseases  of  the  nervous  system 

6.72 

Diseases  of  the  circulatory  system 

Injuries.                                               

5.09 

Diseases  of  the  respiratory  system 

2.65 

Table  X. — Ratio  of  Deaths  in  Each  District. 


District. 

PerlOO 
patients 
treated 
in  hos- 
pital. 

District. 

PerlOO 
patients 
treated 
in  hos- 
pital. 

Atlantic 

3.18 
3.07 
2.96 
3.76 
2.67 

2  63 

West  Indies 

Pacific .... 

5.29 

Gulf 

2  28 

Ohio 

6  77 

Mississippi 

PUBLIC    TIKALTII     AND    MAKINK-IIOSPITAL    SERVICE. 


()85 


Table   XI. — C\)mi-ak.\tivk    Kxiiiiut — M(iutai,itv    "kk    100    Patients  Treated    in 
[  Hospital,  by  Distkicts,  1895-1904. 


Districts. 

Gen- 
eral 
aver- 
age. 

1895. 

1896. 

1897. 

1898. 

1899. 

1900. 

1901. 

1902. 

1903. 

1904. 

Atlantic 

3.41 
3.07 
3.22 
2.98 
2.99 
2.74 
5.29 
5.92 

6.42 

3.73 

3.46 

3.17 

3.32 

3.36 

3.42 

3.23 

3.10 

4.13 

3.18 
3.07 

The  West  Indies 

The  Gulf 

TheOliio 

2.98 
3.23 
2.53 
2.54 
4.38 

2.90 
3.24 
3.20 
2.26 
4.70 

3.33 
2.78 
2.92 
2.86 
4.40 

2.94 
2.73 
3.18 
2.34 
3.43 

2.78 
3.28 
3.13 
3.26 
4.87 

4.11 

:i.  r,» 

3.46 
2.42 
3.78 

2.87 
2.18 
3.46 
2.91 
3.62 

3.59 
2.16 
2.38 
2.34 
3.93 

3.78 
2.86 
2.97 
3.84 
4.90 
8.57 

12.12 

2.96 
3  76 

The  Mississippi 

The  Great  Lakes 

Tlie  Pacific 

2.67 
2.63 
5  29 

The  Pacific  Islands 

2.28 

The    quarantine   sta- 
tions  

4.76 

4.94 

2.68 

1.15 

12.90 

6.38 

6.06 

1 

6  77 

Table   XII. — Comparative   Exhibit — Ratio   of   Deaths   from   Specific  Causes, 

1895-1904. 


Deaths  from — 

Gen- 
eral 
aver- 
age. 

1895. 

1896. 

1897. 

1898. 

1899. 

1900. 

1901. 

1902. 

1903. 

1904. 

General  diseases 

Diseases  of  the— 

Nervous  system . . . 

Circulatory   sys- 
tem  

47.59 

5.50 

10. 72 

12.79 
7.98 
6.34 
6.07 
3.01 

43.94 

4.81 

10.76 

16.24 
10.53 
6.17 
3.43 
4.12 

50.70 

4.65 

11.39 

12.23 
6.51 
3.49 
6.28 
4.65 

48.99 

5.56 

9.85 

10.35 
9.09 
7.07 
6.31 
2.78 

45.45 

6.56 

12.86 

11.29 
7.35 
5.25 
8.66 

55.60 

3.02 

9.07 

9.30 
7.67 
8.37 
5.35 

44.02 

3.62 

9.71 

15.12 
9.70 
9.03 
6.32 
2.48 

45.60 

8.78 

11.87 

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 

49.49 
5.30 
8  76 

Respiratory   s  y  s- 
tem 

14  66 

Digestive  system . . 

Urinary  system 

Injuries 

7.33 
6.72 
5  09 

From  all  other  causes . . 

2.63 

1.62 

3.71 

2.65 

Table  XIV. 


-Comparative  Exhibit — Average  Duration  of  Treatment  in  Hos- 
pital IN  EACH  District,  1895-1904. 


Districts. 

Gen- 
eral 
aver- 
age. 

1895. 

1896. 

1897. 

1898. 

1899. 

1900. 

1901. 

1902. 

1903. 

1904. 

Atlantic 

29.74 
22.18 
23.61 
22.62 
18.00 
24.04 
.38.38 
26.12 

14.52 

31.32 

32.52 

28.93 

30.74 

32.00 

27.88 

28.82 

29.35 

28.36 
20.47 
27.14 
21.53 
15.30 
21.90 
48.16 
26.15 

20.42 

27  48 

The  West  Indies 

23.90 

The  Gulf 

22.46 
25.18 
22.92 
28.34 
40.66 

22.24 
25.43 
20.74 
28.25 
38.81 

22.41 
22.20 
19.00 
26.27 
36.20 

2i.35 
23.83 
18.57 
25.45 
28.41 

21.41 
23.02 
17.56 
24.02 
29.12 

23.15 
21.98 
15.47 
20.24 
31.15 

22.78 
20.88 
15.42 
21.20 
38.17 

2.5.65 
20.81 
18.41 
21.15 
42.  .34 

27.52 

The  Ohio 

21.48 

The  Mississippi 

The  Great  Lakes 

The  Pacific 

The  Pacific  islands 

16.62 
23.61 
50.81 
26.10 

The    quarantine    sta- 
tions  

19.97 

10.00 

11.69 

9.00 

10.43 

13.72 

21.21 

18.48 

10.28 

636  PUBLIC    HEALTH    AND   MARINE-HOSPITAL    SERVICE. 

Table  XIV. — Surgical  Operations,  Fiscal  Year  1904. 


Operations. 


No.  of 
cases. 


Remarks. 


Total  n amber  of  operations. 

Operations  on  Tumors: 

Removal  bv  excision 


1,529 

38 


For  adenoma.. . 

For  lipoma 

For  fibroma 

For  osteoma 

For  chondroma  . 

For  sarcoma 

For  carcinoma . . 
For  condyloma. . 
For  epithelioma. 
For  hematoma. . 
For  papilloma.. , 

Operations  on  cysts.. 


35 


Sebaecous  cyst. 

Bursal  cyst 

Dermoid  cyst.. 
Ranula 


Evacuation  of  Abscesses: 

By  free  incision  and  drainage. 


126 


Abscess  of— 

Antrum 

Arm 

Forearm 

AxiUa 

Back 

Breast 

Face 

Foot 

Finger 

Hand 

Ischio  rectal  fossa. 

Knee 

Leg 

Lower  jaw 

Neck 

Perineum 

Scalp 

Thigh 

Tonsil 

Psoas  muscle 


Carbuncle. 


Neck. 
Back. 


Operations  for  Removal  of  Foreign  Bodies 

From — 

Eye 

Elbow 

Knee 

Wrist 


Operations  on  Blood  Vessels. 
Operations  on  arteries 


Ligation  for  hemorrhage. 
For  aneurism 


Operations  on  veins 

ObUteration  of  varices  leg. 
Operations  on  Nerves 


Excision  of  a  portion  of  a  nerve. 

Stretching  of  a  nerve 

Union  of  divided  nerve 


1    aneurism    femoral:     successful.     1 
aneurism  aorta;  died. 


26  ligation  and  excision;  7  ligation 
only. 


Spinal  accessory. 

Sciatic. 

External  popliteal. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL   SERVICE.  687 

Table  XIV.— Sukcucal  Oi'EitATioNa,  Fiscal  Yeai£  1904 — Continued. 


Operations. 


Operations  on  the  Lymphatic  Organs 

Incision  and  drainage  of  inflamed  and  suppurating 
glands 

O  rein 

Neck 

Axilla 

Removal  of  lymphatic  glands 

Groin 

Neck 

Axilla 

Operations  on  the  Skin  and  Subcutaneous  Tissue. 

For  chronic  ulcer  of  leg 

Wound  of— 

Scalp 

Face 

Ann 

Hand 

Finger 

Abdomen 

Thigh 

Throat 

Back 

Operations  on  Bones 

Excision  of  portion  of  bone 

Of  tibia 

Of  femur 

Of  ribs 

Of  fibula 

Of  metatarsal 

Of  ulna 

Removal  of  fragments  of  bones  by  curetting  and 
sc  raping 

Of  ulna 

Of  inferior  maxilla 

Of  femur 

Of  radius 

Of  sternum 

Of  tarsus 

Of  ilium 

Of  tibia 

Operations  for  ununited  fractures 

Of  tibia 

Of  metatarsus 

Of  femur 

Of  ulna 

Of  inferior  maxilla 

Operations  on  fractured  bones  for  fracture  of 

Inferior  maxilla 

Clavicle 

Humerus 

Radius  and  ulna 

Patella 

Radius 

Femur 

Tibia  and  fibula 

Tibia 

Fibula 

Rib. 

Ilium 

Finger 

Vertebra,  seventh  cervical 


No.  of 
cases. 


311 


93 


196 

21 

1 

36 


Remarks. 


8  Thiersch's  method. 
1  Reverdin's  method. 
4  curetted. 


For  necrosis. 

Do. 

Do. 

Do. 
For  necrosis,  2;  for  bunion. 
For  necrosis. 


For  necrosis. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 


Wired,  successful. 
Do. 

Successful. 

Wired,  successful. 

Removal  of  loose  fragments  and 
scraping  ends  of  bones— all  suc- 
cessful. 


Wired  by  teeth. 

Reduced  and  splint  appUed. 
Reduced;  plaster  of  Paris  splint. 
Reduced,  f)  wired;  1  splint  external. 
Reduced;  plaster  of  Paris. 
Extension  splint  applied. 
Reduced;  plaster  of  Paris  splint 

Do. 

Do. 
Adhesive  straps. 


Splints  applied. 


638  PUBLIC    HEALTH    AND   MARINE-HOSPITAL   SERVICE. 

Table  XIV. — Surgical  Operations,  Fiscal  Year  1904 — Continued. 


Operations. 


Operations  on  Joints 

Reduction  of  dislocation. 


Shoulder 

Elbow 

Radio  carpal  — 
liiferior  maxilla. 


Excisions  of  joints 

Operations  for  anchylosis  of  joints. 


Finger 

Elbow 

Aspiration  and  injection. 

Incision  of  joints 


Wrist.. 
Knee.. 
Elbow. 


Operations  on  Muscles,  Tendons,  and  Fascia 


Tenotomy  of  flexors  of  fingers 

Tenotomy  of  stemo  cleido  mastoid . 

Tenotomy  hamstring 

Tenotomy  ocular 

Suture  of  tendon 


Amputations. 


Of  thigh... 

Of  leg 

At  knee 

Of  arm 

Of  forearm. 
Of  finger... 

Of  toe 

Of  foot 


Operations  on  the  Skull 

Trephining 

Trephining  and  removal  of  portions  of  bone. 


Opening  of  mastoid  cells 

Operations  on  the  Spine  and  Spinal  Cord 

Excision  of  neural  arches 

Operations  on  Face,  Nasal  Cavities,  and  Mouth 

For  deformity  of  nose  from  necrosis  of  nasal  bones. 

Removal  of  polypi 

For  deviation  of  nasal  septum 

Removal  of  tonsils 


Operations  on  the  Eye  and  its  Appendages 


Extraction  of  lens . , 
Excision  of  eyeball. 
Iridectomy 


Operations  on  the  Larynx,  Trachea,  and  Thy- 
roid Body 


Tracheotomy 

Operations  on  the  Thorax  and  Breast. 


Paracentesis  of  the  pleural  cavity 

Thoracotomy  with  excision  of  part  of  rib . 


No.  of 
cases. 


Remarks. 


Elbow    for  tubercular  disease'. 


Brisemint  forc6. 
5  knee,  tubercle. 


For  tubercle. 

4  for  tubercle;  2  for 

For  tubercle. 


Extensor  index  finger. 


1  exploratory,  successful;  1  epilepsy, 
Jacksonian. 

1  Jacksonian  epilepsy,  successful; 
3  depressed  fracture  of  vault,  suc- 
cessful; 3  compound  comminuted 
fracture  of  vault,  2  successful,  1 
died. 


For  relief  of  pressure  and  fracture; 
unsuccessful. 


1  plastic  operation. 

Asch's  operation. 
For  hypertrophy. 


Successful. 


PUBLIC    HEALTH    AND    MARINE-HOSPITAL    SERVICE. 


639 


Taulk  XIV. — Si-u<iKAi-  OrKKATioN.s,  Fiscal  Ykak  1!J04 — CoiitinncMl. 


Operations. 


No.  of 
cases. 


Remarks. 


Operations  on  the  Abdomen.. 
Paracentesis  of  the  ubdomen. 
Abdominal  section 


Talma's  operation 

Appendicitis 

Peritonitis 

Exploration 

Gastro-enterostomy 

Suture  of  intestines 

Olistruction  of  intestines. 

(holpcystectomy 

t'holcoystotomy 

Choledochostomy 

Splenectomy 


Operations  for  hernia 

For  radical  cure — 

(1)  Oblique  ttiguinal. 

(2)  Direct  inguinal. . 

(3)  Umbilical 

(4)  Ventral 

For  strangulated  hernia 


Inguinal 

Operations  on  the  Rectum  and  Anus. 


For  fistula  in  ano. 
For  anal  fissure... 
For  hemorrhoids. 


By  clamp  and  cautery. . . 
By  ligation  and  e.xcision. 
Whitehead's  operation. . 

By  ligature 

Dilatation  of  sphincter. . 


Operations  on  the  Bladder  and  Urethra. 


Upon  bladder 

Median  perineal  cystotomy. 
Suprapubic  cystotomy. . .". . 
Excision  of  bladder 


For  stricture  of  urethra . 


(1)  By  gradual  dilatation 

(2)  By  forcible  dilatation 

(3)  By  internal  urethrotomy. 

(4)  By  external  urethrotomy. 

(5)  By  perineal  section 


Oper.\tions  on  the  Kidney. 


56 


118 
7 
1 
2 
6 


99 


Decapsulation  (EdeboW's  operation) . 

Nephrotomy 

Nephrectomy 


Operations  on  the  Male  Generative  Organs... 


For  phimosis 

For  paraphimosis . 
For  varicocele 


171 

5 

34 


For  hvdrocele. 


(1)  By  tapping 

(2)  By  tapping  and  injection 

n)  Excision  of  parietal  part  of  sac. 

For  castration ". 

Prostatectomy 

Amputation  of  penis 


Operations  on  the  Female  Generative  Organs. 


Abdominal  section — 

For  removal  of  ovaries  . . 
Excision  uterine  polypus. 


Recovered. 

30  recovered;  .'{  died. 

Successful. 

.\11  successful. 

1  died — cancer;  1  recovered. 

1  successful;  3  died. 

3  died;  I  recovered. 

^Successful. 


Recovered;  gunshot  wound. 


112  Bassini;  7  modified  Bassini;  6  Hal- 
stead;  124  successful,  1  died. 
Successful. 
Do. 


5  successful,  1  died. 


Died. 


6  successful,  1  unsuccessful. 
Pyonephrosis;  successful. 
Successful. 


163  circumcision;  8  dorsal  incision. 
5  circumcisions. 


8  tubercle;  2  sarcoma;  1  carcinoma. 
2  carcinoma;  2  phagadena. 


640 


PUBLIC    HEALTH    AND    MAKINE-HOSPITAL    SERVICE. 


Table  XV 


-Nativities  of  Patients  Treated  in  United   States  Marine  Hospi- 
tals DURING  the  Fiscal  Year  ended  June  30,  1904. 


Countries. 


Total 

Africa 

Australia 

Austria 

Belgium 

Canada 

Cape  Verde  Islands 
Central  America. . . 

China 

Cuba 

Denmark 

England 

Finland 

France 

Germany 

Greece.." 

Hawaii 

India 

Ireland 


Number. 


14, 303 


14 

28 
124 

29 
603 
110 

18 


178 
395 
283 
92 
599 
56 
29 
4 
784 


Countries. 


Italy 

Japan 

Mexico 

Netherlands 

Norway 

Philippines 

Porto  Kico 

Portugal 

Russia 

Scotland 

South  America 

Spain 

Sweden 

Switzerland 

Turkey 

United  States 

Wales 

West  Indies 

All  other  countries 


Number. 


23 
18 
79 

932 
11 
24 
68 
98 

204 
42 

126 

719 

19 

2 

,214 

20 

199 
55 


IJN  DEX 


A. 

Paso. 

Abscess  of  hniiii,  fatal  case,  witli  iiecr<)i)sy ^ 408— KiO 

Accouuts 3n-41 

Accounts  and  personnel,  report  of  division  of  (Assistant  Surgeon-General 

Geddiugs)    35-42 

Acting  assistant  surgeons 10, 'iO 

Acute  endocarditis,  fatal  case,  with  necropsy 472 

Acute  pericarditis,  fatal  case,  with  necropsy 472 

Administrative  details — circular  letters 41-42 

Advisory  board  Hygienic  Labox'atory,  reai)pointment  to 3G 

Afghanistan,  cholera  in 71 

.Tables 72 

Africa,  plague  in  (tables) 77,79 

Africa,  yellow  fever  in  (tables) 75 

Affiles  Osirald,  British  ship  detained  at  Colunibai  River  Quarantine 350 

Aguadilia,  P.  K.,  quarantine  transactions  at 117 

Aid  to  Louisiana  Purchase  Exposition 3G5 

Aid  to  other  services 18,40 

Alcohol,  experiments  with 397 

Alcoholism,  fatal  c.-ises  of 404-405 

Alexander,  E.,  A.  A.  Surg. : 

Report  of  EI  Paso  Border  Quarantine.  Texas 350 

Report  of  immigration  inspection  at  El  Paso 205 

Alexandria  Quarantine,  Va.,  report  of  transactions  (Acting  Assistant  Sur- 
geon   Snowden) 333 

Alice,  Tex.,  suspicious  cases  of  yellow  fever  at 323 

Alien  immigrants,  medical  inspection  of.      (Sec  Immigrants.) 

American  Bacteriologists,  meeting  of  As.sociation  of 405 

American  Medical  Association,  papers  I'ead  at  meeting  of: 

Surgeon-General   Wyman 408-411 

Assistant  Surgeon-General  Geddings 412-415 

American  Medical  Association,  reports  on  meeting  of 411-415 

American  Republics,  second  general  international  sanitary  conference  of, 

postponed 29,  303 

American  Roentgen  Ray  Society,  report  on  meeting  of  (Surgeon  Irwin).  405-408 
Amesse,  J.  W.,  Asst.  Surg. : 

Contributed  article,  "  Leprosy  in  the  Sulu  Archipelago  " 455 

Detailed  to  meeting  of  Washington  State  Medical  Association 39 

Report  of  immigration  inspection  at  Seattle,  Wash 211 

Anj^mia  Conunission  of  Porto  Rico,  reports  of,  etc.    (Passed  Assistant  Sur- 
geon King) 300-370 

Anderson,  Frank,  medical  inspector  U.  S.  Navy,  delegate  to  International 

Sanitary  Conference  at  Paris 370 

Anderson,  John  F.,  P.  A.  Surg.: 

Report  on  "  Cerebro-spinal  meningitis  in  Hartford,  Coiin  " 443 

Report  on  typhoid-fever  epidemic  at  Lexington,  Va 381-380 

Aneurism  of  the  aorta,  fatal  case,  with  necropsy 473 

Angina,  Ludwig's,  fatal  case,  with  necropsy 494 

Annual  conference  between  State  and  national  health  authorities 28 

Antimosquito  convention 301 

Antiseptic  properties  of  chloride  of  zinc 388 

.\ntitoxin,  diphtheria,  standard  unit  for 375 

Aorta,  aneurism  of,  fatal  case,  with  necropsy 473 

Appropriation  for  a  quarantine  station  at  Cebu,  P.  I 109 

8639—04 41  641 


642  INDEX. 

Appropriations :  Page. 

Expenditures  from  different 30 

Statement  of  various 39-41 

Arabia,  plague  in  (tables) 79 

Arecibo,  P.  U.,  quarantine  transactions  at 117 

Argentina,  plague  in  (tables) 79 

Armstrong,  Kobt.  R.,  Assistant  Secretary  of  tbe  Treasury  : 

Department  circular  amending  quarantine  regulations 32S 

Letter  relative  assistance  to  Panama 135 

Arroyo,  P.  R.,  quarantine  transactions  at 117 

Association  of  American  Bacteriologists,   report  on   meeting  of    (Passed 

Assistant  Surgeon  Rosenau) 405 

Astoria,  Oreg.,  medical  inspection  of  immigrants  at 197 

Atilles,  I'edro  del   Valle,  A.   A.   Surg.,   report  on  condition  of  lei»rosy   in 

Porto  Rico  1 114-11(; 

Atlantic  district,  diseases  and  injuries  treated  in  (table) 585-593 

Attendants,    hospital IC.  37,  42 

Australia,  plague  in    (tables) 77,79 

Austnjliii,  P.riitish  bark  detained  at  Columbia  River  Quarantine 351 

Average  duration  of  hospital  treatment  in  each  district 584 

Average  duration  of  treatment  in  hospital,  each  district,  comparative  ex- 
hibit, 1895-1904    (table) 635 

B. 

Bahrenburg,  Asst.  Surg.  L.  P.  II.,  contrii)uted  article,  "  Chronic  pancrea- 
titis with   induration" 451 

Bailhache,  Preston  II.,  Surg.  : 

Correspondence  relative  to  danger  from  yellow-fever  infection  on  ves- 
sels arriving  via  northern  ports 233-235 

Detailed  to  meeting  American  Public  Health  Association 38 

Baltimoi-e,  Md. : 

Repairs  to  marine  hospital  at 65 

Report  of  immigration  inspection  at  (Assistant  Surgeon  Wille) 197 

Belize,  British  Honduras,  report  of  quarantine  transactions   (Acting  As- 
sistant  Surgeon   Carson) 133 

Benejam,  Julian,  A.  A.  Sui-g.,  report  of  quarantine  transactions  at  Agua- 

dilia,  P.  R 117 

Beuiberi,  fatal  case  of,  with  necropsy 465 

Beyer,  George  E.,  A.  A.  Surg.,  member  Working  Party  No.  2 359 

Billings,  W.  C,  P.  A.  Surg. : 

Promoted  to  rank  of  passed  assistant  surgeon 35 

Report  of  immigration  inspection  at  Quebec,  Canada 216 

Bills  of  health  for  Panama  to  be  signed  by  service  officers 135-137 

Bills  of  health  not  required  for  vessels  from  United  States  to  Philippines.       158 
Biscayne  Bay  Quarantine,  Fla.,  report  of  transactions  (Acting  Assistant 

Surgeon    Jackson) 345 

"  Bladder,  catheter  in,  removal  through  perineum,"  contributed  article  by 

P.  A.  Surg.  J.  A.  Nydegger ^ 4t;3 

Blount,  B.  B.,  A.  A.  Surg.,  report  of  transactions  at  Boca  Grande  Quaran- 
tine,   Fla --543 

Blue,  Rupert,  P.  A.  Surg.,  report  on  plague  and  plague  work  in  San  Fran- 
cisco, Cal 227-230 

Bluefields,  Nicaragua,  report  of  quarantine  transactions  (Acting  Assistant 

Surgeons  Goodman  and  Reilley) 132 

Boards    convened 16,  37 

Boca  Grande  Quarantine,  Fla.,  report  of  transactions   (Acting  Assistant 

Surgeon    Blount) -^43 

Bocas  del  Toro,  Panama,  report  of  quarantine  transactions   (Acting  As- 
sistant  Surgeon   Osterhout)  129-130 

Boggess,  .John  S.,  Asst.  Surg.,  report  of  Cape  Charles  Quarantine 333 

Bolivia,  plague  in   (tables) 77 

Bombay.  India,  detail  of  Acting  Assistant  Surgeon  Hume  to 23, 192 

Bond,  B.  D.,  A.  A.  Surg.,  in  charge  at  Mahukona,  Hawaii 153-155 

Border  quarantine  against  yellow  fever 324 


INDKX.  643 

Hostoii,  M.iss.  :  Page. 

U('I)iiirs  Mild  iinpi-ovciiicnts  to  niMriiii'  Imspitjil 05 

Uoport  of  iiiiini;;riitioii  iiisnoclioii  iit   ( Actiii^  Assistant  Suri^coii  S;if- 

fonlt     1!»7-12(»:{ 

r.owi*',  Kolicrt  1..  sanitary  inspoftor,  rt'port  of  (niaranlini>  transactidns  a) 

NaK'isaki.    Japan IS." 

Urain,  altsccss  of,  fatal  i-asc,  with  necropsy 4Ci8-4<i'.» 

Krain  and  its  nK'nii»ranes,  diseases  of  tlie,  fatal  cases,  with  necropsies.-  4(><S-471 
I'.razil: 

riaj,'ue   in    (tai)ies) 77,7!) 

Report  of  (juarantine  transactiiins  at  Rio  de  Janeiro 147-ir»2 

Yellow  fever  in   (tal)les) 74,  7r» 

Hrice.  James  \V.,  A.  A.  Surg.,  rejiort  of  quarantine  transactions  at  Ilunia- 

cao.  P.  R 117 

I>ritisli  Honduras,  report  of  (juarantine  transactions  at  Relize 18.'i 

liritisli  Soutli  Africa,  pla,t,'ue  in   (tal)Ies) 79 

RvrunswiiU   (quarantine,   Ua.,   report  of  transactions    (Assist.int    Surgeon 

liurldialter)     . 338 

Rrussels,  lU>]giuni,  Eleventh  International  Congress  of  Hygiene  and  De- 
mography iield  at ' 417^35 

liuhonic  plague.     (Sec  Rlague. ) 

Ruffalo,  N.  Y.,  new  hosjiital  at 17 

Rulletins  of  the  Hygienic  Lahoratory 28,-374 

Runau-Varilla,  P.,  minister  from  I'anania,  requests  assistance  of  Service 

ofticers  stationed  in  foreign  ports 135 

Bureau  puhlications,  resolution  passed  by  Senate 450 

Burkhalter,  J.  T.,  Asst.  Surg.,  report  of  Brunswick  Quarantine,  Ga 338 

C. 

Cairo,  HI.,  repairs  and  improvements  to  mai'ine  hospital  at (i5 

Calcutta,  India  : 

Detail  of  Passed  Assistant  Surgeon  Sprague  to 23.192 

"Topography  and  sanitary  condition  of  [lort  of"   (Passed    Assistant 

Surgeon    Sprague) 193 

Water  supply  of  (Passed  Assistant  Surgeon  Sprague) 193 

California  : 

Plague  in  Contra  Costa  County,  case  of 229,545-573 

Plague  in  San  Francisco  (see  uho  San  Francisco) 70,225-230 

Callao,   Peru,   report  of  quarantine  transactions   at    (Assistant    Surgeon 

Lloyd)     140 

Canada,  immigration  inspection  in 210 

Canal  Connuission,  Isthmian,  pliysical  examinations  made  for  (table) 583 

Canal,  Panama.     (See  Panama.) 

Canal  zone,  quarantine  oi)erations  in 2i> 

Cancer  and  tlie  Roentgen  ray 405-408 

Cannel,  Tex.,  disinfection  against  yellow  fever  at 317 

Cape  Charles  Quarantine,  Va.,  report  of  transactions   (Assistant  Surgeon 

Boggess)     '- 333 

Cape  Fear  Quarantine,   Va.,   report  of  transactions    (Assistant   Surgeon 

Warren)     334 

Cape  Nome,  Alaska,  repairs  and  improvements  to  marine  hospital 07 

Car   sanitation 377,  403 

Carcinoma  of  palate  and  fauces,  fatal  case,  with  necropsy 499 

Carmichael,  D.  A.,  Surg.,  assigned  to  laboratory  for  instruction 374 

Carringtou,  P.  M.,  Surg. : 

Detailed  to  meeting  American  Medical  Association  at  Atlantic  City 38 

Report  of  Sanatorium  at  Fort  Stanton,  N.  Mex 47-01 

Report  on  meeting  of  American  Medical  Association 415 

Carson,  W.  H.,  A.  A.  Surg.,  report  of  quarantine  transactions  at  Belize  —       133 
Carter,  C.   S.,  A.  A.   Surg.,  report  of  quarantine  transactions  at  Puerto 

Cortez,    Honduras 127 

Carter,  H.  R.,  Surg. : 

Detail  for  duty  under  Canal  Counnission 142 

Detailed  to  conference  of  quarantine  oHicers  at  New  Orleans 38 

Paper  on  "  The  conveyance  of  yellow  fever  " 430-443 

Report  ou  meeting  of  Texas  Medical  Association. __ 435-443 


(344  INDEX. 

Page. 

Casualties  in  conimisioned  corps 15 

Catheter  in  IjJaddei-,  removal  through  periueuiu  ;    contributed  article  by 

P.  A.  Surg.  J.  A.  Nydegger 4(;M 

Cattle  at  Fort  Stanton 52 

Cebu,  P.  I. : 

Appropriation  for  (inarantine  station  at 1(J}) 

Report  of  quarantine  transactions  at  (Assistant  Surgeon  Fox) 175-177 

Cedar  Keys,  Fla.,  no  "piarantine  transactions  at 343 

Ceiba,  Honduras,  report  of  quarantine  transctions  (Acting  Assistant  Sur- 
geon   Robertson) 130-132 

Central  America,  detail  of  otHcers  to  ports  in 23 

Central  and  South  America,  fruit-port  inspection  service 123-134 

Cerebral  hemorrhage,  fatal  cases,  with  necropsies 409-471 

Cerebro-spinal  meningitis  in  Hartford,  Conn.,  report  by  1'.  A.  Surg.  John 

F.    Anders(ni 443 

(.Charleston,  S.  C,  report  of  inmiigration   inspection   at  (Acting  Assistant 

Surgeon    Sams) - 204 

Chicago,  111.,  repairs  and  improvements  to  marine  hospital  at (m 

Chile,  plague  in  (tables) 77,79 

China : 

Cholera    in 71 

Tables     72 

Details  of  officers  to  ports  in 23 

Immigration  inspection  in 220-221 

Methods  of  pre])aring  goods  for  shipment  to  United  States 188 

Plague  in    (tables) 77,79 

Report  of  ciuarantine  transactions  at — 

Honglvong    18(>-188 

Shanghai    188-192 

Chinese  emigrants,  difficulty  of  proper  disinfection  of  their  effects 18(> 

Ching  Wo,  British  ship  detained  at  Columbia  River  Quarantine 351 

Chloride  of  zinc  and  chloride  of  lime  as  disinfectants  (Assistant  Surgeon 

McClintic)      38(?-394 

Cholera  : 

Afghanistan    71 

Tables 72 

China    71, 191 

Tables 72 

India 71 

Tables 72 

Japan    71 

Tables 72 

Philippines    71, 165-167 

Tables 72 

Straits    Settlements " 71 

Tables 72 

Turkey   72 

Cholera  in  Celni,  P.  I.,  regulations  on  account  of 176 

"  Chronic  pancreatitis,  with  induration."  contributed  article  by  Assistant 

Surgeon    Bahrenburg 451 

Cienfuegos,  Cuba,  report  of  quarantine  transactions  at  (Acting  Assi.stant 

Surgeon  McMahon)  113 

CinciuTiati,  Ohio,  repairs  and  improvements  to  marine  hospital 65 

Circular  letters  (.s-cr  also  Department  circulars)  : 

Assistance  to  Panama  in  quarantine  matters 135 

Directing  monthly  report  on  condition  of  naphtha  launches,  etc..  at 

quarantine  stations 329 

Instructions  to  officers  at  fruit  ports 124 

Preparation  of  necropsy  reports 449 

Reinstatement  of  employees 41 

Transmitting  semiannual  list  of  attendants 42 

Cirrhosis  of  liver,  fatal  case,  with  necropsy 467 

Civil  Service  Commission,  physical  examinations  made  for  (table) —  18,46,583 

Cleveland,  Ohio,  repairs  and  improvements  to  marine  hos]»ital 65 

Coast  and  Geodetic  Survey,  physical  examinations  made  for  (table) 18,583 


INDEX.  645 

Cofer,  L.  E.,  P.  A.  Surp:. : 

Uoport  <)f  iiiiiiiifjratioii  iiisiK'ction  at  lIoiKiliilu.  Hawaii 'I\:\ 

Uoport  of  «|uaraiitiiie  traiisaclions  at  Honolulu  and  sul)i)orts IftH-l")"* 

Colouibin.  yt'llow  IVvor  in   (taltk's) 74,75 

Colon,  ranania,  (U'tail  of  odiccrs  to V^4 

Colon,  I'anania,  report  of  ((uaiantlne  transactions  at  (Surgeon  I'erry) 14:5 

Colunihia    Kivor    Quarantine,    Grog.,    report    of    transactions    (Assistant 

Surgeon    Earle) 350-852 

Combe,   J.   K.,   A.   A.    Surg.,   correspondence  relative  to  yellow   fever   in 

Texas,  etc.      (l^cc  Yellow  fever — Texas  eiiideniic  ) 
Connnerce  and  liabor,  I)ei)artnient  of,  correspondence  relati\e  to  ollicers  of 

Service  in  China  and  Japan  examining  aliens 195-19(i 

Connuissloned  corps 15,  .".5 

Committees  of  annual  conference  of  States  with  Service 'AM 

Common  carriers,  hygiene  of,  discussion  at  Brussels  congress 410,422 

Connnutatiou  for  quarters  to  otticers  in  Philippines,  corres])ondence  rela- 
tive to ]5!)-l<;l 

Comparative  exhibit: 

Average  diu'ation  of  hospital  treatment   in  each  district,    1,S'.).1-1!)04 

(table) (5:^5 

Mortality  per  100  patients,  by  districts,  1895-1904  (table) (J.?5 

Ratio  of  deaths  from  specific  causes,  1895-1904  (table) ().'>5 

Comparative  table  of  number  of  seamen  treated  annually,  lSf)8-19()4 577 

Conference  of  State  Health  Officers  \\ith  tlie  Service,  Second  Annual  28,  363-3(>5 

Conferences,  sanitary 28 

Connective  tissue,  inflammation  of,  neck,  Ludwig's  angina,  fatal  case,  with 

necropsy 494 

Consumption,  fatal  cases,  with  necropsies 511-545 

(.'ousumption.     {Sec  also  Tuberculosis.) 
Consumptives : 

Sanatorium  for,  at  Fort  Stanton,  N.  Mex 17 

Sanatorium  for,  at  I'ort  Stanton,  N.  j\Iex.,  rei)ort  by  Surg.  P.  M.  Har- 
rington, in  command 47-01 

Contra  Costa  County,  Cal.,  case  of  plague  in 220 

Contributed  articles: 

"  Catheter  in  bladder — removal  through  perineum,"   by   P.   A.    Surg. 

J.  A.  Nydegger .* 4G3 

"  Chronic  pancreatitis  with  induration,"  by  Asst.  Surg.  L.  P.  II.  Bah- 

renburg 451 

"  Leprosy  in  the  Sulu  Archipelago,"  by  Asst.  Surg.  J.  W.  Amesse 4.55 

"  Sanitary  imi)rovements  at  Naples,"  by  P.  A.  Surg.  J.  M.  Eager 458 

Convention  of  American  Republics  postponed 29,303 

"Conveyance  of  yellow  fever,"  by  Surg.  II.  K.  Carter 430-443 

Cooperation  with  local  boards  of  health 361 

Cooperative  arrangement  with  Mexico  to  jtrevent  yellow  fever  in  future.  291-290 
Corput,  G.  M.,  P.  A.  Surg. : 

Promoted  to  rank  of  passed  assistant  surgeon .35 

Report  of  South  Atlantic  Quarantine .337 

Cortelyou,  Hon.  George  R.,  Secretary  of  Conmierce  and  Labor,  correspond- 
ence relative  to  examination  of  aliens  in  China  and  Japan 195-190 

Costa  Rica  : 

Report  of  quarantine  transactions  at  Port  Limon 125-127 

Yellow  fever  in  (tables) 74,75 

Cuba : 

Hsemoglobinuric  fever  in 110 

No  yellow  fever  in 105 

Officers  detailed  to  ports  in 23 

Personal  health  certilicates  issued  at  Ilabana 105 

Quarantine  transactions  in 105-114 

Report  of  quarantine  transactions  at — 

Cienfuegos  113 

Habana 105-107 

Matanzas  107-109 

Nuevitas    109 

Santiago 109-113 

Yellow  fever  in  (tables) 74,75 


646  INDEX. 

Page. 

Cumberland  Sound  Quarantine,  Fla.  (Acting  Assistant  Surgeon  Horsey) 340 

Cumming,  Hugh  S.,  P.  A.  Surg.,  report  of  San  Francisco  Quarantine 349 

D. 

Daiquiri,  Cuba,  hsemoglobinuric  fever  at 110 

David  Evans,  American  ship  detained  at  Columbia  River  Quarantine 350 

Deaths  in  corps 15,85 

Death  rate.      (*S'ee  Mortuary  statistics.) 

Deaths,  causes  of,  among  patients  of  Service  during  year  (table) 632-634 

Deaths  in  each  district,  ratio  of.  Service  patients  (table) 634 

Deaths  from  specific  causes,  ratio  of,  Service  patients  (table) 634 

Deaths,  ratio  of,  from  specific  causes,  1895-1904  (table) 635 

Decisions  of  Solicitor  of  the  Treasury — Vessels  from  United  States  to 

Philippines  not  required  to  carry  bills  of  health 158 

Decker,  C.  E.,  Asst.  Surg.,  death  of 35 

Deficiency    appropriation 16,  41 

Delaware  Breakwater  Quarantine,  Del.,  report  of  transactions    (Passed 

Assistant  Surgeon  Lavinder) 331-332 

Demography  and  Hygiene,  International  Congress  of,  held  at  Brussels, 

Belgium    417^35 

Demolition  and  vacation  of  insanitary  buildings  in  foreign  cities-^ 444-445 

Dengue  and  yellow  fever 254 

Dengue  fever,  recommendaton  for  commission  to  study 381 

Department  Circular  No.  30,  amending  quarantine  regulations  on  account 

of  yellow  fever 328 

Details  of  officers  to  meetings  of  medical  associations,  etc 38 

Details  of  officers.     (See  also  Officers.) 

Detention  camp  for  yellow  fever  refugees  in  Texas 307 

Detroit,  Mich.,  repairs  and  improvements  to  marine  hospital 66 

Dinegar,  R.  H.,  A.  A.  Surg.,  in  charge  at  Kihei,  Hawaii 153-155 

Diphtheria  antitoxtin,  standard  unit  for 28,375 

Diseases  and  injuries  treated  during  year  (table) 585-631 

Diseases  of  brain  and  its  membranes,  fatal  cases,  with  necropsies 468-471 

Diseases  of  kidneys,  chronic  nephritis,  fatal  cases,  with  necropsies 481^89 

Disinfectants  and  germicides 379 

Disinfectants,  cliloride  of  zinc  and  "chloride  of  lime"  as 38<>-394 

Disinfectants,  investigation  of  various 27 

Disinfection  against  yellow  fever,  process  of 308-310 

Disinfection  at  Laredo,  Tex.,  statistics  of 310 

Disinfection,  methods  of  in  vogue  at  Shangliai  for  goods  shipped  to  United 

States  188-190 

Division  of — 

Domestic    quarantine,    report    of   (Assistant    Surgeon-General    Glen- 
nan)    225-356 

Foreign  and  insular  quarantine,  embracing  medical  inspection  of  im- 
migrants, report  of  (Assistant  Surgeon-General  Pettus) 105-221 

Marine-hospitals   and    relief,    report   of    (Assistant    Surgeon-General 

Williams)     45-68 

Miscellaneous,  report  of  (Assistant  Surgeon  McLaughlin) 449-573 

Personnel  and  accounts,  report  of   (Assistant  Surgeon-General  Ged- 

dings)     35^2 

Pharmacology,  Hygienic  Laboratory,  report  of  (Doctor  Hunt) 27,397-398 

Sanitary  reports  and  statistics,  report  of  (Assistant  Surgeon  General 

Vaughan)     71-101 

Scientific  research  and  sanitation,  report  of  (Assistant  Surgeon-Gen- 
eral   Geddings) 359-145 

Zoology,  Hygienic  Laboratory,  report  of  (Doctor  Stiles) 394—397 

Domestic  (luarantine,  report  of  division  of    (Assistant   Surgeon-General 

Glennan)    225-356 

Drinking  water,  typhoid  bacillus  found  in 27,381-386 

Drugs,  examinations  of 46,398 

Drugs  and  chemicals,  examination  of,  in  laboratory 379 

Duke,  B.  F.,  A.  A.  Surg.,  report  of  Pascagoula  Quarantine,  Miss 345 


INDEX.  047 

I'age. 

Duration  of  hospital  troatiiuMit,  ini'raiio  in  eadi  district,  comparative  ex- 

liihit,  1895-1!)()4    (table) (i;i5 

Dwelliugs,  iusauitary,  iu  foreign  cities 444 

K. 

ICagor.  J.  Af..  P.  A.  Surg. : 

(.'oiitributed  article  on  "Sanitary  improvements  at  Naples" 458 

Detailed  to  meeting  of  International  Congress  of  Hygiene  and  Demog- 
raphy at  Brussels ;{8 

Report  on  Eleventh  International  Congress  of  Hygiene  and  Demog- 
raphy at  Brussels 417-435 

Ueport  of  iunuigration  inspection  at  Naples  and  Palermo,  Italy 217-219 

P^agle  Pass,  Tex. : 

Land  quarantine  maintained  at 23 

Report    of    immigration    inspection    at     (Acting    Assistant    Surgeon 

Hume)    204 

Earle,  Bay  lis  H.,  Asst.  Surg. : 

Rei)ort  of  Columbia  River  (Quarantine 350-352 

Report  of  inspection  of  inunigrants  at  Astoria,  Oreg 197 

Eastport  Quarantine,  Me.,  report  of  transactions   (Acting  Assistant  Sur- 
geon   Small) 330 

Ebersole,  R.  E.,  Asst.  Surg.,  report  of  Tampa  Bay  Quarantine,  Fla 339 

Echemendia,   D.   M.,  A.   A.    Surg.,    report  of  (juarantine  transactions   at 

Habana,    Cuba 10,5-107 

Ecuador : 

Report  of  quarantine  transactions  at  Guayaquil 145 

Yellow  fever  in   (tables) 74,75 

Editions  of  Bureau  publications,  joint  resolution  relative  to 450 

Edwards,  Clarence  R.,  Col.,  U.  S.  Army,  correspondence  relative  to  commu- 
tation for  quarters  of  officers  in  Philippines 159-101 

Egypt,  plague  in  (tables) 77,79 

El  Paso,  Tex. : 

Border  quarantine,  report  of  transactions  (Acting  Assistant  Surgeon 

Alexander)    356 

Land  quarantine  maintained  at 23 

Report    of    immigration    inspecticni    at    (Acting    Assistant    Surgeon 

Alexander)    205 

Elliott,  Charles  H.,  A.  A.  Surg.,  report  of  Seattle  Quarantine,  Wash 354 

Empyema,  fatal  case,  with  necropsy 489 

Endocarditis : 

Acute,  fatal  case,  with  necropsy 472 

Acute  (malarial  fever),  fatal  case,  with  necropsy 498 

Engineers,  marine : 36 

Enteric  fever,  fatal  cases,  with  necropsies : 490—494 

Epidemic  diseases : 

Appropriation  to  prevent  spread  of 16 

Expenditures  from 39 

Epidemic  fund,  expenditures  on  account  of 16 

Epidemic  of  yellow  fever  in  Texas 230-325 

Etiologj'  of  yellow  fever 359 

Eureka  Quarantine,  Cal.,  report  of  transactions    (Acting  Assistant  Sur- 
geon Harris) 350 

Evansville,  Ind.,  repairs  and  improvements  t)  marine  hospital 00 

Examination  of  drugs  and  chemicals 46,379 

Examination   of  vaccines 376 

Exhibit  at  Louisiana  Purchase  Exposition 365-379 

Exhibit  of  operations  of  Service,  fiscal  year  1904  (table) 578-582 

Expenditures  and  receipts 39 

Expenditures,  monthly  statement  of,  at  hospitals 45 

Expenditures  of   Service 10 

F. 

Fajardo,  P.  R.,  quarantine  transactions  at 117 

Fatal  cases,  with  necropsies,  reports  of  (.sec  Necropsies,  report  of) 464 

Fatal  cases  of  plague,  with  necropsies  (San  Francisco) 545-573 


648  INDEX. 

Fovfn- :  Page. 

Enteric,  fatal  cases,  with  necropsies 490-494 

Malarial,   remittent,   fatal   case,   with  necropsy    (acute  endocarditis, 

collapse  of  right  lung) 498 

Financial  statement  of  cjuarantine  service  in  Philippines 181-184 

Financial  statement  of  Service 39-41 

Foreign  seamen,  pliysical  examinations  of   (table) 583 

Foreign  and  insular  quarantine,  report  of  division  of  (Assistant  Surgeon- 
General    Pettus) 105-221 

Foreign   and   insular  quarantine   administration,     (»S'ee   ulsu   Quarantine 
administration,  foreign  and  insular.) 

Formosa,  plague  in   (tables) 77,79 

Fort  Stanton,  N.  Mex. : 

Sanatorium  for  consumptives  at 17 

Repairs  and  improvements  to  sanatorium (56 

Report  of  Surg.  P.  M.  Carringtou 47-Gl 

Report  of  Laboratory  at  (Assistant  Surgeon  Trask) 5(>-61 

Fowler,  J.  B.,  A.  A.  Surg. : 

On  duty  for  quarantine  work  at  Kobe,  Japan 180 

Repoi't  of  immigration  inspection  at  Kobe,  .fapau 220 

Fox,  Carroll,  Asst.  Surg.,  report  of  quarantine  transactions  at  C'ebu.  1*.  I-   175-177 

France,  plague  in  (tables) 77 

Francis,  Edward,  Asst.  Surg. : 

Assigned  to  laboratory  for  instruction 374 

Member  Working  Party  No.  2 359 

Frary,  T.  C,  A.  A.  Surg.,  report  of  Iloquiam  Quarantine.  Wash 352 

Frick,  John,  A.  A.  Surg. : 

Continued  on  duty  at  Tampico,  Mex 118 

Ordered  to  Laredo,  Tex 253 

Fricks,  L.  D.,  promoted  to  rank  of  passed  assistant  surgeon 35 

Fruit-port  inspection-  service 123-134 

Fruit  ports : 

Details    of   officers    to 23 

Letter  of  instructions  to  officers  serving  at 124 

Funds,  expenditures  from  various 16 

G. 

Gardner,  C.  H.,  P.  A.  Surg.,  report  of  immigration  inspection  at  Key  West, 

Fla 205 

Geddings,  II.  D.,  Asst.  Surg.  Gen. : 

Detailed  to  International  Sanitary  Conference,  Paris,  and  meeting  of 

American  Medical  Association  at  Atlantic  City .38,370 

Paper  read  before  American  Medical  Association 412-415 

Promoted  to  rank  of  surgeon 35 

Report  of  division  of  personnel  and  accounts 35-12 

Report  of  division  of  scientific  research  and  sanitation 359—445 

Report  on  meeting  of  American  Medical  Association 412 

Report  of  sanitary  board  on  Texas-Mexican  border  insjiection  service.       302 

Report  of  sanitary  board  relative  to  yellow  fever  preventive  measures.       293 

Geographic  distribution  of  yellow  fever  mosquitoes  (Dr.  L.  O.  Howard),  360-361 

Germany,  plague  in  (tables) 77 

Gleiicsslin,  British  ship  detained  at  Columbia  River  Quarantine 351 

Glennan,  A.  H.,  Asst.  Surg.  Gen.,  and  chairman  sanitary  board : 

Report  of  division  of  domestic  quarantine 225-356 

Report  of  sanitary  board  upon  measures  to  in-event  recurrence  of  yel- 
low fever 293 

Report  of  sanitary  board  on  Texas-Mexican  border  inspection  service.       302 
Glover,  M.  W.,  Asst.  Surg. : 

Detailed  to  Victoria,  British  Columbia,  for  immigration  inspection —       193 

Report  of  immigration  inspection  at  Victoria,  British  Columbia 216 

Goldberger,  Jos.,  Asst.  Surg. : 

Assigned  to  laboratory  for  instruction 374 

Continued  on  duty  at  Vera  Cruz 118 

Goldthwaite,  Henry,  health  officer.  Mobile,  Ala.,  letter  relative  to  case  of 
yellow  fever  aboard  the  Mount  Vcnion 232 


INDEX.  649 

(loodiuaii.  D.  W..  A.  A.   Surii.  :  I'age. 

lU'poit  of  qu.iiaiJliuo  tiiiiisnctions  .-it  liluefiolds l.'VJ 

Report  of  quarantine  transactions  at  I'ort  Linion.  Costa  Rica 12(! 

Goodman,  F.  S..  riiarniacist: 

Appointed  disbursing  agent  at  Laredo,  Tex .__       2(V2 

Report  on  woric  against  yellow  fever  at  Minera,  Tex 31.V310 

Gorgas.  Col.  Wni.  C,  I'.  S.  Army,  delegate  to  International  Sanitary  Con- 

fereiite   of   I'aris 370 

(Jrulilis.  S.  li..  1'.  A.  Surg.,  report  of  Gulf  Quarantine,  Miss 345 

Gruver,  Fleetwood.  A.  A.  Surg. : 

Report  of  quarantine  transactions  at  Guayaquil,  Ecuador 145 

Rei)ort  of  (luarantine  transactions  at  Port  Limon,  Costa  Rica 125 

(Juatem.ila.  report  of  (juarantine  transactions  at  Livingston 128 

(iuayaiiuil.  Ecuador,  report  of  quarantine  transactions   (Acting  Assistant 
Surgeon    Gruver) 145 

Guiteras,  G.  ^L.  Surg. : 

Corresixindence  relative  to  yellow  fever  work  at  Laredo,  Tex.     {nee 

Yellow  fever  in  the  Uniteil  States — Texas  epidemic) 252 

Ordered  to  Laredo,  Tex.,  to  take  charge  of  measures  against  yellow- 
fever   epidemic 252 

Report  on  yellow-fever  epidemic  in  Texas .303-320 

Gulf  coast : 

Inspection  of,  to  guard  against  yellow  fever 236-240 

Protection  of,  against  yellow  fever  from  Mexico 235 

Gulf  district,  diseases  and  injuries  treated  in  (table) 594-GOO 

Gulf  Quarantine,  Miss.,  report  of  transactions  (Passed  Assistant  Surgeon 
Grubbs)    345 

Gustetter,  A.  L..  A.  A.  Surg.,  report  of  immigration  inspection  at  Nogales, 

Ariz   208 

Grace,  .T.  G..  A.  A.  Surg.,  on  duty  at  Ililo.  Hawaii 153-155 

Great  Lakes  district,  diseases  and  injuries  treated  in  (table) 012-020 

Greene.  Jos.  B..  P.  A.  Surg.,  relieved  from  duty  at  Habana.  Cuba 106 

Gwyn.  M.  K..  Asst.  Surg. : 

Military  services  of 162 

Report  of  quarantine  transactions  at  .Jolo,  P.  I 180 

H. 

Habana.  Cuba : 

Health  certificates  given  only  at  request  of  steamship  comr.any 105 

Report    of    quarantine   transactions    at    (Acting    Assistant    Surgeon 

Echemendia) 105-107 

Habitations,  hygiene  of.  discussion  at  Brussels  Congress 430 

Hamilton,  H.  .!..  A.  A.  Surg. : 

Correspondence  relative  yellow    fever   in   Texas   and   Mexico.     (See 

yellow  fever  in  the  Uniteil  States) 232-257 

Report  of  inuuigration  inspection  at  liaredo,  Tex 205 

Report  of  Lare(io  liorder  quarantine.  Texas 356 

Hamilton.  J.  II..  A.  A.  Surg.  : 

Report  of  immigration  inspection  at  Richford,  Vt 210 

Hammond.    II.    H..    A.    A.    Surg.,   work    in   connection   with   sni.illpox    in 

Maine   328 

Harris.  B.  Y..  A.  A.  Surg.,  report  of  Eureka  Quarantine,  Cal 350 

Harrison.  J.  F..  A.  A.  Surg. : 

Continued  on  duty  at  Progreso,  Mexico 118 

Report  of  quarantine  transactions  at  Progreso,  Mexico 110,123 

Hartford.    Conn.,    cerebro-spinal    meningitis    in    (Passed    Assistant    Sur- 
geon Anderson)    443 

Hawaii.  Territory  of: 

Honolulu,  repairs  to  quarantine  station  at 152 

Immigration   inspection  in 213 

Plague  in    (tables) 78.79 

Report  of  quarantine  transactions  at  Honolulu  and  subports 153-155 

Hay,  .John.   Secretary  of  State,  letter  relative  assistance  to  Panama  in 
quarantine    matters 1*'-I 

Hay,  John  (see  also  State  Department). 

Heart  and  great  vessels,  diseases  of,  fatal  cases,  with  necropsies 472—480 


650  INDEX. 

Heart :  Page. 

Rupture  of  the,  fatal  case,  with  necropsy 473 

Valvular   disease   of — aortic   and    mitral,    fatal    cases,    with   necrop- 
sies      474-481 

Heiser,  V.  G.,  P.  A.  Surg. : 

Correspondence  relative  commutation  for  quarters  to  officers  in  Phil- 
ippines      159-161 

Letter  relative  transfer  of  Mariveles  quarantine  station 15(> 

Promoted  to  rank  of  passed  assistant  surgeon 3.1 

Report  of  immigration  inspection  at  Manila,  P., I.,  and  subports 21o-21.'j 

Report  of  quarantine  transactions  at  Manila  and  subports,  P.  I 103-175 

Hemorrhage : 

Cerebral,  fatal  cases,  with  necropsies 4(i!)-471 

Pulmonary,  fatal  case,  with  necropsy 510 

Hernia,  right  oblique  inguinal,  strangulated,  fatal  case,  with  necropsy — '__       495 

Ililo,  Hawaii,  quarantine  transactions  at 153-155 

Hobdy,  W.  C,  promoted  to  rank  of  passed  assistant  surgeon 35 

Honduras,  report  of  quarantine  tran.sactions  at — 

Ceiba  130-132 

Puerto  Cortez 127 

Hongkong,  China  : 

Detail  of  officer  to 23 

Report    of    immigration    inspection    at    (Passed    Assistant    Surgeon 

White)    « 220 

Report    of   quarantine   transactions    at    (Passed    Assistant    Surgeon 
White)    186-188 

Honolulu,  Hawaii,  report  of  immigration  inspection  at  (Passed  Assistant 
Surgeon    Cofer) 213 

Honolulu   and    subports,    Hawaii,    report   of   quarantine   transactions    at 

(Passed  Assistant  Surgeon  Cofer) 153-155 

Hookworm  disease,  scientific  work  with —  381,394 

Hoquiam   Quarantine,   Wash.,  report  of  transactions    (Acting   Assistant 
Surgeon    Frary) 352 

Horsey,  J.  Louis,  A.  A.  Sui'g.,  report  of  Cumberland  Sound  Quarantine, 
Fla 340 

Hospital  attendants 37 

Hospital  needed  at  Laredo,  Tex 311 

Hospital  treatment,  average  duration  of,  comparative  exhibit,  1895-1904 

(table)    635 

Hospitals,  marine : 

Statistics    of 17 

New  17 

(See  also  Marine  Hospitals.) 

House-to-house  inspection  of  Laredo,  Tex.,  plan  for 300 

Howard,  Dr.  L.  O.,  chief  of  Division  of  Entomology,  Department  of  Agricul- 
ture, work  with  mosquitoes 360 

Humacao.  P.  R..  quarantine  transactions  at 117 

Hume,  E.  IL,  A.  A.  Surg. : 

Detailed  to  Bombay,   India '    192 

Report  of  immigration  inspection  at  Eagle  Pass,  Tex 204 

Hunt,  Dr.  Reid : 

Appointed  chief  of  division  of  pharmacology 36 

Report  of  division  of  pharmacology.  Hygienic  Laboratory 397-398 

Hygiene  and  demography,  international  congress  of,  at  Brussels 417-435 

Hygiene,  industrial  and  professional,  discussion  of,  at  Brussels  congress-  419,422 

Hygienic  Lalioratory    ' 27 

Advisory  board  of.  reappointment  to 36 

Alcohol,  experiments  with 397 

Bulletins  issued  during  year 28 

Car  sanitation 377 

Chloride  of  zinc  and  chloride  of  lime  as  disinfectants 386-394 

Dengue    fever 381 

Disinfectants  and  germicides 379 

Division  of  pharmacology,  report  of  (Doctor  Hunt) 397-398 

Division  of  zoology,  report  of  (Doctor  Stiles) 394-397 

Examination  of  drugs 398 

Examination  of  drugs  and  chemicals 379 


INDEX.  651 

Hj'Kienio  Laboratory — rontimiod.  Page. 

Kxaiiiiiialion  of  suspected  cases  of  plague ;{71) 

Kxaiiiiiiatioii  of  vaccines ."{70 

Kxliiltit  for  St.  Louis  exposition --       379 

lloolcworiii    disease 381 

linj)rovenients    n«'edetl 373 

Lai  (oratory    l)ulletins 374 

Laboratory  course  for  student  officers 374 

.Malarial    fevers   ^  380 

New   imilding  for -7,  373 

Nitriles,  experiments  with 397 

Tatbologic  specimens  examineil 378 

Quinine  derivatives,  experiments  with 398 

Removal  to  new  building 68 

Kei)ort  of  (Passed  Assistant  teurgeon  Ucseuau) 373-398 

Research  work  in,  address  by  Assistant  Surgeon-(jleneraU>eddings.   412-415 

St;'.ndard  unit  for  diphtheria  antitoxin 375 

Trematode  parasites  of  man,  bulletin  on 395 

Tuberculosis    . 381 

Typhoid  baccillus  found  in  drinldng  w;iter 381-3S(; 

Yellow   fever '^80 

Zoological  collection 395-396 

I. 

Iloilo,    P.    I.,    report    of   quarantine    transactions    at    (Assistant-Surgeon 

McCoy) 177-180 

Innnigrant.-; ; 

Inspection  of,  at  port  of  Shanghai,  China 188-192 

Medical    inspection   of 193-221 

Medical  inspection  of,  in — 

Canada 21(! 

China    -  220-221 

Hawaii   213 

Italy    217-218 

Japan    219-220 

Philiiipines    213-215 

Porto  Rico 212 

United  States- 
Astoria.  Oreg 197 

Baltimore,  Md 197 

Boston,  Mass 197-203 

Charleston,  S.  C 204 

Eagle  Pass,  Tex 204 

El  Paso,  Tex 205 

Key  West,  Fla —       205 

Laredo.  Tex 20G 

Los  Angeles,  Cal 206 

Malone,  N.  Y 206 

Mobile,  Ala 207 

New  Orleans,  La 207 

New  York.  N.  Y 208 

Nogales,   Ariz 208 

Philadelphia,    Pa 208 

Port  Townsend,  Wash 209 

Richford,  Vt 210 

San  Francisco,  Cal 210 

Seattle,  Wash 211 

Medical  inspection  of,  officers  in  China  and  Japan  instructed  to  exam- 
ine  aliens 195-196 

Stripping  for  examination 193-195 

Immigration  from  Italy 218 

Immigration  service,  aid  to 46 

India : 

Cholera  in '^1 

Tables ^^ 

Detail  of  officers  at  Calcutta  and  Bombay 192 


652  INDEX. 

Page. 
India — Coutinuetl. 

Leprosy  in  (Ac-ting  Assistant  Surgeon  Hume) V.YA 

Plague  in 21 

Tables 78,  70 

"Plague  Investigation"  (Acting  Assistant  Surgeon  Hume) 103 

Inflammation  of  eonneotive  tissue,  neclv,  Ludwig's  angina,  fatal  case,  with 

necropsy  404 

Injuries  and  diseases  treated  during  year  (table) 585-(iol 

Insane,  intestinal  parasites  of  the 304 

Insanitary  dwellings  and  the  rehousing  problem  in  foreign  cities 444 

Inspection  of  immigrants  {sec  also  Immigrants) 18,193-221 

Inspection  of  manufacture  of  vaccine,  etc 371-373 

Inspection  of  stations 45 

International  Congress  of  Hygiene  and  Demography,  report  on   (Passed 

Assistant  Surgeon  Eager) 417—435 

International  Sanitary  Conference  of  Paris,  1003 29,370 

International  Sanitary  Convention  of  American  Rei)ublics 363 

Internes   30 

Intestinal  obstruction,  fatal  cases,  with  necropsies 495-498 

Intestinal  parasites  of  the  insane 394 

Investigation  of  suspected  points  on  Mexican  National  and  Mexican  Gulf 

railroads 291 

Irwin,    Fairfax,    Surg.,    report  on   meeting  of   American    Roentgen   Ray 

Society    405-408 

Isthmian  Canal  Commission: 

Aid    to 18,46 

Physical  examinations  made  for  (table) 583 

{See  also  Panama.) 

Isthmian  Canal  Zone,  quarantine  operations  in 26 

Italy  : 

Emigration   from 218 

Immigration   inspectioii   in 217-219 

Plague  in  (tables) 78 


Jackson,  James  M.,  A.  A.  Surg.,  report  of  P.iscayne  Bay  Quarantine.  Fla__       345 

Jamaica,  yellow  fever  in  (tables) 74,75 

Japan  : 

Cholera  in 71 

Tables 72 

Details  of  officers  at  ports  in 23 

Immigration   inspection  in 219-220 

Plague  in    (tables) 78,80 

Report  of  quarantine  transactions  at — 

Kobe   186 

Nagasaki    185 

Yokohama    185 

Joint  resolution  passed  by  Senate  relative  editions  of  Bureau  publications.       4.">0 
Jolo,    P.    I.,    report   of   quarantine    transactions    at    (Assistant    Surgeon 
Gwyn)    -- 180 

K. 

Kahului,  Hawaii,  quarantine  transactions  at 1.53-155 

Kalloch,  P.  C,  Surg. : 

Report  of  operations  against  smallpox  in  Maine 326-328 

Report  of  Portland,  Me.,  quarantine 320 

Kerr,  J.  W.,  promoted  to  rank  of  passed  assistant  surgeon 35 

Key  West,  Fla. : 

Repairs  and  improvements  to  marine  hospital 66 

Report    of    inunigration    inspection    at    (Pj^ssed    Assistant    Surgeon 

Gardner)     205 

Key  West  Quarantine,  Fla.,  report  of  transactions    (Sanitary  Inspector 
Porter)  341-342 

Kidney,  absence  of  right,  necropsy 500 


INDKX.  658 

Page. 

Kidnoys,  diseases  of,  olironic  iH>pliritis,  fatnl  cmscs,  willi  iiccropsies ^_  4.S1— IS!) 

Kiliei.  Hawaii.  quarMiitiiie  transactions  al 153-15") 

Kiiii,'.  W.  W..  r.  A.  Sui;;.  : 

("liief  (luanititine  ollicer  for  Torlo  Kico 114 

Preliminary  reports  of  Torto  Kico  Ana-niia  Coniniission ;'►(;<;.■ '>7(» 

Promoted  to  rank  of  passed  assistant  siirf^eou 35 

Report  of  innn iteration  inspection  at  San  Juan,  P.  H.,  and  sultports Ulli 

Report  of  (piarantine  transactions  at  San  Juan  and  sui)ports,  P.  R__   lir.-llT 
Kol)e,  Japan  : 

Detail  of  officer  at 23 

Quarantine  at  (Acting  Assistant  Surgeon  Fowler) ISfi 

Report    of    immigration    inspection    at    (Acting    Assistant    Surgeon 

Fowler)    220 

Koloa,  Hawaii,  quarantine  transactions  at 153-155 

Kooslier,  J.  C,  A.  A.  Surg.,  report  of  Sitlca  Quarantine,  Alaslca 355 

Korn.    W.    A.,   Asst.    Surg.,    report  of   innnigration    inspection    at    Pfiila- 
delpbia   208 

li. 

Latmratory  at  Fort  Stanton  : 

Report  of  (Assistant  Surgeon  Trasli ) 5(;-Gl 

Statistics  of  worlc  done  in 54 

Lal»oratory    l)ulietins 374 

Laboratory,  Hygienic.     {Sec  Hygienic  Laboratory.) 

Laboratory,  plague,  San  Francisco,  Cal.,  report  of  (Passed  Assistant  Sur- 
geon   Blue) 1 228 

Labaina,  Hawaii,  quarantine  transactions  at 153-155 

Laredo,  Tex. : 

Border  quarantine,  report  of  transactions  (Acting  Assistant  Surgeon 

Hamilton)    ;15() 

Land  (juarantine  maintained  at 23 

Memorandum  of  ordinance  suggested  to  be  passed  by _• 322 

Ordinances  ])assed  by.  relative  to  prevention  of  yellow  fever 320,324 

Report  of  immigration  inspection  at  (Acting  Assistant  Surgeon  Ham- 
ilton)            200 

Yellow  fever  epidemic  at.      {See  also  Yellow  fever,  Texas  ei)idemic)_  21.73 

Launcli  for  quarantine  service  in  I*bilip|>ines 109 

Lavinder,  C.  IL,  P.  A.  Surg.,  rejwrt  of  Delaware  Breakwater  Quarantine,       331 

Law  clerk  needed  in  tbe  Bureau 31 

Legislation  in  Texas  relative  to  disinfection  against  yellow  fever _.       29(! 

lieprosarium  reconuuended 19 

Leprosy    19 

Leprosy  in — 

Pbilii)pines    108 

Porto    Rico 114-11() 

Sulu  Arcliipelago,  contributed  article  by  Asst.  Surg.  J.  W.  Amosse 455 

Leptomeningitis,  tubercular,  fatal  case,  witb  necropsy 544 

Letter  of  transmittal  to  Congress 13 

I^ewis,  F.  S.,  A.  A.  Surg.,  report  of  Port  Angeles  Quarantine,  Wasli 355 

Lexington,  Va.,  report  on  epidemic  of  tyjiboid  fever  at   (Surgeon  I'erry  ; 

Passed  Assistant  Surgeon  Anderson) 381-38(i 

Liceaga,  E.,  president  superior  board  of  bealtb  of  Mexico,  correspondence 

relative  to  cooperation  witb  United  States  relative  to  yellow  fever 291-290 

Licenses  issued  to  vaccine  and  serum  manufacturers 371-373 

f-ife-Saving  Service: 

Aid  to 18,40 

I'bysical  examinations  made  for  (table) 583 

IJgbt-House  Service: 

Aid  to 18,40 

Pbysical  examinations  made  for  (tal)le) 583 

Lime,  cbloride  of.  as  disinfectant 380-394 

Linley,  AVm.  J..  A.  A.  Surg.,  report  of  Savannab  Quarantine 335-330 

Lippincott,  F.  B.,  A.  A.  Surg.,  report  of  quarantine  transactions  at  Tani- 

pico,    Mexico 119-122 

List  of  i)lague  cases  in  California 230 


654  INDEX. 

Page. 

Liver,  cirrhosis  of.  fatal  caso,  with  necropsy 407 

Livingston,  Guatemahi,  report  of  quarantine  transactions  (Acting  Assist- 
ant Surgeon  Peters) lUS 

Lloyd.  B.  .T..  Asst.  Surg.,  report  of  quarantine  transactions  at  Calhio,  Peru.       146 
Lopez,  Esteban,  A.  A.  Surg.,  report  of  quarantine  transactions  at  Faiardo, 

P.   R 117 

Lord.  C.  E.  D.,  Asst.  Surg. : 

Detailed  to  various  ports  to  instruct  officers  in  methods  of  innuigra- 

tion    inspection 193 

Report  of  immigration  insi)ection  at  San  Francisco 210 

Los  Angeles.  Cal.,  report  of  immigration  inspection  at  (Acting  Assistant 

Surgeon   Ross) 200 

Los  Angeles  Quarantine,  Cal..  report  of  transactions    (Acting  Assistant 

Surgeon   Ross) '•'AS 

Louisiana  I'urchase  Exposition : 

Aid  to  management  of ' .3(J5 

Service  exhibit  at .''>(35,  379 

Louisville,  Ky.,  repairs  and  imi»rovements  to  marine  lu)S])it;il 60 

liUdwig's  angina,  fatal  case,  with  necrojtsy 494 

Lumsden.  Ij.  L..  P.  A.  Surg. : 

Ordered  to  Beaumont,  Tex 263 

Ordered  to  Eagle  Pass,  Tex 265 

Report  of  quarantine  transactions  at  Vera  Cruz,  Mexico 118,120-122 

Lung,  collapse  of  right    (malarial   fever,  remittent,  fatal  case,  with   ne- 
cropsy)           498 

M. 
McCliutic,  T.  B.,  Asst.  Surg. : 

Assigned  to  laboratory  for  instruction , 374 

Study   on   "Chloride  of  zinc   and    'chloride   of   lime'    as   disinfect- 
ants " 38&-394 

McConnell,  E.  F.,  A.  A.  Surg.,  report  of  (luarantine  transactions  at  Xue- 

vitas,   Cuba 109 

McCoy,  G.  W.,  Asst.   Surg.,   report  of  quarantine  transactions  at   Iloilo. 

P.   I 177-180 

McKay,  W.  W.,  A.  A.  Surg.,  report  of  San  Diego  Quarantine.  Cal 346 

McLaughlin,  A.  .L.  Asst.  Surg.,  report  of  Miscellaneous  Division 449-573 

McLean,  C.  R.,  A.  A.  Surg.,  in  charge  at  Koloa,  Hawaii 153-155 

McMahon,  R.  L.,  A.  A.  Surg.,  report  of  quarantine  transactions  at  Cien- 

fuegos,    Cuba 113 

Macaulay,  George,  A.  A.  Surg.,  report  of  St.  Johns  River  Inspection  Sta- 
tion,   Fla 340 

MacGregor,  W.  W.,  A.  A.  Surg.,  placed  on  duty  at  Laredo 283 

Mahukona,  Hawaii,  quarantine  transactions  at l."».3-155 

Maine : 

Assistance  rendered  to,  in  smallpox  work :!2(>-328 

Letter  from  State  Board  relative  to  smallpox  in  that  State 327 

Malarial    fever 380 

Malarial  fever,  remittent,  fatal  case,  with  necropsy   (acute  endocarditis, 

collapse  of  right  lung) 40S 

Malone,  N.  Y.,  report  of  immigration  inspection  at  (Acting  Assistant  Sur- 
geon   Williamson) 200 

Maloney,  J.  B.,  A.  A.  Surg.,  report  of  transactions  at  Key  West  Quaran- 
tine  Station "_ 342 

jMaloney,  James,  A.  A.  Surg.,  in  charge  at  Lahaina,  Hawaii 153-155 

Manila,  P.  I. : 

Additional  launch  for  quarantine  service 109 

Mariveles  Quarantine  Station,  transfer  of 15.5-158 

Report   of   quarantine   transactions    at    (Passed    Assistant    Surgeon 

Heiser)  103-174 

Manila,  P.  I.,  and  subports.  report  of  immigration  inspection  at 213-215 

jMarine  engineers  and  pilots 36 

INIarine  hospitals  and  relief 17 

Report  of  division  of  (Assistant  Surgeon-General  Williams) 45—48 

Statistics  of  ojjerations 17 

Marine  hospitals,  new „-,, .__ ^_,,, 17 


iNUKx.  655 

Page. 

Marino  hospitals,  repairs  and  inii)rovfiiu'nts ()r>-r,H 

Marivolcs  Quarantine  Station,  Manila,  transfer  of ir>r>-158 

Matanzas,  Cuba,  report  of  quarantine  transactions  at   (Acting  Assistant 

Surgeon    Nunez) 107-109 

Mauritis.    plague   in    (tables) 78,80 

Mayaguez,  P.  H.,  (luarantine  transactions  at 117 

Medic.-il  inspection  of  immigrants 18,  1!>.''>-221 

Medic.-il    inspectors ;',() 

-Meetings  of  medical  and  public  health  associations  (sec  uIko  Reports  on 

meetings)    404-44.3 

Memorandum  of  ordinance  suggested  to   be  passed   by   city   council   of 

Laredo    ;522 

Memphis,  Tenn..  repairs  and  improvements  to  marine  liospital GO 

^Merchant  marine,  physical  examinations  of  seamen  (table) .58.3 

Mexican  border,  (piarantine  on 23 

Mexico : 

Cooperation  with  United  States  in  preventing  ycilow  fever 291-29G 

Details  of  oUicers  to  ports  in 23 

Plague    in    (tables) 78 

Quarantine  against,  on  account  of  yellow  fever .307 

Quarantine    operations    in 118-123 

Report  of  quarantine  transactions  at — 

Progreso    119, 123 

Tampico    119, 122 

Vera    Cruz 118, 120-122 

Yellow  fever  in    (tables) 74,75 

Yellow  fever  in  {see  also  Yellow  fever  in  tlie  United  States — Texas 

epidemic)     21 

Yellow  fever  in  State  of  Tamaulipa.< 248 

Mexico-Texas  border  quarantine .324,3.5.5-350 

Military  services  of  Asst.  Surg.  M.  K.  Gwyn 162 

Minera,  Tex. : 

Disinfection  work  against  yellow  fever  at 315-317 

Yellow    fever    at 263 

Miners  of  Pennsylvania,  parasites  of 394 

Miraflures  Island,  P.  R.,  improvements  to  quarantine  station  at 23 

Mii-anda,  R.  U.  L.,  A.  A.  Surg.,  report  of  quarantine  transactions  at  May;i- 

guez,    P.    R '___       117 

Miscellaneous  division,  report  of  (Assistant  Surgeon  McLaughlin) 449-573 

Mississippi  district,  diseases  and  injuries  fronted  in  (table) (506-611 

Mississippi  Medical  Association,  report  on  meeting  of  (Doctor  Stiles) 416 

Mobile,  Ala.  : 

Repairs  and  improvements  to  marine  hospital 66 

Report    of    immigration    in.si)ection    at    (Acting    Assistant    Surgeon 

Thomas)     207 

Mohr,  Herman  B.,  A.  A.  Surg.,  detailed  to  Colon 1.34 

Montan.i.  spotted  fever  in 362 

Monthly  statement  of  expenditures 45 

Moore,  Dunlop,  Asst.  Surg.  : 

Report  of  immigration  inspection  at  Yolvohama,  .Japan 219 

Report  of  quarantine  transactions  at  Yokohama,  .Japan 185 

Mortality  among  patients  from  specific  causes,  comparative  exhibit,  189.5- 

1904   (table)    6.35 

Mortality  among  patients  in  each  district,  rate  of  (table) (i34 

Mortality : 

Causes  of.  among  patients  of  Service  during  year  (table) 6.32-6.34 

Per  100  patients,  by  districts,  1895-19(34   (table) ().35 

Rate  of— 

Among  patients,  from  specific  causes   (table) 034 

At  Rio  de  Janeiro.  Brazil 148-149 

For  smallpox  in  the  I'nited  States 80 

Statistics  of.     (.SVc  Mortuary  statistics.) 
Mortuary  statistics  : 

Cholera  in  foreign  countries 72 

Plague  in  foreign  countries 7('>-80 

Plague  in  San  Francisco  ^^^^-^^-„,_„, 227 


656  INDEX. 

Mortuary  statistics — Continuecl.  Page. 

Plague  in  United  States 70 

Rio  de  Janeiro.   Brazil 148-149 

Santiago,   Cuba 111-113 

Shanghai,    China 191-192 

Mosquito  destruction  at  Laredo,  jilan  itrei)ared  by  lUireau 301 

Mosquito  destruction,  tirst  anti-mosquito  convention 3<il 

Mos(iuito-Exterminating    Convention,    report    on    meeting    of    (Surgeon 
Perry)     404 

Mosquitoes  and  yellow  fever,  paiter  by  Surer.  IT.  P.  Carter 430—443 

Mos(]uitoes : 

Collection  and  identification  of 3C»0 

Destruction  of,  at  Laredo,  Tex 21 

Destruction  of.  conclusions  of  French  Commissinn 402 

Disinfection  against,  at  Laredo,  Tex 30S-310 

Importance  in  causing  yellow-fever  epidemic 21 

Relation  to  yellow  fever 401 

Report  of  French  Yellow  Fever  Commission 399-40.'> 

^■f'linit  Vcnioii.  The.  fruit  steamer,  case  of  yellow  fever  ou 231 

:\Iurray.  R.  D..  Surg. : 

Ordered  to  Laredo,  Tex 2.j2 

•  Death  of   15,289 

X. 

Nagasaki.  Japan  : 

Detail  of  officer  at 23 

Rei)ort  of  quarantine  transactions  at  (Sanitary  Inspector  P.owie) IS.") 

Naples.  Italy : 

Report    of    immigration    inspection    at    (Passed    Assistant    Surgeon 

Eager)    217-219 

Sanitary  improvements  at,  contributed  article  Iiy  P.  A.  Surg.  J.  M. 

Eager    4"' 

National  Association  for  the  Study  and  Prevention  of  Tuberculosis : 

Meeting  of 3Gr» 

Report  of  meeting  of  (Passed  Assistant  Surgeon  Rosenau) 408 

National  quarantine  service 22-25 

National  quarantine  stations,  reix>rts  of  transactions  at 328-350 

Nativities  of  jiatients  treated  in  hospitals  during  the  year  (table) C40 

Neck,    inflammation   of   connective  tissue,    Ludwig's    angina,    fatal    case, 

with   necropsy 494 

Necropsies  of  plague  cases  (San  Francisco) 545-573 

Necropsies,  reiwrts  of : 

Abscess  of  In'ain 4(>8— tG9 

Acute  endocarditis 472 

Acute  endocarditis   (malarial  fever,  remittent) 498 

Acute  pericarditis 472 

Alcoholism 404 

Aneurism  of  the  aorta . 473 

Aorta,  aneurism  of 473 

Beriberi    405 

Brain,  abscess  of 408-409 

Brain,  diseases  of.  and  its  niem!.r;uies 408—171 

Carcinoma  of  palate  and  fauces 499 

Cerebral    hemorrhage 4(»9-471 

Cirrhosis   of   liver 407 

Collapse  of  right  lung  (malarial  fever,  remittent) 498 

Connective  tissue,  neck,  inflanunation  of  (Ludwig's  angina) 494 

Consumption   511 -."•45 

Diseases  of  the  brain  and  its  membranes 40.S-171 

Diseases  of  the  heart  and  great  vessels 472-480 

Diseases  of  the  kidneys,  chronic  nephritis- 481-489 

Empyema  489 

Endocarditis,  acute 472 

Endocarditis,  acute  (malarial  fe\('r.  remittent) 498 

Enteric  fever  ___^ ,.-,--, 490-494 


INDEX.  657 

N«'cropsios,  reports  of — Coiitimicd.  rage. 

Fever,  malarial,  reiiiitteiit.  ariitr  eiidotanlitis,  collapse  of  rij;lit  luiiK--       498 

Heart,  diseases  of,  and  great  vessels 472-480 

Rupture    of 47.'{ 

Valvular  disease  of — aortic  and  luitral 474-481 

Ileiuorrliaf^e,    cerebral 4(i'.)-471 

ruliuoiiary     510 

Hernia,    inj^uinal,   strangulated 495 

Intlaniniation  of  connective  tissue,  neck  (Ludwig's  angina) 494 

Intestinal  obstruction 495-498 

Kidney,  absence  of 500 

Kidneys,  diseases  of,  chronic  nephritis 481^89 

Leptonieninj^itis,   tubercular 544 

Liver,  cirrhosis  of 4G7 

Ludwif^'s  angina   (inttauimation  of  connective  tissue,  neck) 494 

Lung,  collapse  of  (malarial  fever) 498 

Malarial  fever,  remittent,  acute  endocarditis,  collapse  of  right  lung__       498 

Neck,  inflammation  of  connective  tissue  (Ludwig's  angina) 494 

New  growth,  malignant,  carcinoma  of  palate  and  fauces 499 

Pancreas,  new  growth  of 497 

Pericarditis,   acute 472 

Pneumonia 500-510 

Psoas   abscess 544 

Pulmonary   hemorrhage 510 

Pytemia    511 

Rupture  of  the  heart 47.'' 

Tubercular    leptomeningitis 544 

Tuberculosis    (lungs) 511-545 

Valvular  disease  of  heart — aortic  and  mitral 474-481 

Volvulus  49<; 

Necropsy  report  of  plague  cases 227 

Necropsy  reports,  circular  letter  relative  to  preparation  of 449 

Nephritis,  chronic,  fatal  cases,  with  necropsies 4.S1-489 

Newbern,  N.  C,  no  quarantine  transactions  at 335 

New  building  for  Hygienic  Laboratory 27 

New  Caladonia,  plague  in  (tables) 78 

New  growth,  malignant,  carcinoma  of  palate  and  fauces,  fatal  case,  with 

necropsy 499 

New  growth  of  pancreas,  fatal  case,  with  necropsy 497 

New   hospitals 04 

New  Orleans,  La. : 

Repairs  and  improvements  to  marine  hospital 00 

Report  of  immigration  inspection  at  (Surgeon  Wertenbaker) 207 

New  Mexico,  Fort  Stanton,  sanatorium  for  consumptive  seamen  at 17.47-01 

New  York.  N.  Y. : 

Repairs  and  improvements  to  marine  hospital 07 

Report  of  immigration  inspection  (Surgeon  Stoner) 208 

New  Zealand,  plague  in  (tables) SO 

Nicaragua,  reix)rt  of  quarantine  transactions  at  Bluefields 132 

Nitrites,  experiments  with 397 

Nogales,  Ariz.,  report  of  immigration  inspection  at  (Acting  Assistant  Sur- 
geon Gustetter)   208 

Noncommissioned  officers  of  Service 30 

Nuevitas,  Cuba,  report  of  quarantine  transactions  at   (Acting  Assistant 

Surgeon   MeConnell) 109 

Nuevo  Laredo.  Mexico,  inspection  of 324 

Number  of  officers  in  commissioned  corps 35 

Number  of  patients  treated  during  year,  by  districts 584 

Number  of  seamen  treated  annually,  1808-1904,  comparative  table 577 

Nunez,  E.  F.,  A.  A.  Surg.,  report  of  quarantine  transactions  at  Matanzas, 

Cuba 107-109 

Nydegger,  J.  A..  P.  A.  Surg.,  contributed  article.  "Catheter  in  bladder — re- 
moval through  perineum" 403 

8629—04 42 


658  INDEX. 

O.  Page. 

Oakley.  J.  H..  P.  A.  Surg. : 

Report  of  immigration  inspection  at  Port  Townsend,  Wash 209 

Report  of  Port  Townsend  Quarantine,  Wash 353 

Officers  : 

Detailed  for  inspection  of  immigrants 193 

Detailed  to  foreign  ports 23 

Detailed  to  meetings  of  medical  and  health  associations 38 

Details  of,  to  Panama  and  Colon 134 

Noncommissioned    36 

Number  of,  in  Service 35 

Ohio  district,  diseases  and  injuries  treated  in  (table) 000-605 

Oliver,  Robert  S.,  Acting  Secretary  of  War,  correspondence  relative  trans- 
fer Mariveles  Quarantine  Station 155-158 

Operations  at  national  quarantine  stations   (see  Quarantine  administra- 
tion,   domestic) 328-356 

Operations  of  Service,  fiscal  year  1904   (table) 578-582 

Operations,  surgical,  during  year  (table) 6.36-639 

Ordinance  passed  by  city  of  Laredo 319,324 

Osterhout.  Paul,  A.  A.  Surg.,  report  of  quarantine  transactions  at  Bocas 

del    Toro 129-1.30 

Other  services,  aid  to 18.40 

P. 

Pacific  district,  diseases  and  injuries  treated  in  (table) 620-627 

I'acific  Islands  district,  diseases  and  injuries  treated  in  (table) 028-630 

Palermo,   Italy,   report  of  immigration   inspection   at    (Passed  Assistant 

Surgeon  Eager) 217-219 

Panama  Canal.     {See  Panama.) 

Panama   Canal   Zone 26 

Panama,  Panama  : 

Assistant  Sui'geon  Pierce  appointed  health  officer  at  port  of 141 

Panama,  Republic  of: 

Bills  of  health  for  vessels  bound  for,  to  be  signed  by  Service  officers.  135-137 

Detail  of  officers  to  Colon  and  Panama 134 

Detail  of  Surgeon  Carter  for  duty  under  Canal  Commission 142 

Goods  destined  for  Panama  disinfected  and  inspected  at  Hongkong, 

China    187 

Quarantine  regulations  of 136 

liecouimendation  that   incoming  quarantine  be   placed   in   hands  of 

Service    137-140 

Report  of  quarantine  transactions  at — 

Bocas  del  Toro 129-130 

Colon    143 

Panama    ^ 144 

Republic  of  Panama,  requests  assistance  of  Service  officers 134 

Surgeon   Perry  and  Assistant  Surgeon   Pierce  ordered  to  report  to 

Canal   Connnission 142 

Yellow  fever  in  (tables) 75 

Pancreas,  new  growth  of,  fatal  case,  with  necroiwy 497 

Pancreatitis,   chronic,  with   induration,   contributed  article  by   Assistant 

Surgeon  Bahrenburg 451 

Papers : 

Research  work  in  the  Hygienic  Laboratory,  by  Assistant  Surgeon-Gen- 
eral Geddings 412-415 

What  the  medical  profession  can  do  for  the  Public  Health  and  Marine- 
Hospital  Service,  by  Surgeon-General  Wyman 408-411 

Parasites  of  Pennsylvania  miners 394 

Paris,  International  Sanitary  Conference  of 29,370 

Parker,  H.  B.,  P.  A.  Surg.,  chairman  Working  Party  No.  2 359 

Pascagoula   Quarantine,  Mi.ss.,  report  of  transactions    (Acting  Assistant 

Surgeon  Duke) 345 

Pasteur  Institute  Commission  on  yellow  fever  and  the  mosquito 275 

Pathologic  specimens  examined  in  Hygienic  Laboratory 378 


INDEX.  G59 

IVirco,  Hon.  II.  II.  I)..  Assistant  Scci'ctar.v  of  Stiilo,  lottor  (o  consuls  rc>- 
(lut'sting  data  concerning  vacation  of  insanitary  dwellings  in  foreign 
cities   44r> 

I'tMuisylvania  miners,  i)ar:isites  of .'{!)4 

rens.uoia,  Fla..  (luarantine  measures  at,  against  yellow  fever 230-2.'W 

rericanlitis,  acute,  fatal  case,  with  necropsj' 472 

Terry,  J.  C\.  Surg. : 

Assigned  to  laboratory  for  instruction ;{74 

Detailed  to  Colon i:}4 

Detailed  to  Mosquito  ExteiMuination  Convention,  New  York 38 

Ordered  to  report  to  Canal  Commission 142 

Promoted  to  rank  of  surgeon 3.") 

Report  on  meeting  of  Mosipiito  Extermination  Convention 404 

Report  of  quarantine  transactions  at  Colon,  Panama . 143 

Report  on  typhoid-fever  epidemic  at  Lexington,  Va .'}81-3S() 

Persia,  plague  in   (tables) 80 

Personnel  and  accounts,  report  of  division  of  (Assistant  Surgeon-Gen- 
eral  Geddings)    85-42 

Personnel   of  service 15,  3r)-37 

Peru  : 

Plague  in   (tables) 78,80 

Rejmrt  of  quarantine  transactions  at  Callao 14(1 

Peters,  R.  II..  A.  A.  Surg.,  report  of  quarantine  transactions  at  Living- 
ston,  Guatemala    128 

Petroleum,  use  of,  in  water  barrels  and  cisterns 2."»T 

Pettus,  W.  J.,  Asst.  Surg.  Gen. : 

Report  of  division  of  foreign  and  insular  quarantine 105-221 

Report  of  sanitary  board  on  Texas-Mexican  border  inspection  service.       302 
Report  of  sanitary  board  relative  to  yellow-fever  preventive  meas- 
ures           293 

Pharmacists    16,36 

Pharmacology : 

Division  of,  in  Hygienic  Laboratory 27 

Chief  of.  ajipointed 36 

Report  of  division  of  (Doctor  Hunt) 397-398 

Philadelphia,  Pa. : 

Rei)airs  and  improvements  to  marine-hospital  office <'«7 

Report  of  immigration  inspection  at  (Assistant  Surgeon  Korn) 208 

Philippines  : 

Additional  launch  for  quarantine  service  in 160 

Cholera  at  Cebu 176 

Cholera  in   (tables) 71.72 

Cholera  stamped  out 105-167 

Commutation  for  quarters  to  olHcers  stationed  in 159-161 

Financial  statement  of  quarantine  service  in 181-184 

Immigration  inspection  in 213-215 

Instructions  to  officers,  in  Orient  to  cooperate  with  chief  quarantine 

officer    161 

Interisland  quarantine  1(>9 

Leprosy    in KiS 

Mariveles  quarantine  station,  transfer  of 155-158 

Personnel  of  service  in 164 

Plague    in Kw 

Plague  in    (tables) 78.80 

Quarantine  regulations  for  vessels  engaged  in  interisland  trade 169-172 

Report  of  quarantine  transactions  at — 

Cebu    175-177 

Iloilo  177-180 

Jolo   180 

Manila  and  subports 163-174 

Sanitary  conditions  in 163-174 

Smallpox   in - 167 

Vessels  bound  to,  from  United  States  not  required  to  carry  bills  of 
health    158 

Physical  examinations  made  by  Service  officers  (table) 583 


660  INDEX. 

Page. 

Physical  examinations  of  merchant  seamen 40 

Pierce,  Claude  C,  Asst.  Surg. : 

Appointed  health  officer  of  port  of  Panama 141 

Detailed  to  Panama 134 

Ordered  to  rejwrt  to  Canal  Commission 142 

Report  of  quarantine  transactions  at  Panama 144 

Pilots  and  marine  engineers .30 

Pilots,  physical  examination  of  (table) 583 

Pittsburg.  Pa. : 

New  hosi)ital  at • 17 

Transfer  of  site  for  new  hospital  at 04 

Piza,  J.  T.,  A.  A.  Surg.,  report  of  quarantine  transactions  at  Arroyo,  P.  It-       117 
Plague : 

E.xamination  in  laboratory  of  suspected  cases 379 

Case  of,  In  Contra  Costa  County,  Cal 229 

Foreign    countries 20,  70-80 

International  Sanitary  Conference  at  Paris 29,370 

Plague  in — 

Philippines    107 

San   Francisco,  Cal 22J3-230 

Cooperation  of  health  authorities  in  overcoming 22.5-22() 

Laboratory  report  of  rats  examined 228 

Method  of  transmission 229 

Necropsy  report  , 227 

Relations  with  State  and  city  authorities 229 

Report  of  Passed  Assistant  Surgeon  Blue 227-230 

Sanitary  measures   228 

Tables  of  cases 2.30 

Types  of  the  disease 227 

Shanghai,   China   191-102 

Rio  de  Janeiro,  Brazil 151 

Plague  necropsies    (San  Francisco) 545-573 

Plague  tables : 

Foreign  countries  70-80 

United  States 20,75.70 

Plan  of  operations  to  prevent  recrudescence  of  yellow  fever  at  Laredo. 

Tex    299-.303 

Pneumonia,  fatal  cases,  with  necropsies 500-510 

Ponce,  P.  R. : 

Report    of    immigration    inspection    at    (Acting    Assistant    Surgeon 

Torres) 212 

Report    of    quarantine    transactions    at    (Acting    Assistant    Surgeon 

Torres) 118 

Porras,  Manual,  yellow-fever  victim,  case  of 319 

Port  Angeles  Quarantine,  Wash.,  report  of  transactions   (Acting  Assist- 
ant Surgeon  Lewis) '555 

Porter,  J.  Y.,  Sanitary  Inspector,  report  of  Key  West  Quarantine 341-342 

Portland,  Me.,  repairs  and  Improvements  to  marine  hospital 07 

Portland  Quarantine,  Me.,  report  and  statistics  of  (Surgeon  Kalloch) —       329 
Port  Llmon,  Costa   Rica,   report  of  quarantine  transactions  at    (Acting 

Assistant  Surgeon  Gruver;  Acting  Assistant  Surgeon  Goodman) 125-127 

Port  Townsend,  Wash. : 

Repairs  and  Improvements  to  marine  hospital 07 

Repoi't  of  immigration  inspection  at  (Passed  Assistant  Surgeon  Oalv- 

ley)    209 

Port  Townsend  Quarantine,  Wash.,  report  of  transactions  (Passed  Assist- 
ant Surgeon  Oakley) -^53 

Porto  Rico  Antemia  Commission,  reports  of.  etc.   (Passed  Assistant  Sur- 
geon King)    .3(!0-370 

Porto  Rico : 

Immigration  inspection  in 212 

Leprosy  in 114-110 

Quarantine  transactions  In 114-118 

Report  of  quarantine  transactions  at — 

Ponce 118 

San  Juan  and  subports 116-117 


INDEX.  ()()1 

Pago, 
rost-opidoiiiio  work  at  Laivdo,  Tex,  otc 291 

rrovoiitiiit,'  rocriKlt'sct'iico  of  yollow  fever  .it  Lareilo '2U8-li0li 

rrintiiij;  Itiireau  imhlicnlioiis.  resolution  passed  l>y  Senate 450 

Proclamation   raisini;  (juarantine  aj^ainst    Laredo 320 

Prof^reso,  Mexico,  ie|)ort  of  (luarantine  transactions  at   (Actinj?  Assistant 

Sur>,'tH)n    Harrison) 119,123 

Psoas  abscess,  fatal  case,  with  necropsy 544 

Public  Ilealtli  and  .Marine  lIos|tital  ai)pr()priati()n,  expenditures,  etc IG,  19 

Pnbiic-liealtli  f(\iture  of  the  S«'rvice  work 29 

I'ublications  of  the  Service: 

Restrictions   ujion 31 

liesohition  passed  by  Senate  relative  to 450 

Puerto  Cortez,  Honduras: 

lvei)ort    of    (luarantine    transactions    at    (Acting    Assistant    Surgeon 

Carter)  127 

Sanitary  condition  of 128 

I*uInionary  lieniorrhaji:e,  fatal  case,  with  necropsy 510 

Purveyinj:;  d(M)ot,  New  York  : 

Keport  of  medical  purveyor  (Surgeon  Sawtelle) 02-G3 

Transactions    at 17 

Pyjeniia,  fatal  case,  with  necropsy 511 

Q- 

Quarantine  administration,   domestic 328-356 

Report  of  division  of  (Assistant  Surgeon-General  Gleunan) 225-35G 

Report  and  statistics  of  transactions  at — 

Alexandria  Quarantine,  Va 333 

Blscayne  Bay  Quarantine,  Fla 345 

Boca  Grande  Quarantine,  Fla 343 

Brunswick  Quarantine,  Ga 338 

Cape  Charles  Quarantine,  Va 333 

Cape  Fear  Quarantine,  N.  C 334 

Carrahelle  Quarantine,   Fla 343 

Cedar  Keys  Quarantine,  Fla 343 

Columbia  River  Quarantine,  Oreg-_"___- 350-352 

Cumberland  Sound  Quarantine,  Fla 340 

Delaware  Breakwater  Quarantine,  Del 331-332 

Eastport  Quarantine,  Me 330 

El  Paso  Border  Quarantine,  Tex 35G 

Eureka  Quarantine,  Cal 350 

Gulf  Quarantine,  Miss ' 345 

Hoquiam  Quai-antine,  Wash 352 

Key  West  Quarantine,  Fla 341-342 

Laredo  Border  Quarantine,  Tex 35G 

Los  Angeles  Quarantine,  Cal 348 

Pascagoula  Quarantine,  Miss 345 

Pensact)la  Quarantine,  Fla 344 

Port  Angeles  Quarantine,  Wash 355 

Port  Townsond  Quarantine,  Wash 353 

Portland  Quarantine,   Me 329 

Punta  Gorda  Quarantine,  Fla 343 

Reedy  Island  Quarantine,  Del 330 

San  Diego  Quarantine,  Cal 34G-348 

San  Francisco  Quarantine,  Cal 349 

St.  George  Sound  Quarantine.  Fla 343 

St.  Johns  River  Quarantine,  Fla 340 

Santa  Rosa  Quarantine,  Fla 344 

Savannah  Quarantine,  Ga 335-336 

Seattle  Quarantine,  Wash 354 

Sitka  Quarantine,  Alaska ;^55 

South  Atlantic  Quarantine,  Ga H37 

Southbeud  Quarantine,  Wash 354 

Tampa  Bay  Quarantine,  Fla 339 


662  INDEX. 

Page. 
Quarantine  administration,  foreign  and  insular : 

Cuba    105-114 

Philippine  Islands,  financial  statement 181-184 

Report  of  division  of  (Assistant  Surgeon-General  Pettus) 105-221 

Report  (jf  transactions  at — 

Belize,   British   Honduras 133 

Bluefields,   Nicaragua 132 

Bocas  del  Toro,  Panama 129-130 

Callao,    Peru 146 

Cebu,  P.  I - 175-177 

Ceiba,   Honduras 130-132 

Cienfuegos,   Cuba 113 

Colon,   Panama 143 

Guayaquil.  Ecuador 145 

Habana,  Cuba 105-107 

Hongkong,  China 18G-188 

Honolulu  and  subports,  Hawaii 153-155 

Iloilo,  P.  I 177-180 

Jolo,  P.  I 180 

Kobe,  Japan 18G 

Livingston,   Guatemala 128 

Manila  and  subports,  Philippine  Islands 163-174 

Matanzas.  Cuba 107-109 

Nagasaki,    Japan 185 

Nuevitas,  Cuba 109 

Panama    144 

Ponce,  P.  R 118 

Port  Limon,  Costa  Rica 125-127 

Progreso.    Mexico 119,  123 

Puerto  Cortez,   Honduras 127 

Rio  de  Janeiro,  Brazil 147-152 

San  Juan,  P.  R.,  and  subports 116-117 

Santiago,   Cuba 109-113 

Shanghai.    China 188-192 

Tampico,   Mexico 119, 122 

Vera  Cruz,  Mexico 118,120-122 

Yokohama,  Japan   185 

Quarantine  against  Laredo,  Tex 318 

Quarantine  against  Laredo,  Tex.,  raised 291,320 

Quarantine  deficiency  appropriation 16 

Quarantine  fund,  expenditures  on  account  of 16 

Quarantine  in  insular  possessions 23 

Quarantine  on  Texas-Mexico  border 355-356 

Quarantine  regulations,  amendments  to.  on  account  of  yellow  fever 328 

Quarantine  regulations  issued  l>y  Panama  Government 134 

Quarantine  service : 

Appropriation  for  and  expenditures  therefrom 40-41 

The  national 22-25 

Quarantine  stations  : 

Circular  letter  directing  monthly  report  on  naphtha  launches,  etc 329 

Transactions  at 328-356 

Statistics  of  (see  also  Statistics) 328 

Quarantine  steamers,  boards  in  relation  to 38 

Quarantine,  table  of  diseases  and  injuries  treated  at (^'U 

Quebec,  Canada,  report  of  immigration  Inspection  at  (Assistant  Surgeon 

Billings)    216 

Quinine  derivatives,  experiments  with 398 

R. 

Railway  cars,  sanitation  of 403 

Ramus,  C,  promoted  to  rank  of  passe<t  assistant  surgeon 35 

Ransom,  S.  A.,  A.  A.  Surg.,  report  of  quarantine  transactions  at  Shanghai, 

China    188-192 

Ratio  of  deaths  from  specific  causes : 

Among  Service  patients  (table) 634 

Comparative  exhibit,  1895-1904    (table) 635 


INDEX.  C^^u^ 

I'ftge. 

Ratio  of  (loaths  in  oarli  district.  Sorviro  patients  (tal)le) <i^54 

Ratio  of  patients  tn'at(>(l  in  oacli  district  (tai)l('l ^ ~>M 

RiHripts  and  expenditures .'{9 

Roody  Island  Quarantine,  Del.,  reix)rt  of  transactions  (Passed  Assistant 

Surgeon    Wiclces) 330 

I{eli()usin,ic  problem  in  foreign  cities .  444-445 

Keilley.  W.  II.,  A.  A.  Surj;..  report  of  quarantine  transactions  at  Rlue(ields_       132 

Keinstatenient  of  employees,  circular  letter  relative  to 41 

Relief  of  seamen 45 

Repairs  and  improvements,  marine-hospital  plants (15-08 

Report  of  division  of — 

Domestii- (piaraiitine  (Assistant  Surseon-(Jeneral  (Jlennan) 225-35(5 

Foreii^n  and  insular  (pinrantine  (embracint;  medical  inspection  of  im- 

miijrants)    (Assistant  Sui'jieon-General  I'ettus) 1(>5-221 

Marine  hospitals  and  relief  (Assistant  Suri^eon-Cieneral  Williams) 45-(!8 

Miscellaneous   (Assistant  Sursjeon  McLausldin) 449-573 

rersonnel  and  Accounts  (Assistant  Surseon-General  Geddings) 35-42 

Pharmacology.  Ily.gienic  Laboratory  (Doctor  Hunt) .397-.398 

Sanitary      reports      and      statistics      (Assistant      Surgeon  -  General 

Vaughan)     71-1(J1 

Scientific  research  and  sanitation    (Assistant  Surgeon-General   Ged- 
dings)    , 3.59-445 

Zoology.  Hygienic  Laboratory  (Doctor  Stiles) 394-397 

Reports  of  fatal  cases,  with  necropsies.     (See  Necropsies,  reports  of.) 

Reitort  of  Fort  Stanton  laboratory  (Assistant  Surgeon  Trask) 5(5-61 

Reports  of  necropsies,  circular  letter  relative  to  prepai-ation  of 449 

Report  of  inspection  of  immigrants.     {See  Immigrants,  medical  Inspection 

of.) 
Report  on  meeting  of — 

American  Medical  Association  by — 

Asst.  Surg.  Gen.  G.  T.  Vaughan 411 

Asst.  Surg.  Gen.  H.  D.  Geddings 412-115 

Surg.  P.  M.  Carrington 415 

P.  A.  Surg.  M.  J.  Rosenau 415 

American  Roentgen  Ray  Society,  l)y  Surg.  Fa.irfax  Irwin 40.")-4(iS 

Association  of  American   Bacteriologists,  by  P.  A.   Surg.   M.   J.   Ro- 
senau         405 

Eleventh    International    Congress   of   Hygiene   and   Demographv,    bv 

P.  A.  Surg.  J.  M.  Eager 417-435 

Mississippi  State  Medical  Association,  by  Doctor  Stiles 410 

Mosquito-Exterminating  Convention,  by  Surg.  J.  C.  Perry 404 

National  Association   for  Study  and  Prevention  of  Tuberculosis,  by 

P.  A.  Surg.  M.  J.  Rosenau 408 

Texas  Medical  Association,  by  Surg.  H.  R.  Carter 4.35-443 

Reports  of  officers  detailed  to  represent  the  Service  at  meetings  of  various 

associations : 404—443 

Report  of  operations  against  smallpox  in  Maine  (Surgeon  Kalloch) .320-.328 

Report  of  purveying  depot.  New  York  (Surgeon  Sawtelle) (j2-03 

Report  of  quarantine  transactions  (domestic)  at — 

Alexandria  Quarantine.   Va -333 

Biscayne  Bay  Quarantine 345 

Boca  Grande  Quarantine,  Fla 343 

Brunswick    Quarantine.   Ga -3.38 

Cape  Charles  Quarantine,  Va 333 

Cape  Fear  Quarantine,  N.  C 3.34 

Carrabelle  Quarantine.  Fla 343 

Cedar  Keys  Quarantine.  Fla 343 

Columbia  River  Quarantine,  Greg 350-352 

Cumberland  Sound  Quarantine.  Fla ? .340 

Delaware  Breakwater  Quarantine .331-3.32 

Eastport  Quarantine.   Me .3.30 

El  Paso  Border  Quarantine,  Tex 350 

Eureka  Quarantine.  Cal 350 

Gulf  Quarantine.  Miss 345 

Hoquiam  Quarantine.  Wash 352 

Key  West  Quarantine,  Fla 341-342 


664  INDEX. 

Report  of  quarantine  transactions  (tloniestit)   at — Continued.  Page. 

Laredo  Border  Quarantine,  Tex 3r)(! 

Los  Angeles  Quarantine,  Cal 34S 

Pascagoula  Quarantine,  Miss 34.5 

Pensacola  Quarantine,  Fla 344 

Port  Angeles  Quarantine,  Wash 355 

Port  Townsend  Quarantine,   Wash '■ 353 

Portland  Quarantine.  IMe 329 

Punta  Gorda  Quarantine,  Fla 343 

Reedy  Island  Quarantine,  Del --       3.30 

San  Diego  Quarantine,  Cal 346-348 

San  Francisco  Quarantine,  Cal 349 

St.  George  Sound  Quarantine,  Fla ■ 343 

St.  John's  River  Quarantine,  Fla 340 

Santa  Rosa  Quarantine,  Fla 344 

Savannah  Quarantine,  Ga .335-3.36 

Seattle  Quarantine,  Wash 354 

Sitka,    Alaska 355 

South  Atlantic  Quarantine,  Ga 337 

Southhend  Quarantine,  Wash 354 

Tampa  Bay  Quarantine,  Fla 339 

Report  of  quarantine  transactions  (foreign  and  insular)  at — 

Belize,  British  Honduras 133 

Blueflelds,    Nicaragua 132 

Bocas  del  Toro,  Panama 129-130 

Callao,   Peru 146 

Cehu,  P.  I 175-177 

Ceiha,    Honduras 130-132 

Cienfuegos,    Cuba 113 

Colon,   Panama 143 

Guavaquil,    Ecuador 145 

Habana.    Cuba 105-107 

Hongkong,   China 186-188 

Honolulu  and  subports,  Hawaii 153-155 

Iloilo,  P.  I 177-180 

Jolo,  P.  I 180 

Livingston,   Guatemala 128 

Manila  and  subports,  P.  I 10.3-174 

Mantanzas,   Cuba 107-109 

Nagasaki,    .Japan 185 

Nuevitas,  Cuba 109 

Panama,   Panama 144 

Ponce,  P.  R 118 

Port  Limon,  Costa  Rica 12.5-127 

Progreso,  Mexico 119-123 

Puerto  Cortez,  Honduras 127 

Rio  de  Janeiro,  Brazil 147-152 

San  .Juan,  P.  R.,  and  subports 116-117 

Santiago,   Cuba _• 109-113 

Shanghai,    China 188-192 

Tampico,   Mexico 119, 122 

Vera  Cruz,  Mexico 118,120-122 

Yokohama,   Japan 185 

Report  of  sanatorium  for  consunq)tives  at  Fort  Stanton,  Ity  Surg.  P.  M. 

Carrington    47-61 

Report  of  Surgeon-General  to  Secretary 15-31 

Report  on — 

Yellow-fever  epidemic  in  Texas  (Surgeon  Guiteras) 303-320 

Yellow-fever  operations  in  Texas  (Passed  Assistant  Surgeon  Richard- 
son   •- 320-325 

Research  work  in  the  Hygienic  Laboratory,  address  by  Assistant  Surgeon- 
General    Geddings 412-415 

Resolution  passed  by  city  council  of  Laredo  requesting  Service  to  take 

charge  of  yellow-fever  work 320 

Resolutions  of  confidence  in  plague  measures  in  force  in  San  Francisco —       365 

Resolutions  relative  to  plague,  cooperation  of  authorities 225 


\ 


INDEX.  665 

rJi'vciuu'-Cuttor  Sorvif'o.  Pajio. 

Aid   to 10,  1S,4(! 

Physical  oxaininutioiis  iiiailo  for   (table) 583 

Richardson,  T.  K..  I*.  A.  Surg. : 

Detailed  to  Conference  of  State  and  County  Ilcaltli  Ollicers  of  Texas 

at  Austin,  'IVx 1 38 

Letter  relative  to  measures  for  quarantine  protection  of  Gulf  coast 

against  yellow    fever 237 

Ordered  to  return  to  Laredo.  Tex '2'Ai 

Promoted  to  rank  of  passed  assistant  surgeon 35 

Report  on  imijracticaliility  of  thorough  disinfection  of  vessels  at  Tani- 

pico  and  other  ports 238-240 

Report  of  operations  against  yellow  fever  at  Laredo,  Tex .■520-325 

Richford,  Vt.,  report  of  inmiigration  inspection  at  (Acting  Assistant  Sur- 
geon   Hamilton) 210 

Riggs,  Herbert  W.,  A.  A.  Surg. : 

Detailed  to  Vancouver,  British  Columbia,  for  examination  of  immi- 
grants  -       193 

Report  of  immigration  inspection  at  Vancouver,  British  Columbia 210 

Rio  de  Janeiro,  Brazil : 

Report    of    quarantine    transactions    at    (Acting    Assistant    Surgeon 

Stewart)    147-152 

Sanitary  condition  of 148 

Work  of  French  Yellow  Fever  Commission  at : 399-403 

Robertson,  W.  B.,  A.  A.  Sui'g.,  report  of  quarantine  transactions  at  Ceiba, 

Honduras 130-132 

Robinson,  D.  E..  promoted  to  rank  of  passed  a.ssistant  surgeon '       35 

Roentgen  Ray  Society,  report  on  meeting  of  (Surgeon  Irwin) 405-408 

Rosello,  M.  M.,  A.  A.  Surg.,  report  of  quarantine  transactions  at  Arecibo, 

P.  R 117 

Rosenau,  M.  J.,  P.  A.  Surg.,  Director  of  Hygenic  Laboratory: 

Appointed  chairman  Working  l*arty  No.  2 359 

Detailed  to  meeting  Society  of  American  Bacteriologists  at  Philadel- 
phia ;  meeting  of  tuberculosis  eouimittee  at  Philadelphia  ;  meeting 
International  Sanitary  Association  for  Study  and  Prevention  of 
Tuberculosis  at  Atlantic  City ;  meeting  American  Medical  Associa- 
tion at  Atlantic  City 38 

Report  of  Hygienic  Laboratoi'y 373-398 

Repoi't  on  meeting  of  American  Medical  Association 415 

Report  on  meeting  of  Association  of  American  Bacteriologists 405 

Report  on  meeting  of  National  Association  for  Study  and  Prevention 

of  Tuberculosis 408 

Report  of  sanitary  board  on  Texas-Mexican  border  inspection  service-       302 
Ross,  M.  H.,  A.  A.  Surg. : 

Report  of  immigration  inspection  at  Los  Angeles,  Cal 200 

Report  of  Los  Angeles  Quarantine,  Cal 348 

Rupture  of  the  heart,  fatal  case,  with  necropsy 473 

Russell,  H.  C,  Asst.  Surg.,  death  of 35 

Russia,  plague  iu  (tables) 80 

S. 

Safford,  M,  V.,  A.  A.  Surg.,  report  of  immigration  inspection  at  Boston, 
Mass   197-203 

St.  Geoi'ge's  Sound  Quarantine,  Fla.,  report  of  transactions  (Acting  Asst. 

Surg.  E.  L.  Stewart) 343 

St.  Johns  River  inspection  station,  Fla.,  report  of  transactions    (Acting 
Assistant  Surgeon  Macaulay) 340 

St.  Louis,  Mo.,  repairs  and  improvements  to  marine  hospital 07 

Sams,  F.  F.,  A.  A.  Surg.,  report  of  immigration  inspection  at  Charleston, 
S.  C 204 

San  Diego  Quarantine,  Cal.,  repoi't  of  transactions  (Acting  Assistant  Sur- 
geon xMcKay) 340-348 

San  Francisco,  Cal. : 

Plague  in  {see  also  Plague) 20,225-230 

Plague  in  (tables) 70 

Plague  necropsies 545-573 


666  INDEX. 

Page. 
San  Francisco.  C.al. — Continued. 

Repairs  and  improvements  to  marine  hospital <>7 

Iteport  of  immigration  inspection  at  (Assistant  Surgeon  Lord) 210 

San  Francisco  Quarantine,  Cal.,  report  ot  transactions  (Passed  Assistant 

Surgeon   Cummings) 349 

San  Juan,  P.  R.,  and  subports,  report  of  immigration  inspection  at  (Passetl 

Assistant  Surgeon  King) 212 

San  .Juan.  P.  R..  report  of  quarantine  transactions  (Passed  Assistant  Sur- 
geon King) 110-117 

Sanatorium  for  c-onsumptives,  Fort  Stanton.  \.  Mex..  report  of  Surg.  P.  INI. 

Carrington    IT.  47-<;i 

Sanitary  board : 

Report  relative  inspection  service  on  Texas-Mexico  border 302 

Report    relative   measures   to   be   prosecuted   by    United    States   and 

Mexico  to  prevent  recurrence  of  yellow  fever ^ 293 

Sanitary  conference  at  Paris 29 

Sanitary    conferences 28 

Sanitary  Convention  of  American  Republics  postponed 29,303 

Sanitary  improvements  at  Naples,  contributed  article  by  P.  A.  Surg.  J.  M. 

Eager    458 

Sanitary    inspectors 30 

Sanitary  reports  and  statistics,  report  of  division  of  (Assistant  Surgeon- 
General  Vaugbau)  71-101 

Sanitary  technology,  di.scusslon  of,  at  Brussels  Congress 419.422 

Sanitation    20 

Sanitation  and  scientific  research,  report  of  division  of   (Assistant  Sur- 
geon-General   Geddings) .3.^9-445 

Sanitation  of  railway  coaches 377,  4().'i 

Santa  Rosa  Quarantine,  Fla.,  report  of  transactions    (Acting  Assistant 

Surgeon    White) 344 

Santiago.  Cuba,  report  of  quarantine  transactions  (Acting  Assistant  Sur- 
geon   Wilson) 109-113 

Savannah.  Ga..  new  hospital  at 17.  &4 

Savannah  Quarantine.  Ga..  report  of  transactions  (Acting  Assistant  Sur- 
geon   Linley) 3.3.")-330 

Sawtelle.  Henry  W..  Surg.,  report  of  purveying  depot 02-03 

Scientific    research,  report    of    division    of    (Assistant    Surgeon-General 

Geddings)     .39.y44o 

Alcohol,  experiments  with 397 

Bulletins  of  the  Hygienic  Laboratory 374 

Chloride  of  zinc  and  chloride  of  liuse  as  disinfectants 38(5-394 

Dengue,  recommendation  for  commission  to  study 381 

Disinfectants   and  germicides 379 

Drugs,  examination  of 398 

Etiology  of  yellow  fever 359 

Examination  of  drugs  and  chemicals 379 

Findings  of  Working  Party  No.  2 359 

Hookworm    disease 381 

Hygienic  Laboratory.     (Sec  Hygienic  Laboratory.) 

Lal)oratory  course  for  student  otticers 374 

Mosquitoes,  collection  and  identification  of 300 

Nitrales.  experiments  with 397 

Parasites  of  Pennsylvania  miners 394 

Plague,  international  conference  relative  to.  at  Paris 370 

Quinine  derivatives,  experiments  with 398 

Sanitation  of  railway  coaches  and  sleepers 403 

Spottetl  fever  in  Montana 302 

Standard  unit  for  dii)htheria  antitoxin 375 

Tapeworm,  work  relative  to 395 

Trematode  parasites  of  man,  bulletin  on 395 

Tuberculosis   381 

Tuberculosis.  National  Association  for  Study  and  Prevention  of 305 

Typhoid  bacillus  found  in  drinking  water 381-380 

Vaccines,  inspection  of  manufacture  of 371-373 

Yellow-fever  institute 359 

Yellow  fever,  investigation  of.  by  French  Yellow  Fever  Commission-  399-403 
Yellow  fever,  work  relative  to 380 


INDEX.  667 

Pago. 

Scientific  research  and  sanitation LMJ-iis 

Seamen : 

Avernjie  dnrntion  of  li<)si)ltal  trcitineiit  in  e.-u-li  district  ( talile) r>S4 

Averajie  duratitui  of  hosiiital  tivatnieiit  in  eacli  district — c()iM|»arative 

exhibit.   lS!tr)-l!«>4    (tabkM <•."..". 

Comparative  exliil)it— mortality  per  KK.)  patients,  by  districts,  1805- 

VMn     (taide) <!3r> 

Comparative  exhibit — ratio  of  deaths  from  specific  causes,  1895-1004 

(tal)le»     GSo 

Comparative  table  of  nunii)er  treated.  18<>8-11)04 577 

Diseases  and  injuries  treated  during  year,  by  districts  (table) 5S5-(j31 

Foreign,  physical  examinations  of   (table) 583 

Nativities  of  patients  treated  in  hospitals  during  the  year  (table) G40 

Numl)er  of.  by  districts,  treated  during  j-ear 584 

Physical  examinations  of 40 

Physical  examinations  of  (table) 583 

Ratio  of  deaths  from  specific  causes 634 

Ratio  of  deaths  in  each  district  (table) 634 

Ratio  treated  in  hospital  in  each  district   (table) 584 

Relief   of 45 

Table  of  surgical  operations  during  year 0:16-039 

Tabular   statement,    by    districts,    of    diseases    and    injuries    treated 
during  year — 

Atlantic    district 585-593 

Great   Lal<es  district 012-620 

Gulf    district r.!t4-C00 

Mississippi  district flOO-Gll 

Ohio  district r,(K)-005 

Pacific  district <;20-627 

Pacific  Islands  district ^^.^-(ao 

West  Indies  district 011-612 

Treated    in    quarantine 631 

Tabulated  statement,  by  districts,  of  causes  of  mortality  among  pa- 
tients during  year <;:32-<"i34 

Under  treatment  for  tuberculosis  at  Foi-t  Stanton 47-61 

(See  also  Tables.) 
Seattle,  ^Yash.,  report  of  immigration  inspection  at    (Assistant  Surgeon 

Amesse)    211 

Seattle    Quarantine.    Wash.,    report    of    tran.sactions    (Acting    Assistant 

Surgeon    Elliott) 354 

Second  Annual  Conference  of  State  Health  Officers  with  the  Service :]()3-365 

Second    General    International    Sanitary    Convention    of    American    Re- 
publics           363 

Secretary  of  the  Treasury.     (See  Treasury  Department.) 

Service  fund,  expenditures  from 16 

Shanghai.  China  : 

Detail  of  officer  at 23 

Report  of  immigration  inspection  at 221 

Report   of    quarantine    transactions    at    (Acting    Assistant    Surgeon 

Ransom)   1S8-192 

Shaw,  Hon.  L.  M.,  Secretary  of  the  Treasury : 

Letter  to  State  Department  requesting  information  concerning  insani- 
tary dwellings  in  foreign  cities 444 

Letter  transmitting  report  to  Congress 13 

(See  also  Treasury  Department.) 

Singapore,  cholera  in 71 

Sitka.  Alaska,  Quarantine,  report  of  transactions  (Acting  Assistant  Sur- 
geon Koosher) 355 

Small.  Edward  ^I..  A.  A.  Surg.,  report  of  Eastport,  Me..  Quarantine 330 

Smallpox : 

Aid  extended  to  Maine  State  authorities 19 

Foreign  and  insular  (tables) -. !t7-101 

Africa 99 

Argentina     97,  99 

Austria-Hungary    97.  99 

Belgium   97,  99 


668  INDEX. 

Smallpox — Continued.  Page. 

Foreign  and  insular  (tables) — Continued. 

Brazil    97,99 

British  (Juiana 97.  !»9 

Canada   97,  99 

Canary    Islands 97 

Chile  98,  99 

China    98,  99 

Colombia    98,  99 

Costa   Rica 98 

Cuba   98,99 

Ecuador   98 

Formosa   c 98,  100 

France    98,  100 

Germany    98,  100 

Gibraltar 100 

Great  Britain 98.  100 

Greece    98 

Hawaiian    Islands 98,  100 

India    98,  100 

Italy    98,  100 

Japan    98,  100 

Java 98,  100 

Malta    98, 100 

Mauritius    '        98 

Mexico    98,  100 

Netherlands    98,  100 

Panama 98,  100 

Philippines    98,  100 

Porto    Rico 99,  100 

Russia    99,  101 

Spain     99.  101 

Straits  Settlements 99,  101 

Switzerland    ^'^ 

Turkey    i»0,  101 

Uruguay 09.  101 

Venezuela    99 

Smallpox  in — 

Philippines    1^8 

United  States 19,  80-97,  320-328 

Assistance  rendered  authorities  of  ^Iaine_-_ X2()-o28 

Kate  of  moi'tality —         SO 

Statistics  of  work  done  in  Maine  by  Service 827-31^8 

Table  of  cases,  by  years,  since  1898 SO 

Tables : 

Alabama    81 

Alaska    00 

Arkansas    00 

California      81,  90 

Colorado    81, 90 

Delaware     90 

Distirct  <f  ('oluinl)ia 91 

Florida    81, 91 

Georgia    81.91 

Illinois    82.91 

Indiana    : 82,91 

Iowa    83.91 

Kentucky    83.  91 

Louisiana  83,  91 

Maine    83.91 

Maryland   84,  92 

Massachusetts     84.  92 

Michigan    84,92 

Minnesota    84,92 

Mississippi     S:" 

Missouri     85,93 

Montana     85,93 


INDKX.  669 

Smallpox  ill CoiiliuiH'd.  \'ak*'- 

riiitcd   StMtcs — Coufinurd. 
Tallies     ( '(nitiiuu'd. 

Nel.iaska    85,93 

Xrw   IIaiui>sbir(.> 85, 9:i 

New  Jersey 85,  '.Ki 

New  York 85,93 

North  Caroliiui 86,  93 

North  Dakota 86,94 

Ohio 86,94 

Pennsylvania 87,  95 

Khode  Island 88 

Sonth  Carolina 88,  9(; 

Tennessee 88,  '.)r, 

Texas 89,96 

Utah 89,96 

Virginia 89,96 

AVashington 89,96 

West  Virginia 89,97 

Wisconsin 90,  97 

Snowden,  Arthur,  A.  A.  Surg.,  rei>ort  of  Alexandria.  Va.,  Quarantine 333 

Solicitor  of   the  Treasury,   decision   that   vessels   from    United   States   to 

rhilippiues  are  not  re(iuired  to  carry  bills  of  health 158 

South  America  : 

Details  of  ofticers  to  ports  in 23 

Fruit-port  inspection  service 123-134 

Plague  in 20 

South  Atlantic  Quarantine,  Ga.,  report  of  transactions 337 

South  Cend  Quarantine,  Wash.,  report  of  transactions 354 

Specific  causes,  ratio  of  deaths  from,  in  Service  hospitals  (table) 634 

Spotted  fever  in  Montana 362 

Sprague,  E.  K.,  I*.  A.  Surg.,  detailed  to  Calcutta,  India 192 

tSpraij,  The,  repairs  of 38 

Standard  unit  for  diphtheria  antitoxin 28,375 

Stausfield,  H.  A.,  Asst.  Surg.,  a.ssigned  to  laboratory  for  instruction 374 

State  and  local  boards  of  health,  cooperation  with 361 

State  Department : 

Circular  letter  to  consular  officers  requesting  data  concerning  vaca- 
tion of  insanitary  dwellings  in  foreign  cities 445 

Correspondence  relative  to  request  of  I'anama  for  assistance  of  Ser- 
vice officers  stationed  in  foreign  ports 1:^4-135 

Stations,  inspection  of 45 

Statistical  tables  (marine  hospitals,  relief  stations,  quai*antines,  etc.) 575-()40 

Statistics.     (See  also  Tables.) 

Statistics  and  sanitary  reports,  report  of  division  of  (Assistant  Surgeon- 

fJeneral    Vaughan) 71-101 

Statistics : 

Aid  to  other  servicef! 18 

Disinfection  work  against  yellow  fever  at  Minera,  Tex • 316 

Immigration  inspection  at — 

Astoria,  Oreg 197 

Baltimore,    Md 197 

Boston,    Mass 197-203 

Charleston,  S.  C 204 

Eagle  Pass,  Tex 204 

El  Paso,  Tex 205 

Hongkong,  China 220 

Honolulu,   Hawaii 213 

Key  West,  Fla 205 

Kobe,   Japan 220 

Laredo,    Tex 206 

Los  Angeles,  Cal 206 

Malone,  N.  Y 206 

Manila,  P.  I.,  and  subports 213-215 

Mobile,  Ala 207 

Naples,   Italy 217 

New  Orleans,  La 207 


670  INDEX. 

statistics — ('ontinuecl.  Page. 

Immigration  inspection  at — Continued. 

New  Yorli,  N.  Y 208 

Nogales,   Ariz li08 

Palermo,  Italy 211 

Philadelphia,    Pa 208 

Ponce,  P.  R 212 

Port  Townsend,  Wash 200 

Quebec,  Canada 21(» 

Richford,  Vt 210 

San  Francisco,  Cal 210 

San  Juan,  P.  R 212 

Shanghai,    China 221 

Vancouver,  British  Columbia 216 

Victoria,  British  Columbia 210 

Yokohama,    Japan 219 

Mortuary,  (See  Mortuary  statistics.) 

Oiling  brigade  at  Laredo,  Tex.,  worii  done  by olO 

Operations  against  yellow  fever  at  Laredo,  Tex 325 

Quarantine  transactions  (domestic)  at — 

Alexandria  Quarantine,  Va 333 

Biscayne  Bay  Quarantine,  Fla_ 345 

Boca  Grande  Quarantine,  P'la 343 

Brunswick  Quarantine,  Ga 338 

Cape  Charles  Quarantine,  Va 333 

Cape  Fear  Quarantine,  N.  C 334 

Carrabelle  Quarantine,  Fla 343 

Cedar  Keys  Quarantine.  Fla 343 

Columbia  River  Quarantine,  Oreg 350-352 

Cumberland  Sound  Quarantine,  Fla 340 

Delaware  Breakwater  Quarantine.  Del 331-332 

Eastport  Quarantine,  Me 330 

El  Paso  Border  Quarantine,  Tex 356 

Eureka  Quarantine,  Cal 350 

Gulf  Quarantine,  Miss 345 

Hoquiam  Quarantine,  Wash 352 

Key  West  Quarantine,  Fla 341-342 

Laredo  Border  Quarantine,  Tex 356 

Los  Angeles  Quarantine,  Cal 348 

Pascagoula   Quarantuie.   ]\Iiss 345 

Pensacola  Quarantine,  Fla 344 

Port  Angeles  Quarantine,  Wash 355 

Port  Townsend  Quarantine,  Wash 353 

Portland  Quarantine,  Me 329 

Punta  Gorda  Quarantine.  Fla 343 

Reedy  Island  Quarantine,  Del ^_ 330 

San  Diego  Quarantine,  Cal 346-348 

San  Francisco  Quarantine,  Cal 349 

St.  Geoi-ge  Sound  Quarantine,  Fla 343 

St.  Johns  River  Quarantine,  Fla 340 

Santa  Rosa  Quarantine,  Fla 344 

Savannah  Quarantine.  Ga 3-35-336 

Seattle  Quarantine,  Wash 354 

Sitka  Quarantine,  Alaska 355 

South  Atlantic  Quarantine.  Ga 337 

Southbend  Quarantine.  Wash 354 

Tampa  Bay  Quarantine.  Fla 339 

Quarantine  transactions  (foreign  and  insular)  at— 

Belize,  British  Honduras 133 

Bluefields,  Nicaragua 132 

Bocas  del  Toro,  Panama 129-130 

Callao.   Peru 146 

Cebu,  P.  I 177 

Ceiba,    Honduras 130-132 

Cienfuegos,  Cuba 113 

Colon.    Panama 143 

Guayaquil,   Ecuador 145 


INDEX.  671 

Statist  iis — ('outiuiuxl.  Page. 

Quaiautiiie  trausactious   (foreign  and  insular)    at — Continued. 

llabana.   C'ulia 107 

Honsiiconjr,   (^"iiina 187 

Honolulu  and  subports,  Hawaii l;j;i-155 

Hoilo.  P.  I 177-180 

Jolo.  r.  I 181 

Livinj;st(Mi.    (Juateiuala 128 

Manila  and  subports.  rbilippine  Islands 163-174 

Matanzas.  Tuba 108 

Nagasaki.  .Japan 186 

Nuevitas,  Cuba 109 

ranania,  Panama 144 

Poiue.  P.  R 118 

Progreso.    Mexit-o 119, 123 

Puerto  C'ortez.  Honduras 127 

Rio  de  Janeiro.  Rrazil 147 

San  Juan.  P.  R..  and  subports 110-117 

Santiago.  Cuba 109-113 

Sbanghai.  Cbiua 190 

Taiupico.  Mexico 119, 122 

Vera  Cruz.   Mexico 118,121-122 

Yokobama,  Japan 185 

Rio  de  Janeiro,  Brazil,  bealtb  conditions  at 147-152 

Sanatorium  for  consumptives  at  Fort  Stanton,  X.  Mex 17 

Smallpox  in  the  United  States 19 

Smallpox  operations  in  Maine 327-328 

Tuberculosis,  treatment  of.  at  Fort  Stanton  Sanatorium 47-61 

Yellow  fever  at  Laredo,  Tex 314 

Yellow  fever  at  Miuera,  Tex 317 

Steamboat-Inspection  Service,  aid  to 18,46 

Stegoniyia  fascidta: 

Report  of  French  yellow  fever  commission 399—408 

{Sec  also  Mosquitoes.) 
Stewart.  E.  L..  A.  A.  Surg.,  report  of  St.  Georges  Sound  Quarantine.  Fla__       343 
Stewart,  W.  J.  S.,  A.  A.  Surg.,  report  of  quarantine  trausactious  at  Rio  de 

Janeiro  147-152 

Stiles.  Dr.  Cb.  Wardell : 

Detailed  to  meeting  of  Medical  Association  of  Mississippi,  at  Jackson, 

Miss    39 

Detailed  to  meeting  of  Mississippi  State  ^ledical  Association 397 

Preliminary  report  on  investigation  of  cause  of  spotted  fever  in  Mon- 
tana           362 

Report  of  division  of  zoologj".  Hygienic  Laboratory 394-397 

Report  on  meeting  of  Mississippi  Medical  Association 416 

Stoner,  George  W.,  Surg. : 

Correspondence  relative  stripping  immigrants  for  examination 193-195 

Directed  to  proceed  to  various  immigration  stations  to  instruct  officers 

in  methods  of  inspection 193 

Report  of  immigration  inspection  at  New  Yoi'k 208 

Straits  Settlements : 

Cholera  in    (tables) 71,72 

Plague  in    (tables) 78,80 

Stripping  immigrants  for  examination 193-195 

Sulu  Archipelago,   leprosy  in,   contributed  article  by   Asst.    Surg.   J.   AV. 

Amesse   455 

Superior  Board  of  Health  of  ^Mexico,  correspondence  relative  cooperation 

with  United  States  in  preventing  I'ecurrence  of  yellow  fever 291-296 

Surgeon-General.      (Sec  Wymau.) 

Surgical  operations  during  year  (table) . 636-639 

T. 

Tables  (see  also  Statistics)  : 

Cause  of  mortality  among  patients  during  year,  by  districts 632-634 

Cholera    (see  Cholera) 71-72 

Comparative;  number  of  seamen  treated  1868-1904 577 


672  INDEX. 

Page. 
Tables — Coutiuued. 

Diseases  and  injuries  treated  during  year,  by  districts 585-631 

Operations  of  Service,  fiscal  year  1004 578-582 

Patients  under  treatment  at  Fort  Stanton  sanatorium 47-(>l 

Physical  examinations  made  by  Service  officers 583 

Plague  in  foreign  countries 70-80 

Plague  in  the  United  States  (San  Francisco) 76 

Quarantine    stations,  transactions    at.     {See   Statistics — Quarantine 

transactions,  domestic.) 
Quarantine  transactions  at  foreign  and  insular  ports.     (»S'rc  Statis- 
tics.) 

Ratio  of  deaths  from  specific  causes  (Service  patients) 034 

Seamen — 

Average  duration  of  treatment  in  each  district 584 

Comparative  exhibit — average  duration  of  hospital  treatnunit  in 

each    district,    1895-1904 635 

Con)parative   exhibit — mortality   per    100   patients,    by   districts, 

1895-1904     035 

Couiparative  exhibit — ratio  of  deaths  from  specific  causes,  1895- 

1904    (table) <535 

Comparative  number  treated  annually,  1808-1904 577 

Diseases  and  injuries  treated  during  year,  by  districts — 

Atlantic    district 5S5-.593 

Great  Lakes  district 012-('>20 

Gulf   district .394-000 

Mississijipi    district (i(H»-011 

Ohio    district  1 '- 000-005 

Pacific   district 020-027 

Pacific  Islands  district 62S-030 

West  Indies  district (;il-(il2 

Treated  at  (luarantine '>31 

Nativities  of  patients  treated  in  hospitals  during  the  year 040 

Number  treated  during  year,  by  districts 584 

Physical  examinations  of 583 

Ratio  of  deaths  in  each  district :       034 

Ratio  treated  in  hospital  in  each  district 584 

Smallpox  in  the  United  States,  by  States  (see  also  Smallpox  in  the 

United    States) 80-97 

Statistical  (marine  hosiatals,  relief  stations,  quarantines,  etc.) ^l^^^ 

Surgical  operations  during  year 03()-G30 

Transactions  at  national  quarantines.     (Sec  Statistics.) 

Yellow  fever  in  foreign  countries  (sec  also  Yellow  fever) ^^'Jp 

Yellow  fever  in  the  United  States 73 

Tabor,  Gearge  R.,  State  health  officer  of  Texas : 

Circular  relative  disinfection  against  yellow  fever 297 

Correspondence    relative    yellow    fever    in    Mexico    and   Texas    (.sec 

Yellow  fever  in  the  United  States) 232-325 

Quarantine  proclamation  against  Lai-edo 318 

Taft,  William  H.,  Secretary  of  War,  transferring  site  for  hospital  at  Pitts- 
burg,   Pa 5t 

Tamaulipas,  Mexico,  yellow  fever  m -       -*» 

Tiimpa  Bay  Quarantine,  Fla.,  report  of  transactions   (Assistant  Surgeon 

Ebersole)     ^^^ 

Tampa,  Mexico : 

Report  on  im))racticability  of  thorough  disinfection  of  vessels  at 2.38-240 

Report   of    ((uarantine    transactions    at    (Acting    Assistant    Surgeon 

Lippincott 11^'  }'-- 

Tapeworm,  scientific  work  in  relation  to 3.)ij 

Taylor,  H.  A.,  Acting  Secretary  of  the  Treasury,  letter  relative  giving  to 

Service  control  of  incoming  Panama  quarantine ^38 

Texas : 

Legislation  relative  disinfection  against  yellow  fever -JO 

Quarantine  against  Laredo  raised -01 

Y^ellow    fever    epidemic    in    (.see    also   Yellow    fever    in    the    Umted 

States— Texas  epilemic) ^^' "'"' ?o?"^4o 

Texas  Medical  Associatiou,  report  of  meeting  of  (Surgeon  Carter) 43o-44d 


INDEX.  673 

Texas-Mexico  border,  correspondence  relative  jjreventlon   recrudescence 

of  yellow  fever  along 2!)S-.">()0 

Texas -Mexito   bonier   (luaraiitiue 23,  324,  ^^^-.^(i 

Thomas.  J.  Grt'.v,  A.  A.  Surg.,  rei)ort  of  immigration  in8i)ection  at  Mobile. 

Ala    207 

Tick  fever  in  Montana 302 

Torres,  J.  F.,  A.  A.  Suig. : 

Report  of  imniigr.itiou  insin'otion  at  rouci>,  P.  K 212 

Report  of  (luarantiiie  transactions  at  I'once,  1*.  R 118 

Transactions  at  national  (juarantiiie  stations    (sec  Quarantine  adminis- 
tration,   domestit') 328-35U 

Trask.  .J.  W..  Asst.  Surg.,  report  of  work  of  laboratorj'  at  Fort  Stanton 5G-<51 

Traveling    laboratory 379 

Treasury  Department : 

Circular  amending  quarantine  regulations  on  account  of  yellow  fever,       328 
Corresi>on(lence    relative    to    request    of    I'anama    for    assistance   of 

Service    otlicers 135 

Corresi)ondence     relative     to     tr.insfer     of     Mariveles     Quarantine 

station 155-158 

Letter  relative  to  giving  control  of  incoming  quarantine  at  Panama 

to    Service 138 

Letter  to   State  Department  requesting  collection  tbrougb   consular 
officers  of  information  concerning  insanitary  dwellings  in  foreign 

cities    444 

Letter  transmitting  report  to  Congress 13 

Trematode  parasites  of  man.  bulletin  on 305 

Trotter,  F.  E..  Asst.  Surg.,  relieved  from  duty  at  Habana,  Cuba 100 

Tubercular  leptomeningitis  fatal  case,  witli  necropsy 544 

Tuberculosis : 

Durability  of  cure 55 

Fatal  cases,  with  necropsies 511-545 

Milk  examinations,  result  of 01 

National  Association  for  Study  and  Prevention  of 305 

Report  of  laboratory  at  Fort  Stanton  relative  to 50-01 

Rei)ort  of  meeting  of  National  Association  for  Study  and  Prevention 

of 408 

Sanatorium  for  treatment  of.  Fort  Stanton,  N.  Mex 17 

Report  of,  by  Surg.  P.  M.  Carrington 47-01 

Scientitic  work  in  relation  to 381 

Turkey  : 

Cholera  in,  with  tables 1 72 

Plague  in    (tables) 78,80 

Typhoid  bacillus  found  in  drinking  water 381 

Typhoid  fever  and  drinking  w^ater 27 

Typhoid  fever  at  Lexington,  Va.,  report  on   (Surgeon  Perry ;  Passed  As- 
sistant  Surgeon  Anderson) 381-386 

U. 
United  States: 

Plague  in,  witli  tables 75,70 

Smallpox    in 80-97,  320-328 

Yellow  fever  in.      (>S'ce  also  Yellow  fever  in  the  United  States 230-325 

(Tables)    73 

V. 

Vacation  and  demolition  of  insanitary  buildings  in  foreign  cities 444-445 

Vaccination  in  Philippines 107 

Vaccines,  examination  of 370 

Vaccines,  serums,  etc.,  inspection  of  manufacture  of 371-373 

Valvular  di.sease  of  heart — aortic  and  mitral,  fatal  cases,  with  necrop- 
sies      474-481 

Vancouver,  British  Columbia,  report  of  immigration  inspection  at  (Acting 
Assistant  Sui'geon  Riggs) 216 

8629—04 43 


674  INDEX. 

VaujrLian,  George  T.,  Asst.  Surg.  Gen. :  rage. 

Detailed  to  meeting  American  Medical  As.sociatiou 38 

Reix>rt  of  division  of  sanitary  reports  and  statistics 71-101 

Report  on  meeting  of  American  Medical  Association 411 

Report  of  Sanitary  board  on  Texas-Mexican  border  inspection  service  302 

Report  of  sanitary  lx>ard  relative  yellow  fever  preventive  measures 20:{ 

Venezuela,  yellow  fever  in   (tal>lesj 74,75 

Vera  Cruz,  Mexico,  report  of  quarantine  transactions  at  (Passed  Assistant 

Surgeon    Lumsdeu) 118,  120-122 

Victoria,  British  Columbia,  report  of  immigration  inspection  at  (Assistant 

Surgeon    Glover 21 C 

Vineyard  Haven,  Mass..  repairs  and  improvements  to  marine  hospital (u 

A'olvulus,  fatal  case,  with  necropsy 49G 

von  Ezdorf.  R.  11.,  P.  A.  Surg.  : 

Assigned  to  laboratory  for  instruction 374 

Directed  to  inspect  suspected  points  on  Mexican  railroads  for  yellow 

fever   cases 291 

Ordered  to  Laredo,  Tex 255 

\'ouchers  passed  for  payment  and  settlement * 39 

W. 

Walerius,  Mathias,  Pharmacist,  ordered  to  Laredo,  Tex 254 

War  Department : 

Corre.six)ndence  relative  to— 

Increa.sed  commutation  for  quarters  to  officers  in  Philippines.-  159-161 
Transfer  Mariveles  Reservation  at  Manila  to  the  Service  for  quar- 
antine purposes  155-158 

Transfer  of  site  for  hospital  at  Pittsburg.  Pa (U 

Warren,  B.  S.,  Asst.  Surg.,  report  of  Cape  Fear  Quarantine 334 

Washington,  N.  C,  no  quarantine  transactions  at 335 

Water,  typhoid  bacillus  found  in 381-386 

Weddick,  John.  A.  A.  Surg.,  in  charge  at  Kahului,  Hawaii 153-155 

Wertenbaker,  C.  P.,  Surg. : 

Ordered  to  Beaumont,  Tex 263 

Ordered  to  El  Paso,  Tex 205 

Promoted  to  rank  of  surgeon 35 

Report  of  immigration  insi)ection  at  New  Orleans,  La 207 

Wesbrook,  Prof.   Frank  E.,  reappointed  on  advisory  board  of  Hygienic 

Laboratory    36 

West  Indies  district,  diseases  and  injuries  treated  in  (table) 611-612 

'■  What  the  medical  profession  can  do  for  the  Public  Health  and  Marine- 
Hospital  Service,"  address  bv  Surgeon-General  Wvman 408—411 

White,  JL  J..  P.  A.  Surg.  : 

Promoted  to  the  rank  of  passed  assistant  surgeon 35 

Report  of  immigration  inspection  at  Hongkong.  China 220 

Report  of  quarantine  transactions  at  Hongkong,  China 186-188 

White,  R.  C,  A.  A.  Surg.,  report  of  Santa  Rosa  Quarantine,  Fla 344 

Wickes,  H.  W.,  P.  A.  Surg.,  report  of  Reedv  Island  Quarantine.  Del 330 

Wille,  C.  W..  Asst.  Surg.  : 

Assigned  to  Laboratory  for  instruction 374 

Report  of  immigration  inspection  at  Baltimore.  Md 197 

Williams,  L.  L.,  Asst.  Surg.  Gen.,  report  of  division  of  marine  hospitals 

and  relief   45-68 

Williamson,  S.  D.,  A.  A.  Surg.,  report  of  immigration  inspection  at  Malone. 

N.   Y   206 

Wilmington,  N.  C,  repairs  and  improvements  to  marine  hospital 67 

Wilson,  Richard,  A.  A.  Surg.,  report  of  quarantine  transactions  at  San- 
tiago, Cuba   109-113 

Working  Party  No.  2.  findings  of 359 

Wyman,  Walter,  Surg.  Gen. : 

Address  before  American  Medical  Association 408-411 

Circular  letter  relative  to — 

Assistance  to  Panama  in  quarantine  matters 135 

Monthly  report  on  condition  of  launches,  etc..  at  quarantine  sta- 
tions           329 

Reinstatement  of  employees 41 


INDEX.  *  ()75 

Wyman,  Walter.  Siirfr.  Gen. — Continued.  ruKc. 

Circular  letter  relative  to — Continued. 

Heiiuoslin.u  s[i«'ciniens  of  niosciuitoes ;•,(>() 

Transniittini:  semiannual  list  of  attendants 42 

Correspondence  relative  to — 

(\ise  of  yellow  fever  on  board  fruit  steamer  Mount  Vernon   at 

Mol)ile.  Ala 231 

Increased  con)inutation  for  quarters  to  officers  in  Phili[)pines__  159-161 

Inspection  of  (Julf  coast  in  re  yellow  fever 2;iG-240 

Officers  in  China  and  .Japan  exainininic  aliens 105-190 

Precautions  with  rcsjard  to  vessels  arriving  via  northern  ports 

(in  !•(' yellow  fever) 2.3.3-235 

I'roti'ction  of  (Julf  coast  against  yellow  fever  from  Mexico 235 

Stripping  inuiiigrants  for  examination 193-195 

Transfer  INIariveles  quarantine  station 1.5.5-1.58 

Letter   api)ointing  Passed  Assistant   Surgeon   King  on   Porto   Kican 

Aiuemia  Connnission 366 

Letter  convening  sanitary  board  for  consideration  of  measures  to  pre- 
vent recurrence  of  yellow  fever 292 

Letters  directing  examination  of  drugs 40 

Letter  of  instructions  to — 

Officers  at  fruit  ports 124 

Officers  in  Orient  to  cooperate  with  chief  quarantine  officer  of 

Philippines 162 

Letters  and  telegrams  to  officers  and  others  in  re  suppression  of  Texas 

yellow-fever  epidemic 2.32-325 

Recommends  that  incoming  I'anama  quarantine  be  placed  in  charge  of 

Service   1.37-140 

Report  to  Secretary 1.5-31 

Telegram  ordering  Perry  and  Pierce  to  report  to  Canal  Commission..       142 
Telegrams  of  instruction  to  officers  in  regard  to  measures  against 

yellow  fever 231 

Trip  to  Mexico  to  secure  cooperative  arrangement  relative  to  yellow- 
fever  work  291-296 

X. 

X  ray,  report  on  meeting  of  Roentgen  Ray  Society  (Surgeon  Irwin) 405-408 

Y. 

Yellow  fever  : 

Amendments  to  quarantine  regulations  to  prevent  introduction  of 328 

Case  aboard  the  Mount  Vernon  at  .Mobile,  Ala 231 

Conveyance  of,  paper  by  Surg.  II.  R.  Carter 436-443 

Etiology  of 359 

Findings  of  Working  Party  No.  2 359 

Foreign  and  insular 73-75 

French  Yellow  Fever  Commission,  abstract  of  report  of 399^03 

Health  certificates  to  passengers  from  infected  ports 105 

In  Rio  de  .Janeiro 147-152 

In  the  United  States 21,73,230-325 

Insi)ection  of  Gulf  coast 236-240 

Instructions  to  officers  at  foreign  ports  relative  to 231 

None    in    Cuba 114 

Precautions  with  regard  to  vessels  arriving  via  northern  ports 23.3-235 

Protection  of  Gulf  ports  against  Mexico 2.35 

Report  on   impracticability  of  disinfecting  vessels  at  Tampico   and 

other   ports   2.38-240 

Tables- 
Africa     75 

Brazil     :: 74,  75 

Colombia    ^ 74,  75 

Costa    Rica 74,  75 

Cuba   74,  75 

Ecuador   74,  75 

Jamaica   74,  75 

Mexico    74,  75 


676  INDEX. 

Yellow  fever — Continued.  Page. 

Tables — Continued. 

Panama    75 

Venezuela 74,  75 

Texas  epidemic — 

Camp  at  Sanchez  started 263 

Camp  equipment   248 

Camp  equiimient  for  Eagle  Pass 251 

Canuel,  disinfection  work  at 317 

Car    disinfection 240 

Certificates  to  passengers  bound  for  United  States 263 

Cooperation  with  State  authorities  of  Texas 251 

Corpus  Christi,  yellow  fever  reported  at 206,267 

Cotulla,  Tex.,  no  quarantine  against 265 

Danger  of  transmission  from  Tampico  to  Monterey 232 

Death  of  Surgeon  Murray ^•_ 289 

Dengue  at  Laredo 250,251 

Detail  of  officers  for  duty  at  Laredo 253 

Detention  camp 307 

Detention  of  mail  from  Monterey 247 

Dewitt  county,  fever  cases  in 281 

Disinfecting  methods  used  in  fighting  yellow  fever  at  Laredo 276 

Disinfection  measures  pushed 269 

Disinfection  of  mail  not  ordered 259 

Disinfection,  process  of 308-310 

Disinfection,  work  of 310-314 

Early  precautions  again.st  introduction  of  yellow  fever 240-250 

Epidemic  increasing  at  Laredo 269 

Epidemic    spreading 2(54 

Fever  reported  at  Linares  and  Monterey,  Mexico 245 

Frick,  Acting  Assistant  Surgeon,  ordered  to  Laredo 1_       253 

Goodman,  Pharmacist,  appointed  disbursing  agent 262 

Guards  and  camp  equipment  at  Eagle  Pass 240 

Guards  for  Laredo 249,2.53 

Guards  for  Wchl)  and  Zapata  counties 251 

Guiteras  ordered  to  Laredo 252 

Hospital,  need  for 311 

House   disinfection 260,  261 

Inspection  of  ferries  in  vicinity  of  Laredo 245 

Laredo  placed  under  strict  quarantine 257 

Lasalle  County,  conference  between  county  health  officer  and  Pur- 

nell    265 

Lumsden,  L.  L.,  P.  A.  Surg.,  ordered  to  Beaumont 263 

Ordered  to  Eagle  Pass 265 

McGregor.  Acting  Assistant  Surgeon,  placed  on  duty 283 

Medical   insiiectors  appointed 253 

Medina  Count.v.  suspicious  cases  in 278 

Mexican  border  inspection  service 261,269 

Mexico  establishes  quarantine  station  on  Mexican  National  Rail- 
road     , 246 

Minera,  Tex.,  disinfection  of  (report  of  Pharmacist  Goodman)   315-317 

Yellow  fever  at , 263 

Monterey,    Mexico,    precautions   at,    taken    bv    Mexican    Govern- 
ment      243-244 

Mosquito  netting  for  use  at  Eagle  Pass  and  Laredo 251 

Mosquito  netting  ordered  used  at  Laredo 252 

Murray.  R.  D.,  Surg.,  ordered  to  Laredo 252 

Fatally   injured   in   runaway 286 

Nolte  to  remain  at  San  Antonio 259 

Nuevo  Laredo,  Mexico,  fever  reported  at 247 

Oiling  brigade,  work  done  I)y 310 

Origin  of  the  epidemic 304 

Pasteur  Institute  commission  letter  I'elative  to  mosquito  and  yel- 
low fever 275 

Petroleum,  use  of,  in  water  barrels  and  cisterns 257 

Plan  of  cami)aisn 2.57 

Post-epidemic   work 290.291 


INDEX.  677 

Yollow  fever — f'ontinuod.  I'aRe. 
Texas  epiikMiiic — Coiitimiod. 

I'recM  lit  ions  at  Matainoras  against  yellow  fever  in  Mexico 242 

I'resence  of  IVvtT  in  Laredo  contirnied 250 

r.vretln-nni  i)o\vder  for  use  at  Laredo 254,256,259 

Quarantine  against  Mexico 307 

Quarantine  on  iK>i'(U'r 249 

Quarantine  i)rocluniation ;^18 

Kcfunces  from  Laredo,  inspection  of 2(J4 

Kiclianlson,  T.  1<\,  Asst.  Surg.,  ordered  to  return  to  Laredo 240 

San  Antonio  P.oard  of  Health  meets  and  acts  upon  situation 204 

San  Antonio.  re])ort  on  conditions  at   (I'urnell) 207 

Sanchez,  detention  camp  estahlished  at 258 

Sanitaiy  hoard,  report  of,  relative  to  inspection  service  on  Texas- 
Mexico   horder 302 

Sanitary  work  of  Service 307 

Situation  upon  Texas-^Mexico  border 232 

Souchon  informed  of  conditions 259 

Spread  of  the  fever  in  the  State  of  Tamaulipas,  Mexico 248 

Statistics  of  yellow  fever  at  Laredo 314 

Surveillance  of  i>crsoiis  leaving  Laredo 250 

Texas  cuts  comnuuiication  with  Monterey,  Linares,  and  Victoria.  245 
Texas  State  health  oHicer  requests  information  relative  yellow 

fever  at  San  Luis  Potosi 241 

Texas  State  quarantine  against  San  Luis  Potosi  removed 242 

Train  disinfection  proposed 260 

von  Ezdorf,  Passed  Assistant  Surgeon,  ordered  to  Laredo 255 

Waierius.  Pharmacist,  ordered  to  Laredo 254 

Werteni)aker,  C.  P.,  P.  A.  Surg.,  ordered  to  Beaumont,  Tex 263 

Ordered  to  El  Paso 205 

i'ellow  fever  reported  at  San  Luis  Potosi,  Mexico 240 

Zapata  County,  additional  guards  for 250 

Work  in  Hygienic  Laboratory  relative  to__ .380 

Yellow  Fever  Institute 359 

Yokohama,  Japan  : 

Detail  of  officer  at 23 

Report  of  immigration  inspection  at  (Assistant  Surgeon  Moore) 219 

Report  of  quarantine  transactions  at  (Assistant  Surgeon  Moore) 185 

Z. 

Zinc,  chloride  of.  as  a  disinfectant 38t3-394 

Zoological  collection  in  Hygienic  Laboratory 395-396 

Zoology : 

Division   of 27 

Report  of  division  of  (Doctor  Stiles) 394-397 


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